Food, physical exercise and medication in patients with diabetes

To control your diabetes, reducing possible complications and feeling better is important:

   Maintain an adequate diet.

    Get daily physical exercise.

    Do not smoke.

    Maintain good control of your blood sugar concentration.

    Take the diabetes medication that has been prescribed for you properly.

    Follow various treatments to prevent the risk of vascular complications and damage to different organs.

    Get the recommended vaccinations.

    Take special care of your feet and wounds.

    Have your eyes checked regularly.

    Consider different special situations.

    Know what a hypoglycemia is.

    Know when to go to the Hospital Emergency Room.

    Know when to go to the primary care physician.

Nutrition in diabetes

There is no specific diet for patients with diabetes. The diet should be aimed at approaching the ideal weight, improving blood glucose control and reducing the risk of cardiovascular complications.

Proper nutrition will help you feel better and reduce the risk of heart disease, kidney disease, stroke and other problems caused by diabetes.

You should follow a Mediterranean-type diet (rich in fruits, vegetables, fish, nuts and olive oil) that is low in simple sugars and low in animal fats. Therefore:

    Reduce the amount of simple sugars in the diet. These include sugar as such, sugary drinks (soft drinks or juice from a bottle), baked goods, cookies, cakes, pies, jam, honey, syrups, candies, chocolates, sweet wine, etc.

Fruit juices and compotes usually have sugar, so you should limit their consumption. Carbohydrates (sugars) from vegetables, fruits, legumes, cereals, or dairy products are generally adequate.

If you are treated with insulin or oral antidiabetics, you should try to maintain a similar daily intake of carbohydrates at each meal of the day. This will allow you to maintain a stable dose of your medication.

    Preferably use vegetable oils, mainly oils rich in monounsaturated fat (olive oil). Some vegetable oils, such as coconut and palm oil, frequently used for making pastries, are rich in saturated fats and should be avoided.

 Saturated fats of animal origin (fatty parts of meat, chicken skin, sausages, and dairy and non-skimmed derivatives) and trans fats (baked goods, cookies, precooked foods, fried foods, etc.), should also be avoided. On the contrary, oils derived from fish are suitable.

Fat consumption should be reduced if you are overweight or obese, since the amount of calories from fat (from oils) is very high, regardless of the type of oil consumed.

    The proteins are necessary for the organism. Proteins are found in egg whites, meat and fish. You should reduce your consumption if you have protein loss through urine (proteinuria).

    Eat foods rich in fiber. These foods reduce the intestinal absorption of sugar and cholesterol, increase the feeling of satiety and reduce constipation, so they should be recommended in all diabetic patients.

 Therefore, eat whole grains, whole wheat bread, fruits with skin, vegetables (such as asparagus) and legumes.

    Avoid regular alcohol consumption, especially if you are overweight and/or have high triglycerides.

 If you decide to drink alcohol, limit it to a maximum of one alcoholic drink per day for women and 2 alcoholic drinks per day for men. An alcoholic drink refers to a glass of wine or a small beer.

    There is no study that supports the consumption of vitamin supplements, antioxidants or minerals.

On the general recommendations discussed, there may be certain more specific recommendations on your diet depending on whether or not you have various risk factors (obesity, high cholesterol, hypertriglyceridemia, high blood pressure) or whether or not you have other associated diseases (kidney failure, loss of protein through urine).

 Salt consumption should be limited, especially if there is associated high blood pressure.

    If you are overweight or obese, you should follow a low-calorie diet to try to reach your ideal weight. Calories are found in all foods. To reduce weight, diets between 1500 and 2000 calories are recommended.

 It is advisable to divide the calories in several meals a day (4 or 5) and that the caloric consumption is always similar, especially if you are in treatment with some oral antidiabetics or insulin.

 It is also important that the meals are made at the same time. All this will allow a better control of your blood sugar. Even small decreases in weight can have a major impact on your health.

Physical activity in patients with diabetes

Physical exercise helps to reduce weight, allows the burning of sugar, and therefore reduces its amount in the blood, increases muscle mass and decreases the risk of developing cardiovascular diseases.

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For all these reasons, it is essential to do physical exercise every day, ideally for at least 30 to 60 minutes:

    Children should get at least 60 minutes of exercise a day.

