Diabetes and Nutrition to Health Prosperity!

Good day, dear readers!

Let's brush up on theory of disease, let's talk about healthy eating. As we know diabetes is of two basic forms (types):

Insulin-dependent diabetes mellitus (IDDM): type 1 diabetes, juvenile diabetes. Autoimmune disease, which manifests itself through an absolute deficiency of insulin. Can be diagnosed at any age, is a high probability of developing the disease in families with an adverse family history (diabetes in the past generation).

Insulin-dependent diabetes mellitus (NIDDM): Type 2 diabetes is most often prevalent in the elderly. The disease is related to the ability of the pancreas to produce insulin due to damaged cells.

Bases of proper nutrition in diabetes.

NIDDM affects about 15% of the population aged over 50 years. The disease is dependent on hormone secretion and insulin resistance of tissues. In most cases, can be compensated by diet. Normal body weight - an important condition for a healthy and fulfilling life, as it greatly enhances the resistance of obesity.

In both forms, the patient must eat regularly to avoid unwanted surges of sugar. In some cases you may need a meal every 2-3 hours, and snacks between meals.

Diabetic needs of a well diet and nutrition plan in the light forms of diabetes, body mass index, age, gender, presence of chronic diseases, physical activity.

Types of diets for diabetes. Key recommendations on nutrition can be found in the diet 9 (treatment table number 9). Depending on the type of diabetes, the patient must adhere to strict or not strict diet.

    A strict diet. Must be followed by patients who take insulin or oral hypoglycemic agents all. With a strict diet are held constant measurement of basic elements (proteins, fats, carbohydrates) that are contained in the products.
    Not strict diet. Recommended for patients with diabetes, which yields no compensation for the use of insulin, and in the absence of obesity. Not strict adherence to diet involves a balanced diet, limiting foods that contain excessive amounts of carbohydrates.

Diet - a key lever to control diabetes. Adjustment of power must necessarily be carried out in case of changes in metabolic needs (growth of the organism, pregnancy, breastfeeding, exercise and activity).

Key elements of the diet.

Proteins. Patients with diabetes tend to have a negative nitrogen balance. Therefore, the need for protein increases 2-fold compared with healthy people. Protein foods in the diet should provide the patient with diabetes from 20 to 25% of calories. A diet high in protein saturates the body with amino acids, regenerating tissue, compared with carbohydrate-protein satisfy hunger better and does not raise blood sugar, protein foods lower in calories than fat or carbohydrates.

Carbohydrates. A daily intake of carbohydrates should provide 40% of calories in order to prevent ketosis. Some studies claim that high carbohydrate intake does not adversely affect blood sugar levels, glucose tolerance and insulin demand, only on condition that the total calories in the diet does not increase.

Fats. After the proteins and fats, carbohydrates should occupy the remaining calories. Allowed 30-35% of fat in the diet of diabetics. Foods high in fat and cholesterol should be limited.

Fiber helps to slow the rate of assimilation of carbohydrates, lowers blood sugar and glucose excretion in the urine. Dietary fiber gives a feeling of satiety, as a consequence of reduced food intake, and struggling with being overweight. Complex carbohydrates, which are contained in the tissue, digested slowly enough so unrefined foods such as beans, brown rice, wholemeal bread have a preference. The most useful product that contains fiber and effectively reducing sugar are fenugreek seeds.

In the next article I will tell you, what are the methods of calculating dietary food for diabetics. Also, examples of calculations and more advice on nutrition in diabetes. Stay tuned!

Honey and Diabetes: Can or Cannot?

All our troubles from ignorance. This also applies to the consumption of honey. Some diabetics say that honey may lead to an undesirable jump in sugar. Others argue - honey is very good for your health and helps reduce blood glucose. Who still believe? In fact, honey and diabetes, have a fairly complicated relationship.

Honey and diabetes: WHY NOT?

It is known that diabetes - a disease that requires strict discipline. And if the patient does not comply with diet, in fact, there is no difference than poison the body - with high doses of sugar or honey. And even more - harmful. In addition, honey is sweeter than sugar, it contains more carbohydrates and calories.

