Patient's question:
My mother was diagnosed with diabetes the day before yesterday. I would like to ask: what should she pay attention to now? What kind of food can help lower blood sugar? What kind of food is suitable for her to eat? What kind of food should she avoid?Doctor's answer:
Diabetic patients should consume high-quality protein. The protein supply for diabetic patients traditionally consists mainly of plant-based proteins such as beans and bean products. However, after clinical observation and research, scholars have concluded that plant proteins contain a higher proportion of non-essential amino acids and have low bioavailability. Additionally, plant protein molecules are larger, which can cause filtration damage during kidney filtration, accelerating the hardening of glomerular capillaries and increasing the burden on the kidneys. Therefore, scholars do not advocate excessive consumption of plant protein by diabetic patients. On the other hand, certain animal proteins are high-quality proteins, such as those found in dairy products, poultry, and aquatic products. These proteins contain a higher proportion of essential amino acids, have high utilization rates, and are of excellent nutritional value. Moreover, these proteins have smaller molecules, and their filtration by the kidneys does not cause filtration damage, providing kidney-protective effects and having no adverse effects on blood sugar levels in diabetic patients. Therefore, scholars recommend that diabetic patients should primarily consume high-quality protein foods rather than plant proteins. Especially for early-stage diabetic nephropathy patients, to prevent further deterioration of renal function, in addition to actively controlling metabolic disorders and lowering blood sugar, selecting a high-protein diet to reduce urinary albumin and protect kidney function is also an essential measure.How much egg should a diabetic eat? Eggs are a highly nutritious food. Consider that a single egg can provide all the substances and energy needed to hatch a chick, making its nutritional value very high. Moreover, eggs contain rich, easily absorbable protein and a large number of trace elements. Eating an egg makes you feel much hungrier than consuming the same amount of grains, so whether used as a main meal, side dish, or snack, it is an excellent food. However, eggs do contain relatively high calories, and the yolk has even higher calorie and cholesterol content, so it is still not advisable to eat too many. Generally speaking, it is appropriate for a diabetic patient to eat one egg per day. If they eat two or more eggs, it is best to consume only one yolk to avoid affecting their weight and cholesterol levels. Duck eggs contain more calories and fat than chicken eggs, and red-skinned eggs contain more calories and fat than white-skinned eggs. These factors should be considered when eating eggs.
Exercise and diabetes In the treatment of diabetes, exercise is a fundamental measure. For type 2 diabetic (non-insulin-dependent diabetes) patients, the immediate effect of physical activity is to lower blood sugar, while the long-term effect is to reduce the dosage of hypoglycemic medications. For type 1 diabetic patients who require insulin treatment, regular exercise is the most important treatment method, helping to stabilize blood sugar levels and enhance the effectiveness of insulin. Exercise can lower triglycerides and cholesterol, increase the content of medium- and high-density lipoproteins, improve blood flow and oxygen supply to peripheral tissues, and strengthen the heart's pumping function, all of which help prevent and alleviate cardiovascular complications caused by diabetes. The most suitable exercise for diabetic patients is continuous, regular aerobic exercise, such as walking, cycling, jogging, badminton, swimming, hiking, and dancing. The exercise intensity should be moderate, so that the patient does not feel fatigued after exercising. Diabetic patients should pay attention to preventing hypoglycemia when exercising and should do so when blood sugar levels are elevated after meals. Type 1 diabetic patients should exercise according to their individual dietary and insulin action times, avoiding exercise during the peak period of blood insulin caused by medication. Diabetic patients have lower resistance and are more prone to infectious complications. After sweating during exercise, they should pay attention to keeping their skin clean.
