Important Information On Diabetes Mellitus
Diabetes mellitus (commonly called diabetes) is a condition found in
16 million Americans. About half of these people do not know they have
diabetes and are not under care for the disorder. Diabetes is not a
single disease but rather a syndrome of hyperglycaemia and glycosuria,
accompanied by varying degrees of ketosis and acidosis, with or without
weight loss. It has several causes and mechanisms of inheritance.
As diabetes is a condition characterized by metabolic abnormalities
(the most evident is hyperglycaemia, an elevated concentration of
glucose in the blood), the treatment of it must also prevent or reduce
the risk and severity of other long term complications involving
multiple organs, the eyes, kidneys, nerves and blood vessels. These
complications result from a deficiency of the hormone insulin or a
reduction in the effectiveness of insulin.
The longer the duration of diabetes, and the worse the long-term
blood glucose control, the more likely are the complications to occur.
There are two major forms of diabetes: Type 1, insulin-dependent, and Type 2, noninsulin dependent.
Type 1 diabetes is characterized by an absolute deficiency of
insulin caused by beta-cell destruction of the Islets of Langerhans in
the pancreas. Type I diabetes usually appears before the age 40.
Typical symptoms are thirst, fatigue, cramps, excessive urination,
increased appetite, and weight loss.
Treatment requires administration of insulin, diet coordinated with
insulin dosage schedule, and regular physical exercise. Dietary
treatment is primary therapy in Type 2 diabetes and is vital treatment
to Type I diabetes. Presently, there is no known method to prevent the
development of this form of the disease.
Type 2 diabetes, usually appears in midlife, among people who are
overweight or obese. Its onset is gradual, and many people have a long
history of mild symptoms, or display no symptoms at all. In type 2
diabetes, the pancreas usually produces insulin, but for some reason,
the body cannot use the insulin effectively. The end result is the same
as for type 1 diabetes--an unhealthy buildup of glucose in the blood
and an inability of the body to make efficient use of its main source
of fuel.
Obesity is strongly associated with the
onset and severity of Type 2 diabetes. New cases of this condition can
be reduced by approximately half by preventing obesity in middle-aged
adults. The risk of diabetes increases with the degree of obesity and
its duration, as well as the distribution of body fat; upper body fat
is more associated with Type 2 diabetes than is lower body fat.
Significant caloric reduction lowers blood glucose levels even
before weight loss occurs. Once desirable weight is achieved, control
of blood sugar levels can be accomplished by consuming just enough
energy to maintain it. As weight falls to desirable levels,
improvements in cardiovascular disease risk factors, hypertension and high blood lipid levels, also occur.
Diabetes is not contagious. People cannot "catch" it from each
other. However, certain factors can increase one's risk of developing
diabetes. People who have family members with diabetes (especially type
2 diabetes ), who are overweight, or who are African American,
Hispanic, or Native American are all at greater risk of developing
diabetes.
Type 1 diabetes occurs equally among males and females, but is more
common in whites than in nonwhites. Data from the World Health
Organization's Multinational Project for Childhood Diabetes indicate
that type 1 diabetes is rare in most Asian, African, and American
Indian populations. On the other hand, some northern European
countries, including Finland and Sweden, have high rates of type 1
diabetes. The reasons for these differences are not known.
People with diabetes must take responsibility for their day-to-day
care. Much of the daily care involves trying to keep blood sugar levels
from going too low or too high. When blood sugar levels drop too low--a
condition known as hypoglycemia--a person can become nervous, shaky,
and confused. Judgment can be impaired. Eventually, the person could
pass out. The treatment for low blood sugar is to eat or drink
something with sugar in it.
On the other hand, a person can become very ill if blood sugar levels rise too high, a condition known as hyperglycemia. Hypoglycemia
and hyperglycemia, which can occur in people with type 1 diabetes or
type 2 diabetes, are both potentially life-threatening emergencies.
The goal of diabetes management is to keep blood glucose levels as
close to the normal (nondiabetic) range as safely possible. A recent
Government study, sponsored by the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK), proved that keeping blood sugar
levels as close to normal as safely possible reduces the risk of
developing major complications of diabetes.
Generally diabetics should avoid foods containing sucrose (table
sugar) and glucose. However, foods containing fructose (fruit sugar)
and lactose are usually safe for diabetics. Very high carbohydrate,
high-fiber diets, providing 70 percent of calories as carbohydrate
consistently improve glucose tolerance. Fiber slows the rate of
absorption of sugar into the bloodstream.
The three principal approaches to diabetes management are diet,
exercise, and treatment with oral antidiabetic agents. Overweight
persons can be managed by diet and exercise alone.
