By : Dr. ATIULLAH KHAN

Managing diabetes by healthy diet

To prevent complications of diabetesTo prevent complications of diabetesby keeping control of:

Blood glucoseCholesterol Blood pressure

Can Lead To:

Heart Attack Kidney Diseases Nerve Damage Eye Disease

A healthy diet may include changing what one eats, in what quantities, and how often.

Controlling body weight Keeping the level of blood-sugar at a normal level Reducing fat in the body

To improve your healthTo improve your healthby making healthy food choicesand being physically active

SO, RECOMMENDED DIET FOR DIABETIC PATIENTS?

HIGH CARBOHYDRATE OR HIGH FAT

Eat starchy foods regularly Eat more fruit and vegetables Reduce animal or saturated fat Cut down on sugar Reduce salt

Hyperglycemia Hypoglycemia• When controlling diabetes, blood sugar can become too high or too low.

These conditions should be taken seriously. Fortunately, one can easily re-establish control of blood sugar.

• When there is too much sugar in the blood, this condition is called hyperglycemia. Hyper is Latin and means "more." Glycemia is also Latin and means "sugar in the blood."

• Hyperglycemia is caused by eating too much food, eating sugary foods, or by not taking one’s medication. It can also occur when one is sick. If not treated, hyperglycemia can lead to a coma.

• Hypoglycemia occurs when too little sugar is present in the blood. Hypo is Latin and means "less."

• Hypoglycemia usually occurs with patients who take insulin or other medications.

• Taking too much insulin can cause it. That is why it is also known as insulin shock.

• Hypoglycemia can also be caused when the food intake is reduced or a meal is skipped. . Signs of low blood sugar, or hypoglycemia .

Hyperglycemia Hypoglycemia

Include foods containing carbohydrate from whole grains, fruits, vegetables and low-fat milk in your diet

The amount of carbohydrate at a meal affects your blood glucose more

than the typeSugar and starch have similar effects on

blood glucose

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Consistency in carbohydrate intake is important from day to dayFor people not taking diabetes medicationFor people taking a fixed dose of insulin

Insulin should be adjusted based on amount of carbohydrate at mealsFor people on varying doses at meal

times

Several things affect how much your blood glucose increases after you eat:amount of carbohydrate type of sugar or starchcooking and food processing food formother foods in the meal that slow digestion

Limited amounts of sugar or foods containing sugar can be used without affecting blood glucosewhen substituted for other carbohydrates at

the meal Large amounts of sugar-containing

foods are not recommended

Usual diet: 45 Usual diet: 45 grams grams carbohydrate carbohydrate (or 3 Carbohydrates (or 3 Carbohydrates Choices)Choices)

1 slice bread1/3 cup rice1/2 cup fruit3 ounces chickenVegetable salad

Substitute ice-Substitute ice-cream for 15 cream for 15 grams of grams of carbohydrate carbohydrate (or 1 (or 1 Carbohydrate Choice)Carbohydrate Choice)

1/2 cup ice-cream1/3 cup rice 1/2 cup fruit3 ounces chickenVegetable salad

To observe effect of new food on blood To observe effect of new food on blood glucose:glucose:

check blood glucose 2 hours after meal for several days

substitute food containing sugar for other carbohydrate in meal

check blood glucose 2 hours after meal and compare

Sugar alcohols (polyols):sorbitol, mannitol, xylitol Used as sweeteners and bulking agents Safe to use May cause diarrhea, especially in

childrenFructose: Not recommended as a sweetener

Cans of soda (maximum/day)

Packets x\\\\\\\\\\\\

25 18 Aspartame 15 86 Saccharin 2 7.5 Sucralose 4.5 60

Fiber: Fiber is encouraged for everyone: 20-35 grams/day Good sources of fiber:

Whole grain cerealsFruitsVegetablesBeans and peas

Fiber: Only large amounts (50 grams/day)

have shown improvement in blood glucose and cholesterolPrimarily soluble fiber (barley, oatmeal,

beans, apples, broccoli)Side effects make this difficult for many

people

Medical Nutrition Management is the corner stone in management of a person with diabetes. Diet plays a major role in regulating carbohydrate, Fat ,protein in patients with diabetes . Further more proper dietary management is required for safe & effective use of insulin .

1) Achieve and maintain – blood glucose level in the normal range or as close to normal as is safely possible ; lipid & lipoprotein profile that reduce the risk of vascular disease ; blood pressure levels in the normal range or as close to normal as is safely possible .

2) To prevent or at least slow the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle.

3) To address individual nutrition needs .4) To maintain the pleasure of eating by only

limiting food choices when indicates by scientific evidence.

