I. Regular and quantitative diet
The total daily calorie requirement is estimated according to age, sex, occupation, and standard weight [(length – 100) × 0,9]. The daily calorie requirement for men is about 5% higher than that for women. The number of kilocalories needed per kilogram of body weight generally varies from adolescents > middle-aged people > elderly people > with an average of 5% to 10% higher per kilogram of body weight per day for each. The daily energy consumption of different manual workers is also different. Light manual workers consume 30~35kcal per kilogram of body weight per day; medium manual workers consume 35~40kcal per kilogram of body weight per day; heavy manual workers need more than 40kcal per kilogram of body weight per day. Generally speaking, pregnant women, lactating mothers, malnourished people and wasting diseases should be increased as appropriate, and obese people should be reduced as appropriate, so that the patient’s weight can be kept at about 5% of the normal weight, and the condition can often be satisfactorily controlled.
Second, reasonable adjustment of the ratio of the three major nutrients
The ratio of sugar, fat and protein in the diet should be reasonably arranged and adjusted. Not only to achieve the purpose of treating the disease, but also to meet the physiological needs of the human body. At present, the American Diabetes Association (ADA) advocates that: carbohydrates in the diet of diabetic patients should account for 55%~60% of the total calories; protein intake should not exceed 15% of the total daily calories. A daily intake of 0.8~1.2g per kg of body weight is appropriate. The daily fat intake should not exceed 30% of the total calories, and 0.6~1g per kg of body weight per day is appropriate. For obese patients, especially those with high blood lipids or arteriosclerosis, the fat intake should be adjusted according to specific conditions.
Three, diet calculation and calorie calculation
There are three kinds of nutrients that supply the body with heat energy: protein, fat and carbohydrate. Among them, carbohydrate and protein can supply 4kcal (1kcal=4,184kj) per gram, and fat can supply 9kcal (37,74kj) per gram. Diabetic patients can allocate the total calories (kcal) needed per person per day according to their labor intensity in the ratio of 69% for carbohydrates, 15% for proteins and 25% for fats to find out the caloric energy supplied by various components, and then convert the weight needed to supply different nutrients to the patient according to 9kcal per gram of fat and 4kcal per gram of carbohydrates and proteins, which can be used for three meals a day or Four meals a day. For example, for an adult diabetic patient with a normal body type and a medium working weight of 60kg, the total calories are 2400kcal per day based on 40kcal per kilogram of body weight, which is distributed in the above ratio, i.e. 1440kcal from Carbohydrate, 360kcal from protein and 600kcal from fat. To provide these calories, 360g of carbohydrate, 90g of protein and 66g of fat should be supplied. We emphasize that the method of calorie control through diet does not require diabetic patients to calculate mechanically every day, but should, after mastering this calculation method, calculate every time or when there is a substantial change in weight, and formulate the next stage of diet plan, while eating less sweets and greasy foods, and choosing diet both in principle and striving for variety.
IV: Exercise therapy
Exercise therapy is based on the patient’s functional situation and disease characteristics, the use of physical exercise to prevent and control disease, strengthen the body’s resistance, to help patients overcome the disease and restore health effective method. The benefits of exercise to the body will be described in the following list of exercise methods. Exercise therapy is an important part of the treatment of diabetes, especially in elderly and obese patients.
In view of the increasing number of outpatients consulting diabetes and antioxidants, combined with my knowledge of astaxanthin and the clinical application experience of the past two years, to talk about some of the concerns of diabetic patients: astaxanthin + insulin therapy for diabetes, the root of diabetes is the overload of the pancreas or islets caused by aging, in order to restore the pancreas to normal must be given to the islets to reduce the load, diet regulation, exercise, insulin injection or Diet modification, exercise, insulin injections or insulin containing, biguanide, acarbose and other treatments are all to reduce the load on the islets, but the load reduction is not enough, but also need to remove the factors that continue to damage the islets in order to restore the function of the islets, this is the effective “anti-oxidative stress”.
Five: Drug therapy
Diabetes drugs are generally divided into six categories.
First: sulfonylureas
Second: biguanides
Third: thiazolidinediones
Fourth: Glinides
Fifth: glycosidase inhibitors
Sixth: insulin
1. Indications.
①Patients with type 1 diabetes, due to the impaired function of their own pancreatic β-cells and absolute insufficiency of insulin secretion, need insulin therapy at the onset, and need lifelong insulin replacement therapy to maintain life and living. It accounts for about 5% of the total number of people with diabetes. ②Patients with type 2 diabetes can start the combination therapy of oral medication and insulin if their blood glucose still does not reach the control goal based on the combination therapy of lifestyle and oral hypoglycemic drugs. Generally, if the HbA1c is still greater than 7.0% after a large dose of multiple oral medications, insulin therapy can be considered to be initiated. (3) Patients with new onset of wasting diabetes mellitus that is difficult to differentiate from type 1 diabetes mellitus. ④In the course of diabetes (including patients with newly diagnosed type 2 diabetes), insulin therapy should be used as early as possible when weight loss without obvious causative factors occurs. ⑤ For patients with type 2 diabetes with high blood glucose, since it is difficult to satisfactorily control blood glucose with oral medication, and the rapid relief of hyperglycemic toxicity can partially reduce insulin resistance and reverse β-cell function, intensive insulin therapy can be used in newly diagnosed type 2 diabetes with significant hyperglycemia. (6) There are also some special cases that require insulin therapy: perioperative period; temporary use of insulin to overcome the risk period in case of serious acute complications or stress, such as diabetic ketoacidosis, hyperosmolar hyperglycemia, lactic acidosis, infection, etc.; serious chronic complications, such as diabetic foot, severe diabetic nephropathy, etc.; combined with some serious diseases, such as coronary heart disease, cerebrovascular disease, hematological disease, liver disease, etc. Gestational diabetes mellitus and women with diabetes mellitus combined with pregnancy, during pregnancy, before and after delivery, and during lactation, if blood glucose cannot be controlled by diet alone to reach the required target value, insulin treatment is required and oral hypoglycemic drugs are prohibited. (7) Secondary diabetes and atopic diabetic patients.
2.Insulin preparations.
Insulin can be classified according to the source and chemical structure: animal insulin, human insulin, and insulin analogues. Human insulin such as Novaline series, insulin analogues such as Novaline, Novaline 30, Novaline and Ping. According to the characteristics of action time can be divided into: rapid-acting insulin analogues, short-acting insulin, intermediate-acting insulin, long-acting insulin (including long-acting insulin analogues) and premixed insulin (premixed insulin analogues), common rapid-acting insulin analogues such as Novolin, long-acting insulin analogues such as Novaline. Clinical trials have proved that insulin analogs are better than human insulin in simulating physiological insulin secretion and reducing the risk of hypoglycemia.
3. Notes on use.
Dietary control and exercise should be continued after starting insulin therapy, and patient education should be strengthened to encourage and guide patients to perform self-monitoring of blood glucose for insulin dose adjustment and prevention of hypoglycemia. All patients starting insulin therapy should be educated on hypoglycemic risk factors, symptoms and self-help measures.
The insulin regimen should mimic the pattern of physiologic insulin secretion and include both basal and mealtime insulin supplementation. The choice of regimen should be highly individualized and follow a stepwise treatment plan driven by glycemic attainment to control blood glucose smoothly at the earliest possible time.