Why should you eat any differently than anyone else just because you have diabetes? The answer is that the way you eat affects your risk of developing the complications of diabetes: eye disease, kidney disease, heart attacks and strokes, and nerve damage. You make changes in what you eat to help keep your blood glucose, cholesterol and other blood fats, and your blood pressure in the desirable range.
You also can improve your health by making healthier food choices and getting at least 30 minutes of moderately intense physical activity most days.
Experts are giving us guidelines on what people with diabetes should eat because there are a lot of misconceptions about nutrition and diabetes. Despite what promoters of some popular diets claim, the majority of your calories should come from carbohydrate. Fruits, vegetables, whole grains and low-fat dairy products contain very important nutrients that are important for good health. A diet that includes these foods will not cause poor blood glucose control. It is important to first eat a healthy diet; then adjust medication ( if needed) to control your blood glucose.
The most important thing to consider in how foods affect your blood glucose is the amount of carbohydrate you eat at one time. The type or source of carbohydrate is much less important.
People who do not take diabetes medication and people who take the same dose of insulin from day to day have better blood glucose levels when they eat about the same amount of carbohydrate from day to day. Since carbohydrate converts to glucose, the more you eat at one time, the greater the rise in blood glucose after the meal. Those who take short-acting or fast-acting insulin before each meal have more flexibility. They should adjust their premeal insulin dose to the amount of carbohydrate they are going to eat for the best blood glucose control.
People may respond to foods differently. You may find that some foods with carbohydrate have more effect than others on your blood glucose. If so, you can reduce the amount of that food that you eat at one time. It’s not a reason to avoid it completely. There are several things that can affect how much your blood glucose increases after you eat a meal. In addition to the amount of carbohydrate, - how long a food is cooked, whether or not it’s highly processed like instant mashed potatoes, the form of the food (whole vs chopped), and what else you’re eating at the meal, such as fat which will slow the absorption of the carbohydrate, all affect how much a meal will increase your blood glucose. Therefore, it’s always best to check your blood glucose frequently.
Studies show that overall, foods with equal amounts of carbohydrate have similar effects on blood glucose. To minimize the effect on blood glucose, foods with sugar need to be substituted for other carbohydrates at the meal and not simply added to the meal. Large amounts or frequent use of foods that contain sugar are not healthy for anyone. They replace more nutritious foods and often contain significant amounts of fat.
For example, if you wanted to have some ice-cream at a meal, and your usual meal plan included 45 grams of carbohydrate or 3 carbohydrate choices, you could have 1/2 cup of ice-cream and leave off either a piece of fruit, a slice of bread, or the 1/3 cup of rice. All contain equal amounts of carbohydrate = 15 grams. However, the ice-cream, depending on what type you eat, may contain more fat than the food you’re replacing.
The best way to determine what effect a particular food has on your blood glucose is to check you blood glucose for several days 2 hours after a particular meal, eating about the same type and amount of food. Then, substitute the new food for your usual food that has the same amount of carbohydrate.Test 2 hours after the meal and compare the results.
Sugar alcohols are safe to use. They’re found in many sugar-free and reduced-sugar foods such as candy, cough drops, gum, and desserts. Although sugar alcohols have less effect on blood glucose and slightly fewer calories than regular products, eating foods with sugar alcohols probably won’t cause weight loss or lower your blood glucose. Many products still contain a significant number of calories and therefore are not “free” foods. Fructose used in place of table sugar has less effect on blood glucose, but large amounts may increase LDL and total cholesterol. Therefore, the sweetener is not recommended, but naturally-occurring fructose found in fruits and vegetables should not be restricted,
There are currently 4 low-calorie sweeteners available in the US. Many sweeteners are now combined in food and beverages to limit the total amount of sweetener used and to improve taste. The FDA sets an ADI (acceptable daily intake) that can be safely consumed on a daily basis over a person’s lifetime without risk . The table shows the number of cans of soda or packets/day needed by a 132 lb person to reach the ADI. Actual intake is much less than the ADI. (FDA does not have an ADI for saccharin- it was set by the World Health Organ- ization) No adverse effects have been found with low-calorie sweeteners during pregnancy in animal studies.
