Diabetic diet includes staple food: such as round-grained rice, rich powder; food containing low calories such as: bok choy, cabbage, cucumber, winter melon, tomato, tofu, soybean sprouts, etc.; and a small amount of lean pork, eggs. Diabetic patients are forbidden to eat glucose, sucrose, maltose and other pure sugar foods; where high starch-containing foods, such as potatoes, yams, vermicelli, etc., in principle, do not use, such as the need to be used should be reduced staple food.
Dietary treatment of diabetes mellitus (a)
Diabetic patients after meals, insulin secretion level can not be increased accordingly or due to insulin effect obstacles, resulting in increased blood glucose. Reasonable control of diet is conducive to the control of blood glucose levels. Dietary therapy is the basic treatment of diabetes, dietary therapy can significantly reduce blood glucose peaks; insulin levels can be significantly increased after treatment, a reasonable diet can reduce
Lighten the burden of pancreatic islet B-cells, so that pancreatic islet tissues to get a chance to recover. Patients with mild diabetes often need only dietary treatment to effectively control blood glucose and prevent complications.
The purpose of dietary treatment is to maintain a standard body weight, correct the metabolic disorders that have occurred, and reduce the burden on pancreatic islet B cells. In practice, the amount of diet (total daily calorie intake) should be controlled according to the individual Long-term reasonable diet structure with, both to ensure the quality of life of the patient and the diet can be properly controlled. Dietary control can not be taken to ban food and other coercive measures． Otherwise, it will make the patient lose confidence in life and reduce the quality of life. Instead, it affects glycemic control.
Methods of dietary control
1. Calorie calculation and application Calculate the total daily calorie requirement according to the standard body weight and activity level.
Standard body weight (kilograms of body weight) is calculated as height (centimeters)-105 for those under 40 years of age; height (centimeters)-100 for those over 40 years of age or (height (centimeters)-100) x 0.9
Adults daily Estimated calorie requirement per kilogram of standard body weight for adults: 25-30 kcal at rest, 30-35 kcal for light manual workers, 35-40 kcal for moderately manual workers, and more than 40 kcal for heavy manual workers. daily calorie requirement per kilogram of standard body weight for adolescents under 18 years old Calories (kcal) = 90-3 x age (years).
Children's growth and metabolism is vigorous, in order to ensure their growth and development, the calorie requirement increases accordingly. In general, the total calorie intake is the same as that of healthy children of the same age. However, attention should be paid to avoid overeating and obesity. Child patients are mostly type 1 diabetic patients, in the process of insulin treatment is prone to obesity, childhood obesity and the later occurrence of cardiovascular disease, hypertension, dyslipidemia and blood coagulation abnormalities have a close relationship.
In the later stages of pregnancy, the calorie requirement should be increased by about 15%, and the calorie supply of nursing mothers should be increased by about 30%. Dietary treatment of diabetes mellitus combined with pregnancy aims to achieve good control of diabetes mellitus. To normalize blood glucose as much as possible, which is the key to ensure the safety of the fetus and the mother, to provide sufficient various nutrients without causing postprandial hyperglycemia and ketosis is essential. Dietary therapy should be combined with exercise therapy and adjusted appropriately as the pregnancy continues. Pregnancy is not a contraindication to exercise therapy, but it must be done under the supervision of a healthcare professional. To assist in glycemic control.
Elderly people and patients with other comorbidities should lose weight on a case-by-case basis. Obese people (more than 20% of standard body weight) should be strictly control the total calories, with a view to weight loss to about +5% of the normal standard. While patients who are emaciated below 20% of standard body weight, or underweight patients below 10% of standard body weight, the total calories should be appropriately relaxed to achieve the purpose of increasing body weight.
Dietary treatment of diabetes mellitus (2)
2. Reasonable distribution of nutrient ratios The principle of nutrient distribution is a high-carbohydrate, high-fiber, low-fat diet. Generally, carbohydrates account for 50%-60% of the total calories; protein accounts for 15%-20% of the total calories (0.8-1.0g per kilogram of body weight per day); and fat accounts for about 20%-25% of the total calories (daily requirement
0.6-1.0g/kg of body weight).
