Diabetes diet

Synonyms

Medical nutrition therapy (MNT) for diabetes mellitus;

Initial description

The diabetes diet has offered a very changeable and also controversial assessment regarding dietary measures in diabetes mellitus in the last 200 years.

The ancient physician Aretaios of Cappadocia first clearly described dietary treatment measures for diabetics in 100 CE (Schmeisl 2019) in the form of milk, soups, pastries, and fruit juices at meals.

Paracelsus (1493 - 1541) had diabetes mellitus treated by starvation diets.

Sydenham (1624 - 1689), who was called the "English Hippocrates" by Paraspyros, recommended a meat diet. This was taken up by the English military physician John Rollo in the middle of the century before last. This is often mistakenly considered the first describer of the animal diet.

(Oyen 1985).

The definition of a diabetes diet has changed frequently throughout history. Nowadays, it is understood to mean a dietary recommendation similar to that of the overweight general population (Kasper 2015).

While the term "diabetes diet" is accurate, it should be avoided if possible because it evokes negative associations (Liebl 2005).

A diabetes diet today is primarily for prevention and is used:

• for weight reduction in high-risk patients, to delay or prevent the onset of diabetes mellitus
• to delay or prevent diabetes-related complications (Kasper 2015).

The formerly strict, restrictive rules for diabetics are no longer taught nowadays.

Today's diabetes diet recommends fruits, vegetables, foods containing fiber and little fat (Kasper 2015).

Important variables in the diabetes diet are:

• Glycemic Index (GI).

The glycemic index can be used to estimate the postprandial increase in blood glucose. Foods with a low glycemic index prevent postprandial glucose surges, thereby improving glycemic control (Kasper 2015).

• Carbohydrate unit (CU).

The measure previously used to determine the carbohydrate content of food was bread units (BU). This designation is now obsolete. Nowadays, one measures in KE. 1 CU = 10 g of carbohydrate (about ½ roll). For 1 KE, approximately 1 IU of insulin is secreted in the islets of Langerhans in healthy individuals (Herold 2022).

The diabetes diet should include several small meals, ideally 5; large meals should be avoided (Herold 2022).

Type 1 diabetes

Type 1 diabetics are usually of normal weight. To avoid triggering additional insulin resistance, possible overweight should be avoided at all costs.

With conventional insulin therapy, the patient is bound to a rigid insulin regimen including prescribed food intake; with intensified insulin therapy, on the other hand, the patient is free to determine the diet in addition to the adjusted insulin amount (Herold 2022).

Type 2 diabetes

In type 2 diabetes, treatment should begin, among other things, in the form of a diabetes diet for weight loss already at the stage of glucose tolerance disorder (Herold 2022).

• The goals of a diabetes diet are:
  • the BMI should be < 25
  • if a BMI < 25 cannot be achieved, a weight loss of 5 - 10% is recommended, which should then be maintained (Herold 2022)

• Diet composition in a diabetes diet:
  • Fat:
    • The fat percentage should be about 35 %, in obese people up to max. 30 %
    • A maximum of 10 % of this should be polyunsaturated fatty acids, the rest consisting of monounsaturated fatty acids
    • Trans- FS < 1 %
    • Cholesterol up to max. 300 mg / d
    • 2 - 3 x / week sea fish
    • Use of vegetable oils such as linseed oil, rapeseed oil, perilla oil
  • Protein:
    • The protein content should be about 10 - 20 % of total calories, although this should be increased with age because of age catabolism
    • In the presence of diabetic nephropathy with persistent proteinuria, on the other hand, a protein restriction to 0.8 g EW / kg bw / d is recommended (in the case of terminal renal insufficiency, however, the reduction is controversial because of the concomitant catabolism).
  • Carbohydrates:
    • The remaining caloric requirement of 45-60% should consist of carbohydrates, measured in KE.
    • Quickly absorbable monosaccharides such as glucose and disaccharides such as lactose (milk sugar) and sucrose (cane sugar) should be avoided if possible.
  • Sweeteners:
    • Aspartame, cyclamate, saccharin, stevia are permitted
    • Sugar substitutes and fructose should be avoided, as they are probably more harmful than beneficial
  • High-fiber source dietary fiber:
    • Recommended > 40 g / d
  • Alcohol:
    • Has a contrainsulin effect and thus increases the risk of hypoglycemia by
    • Inhibiting gluconeogenesis in the liver
    • Inhibits the morning release of growth hormones
    • Should be consumed only occasionally (maximum 10 g / d for women and 20 g / d for men and then always together with carbohydrates
    • Especially in the presence of concomitant arterial hypertension and obesity, consumption should be limited as much as possible
  • Dietary products for diabetics:
    • These are not considered necessary for diabetics (Herold 2022)

Indication

• Diabetestype 1: The aim of a diabetes diet in type 1 diabetes is to,
  • to coordinate and adjust the required amount of insulin according to the calorie intake
  • to be sufficiently flexible to allow for sporting activities
  • to allow deviations in calorie intake
  • to keep a possible weight gain as low as possible (Kasper 2015)
  • to prevent insulin resistance (Herold 2022)
• Type 2 diabetes: In type 2 diabetics, the diet aims to:
  • to allow for weight loss
  • to minimize the greatly increased prevalence of cardiovascular risk factors such as dyslipidemia, arterial hypertension (Kasper 2015)

Worldwide, the recommendations of a diabetes diet are approximately the same. Only in Czech diabetology is the low-carbohydrate diet not recognized because of concerns about its safety (Krejci 2018).

Previous studies have shown that in type 2 diabetics, even a small weight loss of 5-7% in new-onset diabetes leads to a significant reduction in blood glucose levels.

However, long-term weight loss is rare (Kasper 2015). In these rare cases, drug therapy often becomes unnecessary or the manifestation of type 2 diabetes can be delayed or even prevented (Herold 2022).

According to the study, the highest weight loss occurred in type 2 diabetics on:

- Mediterranean diet with - 1.84 kg

- low-carbohydrate diet with - 0.69 kg

The HbA1c value decreased by

- 0,12 % with low carbohydrate diet

- 0.14 % on low glycemic index diet

- 0.47 % with a Mediterranean diet

- 0.28 % with a high-protein diet

The ideal diet is probably the one that the patient is best able to follow (Sandouk 2017)

In the comprehensive care of a diabetic, regular nutritional training is an important component. The restrictive, strict rules that used to be imposed on diabetics are a thing of the past.

Today's diabetes diet aims not only to reduce weight, but also to modify risk factors for arterial hypertension and hyperlipidemia (Kasper 2015).

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2. German Medical Association (2021) National health care guidelines: type 2- diabetes. AWMF- Register- No. nvl-001
3. Herold G et al (2020) Internal medicine. Herold Publishers 731 - 732
4. Kasper D L et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 55, 2408 - 2409, 2421
5. Krejci H et al (2018) Low-carbohydrate diet in diabetes mellitus treatment. Vnitr Lec. 64 (7 - 8) 742 - 752.
6. Liebl A et al. (2005) Diabetes mellitus type 2. Schriftenreihe der Bayerischen Landesapothekerkammer. (71) 23
7. Oyen D et al (1985) On the history of the diabetes diet. Springer Verlag Berlin / Heidelberg / New York / Tokyo 1 - 2, IX - X, 3 - 5.
8. Sandouk Z et al. (2017) Diabetes with obesity - Is there an ideal diet? Cleve Clin J Med. (84) 4 - 14
9. Schmeisl G W (2019) Diabetes training manual. Elsevier Urban and Fischer Publishers 1