Calories ---- Caloric requirements of adults ---obese

or very inactive adults , chronic dieters (20 kcal/kg).

Adults older than 55years of age , active women, sedentary men ( 28 kcal/kg ).

Active men or very active women ( 30 kcal/kg).

Thin or very active men ( 40 kcal/kg).

1000 kcal + Age * 100 kcal for girls.1000 kcal + Age * 125 kcal for boys.

*( From Raghuram TC et al; Diet and Diabetes,NIN,1991)

Carbohydrate should provide 50-60% of energy intake .Generally in Indian diet CHO provide 60-65% of total calories . Diabetics need to restrict CHO intake and can alter the type of CHO in their diet. Unrefined CHO , with natural fiber intact is beneficial coz of there low glycaemic index.

The adult recommended dietary intake ( RDI ) of 0.8 to 1gm /kg IBW.,or 10-15% .

Protein of high biologic value should be given consideration .

Fats are concentrated source of energy .Fat intake generally should not exceed 30% of energy. Excessive fat intake contribute to obesity , insulin resistance, hypertension & atherosclerotic cardiovascular disease .

Different carbohydrates raise blood sugar level…It is there important to know ,while recommending a diet for diabetic, to what extent different foods raise the blood sugar levels. The glycaemic index indicates the extent of rise in blood sugar in response to consumption of food in comparison with the response to an equivalent amount of glucose .

Area under the 2 hour blood glucose response curve(AUC)following the ingestion of a fixed portion of test carbohydrate (50g) as a proportion of the standard either glucose or white bread.

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Protein has very little effect on blood glucose

Avoid large amounts of proteinmay promote kidney disease

Restrict protein only if you have early kidney disease

Protein does not slow the absorption of carbohydrateAdding protein to snacks does not help

prevent hypoglycemia Fruits are good snack foods

Safety of high protein, low carbohydrate weight loss diets are unknowndo not promote long-term weight lossmay increase LDL cholesterol

Primary goal - Lower LDL Primary goal - Lower LDL cholesterol by:cholesterol by:Eating less saturated fat and cholesterol

Eating less trans fats

Foods That Contain Saturated Fats: Meat and meat fats (bacon, lard) Dairy products (whole milk, butter, cheese, cream, ice-cream) Palm and coconut oil Baked goods made from these fats

Foods That Contain Trans Fats: Formed when a liquid oil is made more

solid Found in many types of stick margarine,

fast foods, and baked goods like cookies, crackers, snack foods, pastries and croissants

Foods That Contain Cholesterol: All animal foods Organ meats like liver Egg yolks

Choose monounsaturated fat in place of Choose monounsaturated fat in place of saturated:saturated: olive oil, canola oil, peanut oil, olive oil, canola oil, peanut oil, olives, avocados, nutsolives, avocados, nuts

Eat less total fat Low-fat diets can help:

with weight loss improve cholesterol and other fats

Eat 2-3 servings fish per weekcontain a type of fat protective against

heart disease fatty fish especially beneficial

Permissible Foods1-Green leafy vegetables2-Seasonal vegetables3-Soups4-Dairy products(Skimmed)5-Fruits—Apple, guava, pear, papaya.6-All Pulses -Husked

Non Permissible Foods

1-Sugar , jaggery , honey.2-Potato, beetroot , arvi, sweet potato3-Fried,canned foods, processed foods4-Soft drinks, ice creams, fruit juice

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Vitamins and minerals from foods important

High doses of vitamin and mineral supplements can be toxic

People who may benefit from a multivitamin People who may benefit from a multivitamin supplement:supplement:

persons deficient in a vitamin or mineral elderly pregnant or nursing mothers strict vegetarians persons on calorie-restricted diet

A small amount of weight loss can:A small amount of weight loss can: improve insulin resistance lower blood glucose improve blood cholesterol reduce blood pressure

No clear benefit from vitamin and mineral supplements exceptcalcium for prevention of bone disease folate for prevention of birth defects

Use of antioxidants is not advisedvitamin C, E, selenium, beta carotene long-term safety and effectiveness unknown

Alcohol ideally should be avoided, If you choose to drink, limit to:

1 drink/day for women2 drinks/day for men

To reduce risk of hypoglycemia, should not consume alcohol with food

You can lower blood pressure by:You can lower blood pressure by: Eating less salt Losing a modest amount of weight

The Bottom Line Your lifestyle affects your healthYour lifestyle affects your health

Biblography: ADA 2014-2015 Harisson medicine textbook 19/e 2409 Joslins textbook of diabetes mellitus pg

no.614 Parks textbook of community medicine 23/e IAP textbook of medicine RSSD textbook of diabetes mellitus pg.405