Normal and Therapeutic Nutrition

Normal and Therapeutic Nutrition 3(2+1)

Lesson 30:Diabetes – Dietary management

Dietary Guidelines

• Energy intake is based on age, sex, actual weight in relation to desirable weight, activity and occupation
• For children
  Boys: basal requirements 1000kcal+125k cal x in no of years
  Boys: basal requirements 1000kcal+100k cal x no of years
• should maintain 10% of ideal body weight in
  Broka's index = Height in cm - 100 = Ideal body weight in kg
• Energy needs 20 k cal/kg- overweight,
  30 k cal/kg- Normal
  40 k cal/kg- underweight
• Distribution of calories for each meal if no insulin is given:

Breakfast & Midmorning	33%
Lunch & Tea	33%
Dinner & Before going to bed	33%

• Avoid simple sugars and junk foods, insulin based on need, calorie based on insulin
• Include low GI food
• Mixture of oils
• High protein and water soluble fibre-hypoglycemic
• Timely intake in between meals to avoid hypoglycemic stress
• Use food exchange lists
• Avoid fasting and feasting
• Include hypoglycemic foods like fenugreek
• Sodium greater than 6g/day and 3 g/ hypertensive diabetics
• Include whole wheat instead of rice- acarbose
• Diet should meet the needs of antioxidants, micronutrients and phytochemicals
• Supplement vitamins and minerals if needed.
• Starch encased in its seed coat or coarsely ground is not efficiently hydrolysed to glucose because digestive enzymes are prevented from reaching the starch
• Starch granules subjected to moist heat and subsequent cooling become dense and less available to enzyme action. Retrograded starch has low glycemic index.
• Rice bran, which is rich in fibre and oil has low glycemic index.
• High amylase rice varieties which are slowly digested are potentially useful in low glycaemic diets.
• Chapathis, which need chewing have lower glycemic index compared to wheat ‘kanjee’.
• Raw food has lower glycemic index than cooked food.
• Foods rich in fat and protein have low glycemic index
• Phytic acid present in whole grains decrease GI
• Natural food has low glycemic index compared to processed foods.
• The GI for fructose is low (23) compared to lactose (46), sucrose (65) or glucose (97). Fructose produces lower risk of blood sugar than glucose. In view of its effect on serum lipid, it can be taken only in moderation.

In general high-fibre foods with low glycemic indices (e.g., beans, vegetables, whole fruit and whole grains) are the preferred forms of carbohydrate in a defensive nutrition plan. Meal combination is also an important factor in managing blood glucose levels. Combining protein, fat and carbohydrate at meals and snacks i.e., small serving of nuts and a piece of fruit, can lead to better control of blood glucose levels and less insulin release than meals or snacks that consist mainly of carbohydrate like bread and jam.

Soluble dietary fibre combined with lower glycemic index food is good for diabetics. While planning diets glycemic load that is the amount of carbohydrate derived from the food is also considered.

Glycemic load is also important. Carrots have high glycemic index. The amount of carbohydrate is so low in a carrot that eating a carrot will have little effect on blood glucose or insulin concentrations which has low glycemic load. Glycemic index is more important when the total carbohydrate content of the diet is high.

Foods to be avoided	Eaten in Moderation	Foods permitted
Simple sugars (glucose, honey, syrup, dried fruits, cake, candy, fried foods, alcohol, nuts, jaggery, sweetened juices).	Fats, cereals, pulses, meat, egg, nuts, roots, fruits, artificial sweetener.	Green leafy vegetables, fruits except banana, lemon, clear soups, onion, mint, spices, salads, plain coffee or tea, skimmed and butter milk, spices.

Myths and Facts

Myths	Facts
Diabetics can eat wheat but not rice Any amount of wheat can be consumed. Fasting can be compensated by the next meal. Feasting can be done by fasting the next meal. Diabetic diet is a special diet. Fruits can be eaten in unlimited quantities. Vegetables can be eaten in unlimited quantities. Liquids are easily digestible.	Both have similar glycemic index and raise the blood sugar to a similar extent. Many diabetics feel it convenient to count and limit the number of chapathis and chew count is more and satiety is better. Wheat is more nutritious as it is richer in protein, fibre, and B-vitamins. Large quantities of wheat increases blood sugar. Fasting can lead to hypoglycemia. It is dangerous particularly who are on oral medicines or insulin. This results in hyperglycemia. This is a normal diet eaten regularly in moderation avoiding certain foods. Citrus fruits and apples can be taken. Banana and mango are high in fructose when eaten in unlimited quantities cholesterol levels may increase. If eaten raw or with little fat or no coconut. Preparations like kanjee are not preferred as they have high GI. Chapathis/rotis are preferred.
Fruit juices/cola drinks can be taken. Bitter foods like fenugreek and bitter gourd are good. Sugar is to be totally avoided. Avoid carbohydrates and fats	It is better to avoid empty calories like cola drinks. It is better to eat the fruit as such as glycemic index and nutritive value better. Fenugreek seed (not leaves) to be taken 25g/day to have an impact. This may not apply to all other bitter foods. Sweets where concentrated sugar and fat are used like mysorepak are avoided totally. Permitted levels of 10g of sucrose can be taken. Artificial sweeteners can be added in coffee and tea like aspartame. Best is to appreciate bitterness in tea or coffee. Take good carbohydrates and good fats saturated fats trans-fatty acids unsaturated fatty acids complex carbohydrates