Diabetes is a condition in which there is too much sugar (glucose) in the blood. Although sugar is needed to provide energy for the body, when in excess, it causes problem.
Persons with diabetes have excess sugar because they lack or have deficient supply of insulin.
What is Insulin?
Insulin is a substance produced by pancreas, an organ situated
behind the stomach. Insulin is required for sugar (glucose) to
enter the cells of the body where it is utilized.
It is as if insulin is the key which opens the door to allow sugar
(glucose) to enter.
When sugar is absent or deficient or is defective, sugar
remains in the blood in high amounts.
Diabetes “ Mild Disease” Serious consequences
Diabetes Mellitus A Serious Disease Leading cause of new cases of blindness 25 times more prone to eye problems 6 times higher risk for Paralysis (stroke) 5 times more prone to Kidney failure 20 times more prone to lower limb amputation Nerve damage causes loss of sensation 2-3 times higher risk for heart attack
Diabetes Indian context
Life style changes further accentuate the high genetic predisposition
Under diagnosed due to low awareness
Perhaps occurs a decade earlier
Non obese/lean Type II fairly common
Treated less seriously as considered “Mild Disease”
Differences between Type 1 & Type 2 Low risk to develop Ketoacidosis High risk to develop Ketoacidosis Insulin may be required for achieving good diabetes control Dependant on insulin for life Illness develops slowly Illness develops rapidly Often over weight and have an apple shape Patient are young, lean, and thin Develops later in life after >30 years Develops at an early age <30 years Type 2 Type 1
Insulin Monitoring Diet Education Exercise Treatment of Type 1 Diabetes
Insulin Monitoring Diet Education Exercise Treatment of Type 2 Diabetes Oral Agents
How You Manage Your Diabetes Follow a Healthy Meal Plan Take your Medication Regular Exercise Test blood sugar Regularly
Keeping Track of your Blood Sugar
Take an active part in the treatment of your Diabetes
Taking Charge of your Diabetes
It means keeping your Blood Sugar as normal as possible
Your blood sugar may alter because of :
Tablets or Insulin administration
Benefits of Normal Blood Sugar
It makes you feel normal, and comfortable in your daily life
It will help prevent the long term complication of the Diabetes
Learning Self Management
It requires your time and efforts
It requires your full participation in the treatment
It requires self care practice in your daily life
It requires close co-ordination with your Doctor and
Diabetes Care Team
How to do Self- Management?
Test Your Blood Sugar regularly
Record your Blood sugar readings in the Diary
Identify the Blood Sugar Patterns
Use your Blood Sugar results to adjust your diet and Insulin
Take help of your Doctor and Diabetes Care Team
Setting your blood Sugar targets Optimal blood sugar levels are : > 180 145-180 80-144 Post Prandial mg/dl > 140 111-140 80-110 Fasting mg/dl Poor Borderline Good Blood Sugar
Setting your blood Sugar targets Keeping your blood sugar in this range help you to prevent the long term complications of the Diabetes i.e. eye, kidney and nerve damage. Use Insulin, if advised.
Diabetes and Emergencies
Reduction in Plasma glucose concentration below the normal
value of 60 mg/dl (3.3mmol/L)
Excessive sweating and anxiousness
Blurring of vision
Faintness/loss of consciousness (coma)
Defined as blood glucose < 2.1 mmol/L
Some diabetes develop hypoglycemia when BG > 2.1 mmol/L
Some diabetics do not have symptoms at very low BG
HYPERGLYCEMIA NORMAL HYPOGLYCEMIA
Causes Of Hypoglycemia
Taking more exercise than usual
Delay or omission of a snack or main meal
Administration of too much medication
Eating insufficient carbohydrate
Over-indulgence in alcohol
Mistake in sulphonyureas’s dosage
Treatment Mild Hypoglycemia
Relieved by :
1 glass of fruit juice or soft drink
3 heaped teaspoons of sugar, honey or 3 - 5 sweets
Repeat if symptoms not relieved after 5 to 10 minutes
If next meal not immediately due, take 30 g complex carbohydrate
DKA is an acute life threatening complication of diabetes and
occurs as a result of excessive production of ketones due to
uncontrolled (or undiagnosed) hyperglycemia.
Excessive urination and thirst
Nausea, vomiting and abdominal pain
Deep rapid breathing
Results of animal studies, retrospective analysis of large
patient populations, and prospective clinical trials suggested a
link between degree of hyperglycemia and risk of late diabetic
DCCT conclusively proved that late diabetic complications can
be prevented, onset delayed and progression retarded by
Good Metabolic Control.
