For more information, visit https://www.timberlandmedical.com This presentation is by Dr LO SIAW PING, a visiting dietician at Timberland Medical Centre Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.

1. DIETARY
MANAGEMENTMANAGEMENT
OFOF
DIABETES
By
Mdm. LO SIAW PING
Visiting Dietitian
Timberland Medical Centre

2. OUTLINE
T l1. Treatment goals.
2. Component of a Diabetic Diet.p
3. Nutritional Intervention for Type 1 / Type 2 Diabetes.
4. Body Weight Management.
5 Carbohydrate Types Glycemic Index Exchanges5. Carbohydrate – Types, Glycemic Index, Exchanges
System, Fruits / Vegetables / High Fiber foods
6. Protein
i f & Ch l l7. Dietary fat & Cholesterol
8. Salt & High Sodium Foodsg
9. Alcohol, Alternative Sweeteners & Diabetic Foods

3. TREATMENT GOALS OF
DIABETIC DIET
Optimize blood glucose control.
Achieve and maintain reasonable body weightAchieve and maintain reasonable body weight.
Optimize lipid and lipoprotein profile.
Reduce blood pressure.
Prevent or delay the progression of chronic
complicationscomplications.
Promote overall health through optimal
nutrition.

4. NUTRITION RECOMMENDATION
FOR DIABETES MANAGEMENT
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.
Expressed in terms of total calories, and a ratio
of carbohydrate, protein & fat.
Each Person With Diabetes is Different!

5. SETTING UP THE DIABETIC DIETSETTING UP THE DIABETIC DIET
1. Calculating caloric needs
2. Determining dietary distribution of
Carbohydrate Protein Faty
3. Dividing the daily prescription into practical, healthyg y p p p , y
meals.

6. HOW MUCH ENERGY DO WE NEED ?
Sex
Energy
Age
Energy
Requirement
Physical
Activity
Body
Weight

7. ENERGY REQUIREMENT (KCAL / KG / DAY)
Weight Activity Level
Status Light Activity Moderate Activity Heavy Activity
Obese
(BMI ≥ 30 0)
20 25 30
(BMI ≥ 30.0)
Overweight
(BMI 25.0 – 29.9)
25 30 35
Normal
(BMI 18.5 – 24.9)
30 35 40
Underweight 35 40 45 - 50
Calories allowance decrease with age:
Underweight
(BMI < 18.5)
35 40 45 50
Calories allowance decrease with age:
18 – 39 years old: as abovey
40 – 59 years old: 5% less
> 60 years old: 10% less

8. EXAMPLES:EXAMPLES:
37 years old female 60 kg37 years old female, 60 kg,
normal weight,
li ht ti it ( l k)light activity (clerk).

9. EXAMPLES:EXAMPLES:
37 years old female 60 kg37 years old female, 60 kg,
normal weight,
li ht ti it ( l k)light activity (clerk).
E i tEnergy requirement:
60 kg x 30 kcal / kg / day = 1,800 kcal / day

10. EXAMPLESEXAMPLES:
37 ld f l 60 k37 years old female, 60 kg,
normal weight,
light activity (clerk).
Energy requirement:
60 kg x 30 kcal / kg / day = 1,800 kcal / day
If the lady is overweight,
Energy requirement:
60 kg x 25 kcal / kg / day = 1,500 kcal / day

11. COMPONENT OF A DIABETIC DIET
(2006 Position Statement of the American Diabetes Association)(2006 Position Statement of the American Diabetes Association)
% of Total
Daily Calories
Remarks
y
Intake
CARBOHYDRATE 45 – 65 %
(55%)
- Type and amount of CHO are
both important(55%) both important
- Greatest impact on blood sugar
PROTEIN 12 – 20 %
(15%)
- Patients with nephropathy
should limit protein to < 10%(15%) should limit protein to 10%
FAT 25 – 35%
(30%)
- Monounsaturated & Omega-3
f tt id th b t t(30%) fatty acids are the best types
- Limit Saturated fat to < 7%
- Minimize trans-fatty acids

12. NUTRITIONAL INTERVENTION FOR
Type 1 Diabetes:
1. Primary treatment goal is
ti ht bl d l t ltight blood glucose control.
I t ti i li th i t i di id l’2. Integrating insulin therapy into an individual’s
usual eating & exercise patterns.
3. Eat at consistent times and consume consistent
amounts of CHO to synchronize with the insulinamounts of CHO to synchronize with the insulin
regimes.

13. NUTRITIONAL INTERVENTION:
Type 2 Diabetes:
1. Primary dietary focus is achieving &
maintaining reasonable weight.
1. Lifestyle modification that reduce intakes of
energy, saturated & trans fat, cholesterol, and
disodium.
2. Established type 2 diabetes treated with insulin,
consistency in timing & CHO content of meals is
importantimportant.