    Adults should do a minimum of 150 minutes per week of aerobic exercise (2.5 hours) of moderate intensity, at least spread over 3 days.

 It is not advisable to go more than 2 days without physical exercise. It is also convenient (if there are no contraindications) to do resistance exercises at least twice a week.

Aerobic exercise consists of walking, running, swimming, cycling, gymnastics, etc. Resistance exercise consists of making weights, machines, etc.

It is not a good idea to start doing activities that could endanger your heart in a hurry. Moderate physical activity can be done without medical supervision.

 However, if you decide to engage in more intense physical activity, you should first have a medical evaluation.

 Although there is no consensus among physicians, some recommend a stress test (ergometry) for patients with diabetes who are going to begin a vigorous exercise program, especially if they have type 2 diabetes that has lasted more than 10 years, have peripheral arterial disease, have diabetic nephropathy, neuropathy or retinopathy, or if they have other associated cardiovascular risk factors (high blood pressure, high cholesterol, smoking, etc.).

However, the benefit of ergometry is not clear, and probably the most appropriate thing to do is to apply common sense and start physical activity slowly and gradually and increase it slowly and progressively.

Keep in mind the following regarding physical activity:

    Talk to your doctor about the types of exercises that are best for you.

    Make sure your shoes fit well and that your socks have no seams to rub, and are clean and dry. After exercising, you should check your feet for redness or sores.

    Before exercising, warm up and stretch for at least 5 minutes. For example, start your exercise session by walking slowly. Then stretch and then walk faster.

    After exercising, cool down for several minutes. For example, end your exercise session by walking slowly again.

    Some people may want to take a snack before doing a physical activity. Check with your doctor.

    Take something to eat or a sugar cube with you in case you have low blood sugar during exercise.

    Always carry some form of identification in case you have a health problem.

Vigorous exercise is not recommended:

    If there is ketosis (acetone) in the urine, which can occur in poorly controlled type 1 diabetics with very high blood sugar.

    In patients treated with insulin or oral antidiabetics in which the amount of sugar in the blood is very low before doing the exercise (less than 100 mg/dL). In these cases you should eat something before starting physical activity.

    If there is untreated diabetic retinopathy It is a contraindication for intense physical exercise.

Do not smoke

Tobacco is associated with cardiovascular disease. The risk of these diseases in a person with diabetes is very high. In fact, people with diabetes need preventive treatment to reduce that risk. Quitting tobacco is essential to reduce the risk of these complications.

Maintain good control of your blood sugar (glucose)

It is important to perform periodic blood glucose testing. They are generally recommended in patients treated with insulin, especially when their dose has been modified. The periodicity of its realization depends on various factors.

 Your doctor will indicate when they should be done. In general, glucose measurements are recommended in patients with diabetes treated with multiple daily doses of insulin:

    Before each meal and sometimes after.

    When you go to bed.

    Before doing physical exercise.

    Before driving or doing an activity that may endanger your health or the health of others.

    When your blood sugar is suspected to be low and as often as necessary until your blood sugar is normal.

    When any other intercurrent illness appears.

In general, the following blood glucose values are considered adequate:

    Before meals from 70 to 130 mg/dL

    1 to 2 hours after the beginning of a meal of less than 180 mg/dL.

However, these figures may not be suitable for you, so you should consult your doctor.

Your doctor may perform a glycosylated hemoglobin (HbA1C) test at a certain frequency, usually at least 2 times a year or more if your blood sugar is not well controlled. This test indicates the average blood sugar level over the previous 3 months.

 It is considered an adequate value when it is below 7%. In some people this value should be more demanding (below 6.5%) and in others less demanding (below 8%) depending on their characteristics, such as age, time of evolution of diabetes, associated diseases, etc.

Your blood sugar and HbA1C test results will indicate if any aspect of your diet, exercise plan or medication needs to be modified.

Take your diabetes medication as prescribed

Besides not forgetting the treatment, it is important to take the medication at the time of day that has been indicated. Talk to your doctor about when to take your diabetes medications.

You should follow preventive treatments to reduce the risk of vascular complications and damage to different organs

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Diabetic patients are at high risk of cardiovascular complications since they develop arteriosclerosis more easily than people without diabetes.

