Diabetes is a chronic disease in which the level of glucose (sugar) in the blood is too high. The hormone insulin produced by the pancreas regulates levels blood glucose . In diabetes, the pancreas does not produce enough insulin or there is a problem in the way the cells respond to it.

The prevalence of diabetes between the ages of 18-65 in Croatia is 6.1%. The risk of diabetes increases with age, from 2.5 percent in people aged 35-45 to 23.6 percent in people over 75.

How is glucose utilized in the body?

glucose picture
Glucose molecules

Glucose is the main source of energy in the body. Glucose comes from foods rich in carbohydrates, such as potatoes, bread, pasta, rice, milk and fruit. Glucose is released into the bloodstream after the digestive process. 
Glucose from the bloodstream enters the cells that use it for energy. Excess glucose is stored in the liver or converted to fat and stored in other tissues.

The pancreas produces insulin, a hormone that opens doors (channels) that allow glucose to enter cells. It also allows glucose to be stored in the liver and other tissues. This is part of a process known as glucose metabolism.

In diabetes, the pancreas cannot produce insulin (type 1 diabetes) or the cells do not respond properly to insulin and develop insulin resistance. In case of type 2 diabetes the pancreas does not produce enough insulin for the increased needs of the body.

When insulin does not do its job properly, glucose accumulates in the blood instead of being converted into energy in the cells. High blood glucose levels can cause the health problems we associate with diabetes.

Symptoms of diabetes

diabetes symptoms

When part or all of the glucose is retained in the blood and is not used as a fuel to produce energy, the symptoms of diabetes appear. The body tries to lower the glucose level by expelling excess glucose from the body in the urine.

Some types of diabetes can have very few symptoms and are difficult to diagnose. Common symptoms are as follows:

  • Excessive urination
  • Excessive thirst
  • Weight loss
  • Blurred vision
  • Fatigue and lethargy
  • Slow wound healing
  • Nausea and vomiting
  • Mood swings
  • Itching and infections, especially in the genital area 

Symptoms type 1 diabetes are obvious and develop rapidly in just a few weeks. The symptoms pass quickly when treatment is started.
In type 2 diabetes, the symptoms are not so obvious.

The disease develops slowly over several years and can only be diagnosed by a medical examination. After treatment, there is a rapid relief of symptoms and control of this type of diabetes. Early diagnosis is very useful.

What after symptoms appear?

If you notice any of the above symptoms, consult your GP. Early diagnosis, treatment and control of diabetes are key to reducing the chances of developing serious complications.

What can happen if you ignore the symptoms? 

Untreated type 1 diabetes can lead to serious health problems such as diabetic ketoacidosis, which can lead to potentially fatal coma. 

Type 2 diabetes is more difficult to diagnose, especially when it is at an earlier stage when the symptoms are not so obvious. Diabetes affects most major organs such as blood vessels, nerves, heart, kidneys and eyes.

Early diagnosis is essential for quality control of blood glucose levels and prevention of potential complications.

Types of diabetes

The main types of diabetes are type 1 diabetes and type 2 diabetes. There is also gestational diabetes, gestational diabetes and pre-diabetes.

Type 1 diabetes

Type 1 diabetes most often occurs in young people under the age of 30. Type 1 diabetes causes the autoimmune destruction of insulin-producing cells and stops producing insulin. It is one of the most common chronic diseases in the developed world. It is sometimes referred to as juvenile diabetes or insulin-dependent diabetes mellitus, although these terms are increasingly falling out of use. 

There is no cure for type 1 diabetes but it can be controlled with insulin injections, diet and exercise.

If a person with type 1 diabetes skips a meal. Excessive exercise or taking too much insulin, their blood sugar levels will drop. This can lead to a hypoglycaemic reaction.

Symptoms include dizziness, hunger, sweating, headache, and mood swings. This can be fixed by a quick intake of sugar (such as candies or glucose tablets) or something more important like fruit. A person with type 1 diabetes should have something sweet available at all times.

Type 2 diabetes

Type 2 diabetes is often described as a lifestyle disease as it is more common in people who do not have enough physical activity and who are obese. It is associated with high blood pressure, elevated cholesterol levels and an apple-shaped body in which excess weight is retained in the waist area.

Type 2 diabetes is the most common form of diabetes, affecting 85 to 90 percent of people with diabetes. It mostly affects adults (over 40 years of age) but recently there are more and more young people who are diagnosed with this type of diabetes. The reason for this is the increase in youth obesity. This type of diabetes was once called non-insulin diabetes.

Research has shown that type 2 diabetes can be prevented or delayed with lifestyle changes. But, unfortunately, there is no cure.

Gestational or gestational diabetes

Gestational diabetes occurs during pregnancy and affects three to eight percent of pregnant women. After the birth of a mother, the glucose level usually returns to normal, but women who have had gestational diabetes have a higher chance of developing type 2 diabetes. 