Many patients use strict control of carbohydrate intake, while increasing fat and protein intake to achieve the purpose of glycemic control, which is wrong and unhelpful. Low-carbohydrate diet can inhibit the release of endogenous insulin, in recent years, domestic and foreign scholars on the advantages and disadvantages of sugar diet results show that fasting glucose normal light diabetic patients, the amount of sugar in the food from 45% to 85%, the condition has not worsened, glucose tolerance on the contrary, the improvement of blood insulin level decreased. Therefore, the appropriate increase in sugar intake, can improve the peripheral tissues of insulin sensitivity, such as staple food control is too strict, so that the patient is in a semi-starvation state, can make the glucose tolerance is reduced. The body's energy supply is bound to rely on the decomposition of fat and protein, and lead to ketosis, the condition is difficult to control.
Some studies in recent years have concluded that a high-protein diet causes an increase in glomerular filtration pressure, making it easier for diabetic nephropathy to occur. And low-protein diet can significantly delay the development of diabetic and non-diabetic nephropathy, reducing the risk of kidney disease and death. Receiving
A low to moderate protein (0.7-O.8 g/kg) diet after renal transplantation may also delay or attenuate chronic graft rejection. However, these are not conclusive observations and further research is needed.
Elderly and pregnant women generally do not need to artificially increase their protein intake. In fact, excessive protein intake may be detrimental to diabetes. Unless there is a significant increase in protein requirements or excessive protein loss that requires an increase in protein intake, in general, diabetic patients should not overemphasize protein supplementation, and when the patient is accompanied by high energy expenditure, it is generally not more than 1.5 g/kg per day.In addition, in addition to the quantity of high-quality protein intake should be considered to ensure that the supply of essential amino acids. Adding more fermentable carbohydrates to the diet is more beneficial to patients with diabetic nephropathy because fermentable carbohydrates can increase the extrarenal (fecal) excretion of nitrogen and reduce the concentration of plasma urea nitrogen, and there are a lot of fermentable carbohydrates, such as edible gums, arabinogalactan, inulin, and crude potato starch, etc., whose fermentation in the intestinal tract is more pronounced. Patients with early diabetic nephropathy should limit protein intake (o.6g per kilogram of body weight per day). Animal protein should account for 40%-50% of the total protein because it is rich in essential amino acids and has a high nutritional efficiency and utilization rate. For children and adolescents, in order to meet the needs of their growth and development, protein can be given at 1.2-1.5g/kg per day, pregnancy, lactation, malnutrition, co-infections, and consumptive diseases should be relaxed on the protein limitations of patients.
In the fat distribution ratio, the ratio of saturated fatty acid content and unsaturated fatty acid content should be 1:1. animal fat, except fish oil, mainly containing saturated fatty acids, vegetable oils are rich in unsaturated fatty acids, it is currently believed that polyunsaturated fatty acids, calories (P) and saturated fatty acids (S) of the ratio (P/s) the greater the cholesterol and prevention of atherosclerosis and neuropathy, the more favorable. The greater the ratio (P/s), the better for lowering cholesterol and preventing atherosclerosis and neuropathy. Under the premise of limiting the amount of fat intake, vegetable oils should be used instead of animal oils. Obese patients, especially those with cardiovascular disease, fat intake should be limited to less than 30% of the total calories, cholesterol intake should be limited to 300mg per day.
Food fiber, also known as plant polysaccharides, is divided into two categories of soluble and insoluble food fiber. In the human small intestine is not digested, itself can not become energy. But it can promote the secretion of saliva and gastric juice. To bring a sense of satiety, so as to achieve the purpose of food and weight reduction, food fiber can delay sugar and fat absorption, constraints on postprandial blood glucose and insulin secretion. American Garden Diabetes Association recommended amount of edible fiber for 24 grams (8 grams of soluble fiber plus 16 grams of non-soluble fiber). However, the amount should be reduced as appropriate for emaciated patients, type I diabetics and those with diarrhea symptoms.