What should diabetic patients pay attention to when exercising? Diabetic patients should pay attention to the following aspects when exercising: (1) Gradually increase the amount and duration of exercise, and exercise until they feel fatigued. Overexertion can raise blood sugar levels and worsen the condition. (2) Exercise must be organically combined with dietary and medicinal treatment. (3) When diabetic patients have complications such as heart disease, kidney disease, or retinopathy, exercise intensity should not be too high, and the duration should not be too long. Intense exercise during diabetic heart disease can increase myocardial oxygen consumption, leading to insufficient blood supply to the heart and causing angina or even myocardial infarction. Additionally, acute exercise reduces renal blood flow, worsening diabetic nephropathy; during exercise, blood pressure rises, increasing the risk of vitreous and retinal bleeding. (4) Patients taking insulin or oral sulfonylurea drugs should prevent hypoglycemic reactions during exercise and have appropriate snacks if necessary. (5) Diabetic exercise should be persistent, and exercise should not be interrupted unless there is an acute complication.
The "Five Avoidances" for diabetic patients
1. Avoid excessive hypoglycemia. Diabetic patients are often very concerned about high blood sugar, but in fact, the harm of hypoglycemia is also significant. Mild hypoglycemia may manifest as symptoms such as palpitations, sweating, dizziness, and weakness. Severe hypoglycemia can severely damage the central nervous system, leading to confusion, coma, or even death. Moreover, hypoglycemia can increase the excitability of the sympathetic nervous system, causing blood vessel constriction and elevated blood pressure, leading to cardiovascular accidents such as myocardial infarction or cerebral thrombosis. Additionally, chronic hypoglycemia can lead to intellectual impairment or even dementia.
2. Avoid excessive dietary restriction. Dietary treatment is the foundation of diabetes treatment and is very important for lowering blood sugar and controlling weight. However, dietary treatment does not mean "starvation therapy." It involves appropriately limiting the total calorie intake while ensuring the basic nutritional needs of the patient are met and maintaining nutritional balance. Excessive dietary restriction or unbalanced diet can lead to malnutrition, anemia, and starvation ketosis, reducing the body's resistance and ability to repair. Excessive dietary restriction can also cause a rebound increase in blood sugar after hypoglycemia, making it difficult to maintain stable blood sugar control. Moreover, dietary control should not be one-size-fits-all. Diabetic patients with significant weight loss or those in pregnancy should have their dietary control standards relaxed appropriately.
3. Avoid excessive exercise. Exercise is also one of the basic treatment methods for diabetes and offers many benefits. For example, it can increase the body's calorie expenditure, improve insulin resistance, and lower blood sugar; promote blood circulation and enhance cardiopulmonary function; prevent osteoporosis and improve overall health. However, exercise should be gradual, and the method and intensity of exercise should be mastered, otherwise, it may have the opposite effect. Intense exercise, especially anaerobic exercise, can stimulate the secretion of adrenaline, not only raising blood sugar but also increasing blood pressure. Additionally, smoking can damage the barrier function of the respiratory tract, making it easier to develop respiratory infections. Smoking can also cause blood vessel spasm and increase blood viscosity, leading to tissue ischemia and hypoxia, worsening cardiovascular and microvascular disease. Smoking can also cause liver cell damage and weaken the barrier function of the gastric mucosa. Therefore, diabetic patients should avoid smoking.
4. Avoid excessive overthinking. Many diabetic patients carry heavy psychological burdens, spending their days immersed in anxiety and pessimism about their condition. Some may experience frequent insomnia, which can lead to elevated or fluctuating blood sugar levels. Therefore, diabetic patients must adopt a correct attitude toward their disease, neither ignoring it nor being frightened by it, and strive to maintain psychological balance to help stabilize blood sugar levels.
5. Avoid excessive weight loss. As we know, obesity is an independent risk factor for diabetes, and weight loss for overweight individuals can help reduce insulin resistance and improve the effectiveness of hypoglycemic medications. However, it is not necessarily the case that the thinner, the better. For diabetic patients, the degree of weight loss should be appropriate for standard body weight. Excessive thinness can lead to worsened nutritional status, reduced immune function, and decreased self-regulation ability against hypoglycemia, increasing the risk of hypoglycemia.
