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What Is Diabetes?

  • Diabetes Overview
  • Risk Factors for Diabetes
  • Taking Action Against Dia…
  • How is diabetes treated?
  • Diabetes Treatments
  • Medications for type 2 di…

Diabetes Overview

  Diabetes is a disorder that affects the way the body uses food for energy. Normally, the sugar we take in is digested and broken down to a simple sugar,

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Risk Factors for Diabetes

There are many risk factors for type 2 diabetes. Some of them come from our family history and genetics and so are with us always, but some can be turned

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Taking Action Against Diabetes

When someone has any of the risk factors for diabetes, prediabetes testing is recommended. The main tests are the fasting plasma glucose test and the oral glucose tolerance test, although

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How is diabetes treated?

The major goal in treating diabetes is to minimize any elevation of blood sugar (glucose) without causing abnormally low levels of blood sugar.

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Diabetes Treatments

Diabetes is a complicated disease. It can affect many areas of your body as well as many areas of your life. Treatments for both type 1 and type 2 diabetes

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Medications for type 2 diabetes

t's important to remember that if a drug can provide more than one benefit (lower blood sugar and have a beneficial effect on cholesterol, for example), it should be preferred.

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Announcement : NIDAN a Medico Social NGO shall support the ADF for all its social activities unitedly. Gen secretary ADF and Chairman

NIDAAN


Our sister NGO

NIDAAN involved in medical and sociocultural activities in Upper Assam.

Members of ADF completed their earlier research projects and published their works in national and international journals. Celebrating world Diabetes Day every year and other health care activities in collaboration with NIDAAN.

Members of NIDAAN supported a research methodology workshop on 24th and 25th April in Dibrugarh.

Address:

Satsang Vihar Road, Seujpur

Dibrugarh - 786001

Meal Planning in Diabetes

The goals of Meal Planning are :

1.      To improve health through optimum nutrition

2.      To provide calories for reasonable body weight, normal growth and development

3.      To maintain glycemic control,

4.      To achieve optimal blood lipid (fat) levels.

5.      To minimize nutrition related chronic degenerative complications.

To achieve the above goals, judicious selection of food items is essential and is the primary step in the management of diabetes and by itself, along with optimum exercise, is sufficient to control blood glucose in those who have mild rise of blood sugar and type 2 diabetes. Persons who require insulin or oral pills to control blood glucose should never neglect meal planning, just because they are on blood glucose lowering medicines.

 

            In fact people with diabetes and normal body weight need not reduce the calories consumed in 24 hours. What they need to do is to take small frequent meals, to avoid foodstuff containing refined sugar and reduce fatty food and red meat and to consume sufficient quantities of rough cereals and vegetables to provide for adequate fiber and feeling of satisfaction from eating adequate food.

 

            If a diabetic person understands the basic principles of sensible eating, he can consume food which is very near to his family’s daily food and which does not require any special or separate preparation.

 

            All of us, including those having diabetes, require to consume well balanced food for promotion of growth in our formative years as well as for maintenance of our body functions and repair of wear and tear of our tissues. The objectives of meal planning should be : 1] to provide the required calories to create energy and to attain and maintain ideal bodyweight. 2] To plan a well balanced menu containing proteins, carbohydrates, fats, vitamins. Minerals and fiber in optimum quantities are also required by any person including a diabetic. Overweight people should purposely consume fewer calories than their daily requirement , so that extra deposits of visceral and subcutaneous fat can be  mobilized to bridge the gap between the required energy and that provided by the foodstuff. In this way the patient is able to loose extra weight and this helps in improving insulin sensitivity of his tissues. In other words, insulin ineffectiveness is corrected. About 90% of type 2 diabetic patients and 24% of adult population have Insulin Resistance. In this way tissues get “ extra mileage” out of Insulin, externally administered as well as endogenous insulin.

 

What is a balanced food :

Well balanced food contains all the constituents of food in ideal proportion. Some basic information on various food constituents are as follows.

