Lakhasly

Despite therapeutic advances with new oral medications & insulin formulations,
diet therapy remains an integral part of the overall therapeutic plan in all
diabetic patients.
In some obese / overweight type2 diabetics, MNT can be the predominant
method of treatment & can alone efficiently control many of subjects with impaired
glucose tolerance . It is also essential to continue MNT during the use of
antidiabetic / hypoglycemic drugs. MNT allows achievement of reasonable
reduction in body weight in type2 obese diabetics.
MNT needs to be individualized for each subjects with diabetes.

The basic nutritional requirements of diabetics are the same as those of non diabetics, the daily caloric requirement is estimated according to the body weight & type of work whether sedentary, moderate or hard and is calculated as follow :
Body weight (in kg) X 25 Kcal/day……Sedentary work
X 30-35 Kcal/day.....Moderate work
X 40-45 Kcal/day.....Hard work, pregnancy, or lactation.

If the patient is obese give subcaloric diet ; if he has normal average weight regarding the age, sex & height give isocaloric diet ; if he is underweight give hypercaloric diet.
In children, caloric needs can be estimated as 1000 Kcal /day + 100 Kcal for each year of age during the period of growth.
Since most type2 diabetic patients are overweight, caloric restriction is always advisable & can be of great benefit, as moderate weight loss of just about 5 to 10 % of starting body weight reduces hyperglycemia & improves dyslipidemia & hypertension.
Distribution of calories:
The diet (even subcaloric) should include adequate vitamins & minerals; the nutrient content of total requirement should be as follow:
1. 50-60% as CHO with only 5% of them in form of simple sugars such as sucrose , the remainder in the form of complex CHO ( starch).
2. 15-20% as protein ( 0.85 g/kg body weight).
3. up to 30% as fat: 10% saturated fat, 10% monounsaturated fat, 10% polyunsaturated fat. Cholesterol should be < 300 mg/day, but if LDL-C is above 100mg/dl , cholesterol intake should be <200mg/day.
4. increase consumption of dietary fiber up to35- 40 g/day or 10 to 15 g/ meal slows carbohydrate digestion & absorption & lowers serum triglycerides.
5. Sodium intake should not exceed 3g/day, but if hypertension exists it should be less than 2,400g/day.

Sweeteners can be used preferably the non nutritive ones such as aspartame, saccharin, acesulfane-K & sucralase , as these provide no calories & are safe for use.
Nutritive sweeteners such as fructose provide 4 calories/g.

Type1& type2 insulin requiring diabetic patients should tailor caloric intake to coincide with the time of action of the administered insulin.
Diet should be planned as 3 main meals in type2 diabetes (20% of total caloric intake for breakfast, 40% for lunch & 40% for dinner) & as 3 main meals + 3 snacks in type1 diabetes ( 20% of total caloric intake for breakfast+ 5-10% snack 2 to 3 hours later, 40% for lunch +5-10% snack 2 to 4 hours later & 20% for dinner + 5-10% at bed time).