Diet therapy is the basic therapy for treating diabetes mellitus and is applicable to patients with all types of diabetes mellitus. In mild cases, good results can be received with diet therapy, while in medium and heavy patients, drug therapy must also be reasonably applied on the basis of diet therapy. Adherence to diet control therapy is a key factor in determining whether patients can achieve ideal metabolic control.
I. The importance of dietary control in diabetes
When it comes to diabetic diet control, many diabetic patients may not understand or accept it, thinking that if they are sick, they can just take medication and injections, so why do they have to control their diet? In fact, there are two misconceptions in this understanding. First, due to the relative or absolute lack of insulin in the body of diabetic patients, excessive dietary intake into the body can not be effectively utilized by the body, but instead exists in the form of high sugar in the body, causing chronic and continuous damage to tissue cells. So the food that you eat, into the body is “poison”. Only by controlling the diet and limiting the amount of food intake can the body not overdo it, thus reducing the damage caused by high blood sugar. Secondly, although diabetic patients have been using drugs to lower their sugar, they still need to control their diet. Firstly, from the perspective of diet quantity, although over-eating can be balanced by increasing the dose of medication, the increase of medication dose brings possible increase of adverse effects, higher treatment cost, and if the diet is slightly reduced, it will also cause hypoglycemia due to drug overdose, which is very harmful. Secondly, the uncertainty from the regularity of meal intake. Because, under normal circumstances, human insulin is pulsed secretion, and the secretion amount changes with the amount of food eaten, showing intelligent secretion. And diabetic patients in the use of drug therapy, most of them are in accordance with the three meals a day to allocate the dose, relatively fixed, the drug dose can not be changed with the random addition of meals or eating. If you eat at random before two meals, it will lead to the increase of blood sugar because there is not enough insulin secretion and medication supplement. Some diabetic patients often miss meals for one reason or another, which is also very dangerous and undesirable, because both oral hypoglycemic drugs and insulin, which continue to function under such circumstances, can easily lead to hypoglycemia, and even lead to coma or death.
Second, diet control its main goal
The goal of dietary control for diabetic patients is to control the excessive intake of diet so as to reduce the pancreatic islet burden, bring blood glucose and blood lipids to or near normal values, and prevent or delay the occurrence and development of complications.
1. Maintain reasonable weight: The goal of weight loss for overweight/obese patients is to lose 5% to 10% of body weight in 3 to 6 months. Those who are thin should regain and maintain their ideal weight for a long time through a reasonable nutrition plan. (So the dietary management of diabetic patients is not an emotional diet to control weight, but a healthy diet to restore the ideal weight, not too much nor too little).
2.Provide balanced and nutritious meals.
3.To achieve and maintain ideal blood glucose levels and reduce glycated hemoglobin levels.
4.Reduce the risk factors of cardiovascular disease, including control of dyslipidemia and hypertension.
5.Reduce insulin resistance and reduce pancreatic beta cell load.
Third, the arrangement of dietary structure
The three main substances in the structure of the diet are fat, carbohydrate and protein. It also includes salt, alcohol consumption, dietary fiber and micronutrients, etc.
(A) Fat
1. The energy provided by fat in the diet should not exceed 30% of the total energy in the diet.
2. The intake of saturated fatty acids should not exceed 7% of the total dietary energy, and minimize the intake of trans fatty acids. Monounsaturated fatty acids are a better source of dietary fat, and the energy supply ratio in the total fat intake should reach 10% to 20%. The intake of polyunsaturated fatty acids should not exceed 10% of the total energy intake.
3, cholesterol intake in food <300mg / d.
Simply put, we should eat a low oil diet, not to eat or eat less fried and oil-rich foods, especially animal fats, such as fatty meat, meat soup and so on. It is important to remind you that the effect of fats and oils on blood sugar is much higher than that of carbohydrates, so oil control is an important part of diabetic diet control.
(B) Carbohydrates
1. The energy provided by carbohydrates in the diet should account for 50% to 60% of the total energy. The measurement and evaluation of carbohydrates is a key aspect of glycemic control.
2. Low glycemic index food is good for blood sugar control.
3. It is safe for diabetic patients to consume sugar alcohols and non-nutritive sweeteners in moderation. However, too much sucrose decomposed to generate fructose or add too much fructose is prone to increased triglyceride synthesis and body fat accumulation.
