obese people Clinical Guide for Clinical Nutrition of Type 2 Diabetes Overweight and Obese People
This guide aims to enhance clinical practice that leads to the best medical service in order to obtain optimum results against diabetes, which is a brief guide directed to guide overweight and obese adults with diabetes in particular. Within the field of work of specialized medical dietitians in diabetes, in addition to the specialization of psychological counseling, social counseling, therapeutic physical sports, educated physiotherapists, as well as general and specialized doctors and nurses. According to the leading diabetes specialist centers in the world, every diabetic patient needs evaluation – in addition to the clinical medical evaluation – in terms of his nutritional and metabolic needs, the nature of his metabolic deviation interfering with diabetes, the importance of identifying therapeutic goals related to obesity and nutrition, unhealthy lifestyle adjustments, and physical activity, and the gradual approach to achieve medical therapeutic dietary recommendations.
There are strong evidences that weight loss improves the response to insulin and blood sugar control and levels of blood lipids and blood pressure in patients with type 2 diabetes, and also reduces the risk of developing an explicit type 2 diabetes condition in pre-diabetes and high-risk groups of type 2 infection. To choose the appropriate therapeutic medical approach for the patient, it is preferable to refer to the therapeutic nutritionist to assess the patient’s nutritional habits and physiological and medical needs, integrate the nutritional adjustments into the patient’s medical and therapeutic lifestyle and work towards achieving the desired treatment goals.
The therapeutic priorities of this target group of patients include the following elements:
1 – Weight loss
2 – Determination of meal contents of carbohydrates and distribution of daily carbohydrates on meals in fixed quantities in treatments with fixed doses of insulin.
3 – Taking into account the therapeutic dietary considerations related to the diseases that may accompany diabetes, such as high arterial tension, blood lipids and cholesterol.
The relative table of the main components of the daily food is listed later as a general guide in therapeutic feeding, and some adjustments are made according to the patient’s condition, metabolic, satisfaction, and physiological needs, and taking into account some conditions of his own taste in food. All of that is done by a specialized therapeutic nutritionist, according to an action plan that schedules the dates of reassessment and modification of the therapeutic food plan according to clinical and laboratory standards that include: blood pressure, A1c, recurrence of hypoglycaemia / high blood sugar accidents, hyperlipidemia, and daily blood sugar measurements. In addition to checking the sodium and potassium blood ions, and the vegetarian patients.
- It is necessary to design and develop a systematic plan for lifestyle adjustments that includes changes in daily nutrition, physical activity, and unhealthy lifestyle behaviors with the goal of gradually and healthy weight loss (• the best rate of weight loss is gradually 5 – 1 kg per week or in two weeks) This is done by reducing the daily intake of calories by 250 – 500 calories (1C), and the total daily calories should not be less than 1000-1200 calories for women, and 1200-1600 for men, and determination of the appropriate daily calories depends on the nutritionist’s evaluation of the patient’s daily intakes. (1) • Reducing 5-10% of the patient’s weight provides us with a significant improvement in controlling blood sugar in diabetics, and helps prevent the development of individuals with early diabetes in the pre-diabetes condition. The amount of weight loss depends on the condition of each patient and their data, and progressively proceeds until the appropriate BMI is achieved and / or shared with the amount of achievement of other treatment goals. (It is necessary to direct patients of this target group to the therapeutic and educated dietitians to teach them how to adjust the food rations and help them in practice, which is an effective way of managing weight) Patients should be provided with experiences in alternatives to preserved food designed for weight loss called (replacement meal) under the supervision of a nutritional specialist if they want to use them as alternatives to regular meals.
(With attention to the fact that they contain big amounts of potassium, and the need to reset medications that reduce blood sugar • in spite of the fact that stomach bariatric surgery may result in the nutritional and medical risk to the patient, it is still an effective option when used according to its needs) such as a mass index Body BMI> kg / m², or BMI> kg / m² with other participatory diseases in the patient ()
Till now, there is a limited evidence supporting recommendations for gastric bypass for BMI> kg / m² even if they have type 2 diabetes.