The disease must be in the process of compensation. At a high level of sugar in the blood of honey is contraindicated!

Honey and diabetes: Why can?

Honey - a natural fructose. And not the refined powder that is sold in stores (about the dangers of processed fructose, I wrote the article "Fructose Diabetes: Friend or Foe?", Be sure to read this information).

Science has proven that long apitherapy (healing with honey) in diabetes leads to good results. Honey reduces blood pressure and glycated hemoglobin (an average of 2 - 4%).

Med - smart eating. Even taking into account the fact that the composition of honey are simple carbohydrates, this product is directly converted into liver glycogen, and so not much raises blood sugar levels, as occurs in the use of sucrose.

However, all of the benefits of honey are valid only if a balanced diet and limited use of bee products. Also note, honey should be natural. Some would-be beekeepers breed it with sugar. In this case, any positive effect will not be. Not sure - better not to buy!

Honey and diabetes: HOW CAN I?

The attending physician, as a rule, no objection to the use of honey in diabetes mellitus. The recommended dosage is 1.5 - 2 tbsp a day. Patients should be brought into line with the medical plan of individual power, in parallel to monitor not only the calorie intake of carbohydrates, fats and proteins, but also do not forget about vitamin and mineral micronutrients.

The first tablespoon of honey is better to eat for breakfast along with fruit. The organism is awake and in need of energy, so the honey in the morning - it's very helpful. If you exercise during the day, a teaspoon of honey is simply irreplaceable for 30 minutes before exercise. Well, the rest of a teaspoon can be eaten before bed to improve the process of recuperation.

Note, one tablespoon of honey contains about 60 calories. So if you eat in a healthy 2000 calorie diet, in which simple carbohydrates should not exceed 10% of total calories, two tablespoons of honey a day - is perfectly acceptable.

Eat honey carefully watch the sugar and stay healthy!

Insulin Resistance Syndrome

Fairly common condition that destroys the health of the age of 45 years - the so-called metabolic syndrome.

Metabolic syndrome (syndrome X, insulin resistance syndrome) - a sum of a large number of interrelated pathological factors that create conditions for the emergence and development of cardiovascular disease and insulin-dependent diabetes.

This syndrome first identified an American scientist Gerald Riven. In the late 80s of last century D. Riven proved the existence of insulin resistance syndrome (syndrome Rivena later called), which defines the concomitant development of hypertension, diabetes mellitus type 2, hyperlipidemia and atherosclerosis.

Namely insulin resistance and hypoglycemia are at the root factors of metabolic syndrome.

The loss of cell sensitivity to insulin - insulin resistance develops against the background of obesity, which violates the distribution of glucose and hypoglycemia develops. Scientists have proved that the degree of insulin resistance is directly proportional to the amount of excess fat. With the accumulation of fat in the body fat cells gradually grow in size. The greater the fat cell in size, the less it responds to the hormone insulin. Thus, insulin inhibits the process is less breakdown of fat into fatty acids. As a result, accumulate in the blood free fatty acids.

In accordance with the laws of interaction products of metabolism - glucose and aliphatic acids - the muscle cells of the liver and stimulates the oxidation of free fatty acids, and thus prevent the normal transport of glucose - insulin resistance occurs. In this situation, starting the pancreas to secrete insulin in an even larger quantities, resulting in hypoglycemic disease.

As a result, we have the following chain: physical inactivity, obesity, and abundance in the diet of fatty foods lead to insulin resistance of body tissues. Insulin resistance leads to hyperinsulinism (hypoglycemia). A hyperinsulinism is a cause of hypertension, dyslipidemia, atherosclerosis, coronary heart disease and diabetes type 2. Thus developing metabolic syndrome.

World medical practice suggests that metabolic syndrome is a major factor in the extreme aggravation of these pathologies, raising their overall risk. Metabolic syndrome, sick almost every fifth person aged and elderly vozrasta.Poetomu today so it is important to diagnose early and effective treatment.

