Medical nutrition therapy for type 2 diabetes
Medical nutrition therapy is an important part of the comprehensive treatment of diabetes and is the basic treatment of diabetes. Patients with poor adherence to medical nutrition therapy have difficulty in achieving ideal metabolic control. Poor dietary structure and habits may also lead to the development or aggravation of related cardiovascular risk factors such as hypertension, dyslipidemia and obesity.
General rules of nutritional therapy
Patients with diabetes and prediabetes need to receive individualized medical nutrition therapy according to their treatment goals, which is better done under the guidance of a nutritionist who is familiar with diabetes treatment.
It is better to be guided by a nutritionist who is familiar with the treatment of diabetes. The total energy intake should be controlled and various nutrients should be distributed in a reasonable and balanced way.
The goals of nutrition therapy
1.To achieve and maintain the ideal blood sugar level.
2.Reducing risk factors for cardiovascular disease, including control of dyslipidemia and hypertension.
3.Provide a balanced nutritious diet.
4.Reducing pancreatic beta-cell load.
5.Maintain reasonable body weight: The goal of weight reduction for overweight/obese patients is to lose 5%-10% of body weight over a period of 3-6 months. Lean patients should regain and maintain their ideal weight over time through a balanced nutritional program.
Fats
1. dietary energy provided by fat should not exceed 30% of total dietary energy.
2. the intake of saturated and trans fatty acids should not exceed 10% of the total dietary energy.
Monounsaturated fatty acids are a better source of dietary fat, and the energy supply ratio in the total fat intake should reach 10%-20%. The intake of polyunsaturated fatty acids can be increased appropriately, but should not exceed 10% of the total energy intake.
3. Cholesterol intake in food <300mg/day.
Carbohydrate
1.The energy provided by carbohydrates in the diet should account for 50%-60% of the total energy.
2.Foods with low glycemic index are good for blood sugar control.
3, the increase in blood sugar caused by sucrose is similar to that of the same amount of starch and does not exceed 10% of the total energy.
4. moderate intake of sugar alcohols and non-nutritive sweeteners is safe for diabetics
5.Eat three meals regularly every day with even distribution of carbohydrates.
Protein
1.For diabetic individuals with normal renal function, the recommended protein intake is 10%-15% of the energy supply ratio.
2.Patients with dominant proteinuria should limit protein intake to 0.8g/kg/d. From the time GFR decreases, a low protein diet should be implemented with a recommended protein intake of 0.6g/kg/d and supplemented with compounded a-keto acid preparations.
3. Protein intake does not cause a rise in blood glucose, but can increase the insulin secretion response.
Alcohol consumption
1.Drinking alcohol is not recommended for diabetic patients. The calories contained in alcohol consumption need to be counted into the total energy range when drinking alcohol.
2. no more than 1-2 standard servings/day (one standard serving is 350ml of beer, 150ml of red wine or 45ml of low white wine, each containing about 15g of alcohol).
3. Alcohol may promote hypoglycemia in patients treated with sulfonylureas or insulin.
Salt
1. Limit salt intake to less than 6g per day, and patients with hypertension should limit the intake even more strictly.
2. Limit the intake of foods with high salt content, such as monosodium glutamate, soy sauce, processed foods, flavored sauces, etc.
Physical activity
Physical activity plays an important role in the management of type 2 diabetes. Exercise increases insulin sensitivity, helps blood glucose control and facilitates weight loss. It also benefits inflammation control, disease prevention and mental health. Diabetic patients who adhere to regular exercise for 12-14 years have significantly lower mortality.
1. Exercise therapy should be carried out under the guidance of a physician.
2, blood sugar > 14-16 mmol/L, obvious hypoglycemia or large fluctuations in blood sugar, acute metabolic complications of diabetes and various serious chronic complications of the heart and kidneys and other organs are not suitable for exercise for the time being.
3. The frequency and duration of exercise is at least 150 minutes per week, such as 30 minutes per exercise 5 days a week. Studies have found that even a small amount of physical activity (e.g., as little as 10 minutes per day on average) is beneficial. Therefore if patients find it too difficult to achieve the recommended amount of exercise time, they should be encouraged to do everything possible to engage in appropriate physical activity
4. moderate intensity physical activities include: brisk walking, tai chi, cycling, golfing and gardening activities.
5. stronger physical activities are: dancing, aerobic fitness, jogging, swimming and cycling uphill.
6, the best 2 times a week muscle exercises such as weight lifting training, training with light or moderate resistance. Combined resistance exercise and aerobic exercise can obtain a greater degree of metabolic improvement.
7, exercise programs should be compatible with the patient’s age, condition, social, economic, cultural background and physical fitness.
8. the development of healthy habits and the integration of beneficial physical activities into daily life.
9. Diabetic patients should be advised to adjust their food and medication during heavy or vigorous activities to avoid hypoglycemia.
Quit smoking
Smoking is harmful to health, especially for patients with type 2 diabetes who are at high risk for macroangiopathy. Every diabetic patient who smokes should be advised to stop smoking, which is one of the important elements of lifestyle intervention.