Dietary Management for Diabetics

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Eating healthy food is one of the most basic and important tools of diabetes management. The right food choices can help to control blood sugar and promotes good health. There are several methods of planning meals for improved diabetes control. Every person with diabetes should have a personal meal plan developed by a dietitian or a qualified professional.Why is diet so important for a diabetic?

For overweight or obese people, extra body fat makes it harder for people with type- II diabetics to make and use of their own insulin. Following a reduced calorie meal plan to lose weight is the best way for over weight people with type-II diabetes to control of their blood sugar.

Diabetic medicines must be balanced with the type, timing and amount of food eaten. Therefore, meal planning is very important for people who take insulin or diabetes pills.

High blood pressure is more common in people with diabetes. A diet plan to lose excess weight and reduce salt intake is an important part of the plan to control blood pressure.

Diabetes increases the risk of heart and blood vessel diseases. This risk can be reduced by keeping blood cholesterol, near normal. Avoiding animal fat reduces high cholesterol levels.

High fiber foods such as dried beans and peas, fresh fruits and vegetables, whole grains can help to lower blood sugar and blood cholesterol levels.

Many high sugar foods raise your blood sugar level quickly. They provide few of vitamins and minerals the body needs. For this reason, food with large amounts of added sugar is not a healthy food choice.

Diabetes does not change the need of vitamins, minerals and other nutrients. Choosing foods that help to control diabetes, blood pressure, blood fats, and weight, also help to improve over all health and energy.

What Is Food Made Up Of?

It is important to understand the components of food, and their functions for its balanced intake. Our food has one or more of the following components:

1. Carbohydrates
2. Proteins
3. Fats
4. Fiber
5. Vitamins
6. Minerals and
7. Water

Carbohydrates

Carbohydrates are starches and sugars. These are found in cereals, potatoes, starchy root vegetables, pulses such as peas, beans, and sugars etc. No matter in what form carbohydrates are taken, the body converts them all into glucose.

The glucose is used by our body;

(i) To produce energy or calories
(ii) To make amino acids (Proteins)
(iii) To convert a part into fatty acids (Fats)
(iv) To convert into glycogen, and then it is stored in liver and muscles for need in emergency.

It is misleading to assume that only fatty food can make a person fat. It is excess of total food intake that matters.

In previous decades, carbohydrates were considered to be fattening and generally unimportant. The emphasis was more on proteins as health giving foods. The modern view is that carbohydrates are an essential part of a balanced diet as it is easier to digest them. For a balanced diet more than half of our total energy requirement (55 percent) should come from carbohydrates, about one third (30 percent) from fats and the remaining 15 percent from proteins. Fats and proteins should be taken not for energy, but for such functions as only these can perform.

The accepted pyramid of healthy food now looks like as under:

15% Protein
30% Fats
55% Carbohydrates

Our diet consists mainly of carbohydrates. One gram of carbohydrate provides 4 calories of energy. Generally, in Indian diet, carbohydrate provides 60-70 % of total calories.

Diabetics need not restrict the carbohydrate intake, but they can alter the type of carbohydrate in their diet. Whole cereals and pulses contain complex carbohydrates, which are broken down into simple sugars before they are absorbed from the intestines. On the other hand sugar honey, jaggery and jam contain simple sugars which are directly absorbed. They are referred to as refined carbohydrates and are not recommended for diabetics as they cause a rapid rise in blood sugar.

Sugars present in fruit and milk raise the blood sugar at a slightly slower rate. Fruits can be taken m the right quantity. It is recommended that a diabetic may derive 60 to 70% calories from carbohydrates of the desirable kind.

Distribution of Carbohydrates in Diet

Since the blood sugar level depends mainly on the intake of carbohydrates, it is important to distribute the intake of carbohydrates in accordance with daily needs.

The total amount of carbohydrates can be conveniently divided into four to five equal parts. One- third (33%) of diet is served during lunch and another one-third (33%) during dinner. Of the remaining one-third, 25% is served during breakfast and the rest 8% during evening at bed time. For insulin dependent diabetics, it may be necessary to give additional carbohydrates before the patient goes to sleep to prevent hypoglycemia, if the patient is on slow acting insulin. Individuals who take a heavy breakfast and dinner, and only snacks during lunch, must modify the dietary guidelines accordingly.

Distribution of carbohydrates in the food should be tailor made to individual habit.

