文：彭国民中医师
糖尿病是一种慢性的代谢异常疾病。一般认为糖尿病是由于遗传、环境、化学毒素以及微生物等因素 交互影响，造成体内胰脏分泌胰岛素不足，或体内胰岛素产生抗拒性。使得对于醣类的利用能力减低甚至完全无法利用，造成血糖过高，尿中有糖的现象，同时也造 成蛋白质和脂肪的代谢不正常。
饮食控制良好的糖尿病患者，生活品质也不逊于一般人。糖尿病饮食是以正常饮食的原则为基础，视各人需要调整 热量、蛋白质、脂肪及醣类的摄取量，提供均衡的营养，达到控制病情一种饮食方式，所需要的基本营养与一般人是一样的。所以正常健康的人也可以此原则摄取均 衡营养。糖尿病患者若不注意控制饮食，容易引发急性或慢性并发症，使病情恶化。急性并发症包括低血糖症及高血糖症，严重会致命。慢性并发症则包含眼睛、肾 脏、神经、心血管疾病等病变。
对于糖尿病患而言，营养医疗是重要的一环。不论病情的轻重，不管治疗的方式为何，都应该搭配饮食控制。轻微的糖尿病患者甚至于不需要药物，只要施以适当的饮食调整，再配合运动就可以相当有效的控制病情。
糖尿病患者有时为了控制血糖，往往过度限制自己的饮食，殊不知这样的做法并不科学。由于患者与普通人有不同的生理需求，缺乏某些营养素可能会加重糖尿病的发生、发展。这里以维生素矿物质等营养素为例。
1. 维生素A缺乏可能导致1型糖尿病的发生和胰岛细胞凋亡，日常膳食中增加蛋黄、胡萝卜、南瓜、玉米、 菠菜等富含维生素A的食物可有效补充维生素A。
2. 作为许多代谢途径中关键酶的辅酶，B族维生素在糖代谢中起重要的作用，主要存在于小麦、豆类、芝麻及瘦肉等食物中。
3. 维生素C能够清除自由基，预防糖尿病合并神经和血管病变，多吃草莓、菠菜、卷心菜、番茄等可有效补充维生素C。
4. 维生素D缺乏可以导致胰岛素分泌减少，多晒太阳即可。
5. 锌缺乏则影响胰岛素的合成和分泌，主要存在于豆类、鸡蛋等食物中。
6. 铬可以改善糖耐量异常，减少降糖药或胰岛素需要量，在小麦、花生、蘑菇、茶叶、人参、黄芪等食物中含量丰富。
7. 硒可以降低血糖，抗动脉粥样硬化，主要存在于芝麻、麦芽和黄芪等食中。
有些糖尿病人家属觉得病患三餐需限量，怕病患营养不够，而会准备鸡精、高蛋白、鱼汤或用中药炖鸡来进补，其实有很多糖尿病人处于营养过剩的状态，不当的进补反而会害了病人。糖尿病人只要日常饮食均衡，并不需额外进补。
另 外糖尿病患者可多食苦瓜，因为苦瓜所含的多肽类物质具有降低血糖、降低血压、调节血脂、提高免疫力的作用。同时，苦瓜的果实或种子的萃取物也能促进人体糖 份分解，具有使过剩糖份转化为热量的作用，改善体内的脂肪平衡。此外，它也可消除成为糖尿病原因的肥胖或便秘。因此，糖尿病患者和血糖值较高的人，不妨每 天都喝苦瓜汁。
有些糖尿病人因无法接受限量的肉类，而试图改以吃素方式来控制血糖，甚至有人认为吃素不会影响血糖。素食者常有的问题为蛋 白质摄取过与不及以及油脂摄取过多。素食者蛋白质来源为豆制品，一份豆制品相当一份肉类营养，因此，素食者正餐时为均衡营养必须以豆制品获得蛋白质，然而 一般人对豆制品有相当大的禁忌，若不靠牛奶或蛋之摄取，蛋白质会明显不足。另有些人对豆制品有错误的观念，觉得只要不是肉类就不会影响血糖且不知其油脂量 甚高，而不限制食用，造成血糖居高不下。因此，若为糖尿病而素食者，豆制品的摄取是必须的，其为蛋白质来源，与肉类替换。若为全素者，最好为蛋奶素，一天 至少一至二杯牛奶，偶而以蛋代换豆制品，以提高蛋白质的利用率。不论吃素与否，只要吃得均衡，控制份量，对血糖控制都是有益的。
糖尿病人要多喝白开水，每天应摄取约六至八杯（1600～1800C.C）的水。白开水是人体最健康、最经济的水份来源，应养成摄取白开水的习惯。市售饮料常含高糖份，经常饮用不利于理想体重及血脂肪的控制。
总 之过度限制饮食不利于糖尿病的控制，为能在控制饮食的基础上，全面均衡地摄入营养素，帮助控制疾病的进展，糖尿病患者应树立正确的观念，饮食结构多样化， 做到营养摄入的全面和均衡。日常膳食主要以植物性食品为主，适当限制蛋白质，严格限制脂肪、烟、酒及含糖饮料，提倡高纤维素食物。糖尿病患者还应该在合理 膳食的基础上，适当补充一些维生素矿物质补充剂，以保障营养素摄入的全面、均衡，有效预防糖尿病的发生、发展。
Diabetes & The Diabetic Diet
Chinese Text By Dr. Allen Pang English Text By Y3K Publisher
Diabetes is a condition where there is an abnormally high level of sugar in the blood and the affected patient’s body is unable to control this. Basic causes of the illness are thought to be related to genetic inheritance, environment, coming into constant contact with toxic substances or other infection of harmful organism may trigger the onset. Diabetes results from a failure in the production of insulin which is one of the body’s hormones and its job is to keep the blood’s sugar in control. Without insulin, the body’s cells become deprived of sugar despite the fact that there is a high level in the blood. As the sugar level rises due to lack of insulin, the cells burn on fat and nutrients like protein as it goes through improper circulation.
