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Diet Therapy for Diabetes

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Diabetic Diet

One of the first question usually asked by a newly diagnosed patient with diabetes is what should I eat”? Clearly there is never a simple answer to the question. Although nutrition is central to the management of diabetes, there is no one “diabetic diet”. The nutritional prescription will depend on person’s type of diabetes, food preferences, lifestyle, treatment regimen, comorbidities, and state of health.

Energy

The total calories required in type 1 diabetes depend on the age, the need for growth and development, physical activity. But in type 2 diabetes the requirement depends on ideal body weight (IBW).IBW is calculated on the basis of height-weight chart. It Categories the patient in to normal, over and underweight and determine the caloric requirement based on physical activity. Any person above 50 yrs of age will require 10% less calories for each decade.

Carbohydrate

Carbohydrates are the major calorie provider i.e. 50-60% out of total calories from carbohydrate alone. Complex carbohydrate sources like whole cereals, chapati, fruits, and vegetables should be the options chosen compared to simple carbs like glucose, fruit juices, white bread. The distribution of carbohydrates in various meals is determined by whether or not the patient is on insulin therapy.

Distribution of carbs depends upon the insulin type and unit, a safe distribution of carbohydrates recommended is breakfast-1/7, lunch-2/7, tea time-1/7, dinner-2/7 and midmorning and bed time combined-1/7. 

Intake of carbohydrate should not go below 100gms per day as it may lead to ketosis. The glycemic index (GI) is a numerical system of measuring how much of a rise in circulating blood sugar a carbohydrate triggers the highest the number, the greater the blood sugar.

A GI of 70 or more is high, 56-69 is medium and 55 or less is low. A lower glycemic response usually equates to a lower insulin demand but not always, and may improve long-term blood glucose control. Hence many functional foods manufactured nowadays carry the GI on their nutritional panel.

Protein

The need for protein in diabetics is the same as for the general population if renal function is normal. In diabetes, insulin deficiency and insulin resistance do not affect protein metabolism as severely as they affect carbohydrate metabolism. Studies state person with controlled diabetes have shown that glucose derived from dietary proteins does not appear in the circulation, hence unlikely to contribute to hyperglycemia. 

Diabetic person exhibiting all ranges of hyperglycemia have increased protein turnover. Unfortunately with lower dietary protein intake it may lead to degrees of malnutrition. Therefore good sources like toned milk and milk products, nuts and pulses, lean meat should be included in daily’s diet.

Fat

Fat rich meals can also lead to increase in blood sugar levels. The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acid to <7% of total calories (vanaspati, ghee), minimum trans fatty acid(processed snacks, bakery products ) and limit cholesterol intake to <200mg/day (whole egg, meat, shellfish, organ meat and high fat dairy product) so as to reduce risk for heart. However monounsaturated fats (almond, walnuts, groundnut oil, rice bran oil, canola oil) helps improve lipid profile.

Dietary fiber

Dietary fiber refers to the edible but indigestible cell walls of plants and is only found in plant based foods fibre resist the acids in the stomach and other digestive enzymes in the intestine there are two types of dietary fibers soluble and insoluble.

Soluble fiber readily dissolves in water and is fermented by bacteria in the large bowel. Such fiber is found in oats, flax seeds, fruits and vegetables, legumes and sprouts. Soluble fibre has been shown to lower blood glucose, presumably by delaying absorption.

In contrast insoluble fiber does not dissolve in water and is not easily fermented by colonic bacteria it increases gastrointestinal transit time and contributes to stool bulk. It is found in whole wheat flour, bran, whole cereals, nuts and many vegetables.

Total intake of fiber should be between 25-40gms per day.

Ms Ruhi Peje
Clinical Dietician  
Guru Nanak Hospital,
Mumbai

Ms. Ruhi Peje is a Clinical Dietician at Guru Nanak Hospital, Mumbai. For clarifying any doubts or for any health related assistance, Ms. Ruhi can be reached on This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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