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  1. 1. BY VINITA MEWADA BHOPAL Eating Guidelines for Diabetes
  2. 2. Why Change Eating Habits? <ul><li>To prevent complications of diabetes </li></ul><ul><ul><li>by keeping control of: </li></ul></ul><ul><ul><ul><li>Blood glucose </li></ul></ul></ul><ul><ul><ul><li>Cholesterol </li></ul></ul></ul><ul><ul><ul><li>Blood pressure </li></ul></ul></ul>
  3. 3. Why Change Eating Habits? <ul><li>To improve your health </li></ul><ul><ul><li>by making healthy food choices </li></ul></ul><ul><ul><li>and being physically active </li></ul></ul>
  4. 4. Carbohydrate and Diabetes <ul><li>Include foods containing carbohydrate from whole grains, fruits, vegetables and low-fat milk in your diet </li></ul>
  5. 5. Carbohydrate and Diabetes <ul><li>The amount of carbohydrate at a meal affects your blood glucose more </li></ul><ul><li>than the type </li></ul><ul><ul><li>Sugar and starch have similar effects on blood glucose </li></ul></ul><ul><ul><li>= </li></ul></ul>
  6. 6. Carbohydrate and Diabetes <ul><li>Consistency in carbohydrate intake is important from day to day </li></ul><ul><ul><li>For people not taking diabetes medication </li></ul></ul><ul><ul><li>For people taking a fixed dose of insulin </li></ul></ul><ul><li>Insulin should be adjusted based on amount of carbohydrate at meals </li></ul><ul><ul><li>For people on varying doses at meal </li></ul></ul><ul><li>times </li></ul>
  7. 7. Carbohydrate and Diabetes <ul><li>Several things affect how much your blood glucose increases after you eat: </li></ul><ul><ul><li>amount of carbohydrate </li></ul></ul><ul><ul><li>type of sugar or starch </li></ul></ul><ul><ul><li>cooking and food processing </li></ul></ul><ul><ul><li>food form </li></ul></ul><ul><ul><li>other foods in the meal that slow digestion </li></ul></ul>
  8. 8. Carbohydrate and Diabetes <ul><li>Limited amounts of sugar or foods containing sugar can be used without affecting blood glucose </li></ul><ul><ul><li>when substituted for other carbohydrates at the meal </li></ul></ul><ul><li>Large amounts of sugar-containing foods are not recommended </li></ul>
  9. 9. Substituting Sweets <ul><li>Usual diet: 45 grams carbohydrate (or 3 Carbohydrates Choices) </li></ul><ul><li>1 slice bread </li></ul><ul><li>1/3 cup rice </li></ul><ul><li>1/2 cup fruit </li></ul><ul><li>3 ounces chicken </li></ul><ul><li>Vegetable salad </li></ul><ul><li>Substitute ice-cream for 15 grams of carbohydrate (or 1 Carbohydrate Choice) </li></ul><ul><li>1/2 cup ice-cream </li></ul><ul><li>1/3 cup rice </li></ul><ul><li>1/2 cup fruit </li></ul><ul><li>3 ounces chicken </li></ul><ul><li>Vegetable salad </li></ul>
  10. 10. Carbohydrate and Diabetes <ul><li>To observe effect of new food on blood glucose: </li></ul><ul><li>check blood glucose 2 hours after meal for several days </li></ul><ul><li>substitute food containing sugar for other carbohydrate in meal </li></ul><ul><li>check blood glucose 2 hours </li></ul><ul><li>after meal and compare </li></ul>
  11. 11. Sweeteners and Diabetes <ul><li>Sugar alcohols (polyols): </li></ul><ul><li>sorbitol, mannitol, xylitol </li></ul><ul><li>Used as sweeteners and bulking agents </li></ul><ul><li>Safe to use </li></ul><ul><li>May cause diarrhea, especially in children </li></ul><ul><li>Fructose: </li></ul><ul><li>Not recommended as a sweetener </li></ul>
  12. 12. Sweeteners and Diabetes Low calorie sweeteners: are safe for people with diabetes when consumed within recommended levels
