Diabetes is one of America’s number one killers and if not properly controlled by diet and, if needed, medication, can cause kidney failure, gangrene of the feet and legs, blindness, coma and death.
Diabetes is a complex metabolic disorder in which insulin production is inadequate or ineffective. The pancreas fails to produce insulin in a response to a rise in blood sugar which occurs when food is eaten and absorbed through the intestinal tract. Insulin and glucagon are two hormones synthesized by the pancreas. Insulin regulates carbohydrate metabolism by removing excess glucose or sugar from the blood and glucagon has the opposite effect as insulin, it increases the blood sugar instead of decreasing it.
The liver secretes glucagon, which raises the blood sugar level by stimulating the breakdown of glycogen, stored carbohydrates in the liver. Glycogen is store in the liver until the blood sugar level drops and then it is reconverted into glucose by the influence of insulin for energy. When insulin is inadequate, glucose builds up in the blood resulting in diabetes.
The cause of diabetes is unknown, but there does seem to be a genetic factor involved that tends to predispose some toward diabetes more than others. Also, a diet that is too high in calories may be a factor and the risk of developing diabetes seems to be about four times greater for a person who is obese. Obesity may cause fat cells to become insensitive to insulin causing the failure of insulin to remove excess sugar from the blood. Removal or injury to the pancreas as well as disorders of other endocrine glands can result in diabetes. Experts believe that being obese plays a larger role in developing diabetes than a diet that is too high in sugar.
There are two types of Diabetes, Diabetes Mellitus and Diabetes Insipidus. Diabetes Insipidus is characterized by excessive urination and is caused by a diseased pituitary gland or its nervous pathways. Diabetes Mellitus is the most common type. There are two types of Diabetes Mellitus, juvenile diabetes (growth-onset) and adult diabetes (maturity-onset). Juvenile diabetes usually effects children between the ages of 0 to 14 and almost always requires insulin. Juvenile diabetes is the most difficult to control. Diabetes occurs in all age groups but the greatest occurrence is in middle aged adults. Adult diabetes occurs in the age group of 40 years and over and approximately 85% of the growth-onset diabetics are obese. Adult diabetes is easier to control than juvenile diabetes and can normally be controlled by diet alone. But whether it is Diabetes Mellitus or Diabetes Insipidus all diabetes has to be controlled.
The main concern in controlling diabetes is carbohydrate metabolism. Mild diabetes, (especially if the patient is obese and treatment isn’t delayed) may be controlled by a restricted carbohydrate diet alone. If the diabetes is at all severe, diet along with insulin or a hypoglycemic agent will have to be used. Once diabetes develops, sugar consumption has to be restricted.
Treatment of diabetes consists of a strict diet, insulin or hypoglycemic agent (if needed) physical activity, personal hygiene and constant medical supervision. If insulin is required the amount and type prescribed varies with each person. Two factors influencing the type and amount of insulin prescribed is the severity of the diabetes and amount of physical activity. Insulin’s main effect is to lower blood sugar.
Usually a diet high in complex carbohydrates and low in fat and sugar is prescribed. Fiber should be consumed with carbohydrates. The absorption of carbohydrates is slowed when taken with fiber and may even pass through the intestinal tract unabsorbed. The diabetic diet is an extremely important factor in controlling diabetes.
The diabetic diet prescribed may be one of three, the chemical regulation, clinical method of regulation and the exchange method. The diabetic who is prescribed the chemical method of diet rigidly measures and weighs their food for a year until they are able to judge serving sizes by sight, then they only weigh portions approximately once a week to check their servings. In the clinical method of regulation there is a liberal diet prescribed, which is an unmeasured or “free diet, restricting only sugar and foods high in sugar. The exchange method is the most common and easiest to use. It isn’t as limiting as the chemical method and not as liberal as the clinical method. Foods are chosen from exchange lists. Foods of similar nutritive composition per serving are grouped together and the diabetic is allowed to choose a certain number of servings from each group daily. The caloric allotment is the same for the diabetic weighing a normal weight as is for the non-diabetic. If the diabetic is obese the caloric requirement is adjusted to promote healthy weight loss. The protein requirement is the same as for a non-diabetic and the fat is used to supply the remaining caloric requirement.
When planning meals using the exchange method it is best to first, distribute the exchanges that fulfill the carbohydrate requirements (milk, vegetables, fruit, and bread). Forty to fifty percent of the total amount of calories prescribed are carbohydrates and are to be divided equally into several mini-meals throughout the day to regulate blood sugar levels. Secondly, distribute the protein, primarily the meat and then, distribute the fat exchanges to supply the remaining caloric requirement. It is advised that every meal be completely eaten, especially if insulin or a hypoglycemic agent is prescribed, to prevent insulin shock.
Diabetes is one of America’s killers but with strict diet and medication control along with constant medical supervision the diabetic can live a healthy normal life. However, if medical orders are not followed it could be severely detrimental to the diabetic’s health. Diabetes disturbs metabolism which causes structural changes in the kidneys, eyes, blood vessels and nerves. It also increases the chance of vascular disease, pneumonia and tuberculosis.
The American Diabetes Association publishes a bimonthly magazine for diabetics and their families. It contains information on the disease, recipes based on exchange method and helps the diabetic adjust to their new life style as well as helping family members who also may need encouragement and support in learning to live with a diabetic.