1.The composition and distribution of food components
The main components of food that provide heat are carbohydrates (mainly from foods such as rice and noodles), fats (mainly from fatty meat, cooking oil, etc.) and proteins (mainly from meat, eggs, legumes, etc.). Generally speaking, the calories provided by carbohydrates should account for 50% to 60% of the total calories in the diet; fats account for about 20% to 30% of the total calories; and proteins generally provide no more than 15% of the total calories.
(1)Carbohydrate
The total amount of carbohydrates in the diet of diabetic patients should be appropriately restricted, but should not be restricted too low. Appropriately increasing the carbohydrate content on the basis of controlling the total energy can improve the sensitivity of the body and tissues to insulin and improve the glucose tolerance. Since the only source of energy for the brain is glucose, it is recommended that the daily carbohydrate intake of diabetic patients should not be less than 130g.
Low glycemic index foods help blood sugar control; foods rich in monosaccharides and disaccharides such as honey, all kinds of pastries and white sugar are easily absorbed in the intestinal tract and raise blood sugar more rapidly; in addition, these sugars also promote the synthesis and secretion of triacylglycerol by the liver and increase the concentration of triacylglycerol in the blood, therefore, diabetic patients should avoid eating such foods. Sucrose causes a similar increase in blood sugar as the same amount of starch, not more than 10% of the total energy. Noodles, rice and other cereals mainly contain starch belongs to the polysaccharide class, the content of about 80%, diabetic patients can eat according to the prescribed amount. Potatoes, yams, pumpkin, sweet potatoes, white potatoes, lotus root, vermicelli (strips) and other foods, which contain starch as polysaccharides, can be exchanged with staple foods in equal amounts, diabetics to coarse and fine grains with. Excess fructose may not be conducive to blood lipid metabolism, not recommended in the diabetic diet routinely add a large amount of fructose as a sweetener.
(2) protein
It is an important component of human cells and plays an important role in human growth and development, tissue repair and cell renewal. For individuals with diabetes and normal kidney function, the recommended protein intake is 10% to 15% of the energy supply ratio. Different sources of protein have little effect on blood glucose, but proteins of plant origin, especially soy protein, are more advantageous than animal proteins for lipid control; whey protein helps reduce body weight and postprandial glycemic load in overweight individuals and reduces the risk of obesity-related diseases. Pure protein foods cannot be used to treat acute hypoglycemia or prevent nocturnal hypoglycemia; in patients with type 2 diabetes, protein intake is less likely to cause blood glucose elevation but can increase insulin response; a high-protein diet is not currently recommended as a weight loss method.
High-quality protein provides nine essential amino acids, such as meat, poultry, fish, eggs, milk, cheese and soy. Food sources that are not high quality protein include: grains, nuts and vegetables, and fruits. At least 1/3 of the protein source should be from animal protein to ensure the supply of essential amino acids.
(3) Fats
In addition to providing energy, fat is an indispensable nutrient for brain and nervous system development. The total daily fat intake should not exceed 30% of the total energy ratio, and for overweight or obese patients, the fat intake to total energy ratio can be further reduced. Fat-rich foods include various cooking oils, animal oils, animal skin, meat, poultry, fish, milk, eggs, and various nuts and fried foods. Among them, plant fruits and deep-sea fish can provide monovalent unsaturated fatty acids, polyvalent unsaturated fatty acids, animal foods other than fish (such as meat, milk and eggs) mainly contain saturated fatty acids and cholesterol. Monounsaturated fatty acids are a better source of dietary fat, and the ratio of energy supply in total fat intake should reach 10%-20%. Olive oil and canola oil, which are rich in monounsaturated fatty acids, are ideal sources of fat and should be used in preference. The daily limit of cooking oil is 18-27g, which is 2-3 tablespoons (i.e. 20-30ml). The intake of polyunsaturated fatty acids can be increased appropriately. Corn, soybean and other vegetable oils are the main sources of dietary polyunsaturated fatty acids, but they should not exceed 10% of the total energy intake. The intake of saturated fatty acids and trans fatty acids should be limited, and the ratio of saturated fatty acids and trans fatty acids to total energy should not exceed 10%. Obese patients should adopt a low-fat diet, and both saturated and unsaturated fatty acids should be strictly limited.
