Diabetic patient nutrition

Dietary recommendations for patients with diabetes have changed as studies on the disease have advanced. Nowadays, diets oriented by specialists do not contain so many prohibitions, on the contrary, they promote the consumption of a varied, balanced, palatable, moderate in calories, and of course, take into account some other considerations, in order to maintain stable glucose levels within the required parameters, for the preservation of a good state of health.

Nutritional objectives in patients with diabetes mellitus

Provide a varied, healthy and balanced diet, taking into account the type of diabetes, age, sex, weight, level of physical activity, presence of other risk factors or other associated diseases, and patient preferences, among others.

Reduce blood glucose fluctuations. Avoid hyperglycemia or hypoglycemia. Maintain an adequate weight. If overweight or obese, lose 10% of current weight to improve diabetes control:

• Normalize adequate blood lipid and blood pressure levels.

• Prevent or delay vascular complications.

• Contribute to improved quality of life.

Strategies for the nutrition of patients with type 1 diabetes mellitus.

To achieve daily punctuality and consistency in the number of meals, time and amount of food eaten at each meal, an essential requirement for those who require rigorous control of diet and insulin treatment to control blood glucose levels.

Serial reviews of their blood glucose levels should be carried out and the insulin dose should be adjusted, taking into account the amount of food they usually consume and require.

Dietary transgressions cannot be made, and when they occur by error or other exceptional cause, the patient or caregiver should be able to adjust the insulin dose to compensate for the infraction.

Strategies for nutrition in patients with type 2 diabetes mellitus

The diet of the patient with type 2 diabetes mellitus is primarily aimed at reducing cardiovascular risk by contributing to the maintenance of blood glucose and lipid levels. In addition, if there is overweight or obesity, to reduce body weight.

It is important to moderately reduce caloric intakes (between 250 and 500 kilocalories less than the average daily intake). Reduce fat intakes, especially saturated fats and trans fats (fats from meats, butter, margarine, coconut and palm oils).

Spread nutrient intakes throughout the day. When the expected results are not obtained, the use of oral drugs and/or insulin is essential.

Recommended nutrient intakes

Energy requirements: The calories provided by the diet should ensure adequate body weight stability. The amounts to be ingested depend on the type of diabetes, age, sex, height, weight, level of physical activity and the presence of other risk factors or other associated diseases.

In general, it is estimated that adult diabetics, who do not suffer from associated diseases, should ingest around 25 kcal/kg/day (kilocalories per kilogram of weight, daily).

In overweight or obese patients, diet and exercise should be prescribed, with the aim of creating an energy deficit of 500 kcal/day, to achieve a loss of 0.5 to 1 kilogram of weight per week.

A reduction of 5 to 10% of body weight contributes to the improvement of metabolic control, reducing insulin resistance, improving glycemic control and blood pressure. Diets with very low caloric content should never be used.

The caloric distribution among the different nutrients is as follows:

• Carbohydrates: they should contribute between 50 and 60% of the total calories.

• Fats: should provide between 25 and 30% of the total calories.

• Proteins: they should contribute between 12 and 15% of the total calories.

• The caloric intake should be distributed throughout the day, in five or six meals, paying special attention to the complete breakfast, respecting the appetite and adjusting the insulin doses, if required.

• Periodic monitoring of body weight allows us to assess whether caloric intake levels are adequate.

Carbohydrate requirements: Carbohydrates are the main source of energy for the body, they should provide between 50 and 60% of the total energy provided by the diet. For this reason, they are the nutrient that should receive the most attention in the diet, in order to prevent or control diabetes.

Depending on the type of carbohydrate contained in the food, its assimilation will be faster, it will produce a greater or lesser sensation of satiety, and it will be more or less beneficial for the treatment of diabetes. Carbohydrates can be classified according to their chemical structure in two large groups:

• Simple carbohydrates.

• Complex carbohydrates.

Simple carbohydrates: these can be further classified into two groups: monosaccharides (glucose, fructose, galactose) and disaccharides (sucrose, maltose and lactose). Foods rich in simple carbohydrates are: table sugar, sweets, pastries, cakes, chocolates and soft drinks. These foods take less time to pass into the blood after being ingested, so they are less healthy than complex carbohydrates.

Complex carbohydrates: this group is made up of polysaccharides or long-chain carbohydrates. The most abundant in food is starch. Dietary fiber, contained in foods of vegetable origin, is also made up of polysaccharides that are not digestible by the body, but have important health benefits, especially in the treatment of diabetes.

Foods rich in complex carbohydrates are: legumes, whole grains, potatoes, vegetables and greens; these foods take longer to pass into the blood after being ingested, so they are healthier than simple carbohydrates.