14. BASIC NUTRITIONAL STRATEGIES
1. Distribute The Food Throughout The Day
S ll & f lSmall & frequent meal
Appropriate spacing time: 4 hours interval
Choose healthy CHO, protein & fat
a) Type 1 Diabetes
- Food distribution should synchronize with
insulin therapy
- Most people will need 3 main meals +
3 snacks to avoid hypoglycemia

15. b) Overweight Type 2 Diabetes) g yp
- Calorie restricted diet
(1,200 – 1,500 kcal)( , , )
- 3 main meals
- Snacks are usually not requiredS ac s a e usua y ot equ ed
c) Ideal / Underweight Type 2 Diabetes
- 3 main meals with3 main meals with
a small mid – am &
mid – pm snacksmid – pm snacks

16. 2. Consistency & Variety
Consistent eating habits
Try to eat the same amount of food at about
th tithe same time
Include a variety of foods

17. SPACE ON YOUR PLATESPACE ON YOUR PLATE

18. DESIRABLE BODY WEIGHT:
A A OC S O A SPRIMARY DIETARY FOCUS FOR TYPE 2 DIABETES
75% type 2 diabetes overweight.
Weight loss has been shown to
improve insulin resistance.
Reasonable weight:
achievable and maintainable
Aim for 5 – 10 % weight loss for a start
Gradual weight loss of 0.5 – 1 kg a week

19. APPLE VS PEAR SHAPE
ABDOMINAL OBESITY
1) WAIST HIP RATIO1) WAIST HIP RATIO
> 0.80 IN WOMEN
> 0.92 IN MEN
2) WAIST CIRCUMFERENCE
> 80 cm (31 5”) IN WOMEN> 80 cm (31.5 ) IN WOMEN
> 90 cm (35”) IN MEN

20. WEIGHT REDUCTION
(0.5 KG – 1.0 KG PER WEEK)
LifestyleLifestyle
Diet: Reduced Changes /
Energy & Fat BehaviorEnergy & Fat Behavior
Modification
R l M di ti /Regular Medication /
Physical Bariatric
A ti it SActivity Surgery
(BMI > 35)

21. CARBOHYDRATE
IN DIABETES MANAGEMENTIN DIABETES MANAGEMENT
Simple Carbohydrate
M h idMonosaccharides:
Glucose (fruits, honey, corn syrup)
Fructose (fruits, honey)
Galactose (do not exist in free form in foods)
Disaccharides:
Sucrose = glucose + fructose (cane, molasses &
maple syrup)
Maltose = glucose + glucose (malt products, some
breakfast cereals)
L l l ( ilk &Lactose = glucose + galactose (milk &
milk products)

22. COMPLEX CARBOHYDRATE
(POLYSACCHARIDES)
1 Refined Starches1. Refined Starches

23. COMPLEX CARBOHYDRATE
(POLYSACCHARIDES)(POLYSACCHARIDES)
1. Refined Starches
Mee
White
Rice
Kuehteow /
White tanghoon / meehoon
Bread
Kuih
Plain
Biscuits
Generally with intermediate – high
Glycemic Index (G.I.)

24. COMPLEX CARBOHYDRATE
2. High Fiber Starchy Food
(Generally with low – intermediate G.I.)

25. COMPLEX CARBOHYDRATE
2. High Fiber Starchy Food
Brown rice Whole grain
bread
Rolled oat Beans / lentils
Tuber, corn &
other starchyother starchy
vegetables

26. WHAT IS THE GLYCEMIC INDEX (G.I.)WHAT IS THE GLYCEMIC INDEX (G.I.)
Numerical system that measures how fast a
particular food ill raise the blood glucoseparticular food will raise the blood glucose.
Th hi h th bl d l th hi h thThe 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 glucosea number relative to glucose.
G IG.I.
for: 70 55 33

27. G.I.
for: 70 55 33
G.I. ranges, in general:G.I. ranges, in general:
Low G I Foods ---------------- below 55Low G.I. Foods below 55
Intermediate G I Foods ---- 55 - 70Intermediate G.I. Foods ---- 55 - 70
High G I Foods > 70High G.I. Foods --------------- > 70

28. MEASURING THE G.I. FACTOR
OF A FOODOF A FOOD
Glucose (reference food) Rolled Oats
100 %
53 %
1 hour 2 hours 1 hour 2 hours

29. WHAT GIVES ONE FOOD A HIGH G.I. &WHAT GIVES ONE FOOD A HIGH G.I. &
ANOTHER FOOD A LOW ONE?
The Key is the RATE OF DIGESTION.
CHO that break down quickly during digestion
h hi h G Ihave high G.I.
CHO hi h b k d l l l i lCHO which break down slowly, releasing glucose
gradually into the bloodstream have low G.I.