In the lipids provided by food, in addition to fat, there is cholesterol, the latter is the basic raw material for the synthesis of steroid hormones in the body, the daily intake of cholesterol should be less than 300mg, with hypercholesterolemia of diabetic patients should be used as little as possible or do not use food containing high cholesterol.
(4) dietary fiber
Dietary fiber and starch is also polysaccharide, but the former can not be degraded by enzymes, in the gastrointestinal tract can not be digested and absorbed, and therefore does not produce heat, with delayed digestion and absorption of food, reduce postprandial hyperglycemia, reduce fat absorption, lower blood lipids, keep the stool open and reduce hunger. Soluble fiber includes oats, buckwheat, pectin in fruits, algae pectin and konjac products and other artificial extracts; insoluble fiber includes the skin of grains (coarse grains), the skin and kernel of fruits, vegetable stems and leaves and cornmeal, etc. in the presence of cellulose or hemicellulose. Should try to increase the number of foods rich in dietary fiber: oatmeal, whole wheat buns, buckwheat noodles, nesting yellow brown rice, etc.
(5) Minerals and vitamins, etc.
Many vitamins and minerals are necessary for life activities, is a daily intake of important nutrients from food, such as calcium, sodium, magnesium, chromium, zinc and vitamins A-E, etc.. Milk and soy products are rich in calcium, spinach contains more iron, crude grains, liver and red meat provide chromium and zinc, B vitamins are commonly found in crude grains and green leafy vegetables, and fruits mainly provide rich vitamin C. Supplementation with multivitamin and trace element preparations is beneficial in reducing the risk of infection in diabetic patients. Oral supplementation with vitamin D3 in diabetic patients helps to improve insulin resistance. Routine bulk supplementation with antioxidant vitamins such as vitamin E, vitamin C and carotenoids is not recommended because of the lack of evidence for the effectiveness of such measures and the need to be concerned about their long-term safety.
Salt intake in diabetic patients should be appropriately controlled, with a general requirement that the daily amount should not exceed 6 grams. Patients with hypertension should have even stricter salt control.
2.Determine the diet plan for diabetic patients
Reasonable control of calories is the first principle of diabetes treatment. The calorie supply of diabetic patients is appropriate to maintain or slightly below the ideal weight. For obese patients must reduce calorie intake to reduce body weight. For lean patients, caloric intake must be increased to gain weight.
(1) Determination of ideal body weight and evaluation of nutritional status
First of all, the ideal weight is calculated according to the patient’s age and height with a simple formula: ideal weight (kg) = height (cm) – 105. 10% of the actual weight over the ideal weight is overweight, and 20% is obese; 10% of the actual weight below the ideal weight is weight loss, and 20% below the ideal weight is wasting. It can also be evaluated by body mass index BMI=[weight(kg)/height2(m2)]. According to Chinese standards, the normal range is 18.5~22.6, less than 18.5 is underweight, more than 23 is overweight, and more than 25 is obese.
(2) Calculate the total calories provided by the daily required diet
According to the ideal weight, nutritional status and labor intensity, the total daily calorie requirement is calculated with reference to the original living habits. Generally, adults need 25-30 kcal per kg of ideal body weight per day at rest, 30-35 kcal for light physical labor, 35-40 kcal for moderate physical labor, and 40 or more for heavy physical labor. Children, pregnant women, lactating mothers, malnourished and emaciated people and people with wasting diseases should increase as appropriate, while obese people should reduce about 5 kcal per kg of ideal body weight per day, so that their body weight can gradually recover to about ±5% of their ideal body weight.
Total daily calorie requirement = ideal body weight X daily calorie requirement per kilogram of ideal body weight.
(3) Reasonable calorie distribution
Regular and quantitative meals are very important for diabetic patients, especially those receiving glucose-lowering treatment, and can be said to be the basis for making blood glucose reach the standard. Generally speaking, it is better to have more meals than to eat too much at each meal in order to lower post-meal blood sugar. It is a better diet for diabetic patients to eat less and more meals, at least three times a day, and if necessary, it can be increased to four to six times a day, with additional meals without increasing the amount to prevent hypoglycemia. For those who have three meals a day, the calorie distribution is usually 1/3, 1/3, 1/3 or 1/5, 2/5, 2/5. For those whose blood glucose fluctuates a lot and is difficult to control smoothly, eating less and more meals can help control blood glucose smoothly.