The treatment combines diet and hypoglycemic drugs.
A) The diet of diabetic
Currently, we no longer speak of "diabetic diet" but supply suitable for diabetics. Indeed, the diabetic can, with minor exceptions, eat normally, provided that this power be balanced.
The objectives are threefold:
Ensure a proper nutritional balance;
Avoid excessive variations in blood sugar: it is the necessary "measure" the carbs and adjust their dose of insulin before each meal;
Correct errors dietary accelerating atherosclerosis.
The prescription diet is compared to the habits of the patient. It is essential to keep or return the weight to normal.
The recommended overall caloric distribution is the same as in case of non-insulin-dependent diabetes:
45 to 50% of energy supplied by carbohydrates, the diet is low calorie or normocalorique;
35 to 40% of energy intake is provided by lipids;
15 to 20% by proteins.
Starchy foods are not deleted, but the amount should be assessed at each meal. For that food provides only 30% fat, the diabetic must:
Choose lean foods;
Make cooking without fat: water, steamed, baked, grilled or nonstick pans;
Preferred sunflower oil, corn or grape seed and set aside for salads;
Increase the amount of fish;
Reduce intake of saturated fat for the reduction of cholesterol levels, atherosclerosis is a major mortality factor in diabetic patients.
To fight against high blood pressure, a moderate restriction of salt is recommended.
As for carbohydrates, the diabetic must carefully. The low-carb diet is not recommended because it causes increased lipid harmful long-term.
The focus should be carbohydrates that have the power hyperglycemic lowest: we recommend lentils, split peas, dried beans alternating with potatoes, pasta, rice, semolina, chickpeas and cereals. Sugar remains prohibited without food. A sweet dessert can be made after a full meal, including lipids, proteins and carbohydrates. Regularity of their distribution and carbohydrate intake during the day are paramount when the diabetes is treated by insulin injections two semi-slow. The distribution varies from one patient to another and depends on physical activity, social and professional constraints, type of insulin used, glycemic cycle, etc.... But in any event, any meal, or snack should include protein, lipids and carbohydrates. The fruit does not represent the ideal snack.
They have no nutritional role but are mandatory. Blended foods, they slow the absorption of carbohydrates, reduce cholesterol and regulate intestinal transit. Green vegetables (leeks, spinach, salsify, celery, chard, fennel, asparagus), fruits with skin, whole-wheat bread, bran bread, breakfast cereals, wholemeal or rye, brown rice and pulses (peas, beans, lentils, beans) are required.
Sweeteners and diet products
Two types of sweeteners ("softening") are used throughout the food industry:
Artificial sweeteners like saccharin and aspartame in beverages are called "light" and in yoghourt. These sweeteners, chemical plants, are not nutritious;
Sweeteners mass (or charge). These are polyols (sorbitol, mannitol, maltilol, xylitol, hydrogenated glucose syrup or LYCASIN). Calories, they are found in chewing gum "sugar unattached" (the word "sugar free" in the singular meaning, "without sucrose"), in chocolates and candy "sugar free" or "cariogenic sugar free." Be aware that sugar "non-cariogenic" can make carbohydrates and calories.
Fructose has a special place, and only a very well balanced diabetic patient can eat moderately. It is a source of calories, and sugar is not a "light."
The so-called "diets" are very numerous. A careful reading of labels is recommended. Some of these products are reduced in carbohydrates but rich in fat or other nutrients, and calories are in the end normally. There are products in the market sweetened with either a mixture of pseudo sweeteners and sweetener's mass or artificial sweeteners and fructose, or artificial sweeteners and sucrose ... The label sometimes term "low carb" or "diabetic." The consumer should check in this case the energy value of products and their rate of carbohydrates.
The regularity of meal times is an important factor in glycemic control. In case of sport, the plan must be adapted. The total caloric intake and thus the carbohydrate intake will be increased. An extra snack before and after exercise is desirable.
In the event of intercurrent disease, diabetic patients should not skip meals. Carbohydrates are taken on the form of easily digestible foods (soup's cereal, crackers, mashed potatoes, pasta, rice, stewed, sweetened teas ...).
B) Treatment with insulin
Insulin is the only drug for diabetes mellitus. Sulfonamides and biguanides have no interest beyond the initial period of remission possible. For ten years, manufacturing techniques and purification of insulin have been revolutionized. Currently, the easiest way is the insulin pen. Thus, it allows a very easy injection and virtually painless. The assay is standardized: 100 units per ml.
In the future, the goal is to closely mimic the physiological secretion of insulin, namely mass distribution at mealtime and between meals.
Currently, a number of daily injections allow a high glycemic end but impose strong constraints on patients.
The doctor will then choose the regimen as a compromise between the desirability and constraints acceptable by the customer. Acceptance of a very intensive insulin therapy (so-called "optimized") requires further than three daily insulin injections and more than three checks of blood sugar. In recent years, advances in self-monitoring and the introduction of insulin pens have simplified this insulin.
Insulin pump therapy
This is the best treatment mimicking physiological insulin secretion. Insulin was infused continuously using a syringe miniaturized laptop batteries. Base flow is changed, and dose supplements are provided at mealtimes. Developed around the year 1980, pump therapy has emerged since 1985. The infusion of insulin is by subcutaneous or intraperitoneal.
Medical indications for insulin pump are:
Highly unstable diabetes;
The women wishing to become pregnant;
The patients with severe kidney or eye complications.
There are also indication's socio-economic criteria taking into account variability of activity and schedules. This treatment is totally free for patients with diabetes (as well as the pump consumables). However, only a specialized service can take charge.
C) The processes associated
Exercise is essential: we recommend a minimum of three weekly physical activity sessions of two hours each;
The physician must treat hypertension and high cholesterol associated;
The patient must stop smoking.
D) The future prospects
The artificial pancreas
The artificial pancreas had been around 1980. These large machines include:
An analysis of blood glucose by the glucose electrodes;
Software capable of integrating glucose values and a set amount of insulin based on physiological algorithms;
An insulin infusion pump.
This type of device very expensive, about 100 000 Euros, is used in hospitals for research. The miniaturized implantable artificial pancreas is currently undergoing major construction.
The pancreas transplants
Development since 1984 of immunosuppressive therapy (cyclosporine, anti-lymphocyte serum) has revived research on pancreatic transplantation.
Transplantation of islets of Langerhans
The difficulties of conservation of the pancreas, currently limited to six hours after collection, and collection of the body pose real limits to the pancreas. Transplantation of islets of Langerhans is to isolate and purify the islets of endocrine tissue. They were then implanted into a site within the body where insulin is delivered by the portal vein (liver and peritoneal cavity).
All insulin-dependent diabetics believe that the bite of insulin or bi triquotidienne is tedious. This is why other methods of insulin delivery are being studied. The major problem remains that of absorption. Indeed, insulin is degraded in the stomach and duodenum. It is therefore, necessary to find a mode of entry:
Or outside: the nasal mucosa;
It is beyond: the intestinal mucosa or rectal.
For these possible sites of absorption, several problems remain unresolved:
For oral administration, some authors have proposed to protect insulin from gastric juices by encapsulating in liposomes or in combination with a surfactant in a gelatin capsule surrounded by an acrylic polymer;
For rectal bioavailability is still very low because accurate dosing is required;
Regarding the nasal route, progress is underway but the risk of nasal irritation is not yet resolved.
The voice pulmonary inhalation, is much more promising and its effectiveness is demonstrated.
This is of therapeutic hope on the acceptability of the treatment of diabetes mellitus.
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