This document provides dietary recommendations for managing diabetes through healthy eating. It discusses controlling blood glucose, cholesterol, weight and blood pressure by eating a diet low in saturated fat and cholesterol, moderate in carbohydrates, and high in fiber. Specific foods and nutrients are identified that can help or harm blood sugar and heart health. Portion sizes, meal timing, and consistency are important aspects of a diabetes meal plan. Regular physical activity and modest weight loss also benefit diabetes control.

1. By : Dr. ATIULLAH KHAN
Managing diabetes by healthy diet

2.  To prevent complications of diabetesTo prevent complications of diabetes
 by keeping control of:
 Blood glucose
 Cholesterol
 Blood pressure

3. Can Lead To:
 Heart Attack
 Kidney Diseases
 Nerve Damage
 Eye Disease

4. A healthy diet may include changing what one
eats, in what quantities, and how often.

5.  Controlling body weight
 Keeping the level of blood-sugar at a normal level
 Reducing fat in the body

6.  To improve your healthTo improve your health
 by making healthy food choices
 and being physically active

7. SO, RECOMMENDED DIET
FOR DIABETIC PATIENTS?
HIGH CARBOHYDRATE
OR
HIGH FAT

10.  Eat starchy foods regularly
 Eat more fruit and vegetables
 Reduce animal or saturated fat
 Cut down on sugar
 Reduce salt

11. 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.

12. • 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

13.  Include foods containing carbohydrate from whole
grains, fruits, vegetables and low-fat milk in your
diet

14.  The amount of carbohydrate at a meal
affects your blood glucose more
than the type
 Sugar and starch have similar effects on blood
glucose
=

15.  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

16.  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

17.  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

18. 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

19. 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

20. 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

21. Cans of soda
(maximum/day)
Packets
x
25 18
Aspartame 15 86
Saccharin 2 7.5
Sucralose 4.5 60

22. Fiber:
 Fiber is encouraged for everyone:
20-35 grams/day
 Good sources of fiber:
 Whole grain cereals
 Fruits
 Vegetables
 Beans and peas

23. 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

24. 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 .

25. 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.

26. 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).

27. 1000 kcal + Age * 100 kcal for girls.
1000 kcal + Age * 125 kcal for boys.
*( From Raghuram TC et al; Diet and
Diabetes,NIN,1991)

28. 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.

29. 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 .

30. 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 .

31. 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 .

32.  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

34.  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

35.  Protein does not slow the absorption of
carbohydrate
 Adding protein to snacks does not help prevent
hypoglycemia
 Fruits are good snack foods

36.  Safety of high protein, low carbohydrate
weight loss diets are unknown
 do not promote long-term weight loss
 may increase LDL cholesterol

37.  Primary goal - Lower LDL cholesterolPrimary goal - Lower LDL cholesterol
by:by:
Eating less saturated fat and
cholesterol
Eating less trans fats

38. 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

39. 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

40. Foods That Contain Cholesterol:
 All animal foods
 Organ meats like liver
 Egg yolks

41.  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

42.  Eat less total fat
 Low-fat diets can help:
 with weight loss
 improve cholesterol and other fats

43.  Eat 2-3 servings fish per week
 contain a type of fat protective against heart
disease
 fatty fish especially beneficial

44. 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

45. 8/9

46.  Vitamins and minerals from foods important
 High doses of vitamin and mineral supplements
can be toxic

47. 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

48. 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

49.  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

50.  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

51. You can lower blood pressure by:You can lower blood pressure by:
 Eating less salt
 Losing a modest amount of weight

52. 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