PT. Indosehat Lestari
Diabetes
• Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).
• In 2013 it was estimated that over 382 million people throughout the world had diabetes (Williams textbook of endocrinology).
• Type 1 Diabetes - the body does not produce insulin. Approximately 10% of all diabetes cases are type 1.
• Type 2 Diabetes - the body does not produce enough insulin for proper function. Approximately 90% of all cases of diabetes worldwide are of this type.
Diabetes Type 2
• Type 2 diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up have to take insulin, usually in tablet form.
• Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals that can destabilize the body's cardiovascular and metabolic systems
Insulin and Pancreas
• Insulin is a hormone; a chemical messenger produced in one part of the body to have an action on another. It is a protein responsible for regulating blood glucose levels as part of metabolism.
• The body manufactures insulin in the pancreas, and the hormone is secreted by its beta cells, primarily in response to glucose.
• The pancreas is the organ responsible for controlling sugar
• The endocrine pancreas - islands of cells known as the islets of Langerhans within the "sea" of exocrine tissue; islets release hormones such as insulin and glucagon into the blood to control blood sugar levels.
Diabetes Complication
• High blood glucose levels are damaging to blood vessels and can increase the likelihood of them narrowing through atherosclerosis. This damage also leads to poor supply of blood to nerves
• Poorly controlled hyperglycemia persisting for years can lead to complications affecting small blood vessels (microvascular complications), large blood vessels (macrovascular complications) or both.
• The process by which vascular disease develops is complex and occurs via numerous pathways that scientists continue to investigate.
Microvascular complications - those resulting from damage to small blood vessels - are the most common complications of diabetes and include:
• Retinopathy - disease of the eye
• Nephropathy - disease of the kidneys
• Neuropathy - disease of the nerves.
Macrovascular complications - those resulting from damage to large blood vessels - include:
• Angina pectoris and heart attack
• Transient ischemic attacks and strokes
• Peripheral arterial disease.
Oral Diabetes Drugs
• Oral diabetes drugs are usually reserved for use only after lifestyle measures have been unsuccessful in lowering glucose levels to the target of an HbA1c below 7.0%, achieved through an average glucose reading of around 8.3-8.9 mmol/L (around 150-160 mg/dL).
• The lifestyle measures that are critical to type 2 diabetes management are diet and exercise, and these remain an important part of treatment when pills are added.
• People with type 1 diabetes cannot use oral pills for treatment, and must instead take insulin.
Physical Activities and Exercise
• Exercise does not always need to be hard work and can be effective if done in a way that is enjoyable. Staying active simply through outdoor activities such as walking and gardening or through favorite games such as tennis is a valid approach.
• Exercise helps with weight loss and good for heart health, helps to prevent diabetes complications as well.
• Physical activity increases the use of glucose, so patients who experience symptoms of hypoglycemia during exercise need to monitor their blood glucose and increase carbohydrate intake or lower their insulin dose accordingly. Glucose levels need to be just above normal ahead of starting an activity
• If hypoglycemia occurs during vigorous exercise, it may be necessary to ingest carbohydrates - around 5-15 grams of a simple sugar such as sucrose, for example.
Diet and Food Planning
• Having diabetes does not involve any particularly difficult dietary demands, and while sugary foods obviously affect blood glucose levels, the diet does not have to be completely sugar-free
• For people with type 1 diabetes, diet is about managing fluctuations in blood glucose levels while for people with type 2 diabetes, it is about losing weight and restricting calorie intake
• A healthy diet typically includes a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes and non-tropical vegetable oils
Dietary Tips
• Eat regularly - avoid the effects on glucose levels of skipping meals or having delayed meals because of work or long journeys (take healthy snacks with you)
• Eat vegetables and fruits and eat them in place of high-calorie foods - a variety of fresh, frozen and canned is good, but avoid high-calorie sauces and food containing added salt or sugar
• Whole grains high in fiber are recommended as a healthy source of carbohydrate
• Eat pulses, a low-fat starchy source of protein and fiber, such as beans, lentils, chickpeas and garden peas
• Reduce intake of saturated and trans fats by having poultry and fish without the skin and cooked, for example, under the grill, rather than fried
• Take a similar approach to cooking red meat while reducing intake and looking for the leanest cuts
• Eat fish twice a week or more, but avoid batters and frying - go for oily fish such as salmon, mackerel, sardine, trout and herring, which are rich sources of omega-3
• Avoid partially hydrogenated vegetable oils and limit saturated fat and trans fat - replace them with monounsaturated and polyunsaturated fats
• Dairy awareness helps reduce fat intake - select skim (fat-free) milk and low-fat (1%) dairy products, reduce consumption of cheese and butter and swap out creamy sauces for tomato-based ones
• Cut back on sugar by avoiding added sugars in drinks and foods - have tea and coffee without sugar, avoid fruit that is canned in syrup and pay attention to food labels
• Cut back on salt - prepare foods at home with little or no salt and avoid foods with high sodium such as processed foods
• Cut back on portion sizes - be wary of amounts consumed when eating out
• Be wary of "diabetic" foods - they are of no particular benefit and can be expensive
• Drink alcohol only in moderation - as a guide, no more than one drink a day for women and no more than two for men.
Obesity, Diabetes, and Diet
• Obesity is a risk factor for type 2 diabetes, and obesity in people who already have diabetes results in poor control of blood sugar, blood pressure and cholesterol levels.
• Another concern with being overweight or having obesity is that it can worsen many of the complications of diabetes.
• Weight loss can be achieved by following the recommendations above and restricting the intake of calories.