By: Anidha Ashfaq Bhat.
Kashmir is slowly turning as the sick capital of India. This fact may be attributed to various factors including our unhygienic life styles, increase in pollution, absence of healthy dietary practices and much more. For the progress and prosperity of our motherland these things need to be controlled within time. The general illnesses that the masses are generally ailing with are cancers of the alimentary canal, Psychotic disorders, cardiac ailings, issues related to blood pressure, diabetes,etc. Growing number of people are getting involved into these disorders especially diabetes. This may be attributed to our eating patterns and life styles. A thorough knowledge about these and a healthy life style may play a vital role in keeping these issues at bay.
Diabetes is a condition in which pancreas is not able to produce enough insulin or cells stop responding to the insulin. The defect in the insulin may be due to its formation, liberation or action. Insulin is produced by beta cells of Islets of Langerhans; any reduction in the number of functioning cells will decrease the amount of insulin that can be synthesized. There are three main types of diabetes Type I, Type II and gestational diabetes.
Type 1 diabetes is usually diagnosed in childhood. Many patients are diagnosed when they are older than 20 years of age. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The body`s immune system is believed to be triggered by a virus or another micro-organism that destroys the cells in the pancreas that produce insulin.
Type 2 diabetes is far more common than type 1. It makes up most of the diabetes cases. It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. Under this condition the pancreas does not make enough insulin to keep blood glucose at normal levels, often because the body does not respond well to insulin. Many people with type-2 diabetes do not know they have it, although it is a serious condition. Type-2 diabetes is becoming more common due to increasing obesity and failure to exercise.
Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes. Women who have gestational diabetes are at high risk of type 2 diabetes and cardiovascular diseases in their later phases of life. High blood glucose levels can cause many problems like emaciation( weight loss), Blurred vision, Excessive thirst (polydipsia), Frequent urination (polyuria), Hunger (polyphagia), Fatigue, recurrent infections and slow wound healing. One may also feel burning pain in legs, feet, arms and hands. Diabetics (people with diabetes) can sometimes feel like a viral illness. Bladder and vaginal infections can be a particular problem for women; more than half of the men of age group 50 and above may experience some degree of sexual dysfunction due to the damage caused to nerves that help to produce an erection. Diabetes increases the risk of infection to gums and in the bones that hold teeth in place. As a result, gums may pull away from teeth and become loose, or one may develop sores or pockets in gums. This is especially true if one has gum infection before the onset of the ailment.
Nerve damage (neuropathy) is a particular problem associated with diabetes. Diabetes is one of the major causes of mortality and morbidity in the world. India leads the world with largest number of diabetic subjects earning a dubious distinction of being termed as the “Diabetic capital of worldâ€. According to the Diabetic Atlas 2006 published by the International diabetic federation, the number of people with diabetes in India are currently around 40.9 million and the number is expected to rise to 69.9 million by 2025 unless preventive steps are taken. Figures for the year 2007 show that the five countries with the largest amount of people diagnosed with diabetes hailed from India (40.9 million), China (38.9 million), US (19.2 million), Russia (9.6 million) and Germany (7.4 million).
DIETARY MODIFICATION TO BE ADOPTED FOR PATIENTS
SUFFERING FROM DIABETES:-
To achieve near normal blood glucose levels people with type-1 diabetes and people with type-2 diabetes who are taking insulin or oral medication must coordinate calorie intake with medication or insulin administration, exercise, and other variables to control blood glucose levels in the body. New forms of insulin are now allowing more flexibility in timing meals. To protect the heart, people with type-1 or type-2 diabetes should aim for healthy lipid (cholesterol and triglyceride) levels and control of blood pressure. To achieve reasonable weight; do away with Overweight type 2 diabetics who are not taking medication should aim for a diet that controls both weight and glucose. A reasonable weight is usually defined as what is achievable and sustainable, rather than one that is culturally defined as desirable or ideal. Children, pregnant women, and people recovering from illness should be sure to maintain adequate calories for health.
To manage or prevent complications of diabetes, people with diabetes, whether type 1 or 2, are at risk for a number of medical complications, including heart and kidney disease. Dietary requirements for diabetes must take these disorders into consideration. Overall, experts recommend that foods containing carbohydrates from whole grains, nuts, fruits, vegetables, and low- or non-fat milk should be included in any healthy diet. Carbohydrates and unsaturated fats should provide 60% to 70% of calories, but the mix should depend on calorie intake needed for weight loss or maintenance. Diabetic patients should avoid saturated fats (found in animal products) and trans-fatty acids (hard margarines, commercial products, fast foods). In selecting fats or oils, prefer monounsaturated fats (virgin olive oil, canola oil), although also include polyunsaturated oils as well (sunflower, rapeseed).
Different studies have reported an association between type 2 diabetes and both saturated fats and trans-fatty acids. People with diabetes should limit protein intake. Protein should provide 15% to 20% total calories (less in people with nephropathy). In selecting proteins, eat in moderation and prefer fish or soy protein to poultry or meat. (High fat meats should be avoided in any case.)
RECOMMENDATIONS/SUGGESTIONS:-
Nutritional care is an important pre-requisite in the management of diabetes. Diet plays a key role in the
management of diabetes. Diet is the cornerstone of treatment of diabetes. Although, it is not possible to cure diabetes completely, diabetics can lead almost a normal life if they follow certain do`s and don’ts scrupulously. Co-operation of the patient is very important in the management of diabetes. Following suggestions can prove to be helpful for overcoming diabetes:
• Educating the patients and their family members about the role of diet in the management of diabetes.
• Development of NIDDM (Non insulin dependent diabetes) in middle age can be prevented, and at early age NIDDM is reversible with weight loss and physical activity. Weight control should be targeted at the whole family.
• The goal of dietary advice to diabetics is to maintain health and quality of the life and avoid the vascular complications of diabetes.
• The pattern of meals should provide food every 2- 3hours. This is best achieved by three regular, well spaced meals, with three snacks in between. • A diet lower in fat and lower in carbohydrate may be all that is needed to control weight.
• Dietary advice for diabetics is similar to that for the general population, and particularly relevant for the avoidance of vascular complications.
• Soluble fiber such as gums, gels and pectins in natural foods are beneficial in odulating glycaemia.
• Patients should avoid fasting and feasting.
• Sodium intake is to be more than 6g daily. Sodium is restricted to 3g in hypertensive diabetic patients.
(The writer is a research scholar at AIIMS)
E-mail: bhatanidha@gmail.com