Markers of metabolic syndrome: abdominal obesity, hypertension, dyslipidemia. All these markers typically originate from the tissue to insulin resistance and hypoglycemia.

Metabolic syndrome consists of the following abnormalities:
- High blood pressure - more than 170/100 mm Hg. Art.
- Hyperlipidemia: increased concentration of fat in the blood (more than 1.72 millimoles / liter) and decreased concentration of HDL cholesterol - less than 0.9 millimoles / liter for men and less than 1 mmol / liter for women.
- Overweight: BMI - over 30 kg/m2, or the ratio of waist circumference to hip circumference greater than 0.9 in men and 0.86 in women.
- Hyper Albuminuria (concentration of albumin in the urine - a 0.02mg/ml).
- Insulin-dependent diabetes.

According to generally accepted rules of medical suffering from metabolic syndrome are at high risk of serious heart disease and circulatory system, as well as renal pathology.

Patients with metabolic syndrome to lead healthy lives, to establish a healthy food system with effective dietary supplements.

It should be noted that pharmacological drugs that are often used to control blockers in this situation are not welcome, because they exacerbate the imbalance of metabolism and provoke damage the glomerular apparatus of the kidneys and increase resistance to insulin.

Medicine today has detailed data on metabolism at the intracellular level, and allows you to regulate it in various diseases. Therefore, in recent years people are increasingly interested in various biologically active supplements containing active ingredients: fermentarnye substrates, amino acids, enzymes, cell membrane stabilizers, antioxidants, catalysts education RNA, DNA and other nucleic acids.

So now gaining popularity dietary supplements Tianshi Corporation, which are composed of vitamins, macro-and micronutrients, dietary flavonoids (fat eel Biotsink, Holikan, Biocalcium). Receiving the substance, the body is able to synthesize the most important structures that support health and normal activity (enzymes, peptides, neurotransmitters, nucleic acids, etc.).

Diabetes and Anemia

Diabetes mellitus is a chronic endocrine disorder characterized by disturbance of all types of metabolism on the background of an absolute or relative insulin deficiency. Metabolic disorders that occur with diabetes, negatively affect the state of internal organs, which is why diabetes mellitus often develops in such a state as diabetic nephropathy. One of the consequences of diabetic kidney disease is anemia that occurs in most patients with this disease. In this article we would like to tell about the causes, the importance and principles of treatment of anemia in patients with diabetes mellitus.

What is diabetes?
Diabetes is an endocrine disorder that is caused by absolute or relative deficiency of insulin. What does this mean?

Insulin - a hormone in our body, which regulates the exchange of carbohydrates (glucose) lipids and proteins. Insulin is produced by the pancreas in response to raise blood glucose levels (eg after a meal). Once in the blood, insulin is spread throughout the body, reacts with the cells and enables you to capture and process glucose. Thus, insulin lowers blood glucose and tissue nutrition (some tissues of the body is not able to capture in the absence of glucose, insulin). The cause of diabetes is insulin deficiency. Insulin deficiency may be

absolute - that is, the pancreas produces too little insulin (or not produce it). Absolute insulin deficiency occurs in diabetes mellitus type I.

relative - when produced in normal amounts of insulin can not provide adequate glucose metabolism. This situation is observed in type II diabetes, when physiological amounts of insulin can not provide the decrease in blood glucose levels due to reduced tissue sensitivity to insulin itself (this phenomenon is called insulin resistance).

Why diabetes leads to kidney impairment?
With inadequate treatment and long-term increase in blood glucose levels, diabetes leads to significant damage of internal organs. The first of diabetes affects the small blood vessels of arterioles and capillaries that feed blood, all organs and tissues of the body. In patients with diabetes (long-term preservation of high blood glucose levels) the walls of the arterioles are saturated fat and carbohydrate complexes, which in turn leads to cell death in the walls of these vessels is the widening of the connective tissue in them. The affected arterioles are closed, and fed their body begins to suffer from lack of oxygen and nutrients. Renal disease in diabetes (diabetic nephropathy) is developing by this mechanism. Massive destruction of the renal vessels with diabetes leads to the death of a working kidney tissue and replacing it inactive connective tissue. With the development of nephropathy, the kidneys gradually lose the ability to filter blood and form urine - with chronic renal failure. Today, more than half of all cases of chronic renal failure caused by the problem of diabetes.

