How do I recognize diabetes?
The first signs of diabetes can be frequent urination, as well as severe thirst and persistent fatigue. Diabetes can also occur in babies, toddlers or children and can also manifest itself through frequent urination and extreme thirst. Pregnant women can also be affected by diabetes, but they do not show the typical signs.
In principle, nutritional therapy is the same for all types of diabetes and aims to compensate for the diabetic metabolic defect. The diet is combined with physical activity and, if necessary, with blood sugar-lowering medication or insulin. In type 2 diabetes, nutritional therapy is sometimes sufficient as the only treatment.
It prevents the occurrence of acute (e.g. hypoglycaemia) and chronic (nerve damage, vascular changes in the eyes and kidneys, diabetic foot, heart attack, stroke) complications. The development of consequential damages of diabetes depends essentially on the quality of a long-term optimal metabolic control. Target values of metabolic adjustment: blood glucose fasting: 80 – 110 mg/dl, after food intake up to 145 mg/dl.
HbA1 below 8.0%. The diabetic himself can determine fasting blood glucose and blood glucose after food intake with the help of blood glucose meters. However, this is only a snapshot and the blood sugar can be subject to considerable fluctuations during the course of the day.
For this reason, a long-term parameter is determined at certain intervals, the so-called HbA1. HbA1 means haemoglobin A1. Hemoglobin is the red blood pigment in the red blood cells and depending on the level of blood sugar, glucose molecules accumulate.
This is called glycosylation. In metabolically healthy individuals with always normal blood sugar levels, the HbA1 is up to 7%, in poorly adjusted diabetics, values of 16% and more can be reached. Corresponding to the life span of the red blood cells of 120 days, this value is thus an indicator of the metabolic situation in the last weeks and months.
Further goals are: Urinary glucose 0%, serum cholesterol under 200mg/dl, HDL > 40mg/dl, triglycerides under 150mg/dl, body mass index for women 19 to 24 for men 20 to 25, blood pressure under 140/90 mmHg. The aim is to avoid hypoglycaemia or hyperglycaemia. Meals must be planned according to their composition.
For overweight diabetics, weight reduction is the main goal of nutritional therapy. The distribution of food throughout the day and the amount of food is also dependent on physical activity.If these measures are not sufficient, blood sugar-lowering drugs are also used and meals must be adapted to this therapy. Since the body can no longer regulate the sugar metabolism independently in diabetes, this must be actively and consciously controlled from the outside.
To this end, it is very important that those affected deal well with their illness and learn in diabetes training courses how they can change their eating habits and lifestyle in the future. The disease can be influenced positively by a change in lifestyle and diet. In some cases, the blood sugar level even normalizes completely under strict dietary changes and no drug therapy is necessary.
However, this requires some discipline and commitment from the patient. The family doctor can help by providing thorough and individual information about the necessary changes and considering together with the patient what measures he or she can take. For example, sports that patients used to enjoy but then gave up can be resumed.
In terms of nutrition, too, alternatives should be found that are healthy but are still eaten with pleasure. For lifestyle changes, realistic suggestions should be developed that the patient can implement and that can be easily integrated into the individual’s everyday life. Last but not least, lifestyle changes can reduce or even completely prevent secondary diseases.
To achieve this, however, blood pressure must remain consistently within the normal range, weight and blood lipid values must be monitored, and the long-term blood sugar level (also: HbA1c, see above) must not exceed 6.5- 7.5% in the long term. This value is regularly checked by the family doctor. If the diet and lifestyle are not optimized, there is a risk of long-term damage to the retina of the eyes, the kidneys or damage to the nervous system with the so-called diabetic foot syndrome and other complications.
Regular monitoring of these organ systems as part of screening examinations is also an important part of diabetes therapy. Diabetics should pay particular attention to a balanced diet. The same nutritional recommendations apply as for healthy people.
In principle, they may eat anything, but the carbohydrate content plays an even more important role. It is especially important for insulin-dependent diabetics to carefully calculate the carbohydrate units before eating and to adjust the amount of insulin afterwards. According to the German Diabetes Society, the choice of food should be made individually.
The general practitioner can help here by responding individually to those affected and discussing with them exactly those foods that are eaten frequently and with pleasure. Although there is no general ban on sugar, type II diabetics should be able to safely identify foods that contain many rapidly digestible carbohydrates and thus cause blood sugar to rise rapidly, in order to at least reduce it. This includes above all sweets and household sugar; these should be avoided if possible.
