
pramehathil bhakshanakramam

pramehamullavaro uyarnna rakthathile panchasaarayo ullavaro rakthathile panchasaarayude deerghakaala uyarchayude lakshanangalum apakadakaramaaya sankeernathakalum kuraykkunnathinu upayogikkunna bhakshanamaanu prameha bhakshanakramam (athaayath.iii.: hridayasambandhamaaya asukhangal, vrukkasambandhamaaya rogangal, ponnatthadi).
american diabetis association (eiii. dii. eiii), diabetis yuke ennivayulppedeyulla maarganirddesha shupaarshakalil, oru prathyeka bhakshanakramam mattullavayekkaal mikachathaanennu samavaayamilla. eee vishayathil deerghakaala uyarnna nilavaaramulla padanangalude abhaavamaan ithinu kaaranam.
amithabharavum ponnathadiyumulla prameharogikalkku, eathoru bhakshanakramathinteyum ettavum pradhanappetta vasham athu shareerathile kozhuppu kuraykkaan kaaranamaakunnu ennathaanu. shareerathile kozhuppu kuraykkunnathu rakthathile glucose niyanthranam mechappeduthukayum insulin alavu kuraykkukayum cheiyumennu theliyikkappettittund.
bhakshanathil panchasarayum shudheekaricha carbohydrate kuravaayirikkanamennum, athesamayam bhakshana naarukal, prathyekichu layikkunna naarukal thaarathamyena kooduthalaayirikkanamennum ettavum yojicha shupaarsha. athupole, pramehamulla aalukale uyarnna glycemic soochika (jii) ulla carbohydrateukalude upabhogam kuraykkaan prothsaahippikkaamenkum eee shupaarshaykk kooduthal thelivukal aavasyamaanennu adaa, diabetis yuke enniva shradhikkunnu.
bhakshana ghadana.
general.
pramehamullavarkku avarkk ishtamulla eathu bhakshanavum kazhikkaam, munganana kurachu carbohydrateukallulla aarogyakaramaya bhakshanakramam, ennaal avar bhakshanangalile carbohydrate ulladakkathekkurichu kooduthal bodhavaanmaaraayirikkukayum jyoosukal, panchasaara madhuramulla paneeyangal thudangiya lalithamaaya panjasaarakal ozhivaakkukayum venam. insulin kuthivayppukale aasrayikkunna aalukalkk (type 1, type 2 prameharogikal), rakthathile panchasaarayude niyanthranam eluppamaakkunnathinu sthiramaaya alavil carbohydrate kazhikkunnath sahaayakaramaan.
macro neutriyantukal.
eathenkilum prathyeka macro nyootriyant ghadana adangiya bhakshanakramam kazhikkunnath sambandhicha samavayam innuvare undayittilla (athaayath.iii.: bhakshanathile kozhuppu, protein, carbohydrate ennivayude anupatham) prameharogikalkku kooduthal gunam cheyyum. ennirunnaalum, poshakaahaara gaveshanathinte swabhaavam kaaranam prameha bhakshanathekkurichulla gaveshanam parimithamaanu. eee sthalathe padanangal pareekshanaathmakamallaathum thaarathamyena hrasvamaaya dairkhyamullathum padanatthil pankedukkunnavarude bhakshanakramam divasathile ellah manikorukalilum deerghakaalathekku niyantrikkaan budhimuttullathinaal thaarathamyena mosham paalikkalumaan. athinaal, shupaarshakale kooduthal nirvachikkunnathin bhaviyil kooduthal valia thothilulla multy-sentar pareekshanangal aavasyamaanu.
carbohydrateukal.
panchasaara, annajam, naarukal enniva carbohydrateukalil ulppedunnu. eee bhakshanagal rakthathile panchasaarayude alavil ettavum valia swaadheenam cheluthunnu, kaaranam avaa kazhichukazhinjaal avaa panjasaarayaayi vibhajikkappedukayum pinneedu cherukudalil agiranam cheyyappedukayum cheiyunnu.
american diabetis association (eiii. dii. eiii) prameha bhakshanathinu oru prathyeka alavil carbohydrate upabhogam shupaarsha cheiyunnilla. plasma lipidukale prathikoolamaayi baadikkumennathinaal fructose oru adhika madhurapalahaaramaayi upayogikkaan shupaarsha cheiyunnilla. gluconiogenesis, glycogenolysis ennivayulppede vividha upapachayam prakriyakaliloode sareerathinu glucose nirmmikkaan kazhiyunnathinaal dainamdina bhakshana carbohydrateukalude kuranja alavu aavasyamilla. manushyante mettabolisathiloode samanvayippikkaan kazhiyaathathum athyaavasyavumaaya gadakangal adangiyirikkunnathinaal proteinteyum kozhuppinteyum kaaryatthilum ithu shariyalla.
