With the introduction of insulin and clinical research, the principles of nutritional treatment of diabetes have changed. In the past, diabetes was treated with a low-carbohydrate, low-calorie, high-fat diet, and patients were treated with semi-starvation therapy. Practice has proved that the dietary treatment of diabetes mellitus is not the lower the carbohydrate the better, but to appropriately limit calories and fat, increase the proportion of carbohydrates and protein. Combined with China's national conditions and years of clinical practice, the following dietary principles and requirements are proposed.
1. Control of total caloric energy
Reasonable control of total caloric energy is the first principle of diabetes nutritional therapy. The caloric supply of diabetic patients is appropriate to maintain normal body weight or slightly lower than normal body weight. For obese people, caloric intake must be reduced to reduce body weight, lower blood glucose, and improve glucose tolerance; for those who are emaciated or malnourished, caloric intake should be increased, and at the same time, protein supply should be increased to increase body weight (obese people refer to body weight ≥20% of normal value, and emaciated people refer to body weight ≤20% of normal value). Pregnant women, lactating mothers, and children need to increase their caloric intake to maintain their special physiological needs and normal growth and development. Therefore, the supply of calories should be determined according to the patient's condition, blood glucose, urinary glucose, age, gender, height, weight, labor intensity, activity level, and the presence or absence of complications. The caloric needs of men are higher than those of women, the elderly are lower than the young, and the more active are higher than the less active. Total caloric intake is appropriate to maintain or slightly lower than ideal body weight.
2. Carbohydrate supply
The main function of carbohydrates is to supply heat energy. If the supply of calories is sufficient, it can reduce the decomposition of protein and fat in the body, which is good for health; if the supply is insufficient, it is easy to cause ketonuria, which is not conducive to the control of the disease.
In recent years, experimental data show that, on the basis of reasonable control of calories, given a high carbohydrate diet, can improve insulin sensitivity, as for the increase in carbohydrate intake can make the serum triglyceride rise the problem of views are not unanimous. This is because fasting lipids are influenced by many factors, such as total dietary fat, saturated fatty acid content, total calories and other factors. It is believed that in diabetic patients, the elevation of fasting triglycerides caused by a high-carbohydrate diet is temporary, and once the disease is under control, serum triglycerides can be reduced. Currently, most advocate that dietary carbohydrates be increased to about 60% of total calories and that daily intake be limited to 250-300 grams. For those with normal body weight and using dietary therapy alone, carbohydrates should be controlled more tightly at the beginning, with 200 grams per day, which is equivalent to 250 grams of staple food. After a period of treatment, such as blood sugar drop, urine sugar disappears, can gradually increase to about 300 grams, equivalent to about 300 to 350 grams of staple food. For those who are treated with drugs, when the control of the condition is unsatisfactory, carbohydrates can be controlled at 200 to 250 grams, equivalent to about 250 to 300 grams of staple food; after the decline of urinary glucose and stabilization of the condition, it can be relaxed to 250 to 350 grams. It can be relaxed to 250-350 grams, which is about 300-400 grams of staple food. For light manual laborers, especially the elderly, the staple food generally does not exceed 300 grams. For obese people, carbohydrates can be controlled at 150 to 200 grams, equivalent to 150 to 250 grams of food. For those who use insulin, it can be appropriately relaxed. For those who are not satisfied with simple dietary control can be appropriately reduced. For those who are temporarily unable to eat due to other diseases, 150 to 250 grams of glucose should be injected daily to prevent ketoacidosis.
3. Reduce fat intake
Fat is also an indispensable source of energy for the human body, and its calorie production is more than two times that of carbohydrates. The food sources of fat are animal fats and vegetable fats.
In order to prevent or delay the occurrence and development of vascular complications in diabetics, it is very important to reduce the intake of fat in food. Currently, it is advocated that the caloric value of fat in the diet should be reduced to 25% of the total calories, or even lower, less than 1 gram per kilogram of body weight, and the intake of saturated fatty acids should be limited.