There are many health advantages to including fiber-rich foods in your diet such as preventing and relieving constipation, prevention of some types of cancer and helping with weight loss by making you feel full longer. Americans eat only half the recommended amount of fiber. Food sources of fiber are recommended instead of fiber supplements.
The amount of fiber that is encouraged for most Americans has not been shown to improve blood glucose or cholesterol. It takes more fiber than most Americans can usually tolerate to improve glucose or cholesterol.
New research shows that protein (found in meats, cheese, chicken, and legumes) has very little affect on blood glucose. Carbohydrates are still the primary nutrient that affects blood glucose. The usual protein intake in the US is adequate for people with diabetes (15-20% of calories) and should not be excessive. Serving sizes of meat, fish, poultry should be about 3 ounces (or total of 6ounces/day) High protein intakes may promote kidney disease in people with diabetes. If your doctor has diagnosed you with early kidney disease, you should see a registered dietitian to design a meal plan for you that contains less protein.
Protein does not slow the absorption of food into the bloodstream. Although many experts used to believe that protein should be included in snacks because it slows absorption and helps prevent hypoglycemia through the night, new research shows that is not the case. A snack of pure carbohydrate such as a piece of fruit or some crackers works as well and does not contain the extra fat and calories that most protein foods (like meat, cheese, and peanut-butter) contain.
The long-term effects of diets high in protein and low in carbohydrate are unknown. Although short-term weight loss does occur, they have not been shown to result in long-term weight loss. There is also concern that they may increase LDL cholesterol.
Saturated fat has the most effect on LDL cholesterol. People with diabetes appear to be more sensitive to dietary cholesterol than the general public. Trans fats are formed when liquid vegetable oils are processed to become solid.
Eating less saturated fats is the most effective way you can lower your LDL cholesterol.
Trans fats are thought to be just as bad for your heart as saturated fats. In addition to many stick margarines, they’re also found in many commercially prepared foods.
Many foods that contain cholesterol also contain saturated fat. The foods highest in dietary cholesterol are egg yolks and organ meats like liver.
LDL cholesterol can be lowered by replacing saturated fats with monounsaturated fats. Monounsaturated fats like olive oil or canola oil can be used in food preparation and substituted for saturated fats in spreads and snacks.
For most people, eating less total fat is best (less than 30% of your calories). Eating less fat makes it easier to lose weight and improves your cholesterol. Eating fat-free or reduced fat foods may be beneficial.
Studies done with the general public show a protective effect from eating at least 2 servings of fish/week, especially fatty fish like salmon. The type of beneficial fat is known as omega-3 fatty acids. Flaxseed , flaxseed oil, canola oil, soybean oil, and nuts also contain omega-3 fatty acids.
Vitamin and mineral supplements are not a replacement for eating a nutritious diet. The beneficial nutrients that keep us healthy and protect us from disease have not all been identi- fied.Therefore, you cannot take a pill and get the nutrients you need. Several types of vitamins and minerals can be highly toxic if taken in very large doses.
Most people in the US are not deficient in vitamins and minerals. If a deficiency is identified, supplements maybe useful.
Obesity and overweight in type 2 diabetes increases insulin resistance. Therefore, even a small amount of weight loss (10lbs) is important in overweight people with type 2 diabetes to improve insulin resistance and lower blood glucose. Weight loss is also associated with improvement in cholesterol and blood pressure.
A daily intake of 1,000-1,500 mg of calcium, especially in older people with diabetes is recommended to reduce the risk of osteoporosis (bone disease). Folate for prevention of birth defects is important in women of child-bearing age. There has been interest in prescribing antioxidant vitamins to people with diabetes. Large doses are not advised as they have resulted in adverse effects.
Pregnant women should not drink alcoholic beverages. People with the following conditions should also abstain: those with pancreatitis, advanced diabetic neuropathy, extremely high triglycerides, and alcohol abuse. One drink is defined as 12 ounce beer, 5 ounces wine, or 1.5 ounces of distilled spirits.
The major ways to lower blood pressure by making lifestyle changes is to eat less salt (the blood pressure response to salt varies from person to person) and lose a modest amount of weight. Increased physical activity may also lower blood pressure Drinking 3 or more alcoholic drinks a day may increase blood pressure.