Dietary treatment of diabetes mellitus (3)
3, food choices and precautions
Diabetic patients often ask their doctors what to eat and what not to eat. Answers to such questions should not be absolute or set in stone. Patients should generally be told that sugary sweets should not be consumed (except in the event of hypoglycemia). To satisfy taste, sugar
substitutes (sweeteners) can be used, such as xylitol and sweet leaf glucosinolates. Carbohydrates are mainly found in cereals, potatoes, beans, vegetables and fruits that contain a lot of sugar. Those who eat mainly cereals should choose crude products as much as possible. When choosing fatty foods, the intake of animal fats should be minimized and plant fats should be consumed appropriately. Animal fats mainly come from fatty meat, lard, poultry, mutton, beef is low in fat content, while pork is high in fat content, fish and aquatic products are low in fat content, followed by poultry and eggs, diabetic patients should be limited to cooking oil (vegetable oil 2-3 tablespoons), peanuts, melon seeds and other snacks need to be counted in the total calorie and fat intake. Animal proteins mainly come from lean meat, animal meat, poultry, fish, shrimp, eggs, dairy products, etc. The highest content of vegetable proteins is soybeans. Vegetable protein is highest in legumes. Daily staple food can provide 25-50g protein. Diabetic patients should eat some fresh fruits to replenish vitamins. The calories of fruits are counted in the total calories, and it is recommended to start with a small amount of fruits, and it is better to eat fruits on an empty stomach and between meals. The type of diet for diabetic patients can refer to the original living habits, pay attention to diversification, control the total daily calories.
4. Design and calculation of recipes
1) Coarse method Applicable to outpatients. The staple food for those with roughly normal body weight and good physical condition can be roughly estimated according to the labor intensity, 200-250 grams for resting people, 250-350 grams for light laborers, 350-400 grams for middle laborers, 400-500 grams for heavy laborers, vegetables are not restricted in the by-products, and the proteins are about 30-40 grams, and the fats are 40-50 grams. Fat 40-50 grams, obese people should strictly limit the total calories, choose low-carbohydrate, low-fat, high-protein diet, 200-250 grams of staple food per day, about 30-60 grams of protein in the side dishes, about 25 grams of fat.
2) The fine algorithm, also known as the food composition table calculation method, is highly scientific, but it is necessary to check the food composition table frequently. Calculation and design of primary and secondary food is more complicated, suitable for hospitalized patients. The method and steps are:
① Calculate the standard weight according to the patient's gender, age and height;
② Determine the total daily calorie requirement according to the patient's labor intensity;
③ Determine the supply of carbohydrates, fats and proteins. Each gram of carbohydrate and each gram of protein produce 4 kcal, and each gram of fat produces 9 kcal. Set the total calories for the whole day = X, the whole day carbohydrate (g) = X × (50%-60%)/4; the whole day protein (g) = X × (15%-20%)/4; the whole day fat (g) = X × (20%-35%)/9
For example, the height of a 50-year-old female diabetic patient is 165 cm, and her actual weight is 65 kg. The patient is resting in the hospital and needs 30 kilocalories per kilogram of body weight per day. Standard body weight = 165-105 = 60 kilograms, total calories for the whole day = 60 × 30 = 1800 kilocalories, carbohydrates for the whole day = 1800 × 60% = 270 grams, proteins for the whole day = 1800 × 20%/4 = 90 grams, fat for the whole day = 800 × 20%/9 = 40 grams,
For example, a 50-year-old female diabetic patient with a height of 165cm and actual body weight of 65kg is resting at the hospital. 40 g.
Total calories are distributed among the three meals according to 1/5, 2/5, and 2/5.
