Diabetes

What is Diabetes?

Diabetes, also known as diabetes mellitus, refers to a group of diseases that affect how the body uses blood sugar. Glucose is critically important as an energy source for the cells that make up muscles and other tissues and is also the main fuel for the brain.

The fundamental cause of diabetes varies by type, but any form of diabetes results in excess glucose in the blood, leading to serious health issues.

Chronic types of diabetes include type 1 and type 2 diabetes. These forms persist lifelong, even though they can be managed with medications. Potentially reversible types include prediabetes and gestational diabetes.

Types of Diabetes

Diabetes types fall into two main categories: chronic and reversible diabetes.

Type 1 Diabetes

Type 1 diabetes can occur at any age but is typically diagnosed in childhood and adolescence. It is an autoimmune disease where the immune system attacks and destroys insulin-producing cells in the pancreas for unknown reasons. Approximately 10% of people with diabetes have type 1 diabetes.

Type 2 Diabetes

Type 2 diabetes arises when the pancreas does not produce enough insulin and/or the body's cells do not respond properly to insulin, also known as insulin resistance. It is the most common form, generally affecting adults, though it is increasingly seen in children.

Gestational Diabetes

This type of diabetes develops during pregnancy and typically resolves after giving birth. However, those who have had gestational diabetes have a higher risk of developing type 2 diabetes later in life.

Prediabetes

Prediabetes is a condition where blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes.

Type 3c Diabetes

Type 3c diabetes occurs due to damage to the pancreas from causes other than autoimmune issues, affecting insulin production. Conditions like cystic fibrosis, pancreatitis, pancreatic cancer, and hemochromatosis can cause pancreatic damage leading to diabetes. Removal of the pancreas also results in type 3c diabetes.

Latent Autoimmune Diabetes in Adults (LADA)

Similar to type 1 diabetes, LADA is an autoimmune reaction but progresses much more slowly. It is typically diagnosed in individuals over the age of 30.

Maturity-Onset Diabetes of the Young (MODY)

Also known as monogenic diabetes, MODY is caused by a genetic mutation affecting how the body produces and uses insulin. There are currently more than ten different types identified. MODY accounts for about 5% of all diabetes cases and often runs in families.

Neonatal Diabetes

One of the rarer forms of diabetes, neonatal diabetes appears within the first six months of life and is also a type of monogenic diabetes. Approximately half of the infants with neonatal diabetes have a lifelong condition known as permanent neonatal diabetes mellitus. For the other half, the condition typically disappears within a few months after birth but can return later in life, known as transient neonatal diabetes mellitus.

Brittle Diabetes

Brittle diabetes is a type of type 1 diabetes characterized by frequent and severe fluctuations in blood sugar levels, often requiring hospitalization. In rare cases, a pancreas transplant may be necessary for permanent treatment of brittle diabetes.

Causes of Diabetes

To understand diabetes, it is necessary to understand how the body uses glucose, which starts with knowing the functions of insulin. Insulin is a hormone produced by the pancreas, located behind and below the stomach.

The pancreas secretes insulin into the bloodstream. Insulin helps sugar enter cells, lowering the amount of sugar in the blood. This drop in blood sugar levels causes the pancreas to secrete less insulin.Another important component to understand diabetes is glucose, which serves as an energy source for cells that make up muscles and other tissues. Glucose comes from two main sources: food and the liver. Sugar mixes with the bloodstream with the help of insulin and enters cells. The liver stores and produces glucose. When glucose levels are low, the liver breaks down stored glycogen into glucose, helping to maintain glucose levels within a typical range.Regardless of type, the fundamental cause of diabetes is having too much sugar in the blood. However, high blood sugar levels can occur for various reasons depending on the type of diabetes.

Insulin Resistance

Type 2 diabetes is primarily caused by insulin resistance. This occurs when cells in the muscles, fat, and liver do not respond properly to insulin. Various factors contribute to insulin resistance, including obesity, lack of physical activity, diet, hormonal imbalances, genetics, and certain medications.

Autoimmune Disease

Type 1 diabetes and LADA occur when the immune system attacks the insulin-producing cells in the pancreas.

