[Diabetes and diet revisited]

Abstract

In the treatment of diabetes the diet has an important role complementary to the pharmaceutical treatment. The diet must provide the right amount of nutrients and calories in order for the individual to reach and maintain the ideal weight, stabilize the blood glucose levels close to the norm, and attain an optimal lipid profile. The daily caloric intake is represented by 55-60% of carbohydrates with a preference for nutrients rich in fiber and with a low blood glucose index. Of the daily caloric intake 10% may include sucrose as long as it is consumed in the context of a balanced meal. A moderate use of fructose is allowed, and an increased intake of fiber is encouraged. The consumption of proteins represents about 10-15% of the daily caloric intake. A consumption close to the lower limits of the range (about 0,8 gr/kg of body weight) is required for diabetes patients with nephropathy, while a daily intake of 0,6 gr/kg of body weight is considered to be the malnutrition risk factor for lower levels. The total intake of fats required is < or = 30%, of which saturated fatty acids are less than 8-10% (with a further restriction to 7-8% for individuals with LDL cholesterol of > or = 100mg/dl and other cardiovascular risk factors), the polyunsaturated fatty acids less than 10%, and the monounsaturated fatty acids at 10-15% of the total caloric intake. The intake of cholesterol through the diet should be <300 mg/die and still lower (< 200 mg/die) for individuals with high levels of LDL cholesterol. Multivitamin supplements are recommended only for certain categories of diabetic patients that may be at risk of micronutrient deficiency. A moderate quantity of alcohol (5-15 gr/die) is allowed in the case of stabilized diabetes and lack of hypertrigliceridemia. Although the diet may determine a ponderal decrease of up to 10% of the initial weight, it is good to insert a correct nutritional program into a well defined behavioral program that, other than a reduced caloric intake, takes into consideration an increased energetic expenditure through physical activity.