Diabetes, also known as diabetes, is a common and chronic disease that we define as an increase in the blood glucose taken into our body through food. Our cell called pancreas secretes the hormone insulin, which draws glucose from the blood and allows it to enter the cells. Glucose entering the cell is used as energy. If more glucose is consumed than needed, it is stored as glycogen in the muscles and liver. In diabetic patients, not enough insulin is produced or the insulin produced is not used effectively. In this case, glucose cannot enter the cell and rises in the blood. There are four types: type 1 diabetes, type 2 diabetes, gestational diabetes and prediabetes. The fasting blood sugar level of an individual without diabetes is 120 mg/dl; The postprandial blood sugar level (two hours after a meal) does not exceed 140 mg/dl. An increase in the blood sugar measured during hunger and satiety above these values indicates the presence of diabetes. It is understood whether a person has diabetes or not by measuring Fasting Blood Sugar (FBG) or Oral Glucose Tolerance Test (OGTT). A fasting blood sugar measurement of 100-125 mg/dl is a signal of prediabetes (hidden sugar). A fasting blood sugar measurement of 126 mg/dl and above indicates the presence of diabetes. If the oral glucose tolerance test (blood sugar measurement taken 2 hours after consuming glucose) is 140-199 mg/dl, it is considered prediabetes (hidden sugar); If it is 200 mg/dl or above, diabetes is diagnosed.
Type 1 diabetes occurs when the insulin-producing beta cells in the pancreas are damaged as a result of an autoimmune process. In type 1 diabetes, there is absolute insulin deficiency, and type 1 diabetic patients must take the insulin hormone externally (via injection) throughout their lives. Because type 1 diabetes often occurs in childhood and adolescence, it is also called 'juvenile diabetes'. It is also called insulin-dependent diabetes. If we talk about people at high risk of type 1 diabetes; Those with type 1 diabetes in their first degree relatives such as mother, father, sibling, those with many relatives with type 2 diabetes, and women whose diabetes developed during pregnancy are in the high risk group.
When we look at the symptoms; When insulin cannot be produced in the body, other functions of the insulin hormone cannot be fulfilled fully, that is, glucose cannot be used as energy and accumulates in the blood. and after a certain level, it begins to be excreted in the urine. Since the sugar excreted in urine is excreted with water, the person begins to urinate frequently. As a result, a person needs to drink a lot of water because a lot of water is lost. Unable to use glucose, the body begins to use stored fats and proteins to meet its energy needs, causing the person to lose weight. Excessive fat burning also causes ketoacidosis, which causes discomfort such as abdominal pain, weakness and fatigue.
The absolute solution in the treatment of type 1 diabetes is insulin injection. Other methods that help treatment are healthy nutrition, regular exercise and education. When we look at insulin treatment; Insulin is a protein hormone and is digested in the stomach, so it cannot be taken orally, injection is mandatory. Today, purified preparations with a structure similar to human insulin are used. Daily insulin need varies depending on the person's age, height, weight, food consumption and daily exercise status. Storage conditions of insulin are +4/+8 degrees.
Nutrition therapy in type 1 diabetes is one of the most important treatment methods that helps insulin injection and balances blood sugar. The aim of medical nutrition therapy is to ensure growth and development in accordance with the person's cultural and physical wishes, to prevent obesity or thinness by maintaining the ideal body weight, to improve health with healthy food choices, to prevent acute and chronic metabolic complications of diabetes by keeping the blood sugar level within normal limits or to prevent their emergence. extend the time; If complications occur, it is to reduce the symptoms. Most people with type 1 diabetes are underweight when diagnosed and will reach their desired weight with an adequate diet. In obese people, weight loss and better glycemic control should be achieved by energy restriction. Today, carbohydrate restriction is not recommended in the diet of diabetic patients. The amount of daily energy coming from carbohydrates should not be less than 50%. When carbohydrate restriction is applied, a person's blood lipid and cholesterol levels increase and there is a predisposition to coronary heart disease. Carbohydrate counting is also very important in type 1 treatment. It is important. What do we call carbohydrate counting? It is the determination of the amount of carbohydrates a person consumes at meals. The basis of this method is based on consuming the right amount of carbohydrates in main and snack meals. The amount of carbohydrates in main and snack meals should be adjusted according to the blood sugar level measured before the meal. Since protein consumption does not raise blood sugar as much as carbohydrates, it is important to include it in sufficient amounts in the diet. People with diabetes have a higher risk of cardiovascular disease than normal individuals. The main thing to do about fats in the diet of diabetic individuals is to limit saturated fat and cholesterol. Vitamin and mineral supplements are needed in diabetics who do not have symptoms of deficiency or special conditions. However, studies have concluded that antioxidant vitamin and mineral supplements provide various benefits in treatment. Group B vitamins are given additionally to patients with diabetes. Although fat intake is limited in diabetics, vitamins A and D are recommended. Since there is a risk of hypertension in diabetic patients, excessive salt intake should be prevented. Although it is recommended that type 1 diabetics eat 6 meals, 3 main and 3 snacks, in order to prevent blood sugar fluctuations, this varies depending on the insulin used by the patient and his lifestyle. One of the most common acute complications in the treatment of type 1 diabetes is hypoglycemia. Hypoglycemia is blood sugar falling below 55-65 mg/dl. Reasons such as excessive insulin dose, skipping meals, long-term intense exercise, diarrhea, vomiting, digestive difficulties, and excessive alcohol cause hypoglycemia.
Type 2 diabetes; It is an excessive increase in blood sugar as a result of the pancreas not producing enough insulin or the insulin produced not being used effectively. It is more likely to be seen in obese individuals, women who give birth to babies weighing more than 4 kg, people with diabetes in their families, and people who live under stress. It has symptoms such as frequent urination, drinking a lot of water, feeling of hunger, numbness in hands and feet, and dry mouth. The first step in treatment is medical nutrition therapy. Therapeutic methods such as changing eating habits and lifestyle and increasing exercise in daily life are not enough to keep blood sugar within normal limits. Then oral pill treatment is started. For some people with type 2 diabetes, the pill may not be sufficient and in this case, insulin injection may be needed. For some type 2 diabetics, medical nutrition therapy alone is sufficient to keep blood sugar balanced. The nutrition program should be prepared individually according to the patient's needs. For people with type 2 diabetes, it is essential to consume the daily energy required not in 2-3 portions but spread throughout the day. It has been determined that eating small and frequent meals is essential for endogenous insulin production in type 2 diabetics who can produce even a small amount of insulin. Medical nutrition therapy given to people with type 1 and type 2 diabetes is not the same for everyone. When planning medical nutrition treatment, the eating habits of the person and his family and their level of knowledge about diabetes should be evaluated. It should not be forgotten that it requires joint work (doctor, dietician, nurse, psychologist).
Gestational diabetes; It is a type of diabetes that occurs during pregnancy in a woman who has not had diabetes before and usually disappears after birth. 24-28 weeks of pregnancy. Diagnosis is made with OGTT performed during the week. The most important criteria are fasting blood sugar over 92 mg/dl, over 180 mg/dl at the 1st hour, over 153 mg/dl after the 2nd hour, and over 140 mg/dl after the 3rd hour. If at least two are present, the diagnosis is made. For a healthy pregnancy and birth, gestational diabetes should not be neglected and regular blood sugar monitoring should be done.
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