Diabetes is a regrettable disease, but fortunately it is a chronic disease that can be managed. The threat of diabetes is mainly due to various chronic complications, and numerous studies have confirmed that long-term stable and regular treatment can minimize the appearance of chronic complications. In the long-term treatment process, the patient’s understanding and cooperation is the key to achieving good and expected results from the treatment.
I. Diet therapy
Diet therapy is the foundation of diabetes treatment and is a measure that is used throughout the prevention and treatment of diabetes.
The purpose of diet therapy is to correct metabolic disorders, reduce pancreatic β-cell load, maintain ideal body weight, and prevent complications while ensuring normal life requirements.
Diabetes diet principles: balance, variety and reasonable nutrition
Balance: It means the balance of fat, protein and carbohydrate is reasonable, with fat generally accounting for 20% to 30% of total calories or slightly less; protein accounting for 12% to 20% of total calories; and carbohydrate accounting for 55% to 65% of total calories.
The American Diabetes Association (ADA) issued guidelines for the treatment of type 2 diabetes in 2006, which stipulate that the intake of carbohydrates should be 45% to 65% of total calories, and the total carbohydrate intake should not be less than 130 g/d. Protein intake should account for 15% to 20% of the average energy intake, but the proportion of protein intake in patients with kidney disease should not exceed 10% of total calories. Fat should account for 25% to 35% of the total calories.
Variety: It means that various foods such as cereals and potatoes, vegetables and fruits, meat, poultry, fish, eggs, beans, fats and oils should be appropriately consumed, and no partial diet.
Nutrition: It means that we should pay attention to various nutrients in food, such as plant fiber, vitamins, inorganic salts, calcium minerals, etc.
The purpose of diet therapy is not to turn patients into ascetics, but to develop a reasonable diet plan for patients according to their condition, treatment needs, lifestyle, cultural background, socio-economic status, and personal dietary preferences.
Diet therapy mainly involves four aspects, such as total calories of diet, carbohydrate content, food glycemic index and Chinese medicine evidence-based food administration.
1.Total calories of diet
The simple formula for calculating ideal weight is: height (cm) – 105 = standard weight (kg). Standard weight ± 10% for the ideal weight; more than 20% for obesity; less than 20% for wasting.
The total daily calories of diabetic diet is calculated according to the patient’s weight, physical activity and condition.
Each gram of fat produces 9kcal of heat, each gram of protein produces 4kcal of heat, each gram of carbohydrate produces 4kcal of heat.
2.The content of carbohydrates
Carbohydrates are the main component of our daily staple food cereals and potatoes. Since carbohydrates are absorbed by the body and become the main factor in the rise of blood sugar after meals, controlling the intake of carbohydrates is the focus of diabetic diet treatment. Since cereals are the main component of our daily diet, they are also the first foods that are asked to be reduced when diet therapy is carried out. Only by knowing the amount of carbohydrates contained in such foods, it is possible to target the dietary control. If only carbohydrate-based foods (staple foods) are reduced to a very small amount (1 to 2 taels), while relaxing the control of high-calorie foods such as fat and protein (e.g. meat, eggs, milk, etc.), it is also difficult to receive good results. This is because, if the total calorie limit is exceeded, a single strict carbohydrate control program will also fail to achieve the goals of controlling body weight in the ideal state, reducing insulin resistance and correcting metabolic disorders. Reasonable carbohydrate intake is beneficial to improve insulin sensitivity and glucose tolerance. Meanwhile, staple foods are rich in starch polysaccharides, dietary fiber, vitamins and minerals, and have good effects on total food intake, total calories and body weight control due to their large size and strong sense of satiety.
3, food glycemic index
Glycemic index (GI) is a physiological parameter of food, which is a valid indicator to measure the postprandial blood sugar response caused by food. It indicates the percentage value of blood glucose response level in the body within a certain period of time (generally 2 hours) for food containing 50g of valuable carbohydrates and an equivalent amount of glucose or white bread.
