Presentation on the guidelines of Diet for Diabetics

1. DIETARY MANAGEMENT
OF DIABETES
Mrs. PREMAKUMARI. C
Assistant professor
Dept. of Home Science
Anna Adarsh college for Women

2. What is diabetes?
■ Diabetes is a lifelong condition
characterized by high blood
sugar resulting from:
Lack or insufficient production
of insulin
Insulin resistance (inaction)
Both

3. TYPES OF DIABETES
■ Type 1
 Results from absolute lack of insulin
 It is of a sudden onset and can develop at any age
 The causes of this are when the pancreas cannot produce insulin.
 People with type 1 diabetes need insulin for survival.

4.  Type 2
 Type 2 diabetes develops when the body cannot make enough insulin or
when the insulin that is produced does not work properly
 Usually appears in people over the age of 40.
 It can be controlled by a healthy diet, increased physical activity and oral
drugs
 Gestational diabetes
 Diabetes detected for the first time during pregnancy.
 GDM occurs because the body cannot produce enough insulin to meet
the
 extra needs of pregnancy.
 GDM usually disappears after giving birth and may indicate an increased
risk of Type 2 diabetes

5. Signs and Symptoms of Diabetes

6. ■ Frequent urination - Polyuria
■ Excessive thirst - Polydipsia
■ Extreme hunger - Polyphagia
■ Unexplained weight loss
■ Increased fatigue
■ Irritability
■ Blurred vision
■ Itching of the private parts in women
■ Slow healing of cuts and wounds
■ Impotence
■ Numbness, burning sensations, pins and needles of the feet and hands

7. Risk factors of diabetes
1. Non – modifiable
a. Advancing age
b. Family history of diabetes
2. Those that are
modifiable
a. Overweight and obesity
b. Alcohol use
c. Tobacco use
d. Physical inactivity
e. A stressful lifestyle
f. Unhealthy diet

8. Diagnosis of Diabetes
The ADA recommends that the following people be screened for diabetes:
■ Anyone with a body mass index higher than 23, regardless of age, who
additional risk factors
■ Anyone older than age 45 is advised to receive an initial blood sugar
screening, and then, if the results are normal, to be screened every three
years thereafter.
■ Any woman who has had gestational diabetes, is advised to be screened
for diabetes every three years.
■ Anyone who has been diagnosed with prediabetes is advised to be tested
every year.

9. Tests to diagnose diabetes
■ Random blood sugar test - A random blood sugar level of 200
milligrams per deciliter (mg/dL) or higher suggests diabetes.
■ Fasting blood sugar test - A fasting blood sugar level less than 100 mg/dL
is normal.
 A fasting blood sugar level from 100 to 125 mg/dL is considered
prediabetes.
 A value of 126 mg/dL or higher on two separate tests, confirms
diabetes.
■ Oral glucose tolerance test
 A blood sugar level less than 140 mg/dL is normal.

10. Complications of Diabetes
SHORT TERM COMPLICATIONS
Hypoglycemia (low blood sugar)
Causes:
- Skipping or delaying meals
- Wrong timings of medication
- Eating inadequate meal portions
- Drug overdose
- Side effect of medication
- Unplanned and excessive physical
activity
- Alcohol Intake

11. ■ Signs and Symptoms:
- Dizziness
- Confusion
- Weakness
- Reduced concentration
- Cold , sweaty skin –
- Nervousness
- Profuse sweating
- Fast heartbeat
- Hunger
- Headache
- Irritability
- Numbness of tongue and mouth
- Fainting and loss of consciousness

12. Long term complications of diabetes
■ Long term complications arise due to damage of the blood vessels resulting
in;
1. Diseases of the large blood vessels (affects the brain and heart)
2. Diseases of the small blood vessels and nerves (affects the eyes, kidneys,
sexual organs and feet)

14. Management of diabetes
■ The goal of diabetes management is to improve the quality of life and
productivity of people living with diabetes.
- Non drug method (use of proper diet and physical activity)
- Use of Drugs e.g. diabetes tablets for lowering blood sugar and insulin
Treatment of Type 2 Diabetes requires that you follow a healthy lifestyle
which includes following healthy eating guidelines and taking regular activity.

