Healthy eating habits, regular physical activity, and regular medication are key components of diabetes management. Although non-pharmacological treatment of diabetes has received increasing attention in recent years, there are still many patients who are troubled about what to “eat”. Today, we will talk about nutritional therapy for diabetes. But first of all, it should be stated that all this should be done on the basis of standardized medication.
1. What is nutritional therapy?
Nutritional therapy refers to the improvement of physical status by adjusting the intake of food or nutrients. For diabetic patients, nutritional therapy includes the establishment of personalized dietary patterns, proven dietary programs to help lower blood sugar, blood pressure, change blood lipid profiles, as well as reduce the risk of cardiovascular disease, coronary heart disease and stroke.
2. Does nutritional therapy for diabetes work?
In 1999, the Institute of Medicine (IOM) released a report that showed evidence that medical nutrition therapy can improve clinical outcomes for patients with diabetes and reduce health care costs for diabetes management. Part of a multidisciplinary approach to patient benefit in health care.
3. What should adults with diabetes achieve through nutritional therapy?
To achieve individual goals for blood glucose, blood pressure and lipids using an individualized dietary pattern and consuming a variety of natural food sources rich in nutrients in appropriate amounts to maintain energy balance and achieve and maintain target weight. Delay or prevent complications of diabetes. Change poor eating behavior habits and provide feasible solutions for daily meal planning for diabetic patients.
4.What is the key to diabetic diet?
In short, the key is to keep blood glucose levels stable and to intervene in modifiable risk factors by.
(1) Maintaining energy balance.
Control the total calorie intake of food to reduce and maintain body weight. Food provides energy for the body and daily activities and exercise consume energy, which is an energy balance. If the total calorie intake of food is too large and the amount of exercise is not enough, the excess energy will accumulate in the body in the form of fat, increasing weight and causing overweight or obesity; on the contrary, if the calorie intake is not enough, low weight or wasting can be caused by insufficient energy.
Studies have shown that in adults with type 2 diabetes who are overweight or obese, reducing energy intake while maintaining a healthy eating pattern can help with weight loss. Moderate weight loss has clinical benefits for some patients with diabetes (improving blood glucose, blood pressure, and lipids), especially for those in the early stages of the disease. To achieve moderate weight loss, intensive lifestyle interventions and ongoing support are recommended.
(2) Recognizing the effect of carbohydrates on blood glucose
Carbohydrates can be simply divided into monosaccharides (glucose, fructose, sucrose, dextrose, maltose, lactose) and polysaccharides (starchy, cellulose). The simpler the structure, the faster the digestion and absorption, which can make the blood sugar rise rapidly and the blood sugar level fluctuate greatly; while the more complex the structure, the digestion and absorption become relatively slower, the blood sugar level rises more slowly and the blood sugar level fluctuates less. Carbohydrate-containing foods and beverages and endogenous insulin are determinants of postprandial blood glucose levels.
It has also been shown that certain carbohydrate-rich foods can cause a surge in blood sugar and insulin in the body, which can lead to obesity and even diabetes and heart disease, due to the high glycemic load of these carbohydrate foods. Therefore, for people with diabetes, the type and amount of carbohydrates in food should be a major concern.
When choosing foods containing carbohydrates, choose foods that are high in nutrients and high in dietary fiber (e.g., vegetables, fruits, legumes). Highly nutritious foods and beverages provide vitamins, minerals and other healthful substances while providing relatively small amounts of energy. High-fiber carbohydrates are digested more slowly and as a result keep blood sugar levels in the body from rising too quickly. In contrast, low-fiber carbohydrates are digested more quickly, so blood sugar levels in the body can rise rapidly. Try to avoid processed foods that have extra sodium, fat and sugar added to them.
(3) Whether whole grains are good for blood sugar control
Whole grains are not beneficial for blood glucose control in people with type 2 diabetes, but they may have other health benefits, such as reducing systemic inflammatory responses. Studies have shown that the intake of whole grains (including cereal fiber, bran and germ) is associated with all-cause mortality and cardiovascular disease-related mortality in women with type 2 diabetes. Therefore, whole grains, although not proven to be beneficial for glycemic control, are still an optional healthy food.
(4) Improvement of cardiovascular risk factors in diabetic patients by unsaturated fatty acids
The Mediterranean diet helped improve cardiovascular risk factors (lipids, blood pressure, triglycerides) in diabetic patients; the incidence of cardiovascular events and stroke was reduced when mixed nut oils (e.g., walnuts, almonds) or olive oil were added to the diet. Patients on the Mediterranean diet with restricted energy intake had improved glycemic control. Replacing carbohydrates and/or saturated fats with MUFA improved glycemic control and/or lipid levels in patients with type 2 diabetes.
