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Recommendations for patients with diabetes

To control your diabetes, reduce possible complications, and feel better is important:

Maintain an adequate diet. Daily physical exercise. Do not smoke. Maintain good control of your blood sugar levels. Take your prescribed diabetes medication properly. Follow various treatments to prevent the risk of vascular complications and organ damage. Get the recommended vaccinations. Take special care of your feet and wounds. Have your eyes checked periodically. Consider different special situations. Know what hypoglycemia is. Know when to go to the Emergency Room. Know when to go to the primary care physician. Nutrition in diabetes

There is no specific diet for patients with diabetes. The diet should be aimed at approaching the ideal weight, improving blood glucose control and reducing the risk of cardiovascular complications. A proper diet will help you feel better and reduce the risk of heart disease, kidney disease, stroke and other problems caused by diabetes.

To do this you should follow a Mediterranean-type diet (rich in fruits, vegetables, fish, nuts and olive oil), low in simple sugars and low in animal fats. Therefore:

You should reduce the intake of simple sugars in your diet. These include sugar as such, sugary drinks (soft drinks or canned juices), baked goods, cookies, cakes, pies, pastries, jams, honey, syrups, candies, sweets, chocolates, sweet wine, etc. Fruit juices and compotes usually contain sugar, so you should limit their consumption. Carbohydrates (sugars) from vegetables, fruits, legumes, cereals, or dairy products are generally adequate.

If you are being treated with insulin or oral antidiabetics, you should try to maintain a similar daily intake of carbohydrates at each of your meals during the day. This will allow you to maintain a stable dose of your medication.

Use vegetable oils preferably, mainly oils rich in monounsaturated fats (olive oil). Some vegetable oils, such as coconut and palm oil, often used in the manufacture of pastries, are rich in saturated fats and should be avoided. Saturated fats of animal origin (fatty parts of meat, poultry skin, sausages, and non-skimmed dairy products and derivatives) and trans fats (bakery products, cookies, convenience foods, fried foods, etc.) should also be avoided. On the other hand, oils derived from fish are suitable. Fat consumption should be reduced if you are overweight or obese, since the amount of calories from fat (from oils) is very high, regardless of the type of oil consumed.

Proteins are necessary for the body. Proteins are found in egg whites, meat and fish. You should reduce your intake if you have protein loss through urine (proteinuria).

Eat foods rich in fiber. These foods reduce the intestinal absorption of sugar and cholesterol, increase the feeling of satiety and reduce constipation, so they should be recommended in all diabetic patients. Eat therefore whole grains, whole wheat bread, fruits with skin, vegetables (such as asparagus), and legumes.

Avoid regular alcohol consumption, especially if you are overweight and/or have high triglycerides. If you decide to drink alcohol, limit your intake to a maximum of one alcoholic drink per day for women and 2 alcoholic drinks per day for men. One alcoholic drink refers to one glass of wine or one small beer.

In addition to the general recommendations mentioned above, there may be certain more specific recommendations on your diet depending on whether or not you have various risk factors (obesity, high cholesterol, hypertriglyceridemia, arterial hypertension) or whether or not you have other associated diseases (renal insufficiency, loss of protein in the urine). Salt intake should also be limited, especially if there is associated arterial hypertension.

If you are overweight or obese, you should follow a low-calorie diet to try to bring your weight to the ideal. Calories are found in all foods. To reduce weight, diets of between 1500 and 2000 calories are recommended. It is advisable to divide calories into several meals a day (4 or 5) and that caloric intake is always similar, especially if you are on treatment with some oral antidiabetics or insulin. It is also important that meals are taken at the same time. All this will allow better control of your blood sugar. Even small decreases in weight can have very important repercussions for your health.

Physical activity in patients with diabetes

Physical exercise helps to reduce weight, burns sugar and therefore reduces the amount of sugar in the blood, increases muscle mass and reduces the risk of developing cardiovascular diseases. For all these reasons, it is essential to exercise daily, ideally between 30 and 60 minutes as a minimum:

The recommendation is for children a minimum of 60 minutes of exercise a day.