Proper diet still form the basis for management of diabetes and the so-called diabetic diet is nothing more than a modification of a well-balanced diet of others. Whatever others eat, diabetics can eat too but with certain adjustments altered to suit each individual’s needs. The intake of calories, proteins, fat, sugar should be carefully monitored as a balanced diet supplies nutrients needed by a person to support daily health. A diabetic person requires the same food nutrients as any other non-diabetic person. But protein, fat and carbohydrates are not metabolized in the same way so there is a need to lower this range of food groups. An uncontrolled diet may bring about problems whether the patient belongs to the Diabetes Mellitus (blood glucose level is higher than normal) or Maturity Onset Diabetes, which is a type of diabetes where the pancreas does produce insulin but the tissues of the body are sensitive to its action and because of this, a condition of high blood sugar level starts.
Sometimes, a diabetic can lapse into problems like hypoglycameia (which means low blood sugar level) or develop hyperglycaemia (which means high blood sugar level). Both conditions can be cured but complications can have an effect on the eyes, start of abnormalities in the nerves and has a tendency to develop artery trouble.
Diet is a must for those who suffer from diabetes. Once you understand the role of diet, there is a better overall control of the disease. With a proper diet and combined with the correct set of exercise, the illness can be managed. A diabetic should bring blood glucose level near to normal in order to lessen the risk of toxic effects and whether a patient is on medication or insulin, the diet should be tailored to each individual’s nutritional requirement. Below is a simple guide to the source of vitamins needed in a diet:
1. Vitamin A (retinol) is needed for Group 1 as they tend to have insulin resistance. A good origin of this vitamin comes from egg yolks, carrots, pumpkins, maize, spinach and since vitamin A is fat soluble, it can also be made in the body from carotene, a substance found in carrots, spinach.