30. THE GLYCEMIC INDEX OF SOME
COMMON FOODSCOMMON FOODS
Sugars G.I. Grains G.I.
Glucose 100 Rice – white (av) 72Glucose 100 Rice – white (av) 72
Sucrose 65 brown (av) 60
Honey 58 basmati 58Honey 58 basmati 58
Lactose 46 Oat – instant 66
F t 23 ll d 53Fructose 23 rolled 53
Puffed rice 90
Bread Cornflakes 83
White 70 Muesli 60
Wholemeal 68 Meehoon 58
Pita (wholemeal) 57 Corn 55
Mixed grain 45 Spaghetti 37

31. THE GLYCEMIC INDEX OF SOME
COMMON FOODSCOMMON FOODS
Root Veg G.I. Dairy Products G.I.
Potato - baked 85 Ice cream 61Potato - baked 85 Ice cream 61
mashed 70 Milk – full cream 27
boiled 56 skim 32boiled 56 skim 32
Sweet potato 54 chocolate 34
Y 51 flYam 51 flavour
Legumes Yogurt – low fat 33
Baked beans 48 (sweetened with
Lentils (dal) 46 fruit sugar)
Chick peas 33
Kidney beans 27
Soya beans 18

32. FACTORS WHICH INFLUENCE
THE G I OF A FOODTHE G.I. OF A FOOD
1. The degree of processing / cooking
- The more processed / refined a food is, the
higher the G.I.g
fine white flour
coarse flour
cracked wheat
whole wheat
1 hour 2 hours

33. FACTORS WHICH INFLUENCE
THE G I OF A FOODTHE G.I. OF A FOOD
2. Fiber
Soluble fiber helps to slow down the digestion of
starches & absorption of glucosestarches & absorption of glucose.
E.g. Fruit pectin (guava, apples, plums).g. pec (g ava, app es, p s)
Oats fiber
Legume fiber (beans & lentils)

34. FACTORS WHICH INFLUENCE
THE G.I. OF A FOOD
T f St h3. Type of Starch
The more amylose a food contains, the lower its rate
of starch digestion.of starch digestion.
Individual glucose branch pointg p
molecules
Amylose slowly Amylopectin
digested quickly digested
e.g. long grain rice, e.g wheat flour,
all sorts of legumes white bread

35. 4. Degree of Ripenessg p
the riper the food, the higher the G.I.
e.g. ripe bananas vs just ripe bananasg p j p
T f5. Type of sugars
• Pure Glucose G.I. 100
P F• Pure Fructose 23
• Sucrose 65
• Honey 58

36. 6. Combination of Foods in Mixed Meals
Addi t i i h f d i l l thAdding protein rich food in a meal lower the
overall G.I. of the meal
Adding fat to a meal will also
l G I b d l ilower G.I. by delaying
stomach emptying.

37. 7. Acidity: Acidic foods in a meal help slow
dig ti f t h g lldigestion of starches generally.
e.g. lemon juice, vinegar, fruits with higher
idit h l G Iacidity have lower G.I.
A8. Anti-nutrients
Some food contain substances that inhibit
di ti f t hdigestion of starch.
e.g. soybeans, yams

38. CARBOHYDRATE
RECOMMENDATIONRECOMMENDATION
Choose the correct type & amount of CHO.
Healthier CHO sources: High Fiber, Low G.I.
☺ unpolished / brown rice
☺ rolled oats
☺ beans / lentils
☺ tubers e.g. : yam, sweet potato, tapioca
☺ wholemeal / mixed grain breadg
☺ corn, barley

39. CARBOHYDRATE
CHO distribution NOT RESTRICTIONCHO distribution NOT RESTRICTION
Should not < 130 g / day (6 exchanges / day)Should not < 130 g / day (6 exchanges / day)
Some useful tools:Some useful tools:
1. Glycemic Index
Diabetic Exchange List2. Diabetic Exchange List
3. Plate Method

40. CEREALS, GRAIN PRODUCTS AND STARCHY
VEGETABLESVEGETABLES
Each exchange contains 15 g carbohydrate,
2 g protein, 0.5 g fat, 75 kcal

