- Food exchange lists help in preventing both hypo and hyper glycemia.
- Diet is based on type of insulin intake
Table:Types of insulin and their action
| Type
|
Onset hours
|
Peak Action hours
|
Duration hours
|
- Rapid action-short duration- Regular soluble crystalline semi lente
|
½
½
|
2-4
2-4
|
6-8
10-12
|
- Intermediate action and duration lente NPH (neutral Protamine Hagedom)
|
2
2
|
6-12
6-12
|
18-24
18-24
|
- Delayed action-Prolonged duration- Protamine Zinc Insulin (PZI) Ultralente
|
4-8
4-8
|
14-20
16-18
|
24-36
18-24
|
- The action of insulin and the peak absorption of carbohydrate should be at the same time.
Insulin and meal distribution of calories
| Type of insulin
|
Breakfast
|
Noon
|
Mid AN
|
Evening
|
Bed time
|
| None
|
1/3
|
1/3
|
|
1/3
|
|
| Short acting
|
2/5
|
1/5
|
|
2/5
|
|
| Intermediate
|
1/7
|
2/7
|
1/7
|
2/7
|
1/7
|
| Acting NPH Long acting
|
1/5
|
2/5
|
|
2/5
|
80-160 kcal
|
| Long acting with regular insulin at BF
|
1/3
|
1/3
|
|
1/3
|
|
- Carbohydrate: High carbohydrate and high fibre diet improves monocyte insulin receptor binding capacity, 60-65% total calories.
- Proteins: A diet high in protein (20% of k cal). Requirement for adults is 1gm/kg body weight and for children 1-1.5g/kg body weight
- Fat: 15-25% of total calories from PUFA
Vitamins and minerals:
- Needed to overcome oxidative stress and deficiency
- Vitamin C, vitamin E, magnesium and zinc are needed
- Normal requirement of calcium
- Vitamin D deficiency contributes to Impaired Glucose Tolerance
- Chromium supplementation reduces insulin dose
Dietary fibre: About 25-50g of dietary fibre and complex carbohydrate for type I and II diabetes.
- Decreases insulin requirements
- Increases peripheral tissue insulin sensitivity
- Decreases serum cholesterol and triglycerides
- Aids in weight control
- Decreases blood pressure.
Artificial Sweeteners: Sugar substitutes, non caloric and high intense sweetners.
Ideal sweetener:
- Pleasant taste with no after taste
- Sweet as sucrose
- Colourless, odourless
- Readily soluble, stable
- Nontoxic, does not promote dental cavities
- Functional and economically feasible
- Without metabolic abnormalities
Low calorie sweeteners
- Polyols: 2.4 k cal/ g, synthesized from carbohydrate like starch, sucrose, glucose, invert sugar, xylose, sugar alcohols xylitol, sorbitol, mannitol, maltitol, lactitol etc 40-50g/day for adults and 30 g/day for children.
Non-calorie sweeteners
- Cyclamate: 30 times sweeter than sucrose, heat stable.
- Acelsulfame-K: Synthetic derivative of acetoacetic acid, non digestive, after taste, high concentration has metallic flavour, 200 times sweeter than 3% sucrose heat stable.
- Alitame: Di peptide based amide, 2000 times sweeter than sucrose.
- Aspartame: Made of aspartic acid and phenylalanine 180- 200 times sweeter than sucrose. Not heat stable.
- Saccharin: Sodium ortho benzene sulphonamide, stable, 300 times sweeter than sucrose.
- Sucralose: 600 times sweeter than sucrose easily soluble in water, stable
- Oral hypoglycaemic drugs: Sulphonylureas, biguanides
|
Participants