Diabetes, Prevention and Treatment Methods

Diabetes Mellitus (DM), which can be defined as the increase of blood sugar above the normal level in fasting and/or satiety states, is a common public health problem today. There are roughly two types of the disease and there is a complete absence of the insulin hormone in the form called Type-1 DM, which is mostly seen in children and young people; Type-2 DM, which starts with insulin resistance but continues with the absence of insulin, is seen in older people, generally obese and individuals with a family history of DM.

What can be done to prevent the development of DM?

Unfortunately, there is not much that can be done to prevent Type-1 DM. This form of DM, which occurs when the body creates antibodies against itself, can only be diagnosed early with public awareness. If Type-1 DM develops in one of the identical twins, the probability of developing Type-1 DM in the other is around 10%, showing how difficult it is to detect risky individuals beforehand.
Type-2 DM, on the other hand, is an almost preventable disease due to its insidious onset, having DM in the family, and being seen due to the characteristics that the person can change. Maybe the last exit before DM; Pre-DM, that is, the period before diabetes in Turkish, is a completely reversible condition with the right moves. To describe the pre-DM period simply, it is a transitional period when blood sugar is above normal but below the values ​​diagnosed with DM. These values ​​are between 100-125 mg/dl glucose in fasting and 140-199 mg/dl in satiety. Apart from this, another value is the HbA1c value, which is known as three-month sugar among the people. The logic of HbA1c is a technique that shows how much sugar (glucose) the red blood cells, which have an average lifespan of three months, encounter on average in this process. If this value is between 5.7-6.4%, it indicates that you are at risk for DM. However, it is essential that the test be performed in a reliable laboratory, otherwise the results will not be reliable.

An adult with or without Pre-DM should follow the dietary and exercise recommendations that apply to a healthy life. Especially in individuals who are overweight, sedentary and continue to eat high-calorie diets, the risk of almost all diseases, not only DM but also cardiovascular diseases, has increased. It should not be forgotten that there are almost no health conditions in which obesity and sedentary life are beneficial, and human nature is not suitable for living in this way.

Diet and exercise are a situation that confuses not only patients but also doctors. Because nutrition is a separate area of ​​expertise in itself, and it is healthier to do it especially under the control of a dietitian. The exercise part is also similar, “the patient was recommended diet and sports,” written in many polyclinic notes. Unfortunately, his grades have no practical value. Especially in our country, it is delusional to expect a doctor to give detailed information about nutrition and sports due to the reduced examination times. No matter how successful and competent a dietitian is, of course, patients will evasive unless they observe patients 24/7. Prescription or even pre-printed diet lists do not work in most cases. Here, health literacy comes to the fore. The patient should have a good grasp of many issues related to nutrition, especially calorie counting and diet goals.
I think that perhaps the most important learning goal in nutrition is basal metabolic rate. Basal metabolic rate (BMR) can simply be thought of as an individual's daily calorie budget. By definition, it is the lowest amount of energy required for the continuation of bodily functions while the individual is at full rest. BMR; It varies according to age, gender, muscle mass, body weight, physical activity, hormonal status, environmental effects, medications, nutrition and of course genetic factors.

Age, gender and currently genetic factors are parameters that cannot be changed. Men and teenagers have a higher BMR than women and the elderly. Some people have high familial BMR values ​​regardless of these two.

Muscle mass is the amount of red muscle in a person's body. Red muscles consume a lot of energy even at rest. This can increase the BMR value and cause weight loss. However, the problem here is the desire for more nutrition to reach the energy needed by the muscles. There are researchers who argue that when BMR increases in this way, the basal calorie intake also increases. However, reducing fat mass and increasing muscle mass is of course a logical move, as it is beneficial other than increasing the BMR value.

Although an increased body weight without muscle mass, that is, fat mass, also increases the basal metabolism a little, this is of course not a desirable situation. This may only explain the fact that initially overweight individuals lose weight more easily due to the higher BMR value.
daily physical activity There is a lot of information that gearing increases BMR. However, how much it increases is usually not mentioned here. Even in professional runners, this rate is around 7-10%, and this effect decreases rapidly in the first two hours and then slowly within 48 hours if no exercise is done. In short, if a permanent and strong BMR increase is aimed by exercising, life should be dedicated to sports.

The most known effect on hormonal status is the effect of thyroid hormones. In cases where the thyroid hormone, which is responsible for roughly adjusting the BMR value, increases in the body (hyperthyroidism), BMR increases, while in cases where it decreases (hypothyroidism), BMR decreases. However, since these conditions are another disease condition, they cannot of course be used for BMR increase. Apart from this, many hormones increase the BMR value.

Environmental effects, such as heat and cold, make temporary changes in the BMR value in order to maintain body temperature.

Many drugs have an effect on BMR or appetite, and many are just side effects, meaning they are not used for treatment. Since drugs that increase BMR will also change the heart rate, this situation creates serious problems, especially in people with rhythm disorders. Unfortunately, this is the reason for the deaths in the "slenderness drug rush from China".

