What everyone should not eat when having diabetes, everyone knows, and not everyone knows how to treat this disease. Many traditional healers believe that it is best to use traditional medicine. There are many herbs that are very effective in treating this ailment. Methods of physical impact, various natural substances can also be of great help in the treatment of diabetes due to the fact that they contribute to the partial restoration of pancreatic cells that produce insulin.
In the treatment of diet and medicinal plants must constantly monitor blood sugar levels. Based on the nature of the disease, it follows from the following tools to choose for themselves the most accessible.
1. Millet, buckwheat and corn very well reduce blood sugar. It is necessary to grind the grits and in the evening pour 1 tbsp. l flour of any of these cultures with a glass of water or kefir. Insist night and drink in the morning. The constant use of such a solution normalizes the sugar in the crop. Only flour must be made from raw, not fried cereals.
2. Legumes help reduce blood sugar. Traditional medicine knows many cases of their use for this purpose. One diabetic, for example, every morning, on an empty stomach, swallowed one small dry black bean, the second soaked two white beans for the night, and in the morning chewed and ate them. In both cases, the result was positive. The third to maintain normal sugar, you had to eat six grains of beans.
Traditional medicine has a large arsenal of medicinal plants that reduce blood sugar levels. These plants include: orange, small periwinkle, black elderberry, red beet, alder, mustard seeds, Indian yogi fungus, birch and aspen tar, birch leaves and buds, watermelon, golden mustache, potatoes, beans, cinnamon, two-nettle, dandelion, bay leaf, quinoa, burdock, Chinese lemongrass, flax seeds, mummy, aspen, quail eggs, parsley, Rhodiola rosea, cloves (spice), wild strawberries, onions, chicory, blueberries, sage, mulberry, etc. Each patient should to look for his medicine, he himself must select a dose. Of great importance here is the psychological factor.
Peanut has good sugar-lowering properties. Traditional medicine recommends pouring vinegar 0.5 cups of raw peanuts, insist a week and eat 1 nut in the morning and evening, regardless of the food. In some cases, the sugar decreased from 13 to 5.5 units, that is, to the ideal rate. If you use instead of 1 peanut nut 10, then you can normalize the pressure in hypertension. Peanuts for treatment should be taken raw, with an intact film, in any case not packaged in cellophane.
Jerusalem artichoke has good sugar-lowering properties, its effect is mild and resistant. Use Jerusalem artichoke, adding to its salads young leaves and tubers. In the fall and spring, they are eaten fresh, and in the winter - dried.
Baths with Jerusalem artichoke: 1.5 kg of chopped mixture of tops, leaves, flowers, fresh or dried tubers pour a bucket of boiling water, bring to a boil and boil for 10-15 minutes. Remove from heat, insist 20 minutes, pour into a bath with not very hot water and steam for 15 minutes. Perform the procedure every other day. All you need to take 15-40 of these baths, depending on the result achieved. Helps with this treatment for hypertension, diabetes and salt deposition.
Good results in reducing sugar in diabetes mellitus are used in the treatment of flax.
2 tbsp. l seed plants need to grind into flour, pour 0.5 liters of boiling water and boil for 5 minutes in an enamel bowl. Cool without removing the cover. Drink the broth warm, at a time, for 20-30 minutes before eating. The thick can be thrown away, but if you have constipation, it is better to use the broth along with the thick. In a month you will feel light in the stomach, pain in the pancreas will pass, and the complexion will improve. The broth should be drunk fresh.
You can take infusions and decoctions of herbs.
Eat parsley (parsley juice has the ability to strengthen blood vessels, especially the capillaries, which is important for diabetes, greens and parsley root also have a sugar reducing effect).
Add salads to your diet: 100 g of parsley root, grate apples, 2 g of fruit sugar (xylitol or sorbitol), juice of 1 lemon, add parsley to taste.
60 g of blueberry leaves to collect in May-June, pour 500 ml boiling water, insist 20 minutes, cool, strain. Take 0.5 cups 3-4 times a day. It is useful to eat blueberries, because the trace elements contained in the leaves reduce the sugar content in the blood.
Young leaves of a dandelion to use in the form of salads (young leaves of a dandelion contain insulin). Soak the leaves for 30 minutes in water, dry and chop finely, add herbs (parsley, dill, radish tops or young turnips, etc.), egg yolk, dress with mayonnaise, sour cream or vegetable oil.
Take ready (sold in a pharmacy) extract of Eleutherococcus spiny 20 drops two or three times a day before meals.
Ready tincture of lemongrass Chinese to take 20-25 drops 1-3 times daily before meals.
Rosehip infusion: 1 cup of boiling water for 10 pcs. crushed rosehips. Fruits pour boiling water and hold on low heat for 3-5 minutes, insist 5-6 hours, drain. Drink 0.5 cups 3-4 times a day.
Daily take 1 tsp. powder of Jerusalem artichoke (earthen pear). Wash the nodules of Jerusalem artichoke wash, dry, finely chop, dry and grind into powder.
The use of Jerusalem artichoke treats almost all vascular and metabolic diseases.
