COVID-19 has been accepted as a Pandemic by the World Health Organization and has affected the whole world. The disease can be more severe in the elderly, individuals with hypertension, heart disease, obesity and diabetes. .
- HOW DOES COVID -19 AFFECT INDIVIDUALS WITH DIABETES?
It has been determined that the COVID-19 virus triggers infection and stress in individuals with diabetes, causing blood sugar levels to rise more. Hyperglycemia management is very important in individuals with diabetes, since the immune system is more affected when the blood sugar levels of individuals with diabetes fluctuate or are constantly high.
- WHAT ARE THE MEASURES TO BE TAKEN?
- Individuals with diabetes should follow nutrition, medication and exercise treatments for blood sugar control.
- Type 1 diabetics should definitely monitor ketones in the urine along with blood sugar monitoring.
- Glucometer-strips and ketone meters should be available to monitor blood sugar at home.
- If they are at risk of hypoglycemia and are too depressed to provide adequate food intake, foods containing sufficient amounts of simple carbohydrates, such as honey and jam, should be kept near the patients to increase blood sugar.
- Since there is a risk of weight gain with less movement in gestational diabetes (gestational diabetes), a balanced and adequate diet should be accompanied by adequate physical activity.
- It should be aimed to reach the ideal weight in obese diabetic individuals.
- If there is a lack of vitamins and minerals, the deficiency should be corrected.
- HOW SHOULD MEDICAL NUTRITIONAL TREATMENT (TBT) BE TAKEN FOR INDIVIDUALS WITH DIABETES?
Medical nutrition therapy is the most important part of the treatment for the prevention and treatment of diabetes and the delay and treatment of diabetes-related complications.
- CARBOHYDRATES:
Low glycemic index and slow release carbohydrates (complex carbohydrates) should be preferred to minimize the effect on blood sugar level. 45-60% of daily energy should consist of carbohydrates.
Whole wheat or wholemeal bread should be preferred instead of white bread. Bulgur instead of rice, whole wheat or wholemeal pasta should be preferred instead of white pasta. Fruit, vegetables and low-fat dairy products should be included in your daily diet.
- PROTEINS:
A diet low in protein causes weakening of the immune system and an increased risk of infectious diseases. Adequate protein intake supports optimum antibody production and immunity. Some studies support the beneficial effects of high-protein diets on glycemic control, insulin resistance, and maintenance of lean body mass in diabetic persons. It is recommended to meet 15-20% of the daily energy (0.8-1 g/kg/day) from proteins (meat, egg, cheese, milk, yogurt).
- OILS:
Individuals with diabetes are more exposed to oxidative stress. Therefore, it is important to consider the quantity and quality of fatty acids in the diet, especially during infections and inflammatory conditions. In addition, fat is absolutely necessary for the absorption of fat-soluble vitamins into the body. Olive oil would be a useful choice. Solid fats and trans fats should be avoided.
- OMEGA 3:
It is known that omega-3 fatty acids have antioxidant effects and support the immune system. It is recommended to increase the foods containing long-chain n-3 fatty acids (EPA and DHA) considering the beneficial effect on lipoproteins and the preventive effect on heart disease for individuals with diabetes. Care should be taken to consume two or more servings of fish per week.
- POA AND PREBIOTICS:
It is seen in studies that adequate fiber intake from foods (prebiotics such as beta glucan, FOS) can help through a direct effect on the intestinal microbiota and strengthen the immune system. Include fiber-containing legumes, whole grains, fruits and vegetables in your daily diet. Consume the skins of fruits and vegetables without peeling them.
- WHICH VITAMIN-MINERALS SHOULD BE ATTENTION TO IN DIABETES?
- B 9 AND B 12:
It is known that diabetic patients using metformin are more prone to folate and vitamin B12 deficiency due to food-drug interactions. Low serum folate and B12 levels in type 2 DM patients are associated with low circulating glutathione and total antioxidant status. Nuts, chicken and liver are foods rich in folate. Foods of animal origin (meat, milk, eggs, chicken) are foods rich in B12.
- VITAMIN D:
Vitamin D has the effect of stimulating insulin secretion and reducing peripheral insulin resistance through vitamin D receptors in the muscle and liver. It has been reported that the risk of infection increases in individuals with vitamin D deficiency during the pandemic period, and there is a significant inverse relationship between serum 25-OH vit D level and covid-19 severity. Foods such as egg yolk, liver, fish oil, milk, ayran, kefir, cheese, yogurt, oats, parsley are rich in vitamin D.
- C VITAMIN:
There is evidence that vitamin C deficiency is more common in patients with diabetes. In addition, the protective effects of vitamin C against oxidative damage in diabetes are known. Foods such as lemon, orange, tangerine, grapefruit, kiwi, strawberry, pepper, tomato, parsley, arugula are rich in vitamin C.
- VITAMIN E:
Studies have shown that patients with vitamin E deficiency are more susceptible to viral infections and have lower immune system responses. Broccoli, pumpkin, celery, banana, kiwi, avocado, walnuts, hazelnuts, almonds, sunflower seeds, pumpkin seeds are foods rich in vitamin E.
- ZINC:
In general, zinc supplementation has the potential to reduce the incidence and severity of Covid-19, especially in high-risk groups such as DM, children and the elderly. Fish, red meat, milk, eggs, almonds, walnuts, pumpkin seeds are foods rich in zinc.
- SELENIUM:
Low selenium levels are associated with lower immune function and an increased risk of mortality. It has been reported that high levels of serum selenium reduce the prevalence of diabetes as well as its chronic complications. Selenium supplementation may be a useful choice in the treatment and prevention of Covid-19, as diabetic patients are susceptible to low antioxidative levels. Fish, red meat, chicken, turkey, eggs, rice, beans, mushrooms, whole grain foods are rich in selenium.