Fat-containing foods are a variety of cooking fats and oils, the content of about 100%; followed by butter, containing 83%; sesame paste for 54%; again for peanuts, walnuts, melon seeds and other hard fruits, containing 40% to 70% vary. All kinds of meat depending on its fat and lean degree of different, fat pork up to 60% or more, lean meat only 1% to 3%, such as chicken. Eggs contain about 15%, dairy for about 4%.
In order to prevent atherosclerosis, it should be noted that the fat intake of saturated fatty acids should be less than 10% of the total calories, accounting for about 1/3 of the total amount of fat. in general, the solid butter, butter, mutton fat, lard containing saturated fatty acids, more than poultry fat than veterinary fat containing unsaturated fatty acids. Cream, cocoa butter, coconut oil contain more saturated fatty acids than other vegetable oils. Vegetable oils, fish oils, hard fruit oils are mainly unsaturated fatty acids, mostly liquid. Therefore, diabetics should consume vegetable oils and minimize or eliminate animal fats.
Essential fatty acids, which cannot be synthesized in the human body and must be consumed from food, are important substances in human metabolism. They have the function of promoting the transformation and excretion of cholesterol, and can reduce the concentration of cholesterol in the blood, which is favorable to diabetes. Vegetable oils are the main source of essential fatty acids for humans.
Cholesterol is closely related to cardiovascular disease, and it is generally believed that cholesterol intake should be less than 300 mg per day, so it should be limited to the selection of high-cholesterol foods. All meat foods contain cholesterol, and others such as egg yolks, butter, crustaceans and animal offal are also high in cholesterol. But foods high in cholesterol do not always cause an increase in serum cholesterol.
Cholesterol is one of the factors that contribute to atherosclerosis. Therefore, people generally have a sense of fear of cholesterol, especially middle-aged and elderly people and patients suffering from cardiovascular disease, diabetes and obesity and other diseases, often exclude cholesterol content of higher food. In fact, cholesterol is an important constituent of human nervous tissue and some hormones, and can destroy red blood cells into harmless substances, is the body's normal metabolism is indispensable to the important substances. If because of the fear of atherosclerosis and blindly exclude all cholesterol-rich foods, then the intake of many good protein foods will be limited. Such as poultry, aquatic products, eggs, etc. is the body's source of high-quality protein, but also rich in cholesterol.
In addition, serum cholesterol concentration, in addition to dietary cholesterol content, is also affected by total dietary calories, total fat and polyunsaturated fatty acid to saturated fatty acid ratio (P/S) and other factors. Therefore, the treatment of hypercholesterolemia should not solely emphasize cholesterol intake, but should be considered comprehensively.
4. Supply sufficient protein
Protein is an important nutrient that constitutes human tissues and repairs and renews human tissues as well as regulates physiological functions.
Diabetics should have an adequate supply of protein in their diets, and their intake should be comparable or slightly higher than that of normal people. The metabolic disorder caused by diabetes makes the body protein decomposition too fast, too much loss, easy to negative nitrogen balance. Therefore, the diet should be supplemented with enough protein-rich foods. The percentage of protein in total calories should be 15% to 20%. Each gram of protein supplies 16.7 kilojoules of calories. There are 20 kinds of amino acids involved in protein biosynthesis, among which 8 kinds of amino acids are essential amino acids: lysine, tryptophan, phenylalanine, leucine, isoleucine, threonine, methionine and valine. Essential amino acids mainly come from animal foods, and proteins rich in essential amino acids are called high-quality proteins. Therefore, 1/3 of the daily intake of protein should come from meat or eggs. Legumes from plants are also rich in essential amino acids. If there is a lack of essential amino acids, even if the amount of protein is sufficient, or even too much, the body still shows a negative nitrogen balance.
5. Vitamin supplementation
Vitamins are closely related to diabetes, especially vitamin B1, vitamin C, vitamin B12 and vitamin A. Vitamins are essential for regulating the body's physiological functions. Vitamins are indispensable nutrients that regulate the physiological functions of the human body. Therefore, the diet of diabetics should be supplemented with enough vitamins, especially pay attention to the supply of vitamin B1. Generally cereals are high in vitamin B1. As the diabetic diet restricts the intake of staple foods, it often results in insufficient sources of vitamin B1, and is prone to neurological disorders caused by vitamin B1 deficiency, such as numbness of the hands and feet and polyneuritis, which are common. The content of thiamine in common foods is shown in Table 14. Vitamin B1 is affected by the way of cooking and is generally more stable in acidic solutions and easily destroyed by alkaline solutions. Therefore, alkali should not be added during cooking. Vitamin B1 is a water-soluble vitamin, relatively stable in a dry environment, but in aqueous solution, such as high temperature for too long, easy to be destroyed.