50 g of nettle leaves (preferably fresh) pour 500 ml boiling water in an enamel pot, insist. After 2 h, strain. Drink 1 tsp. 3 times a day before meals. It is recommended to use in food and nettles. The leaves and shoots of young nettles are best harvested for the winter, dried or leavened. And all winter use infusions, soups, teas with nettle leaves. The same can be done with dreams. Nettle leaves and slyti - a storehouse of trace elements.
Horsetail in the form of lettuce and infusions, pour a glass of boiling water 30 g of horsetail, boil for 5-7 minutes, insist 2-3 hours, drain. Take 2-3 tbsp. l 3 - 4 times a day before meals.
Collection for the treatment of diabetes: 20 g of blueberry shoots, bean leaves, 15 g of horsetail, hips, 10 g of Manchurian root of Aralia, St. John's wort herb, chamomile flowers. Mix everything, put in an enamel bowl 10 g of collection, pour 2 cups of hot water, heat in a water bath for 15 minutes, cool to room temperature, strain. Take an infusion of 0.3 cups 2-3 times a day 30 minutes before meals for 20-30 days. After 10-15 days, repeat the course. During the year, you can repeat such courses every 3 months.
Pour 1 tbsp. l crushed leaves of walnut with boiling water, boil on a low heat for 20-30 minutes, insist, strain, take during the day.
Fresh juices of carrots, cabbage or raw potatoes drink 0.25 cups of each juice 4 times a day.
For the treatment of diabetes is used up to 150 medicinal plants. So, infusions and decoctions obtained from the roots and shoots of rice, wheat, and barley have some sugar-lowering effects. Apply infusions of stems and leaves of the mulberry tree, seeds of buttercup, cumin, garlic, lemon peels, hops, tea from the extracts of the peel of sage and beans, decoctions of blueberries, tinctures zamanihi.
The recipe for treating diabetes mellitus with an oatmeal diet is common: pour 100 g of grains with 3 cups of water, boil for 1 hour, leave overnight, strain and take half a glass 3-4 times daily before meals.
It has been proven that plants contain substances that in their structure are close to guanidine derivatives, they have sugar-lowering properties.
The following charges also have a good effect in diabetes mellitus:
1. Blueberry leaves - 20 g, St. John's wort flowers - 20 g, pods of beans - 20 g.
Mix all. Pour the mixture of 1 liter of boiling water, boil the contents for 1-2 minutes with the lid closed, insist 8-12 hours in a dark place. Take 0.3 cup 3 times daily before meals.
2. Galega medicinal herb - 20 g, bean pods - 20 g, bilberry leaf - 20 g, rosehip berries - 20 g
Cooking as in the previous recipe. Take 0.5 cups 3 times a day before meals.
3. Flowers of Hypericum ordinary - 25 g, dandelion leaves - 10 g, galegi lexicological grass - 20 g, nettle leaves - 15 g.
Cooking as in the previous recipe. Take 0.3-0.5 cups 4 times a day before meals.
4. Bilberry leaf - 25 g, bean pods - 20 g, dandelion leaf - 15 g.
Cooking, as in previous recipes. Take 0.3 cup 3-4 times daily before meals.
5. Blueberry leaf - 25 g, St. John's wort - 20 g, bean pods - 20 g, medicinal galegi herb - 25 g
Preparation and use, as in the previous recipes.
6. St. John's wort flowers - 25 g, black elderberry flowers - 20 g, nettle leaf - 15 g, walnut leaf - 20 g, strawberry leaf - 15 g.
Preparation and use, as in the previous recipes.
7. Fresh blueberries: 30 g; Galega medicinal herb: 20 g; fresh cowberry berries: 30 g; St. John's wort flowers: 20 g; strawberry leaves: 15 g; bearberry leaves: 10 g
Preparation and use, as in the previous recipes.
8. Field horsetail - 20 g, black elderberry leaf - 10 g, root of the elecampane - 5 g, St. John's wort - 10 g, nettle leaf —5 g
Preparation and use, as in the previous recipes.
9. Zamanihi root - 5 g, dandelion root - 5 g, chicory root - 10 g, flax seeds - 5 g, St. John's wort - 10 g, lime color - 10 g, chicory root - 5 g
Mix all. Boil over low heat for 30 minutes in 1 liter of water. Infuse in a warm place for 3-4 hours. Strain. Take 3 tbsp. l 3-4 times a day for 20 minutes before meals.
In pharmacies, you can buy the following collection (harpase-ting) for the treatment of diabetes.
Bilberry shoots - 20 g, bean leaves - 20 g, Aralia Manchurian roots - 10 g, horsetail - 15 g, rosehips - 15 g, St. John's wort grass - 10 g, chamomile flowers - 10 g. Pour the collection into an enamel dish, pour 2 cups boiling water (400 ml), heat on a water bath for 15 minutes, cool at room temperature for at least 45 minutes, strain, squeeze out the remaining raw materials. The volume of the resulting infusion topped up with boiled water to 400 ml. Take 30 minutes before a meal (preferably in the form of heat) 0.3-0.5 cups 2-3 times a day for 20-30 days. After 2 weeks, repeat the course. In the year to spend 3-4 courses.