4, regular daily meals, try to maintain an even distribution of carbohydrates.
In practice, more arrangements are made according to lifestyle habits, medical conditions and the need to cooperate with drug therapy. In practice, the arrangement should be based on the lifestyle, the condition and the need for medication. three meals per day can be distributed as 1/5, 2/5, 2/5 or 1/3, 1/3, 1/3. generally, about 2 taels of staple food per meal, avoid eating thin rice.
(iii) Protein
1.For diabetic individuals with normal renal function, the recommended protein intake accounts for 10% to 15% of the energy supply ratio, and ensure that the intake of high-quality protein exceeds 50%.
2.Patients with dominant proteinuria should limit protein intake to 0.8g per kg of body weight per day. from the glomerular filtration rate (GFR) decline, a low protein diet should be implemented, the recommended protein intake is 0.6g per kg of body weight per day, to prevent protein malnutrition, can be supplemented with compound alpha-keto acid preparations.
3. Protein intake alone is not likely to cause blood glucose elevation, but may increase insulin secretion response.
(D) Drinking alcohol
1.Drinking alcohol is not recommended for diabetic patients. If you drink alcohol, you should calculate the total energy contained in alcohol.
2. The amount of alcohol consumed per day should not exceed 15g for women and 25g for men (15g of alcohol is equivalent to 450ml of beer, 150ml of wine or 50ml of low-grade white wine). No more than 2 times a week.
3, should be alert to the possible hypoglycemia induced by alcohol and avoid drinking alcohol on an empty stomach.
4. Individuals with risk of type 2 diabetes should limit the intake of sugary drinks.
(V) Dietary fiber
Legumes, fiber-rich cereals (≥5g fiber per serving), fruits, vegetable dishes and whole grains are good sources of dietary fiber. Improve fiber intake for health benefits.
(F) Salt
1, salt intake is limited to 6g per day, combined with hypertension patients should be strictly limited intake.
2, at the same time should limit the intake of food containing high salt, such as monosodium glutamate, soy sauce, salt dipping and other processed foods, seasoning sauce, etc.
(VII) Micronutrients
Diabetic patients are prone to deficiency of B vitamins, vitamin C, vitamin D, as well as chromium, zinc, selenium, magnesium, iron, manganese and other micronutrients, which can be supplemented in appropriate amounts according to the results of nutritional assessment. Long-term metformin users should prevent vitamin B12 deficiency. Long-term supplementation of large amounts of vitamin E, vitamin C and carotenoids with antioxidant effects is not recommended, and their long-term safety remains to be proven.
In conclusion, dietary therapy should be adjusted and flexible according to the condition at any time. In lean patients, the diet can be relaxed to ensure total calories. Obese patients must strictly control their diet, mainly low-calorie and low-fat diet, to reduce body weight. For those treated with insulin, care should be taken to add meals at 9-10 a.m., 3-4 p.m. or before bedtime as appropriate to prevent hypoglycemia (those with poor blood sugar control should not add meals). Attention should also be paid to appropriate increase of main meals or additional meals when there is a lot of physical work or activities.
Diet therapy should be scientific and reasonable, not too much and not too little. It should neither be subjective and arbitrary, nor too restrictive, and a little carbohydrate should not be dared to eat, but aggravate the condition, or even ketosis. According to your condition, weight and height, you should make strict calculations and arrange your diet scientifically and reasonably under the premise of controlling the total calories, so as to achieve the purpose of meeting the minimum needs of the body and controlling the total calories at the same time.
Scientifically arrange the main food and side food, and do not pay attention to the main food and ignore the side food. Although the main food is the main source of blood sugar and should be controlled, but the protein and fat in the side food can also be turned into blood sugar and become the source of blood sugar when they enter the body. Protein and fat in the metabolism of 58% and 10% respectively into glucose. Therefore, in addition to reasonable control of the main food, the side dishes should also be reasonably matched, otherwise the expected results will not be achieved.
In addition, it should be emphasized that the treatment of diabetes is lifelong, and diet therapy, as the basic treatment, is also an effective treatment method throughout the treatment of diabetes, which must be adhered to for a long time in order to achieve good blood sugar control and thus reduce the emergence of complications or delay their progress.