Can diabetic patients eat sugar? Commercially available foods such as brown sugar, white sugar, rock sugar, honey, sugary pastries, beverages, and fruit candies are not suitable for diabetic patients to consume but can be reserved for correcting hypoglycemia when it occurs. Because these sugary foods contain glucose, maltose, and other substances that are rapidly absorbed after entering the gastrointestinal tract, causing a rapid increase in blood glucose and increasing the burden on pancreatic β cells. However, due to the absolute or relative insufficient insulin secretion in diabetic patients, leading to postprandial hyperglycemia, healthy individuals with normal pancreatic β cell function can consume sugar, and their blood sugar will not exceed the normal range. Some people ask whether sugary foods such as fruit candies and sugarcane juice, which contain sucrose and maltose, are suitable for diabetic patients. The answer is no. Because sucrose and maltose are also converted into glucose after entering the body, they can raise blood sugar levels. Rice, white flour, and sweet potatoes also contain sugar, but eating them can leave a sweet taste. Can they still be eaten? Because rice, white flour, and sweet potatoes contain polysaccharides and dietary fiber, they must be digested before being absorbed in the form of glucose. Therefore, they can be eaten, but in moderation.
Can diabetic patients drink milk? Some people think that milk contains sugar and is not suitable for diabetic patients to drink, but this view is incorrect. Milk has a low sugar content, is rich in water, contains a variety of trace elements, proteins, and vitamins, and has a moderate amount of fat. The calories in 100 grams of milk are the same as those in an equal amount of apples. Therefore, diabetic patients can drink milk. Diabetic patients often lack calcium, especially elderly diabetic patients, who are prone to osteoporosis. Milk contains rich calcium salts that are easily absorbed by the body. Drinking 100–200 milliliters of milk daily is very beneficial for calcium supplementation, as its low sugar content has little impact on blood sugar levels. When drinking milk, commercially available milk should not be sweetened, and sugar-free milk specifically produced for diabetic patients can also be consumed. The calorie content of 100 grams of milk powder is higher than that of an equal amount of staple food, so the daily consumption should not be excessive, and the staple food intake should be reduced accordingly.
How should diabetic patients eat vegetables, and which vegetables are more suitable? Vegetables contain more dietary fiber in their carbohydrates, which do not require insulin to participate in metabolism. They have low calorie content and do not raise blood sugar levels, benefiting the body. However, eating too many vegetables and too few staple foods can lead to insufficient calorie intake. On the premise of consuming an appropriate amount of staple foods, animal-based foods, and edible oils, it is beneficial to eat more vegetables to reduce feelings of hunger. The Chinese people have a habit of eating pickled or marinated vegetables, but diabetic patients should eat them sparingly or not at all, as processing can lead to the loss of many nutrients such as vitamins and trace elements, while increasing harmful substances such as nitrites. Green vegetables such as cabbage, chives, bamboo shoots, spinach, rapeseed, cucumber, lettuce, and celery have low sugar content and can be eaten without restriction daily. Bitter gourd and pumpkin have hypoglycemic effects and can be eaten more. Colorful vegetables such as tomatoes, eggplants, and winter melons also have low sugar content and can be eaten more. Carrots, onions, potatoes, taro, broad beans, and peas have higher sugar content and should not be eaten excessively.
Dietary taboos for diabetic patients Avoid: White sugar, red sugar, glucose, and sugar-based desserts such as cakes, jams, honey, and fruit preserves. Limit: Potatoes, yam, taro, lotus root, onions, carrots, lard, sheep fat, butter, cream, peanuts, walnuts, sunflower seeds, egg yolks, kidneys, and brains. Prefer: Whole grains such as buckwheat, oatmeal, cornmeal, soybeans, and soy products, as well as vegetables.
Diabetic patients are prone to hypoglycemia during treatment, which occurs when blood sugar drops too quickly. Adult diabetic patients usually develop hypoglycemia due to skipping meals, delayed meals, or intense exercise. Symptoms of mild hypoglycemia include numbness in the mouth, cold and sweaty skin, a trembling sensation in the chest, and hunger. How to treat it? Simply consume available sugary foods. Drink sweet beverages such as juice or soda, or eat a piece of sugar, and carry candy with you for emergencies.
