Treatment Of Diabetes Mellitus: Significance Of Dietary Regulation And Exercise Regimen
Diabetes Weight Loss Diet Plan
The aim of the treatment of diabetes mellitus is to achieve normal blood glucose levels throughout the day to alleviate symptoms and prevent complications. This involves:
- Dietary regulation
- Exercise regimen
- Drug therapy, and
- Prevention and treatment of complications.
Proper instruction on the nature of the disease and its management is absolutely essential to enlist the full co-operation of the patient and his family.
All diabetics should have dietary regulation irrespective of the type. Prescription of a diet depends on:
- Identification of the total caloric requirement which depends upon the patient’s age, weight, occupation and type of diabetes;
- His dietary habits;
- Working conditions; and
- Economic status.
It is now accepted that once the total caloric requirement is fixed, 50- 60% should be supplied as carbohydrates, 20% as proteins and 20% as fats. The proximate principles should be supplied as dietary articles suited to the socio-cultural background of the patient and timing and quantity of food should be fixed to suit the occupation and convenience.
Total calories: The total calories should be adjusted to meet the metabolic demands, but without straining the beta cells. On an average, the energy requirements for rest, moderate activity, and heavy activity are 1.5, 2.5 and 6 Kcal/Kg/hr. For the average diabetic doing, moderate activity, an allowance of 30 Cal/Kg ideal body weight is adequate and it also helps to reduce weight in the obese. In IDDM patients with low body weight, 40Cal/Kg is required to provide for growth and physical activity.
Carbohydrates: A minimum of 100 g of carbohydrate per day is required to prevent ketosis and protein catabolism. On an averate, 200- 250 g carbohydrate is agreeable to most of the patients. As far as possible, refined carbohydrates like sugar should be omitted, since they cause rapid rise in blood sugar. Moreover, being small in bulk they do not produce satiety.
Proteins: These should be given at the rate of 1 g/Kg body weight which is an adequate quantity to achieve positive nitrogen balance.
Fats: Fats are not absolutely essential for life, though they are the sources of fat soluble vitamins and essential fatty acids. Excess of fats lead to atherosclerosis and it is difficult to plan a satisfactory palatable diet with less than 15- 20% of the total calories made up by fat. The general principle is to keep fat the minimum.
The average African diet contains 70 to 90% of total calories as cereals. Cereal based diet with restriction of the total calories and avoidance of free sugar is more acceptable in Indian patients for instance. Such a diet is quite effective in controlling the diabetic state. Animal and vegetable proteins are included to supply 20% of the calories. Fats constitute about 14- 15%. High fiber content of the traditional Indian (average 52 g/day) retards the rapid absorption of carbohydrate and thereby helps to avoid postprandial hyperglycemia. The high carbohydrate, high fiber (HCHF) diet has also been observed to bring down serum cholesterol and serum triglycerides more effectively.
Proteins: Animal sources include milk, egg, meat and fish. In addition to animal foods, pulses and groundnuts (Peanuts) are cheap, acceptable and freely available sources.
Fats: The fat content of the diet should be restricted to the oil used in cooking. At least, 50% should constitute polyunsaturated fats like mustard oil, groundnut oil, Safflower oil which help to lower serum cholesterol levels. Coconut oil, animal fats like butter and ghee and hydrogenated oils contain large amount of saturated fatty acids. In communities with marginal nutritional status, vitamin deficiencies may occur on a partially restricted diet. Administration of a multivitamin preparation once a week helps to prevent such deficiencies.
Regular exercise helps to normalize glucose homeostasis by increasing the sensitivity of the tissue to insulin and utilization of glucose. Regular exercises probably prevent the development of serious ischemic heart disease. A regular program of exercises worked out for each individual should be instituted. The exercise program should be designed to suit the cardiovascular status. Over-enthusiastic and unaccustomed heavy exercise should not be undertaken since this may precipitate hypoglycemia and myocardial ischemia. Walking for one hours, running, swimming and games are all suitable depending on the age and physical condition.
© 2014 Funom Theophilus Makama