This definition, popularly known as hidden sugar, is an evaluation used when the individual's blood sugar is at values between normal blood sugar and diabetic blood sugar. It has been given names such as borderline diabetes, latent diabetes or subclinical diabetes by various authors. In these people, blood sugar levels may show diabetic values at certain times of the day, or may sometimes remain at normal or even subnormal levels.
The mechanism of formation of Glucose Tolerance Disorder is thought to be the development of resistance to the use of insulin in the tissues.
Studies have shown that fat accumulation in the abdominal area, especially in obese individuals, causes deterioration in glucose tolerance.
Glucose tolerance disorder, which can be seen especially in adults, is an indication that type 2 diabetes will develop over time.
Advanced. It is seen in approximately 15% of adults in some countries. The reason why this rate has increased in developed countries is a more sedentary life and increasing obesity.
In people with type 2 diabetes, the disease is thought to have continued as "Glucose Tolerance Disorder" (GTB) for 8-10 years before the diagnosis of diabetes.
Insulin hormone, which normally allows the sugar in the blood to enter the cells, cannot enter the cells due to insulin resistance, thus the sugar level in the blood remains high. To lower the high blood sugar, the pancreas secretes more insulin hormone, but due to insulin resistance in the cells, the sugar cannot enter the cells again. In this case, both the insulin level in the blood and the blood sugar level of the person are high. Over time, the insulin reserve in the pancreas decreases and the disease passes from the GTB stage to the overt diabetes stage.
The fact that glucose remains at high levels in the blood for a long time means death for the endothelial cells lining the inner walls of the arteries. This damage, which first affects small vessels, can gradually affect larger vessels. As a result, serious problems such as atherosclerosis (hardening of the arteries), cardiovascular diseases, myocardial infarction and stroke may occur. For this reason, as soon as diabetes is revealed, considering the course of the previous 8-10 years, these patients are diagnosed with micro and macro vascular systems. should be evaluated immediately. The basis of eye, kidney, vascular and other system diseases that develop due to diabetes began to develop in the period of GTB, known as hidden diabetes. I mentioned it before. One of the important factors in the relationship between obesity and GTD is age. As age progresses, glucose tolerance also deteriorates. For this reason, individuals in this group should be carefully examined for diabetes during routine check-ups and, in suspicious cases, a glucose tolerance test should be performed. Because although fasting glucose values between 110-126 mg/dl indicate GTB, the definitive diagnosis can be made with an oral glucose tolerance test.
According to WHO (World Health Organization) criteria;
The diagnosis is made when the second hourly glucose value of the plasma sugar level is between 140-200 mg/dl after ingesting 75 g of oral glucose. GTB is diagnosed when this test gives this result at least twice.
Preventing GTB or preventing it from passing from this stage to the type 2 diabetes stage if it has occurred;
It is possible by changing some life habits.
Insulin resistance and GTB improve after losing weight. Even in patients with diabetes, weight loss can normalize blood sugar. Exercise also improves GTB and insulin resistance, regardless of weight loss.
- Before moving on to recommendations on diet and lifestyle, it is useful to remember the following:
- Care should be taken in terms of GTB, especially in obese individuals with increased fat around the waist.
- If the fasting blood sugar value is between 110-126 mg/dl, an oral glucose tolerance test known as the "Loading Test" should be performed.
- Individuals with PCOS (polycystic ovary syndrome) in women should not be obese as they are at increased risk of developing diabetes. If these people have a thick waist circumference and a history of diabetes in their first-degree relatives, they should apply to a health institution for evaluation.
If GTB is diagnosed as a result of the examinations, diet and exercise are started. The person is helped to lose weight and, if necessary, takes medication. Internal support is sought.
The person should be put on a diabetic diet. At the same time, it should be evaluated in terms of hypertension and hyperlipidemia, tobacco habits should be avoided and routine health checks should be taken in a system where it can be monitored throughout life.
The principles of the diet that the person will follow are listed below
- Blood sugar regulation. To ensure that the meal number and frequency should be arranged as 3 main meals + 3 snacks.
- At least a triple combination of five basic food groups (bread, meat, vegetables, fruit and milk) should be consumed in main meals. For snacks, a meal containing both carbohydrates and protein, such as fruit and milk) or bread and cheese, should be arranged.
- There is no forbidden fruit in diabetes. However, the amounts should be determined by the dietitian and the amount should not be exceeded.
- The amount of fat to be taken with meals should be adjusted so that the energy coming from fat is 25-30% of the total energy. What can be done for this; Do not add oil to vegetable dishes cooked with minced meat or meat, add no more than one or two teaspoons of oil to salads, and stay away from deep-fried dishes. The consumed oil should not be solid. Oil should be preferred in meals. Recently, a combination of soybean oil, hazelnut or sunflower oil and olive oil has been recommended.
- The diet should be rich in fiber. For this reason, when choosing food from the bread group, by choosing whole wheat bread instead of regular bread, bulgur instead of rice, legumes instead of potatoes, the amount of fiber consumed will be increased and a meal with a low glycemic index (rate of raising blood sugar) will be created. Additionally, blood fats such as cholesterol and triglycerin can be kept at optimal levels. Consumed vegetables and fruits also significantly increase fiber intake.
- The diet should be balanced and sufficient in terms of vitamins and minerals. If nutrients are taken from all food groups every day, deficiency will not occur. It is also recommended to give B group vitamins as preparations in diabetes. Additional chromium, vitamin E and selenium preparations can also be taken as deemed appropriate by the doctor.
- Artificial sweeteners can be used. Those containing aspartame should be preferred.
- Ensure adequate fluid consumption, especially water. Care should be taken, daily fluid intake should not be reduced below 1.5 liters. If the basic principles of diet treatment are followed and routine blood sugar monitoring is carried out by regular doctor checks, diabetes will now be like a friend that the person will not be uncomfortable living with. Elements such as exercise and foot care should not be skipped.
THINGS SHOULD NOT BE CONSUMED
Candy and sugary desserts; (In the treatment principles announced by the American Association in 2000, it was stated that foods containing up to 30 grams of normal sugar per day could be calculated by the dietitian and included in the menu.)
Jam, honey, molasses, cake, cake, chocolate;
Solid fats (tallow, margarine, butter);
Cream, cream, fatty dairy products;
Delicatessen type foods (sucuk, pastrami, sausage, salami, etc.);
Offal (such as liver, kidney, brain);
All kinds of food prepared by frying or roasting in oil;
Nuts, oilseeds (calculated by the dietitian and added to the menu). may be included.);
Fruit juices, carbonated and sugary drinks, alcoholic beverages;
Prepared foods of unknown composition.
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