The key requirement for 1 diabetic patients is to master the balance between insulin, diet and activities, and flexibly adjust insulin, diet and meal times according to the increase or decrease of activities.
The key requirement for type 2 obese patients is to limit the intake of total calories in diet, so as to lose weight, improve insulin sensitivity and improve clinical symptoms.
Diet therapy is one of the basic treatment measures for type 2 diabetes. In the treatment of diabetes, 70% ~ 80% of the problems are related to the quality of diet control [1], so it is very important to give dietary guidance to diabetic patients. From June 2003 to July 2004, 48 patients with type 2 diabetes were treated in our department. Through systematic dietary guidance, the patient actively cooperated with the adjustment of diet, and his condition was well controlled.
Clinical data of 1
Among the 48 patients, 25 were male and 23 were female, all of which met the diagnostic criteria of type 2 diabetes. The age ranged from 26 to 82 years, with an average of 56.8 years. The shortest course of disease is 9 months, and the longest is 1 1 year. The lowest fasting blood glucose is 6.7 mmol/L and the highest is 34 mmol/L. Complications: ketoacidosis in 4 cases, diabetic foot in 2 cases, hypertension 16 cases and hyperlipidemia in 29 cases.
Two methods
2. 1 evaluation
After the patient was admitted to the hospital, the nurse collected information, focusing on the following contents: (1) the patient's condition, course of disease and previous treatment; (2) Living habits of patients, such as diet, activities and hobbies; (3) economic conditions, education level, etc. ; (4) Age, height, weight and body shape; (5) Understand the basic knowledge of diabetes and master the prevention and treatment skills.
2.2 Make a diet plan
The nurse provides the evaluation data to the competent physician, so that the physician can formulate the drug and diet treatment plan. But nurses should master the calculation of dietary calories of diabetes. The traditional method is to calculate the daily total calories according to the patient's standard weight and work nature. It can also be calculated according to the formula of heat energy requirement established by Tang et al. [2], that is, e (kcal) = [(h-a )× 6 500 ÷ WI2 ]× AF× CF. According to this formula, the older you are, the higher your weight will be, and the lower the heat required for the calculation result will be. This calculation is more reasonable and more in line with the individual needs of patients.
2.3 Calculation of food intake and distribution of three meals
After determining the total calories, the three nutrients (carbohydrate, protein and fat) should be reasonably matched. At present, both who and idf advocate relaxing the proportion of carbohydrates under the premise of total calorie restriction. Carbohydrate can account for 55% ~ 65% of total calories, protein accounts for 65,438+02% ~ 65,438+05%, and fat accounts for 25% ~ 30%. Generally speaking, according to the above ratio, the intake of fat and protein should be reduced appropriately, and the distribution of three meals should be 1/5, 2/5 and 2/5.
2.4 Dietary guidance
Use one-on-one individual guidance. Guidance content: (1) Explain the importance of diet regulation, and inform patients that diet control is the basic treatment method for diabetes, which should be strictly implemented and persisted for life regardless of the severity of the disease or whether there are complications or not. (2) For patients who can read and write, teach them to calculate the calories they need every day and convert the amount of food they need. For illiterate or poorly understood patients, we guide their families to convert. (3) To guide patients and their families to choose and match food types reasonably, including carbohydrates, protein, fat, cellulose, minerals and trace elements, salt, etc. (4) If you don't feel full, you can appropriately increase vegetables and fruits with sugar content within 5%. (5) Eat on time and in quantity, and eat within half an hour after using insulin to prevent hypoglycemia. (6) Reserve some emergency foods to deal with hypoglycemia.
2.5 diet management
After the implementation of the diet treatment plan, nurses should always supervise and check the implementation of patients, understand the types and quantities of food eaten by patients, and ask patients whether their appetite is normal and whether they feel hungry. If you have indigestion or anorexia, report it to the competent doctor in time so as to adjust the treatment plan. Educate patients to do self-management, besides adhering to the principle of diet, they should also refrain from eating dinner, socializing and being persuaded by others.
Three results
Among the 48 patients in this group, 39 patients have basically mastered the knowledge of dietotherapy, understood the importance of dietotherapy, and knew how to calculate the daily total calories and recipe collocation. Because of their older age and poor thinking ability, 9 cases did not master the relevant methods, but their families could also master the corresponding knowledge. 48 cases of blood sugar decreased and stabilized in the normal range.
4 experience
4. 1 Diet control should be gradual.
Dietary treatment of diabetes requires lifelong persistence. Therefore, when making a treatment plan, patients who used to eat a lot should be gradually reduced according to their previous diet, so that patients can adapt to the process and make them easy to accept and persevere.
4.2 recipes should be flexible.
Under the premise of strictly controlling the total calories, according to patients' eating habits, meet or try to meet patients' dietary preferences. In addition to avoiding eating nutritional sweeteners such as white sugar, brown sugar and sweet drinks, other food types should not be too limited, so that patients can enjoy a diet close to normal people, which can improve their compliance and persistence in diet therapy.
"Six Suits and Three Disadvantages" for Diabetic Patients
Nutrition experts prescribe healthy recipes for diabetics.
Nutrition experts in the General Hospital of Lanzhou Military Region believe that, first of all, diabetics are forbidden to eat sweets and various fruits, because glucose and sucrose are digested and absorbed quickly, which will increase blood sugar; Also eat less foods with high carbohydrate content, such as sweet potatoes, potatoes and lotus roots. It's best not to drink either.