2. Vitamin B is water soluble so you need a daily supply. There are many vitamins in this group (B1, B2, B6, B12) and is needed for growth and general health, especially for the nervous system. Sources of this vitamin comes from wheatgerm, pulses, sesame seeds and animal products.
3. Vitamin C (ascorbic acid) acts as antioxidant, mopping up free radicals, prevents irregularities in the nervous system or formation of arterial disease. Fresh fruits particularly strawberries, spinach, tomatoes, contain a useful amount of vitamin C.
4. Vitamin D is needed for the production of insulin. It is an odd vitamin as it can be made in the body. This process occurs in the skin where a substance is converted into vitamin D in response to exposure to sunlight. General exposure should be sufficient.
5. Lack of Zinc can be a problem factor to the secretion of insulin by the pancreas. Foods rich in this nutrient are cereals, eggs.
6. Chromium can help to lower blood sugar and a good source comes from malt, groundnuts, button mushrooms, tea leaves, ginseng and the herb Wong Chi.
Selenium can lower blood sugar and prevents hardening of the heart’s arteries. A rich source comes from sesame seeds, malt and herb Wong Chi.
It is rather common to find many family members of diabetic patients who expect complications to the patients everyday diet. There are misconceptions that these patients need booster nutrition like chicken essence, foods high in proteins, fish soups or double-boiled chicken with Chinese herbs. In fact this can be a danger as there lies the inability to resist temptation over heavy meals. A well-balanced diet is important for patients but they should not be deprived of good food too.
Bittergourds have enzymes for lowering blood sugar and is a booster for the immune system. The flesh and seeds of this fruit vegetable has loads of goodness and can be taken as a juice drink on a daily basis. It not only helps to prevent constipation but helps to reduce excess weight gained.
As fat restriction is necessary for diabetics, many opt to leave out meat in return for vegetarianism. Eating meat is not harmful in itself but eating anything in excess can be dangerous. As meat is an excellent source of protein, iron and fat, a full vegetarian diet has to be supplemented with the right proportion of nutrients needed in a balanced diet. In a vegetarian diet, protein can only be obtained through plant protein and a combination of nuts, pulses, cereals can help. But it can have its disadvantages as many people are allergic to nuts or flatulence can be formed by eating high fibre foods such as beans. There is often a mistaken idea that if no meat is consumed, the sugar level will be good. This is not true as when there is insufficient insulin, glucose cannot be processed and this remains circulating in the blood stream and can be toxic to the body. Vegans can have an exchange for meat by consuming eggs as it has good protein food. For lacto-vegetarians, the substitution list should include one to two glasses of milk daily and eggs to replace beans. A knowledge of nutrition is the must important factor in preparing a diabetic diet.
Diabetics should drink a lot of water, around 1600 to 1800ml. Water is not a nutrient but the base for the body’s major transport system. Alcohol consumption, smoking and excessive sugary drinks should be avoided. Soluble fibres can be beneficial in the diets too. Be wise with your choice and any diabetic patient can still enjoy dining in or out.
糖尿病药膳
文:张慧兰医师
中医称糖尿病为消渴病。分为上消、中消、下消三型，采用药膳治疗，有助于降低血糖及尿糖。
上消型以多饮为主，小便较多、色黄，咽干灼热，食量如常，舌红少津，苔黄而干。多采用生津止渴、清热润肺的方法调整。
中消型常以多食易饥为主，伴有口渴多饮、口苦、口臭、口干、小便频、大便干结。宜清胃泻火、养阴生津。
下消型以小便频多为主。一般采用滋阴补肾、清热降火的方法调理。糖尿病的主要症状是口渴多饮，多食而消瘦、多尿或尿浑浊。运用药物与药膳相结合的疗法，可取得令人满意的效果。
糖尿病患的饮食原则「三低一高」，也就是「低油、低盐、低糖、高纤维」，把握此一糖尿病饮食原则，让糖尿病患者既可品尝美食，又不增加身体负担。 以下药膳可根据患者所表现的症状酌情选用。
Diabetes & Herbal Foods
By Dr. Chong Fee Lan
Chinese physicians classify diabetes into three sectors, namely upper sector, middle sector and lower sector illness. Herbal medicines are normally prescribed to be combined with food for cooking. Their main role in cuisine is to keep the blood glucose level near to normal as much as possible.
