The diabetic diet is designed and calculated in six steps
① Calculate ideal weight
② Evaluate current weight status
③ Further determine the total calorie requirement of a day according to the work intensity and weight
④ Determine the basic framework of the six food exchange portions Feng Zhihai, Department of Endocrinology, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
⑤ Pay attention to special circumstances and make appropriate adjustments
⑥ Formulate recipes flexibly according to the principles of distribution.
Examples of diet design for light workers.
Mr. Liu, 54 years old, a teacher, 170 cm in height and 80 kg in weight, was newly diagnosed with type 2 diabetes, fasting blood glucose 12.0 mmol/L, glycosylated hemoglobin 7.0%, used to drink a bottle of milk every day on weekdays, and his doctor recommended diet and exercise therapy.
1 First step: calculate ideal body weight
Formula: ideal weight (kg) = actual height (cm) – 105
According to the formula, Mr. Liu’s ideal weight should be: 170 (cm) – 105 = 65 (kg)
2 Second step: evaluate the current weight status
Formula: current weight status (%) = [(actual weight – ideal weight) ÷ ideal weight] × 100%
More than 10% of ideal weight belongs to overweight; more than 20% belongs to obesity; more than 40% belongs to severe obesity
10% below the ideal weight is thin; 20% below the ideal weight is wasted.
Mr. Liu’s actual weight is 80 kg, and according to the evaluation, Mr. Liu’s current weight status is
【(80-65)÷65】×100%=23%, which is more than 20%, so it belongs to obesity.
According to the body mass index (BMI) formula.
BMI = weight (kg) ÷ height (m)2 = 80 ÷ (1.70)2 = 27.7
Mr. Liu’s BMI is 27.7, is obese
3, Step 3: Determine the total calories needed for a day according to work intensity and weight
(1) Mr. Liu’s job is a teacher, so he is a light worker
(2) According to the results of the second step, he is obese
(3) Check the following table
Caloric energy requirement of different physical work
Labor intensity
Example
Heavy person
(kcal/kg/day)
Bed rest
20-25
15-20
15
Light physical work
Office workers, teachers, salesmen, watch repairers
35
30
20-25
Medium physical work
Students, drivers, electricians, surgeons, sports activities
40
35
30
Heavy physical labor
Farmers, builders, porters, lumberjacks, smelters, dancers
45-50
40
35
Obese light manual workers require 20-25 kcal per kg body weight per day.
(4) Calculate the total daily calorie requirement for Mr. Liu at his ideal body weight.
Formula: Total calories = ideal weight × calories needed per kg of body weight per day
According to the formula, the total calories needed by Mr. Liu in a day are
65 kg × (20-25) (kcal)/kg = 1300-1625 kcal
(5) The daily calorie intake of an obese person takes the minimum value of the calculation result, so Mr. Liu’s daily calorie intake is 1300 kcal
4. Step 4: Determine the basic framework of the six food exchange portions
(1) Check the following table.
The basic framework of different calorie diet programs
Total calories kJ (kcal)
Total exchange servings (servings)
Staple foods (servings)
Vegetables (servings)
Fish meat (beans) (servings)
Dairy (servings)
Fruits (portion)
Fats and oils (servings)
4185 (1000)
12
6
1
2
2
0
1
5021 (1200)
14.5
7
1
3
2
0
1.5
5858 (1400)
16.5
9
1
3
2
0
1.5
6694 (1600)
18.5
9
1
4
2
1
1.5
7531 (1800)
21
11
1
4
2
1
2
8368 (2000)
23.5
13
1
4.5
2
1
2
9205 (2200)
25.5
15
1
4.5
2
1
2
10042 (2400)
28
17
1
5
2
1
2
The basic number of servings of the six major food groups exchanged in Mr. Liu’s daily diet was obtained, and the insufficient portion between each class was supplemented by staple foods.
(2) The total caloric intake of Mr. Liu is 1300 kcal, so 1 serving of staple food can be added or subtracted between 1200 kcal and 1400 kcal, and one serving of staple food produces 90 kcal, resulting in 1290 kcal or 1310 kcal, both close to 1300 kcal.