But also products with white flour such as noodles or white rolls are among them; these can be replaced by wholemeal products or dishes with vegetables or eggs. Diets rich in fiber, such as salads with food, can delay the absorption of carbohydrates and thus relieve the metabolic situation. Fruit and vegetables are recommended, but vegetables usually contain less sugar than fruit and are therefore preferable.
Vegetable fats such as olive oil as well as fish, nuts and seeds are also suitable for a healthy diet. A good alternative for sweetening drinks or meals is the sweetener stevia. However, when buying it, you should make sure that Stevia is actually contained in the product, as sometimes false declarations can be found on the label.
In the current nutritional recommendations of the German Diabetes Society, weight reduction is an important pillar, especially for overweight type II diabetics. This additionally lowers the risk of vascular diseases and other consequences. This means that attention should also be paid to the number of calories in order to reduce overweight if possible.
However, sport can also help. The regularity and number of meals is of great importance in the context of the diet in diabetes.If possible, three meals should be taken at fixed times without skipping one or eating continuously in between. For diabetics with insulin-dependent diabetes, the carbohydrate content of the food should be calculated before eating in order to adjust the amount of insulin accordingly and to avoid sugar imbalance.
For the calculation or estimation of the carbohydrate units, food maps or tables should be used, at least in the initial phase. They can quickly provide those affected with a good orientation. There is no general ban on food for diabetics as long as the diet is balanced and healthy.
The consumption of foods with a high sugar content such as chocolate, chips or fast food as well as beverages with a high sugar content such as soft drinks or juices should be avoided or at least reduced or compensated for by the other foods. An example for the reduction of rapidly absorbable carbohydrates would be the reduction of the amount of pasta and the replacement by vegetables or salad. The frequent and extensive consumption of very fatty foods should also be restricted, including foods such as sausages, fatty cheeses and various convenience foods.
It is essential to avoid large amounts of alcohol. Excessive consumption of alcohol can lead to sugar imbalances or even acute cramping in the context of hypoglycemia. Finally, heavy alcohol consumption inhibits the release of sugar from the liver, as this organ is then primarily concerned with the breakdown of ethanol.
This can be very dangerous, especially for insulin-dependent diabetics. There is no general ban on alcohol, but according to the German Diabetes Society, consumption should be limited to about one to a maximum of two small glasses per day. Apart from the sugar content, the fat and salt content of the food should also be taken into consideration in the case of diabetes, as successful diabetes therapy also requires a good blood pressure and blood fat level.
When choosing food, it is important to ensure a balanced diet. For example, the first meal of the day may consist of oatmeal with milk and fruit. Wholemeal bread is also a good alternative, as it contains less readily available carbohydrates and more fiber than white bread or rolls.
You can drink a cup of tea or coffee with it, but when sweetening it, you should pay attention to the amount or type of sweetener. A total of about 4 bread units can be estimated for breakfast. At lunchtime you should calculate about the same amount of units.
An example of a meal would be carbohydrates in the form of noodles or potatoes with vegetables as a side dish. Whole grain pasta is a healthier alternative. Meat can also be eaten as long as it is not too fat and too much.
A good alternative to meat can also be fish. In the evening the amount of bread units should be reduced to about 2. Some slices of wholemeal bread with some vegetables or with light cream cheese can be added to the menu.
Low-fat quark or natural yogurt are also recommended. To reduce weight, it is helpful to completely avoid carbohydrates in the evening and eat eggs, vegetables, curd cheese or salad, for example. It is important not to eat sweets in between.
In general: what is healthy for everyone is also good for diabetics. According to the German Diabetes Society, there are no general prohibitions for diabetics. On the contrary, diabetes patients should make sure that their diet is as varied as possible and that it is individually adapted to their own tastes.
As a benchmark, the diet should, if possible, consist of only half carbohydrates, one third fats and about 15% proteins. Only in the case of sugar, fats and especially alcohol should consumption be reduced as much as possible. Furthermore, diabetics should be under constant medical supervision in order to be able to regularly check not only their blood sugar level but also their blood lipids and blood pressure and thus prevent long-term damage.
Doctors can also provide information about the carbohydrate and calorie content of individual foods. Adequate exercise is also of elementary importance and has a very positive effect on the course of the disease in addition to weight reduction. All in all, diabetes today is a disease that is easily treatable.Some of those affected manage to keep their blood sugar within the normal range without medication, only through their own commitment. The resulting normalization of weight can often lead to a better attitude towards life. Although the change of lifestyle is a challenge, it can also be an enrichment and can be used as a motivation to listen to the needs of one’s own body and to integrate sports, physical activity and healthy nutrition into one’s everyday life.
