diabetes
The cause of
1. Genetic factors,
Both type 1 and type 2 diabetes have significant genetic heterogeneity. Diabetes has a familial predisposition, with a family history of diabetes in 1/4 to 1/2 of the patients. Clinically, at least 60 genetic syndromes may be associated with diabetes. Type 1 diabetes is associated with multiple DNA loci, and DQ loci polymorphisms in HLA antigen genes are most closely related. Many specific gene mutations have been found in type 2 diabetes, such as insulin gene, insulin receptor gene, glucose kinase gene and mitochondrial gene.
2. Environmental factors
Obesity caused by too much food and reduced physical activity is the most important environmental factor of type 2 diabetes, making individuals with genetic susceptibility to type 2 diabetes susceptible to disease. Type 1 diabetes patients have an abnormal immune system, and some viruses, such as coxsackievirus, rubella virus, and parotid gland virus, lead to an autoimmune response that destroys insulinoblast cells.
Clinical manifestations of
1. Drink more, urinate more, eat more and be thin
When severe hyperglycemia occurs, the typical "three more and one less" symptoms are more common in type 1 diabetes. The symptoms of ketosis or ketoacidosis were more obvious.
2. Tired and weak and fat
More common in type 2 diabetes. Type 2 diabetes often occurs before obesity, if not diagnosed in time, weight will gradually decline.
check
1. Blood sugar
Is the only diagnostic criteria for diabetes. Those with obvious symptoms of "three more and one less" can be diagnosed with only one abnormal blood glucose level. Asymptomatic patients need two abnormal blood glucose levels to diagnose diabetes. 75g glucose tolerance test is required for suspicious subjects.
2. Urine sugar
Often positive. When blood glucose concentration exceeds the kidney sugar threshold (160 ~ 180 mg/l), urine sugar is positive. When the renal sugar threshold is raised, even if the blood glucose reaches the diagnosis of diabetes, it can be negative. Therefore, urine sugar assay is not the diagnostic criteria.
3. Urine ketone body
Urine ketone positive in ketosis or ketoacidosis.
4. Glycosylated hemoglobin (HbA1c)
It is a product of non-enzymatic reaction of glucose and hemoglobin. The reaction is irreversible and the level of HbA1c is stable, which can reflect the average blood glucose level in the first 2 months of blood collection. It is the most valuable index to judge the blood glucose control state.
5. Glycosylated serum protein
It is the product of combining blood glucose and serum albumin nonenzymatic reaction, reflecting the average blood glucose level of 1-3 weeks before blood collection.
6. Serum insulin and c-peptide levels
Reflect the reserve function of islet oocytes. In the early stage of type 2 diabetes or obesity, serum insulin is normal or increased. With the development of the disease, islet function gradually decreases and insulin secretion capacity decreases.
7. Blood fat
Dyslipidemia is common in diabetic patients, especially when blood glucose control is poor. Elevated levels of triglycerides, total cholesterol, and LDL cholesterol. HDL cholesterol levels go down.
8. The immune indexes
Islet cell antibodies (ICA), insulin autoantibodies (IAA) and glutamate decarboxylase (GAD) antibodies are three important indicators of fluid immunity abnormality in type 1 diabetes, among which the positive rate of the GAD antibody is high, lasting for a long time and has great diagnostic value for type 1 diabetes. There is also a positive rate in first-degree relatives of type 1 diabetes, which has implications for predicting type 1 diabetes.
9. Urinary albumin excretion, release or enzyme - linked method
Urine albumin excretion can be detected sensitively, and urine albumin is slightly elevated in early diabetic nephropathy.
