In principle the same nourishing recommendations apply to Diabetiker as they for the healthy attitude of all humans will guessed/advised. With overweight The body weight should be in a range of the body mass index from 19 to 25. In the case of existing overweight a weight reduction is advised.
A weight loss of 1 – 2 kg per month is aimed at and is achieved by keeping the daily calorie intake 500 calories below consumption. Particularly suitable for this is an energy-reduced (total fat intake below 30% of the total energy) balanced, varied mixed diet. This form of nutrition is described in detail in the chapter “Therapy of overweight in adults”. In the case of concomitant elevated blood lipid levels, high blood pressure and fat accumulation in the abdomen, the need for weight loss must be particularly emphasized. Even slight weight loss can lead to an improved metabolic situation.
Nutrient supply
The daily calorie intake should be such that a desirable weight corresponding to a body mass index between 19 and 25 can be maintained. Most of the energy supplied should consist of carbohydrates. Fiber-rich carbohydrates (whole grain cereals, vegetables, salad, legumes, fruit) are particularly recommended.
They are also rich in vitamins and minerals. All these foods have a so-called low glycemic index. This means that they increase blood sugar only slightly and can contribute to improved blood sugar levels and blood fat values.
A low intake (less than 10% of total calorie intake) of household sugar is possible. However, sugar should never be taken in alone, but together with other foods. The high calorie value of sugar must be taken into account.
More frequent blood sugar self-monitoring may also be necessary. Drinks containing sugar increase the blood sugar very quickly and strongly and are therefore unsuitable. They are only used to treat hypoglycaemia.
For diabetics who are treated with insulin or blood sugar-lowering drugs, carbohydrate-rich meals must be coordinated with the drug therapy. Diet products for diabetics contain sugar substitutes such as fructose, sorbitol, xylitol or mannitol. These forms of sugar have no advantages over normal household sugar and are not recommended in a healthy diet for diabetics.
Dietary products are often rich in fat and calories (chocolate, cookies), more expensive than normal products and their benefits are not proven. Calorie-free sweeteners (saccharin, aspartame, cyclamate) can be helpful for diabetics in the preparation of meals. However, economical use is recommended.
Ideally, the total amount of fat should not exceed 30% of the calorie intake daily. The intake of saturated fatty acids and trans-unsaturated fatty acids should be limited. They should account for less than 10% of the daily energy intake.
Saturated fatty acids are primarily found in animal fats and trans-unsaturated fatty acids in chemically hardened fats. Trans-unsaturated fatty acids are formed during the chemical hardening of oils and are often found in industrially produced sweets and baked goods. Simultaneously with the reduction of animal fats, the intake of cholesterol is also limited, which is important in cases of elevated blood lipid levels.
Monounsaturated fatty acids (vegetable oils such as olive oil, rapeseed oil) and polyunsaturated fatty acids (thistle oil, wheat germ oil) should be present in a ratio of 2 to 1 in the daily nutrition. 4. protein 10 to 20% of the daily energy quantity can consist of protein. In diabetics with already existing restriction of the kidney function the supply should rather be in the lower range of this recommendation.
The intake of 0.8 g protein per kg body weight is sufficient to cover the requirements. A protein intake of more than 20% of the daily energy intake is not recommended under any circumstances, especially if high blood pressure and HbA1 values above the norm are present. Choose low-fat protein carriers, limit the consumption of meat, sausage and eggs.
Prefer milk and dairy products. Fish is recommended. It is possible to drink 1 to 2 glasses of wine a day for many diabetics, if they wish.
Note the high energy content of alcohol. For diabetics treated with blood sugar-lowering medication, the blood sugar-lowering effect of alcohol should be taken into account. It is best to drink alcohol only with carbohydrate-containing meals.Alcohol should avoid overweight diabetics, diabetics with increased blood fat values, high blood pressure and in pregnancy.
It is recommended to consume foods that are naturally rich in antioxidants (carotenoids, vitamin C, E and flavinoids). These active ingredients bind free radicals (they are part of the immune system, but if too numerous they can attack and alter cells) and protect the cells. This also prevents the development of cardiovascular diseases.
For Diabetiker there is no special supply recommendation for mineral materials. The same applies as for metabolically healthy ones. The intake of common salt should be limited and should be less than 6g per day.
In the case of diabetics who require drug therapy, certain rules must be observed in addition to the principles of healthy nutrition for all forms of diabetes. 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.
Today, in most cases the so-called “intensified insulin therapy” is aimed at, which means that the diabetic injects delay insulin in the morning and in the evening as a basis and supplies short-acting normal insulin as required before eating. Important here is regular blood sugar monitoring and knowledge of the blood sugar effect of the various foods. Diabetics with intensified insulin therapy must always carry rapidly effective carbohydrates (dextrose, orange juice, etc.)
with them to be able to react immediately to signs of hypoglycaemia. Even with unusual or pronounced physical activity, the diabetic must have carbohydrates ready or eat them beforehand to avoid hypoglycemia. With the intensified insulin therapy, meals can be individualized according to individual preferences in terms of composition and time distribution throughout the day.
The composition must be planned in order to correctly dose the insulin intake before the meal. That is, the Diabetiker must know the blood sugar effect of the individual coal hydrates and know how much insulin is necessary with for example 100 g potatoes around the blood sugar mirror normally to hold. At the beginning of the therapy regular blood sugar measurements before and after the meals for certain meals help to find the correct insulin dose and to reach a satisfying metabolic situation.
Patients for whom no intensive insulin therapy is possible are given fixed doses of insulin (delayed insulin) injected at specific times (conventional insulin therapy). In this case, a flexible design of the food supply cannot be practiced. The distribution of meals throughout the day at regular intervals and the control of their quantity is necessary to avoid hypoglycaemia in the first place.
No meals may be skipped and additional carbohydrates must be eaten when doing unaccustomed physical work or sports. Similar rules apply to diabetics who are treated with sulfonylureas instead of insulin. Treatment with alpha-glucosidase inhibitors and diet does not cause hypoglycemia.
However, if sulfonylureas are taken or insulin is injected, hypoglycemia is possible. In this case, glucose must be used to combat hypoglycaemia because alpha-glucosidase inhibitors delay the absorption of other carbohydrates into the bloodstream (including household sugar!) and the effect would not be fast enough to treat hypoglycaemia. In the case of treatment with biguanides, no further measures are necessary apart from the usual nutritional recommendations for diabetics.
