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Dietary principles and suggestions for patients with diabetes

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According to the theories of nutritional science, traditional Chinese medicine, and current scientific research evidence on diet-related chronic diseases, the expert panel proposes 8 principles and recommendations for the daily nutrition of diabetes patients. These include:

1.Diverse food choices to develop and establish sensible dietary habits.

2.Appropriate energy intake to control overweight and prevent wasting.

3.Quantitative consumption of staple foods, with a preference for whole grains and foods with a low glycemic index.

4.Regular exercise to improve physical fitness and insulin sensitivity.

5.Light and moderate diet, limiting alcohol consumption to prevent and delay complications.

6.Guided nutrition, making rational choices in the use of food and medicinal substances.

7.Regular and balanced meals, sensible snacks to promote stable post-meal blood sugar levels.

8.Self-management, regular nutritional counseling to enhance blood sugar control capabilities.

(1) Diverse Food Choices, Cultivating and Establishing Rational Dietary Habits

Dietary management and treatment are at the core of blood sugar control for diabetes patients. One should adhere to the principles of a balanced diet, ensuring diverse food choices, appropriate staple food intake, rich consumption of vegetables, fruits, milk, and beans, along with reduced oil, salt, and sugar. While controlling blood sugar, it is important to ensure daily energy intake is appropriate and nutritional requirements are met.

Diverse food choices form the foundation for achieving a balanced and nutritious diet. A varied diet should include five major food categories: the first category comprises grains and tubers, including cereals (whole grains), potatoes, and miscellaneous legumes; the second category consists of vegetables and fruits; the third category includes animal products such as meat, poultry, fish, eggs, and dairy; the fourth category encompasses soy products and nuts; the fifth category involves cooking oil and salt.

Diabetes patients should also maintain a diverse food intake, ensuring a colorful and nutritionally rich diet while limiting oil, salt, sugar, and alcohol.

A rational diet refers to adjusting and optimizing food types and quantities with the goal of controlling blood sugar on the basis of a balanced diet to meet individual health needs.

Staple foods should be consumed in appropriate quantities, with carbohydrates primarily sourced from whole grains, various legumes, and vegetables. Fruit intake should be limited.

Vegetables should be included in every meal, with a daily target of 500g, including more than half being dark-colored vegetables.

Dairy products and soy should be consumed regularly, along with regular consumption of fish, poultry, and moderate amounts of eggs and lean meat, as these are good sources of protein.

Reducing the intake of fatty meats, avoiding smoked, baked, and processed meat products, and controlling the use of salt, sugar, and oil are also recommended.

(2) Appropriate Energy Intake, Controlling Overweight and Preventing Malnutrition

Body weight serves as an objective indicator reflecting dietary conditions over a period and assessing overall health status, playing a crucial role in influencing the onset and progression of diabetes.

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Dietary energy is central to weight management and blood sugar control. Energy needs are influenced by factors such as age, gender, weight, and physical activity levels, and can be determined using the DRI (Dietary Reference Intakes) for Chinese residents’ nutritional needs. Alternatively, estimates based on weight can be used; for example, a moderately active adult female weighing 60kg may require daily energy intake between 1500-1800kcal.

Recommended macronutrient distribution of energy for diabetes patients includes: protein 15%-20%, carbohydrates 45%-60%, and fat 20%-35%. Dietary energy is derived from foods such as grains, oils, meat, eggs, dairy, nuts, fruits, and vegetables.

The energy requirements of diabetes patients vary based on individual factors and blood sugar regulation. Consultation with nutrition experts is advisable to determine daily energy intake levels, activity levels, and to develop personalized dietary management, blood sugar, and weight control plans.

Diabetes patients should pay special attention to maintaining their weight within the ideal range, enhancing immune function, and reducing the risk of disease development. For adults in China, the Body Mass Index (BMI) should be maintained between 18.5 and 23.9 kg/m2. Individuals aged 65 and above may consider a moderate increase in weight for the purpose of reducing the risk of mortality.

Weight loss in obese patients can lead to improved insulin resistance and better blood sugar control. For individuals with type 2 diabetes who are overweight or obese, a 3% to 5% reduction in body weight can result in clinically significant health benefits. It is recommended for overweight and obese patients to aim for a monthly weight loss of 1 to 2 kg, achieving a 5% to 10% reduction in body weight over 3 to 6 months.

Due to the absolute or relative lack of insulin in the body, diabetes patients cannot fully utilize insulin to promote glycogen, protein, and fat synthesis while inhibiting their breakdown. Poor blood sugar control can lead to excessive breakdown of fats and proteins, resulting in weight loss or even malnutrition.

For patients experiencing malnutrition or being underweight, guidance from nutrition professionals is essential. Increasing dietary energy and protein intake, incorporating resistance exercises, and achieving and maintaining an ideal weight should be done under the supervision of nutrition experts. Older patients, in particular, should focus on preventing muscle atrophy and maintaining a healthy weight.