(3) The total number of exchanged servings of food exchange for Mr. Liu is 15.5 servings.
5 Step 5: Pay attention to special circumstances and make appropriate adjustments
(1) Since Mr. Liu has the habit of drinking one bottle of milk per day, he should use 2 servings of dairy food for milk intake
(2) Considering that obese people should take low calorie and high protein as dietary principles, it is appropriate to use skim milk.
(3) Since skim milk is relatively low in calories, the calories saved by Mr. Liu’s consumption of skim milk can be supplemented by an additional serving of fish and meat.
(4) Mr. Liu’s blood glucose control is unstable and his postprandial blood glucose is high, so the diet plan is not designed for fruit for the time being.
(5) The finalized meal structure of Mr. Liu for one day was as follows
8 servings of staple foods 1 serving of vegetables 4 servings of fish and meat (beans) (3+1) 2 servings of dairy (calories saved from skim milk, 1 exchange serving, added to fish and meat) 0 servings of fruits 1.5 servings of oils and fats
6 Step 6: Flexible recipes according to the principles of distribution
(1) The most common distribution scheme for three meals a day is 1/5 in the morning, 2/5 at noon, and 2/5 at night.
(2) According to the above principles, design a food framework table for the whole day
(Allocate food exchange portions by meal)
Recipe content
Food Exchange Portion
Breakfast (portions)
Lunch (portions)
Dinner (portions)
Staple food category
8
2
3
3
Vegetables
1
0
0.5
0.5
Fruits
0
0
0
0
Fish meat (beans)
4
0
2
2
Dairy
2
2
0
0
Oil and fat
1.5
0
1
0.5
(3) Formulation of diabetic recipes for light-duty workers
Example of diabetic recipe for light manual workers1 (1300 kcal)
Recipe content
Food exchange
Breakfast
Lunch
Dinner
Staple food category
8
Salted bread 75g
Rice 75g
Rice 75g
Vegetables
1
0
Stir-fried bok choy 250g
Celery 250g
Fruits
0
0
0
0
Fish and meat (beans)
4
0
White chopped chicken 100g
Lean beef 75g dried bean curd 25g
Milk
2
Skim milk 220ml (1 bottle)
0
0
Oil and fat
1.5
0
Cooking oil 1 tbsp
Cooking oil ½ tbsp
Example of diabetic recipe for light workers 2 (1300 kcal)
Recipe content
Food exchange portions
Breakfast
Lunch
Dinner
Staple food category
8
Oatmeal 50g
Rice 75g
Noodles 75g
Vegetables
1
0
Fried cucumber 250g
Tomato 250g
Fruits
0
0
0
0
Fish and meat (beans)
4
0
Steamed pomfret 100g
Egg 110g
Dairy
2
Skim milk 220ml (1 bottle)
0
0
Oil and fat
1.5
0
Cooking oil 1 tbsp
Cooking oil ½ tbsp
Example of diet design for middle-aged manual workers
Master Zhao, 45 years old, a car driver by profession, has suffered from type 2 diabetes for 4 years, takes oral hypoglycemic drugs, has a recent glycosylated hemoglobin laboratory value of 6%, is 165 cm tall and weighs 64 kg.
1 First step: calculate the ideal weight
According to the formula, the ideal weight of Master Zhao is: 165 (cm) – 105 = 60 (kg)
2 Step 2: Evaluate the current weight status
Master Zhao’s actual weight is 64 kg, according to the formula evaluation: [(64-60) ÷ 60] × 100% = 6.7%
Master Zhao’s weight does not exceed 10% of the ideal weight, so it belongs to the normal range of standard weight.