What relation to diabetes has anemia?
Anemia is a condition in which blood is reduced red blood cells and hemoglobin.

As you know, in our body blood cells are formed in the bone marrow. However, for the red marrow was working, he should get a definite signal in the form of the hormone erythropoietin. Erythropoietin is produced by special cells in the kidneys. In diabetic nephropathy (see above) not only kills kidney cells involved in blood filtration, but also the cells that produce erythropoietin, so in conjunction with chronic renal failure in diabetic patients develop anemia (lack of erythropoietin leads to the termination of the bone marrow).

In addition to lack of erythropoietin in the pathogenesis (development) of anemia in patients with diabetes is the role of iron deficiency and chronic protein loss accompanying renal failure.

What is the impact on the state of anemia in patients with diabetes? According to recent research, for chronic renal failure that developed against the background of diabetic nephropathy complicated by anemia in more than half the cases.

Anemia significantly reduces the quality of life in patients with diabetes mellitus. Against the background of anemia a decrease in appetite, physical abilities, intellectual, and sexual function of patients. People with diabetes with anemia are at greater risk of developing cardiovascular disease, as is likely, anemia is an independent factor contributing to the malfunction of the heart and blood vessels.

How to carry out the treatment of anemia in patients with diabetes? Unlike the cases of anemia caused by iron deficiency or vitamin (iron deficiency anemia, anemia with a deficit of vitamin B12 and folic acid), and anemia that occurred against the background of renal failure in patients with diabetes, not only to treat vitamin and mineral preparations and without adequate treatment can take a very severe form.

How to carry out the treatment of anemia in patients with diabetes?
Given that the main factor in the development of anemia in patients with diabetes is a lack of erythropoietin in its treatment used medications containing erythropoietin.

Erythropoietin - a complex organic compound of the carbohydrate-protein nature. Carbohydrate component of the molecule of erythropoietin may be of two types: alpha and beta (hence the name drug erythropoietin). Erythropoietin for anemia treatment with recombinant get it, that is to synthesize a bacteria, which were introduced human genes that encode the structure of erythropoietin. During the preparation of drugs erythropoietin treatment is repeated, which allows to minimize the incidence of adverse reactions.

Diabetics with diabetic nephropathy should enter with a decrease in erythropoietin hemoglobin level below 120 g / l (ie, early anemia), the ineffectiveness of other treatments (eg, iron). Early treatment with erythropoietin can slow the development of angiopathy (damage small blood vessels), and, consequently, renal disease, which improves the prognosis of the disease and facilitate its flow.

Patients with diabetes, erythropoietin is administered in two ways: intravenously and subcutaneously. Standard injection frequency - 3 times a week. Recent studies in the treatment of anemia in patients with diabetes showed that subcutaneous injections of erythropoietin is not as effective as intravenous, which greatly simplifies the process of treatment (patients can self-perform the injection), and the frequency of injections can be reduced to 1 time per week, subject to the introduction of triple dose.

To increase the effectiveness of treatment of anemia in patients with diabetes, injections of erythropoietin supplement with iron.

Prevention of anemia in patients with diabetes mellitus
We have already mentioned that the diabetic nephropathy, chronic renal failure and, consequently, anemia, most often develop in diabetic patients not taking medication or in patients whose treatment does not ensure the maintenance of normal blood glucose levels. Therefore, the main measures to prevent anemia in patients with diabetes are:
• Earlier access to a doctor at the first symptoms of diabetes, or immediately after the detection of diabetes through a blood test;
• Strict adherence to prescribed treatment (antidiabetic drugs, insulin) and diet in the first days of illness;
• Regular self-monitoring: checking blood glucose levels, the correction of the treatment regimen with your doctor.
• Avoid bad habits - can significantly reduce the risk of cardiovascular disease and diabetes makes it easier for;
• Weight loss (for obese people) - can not only relieve for diabetes, but also to remove it. In addition, weight loss has a positive effect on the course of other diseases related diabetes (hypertension, coronary heart disease, etc.);