  13. 13. Carbohydrate and Diabetes <ul><li>Fiber: </li></ul><ul><li>Fiber is encouraged for everyone: </li></ul><ul><li>20-35 grams/day </li></ul><ul><li>Good sources of fiber: </li></ul><ul><ul><li>Whole grain cereals </li></ul></ul><ul><ul><li>Fruits </li></ul></ul><ul><ul><li>Vegetables </li></ul></ul><ul><ul><li>Beans and peas </li></ul></ul>
  14. 14. Carbohydrate and Diabetes <ul><li>Fiber: </li></ul><ul><li>Only large amounts (50 grams/day) have shown improvement in blood glucose and cholesterol </li></ul><ul><ul><li>Primarily soluble fiber (barley, oatmeal, beans, apples, broccoli) </li></ul></ul><ul><ul><li>Side effects make this difficult for many people </li></ul></ul>
  15. 15. Protein and Diabetes <ul><li>Protein has very little effect on blood glucose </li></ul><ul><li>Avoid large amounts of protein </li></ul><ul><ul><li>may promote kidney disease </li></ul></ul><ul><li>Restrict protein only if you have </li></ul><ul><li>early kidney disease </li></ul>
  16. 16. Protein and Diabetes <ul><li>Protein does not slow the absorption of carbohydrate </li></ul><ul><ul><li>Adding protein to snacks does not help prevent hypoglycemia </li></ul></ul><ul><ul><li>Fruit or crackers are good snack foods </li></ul></ul>
  17. 17. Protein and Diabetes <ul><li>Safety of high protein, low carbohydrate weight loss diets are unknown </li></ul><ul><ul><li>do not promote long-term weight loss </li></ul></ul><ul><ul><li>may increase LDL cholesterol </li></ul></ul>
  18. 18. Dietary Fat and Diabetes <ul><li>Primary goal - Lower LDL cholesterol by: </li></ul><ul><ul><li>Eating less saturated fat and cholesterol </li></ul></ul><ul><ul><li>Eating less trans fats </li></ul></ul>
  19. 19. Dietary Fat and Diabetes <ul><li>Foods That Contain Saturated Fats: </li></ul><ul><li>Meat and meat fats (bacon, lard) </li></ul><ul><li>Dairy products (whole milk, </li></ul><ul><li>butter, cheese, cream, ice-cream) </li></ul><ul><li>Palm and coconut oil </li></ul><ul><li>Baked goods made from </li></ul><ul><li>these fats </li></ul>
  20. 20. Dietary Fat and Diabetes <ul><li>Foods That Contain Trans Fats: </li></ul><ul><li>Formed when a liquid oil is made more solid </li></ul><ul><li>Found in many types of stick margarine, fast foods, and baked goods like cookies, crackers, snack foods, pastries and croissants </li></ul>
  21. 21. Dietary Fat and Diabetes <ul><li>Foods That Contain Cholesterol: </li></ul><ul><li>All animal foods </li></ul><ul><li>Organ meats like liver </li></ul><ul><li>Egg yolks </li></ul>
  22. 22. Dietary Fat and Diabetes <ul><li>Choose monounsaturated fat in place of saturated: </li></ul><ul><ul><li>olive oil, canola oil, peanut oil, </li></ul></ul><ul><ul><li>olives, avocados, nuts </li></ul></ul>
  23. 23. Dietary Fat and Diabetes <ul><li>Eat less total fat </li></ul><ul><li>Low-fat diets can help: </li></ul><ul><ul><li>with weight loss </li></ul></ul><ul><ul><li>improve cholesterol and other fats </li></ul></ul>
  24. 24. Dietary Fat and Diabetes <ul><li>Eat 2-3 servings fish per week </li></ul><ul><ul><li>contain a type of fat protective against heart disease </li></ul></ul><ul><ul><li>fatty fish especially beneficial </li></ul></ul>
  25. 25. Weight Loss and Diabetes <ul><li>A small amount of weight loss can: </li></ul><ul><li>improve insulin resistance </li></ul><ul><li>lower blood glucose </li></ul><ul><li>improve blood cholesterol </li></ul><ul><li>reduce blood pressure </li></ul>
  26. 26. Weight Loss and Diabetes <ul><li>Successful weight loss usually requires: </li></ul><ul><li>a structured weight loss program </li></ul><ul><li>education </li></ul><ul><li>reduced fat and calories </li></ul><ul><li>regular physical activity </li></ul><ul><li>frequent follow-up </li></ul>
