What is diabetes? How does this happen?
Diabetes is a complex metabolic disorder characterized by impaired insulin secretion and insulin action that lead to hyperglycemia. Multiple mechanisms lead to the development of Type 2 Diabetes and the established type 2 diabetes is characterized by defective and delayed insulin secretion as well as abnormal postprandial suppression of glucagon. These abnormalities explain in part the defective suppression of endogenous glucose production after meal ingestion and contribute to postprandial hyperglycemia. Furthermore, the common genetic variant that affects β cell function and therefore quantitative insulin secretion increases the risk of developing from glucose intolerance to type 2 diabetes. Diabetes can be developed into uncontrolled diabetes due to several causes. Uncontrolled can mean either hyperglycemia or hypoglycemia. Not using enough insulin or oral diabetes medication, not following a proper eating plan, being inactive, having an illness or infection, and using certain medications such as steroids, etc. contribute to the development of uncontrolled diabetes conditions.
Type 2 Diabetes and Complex Comorbidities
The person who does not manage their diabetes condition is at high risk of dangerously high blood glucose and this can trigger a cascade of systems, ranging from mood changes to organ damage. With time, uncontrolled diabetes can lead to major complications such as hypertension, heart attack, stroke, eye disease, kidney disease, nerve disease, and infection if left untreated. Because long-term high blood sugar levels can damage the blood vessels in the heart, kidneys, and the optic nerve in the eye and to the other nerves throughout the body. If nerve damage happens in the eye, it is called diabetic retinopathy. If the blood vessel damage happens in the kidneys, it is called diabetic nephropathy. And if the damage happens to the nerves, then it is called diabetic neuropathy. In addition to that uncontrolled diabetes patients can develop diabetic ketoacidosis (DKA), a life-threatening emergency due to dehydration along with frequent urination.
Management of type 2 diabetes
A proper management plan should be followed by the patients who are suffering from type 2 diabetes including healthy dietary practices and lifestyle modifications to maintain their quality of life. Monitoring calories, portion control, fluid balance, focusing on macronutrient intakes such as carbohydrate, protein, fat, and focusing on micronutrient intake especially calcium, phosphorus, potassium, sodium, etc. should be well focused when establishing a management plan for a person with diabetes while considering uncontrolled diabetes condition and other complex comorbidities. Ultimately patient should be able to achieve and maintain blood glucose levels in the normal range or as close to normal as is safely possible, a lipid and lipoprotein profile that reduces the risk for vascular disease, Blood pressure in the normal range, or as close to normal as is safely possible, to prevent, or at least slow, the rate of development of the chronic complications of diabetes by changing nutrient intake and lifestyle, to address individual nutrition needs, taking into account personal and cultural preferences and willingness to change, to maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence.
The macronutrient distribution as a percentage of total energy for a person with diabetes can range from 45 to 60% carbohydrate, 15 to 20% protein, and 20 to 35% fat on preferences and treatment goals. And should maintain regularity in timing and spacing of meals to “optimize glycemic control”. A nutritionally balanced, calorie-reduced diet rather than getting energy-dense diet should be followed to achieve and maintain lower, healthier body weight. Weight loss of 5-10% of initial body weight improved insulin sensitivity, glycemic control, blood pressure control, lipid level. A person with diabetes should consume unrefined or minimally refined carbohydrates with a low glycemic index. Because refined carbohydrates or simple carbohydrates have a high glycemic index and it will raise blood glucose levels quickly. Not only that but also these patients should completely cut extrinsic sugar as it contributes to the blood glucose level rising. And diabetes patient’s diet should contain protein sources (legumes like chickpea, soya, green grams, egg, fish, white meat, etc.) but should not eat more if they have kidney problems. Because a high protein diet further will damage the kidneys. And when considering fat, saturated fat, and trans-fat-containing food should be avoided to reduce the risk of getting CVD. Diabetes patients should consume less than 9% of total daily energy from saturated fatty acids (SFA) replacing these fatty acids with polyunsaturated fatty acids (PUFA-Walnuts, Sunflower seeds, Flax seeds or flax oil, Fish, such as salmon, mackerel, herring, albacore tuna, and trout, Corn oil, Soybean oil), particularly mixed n-3/n-6 sources, monounsaturated fatty acids (MUFA-Olive, peanut, and canola oils) from plant sources, whole grains, or low GI carbohydrates. Eating fatty fish that contain omega-3 such as at least 2-3 times per week is good to reduce the risk of heart diseases.
In addition to that, a person with diabetes should especially focus on their micronutrient intake as well. Because these patients should limit the consumption of phosphorus, potassium-rich food sources frequently if they have kidney problems. And also sodium (salt) consumption should be limited to less than 1 teaspoon per day as these patients have a risk of getting into hypertension condition.
Apart from that, another important part of diabetes patients’ diet is fruit and vegetables. Fruits and vegetables are rich in fiber and fiber helps to reduce the absorption of nutrients and helps to increase blood glucose levels slowly especially soluble fiber. So it is recommended to consume 30 to 50 g/day of dietary fiber with a third or more (10 to 20 g/day) coming from soluble dietary fiber (whole-grain products, fruits, vegetables, beans peas, other legumes, nuts, and seeds). It is important to add non-starchy vegetables to every meal. And less ripped fruits should be consumed because ripped fruits are rich in fructose and that will cause to increase blood glucose levels quickly. And fruits should eat as whole fruit rather than making juices from them as fruit juices can raise blood glucose levels quickly. And persons with diabetes should drink an adequate amount of water because of frequent urination. So fluid and electrolytes balance should be important.
Not only healthy dietary practices but also lifestyle modification is also important. So the next most important thing is maintaining healthy body weight and doing proper exercises. Because of the effects of obesity on insulin resistance, weight loss is an important therapeutic objective for individuals with uncontrolled diabetes. Therefore, diabetes patients should do exercise for 30 minutes daily or at least 30-45 minutes 3 or 4 days a week (brisk walking, running, swimming, cycling, etc.). It will burn a significant amount of calories and also help to improve insulin sensitivity. And also patients with diabetes should avoid smoking and limit consumption of alcohol. Because smoking and excess alcohol increase the risk of CVD. And most importantly, meals should be taken on time. And frequent light meals are a good option.
Nevertheless, while following proper dietary practices with lifestyle modifications, it is important to early catch up with other complex comorbidities such as heart diseases, kidney diseases, etc. before to a dangerous situation. So it is important to be aware of the signs and symptoms to early catch up before a dangerous situation. Treatment of patients with uncontrolled type 2 diabetes includes therapy based on the specific diagnosis, evaluation, and management of comorbid conditions. In addition to that proper nutrition and being physically active are also very much important to maintain the treatment power and to reduce the risk of turning his situation worse and improve the lives of patients. So following this kind of well-organized management plan including healthy eating practices and lifestyle practices with being physically active and early diagnosis are important to manage uncontrolled diabetes and other complex comorbidities.