The following medicines are very popular with diabetes:
1. HAPPY LITTERAL KIDNEY: 20 g of kidneys pour 200 ppm of boiling water and insist 1 hour. Take 1 tbsp. l three times daily before meals.
2. Dry bilberry leaves insist and drink as tea 3-4 times a day, 0.5 cups.
3. Chop the tail of the pumpkin, chop into 15 cm thick elder-sized elder stem, shells from 20 bean pods and 30 g of corn stigmas. All pour 1 liter of boiling water and insist for 8 hours in a sealed container and a warm place. Strain. Take 100 ml 3-4 times a day.
4. Fresh potato juice is very useful. Take it to 0.5 cups half an hour before meals.
5. If you take inside mustard seeds 1 tsp. three times a day, the blood sugar level decreases.
6. Infusion of red clover flowers: 1 tbsp. l raw materials brew 200 ml boiling water, insist 1 hour. Drink 1 tbsp. l three times a day.
7. Blueberry leaves - 1 part
Sash dry pods of beans - 1 piece
Flax seeds - 1 part
Straw oats - 1 part
3 tbsp. l Mix boil in 3 cups of water for 10 minutes. Insist in the oven for 2 hours. Take 0.3 cups 6-8 times a day.
Table of contents
- Foreword from the editors
- Chapter 1. "Likbez" on diabetes
- Chapter 2. Insulin: Myths and Reality
The given introductory fragment of the book Diabetes. Advice and recommendations from leading doctors (O. S. Kopylova, 2016) provided by our book partner - the company Liters.
Chapter 1. "Likbez" on diabetes
Diabetes: the magnitude of the disaster
Almost everyone knows about the existence of diabetes. Do you know how it appears? What are the first signs of this disease? Can a person suspect the presence of diabetes?
Of course, there are certainly those who suffer from this disease and know almost everything about this disease. However, there are a huge number of people who simply do not suspect that they have diabetes.
According to some statistics, for every patient who has diabetes, there are 3-4 people who suffer from this disease, but are not aware of it!
According to the WHO, the incidence of diabetes in the world is approximately 347 million people. The high prevalence of diabetes mellitus is caused by such factors as population aging, decreased physical activity, and unhealthy diet - excessive consumption of sweet and fatty foods.
Terrible complications of diabetes - heart attack and stroke. Damage to blood vessels and nerve damage can lead to foot problems, gangrene, and even amputation. More than 60% of cases of amputations are not due to injuries, but as a complication of diabetes. Diabetes can cause eye diseases and even lead to loss of vision. Diabetes is a common cause of renal failure.
According to the State Register of Patients with Diabetes, as of January 1, 2014, 3,964,889 patients were registered in Russia. The most common type 2 diabetes, which most often occurs in people with overweight and low physical activity. The number of patients with type 1 diabetes was 339,373 people, including 20,373 children, 10,038 adolescents, 308,949 adults, and the number of patients with type 2 diabetes - 3,625,529 people, including 409 children, 342 teenager, 3,624,778 adults.
The International Diabetes Federation (IDF) estimates that the actual number of patients, including undiagnosed cases, is more than 12 million people.
Another important point: how well people are informed about diabetes, about its initial, not very noticeable signs, how soon they will go to the doctor, the manifestation and dynamics of vascular complications depend. After all, the main problem of diabetes mellitus is not in itself the presence of sugar in the blood, but the appearance of vascular complications. In some cases, because of them, there is a need for limb amputation, the likelihood of stroke and myocardial infarction increases significantly.
What is diabetes?
“Diabetes” is a word of Greek origin. Diabetes, which means “siphon” or “leaking”, because it is accompanied by a greater use and elimination of fluids from the body.
The first description of diabetes was made by Egyptian doctors in 1500 BC. Until the discovery of insulin in 1921, the only method for treating diabetes was diet.
The first symptoms of diabetes
The first question that doctors now ask patients: "How old are you?" If 40 or more, then a person automatically falls into the risk group for type 2 diabetes.
In our country, the average life expectancy, unfortunately, is not so high, but in those countries where this figure is more than 80 years, there is a clear trend: with every year of life the likelihood of diabetes mellitus increases. And if today in developed countries, 5–7% of the population suffers from diabetes, in the group of 70-80-year-olds, this figure reaches 17%.
50-60 years - the most "fertile" period for the onset of diabetes.
If you are over 40 years old, you should definitely pay attention to the following points: if there is overweight, if there is obesity (if you have, you should regularly take tests for blood sugar).
An important indicator is the fact whether a person often feels a feeling of thirst, how much water he consumes and how much he expels, how many times he gets up to bed in the night.
Disturbing symptoms can be the presence of furunculosis, pustules on the body, itching - especially in the perineal area (urine containing glucose is a favorable medium for the reproduction of microbes).
Causes of type 1 and type 2 diabetes
Worldwide, an increase in the incidence of diabetes mellitus (primarily diabetes type 2) is recorded. Type 2 diabetes is much more common than type 1 diabetes.
