General principles for diet for diabetic patients

Healthy eating is a cornerstone of any diabetes management plan. But it's not just what you eat that affects your blood sugar level, how much you eat and when you eat matters, too.

What to do:

Keep to a schedule. Your blood sugar level is highest an hour or two after you eat, and then begins to fall. But this predictable pattern can work to your advantage. You can help lessen the amount of change in your blood sugar levels if you eat at the same time every day, eat several small meals a day.

Make every meal well-balanced. It is good if you learn to plan for every meal to have the right mix of starches, fruits and vegetables, proteins, and fats. Traditional Indian thali with 2-3 chapattis, one vegetable, 1 /2 katori dal, salad and 1cup curd or butter milk makes a good example of well-balanced diet.

Eat the right amount of foods. Learn what portion size is appropriate for each type of food. In this way you can add variety of food items in your diet.

Coordinate your meals and medication. Too little food in comparison to your diabetes medications — especially insulin — may result in dangerously low blood sugar (hypoglycaemia). Too much food may cause your blood sugar level to climb too high (hyperglycaemia). Talk to your diabetes health care team about how to best coordinate meal and medication schedule. Also know when to take medication in relation to intake of meal.

Diabetes never means big no to anything .A diet for diabetes is not so different from any good, healthy eating routine. People with diabetes can eat most of the foods which is healthy. But one might have to change- Quantity, Frequency and Duration of eating.

The main goal for diabetic diet is to maintain blood sugar levels, and this can be achieved by a combination of three separate actions.
1. Avoiding foods that are high in sugar especially simple sugars like Gur, Honey, Jam, sugary cold drinks, sweets and chocolates.
2. Using portion control to limit your intake of all foods while still providing proper nutrition.
3. Eating 6 meals a day rather than three large.

So, a diabetic can eat all the foods that are healthy to every one- grains, beans, vegetables, fruits, low fat milk and meat.

With diabetes you have to just consider few things. These are –

• It is important to eat about the same amount of food at the same time each day. Skipping meals or overeating both is harmful, so fasts and feasts are both to be avoided. Keep a diary of how much you eat. A food dairy helps you make important decisions about your medications, meal plan and exercise plan and also help your doctor and dietician to help you.

• It is true that the carbohydrate in table sugar has the same effect on your blood glucose as any other carbohydrate, such as that in bread, potatoes or fruit. All carbohydrates, in equal amounts will raise your blood glucose level the same way no matter what type of diabetes you have .For blood glucose control, focus on the total carbohydrates you eat, rather than where it comes from. You can follow carbohydrate exchange for your guidance Thus; you can substitute sweets into your meal plan for other carbohydrates but do not add them on top. You should not have sweet substitute at every meal. Sugary foods do not have the nutrients, vitamins and minerals that your body needs to be healthy. That is why we call these calories empty.

• Fiber can keep your blood glucose from going high after a meal because it slows down the speed at which the food is digested. A high fiber, low fat way of eating not only helps in diabetes but also can reduce the risk of cancer, cardiovascular diseases, high blood pressure and obesity. Fiber has a favourable effect on cholesterol too.

• Avoid fried food. Too much oil results in obesity and insulin resistance.

• Be prepared; always carry a snack with you in case of delayed meal or unexpected change in your schedule. Having good food on hand will save you from hypoglycemia and from having to settle for less nutritious and high calorie fast foods.

• Always carry something with you to treat low blood glucose. Do not use chocolate, candy bar or sweets because they may not bring your blood glucose up quickly enough. If it is below 70 mg\dl or you have signs of hypoglycemia but cannot test, eat one of any foods like 1\2 cup juice or regular soft drink, 1 tablespoon honey, 3 teaspoon sugar, 3 pieces of hard candy.

• When you are sick, take your usual medication, check your blood glucose and test your urine ketones. If you cannot eat regular food, have carbohydrates in liquid or soft foods. Drink plenty of fluids. If you cannot eat at your usual times, have 15 grams of carbohydrate every hour to keep blood glucose from dropping. Never miss your usual medication when you are sick.

• If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount (one drink per day or less for adult women and two drinks per day or less for adult men). One alcohol containing beverage is around 350 ml beer, 150 ml wine, or 50 ml distilled spirits. To reduce risk of nocturnal hypoglycemia, alcohol should be consumed with food. Abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia.