Carbohydrates :

About 60-65% of energy should come from carbohydrates, mainly complex carbohydrates, while simple sugar or items containing it should be avoided or very sparingly consumed. Cereals and cereal based foods supply complex carbohydrates, while sugar, honey, Jam etc. provide simple carbohydrates. Cereals based foodstuff such as chapatti, roti, rice, bajara roti, etc form the bulk of the food in our country and is ideally suited for diabetic patients. Complex carbohydrates in these foodstuffs are slowly digested and converted in to glucose a gradual manner and hence their consumption is not associated with quick and sharp rise in blood glucose level. However simple carbohydrates such as  table sugar [sucrose], honey etc are rapidly converted into glucose and hence are to be avoided.

 

Proteins :       

Proteins are essential for growth as well as repair of wear and tear of our body. Milk and milk products, egg white, meat, fish, dals are rich sources of proteins. About 15-20% of daily calories should come from proteins. Diabetics should consume 0.8gm of proteins per Kilogram of their ideal body weight. Patients with diabetic kidney disease should restrict protein consumption.

 

Fats :

Fats are important constituents of cell membrane and  are storage centers for energy. 20% of daily energy requirement should be obtained from dietary fats. Fats consist of fatty acids and glycerides. Depending upon the type of fatty acid it contains, fat is classified in to following types :

1] Saturated fat

Animal fat, including fat in milk and milk products and vanaspati are rich in saturated fat. Animal fats are also rich in cholesterol. Among the oils, coconut oil is a rich source of saturated fats. Excessive consumption of saturated fat leads to rise in serum cholesterol level which accelerates atherosclerosis or hardening of our blood vessels. However animal fats are also a source of vital omega 3 fatty acids and thus should be consumed in moderation. One third of the energy from fat should be derived from saturated fats. Thus a small amount of ghee, half to one teaspoonful per day is recommended particularly for vegetarians.

2] Mono unsaturated fats :

Ground nut oil, mustard oil, and palm oil are rich in mono unsaturated fats. One third of the energy obtained from fat should come from mono unsaturated fat. This can be possible by using a judicious mixture of various cooking oils.

3] Poly unsaturated fats :

Safflower oil, sunflower oil, corn oil, soybean oil, cotton seed oil etc are rich sources of poly unsaturated fats. One third of the energy obtained by fats should be derived from poly unsaturated fats.

 

Essential fatty acids :-

These are vital fatty acids which cannot be synthesised by the body hence should be derived from food. Omega 6[w6] and omega 3 [w3] fatty acids belong to this class. Each sources of fatty food has different w6 and w3 fatty acids in different proportions. The ideal w6/3 ratio should be 4:1. It should be noted that certain oils rich in poly unsaturated fats, such as sunflower oil safflower oil are marketed as safe oils because their consumption does not lead to rise in serum cholesterol. The advertisements even make an indirect claim that one can consume large quantities of these oils. However these oils contain very unhealthy w6/w3 ratio thus should never be used as sole source of cooking medium. Moreover all oils provide same calories, 9 per gram. Hence excessive consumption of poly unsaturated oils is also harmful for the body.

 

In order to provide a better w6/w3 ratio one should not solely depend upon poly unsaturated oils but use a judicious mixture of these oils with mustard oil. Fish oil is very rich source of w3 fatty acids and it has been demonstrated that in countries where fish is a staple food, have a low incidence of coronary heart disease. Therefore fish consumption is encouraged. Those who are vegetarians may consume 1 to 3 capsules of fish oil daily. However it has not yet been proved that capsulated fish oil is a good as consumption of natural fish.

The normal weight diabetic should consume four teaspoonful of cooking oil daily[.5 kg per month]. Over weight diabetics should consume less.

 

Other constituents of food.

 

Fiber :

            Fiber is provided by indigestible plant cell components in our food. There are two types of fiber.

1] Water insoluble fiber : It is present in skin of fruits and peel of husks. It is good laxative. One should not peel off the skin of fruits before eating.

 

2] Water soluble fiber ; It has a property of holding or adsorbing water and getting swollen. Many vegetables and cereals particularly fenugreek, oats, beans, carrots, barley etc are rich in water soluble fiber.

Traditional Indian vegetarian food rich in vegetables and cereals provide adequate fiber and hence supplementary medicated fiber preparations are usually not required. Also these preparations are expensive. One can provide adequate fiber rich, natural food to entire family at the same cost. [Provided of course the family has a reasonable size] Fiber rich food provide following advantages ;

1] Digestion of carbohydrates to glucose and its absorption is delayed., thus a rapid post meal rise in blood glucose is avoided.

