Patient's question:
Diabetic patient, dry mouth, sore tongue, feeling hot in the heart, what's going on, what medications can be used. Have taken cimetidine, but it wasn't effective.Doctor's answer:
Diabetes Diet Therapy (1) Controlling total energy intake is the primary principle of diabetes diet therapy. The intake of calories should be sufficient to maintain a normal weight or slightly below the ideal weight. Obese individuals must reduce their caloric intake, while underweight individuals can moderately increase their calories to gain weight. (2) Providing an adequate amount of carbohydrates. Currently, it is recommended not to overly restrict carbohydrates. Carbohydrates should account for about 60% of total energy intake, with daily consumption ranging from 250 to 300 grams, and 150 to 200 grams for obese individuals. Grains are the main source of energy in daily life, with 50 grams of rice or white flour providing approximately 38 grams of carbohydrates. Other foods, such as dairy, legumes, vegetables, and fruits, also contain a certain amount of carbohydrates. Foods like buckwheat, rolled oats, buckwheat noodles, cornmeal, mung beans, and kelp have the ability to lower blood sugar. Nowadays, "sugar-free foods" and "low-sugar foods" are commonly seen on the market. Some patients, after consuming these foods, not only do not see improvement but experience a rise in blood sugar. This is due to the misunderstanding of "low-sugar" and "sugar-free." People believe these foods contain no sugar and thus relax their dietary control, leading some patients to consume these foods without restraint, resulting in elevated blood sugar. In fact, low-sugar foods refer to those with low sucrose content, while sugar-free foods refer to those without sucrose. However, these foods are primarily composed of starch. When people consume starch-based foods, they can be converted into glucose and absorbed by the body, so these foods should also be controlled. (3) Providing sufficient dietary fiber. Epidemiological surveys suggest that dietary fiber can lower fasting blood sugar, postprandial blood sugar, and improve glucose tolerance. The mechanism may be that dietary fiber has water-absorbing properties, which can alter the transit time of food in the gastrointestinal tract. Therefore, it is recommended to increase the amount of dietary fiber in the diabetes diet. Vegetables, wheat bran, legumes, and whole grains should be included in the diet. Dietary fiber has the ability to degrade bacteria. After consuming rough fiber foods, they can be broken down into polysaccharides in the large intestine, producing short-chain fatty acids and bacterial metabolites, while also increasing the volume of feces. These types of dietary fiber belong to polysaccharides. Pectin and mucilage can retain moisture, expand intestinal contents, increase viscosity, slow gastric emptying and nutrient absorption, and increase the excretion of bile acids, thereby slowing down small intestinal digestion and absorption. Foods rich in these types of dietary fiber include wheat germ and legumes. Previously, it was believed that dietary fiber was not absorbed because the basic structure of most dietary fiber is composed of glucose units. However, the way glucose is linked differs significantly from that of starch, making it difficult for the body's digestive enzymes to break it down. However, recent studies have found that dietary fiber can be decomposed and utilized by intestinal microorganisms. Short-chain fatty acids produced during decomposition can be partially absorbed by the body and rapidly absorbed. Soluble fiber in oats can increase insulin sensitivity, which can reduce the sharp rise in postprandial blood sugar, allowing the body to secrete less insulin to maintain metabolism. Over time, soluble fiber can lower insulin levels in the bloodstream, reducing the need for insulin in diabetic patients. It can also lower cholesterol and prevent diabetes complicated by hyperlipidemia and coronary heart disease. (4) Providing sufficient protein. Diabetic patients should consume an adequate amount of protein in their diet. Some patients are afraid that consuming too much protein will increase the burden on their kidneys. When kidney function is normal, the dietary protein for diabetes should be similar to that of healthy individuals. When combined with kidney disease, the daily protein intake should be reasonably planned under the guidance of a nutritionist. Dairy products, eggs, lean meat, fish, shrimp, and soy products are rich in protein. High-quality protein should be consumed appropriately. Currently, it is recommended that protein should account for 10% to 20% of total energy intake. Grains contain plant protein. If 300 grams of grains are consumed daily, it can provide 20 to 30 grams of protein, accounting for 1/3 to 1/2 of the daily protein intake. The physiological value of plant protein is lower than that of animal protein, so plant protein should also be controlled appropriately in the diet. Especially when combined with kidney disease, the consumption of plant protein should be controlled. (5) Controlling fat intake. Some diabetic patients mistakenly believe that diabetes diet therapy only involves controlling the intake of staple foods. In fact, it is not the case. Currently, it is recommended not to excessively control carbohydrates but to strictly control fat intake, which is essential. Controlling fat can delay and prevent the occurrence and development of diabetes complications. Currently, it is recommended that dietary fat should be reduced to 25% to 30% of total energy intake, or even lower. Saturated fatty acids, such as butter, lamb fat, pork fat, and cream, should be limited, and unsaturated fatty acid-rich vegetable oils, such as soybean oil, peanut oil, sesame oil, and rapeseed oil, should be used instead. However, coconut oil should be avoided. Nuts like peanuts, walnuts, and pine nuts also contain high fat content and should be consumed in moderation. Cholesterol intake should also be appropriately controlled to prevent complications. High-cholesterol foods, such as animal liver, kidneys, and brains, should be consumed in moderation. Eggs are also rich in cholesterol, and it is recommended to consume one per day or every other day. (6) Providing sufficient vitamins and inorganic salts. Patients with poor disease control are prone to infections or ketoacidosis and should pay attention to supplementing vitamins and inorganic salts. Especially, the consumption of B vitamins increases, so B vitamin preparations should be provided to improve neurological symptoms. Coarse grains, dried beans, eggs, animal organs, and green leafy vegetables are rich in B vitamins. Fresh vegetables are rich in vitamin C and should be supplemented accordingly. In elderly diabetic patients, the content of chromium should be increased. Chromium can improve glucose tolerance, lower serum cholesterol and blood lipids. Foods rich in chromium include yeast, beef, liver, mushrooms, and beer. At the same time, it is important to consume more foods rich in zinc and calcium to prevent tooth loss and osteoporosis. Diabetic patients should not consume excessive salt to prevent the occurrence of hypertension, and daily salt intake should be less than 6 grams. (7) Diabetic patients should avoid alcohol. Alcohol can produce energy, but its metabolism does not require insulin, so moderate alcohol consumption is allowed. However, it is generally recommended not to consume alcohol because, in addition to providing energy, alcohol does not contain other nutrients. Long-term alcohol consumption is harmful to the liver and can easily lead to hyperlipidemia and fatty liver. Additionally, some patients may experience palpitations, shortness of breath, or even hypoglycemia after drinking alcohol while taking hypoglycemic medications. (8) Diabetic patients should arrange their daily three meals reasonably, ensuring that each meal contains carbohydrates, fat, and protein to slow down the absorption of glucose. (9) Fried foods, vermicelli, tubers, and fruits should be controlled. However, tubers and fruits should not be completely avoided. Patients should learn to independently manage the exchange of various foods to achieve balanced nutrition.