In Western countries, diabetes has long ceased to be considered "incurable disease" or "sentence". Thanks to modern possibilities of control of blood glucose (insulin preparations, antidiabetic drugs) diabetes was seen as a "special way of life", not a disease. Indeed, compliance with treatment regimens and streamlined diet can compensate for a lack of insulin for decades, without causing any complications of diabetes.

Treatment of anemia in patients with diabetes should be mandatory, since anemia is not only lowers the quality of life in patients with diabetes but also accelerates the development of the disease and its complications. At the moment the main problem of drug use erythropoietin to treat anemia in patients with diabetes is a high cost of drugs themselves.

Diabetic Foot Treatment

1. Normalization of carbohydrate metabolism.

The majority of patients with ulcerative lesions stop marked hyperglycemia, and one of the conditions conducive to healing, is to normalize blood glucose levels. Keep in mind that in infectious inflammation and fever in patients with diabetes type 1 require higher doses of insulin.

Diabetes type 2 in inadequate compensation for the background diet and taking tablets recommended transfer to insulin therapy in non-healing ulcers of the foot.

2. Treatment of diabetic neuropathy and angiopathy.

Apply non-pharmacological (diet, etc.) and drug therapies, as set out in the thematic sections of diabetic neuropathy, treatment of diabetic neuropathy, atherosclerosis and coronary heart disease, coronary heart disease, clinical nutrition and atherosclerosis.

Of great importance is the normalization of blood pressure with concomitant hypertension and slow progression of the complications of diabetes like nephropathy.

These areas of treatment are interrelated, although each has its own peculiarities. Thus, it is a difficult task effects on different mechanisms for development, but, in some degree, interdependent co-morbidities and complications of diabetes. Particularly difficult choice of only those necessary and demonstrably effective drugs, which would preclude excessive medical treatment, leading to drug overload the body and excessive material costs.

Therefore, patients should not self-medicate based on information received from the media - popular magazines, newspapers, and radio and television.

3. Unloading of the affected limb.

In the past, patients recommended increasing physical activity in relation to the concept of leadership in the development of vascular diabetic foot.

Currently, discharge of the affected limb or part of it is considered a prerequisite of treatment of purulent-necrotic lesions in all forms of diabetic foot problems of any severity. Lack of, or at least limit load reduces inflammation and swelling, slows the growth of corns around the ulcer, increasing the regenerative processes in tissues. Unloading of the affected limb is particularly effective for neuropathic ulcer of the foot.

Increased physical activity is shown for ischemic, and partly neuroischemic form of diabetic foot (with no necrotic effects). In this case, dosed walking in combination with aspirin can reduce the pain of movement.

Enforcement of unloading is not always easy to be done. Preferred almost complete abandonment of walking and maintaining an elevated position of the limbs. However, bed rest is applicable only for a short period of time and only in some patients. A simple method of unloading is the use of crutches, but for many patients, this method is difficult and affects the quality of life. More convenient for some patients is a wheelchair.

Permissible to use a special shoe that provides unloading of fingers or toes.

At home, like orthopedic device can be made out of old sneakers. Specialists of the St. Petersburg Diabetes Center are among the most effective ways to discharge under the application of bandages of ulcers from synthetic materials during solidification acquiring greater strength than plaster casts, but with less weight. An example of such material is tsellokast, which can be purchased at pharmacies. Studies conducted in several countries indicate a decrease in the duration of treatment of diabetic foot ulcers (4-8 weeks) when using this method. However, in the form of ischemic lesions of the lower extremities, this method of treatment should not be used.

After healing, the ulcer treatment discharge, or at least limiting distance shall be maintained for 2 - 4 weeks. It is necessary to create conditions for the restoration of full tissue in place of the former ulcer.