Observational studies have shown that a higher intake of foods containing long-chain omega-3 fatty acids (EPA and DHA) (present in fish fat) and omega-3 linolenic acid (seeds) is beneficial for lipoproteins and prevention of heart disease. Therefore, it is recommended that diabetic patients consume more foods containing long-chain polyunsaturated fatty acids and monounsaturated fatty acids while limiting their total energy intake.
(5) Intake of appropriate high-quality protein
Due to the prevalence of biochemical specificity, each individual has a different nutrient requirement, so there is no uniform standard for protein intake. On the other hand, the closer the amino acid pattern of food proteins is to that of human proteins, the easier such proteins are absorbed and utilized by the body and are called high-quality proteins. Examples of animal proteins include eggs, milk, meat, fish, etc., as well as soy protein.
However, studies have shown that diets consistently high in protein can increase the burden of acid metabolism in the kidneys, increase the risk of stone formation, reduce calcium balance levels, and increase the risk of bone loss. And when choosing a protein source, you should not only consider the protein content, but also the pros and cons of the other nutritional components of the food. A simple example: 25% of the energy provided by lamb comes from protein and 75% from saturated fatty acids. Soybeans, on the other hand, get 50% of their energy from protein and the remaining 50% from carbohydrates (dietary fiber, polysaccharides) and unsaturated fatty acids. Therefore, the recommendations for protein: reduce animal protein sources, eat moderate amounts of fish, poultry, eggs and lean meat; eat dairy, soy, seed vegetables and other plant protein foods every day.
(6) Appropriate intake of nutritional supplements
There is no clear evidence that vitamin or mineral supplements are beneficial for people with diabetes who do not have deficiencies. The recommended individual diet plan should diversify food choices to allow for adequate intake of micronutrients. However, diabetes that is not well controlled often causes micronutrient deficiencies, and people with diabetes should be fully aware of the importance of getting enough vitamins and minerals from a balanced diet. For certain specific groups of people, such as the elderly, pregnant women, vegetarians, and those on diets, taking multivitamin supplements may be necessary.
(7) Drink alcohol in moderation
Alcoholic beverages are essentially pure energy foods and contain no other nutrients. Uncontrolled drinking can cause a decrease in appetite and food intake, resulting in a variety of nutrient deficiencies, acute and chronic alcoholism, alcoholic fatty liver, and in severe cases, alcoholic cirrhosis of the liver. Excessive alcohol consumption can also increase the risk of hypertension, stroke and other diseases. Alcohol should be consumed in moderation to minimize the acute or long-term effects of alcohol on blood sugar in diabetic patients. Patients with diabetes who use insulin or insulin stimulants should consume alcohol with food to reduce the risk of hypoglycemia.
(8) Adjust eating according to the medication regimen of the diabetic patient
(1) For patients using insulin stimulants or a combination of two or more medications, care should be taken to reduce the risk of hypoglycemia.
The appropriate amount of carbohydrate should be consumed at each meal and each snack Diet should be regular, do not skip any of the exercise at certain times (such as before meals), which may cause hypoglycemia. Carbohydrate-containing foods should be carried along regardless of the time of exercise to reduce the risk of hypoglycemia.
② For people with type 1 diabetes and people with type 2 diabetes who require insulin therapy, learn how to calculate carbohydrate intake or use other meal plans to quantify carbohydrate intake to ensure that insulin use matches carbohydrate intake.
If you are injecting insulin multiple times a day or using an insulin pump.
Using insulin before a meal allows for food intake at a different time. If physical activity occurs within 1 to 2 hours of insulin injection, the dose of insulin should be reduced to reduce the risk of hypoglycemia.
For patients using premixed insulin.
The number of daily insulin doses should be consistent, and the number of daily meals should be kept more or less the same, without skipping any meal, to reduce the risk of hypoglycemia.
For patients on a fixed insulin dose should consume a similar amount of carbohydrate each day to match the set insulin dose.
(9) Foods that should be avoided
Patients with diabetes are instructed to carry with them foods that contain carbohydrates that can provide energy quickly to reduce the risk of hypoglycemia. In case of hypoglycemia, choose those foods that can raise blood sugar quickly, such as sugar water, fruit juice, honey, sugar cubes, cookies, rice or buns.
Glucose tablets or carbohydrate-rich foods or drinks (e.g. sports drinks, hard candy) are currently recommended and can be absorbed quickly by the gastrointestinal tract so that blood sugar can rise in a short period of time and correct the hypoglycemic state. The general recommended dose of glucose is 15~20g. When the blood sugar level is 2,8~3,3mmol/L, the therapeutic dose of each 15g of glucose can raise the blood sugar by 2,8mmol/L.
When there is hypoglycemia, food containing a lot of fat or protein (such as ice cream) is not suitable for emergency. Protein intake in people with type 2 diabetes may help increase insulin response without increasing blood glucose levels.