Common foods for diabetic patients According to the nutritional characteristics of the foods, diabetic patients' commonly used foods can be classified into the following six categories:
1. Grains: Including rice, flour, coarse grains, red (green) beans, and noodle skins (strips).
2. Vegetables: Including Type A vegetables (1%–3% sugar), Type B vegetables (4%–6% sugar), and Type C vegetables (7%–9% sugar).
3. Fruits.
4. Legumes and dairy products: Including dried yellow (green) beans, tofu powder, soy milk, milk, and milk powder.
5. Lean meats: Including lean meat, fish, shrimp, poultry, eggs, and bean products.
6. Fats and oils: Including cooking oil, peanuts, and walnuts.
Can diabetic patients smoke? Diabetic patients should not smoke, as smoking offers no benefits but only harms diabetes. Smoking stimulates the secretion of adrenaline, not only raising blood sugar but also increasing blood pressure. Smoking can damage the barrier function of the respiratory tract, making it easier to develop respiratory infections. Smoking can also cause blood vessel spasm and increase blood viscosity, leading to tissue ischemia and hypoxia, worsening cardiovascular and microvascular disease. Smoking can also cause liver cell damage and weaken the barrier function of the gastric mucosa. Therefore, diabetic patients should avoid smoking.
Dietary sodium restriction for diabetic patients Hypertension is a risk factor for coronary heart disease, and most diabetic patients have hypertension and obesity. Consuming excessive sodium is not conducive to the prevention and treatment of hypertension, so diabetic patients should not eat too salty food and prefer a lighter diet. Generally, daily salt intake should be less than 10 grams (about 2 teaspoons), which is equivalent to about 4 grams of sodium. When diabetic patients have kidney edema, sodium intake should be even lower.
Diabetic patients should prefer vegetable oils Typically, the fats we consume can be divided into two categories: One is animal fat, such as cooking butter, lard, and sheep fat, as well as fat in meat, milk, and eggs. This type of fat, except for fish oil, contains more saturated fatty acids, which can increase serum cholesterol levels. The other is vegetable oil, including peanut oil, soybean oil, sesame oil, rapeseed oil, and corn oil. Vegetable oils, except for coconut oil, contain more unsaturated fatty acids, which can help lower serum cholesterol levels. Therefore, diabetic patients should prefer vegetable oils and limit animal fats, using vegetable oils to replace animal fats as much as possible. Since vegetable oils can lower serum cholesterol, does that mean the more, the better? Not necessarily. On the contrary, consuming vegetable oils in large quantities without restriction can lead to weight gain, making it harder to control diabetes.
Methods for calculating diabetic diets The steps for calculating diabetic diets include the following: ① Measure height and weight to determine body type. ② Calculate the total daily calorie intake based on body type and physical activity level. ③ Allocate the three major nutrients—carbohydrates, fats, and proteins—in the diet. ④ Plan the main and side dishes and the daily meal plan.
Calculation method: Measure height and weight. Determine whether the patient is obese, underweight, or within the normal weight range. Obesity is defined as exceeding the standard weight by more than 20%, underweight as being less than 20% below the standard weight, and normal as being within ±10% of the standard weight. The approximate formula for standard adult weight: Height (cm) – 105 = standard weight (kg). The percentage by which the actual weight exceeds or is below the standard weight (%) = (actual weight – standard weight) / standard weight × 100%.
How much should diabetic patients eat daily? Most people now advocate that the proportion of grains in the dietary calorie composition of diabetic patients should be 50%–60% of the total calories, which is more appropriate. Specifically, the staple food for each diabetic patient should be 4–8 two (dry weight) per day. Here, staple food refers to dry weight. Fats are an important source of calories, but excessive fat intake can have adverse effects on the body. Therefore, the daily fat intake for diabetic patients should be around 30% of the total calories, which is ideal. The total daily intake of oils should not exceed 1.5 two, with vegetable oil not exceeding 1 two and animal oil not exceeding half a two. It is best to eat less fried or deep-fried food and more boiled, steamed, or cold-dressed food. The protein intake can be calculated as 15% of the total calories or 1 gram per kilogram of body weight per day (here, body weight refers to standard weight, standard weight = [height (cm) – 100] × 90%). The daily protein intake for adults is about 50–80 grams. Adults can consume about 2 two of bean products or 4 two of tofu per day. Animal-based protein is an indispensable high-quality protein in the diet, and adults can consume about 2 two of various meats per day.
