Diabetes Mellitus Type 1
Type 1 diabetes mellitus is an endocrine-metabolic disease, which negatively affects the secretion of insulin by the pancreas. In subjects affected by this disease, the amount of insulin produced by the pancreas is insufficient to ensure the correct functioning of the organism; consequently, it is necessary to resort to daily synthetic insulin injections.
The pancreas, which performs a promiscuous function (endocrine and exocrine), can undergo a reduction in its general or specific functionality for reasons: genetic, autoimmune, infectious, inflammatory, etc.
Insulin is an essential hormone for the body, because it regulates blood sugar by fueling the massive entry of glucose into certain specific tissues (muscle, heart and adipose).
In the case of type 1 diabetes mellitus there is NO definitive cure, but rather a maintenance drug therapy. As mentioned, the reference drug is synthetic insulin based, subcutaneously injectable - or intravenously, in case of emergency.
The dosage and duration of action of the injected insulin vary according to the subjective characteristics and the type of food consumed in the meal. For further information: Drugs to Treat Type 1 Diabetes Mellitus
Diet, Insulin and Diabetes 1
Diet for type 1 diabetes mellitus is a very important aspect for the prevention of chronic complications due to hyperglycemia.
In healthy subjects, the glycemic surge is only postprandial. However, if insulin is absent or insufficient, this hyperglycemic condition continues over time, causing various damage to: eyes, kidneys, nervous system, cardiovascular system and autonomic system.
The insulin injection aims to prevent this circumstance by lowering the postprandial blood glucose. Nonetheless, the amount of drug must be chosen carefully, without running out (for the reasons mentioned above) or exceeding. In fact, too much insulin can lower blood sugar levels (hypoglycemia), causing serious reactions such as ketoacidosis and hypoglycemic shock (loss of consciousness, coma and death).
It is therefore understandable that the eating habits of the type 1 diabetic must be more or less standardized, in order to avoid complications in the short and long term.
On the other hand, if properly instructed, the subject is able to effectively manage their diet by changing foods, portions and the level of physical activity.
When the glycemic and glycated hemoglobin parameters return to normal, diet, physical activity and pharmacological doses can be defined as satisfactory.
The nutritional organization of a diabetic must take into account above all the glycemic impact of food. The greater the knowledge of this variable, the easier the choice of foods and portions will become.
Let's go into more detail:
Is it better to eat proteins, fats or carbohydrates?
The body is able to maintain blood sugar starting from the energetic macronutrients present in food. Among these, the most effective are certainly carbohydrates; however, blood glucose can be maintained using certain alternative molecules: protein amino acids, triglyceride glycerol, lactic acid and pyruvic acid (intermediate products of cellular respiration).
The higher the blood glucose, the higher the patient's insulin dose should be.
Meals that require higher drug doses are those rich in carbohydrates. Of these, easily digestible carbohydrates and sugars that do NOT require any metabolic transformation (e.g. the conversion of fructose or galactose into glucose) are responsible for a faster glycemic surge.
For the same portion, there are factors that allow you to limit the increase in blood sugar and the speed with which it rises (glycemic index); for example the concomitant intake of:
- proteins and lipids
- plenty of water.
How are the nutrients broken down?
The simplest criterion to respect is that of the Mediterranean diet: 10-15% of proteins (never more than 20%), 25-30% of fats and 55-65% of carbohydrates (10-16% simple). For further information: Distribution of the Diet.
Many choose to adopt intermediate solutions, in which total carbohydrates are reduced by up to 50 or 40%, to the advantage of fats (30-35%) and proteins (15-20%)
A practical example is the following:
Pasta and Beans: Wholemeal Pasta 40g, Dried Beans 40g, Total Water 500ml (hydration and cooking), Parmesan 10g, Extra Virgin Olive Oil 5g
Fennel Salad: Fennel 150g, Extra Virgin Olive Oil 5g
Whole Wheat Bread: 25g
Drinking water: 2 glasses
Where are carbohydrates found? Which? How many?
Dietary carbohydrates can be simple and complex.
Simple sugars are found in fruit, vegetables, milk, honey, table sugar (fructose and sucrose), in the sweets that contain them (including drinks) and in some cooked foods (toasted cereals, bread crust, etc.).
The complex ones (starch) are instead found in cereals, legumes and some tubers.
As anticipated, the amount of carbohydrates must be balanced with the right amount of insulin. Obviously, this requires a real count of the total carbohydrates in the meal.
Many help tools are available to carry out this daily operation correctly, starting from real training courses, up to the use of automatic calculators.
NB. Food labels are always a great gimmick.
Other useful tips
After establishing the insulin dose referred to the glycemic load and having learned how to manage food, all that remains is to follow a balanced diet.
In fact, the nutritional recommendations for the type 1 diabetes mellitus diet are the same as for a common nutritional regimen.
It is recommended to:
- Prefer fresh foods, to the detriment of processed ones and especially junk food
- Take care of your intake of fiber, vitamins and minerals
- Emphasize the intake of natural antioxidants, both vitamins and saline, and of other kinds (eg phenolic ones). These are mainly contained in vegetables and fruit
- Reduce the amount and percentage of saturated or hydrogenated fats contained in junk foods, dairy products and fatty meats
- Reduce the amount of total cholesterol, mainly contained in dairy products and fatty meats
- Promote the intake of essential fatty acids (AGE), especially omega 3 (more difficult to introduce with the diet). AGEs are found mainly in cold-pressed oils, oilseeds, oily fish and algae.
- Reduce the amount of sodium and increase that of iodine. Sodium may already be present in preserved foods (canned food, preserved meat, etc.) or added (called discretionary). Iodine is mainly introduced with fortified foods and food supplements.
- Reduce the amount of toxic molecules and foods that contain them. Among these we could mention all the residues of carbonization, nitrates and nitrites, foods with pharmacological residues or pollutants, products with many food additives, etc.