prameharogikalumaayi bandhapetta bhakshanangalude glycemic soochikayeyum glycemic lodineyum adaa abhisambodhana cheiyunnu, pakshe klinikkal yoottility vyakthamallathathinaal avaa nirddishta shupaarshakal nalkaan visammathikkunnu. ennirunnaalum, ettavum puthiya cochrain chittayaya avalokanam ulppedeyulla mettaa vishakalanangal glycated haemoglobin eiii1sii (echbie1sii) alakkunnathupole kuranja glycemic soochika bhakshanakramam rakthathile glucose niyanthranathinu kaaranamakunnuvennum athupole hypoglycemic episodukal kuravaanennum kandethi.
fiber.
bhakshanathile naarukalude upabhogam gunam nalkum. dayattari fiber kazhikkunnath rakthathile panchasaarayude alavu niyantrikkaan sahaayikkumennathin chila thelivukalundu; ennirunnaalum, prameharogikalkku prameharogikalumaayi thaarathamyappeduthumbol fiber kazhikkunnathinu vyathyastha lakshyangalonnum adaa shupaarsha cheiyunnilla.
kozhuppukal.
prameharogikal divasena kazhikkenda motham kozhuppinte alavinekkurichu adaa oru prathyeka shupaarsha cheiyunnilla. carbohydrateukale kozhuppumayi maattisthaapicha uyarnna kozhuppu bhakshanagal kuranja kozhuppu bhakshanangalumayi thaarathamyappeduthumbol mechappetta glycemic niyanthranavum mechappetta raktha lipid profileukalum (echdl saandrata vardhippikkukayum triglycerideukal kuraykkukayum cheythu) kaanikkunnuvenn padanangal theliyichittundennu avar shradhikkunnu. trans faatsinte krithrima srothassukalulla ellah bhakshanangalum ozhivakkaan adaa shupaarsha cheiyunnu, ennaal maamsathilum paalilum swaabhaavikamaayi undaakunna cheria alavil trans phaatts aashankappedenda kaaryamallenn shradhikkuka.
collustroll.
eee samayat bhakshanathile collustroll kazhikkunnathinu adaykku prathyeka shupaarsha illa. bhakshanathile collustroll upabhogavum hridayasambandhamaaya rogangalum thammilulla oru kaaranaparamaaya bandham sthaapichittilla.
protein.
charitraparamaayi, prameham moolamulla vrukkarogamulla vyakthikalil protein upabhogathinte thoth sambandhichu aashankayundu; ennirunnaalum, kuranja protein bhakshanagal vrukkayude pravartthanam mechappeduthunnu ennathinu thelivukalonnumilla. pramehathaal undaakunna vrukkarogamulla vyakthikal oru sharashari vyakthiyude upabhogathekkaal kuranja protein upabhogam niyanthrikkendathunde thelivukalonnumilla.
prathyeka bhakshanakramangal.
kuranja carbohydrate bhakshanakramam.
type 1 prameharogikalkku, eee vishayathekkurichulla parimithamaaya patanam kaaranam kuranja carbohydrate bhakshanangalude upayogathekkurichu krithyamaaya thelivukalude abhaavamund. 2017 march vareyulla kanakkukal prakaram type 1 prameharogikalil kuranja carbohydrate bhakshanagal nadappaakkunnathinekkur vendathra padicha ombathu prabandhangal maathramaan aduthide nadatthiya oru mettaa vishakalanathil kandethiyathu. kuranja carbohydrate bhakshanagal insulin aavasyakatha sthiramaayi kurachuvenkilum rakthathile glucosinte alavil bhakshanathinte swaadheenavumaayi bandhappett asthiramaaya phalangal kandethiyathayi eee avalokanam kandethi. kuranja carbohydrate bhakshanangalil echu. bii. eiii 1 sii. yill ganyamaaya kuravundaakunnathaayi 3 padanangal kandethi, athesamayam 5 padanangal echu. bii. eiii 1 sii. alavu sthiramaanennu kandethi. eee avalokanavum adaa samavaaya prasthavana soochippikkunnathu kuranja carbohydrate bhakshanakramam type 1 prameharogikalkku gunam cheiyumennu, ennaal kooduthal thelivukalkku valia klinikkal pareekshanangal aavasyamaanu.