The recommendation for adults is a minimum of 150 minutes of aerobic exercise per week (2.5 hours) of moderate intensity, at least spread over 3 days. It is not advisable to go more than 2 days without physical exercise. It is also advisable (if there are no contraindications) to do resistance exercises at least 2 times a week. Aerobic exercise consists of walking, running, swimming, cycling, gymnastics, etc. Resistance exercise consists of doing weights, machines, etc.

It is not advisable to abruptly start activities that may endanger your heart. Moderate physical activity can be performed without medical supervision. However, if you decide to engage in more intense physical activity, you should first undergo a medical evaluation. Although there is no consensus among physicians, some recommend performing a stress test (ergometry) in patients with diabetes who are going to start a vigorous exercise program, especially if they have type 2 diabetes of more than 10 years’ duration, have peripheral arterial disease, have diabetic nephropathy, neuropathy or retinopathy, or if they have other associated cardiovascular risk factors (high blood pressure, high cholesterol, are smokers, etc.). However, the benefit of exercise testing is not clear and it is probably best to apply common sense and start physical activity slowly and gradually and increase it slowly and progressively.

Please note the following with regard to physical activity:

Talk to your doctor about the types of exercises that are best for you. Make sure your shoes fit well and that your socks do not have seams that rub, and that they are clean and dry. After exercising, it is a good idea to check your feet for redness or sores. Before exercising, warm up and stretch for at least 5 minutes. For example, start your exercise session by walking slowly. Then stretch and then walk faster. After exercising, cool down for several minutes. For example, end the exercise session by walking slowly again. For some people, it may be appropriate to have a snack before physical activity. Consult your physician. Carry something to eat or a sugar cube with you in case you experience low blood sugar during exercise. Always wear some form of identification in case you have a health problem. Vigorous physical exercise is contraindicated: If there is urine ketosis, something that can occur in poorly controlled type 1 diabetics with very high blood sugar. In patients treated with insulin or oral antidiabetics in which the amount of sugar in the blood is very low before exercise (less than 100 mg/dL). In these cases, a snack should be eaten before starting physical activity. If there is untreated diabetic retinopathy. This is a contraindication for intense physical exercise.

Do not smoke Tobacco is associated with cardiovascular diseases. The risk of these diseases in a person with diabetes is very high. In fact, people with diabetes need preventive treatment to reduce this risk. Smoking cessation is essential to reduce the risk of these complications.

Maintain good control of your blood sugar (glucose).

Regular blood glucose testing is important. In general, they are recommended in patients treated with insulin, especially when the dose has been modified. The frequency of testing depends on several factors. Your physician will indicate when they should be performed. In general, glucose measurement is recommended in patients with diabetes treated with multiple daily doses of insulin:

Before each meal and sometimes after. When going to bed. Before doing physical exercise. Before driving or any activity that may endanger your health or someone else’s health. When you suspect that your blood sugar may be low and as often as necessary until your blood sugar returns to normal. When any other intercurrent disease appears. In general, the following glucose values are considered adequate:

Before meals 70 to 130 mg/dL. 1 to 2 hours after the start of a meal less than 180 mg/dL. However, these numbers may not be appropriate for you, so you should consult your doctor.

Your doctor may test your glycosylated hemoglobin (HbA1C) at a certain frequency, usually at least 2 times a year or more if your blood sugar is not well controlled. This test indicates the average blood sugar level over the previous 3 months. It is considered an adequate value when it is below 7%. In some people this value should be more demanding (below 6.5%) and in others less demanding (below 8%) depending on their characteristics, such as age, time of evolution of diabetes, associated diseases, etc.

The results of your blood sugar tests and HbA1C test will indicate if any aspect of your diet, exercise plan or medication needs to be modified.

Take your prescribed diabetes medication properly.