Hormonal Imbalances

During pregnancy, the placenta secretes hormones that cause insulin resistance. If the pancreas does not produce enough insulin to overcome this resistance, gestational diabetes can develop. Other hormonally related conditions like acromegaly and Cushing's syndrome can also lead to type 2 diabetes.

Pancreatic Damage

Physical damage to the pancreas can affect its ability to produce insulin, leading to type 3c diabetes. This damage can occur due to disease, surgery, or injury.

Symptoms of Diabetes

General symptoms of diabetes include:

• Increased thirst and dry mouth
• Frequent urination
• Fatigue
• Blurred vision
• Unexplained weight loss
• Numbness or tingling in the hands or feet
• Slow healing of wounds or cuts
• Frequent skin or vaginal yeast infections
• Presence of ketones in the urine, a byproduct of muscle and fat breakdown when insulin is insufficient
• Irritability or other mood changes
• Gum infections

Type 1 Diabetes

Symptoms of type 1 diabetes (T1D) develop quickly and can become severe within weeks or months. Additional symptoms indicating a serious complication known as diabetic ketoacidosis may develop, which is life-threatening and requires emergency medical treatment. Symptoms of this condition include vomiting, stomach pain, fruity-scented breath, and difficulty breathing.

Type 2 Diabetes and Prediabetes

In cases of type 2 diabetes or prediabetes, symptoms may not be present or may develop so slowly that they go unnoticed. Routine blood tests can show high blood sugar levels before symptoms are apparent. Another possible sign of prediabetes is the appearance of darkened skin in certain areas of the body.

Gestational Diabetes

Symptoms of gestational diabetes usually appear between the 24th and 28th weeks of pregnancy. The initial symptoms may go unnoticed by the patient, hence experts conduct blood tests during these weeks.

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Diabetes Complications

Complications in diabetes patients can be divided into acute and long-term complications. The main ones include the following.

Acute Diabetes Complications

Life-threatening acute diabetes complications include:

Hyperosmolar Hyperglycemic State (HHS)

This complication primarily affects individuals with type 2 diabetes. It occurs when blood sugar levels remain very high for an extended period and can lead to severe dehydration and confusion, requiring emergency medical treatment.

High blood sugar can arise from many causes, including overeating, illness, or not taking enough glucose-lowering medication. Blood sugar levels must be managed as directed by a doctor. High blood sugar symptoms to watch for include:

• Frequent urination
• Feeling thirstier than usual
• Blurred vision
• Fatigue
• Headache
• Irritability

If hypoglycemia occurs, it may be necessary to adjust the diet, medication, or both.

Hyperglycemic Hyperosmolar Nonketotic Syndrome

This condition involves blood sugar becoming so high that the blood thickens and becomes syrup-like. This life-threatening condition includes symptoms such as:

• Blood sugar levels exceeding 600 mg/dl
• Dry mouth
• Extreme thirst
• Fever
• Drowsiness
• Confusion
• Vision loss
• Hallucinations

These complications are generally seen in people with type 2 diabetes and often occur after an illness.

Diabetic Ketoacidosis (DKA)

This complication typically affects individuals with type 1 diabetes or those with undiagnosed type 1 diabetes. It occurs when there is not enough insulin in the body. Without insulin, the body cannot use glucose for energy.

Instead, the body breaks down fats, resulting in the release of substances called ketones, which cause the blood to become acidic. This condition leads to symptoms such as:

• Nausea
• Vomiting
• Abdominal pain
• Shortness of breath
• Fruity-smelling breath
• Dry mouth
• Weakness
• Confusion
• Coma

Severe Hypoglycemia

Hypoglycemia occurs when blood sugar levels fall below the healthy range. Severe hypoglycemia involves very low blood sugar levels and primarily affects people who use insulin.

This drop can occur for many reasons, including taking medications, intensive exercise, or skipping meals. Emergency glucagon and/or medical intervention are required. Symptoms of low blood sugar include:

• Sweating
• Trembling
• Weakness
• Hunger
• Dizziness
• Headache
• Palpitations
• Irritability
• Speech difficulties
• Drowsiness
• Confusion
• Fainting
• Seizures

In the event of low blood sugar, quick intervention with carbohydrates such as fruit juice or glucose tablets is required.