4. Local treatment of ulcers involves the removal of (most often with a scalpel), hyperkeratosis and corns around the ulcer in order to reduce pressure on the affected area. Another method of local treatment is the removal of necrotic, nonviable tissue as a source of infections and toxins, and the healing is stimulated.

For moist ulcers using moisturizing dressings, dry - dry.

In the first phase of wound healing dressings are used for dampening solutions furatsilina, yodovidona, yodopirona, chlorhexidine, dioksidina, lavasepta or other antiseptic.

Do not use this alcohol solutions, including cologne, iodine tincture, "manganese", "green fodder," hydrogen peroxide

The frequency of dressings depends on the amount of discharge from the ulcer - usually 1 - 2 times a day. In the second phase of wound healing (after cleansing ulcers) use a variety of wound coverage (based on collagen), oil (sea buckthorn, shipovnikovoe oil) and hydrogel dressings. The patient and his household should learn how to make dressings for ulcers.

5. Antimicrobial drug treatment. Used mainly antibiotics, type, route of administration, dose and duration of which is determined only by a physician, based on the severity of the process and speed healing of ulcers.
However, patients should have some understanding of the principles of antimicrobial therapy of diabetic foot syndrome, namely:

Prophylactic antibiotics is not appropriate for long-existing ulcers, and even I II degree (see table diagnostic criteria for different forms of diabetic foot syndrome in the thematic section neuroischemic form on an information portal on vital diabetunet.ru) in providing local care, discharge in the absence of foot and signs of intoxication of the infectious process;

Antibiotics should have a broad spectrum of antimicrobial action, since the majority of infections in ulcers associated with several types of microbes. For a correct choice of antibiotic is desirable laboratory to determine the sensitivity to it of microbes isolated from affected tissues;

For ulcerative lesions without involvement of bone or joint and marked signs of intoxication acquitted of infectious oral antibiotics for 7 - 14 days. In a severe infectious process antibiotics administered intramuscularly or intravenously. From the set used for diabetic foot ulcers, antibiotics to select-amoksiklav, azithromycin (sumamed), moxifloxacin (aveloks) tsiprofloksvtsin (tsifran), ertapenem (invanz).

At the same time we note once more - the choice of antibiotic in each case decides physician.

Nor can we ignore the financial side of choice due to the cost of new imports of antibiotics;

Complications of antimicrobial therapy is most common intestinal bacteria overgrowth - the disruption of its micro-organisms.

For the prevention and treatment of intestinal dysbiosis probiotics and prebiotics are used relating to the biologically active additives to food or drugs.

Another complication of treatment with antibiotics are fungal infections of the mucous membranes of the mouth, intestines, vagina. As antifungal agents used for systemic effects of fluconazole (Diflucan, diflazon), which suppresses the most common cause of fungal infections - yeast-like fungi Candida genus.

If the vaginal fungal infection in women using natamycin (pimafutsin) - topically in the form of suppositories and oral.

6. Surgical treatment.

In severe lesions of the lower extremities, which are not disposed of the above therapeutic methods of treatment, surgical intervention is necessary - removal (amputation) of non-viable limb to save the remaining part of it and / or the patient's life.

Surgical techniques used for the restoration of blood flow in severe limb ischemia, as well as for the closing of large tissue defects with the use of plastics at the expense of their own or artificial skin.

To surgery also includes excision and vaporization of the affected tissue with a laser beam further grafting the wound with local tissues.

Diabetes Mellitus as a Cause of Blindness

Diabetes - a disease characterized by impaired endocrine metabolic processes of the body. One of its complications - is diabetic retinopathy (damage of the retina).

The prevalence of diabetic retinopathy is 90% of those with diabetes type I and 38.9% of those with diabetes type II.

The cause eye damage in diabetes
With prolonged and uncompensated (when higher than normal sugar), diabetes, retinal damage occurs - diabetic retinopathy.

