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Dietetyczne aspekty leczenia cukrzycy typu 2  fakty i mity PDF Drukuj Email
14.08.2013.
 

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Opublikowane w : Porady, Dieta cukrzycowa

Cukrzyca typu 2 jest powikłaniem, a nie przyczyną nadwagi lub otyłości. Tymczasem dla wielu osób dopiero rozwój powikłań otyłości jest wystarczającą motywacją do podjęcia próby redukcji masy ciała.

 

Jednak nie zawsze wystarczającą do tego, żeby zmiany były konsekwentne i długotrwałe. Na chcących zmodyfikować swoje nawyki żywieniowe czeka jednak wiele pułapek. Eksperci z Polskiego Towarzystwa Badań nad Otyłością podpowiadają, jak sobie z nimi poradzić.

MIT! Zmiana nawyków żywieniowych powinna oznaczać przede wszystkim zmniejszenie ilości spożywanych pokarmów.
W pierwszej kolejności należy dążyć do zmiany jakości posiłków, polegającej na obniżeniu energetyczności spożywanych dań. W żadnym wypadku osoba, która zmienia swój sposób żywienia nie może być głodna. Należy zacząć od prostych modyfikacji np.: zamiast półtłustego twarogu wybrać chudy, zamiast tuńczyka w oleju, w sosie własnym, zamiast mielonki - szynka z indyka. Zamiast smażenia potraw w głębokim tłuszczu należy wybrać pieczenie lub duszenie bez użycia tłuszczu, zrezygnować z zagęszczania zup zasmażkami i doprawiać je jedynie jogurtem.

Przykład ekonomicznego zarządzania kaloriami – zamiana produktów

Twaróg półtłusty, 100 g. Twaróg chudy, 100 g.
133 kcal 99 kcal
Tuńczyk w oleju, 100 g. Tuńczyk w sosie własnym, 100 g.
190 kcal 96 kcal
Mielonka, 100 g. Szynka z indyka, 100 g.
171 kcal 84 kcal

Takie małe zmiany stanowią przykład ekonomicznego zarządzania kaloriami, które powinno również uwzględniać unikanie dodatków do potraw, które zwiększają kaloryczność produktów bez jednoczesnego wzrostu odczuwania sytości. Dodanie łyżki oliwy czy oleju do surówki zwiększy jej kaloryczność o 133 kcal, jeżeli użyje się sosu winegret (łyżeczka oliwy czy oleju z 2 łyżeczkami wody i przyprawami ziołowymi) zaoszczędzimy 89 kcal. Jeżeli łyżeczkę majonezu zastąpimy łyżką jogurtu z łyżeczką musztardy zaoszczędzimy 142 kcal, gdy nie polejemy pierogów tłuszczem ze skwarkami zaoszczędzimy około 100 kcal. Energetyczność spożywanych posiłków możemy kontrolować prowadząc dzienniczek żywieniowy.
MIT! Zmiana nawyków żywieniowych oznacza, że są produkty na zawsze zakazane, które należy wykluczyć z jadłospisu.
Od początku podjęcia decyzji o zmianie trzeba mieć świadomość, że żaden pokarm nie jest „zakazanym owocem” bo wtedy podświadomie odczuwa się potrzebę jego zjedzenia, silniejszą niż wynikałoby to z rzeczywistych preferencji pokarmowych. Trzeba tyko nauczyć się, że są takie pokarmy, które możemy jeść codziennie, takie które 1-2 razy w tygodniu (np. niewielka ilość słodyczy, do produkcji których użyto słodzika a nie fruktozy, czy plasterek żółtego sera), raz w miesiącu (np. smażona ryba) i nie częściej niż raz na kwartał (np. 1-2 plasterki boczku czy fast-food). Jeżeli szczególnie wysokokaloryczne pokarmy będziemy jeść tylko w wyjątkowych sytuacjach to kolejny odcinek drogi do trwałego sukcesu.

