Can't eat anything if you have diabetes? Beware of malnutrition!

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According to data from the International Diabetes Federation (IDF) in 2021, China has become the country with the largest number of diabetes patients in the world. There are 140 million diabetes patients (aged 20 to 79) in my country, and one in every 10 adults has diabetes. Our family is one of them. My mother and my uncle have been diagnosed with diabetes for many years.

The harm of diabetes is that it can lead to many complications. From the typical "three mores and one less" symptoms (drinking more, urinating more, eating more and losing weight) to a series of chronic diseases caused by poor blood sugar control, such as diabetic retinopathy, cardiovascular and cerebrovascular diseases, diabetic nephropathy and diabetic foot, they will slowly erode people's health.

How to supplement nutrition to help diabetics live a better life has become everyone's biggest concern.

1

Malnutrition is the tragedy of diabetes patients

Many diabetics tend to only focus on their blood sugar levels, and fearing that their blood sugar levels will be too high, they dare not eat anything, such as meat, staple foods, eggs, or fruits, thinking that this will help control their blood sugar levels. However, they often overlook a more dangerous factor: malnutrition.

In fact, diabetes itself is a risk factor for malnutrition, which also increases the risk of various complications. Data show that the proportion of malnutrition in diabetic patients can be as high as 50%.

Why are diabetic patients prone to malnutrition? The main reasons are:

1. Insulin metabolism disorder. Diabetes is caused by insulin deficiency or utilization disorder (i.e. insulin resistance). Insulin metabolism disorder will weaken the ability of diabetic patients to convert glucose into energy. In order to meet the needs of the body, the body will use protein and fat to convert and generate energy, which will lead to insufficient protein for other functions and cause malnutrition.

2. Unreasonable diet. Many diabetic patients often have unreasonable diet problems because they are afraid of poor blood sugar control. For example, they dare not eat staple foods, fruits, and meat, which will lead to insufficient nutrition and cause malnutrition.

3. Loss of nutrients. Since diabetic patients have high blood sugar, when the blood sugar concentration exceeds the tolerance of the kidneys, the sugar will be excreted from the urine, so diabetic patients often have symptoms of "polyuria", which will lead to the loss of many minerals and water-soluble vitamins (such as vitamin B1, B2, etc.).

4. Poor absorption and utilization. In order to control blood sugar, diabetic patients often take long-term medications, such as metformin and acarbose, which more or less affect the digestion and absorption of nutrients. In addition, many diabetic patients also have complications of intestinal digestive system diseases, which can also cause poor absorption and utilization of nutrients.

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2

How difficult is it to supplement nutrition for diabetic patients after surgery?

Adequate nutrition is even more important for diabetic patients who are hospitalized for surgery due to complications.

On the one hand, most diabetic patients are older, and due to high blood sugar, they often face problems with difficult wound healing after surgery, which leads to a higher risk of infection.

On the other hand, after surgery, diabetic patients have more obvious insulin resistance, which makes them more likely to suffer from "hyperglycemia" and malnutrition. If they only rely on infusion to supplement nutrition, their blood sugar will often fluctuate greatly.

In addition, most diabetic patients need a long bed rest period after surgery. During this period, their gastrointestinal motility slows down and their digestive ability decreases. Many people only give them "liquid food", such as old hen soup, fish soup, pork rib soup and various porridges. However, various broths contain a lot of oil and sugar, and the glycemic index of porridge is generally high, and the nutritional value is very low.

In addition, the patients have irregular diet after surgery, making it very difficult to control blood sugar after surgery. Poor blood sugar control may lead to delayed wound healing, infection, ketoacidosis, and electrolyte imbalance, which is even more detrimental to postoperative recovery.

Therefore, after surgery, diabetic patients need adequate nutrition to ensure wound healing and avoid large fluctuations in blood sugar.

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3

How do diabetic patients supplement nutrition?

For ordinary diabetic patients and those who have undergone surgery for diabetes, they should ensure adequate nutrition intake and arrange their daily diet reasonably.

The "Chinese Diabetes Dietary Guidelines (2017)" recommends starting from the following aspects:

1. Balance eating and exercise, use medication appropriately, control blood sugar, and achieve or maintain a healthy weight.

2. The staple food should be fixed in quantity, with a combination of coarse and fine grains, and whole grains and beans should account for 1/3.

3. Eat more vegetables and fruits in moderation, with a variety of types and colors. Daily vegetable intake should be 300-500 grams, with dark vegetables accounting for more than 1/2, including no less than 70 grams of green leafy vegetables.

4. Eat fish, poultry, eggs and livestock meat regularly in moderation, and limit processed meat.

5. Have dairy products and beans every day, and choose snacks and meals reasonably; ensure the daily intake of 300 grams of liquid milk or an equivalent amount of dairy products.

6. Eat a light diet, drink plenty of water, and limit alcohol consumption; use less oil and salt when cooking. Adults should use 25-30 grams of cooking oil per day, and no more than 6 grams of salt.

7. Eat at regular times and in regular amounts, chew slowly and thoroughly; pay attention to the order of eating; change the order of eating, eat vegetables first, then meat, and finally staple food.

8. Pay attention to self-management and receive individualized nutrition guidance regularly. Receive individualized professional guidance from nutritionists and dietitians regularly, at least four times a year, etc.

Of course, in addition to diet, nutritional support is also very important. After all, many people still prefer heavy flavors, high oil and high salt, and their diet is not healthy. Many elderly people cannot eat so many kinds of food because of bad teeth or bad stomach. Postoperative diabetic patients should undergo regular nutritional screening. If the screening is found to be at risk of malnutrition or severe nutrition, a nutritional support plan should be formulated and appropriate medical nutrition products should be selected. If this is not easy to achieve, you can also choose a nutritional formula powder specifically for people with high blood sugar.

References

[1]Internal Diabetes Federation. IDF Diabetes Atlas, 9th edn[EB/OL]. [2021-01-30]. http://www.idf.org:diabetesatlas.

[2] Chinese Journal of Diabetes, 2021, 13(12): 1109-1114. DOI: 10.3760/cma.j.cn115791-20210222-00098

[3] Chronic Complications Survey Group of the Diabetes Branch of the Chinese Medical Association. Retrospective analysis of chronic complications and related macrovascular diseases in hospitalized diabetic patients nationwide from 1991 to 2000 [J]. Journal of the Chinese Academy of Medical Sciences, 2002(05):447-451.

[4] Ye Xueyan, Tong Xuewei, Deng Zhaohui, Zhang Ye, Ge Ruoqing, Li Lisha, Liu Xianxian, Liu Chunyan, Zhang Xin. Evaluation of nutritional status and analysis of influencing factors in hospitalized patients with type 2 diabetes mellitus[J]. International Journal of Laboratory Medicine, 2020, 41(11): 1310-1313.

[5] Chinese Dietary Guidelines for Diabetes (2017)

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