Long-Term Complications

Long-term high blood sugar levels cause damage to the body's tissues and organs, mainly resulting from damage to the blood vessels and nerves that support these tissues.

Cardiovascular problems are the most common type of long-term diabetes complications, including:

• Coronary artery disease
• Heart attack
• Stroke
• Atherosclerosis

Other complications of diabetes include:

• Neuropathy, which can cause numbness, tingling, or pain.
• Kidney failure, which may require dialysis or a kidney transplant.
• Retinopathy, which can lead to blindness.
• Diabetic foot diseases
• Skin infections
• Amputations
• Sexual dysfunction due to nerve and blood vessel damage
• Gastroparesis
• Hearing loss
• Oral health issues such as gum disease

Being diabetic can also affect mental health, making those with diabetes 2-3 times more likely to experience depression than those without diabetes.

Complications of Gestational Diabetes

Most women with gestational diabetes deliver healthy babies. However, untreated or unmanaged blood sugar levels can cause health problems for both mothers and babies. Complications in babies due to gestational diabetes may include:

Excessive Growth

Excess glucose can cross the placenta, triggering the baby's pancreas to produce more insulin. This can lead to excessive growth, which may result in a difficult birth and sometimes a need for a cesarean section.

Low Blood Sugar

In some cases, babies of mothers with gestational diabetes develop low blood sugar shortly after birth due to their own high insulin production.

Later Life Type 2 Diabetes

Babies of mothers with gestational diabetes are at a higher risk of developing obesity and type 2 diabetes later in life.

Death

Untreated gestational diabetes can lead to the death of the baby either before or shortly after birth.

If gestational diabetes is not managed, complications in the mother may include:

Preeclampsia

Symptoms of this condition include high blood pressure, excessive protein in urine, and swelling in the legs.

Recurrent Gestational Diabetes

If gestational diabetes occurs in one pregnancy, it is highly likely to recur in subsequent pregnancies.

Diabetes Treatment Methods

Diabetes is a complex condition, and its management involves various strategies. Additionally, diabetes affects each patient differently, which is why management plans are highly personalized.

Treatment for All Types of Diabetes

Regardless of the type of diabetes, the most crucial step in maintaining general health and managing diabetes is maintaining a healthy diet and exercise plan along with a healthy weight.

Healthy Eating

The diet for diabetes patients helps control blood sugar levels. The diet should include more fruits, vegetables, lean protein, and whole grains. These foods are rich in nutrients and fiber and low in fat and calories. It is also necessary to reduce saturated fats, refined carbohydrates, and sweets in the diet. This diet, aimed at diabetes, is actually the best nutrition plan for the entire family.

It is important for diabetes patients not only what they eat but also how much they eat. If patients struggle with portion sizes, it is recommended they seek help from a dietitian. Carbohydrate counting is usually implemented in such cases, especially important for individuals with type 1 diabetes.

Physical Activity

Everyone needs to engage in regular exercise, including those with diabetes. Physical activity helps lower blood sugar levels by moving sugar into cells for energy use and makes the body more sensitive to insulin, meaning less insulin is needed to transport sugar into cells.

Patients should get approval from their doctors before starting an exercise regimen. Activities like walking, swimming, or cycling are recommended for diabetes patients. The most important thing is to make physical activity a part of daily routine.

It is recommended to engage in at least 30 minutes of moderate physical activity on most days of the week or at least 150 minutes per week. Activity sessions can be spread out through the day. Those who have been inactive should start slowly and gradually increase their activity levels. Also, it is advisable to avoid sitting for long periods; if sedentary for more than 30 minutes, standing up and moving around is recommended.

Types 1 and Type 2 Diabetes Treatments

Type 1 diabetes treatment includes insulin injections or using an insulin pump, frequent blood sugar checks, and carbohydrate counting. For some individuals with type 1 diabetes, a pancreas transplant or islet cell transplant may be an option.