FAKT! Samokontrola to klucz do sukcesu

Samodzielne kontrolowanie energetyczności spożywanych posiłków wymaga systematycznego, ścisłego „rozliczania kalorii”. Dużo łatwiej to zrobić, prowadząc dzienniczek żywieniowy. Zanim zapiszemy w nim posiłek, który zamierzamy zjeść, musimy go zważyć i sprawdzić w tabelach kalorycznych Instytutu Żywności i Żywienia kaloryczność 100 g tego produktu. Później z proporcji wyliczyć kaloryczność zważonej porcji i odnotować ją w dzienniczku.
Jeśli okaże się, że danego dnia zaoszczędziliśmy określoną ilość kalorii, możemy sobie pozwolić na zaspokojenie naturalnej potrzeby słodkiego smaku. Sięgnijmy wtedy po takie produkty, które dla obniżenia kaloryczności zawierają niskokaloryczne substancje słodzące (słodziki). Są to związki, których słodki smak jest tak intensywny, że można je dodawać do produktów spożywczych w bardzo małych ilościach. Ponadto ich energetyczność nie przekracza kilku kilokalorii. Spożycie pokarmów i napojów, których kaloryczność została obniżona dzięki zastosowaniu słodzików może przyczynić się do zmniejszenia dobowego poboru energii oraz korzystnie wpłynąć na poposiłkowe stężenia glukozy. Polskie Towarzystwo Badań nad Otyłością i Polskie Towarzystwo Diabetologiczne potwierdzają, że stosowanie słodzików w żywności i napojach jest bezpieczne. Należy jednak pamiętać, że większość słodyczy, w których cukier zastąpiono słodzikami, nadal ma sporo kalorii, z powodu zawartości tłuszczów, głównie nasyconych. Starajmy się więc za każdym razem porównywać kaloryczność produktów z tymi słodzonymi cukrem.

FAKT! Optymalne jest jedzenie 5 posiłków dziennie a jeżeli to nie jest możliwe ze względów organizacyjnych – przynajmniej 3.

Wiele osób otyłych większość jedzenia spożywa w godzinach późno popołudniowych i wieczornych. Ten utrwalony błędny nawyk żywieniowy powoduje, że nie jedzą one śniadań. Taki schemat żywienia powoduje, że o ile za pomocą leków udaje się uzyskać dobrą kontrolę stężeń glukozy po posiłkach, o tyle stężenia w surowicy glukozy na czczo jest zwykle wysokie. Dodatkowo spożycie obfitego posiłku lub zawierającego duże ilości węglowodanów prostych (głównie glukozy, fruktozy i laktozy) w godzinach wieczornych nasila to zaburzenie i utrudnia uzyskanie właściwych stężeń glukozy na czczo, mimo zwiększania wieczornych dawek leków, w tym insuliny. Jeżeli odczuwa się potrzebę dojadania między posiłkami to należy wypić szklankę wody, lub zjeść warzywo, nie owoc (owoce należy traktować jako posiłek - II śniadanie lub podwieczorek). Osoby chore na cukrzycę typu 2 zdecydowanie nie powinny jeść owoców po kolacji, ani zamiast kolacji, ponieważ pogarsza to kontrolę porannych stężeń glukozy.


Tabela 2. Prawidłowy rozkład kaloryczności posiłków w ciągu dnia
I śniadanie 25% 40%
II śniadanie 15 %
Obiad 35 % 40 %
Podwieczorek 10 %
Kolacja 15 % 20 %


FAKT! Aktywność fizyczna – ważny element zmiany stylu życia i kontroli glikemii

Wielu chorych na cukrzycę typu 2 obawia się, że zwiększony wysiłek fizyczny może im zaszkodzić, m.in. powodując hipoglikemię. Tymczasem narażeni są na nią w chorzy na cukrzycę typu 2 leczeni pochodnymi sulfonylomocznika lub insuliną. Dlatego osoby te powinny pamiętać o spożyciu przed wysiłkiem posiłku zawierającego węglowodany złożone oraz ewentualnie zmniejszyć o 30-50% (w zależności od indywidualnych reakcji) dawki insuliny szybko-/krótkodziałającej, której szczyt działania przypada na czas wysiłku lub krótko po jego zakończeniu. Rodzaj i intensywność wysiłku powinien zostać dobrany indywidualnie w porozumieniu z lekarzem prowadzącym w zależności od możliwości i występujących powikłań cukrzycy. Ważnym elementem w aspekcie zapobiegania ryzyku uszkodzeń stóp w czasie wysiłku jest odpowiedni dobór obuwia oraz ich pielęgnacja.

Konsultacja merytoryczna: prof. dr hab. Magdalena Olszanecka – Glinianowicz, Prezes Polskiego Towarzystwa Badań nad Otyłością, Zakład Promocji Zdrowia i Leczenia Otyłości, Katedra Patofizjologii Śląskiego Uniwersytetu Medycznego w Katowicach.

źródło Gazeta Czestochowska

   
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