2] High fiber intake is helpful to reduce serum cholesterol and triglycerides.

3] Due to bulk formation after water holding in the fiber, one gets a feeling of fullness in abdomen thus limiting food intake.

4] By preventing chronic constipation, risk for cancer of large intestine is reduced.

Sodium:

Allowance is <3000mg/day, which is same as general population.

<2400mg/day is associated with mild to moderate hypertension.

<2000mg/day if associated with diabetic nephropathy(kidney disease), hypertension and oedema (swelling of the body).

Sweeteners:

Sucrose need not be restricted, must be substituted as carbohydrate.

Non nutritrive sweeteners ( aspartame, acesulfame-K) are safe to consume

Water :

            Water is an important constituent of food and is absolutely essential for survival. Sufficient amount of water is required for maintenance of blood volume and digestion of food.            

Vitamins and minerals :

            Persons with diabetes required vitamins and minerals in adequate quantities just like any normal person requiring these. There is no difference in daily requirement. Well balanced food provides all the vitamins and minerals in adequate quantities and regular lifelong vitamins supplements are not required for all the diabetes. However those on low calorie diet should take one Multi vitamin preparation.

Average diabetic, particularly the one who has it for several years usually requires several medications such as for example, two or three oral anti diabetic pills, two antihypertensive pills, a statin to reduce his cholesterol; and aspirin. All these medicines are absolutely necessary, thus make the matters less complicated from the patient by avoiding vitamins and anti oxidant pills. Remember lesser the number of pills, higher are the chances of compliance. Thus you may avoid prescribing a vitamin preparation or a preparation containing methycobal with various other agents in each and every diabetic.

Step I Calculate desirable body weight

Take height in centimeters and subtract 100 or 109 in men and women respectively. For example, if height is 170 centimeter, ideal body weight should be 70 kg for mean and 61 kg for women. If one wants to be more specific, he should calculate patient’s Body Mass Index [BMI] by using following formula.

BMI=Weight in Kg/[Height in meter] 2

The normal ratio is 18-23 for men and 19-25 for women. One should keep his BMI in normal range. If it is high, he needs to loose weight.

Step II Calculate the calorie requirement.

Refer to Table I to decide about the calories required.

Table I:  Calories/Kg of desirable body weight based on physical activity.

 

Sedentary

Moderate

Heavy

Over weight

20

30

35

Normal Weight

30

35

40

Under weight

35

40

45-50

Bedridden Patient

25

-

-

 

Growing children and pregnant and lactating  women require extra calories.

Physical activities carried out by following groups are classified as sedentary activity : Teacher, doctor, Nurse. Tailor, Peon, housewife and retired people.

Physical activities carried out by following groups are classified as moderate activity.

Fisherman, agricultural labour, electrician, carpenter, welder, turner, industrial labour, automobile driver, etc. Physical activities carried out by following groups are classified as heavy activity:

Stone cutter, mine worker, wood cutter, porter, etc.

Step III convert required calories in to meal plan.

To do this, one has to know the composition of foodstuffs we eat and the calories provided by each gram of protein, carbohydrate, and fat, and also have some information on food exchange system.

Cereals [rice, wheat etc] are rich in carbohydrates which form about 70% of their weight, but poor in proteins, while pulses [various dals] are comparatively richer in proteins. Vegetables are a good source of carbohydrates, fiber, vitamins and micronutrients but are a poor source of proteins. All these foodstuffs provide a small quantity of fat which is known as “invisible fat”. Meat and fish are rich in proteins while former, particularly red meat also is rich in fat. Meat and fish do not provide carbohydrates. Milk provides all the three with quantity of fat varying depending. To do this, one requires to know the composition of foodstuffs we eat and the calories provided by each gram of protein, carbohydrate, and fat, and also have some information on food exchange system.

Cereals [rice, wheat etc] are rich in carbohydrates which form about 70% of their weight, but poor in proteins, while pulses [ various dals] are comparatively richer in proteins. Vegetables are a good source of carbohydrates, fiber, vitamins, and micronutrients but are a poor source of proteins. All these foodstuffs provide a small quantity of fat which is  known as “invisible fat”. Meat and fish are rich in proteins while former, particularly red meat also is rich in fat. Meat and fish do not provide carbohydrates. Milk provides all the three with quantity of fat varying depending upon the animal source and also whether it is processed to make it “low fat” milk. Cow’s milk contains less fat as compared to buffalo’s milk. Each gram of protein and carbohydrate provides 4 calories while each gram of fat provides 9 calories.

