Diabetes is a condition in which the level of glucose or sugar in the blood is chronically elevated. That is why one also speaks of 'sugar' or diabetes. Philippine Statistics Authority data showed that deaths due to diabetes ranked fourth in 2020 at 37,265, after heart diseases (99,680), cancer (62,289), and cerebrovascular diseases (59,736).
Glucose is the main energy source of the cells. In order to absorb these, the cells need insulin. Insulin is, as it were, the key that opens the cell to glucose. When no or insufficient insulin is produced or when the insulin is less effective for some reason, the glucose does not enter the cell and the sugar level in the blood rises. This is what happens in diabetes.
Insulin is a hormone and that hormone is produced in the pancreas.
There are different forms of diabetes. The two most important are type 1 diabetes, sometimes called "insulin-dependent diabetes" or juvenile diabetes, and type 2 diabetes, also called "non-insulin-dependent diabetes" or old-age diabetes. These two forms differ so much from each other, both in symptoms, mechanisms of onset and treatment and in a number of important consequences, that they are almost two different diseases.
- In type 1 diabetes, the pancreas hardly makes insulin. This form occurs from childhood.
- In type 2 diabetes, the pancreas makes too little insulin and/or the body's cells are less sensitive to insulin. This form occurs from the fortieth year and is also called old-age diabetes.
Neither type of diabetes is currently curable, but one can try to control the disease by getting and keeping the blood sugar level, the glycemia levels, as close to normal as possible. In this way, both acute complications (a sudden drop or increase in blood sugar, which can lead to coma and brain injury, among other things) and long-term complications (such as blindness, kidney problems, amputations of limbs) can be avoided or postponed.
Control in type 1 diabetes
In type 1 diabetes, this is done in the first place by injecting insulin several times a day. There are different types of insulin depending on their duration of action. In addition, the absorption and duration of action of insulin varies from person to person and may even differ in one individual depending on the circumstances. That is why it is important that diabetes patients measure their sugar levels several times a day and inject an adjusted dose of insulin accordingly. The number of checks one should perform daily depends on the treatment, the type of insulin, the meals and snacks, the physical exertion, etc. In order to determine a daily curve of the sugar level, 3 to 4 checks per day are required, especially with intensive treatment. Some people check themselves more often, e.g. because they have to make intensive physical efforts.
Fortunately, self-monitoring is becoming easier thanks to the technical improvements to the devices to determine blood sugar levels and to the injection pens and pens to administer the insulin.
A regular examination by a doctor, usually every two to three months, complements the self-check. Among other things, attention is paid to symptoms, complaints or injuries that may indicate the development of complications, such as nerve and blood flow disorders or a vision loss.
The main goal of treatment is to normalize blood sugar.
So adjusting the glycemia
- type 1: between 60-150 mg/dl
- type 2: between 140-180 mg/dl
As the risks associated with hypoglycemia increase for older individuals, glycemia levels for diabetics over 65 years of age are slightly higher, namely between 140 and 180 mg/dl.
Control in type 2 diabetes
In type 2 diabetes, drugs (insulin and medications that must be taken by mouth) come in second place. A weight reduction through an adapted diet is the cornerstone of the treatment of these patients who are usually also obese. Even a limited weight loss often causes a significant improvement in sugar levels. Sometimes the condition even disappears completely as long as one can maintain the lower weight and comes back when one gains weight again. The weight loss also has a beneficial effect on fat levels, blood pressure, etc. reducing the risk of cardiovascular disease.
A 'tailor-made' dietary prescription
Also for type 1 diabetes, an adapted diet is an essential part of the treatment. The diet should be tailored to the individual needs of the patient and take into account age, weight, physical activity, drug treatment, etc. and above all be realistic. Every individual must therefore receive a 'tailor-made' nutritional prescription.