People with diabetes can eat more high-fiber foods to promote the body's sugar metabolism. Such as corn, wheat, Chinese cabbage, leek, bean products, etc.
Vegetables with low sugar content. Such as leek, zucchini, wax gourd, pumpkin, green vegetables, green peppers, eggplant and so on. Tomatoes, on the other hand, have low sugar content and can be used as both vegetables and fruits.
Eat more foods containing calcium. Calcium deficiency will aggravate the condition of diabetic patients. Such as shrimp skin, kelp, ribs, sesame sauce, soybeans, milk and so on.
Foods rich in selenium. Selenium has the same physiological activity as insulin in regulating glucose metabolism. Such as fish, mushrooms, sesame, garlic, mustard and so on. , can lower blood sugar and improve diabetes symptoms.
Foods rich in vitamin B and vitamin C, supplementing these two elements is beneficial to slow down the process of diabetic complications and reduce diabetic retinopathy and nephropathy. Such as fish, milk, cabbage, beans, vegetables, mustard greens, kale, green peppers, fresh dates and so on.
In addition, pumpkin, bitter gourd, onion, eel and so on. It can obviously improve the symptoms of patients with polydipsia, polyphagia and polyuria, and has the functions of lowering blood sugar and regulating blood sugar concentration, which is suitable for polyphagia.
Main points of application of dietotherapy
(1) Diet therapy is the basic therapy for diabetes, and it is the premise of all treatment methods, and it is suitable for all types of diabetic patients. Mild cases can achieve good results mainly through diet therapy, and moderate and severe patients must also apply physiotherapy and drug therapy reasonably on the basis of diet therapy. Only by controlling diet, oral hypoglycemic drugs or islets can play a good role. Otherwise, it is difficult to achieve good results in clinic by blindly relying on so-called new drugs and drugs and ignoring diet therapy.
(2) Dietotherapy should be flexibly adjusted and mastered according to the condition. Thin patients can relax appropriately to ensure the total calories. Obese patients must strictly control their diet and focus on a low-calorie fat diet to lose weight. For patients treated with insulin, we should pay attention to adding meals at 9 ~ 10, 3 ~ 4 pm or before going to bed as appropriate to prevent hypoglycemia. When manual labor or activities are long, attention should also be paid to appropriately increasing staple food or dinner.
(3) Dietotherapy should be scientific and reasonable, neither too much nor too little. Just don't be arbitrary, too strict, and dare not eat any carbohydrates. On the contrary, it will aggravate your condition and even cause ketosis. We should strictly calculate according to our own conditions, weight, height, etc., and arrange our diet scientifically and reasonably under the premise of controlling the total calories, so as to meet the minimum needs of the human body and control the total calories.
(4) Arrange staple food and non-staple food scientifically, and don't just pay attention to staple food and despise non-staple food. Although staple food is the main source of blood sugar and should be controlled, some protein and fat in non-staple food can also become blood sugar and become the source of blood sugar. In metabolism, 58% of protein and 10% of fat become glucose. Eating too much of this kind of non-staple food will also make people fat, which is not good for their illness. Therefore, in addition to reasonable control of staple food, non-staple food should also be reasonably matched, otherwise the expected effect will not be achieved.
(5) Choosing foods suitable for diabetics is also very important to control diabetes. Attention should be paid to the following two points:
(1) The foods that should not be eaten are:
I. Foods that can easily raise blood sugar rapidly: white sugar, brown sugar, rock sugar, glucose, maltose, honey, chocolate, toffee, fruit candy, candied fruit, canned fruit, soft drinks, fruit juice, sweet drinks, jam, ice cream, cookies, cakes, sweet bread and sweets made of sugar.
Ii. Foods that are easy to raise blood lipids: butter, sheep oil, lard, butter, cream and fat. For foods rich in cholesterol, special attention should be paid to using them less or not to prevent the occurrence of atherosclerotic heart disease.
Iii. it is not advisable to drink alcohol. Because the alcohol contained in the wine contains no other nutrients, it only provides heat energy, and each gram of alcohol produces about 7 kilocalories (294 joules), which is harmful to the liver and easy to cause the increase of serum triglycerides. A few patients who take sulfonylurea hypoglycemic drugs are prone to palpitation, shortness of breath and blushing after drinking. Note that insulin patients who drink alcohol on an empty stomach are prone to hypoglycemia. For the safety of patients, it is best not to drink alcohol.
2 Suitable foods: mainly foods that can delay the increase of blood sugar and blood lipid.
Ⅰ. Soybean and its products: These foods are rich in protein, inorganic salts and vitamins. There are more unsaturated fatty acids in soybean oil, which can reduce blood cholesterol and triglycerides, and the sitosterol contained in them also has lipid-lowering effect.
Ⅱ. Coarse miscellaneous sugar: such as naked oats powder, buckwheat powder, hot cereal, corn flour, etc. contain various trace elements, vitamin B and dietary fiber. Experiments show that they can delay the rise of blood sugar. Corn flour, soybean flour and white flour can be made into steamed bread, pancakes and noodles in a ratio of 2: 2: 1. If you stop using it for a long time, it will not only help reduce blood sugar and fat, but also reduce hunger.