• Get help in developing a personalized meal plan that works for you. Just as there is no one medication that works for all people with diabetes there is no single meal planning approach. You and a dietician or diabetic educator design the best meal plans and are based on your health, other medications, activity levels and treatment goals.

Few examples of these approaches are-

1. Food Pyramid-The food pyramid can help you make wise food choices. It divides foods into groups, based on what they contain. Eat more from the groups at the bottom of the pyramid, and less from the groups at the top.

2. Plate Method- It’s simple and effective for managing diabetes. Creating your plate let's you still choose the foods you want, but changes the portion sizes so you are getting larger portions of non-starchy vegetables and a smaller portion of starchy foods. When you are ready, you can try new foods within each food category. All you need is a approx 9-inch plate.

Put an imaginary line down the middle of the plate. Then on one side, cut it again so you will have 3 sections on your plate.

1.Fill the largest section with non-starchy vegetables such as: spinach, carrots, lettuce, greens, cabbage, cucumber, green beans, broccoli, cauliflower, tomatoes, okra, mushrooms, peppers, turnip etc.

2.Now in one of the small sections, put starchy foods such as: wheat chapatti, brown rice, whole grain breads, cereal such as oatmeal or corn flakes, pasta, noodles, potatoes, green peas, corn, lima beans, sweet potatoes, and then on the other small section, put your proteins or meat such as: Whole Pulses, Grams, soybean ,chicken ,fish, eggs, low-fat cheese/Paneer.

4.Add a small bowl and/or glass for your fruit and dairy products.

3. The food exchange system - Exchange list programs are useful for patients who are willing to follow a more structured system to control blood glucose or weight but want some flexibility to create their own menus. It contains group of measured foods of the same calorific value and similar proteins, fats and carbohydrates and can be substituted for one another in a meal plan; these are starch/bread, meat, vegetables, fruit, milk, and fat. A person is allowed a certain number of exchange choices from each food list per day. Foods can be substituted for each other within an exchange list but not between lists even if they have the same calorie count.

E.G. Fruit Exchange- 1 Small Apple=1/2 medium banana = 1/2 mango= 3 Dates= 1 1/4 cup watermelon=1/2 chikoo= 1 Guava =15 Grapes=1 Orange= 1/2 pomegranate=1 kiwi =2 Figs = 2-3 slice of papaya= 3 Plums= 1 1/2 slice pineapple.

E.g. Starch Exchange- 1 chappatti- approx 6 inch wide =1dosa- approx 10 inch wide =2 medium idli- Approx 15 gm weight =1 large slice of bread =1/2 katori rice = 1 small potato

It is always advisable for the near and dear ones of the person with diabetes to have same diet, as diabetic diet is not a special diet but an idealistic balanced diet

GOLDEN RULES TO HEALTHY EATING

Other than general population, diabetics should also aim to attain healthy mind and healthy body by keeping golden rules in mind:

• Keep your surroundings clean.

• Always keep your food and drinking water covered

• Never allow garbage to collect near your home

• Use safe water for drinking

• Wash vegetables before chopping and peeling.

• Do not throw away the water, in which vegetables and rice are cooked, it contains minerals and vitamins.

• Include some vegetables as salads with your meal

• Do not overcook your food as this procedure destroys vitamins.

GUIDELINES OF SNACKING AND EATING OUT FOR DIABETES PATIENT

1. SNACKING

• Frequent patient question:

Q) To snack or not to snack?

Answer) Snack but on healthful foods

Carry nutritious snacks that safeguard you from eating outside meals, the chances of infection, or inaccessibility of food in case one is unexpectedly delayed.

Swapping healthful carbohydrates (carbs which contain fibre and provide vitamins and minerals) for less healthful carbohydrates (refined foods)

NOTE

2. EATING OUT

Eating out can be a challenge for people with diabetes.

Tips:

• Become a fat detective. Look for high fat foods

• Understand portion sizes and when portion sizes are generous, ask for extra food to be shared or made ready to be taken away.

• Exercise control. The best way not to eat too much is to order less.

• Limit the frequency of eating out.

• Avoid restaurants that allow you to eat as much as you want for one price.