Diabetes mellitus is the common name of two essentially different diseases. They proceed in the same way, but their nature is different. Type 1 diabetes, which is much less common, is diabetes caused by damage to the pancreas and its complete “dying”, termination of its function. This is most often due to an autoimmune lesion of the pancreas, when the body’s immune system mistakenly starts a “war” against its own organ, in this case against the pancreas.
A similar process can also begin as a result of injuries, ischemic damage, severe inflammatory changes, pancreatitis, occurring with a massive disintegration of pancreatic cells. That's when type 1 diabetes begins. This is an acute, often autoimmune disease that occurs as a response to some kind of "provocation."
Type 2 diabetes is a completely different situation. This is diabetes, which is primarily inherited. Moreover, like all other hereditary diseases, the longer the “history of inheritance”, the earlier the disease manifests itself and the harder it eventually is if it does not work.
Type 1 diabetes mellitus usually appears in children or young people - up to 30 years. This is due to a decrease in the number of beta cells - the pancreatic structures responsible for insulin secretion. Massive destruction of the endocrine cells of the pancreas leads to a critical decrease in the level of insulin in the blood.
Such cell death may be associated with viral infections, cancer, pancreatitis, toxic lesions of the pancreas, but most often this disease is genetically determined and due to defects in a number of genes.
The human body has enormous compensatory possibilities, but if diabetes mellitus has appeared, the regression (decrease in the number of beta cells) continues. The clinical symptoms of type 1 diabetes are different from those of type 2 diabetes. If rapid weight loss occurs, malaise and general weakness appear, and the patient does not consult a doctor and does not receive proper treatment, ketoacidosis occurs. This is due to the high concentration of glucose and ketone bodies in the blood. Urine gets the unpleasant smell of pickled apples, acetone. Such a state is already life threatening. If you do not help such a patient, diabetic ketoacidosis coma develops.
Type 1 diabetes develops transiently: if in the case of type 2 diabetes from the first symptoms to the doctor you can wait, then ketoacidosis often develops rapidly and sometimes leads to diabetic coma, loss of consciousness. This is a very terrible complication of diabetes.
Type 2 diabetes - what is it cunning?
Type 2 diabetes is a very insidious disease. It comes quietly, gradually: sometimes patients for 2–3 years have the whole bunch of alarming symptoms, however, these signs are not too pronounced. They only very slightly affect the human performance, on his attitude to life. That is, a person always finds some explanation for his abnormal state.
If the patient shows signs of ketoacidosis, you should immediately seek medical help. This condition may end in a diabetic coma.
Indicators of diabetic ketoacidosis:
• blood glucose is significantly increased (> 13.9 mmol / l),
• the concentration of ketone bodies in the blood is increased (> 5 mmol / l),
• test strip shows the presence of ketones in the urine,
• acidosis in the body, i.e., the acid-base balance has shifted towards an increase in acidity (pH of arterial blood is 125–150 g per day) and adhere to usual physical activities
• research is carried out after an overnight fast for at least 10–14 hours (at this time do not eat, do not smoke, do not take alcohol, do not drink medicine),
• during the test, the person must rest - while not smoking, not doing physical work, do not supercool,
• The test is not recommended after diseases and operations, during menstruation, in diseases of the gastrointestinal tract with impaired glucose absorption.
False-positive test results are possible with hypokalemia, liver dysfunction, and endocrinopathy.
In diabetes, it often happens that different experts give conflicting recommendations. In fact, you can eat almost everything that a healthy person eats. The exception is easily digestible, refined carbohydrates. These include soda, sweets (cakes, pastries, ice cream, etc.).
You probably know that all sweet causes a feeling of pleasure. Even cows that give chocolate, milk production increases! But a person who is obsessed with a passion for sweets, there is also a predisposition to diabetes.
If you like sweets and moreover allow yourself to eat large portions of dessert at once, go to the doctor. You just need to monitor blood sugar levels!
It is very important to adjust not only the content of the diet, but also the diet. Eating should be at least three times, and better and five times - provided that you eat small portions.
Easily digestible carbohydrates are sugar, honey, chocolate, everything is sweet. But there are also unrefined carbohydrates that are useful for diabetes. In the diet 55–60% should be given to carbohydrates, but carbohydrates unrefined. Such complex carbohydrates are found in vegetables, legumes, nuts, seeds, and whole grains. Complex carbohydrates are converted into simple sugars. The important thing is that this happens very slowly, and this is the protection for the diabetic.
Patients with diabetes need carbohydrates, like all healthy people. But carbohydrates are special - those that are absorbed slowly enough. Nutritionists offer patients with diabetes unrefined cereals, bran, any bread from wholemeal flour.
In diabetes, which is not insulin-dependent, doctors advise consuming lots of vegetables, fruits, and juices. Of course, both fruits and juices are different, among them there are very sweet. What can, what can not?
If you make juice from 100 grams of grapes, drink it and then check the sugar content in the blood, the rate will be very high. If the same 100 g is eaten whole with the peel, the glucose level will not increase. The skin of grapes contains substances that slow down the absorption of glucose in the gastrointestinal tract!
It's all about quantity. Modern scientists have concluded that a healthy person needs to eat 5 different fruits a day.