15. The 3 D’S of Diabetes Management
DIET
DAILY PHYSICAL ACTIVITY
DRUGS

16. Dietary management of DM
■ Goals
Maintain near-normal blood glucose levels
Achieve optimal serum lipid levels
Reduce blood pressure
Provide adequate calories for reasonable weight
Prevent & treat acute complications of insulin- treated diabetes
Improve overall health through optimal nutrition

17. Healthy eating for Diabetics
■ There is no one diabetes diet that can suite all.
■ Modification of a normal , well-balanced diet, based on the nutritional needs of an
individual.
■ Important things to consider
what to eat
how much to eat
when to eat

18. BASIC NUTRITIONAL STRATEGIES
■ DistributeThe FoodThroughoutThe Day
■ Small & frequent meals
■ Appropriate spacing time: 4 hours interval
■ Choose healthy CHO, protein & fat
■ Food distribution should synchronize with insulin therapy –
■ Most people will need 3 main meals + 3 snacks to avoid hypoglycemia
■ Consistency &Variety
■ Consistent eating habits
■ Try to eat the same amount of food at about the same time
■ Include a variety of foods

19. ■ WEIGHT REDUCTION (0.5 KG – 1.0 KG PERWEEK)
– Diet: Reduced Energy & Fat
– Lifestyle modification
– Regular physical activity

21. COMPONENTS OF A DIET

22. Carbohydrates
■ These foods are starchy or sweet.
■ Important source of energy.
■ Functioning of central nervous system, kidneys, brain and muscles. 55%-65% of
carbohydrate required daily.
■ There are three main types of carbohydrate in food:
■ Starches
■ Sugars
■ Fiber

23. ■ STARCH
■ Foods high in starch include:
■ Starchy vegetables like peas, corn, beans
■ Roots and tubers like potatoes, yam, colacassia, tapioca
■ Pulses
■ Grains like oats, barley, wheat, rice, jowar, bajra,ragi .
■ Grain-based foods like bread, cereal, pasta, and crackers
■ The grain group can be broken down even further into whole grain or refined grain.

24. Avoid/ Limit
■ White bread • Pasta •White rice •
Maida products lke romalli roti, nan,
pav ,bun etc. • Processed snack food
Choose from
■ Whole grains • Brown rice • Millets
like Jowar, Bajra, Ragi •Whole wheat
•Whole barley • Oats • Muesli etc.

25. Sugar - It’s another type of carbohydrate. Also referred to as
simple or fast-acting carbohydrate.There are two main types
Natural
■ Milk sugar also known as lactose.
Include low fat milk in moderation
■ Fruit sugar also known as fructose.
Include fruits with skin, seeds & pulp
■ Limit high calorie fruits and fruit
juices.
Processed/ concentrated
■ Fruit canned or preserved in heavy
syrup
■ Sugar added to make a cookies, pies,
candy, pudding, sweets, jams, jellies,
chocolates, ice cream, aerated drinks
fruit juices etc.
■ These sugars listed on the food label
like, high-fructose corn syrup,
dextrose, sucrose, corn sweetener
and corn syrup

27. ■ Fiber is another carbohydrate that plays a critical role in digestion.
■ Good sources of dietary fiber include:
■ Beans like Soya bean, kidney beans, lima beans.
■ Cereals like whole wheat , bajra, barley, oats,museli, jowar, ragi, bran.
■ Pulses like Bengal gram dal , peas dried, horse gram, sprouts.
■ Fruits like guava, cape gooseberry, figs, amla, pomegranate
■ Vegetables like drumstick, peas, green beans, broccoli, lady's finger, green leafy veg.
■ Seeds like fenugreek, flaxseeds, coriander seeds.
■ Soluble fiber present mostly in oatmeal, nuts, beans, apple,citrus fruits, apricots various
berries .
■ Adults need to eat 25 to 30 grams of fiber each day Helps in reducing blood cholesterol levels
, reduces risk of heart disease, obesity a type -2 diabetes, maintain proper bowel function and
reduces constipation

28. WHAT ISTHEGLYCEMIC LYCEMIC
INDEX(G.I.)
■ Numerical system that measures how fast a particular food ill raise the blood glucose
particular food will raise the blood glucose.
■ The higher the blood glucose response, the higher the G.I.
■ Glucose is given a value of 100, other CHOs are given a number relative to glucose a
number relative to glucose.

29. ■ Increasing the consumption of whole grains, nuts, legumes, fruit, and non-starchy
vegetables
■ Decreasing the consumption of starchy high-glycemic index foods like potatoes, white
rice, and white bread
■ Decreasing the consumption of sugary foods like cookies, cakes, candy, and soft-drinks

32. PROTEINS
■ These are body building foods
■ They help in:
■ Growth
■ Tissue repair
■ Supporting the immune system
■ 20%-25% protein required daily.
■ Sources : Meat, poultry, milk/milk products, pulses, dry beans, soy nuts.