(3) Quantitative Intake of Staple Foods, Preferentially Choosing Whole Grains and Low Glycemic Index Foods

Staple foods, rich in carbohydrates, are a core factor influencing postprandial blood glucose levels. Diabetes patients should learn to select and measure their intake of staple foods.

The Glycemic Index (GI) is a relative indicator measuring the impact of food on blood glucose levels. Choosing low-GI foods is beneficial for postprandial blood glucose control. When selecting staple foods or grains, reference can be made to the Glycemic Index table for commonly consumed foods in China.

Low-GI foods spend more time in the gastrointestinal tract, have lower absorption rates, release glucose slowly, and result in lower and slower peaks of glucose in the bloodstream. In simple terms, they cause smaller fluctuations in postprandial blood glucose, aiding in blood sugar control.

Quantitative intake of staple foods should not be excessive. It is advisable to choose whole grains and low-GI foods. Whole grains and legumes, which are low-GI foods, should constitute more than one-third of the staple food intake. It is recommended that the proportion of energy derived from carbohydrates for diabetes patients be 45% to 60% of total energy intake, slightly lower than that for generally healthy individuals.

Using the example of an adult with a daily energy intake of 1800-2000kcal, this is equivalent to a total daily carbohydrate intake of 200-300g. However, for individuals newly diagnosed with diabetes or those with poor blood sugar control, it is advisable to consult with a physician or nutrition expert for personalized guidance. This may involve adjusting the amount of carbohydrates in the diet to lower blood glucose levels or reduce the use of antidiabetic medications.

Blood glucose levels are a comprehensive reflection of factors such as carbohydrate intake, physical activity, dietary structure, and fasting duration. Maintaining an excessively low carbohydrate intake may not lead to better long-term health benefits. Regular monitoring of blood glucose is essential to assess the body’s response to the diet, especially to staple foods, and to plan adjustments promptly.

When considering snacks containing grains, fruits, nuts, etc., it is important to check the carbohydrate content in the nutritional information and include it in the overall daily intake. Adjusting the sequence of meals can be beneficial for blood sugar control, such as developing a habit of eating vegetables first and consuming staple foods last.

Keeping a record of diet, exercise, and blood glucose levels is recommended to enhance scientific planning for blood sugar control and self-management.

Whole grains, legumes, vegetables, and other foods rich in dietary fiber and phytochemicals have a lower Glycemic Index (GI). They also contain abundant vitamins B1, B2, as well as minerals such as potassium and magnesium. These foods are more satiating and can effectively slow down postprandial blood glucose fluctuations.

For elderly diabetes patients with weakened gastrointestinal function, particularly when choosing whole grains rich in dietary fiber, attention should be given to cooking methods and quantities to reduce the burden on the digestive system.

The type and quantity of carbohydrates are the most crucial nutritional factors influencing postprandial blood glucose levels. Learning about the carbohydrate content of foods, their exchanges, and adopting regular meal patterns are key measures for diabetes patients to understand and manage the relationship between food, medications, and blood glucose responses. This is a crucial aspect of overall rational dietary planning and adjustment.

(4) Active Exercise, Improving Physical Fitness and Insulin Sensitivity

Exercise can expend energy, and resistance training helps increase muscle mass. Furthermore, physical activity can enhance the quantity of Glucose Transporter-4 (GLUT-4) on the membrane of skeletal muscle cells, facilitating glucose uptake and improving insulin sensitivity in these cells, thereby stabilizing blood glucose levels.

There is ample evidence indicating that insufficient physical activity can lead to excessive weight gain. Regular physical activity is not only beneficial for maintaining a healthy weight and promoting emotional well-being but also reduces the risk of developing diseases such as obesity, type 2 diabetes, cardiovascular diseases, and certain cancers, as well as overall mortality risk.

Diabetes patients can engage in postprandial exercise, aiming for at least 5 days a week, with each session lasting 30-45 minutes. Moderate-intensity exercise should constitute more than 50%, gradually progressing and consistently maintained. Moderate-intensity activities include brisk walking, cycling, table tennis, badminton, jogging, swimming, etc. If there are no contraindications, resistance training, such as using dumbbells, push-ups, and weightlifting, is recommended at least twice a week to enhance muscle strength and endurance.

Incorporating daily activities and exercise into one’s routine is crucial. Blood glucose monitoring should be intensified before and after exercise to prevent hypoglycemia. It’s essential for everyone to recognize that physical activity is an opportunity to improve health, not a waste of time.

Diabetes patients should seek and cultivate forms of exercise they enjoy, incorporating them into their daily schedule. Developing an awareness and habit of exercise, progressing gradually, and steadily increasing activity levels to reach target levels are key to a well-planned and sustainable exercise routine.