The food exchanges:

A person with diabetes can and should make frequent changes in his menu, so that the person can actually enjoy his meals. While making changes, he should know that the total calories consumed in a day and the proportions of calories provided by proteins, carbohydrates, and fats should remain same. In other words, he must know the various alternatives he can eat in place of each food item on his menu. For example, if one does not want to consume a cup of cow’s milk at breakfast, what are the various alternatives which he can consume instead of milk? This information is provided by a list of food exchanges, which is given below.

 

Cereal exchange

Each exchange provide:

Carbohydrates -         15 gm.

Proteins           -             2 gm

Calories           -          70

One exchange is = any one of the following:

Cooked rice

75 gm. [3 tablespoons]

Chapatti

20 gm atta

Roti

20 gm atta of Jowar/Bajra/Corn/Ragi

Idli

1 medium

Bread

30 gm [ 1 large slice\one and half average size]

Cornflakes

20 gm [3 tablespoons]

Dosa

1 medium

Porridge (cooked)

120 gm 3/4 cup

Marie cream

Craker Biscuits

2-3 pieces

 

 

Pulses and Dal exchange :

Each  exchange provides :

 

Carbohydrates 15 gm

Proteins               6 gm

Fat                        1 gms

Calories             91

One exchange is = any one of the following [in raw weight]

Rajmah

25 gm(raw wt)

Bengal Gram

25 gm(raw wt)

Black Gram

30 gm (raw wt)

Chawli

25 gm(raw wt)

Mung

25 gm(raw wt)

Kesari Dal

25 gm(raw wt)

Red gram

25 gm(raw wt)

Masur Dal

25 gm(raw wt)

Nutrinuggets

25 gm(raw wt)

Lobia

25 gm(raw wt)

 

Milk exchange:

Each exchange provides

Carbohydrates  - 12 gm

Proteins              - 8 gm

Fats                    - 7 gm

Calories             - 145

 

One exchange = any one of the following

 

Cow’s milk

240ml( 1 glass, 3% fat)

Butter milk

750 ml (3 glasses)

Skimmed milk

350 ml

Skimmed milk powder

45 gm [ 3 table spoons]

Cards

240 gm 2 bowls-30g x 2’’x 3’’x 1’’cube

 

Meat exchange:

Proteins-7 gm

Fat – 6 gm

Calories-70

Egg- 40g(1)

Mutton- 30 gm

Chicken- 30 gm

Fish- 30 gm

Pork- 30 gm

Sausage- 20 gm (2 cocktail links)

Ham- 20 gm

Cheese- 20 gm

Cottage cheese- 20 gm

 

Fruits exchange

Each exchange provides

Carbohydrates  10 gm

Calories             -40

 

Orange

100 gm [1 medium]

Pear

90 gm [1 medium]

Apple

90 gm [ 1 medium]

Banana

40 gm [ ½ small]

Mango

60 gm [1/2 small]

Water melon

300 gm [ 3 slices]

Papaya

120 gm [ 2 slices]

Grapes

75 gm [12 numbers]

Figs

100gm [3 medium]

Pineapple

90 gm [5-6 thin round slices]

Coconut water

200 ml [1 glass]

Guava

100 gm [1 medium]

Tomato

1 glass juice (240ml)

 

 

 

Vegetables A group

All leafy and green vegetables except those mentioned in group B. they provide negligible calories.

 

 

Vegetables B group

 100 gm 1 exchange = 1 katori provides

Carbohydrates           6 gm

Proteins                        2 gm

Fats                             Nil

Calories                       36

Examples: Pumpkin, Bhindi, Raddish, Tubers, Carrot, Beetroot, Green mango, Beans, Green peas, Onion, Lotus stem.

 

Roots and Tubers:

100 gm = 1 exchange = 1 katori provides

Carbohydrates           25 gm

Proteins                       Nil

Calories                       100

Examples: Potato, Sweat potato [ratala], Yam [Suran], Colocasia [Arwi], Tapioca [ Simla Aloo], khamealu.