Because of the secondary conditions (heart disease, hypertension and
loss of sight) persons with diabetes need to be very selective with
other nutrients besides sugars.
In recent years, advances in diabetes research have led to better
ways to manage diabetes and treat its complications. Major advances
include:
In the future, it may be possible to administer insulin through
nasal sprays or in the form of a pill or patch. Devices that can "read"
blood glucose levels without having to prick a finger to get a blood
sample are also being developed.
Researchers continue to search for the cause or causes of diabetes
and ways to prevent and cure the disorder. Scientists are looking for
genes that may be involved in type 2 diabetes and type 1 diabetes. Some
genetic markers for type 1 diabetes have been identified, and it is now
possible to screen relatives of people with type 1 diabetes to see if
they are at risk for diabetes.
The
nutrients mentioned above reflect the major nutritional supplements
that may help the condition. Please do remember however that
nutritional supplementation is an adjunct to medical treatment and in
no way replaces medical treatment.
Diabetes mellitus (commonly called diabetes) is a condition found in
16 million Americans. About half of these people do not know they have
diabetes and are not under care for the disorder. Diabetes is not a
single disease but rather a syndrome of hyperglycaemia and glycosuria,
accompanied by varying degrees of ketosis and acidosis, with or without
weight loss. It has several causes and mechanisms of inheritance.
As diabetes is a condition characterized by metabolic abnormalities
(the most evident is hyperglycaemia, an elevated concentration of
glucose in the blood), the treatment of it must also prevent or reduce
the risk and severity of other long term complications involving
multiple organs, the eyes, kidneys, nerves and blood vessels. These
complications result from a deficiency of the hormone insulin or a
reduction in the effectiveness of insulin.
The longer the duration of diabetes, and the worse the long-term
blood glucose control, the more likely are the complications to occur.
There are two major forms of diabetes: Type 1, insulin-dependent, and Type 2, noninsulin dependent.
Type 1 diabetes is characterized by an absolute deficiency of
insulin caused by beta-cell destruction of the Islets of Langerhans in
the pancreas. Type I diabetes usually appears before the age 40.
Typical symptoms are thirst, fatigue, cramps, excessive urination,
increased appetite, and weight loss.
Treatment requires administration of insulin, diet coordinated with
insulin dosage schedule, and regular physical exercise. Dietary
treatment is primary therapy in Type 2 diabetes and is vital treatment
to Type I diabetes. Presently, there is no known method to prevent the
development of this form of the disease.
Type 2 diabetes, usually appears in midlife, among people who are
overweight or obese. Its onset is gradual, and many people have a long
history of mild symptoms, or display no symptoms at all. In type 2
diabetes, the pancreas usually produces insulin, but for some reason,
the body cannot use the insulin effectively. The end result is the same
as for type 1 diabetes--an unhealthy buildup of glucose in the blood
and an inability of the body to make efficient use of its main source
of fuel.
Obesity is strongly associated with the
onset and severity of Type 2 diabetes. New cases of this condition can
be reduced by approximately half by preventing obesity in middle-aged
adults. The risk of diabetes increases with the degree of obesity and
its duration, as well as the distribution of body fat; upper body fat
is more associated with Type 2 diabetes than is lower body fat.
Significant caloric reduction lowers blood glucose levels even
before weight loss occurs. Once desirable weight is achieved, control
of blood sugar levels can be accomplished by consuming just enough
energy to maintain it. As weight falls to desirable levels,
improvements in cardiovascular disease risk factors, hypertension and high blood lipid levels, also occur.
Diabetes is not contagious. People cannot "catch" it from each
other. However, certain factors can increase one's risk of developing
diabetes. People who have family members with diabetes (especially type
2 diabetes ), who are overweight, or who are African American,
Hispanic, or Native American are all at greater risk of developing
diabetes.
Type 1 diabetes occurs equally among males and females, but is more
common in whites than in nonwhites. Data from the World Health
Organization's Multinational Project for Childhood Diabetes indicate
that type 1 diabetes is rare in most Asian, African, and American
Indian populations. On the other hand, some northern European
countries, including Finland and Sweden, have high rates of type 1
diabetes. The reasons for these differences are not known.
People with diabetes must take responsibility for their day-to-day
care. Much of the daily care involves trying to keep blood sugar levels
from going too low or too high. When blood sugar levels drop too low--a
condition known as hypoglycemia--a person can become nervous, shaky,
and confused. Judgment can be impaired. Eventually, the person could
pass out. The treatment for low blood sugar is to eat or drink
something with sugar in it.
On the other hand, a person can become very ill if blood sugar levels rise too high, a condition known as hyperglycemia. Hypoglycemia
and hyperglycemia, which can occur in people with type 1 diabetes or
type 2 diabetes, are both potentially life-threatening emergencies.
