Internal Medicine

Diet recommendations for diabetics

introduction

In principle, the same dietary recommendations apply to diabetics as they are advised to keep everyone healthy.

At Obesity

The body weight should be in a range of Body mass index move from 19 to 25.

If you are overweight, weight reduction is recommended. A weight loss of 1 - 2 kg per month is aimed for and is achieved by keeping the daily calorie intake 500 calories below consumption. An energy-reduced (total fat intake less than 30% of the total energy), balanced, varied mixed diet is particularly suitable for this. This form of nutrition is in the chapter

"Therapy of obesity in adults" is described in detail.

In the case of high blood lipid levels, high blood pressure and fat accumulation in the abdomen, the need for a Weight loss particularly emphasized. Even small weight losses can lead to an improved metabolic situation.

Nutrient intake

The daily calorie intake should be such that a desirable weight which one Body mass index between 19 and 25 matches can be kept.

1. Carbohydrates

Most of the supplied energy should come from Carbohydrates consist. These include high-fiber carbohydrates (Whole grains, vegetables, lettuce, legumes, fruits) highly recommended. They are also rich in vitamins and minerals. All of these foods have what is known as a low glycemic index. This means that they only increase blood sugar slightly and can contribute to improved blood sugar and blood lipid values.
A low intake (less than 10% of the total calorie intake) of household sugar is possible. However, sugar should never be consumed alone, but together with other foods. The high calorie content of sugar must be taken into account. A more frequent blood sugar self-check may also be necessary here.
Drinks that contain sugar increase blood sugar very quickly and strongly and are therefore unsuitable. They are only used to treat hypoglycaemia.
In diabetics, those with insulin or with blood sugar lowering drugs Meals rich in carbohydrates must be treated with drug therapy.

2. Sugar substitutes, sweeteners and diet foods for diabetics

Diet products for diabetics contain sugar substitutes such as fructose, sorbitol, xylitol or mannitol. These forms of sugar have no advantages over normal table sugar and are not recommended in a healthy diet for diabetics. Diet products are often high in fat and calories (Chocolate, cookies), more expensive than usual products and their benefits have not been proven.
Calorie-free sweeteners (Saccharin, aspartame, cyclamate) can be helpful for the diabetic when preparing meals.However, it is recommended to use it sparingly.

3. Fats

Ideally, the total amount of fat should not exceed 30% of the calorie intake daily.

The supply of saturated fat and trans-unsaturated fatty acids. They should make up less than 10% of the daily energy intake. Saturated fatty acids are found primarily in animal fats and trans-unsaturated fatty acids in chemically hydrogenated fats. Trans fatty acids are produced during the chemical hardening of oils and are often found in industrially manufactured confectionery and baked goods. Simultaneously with the reduction of animal fats, the intake of cholesterol is also restricted, which is important in the case of elevated blood lipid levels.
Monounsaturated fatty acids (vegetable oils such as olive oil, rapeseed oil) and polyunsaturated fatty acids (Safflower oil, wheat germ oil) should be in a ratio of 2 to 1 be present in the daily diet.

4. Egg white

10 to 20% of the daily amount of energy can be taken out protein consist. In diabetics who already have impaired kidney function, the intake should be in the lower range of this recommendation. The intake of 0.8 g protein per kg body weight is sufficient to cover the requirement. A protein intake of more than 20% of the daily amount of energy is not recommended in any case, especially not if high blood pressure and HbA1 values are above normal.
Choose low-fat protein sources, limit the consumption of meat, sausage and eggs. Prefer milk and milk products. Fish is recommended.

5. Alcohol

Many diabetics can have 1 to 2 glasses of wine a day if they so wish. Note the high energy content of alcohol. In the case of diabetics treated with blood sugar lowering drugs, the blood sugar lowering effect of alcohol should be taken into account. It is best to drink alcohol only with meals containing carbohydrates.
Alcohol should be avoided by overweight diabetics, diabetics with high blood lipid levels, high blood pressure and during pregnancy.