But the story of how humanity came to refined nutrition is very instructive. Peter I believed that the soldiers ’daily ration should include 1 kg of 300 g of black bread and 500 g of meat. True, it turns out that in such an amount of bread prepared according to the old technology, in fact, contained the entire daily set of vitamins and microelements needed by man. And today's bread contains only 10% of the previous norm of all vitamins and minerals.
Much depends on the form in which fruit is eaten. Some people prefer to peel the fruit, considering that the peel is harmful. In the case of diabetes, this is not the case.
The amount of fruit also needs to be limited: for example, today you eat an apple, tomorrow is an orange.
As for healthy people, fruit for them is a wonderful source of trace elements and vitamins, they cannot be abandoned.
A healthy person needs vitamins and minerals, and a diabetic patient needs even a little more - to reduce the oxidative stress that a person suffers as a result of increased glycemia. Vitamins in the body of a sick person are destroyed faster.
Among diabetics who have stepped over 40 years of age, there are more women than men.
In recent years, diabetes has become dramatically younger. There are many schoolchildren and even children of preschool age among the patients.
Typical signs of diabetes are feelings of weakness and fatigue, rapid fatigue and dry mouth, thirst, weight loss with increased appetite, obesity, slow healing of wounds, dizziness, a decrease in body temperature below the average mark and a well-perceptible odor of acetone from the mouth.
Regular consumption of radish, grapefruit, cranberries, fresh beet juice, as well as infusion of blueberry leaves and birch buds helps to lower blood sugar levels.
Diet and diabetes
A rather typical question asked by many diabetic patients and individuals predisposed to developing this disease: “I weighed a lot. For three months she was dieting and lost 15 kg. Recently, I was at the doctor, and I was found to have high blood sugar. Explain, please, how this could happen, is it really because of the diet? I eat very little now. ”
Here it is imperative to warn people who want to lose weight that the optimal weight loss is 500 g per week. If it takes a kilogram per week, then this is not due to the loss of adipose tissue, but due to loss of muscles. And that's bad. Rapid weight loss is stressful for the body. In cases like the one described, weight reduction often no longer occurs due to physical exertion and food restrictions. Most likely, the person was already sick with diabetes mellitus, and beta-cell weakness has already occurred before. And the stress of the draconian diet simply exacerbated the problem and forced the person to see a doctor.
Patients with diabetes emit a lot of sugar in the urine - sometimes they even joke that the diabetic's body works almost like a sugar producing plant. But a person needs energy to live, and then energy comes from the burning of adipose tissue. This explains the sharp drop in weight in patients with type 1 diabetes.
In addition to diet, for a patient with diabetes, exercise is very important. Not so long ago there was a common opinion among doctors that in case of diabetes mellitus it is impossible to play sports, physical activity is contraindicated.
But, by the way, Fedor Ivanovich Chaliapin suffered from type 2 diabetes. In those days, diabetes was not treated with insulin, and doctors advised the great singer ... chop wood before eating.
From the standpoint of modern medicine, this recommendation is correct. Attempt to avoid the load is fraught with health problems, especially it is dangerous for a patient with diabetes. It is now known that a working muscle is capable of utilizing glucose. That is, physical activity, muscle contraction contribute to the utilization of glucose. There are data from studies on the prevention of diabetes in patients with obesity, and the percentage of such patients is now very high.
The study involved groups of patients who were engaged in physical exercise, patients who were just on a diet, patients on a diet with exercise, patients with xenical, patients taking other medications. The study was conducted for 3-5 years. As a result, it turned out that the best indicators were in the group of patients whose diet was combined with physical activity.
A separate question - what should be the physical burden of a patient with diabetes? How to control your motor activity? About people who "sit" on insulin, you need to talk separately. This is a special conversation, because with type 1 diabetes and the use of insulin, exercise can be tolerated only under the supervision of a physician and with certain indications. There are also patients with severe comorbidities, in which much is contraindicated.
But in people with type 2 diabetes and not using insulin, at the initial stage, more or less intact health, normal blood pressure, no coronary disease.
In this case, it is possible and necessary to expose yourself to physical stress, because the motor activity for a diabetic is also a “pill”. But the load should be dosed, mainly aerobic. No need to get involved in exercise machines, but walking, swimming and regular walks (no less than half an hour a day) are fine.
So deeply mistaken are those who abuse drugs. The strategy “Give me any medicine, but allow me to eat sausages and drink beer after work” does not work! Of course, both physical exercise and diet require strong-willed efforts from a person. As for the amount of physical activity, it all depends on age. Ninety percent of patients with type 2 diabetes are obese, so exercise should increase gradually. You can start with walking, then enter into small walking jogging, and so on. Many people with type 2 diabetes who adequately perceive the advice of the doctor and begin to move, even if they initially took any medications, gradually refuse to use them! But for this you need to work hard.
Insulin therapy and nutrition
Sometimes patients are recommended to use so-called flexible insulin therapy, but this term is not used professionally.
Traditional insulin therapy is a treatment prescribed adequately to the patient’s condition, his sugar level.