3 Step 3: Determine the total calories required for a day according to the work intensity and weight
(1) Master Zhao’s job is a driver, so it belongs to medium physical activity
(2) According to the results of the second step, he belongs to the standard weight
(3) Check the table
Caloric energy requirements for different physical work
Labor intensity
Example
Heavy person
(kcal/kg/day)
Bed rest
20-25
15-20
15
Light physical work
Office workers, teachers, salesmen, watch repairers
35
30
20-25
Medium physical work
Students, drivers, electricians, surgeons, sports activities
40
35
30
Heavy physical labor
Farmers, builders, porters, lumberjacks, smelters, dancers
45-50
40
35
The daily calorie requirement per kg of body weight for a standard weight medium manual worker is 35 kcal
(4) Calculate the total daily calorie requirement for Master Zhao at his ideal weight
60 kg × 35 (kcal)/kg = 2100 kcal
4 Step 4: Determine the basic framework of the six food exchange portions
(1) Check the table
Basic framework of different calorie diet plans
Total calories kJ (kcal)
Total exchange servings (servings)
Staple foods (servings)
Vegetables (servings)
Fish meat (beans) (servings)
Dairy (servings)
Fruits (portion)
Fats and oils (servings)
4185 (1000)
12
6
1
2
2
0
1
5021 (1200)
14.5
7
1
3
2
0
1.5
5858 (1400)
16.5
9
1
3
2
0
1.5
6694 (1600)
18.5
9
1
4
2
1
1.5
7531 (1800)
21
11
1
4
2
1
2
8368 (2000)
23.5
13
1
4.5
2
1
2
9205 (2200)
25.5
15
1
4.5
2
1
2
10042 (2400)
28
17
1
5
2
1
2
The number of servings of the six major food groups exchanged in Chef Zhao’s daily diet was obtained. The total caloric intake of 2100 kcal per day was determined in the third step, so 1 serving of staple food can be added or subtracted between 2000 kcal or 2200 kcal (because one serving of staple food can produce 90 kcal), and 2090 kcal or 2110 kcal was calculated, both close to 2100 kcal.
(2) Master Zhao’s total number of food exchange portions is 24.5
5 Step 5: Pay attention to special circumstances and make appropriate adjustments
(1) Since Chef Zhao has no special habits or requirements, this step can be omitted.
(2) Finalize Master Zhao’s daily meal framework as follows: 14 servings of staple foods, 1 serving of vegetables, 4.5 servings of fish and meat (beans), 2 servings of dairy, 1 serving of fruits, 2 servings of oils and fats.
6 Step 6: Develop recipes flexibly according to the distribution principles
(1) The recipes developed according to the fifth step are shown in Tables 1 and 2 below
Table 1 Example of diabetic recipes for middle-aged manual workers1 (2100 kcal)
Recipe content
Food exchange portions
Breakfast
Lunch
Dinner
Staple food category
14
Congee 100g
Rice 125g
Rice 125g
Vegetables
1
0
Stir-fried cucumber 250g
Stir-fried cucumber 250g
Fruits
1
0
0
Strawberries 300g (additional meal after dinner)
Fish (beans)
4.5
0
Chicken 125g
Chicken 100g
Dairy
2
Milk 220ml (1 bottle)
0
0
Fats and oils
2
0
Cooking oil 1 tbsp
Cooking oil 1 tbsp
Table 2 Example of diabetic recipes for middle-aged manual workers1 (2100 kcal)
Recipe content
Food exchange portion
Breakfast
Lunch
Dinner
Staple food category
14
Steamed buns with rolls 70g Congee 50g
Rice 125g
Hanging noodles 125g
Vegetables
1
0
Stir-fried spinach 250g
Roasted eggplant 250g
Fruits
1
0
Apple 200g (additional meal after lunch)
0
Fish and meat (beans)
4.5
0
Salt water duck 125g
Mackerel 150g
Milk
2
Soy milk 400ml (1 bottle)
0
0
Oil and fat
2
0
Cooking oil 1 tbsp
Cooking oil 1 tbsp
(2) Master Zhao’s blood sugar is well controlled (glycosylated hemoglobin is 6%), so he can eat some fruits as an additional meal. If his blood sugar is not well controlled, he should not eat fruits, and the fruits can be replaced by fats and oils or main food.
(3) Mr. Zhao is a driver and it is not easy to have three meals on time, so he should prepare some food, such as soda cookies, dried tofu or apples, to be used as extra meal when he cannot eat on time to prevent hypoglycemia. The amount of extra meal should be deducted from the regular meal.