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Diet in diabetes by Dr. Atiullah khan


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Diet in diabetes by Dr. Atiullah khan

  1. 1. By : Dr. ATIULLAH KHAN Managing diabetes by healthy diet
  2. 2.  To prevent complications of diabetesTo prevent complications of diabetes  by keeping control of:  Blood glucose  Cholesterol  Blood pressure
  3. 3. Can Lead To:  Heart Attack  Kidney Diseases  Nerve Damage  Eye Disease
  4. 4. A healthy diet may include changing what one eats, in what quantities, and how often.
  5. 5.  Controlling body weight  Keeping the level of blood-sugar at a normal level  Reducing fat in the body
  6. 6.  To improve your healthTo improve your health  by making healthy food choices  and being physically active
  8. 8.  Eat starchy foods regularly  Eat more fruit and vegetables  Reduce animal or saturated fat  Cut down on sugar  Reduce salt
  9. 9. Hyperglycemia Hypoglycemia • 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.
  10. 10. • 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 medications. • Taking too much insulin can cause it. That is why it is also known as insulin shock. • Hypoglycemia can also be caused when the food intake is reduced or a meal is skipped. . Signs of low blood sugar, or hypoglycemia . Hyperglycemia Hypoglycemia
  11. 11.  Include foods containing carbohydrate from whole grains, fruits, vegetables and low-fat milk in your diet
  12. 12.  The amount of carbohydrate at a meal affects your blood glucose more than the type  Sugar and starch have similar effects on blood glucose =
  13. 13.  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 times
  14. 14.  Several things affect how much your blood glucose increases after you eat:  amount of carbohydrate  type of sugar or starch  cooking and food processing  food form  other foods in the meal that slow digestion
  15. 15.  Limited amounts of sugar or foods containing sugar can be used without affecting blood glucose  when substituted for other carbohydrates at the meal  Large amounts of sugar-containing foods are not recommended
  16. 16. Usual diet: 45 gramsUsual diet: 45 grams carbohydratecarbohydrate (or 3 Carbohydrates(or 3 Carbohydrates Choices)Choices) 1 slice bread 1/3 cup rice 1/2 cup fruit 3 ounces chicken Vegetable salad 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 Vegetable salad
  17. 17. 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 several days  substitute food containing sugar for other carbohydrate in meal  check blood glucose 2 hours after meal and compare
  18. 18. Sugar alcohols (polyols): sorbitol, mannitol, xylitol  Used as sweeteners and bulking agents  Safe to use  May cause diarrhea, especially in children Fructose:  Not recommended as a sweetener
  19. 19. Cans of soda (maximum/day) Packets x 25 18 Aspartame 15 86 Saccharin 2 7.5 Sucralose 4.5 60
  20. 20. Fiber:  Fiber is encouraged for everyone: 20-35 grams/day  Good sources of fiber:  Whole grain cereals  Fruits  Vegetables  Beans and peas
  21. 21. Fiber:  Only large amounts (50 grams/day) have shown improvement in blood glucose and cholesterol  Primarily soluble fiber (barley, oatmeal, beans, apples, broccoli)  Side effects make this difficult for many people
  22. 22. 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 .
  23. 23. 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 lifestyle. 3) To address individual nutrition needs . 4) To maintain the pleasure of eating by only limiting food choices when indicates by scientific evidence.
  24. 24. Calories ----  Caloric requirements of adults ---obese or very inactive adults , chronic dieters (20 kcal/kg).  Adults older than 55years of age , active women, sedentary men ( 28 kcal/kg ).  Active men or very active women ( 30 kcal/kg).  Thin or very active men ( 40 kcal/kg).
  25. 25. 1000 kcal + Age * 100 kcal for girls. 1000 kcal + Age * 125 kcal for boys. *( From Raghuram TC et al; Diet and Diabetes,NIN,1991)
  26. 26. 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.
  27. 27. The adult recommended dietary intake ( RDI ) of 0.8 to 1gm /kg IBW.,or 10-15% . Protein of high biologic value should be given consideration .
  28. 28. 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 .
  29. 29. 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 glucose .
  30. 30.  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. 6/9
  31. 31.  Protein has very little effect on blood glucose  Avoid large amounts of protein  may promote kidney disease  Restrict protein only if you have early kidney disease
  32. 32.  Protein does not slow the absorption of carbohydrate  Adding protein to snacks does not help prevent hypoglycemia  Fruits are good snack foods
  33. 33.  Safety of high protein, low carbohydrate weight loss diets are unknown  do not promote long-term weight loss  may increase LDL cholesterol
  34. 34.  Primary goal - Lower LDL cholesterolPrimary goal - Lower LDL cholesterol by:by: Eating less saturated fat and cholesterol Eating less trans fats
  35. 35. 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 these fats
  36. 36. 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
  37. 37. Foods That Contain Cholesterol:  All animal foods  Organ meats like liver  Egg yolks
  38. 38.  Choose monounsaturated fat in place ofChoose monounsaturated fat in place of saturated:saturated:  olive oil, canola oil, peanut oil,olive oil, canola oil, peanut oil, olives, avocados, nutsolives, avocados, nuts
  39. 39.  Eat less total fat  Low-fat diets can help:  with weight loss  improve cholesterol and other fats
  40. 40.  Eat 2-3 servings fish per week  contain a type of fat protective against heart disease  fatty fish especially beneficial
  41. 41. Permissible Foods 1-Green leafy vegetables 2-Seasonal vegetables 3-Soups 4-Dairy products(Skimmed) 5-Fruits—Apple, guava, pear, papaya. 6-All Pulses -Husked Non Permissible Foods 1-Sugar , jaggery , honey. 2-Potato, beetroot , arvi, sweet potato 3-Fried,canned foods, processed foods 4-Soft drinks, ice creams, fruit juice 7/9
  42. 42. 8/9
  43. 43.  Vitamins and minerals from foods important  High doses of vitamin and mineral supplements can be toxic
  44. 44. People who may benefit from a multivitaminPeople who may benefit from a multivitamin supplement:supplement:  persons deficient in a vitamin or mineral  elderly  pregnant or nursing mothers  strict vegetarians  persons on calorie-restricted diet
  45. 45. 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
  46. 46.  No clear benefit from vitamin and mineral supplements except  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
  47. 47.  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
  48. 48. You can lower blood pressure by:You can lower blood pressure by:  Eating less salt  Losing a modest amount of weight
  49. 49. The Bottom Line Your lifestyle affects your healthYour lifestyle affects your health Biblography: ADA 2014-2015 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