The diagnosis
The diagnosis of diabetes is generally not difficult. Fasting blood glucose is greater than or equal to 7.0 mm/l, and/or two hours after meal blood glucose is greater than or equal to 11.1 mm/l. Type of diabetes after diagnosis:
1. Type 1 diabetes
Young onset age, mostly <30 years old, sudden onset, symptoms of polydiuresis, polyphagia and wasting are obvious, blood sugar level is high, many patients with ketoacidosis as the first symptom, low level of serum insulin and c-peptide, ICA, IAA or GAD antibodies can be positive. Oral medication alone is ineffective and insulin is needed.
2. Type 2 diabetes
Common at old and middle age, obese patients have a high incidence, often accompanied by hypertension, dyslipidemia, arteriosclerosis and other diseases. Disease onset is latent, early without any symptoms, or only mild fatigue, thirst, blood sugar increase is not obvious people need to do sugar tolerance test to confirm. Serum insulin levels were normal or elevated early and low late.
The differential diagnosis
1. Liver disease
Patients with cirrhosis often have abnormal glucose metabolism, and the fasting blood glucose is normal or low, and the blood glucose rises rapidly after meals. The fasting blood sugar of the elderly can also be increased.
2. Chronic renal insufficiency
Mild abnormal glucose metabolism may occur.
3. The stress state
Many stress states, such as cardiovascular and cerebrovascular accidents, acute infection, trauma and surgical operation, may lead to hyperglycemia, which can be recovered within 1 to 2 weeks after the elimination of stress factors.
4. Multiple endocrine diseases
For example, acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma, and glucagonoma can lead to secondary diabetes. In addition to elevated blood glucose, there are other characteristic manifestations, which are not difficult to identify.
treatment
Currently, there is no cure method for diabetes, but diabetes can be controlled through a variety of treatment methods. It mainly includes five aspects: education of diabetic patients, self-monitoring of blood sugar, diet treatment, exercise treatment and drug treatment.
(1) general treatment
1. education
Education diabetic patients should understand the basic knowledge of diabetes, build confidence to conquer the disease, how to control diabetes, and control the health benefits of diabetes. According to the characteristics of each patient with diabetes to develop appropriate treatment program.
2. Self-monitoring of blood glucose
With the gradual popularity of small and rapid blood glucose meters, patients can adjust the dose of hypoglycemic drugs at any time according to the blood glucose level. Type 1 diabetes is monitored at least 4 times a day (before meals) for intensive treatment, and 8 times for unstable blood glucose (before, after meals, before bed at night and 3:00 in the morning). Fasting blood glucose should be controlled below 7.2 millimol /L during intensive treatment, and blood glucose should be less than 10mmol/L and HbA1c less than 7% two hours after meal. The frequency of self-monitoring of blood glucose can be appropriately reduced in patients with type 2 diabetes.
(2) drug treatment
1. Oral medication
(1) sulfonylureas: type 2 DM patients can use sulfonylureas after diet control, exercise, weight reduction and other treatments. Because the hypoglycemic mechanism is mainly to stimulate insulin secretion, so to have a certain islet function of the curative effect is better. For some younger age of onset, shape is not fat diabetic patients in the early also has certain curative effect. However, when using sulfonylureas for obese people, special attention should be paid to diet control to gradually lose weight, which is better combined with biguanidine or glucosidase inhibitors. The following situations are contraindications: first, severe hepatic and renal insufficiency; Second, the combination of severe infection, trauma and major surgery, temporary use of insulin treatment; Third, diabetes ketosis, ketoacidosis, temporary use of insulin treatment; Four is diabetic pregnant women, pregnancy hyperglycemia of fetal deformity role, high incidence of preterm birth, stillbirth, reason should be strict control of blood sugar, should be the fasting blood glucose control in 105 mg/dl (below 5.8 millimoles/l), postprandial 2 hours blood glucose control in 120 mg/dl (below 6.7 millimoles/l), but to control blood sugar is unfavorable use oral medications; The fifth is allergy to sulfonylureas or obvious adverse reactions.