type 2 pramehathil kozhuppu kuranja bhakshanathekkaal kuranja carbohydrate bhakshanakramam glucose mettabolisatthinte alppam mikacha niyanthranam nalkunnu. pramehavum prediabetis ulla muthirnnavarkkulla poshakaahaara chikithsayekkurichulla 2019 leeii oru samavaaya reportil american diabetis association (eiii. dii. eiii) prasthaavikkunnath "pramehamulla vyakthikalkk mothatthilulla carbohydrate upabhogam kuraykkunnathu glycemia (rakthathile panchasaara) mechappeduthunnathinulla ettavum valia thelivukal theliyichittundu, koodaathe vyakthigatha aavasyangalum mungananakalum niravettunna vividha bhakshana reethikalil ithu prayogikkaam.", kuranjatho valare kuranjatho aaya carbohydrate bhakshanapadhathikal upayogichu mothatthilulla carbohydrate upabhogam kuraykkunnathu oru praayogika sameepanamaanennum ithu parayunnu.
type 2 pramehamulla aalukale sareerabhaaram kuraykkaan sahaayikkunnathin kuranja carbohydrate bhakshanagal upayogapradamaakumennu adaa parayunnu, ennaal eee bhakshanagal moshamaayi nirvachikkappettathum nilanirthaan prayasamullathum chila koottam aalukalkk anuyojyamallaathathum pothuve bhakshana gadanaykku anuyojyamallathathumaanu. mothatthil, pramehamulla aalukal "vyakthigatha macro neutriyantukal, micro neutriyantukal allengil otta bhakshanangalil shradha kendreekarikkunnathinum aarogyakaramaya bhakshana reethikal" vikasippikkaan adaa shupaarsha cheiyunnu. bhakshanathile carbohydrateukal pachakkarikal, payarvarggangal, pazhangal, paalulppannangal (paal, thairu), daanyangal ennivayil ninnu undaakanamenn avar shupaarsha cheiyunnu; uyarnna shudheekaricha bhakshanangalum panchasaara paaneeyangalum ozhivaakkanam.
sasyahaaram/sasyahaaram.
sasyahaaravum sasyahaaravum kazhikkunna bhakshanathinte tharatthilum bhakshanathinte macro neutriyant profile valareyadhikam vyathyaasamundengilum, avaa randum sasyangale adisthaanamaakkiyulla bhakshanangalayi kanakkakkappedunnathinaal shaasthreeya saahithyathinte pashchaathalatthil palappozhum orumichu cherkkappedunnu. pramehathil mattethoru bhakshanakramathinteyum swaadheenam pole, ettavum pradhanappetta ghadakam mothatthilulla kozhuppu pindam nashtappedunnathaanu. saadhaarana american bhakshanakramavumaayi thaarathamyappeduthumbol sasyahaaravum sasyahaaravum sareerabhaaram kuraykkaan gunam cheiyumennu theliyikkappettittund. type 2 prameharogikalkku, sasyaahaaramo sasyaahaaramo aaya bhakshanakramatthinte shradha kozhuppu kuraykkunnathinum mathiyaya protein upabhogathinum mruga uthppannangalil ettavum jaiva labhyamaya samyukthangalude mathiyaya upabhogathinum kaaranamakunna kalori upabhogathinte alavu nilanirthunnathaayirikkanam (athaayath.iii. vitaamin bii-12, irumbu, kriyetteen), glycemic soochika kurravulla muzhuvan bhakshya carbohydrate srothassukal.
nannayi roopappeduthiya sasyahara, sasyahara bhakshanagal ellah praayathilumulla aalukalkkum aarogyakaravum poshakasamriddhavumaanennu akkadami oof nutrition aandu dietetics abhipraayappedunnu. pramehathinu sasyaahaaramo sasyaahaaramo upayogikkunnathinu saahithyathil anischithamaaya phalangal undaayittundennu american diabetis association abhipraayappedunnu. rund mettaa vishakalanangal echu. bii. eiii1siyil cheria mechappeduthalukal kaanichu; athesamayam, randil onnu bhakshanakramam sareerabhaaram kuraykkaanum hridayasambandhamaaya apakadasaadhyatha gadakangal mechappeduthaanum kaaranamaayathaayi kandethi.
kuranja glycemic soochika bhakshanakramam.