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(5) Light Diet, Limit Alcohol Intake, Prevent and Delay Complications

Preventing and delaying the occurrence of related complications emphasizes reinforcing lifestyle changes. The first step is to control oil, salt, sugar, refrain from alcohol consumption, and maintain ideal levels of blood sugar, lipid profile, and blood pressure. A light diet, controlling the amounts of oil, salt, and sugar, is recommended for everyone, including those in the prediabetic stage and all diabetes patients.

Excessive intake of cooking oil or fatty foods can lead to an overall high dietary energy intake, resulting in overweight and obesity, which is detrimental to the control of metabolic indicators such as blood sugar, lipids, and blood pressure. Research evidence indicates that excessive salt intake can increase the risk of diseases such as hypertension and stroke.

Alcohol consumption can disrupt the normal diet and medication regimen of diabetes patients, leading to blood glucose fluctuations. It may increase the risk of hypoglycemia, especially in those taking insulin or insulin-secretion-promoting agents. Additionally, alcohol consumption often involves a high intake of food, leading to excessive total energy intake and elevated blood sugar levels. Excessive alcohol intake can also damage the pancreas, causing liver damage and serving as a significant risk factor for conditions such as gout, cancer, and cardiovascular diseases.

Cultivating a preference for a light taste is recommended. Daily cooking oil usage should be controlled to less than 25g, and the consumption of animal fats should be limited. Cholesterol-rich foods should be consumed moderately to prevent lipid abnormalities. Daily salt intake should not exceed 5g, and attention should be given to limiting the use of high-salt condiments and foods, such as soy sauce, chicken essence, monosodium glutamate, pickles, salted meat, and pickled vegetables.

Adequate water intake is important, and moderate consumption of plain tea or coffee is acceptable, while sugary beverages should be avoided.

Diabetes patients should actively engage in a well-balanced diet and moderate exercise under the guidance of physicians and nutrition experts to maintain stable blood sugar levels and prevent the occurrence and progression of diabetes complications.

(6) Regular Meals, Appropriate Snacking to Promote Postprandial Blood Sugar Stability

Regular and timely meals, with a set quantity, form the foundation for maintaining stable blood sugar levels. Regular meals refer to fixed times for the three main meals and snacks, with scheduled and measured eating to avoid overeating due to delayed satiety responses caused by excessive hunger.

Avoiding binge eating, refraining from casual snacking on snacks and beverages, minimizing social dining occasions, and reducing the number of meals are important practices. Whether dining at home or outside, individuals should follow a dietary regimen tailored to their physiological conditions and activity levels. This involves standardized, quantified nutritional meal planning, and a well-thought-out energy distribution throughout the day. Eating should be done slowly and deliberately, promoting the development of good dietary habits.

The decision on whether to include snacks, the timing of snacks, and the choice of snacks should be based on the specific blood sugar fluctuations of the individual. For individuals with long-term diabetes, poor blood sugar control, and those with Type 1 diabetes who use insulin injections, blood glucose monitoring is crucial. Depending on the situation, additional snacks may be added to prevent hypoglycemia.

For underweight diabetes patients and those with gestational diabetes, adding snacks or incorporating appropriate snacks can be considered to prevent hypoglycemia, increase energy intake, and promote weight gain.

(7) Self-Management, Regular Nutritional Counseling, Enhancing Blood Sugar Control Ability

Effectively managing and maintaining stable blood sugar levels largely depend on the self-management capabilities of the patient. Diabetes management requires a comprehensive approach that is personalized and diverse, taking into account factors such as the patient’s disease progression, condition, and behavior change characteristics.

Diabetes patients should place significant emphasis on learning about diabetes knowledge and self-management skills, including dietary adjustments, regular exercise, blood glucose monitoring, adherence to prescribed medications, insulin injection techniques, and prevention and management of hypoglycemia. Nutritional meal planning, cooking sensibly, exercise management, and blood glucose monitoring should be considered fundamental skills for diabetes patients.

Understanding the carbohydrate content and Glycemic Index (GI) of foods, learning to use food exchanges, and incorporating self-behavior management into daily life are essential. Patients should establish a consulting and follow-up relationship with experienced nutritionists and healthcare teams, actively participating in regular consultations to receive personalized nutritional education, dietary guidance, and skills training. This helps facilitate effective implementation of nutritional therapy plans and improves self-health status and clinical outcomes.

Particularly during initial diagnosis, annual check-ups, or when treatment goals are not met, or when there are changes in the disease or environment, timely medical consultations or advice should be sought. Nutritional counseling should encompass dietary assessments and adjustments, nutritional status evaluations and diagnoses, as well as the formulation of nutritional prescriptions and exercise prescriptions.

With the assistance of healthcare professionals, timely adjustments to dietary, exercise, and behavioral plans, as well as medication dosages, should be made to maintain a healthy lifestyle, control blood sugar levels, and prevent the occurrence of complications.

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