The requirements for 1 type diabetics focus on grasping the mutual balance among insulin, diet and activity, and flexibly adjusting insulin, diet and meal times according to the increase or decrease of activity.
The key requirement for type 2 obese patients is to limit the intake of total calories in diet, so as to reduce weight and improve insulin sensitivity, thus improving clinical symptoms.
Diet therapy is one of the basic treatment measures for type 2 diabetes. In the treatment of diabetes, 70% ~ 80% of the problems are related to the quality of diet control [1], so it is very important to give dietary guidance to diabetic patients. From 2003 1 month to July 2004, 48 patients with type 2 diabetes were treated in our department. Through systematic dietary guidance, patients actively cooperated to adjust their diet, and their condition was well controlled.
1 clinical data
Among the 48 patients, 25 were male and 23 were female, all of which met the diagnostic criteria of type 2 diabetes. The age ranged from 26 to 82 years, with an average of 56.8 years. The shortest course of the disease is 9 months, the longest is 1 1 year, and the lowest fasting blood glucose is 6.7 mmol/L and the highest is 34 mmol/L. Complications: ketoacidosis in 4 cases, diabetic foot in 2 cases, hypertension 16 cases and hyperlipidemia in 29 cases.
2 methods
2. 1 evaluation
After the patient was admitted to the hospital, the nurse collected information, focusing on the following: (1) the patient's condition, course of disease and previous treatment; (2) Living habits of patients, such as diet, activities and hobbies; (3) economic conditions, education level, etc.; (4) Age, height, weight and body shape; (5) Understand the basic knowledge of diabetes and master the prevention and treatment skills.
2.2 Develop a diet plan
Nurses provide the evaluation data to the competent physician, so that the physician can formulate the drug and diet treatment plan. However, nurses should master the calculation of dietary calories of diabetes mellitus. The traditional method is to calculate the total daily calories according to the standard weight of patients and the nature of work. It can also be calculated according to the formula of heat energy requirement established by Tang Dahan et al. [2], that is, e (kcal) = [(h-a) × 6 500 ÷ WI2 ]× AF× CF. According to this formula, the older you are, the higher your weight is, and the lower the calories required for the calculation results. This calculation is more reasonable and more in line with the individualized needs of patients.
2.3 Calculation of food intake and distribution of three meals
After determining the total calories, the three major nutrients (carbohydrate, protein, fat) are reasonably matched. At present, who and idf advocate that the proportion of carbohydrates should be appropriately relaxed under the premise of total calorie restriction. Carbohydrates in diet can account for 55% ~ 65% of total calories [3], protein accounts for12% ~15%, and fat accounts for 25% ~ 30%. Under normal circumstances, according to the above-mentioned ratio, the intake of fat and protein should be reduced as appropriate in cases of hypertension, hyperlipidemia and nephropathy, and the amount of food for three meals should be allocated according to1/5, 2/5 and 2/5.
2.4 Dietary guidance
One-on-one individual guidance method is adopted. Guidance content: (1) explain the importance of diet regulation, and inform patients that diet control is the basic treatment method for diabetes, which should be strictly implemented and persisted for life regardless of the severity of the disease, whether there are complications or not, and whether medication is used or not. (2) For patients with literacy, teach them to calculate the daily calories needed and convert the amount of food needed. For patients with illiteracy or poor understanding, we guide their families to convert. (3) Guide patients and their families to choose and match food types reasonably, including carbohydrates, protein, fat, cellulose, minerals and trace elements, salt, etc. (4) If you don't feel full, you can appropriately increase vegetables and fruits with sugar content within 5%. (5) Eat according to the quantity on time, and eat within half an hour after insulin is used to prevent hypoglycemia. (6) Keep some emergency foods in stock for low blood sugar.
2.5 diet management
After the implementation of the diet treatment plan, nurses should always supervise and inspect the implementation of patients, understand the types and quantities of food eaten by patients, ask patients whether their appetite is normal, whether they feel hungry, etc., and report to the competent physician in time if they have indigestion or anorexia, so as to adjust the treatment plan. Educate patients to do a good job of self-management, in addition to adhering to the principle of diet at ordinary times, they should also refrain from eating at dinner, socializing and being advised by others.
3 results
Of the 48 patients in this group, 39 have basically mastered the knowledge of dietotherapy, understood the importance of dietotherapy, and knew how to calculate the daily total calories, recipe collocation, etc. 9 cases have not mastered the relevant methods because of their older age and poor thinking ability, but their families can also master the corresponding knowledge. The blood sugar of 48 cases decreased and stabilized in the normal range.
4 experience
4. 1 Diet control should be gradual.
Dietary therapy for diabetes needs lifelong persistence. Therefore, when making a treatment plan, patients with a large amount of food in the past should be gradually reduced according to their previous diet, so that patients can adapt to the process and make them easy to accept and persevere.
4.2 recipes should be flexible.
Under the premise of strictly controlling total calories, according to patients' eating habits, patients' dietary preferences should be satisfied or as far as possible. In addition to avoiding eating nutritional sweeteners such as white sugar, brown sugar and sweet drinks, other food types should not be too limited, so that patients can enjoy a diet close to normal people, which can improve patients' compliance and persistence in dietary treatment.
"Six Suitable Diets and Three Unsuitable Diets" for Diabetic Patients
Nutrition experts have prescribed healthy recipes for diabetics.
