Diabetes mellitus: therapeutic diets
In diabetes mellitus, due to absolute or relative insulin deficiency, the regulation of carbohydrate, protein and fat metabolism is disrupted, as a result of which atherogenesis is accelerated and the risk of cardiovascular diseases is increased .
About 10% of patients suffer from insulin-dependent diabetes mellitus , characterized by a deficiency of endogenous insulin, the rest – non – insulin – dependent diabetes mellitus , in which insulin resistance is observed, but insulin secretion is preserved.
All patients with diabetes mellitus, along with medical treatment and regular physical activity, need diet therapy . The purpose of treatment is to maintain plasma glucose and lipid profile at a level close to normal, as well as the prevention of acute complications (primarily hypoglycemia and hyperglycemia ) and chronic complications ( ophthalmopathy , renal failure , cardiovascular disease and neuropathy ).
Diet therapy should be aimed at achieving ideal weight ( obesity is often observed in non-insulin-dependent diabetes mellitus ) and is made taking into account the required ratio of carbohydrates, fats and proteins in the diet, as well as the effect of carbohydrates and fats consumed on plasma glucose levels and lipid profile. In obesity ( body mass index more than 30 kg / sq.m), even moderate weight loss (by 4-9 kg) can significantly alleviate the course of the disease. It is best to moderate the calorie content of food (it should be 250-500 kcal less than energy requirements) and increase physical activity.
Even if the ideal weight cannot be reached, the sensitivity of tissues to insulin increases and glucose production in the liver normalizes.
To ensure normal growth and development of children and maintain sufficient protein reserves in adults, the share of proteins in patients with diabetes should account for 10-20% of the total calorie content of food. This roughly corresponds to the average protein content in the diet of healthy Americans (14-18%) and the recommended protein intake (0.8 g / kg / day). Protein intake can accelerate the development of renal failure , but its restriction to 10% of the total calorie intake in most cases is well tolerated by patients with diabetes. In terminal chronic renal failure , if the patient is not on chronic hemodialysis, protein intake is limited to 0.6 g / kg / day.
In diabetes mellitus, dyslipoproteinemia ( hypertriglyceridemia and a decrease in HDL cholesterol ) is observed . Hypertriglyceridemia is due to increased production of triglycerides rich in VLDL ; in this case, small LDLs are formed . Due to the increased risk of heart disease, a diet low in fat (especially saturated fatty acids ) and high in carbohydrates is usually recommended . However, such a diet can exacerbate hypertriglyceridemia and lower HDL cholesterol . Therefore, there is an alternative option when saturated fatty acids are replaced not with carbohydrates, but with unsaturated fatty acids ; the ratio of fat and carbohydrate is not predetermined, but is selected in such a way as to provide the desired plasma glucose and lipid levels. Mono-, di-, and polysaccharides are included in the diet, since they equally affect the plasma glucose level.
When choosing a diet, they take into account the lifestyle, cultural traditions and tastes of the patient.