This implies that you should reduce your risk factors as much as possible. For this reason:

    Do not smoke.

    Maintain optimal control of your blood pressure (generally below 135/85 mmHg).

    Maintain optimal control of your bad cholesterol (LDL-cholesterol). You will probably receive a cholesterol medication from the statin family (pravastatin, simvastatin, atorvastatin or similar) for this purpose. The goal is to keep your LDL-cholesterol below 70 or 100 mg/dL.

    To prevent kidney damage, treatment with medications used to lower blood pressure from the angiotensin-converting enzyme inhibitor group (captopril, enalapril, lisinopril, ramipril, or others) or angiotensin 2 receptor inhibitors (losartan, irbesartan, olmesartan, or others) may be recommended.

 These medications may be indicated even if your blood pressure is normal.

    The administration of aspirin to prevent the risk of cardiovascular complications in diabetic patients is controversial.

 All diabetic patients with a history of transient ischemic attack, stroke, angina pectoris, myocardial infarction, coronary or carotid revascularization or risk problems in the legs (i.e. with established cardiovascular disease), should receive 100 mg of aspirin (acetylsalicylic acid) daily. Its use in patients without cardiovascular disease is not clear.

 Some societies do not recommend treatment with aspirin and others (such as the American Diabetes Association) recommend giving aspirin to most diabetics over the age of 50.

Vaccinations for patients with diabetes

    All patients with diabetes should get an annual flu shot.

    All patients over 2 years of age with diabetes should receive the pneumococcal vaccine. Those over 65 years of age should be revaccinated if they have not received the vaccine in the last 5 years. Patients with severe kidney problems should also be revaccinated.

    Adult patients with diabetes should receive the hepatitis B vaccine.

Special care of feet and wounds

Patients with diabetes may have decreased sensation somewhere in their body, usually in the legs and feet. In turn, in advanced diabetes, circulation problems are frequent, with poor blood flow to the legs due to the presence of arteriosclerosis.

 For this reason, diabetics can get small wounds or scratches that are not noticeable due to the absence of pain, which can increase in size and be difficult to heal, without healing due to the lack of irrigation.

The presence of previous alterations in the feet (flat feet, cavus feet, bunions, etc.) facilitates the development of these problems. For all this patients with diabetes should:

    Properly select comfortable footwear that does not encourage the appearance of wounds, and value the use of orthopedic shoes. To avoid rubbing it is convenient to use socks without seams.

    Make sure there is no object inside the shoes before putting them on.

    Inspect daily the feet to identify small wounds or zones of rubbing.

    Maintain an optimum hygiene of the feet, they should be clean and hydrated.

    Seek specialized care for handling corns and cutting nails.

    Avoid walking barefoot and other actions that may favor getting a wound. Always wear shoes.

    Never use hot water bottles or any other system to heat your feet.

    Receive care from specialized personnel (podiatrists).

    Consult immediately when an injury appears that could be complicated.

    To control in an optimal way the sugar in blood and the factors of cardiovascular risk.

Special care of the eyes

Patients with diabetes are at greater risk for cataracts, glaucoma and retinal problems than non-diabetics.

 Control of risk factors (cholesterol, blood pressure and smoking) and good control of blood sugar are the only factors that can prevent or delay the onset of these diseases. It is necessary for the patient with diabetes to carry out periodic revisions of his or her eyes in order to be able to detect any of these diseases early and proceed to their early treatment.

Care in special situations

In various special situations people with diabetes should follow specific recommendations:

What should I do if I am diabetic and take pills or insulin and have to fast for a test? In general, if the fast is very short, for example for a blood test, you can wait to have the test for breakfast later and then take the insulin or the pill with breakfast.

 If you fast for a longer period of time, there may not be any problem with postponing or skipping a pill, but you should discuss with your doctor what to do about your insulin injection.

What do I do if I am sick from any other cause?  Any intercurrent illness can cause your blood sugar level to rise too high. Therefore, if I have any other illness that gives me a fever or can be serious (a flu, a bad cold, pneumonia, gastroenteritis, etc.) you should

    Check your blood sugar every few hours, for example.

    If you do not vomit, you should continue to take your diabetes medicines even if you have no appetite and eat little. In this case, you should drink sugary liquids, soups or even ice cream frequently.