In addition to not forgetting your treatment, it is important to take your medication at the prescribed time of day. Talk to your doctor to find out when you should take your diabetes medications.

You should follow preventive treatments to reduce the risk of vascular complications and organ damage.

Diabetic patients are at an increased risk of cardiovascular complications because they develop arteriosclerosis more easily than people without diabetes. This implies that you should reduce your risk factors as much as possible. For this reason:

Do not smoke. Maintain optimal control of your blood pressure (usually less than 135/85 mmHg). Maintain optimal control of your bad cholesterol (LDL-cholesterol). The goal is to maintain an LDL-cholesterol below 70 or 100 mg/dL. These medications may be indicated, even if your blood pressure is normal.

The administration of aspirin to prevent the risk of cardiovascular complications in diabetic patients is controversial. All diabetic patients with a history of transient ischemic attack, stroke, angina pectoris, myocardial infarction, coronary or carotid revascularization or risk problems in the legs (i.e., with established cardiovascular disease) should receive 100 mg daily of aspirin (acetylsalicylic acid). Its use in patients without cardiovascular disease is not clear. Some societies do not recommend treatment with aspirin and others (such as the American Diabetes Association) recommend giving aspirin in most diabetics over 50 years of age.

Vaccinations in patients with diabetes All patients with diabetes should be vaccinated annually for influenza. All patients older than 2 years with diabetes should receive the pneumococcal vaccine. Those over 65 years of age should be revaccinated if they have not received the vaccine in the last 5 years. Patients with severe kidney problems should also be revaccinated. Adult patients with diabetes should receive the hepatitis B vaccine. Special care for feet and wounds.

Patients with diabetes may have reduced sensation in some part of their body, usually in the legs and feet. In turn, in advanced diabetes, circulation problems are frequent, with poor blood flow to the legs due to the presence of arteriosclerosis. For this reason, diabetics can get small wounds or scratches that they do not notice because of the absence of pain, which can increase in size and be difficult to heal, without healing due to the lack of irrigation. The presence of previous alterations in the feet (flat feet, cavus feet, bunions, etc.) facilitates the development of these problems. For all these reasons, patients with diabetes should:

Properly select comfortable footwear that does not favor the appearance of wounds, and the use of orthopedic footwear should be considered. To avoid chafing, it is advisable to use seamless socks.

Make sure there are no objects inside the shoes before putting them on. Inspect the feet daily to identify small wounds or areas of chafing. Maintain optimal foot hygiene and keep feet clean and moisturized. Seek specialized care for callus management and nail trimming. Avoid walking barefoot and other actions that may favor getting a wound. Always wear shoes.

Never use hot water bottles or any other system to heat the feet. Receive care from specialized personnel (podiatrists). Consult immediately when any injury that may become complicated appears. Optimally control blood sugar and cardiovascular risk factors.

Special eye care

Patients with diabetes have a higher risk of cataracts, glaucoma and retinal problems than non-diabetics. The control of risk factors (cholesterol, blood pressure and smoking) and good blood sugar control are the only factors that can prevent or delay the onset of these diseases. It is necessary for patients with diabetes to have their eyes checked periodically in order to be able to detect any of these diseases at an early stage and to proceed to their early treatment.

Care in special situations

In several special situations, people with diabetes should follow specific recommendations:

What should I do if I am diabetic and take pills or take insulin and have to fast for a test? In general, if the fast is very short, for example, for a blood test, you can wait until the test is done to have breakfast later and then take the insulin or take the pill with breakfast. If the fast is longer, there may not be any inconvenience in postponing or skipping a pill, however, you should discuss with your doctor what to do with the insulin injection.

What do I do if I am sick from any other cause? Any intercurrent illness can cause the blood sugar level to rise too high. Therefore, if I have any other illness that causes fever or could be serious (a flu, a bad cold, pneumonia, gastroenteritis, etc.) you should:

Measure your blood sugar level every less time, for example, every few hours. If you do not vomit, you should continue with your diabetes medicines, even if you have no appetite and eat very little. In this case, you should drink sugary liquids, soups or even ice cream frequently.