It is generally considered that: when the glycemic index is below 55, the food is low GI food; when the glycemic index is between 55 and 75, the food is medium GI food; when the glycemic index is above 75, the food is high GI food. Since the glycemic index of food is influenced by the type and structure of carbohydrates in food, the chemical composition and content of food, as well as the physical condition and processing and production process of food, it is not necessarily completely correlated with the carbohydrate content of food.
Low GI food has a long residence time in the gastrointestinal tract, low absorption rate, slow glucose release and low peak value after entering the blood; high G I food has fast digestion and high absorption rate after entering the gastrointestinal tract, fast glucose release and high peak value after entering the blood.
4.TCM evidence-based food administration
The dietary control mentioned above is based on modern nutrition research, but in fact, Chinese medicine has a history of nearly two thousand years in the dietary treatment of diabetes. For example, Sun Simiao of the Tang Dynasty put diet control therapy in the first place in the treatment of the disease of thirst (diabetes), and he said, “Those who can be careful about this, although they do not take medicine and can be free from others, do not know this, even with the golden elixir, but also can not be saved, think deeply and carefully.” Modern Chinese medicine’s diet therapy, based on the research of modern nutrition, according to each patient’s type of disease, discriminates food and guides diabetic patients’ diet control, which is not only conducive to patients’ blood sugar control, but also helps correct patients’ imbalanced yin and yang, adjust the function of internal organs, and restore normal physiological state.
Modern research has found that the basic evidence of diabetic patients is deficiency of both qi and yin, internal heat and injury to fluid, and the common pathogenic evil is damp heat and blood stasis. Therefore, the dietary treatment in Chinese medicine is concerned with: clearing heat without harming qi and nourishing yin without helping evil. The cold and hot, warm and cool properties of natural foods are used to correct the deviations of yin and yang in the organism and to achieve the goal of yin and yang balance.
Among the staple foods, wheat and millet are slightly cold in nature; rice is warm in nature, so it is appropriate to eat these staple foods in combination.
Pork is cool in nature; carp is flat in nature and should be eaten by patients with Yin deficiency and internal heat.
Beef, lamb, chicken, grass carp, crucian carp, eel and shrimp are warm in nature and should be eaten by patients with yang deficiency.
Eggs are sweet and calm, which can calm the heart and the five organs; milk is sweet and slightly cold, which can nourish weakness, quench thirst, nourish the heart and lungs, detoxify heat and moisten the skin; very suitable for diabetics.
Soybeans are warm, but the glycemic index is very low, so you can drink it properly after making soy milk.
Among the vegetables, celery, bitter melon, loofah, cabbage, lettuce, eggplant, winter melon, spinach, etc. are all mild or slightly cold in nature and suitable for diabetics. Carrots, pumpkins and leeks are not suitable for patients with warmth and yin deficiency, and the glycemic index of carrots is 71 and that of pumpkins is 75.
Among fruits, apples, peaches, pears, plums, cherries, mandarins, grapefruit and grapes have a glycemic index lower than 50 and are suitable for diabetic patients; however, plums and cherries are warm and hot in nature, so patients with internal heat of yin deficiency should not eat more of them.
Kiwi, mango, banana, apricot, pineapple, watermelon and other glycemic index between 52 and 72, diabetic patients should be careful to eat, including apricot, mango, pineapple, warm nature, which can help wet produce heat, eat more cautious. In addition, lychee is hot, diabetics should also eat less.
Fried dried fruits, such as peanuts, melon seeds, cashew nuts, pistachios, etc., because they contain few carbohydrates, although the glycemic index is not high, but because they contain more fat, plus after frying, warm and dry, easy to damage the body’s fluids after eating, so patients with internal heat Yin deficiency should not eat.
Condiments such as onion, ginger, garlic and chili are all pungent and hot products, which can help heat and harm yin, so they should be used with caution.
The daily distribution of calories for three meals is generally 1/5 for breakfast, 2/5 for lunch and 2/5 for dinner; or 1/3 for breakfast, lunch and dinner.