    If you are injecting insulin and do not eat, you should reduce the amount of insulin you inject so that you do not have a hypoglycemia. Check with your doctor.

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    In people with type 1 diabetes, the body produces acetone (ketones) when the blood sugar level is high. It is therefore advisable to measure the production of ketones in urine with a urine test strip if

       Your blood sugar level is greater than 240 mg/dL.

        You have vomiting that prevents you from eating or drinking.

Low blood sugar (hypoglycemia)

Low blood sugar can cause dizziness, trembling, weakness, confusion, irritability, hunger or tiredness. You may sweat a lot or have a headache.

 If you have these symptoms, check your blood sugar. If it is less than 70 mg/dL you have hypoglycemia (low blood sugar). Hypoglycemia is a very dangerous situation because if it is significant it can lead to unconsciousness and even death.

For this reason, if you suspect that you may have a hypoglycemia and you do not have the possibility to measure your blood sugar or you do not have time to do so, do not hesitate, act as if you have it and consume it immediately:

    Sugar.

    Glucose gel.

    Any fruit juice or sweetened drink (lemon, cola, etc.).

    Milk.

    Several candies.

    Honey, jam.

    Anything sweet.

After 15 minutes, check your blood sugar again. If it is still low, eat another serving. Repeat these steps until your blood sugar is 70 ng/dL or higher. Also, eat a snack if it will be an hour or more before your next meal.

There is no problem with taking these foods and not actually having a hypoglycemia. At best, your blood sugar will be a little higher than usual but it won’t have any effect on your health. It is much more dangerous to have low blood sugar than high.

For patients at risk of severe hypoglycemia, it is a good idea to have glucagon injections available at home. If a patient loses consciousness completely as a result of hypoglycemia, it is clear that he or she cannot eat or drink anything.

 In these circumstances, the only way to restore blood glucose and wake the patient up is to give him or her sugar fluids (not immediately available in the home) or to have a trained family member inject a pre-filled syringe of glucagon. This injection can save your life.

Hypoglycemia can result from injecting more insulin than needed, eating less food than usual or exercising more than usual. They are frequent with changes in dosage.

 The hypoglycemias produced by slow insulins last much longer than the hypoglycemias produced by the injection of fast insulins. For this reason, if your sugar drops a lot and recovers after eating sweet things, keep an eye out because it can drop again.

 Hypoglycemias can also occur with diabetes medications. In this case they are also usually prolonged and can reappear after initial recovery. If you don’t know why you may have had hypoglycemia, ask your doctor or inject less insulin than you did and it caused your blood sugar to drop.

Other considerations for patients with diabetes

Pregnancy. There are no disadvantages to pregnancy in women with diabetes, however, pregnancy in these women is considered high risk and requires a series of special controls.

Driving. The main risk of driving is the development of hypoglycemia (low blood sugar). For this reason, diabetic patients should be educated about the importance of blood sugar control and the convenience of checking before traveling to distant destinations:

    You should not start driving if your blood glucose is too low (less than 100 mg/dL).

    Always carry high-sugar food in the car.

    If you have symptoms suggesting hypoglycaemia, stop the car immediately.

    Avoid driving if you have recently had your treatment dose changed or new diabetes medication added.

    Always protect your medication from heat and cold.

    Be careful with your vision problems.

In our country, patients treated with pills (oral antidiabetics) must provide a recent report from the doctor that allows them to drive, the period of validity of the license being at the discretion of the doctor.

Patients receiving treatment with insulin must provide a specialist report indicating that the disease is well controlled and that the patient knows the risks of driving in their circumstances, being the maximum period of validity of 4 years.

When should I go to the hospital emergency room?

A person with diabetes should go to the emergency room if

    Loses consciousness.

    Your blood glucose level is very high, usually above 400 or 500 mg/dL.

    You maintain high blood sugar levels (above 250 mg/dL) for several days but cannot access your primary care physician.

    You have dizziness or continuous sleepiness.

    You have vomiting that makes it difficult to eat.

    In any other situation that you may consider serious.

When should you see your primary care physician?

You should see your primary care doctor if

    Your glucose levels remain high for several days.

    You have several tests with lower than normal blood sugar.

    You have a fever.

    You have any other intercurrent illnesses.

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