Nutrition experts in the General Hospital of Lanzhou Military Region believe that, first of all, diabetics are forbidden to eat sweets and many kinds of fruits, because glucose and sucrose are digested and absorbed quickly, which will increase blood sugar after eating; Also eat less foods with high carbohydrate content, such as sweet potatoes, potatoes, lotus roots, etc. It's best not to drink either.
People with diabetes can eat more high-fiber foods to promote the body's sugar metabolism. Such as corn, wheat, Chinese cabbage, leek and bean products.
Vegetables with low sugar content. Such as leek, zucchini, wax gourd, pumpkin, green vegetables, green peppers and eggplant. Tomatoes, on the other hand, have low sugar content, so they can be used as both vegetables and fruits.
Eat more foods containing calcium. Calcium deficiency can aggravate the condition of diabetic patients. Such as shrimp skin, kelp, ribs, sesame sauce, soybeans, milk and so on.
Foods rich in selenium. Selenium has the same physiological activity as insulin in regulating glucose metabolism. Such as fish, mushrooms, sesame, garlic, mustard, etc., which can lower blood sugar and improve the symptoms of diabetes.
Foods rich in vitamin b and vitamin C. Supplementing these two elements is conducive to slowing down the process of diabetic complications and alleviating diabetic retinopathy and nephropathy. Such as fish, milk, cabbage, beans, green vegetables, mustard greens, kale, green peppers, fresh dates and so on.
In addition, pumpkin, bitter gourd, onion, rice field eel, etc. can obviously improve patients' symptoms of drinking more, eating more and urinating more, and have the functions of lowering blood sugar and regulating blood sugar concentration, so they are suitable for eating more.
Main points of application of diet therapy
(1) Diet therapy is the basic therapy for diabetes, and it is the premise of all treatment methods, and it is suitable for all types of diabetes patients. Mild cases can get good results mainly by diet therapy, and moderate and severe patients must also apply physical therapy and drug therapy reasonably on the basis of diet therapy. Only when the diet is well controlled, oral hypoglycemic drugs or pancreatic islets can play a good role. Otherwise, it is difficult to achieve good results in clinic by blindly relying on so-called new drugs and medicines and ignoring diet therapy.
(2) Diet therapy should be adjusted and mastered flexibly according to the condition. Thin patients can relax appropriately to ensure the total calories. Obese patients must strictly control their diet and give priority to a low-calorie fat diet to lose weight. For those who are treated with insulin, we should pay attention to adding meals at 9 ~10 am, 3 ~ 4 pm or before going to bed as appropriate to prevent hypoglycemia. Attention should also be paid to appropriately increasing staple food or meals when manual labor or activities are long.
(3) Diet therapy should be scientific and reasonable, not too much and too little. That is, you can't be subjective and arbitrary, you can't be too strict, and you dare not eat any carbohydrates. On the contrary, it will aggravate your condition and even appear ketosis. We should calculate strictly according to our own condition, weight and height, and arrange our diet scientifically and reasonably under the premise of controlling the total calories, so as to meet the minimum needs of the human body and control the total calories.
(4) Arrange staple food and non-staple food scientifically, and don't just pay attention to staple food and despise non-staple food. Although staple food is the main source of blood sugar and should be controlled, some protein and fat in non-staple food can also become blood sugar and become the source of blood sugar. In metabolism, 58% of protein and 58% of fat become glucose. Too much of this kind of non-staple food can also make people gain weight, which is not good for their illness. Therefore, in addition to reasonably controlling the staple food, non-staple food should also be reasonably matched, otherwise the expected effect will not be achieved.
(5) It is also very important to control diabetes by choosing foods suitable for diabetic patients. Attention should be paid to the following two points:
(1) should not eat food are:
ⅰ。 Foods easy to raise blood sugar rapidly: white sugar, brown sugar, rock sugar, glucose, maltose, honey, chocolate, toffee, fruit candy, preserves, canned fruits, soft drinks, fruit juice, sweet drinks, jam, ice cream, sweet biscuits, cakes, sweet bread and confectionery made of sugar.
ⅱ。 Foods that are easy to raise blood lipids: butter, sheep oil, lard, butter, cream and fat. For foods rich in cholesterol, special attention should be paid to them, and they should be used sparingly or not to prevent the occurrence of atherosclerotic heart disease.
ⅲ。 It is not advisable to drink alcohol. Because the alcohol contained in the wine contains no other nutrients and only provides heat energy, each gram of alcohol produces about 7 kilocalories (294 joules), which is harmful to the liver and easy to cause the increase of serum triglycerides. A few patients who take sulfonylurea hypoglycemic drugs are prone to palpitation, shortness of breath, red cheeks and other reactions after drinking. Note that patients with insulin drinking on an empty stomach can easily cause hypoglycemia, so it is better not to drink alcohol for the safety of patients.
2 Suitable foods: mainly foods that can delay the increase of blood sugar and blood lipid.
ⅰ。 Soybeans and their products: These foods are rich in protein, inorganic salts and vitamins, and there are more unsaturated fatty acids in soybean oil, which can reduce blood cholesterol and triglyceride, and the contained sitosterol also has lipid-lowering effect.
ⅱ。 Coarse miscellaneous sugar: such as naked oats flour, buckwheat flour, hot cereal and corn flour contain many trace elements, vitamin B and dietary fiber. Experiments show that they can delay the increase of blood sugar. Corn flour, bean flour and white flour can be made into three-in-one steamed bread, pancakes and noodles according to the ratio of 2: 2:1.If they are stopped for a long time, it will not only help reduce blood sugar and fat, but also reduce hunger.