What are the causes of this disease?
In diabetes disturbed metabolism of carbohydrates (sugars) and fats (triglycerides and cholesterol). These substances are not absorbed by the body for a long time and remain in the blood, damaging the lining of blood vessels (endothelium). As a result of microvascular damage - in the past formed clots, narrowing their clearance and as a result, there is a lack of oxygen to tissues and organs (called ischemia). If ischemia persists for a long time, irreversible changes in the affected organs - they atrophy (if there was a gradual decrease in blood flow) or infarction (with a sharp decrease in blood supply to any part or organ). In the body there is a compensation mechanism of ischemia - education about the blockage of new blood vessels. But the problem is that the newly formed vessels are not full - their walls thin, endothelial lining with defects that lead to undesirable consequences:

- Swelling of tissue due to passage through the vascular wall of blood plasma
- Bleeding in the retina (even with a slight increase in blood pressure)
- The deposition in the tissues of organic matter (formation of hard exudates)
- Retinal detachment
- Bleeding into the vitreous

The manifestations of diabetic retinopathy:
- Gradual reduction of vision is not improving after spectacle correction

- The appearance of dark spots in the field of view

- A sharp sudden decrease of
Diagnosis of Diabetic Retinopathy:
- Ophthalmoscopy (fundus examination) can detect retinal edema, exudates, microbleeds on the retina, vitreous hemorrhage, the newly formed blood vessels.

Fluorescence angiography (study of blood flow to the retina) reveals the ischemic zone, the newly formed blood vessels, retinal vascular occlusion.
- Optical coherence tomography - at the cellular level defines the retinal lesions.
Treatment of diabetic retinopathy:
Drug treatment is carried out ophthalmologist in an outpatient or inpatient setting and has the following objectives:

1. compensate for diabetes - when blood sugar levels will be kept at a high level, there is no long-term effect of treatment should be expected. For this purpose, appointed by the consulting endocrinologist.
2. Improve blood flow through the vessels of the retina
vasodilators Pentoxifylline (Pentoxifylline)
Antiplatelet Acidum acetylsalicylicum (Aspirin)
3. Antioxidant therapy:
Vitamin E
Methylethylpiridinol (emoksipin)
4. Angioprotective therapy (medicines strengthen the vascular wall)
Acidum Ascorbicum (Vitamin C)
Etamsylate (etamzilata)
5. Improvement of metabolic processes of the retina (retinal preparations containing the necessary trace elements and vitamins)
Retinalamin
Trimethylhydrazinium propionate (Mildronate)
Wobenzym

Surgical treatment is performed in a hospital:
Laser coagulation of the retina - is to reduce the swelling of the retina. Is to apply laser-coagulants on the retina - formed through the pores of the liquid, creating a swelling of the retina, an additional outflow of preretinalnoe space.

- Injection drug (Avastin, Lucentis) in the vitreous. These drugs at the molecular level, blocking the vascular growth factor, preventing the appearance of newly formed blood vessels, contribute to the disappearance of already appeared.
- Surgery on the retina - vitrectomy is used when the long-term absorbable hemorrhages into the vitreous.

Diabetic retinopathy is a terrible complication, potentially leading to complete blindness. For the treatment of this disease requires constant monitoring of blood sugar and blood cholesterol, maintaining blood pressure within normal limits and timely assistance ophthalmologist. If exposed to diagnose diabetic retinopathy, the ophthalmologist inspections should be carried out at least 2 times a year.

Diabetic and Sweetener

Sweeteners are very similar in substance to the purpose, but belonging to different groups. Such a separation due to the fact that sweeteners have some nutritional value as a source of energy for the body, such as sweeteners do not have.

Sweeteners are used patients with diabetes mellitus, as well as the combination of diabetes with obesity to sweeten food because many people find it very difficult to limit myself of the habit is sweet. If there is no craving for sweets, you need a sweetener or sweeteners disappears.

Sweeteners

To substitute sugar include fructose and sugar alcohols different (polyols), mainly xylitol and sorbitol. Fructose is the same nutrients as glucose and sucrose (ie, sugar) but, unlike them, requires for its absorption of smaller amounts of insulin. Fructose is absorbed from the intestine more slowly than glucose, but more rapidly undergoes oxidation in the liver, which leads to a smaller increase in blood glucose levels after meals.

