A. Principles and requirements of dietary nutrition therapy
1.Heat energy
The internal and external activities of the human body need heat energy to promote, the body needs heat energy mainly by carbohydrates, fats and proteins in the body burning supply, diabetic patients’ heat energy needs to be able to maintain normal body weight, or slightly below normal body weight as appropriate. Therefore, all obese people need to reduce their caloric intake to reduce body weight, while lean people should increase their caloric intake to increase body weight.
Calculation of caloric energy needs should be based on the patient’s gender, age, body type (fat or thin) and labor situation, the caloric energy needs of men are higher than those of women, the elderly are lower than those of the young; those with high activity are higher than those with low activity, the calculation of the caloric energy needs of adults can be referred to the following table. ((Simple formula for calculating normal weight, height (cm) a 105 = weight (kg. Another simple method is the estimation of body mass index: body mass index = weight (kg) / height (m) 2 ideal value of 22)
2.Carbohydrate
The main function of carbohydrates is to supply caloric energy, if the supply is sufficient to reduce the decomposition of protein and fat in the body, which is beneficial to health, but if the supply is insufficient, it is easy to cause ketonuria, which is not conducive to disease control.
How many carbohydrates should diabetic patients consume daily and how many staple foods should they eat? For people with normal body weight and simply using nutritional therapy, at the beginning, carbohydrates should be controlled more strictly, 200 grams per day. After a period of treatment, if the blood sugar drops and urine sugar disappears, you can gradually increase to about 300 grams, which is equivalent to about 6 grams of staple food.
For people treated with drugs, when the condition is not satisfactorily controlled, carbohydrates can be controlled at 200-250 grams. When the urine sugar decreases and the condition is stable, it can be relaxed to 250-350 grams. For light manual workers, especially the elderly, the staple food generally does not exceed 6 taels (300 grams). Even for those who cannot eat temporarily for some reason, 150-250 grams of glucose should be injected daily to prevent the occurrence of ketoacidosis.
3.Fat
Fat is an indispensable source of energy in the human body, and its heat production is more than two times that of carbohydrates. In order to prevent or delay the occurrence and development of vascular complications. According to the kilogram of body weight is about l grams or less than 1 gram. And to limit the intake of saturated lipids and acids. Most advocate a ratio of saturated fatty acids (S), polyunsaturated fatty acids (P) and monounsaturated fatty acids (M) of 1:1:1 in the diet. in other words, the use of animal fats rich in saturated fatty acids should be limited in the diet. In addition cholesterol intake is less than 30Omg/d.
4.Protein
The protein intake of diabetic patients is approximate to that of normal people. Adults are supplied at 0.8 one gram per kilogram of body weight per day. If the disease is not well controlled and negative nitrogen balance is easy to occur, it should be increased appropriately and supplied at 1.2-1.5 grams per kilogram of body weight per day, at least 1/3 of which is animal protein. If the diet is mainly vegetarian, the amount of protein supply should be increased appropriately. In case of combined diabetes without nitrogen retention, protein intake should be increased if there is more urine protein, and the intake of egg should be reduced if there is liver and kidney failure. In short, the amount of protein intake should be considered in conjunction with the disease.
5.Dietary fiber
Epidemiological surveys and clinical studies have shown that dietary fiber has the effect of lowering fasting blood sugar and postprandial blood sugar and improving glucose tolerance. It may be related to fiber absorbency, and fiber changes the transmission time of food in the gastrointestinal tract. Therefore, it is mostly advocated to increase the supply of dietary vitamins in the patient’s diet.
6.Vitamins and inorganic salts
All patients with poorly controlled disease, complications of infection or ketoacidosis should pay attention to the supplementation of vitamins and inorganic salts, because the glycogen isogenesis of these patients is vigorous, water-soluble B vitamins are consumed, supplementation of B vitamins including B12 can improve neurological symptoms. Supplementation of vitamin C can prevent deficiency due to microangiopathy. In ketoacidosis, sodium, potassium and magnesium should be supplemented to correct electrolyte disturbance. Normally, sodium intake should not be too high, too high may cause hypertension. Calcium intake should be increased, long-term calcium deficiency is likely to lead to osteoporosis. Vegetables are a good source of inorganic salts and vitamins, and dairy is a good source of calcium.
