What is Diabetes Mellitus?
Diabetes Mellitus (DM) is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin that is produced. Insulin is a hormone whose main action is to transport glucose into cells in order to regulate euglycemia.
Types of Diabetes Mellitus
- Type 1 or insulin-dependent Diabetes Mellitus: This type is characterized by the autoimmune destruction of the β-cells of the pancreas, resulting in the inability to secrete insulin. It usually appears at a young age and there is a complete lack of insulin, as a result of which its treatment includes the exogenous administration of insulin for life.
- Type 2 or non-insulin-dependent Diabetes Mellitus: It is characterized by increased resistance of the body to insulin, with the result that the insulin produced is not sufficient to cover the metabolic needs of the body. Type 2 Diabetes Mellitus constitutes the majority that we encounter in daily medical practice and is influenced by lifestyle. Its treatment requires weight loss (with proper diet and exercise) and the initial administration of antidiabetic tablets and, in advanced stages, the administration of insulin.
- Gestational Diabetes: This form appears for the first time during pregnancy and usually regulation returns after the end of pregnancy. It is treated with an appropriate diet and, if necessary, with the use of insulin. Women who experience gestational diabetes are more likely to develop type 2 diabetes at an older age.
- Other specific types of Diabetes Mellitus: There are various types of diabetes mellitus that are due to medications, hormonal disorders, pancreatic diseases, genetic syndromes.
Symptoms of Diabetes Mellitus
In its initial stages, the disease may be completely asymptomatic and therefore the patient may not know that he or she is suffering. The main symptoms include:
- Polyuria
- Polydipsia
- Xerostomia
- Polyphagia
- Unexplained weight loss
- Blurred vision
- Fatigue
Diagnosis of Diabetes Mellitus
Early diagnosis of diabetes is important, as it reduces the risk of developing complications and improves the quality of life of patients.
The diagnosis is made when:
- Random blood sugar measurement ≥ 200 mg/dl with simultaneous presence of symptoms (polyuria, polydipsia, weight loss)
- Fasting sugar ≥ 126 mg/dl
- Blood sugar 2 hours after taking 75g of glucose (sugar curve) ≥ 200 mg/dl
- Glycosylated hemoglobin HbA1c ≥ 6.5%
Diabetes Complications
Uncontrolled diabetes can lead to serious complications. These are caused by damage to small blood vessels (microangiopathy) or larger blood vessels (macroangiopathy). The former include damage to the retina of the eye (retinopathy), damage to the kidneys (nephropathy), and damage to various nerves in the body (neuropathy). Macrovascular complications mainly affect the arteries, heart, or lower extremities, and may cause strokes, heart attacks, or peripheral arterial disease of the lower extremities.
Treatment of Diabetes Mellitus
After the diagnosis of diabetes, diet and exercise are the cornerstones of treatment. Regular monitoring for complications (cardiogram, fundus examination, etc.) is also necessary. Regular measurements of sugar and glycosylated hemoglobin are necessary to monitor the treatment. Desired values for optimal regulation are fasting sugar ≤120 mg/dl and postprandial (2 hours after a meal) ≤ 160 mg/dl. For glycosylated hemoglobin, the desired values are ≤7%. These values are individualized for each patient and determined by the attending physician.
Diet and Diabetes
Carbohydrates in the body are converted into glucose. Diabetes control is based on maintaining blood glucose levels as low as possible. Consuming a fixed amount of carbohydrates each day helps to maintain blood sugar levels within the desired range.
The amount of carbohydrates that should be consumed depends on gender, age, body mass index (BMI), physical activity and medications that may be taken.
In addition to the amount of carbohydrates that should be consumed, the quality is also important. It is beneficial to increase the consumption of fiber and reduce foods rich in simple sugars. The consumption of foods with a low glycemic index is of particular importance for regulating blood sugar.
The glycemic index (GI) is a system for classifying foods containing carbohydrates (pasta, legumes, cereals, fruits, vegetables, etc.) and shows us how much they increase blood sugar levels, 2 to 3 hours after consuming them. The GI value varies from food to food and the higher it is in a food, the more blood sugar increases once we consume it. This means that more insulin is secreted to reduce sugar levels, transporting the excess sugar to the cells where it is converted into fat. The classification scale ranges from 0 to 100.
- Low GI: <55
- Moderate GI: 56-69
- High GI: >70
- Maximum GI value: 100 (glucose)
The glycemic index of foods is affected by:
- Their processing: The more processed a food containing carbohydrates is, the higher its GI. That is why whole grain products raise blood sugar less than white ones.
- Their ripeness: The riper the fruits, vegetables and nuts are, the higher their GI.
- The cooking time: The longer the pasta, legumes or vegetables are cooked, the higher their GI.
- Their acidity: Adding acidic substances, such as lemon juice or vinegar, reduces the GI of foods.
- Their composition: If we mix high GI foods with low GI foods, such as rice with vegetables, we reduce its effect on blood glucose levels.
Dietary Strategy
- Promotion of a healthy diet (Mediterranean diet, DASH diet)
- Reduced fat consumption, mainly monounsaturated fats (ω-3, ω-6) and limited amounts of saturated fats.
- Consumption of small but frequent meals to maintain glucose levels
- Particular attention to the amount of carbohydrates, which should be constant daily in order to maintain sugar levels within the desired range.
- Reduced consumption of simple carbohydrates and increased consumption of foods with a low glycemic index and high fiber content.
Sources
American Diabetes Association, 2019. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care.
EDE, 2019. Guidelines for the Management of People with Diabetes Mellitus.