Vitamin B12 can alter and relieve neurological symptoms. Roughage, dry beans, viscera, eggs and vegetables (especially green leafy vegetables) class contains more B vitamins. Vitamin C supplementation can prevent microangiopathy caused by vitamin C deficiency. Fresh vegetables and fruits are good sources of vitamin C.
6. Supply of inorganic salts and trace elements
Dietary therapy for diabetics should pay attention to reducing sodium intake. High sodium is easy to induce hypertension, atherosclerosis, coronary heart disease, hyperlipidemia and renal insufficiency and other complications. When the condition is not well controlled, it is easy to have various infections and ketoacidosis, pay attention to appropriate supplementation of inorganic salts, such as potassium, magnesium, calcium, chromium, zinc and other elements. Diabetic patients with low blood magnesium are prone to retinopathy, appropriate supplementation of magnesium is an effective measure to prevent retinopathy. Insufficient calcium intake can lead to osteoporosis. Diabetic patients serum chromium is significantly lower than normal people, chromium has a direct effect on carbohydrate metabolism, promote protein synthesis, activate insulin. Peripheral tissue sensitivity to insulin decreases when chromium is deficient, and increasing chromium supply can improve glucose tolerance. With age, the amount of chromium in the adult body gradually decreases, so trace element chromium deficiency is common in the elderly. Chromium is one of the essential trace elements in the human body and is an insulin bioactive agent. Although chromium only accounts for 0.01% of body weight in the human body, it plays an important role in maintaining normal physiological functions of the human body. Mild deficiency will reduce the sensitivity of the body to insulin, and severe deficiency can be clinically found in increased fasting blood glucose and positive urine glucose. In the human body is mainly trivalent active chromium, is a component of glucose tolerance factor, and insulin binding can increase the insulin receptor, promote the entry of glucose into the cell. Studies have shown that if elderly patients are given a daily supplement of 8 grams of chromium-containing brewer's yeast, it can improve glucose tolerance and lower serum cholesterol and total lipids. Foods containing active chromium include brewer's yeast, beef, mushrooms, and beer.
The role of zinc in the diabetic diet should not be overlooked. There are dozens of enzymes in the human body that require the participation of zinc in order to maintain their activity and fulfill their functions. Zinc is not only involved in the synthesis of insulin, and has a stabilizing effect on the structure of insulin, and can assist in the transport of glucose in the cell membrane, there are two zinc atoms in each insulin molecule. Inadequate supply of zinc can reduce insulin secretion. In addition, most diabetic patients suffer from zinc malabsorption and should therefore be supplemented in a timely manner. Adults daily zinc needs and dietary nitrogen levels are related to the general dietary protein content is high, the body's demand for zinc is also high. China's recommended standard of zinc supply for adults is 15 mg per day. General dietary zinc content, there will not be zinc poisoning, but if the use of zinc-containing drugs or zinc-containing additives, should be under the supervision and guidance of a physician. The normal standard for plasma zinc is 90 to 130 mg. The best sources of dietary zinc are meat, seafood and poultry. The bran of cereals is also high in zinc.
7. Supply of dietary fiber
Epidemiological investigations and clinical studies have confirmed that dietary fiber has the effect of lowering fasting blood glucose, postprandial blood glucose and improving glucose tolerance. Areas with higher intake of dietary fiber have a lower incidence of diabetes. Food fiber has the effect of lowering blood lipids, lowering blood pressure, lowering cholesterol and preventing cardiovascular disease, chronic cholecystitis, cholelithiasis and other complications; diabetic dietary fiber increases, urinary glucose decreases. However, too much increase in food fiber can affect the absorption of minerals and trace elements. It is generally believed that every 4.184 megajoule heat supplement 12 to 28 grams of food fiber.
