In the absence of contraindications, the patient is prescribed a trial diet..

Trial Diet B. Baranova approved by order of the Ministry of Health (MH) of the USSR of May 6, 1971.

Chemical composition: proteins - 116 g; carbohydrates - 130, fats - 136 g, energy value - 2170-2208 kcal. The ratio of proteins: fats: carbohydrates \u003d 1: 1.3: 1.2 (table. 33. 13).

This diet contains too much fat, but a sharply reduced amount of carbohydrates reduces the load on the pancreatic insular apparatus.. Against the background of a trial diet, fasting blood sugar and daily urine for sugar are examined at least 1 time in 5 days.

Table 33. 13. Trial Diet Daily Set B. Baranova Products Gross weight, g meat, fish 250 cottage cheese 300 cheese 25 milk, kefir 500 butter and vegetable oil 60 vegetables (except potatoes and legumes) 800 fruits (except grapes, bananas, persimmons, figs) 300 black bread 100 With normalization of carbohydrate. Before each new increase, blood and urine are examined for sugar.. Having expanded the trial diet by 12 XE, stand for 2 months, then add another 4 XE with an interval of 3-7 days. Further expansion of the diet, if necessary, is carried out after 1 year.

Medicines are added to the diet in the following cases:.

- when following a trial diet for 10 days, carbohydrate metabolism did not normalize; - with the expansion of the diet, hyperglycemia and glucosuria appeared.

Diet No. 9 can also be used as a trial (Table. 33. 14, 33. fifteen).

Table 33. fourteen. Characteristics of the numbered diet No. 9 Purpose Create conditions conducive to the normalization of carbohydrate metabolism General characteristics: Diet with restriction of fats and carbohydrates due to animal fats, sugar and sweets Diet mode Fractional, 5-6 times a day Culinary processing Varied: boiling, stewing, baking.

proteins fats carbohydrates energy value free liquid 100 g 70-800 g 300 g 2300 kcal 1.5-2 l Recommended:.

Bread and bakery products: mostly black bread up to 200-300 g per day, baked goods (cakes, biscuits) on xylitol or aspartame Soups: mostly vegetarian, on a weak broth 1-2 times a week Meat, fish, poultry dishes: beef. Potatoes, beets, carrots, rutabagas up to 200 g per day.

They use vegetable purees, souffles, boiled, stewed and baked vegetables Dishes and side dishes from cereals, legumes and pasta: they are consumed in a limited way, taking into account the total amount of carbohydrates due to the reduction of bread. Recommended 50 g of cereals (preferably buckwheat or oatmeal) per day. Semolina and rice cereals are excluded Egg dishes: no more than two pieces per day soft-boiled, in the form of an omelette and for adding to other dishes. In the presence of concomitant atherosclerosis, cholecystitis, yolks are limited to 3-4 per week Fruits, berries: sour varieties (containing less than 5 g of carbohydrates per 100 g) without restrictions, sweet and sour varieties (containing 5-10 g of carbohydrates per 100 g) up to 200. Sour cream, cheese, limited cream Sauces: mild, vegetable broth, dairy, sour cream. Only white fat-free sauteing of flour is used Snacks: salads, vinaigrettes, jellied meat and fish, cheese Drinks: tea, tea with milk, weak coffee, coffee with milk, juices from sour and sour-sweet varieties of fruits and berries, compotes, blackcurrant decoctions. fifteen. An approximate set of products per day (g, gross) for diet No. 9 Vegetable oil 20 Tomatoes 20 Butter 20 Carrots 75 Milk 200 Potatoes 200 Kefir 200 Cabbage 600 Cereals 50 Other greens 25 Beef 150 Beef 150 White bread 100 X Black fish 120. In recent years, the norms of the physiological need for nutrients and energy have been repeatedly revised in the direction of their reduction..

At present, during treatment in medical institutions (MPI) according to order No. 330 of the Ministry of Health of the Russian Federation dated 5. 08. 03 g. patients with diabetes mellitus (DM) should receive the main standard diet option.