To guarantee the required intake of carbohydrates, without causing a sudden increase in sugar levels, we must select those that require a longer digestion, with a slower absorption and therefore produce smaller glycemic oscillations. In general, foods that meet these requirements are those rich in complex carbohydrates.

There are two indexes to determine how each food raises blood glucose levels:

• Glycemic index (GI).

• Glycemic load (GL).

Glycemic index (GI): this is the capacity of foods to raise glucose levels after ingestion. Foods with a high GI raise glucose levels more rapidly than foods with a medium or low GI.

Glycemic load (GL): the glycemic load allows us to know how a certain amount of food influences our glucose levels. This parameter is more practical than the glycemic index, since it allows us to know the exact amount of food we should consume to maintain stable glucose levels.

There are tables where the glycemic indexes of different foods are specified, and the glycemic load calculated for different portions of the same food, allowing us to make an appropriate selection of the food and the amount depending on the medical indications.

It is recommended to the diabetic population to select foods with low glycemic index, and to control the levels of glycemia before and after ingestion, to have an approximate idea of how certain foods modify their glycemic level, contributing to the increase of self-responsibility in the treatment of diabetes and to the improvement of their health.

Fat requirements: Fats in the diet contribute to the digestibility and palatability of foods, their main function is energy intake. In addition, they play structural roles in the formation of membranes, and participate in the synthesis of neurotransmitters:

• Fats should contribute between 25 and 30% of total energy to the diabetic diet. They do not modify glycemia, but favor obesity, hyperlipidemia and the development of cardiovascular diseases.

• It is indicated that the total lipid intake should be obtained from the different types of fats, in the following proportions.

• Between 15 and 20% of monounsaturated fatty acids, mainly from olive oil. This type of fat has been shown to protect against cardiovascular complications caused by diabetes.

• Between 7% and 8% of saturated fatty acids, coming from whole milk, butter, fatty meats and industrially processed foods, etc.

• Between 7% and 8% of polyunsaturated fatty acids, mainly from oily fish, nuts and seed oils, such as sunflower, corn and soybean oil.

To ensure that the total fat intake supports the treatment of diabetes, the following recommendations should be followed. Promote the consumption of olive oil, sunflower oil or walnuts, taking into account that they guarantee a good fat profile, but they are very caloric foods, so their intakes should also be limited.

Reduce the consumption of animal fat, making the following modifications:

• Substituting the consumption of red meat for poultry or fish.

• Consuming skimmed milk and cheeses.

• Avoiding the consumption of butter and margarine.

• Avoiding the consumption of processed meats (ham, chorizo, etc.).

• Reduce egg consumption to three or four eggs a week.

Protein needs: Proteins are the main constituent of cells, necessary for the growth, repair and renewal of body tissues subjected to continuous wear and tear. They also provide raw materials for the formation of digestive juices, hormones, plasma proteins, hemoglobin, vitamins and enzymes. They can be used to supply energy when carbohydrates and fats do not provide the necessary energy.

Proteins should contribute between 12 and 15% of total energy to the diabetic diet. Diabetics are recommended to ingest between 0.8 and 1 gram per kilogram of weight per day. This value should be 0.8 grams if the patient suffers from nephropathy.

The most suitable foods as a source of protein for diabetic patients are: chicken, turkey and rabbit meat; fish; eggs; skimmed dairy products, cereals and legumes. Cooking methods that do not provide much fat should be used, such as baking, roasting, steaming and stewing. Needs of vitamins and minerals: Vitamins and minerals are essential elements for the maintenance of the functions of the organs and tissues that integrate the organism. In addition, they contribute to the prevention of certain degenerative diseases, such as some types of cancer and cardiovascular diseases.

Although there is no evidence that diabetics need a higher intake of vitamins and minerals than the healthy population, it is essential that they consume a varied diet to ensure the necessary intake of vitamins, minerals and other antioxidant substances, which are essential to achieve adequate metabolic control and protect them from the oxidative stress they suffer. Sodium content (common salt) in the diet: for many people, foods with excess salt increase the risk of arterial hypertension, causing other health disorders related to diabetes. The maximum recommended intake varies between 2.4 and 3 grams of salt per day in diabetics who do not suffer from other complications. Diabetics with arterial hypertension less than 2.4 grams daily; and those with nephropathy and arterial hypertension less than 2 grams daily. Water needs in diabetic patients: Water is the main component of the human body, representing 60% of total body weight. It is involved in the process of digestion and excretion, protects the joints, transports nutrients and eliminates waste substances, and regulates body temperature.

To achieve proper hydration, diabetics should drink about 2.5 liters of water daily. The consumption of fruit juices is not recommended, since these would cause an increase in blood glucose levels.

Hydration is essential for all people, esp