Abc do diabetes

Abc do diabetes

(Parte 6 de 19)

*This is the ideal and may be difficult, impossible, or unnecessary to achieve in certain patients (for example, elderly people) Individual targets should be established for each patient †The optimal range in Type 1 diabetes is about 4·0-9·0mmol/l

Progression of retinopathy

Progression of persistent proteinuria

Progression of clinical neuropathy

Conventional Intensive

Risk reduction for complications in young Type 1 diabetic patients under intensive diabetic control: results from the DCCT

Aims of treatment: a healthy lifestyle are of great benefit, and may also substantially reduce the need for medication. Behaviour change strategies may be needed to help patients to implement them.

Healthy eating Healthy eating is the cornerstone of diabetic treatment, and control of the diet should always be the first treatment offered to Type 2 diabetic patients before drugs are considered. Eliminating sugar (sucrose and glucose) lowers blood glucose concentrations in both Type 1 and Type 2 diabetic patients, and although recent dietary recommendations suggest that eating small amounts of sugar is of little consequence, this practice is not recommended. Artificial sweeteners can be used. Good dietary advice is essential to the proper care of diabetic patients; ill considered advice can be very damaging or else it is ignored. I recall one patient who kept to the same sample menu for many years before she reported it to be rather boring. The diet needs to be tailored to the patient’s age and weight, type of work, race, and religion.

Recommendations for Type 2 diabetic patients Diets for overweight Type 2 diabetic patients should aim to eliminate all forms of sugar and restrict the total energy intake. Many of the patients are overweight, and their main goal is to lose weight, although this aim is difficult to achieve. It is important to try to ensure that when patients reduce their intake they do not replace it by an increase of fatty foodstuffs, notably a high intake of cheese. The present emphasis is on reducing total calorie intake, with special emphasis on fat reduction and a proportionately more generous allowance of carbohydrate than in previous years. It has been suggested that as much as half the energy content of the diet may be derived from carbohydrate, while the fat intake is drastically reduced, although these diets in practice require rather difficult and radical changes in the types of food normally eaten. The use of polyunsaturated fats is desirable. These diets are of value and help to reduce blood glucose concentrations if enough fibre is taken. Bran, All Bran, wholemeal bread, and beans have a relatively high fibre content, and are therefore recommended, but foodstuffs with a very high fibre content, such as guar gum, are unpalatable.

For some elderly patients it is enough simply to eliminate all forms of sugar from the diet. Their blood glucose concentrations then fall and symptoms may resolve.

Simple dietary guidelines

•Never take any form of sugar •Do not take too much fat

•There is no need to restrict most meat, fish, or vegetables

•Control your weight

There is no need to buy proprietary diabetic foodstuffs. Most forms of alcohol (other than sweet wines and liqueurs) are suitable for diabetics, with the usual restrictions for the overweight

Year

Percentage with BMI >

30 kg/m

Men Women

Prevalence of obesity in England

A diabetic diet: elimination of sugar/glucose/sucrose

Do not eat or drink:

•Sugar or glucose in any form and do not use sugar in your cooking •Jam, marmalade, honey, syrup, or lemon curd

•Sweets or chocolates

•Cakes and sweet biscuits

•Tinned fruit

•Lucozade, Ribena, Coca-Cola, Pepsi-Cola, lemonade, or other fizzy drinks

You may use artificial sweeteners, such as saccharin, Sweetex, Hermesetas, Saxin, but NOT Sucron, and any sugar-free drinks including squashes and Slimline range

Fibre content of diet The following will increase the fibre content of the diet:

BreadWholemeal or stoneground— wholemeal for preference If these are not available use HiBran or wheatmeal or granary loaves

Biscuits and crispbreadsRyvita, Macvita, and similar varieties. Digestive, oatcakes, coconut, and bran biscuits, etc. Crackawheat

Breakfast cerealsPorridge, Weetabix, Weetaflakes,

All Bran, Bran Buds, Shredded Wheat, Oat Krunchies, muesli, Alpen, and similar cereals

Wholemeal flour orShould be used with white flour 100% rye flourfor making bread, scones, cakes, biscuits, puddings, etc

Fresh fruit and vegetablesShould be included at least twice daily. The skin and peel of fruit and vegetables such as apples, pears, plums, tomatoes, and potatoes should be eaten

Dried fruit and nutsEat frequently Brown rice, wholemeal pasta

Pulse vegetablesSuch as peas and all varieties of beans

ABC of Diabetes

Foods suitable during intercurrent illness

For patients who are feeling ill but need to maintain their carbohydrate intake, the following are useful (each item contains 10g of carbohydrate):

•1/3pint (0.15l) tinned soup •1 glass fruit juice

•1 scoop of ice cream

•1 glass of milk

The following each contain 20g of carbohydrate:

•2 teaspoons Horlicks and milk •2 digestive biscuits

•1 Weetabix and a glass of milk

•1 ordinary fruit yoghurt

•“Build-up” made with 1/2a pint (0.25l) of milk and 1/2 a sachet

Optimal control may not be needed and it is best to interfere as little as possible with the patient’s usual way of life.

Diets for Type 1 diabetic patients Greater finesse is required in managing the diets of Type 1 diabetic patients; if they eat too much, diabetic control deteriorates; if they eat too little they become hypoglycaemic. The important principles are that carbohydrate intake should be steady from day to day and that it should be taken at fairly regular times each day. If this discipline is not followed diabetic control becomes difficult, although new approaches to the management of Type 1 diabetes such as dose adjustment for normal eating (DAFNE) (see page 29) may permit flexibility in which calculation of carbohydrate intake is used to calculate the insulin dose, thus freeing the patient from a rigidly controlled dietary intake. Severe carbohydrate restriction is not necessarily required; indeed, if the diet is fairly generous patients are less likely to resort to a high fat intake, which may be harmful in the long term.

(Parte 6 de 19)

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