oraalude bhakshanathile glycemic soochika kuraykkunnathu pramehatthinte niyanthranam mechappeduthum. chila reethikalil pakam cheytha urulakkizhangu polulla bhakshanagal ozhivaakkunnath ithil ulppedunnu (athaayath.iii.: vevichathum porichathumaaya urulakkizhangu varuthathinekkaal uyarnna jii aanu) velutha bread. kuranja glycemic soochika carbohydrate srothassukalil pachakkarikal, payarvarggangal, uyarnna naarukal adangiya daanyangal enniva ulppedunnu, avaa samskaricha carbohydrateukalekkaal pathukke rakthapravaahathilekk agiranam cheyyappedukayum agiranam cheyyappedukayum cheiyunnu.
uyarnna naarukalulla bhakshanakramam.
amerikkakkaarude bhakshana maarganirddeshangalkku anusrithamaayi fiber upabhogathinte alavu (1,000 kiloo caloric kuranjathu 14 gram fiber) adaa shupaarsha cheiyunnu. ennirunnaalum, uyarnna alavil kazhikkunnath (50 gram narum athil kooduthalum dainamdina upabhogam) rakthathile panchasaarayude alavil cheria mechappeduthalukalkku kaaranamaakumennathin chila thelivukalundu. amithamaayi kazhikkunnath vaayusanjaaram, veekkam, vayarilakkam thudangiya dahana prashnangalkk kaaranamaakumenn adaa munnariyipp nalkunnu."
bhakshanathinte samayam.
prameharogikalkku aarogyakaramaya bhakshanam kazhikkunnath oraal enthaanu kazhikkunnath ennathine mathramalla, oraal eppol kazhikkunnu ennathinekkurichum koodiyaanu. insulin ashrita prameharogikalkku, avar bhakshanam kazhikkunnath avarude rakthathile panchasaarayude alavineyum avar edukkunna insulin tharatheyum aasrayichirikkunnu (athaayath.iii.: deergha, idatharam allengil vegathil pravartthikkunna insulin). rogikal urakkasamayath avarude rakthathile glucose parishodhichu athu kuravaanennu kandethukayaanengil, udaaharanathinu littarin 6 millimolukalkku thaazhe (108 milligram/dii. ell), rathrikaala hypoglycemia thadayunnathinu urangaan pookunnathinu munbu deerghaneram pravartthikkunna kurachu carbohydrate kazhikkunnath nallathaanu. raathriyile vearp, thalavedana, aswasthamaaya urakkam, pediswapnangal enniva raathriyile hypoglycemy lakshanamakaam, ithu anganeyaanennu kandethiyaal rogikal avarude insulin dinacharyayil krameekaranangalkkayi doctore sameepikkanam. raathriyile hypoglycemy mattoru saadhyamaaya adayaalam prabhatha hyper glycemiayaanu, ithu yadhaarthathil raathriyil rakthathile panchasaarayude alavu valare kurayunnathinodu prathikarikkunnathinaan sambhavikkunnath. ithine somogi prabhavam ennu vilikkunnu.
type 2 pramehavumaayi bandhappett, divasathil neratthe mikka bhakshanangalum kazhikkunnath amithabhaarathinteyum ponnathadiyudeyum alavu kurayunnathumaayum type 2 prameham varaanulla saadhyatha kuraykkunna mattu gadakangalumaayum bandhappettirikkam. rakthathile panchasaarayude niyanthranatthil edavittulla upavaasathinte prayojanam niravadhi padanangal kaanichittundennu adhaa parayunnu. ennirunnaalum, eee padanangal thaarathamyena cheruthum hrasvamaaya kaalayalavullathumaayirunnu, kooduthal patanam aavasyamundu. padanangaliludaneelamulla thaarathamyangal kooduthal budhimuttaakkunna upavaasathin vyathyastha protocolukalum undaayirunnu.
prathyeka prameha bhakshana uthppannangal.
pramehamullavarkkayi prathyekamaayi nirmmicha uthppannangal vaangunnathinethire prameha yuke munnariyipp nalkiyittundu, kaaranam
naise (yunaittad kingdatthile naashanal instittyoott phoor health aandu klinikkal exalance) doctormare mattu aarogya professionalukaleyum "pramehamullavarkkayi prathyekamaayi vipananam cheiyunna bhakshanangalude upayogam niruthsaahappeduthaan" upadeshikkunnu.
madyam.