(2) the main mechanism of biguanidine glucose-lowering drugs to reduce blood glucose is to increase the use of glucose by peripheral tissues, increase anaerobic digestion of glucose, reduce the absorption of glucose by gastrointestinal tract, and reduce weight. Patients with obesity type 2 diabetes and unsatisfactory effect of diet therapy alone; Sulfonylureas alone in type 2 diabetes is not effective, biguanidine drugs can be added; Type 1 diabetes is treated with insulin, which can reduce the dose of insulin. When the secondary failure of type 2 diabetes is treated with insulin, biguanidine drugs can be added, which can reduce the dosage of insulin. Severe liver, kidney, heart, and lung diseases, consumptive diseases, malnutrition, and hypoxia diseases. Diabetic ketosis, ketoacidosis; With severe infection, surgery, trauma and other stress conditions, biguanidine drugs were suspended, to use insulin treatment; During pregnancy. One side effect is gastrointestinal reactions. The most common symptoms are nausea, vomiting, decreased appetite, abdominal pain and diarrhea, with an incidence of up to 20%. To avoid these adverse reactions, take medication during or after meals. Second, headache, dizziness, metallic taste. Third, lactic acid acidosis, mostly seen in long-term, a large number of applications of hypoglycine, accompanied by liver and kidney function hypoxia, hypoxic diseases, acute infection, gastrointestinal diseases, hypoglycemic tablets cause fewer opportunities for acidosis.
(3) type 1 and type 2 diabetes, which can be used with sulfonylureas, biguanides or insulin. Serge sugar is taken immediately before the meal. She takes it immediately before the meal. Major adverse reactions include abdominal pain, flatulence, diarrhea, and increased anal exhaust.
(4) insulin sensitizer can enhance insulin action and improve glucose metabolism. It can be used alone or combined with sulfonylureas, biguanides or insulin. Those with liver disease or cardiac insufficiency should not be used.
(5) glienet type insulin secretion stimulator, which is a fast insulin secretion agent, should be taken immediately before meals and taken at every main meal. The effect of grenai is similar to that of Regina.
2. Insulin therapy
Insulin preparations include animal insulin, human insulin and insulin analogues. According to the action time, it can be divided into short -, medium - and long-acting insulin, and has been made into mixed preparations, such as nuoheeling 30R and yohedrine 70/30.
(1) type 1 diabetes requires insulin treatment. Non-intensive patients were given 2 ~ 3 injections per day, and 3 ~ 4 injections per day, or were treated with an insulin pump. Doses need to be adjusted frequently.
(2) oral medications for type 2 diabetes failure first adopts the combined treatment method, the method is used for the original oral medications dose is changeless, sleep the night before last 10:00 in the effect of insulin injection or long-acting insulin analogue, adjusted once every 3 days commonly, the purpose of fasting blood sugar dropped to 4.9 ~ 4.9 millimoles/l, no effective stopping oral medications, insulin injections twice a day.
The greatest adverse effect of insulin therapy is hypoglycemia.
Exercise therapy
Increased physical activity can improve the body's sensitivity to insulin, reduce body weight, reduce body fat, increase physical strength, improve work capacity and quality of life. The intensity and duration of the exercise should be determined according to the overall health status of the patient, and find the appropriate amount of exercise and items of interest for the patient. There are various forms of sports, such as walking, brisk walking, aerobics, dancing, shadowboxing, running, swimming, etc.
(iv) diet treatment
Diet therapy is the basis of all types of diabetes treatment, and some patients with mild diabetes can control the disease with diet alone.
1. The total quantity of heat
The need for total calories should be determined according to the patient's age, gender, height, weight, physical activity, illness and other comprehensive factors. The standard weight of each person should be calculated first. The following formula can be used: standard weight (kg) = height (cm) -105 or standard weight (kg) =[height (cm) -100] x 0.9; Women should lose an additional 2kg of their standard weight. It can also be obtained according to the age, sex and height table. Figure out the standard body weight and then estimate the amount of calories per kg of standard body weight according to each person's daily physical activity.