If you are injecting insulin and do not eat, you will need to reduce the amount of insulin to be injected to avoid hypoglycemia. Consult your doctor. In people with type 1 diabetes, the body produces ketones when the blood sugar level is high. Therefore, it is a good idea to measure your urine ketone production with a urine test strip if:

Your blood sugar level is greater than 240 mg/dL. You have vomiting that prevents you from eating or drinking. Low blood sugar (hypoglycemia). Low blood sugar may cause dizziness, shakiness, weakness, confusion, irritability, hunger or tiredness. You may sweat a lot or have a headache. If you have these symptoms, test your blood sugar level. If it is less than 70 mg/dL you have hypoglycemia (low blood sugar). Hypoglycemia is a very dangerous situation because if it is significant it can lead to unconsciousness and even death. For this reason, if you suspect that you may have hypoglycemia and you do not have the possibility to measure your blood sugar or you do not have time to do it, do not hesitate, act as if you had it and consume immediately:

Sugar. Glucose gel. Any fruit juice or sweetened beverage (lemon, cola, etc.). Milk. Various candies. Honey, jam. Anything sweet. After 15 minutes, check your blood sugar again. If it is still low, eat another serving. Repeat these steps until your blood sugar is 70 mg/dL or higher. Also, eat a snack if it will be an hour or more before your next meal.

There is no problem in taking these foods and not actually having hypoglycemia. At most, your blood sugar will go slightly higher than usual, but it will not have any consequences for your health. It is much more dangerous to have low blood sugar than to have high blood sugar.

In patients at risk of severe hypoglycemia, it is advisable to have glucagon injections at home. If a patient loses consciousness completely as a result of hypoglycemia, it is obvious that he/she cannot eat or drink anything. In these circumstances, the only way to recover his blood sugar and to wake him up is to give him serums with sugar (something not immediately accessible at home) or to inject him with a syringe already pre-filled with glucagon by a trained family member. This injection can be life-saving.

Hypoglycemia may be caused by injecting more insulin than necessary, eating less food than usual or exercising more than usual. They are frequent with dose changes. Hypoglycemia caused by slow insulin lasts much longer than hypoglycemia caused by injecting rapid insulin. For this reason, if your blood sugar drops very low and recovers after eating sweet things, keep an eye on your blood sugar because it may drop again. Hypoglycemia can also occur with diabetes medications.

In this case, they are also usually prolonged and may recur after you have initially recovered. If you do not know why you may have had hypoglycemia, ask your doctor or inject a smaller amount of insulin than the one you injected that caused your blood sugar to drop.

Other considerations for patients with diabetes

Pregnancy. There are no pregnancy concerns for women with diabetes; however, pregnancy in these women is considered high-risk and requires special monitoring.

Driving. The main risk of driving is the development of hypoglycemia (low blood sugar). For this reason, diabetic patients should be educated about the importance of blood sugar control and the convenience of having controls before traveling to distant destinations:

You should not start driving if your blood glucose is too low (less than 100 mg/dL). Always carry sugar-rich foods in the car. If you have symptoms suggesting hypoglycemia, stop the car immediately. Avoid driving if your treatment dose has recently been changed or a new diabetes medication has been added. Always protect your medication from cold and heat. Be careful with your vision problems.

When should I go to the hospital emergency room?

A person with diabetes should go to the emergency room if:

He/she loses consciousness. Their blood glucose level is very high, usually above 400 or 500 mg/dL. You have high blood sugar levels (greater than 250 mg/dL) for several days but are unable to reach your primary care physician. You have ongoing dizziness or drowsiness. You have vomiting that makes it difficult to eat. In any other situation that you may consider serious. When should you see your primary care physician?

You should visit your doctor if: Your glucose levels remain high for several days. You have several tests with blood sugar below normal. You have a fever. You have any other intercurrent illness.

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