Large food ingredients
There is general agreement on the importance of the quality of fat as well as its amount, and it is recommended that the total fat intake per day be less than 35% of the total daily calories. (2B) • The amount of saturated fat is set> 7% of the total daily calories. (1B) • The amount of mono-bonded and polyunsaturated fats remaining is equivalent to the total recommended fat calories. (2B) • The amount of cholesterol in the food is determined> 300 mg / day for people with LDL cholesterol> mg / dl. 1C
Eat mono- and polyunsaturated fat (such as olive oil, nuts / seeds, avocado). (1B) • Eat fish types rich in fatty acids (omega-3) (120 g salmon, trout, sardines, tuna) twice per week as a good source of omega-3 fatty acids. 1B
For foods rich in saturated fats such as beef, ribs, whole milk products, and rich milk products (creamy and liquid cooked cheese, full-fat milk and milk) • Foods containing trans fats (fast food, pastries and baked goods prepared for commercial circulation, and some Types of margarine like ghee. Foods rich in cholesterol such as (egg yolks, and organs of the guts of animals such as the liver, marrow, and drops)
The daily protein intake should not be less than 2.1 g / kg of adjusted body weight (ABW) Weight Body Adjusted = ideal weight + IBW (weight body Ideal 25.0). Current weight – ideal weight. This amount is generally equivalent to 20- 30% of the total daily calories. (1B) There are no reliable scientific data that support increasing the daily intake of protein to 2 g / kg of adjusted body weight ABW • Available data confirm that eating protein portions in the meal helps to feel fullness. Reducing the content of meals, which increases the feeling of hunger), as a moderate increase in the protein content of the meal decreases the appetite for food, and this helps to continue Use weight (2B) and protein intake also helps reduce muscle mass loss in the body. (2B)
Eat fish meat, skinless chicken meat, skimmed or low-fat dairy products, nuts, seeds, and legumes.
- Sources of protein rich in saturated fats (cow and lamb, ribs, pork, full-fat dairy products) in relation to these nutritional sources with a high risk of cardiovascular disease.
Diabetics with kidney disease
Although decreasing the total calories consumed per day will also decrease the amount of proteins consumed, the kidney patients must seek advice from the kidney specialist before increasing the total or the ratio percentage of protein in their diet.) • Rationing in protein is no longer recommended
The daily diet of diabetic nephropathy patients and restricting them to less than 8,0 g / kg of weight, as it was found that this does not change blood sugar control or coronary heart risk criteria, and it has no role affecting the renal impairment of the renal renal function in patients. A
The percentage of carbohydrates in the total daily caloric intake is 40-45 (1% .C) • The minimum carbohydrate for daily feeding must be 130 grams (1C) Patient
Considerations for glucose indicator / carbohydrate loading and glucose loading
The rules for index glycemic and load glycemic are important factors that the patient must know and care for to follow in daily food when choosing carbohydrate foodstuffs • It is recommended to choose foods with low glucose indicator. 2B) For example: whole grains, legumes, fruits, veggies, most vegetables
Eating vegetables, fruits, legumes, whole grains, and processed grains is recommended to be kept to a minimum (not removed from the rest of its dietary fibers).
Table sugar, crushed purified starch, industrially processed fiber-free grains, starchy foods, sugary drinks, pasta of various kinds, white bread, white rice (2B) • Low-fiber cereals (peeled) and white potatoes can be eaten in limited quantities (2B)
It is recommended to eat 14 grams of fiber / 1000 calories (equivalent to 35-35 grams / day), (1B) • If a well tolerated patient can eat 50 grams of dietary fibers to improve high blood sugar levels after a meal. (2A) • Fibers in uncooked foods such as vegetables, fruits, seeds, nuts, and legumes are good to eat but need to take fibrous supplements with them such as psylium, resistant starch, and glucan beta.
Fine nutritional ingredients
It is recommended that the daily intake of sodium> 2300 mg) equal to one teaspoon of salt (/ day. 1A) • It is recommended to reduce the amount to 1500 mg / day for people over the age of 50 years, including patients with chronic kidney disease. (2B) • It is advised to recommend the patient to gradually reduce salt intake.
- It is recommended that the daily intake of potassium is 4700 mg unless the patient has a problem with the excretion of potassium • Potassium helps to neutralize the intake of sodium by increasing the activation of sodium excretion mechanisms through the kidney • Foods rich in potassium include bananas, mushrooms, spinach and almonds in addition to Pan fruits and vegetables
For some patients without nutritional deficiency and malnutrition, data on this topic do not support the use of vitamins and mineral electrolytes to improve blood glucose control or the use of herbal supplements or spices to enhance blood sugar control
Non – nutritive sweeteners
The U.S. Food and Drug Administration has stated that it is safe to use all artificial non-nutrient sweeteners in moderate quantities daily (e.g. one diet soda can per day), while artificial non-household sweeteners can be used in a larger amount daily
Life behavioral modifications and physical physical activity
Physical activity must be included within the medical nutritional prescription, as increased physical musculoskeletal activity is a component integrated in any weight-loss program, as well as it raises the benefits of controlling blood sugar to the upper limits, and contributes to the prevention of cardiovascular disease or cerebral. (1B) • Mild physical exercise is required at least 60-90 minutes five times a week at least, as this leads to weight loss, unless the patient has an indication for this effort in timing or intensity. (1B) • Physical activity should be a combination of strength, flexibility, and cardiovascular revitalization exercises, to achieve or increase the muscle mass in the body.