It happens that the patient has very busy everyday life, and there is no opportunity to eat often and equally, because there is no stability. In such cases, the doctor may recommend insulin therapy (insulin administration), respectively, loads.
A diabetic patient should always know how much he plans to get grams of carbohydrates, that is, bread units. And if he eats less carbohydrates, and the insulin dose is normal, he will have hypolikemia. If you eat more, there will be hyperglycemia. What's better? It is better to have a small hyperglycemia, than a hypoglycemia.
What is hypoglycemia?
This question is asked by many people. Hypoglycemia is an acute condition that diabetics should try to avoid. It is especially dangerous for patients receiving insulin therapy.
When hypoglycemia decreases the level of glucose in the blood below the lower limit of normal. The lower limit of the norm for a healthy person is 3.3. The decrease in performance below this limit is fraught with such processes. Glucose is so distributed in the human body that its main amount nourishes the brain. Glucose is actually the only source of energy for our body. Only in the most neglected cases does the body utilize energy from ketone bodies. When this occurs, a decrease in body temperature, the person falls into a pre-comatose state. If during this period the patient cannot take carbohydrates (does not have time to eat), a convulsive period may begin with loss of consciousness.
This condition is very serious. Every 10 minutes of being in a hypoglycemic coma is fraught with the death of several thousand neurons. Our mental abilities depend on the number of neurons, so it’s easy to imagine what the consequences might be if a person fell into one more than once.
Despite the sad statistics (the number of diabetic patients in the world is growing all the time), it is encouraging that the life expectancy of these people is increasing. Diabetics can be found in ski resorts.Among them are traveler-athletes, and the age of these tourists is often under 70 and under 80. That is, you can compensate for diabetes.
In 1988, the Diabetes Program was approved in our country. Since then, the average life expectancy of the Russian population has decreased significantly, but the average life expectancy of patients with diabetes mellitus type 1 and type 2 has increased by several years! This can be explained by the fact that diabetics have to monitor their health all the time, maintain it, lead a healthy lifestyle, and the so-called healthy people look after their health much worse.
In this regard, the question arises - is it possible in our time to radically cure type 1 and type 2 diabetes? Unfortunately, today this disease is incurable. And if diabetes came, as they say, “you have to go with diabetes by the handle,” in collaboration, and follow the doctor’s instructions.
Indications for insulin therapy
- Type 1 diabetes.
- Ketoacidosis, diabetic, hyperosmolar, hyperlaccidemic coma.
- Pregnancy and childbirth with diabetes.
- Significant decompensation of type II diabetes due to various factors (stressful situations, infections, injuries, surgeries, exacerbation of somatic diseases).
- The lack of effect from other methods of treating diabetes mellitus type II.
- Significant weight loss in diabetes.
- Diabetic nephropathy with impaired nitrogenous kidney function in type II diabetes.
Currently, there is a large range of insulin preparations, differing in duration of action (short, medium duration and long), degree of purification (mono-peak, mono-component) and species specificity (human, pig, cattle - beef).
The Pharmacology Committee of the Ministry of Health of the Russian Federation recommends using only monocomponent preparations of human and porcine insulin for treating patients, since beef insulin causes allergic reactions, insulin resistance, lipodystrophy.
Insulin is released in vials of 40 U / ml and 100 U / ml for the injection subcutaneously with disposable syringes, specially designed for the use of insulin of the appropriate concentration of 40-100 U / ml.
In addition, insulin is produced in the form of inserts-penfillov with an insulin concentration of 100 U / ml for syringe pens. Penfill may contain insulins of different duration of action and combined (short + prolonged action), the so-called mixstars.
For the use of patients produce a variety of syringe pens, allowing to enter from 1 to 36 U insulin once. Novopen I, II, and III syringe pens are manufactured by Novonordisk (1.5 and 3 ml liners), Optipen 1, 2 and 4 - by Hoechst (3 ml liners), Berpinpen 1 and 2 "- the company" Berlin-Chemie "(liners 1.5 ml)," Liliphen "and" BD pen "- the company" Eli Lilly "and" Bekton-Dickenson "(inserts 1.5 ml).
Domestic production is represented by a pen-handles "Crystal-3", "In-Sulpin" and "Insulpen 2".
In addition to traditional insulins, the insulin analogue “Humalog” (by Eli Lilly), obtained by rearranging the amino acids lysine and proline in the insulin molecule, is used in the treatment of patients. This led to the acceleration of the manifestation of its hypoglycemic effect and to its significant shortening (1-1.5 h). Therefore, the drug is administered immediately before meals.
An individual type of insulin is selected individually for each diabetic patient in order to improve overall well-being, achieve minimal glucosuria (no more than 5% of the sugar value of food) and fluctuations in blood sugar levels acceptable for this patient during the day (not more than 180 mg% ). J.S. Skyler and M.L. Reeves believe that in order to more effectively prevent or slow down the manifestations of diabetic microangiopathy and other late metabolic complications of diabetes, the criteria for its compensation should be more stringent. For patients prone to hypoglycemic conditions, the level of glucose before a meal can be 120-150 mg / 100 ml.