Upper sector diabetes patient needs an extra fluid diet as he or she may have a strong urine flow but the colour tends to be very yellow. The throat is parched and tongue reddish. Food choice should be on ingredients that can ease the thirst and soothe lungs.
Middle sector diabetics require extra intake of meals. Frequency can increase but the portions should be small. The patients feel thirsty and have bitter taste in their mouths. Bad breath, parched mouths and constipations occur. Hard stool comes with difficult bowel movements. Some light herbal food can improve the general health.
Lower sector diabetes patients may have a constant urge to ease themselves and tend to be rather thin despite consuming a large amount of food. Herbs used can help to speed up the detoxification process and clear body heat.
Always ensure a diabetic diet has “three lows and one high”. It must be low in oil, salt and sugar but high in fibre intake. Recipes printed are suitable food as they tend to have some curative value.
Recipe 1
聪耳明目粥
Huai Shan Porridge
材料：
山药20克
兔丝子10克
覆盆子10克
枸杞子20克
良质米半杯
水1550毫升
Ingredients:
20g Huai Shan
10g Du Si Zi
10g raspberry
20g Kei Chi or medlar seeds
½ cup rice grains
1550ml water
做法Method:
1. 首先把白米及山药以1250毫升水熬成粥，再利用兔丝子和覆 盆子加入300毫升煮10分钟熬成高汤。
Boil rice grains, huai shan and 1250ml water to a porridge-like. Place du si zi and raspberry with 300ml water. Boil to a stock.
2. 将高汤去渣后加入煮得黏稠的粥中，盖上锅盖用大火煮到沸腾。
Add stock into porridge. Place pot lid on and turn to high heat. Bring it to a roaring boil.
3. 滚了以后改用小火，再添加枸杞子。
Turn to low heat, add in kei chi.
功效 Herbal properties:
长期的糖尿病常会造成视力退化，聪耳明目粥不但能明目，还具有壮阳补精，健脾益肾的功能，不但适合糖尿病患食用，也适合青少年补眼力。
Kei chi has been renowned for its vision improving properties. As kei chi are good for the eyes, young people who strain their eyes a lot can take this porridge.
Recipe 2
清蒸茶非洲鱼
Steamed Fish with Tea Leaves
材料：
非洲鱼500克（洗净）
绿茶适量
Ingredients:
1 tilapia or talapia fish (500g, cleaned)
Some brewed green tea
做法Method:
1. 将非洲鱼去鳃、内脏，洗净，腹内装满绿茶叶，放盘中，放上蒸锅清蒸，熟透即可。
Place rinsed fish on a platter. Pour green tea into cavity, Steam till fish is well-cooked. Consume this dish daily, eating only the flesh of the fish.
功效 Herbal properties:
补虚，止烦消渴，适用于糖尿病口渴，多饮不止以及热病伤阴。
It treats thirst caused by diabetes, expels heat in the body.
Recipe 3
土茯苓猪骨汤
Tu Fu Ling Soup
材料：
猪脊骨500克
土茯苓50克
水2000毫升
Ingredients:
500g pig’s back bones
50g Tu Fu Ling
2000ml water
做法Method:
1. 将猪脊骨加适量水熬成3碗，去骨及浮油，加入土茯苓，再煎至2碗即成，每日服一次，分两次服完。
Boil bones and water. Strain residue and oil contents. Add tu fu ling to strained solution. Bring to a boil, simmer till 2 bowls of solution remains. Divide into 2 portions. Drink once a day.
功效 Herbal properties:
健脾气，利水湿，补阴益髓。
Strengthens the spleen, has good diuretic effect.