Note: Roots and tubers should be avoided or taken in very small quantity only.

Fat\Oil exchange:

Each exchange provides

Fats                   5 gm

Calories           45 gm

 

Examples: One teaspoonful [ 5gm] of following cooking oil: Safflower, Sunflower, Soya, Mustard, Til, Vanaspati(5 gm), Butter (7gm); or 2 teaspoonfuls [ 10 gm] of cream(Med).

 

General Guidelines:

Food to be consumed in very limited quantity.

 

·         Fried snacks like shev, chivda, papad, bhujiya, wafers chips, batatawada, etc.

 

·         Saturated fats like butter, ghee, cream, animal fat, fatty meat [beef, lamb, organ meat, ham, pork], coconut oil, and hydrogenated oil [vanaspati], Yellow of egg.

 

·         Fatty gravies.

 

·         Nuts and oil seeds such as cashew nut, pista, walnut, groundnut, coconut, etc.

·         Beer, wines, whisky and other alcoholic drinks are best avoided as far as possible. If total abstinence is not possible, intake should be limited to one peg per day and 5 pegs per week of hard drinks or one bottle per day and 5 bottles per week of mild beer and calories provided by alcohol should be accounted in the meal plan. One gm of alcohol provides 7 calories.

 

·         Avoid excess of salt as this can lead to hypertension, which as such is extremely common in diabetic patients. Both diabetes and hypertension are independent risk factors for coronary heart disease and when present together, the risk is compounded. Foods high in salt are papad, pickles, chutney.

 

·         Baking soda containing eatables, dried fish, processed food, preserved and canned food, cured meat, Chinese food etc. there is no difference between rock salt and common salt. Salt intake should not exceed 5 gm per day in diabetics who have concomitant hypertension and \ or cardiac failure.

Food items to be totally avoided

·        Simple sugars such as glucose, sucrose [common sugar], dextrose, honey, jiggery, jam, jelly, syrups, marmalade, cakes, pastries, pies, puddings, ice cream, sweat biscuits, sweat meats, chocolates, condensed milk, aerated soft drinks such as coca cola, limca, thums up, pepsi cola gold spot, tinner juices, sweat pickles, Diet coke or diet pepsi can be consumed.

 

Food items allowed in unlimited quantities:

 

Condiments and spices, lime water [without sugar], tea and coffee [ without sugar and using milk from the mild quota], thin butter mild, raw and green vegetables etc.

 

Meal Planning Chart

Bed Tea/coffee

1200

1600

1800

2000

2200

2400

Bed tea\ coffee

1 cup

1 cup

1 cup

1 cup

1 cup

1 cup

 

Breakfast

cereal ex.

2

2

2

3

3

4

Milk ex.

1

1

1

1

1

1

Fat ex.

-

1

1

 

1

1

1

Mid morning

Snack cereal ex.

1\2

1\2

1\2

1\2

1\2

1\2

Milk ex.

--

-

-

-

-

-

Lunch

Cereal ex.

2

2

3

4

4

5

Pulse ex.

1

1

1.5

1.5

1.5

1.5

Curds

50 ml

100 ml

100 ml

100 ml

100 ml

100 ml

A gr. vegetables

unlimited

unlimited

unlimited

unlimited

unlimited

unlimited

B. Gr. Vegetables ex

1

1

1

1

1

1

 Fat ex.

Nil

Nil

Nil

Nil

Nil

Nil

 

Afternoon snack

Tea/coffee

1 cup

1 cup

1 cup

1 cup

1 cup

1 cup

Cereal ex

1

2

2

2

2

2

Fat ex.

--

--

--

--

--

--

 

Mid evening

Fruit ex

1

1

1

1

1

1

Milk ex.

--

--

--

--

--

--

 

Dinner

Dinner

Same as Lunch

Same as Lunch

Same as Lunch

Same as Lunch

Same as Lunch

Same as Lunch

 

Bed Time

Milk ex.

1

1

1

1

1

1

Fruit ex.

-

1

1

1

1

1

 

Notes : 1] 1 egg can be exchanged for  1 milk exchange.

2] Half cereal exchange can be exchanged with 1 fruit exchange at mid evening and at bed      

    time.

Planning of the meal should be done in consultation with the treating Physician along with the  flexibility of using the food exchanges shown above.

 

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