CC BY
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MEDICAL SCIENCES / «<g©yL©(MUM~J©U©MaL» #5(164), 2©21
MEDICAL SCIENCES
UGC 616.379
Piddubna A.A.,
ORCHID: 0000-0002-9143-9574 Candidate of medical sciences, Docent of Endocrinology, Allergology and Immunology Department, Higher State Medical Establishment «Bukovinian State Medical University»
Chernivtsi, Ukraine Honcharuk L.M.,
Candidate of medical sciences, Docent of the Department of Internal Medicine, Higher State Medical Establishment «Bukovinian State Medical University»
Chernivtsi, Ukraine Teslia I.M., 6thyear student,
Higher State Medical Establishment «Bukovinian State Medical University»
Chernivtsi, Ukraine Kozak Y.P.,
6th year student,
Higher State Medical Establishment «Bukovinian State Medical University»
Chernivtsi, Ukraine Makoviichuk K. Y.
4th year student,
Higher State Medical Establishment «Bukovinian State Medical University»
Chernivtsi, Ukraine DOI: 10.24412/2520-6990-2023-5164-4-6 MODIFICATION OF LIFESTYLE IN DIABETES
Abstract.
The article discusses the main aspects of psychological and nutritional approaches to lifestyle modification in diabetes. The main questions regarding the consumption ofproducts while following a diet are highlighted, the proportions in the patient's diet are indicated. Proposals regarding the necessary frequency of visiting a nutritionist and performing physical exercises are described, the main stages ofpsychotherapy are considered.
Keywords: diabetes, lifestyle, diet therapy, diet, psychotherapy.
Diabetes mellitus (DM) is one of the main causes of premature death, often leading to kidney failure, cardiovascular diseases, vision loss, limb amputation (World Health Organization, 2017). According to official statistics, about 1.3 million people in Ukraine suffer from diabetes. However, in reality, there are 2-2.5 times more patients, because most people do not even know about their diagnosis until they begin to develop severe complications.
Diabetes mellitus is a metabolic disorder due to absolute or relative insufficiency of insulin. The disease is more common among people with excess body weight, the reduction of which (in case of obesity) significantly facilitates the course of diabetes. However, people with a normal body weight are also not immune to the development of this disease. To date, a large number of studies devoted to various aspects of the treatment of diabetes mellitus have been conducted. Different programs for the treatment of diabetes mellitus have been developed, which describe the rules of nutrition and the need for psychological support of patients. The main task in the treatment of patients with DM is to determine different approaches to therapy that would ensure comfortable rehabilitation of patients and imperceptibility of lifestyle modification. That is why
it is necessary to develop a treatment system based on psychological and nutritional support.
Patients with DM have a high risk of decreased psychological balance function and the possible development of anxiety or depression. This is due to the strain that patients experience when faced with the need to make changes in life composition, work-related relationships, and financial issues after diagnosis (Walker R.J. et al., 2012; Stuckey H.L. et al., 2014). As is known, the proportion of patients with DM who were found to have depression and other psychological disorders related to the disease was 13.8 and 44.6%, respectively, with an overall low quality of life of 12.2% (Nicolucci A. et al ., 2013). And, despite the evidence of numerous studies that psychosocial support plays an important role in adaptive self-care of patients with DM, the psychological approach is currently not widespread enough to combat such psychological co-morbidities as depression and other psychological disorders. Psychological support, manifested through the care and compassion of family, friends, health professionals and even other patients with DM, can instill a positive attitude, sense of resilience and well-being in patients with DM. If anxiety or depression is suspected, the patient should be referred to a medical psychologist. Dispensary supervision by specialist doctors of patients
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with eating disorders is necessary to prevent persistent hyperglycemia and recurrent hypoglycemia. It is also necessary to inform patients and their family members about the risk of long-term cognitive dysfunction in the presence of persistent hyperglycemia. Specialists, namely psychologists and social workers, should be available to communicate not only with patients and their families for screening and more comprehensive assessments of psychosocial functioning, but also to support the DM therapy team in recognizing and addressing health and behavioral problems. Psychologists need to assess the dynamics of all components of the quality of life (physical, intellectual, academic, emotional, social development) using methods generally accepted in psychology. Psychosocial support of the patient and his family is extremely important for complications of diabetes. After the diagnosis is made, it is necessary to educate the patient and his family members about diabetes therapy so that they feel confident in providing medical care at home.