Achieve as good a control as possible.
Within constraints of individual ability and willingness, patients should be encouraged to aim for best possible control without increasing risk of serious hypoglycemia.
Every incremental improvement in control translates into concrete benefits for patients. Take insulin, if advised.
Diabetes and Diet
Importance of Nutrition Advice
Nutrition therapy is an integral part of management
Diabetes is a metabolic disorder affecting carbohydrate, fat and protein metabolism
Effective tool in combination with physical exercise and preferable to pharmacological therapy
For patients with IGT; those at risk of; or in early stages of type 2 diabetes
Inappropriate nutrition can make best planned pharmacological intervention ineffective
Food Groups Food Exchange
Milk and Milk products
Fat, Oils and Nuts
Meat, Fish and Eggs
Cereals are the staple diet in most cultures. They are rich in
carbohydrate and a fair source of minerals and B Group
Commonly used cereals are Wheat Flour, Rice,
Maize, Bajra, Jowar,Ragi etc
Processed cereal based food items are Roti,
Paratha, Puri, Idli, Dosai, Biscuit, Bread,
Dinner Roll, Macaroni, Noodles etc
Pulses (legumes and Dals) are an important source of protein for
Some of the common pulses are whole and/or, dehusked and split dals, Green
gram, Bengal gram, Rajmah, Black gram, Cow pea, Red gram dal etc.
Milk and Milk Products
Milk is an universal food for all age groups. Milk contains good quality protein. Buffalo milk is richer in fat as compared to Cow's Milk.
Milk is also consumed in the form of Yogurt, Cheese, Cottage Cheese (paneer), Milk Powder etc.
Vegetables are important for their mineral,
vitamins and fibre content. Vegetables classified
into 3 groups.
Green Leafy Vegetables: like Spinach, Lettuce, Cabbage, Fenugreek etc.
Roots And Tubers: like Potato, Onion, Yam, Carrot, Beet root, Radish, Turnip etc
Other Vegetables: They are Peas, Brinjal, Cauliflower, Ladyfinger, Gourd etc.
Fruits are a rich source of Vitamin C, most fruits are also good
source of carbohydrates. Yellow fruits like Mango and Papaya
are rich in carotene.
Common fruits are apple, banana, grapes, orange, guava etc.
Fat,Oils & Nuts
Oilseeds and nuts are rich source of fat, energy, vitamins and minerals. In addition they also provide proteins.
Peanuts, Pistachios, Almonds, Cashew, Coconut, Walnut are part of this group
Visible fats commonly consumed in India are butter, Ghee, hydrogenated oils, and various vegetable oils.
Fats are a concentrated source of energy providing 9 kcal/g.
Meat, Fish & Egg
Rich in protein, vitamins, iron and phosphorous. Egg is considered the best quality protein. It contains all the essential amino acids in adequate proportions. Flesh foods are also a good source of vitamin B12.
Common sources are mutton, chicken, fish, egg, pork, beef etc
Food exchanges are food equivalent units designed to facilitate easy variation in diet.
Exchange lists with specified caloric values are made by experts. These lists contain specified quantities (weight/size/measure) of food items which are units .
A single unit within the group has the same caloric value and therefore can be interchanged.
Thus one unit of a cereal exchange - one medium chappati, can be exchanged for three-fourth katori cooked rice or one idli or two medium slices of bread.
One chappati cannot be exchanged for two spoons of Ghee although calories from both is the same.
Dietary Recommendations Diabetes Food Pyramid Cereals & Pulses 8-12 Units 10-14 units (veg) Fruits 2-3 Units Vegetables 3-4 Units Milk & Milk Products 2-3 Units Meat & Fish 1-2 Units Fats, Oils & Nuts 2-3 Units
mainly complex carbohydrates
cholesterol < 300 mg/day
Sodium: < 6 g/day
hypertensive diabetic< 3 g/day
Foods that have few or no calories and can be consumed in large quantity to satisfy hunger are called free foods
Raw vegetables like tomato, cabbage, lettuce, cucumber etc
Tea, coffee without milk or sugar
Plain lemon juice (nimbu pani) without sugar
Clear vegetable soups
Utilize food exchanges to introduce variety
Use household measures
Make corrections on existing meal plan and pattern rather than
introduce new regimen
Meal timings, frequency and quantity to be adjusted according to