Liberal diets in type I diabetes mellitus (Review of literature and authors’ data)

Abstract

The treatment options for insulin-dependent (T1DM) and insulin-independent (T2DM) diabetes mellitus are significantly different, although they have a number of common goals (eliminating the symptoms of hyperglycemia, minimizing the risk of hypoglycemia, and preventing micro- and macroangiopathies). The main method for the correction of hyperglycemia in T2DM is the normalization of body weight (BW) with a low-calorie diet and increased physical activity. With T1DM, the genesis of which is associated not with excess BW, but with autoimmune death of p-cells and insulin deficiency, insulin replacement therapy is the main treatment method, and dietary restrictions for T1DM patients, according to modern views, are auxiliary and should be prescribed only to the extent in which their insulin therapy is different from the physiological secretion of insulin. The fundamental principles of traditional diet therapy for T1DM have been critically reviewed in recent years. The most important requirement of traditional dietetics is the so-called "calorie balance"; hence, with an excess BW, a hypocaloric diet is usually recommended, with a deficiency of BW, a diet with a high calorie content, and with normal BW, one that guarantees the maintenance of BW. However, it has recently been proven that with normal BW, the lowest rates of morbidity and mortality are by no means always observed. In contrast, the highest expected life expectancy was found in individuals with relatively small excess BW. Based on this, patients with T1DM are unlikely to strive at all costs for a true "ideal weight". A diet with a reduced number of calories compared to a healthy person with the same physical activity cannot provide a patient with T1DM with a normal weight of sufficient physical performance. A deficiency of carbohydrates leads to an insufficient supply of energy to the body. In adults, this is manifested by a decrease in working capacity, in children - by a lag in physical development. In addition, insufficient intake of carbohydrates is accompanied by the emptying of glycogen depots in the liver and an increased risk of hypoglycemia. With a deficiency of carbohydrates, endogenous fats begin to be consumed as an energy source, which leads to acetonuria.