The change in BMR value with nutrition is usually caused by stimulating foods such as coffee, but this is a temporary and negligible effect, and it is not a logical move to consume coffee for the continuation of the effect and "burning fat". The harmful effects of caffeine start around 1 gram, and taking up to 10 grams of caffeine in short intervals is fatal. An average coffee contains around 100-200 mg of caffeine. In addition, as an adverse effect, conditions such as extremely strict diets, very low calorie intake and prolonged hunger cause the BMR value to decrease. For this reason, BMR and daily additional energy consumption should be calculated while making a diet program, and it should be tried to remain roughly 500 kcal below this value.

Unfortunately, it is not possible to lose weight by increasing the BMR value alone. Moreover, this value, which decreases with age, causes you to lose weight more and more each day. The sole purpose of BMR should be to roughly know the individual's own value and to create their daily calorie intake and exercise plans accordingly.

Since BMR alone is not enough to lose weight, diet and exercise come into play. First of all, it would make sense to set exercise goals, calculate roughly how many calories it will amount to, and then create a diet plan accordingly.

The most important thing to know before deciding on the type of exercise is that you should allocate time to exercise. Short walks during the day, running to catch the subway, walking in the shopping mall or doing housework are unfortunately insufficient in terms of exercise. For example, if a man weighing 70 kg walks 5 km for 1 hour, he spends 286 kcal calories, which is equal to the calorie of an average chocolate bar. Different types of exercise come into play here, but the problem here is that these exercises are generally planned for young and healthy individuals and may not be suitable for middle-aged and elderly individuals at risk for osteoporosis, who may have possible heart disease and lung disease. High Intensity Interval Training can be translated as Intermittent High Intensity Exercise and is abbreviated as HIIT. This exercise consists of quick exercises that push the limits of the body and that are repeated after a short rest period, instead of the classic long-term and relatively more comfortable exercises, and it is a distinguished exercise type with reducing insulin resistance. However, it is a fact that it is necessary to go through a doctor's control before such intense exercise and it will not be suitable for many elderly individuals due to musculoskeletal problems. Apart from these, especially the sports that the individual will enjoy and if possible in pairs or in groups, are valuable in terms of motivation.

Although walking takes time, it is the most ideal type of exercise for many disease conditions and age groups. Walk; It has direct effects on the prevention of DM due to glucose consumption of the muscles, blood sugar control, heart health and weight control. However, DM patients should pay attention to foot injuries during walking and should have sugar with them against sudden blood sugar drops. In addition, a card or wristband with written illness and medications will help in case of a possible unexpected situation. If there is a device that controls heart rate, blood pressure and oxygen level in the blood during walking, these will also be useful in doctor's visits.

Cycling, swimming, weight lifting and all similar sports have a place in DM protection because they cause energy expenditure and weight loss, but the individual should choose the sport that is suitable for him and his health. A statement as the best sport to lose weight or avoid DM It should not be forgotten that it is definitely unnecessarily ambitious. It should not be forgotten that walking is the most beneficial sport for an individual who walks for 2 hours a day without getting bored, or that the healthiest sport for a person who can play tennis for half an hour a day is tennis.
Unfortunately, there is a search for the "best diet" in diet. While people are looking for the "perfect" diet, they leave dozens of diets in the first week. Moreover, especially DM individuals should not copy the diet lists and plans of healthy individuals. Things to consider as the main lines in nutrition; not to eat too little or too much, not to look at foods only in terms of caloric value, and to stay away from processed foods. Although processed food can be confusing here, for example, even reduced-fat products can be nutritionally inadequate because they lose fat and other nutrients.

It should be noted here again that it is absolutely wrong to advertise diets by putting them with fancy names. Although a recommendation in the best form is not mentioned in any scientific publication, unconscious diets harm the body. It would be appropriate to mention two popular diets in particular.

Low-carb diet or ketogenic diet: Although this type of diet, which aims to keep the amount of carbohydrates consumed below 50-100 g as much as possible, is beneficial for overweight patients with pre-DM, DM patients using drugs or insulin should be especially careful. Sudden decreases in blood sugar, especially due to insulin, trigger very serious health problems, especially loss of consciousness. In addition, the fluctuation in blood sugar that will occur due to non-compliance with the diet is as dangerous for the heart as high blood sugar. In short, before switching to this diet type, which is very difficult, the individual should definitely talk to his/her doctor and definitely have detailed information about the disease. However, small studies have also shown that the ketogenic diet has a reversal effect on DM, especially in obese, newly diagnosed DM patients, but unfortunately, this effect returns 6 months after the diet is stopped.

Intermittent fasting or intermittent fasting is a type of diet in which eating and drinking is generally allowed for 6-8 hours and the rest is prohibited. Again, as in the ketogenic diet, patients using drugs and insulin must be careful. Again, sudden drops and increases in blood sugar can be dangerous.

In summary, I wanted to introduce DM and talk about the diet and sports recommendations that doctors talk about in order to prevent DM. I think the most important thing to know is that there is no program that is ideal for everyone, and that most accounts made at home do not fit the market. I know that if personalized programs are made with the participation of the patient, instead of rote programs, they will be successful.