Can diabetic patients drink tea? Tea is a traditional beverage in China, which was introduced to Europe via the Silk Road and to Japan to the east. To this day, tea is still loved by most people in the country. Can diabetic patients drink tea? The answer is yes, but the following points should be noted: ① It is not advisable to drink strong tea before bed. Because tea contains caffeine, also known as theine, which can stimulate the cerebral cortex and cause excitement, so drinking strong tea before bed can easily lead to insomnia, which is not conducive to blood sugar control in diabetes. Additionally, tea contains tannins, which have astringent properties, and excessive consumption of strong tea can lead to constipation. ② It is better to use cold boiled water to make tea rather than hot boiled water. Because tea contains a relatively ideal hypoglycemic substance and is rich in vitamins, these are very beneficial for diabetic patients. If hot boiled water is used to make tea, the active ingredients of the hypoglycemic substance and various vitamins will be destroyed. Therefore, diabetic patients should use tea to lower blood sugar and avoid using boiling water to make tea.
Ten golden rules for diabetic dietary therapy ① Control the total daily calorie intake to achieve or maintain ideal body weight; ② Balance the diet; ③ Diversify food choices, with grains as the foundation; ④ Limit fat intake; ⑤ Choose high-quality protein in moderation; ⑥ Reduce or avoid monosaccharides and disaccharides; ⑦ High-fiber diet; ⑧ Reduce salt intake; ⑨ Adhere to small, frequent meals, with fixed timing, quantity, and meals; ⑩ Drink plenty of water and limit alcohol consumption.
Six misconceptions about diabetic diet
Dietary treatment is the foundation of diabetes treatment, and many patients can control their condition with diet alone, without the need for medication. Even for patients who must take medication, even the slightest relaxation in dietary treatment is unacceptable. Focusing solely on medication while neglecting diet may lead to excessive medication dosage and metabolic imbalance in patients. For example, patients taking sulfonylureas may develop secondary sulfonylurea resistance, and patients taking insulin may experience increased insulin resistance, leading to the occurrence and worsening of various complications, ultimately resulting in treatment failure.
1. The less you eat, the better Each patient's calorie and nutrient requirements vary based on factors such as age, occupation, weight, and complications. For normal-weight light laborers, the daily calorie requirement is approximately 30–35 kilocalories per kilogram of body weight. Medium laborers and heavy laborers should increase this by 5–10 kilocalories. Based on the dietary habits of the Chinese people, this is equivalent to about 250–300 grams of staple food per day for normal-weight light laborers, with an additional 100 grams or so for medium laborers and heavy laborers. For obese patients and those with hyperlipidemia, the calorie intake should be reduced accordingly to allow the weight to gradually return to the normal standard, but it should not be less than 130 grams per day. Pregnant women, malnourished patients, and those with wasting diseases should have their calorie intake increased by 10%–20%. Children in developmental stages should have even higher calorie standards. For patients with hyperthyroidism and elevated blood sugar, dietary restrictions should not be imposed until the thyroid function returns to normal. If blood sugar remains high after normalization, calorie restrictions should be considered.
2. Skipping breakfast to limit calorie intake Many diabetic patients, especially the elderly, skip breakfast or eat only milk and eggs for breakfast without staple food, thinking this is a good way to limit calories. In fact, this is incorrect. Due to the absolute or relative insufficient insulin secretion in diabetic patients, the requirement is to limit the total daily calorie intake, but more importantly, to limit the calorie intake per meal. Therefore, the calories for each meal must be balanced to reduce the calorie intake per meal. If possible, two additional meals (at 9:00 and 15:00) can be added outside of the three main meals to ensure that the staple food per meal is less than 100 grams. However, for those who skip breakfast, the other two meals will necessarily include more, which is like a sick horse that cannot pull a full cart but can pull half and run twice, but never run once with increased weight.