For patients with good control of total diet but large postprandial blood glucose fluctuations, the total daily diet can be divided into 4 to 5 servings, and sometimes good results can be achieved.
In the process of diet therapy, when the weight continues to drop below the standard weight or even to the level of wasting, it means that the total calorie control is too strict and malnutrition has occurred. The dietary treatment plan should be adjusted in time.
II. Exercise
Exercise therapy is an important part of the diabetes treatment plan. Exercise can improve insulin sensitivity, improve blood pressure and blood lipids, strengthen the function of the cardiovascular system, and control body weight, and regular exercise is also beneficial to blood sugar control and reduce the dosage of hypoglycemic drugs. Exercise for diabetic patients must pay attention to the following points.
1, safety: as many diabetic patients have complications, patients with proliferative retinopathy have the possibility of vitreous hemorrhage; patients with peripheral neuropathy have the risk of trauma to the lower limbs (especially the foot). And exercise may induce angina pectoris, myocardial infarction, and arrhythmia in patients with coronary artery disease; therefore, all diabetic patients should be examined and evaluated accordingly before exercise, and a reasonable exercise program should be developed under the guidance of a physician. In addition, low to moderate intensity exercise can reduce the level of blood sugar during and after exercise, and there is a risk of inducing hypoglycemia; therefore, the dosage of insulin or insulin-producing agents should be adjusted according to the situation, or the intake of carbohydrates should be supplemented before or during exercise. Proper hydration should be provided before exercise.
2. Exercise time: The best time to exercise is to start 1 hour after meal. Patients using insulin or insulin-producing agents should avoid exercising on an empty stomach, otherwise it may induce hypoglycemic reaction. Blood sugar can also be checked before exercise. If blood sugar is lower than 100mg/dl (5.6mmol/L), no less than 15g of carbohydrates should be supplemented immediately, and exercise should be started again when blood sugar is restored to more than 100mg/dl.
3. Exercise amount: The principle of exercise therapy is moderate, regular and individualized. Daily at least 30 minutes of moderate intensity (no time to talk to others during exercise) exercise, such as brisk walking, jogging, cycling, swimming, etc.
4, the control of exercise heart rate: generally is (220 – age) × 70%
In normal adults, the highest heart rate that can increase cardiac output is 160 to 180 beats/min. When the heart rate exceeds this limit, the volume per beat is often significantly reduced, so cardiac output is reduced instead. In trained athletes, the heart rate reserve is also increased, as shown by the fact that the heart rate can increase to 200-300 beats/min before the decline in cardiac output begins to occur.
Because diabetic patients may have autonomic neuropathy, which creates a fixed heart rate, and because some patients take beta-blockers, which affect heart rate variability, both types of patients should not use the above method to develop exercise volume.
Professor Krisk of the University of Pittsburgh, USA, has the following views on exercise interventions.
(1) The amount of exercise should be gradually increased from small to large.
(2) Emphasize that doing some exercise is better than not doing it.
(3) Do not emphasize the intensity and duration of a single exercise, but advocate a variety of exercises suitable for the specific situation of individual patients, and accumulate the total amount of various exercises, the more the total amount, the better the effect, just like “accumulating fish into whales”.
(4) Emphasize not only project-based exercise. The calculator is probably the easiest and most effective helper. His advice to people is to exercise at least 30 minutes a day, depending on their respective backgrounds.
III. Medication
The aim of diabetes medication is to prevent acute complications and reduce the risk of chronic complications by correcting metabolic disorders and controlling blood glucose to the desired goal through continuous treatment with drugs. Therefore, it is necessary to frequently monitor blood glucose values at different times (e.g. fasting, after breakfast, before lunch, after lunch, after dinner, before going to bed) in order to timely adjust medication and achieve the best therapeutic effect.
Since whether the treatment meets the standard is the key to determine whether the risk of diabetic complications can be reduced, it is especially important to review the above indicators regularly.
Any blind adjustment of medication on your own may be dangerous or incorrect.