Proteins

The proteins we eat are broken down by digestion into amino acids. Amino acids are of about 20 different types. Most of them are made with in the body from carbohydrates and fats. But eight of these are called essential amino acids which can not be made within system. Their deficiency can cause health problems. The main reason we need protein in our diet is to supply the essential amino acids.

Protein in the Diet

Protein is essential for most of the body’s vital functions, including growth, maintenance and repair of cells.

But eating too much protein is counter productive as the body can not store it for later use. Instead the liver converts excess protein into glucose and by-products such as uric acid which has to be excreted or else can cause inflammation and pain in the joints.

Too much protein thus puts a strain on the liver and kidney. It also leads to the production of acidic urine which in turn leads to an increased loss of calcium from the bones leading to osteoporosis and arthritis.

Source of Protein

Protein is obtained from plant sources such as cereals, pulses, and nuts and animal source as milk and butter milk for vegetarians.

Fats

The chief benefits of fats are:
(1) Rich source of calories for energy
(2) Provide fat soluble vitamins (A, D, E and K) and help in their absorption by the digestive system
(3) Supply essential fatty acids for regulating body functions and healthy skin
(4) Make food more palatable and tasty Do We Need Fat?

The answer is both yes and no. Let us try to understand the facts.

Fats are broken into fatty acids by our digestive system. These are of mainly two types,

Saturated fats rich in saturated fatty acids, such as ghee and butter etc, tend to be solid at room temperature.

Unsaturated fats rich in unsaturated fatty acids such as vegetable oils, tend to be liquid at room temperature.

The latest recommendation suggests combination of fats with low intake of saturated fats (10-20 percent) and high intake of unsaturated fats (80-90 percent).

Both the total quantity as well as the type of fat influence the serum lipids and could increase the risk of heart diseases. Since serum lipids are generally raised in diabetics, therefore, they have to be careful with the amount and nature of fat they consume. Diabetics can take 30 grams visible fat per day. Persons with high serum lipids or obesity should restrict their fat consumption particularly of saturated fats. Fats from vegetables sources are better than those from animal sources.

Cooking method is also significant. It is much healthier to cook by steaming or boiling at low temperature or grilling. Free radicals are produced by heating fats too much which can cause cancer.

Vitamins

Vitamins are not sources of energy by themselves. But they help in building up and breaking down activities, which are continuously going on in our body during metabolism. Hence very essential for our well being.

These are required in very small quantities, and it should not be difficult to get an adequate supply. But unfortunately it has become difficult because:

(i) These are lost during processing of food e.g. milling and polishing
(ii) These are lost by cooking the food i.e. washing and deep frying
(iii) Our diet may not include enough fresh green vegetables, fruits, dairy products, nuts grains and seeds.

Water Soluble Vitamins

Some vitamins are water soluble such as B-Complex and C. These are present in cereals, pulses, vegetables and fruits. These cannot be stored by the body and are washed out through urine. Adequate daily intake is important, but excess is waste of money.

Fat Soluble Vitamins

These are vitamins A, D, E and K are fat soluble vitamins. Wholesome, well balanced food with good cooking habits has vitamins to meet our normal need.

Diabetics during infections and other complications may require higher amount of vitamins and minerals through natural food sources.

Fiber

All plant foods contain some fibre such as the outer skin of cereals, pulses, beans, nuts and seeds, pectin in fruits, and cellulose in green leafy vegetables, cabbages etc. Fiber is not digested by the human body but nevertheless plays important role in the body’s food cycle. Fiber acts like a sponge, increases the stool bulk, making the stools softer and easier to expel, reducing constipation, piles and other bowl disorders. It reduces cholesterol and prevents colon cancer. It nourishes certain useful bacteria in the intestines. Non vegetarian diet is deficient in fibre content.

Types of fibres

Water insoluble fibre : Water insoluble fibre is the type of fibre that adds bulk to the diet and has a laxative effect on the digestive system. Sources are skin, peel and husk of fruits, vegetables and whole grains.

Water soluble fibre holds water and forms a gel. Sources are oats, barley, fenugreek and pectin. Fiber prevents excessive rise of blood glucose after meals thus resulting in lower drug/insulin requirements. Fiber substantially decreases plasma cholesterol and triglycendes which are usually high in most diabetics. So fibre provides protection to your heart. It is better to obtain fibre from a variety of plant foods.