3. Eat less grains, more meat, and more oil To avoid feeling hungry while eating fewer staple foods, some patients may choose to eat more meat, peanuts, and other oily foods. The medical community once promoted low-sugar, high-fat, and high-protein dietary treatment plans. However, with the advent of insulin and deeper research, current diabetes treatment plans have shifted to a grain-based, high-protein, low-fat, and high-fiber approach. A grain-based diet (meaning grains account for 50%–65% of total calories) is more in line with the dietary habits of the Chinese people and is beneficial for increasing the body's sensitivity to insulin and improving glucose tolerance. Generally, diabetic patients have sugar synthesis and high protein consumption, so in the case of normal renal function, a high-protein diet (15% of adult total calories, about 1 gram per kilogram of body weight) should be provided. Pregnant women, lactating women, malnourished patients, and those with wasting diseases can increase it to 1.5–2.0 grams, and children can have 2.0–4.0 grams. In terms of food, adults can have 200 grams of milk for breakfast, one egg (yolk can be omitted for those with hypercholesterolemia), and an additional 50 grams of beef (or 60 grams of pork, 60 grams of fish, 50 grams of chicken, or 100–125 grams of tofu) for lunch and dinner. Some patients may still feel tired and weak even when blood sugar control is good, often due to insufficient protein intake rather than overly strict sugar restriction. When renal function is severely impaired, protein intake should be limited, especially the intake of plant protein. Diabetic patients often have fat metabolism disorders, so a low-fat diet (less than 30% of adult total calories) should be provided. Grains and meats already contain sufficient fat, so patients should not intentionally consume foods rich in oils such as peanuts and oil sticks. Cooking oil should be limited to 25 grams per day, and vegetable oil should be used instead of animal oil. Patients can consume more than 500 grams of vegetables daily, which can provide various vitamins, minerals, and mainly fiber to delay sugar absorption, improve sugar metabolism, and increase satiety.
4. Fruits cannot be eaten Fruits are rich in vitamins, minerals, and fiber, which are beneficial for diabetic patients. The sugar in fruits is mainly glucose, fructose, and sucrose. Fructose does not require insulin to participate in metabolism, so diabetic patients whose blood sugar has been controlled are not necessarily excluded from eating fruits. The sugar content of different fruits varies. Watermelon has the lowest sugar content (4%), while jujubes, sugarcane, and red dates have about 20%. Under the premise of strictly limiting total calories, it is acceptable to eat some low-sugar fruits such as watermelon. However, after eating fruits, the corresponding amount of staple food must be deducted. For example, 200 grams of oranges or apples are equivalent to 25 grams of staple food. Generally, when staple food intake is controlled at 50 grams or 75 grams for lunch and dinner, a piece of watermelon or an apple can be eaten at 15:00 to replace a snack. Of course, fruits should not be eaten when blood sugar is not controlled.
5. Eating a little before bed to avoid night-time hypoglycemia It was once believed that high morning blood sugar was often caused by night-time hypoglycemia, but recent studies have shown that this view is immature. Eating staple food before bed is not a reliable way to lower morning high blood sugar and may even cause morning blood sugar to rise in some patients.
6. If you are taking insulin, you can increase your diet After controlling blood sugar with insulin, some insulin-dependent diabetic patients and those with malnutrition may increase their diet to improve their development and metabolism. However, most diabetic patients with secondary sulfonylurea failure should not think that they can eat more once their blood sugar improves with insulin. As the calorie intake increases, the insulin dosage will also increase, and the patient's weight will continue to rise. Obesity is a significant factor or cause of insulin resistance in diabetic patients, making treatment more difficult. Therefore, relaxing dietary treatment under any treatment condition is incorrect.