Type 2 diabetes treatment generally involves lifestyle changes, monitoring blood sugar levels, oral diabetes medications, insulin, or a combination of these.

Blood Sugar Monitoring

Depending on the treatment plan, it may be necessary to check and record blood sugar levels up to four times a day or more frequently if using insulin. Blood sugar testing is the only way to ensure that your levels are within the target range. Patients with type 2 diabetes who do not take insulin usually check their blood sugar much less frequently.Patients on insulin therapy may also choose to monitor their blood sugar levels continuously with a continuous glucose monitor (CGM). Although this technology has not completely replaced glucose meters yet, it can reduce the frequency of finger pricks needed for blood sugar testing and provide valuable insights about trends in blood sugar levels.Despite careful management, blood sugar levels can sometimes change unpredictably.The healthcare team assisting in diabetes treatment will help patients learn how food, physical activity, medication, illness, alcohol, or stress affect their blood sugar levels.

For women, blood sugar levels can also vary with changes in hormone levels.Patients should also regularly perform A1C tests in addition to daily blood sugar measurements. The A1C test provides a better picture of how well the diabetes treatment plan is working overall compared to repeated daily blood sugar tests. A higher A1C level may signal the need to adjust oral medications, the insulin regimen, or the meal plan.The target A1C level varies depending on age and other medical conditions the patient may have or how well they can sense low blood sugar levels. However, for most people with diabetes, an A1C level below 7% is recommended. Thus, every patient should know their target A1C level.

Insulin

Patients with type 1 diabetes must manage their blood sugar with insulin to survive. Many individuals with type 2 diabetes or gestational diabetes also need insulin therapy.

There are several types of insulin, including rapid-acting, short-acting, long-acting, and intermediate options. Depending on needs, specialists can prescribe a mixture of insulin types for use during the day and night.

Insulin is not taken orally because stomach enzymes would neutralize its effect. It is usually injected using a thin syringe or an insulin pen, which looks like a large pen.

An insulin pump may also be an option for some patients. The pump is a device the size of a small cellphone that is worn outside the body. It connects a tube from an insulin reservoir to a catheter inserted under the skin of the abdomen. The insulin pump is programmed to continuously deliver specific amounts of insulin, adjusting doses based on meals.

Today, there are also wireless, tubeless insulin pumps available. An insulin pump can be programmed to dispense specific amounts of insulin, adjusting the dosage based on meals, activity levels, and blood sugar levels.

A closed-loop system is a device that connects a continuous glucose monitor to an insulin pump implanted in the body. The monitor regularly checks blood sugar levels and the device automatically releases insulin when needed.

Several hybrid closed-loop systems have been approved for type 1 diabetes. They are called "hybrid" because the systems require some manual inputs by the user, such as telling the device how much carbohydrate is being consumed or occasionally checking blood sugar levels. A fully closed-loop system that requires no user input is not yet available.

Oral or Other Medications

In some cases, specialists may prescribe other oral or injectable medications. Some diabetes drugs help the pancreas release more insulin. Another group acts by preventing the liver from making and releasing glucose, which means less insulin is needed to move sugar into cells.

Other drug groups slow the absorption of carbohydrates by blocking the digestive action of stomach and intestinal enzymes, or they make tissues more sensitive to insulin. These drugs are typically prescribed for type 2 diabetes.

SGLT2 inhibitors work by preventing the kidneys from reabsorbing sugar filtered from the blood, instead, the sugar is excreted in the urine.

Transplantation

Pancreas transplants are an option for some patients with type 1 diabetes. Islet cell transplantation is also being studied. A successful pancreas transplant eliminates the need for insulin therapy, but not all transplants are successful and the procedure carries significant risks. Lifelong immunosuppressive drugs are needed to prevent organ rejection, which can have serious side effects. Therefore, transplants are generally more appropriate for individuals whose diabetes is unmanageable or who also need a kidney transplant.

Bariatric Surgery

Some individuals with type 2 diabetes, who are obese and have a body mass index above 35, may benefit from certain types of bariatric surgery. People who undergo gastric bypass surgery often see significant improvements in their blood sugar levels. However, the long-term risks and benefits of this procedure for type 2 diabetes are not yet fully understood.