33. ■ Avoid red meat, egg yolk as they are high in saturated fat.
■ Choose low-fat or lean meats and poultry
■ Select some seafood that is rich in omega-3 fatty acids, such as salmon, trout, sardines,
anchovies, herring, Pacific oysters, and mackerel.
■ Cook meat, poultry and fish using low-fat cooking methods like baking, broiling and
roasting.
■ Good vegetarian protein sources are soy products, tofu, nuts, seeds, sprouts and beans.
■ Choose unsalted nuts and seeds to keep sodium intake low.
■ Choose low-fat or fat-free milk, yogurt, and other milk products

34. FATS
■ These foods are oily or fatty.
■ Source of energy.
■ Insulation and padding
■ Source of essential fatty acids .
■ Absorption of vitamins.
■ 20-25% of fat required daily
■ SOURCES - vegetable oil , lean meat ,nuts , fish, seeds

35. Cholesterol
Used in the body for physiological and structural functions
The body makes cholesterol and humans do not need to consume this in their diet
Higher intakes have been shown to raise blood levels of LDL cholesterol (a positive risk
factor for heart disease)
Varying levels can be found in different animal products: meat, seafood, poultry, eggs,
dairy products

36. ■ Try to eliminate trans fats from partially hydrogenated oils.Check food labels for trans
fats; limit fried fast foods.
■ Limit intake of saturated fats by cutting back on processed and fast foods, red meat,
and full-fat dairy foods.Try replacing red meat with beans, nuts, skinless poultry, and
fish whenever possible, and switching from whole milk and other full-fat dairy foods to
lower fat versions.
■ In place of butter or margarine, use liquid vegetable oils rich in polyunsaturated and
monounsaturated fats in cooking and at the table.
■ Eat one or more good sources of omega-3 fats every day—fatty fish, walnuts, soybean
oil, ground flax seeds or flaxseed oil

37. Good fats
■ Oils are the major source of monounsaturated fats (MUFAs) and polyunsaturated fats
(PUFAs) in the diet
■ PUFAs contain some fatty acids that are necessary for health—called "essential fatty
acids”
■ Omega-6 PUFAs (liquid vegetable oils)
■ Omega-3 PUFAs ( soybean oil, canola oil, walnuts, flaxseed, fish)
■ Vitamin E - A powerful antioxidant that has may reduce the risk of heart disease and
cancer

39. The plate concept

40. FUNCTIONAL FOODS HELPFUL IN
DIABETES
■ Neem
■ Cinnamon
■ Garlic
■ Bitter gourd
■ Fenugreek
■ flaxseeds

41. DIETARY GUIDELINES
■ Energy intake to be estimated based on the age, gender, desirable body weight and
level of physical activity.
■ The BMI should be maintained at <23.
■ The total intake of calories is more important for a diabetic patient
■ Dietary calories should be
– 55-60% from carbohydrates
– 15- 20 % from proteins
– 15-20 % from fats

42. ■ Simple sugars should be restricted
■ Complex carbohydrates and fibre should be included – 25 – 40 g per day
■ Soluble fibre has the greatest hypoglycemic and hypocholestremic effect
■ Refined cereals should be avoided and millets should be consumed
■ Use a mixture of oils
■ Consume fish and chicken over red meat
■ Fried foods should be restricted
■ High protein vegetarian foods should be preferred.
■ Influence of chew count, glycemic indices and form of food should be recognised
■ Consume dry, roasted, unsalted nuts
■ Eat a wide variety of foods
■ Avoid alcohol
■ Avoid fasting and feasting

43. ■ Probiotics help improve insulin sensitivity
■ Sodium intake should be monitored
■ Do not depend on artificial sweeteners
■ Junk foods should be avoided
■ Bran can be added in your flours to reduce the GI and increase fiber.
■ Whole wheat breads , Multi-grain breads with broken grains are healthier than refined flour
breads.
■ Majority of vegetables are low in glycemic index and can be liberally used in day to day life.
■ One must always eat variety of vegetables than repeating the same ones every day.
■ Include brown rice over white rice.
■ You can enjoy the whole wheat varieties of pastas and noodles .
■ Salads should be a compulsory part of both main meals, this provides fiber and helps in slow
release of glucose in the blood stream.
■ You can have sweets and mango (1-2 pieces ) during mid meals / In between 2 meals
■ It is always better to avoid eating sweets and fruits along with the meal , this may lead to sugar
spikes in the blood .