Criteria for compensation of diabetes
Glucose level (mg / 100 ml)
Fasting before breakfast
Before meals during the day
1 hour after meal
2 hours after meals
When selecting insulin, the severity of the disease, the previous therapy and its effectiveness should be taken into account. Under polyclinic conditions, the criteria for insulin selection are fasting glucose indicators, data of the glucosuric profile or daily glucosuria. In the hospital there are great opportunities for a more proper administration of insulin, since a detailed examination of carbohydrate metabolism is carried out: the glycemic profile (determination of blood sugar every 4 hours during the day: 8-12-16-20-24-4 hours), 5- one-time glucosuric profile (the 1st portion of urine is collected from breakfast until lunchtime, the 2nd one - from lunchtime to dinner, the 3rd one - from dinner until 22 hours, the 4th one - from 22 to 6 hours, the 5th one - from 6 up to 9 h. Insulin is prescribed depending on the level of glycemia and excessive glucosuria.
Depending on the method of their production, all insulins can be divided into 2 main groups: heterologous insulins from the pancreas of cattle and pigs and homologous human insulins from the pancreas of the pig (semi-synthetic) or obtained by bacterial synthesis.
Currently, monovid high-purity insulins are produced (mono-peak and monocomponent), devoid of impurities. These are mainly pork insulin preparations with different duration of action. They are used mainly in allergic reactions to bovine insulin, insulin resistance, lipodystrophy. Certain hopes were pinned on the use of human semi-synthetic and genetically engineered insulin in medical practice. However, the expected significant differences in the glucose-lowering effect or effect on the formation of antibodies to insulin compared with monocomponent porcine insulin was not found.
Thus, at present, industrial production of various insulin guides has been adjusted, the prolonged effect of which depends on special treatment and the addition of protein and zinc to them.
Patients with newly diagnosed diabetes mellitus and hyperglycemia and glucosuria that do not disappear within 2–3 days, on the background of a restricted diet, require insulin therapy. If the patient's body weight does not deviate from the ideal by more than ± 20% and there are no acute stressful situations and intercurrent infections, then the initial insulin dose may be 0.5–1 U / (kg-day) (calculated on the ideal mass body), followed by correction within a few days. Short acting insulin in the form of 3-4 single injections or a combination of short insulin with an extended one can be used. J.S. Skyler and M.L. Reeves recommend, even in the remission phase, that patients be given insulin at a dose of 0.4 U / (kg-day), and pregnant women (during the first 20 weeks) - 0.6 U / (kg-day). The dose of insulin for patients with diabetes mellitus who have already been treated previously should, as a rule, not exceed, on average, 0.7 U / (kg-day) in terms of ideal body weight.
The presence in the medical practice of drugs of different durations of action led initially to the tendency to create "cocktails" to ensure the sugar-reducing effect during the day with a single injection. However, this method did not allow in most cases, especially in a labile disease, to achieve good compensation. Therefore, in recent years, various modes of insulin administration have been applied, providing maximum compensation for carbohydrate metabolism with glycemic fluctuation limits during the day from 70 to 180 or 100–200 mg / 100 ml (depending on criteria). The insulin therapy regimens used in patients with type 1 diabetes mellitus are largely due to factors such as the presence and severity of residual secretion of endogenous insulin, as well as the involvement of glucagon and other contra-insulin hormones in the elimination of significant blood sugar fluctuations (hypoglycemia) and the severity of insulin response to administered food components, glycogen stores in the liver, etc. The most physiological is the regimen of reusable (before each meal) insulin injections, which allows to stop postprinting andial hyperglycemia. However, it does not eliminate fasting hyperglycemia (at night), since the duration of the effect of simple insulin until the morning is not enough. In addition, the need for frequent injections of insulin creates inconveniences for the patient. Therefore, the mode of repeated administration of insulin is most often used to quickly achieve compensation for diabetes as a temporary measure (to eliminate ketoacidosis, decompensation against the background of intercurrent infections, as preparation for surgical intervention, etc.). Under normal conditions, simple insulin injections are usually combined with the administration in the evening of a prolonged-release preparation, taking into account the peak time of their action to prevent nighttime hypoglycemia. Therefore, in some cases, the tape and long drugs are administered after the second dinner before bedtime.
The most convenient for students and working patients is a double insulin regimen. At the same time, in the morning and in the evening, short-acting insulin is administered in combination with medium or long-acting insulin. If at 3-4 hours of the night there is a decrease in blood sugar below 100 mg / 100 ml, then the second injection is transferred to a later time so that the decrease in sugar occurs in the morning when you can examine the level of glycemia and take food. In this case, the patient should be transferred to a 3-time insulin administration regimen (in the morning - a combination of insulin, before dinner - simple insulin and before bedtime - prolonged). Calculation of insulin dose when transferring a patient to 2 single injections is performed as follows:% of the total daily dose is administered in the morning and 1/3 in the evening, 1/3 of each calculated dose is short-acting insulin, and 2/3 is prolonged. With insufficient compensation of diabetes, the insulin dose is increased or decreased, depending on the blood sugar level at a specific time of day, by no more than 2–4 IU once.