The goal of diabetes management is to keep blood glucose levels as
close to the normal (nondiabetic) range as safely possible. A recent
Government study, sponsored by the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK), proved that keeping blood sugar
levels as close to normal as safely possible reduces the risk of
developing major complications of diabetes.
Generally diabetics should avoid foods containing sucrose (table
sugar) and glucose. However, foods containing fructose (fruit sugar)
and lactose are usually safe for diabetics. Very high carbohydrate,
high-fiber diets, providing 70 percent of calories as carbohydrate
consistently improve glucose tolerance. Fiber slows the rate of
absorption of sugar into the bloodstream.
The three principal approaches to diabetes management are diet,
exercise, and treatment with oral antidiabetic agents. Overweight
persons can be managed by diet and exercise alone.
Because of the secondary conditions (heart disease, hypertension and
loss of sight) persons with diabetes need to be very selective with
other nutrients besides sugars.
Dietary Recommendations for Persons with Diabetes
| Calories | Should be prescribed to achieve and maintain a desirable body weight. |
| Carbohydrate | Should comprise 60% of calories. Unrefined should replace all refined carbohydrates. |
| Protein | Should follow the RDA of 0.8 g per kg of body weight for adults. Some reduction in protein intake may prevent or delay the onset of the kidney complications of diabetes. |
| Fat | Should comprise less than 30% of total calories. Replacement of saturated fats for polyunsaturated fats to reduce the risk of CHD. |
| Cholesterol | Should be limited to 300 mg or less per day to reduce cardiovascular risk. |
| Sweeteners | Both nutritive and non-nutritive sweeteners are acceptable in diabetes management. |
| Sodium (Salt) | Should not exceed 3g per day, to minimize symptoms of hypertension. |
| Alcohol | Should be moderate and may need to be restricted entirely by persons with diabetes and insulin-induced hypoglycaemia, neuropathy, poor control of blood sugar, blood lipids, or obesity. |
| Vitamin C | Often deficient in diabetics. May help to control blood cholesterol levels and reduce the chances of other complications. |
| Selenium | Selenium has been shown to reduce the risk of CHD and hypertension. |
| Potassium | Potassium regularly produces a decline in blood pressure. |
| Chromium | Chromium is a constituent part of glucose tolerance factor in the prevention of diabetes. |
| Magnesium | Lost in urine due to the diuretic effect of high blood sugar. Studies suggest that a deficiency in magnesium may worsen the blood sugar control in Type 2 diabetes. Scientists believe that a deficiency of magnesium interrupts insulin secretion in the pancreas and increases insulin resistance in the body's tissues. Is also used extensively for the treatment of CHD. |
| Vanadium | A recent study found that when people with diabetes were given vanadium, they developed a modest increase in insulin sensitivity and were able to decrease their insulin requirements. Currently researchers want to understand how vanadium works in the body, discover potential side effects, and establish safe dosages. |
In recent years, advances in diabetes research have led to better
ways to manage diabetes and treat its complications. Major advances
include:
- New forms of purified insulin, such as human insulin produced through genetic engineering.
- Better
ways for doctors to monitor blood glucose levels and for people with
diabetes to test their own blood glucose levels at home. - Development of external and implantable insulin pumps that deliver appropriate amounts of insulin, replacing daily injections.
- Laser treatment for diabetic eye disease, reducing the risk of blindness.
- Successful transplantation of kidneys in people whose own kidneys fail because of diabetes.
- Better ways of managing diabetic pregnancies, improving chances of successful outcomes.
- New drugs to treat type 2 diabetes and better ways to manage this form of diabetes through weight control.
- Evidence
that intensive management of blood glucose reduces and may prevent
development of microvascular complications of diabetes. - Demonstration that antihypertensive drugs called ACE-inhibitors prevent or delay kidney failure in people with diabetes.
In the future, it may be possible to administer insulin through
nasal sprays or in the form of a pill or patch. Devices that can "read"
blood glucose levels without having to prick a finger to get a blood
sample are also being developed.
Researchers continue to search for the cause or causes of diabetes
and ways to prevent and cure the disorder. Scientists are looking for
genes that may be involved in type 2 diabetes and type 1 diabetes. Some
genetic markers for type 1 diabetes have been identified, and it is now
possible to screen relatives of people with type 1 diabetes to see if
they are at risk for diabetes.
The
nutrients mentioned above reflect the major nutritional supplements
that may help the condition. Please do remember however that
nutritional supplementation is an adjunct to medical treatment and in
no way replaces medical treatment.
- The Surgeon General's Report on Nutrition & Health, 1988
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