Dietary treatment of diabetes mellitus (IV)
The patient's dietary treatment may be unaccustomed to the beginning. Easy to produce hunger, can eat more vegetables to reduce hunger, but frying vegetables with oil can not be too much, do not eat more fatty meat and other greasy food to reduce hunger. When combined with diabetic nephropathy, especially when renal insufficiency, should limit the intake of protein. Must choose high-quality animal protein, daily phosphorus intake should be less than 3-5mg/kg or less than 0.15-0.3g per day; appropriate limitation of sodium (hypertension should be limited to 3g/day), adjusted according to the level of blood sodium and the degree of edema, generally should be less than 4 grams per day.
When diabetes is combined with pregnancy, in order to meet the nutritional needs of the mother and fetus, and to ensure the normal growth and development of the fetus, the diet should not be overly restrictive in terms of calories, 30-35 kcal/kg per day, or more than 2,000 kcal per day, 1.5-2.0 g/kg of protein per day, about 50 grams of fat per day, and not less than 50% of the total calories from carbohydrate, or about 300-400 grams of fat per day. Carbohydrates should not be less than 50% of the total calories, about 300-400g, and eat less and more meals (5-6 meals per day). Prevent hypoglycemia and starvation ketosis. During pregnancy, the weight gain in the first 3 months should not exceed 1-2kg, and then the weekly weight gain should be controlled at about 350g, and attention should be paid to supplementing the right amount of vitamins, calcium, iron and zinc during pregnancy.
Non-diabetic patients who consume alcohol for a long time (with alcohol-related chronic pancreatitis) can develop alcoholic autonomic neuropathy. type 2 diabetic patients who consume alcohol for a long time are susceptible to hypoglycemia and aggravate hyperglycemia. Long-term alcohol consumption in diabetic patients can cause alcoholic cirrhosis, pancreatitis and multiple organ damage. It is difficult to prohibit alcohol consumption in some patients, so small amounts of alcohol may be allowed in the following cases:
1) good glycemic control;
2) no chronic complications of diabetes;
3) normal liver and renal function;
4) non-obese;
5) no acute complications;
6) activation of the ALDH-2 gene phenotype.
The maximum permissible alcohol consumption is 50ml of white wine and 200ml of beer.
How to choose diet for diabetic patients
First of all, we should maintain a balanced diet:
To achieve the goal of controlling blood glucose in diabetic patients, no matter whether they belong to the first type or the second type, they must develop the correct dietary habits in order to wisely choose their diets and moderate exercise. Control of the condition. Eating right involves eating three regular meals and maintaining a
balanced diet. Most importantly, eat less oily, sugary foods and more high-fiber foods, such as a variety of vegetables, whole-grain bread, whole-grain crackers, and boiled potatoes. The diet that diabetics need is actually a healthy diet for everyone.
Some people mistakenly believe that diabetics should not eat carbohydrate foods such as rice and bread. In fact, diabetic patients should also consume a moderate amount of carbohydrates, patients can choose the daily staple food whole wheat bread or white rice, such as two pieces of whole wheat bread for breakfast, lunch or dinner can eat a bowl of white rice, but should try to avoid eating fried rice and other greasy food.
The most important thing for people with diabetes is to choose low-fat cooking methods, such as boiling, baking, roasting, simmering, steaming, or cooking by microwave oven, instead of eating fried or deep-fried greasy food.
The next step is to reduce salt intake:
Diabetes is a chronic metabolic disease that is prone to complications, which include retinopathy, stroke, renal failure, numbness in the limbs of the hands and feet, necrosis of limbs, and cardiovascular disease.
Therefore, the diet of diabetic patients should also reduce the intake of salt. Because a high-salt diet is an important causative factor for hypertension, which in turn increases the risk of stroke and cardiovascular disease. Therefore, controlling salt intake is not something diabetic patients should take lightly. To reduce salt intake, use less salt in cooking, as well as seasonings such as oyster sauce, soy sauce, chili peppers and tomato sauce. At the same time, try to eat fresh food, avoid eating canned fish, canned soup, canned meat and other canned food, eat less salted vegetables, salted fish, salted eggs and other pickled food.