6. Vitamins and Antioxidants

The consumption of foods that are naturally rich in antioxidants such as (Carotenoids, vitamins C, E and flavinoids). These active ingredients bind free radicals (are part of the immune system, but if too numerous they can attack and change cells) and protect the cells. This also prevents the development of heart and vascular diseases.

7. Minerals

There is no special recommended intake for minerals for diabetics. The same apply as for those with a healthy metabolism. The intake of table salt should be restricted and below 6g per day.

Nutritional therapy for diabetics with different forms of treatment

In diabetics who have one medical therapy becomes necessary, in addition to the principles of healthy nutrition for all forms of diabetes, certain rules must also be observed. While nutritional therapeutic measures are often sufficient for type 2 diabetics, type 1 diabetics are dependent on an external insulin supply from the outset. These insulin doses must be adapted to the food intake.
In most cases today, the so-called "intensified insulin therapy“On, which means that the diabetic injects delay insulin in the morning and evening as a basis and, if necessary, supplies short-acting normal insulin before eating. It is important to check your blood sugar regularly and to be aware of the effects of various foods on the blood sugar.
Diabetics with intensive insulin therapy must always take effect quickly carbohydrates (Dextrose, orange juice, etc.) to be able to react immediately to signs of hypoglycaemia. Even with unusual or extensive physical activity, the diabetic must have carbohydrates ready or eat them beforehand in order to avoid hypoglycaemia.
In the case of intensified insulin therapy, meals can be individual depending on individual preferences in terms of composition and time distribution over the day. The composition must be planned in order to correctly dose the insulin intake before the meal. This means that the diabetic must know the blood sugar effect of the individual carbohydrates and how much insulin is necessary for, for example, 100 g of potatoes to keep the blood sugar level normal. At the beginning of therapy, regular blood sugar measurements before and after meals help to find the right insulin dose for certain meals and to achieve a satisfactory metabolic level.
In patients for whom intensified insulin therapy is not possible, insulin doses are set (Delay insulin) injected at certain times (conventional insulin therapy). Here no flexible design of the food supply can be practiced. The distribution of meals at regular intervals throughout the day and the control of their amount is necessary in order to avoid hypoglycaemia in the first place. Meals must not be missed and additional carbohydrates must be eaten when doing unusual physical work or sport.
Similar rules also apply to diabetics who are treated with sulfonylureas instead of insulin.
When treating with Alpha-glucosidase inhibitors and diet, there are no hypoglycaemia. Will, however Sulfonylureas taken or insulin are injected Hypoglycaemia possible. In this case, these must be fought with glucose, because Alpha-glucosidase inhibitors delay other carbohydrates from being absorbed into the bloodstream (also table sugar!) and so the effect would not be fast enough to treat hypoglycaemia.

When treating with biguanides, no further measures are necessary besides the usual dietary recommendations for the diabetic.

Dietary recommendations for overweight type 2 diabetics without insulin treatment

An energy-reduced, low-fat, balanced mixed diet as described in the chapter " Therapy of obesity in adults“Is described.
The aim is to reduce body weight slowly and over the long term. In most cases, this leads to a decisive improvement in blood sugar levels and the general metabolic situation.
The daily amount of energy that is approximately 500 calories below actual consumption should ideally be divided into several small meals throughout the day. A rigid definition is not necessary and the quantitative calculation of carbohydrate portions is not necessary for diabetics without insulin treatment. A nutritional table with calories is helpful in planning low-calorie, low-fat meals.

Dietary recommendations for diabetics with conventional insulin therapy

Here food intake regulations are required. Even with careful selection of the injected insulin and coordination of the insulin injection times (mostly morning and evening) on the rhythm of life, individual wishes regarding the choice of food and the timing of meals can only be taken into account to a very limited extent.
You need at least 5 to 6 meals spread over the day and with constant carbohydrate portions (for example bread, oatmeal, potatoes, rice, pasta).
A carbohydrate table is very helpful for portioning foods that contain carbohydrates.
In addition to the three main meals, two snacks (mornings and afternoons) and a late meal.
The schedule for meals and the timing of insulin injections must be kept largely constant.
The diabetic must learn to recognize hypoglycaemia in good time and to react quickly with emergency carbohydrates.