Gestational Diabetes Treatment

Controlling blood sugar levels during pregnancy is essential for the baby's health and can also prevent complications during delivery. In addition to a healthy diet and regular exercise, the treatment plan for gestational diabetes includes monitoring blood sugar levels. In some cases, insulin or oral medications may also be necessary.

Specialists continue to monitor blood sugar levels during delivery. High blood sugar can cause the baby to produce high levels of insulin, which can lead to low blood sugar in the baby shortly after birth.

Prediabetes Treatment

Treatment for prediabetes typically involves healthy lifestyle choices that can help return blood sugar levels to normal and prevent them from reaching the levels seen in type 2 diabetes. Maintaining a healthy weight through exercise and healthy eating can help. Engaging in at least 150 minutes of exercise per week and losing about 7% of body weight can prevent the onset of type 2 diabetes.

Drugs like metformin, statins, and high blood pressure medications may be an option for some individuals with prediabetes and other conditions like heart disease.

Who Gets Diabetes?

Diabetes is an extremely common disease. The most common type of diabetes is type 2 diabetes. It is known that approximately 537,000,000 adults worldwide have diabetes. Experts predict this number will rise to 643 million by 2030 and 783 million by 2045.

Diabetes can occur in anyone, however, some people are more susceptible to diabetes. These risk factors include:

• Family history plays a role in all types of diabetes.
• Environmental factors and geography increase the risk of type 1 diabetes
• Having autoantibodies increases the risk of developing type 1 diabetes
• Diabetes is more common in Black, Hispanic, Native American, and Asian populations
• Prediabetes, type 2 diabetes, and gestational diabetes are more common in overweight or obese individuals

Living with Diabetes and Wounds

Diabetic foot ulcers occur in about 15% of diabetic patients and are usually found on the bottom of the foot. 6% of those who develop a foot ulcer are hospitalized due to infection or other complications related to the ulcer. Diabetes is the leading cause of non-traumatic lower extremity amputations. Approximately 14% to 24% of diabetic patients with a foot ulcer will require an amputation. Foot ulcers account for 85% of diabetes-related amputations. However, research shows that the development of foot ulcers is preventable.

Anyone with diabetes can develop a foot ulcer. Those at higher risk include:

• Older males
• Patients who use insulin
• Patients with diabetes-related kidney, eye, and heart diseases
• Overweight patients
• Patients who use alcohol and tobacco

Ulcers occur due to a combination of factors such as loss of sensation, poor circulation, foot deformities, irritation, and trauma, all influenced by the duration of diabetes. Long-term diabetics may develop neuropathy, a condition where elevated blood sugar levels over time cause nerve damage leading to decreased or total loss of feeling in the feet. This nerve damage often occurs without pain, and the individual may not be aware of the problem. A monofilament device is used for testing this.

Vascular disease can complicate a foot ulcer, making it more complex and decreasing the body's ability to heal, increasing the risk of infection. Elevations in blood sugar can impair the body's ability to fight potential infections.

Symptoms

Many patients with a foot ulcer do not feel pain due to the loss of sensation. Instead, patients may notice discharge on their socks. Redness and swelling can also be associated with the ulceration and may be noticeable if the infection has progressed significantly.

Treatment

The primary goal in treating a foot ulcer is to achieve healing as quickly as possible. The faster the healing, the less chance there is for infection. Several key factors determine the appropriate treatment options for diabetic foot ulcers:

• Preventing infection
• Reducing pressure on the area by removing dead skin and tissue
• Applying medication or dressings to the ulcer
• Managing blood sugar and other health problems

Not all foot injuries are infected, but if a foot doctor diagnoses an infection, antibiotic treatment, wound care, and possibly hospitalization may be necessary. Preventing an ulcer from becoming infected includes:

• Tightly controlling blood sugar levels
• Keeping the wound clean and bandaged
• Cleaning the wound daily using dressing or bandage
• Avoiding walking barefoot

To ensure optimal healing, pressure should be relieved from the ulcers, especially those under the foot. This can be achieved using special shoes or supports. The use of a wheelchair or crutches may also be necessary to decrease pressure and irritation on the ulcerated area, aiding the healing process.

