Prevention of diabetes - how to prevent the disease? Advice from a doctor and nutritionist

Estimates from the International Diabetes Federation (IDF) indicate that 537 million people worldwide will have diabetes in 2021 ^[1]. Up to 95% of diabetics are patients with type 2 diabetes - the type of diabetes that you can prevent. The best prevention is a proper diet and an active lifestyle. But what does it involve and how do you do it? In this article you will read how to start preventing type 2 diabetes today.

Diabetes - a disease of civilisation

Diabetes mellitus is a metabolic disease that manifests itself as hyperglycaemia, i.e. elevated levels of glucose in the blood ^[2]. Glucose is the main source of energy for the cells of the human body. Insulin, a hormone produced by the pancreas, helps glucose to enter the cells and use it as energy ^[3]. In people with diabetes (diabetics), their body does not produce enough insulin or does not use it properly. Glucose then remains in the blood and does not reach the cells.

Chronic hyperglycaemia associated with diabetes is associated with long-term damage, dysfunction and failure of various organs, including the eyes, kidneys, nerves, heart and blood vessels ^[4].

Metabolic diseases affect the body's ability to digest, absorb or utilise food and nutrients, leading to problems with energy, growth and other bodily functions ^[5]. Diabetes mellitus is an example of a metabolic disease ^[6] because it interferes with the normal conversion of food into glucose, which is the fuel for cells.

The term diabetes is derived from a combination of the Greek verb diabaínein, meaning 'passing through' and the Latin mellitus - 'sweet as honey' ^[7]. The combination of these words refers to excessive urine production and high blood and urine glucose levels in people with diabetes ^[8].

Types of diabetes

Diabetes mellitus is not a uniform disease and several types are distinguished. The most common forms of the disease are type 1 and type 2 diabetes, which are diagnosed based on strict criteria ^[9]. Approximately 5-10% of diabetics have type 1 and approximately 90-95% have type 2 ^[10,11].

Type 1 diabetes

Type 1 diabetes is an incurable autoimmune disease in which the immune system attacks and destroys the cells of the pancreas, responsible for producing insulin. Patients with type 1 diabetes must take insulin by injection for life. Type 1 is usually diagnosed in children and adolescents ^[12]. Genes and environmental factors are thought to influence the onset of type 1 diabetes ^[13]. The health of diabetics struggling with type 1 depends on constant co-operation with their doctor, taking set doses of insulin and following a strict diet.

Type 2 diabetes

Type 2 diabetes occurs when the body becomes resistant to insulin and sugar builds up in the blood. Current scientific evidence suggests that the incidence of type 2 diabetes is increasing due to inappropriate lifestyles, obesity and physical inactivity ^[14,15]. The disease is characterised by an asymptomatic period between the actual onset of diabetic hyperglycaemia and clinical diagnosis. It is estimated that this stage lasts at least 4-7 years, and 30%-50% of patients with type 2 diabetes remain undiagnosed ^[16]. Treatment consists of following an appropriate diet, reducing body weight (if it was too high), implementing physical activity and taking medication.

It is also worth mentioning the pre-diabetic state. This is the term used when blood glucose levels are high, but not enough to diagnose type 2 diabetes. It occurs when cells in the body do not respond to insulin as they should ^[17]. The pre-diabetic state may - but does not necessarily - lead to type 2 diabetes.

How to diagnose diabetes?

The primary screening test used to diagnose diabetes or pre-diabetes is the blood and urine glucose test ^[18]. The test is performed on an empty stomach, 8-14 hours after the last meal. The doctor may also order an oral glucose tolerance test (otherwise known as a glucose load test or sugar curve). Further diagnostic management is determined by the doctor on the basis of the results and the patient's history.

As a prophylactic health check, it is advisable to test blood and urine glucose levels once every six months. It is particularly recommended ^[19]:

• pregnant women,
• women with a history of gestational diabetes,
• people who are overweight or obese,
• when there is a family history of diabetes,
• when there is sudden weight loss, lethargy, fatigue, excessive urination,
• in conditions of hypertension, arterial disease, hypertriglyceridemia, dyslipidemia,
• women with PCOS.

Doctor Kacper Nihalani, adds:

Glucose levels fluctuate throughout the day. People who are prediabetic may have generally higher blood test results. Type 2 diabetes has three cardinal symptoms - excessive thirst, excessive appetite and excessive urination.

Diabetes prevention

Researchers estimate that as many as 592 million people will have diabetes in 2035 ^[20]. Unfortunately, type 1 cannot be prevented, but with medication, the right diet and lifestyle, you can function normally with the disease. However, you have a real impact on reducing

risk factors and the development of type 2 diabetes ^[21]. There are dietary and physical activity strategies that are great preventive measures.

Physician Kacper Nihalani comments:

'Unfortunately, our diet is made up of more and more foods rich in sugar and other high glycaemic index ingredients. Sport and physical activity helps our cells to take up glucose. Movement results in greater recruitment of the enzymes responsible for glucose transport into the cell, which increases the cells' sensitivity to insulin. Lack of exercise combined with the inappropriate composition of the modern human diet is causing more and more people to develop type 2 diabetes.

Diet

A well-balanced diet is a great preventive measure against the development of type 2 diabetes ^[22]. Maintaining a healthy body weight is key, as being overweight promotes the development of many diseases, including type 2 diabetes ^[23].