Dietary recommendations for diabetics with intensive insulin therapy

Here it is important that the diabetic is able to correctly assess the carbohydrate content of the individual meals. Carbohydrate tables are useful for reference both in school and in everyday life.
Food portions containing 10 to 12 g of carbohydrates can be exchanged for each other. For such a portion 1 to 2 units of short-acting normal insulin are usually required.
With regular blood sugar checks, the diabetic must check how the food affects the blood sugar level and can use the results to provide insulin in advance or, if necessary, corrective.
The number of meals and their timing do not have to be specified. Hypoglycemia must be recognized in good time and countered with emergency carbohydrates.
Individual food selection is possible here. However, the diet should also be healthy, balanced, varied and low in fat.

Food selection

The daily diet of the diabetic should correspond to the general recommendations for a healthy diet.
Here, too, there are no absolute taboos when choosing food. However, it is important to point out that the consumption levels of foods with a high proportion of saturated fat and trans-unsaturated fatty acids should be kept as small as possible. This means eating animal-based, high-fat foods and finished products as rarely as possible and, if so, then preferring the low-fat variants. For mono- or polyunsaturated fatty acids (in rapeseed oil, olive oil, sunflower oil) can be accessed a little more generously.
The diet should also include fresh fruits, vegetables, lettuce, whole grain foods, lean dairy and dairy products, lean meat and lean meat products and fish.
Ensure adequate hydration (1.5 to 2.0 liters of calorie-free drinks under normal conditions) should be respected in any case.

Sugar in the diet of the diabetic

Household sugar is no longer on the prohibited list today. However, diabetics are recommended (like the general population too) to restrict the consumption of sugar in principle. Sugar only provides “empty calories”, which means that apart from energy it contains no other important nutrients such as vitamins or minerals. Especially at obese diabetics the intake of sugar is very unfavorable and should therefore be restricted.
If the insulin therapy is intensified, it is also possible to adjust the insulin dose to foods containing sugar. Moderate consumption of sugar does not have to lead to a deterioration in blood sugar levels if the adjustment measures are taken accordingly.

Sugar substitute:

Since there is no longer a general ban on household sugar for diabetics, the recommendation for so-called sugar substitutes has also changed.
This sugar like Sorbitol, mannitol, xylitol, isomalt and Fructose are dispensable in the diet of the diabetic. Their long-term metabolic control benefit has not been proven. In addition, products with these forms of sugar have just as many calories as products with table sugar. They are usually more expensive and often have flatulence and laxative effects.
The use of calorie-free sweeteners (Aspartame, saccharin, cyclamate) in tablet form or in liquid form is possible but not necessary.

Carbohydrate exchange tables

These tables can help insulin-treated diabetics with the portioning of meals containing carbohydrates. However, it does not make sense to rigidly determine the number of grams of foods that contain 12 g or 10 g of carbohydrates. The biological fluctuation range of the individual foods is large and amounts to 20 to 30%. Today in the carbohydrate exchange tables food portions are given that contain 10 to 12 g of usable carbohydrates. These can be exchanged for each other. The portions can be assessed using kitchen measurements (a thin slice of bread, a medium-sized apple, 2 tablespoons of coarse wholegrain oat flakes, etc. ) and no longer has to be precisely determined in grams on the kitchen scale.

Menu example

for a type 2 diabetic with conventional insulin therapy:
Insulin injection before breakfast and before dinner

The carbohydrate carriers are printed diagonally in the example.

Breakfast (3 carbohydrates)

Muesli 3 tablespoons of whole grain oat flakes, 1 tablespoon chopped walnuts, 1 smaller Apple and 1 small cup of natural yogurt (1.5% fat)

Snack (1 carbohydrate portion)

1 small slice of wholemeal bread, some vegetable margarine, 1 slice of turkey breast, 3 to 4 radishes

Snack (1 carbohydrate portion)

1 serving of fresh fruit of your choice, for example two medium-sized apricots
Lunch 3 carbohydrates
1 small portion of chicken breast fillet with mushrooms, 1 large portion of broccoli vegetables, 2 medium-sized potatoes

Snack (2 carbohydrates)