"It is very important that the diet does not differ too much from what the family and environment of the diabetic eat," says Dr. Raoul Rottiers, diabetes specialist at UZ Gent. "Unless the previous diet is really wrong in terms of quality, it is preferable that the diabetic can choose his or her own diet schedule that is as close as possible to his or her previous dietary habits."
Above all, the diet must be healthy and balanced. For a diabetic, broadly the same advice for a healthy and balanced diet applies that applies to everyone. This means that the daily energy application (the total number of calories) must consist of 50 to 55% carbohydrates, 30 to 35% fats (of which two-thirds are of the unsaturated type) and 10 to 15% proteins. In addition, an adequate application of vitamins, minerals and dietary fiber (approx. 30 to 40 g per day) must also be ensured.
In concrete terms, this means that every Fleming, and not only the diabetics, should consume fewer fats, and especially less saturated fats (which are mainly found in meat and dairy products, but also in coconut and palm oil), more carbohydrates and less protein.
The reduction in fat consumption is all the more important for diabetics as they are at greater risk of arteriosclerosis (atherosclerosis). A diet rich in (saturated) fats and cholesterol is an important risk factor for atherosclerosis.
The sugar level is mainly influenced by the proportion of carbohydrates in a meal. The speed at which this happens depends on the speed at which the carbohydrates from the diet are converted into glucose. This differs depending on the nature of the carbohydrates and whether they are eaten together with fiber, proteins and fats. In order to keep the sugar level as stable as possible, the intake of all types of carbohydrates should be spread as well as possible throughout the day.
In order to be able to estimate the influence of the diet on the sugar level, it is recommended to eat as much as possible at fixed times. The number of meals, e.g. 3 main and 3 intermediate meals, must correspond to the insulin schedule that is followed.
Ordinary table sugar may be used, preferably as much as possible during meals. The special diabetes diet products are useless and unnecessary. They also often cause confusion.
A third pillar in diabetes treatment is physical exertion, especially in type 2 patients. Regular sports practice has a long-term beneficial effect on the sugar level in this group, which can sometimes reduce the use of medicines. Regular exercise also contributes to weight loss.
In type 1 diabetes, sports practice is not part of the treatment in itself, although it can of course contribute to general physical well-being. In principle, these diabetes patients can practice all sports - just think of star football player Pär Zetterberg - with the exception of those sports that can pose a danger when their blood level suddenly drops (such as scuba diving, mountaineering, solo sailing, etc.). However, an important condition is a good glycemia control. Adjustments in insulin therapy and nutrition are usually necessary if one wants to do sports safely.
Diabetes and overweight
Type 2 diabetes, which usually occurs only in old age and was therefore also considered a typical age-related condition, has recently been diagnosed at an increasingly younger age and even in children. According to Dr Rita Craen of the paediatrics department of the UZ Gent, this concerns very obese children, very often with parents who are also obese and/or have diabetes.
For those who are familially burdened for type 2 diabetes and/or obesity, it is certainly true that the pursuit of a 'normal' body weight is the best prevention, says diabetes specialist Dr Raoul Rottiers of the UZ Gent. "This applies not only to avoid diabetes later in life, but also to reduce the other metabolic abnormalities and the resulting cardiovascular risk." In addition, oral diabetes drugs as well as insulin often have much less effect in obese patients.
Especially the consumption of fats must be limited because they provide the most energy, and are also - certainly the animal - the most harmful to the heart and blood vessels. Energy sources such as sugar and alcohol - which produce so-called empty calories, because they do not contain vitamins and minerals - should of course also be avoided. Sugary soft drinks and sweets are also a not to be underestimated source of useless energy.
In addition to the slimming diet, the obese must be convinced to move more. Muscles that don't move are more insulin-insensitive. Conversely, actively used muscles need a lot less insulin, and moreover, that insulin works much better. The energy consumed during exercise, however small, allows the fat reserves to be reduced. Preference is given to moderately intensive sports practice, at least three times a week for 20 to 30 minutes. Brisk walking, cycling and swimming are favorites.