According to the beginning and maximum effect of each type of insulin and the number of injections, meals are distributed throughout the day. Approximate ratios of the daily ration are: breakfast - 25%, second breakfast - 15%, lunch - 30%, afternoon tea - 10%, dinner - 20%.
The degree of compensation of diabetes mellitus on the background of the therapy is assessed according to the glycemic and glycosuric profile, HbA hemoglobin content in the blood.1c and the level of fructosamine in the serum.
Methods of intensive insulin therapy
Along with the traditional methods of insulin therapy, from the beginning of the 80s, the regimen of reusable (3 or more) insulin injections began to be applied during the day (basal bolus). This method allows you to reproduce the rhythm of insulin secretion by the pancreas of a healthy person. It is proved that the pancreas of a healthy person secretes 30-40 U of insulin per day. It is established that insulin secretion in healthy people occurs constantly, but at different rates. So, between meals, the rate of its secretion is 0.25-1.0 U / h, and during meals - 0.5-2.5 U / h (depending on the nature of the food).
The intensive insulin therapy regimen is based on imitation of constant pancreatic secretion - the creation of a basic level of insulin in the blood by administering long-lasting or intermediate insulin before bedtime at 22 h at a dose of 30-40% of daily. During the day, before breakfast, lunch and dinner, sometimes before the 2nd breakfast, short-acting insulin is administered in the form of supplements - boluses, depending on need. Insulin therapy is carried out with the help of a syringe pen.
When using this method, the level of glucose in the blood is maintained within 4-8 mmol / l, and the glycosylated hemoglobin content is within its normal values.
The mode of intensive insulin therapy by multiple injections can be carried out only if there is motivation (the patient’s desire), active training, the opportunity to examine the glucose level at least 4 times a day (test strip or glucometer) and constant contact of the patient with the doctor.
The indications for intensive therapy are newly diagnosed type I diabetes, childhood, pregnancy, absence or the initial stages of microangiopathy (retino, nephropathy).
Contraindications for using this method of insulin therapy are:
- tendency to hypoglycemic conditions (if before going to bed glucose level + -K + -ATPase in the renal tubules. It is suggested that treatment with insulin in combination with C-peptide is suggested.
Research continues on unconventional routes of insulin administration: internally, in the form of inhalations, intranasally, as subcutaneous polymeric granules subjected to biodegradation, as well as the creation of devices for individual use with a feedback system.
It is hoped that the available serious research in this area will lead in the near future to a positive solution to the most important task of the radical improvement of insulin therapy in patients with diabetes.
During exercise in the working muscles increase metabolic processes aimed at replenishing consumed energy. There is an increase in utilization of energy substrates in the form of muscle glycogen, glucose and fatty acids, depending on the intensity and duration of physical activity. Energy costs during intensive but short-term physical activity, which lasts for several minutes, are replenished by muscle glycogen. A longer (40-60 min) and intense physical activity is accompanied by an increase of glucose utilization by about 30-40 times. With an even longer muscle load, fatty acids become the main energy substrate, since after 4 hours of work, the glycogen stores in the liver are reduced by 75%.
Glycemia level during intensive work of muscles depends on two multidirectional processes: the rate of glucose utilization by muscles and the factors ensuring the flow of glucose into the blood. The main role in maintaining the normal level of glucose in the blood of healthy people is played by increased gluconeogenesis, glucogenolysis, activation of the sympathetic adrenal system and contrainsular hormones. Insulin secretion is somewhat reduced. In patients with diabetes mellitus, the response of the body to exercise can vary depending on the initial level of glycemia, which reflects the degree of compensation for diabetes mellitus. If blood sugar did not exceed 16.7 mmol / l (300 mg%), then exercise causes a decrease in glycemia, especially for those who exercise regularly, and a decrease in the need for insulin by 30–40%. At one of the free daily runs of 25 km helped reduce the previously obtained insulin disin (30 U), and later - its complete abolition. However, it should be borne in mind that incomplete replenishment of energy costs, i.e., inadequate and delayed intake of carbohydrates from food before exercise at a constant dose of insulin can cause a hypoglycemic state with subsequent hyperglycemia and ketoacidosis.
In patients with decompensated diabetes, if the initial level of glycemia exceeds 19.4 mmol / l (350 mg%), physical activity causes activation of contrainsular hormones and increased lipolysis, since the main energy substrate for working muscles (in conditions of insulin deficiency) become free fatty acid. Increased lipolysis contributes to ketogenesis, which is why inadequately compensated patients with type 1 diabetes during exercise often develop ketoacidosis.Available in the literature information about the role of duration and intensity of physical activity during diabetes mellitus indicates an increase in glucose tolerance due to an increase in the sensitivity of insulin-dependent tissues to the action of exogenous or endogenous insulin, which may be associated with an increase or activation of insulin receptors. However, the interdependence between the sugar-reducing effect of physical activity, caused by an increase in the body's energy consumption, the required insulin dose and the degree of adequate energy replenishment due to dietary carbohydrates did not receive a clear quantitative expression. This circumstance requires a careful approach to the use of physical activity in the treatment of diabetes mellitus, especially type I.
Energy consumption during various types of physical activity