Brief description: a diet with a physiological content of proteins, fats and carbohydrates, enriched with vitamins, minerals, vegetable fiber (vegetables, fruits). Refined carbohydrates (sugar) are excluded. Limit nitrogenous extractives, table salt (6-8 g / day), products rich in essential oils; exclude spicy seasonings, spinach, sorrel, smoked meats. Dishes are cooked boiled or steamed, baked.

The temperature of hot dishes is not more than 60-65°С, cold dishes are not lower than 15°С. Free liquid - 1.5-2 l. The rhythm of nutrition is fractional, 4-6 times a day.

Chemical composition: proteins - 85-90 g (animals - 40-45 g); carbohydrates 300-350 g (mono- and disaccharides - 50-60 g) fats 85-90 g (vegetable - 40-45 g), energy value - 2170-2480 kcal.

One of the important problems in the nutrition of patients with diabetes is the fight against obesity, which occurs in 80% of patients with type I diabetes.. For this category of patients. Baranov proposed a trial diet with a reduced energy value (1760-1800 kcal) (Table. 33. sixteen).

Table 33. 16. Daily set of products of a trial diet with a reduced energy value B. Baranova Products Gross weight, g Meat, fish 250 Cottage cheese 300 Milk, kefir 500 Butter 10 Vegetables (except potatoes and legumes) 800 Fruits (except grapes, bananas, persimmons, figs) 300 Black bread 100 Chemical composition: proteins - 113 g; carbohydrates - 120 g, fats - 92 g, energy value - 1760 kcal.

Due to the fact that the diet is poor in fat-soluble vitamins, it is necessary to prescribe vitamins A and D. With sufficient weight loss (4-5 kg \u200b\u200bin 4 weeks), after 1 month, 5 g of butter and 50 g of bread are added to the trial diet, and a similar increase is made a month later. On this, the expansion of the diet is stopped until the normalization of body weight. If after 10 days from the start of treatment hyperglycemia and glucosuria are not eliminated, then it is necessary to prescribe oral sugar-lowering drugs..

With the entry into force of Order No. 330 of the Ministry of Health of the Russian Federation dated 5. 08. 2003 in health care facilities for patients with type II diabetes and obesity recommend a low-calorie diet option.

Brief description: a diet with a moderate restriction of energy value (1300-1600 kcal) mainly due to fats and carbohydrates. Exclude simple sugars, limit animal fats, table salt (3-5 g / day). Includes vegetable fats, dietary fiber (raw vegetables, fruits, dietary bran). Avoid refined carbohydrates (sugar). Food is cooked boiled or steamed, without salt. Free liquid is limited to 0.8-1.5 l / day. Diet 4-6 times a day.

Chemical composition: proteins - 70-80 g (animals - 40 g), fats - 60-70 g (vegetable -25 g), carbohydrates - 130-150 g, energy value - 13401550 kcal.

All variants of diets with low energy value have disadvantages inherent in group diets, so it is important to be able to calculate individually the diet for a particular diabetic patient who is overweight. To do this, it is necessary to determine the physiological need for energy, reduce it by 30% and calculate the chemical composition of the diet.. With insufficient effectiveness of such a diet, the energy value can be reduced by 40 or 50% of the physiological norm..

Ambiguous attitude of clinicians to unloading dietary therapy (RDT) in patients with diabetes mellitus in combination with obesity. Some experts speak out against RDT, citing the fact that ketoacidosis develops during fasting, which can aggravate ketoacidosis due to diabetes mellitus..

We have obtained good results in the treatment of patients with mild type II diabetes and obesity using the RDT method.. After 2-3 weeks of fasting, there was a decrease in body weight, a decrease in high blood pressure, normalization of sugar and serum cholesterol. Thus, unloading and dietary therapy can be used to treat obesity in patients with diabetes mellitus, subject to the correct selection of patients, taking into account contraindications..

Baranovsky medbe. en.