  27. 27. Vitamins and Minerals and Diabetes <ul><li>Vitamins and minerals from foods important </li></ul><ul><li>High doses of vitamin and mineral supplements can be toxic </li></ul>
  28. 28. Vitamins and Minerals and Diabetes <ul><li>People who may benefit from a multivitamin supplement: </li></ul><ul><li>persons deficient in a vitamin or mineral </li></ul><ul><li>elderly </li></ul><ul><li>pregnant or nursing mothers </li></ul><ul><li>strict vegetarians </li></ul><ul><li>persons on calorie-restricted diet </li></ul>
  29. 29. Vitamins and Minerals and Diabetes <ul><li>No clear benefit from vitamin and mineral supplements except </li></ul><ul><ul><li>calcium for prevention of bone disease </li></ul></ul><ul><ul><li>folate for prevention of birth defects </li></ul></ul><ul><li>Use of antioxidants is not advised </li></ul><ul><ul><li>vitamin C, E, selenium, beta carotene </li></ul></ul><ul><ul><li>long-term safety and effectiveness unknown </li></ul></ul>
  30. 30. Alcohol and Diabetes <ul><li>If you choose to drink, limit to: </li></ul><ul><ul><li>1 drink/day for women </li></ul></ul><ul><ul><li>2 drinks/day for men </li></ul></ul><ul><li>To reduce risk of hypoglycemia, consume alcohol with food </li></ul>
  31. 31. High Blood Pressure and Diabetes <ul><li>You can lower blood pressure by: </li></ul><ul><li>Eating less salt </li></ul><ul><li>Losing a modest amount of weight </li></ul>
  32. 32. Preventing Diabetes <ul><li>Family members of people with Type 2 diabetes can prevent diabetes by: </li></ul><ul><li>Weight loss if overweight </li></ul><ul><ul><li>using a structured weight loss </li></ul></ul><ul><ul><li>program </li></ul></ul><ul><li>Regular physical </li></ul><ul><li>activity </li></ul>
  33. 33. The Bottom Line <ul><li>Your lifestyle affects your health </li></ul>Eat healthy foods Daily Physical Activity

Editor's Notes

  • 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.
  • 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.
  • It is well known that losing weight and maintaining it is difficult. The people who have been the most successful at keeping the weight off are those who have attended structured weight loss programs composed of the above. Fat is probably the most important nutrient to restrict in a weight loss program (&lt;30% of calories) Regular physical activity not only aids in weight reduction, it is important in maintaining weight loss, it improves insulin sensitivity, and lowers blood glucose. Weight loss programs that provide meal replacements result in weight loss while a person continues to use the meal replacements. Weight is usually regained once a person discontinues the meal replacements.
  • 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.
  • 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.
  • Although heredity plays a role in the development of type 2 diabetes, excess weight is probably the most important factor they you can change to reduce the risk. An active lifestyle has been shown to decrease the risk of type 2 diabetes - both moderate and vigorous activity. A recent landmark study showed that people at high risk for diabetes who maintained physical activity at about 30 minutes/day and reduced their fat intake and lost an average of 15 lbs, reduced their risk of developing diabetes by 58% over 3 years. (People over 60 years of age lowered their risk by 71%).
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