Gestational diabetes can cause a child to overgrow and gain weight. If the mother’s glucose levels are not lowered, the baby may be higher than normal. After birth, the baby may have lowered glucose levels
The following groups of women have an increased risk of developing gestational diabetes:

  • women older than 30
  • overweight women and obese women
  • women with a family history of type 2 diabetes
  • women of specific cultural groups such as women of Indian, Chinese, Malaysian, Vietnamese and Polynesian descent
  • Aborigines and residents of some islands
  • women who already had gestational diabetes in a previous pregnancy.

Gestational diabetes can be controlled and treated, and with proper control, the risks are greatly reduced. A child will not be born with diabetes.

Pre-diabetes

Pre-diabetes is a condition in which blood glucose levels are higher than normal, but still insufficient to be classified as diabetes. There are no specific symptoms but there are a number of risk factors such as obesity, smoking, heart disease, polycystic ovary syndrome and high blood pressure. Without treatment, one-third of people with pre-diabetes develop type 2 diabetes.

Diabetes insipidus

Symptoms include severe thirst and large amounts of urine. It is caused by an insufficient amount of vasopressin, a hormone produced by the brain and which orders the kidneys to retain water. Without a sufficient amount of vasopressin, the body loses too much water in the urine causing the affected person to drink large amounts of fluid in an attempt to maintain fluid levels.

In the most severe cases, a person can pass up to 30 liters of urine. Treatment is necessary because otherwise dehydration occurs and eventually coma due to the concentration of salt in the blood, especially sodium. 

This type of diabetes is not caused by elevated blood sugar levels. It is treated with medications, a vasopressin replacement, and a low-salt diet.

Sudden diabetes

There are cases when diabetes appears suddenly. It is mostly type 1 diabetes. This leads to ketoacidosis, a condition that requires urgent medical treatment.

Symptoms of ketoacidosis include loss of appetite, weight loss, excessive urination, vomiting, loss of consciousness and eventually coma. 
If any of these symptoms occur, seek medical advice immediately.

Complications in case of untreated diabetes

diabetes treatment

When left untreated, diabetes can cause very serious complications such as:

  • kidney damage (nephropathy)
  • eye damage (retinopathy)
  • heart disease (heart attack or angina), problems with circulation in the legs and stroke
  • nerve damage (especially of the feet)
  • problems of a sexual nature, including erectile dysfunction
  • ulcers and foot infections caused by circulatory problems and nerve damage.

Diabetes treatment

There is no cure. The goal is to prevent complications by controlling blood glucose levels, blood pressure, cholesterol and body weight.
Treatment includes:

  • Taking insulin with daily insulin injections or an insulin pump
  • Self-monitoring of blood sugar levels by testing using a meter  glucose
  • Self-testing of urine when problems are suspected
  • Adjusting diet to insulin and physical activity
  • Increase slow carbohydrates in the diet, such as fruits and legumes that need more time to absorb
  • Regular physical activity and exercise
  • Drugs and insulin
  • Weight management
  • Smoking cessation
  • Regular medical examinations

Self-management of diabetes

  • Regularly check your blood glucose levels.
  • Strict adherence to medication instructions.
  • Frequent physical activity.
  • Regular visits to the doctor and liaising with associations for diabetics.
  • Healthy diet. Choosing healthy foods in appropriate quantities.
  • Positive attitude. In case of depression seek the help of a doctor or diabetic association.
  • If you feel unwell, seek medical advice
  • Join support groups.

How Lifestyle Affects Type 2 Diabetes

Overweight and obesity are significant factors. Especially weight gain around the waist. Important factors include poor physical activity, excessive television watching and sitting at a computer, an unhealthy diet high in fat, sugar, salt, and low-fiber foods, and smoking.

People at risk should have a laboratory glucose test to check for diabetes. It is important not to wait for the symptoms to appear, as they can only appear when the blood glucose rises significantly. 

Nutrition in diabetes

diabetes diet image

To help control your diabetes, make sure your meals are regular, low in fat, especially saturated fat. Eat high-fiber carbohydrates such as whole grain breads and cereals, beans, lentils, vegetables and fruits.

It is important to balance food intake with energy expenditure. It is important not to overeat.

In addition to a healthy diet, regular physical activity helps maintain blood glucose levels, reduces blood fat (cholesterol and triglycerides) and maintains a healthy body weight.