However, fructose absorption from the intestine is significantly increased when it is consumed along with other sugars or starches, such as fructose in the honey, or drink with fruit along with the bread. The consumption of one of its fructose glycemic index, which characterizes the increase in blood glucose levels, approximately 4 times lower than the glycemic index after ingestion of glucose. However, the glycemic index of honey, in which fructose is nearly 40%, only slightly inferior to the glycemic index of glucose.

For the same caloric and sugar fructose is sweeter than a factor of 1.7 and therefore used in smaller doses, thus reducing caloric different foods and dishes, as well as the need for insulin. The sweetness of fructose is especially noticeable in cold and acidic drinks and expressed little if added to hot dishes. Fructose in an amount not to exceed 30 - 40 grams per day is used for patients with diabetes, and 20% fructose adopted must be considered in the carbohydrate composition of the diet. When consumption of 30 grams of fructose per day it will be half the "bread of unity" (6 g carbohydrates). Excessive consumption of fructose (40 g) can cause flatulence, diarrhea, as well as disrupt fat and purine metabolism - increase blood levels of triglycerides and uric acid. Recent side effects limit its use of fructose in the diet of diabetics, especially type 2, as well as the presence of metabolic syndrome.
 

In the diet therapy of diabetes, coupled with obesity, fructose is not recommended because of its caloric: 1 g of fructose yields about 4 calories. However, when choosing between sugar and fructose preference should be given to the latter. If you can not replace hypoglycemic states receiving glucose or sugar fructose, as it is slowly absorbed from the intestine. Thus, the question of the use of fructose in diabetes mellitus is ambiguous, since it has both positive and negative sides.

"Fruit" - a mixture of fructose and vitamin C, which makes it more useful - it is used in the same doses and under the same conditions as conventional fructose, but 20 g fruktovita provides almost daily rate of demand for vitamin C. Xylitol (ksilisorb) and sorbitol - natural sugar alcohols are solid, well- soluble in water.
They have a caloric close to that of glucose or fructose, 1 g of xylitol yields about 4 calories, 1 g sorbitol 3.4 calories. For sweets xylitol is sugar, sorbitol, almost half as sweet. They can be used for hot food handling.
Xylitol and sorbitol are used in diabetes, at least - in obesity, and in connection with a light and choleretic laxative action (30 g PCP) - chronic cholecystitis with bile stasis and constipation. Preferred method of xylitol - up to 30-40 grams per day, for 2 - reception (drinks and desserts).

When excess consumption (40 g), xylitol and sorbitol have an adverse effect on the gastrointestinal tract, causing a rumbling, bloating, heaviness in the stomach, diarrhea. Currently, many countries in the production of dietary products for patients with diabetes, at least - for immediate consumption, use of new sweeteners from the group of sugar-alcohols: maltitol, isomalt, lactitol, erythritol.

If the sweetness of sugar to take the unit (1.0), the sweetness of maltitol (maltisorba) and izomaltita (palantinita) is equal to 0.65 and 0.45. Caloric 1 g maltitol or izomaltita 2 kcal, that is 2 times less than sugar or xylitol, which enhances their use in diabetes mellitus type 2 with obesity. Daily consumption of sweeteners is limited to 30 grams in order to avoid disorders of the intestine. Lactitol 2.5 times less sweet than sugar. Caloric 1 g lactitol is 2 kcal.

After receiving lactitol blood glucose level is almost not increased. If the glycemic index of glucose taken as 100, the glycemic index of maltitol is equal to 35 Xylitol - 13, and lactitol - 6. In addition, lactitol has the properties of prebiotic - it stimulates the growth of beneficial bacteria in the colon. Daily consumption of lactitol can be up to '20 By caloric, and the effect on blood glucose levels and prebiotic properties of erythritol is close to lactitol, but it is sweeter.

Erythritol is intended mainly for the production of low-calorie diet products.