After the daily calorie intake is calculated according to the standard body weight, it should be adjusted according to other conditions of the patient. Children, adolescents, lactation, malnutrition, wasting, and chronic wasting diseases should increase total calories as appropriate. Fat person wants strict limitation total quantity of heat and adipose content, give low quantity of heat to eat, every day total quantity of heat does not exceed 1500 kilocalorie, reduce normally with every months 0.5 ~ 1.0kg advisable, when waiting for close to standard weight, calculate daily total quantity of heat again by afore-mentioned method. In addition, older people require fewer calories than younger people, and adult women require fewer calories than men.
carbohydrates
Carbohydrates produce 4 kcal per gram, which is the main source of calories. It is now believed that carbohydrates should account for 55% ~ 65% of the total calories of the diet. The following formula can be used to calculate:
According to the living habits of Chinese people, the staple food (rice or noodles) can be imported at 250 ~ 400g, which can be preliminarily estimated as follows: for the rest, the daily staple food is 200 ~ 250g, for the mild manual workers at 250 ~ 300g, for the moderate manual workers at 300 ~ 400g, and for the heavy manual workers at more than 400g.
3. Protein
Protein yields 4 kcal per gram. Between 12% and 15% of total calories. Protein requirements are about 1g per kg of body weight for adults. In children, pregnant women, lactating women, malnutrition, emaciation and wasting diseases should be increased to 1.5-2.0g/kg body weight. Diabetic nephropathy patients should reduce their protein intake by 0.8g/kg body weight. If they have renal insufficiency, they should take in high-quality protein and their intake should be further reduced to 0.6g/kg body weight.
4. The fat
The energy of adipose is higher, yield quantity of heat 9 kilocalorie per gram. About 25% of total calories, generally no more than 30%, each day weight 0.8-1g. Animal fats are mainly saturated fatty acids. Vegetable oil contains many unsaturated fatty acids, which may cause atherosclerosis in diabetic patients.
1. Genetic factors,
Both type 1 and type 2 diabetes have significant genetic heterogeneity. Diabetes has a familial predisposition, with a family history of diabetes in 1/4 to 1/2 of the patients. Clinically, at least 60 genetic syndromes may be associated with diabetes. Type 1 diabetes is associated with multiple DNA loci, and DQ loci polymorphisms in HLA antigen genes are most closely related. Many specific gene mutations have been found in type 2 diabetes, such as insulin gene, insulin receptor gene, glucose kinase gene and mitochondrial gene.
2. Environmental factors
Obesity caused by too much food and reduced physical activity is the most important environmental factor of type 2 diabetes, making individuals with genetic susceptibility to type 2 diabetes susceptible to disease. Type 1 diabetes patients have an abnormal immune system, and some viruses, such as coxsackievirus, rubella virus, and parotid gland virus, lead to an autoimmune response that destroys insulinoblast cells.
Clinical manifestations of
1. Drink more, urinate more, eat more and be thin
When severe hyperglycemia occurs, the typical "three more and one less" symptoms are more common in type 1 diabetes. The symptoms of ketosis or ketoacidosis were more obvious.
2. Tired and weak and fat
More common in type 2 diabetes. Type 2 diabetes often occurs before obesity, if not diagnosed in time, weight will gradually decline.
check
1. Blood sugar
Is the only diagnostic criteria for diabetes. Those with obvious symptoms of "three more and one less" can be diagnosed with only one abnormal blood glucose level. Asymptomatic patients need two abnormal blood glucose levels to diagnose diabetes. 75g glucose tolerance test is required for suspicious subjects.
2. Urine sugar
Often positive. When blood glucose concentration exceeds the kidney sugar threshold (160 ~ 180 mg/l), urine sugar is positive. When the renal sugar threshold is raised, even if the blood glucose reaches the diagnosis of diabetes, it can be negative. Therefore, urine sugar assay is not the diagnostic criteria.