Ishrana dijabetes

Masnoće nam daju najviše energije (kalorija). No, jedenje prevelike količine masnoća može vas učiniti pretilima što otežava kontrolu glukoze u krvi. Važno je smanjiti unos masnoća, no moramo zapamtiti da je određena količina masnoće dobra i zdrava.
Zasićene masnoće podižu razinu lošeg kolesterola (LDL) pa je stoga potrebno smanjiti njihov unos. Zasićene masnoće se nalaze u hrani životinjskog porijekla kao što su masno meso, mlijeko, putar i sir. Zasićenih masnoća ima i u izvorima koji dolaze od povrća kao što su palmino ulje i proizvodi od kokosa. Napuci za smanjenje zasićenih masnoća: Odaberite niskomasne mliječne proizvode. Jedite nemasno meso i uklonite masnoće prije kuhanja. Skidajte kožu s piletine. Izbjegavajte putar, mast, vrhnje, kokosovo mlijeko, margarine i sl. Izbjegavajte kolače, pite i pekarske proizvode. Smanjite unos sira. Ograničite unos keksa, pudinga, biskvita i sl. na posebne prilike. Smanjite korištenje gotove hrane i smrznutih jela. Ograničite korištenje mesnih prerađevina (salama, šunki, parizera itd.). Izbjegavajte duboko prženu hranu. Ograničite unos krem juha. Umjesto umaka na bazi vrhnja koristite one na bazi, rajčice, soje ili sličnih drugih niskomasnih sastojaka.
Jedenje manjih količina ovih kiselina može pomoći pri unosu esencijalnih masnih kiselina i vitamina koje vaše tijelo treba. Višestruko nezasićene kiseline uključuju: Margarini koji sadrže ove kiseline (na ambalaži piše da sadrže višestruko zasićene masne kiseline) Suncokretovo, sojino, kukuruzno i sezamovo ulje. Plava riba poput sleđa, skuše, srdele, lososa i tune. Mononezasićene masne kiseline uključuju: Canola® i maslinovo ulje Neke vrste margarina Avokado. Sjemenke, orašasti plodovi, maslac od kikirikija i ulje od kikirikija sadrže kombinaciju višestruko nezasićenih i mononezasićenih masnih kiselina.
Kratko poprženo meso na malo masnoće. Salate ili pareno povrće s malo maslinovog ulja i limuna ili octa. Po parenom povrću posipajte sjemenke sezama. Kruh sa sjemenkama lana premažite s malo margarina. Koristite avokado u sendvičima ili salatama. Jedite više ribe (bar tri puta tjedno) jer sadrži zdrave omega-3 masne kiseline. Izbjegavajte duboku prženu i pohanu hranu. Za prženje koristite neprijanjajuću tavu.
Ugljikohidrati su najbolji izvor energije za tijelo. Nakon probave u krvotoku prelaze u glukozu. Inzulin glukozu iz krvi unosi u stanice tijela gdje se koristi kao izvor energije. Redoviti unos ugljikohidrata osigurava vašem tijelu i mozgu potrebnu energiju. Dijete s niskim unosom ugljikohidrata se ne preporučaju za ljude s dijabetesom. Redovita jela i raspoređen unos ugljikohidrata tijekom cijelog dana pomoći će vam održati razinu energije bez velikog povećanja razine glukoze u krvi. Osobe koje uzimaju inzulin možda će morati uzimati grickalice između obroka. Ugljikohidrati se probavljaju različitim brzinama te različito brzo proizvode glukozu. Glikemijski indeks (GI) opisuje kako hrana koja sadrži ugljikohidrate utječe na razinu glukoze u krvi. Stoga je vrsta ugljikohidrata koji jedete veoma važna jer neki uzrokuju veće povišenje glukoze u krvi od drugih. Najbolje je jesti umjerene količine ugljikohidrata i uključiti hranu s visokim udjelom vlakana koja ima niski GI indeks.
Jedite proteine s malim udjelom masti. To će smanjiti količinu zasićenih masnih kiselina koju unosite. Jedite nemasno meso, perad bez kože, plodove mora, jaja (ne pržena), nezasoljene orašaste plodove i proizvode od soje kao što je tofu.
Zdrava prehrana u dijabetesu može uključivati nešto šećera no važno je obratiti pažnju na nutritivnu vrijednost hrane koju jedete. Hranu s dodanim šećerom jedite umjereno. Posebice visokoenergetsku hranu poput slatkiša, bombona i standardnih gaziranih pića koje ne bi trebali redovito konzumirati. Možete koristiti malo šećera tijekom kuhanja no prilagodite recepte i koristite manje šećera nego što je originalno naznačeno ili šećer zamijenite alternativnim zaslađivačima.
Kod dijabetičara se preferira korištenje zaslađivača umjesto prirodnih šećera.
Kako bi začinili jela i unijeli raznovrsnost u svoje obroke, možete koristiti sljedeće: Začini, češnjak, sok od limuna, čili, ocat i slični dodaci. Proizvodi označeni kao "niskoenergetski“ (pića i sl.) Kava, čaj, biljni čajevi, voda, soda voda, mineralna voda.

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