Diet in diabetes by Dr. Atiullah khan
By : Dr. ATIULLAH KHAN
Managing diabetes by healthy diet
To prevent complications of diabetesTo prevent complications of diabetes
by keeping control of:
Can Lead To:
A healthy diet may include changing what one
eats, in what quantities, and how often.
Controlling body weight
Keeping the level of blood-sugar at a normal level
Reducing fat in the body
To improve your healthTo improve your health
by making healthy food choices
and being physically active
SO, RECOMMENDED DIET
FOR DIABETIC PATIENTS?
Eat starchy foods regularly
Eat more fruit and vegetables
Reduce animal or saturated fat
Cut down on sugar
• When controlling diabetes, blood sugar can become too high or too low.
These conditions should be taken seriously. Fortunately, one can easily re-
establish control of blood sugar.
• When there is too much sugar in the blood, this condition is called
hyperglycemia. Hyper is Latin and means "more." Glycemia is also Latin and
means "sugar in the blood."
• Hyperglycemia is caused by eating too much food, eating sugary foods, or by
not taking one’s medication. It can also occur when one is sick. If not
treated, hyperglycemia can lead to a coma.
• Hypoglycemia occurs when too little sugar is present in the blood. Hypo is
Latin and means "less."
• Hypoglycemia usually occurs with patients who take insulin or other
• Taking too much insulin can cause it. That is why it is also known as insulin
• Hypoglycemia can also be caused when the food intake is reduced or a meal
is skipped. . Signs of low blood sugar, or hypoglycemia .
Include foods containing carbohydrate from whole
grains, fruits, vegetables and low-fat milk in your
The amount of carbohydrate at a meal
affects your blood glucose more
than the type
Sugar and starch have similar effects on blood
Consistency in carbohydrate intake is
important from day to day
For people not taking diabetes medication
For people taking a fixed dose of insulin
Insulin should be adjusted based on amount
of carbohydrate at meals
For people on varying doses at meal
Several things affect how much your blood
glucose increases after you eat:
amount of carbohydrate
type of sugar or starch
cooking and food processing
other foods in the meal that slow digestion
Limited amounts of sugar or foods containing
sugar can be used without affecting blood
when substituted for other carbohydrates at the
Large amounts of sugar-containing foods are
Usual diet: 45 gramsUsual diet: 45 grams
(or 3 Carbohydrates(or 3 Carbohydrates
1 slice bread
1/3 cup rice
1/2 cup fruit
3 ounces chicken
Substitute ice-creamSubstitute ice-cream
for 15 grams offor 15 grams of
carbohydratecarbohydrate (or 1(or 1
Carbohydrate Choice)Carbohydrate Choice)
1/2 cup ice-cream
1/3 cup rice
1/2 cup fruit
3 ounces chicken
To observe effect of new food on blood glucose:To observe effect of new food on blood glucose:
check blood glucose 2 hours after meal for
substitute food containing sugar for other
carbohydrate in meal
check blood glucose 2 hours
after meal and compare
Sugar alcohols (polyols):
sorbitol, mannitol, xylitol
Used as sweeteners and bulking agents
Safe to use
May cause diarrhea, especially in children
Not recommended as a sweetener
Cans of soda
Aspartame 15 86
Saccharin 2 7.5
Sucralose 4.5 60
Fiber is encouraged for everyone:
Good sources of fiber:
Whole grain cereals
Beans and peas
Only large amounts (50 grams/day) have
shown improvement in blood glucose and
Primarily soluble fiber (barley, oatmeal, beans,
Side effects make this difficult for many people
Medical Nutrition Management is the corner
stone in management of a person with
diabetes. Diet plays a major role in
regulating carbohydrate, Fat ,protein in
patients with diabetes . Further more proper
dietary management is required for safe &
effective use of insulin .
1) Achieve and maintain – blood glucose level in
the normal range or as close to normal as is
safely possible ; lipid & lipoprotein profile that
reduce the risk of vascular disease ; blood
pressure levels in the normal range or as close
to normal as is safely possible .
2) To prevent or at least slow the rate of
development of the chronic complications of
diabetes by modifying nutrient intake and
3) To address individual nutrition needs .
