Diet in diabetes.

One of the problems of diabetes, especially type 1 diabetes mellitus patients is to calibrate the power. Read calmly and without panic and try to understand in a simple and straightforward, as I like to explain to patients, such as diet and calculations set, and especially how to customize the "proper diet."

The use of the pump has now become a daily practice of a large number of patients with diabetes mellitus type 1, its use allows great flexibility in food choices. In fact, if a patient was adequately informed about the carbohydrate content of his diet, he can change the choice of foods and adapt and give the precise amount of insulin needed to 'metabolize' the carbohydrates in a meal, a drink, a snack. In essence, the use of an insulin pump allows insulin shots very accurately, provided that the patient is to plan, the patient, but must know what eats well, how many carbohydrates or sugar contains his diet and carbohydrate value of foods, namely their glycemic index, ie if they are more or less absorbed quickly. Finally, it must take account of its ability to metabolize carbohydrates depending on the dose of insulin, this variable is individual and reflects the so-called "insulin resistance device" more or less rapid absorption of carbohydrates.

You discouraged?

Not at all! We try to understand how this and how do you know exactly how many units of insulin must be injected before a meal? The method is called "count carbs" or "carbohydrate counting" and is recommended for all persons with type 1 diabetes treated with insulin, and even more forcefully to pump users, in order to tailor insulin therapy and adjust precisely intro carbohydrates.

Calculation of carbohydrates.

To begin you must know the food and those that contain a significant proportion of carbohydrates

Preferable, for example, you eat with vegetables that contain carbohydrates in the right proportion, but which are absorbed slowly, because of their slow digestion and difficult, this thing is very important for the diabetic patient, where the "power of the pancreas" in producing Insulin is limited or absent in type 1 diabetes. You have to know that many drinks, "sugarless" actually contain it. At this point, with paper and pen in hand, you begin to prepare a detailed diary for a few weeks back in which:

· The food consumed (eg pasta, bread, rice, pulses, potatoes etc..)

° their carbohydrate content (see glycemic index food)

• The weight of the uncooked portions to the beams, precision tuned to the pound

· Unit we injected insulin (obviously preferring analogues fast)

AII'inizio all means weigh with a balance, and assess how many carbs are in that slice of bread.


Example:

· Eat a serving of 40 grams of bread (a treat), since bread contains 60% carbohydrates

Multiply 40 grams x 0.60 = 24 grams of carbohydrates

· A slice of pie 50 grams, but contains 65% carbohydrate glycemic index because it has more


Multiply 50 grams x 0.65 = 32.5 grams carbohydrates


Now I go to the dr. Italian Claudio and I have to wonder how many units of insulin administered in relation to meal carbohydrate particular patient that I assume the diet. This is because not all patients can do the same insulin. Some people respond better to unitů administered and regulates its blood sugar better, somebody is more "resistant" to insulin. This problem is defined:

"Your ratio insulin / carbohydrate

That is to say how many carbohydrates I can 'burn' with one unit of insulin.

For example if my ratio is 1:10, meaning that every 10 grams of carbohydrates in the meal, I have to inject one unit of insulin.


So if I ate 50 grams of apple pie because it is Christmas, I injector 3.5 units of insulin similar to the quick meal given that the cake absorbs immediately, because it is sweet, while the bread (24 g), I administered 2.5 units of insulin. If you eat both, but my meal is very unbalanced (!) Will total 3.5 +2.5 = 6 units of insulin, for this snack!


To find out your insulin-carbohydrate ratio is not enough to ask the doctor, but must be for at least a week, be there to report on the sheet diet and insulin, reasoning about precise proportion of income collected carbohydrates that I am! Then I do the "eye" of portions and always eat the same food and try not iperinsulinizzarmi or chewing on the wrong foods, and move, so always make a lifestyle.

It is important that week where I do my calculations is varied exercise and that there are days of special stress of illness. By measuring blood glucose before and after the meal I can understand what dose of insulin should be given (see the dangerous post-glucose prandium) to bring

the two-hour postprandial blood glucose as close as possible to the target values of 140-160m g / dl.

Another example.

If a meal with 120 grams of carbohydrates was approached at a dose of 8 units, this means that each unit in the metabolism of insulin that patients 'burn it' 15 units of carbohydrates, in fact:

· 120g / 15 g = 8 units, ie one unit of insulin I need every 15 grams of carbohydrates

But if that were the case always, be just. Rather unfortunately been stress, illness, fever, and periods of inactivity increase the ratio, conversely, physical activity reduces.

The patient with type 1 diabetes, the bearer of pump can regulate better by this stage I'utilizzo a bolus calculator that facilitates the operation, storing up to 8 different insulin-carbohydrate ratios to monitor changes in sensitivity to ' insulin.

What matters, however, are 'calculations at home', ie keeping a diary in which blood sugar levels are compared before and after meals, insulin doses and carbohydrate taken.

After all, nine times out of ten eat the same things-usually in the same portions and calculation. (See diabetes diet)

carbohydrate itself is used only before new dishes (see substitution of foods in the diabetic). At this point it might be worth adding another element: the evaluation of the glycemic index. In fact it should be noted that the effect on postprandial glycemic foods depends not only on the amount of carbohydrates but also on the quality of the food type. Foods that contain the same

carbohydrate glycemic responses may give very different: for example, ingesting 50 grams of carbohydrates in the form of bread or spaghetti causes different glycemic responses and the same if it is I always eat spaghetti pasta 80 grams Spaccarelli very hot, perhaps within a soup!

To quantify the glycemic response and have more sophisticated calculations, using the glycemic index. If a

food has a low glycemic index, carbohydrates are digested slowly and have less impact on blood sugar. Conversely, a food with a high GI are quickly transformed into glucose in the blood and in the absence of adequate insulinizzazione will result in hyperglycemia.



Glycemic index of the main food

Orange
31-51

Banana
70

Eg biscuits. gold Saiwa
65

Coke
58

Croissant
67

Corn flakes
91

Beans
30

Fructose
19

Gatorade
85

Glucose
100

Milk
27

Apple
28-44

White bread
30-110

Wholemeal bread
53

Boiled potatoes
56-101

Pear
38

Fishing
28-56

Canned fish
30-71

Rice
48-112

Sugar cane
68

Grape
46-59

Yogurt
36

Dietary fat yogurt
14

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