Trivalent chromium is a component of glucose tolerance factor (GTF), which binds to insulin to increase insulin receptors and promote the entry of glucose into cells. Foods containing active chromium include yeast, beef, liver, mushrooms, and beer. Zinc assists in the transport of glucose across the cell membrane. There are two zinc atoms in each insulin molecule, and it is estimated that zinc is related to insulin activity. Animal food is the main source of zinc.
7.Meal time
In order to reduce the burden of the pancreas and make it secrete insulin reasonably, diabetic patients should eat at least three meals a day and at regular intervals. Patients treated with insulin or patients prone to hypoglycemia should also add 2-3 times between the three meals, that is, from the morning, noon and evening meals, a small portion of staple food left for additional meals, which is a proven measure to prevent hypoglycemia, have to be used, according to our experience, even non-insulin treated patients can also eat more meals, so that the amount of staple food per meal does not exceed 2 taels ( 100 grams) per meal. This is beneficial to the control of blood sugar.
Second, the food choice of diabetic patients
The diet of diabetic patients should be as diverse as possible, in addition to limiting the number of sugary sweets and foods, as well as normal people, to make it meet the requirements of a balanced diet.
1.Foods that should not be eaten or eaten less
a Brown sugar, white sugar, glucose and other refined sugars, as well as sweets and pastries, preserves, ice cream, sweet drinks and other sweet foods (with the exception of when there is hypoglycemia).
bHigh carbohydrate-containing potatoes, taro, lotus root, garlic, carrots, fresh peas, etc. can be eaten sparingly, and if more are eaten, the amount of staple foods needs to be reduced. See (Food Equivalence Exchange Table) for the amount of reduction.
cThe incidence of combined cardiovascular complications in diabetes is high, so the intake of animal fats should be reduced in the diet and replaced by vegetable fats. Obese patients use less fatty foods, including peanuts, walnuts and other hard fruits.
2, it is recommended to use more food
Soybean and its products: because of the amount of protein contained, good quality, and the fat contained in the polyunsaturated fatty acids, mainly, has the effect of reducing blood lipids, and does not contain cholesterol and contains plant sterols, are beneficial to the prevention of atherosclerosis. Soybean digestibility is low, after processing into tofu, soy milk and other soy products, digestibility significantly increased, so diabetic patients should try to use soy products instead of some meat and other animal foods within the limits. Meat, especially pork contains high fat, is not conducive to the prevention and treatment of cardiovascular disease.
Coarse grains: such as oatmeal, corn flour and beans, etc., contain more trace elements, vitamins and dietary fiber, to improve glucose tolerance, reduce blood lipids have a good effect, some people use corn flour, soybean flour, white flour in the ratio of 2:2:1 made of triple noodles steamed buns, pancakes and noodles as a staple food, long-term consumption, its blood sugar, blood lipids have been more satisfactory control, and that than fine grains by satiety. It is not a bad idea to choose more food within the limit. For patients with obvious hunger is more appropriate to eat.
Vegetables: especially the leafy stems containing more water, vegetables, melons and fruits, containing inorganic salts, vitamins and dietary fiber rich, in the gastrointestinal tract digestion and absorption function can have more, vegetables contain low calories, still can be used to do hunger food.
Sugar-lowering food: yellow meal, purple water spinach, onion, grapefruit, pumpkin, etc.
Third, the cautious use of food
Fruits: containing fructose and glucose, it is generally believed that diabetic patients should be careful to eat, must be limited, and to reduce the amount of staple foods accordingly, fruits such as apples, pears, oranges 4 to 5 two (200-2509) can be replaced by half two (25 grams) of staple foods. It is recommended that it is best to eat between meals or before going to bed for dinner, as for patients with poor disease control is best not to eat.
Alcohol: Each gram of alcohol can provide 29.3 kJ of caloric energy. alcohol metabolism does not require insulin, so some people think it is okay to drink less. But for the sake of caution, it is also appropriate not to drink. In addition to heat, alcohol does not contain or contains few other nutrients, long-term drinking, the liver is not conducive, easy to cause hypertriglyceridemia, and a few patients taking sulphur pulse drugs are prone to panic, shortness of breath, red cheeks and dryness after drinking alcohol, and patients injecting insulin are prone to hypoglycemia after drinking alcohol on an empty stomach.