4) To maintain the pleasure of eating by only
limiting food choices when indicates by
Caloric requirements of adults ---obese or
very inactive adults , chronic dieters (20
Adults older than 55years of age , active
women, sedentary men ( 28 kcal/kg ).
Active men or very active women ( 30
Thin or very active men ( 40 kcal/kg).
1000 kcal + Age * 100 kcal for girls.
1000 kcal + Age * 125 kcal for boys.
*( From Raghuram TC et al; Diet and
Carbohydrate should provide 50-60% of
energy intake .Generally in Indian diet CHO
provide 60-65% of total calories . Diabetics
need to restrict CHO intake and can alter the
type of CHO in their diet. Unrefined CHO ,
with natural fiber intact is beneficial coz of
there low glycaemic index.
The adult recommended dietary intake ( RDI )
of 0.8 to 1gm /kg IBW.,or 10-15% .
Protein of high biologic value should be given
Fats are concentrated source of energy .Fat
intake generally should not exceed 30% of
energy. Excessive fat intake contribute to
obesity , insulin resistance, hypertension &
atherosclerotic cardiovascular disease .
Different carbohydrates raise blood sugar
level…It is there important to know ,while
recommending a diet for diabetic, to what
extent different foods raise the blood sugar
levels. The glycaemic index indicates the
extent of rise in blood sugar in response to
consumption of food in comparison with the
response to an equivalent amount of
Area under the 2 hour blood glucose response
curve(AUC)following the ingestion of a fixed portion
of test carbohydrate (50g) as a proportion of the
standard either glucose or white bread.
Protein has very little effect on blood
Avoid large amounts of protein
may promote kidney disease
Restrict protein only if you have
early kidney disease
Protein does not slow the absorption of
Adding protein to snacks does not help prevent
Fruits are good snack foods
Safety of high protein, low carbohydrate
weight loss diets are unknown
do not promote long-term weight loss
may increase LDL cholesterol
Primary goal - Lower LDL cholesterolPrimary goal - Lower LDL cholesterol
Eating less saturated fat and
Eating less trans fats
Foods That Contain Saturated Fats:
Meat and meat fats (bacon, lard)
Dairy products (whole milk,
butter, cheese, cream, ice-cream)
Palm and coconut oil
Baked goods made from
Foods That Contain Trans Fats:
Formed when a liquid oil is made more solid
Found in many types of stick margarine, fast
foods, and baked goods like cookies, crackers,
snack foods, pastries and croissants
Foods That Contain Cholesterol:
All animal foods
Organ meats like liver
Choose monounsaturated fat in place ofChoose monounsaturated fat in place of
olive oil, canola oil, peanut oil,olive oil, canola oil, peanut oil,
olives, avocados, nutsolives, avocados, nuts
Eat less total fat
Low-fat diets can help:
with weight loss
improve cholesterol and other fats
Eat 2-3 servings fish per week
contain a type of fat protective against heart
fatty fish especially beneficial
Vitamins and minerals from foods important
High doses of vitamin and mineral supplements
can be toxic
People who may benefit from a multivitaminPeople who may benefit from a multivitamin
persons deficient in a vitamin or mineral
pregnant or nursing mothers
persons on calorie-restricted diet
A small amount of weight loss can:A small amount of weight loss can:
improve insulin resistance
lower blood glucose
improve blood cholesterol
reduce blood pressure
No clear benefit from vitamin and mineral
calcium for prevention of bone disease
folate for prevention of birth defects
Use of antioxidants is not advised
vitamin C, E, selenium, beta carotene
long-term safety and effectiveness unknown
Alcohol ideally should be avoided,
If you choose to drink, limit to:
1 drink/day for women
2 drinks/day for men
To reduce risk of hypoglycemia, should not
consume alcohol with food
You can lower blood pressure by:You can lower blood pressure by:
Eating less salt
Losing a modest amount of weight
The Bottom Line
Your lifestyle affects your healthYour lifestyle affects your health
Harisson medicine textbook 19/e 2409
Joslins textbook of diabetes mellitus pg no.614
Parks textbook of community medicine 23/e
IAP textbook of medicine
RSSD textbook of diabetes mellitus pg.405