amerikkakkaarude bhakshana maargganirddeshangal shupaarsha cheiyunnathupole pramehamullavar madya upabhogam parimithappedutthanamennu adaa shupaarsha cheiyunnu (sthreekalkku prathidinam oru paaneeyavum purushanmaarkk prathidinam rund paaneeyangalum vare). eee alavil kooduthal madyam kazhikkunnath rakthathile panchasaarayude alavu uyaran idayaakkum. madyam kazhikkunnath prameharogikalkku hypoglycemiaykkula saadhyatha vardhippikkunnu. gluconiogenesis thadayal, madyathinte cerebral efakttukal kaaranam hypoglycemia avabodham kurayal, koodaathe/allengil hypoglycemiayodulla prathirodha prathikaranangal enniva ithinu kaaranamaayirikkaamenn adaa parayunnu.insulin allengil mattu aanti-hyper glycemics kazhikkunna prameharogikalkku raathrikaalathino upavaasa hypoglycemiayko ithu saadhyathayund. madyathodoppam bhakshanam kazhikkunnath hypoglycemiaykkula saadhyatha kuraykkunnu.
charithram.
pramehathinu bhakshanakramathil chikitsa nalkunnathinu oru neenda charithramund. bii. sii. 3,500 muthal eejiptil diabetis mellitus chikitsa upayogichirunna ithu 2000 varshangalkk munbu indiayil sushruthayum carakayum upayogichirunnu. pathinettaam noottaandil, kalori niyanthranam pramehathile glycosuria kuraykkaan kazhiyumennu joonn rollo vaadichu.
prameha bhakshanathinte kooduthal aadhunika charithram aarambhikkunnath frederic maadisan aalan, eliot joslin ennivaril ninnayirikkaam, irupathaam noottaandinte thudakkathil, insulin kandethunnathinumbu, pramehamullavar kuranja calorie eathaandu poojyamaaya carbohydrate maathram kazhikkanamennu shupaarsha cheythu. eee sameepanathin parimithamaaya kaalayalavilekku ayuss vardhippikkaan kazhiyumenkilum, rogikalkku mattu palatharam medical prasnangal vikasichu.
1922ll frederic banting insulin avatharippichathu rogikalkku avarude bhakshanathil kooduthal vazhakkam nalki.
exchange skeem.
1950kalil american diabetis association yuu. esum chernnu.ezz. pothujanaarogya sevanam "exchange skeem" avatharippichu. ithu samanamaaya poshakaahaara moolyamulla bhakshanagal maattaan aalukale anuvadichu (udha.jii., carbohydrate) mattonnin. udaaharanathinu, madhurapalahaarathinu saadhaarana carbohydratinekkaal kooduthal kazhikkaan aagrahikkunnuvenkil, oraalkk aadyaghattathil thanne urulakkizhangu kuraykkaan kazhiyum. 1976, 1986, 1995 varshangalil exchange skeem parishkarichu.
pinneedulla sambhavavikasangal.
innu ellah diabetis dieticianmaarum exchange skeem shupaarsha cheiyunnilla. pakaram, avar oru saadhaarana aarogyakaramaya bhakshanakramam shupaarsha cheyyaan saadhyathayunda fiber kooduthalullathum, vaividhyamaarnna pazhangalum pachakkarikalum, panchasarayum kozhuppum, prathyekichu pooritha kozhuppum kuravullathum.
sasya naarukal kooduthalulla bhakshanakramam jaims aandezhsan shupaarsha cheythu. dayattari fiberil denis burkit, hugg troval ennivayude pravartthanatthinte thudarchayaayi ithu manassilakkaam, ithu vilayude pravartthanatthinte thudarchayaayi manassilakkaam. pramehamullavar bhakshanathile naarukal kooduthalulla bhakshanakramam kazhikkanamennu ippozhum shupaarsha cheyyappedunnu.
1976ll, rogikale bhakshanakramathilum vyaayaamathilum (pridikin prograam) earppeduthunna oru kendram nathan pridikin thurannu. eee bhakshanathil carbohydrate naarukalum, puthiya pazhangal, pachakkarikal, daanyangal enniva kooduthalaanu. 2005ll yuu. sii. ell. eiii. yill nadatthiya oru padanatthil, moonnaazhchaykkullil pramehamo pree-diabeteso ulla oru koottam aalukalkk ithu naadakeeyamaaya purogathi konduvannathayi kaanichu, athinaal pakuthiyolam perr rogathinte maanadandangal palikkunnilla.

