Nutritional intervention in type 1 and type 2 diabetes mellitus
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body does not use the insulin it produces effectively. Insulin is a hormone that regulates blood sugar. In this text, we will address nutritional intervention in type 1 diabetes mellitus (DM1) and type 2 diabetes mellitus (DM2).
DM1 is characterized by a deficient production of insulin, for which the daily administration of this hormone is required. The cause of DM1 is still unknown and cannot be prevented with current knowledge. It usually appears in childhood or youth.
In the case of DM2, the body makes ineffective use of insulin. Most people with DM2 are largely due to excessive body weight and physical inactivity. It appears in adulthood. It represents 85% of the cases of diabetes.
Poorly controlled diabetes can cause hyperglycemia (increased blood sugar), which over time seriously damages systems and organs (such as the heart or kidneys), blood vessels, and vision. Diabetic adults have a two to three times higher risk of heart attack and stroke. Neuropathy of the feet combined with reduced blood flow increases the risk of foot ulcers, infection and ultimately amputation. Diabetic retinopathy is a major cause of blindness and is the consequence of accumulated damage to the capillaries of the retina over time. 2.6% of the world's cases of blindness are a consequence of diabetes. Also, diabetes is among the leading causes of kidney failure. It is estimated that the cost of diabetes and its intervention accounts for 11.6% of global health spending.
A healthy eating pattern, regular physical activity, and drug therapy are key components for managing diabetes. The American Diabetes Association (ADA) believes that there is no single dietary guideline for people with diabetes, but it does recognize the critical role of nutritional therapy in the overall management of diabetes. Recommend that people with diabetes actively participate in self-management, education, and treatment planning with a healthcare professional.
In the case of overweight or obese adults with DM2, it is recommended to reduce energy intake while maintaining a healthy eating pattern, to promote weight loss. Weight loss in some individuals with diabetes can improve blood glucose, blood pressure, and/or lipids, especially in those in the early stages of the disease. Several nutritional intervention studies show that glycemic control can be achieved by maintaining or even reducing weight when appropriate lifestyle advice is provided. Achieving blood pressure and lipid goals can help reduce the risk of CVD events. Therefore, a correct food choice will have a direct effect on energy balance, body weight, blood pressure, and lipid levels.
Regarding the objectives of nutritional therapy that apply to adults with diabetes are:
Promote and support healthy eating patterns, emphasizing varied foods that are nutrient-dense and the appropriate serving size, in order to improve overall health and achieve individualized desired goals (blood glucose, blood pressure, lipids, maintenance and weight loss etc.). Delay or prevent complications of diabetes. In addition, it is very important to address individual nutritional needs based on personal and cultural preferences, health and numerical knowledge, access to healthy food options, willingness and ability to make behavioral changes, as well as obstacles to change. Maintain the pleasure of eating by providing positive messages about food choices and limiting food choices only when indicated by scientific evidence. Provide the person with diabetes with practical tools for daily meal planning rather than focusing on individual macronutrients (carbohydrates, proteins and lipids), micronutrients (calcium, sodium, etc.) or specific foods.
Adequate metabolic control can be considered essential in the treatment of diabetes.
Evidence suggests that there is no ideal percentage of calories from carbohydrates, protein, and fat for all people with diabetes. Therefore, the distribution of dietary nutrients for the diabetic population is the same as that recommended for the general population (45-60% carbohydrates, 10-20% proteins and 20-35% lipids of the caloric intake total daily, 20-30 grams / day of fiber) and should be based on an individualized assessment of current eating patterns, preferences, and metabolic goals.
There are multiple meal planning approaches and eating patterns that can be effective in meeting your metabolic goals. Some examples are: carbohydrate counting, healthy food choices / plate method, methods based on macronutrient percentages, list of exchanges for meal planning, glycemic index, etc. Here we show you some of them.
The Clinical Method exchange table is a patented method of the Hospital Clínico de Barcelona. It consists of a table of equivalences. The amount of each food is shown with its raw grams, which are equivalent to one serving. The grams you sample of these foods equals 10 grams of carbohydrates.
The following is the plate method which consists of dividing the plate into sections. Each section is distributed for the different food groups and their portion. It should be a normal size plate. It is quite a practical and visual method.
Next, we have the measuring cup method, it allows to measure and exchange already cooked foods from the group of flours (pasta, potatoes, peas, rice, legumes, etc.). The measuring cup has 3 levels: on level 1 is the rice, on level 2 the legumes and on level 3 the pasta, peas and potatoes. When the glass is filled with said foods already cooked to the corresponding level, we will have an equivalence of 2 servings. It is a very useful and simple method.
Finally we have the table of carbohydrate servings from the Diabetes Foundation. The table can be downloaded and the patient can have it to consult. In addition to placing the tables of equivalence in grams of weight of foods equivalent to a serving of 10 grams of carbohydrates, it also includes the glycemic index of foods with a colored traffic light, to indicate the most recommended.
For people with T1D who do not use fixed doses of insulin, carbohydrate counting meal planning can lead to better glycemic control. However, for people who use fixed daily doses of insulin, the constant intake of carbohydrates with respect to time and quantity can improve glycemic control and reduce the risk of hypoglycemia.
For people with T2D, a simple meal planning approach such as portion control or healthy food choices may be more appropriate, as these people are identified with health problems and knowledge of numeracy. This could be an effective meal planning strategy for older adults.
Ideally, the person with diabetes should be referred to a registered dietitian for nutritional therapy at the time of diagnosis, or shortly thereafter, and for ongoing follow-up. The goals of nutrition therapy should be developed in collaboration with the person with diabetes and based on an assessment of the person's current eating patterns, preferences, and metabolic goals. Keep in mind that it may need to be adjusted over time based on changes in life circumstances, preferences, and the course of the disease. Also, more research is needed on the best tools and strategies to educate people with diabetes and how to improve their adherence to healthy eating patterns.
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