Food fiber is divided into soluble and insoluble two kinds. Soluble fiber includes pectin (containing fruit and other soft tissue substances), alginate gum, soybean gum and so on. Insoluble food fiber including cellulose, hemicellulose and lignin, etc., is a constituent of the cell wall, from cereals, legumes seeds of the epidermis and plant stems and leaves. When supplementing insoluble fiber such as wheat bran and soybean hulls, the amount should not be too much, otherwise it will affect the absorption of inorganic salts and vitamins. Again, dietary fiber is best consumed mixed with carbohydrate foods to bring out its effects. At present, the crude fiber content of some food composition lists is not sufficient to reflect the actual content of fiber. Soluble fiber has a significant blood sugar lowering effect. The diabetic diet advocates the use of more natural food fiber and no purified fiber. The amount of crude fiber in diabetic recipes should be about 15 to 20 grams per day, and preferably from natural foods. Long-term consumption of crude fiber-rich plants, should pay attention to regular measurement of blood sodium, potassium, calcium, phosphorus, iron, magnesium, etc., because crude fiber foods can lead to the loss of inorganic salts and amino acids. Those who have diarrhea and vegetative disorders should choose foods under the guidance of a doctor.
8. Reasonable arrangement of meals
In order to reduce the burden on the pancreatic β-cells, so that the normal secretion of insulin, diabetic patients eat at least three meals a day, and can increase the number of meals or additional meals. It is best to mix and match the main and side dishes in each meal, so that there are main dishes, side dishes, vegetables and cooking oil in each meal.
Three meals a day, staple food distribution can be based on the morning, midday and evening each accounted for 1/3, or breakfast accounted for 1/5, lunch and dinner each 2/5 ratio, and requires regular quantitative.9.
Diabetes diet
The distribution ratio of caloric meals is particularly important. Usually combined with dietary habits, blood glucose and urine sugar elevation time, taking hypoglycemic drugs, especially the injection of insulin time and whether the condition is stable, to determine the proportion of its distribution. Eat as little and as often as possible, at regular intervals. Prevent eating too much at one time, increasing the burden on the pancreatic islets; or eating too little at one time, hypoglycemia or ketoacidosis.
Patients with diabetes who inject insulin or are prone to hypoglycemia should eat between meals, and it is more important to eat before going to bed, and the calories from the additional meals should be counted in the total daily calories. A small portion of staple food from the main meal is an effective way to prevent hypoglycemia.
Diabetic dishes should be light, as little as possible to eat fried, deep-fried, popped, fried food. Food processing should be blanching, stewing, simmering, boiling, steaming, braising, stewing, cold, to reduce the intake of excess fat.
10. Dietary precautions
(1) weighing treatment diet: diabetic diet is a weighing treatment diet, including staple foods, side dishes, vegetables and cooking oil, salt, should be cooked before the skin, roots, bones and other inedible parts of the removal of the weighing, processing, and then cooking.
(2) prohibit the addition of sugar: diabetic diet cooking principles do not add sugar, do not use sugar and vinegar cooking method, onions, ginger and other seasonings do not add restrictions. Diabetics with a sweet tooth can use sweeteners instead.
(3) dietary contraindications: fasting glucose, sucrose, maltose, honey, sweet snacks and other pure sugar foods. Any food containing high starch, such as potatoes, sweet potatoes, taro, cichlid mushrooms, vermicelli, etc. are not used in principle. If you need to eat, you should reduce part of the staple food to replace it.
(4) Do not arbitrarily increase the amount: diabetic patients according to the prescribed amount of food intake, do not arbitrarily add other foods. If the hunger is unbearable and the condition permits, with the consent of the medical staff, add a large volume of low-calorie food. Such as bok choy, cabbage, cucumber, winter melon, tomatoes and so on.
(5) lifelong control of diet: diabetes requires lifelong dietary treatment, usually not only according to the therapeutic dietary requirements for the intake of nutrients, but also to take care of the patient's dietary habits, as far as possible to achieve a variety of colors, delicious. After the disease is stabilized, according to the intensity of labor and activity, appropriate relaxation of restrictions to ensure normal work and activities.