3. Urine ketone body
Urine ketone positive in ketosis or ketoacidosis.
4. Glycosylated hemoglobin (HbA1c)
It is a product of non-enzymatic reaction of glucose and hemoglobin. The reaction is irreversible and the level of HbA1c is stable, which can reflect the average blood glucose level in the first 2 months of blood collection. It is the most valuable index to judge the blood glucose control state.
5. Glycosylated serum protein
It is the product of combining blood glucose and serum albumin nonenzymatic reaction, reflecting the average blood glucose level of 1-3 weeks before blood collection.
6. Serum insulin and c-peptide levels
Reflect the reserve function of islet oocytes. In the early stage of type 2 diabetes or obesity, serum insulin is normal or increased. With the development of the disease, islet function gradually decreases and insulin secretion capacity decreases.
7. Blood fat
Dyslipidemia is common in diabetic patients, especially when blood glucose control is poor. Elevated levels of triglycerides, total cholesterol, and LDL cholesterol. HDL cholesterol levels go down.
8. The immune indexes
Islet cell antibodies (ICA), insulin autoantibodies (IAA) and glutamate decarboxylase (GAD) antibodies are three important indicators of fluid immunity abnormality in type 1 diabetes, among which the positive rate of the GAD antibody is high, lasting for a long time and has great diagnostic value for type 1 diabetes. There is also a positive rate in first-degree relatives of type 1 diabetes, which has implications for predicting type 1 diabetes.
9. Urinary albumin excretion, release or enzyme - linked method
Urine albumin excretion can be detected sensitively, and urine albumin is slightly elevated in early diabetic nephropathy.
The diagnosis
The diagnosis of diabetes is generally not difficult. Fasting blood glucose is greater than or equal to 7.0 mm/l, and/or two hours after meal blood glucose is greater than or equal to 11.1 mm/l. Type of diabetes after diagnosis:
1. Type 1 diabetes
Young onset age, mostly <30 years old, sudden onset, symptoms of polydiuresis, polyphagia and wasting are obvious, blood sugar level is high, many patients with ketoacidosis as the first symptom, low level of serum insulin and c-peptide, ICA, IAA or GAD antibodies can be positive. Oral medication alone is ineffective and insulin is needed.
2. Type 2 diabetes
Common at old and middle age, obese patients have a high incidence, often accompanied by hypertension, dyslipidemia, arteriosclerosis and other diseases. Disease onset is latent, early without any symptoms, or only mild fatigue, thirst, blood sugar increase is not obvious people need to do sugar tolerance test to confirm. Serum insulin levels were normal or elevated early and low late.
The differential diagnosis
1. Liver disease
Patients with cirrhosis often have abnormal glucose metabolism, and the fasting blood glucose is normal or low, and the blood glucose rises rapidly after meals. The fasting blood sugar of the elderly can also be increased.
2. Chronic renal insufficiency
Mild abnormal glucose metabolism may occur.
3. The stress state
Many stress states, such as cardiovascular and cerebrovascular accidents, acute infection, trauma and surgical operation, may lead to hyperglycemia, which can be recovered within 1 to 2 weeks after the elimination of stress factors.
4. Multiple endocrine diseases
For example, acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma, and glucagonoma can lead to secondary diabetes. In addition to elevated blood glucose, there are other characteristic manifestations, which are not difficult to identify.
treatment
Currently, there is no cure method for diabetes, but diabetes can be controlled through a variety of treatment methods. It mainly includes five aspects: education of diabetic patients, self-monitoring of blood sugar, diet treatment, exercise treatment and drug treatment.
(1) general treatment
1. education
Education diabetic patients should understand the basic knowledge of diabetes, build confidence to conquer the disease, how to control diabetes, and control the health benefits of diabetes. According to the characteristics of each patient with diabetes to develop appropriate treatment program.