44. ■ Foods to be avoided
– Simple sugars
– Sweets
– Dried fruits
– Cakes and candies
– Alcohol
– Jagery and brown sugar
– Sweetened juices
– Roots and tubers
– Banana and pineapple

45. ■ Foods to be consumed in moderation
– Fats
– Cereals
– Pulses
– Meat
– Eggs
– Nuts
– Fruits
– Artificial sweeteners

46. ■ Foods permitted
– GLVs
– Acidic fruits’
– Salads
– Plain coffee and tea
– Skimmed milk and buttermilk
– Spices

47. MEAL FOODS TO EAT
Early Morning Options:
 Fenugreek water (1 teaspoon fenugreek seeds
soaked in a glass of water overnight)
 Overnight soaked almonds (4-5 pieces)
Breakfast Options:
 2-3 idlis with chutney and drumstick sambar
(use less salt)
 2 dosas with chutney and vegetable sambar
(use less salt)
 1 small cup of vegetable upma with chutney

48. Pre-Lunch Options:
 1 apple/ guava/ 1 cup papaya
 Unstrained vegetable juice/ Bitter gourd juice
 Tender coconut water
 A glass of ragi malt with thin buttermilk
Lunch Options:
 Cucumber and tomato salad + ½ cup brown rice + 1 cup
sambar with lots of vegetables + any vegetable curry
(with less spice) + 1 glass mint jeera buttermilk
 Cucumber and tomato salad + ½ cup brown rice + 1
cup vegetable curry + ½ cup fish or chicken curry with
less spice + 1 glass mint jeera buttermilk

49. Evening Snacks Options:
 Green tea with roasted flaked rice with curry leaves
and chopped garlic
 Black coffee and ¼ cup homemade snacks (Use less
oil)
 Filter coffee with less milk and ½ cup roasted chana
Dinner Options:
 Vegetable clear soup or chicken and vegetable clear
soup +2 chapatis
 Mixed vegetable curry + 2 chapatis + curd
Before Bed  1 cup warm low-fat milk with a pinch of raw ground
turmeric or cinnamon powder

50. ■ Breakfast:Vegetable stuffed chapati or roti/vegetable dalia/1 egg with 1-2 whole wheat
toast with grilled vegetables and a cup of tea or coffee or low-fat milk.
■ Mid-morning snack: Fruits (low-glycemic fruits)
■ Lunch: 1-2 chapatis with barley (50%), vegetables, 1 bowl of dal or chicken and curd.
■ Evening snack: Roasted chana, bajra or jowar or fruits or 1 cup of curd.
■ Dinner: 1-2 chapatis with vegetables and salad along with 1 bowl of dal or curd.

51. ■ Breakfast:Whole wheat sandwich/chicken sandwich along with a cup of tea or coffee
or low-fat milk.
■ Mid-morning snack: Fruits (low-glycemic fruits).
■ Lunch: 1-2 chapatis ( 50% chana flour) with mixed vegetables, salad and low-fat
paneer (50 gm)/1 bowl of curd.
■ Evening snack: Roasted chana, bajra or jowar or fruits or 1 cup of curd.
■ Dinner: 1-2 chapatis (50% chana flour) with mixed vegetables and salad along with 1
bowl of fish or dal.

52. ■ Breakfast: Moong dal cheela with vegetables or stuffed multi-grain chapatti with a
cup of tea or coffee or low-fat milk.
■ Mid-morning snack: Fruits (low-glycemic fruits).
■ Lunch: 1-2 chapatis (knead with any green leafy vegetable), vegetables, salad and 1
bowl of sprout or 2 egg white curry.
■ Evening snack: Roasted chana, bajra or jowar or fruits or 1 cup of curd.
■ Dinner: 1-2 chapatis with vegetables and salad along with curd or dal.

53. MYTHS
■ Diabetics can eat wheat but not rice
■ Any amount of wheat can be consumed
■ Fasting can be compensated by the next meal
■ Fruits and vegetables can be eaten in unlimited quantities
■ Liquids are easily digestible
■ Avoid carbohydrates and fats
■ You must avoid sugar at all costs
■ You’ll no longer be able to eat normally.