Diabetes: Types, Nutritional Therapy, and Recommendations
Gestational Diabetes and Secondary Forms
Gestational diabetes appears during pregnancy (2nd or 3rd trimester), affecting approximately 2% of pregnancies. There is often a genetic predisposition. In the 2nd or 3rd trimester, an increase in insulin antagonist hormones and insulin resistance is normal. This impacts both the mother and fetus, potentially leading to perinatal complications. After delivery, a percentage of women may develop Type 2 diabetes.
Secondary Diabetes
Secondary diabetes can arise from various factors:
- Diabetes and Malnutrition
- Pancreatic issues: acute and chronic pancreatitis, pancreatectomy, pancreatic tumors
- Endocrinopathies: Cushing’s syndrome, acromegaly, hyperthyroidism
- Hyperglycemic drugs: Glucocorticoids, T3, T4, diuretics
- Genopathies: Lawrence-Moon syndrome, myotonic dystrophy, Friedreich’s ataxia, Prader-Willi syndrome, Tesaurismosis, Porphyrias, Hemochromatosis
Aims of Nutritional Therapy in Diabetes
Nutritional therapy aims to:
- Help individuals with diabetes change their eating habits and lifestyle to improve glucose control and maintain healthy blood glucose levels.
- Obtain and maintain a lipid profile and circulating lipoproteins that reduce the risk of vascular disease, as well as blood pressure levels that also reduce vascular disease risk.
- Prevent or slow the development of complications such as retinopathy, neuropathy, nephropathy, and vascular damage.
- Fulfill individual nutritional needs, taking into account personal preferences, cultural factors, and willingness to change.
Nutritional Recommendations for Diabetes
- Maintain a consistent amount and distribution of carbohydrates to avoid adverse effects on blood glucose, especially when taking hypoglycemic medications.
- Follow a diet poor in saturated fats to normalize LDL cholesterol levels.
- Individuals with diabetes who are obese should reduce energy intake to lose weight and improve metabolic status.
- Diabetics with established nephropathy should restrict dietary protein intake (<0.8 g/kg/day) to slow its progression.
Recommendations for Nutrition and Lifestyle
- Calories: Sufficient to maintain correct growth in children; for adults with obesity, aim to maintain a normal weight.
- Macronutrients: Distribution and composition should generally align with healthy dietary recommendations for the general population.
- Exercise: Regular exercise improves insulin sensitivity, circulating lipid profile, and hypertension.
Specific Nutritional Recommendations
- Carbohydrate: The percentage may vary depending on habits and glycemic control goals. Consider the total amount more than the type of carbohydrate. Synchronize intake (quantity and timing) with insulin action and exercise.
- Fiber: As for the general population: 20-30g/day.
- Proteins: 15-20% of total caloric intake; restrict to 0.8 g/kg/day at the beginning of nephropathy.
- Fat: The percentage of kcal/day may vary. Saturated fat <10% kcal, <7% when LDL cholesterol is elevated; dietary cholesterol <300 mg/day.
- Sweeteners: Moderate amounts are acceptable, considering nutrient content (fructose, sucrose, honey, sorbitol, dextrose) and synthetic options (aspartame, saccharin, acesulfame K). Note: Large quantities of fructose can worsen the lipid profile and negatively affect insulin sensitivity.
- Sodium: Avoid excessive amounts. Hypertensive patients should consume <2.4 g/day.
- Vitamins and Minerals: If the diet is balanced, supplements are generally not needed.
- Alcohol: Permitted in moderation unless there are frequent hypoglycemic episodes, hypertriglyceridemia, poor glycemic control, or other contraindications.
Data for Designing an Individualized Diet
- Clinical History: Glycemic control, blood pressure.
- Dietary/Nutrition History: Energy intake, nutritional education.
- Social History: Food hours/work schedule, capacity to acquire new knowledge.