2. Self-monitoring of blood glucose
With the gradual popularity of small and rapid blood glucose meters, patients can adjust the dose of hypoglycemic drugs at any time according to the blood glucose level. Type 1 diabetes is monitored at least 4 times a day (before meals) for intensive treatment, and 8 times for unstable blood glucose (before, after meals, before bed at night and 3:00 in the morning). Fasting blood glucose should be controlled below 7.2 millimol /L during intensive treatment, and blood glucose should be less than 10mmol/L and HbA1c less than 7% two hours after meal. The frequency of self-monitoring of blood glucose can be appropriately reduced in patients with type 2 diabetes.
(2) drug treatment
1. Oral medication
(1) sulfonylureas: type 2 DM patients can use sulfonylureas after diet control, exercise, weight reduction and other treatments. Because the hypoglycemic mechanism is mainly to stimulate insulin secretion, so to have a certain islet function of the curative effect is better. For some younger age of onset, shape is not fat diabetic patients in the early also has certain curative effect. However, when using sulfonylureas for obese people, special attention should be paid to diet control to gradually lose weight, which is better combined with biguanidine or glucosidase inhibitors. The following situations are contraindications: first, severe hepatic and renal insufficiency; Second, the combination of severe infection, trauma and major surgery, temporary use of insulin treatment; Third, diabetes ketosis, ketoacidosis, temporary use of insulin treatment; Four is diabetic pregnant women, pregnancy hyperglycemia of fetal deformity role, high incidence of preterm birth, stillbirth, reason should be strict control of blood sugar, should be the fasting blood glucose control in 105 mg/dl (below 5.8 millimoles/l), postprandial 2 hours blood glucose control in 120 mg/dl (below 6.7 millimoles/l), but to control blood sugar is unfavorable use oral medications; The fifth is allergy to sulfonylureas or obvious adverse reactions.
(2) the main mechanism of biguanidine glucose-lowering drugs to reduce blood glucose is to increase the use of glucose by peripheral tissues, increase anaerobic digestion of glucose, reduce the absorption of glucose by gastrointestinal tract, and reduce weight. Patients with obesity type 2 diabetes and unsatisfactory effect of diet therapy alone; Sulfonylureas alone in type 2 diabetes is not effective, biguanidine drugs can be added; Type 1 diabetes is treated with insulin, which can reduce the dose of insulin. When the secondary failure of type 2 diabetes is treated with insulin, biguanidine drugs can be added, which can reduce the dosage of insulin. Severe liver, kidney, heart, and lung diseases, consumptive diseases, malnutrition, and hypoxia diseases. Diabetic ketosis, ketoacidosis; With severe infection, surgery, trauma and other stress conditions, biguanidine drugs were suspended, to use insulin treatment; During pregnancy. One side effect is gastrointestinal reactions. The most common symptoms are nausea, vomiting, decreased appetite, abdominal pain and diarrhea, with an incidence of up to 20%. To avoid these adverse reactions, take medication during or after meals. Second, headache, dizziness, metallic taste. Third, lactic acid acidosis, mostly seen in long-term, a large number of applications of hypoglycine, accompanied by liver and kidney function hypoxia, hypoxic diseases, acute infection, gastrointestinal diseases, hypoglycemic tablets cause fewer opportunities for acidosis.
(3) type 1 and type 2 diabetes, which can be used with sulfonylureas, biguanides or insulin. Serge sugar is taken immediately before the meal. She takes it immediately before the meal. Major adverse reactions include abdominal pain, flatulence, diarrhea, and increased anal exhaust.
(4) insulin sensitizer can enhance insulin action and improve glucose metabolism. It can be used alone or combined with sulfonylureas, biguanides or insulin. Those with liver disease or cardiac insufficiency should not be used.
(5) glienet type insulin secretion stimulator, which is a fast insulin secretion agent, should be taken immediately before meals and taken at every main meal. The effect of grenai is similar to that of Regina.