Advances in diabetic wound care over the last decade have been significant. Previously, allowing air to enter the wound was considered beneficial; now, it is known to be harmful. Wounds and ulcers heal faster and with a lower risk of infection when they are kept closed and moist. Strong antiseptics like iodine and hydrogen peroxide are not recommended as they can lead to more complications.

Proper wound management includes the use of dressings and topically applied medications. Employed methods range from normal saline to growth factors, which have proven highly effective in healing and managing foot ulcers.

For a wound to heal, adequate blood circulation to the ulcerated area is essential. A foot doctor can determine the level of circulation using non-invasive tests.

Tight glucose control during the treatment of a diabetic foot ulcer is crucial. Working closely with a doctor to control blood sugar will enhance healing and reduce the risk of complications.

Surgical Treatment

Most non-infected foot ulcers can be treated without surgery. However, if non-surgical treatment fails, surgical intervention may be recommended. Surgical care suggestions include shaving or removing bones or correcting deformities in the foot to relieve pressure on the affected area.

Factors that influence the healing time include:

• The size and location of the wound
• Pressure applied by walking or standing on the wound
• Swelling
• Circulation
• Blood sugar levels
• Wound care
• Treatments applied to the wound

Prevention

The best way to treat diabetic foot ulcers is to prevent them from developing in the first place. Recommended guidelines include regularly consulting with a foot disease specialist. A Foot Disease Specialist can determine if there is a high risk of developing a foot ulcer and can implement prevention strategies.

High risk is present if any of the following conditions exist or actions are taken:

• Neuropathy
• Poor circulation
• Foot deformity
• Inappropriate footwear use
• Uncontrolled blood sugar
• Previous history of foot ulcers

In addition, reducing additional risk factors such as smoking, drinking alcohol, high cholesterol, and high blood sugar is extremely important in the prevention and treatment of diabetic foot ulcers. Wearing appropriate shoes and socks is one of the most effective methods to reduce risks. For this, a foot specialist can guide patients in selecting the right footwear.

Learning how to inspect feet is crucial for diagnosing a potential problem as early as possible. The feet, especially the soles and between the toes, should be checked daily for cuts, bruises, cracks, blisters, redness, ulcers, and any signs of abnormality. When visiting any health care provider, shoes and socks should be removed to allow the feet to be examined. Any issue, no matter how simple it may appear, should be reported to a foot specialist as soon as possible.

The key to healing a foot ulcer is providing gold standard care, which includes:

• Lowering blood sugar
• Properly debriding the wounds
• Treating any infections
• Reducing friction and pressure
• Restoring adequate blood flow

Nutrition in Diabetes

The diabetes diet simply means eating the healthiest foods in moderate amounts and sticking to regular meal times. A healthy diet naturally rich in nutrients and low in fat should be created. The main elements are fruits, vegetables, and whole grains. Indeed, this type of diet is the best nutrition plan for most people.

Specialists generally recommend a healthy eating plan to patients with diabetes or prediabetes. This plan helps control blood sugar, manage weight, and keep risk factors for heart disease under control. These factors include high blood pressure and high blood fats.

Consuming excess calories and carbohydrates can raise blood sugar levels. If blood sugar is not controlled, serious complications can develop. Prolonged high blood sugar levels can lead to complications such as nerve, kidney, and heart damage.

Recommended Foods

Diabetics need to choose their foods from nutritious items. Healthy carbohydrates, fiber-rich foods, fish, and good fats should be included.

Healthy Carbohydrates

During digestion, sugars and starches break down into blood glucose. Sugars are known as simple carbohydrates and starches as complex carbohydrates. Healthy carbohydrates like the following should be added to the diet:

• Fruits
• Vegetables
• Whole grains
• Legumes
• Low-fat milk and dairy products

Less healthy carbohydrates, such as those containing added fats, sugars, and sodium in foods and beverages, should be avoided.