Intake of 25 grams of dietary fibre per 1000 calories is considered to be optimum for a diabetic. High fiber foods have low caloric value and low glycaemic index and therefore diabetics should consume such foods liberally.

Due to its water holding capacity, fibre becomes bulky and gives a feeling of fullness. This correspondingly lowers the calorie intake and helps obese diabetics to lose weight.

How to increase fibre in your diet?

Eat a wide variety of vegetables, fruits, cereals, legumes on a regular basis. These should be eaten in natural form with strings and skin intact – like eating apples, sapotas, guavas with their skin on, cooking potatoes without peeling. Prefer whole gram and cereal over more processed and refined food, like consuming whole wheat flour instead of maida, whole wheat bread (brown) instead of refined bread ). Drink six to eight glasses of fluids each day to help your body use fibre effectively.

Minerals

The human body needs about 16 mineral’s for its proper functioning. Most of these are required in very small quantities. Some such as calcium, magnesium, sodium and potassium are required in comparatively larger quantities.

Trace minerals

Some of the trace minerals required are iodine, zinc, chromium, copper, manganese and selenium. Each of the trace minerals performs some vital role for which no substitute will do. A deficiency of any mineral will have harmful effect, and an excess of many can have adverse health consequences. Whole grains, seasonal fruits, dry fruits, nuts and sprouts of legumes, and dark green vegetables are rich in trace minerals.

Salt

Minimum salt is essential for health. However, diabetics are at an increase risk of developing high blood pressure and excess salt intake can aggravate this. Excess salt intake should therefore, be avoided-chutneys, papads, ketchup, salted butter, salted nuts, baked food, salted snacks and biscuits etc contains more salt.

The body can maintain its own mineral balance over for short periods. If the intake of minerals is low, it is drawn from stores present in the muscles, liver and even from the bones. The deficiency needs to be met by intake of balanced food.

Minerals are present in leafy vegetables, fruits, whole grain cereals, seeds, nuts and dairy products.

Water

Although water is not a nutrient, there would be no life without water. Human beings can survive for some weeks without food, but without water we would perish within days.

Around 60 percent of an adult’s body weight is water. An average adult needs to drink around three liters of water in a day.

Water is needed for digestion. It acts as a lubricant for eyes and joints. It is essential for regulation of body temperature. It helps in the elimination of waste products, and flushes out bladder and kidney infections.

Water should preferably be taken on empty stomach early morning, before half an hour intake of food but not along with food intake. One can drink after half an hour of food intake when thirsty. About 2/3 litres of water to be taken in a day. Foods to be avoided : Under usual circumstances avoid, sugar, glucose, jam, honey, syrup, chocolates, sweets like jalebi and gulab jamun etc.

Bakery items, containing sugars like cakes, pastries, biscuits, sweet bun, sweet bread, and any type of refined foods.

Soft drinks, pepsi, frooti, coke, ice creams, kulfi and milk shakes. Food exchanges:

You can eat different varieties of food every day. Choose from different types of cereals, fruits, vegetables, low fat diary foods and low fat proteins.

Eat more fibre :
Choose bran or whole grain chapattis instead of whole bread.
Eat edible skins and peels of fresh fruits and vegetables.

Use less salt:
Avoid foods prepared with large amount of added salt. Do not keep salt shaker on the table.

Eat less fat:
Avoid fried foods. Limit butter, ghee and salted dressing. Substitute skimmed milk, yogurt and other low fat diary foods.

Eat meals and snacks at regular times to balance medicines and control hunger.

Ask your doctor when to take your diabetics medicines in relation to meal times

Free food group :
The following foods contain very few calories and may be used freely in your meal plan.

Clear soups, thin buttermilk, unsweetened lime water and salads.

Eat the right amount of food :
If you have type -II diabetes and are over weight, get the help with a plan to eat right food. If you have type-1 diabetes eat the amount of food that satisfies your appetite and keeps your weight at a healthy level. Consult your doctor, dietician or diabetic educator or expert naturopath to reduce your insulin dose, food intake and physical activity.

Conclusion
Minor changes in the eating and cooking habits can lead to major changes in health.

What one eats not only affects our day-to-day health, but also determines how long one would live and the quality of life.

A vegetarian thali comprising two vegetables, dal, curd, salad, whole grain rotis, or unpolished rice is a wholesome well balanced food. All extra you need is some fruits, nuts and sprouts.

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