2. Insulin therapy
Insulin preparations include animal insulin, human insulin and insulin analogues. According to the action time, it can be divided into short -, medium - and long-acting insulin, and has been made into mixed preparations, such as nuoheeling 30R and yohedrine 70/30.
(1) type 1 diabetes requires insulin treatment. Non-intensive patients were given 2 ~ 3 injections per day, and 3 ~ 4 injections per day, or were treated with an insulin pump. Doses need to be adjusted frequently.
(2) oral medications for type 2 diabetes failure first adopts the combined treatment method, the method is used for the original oral medications dose is changeless, sleep the night before last 10:00 in the effect of insulin injection or long-acting insulin analogue, adjusted once every 3 days commonly, the purpose of fasting blood sugar dropped to 4.9 ~ 4.9 millimoles/l, no effective stopping oral medications, insulin injections twice a day.
The greatest adverse effect of insulin therapy is hypoglycemia.
Exercise therapy
Increased physical activity can improve the body's sensitivity to insulin, reduce body weight, reduce body fat, increase physical strength, improve work capacity and quality of life. The intensity and duration of the exercise should be determined according to the overall health status of the patient, and find the appropriate amount of exercise and items of interest for the patient. There are various forms of sports, such as walking, brisk walking, aerobics, dancing, shadowboxing, running, swimming, etc.
(iv) diet treatment
Diet therapy is the basis of all types of diabetes treatment, and some patients with mild diabetes can control the disease with diet alone.
1. The total quantity of heat
The need for total calories should be determined according to the patient's age, gender, height, weight, physical activity, illness and other comprehensive factors. The standard weight of each person should be calculated first. The following formula can be used: standard weight (kg) = height (cm) -105 or standard weight (kg) =[height (cm) -100] x 0.9; Women should lose an additional 2kg of their standard weight. It can also be obtained according to the age, sex and height table. Figure out the standard body weight and then estimate the amount of calories per kg of standard body weight according to each person's daily physical activity.
After the daily calorie intake is calculated according to the standard body weight, it should be adjusted according to other conditions of the patient. Children, adolescents, lactation, malnutrition, wasting, and chronic wasting diseases should increase total calories as appropriate. Fat person wants strict limitation total quantity of heat and adipose content, give low quantity of heat to eat, every day total quantity of heat does not exceed 1500 kilocalorie, reduce normally with every months 0.5 ~ 1.0kg advisable, when waiting for close to standard weight, calculate daily total quantity of heat again by afore-mentioned method. In addition, older people require fewer calories than younger people, and adult women require fewer calories than men.
carbohydrates
Carbohydrates produce 4 kcal per gram, which is the main source of calories. It is now believed that carbohydrates should account for 55% ~ 65% of the total calories of the diet. The following formula can be used to calculate:
According to the living habits of Chinese people, the staple food (rice or noodles) can be imported at 250 ~ 400g, which can be preliminarily estimated as follows: for the rest, the daily staple food is 200 ~ 250g, for the mild manual workers at 250 ~ 300g, for the moderate manual workers at 300 ~ 400g, and for the heavy manual workers at more than 400g.
3. Protein
Protein yields 4 kcal per gram. Between 12% and 15% of total calories. Protein requirements are about 1g per kg of body weight for adults. In children, pregnant women, lactating women, malnutrition, emaciation and wasting diseases should be increased to 1.5-2.0g/kg body weight. Diabetic nephropathy patients should reduce their protein intake by 0.8g/kg body weight. If they have renal insufficiency, they should take in high-quality protein and their intake should be further reduced to 0.6g/kg body weight.
4. The fat
The energy of adipose is higher, yield quantity of heat 9 kilocalorie per gram. About 25% of total calories, generally no more than 30%, each day weight 0.8-1g. Animal fats are mainly saturated fatty acids. Vegetable oil contains many unsaturated fatty acids, which may cause atherosclerosis in diabetic patients.
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