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  Nutrition in Diabetes

Diabetes is a disorder that affects the way your body uses food for energy. The source of energy the body uses is mainly from carbohydrates. When we eat carbohydrates, the carbohydrates are then digested and broken down to simple sugar, known as glucose. The glucose then circulates in blood, and then blood glucose levels are increased. Insulin a hormone produced by the beta cells of the pancreas helps glucose to enter cells and energy produced is utilized by the body. In Diabetes, either the pancreas cannot produce enough insulin or what is produced is not effective in controlling the blood sugar. Lack of effective insulin results in inadequate utilization and consequent rise in blood sugar. In Diabetes there is too much sugar in blood and urine.

Types of Diabetes:

  1. Insulin dependent diabetes mellitus.
  2. Non – insulin dependent diabetes mellitus.

Insulin dependent diabetes mellitus:

This type of diabetes mostly affects children or adolescents. This type of diabetes is also known as juvenile diabetes. In type 1 diabetes there is no insulin or little insulin is produced and such individuals require insulin injections. As a result without insulin glucose builds up in the bloodstream and the body is unable to use this glucose for energy.

Non – insulin dependent diabetes mellitus:

Type 2 diabetes affects overweight or obese adults. The insulin production may be normal or even high. The insulin produced is not effective as normal insulin. This is called insulin resistance. In type 2 diabetes family history and genetics play a role .

Gestational diabetes:

Diabetes developed during pregnancy is called gestational diabetes. Pregnant women who have family history of diabetes should be screened for gestational diabetes. When body is not able to use insulin due to insulin resistance it develops into gestational diabetes.

Nutrition therapy for type 1 and type 2 diabetes:

Carbohydrates:

Carbohydrates are main source of energy. One gram of carbohydrate provides 4 kcals. Diabetes does not mean that carbohydrates containing foods must be restricted from the diet. The intake of carbohydrates should be controlled in terms of portion size and frequency of eating carbohydrate. The type of carbohydrate in diet can be altered. Complex carbohydrates are good for diabetes. Cereals and pulses contain complex carbohydrates which are broken down into simple sugars before they are absorbed from the gut. Simple sugars are directly absorbed. Simple sugars raise blood glucose more quickly than complex carbohydrates. Simple fibers are refined and include white rice, maida, sugar, jam etc. There should be right amount of carbohydrates in your diet. Generally, 50 to 60% of your total daily calories should be from carbohydrates. Serving size of carbohydrates is most important part. 1 serving of carbohydrates is usually 15 gms. The blood sugar levels mainly depend on type of carbohydrate and amount of carbohydrate intake. It is important to distribute the amount of carbohydrates according to daily needs in our diet. According to the meal plan distributed in a day , carbohydrates can be distributed 4 to 5 parts. One third of the diet is served during lunch, another one third during dinner and from the remaining 25% during breakfast and 9% during snacks time. If you take insulin, counting the amount of carbohydrates in each meal helps you to adjust the insulin dose. Glycemic index is also another important aspect on measuring how rapidly carbohydrate enters bloodstream and how high it raises blood sugar levels. Carbohydrates with high glycemic index raise the blood sugar levels high and carbohydrates with low glycemic index has slower digestion rate and hence blood glucose raises at a slower rate.

Proteins:

In diabetes protein requirements are increased as glycemia increases. Proteins supply essential amino acids needed for tissue repair. High protein diets are useful in controlling glycemia (presence of glucose in blood). 15 to 20% of total daily calories should meet from proteins. The recommended dietary allowance of protein is 1 gm /kg body weight per day. Protein intake along with carbohydrates will lower the blood glucose concentration due to amino acid stimulation of insulin secretion; this will help to compensate for defect in glucose mediated insulin secretion.

Fats:

Total fat you eat depends on many factors but more important is the type of fat you eat. The type of fat you eat influence the serum lipids and could increase the risk for heart disease. It is recommended that 15 to 25% of the total calories can be derived from fat. Persons with high serum lipids or obese persons should restrict their fat consumption particularly saturated fats. All three types of fats saturated, monounsaturated and polyunsaturated should provide total calories derived from fat.
Saturated fats raise blood cholesterol levels. And this is a risk factor for heart disease. In diabetes saturated fats should provide less that 7% of calories. Food which contain less than 1gram of saturated fats per serving are known to be low saturated fats.

Saturated fats include:

Palm oil, butter, cream, ice cream, lard, hot dogs, ground beefs, chocolates, cookies, cakes, lard, sausages, sour cream, full fat cheese, whole milk, margarine, bacon.
Cholesterol: Foods from animal sources are high in dietary cholesterol. This cholesterol from the food you eat may increase your blood cholesterol. It is recommended to eat less than 150 to 200 mg per day.

Foods that contain high cholesterol include: Egg yolks, whole milk, liver, chicken , meat, cream etc.

Mono unsaturated fats: These fats improve good cholesterol that id HDL. Monounsaturated fats are good for health or healthy fats. It is recommended that monounsaturated fats can provide around 10% of calories from total fat in your daily diet.

Monounsaturated fat foods include: canola oil, sesame oil, olive oil, peanut oil, almonds, pecans, peanuts.

Polyunsaturated fats: Polyunsaturated fats are healthy fats. They increase HDL levels. Polyunsaturated fats provide omega 3 and omega 6 fatty acids. Omega 3 acts as anti-inflammatory and omega 6 acts as pro inflammatory. Fish are rich source of omega 3 fats. You can include fish two times a week.

Polyunsaturated fat foods include: walnuts, fish oil, fish, corn oil, soy bean oil , sunflower oil, cottonseed oil, safflower oil. Omega three rich fatty acid foods include fish oils , flax seeds and flax seed oil, soy bean oil.

Transfats: They increase LDL cholesterol. They are not good for health. Hydrogenated fats and shortenings should be avoided. A food should be free of trans fats.

Trans fat foods include:

Margerine, dalda, French fries, muffins, cakes etc.

Dietary Fiber: It is good to include high fiber foods. High fiber foods can reduce blood sugar and serum cholesterol levels. Fiber present in fruits, vegetables, legumes and fenugreek are more effective in controlling blood sugar. Intake of 25 gms of fiber per 1000 calories is good for diabetic patients.

Foods to eat and avoid:

Vegetables include green leafy vegetables, cucumber, bitter gourd, cabbage, onions, garlic, tomato, ginger, field beans, cluster beans etc, are good. Root vegetables should be avoided.

  • Fruits like guava, kiwi, apples, pomegranate, oranges, jamun etc are good for diabetic patients.
  • Fruits such as mango, custard apple, sapota, dates, banana, strawberries should be avoided.
  • Small frequent meals are good .
  • Brown rice better than white rice.
  • Raw vegetables should be taken in large quantity, as cooked food raises the level of blood sugar fast.
  • Drink plenty of water.
  • Avoid drinking alcohol and smoking.
  • Sprouted grams are good to include in diet.
  • Too much salt to be avoided.
  • Avoid fast foods.
  • Avoid commercially packaged ready to eat foods.
  • Drink skim milk and eat non fat dairy products.
  • Avoid whole milk and avoid eating full fat dairy products.
  • Avoid eating sugar and sweets.
  • Choose grilled, steamed or baked foods.
  • Instead of fruit juices which lack dietary fiber and high in sugar content have whole fruit .
  • Eat skinless chicken.


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