To prevent the development of type 2 diabetes, follow these 10 dietary principles:

• Take care of meal regularity. Consume 4-5 meals a day, preferably at equal intervals. Don't leave long gaps and cause severe hunger.Doing this will take care of the correct blood glucose concentration.
• Control your kilocalories. Eat as much as your daily calorie requirement to avoid weight gain.
• Eat fruit and vegetables. Try to include fruit or vegetables with a low glycaemic index in every meal. This is a serving of vitamins, minerals, antioxidants and fibre.
• Choose complex carbohydrates. Whole-grain bread, pasta, rice, coarse cereals, bran, among others, are best, as they contain a lot of valuable fibre ^[24] and are filling.
• Include healthy fats in your diet. Ensure sources of unsaturated fatty acids in your diet, especially omega-3 fatty acids. Eat oily fish (the best source of DHA and EPA), nuts, pumpkin seeds, avocado, olive oil. If you don't eat fish, consider supplementation.
• Give up harmful foods. Fast food, highly processed foods with high salt and sugar content are harmful and promote obesity, the onset of cardiovascular disease ^[25] and type 2 diabetes ^[26].
• Drink adequate amounts of fluids. Try to drink 30 ml/kg body weight of fluids per day. Ideally, this should be mineral water, but teas, infusions, smoothies or soups, for example, also count.
• Choose natural dairy products. Yoghurts, kefirs, milk, skyras or cottage cheese are good sources of protein and calcium. Don't eat 'coloured' fruit products, which often contain sugar or glucose-fructose syrup.
• Use proper cooking techniques. Opt for preparing meals by steaming, braising, baking rather than frying in fat.
• Avoid alcohol. Regular consumption of alcoholic beverages can lead to chronic diseases and obesity.^[27]

A large meta-analysis of 25 scientific studies that examined the effects of omega-3 fatty acids (DHA and EPA) on parameters related to the prevention or treatment of type 2 diabetes was published in 2021, with results suggesting that supplementation with omega-3 fatty acids may help in the dietary management or prevention of diabetes by reducing insulin resistance and fasting blood glucose levels ^[28].

Dietitian and personal trainer Marta Kaczorek adds:

'The Polish Diabetological Association recommends a Mediterranean, DASH, vegetarian or low-carbohydrate diet to improve the insulin sensitivity of body tissues. It is beneficial for health to eat carbohydrates with a low glycaemic index (e.g. raw vegetables), from whole grains (e.g. whole-grain bread), an adequate supply of proteins and fats, with an emphasis on monounsaturated and polyunsaturated fatty acids, which can be found in olive oil, rapeseed oil, sesame, avocado or nuts.

Physical activity

Current World Health Organisation guidelines for moderate physical activity are ^[29]:

• for children - 60 minutes per day,
• for adults up to 65 years of age - 150 to 300 minutes per week.

There is scientific evidence that regular exercise is associated with better wellbeing and health, and may even delay the onset of 40 chronic diseases ^[30]. How active are you? If you want to increase your activity levels, follow a few guidelines:

• Exercise and do the kind of activity you enjoy - walking, rollerblading, the gym, tennis or Nordic walking. You can also encourage your loved ones to get active (your dog in particular will be delighted!).
• Any activity counts. climbing the stairs, parking a little further away, getting off the bus a stop earlier, walking a longer route, getting up from your desk every hour - these small activities increase the amount of exercise you get throughout the day.
• Plan longer activities. When you have time at the weekend, plan longer hikes, walks, workouts or other activities where you spend active time.

Dietitian and personal trainer Marta Kaczorek adds:

Sport increases tissue sensitivity to insulin, has a positive effect on glycaemic control and glycated haemoglobin levels, has a beneficial effect on the lipid profile and helps reduce body weight. Every movement matters - a daily brisk 30-minute walk divided into up to three equal sessions is a great preventive measure against many diseases, including type 2 diabetes.

Lifestyle

In addition to a balanced diet and regular activity, take care of a hygienic lifestyle, viz:

• Adequate quantity and quality of sleep. Your body needs nutritional regeneration at night. Try to implement sleep hygiene principles to ensure uninterrupted and quality sleep.
• Stress reduction. You can't escape from stressors - noise, people, responsibilities or challenges in your life, but you can learn to deal with them skilfully. Take an interest in relaxation techniques and look after your mental health.
• Giving up addictions. Alcohol and smoking are detrimental to your health. Don't put off fighting your addictions, start reducing and eliminating them from today and in a few weeks your body will thank you.

Diabetes prevention - checklist

We'll help you organise your knowledge and give you tips on how to plan changes to prevent diabetes. Below is a checklist - plan to tick off tasks in small steps today:

• Schedule blood tests if you haven't had them in a while. In addition to a basic blood count, have your blood glucose checked. You can get a referral from your GP or have the tests done at a private facility.
• Add three vegetables and fruits you like to your shopping list. Try to eat one at each meal. After a while, vary your meals with new flavours.
• Look after your daily portion of healthy fats (fish, nuts, olive oil, avocado) or consider omega-3 fatty acid supplementation.
• Buy a bottle and control your water drinking. Try smoothies, shakes or soups - these are also great sources of fluids.
• Think about what activity you will enjoy and want to do regularly. Or maybe it's time to try something new? Try increasing your number of steps per day. A watch or phone with a step-counting app will help.

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