Nutritional support according to the order of the Ministry of Health of Ukraine dated 29.10.2013 No. 931 "On improving the organization of medical nutrition and the operation of the dietetic system in Ukraine" takes into account the nutritional status of the patient, his individual nutrient needs and clinical condition (MoH of Ukraine, 2013 ). Nutritional support of patients increases the effectiveness of treatment, reduces the risk of complications and improves the prognosis. The main task of patients with diabetes mellitus is to compensate for the disease by following certain rules of a healthy lifestyle, namely, the rules of nutrition, exercise and adequate rest. The main principle of nutrition for patients with diabetes mellitus is an appropriate regimen. With diabetes, it is recommended to eat small meals (4-6 times a day), while the break between meals should not exceed 3-5 hours. With type 1 diabetes, it is important to choose a diet that best matches the condition of a particular patient, taking into account excess body weight, arterial hypertension, other concomitant diseases and complications (Dedyshina L., 2016). In this regard, food products are divided into three groups: 1) permitted, containing complex carbohydrates and fiber (those that can be consumed in unlimited quantities); 2) limited, containing unsaturated fats (require strict control of the amount consumed); 3) forbidden, containing refined carbohydrates (consumed only to eliminate attacks of hypoglycemia). Usually there are no restrictions on the caloric content of the diet, provided the patient has a normal body weight. Given the fact that type 1 diabetes mainly affects children and young people, nutrition should be complete. The main attention should be paid not so much to the choice of products, but to the amount consumed, because the dose of insulin for adequate insulin therapy directly depends on this. Carbohydrate products must be controlled with the help of so-called bread units (BU). With type 1 diabetes, it is important not to skip meals, control body weight, limit the consumption of table salt to normalize blood pressure indicators, consume a sufficient amount of liquid (at least 1.5 l/day), regularly perform complexes of physical exercises, consciously choose products and their amount for food. Intake of energy
and essential nutrients should be aimed at maintaining normal body weight, optimal growth, development, health, and help prevent acute and chronic complications of DM. Dietary therapy combined with other components of diabetes management can improve clinical and metabolic outcomes, and the frequency of regular exercise is associated with lower glycosylated hemoglobin (HbA1c) values without increasing the risk of severe hypoglycemia. At the same time, the positive impact of physical activity is manifested much more widely: control of body weight, reduction of cardiovascular risks, as well as improvement of general well-being. Exercise after eating can be an effective means of reducing postprandial hyperglycemia. However, planned or unplanned physical activity is one of the most common causes of hypoglycemia in young people with type 1 diabetes, and vigorous physical activity can sometimes cause hyperglycemia. Advice on meal planning, its content and the schedule of additional meals (snacks) should be provided by a nutritionist in the context of the individual characteristics of each patient, lifestyle and profile of insulin action, should help parents, other family members, and medical personnel in teaching self-control, conducting monitoring and patient support. The main goal of diet therapy is to preserve social, cultural and psychological comfort along with changing the approach to nutrition and eating skills for life; eating three times a day with supplements (if necessary), which will ensure the supply of all the necessary nutrients; maintenance of a healthy body weight, prevention of abuse; ensuring a sufficient level of digestible energy and the amount of nutrients, which is the key to optimal development for young people and maintaining good health; achieving and maintaining a normal body weight; achieving a balance between metabolic needs, food intake, insulin action profiles and energy expenditure; prevention and treatment of diabetes complications. A trusting, productive, supportive relationship is needed to facilitate behavioral changes and subsequent positive changes in diet. Although energy intake can be regulated by appetite, when eating too much, excess energy intake can lead to obesity. In patients with diabetes, overeating and limited physical activity require an increase in the dose of insulin, which in the future requires the consumption of additional food ("snacks") to avoid hypoglycemia. Prevention of obesity is extremely important in the treatment of patients with diabetes and relies on self-discipline, taking into account the energy content of food, choosing the appropriate portion size, regular meals, the necessary content of fats and carbohydrates in food, and physical activity. The total daily intake of calories should be distributed as follows: carbohydrates should make up 5055%, fats - 30-35%, proteins - 10-15% of the entire diet. Food rich in carbohydrates (whole grain bread, cereals, legumes (peas, beans, lentils), fruits, vegetables and low-fat dairy products) should be encouraged. In moderate amounts, sucrose can be replaced by other sources of carbohydrates that do not cause hyperglycemia. In the case of taking sucrose, its amount should be balanced in relation to insulin doses. Eating a variety of foods that contain fiber (beans, fruits, vegetables, and cereals) should be encouraged, which is beneficial as a
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lipid-lowering factor. Fruit pectin may also be useful in increasing protection against cardiovascular disease. After processing, food usually loses its fiber content, so eating fresh, unprocessed food should be recommended. Protein contributes to the body's growth only if there is sufficient total energy. Vegetable protein sources such as legumes should be recommended. Recommended sources of proteins of animal origin: fish, lean meat and low-fat diet products. Optimal intake of vitamins, minerals, and antioxidants should be maintained for overall health and cardiovascular health. Many fresh fruits and vegetables are naturally rich in antioxidants (tocopherol, carotenoids, vitamin C, flavo-noids) and should be strongly recommended for people with diabetes. Excessive alcohol consumption is dangerous due to suppression of gluconeogenesis and can cause long-term hypoglycemia in people with diabetes. Patients with diabetes are recommended to drink water instead of sweetened and stimulant drinks. The first dietary consultation should be conducted by a dietician with experience in diabetes management as soon as possible after diagnosis. It is necessary to take into account the quality of the selected food, including fast food, as well as the time of meals and the patient's daily activity. During the first consultation, simple advice should be given, which will be reviewed in the future at least 1 month after the diagnosis. Follow-up contacts depend on local conditions and are required at least 3-5 times during the 1st year, followed by 2 times a year. Disease progression, diabetes control, psychological adaptation, lifestyle changes, and identification of specific dietary problems such as unhealthy eating habits, family food problems, obesity, and eating disorders should be taken into account. For the convenience of food calculations, the system of carbohydrate units (BU) is used, which is a conventional indicator of the amount of a product that contains 10-12 g of carbohydrates; 1 BU is able to increase the level of glucose in the blood by 1.5-2 mmol/l. In order for the cell to receive 1 BU, 0.5-4 units are needed. insulin A system of counting BUs, or servings, can be used to have recommended amounts of carbohydrates for each meal or snack in order to create a more consistent daily carbohydrate intake. Conversely, volumes or servings can be used in intensive insulin therapy to match the insulin dose to carbohydrate intake.
Conclusions. The considered psychological and nutriological approaches to lifestyle modification after the diagnosis of DM significantly change all areas of the patient's life, primarily related to changes in nutrition, the appointment of a diet and the attitude of others
towards the patient. A properly selected diet and the work of psychologists and nutritionists increase the effectiveness of treatment. The results of numerous studies of these approaches confirm their effectiveness, but today in many cases they are not widely used in the treatment of patients, which negatively affects the general trends of the course of the disease and the recovery process. Correctly set priorities in accordance with the individual characteristics of each patient will be able to ensure the best quality of treatment.
References/
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