Fiber-Rich Foods

Dietary fiber includes all parts of plant foods that the body cannot digest or absorb. Fiber helps regulate how food is digested and helps control blood sugar levels. Fiber-rich foods include:

• Vegetables
• Fruits. To gain the most benefit in terms of fiber, eat the whole fruit instead of drinking fruit juices.
• Nuts
• Legumes
• Whole grains

Fish

Eating heart-healthy fish at least twice a week is recommended. Fish like salmon, mackerel, tuna, and sardines are rich in Omega-3 fatty acids, which can help prevent heart disease. However, fried fish should be avoided.

If you are pregnant or planning to become pregnant, it is usually advised to avoid fish high in mercury. Fish that contain high levels of mercury include shark, swordfish, mackerel, and tilefish.

Good Fats

Foods containing monounsaturated and polyunsaturated fats can help lower cholesterol levels. These fats include:

• Avocado
• Nuts
• Canola
• Olive oil
• Peanut oil

However, it is important to avoid excessive consumption of fats as all fats are high in calories.

Foods to Avoid

Diabetes accelerates the development of blocked and hardened arteries, increasing the risk of heart disease and stroke. Foods containing the following should be avoided as they can counteract a heart-healthy diet:

• Avoid high-fat dairy products and animal proteins such as butter, beef, hot dogs, sausage, and bacon. Additionally, limit coconut and palm kernel oils as they contain saturated fats.
• Avoid trans fats found in processed snacks, baked goods, solid fats, and solid margarines.
• High cholesterol sources include high-fat dairy products and high-fat animal foods. The maximum cholesterol intake should be no more than 200 milligrams per day.
• The maximum amount of sodium intake should be no more than 2,300 milligrams per day, which should be reduced if high blood pressure is present.

Creating a Plan

Several approaches can be used to develop a healthy diet that will help maintain normal blood sugar levels. A dietitian can help implement one or a combination of the following methods:

Plate Method

Patients who prefer the plate method focus on eating more vegetables. The following steps are recommended when preparing a plate:

• Half the plate should be filled with non-starchy vegetables such as spinach, carrots, and tomatoes.
• One quarter of the plate should be filled with lean protein sources like tuna, lean pork, or chicken.
• The remaining quarter should be filled with a carbohydrate such as brown rice or a starchy vegetable like green peas.
• A small amount of good fats like nuts or avocado is recommended.
• A piece of fruit, a serving of dairy, a glass of water, or unsweetened tea can be added to the meal.

Carbohydrate Counting

Another method used in diabetes nutrition is carbohydrate counting. Since carbohydrates break down into sugar, they have the greatest effect on blood sugar levels. The amount of carbohydrates consumed should be calculated with the help of a dietitian, and insulin doses can be adjusted accordingly. Tracking carbohydrate amounts at each meal or snack is crucial.

To calculate carbohydrate amounts, learning how to measure portions and read labels healthily is necessary. It's also essential to pay special attention to portion sizes and carbohydrate content.

Food Choices

Another method for creating a meal plan is based on selecting specific foods. A dietitian can recommend selecting certain foods to help plan meals and snacks. A variety of foods can be chosen from lists that include categories such as carbohydrates, proteins, and fats, and applied to the diet plan.

A selection in one category is called a "choice." One food choice has about the same amount of carbohydrates, proteins, fats, and calories as any other food in the same category and has the same effect on blood sugar. For example, the starch, fruit, and milk lists all include selections that contain between 12 and 15 grams of carbohydrates.

Glycemic Index

Some people with diabetes use a glycemic index to choose foods, especially carbohydrates. This method ranks carbohydrate-containing foods by how much they raise blood sugar levels. Discussing whether this method is suitable for the patient with a specialist is necessary.

Itching in Diabetic Patients

Itching is common in diabetic patients. This itching can be due to yeast infections, dry skin, or poor circulation. When poor circulation is the cause, the most itchy areas are often the lower parts of the legs.

Itching can be treated by patients. Particularly when skin moisture is lost, limiting the frequency of bathing is necessary. Also, using a mild, moisturizing soap and applying skin creams after bathing is recommended.