41. EACH EXCHANGE CONTAINS
15 G CARBOHYDRATE,15 G CARBOHYDRATE,
2 G PROTEIN, 0.5 G FAT, 75 KCAL
Suitable as snacks
60

42. SAMPLE MEAL PLAN FOR CHO DISTRIBUTION
1,200 kcal 1,800 kcal
Breakfast 2 ex 3 ex
Morning
Tea
nil 1 ex
Lunch 2 ex 2/3 rice
bowl
3 ex 1 rice bowl
of rice
Afternoon
Tea
1 ex 1 ex
Dinner 2 ex 3 ex
Supper nil 1 ex
T t l 7 h f 12 h fTotal
exchanges
Per day
7 exchanges of
Carbohydrate / day
12 exchanges of
Carbohydrate / day

43. ARE SUGARS (SUCROSE) ALLOWED
IN DIABETIC DIET?IN DIABETIC DIET?

44. ARE SUGARS (SUCROSE) ALLOWED
IN DIABETIC DIET?IN DIABETIC DIET?
Concept of G.I. says YES
G.I. for sucrose: 65
white bread: 70
white rice(av): 72
2006 Nutrition Recommendations and Interventions
f h i d f i bfor the Prevention and Treatment of Diabetes:
Sucrose-containing food can be substituted for
th b h d t i th l l ifother carbohydrates in the meal plan or, if
added to the meal plan, covered with insulin or
other glucose-lowering medication.other glucose lowering medication.

45. HOW MUCH SUCROSE IS ALLOWED?
Not more than 5% of total calories
Example: 1,200 – 1,800 kcal
All l 15 22 5 f ( i ibl & hidd )- Allow only 15 – 22.5 g of sugar (visible & hidden)
- 3 – 4 ½ teaspoons of sugar / day
A little sugar added to a healthy & lower GI foods,
h g i g b idg f it jsuch as sugar in green bean porridge or fruit jam on
wholemeal bread is acceptable.

46. However, AVOID food products with a lot of
hidden sugar.
Amount
of Sugar
Calories
(kcal)
Soft drink, 1 can
(325 ml)
9 tsp
5g / tsp
180
( ) g p
Chocolate, small
30 g bar
6 tsp 120
30 g bar
Cordial, 1 glass
(250 ml)
5 tsp 100
(250 ml)
Ice cream, 1 scoop 4 tsp 80
Packet drink, less 3 tsp 60
sugar (250 ml)

47. SUGAR: THE SWEET KILLER
Sugar adds calories, provides no other nutrients
One of the most health impairing substancesp g
Linked to a wide range of diseases:
Suppress Immune SystemSuppress Immune System
↑ TG level
↑ LDL-C, ↓ HDL-C↑ LDL C, ↓ HDL C
Contribute to weight gain & obesity
Promote factors in the inflammatoryPromote factors in the inflammatory
response that cause a number of disease
including Alzheimers, atherosclerosis,including Alzheimers, atherosclerosis,
cataracts & osteoporosis
Cause hyperactivity, anxiety &yp y y
concentration difficulties in children

48. HOW ABOUT FRUITS?

49. HOW ABOUT FRUITS?
Good source of vitamin, mineral, fiber &
antioxidantantioxidant.
90% of vitamin C 2/3 of vitamin A are obtained90% of vitamin C, 2/3 of vitamin A are obtained
from fruits & vegetables.
Best taken fresh.
Minimum amount of peeling.
Fruit juices are poorer choice
(fiber free mixture of(fiber-free mixture of
sugar & water).

50. FRUIT IN THE DIABETIC DIET
Generally, 2 – 3 fruits exchanges are allowed / day.
Each exchange contains 15 g carbohydrate, 60 kcal
f i100 Starfruit
60 75

51. EACH EXCHANGE CONTAIN 15G CHO, 60 KCAL

52. Fruits G.I. Fruits G.I.
Watermelon 72 Orange 44
Pineapple 66 Apple 38Pineapple 66 Apple 38
Papaya 60 Pear 38
Banana 55 Strawberries 32
Mango 55 Apricot (dried) 31a go 55 p cot (d ed) 3
Kiwi 52 Grapefruit 25
G 46 Ch i 22Grape 46 Cherries 22

53. ADD FIBER WITH LOTS OF VEGETABLES &
OTHER HIGH FIBER FOODS

54. ADD FIBER WITH LOTS OF VEGETABLES
& OTHER HIGH FIBER FOODS& OTHER HIGH FIBER FOODS
Fiber intake goals: 14 g / 1,000 kcal
Include a variety of fiber-containing foods in each
main meals & snacks, such as:
V blVegetables
Beans, lentils
Fruits
Whole grain products
Fiber – rich cereals (> 5 g fiber / serving)

56. LIST OF HIGH-FIBER FOODS
Dietary fiber (g / 100 g edible portion)
Vegetables Fiber
(g)
Fruits Fiber
(g)(g) (g)
Long bean 5.55 Jackfruit 5.47
Lady’s finger 4.95 Guava 5.18Lady s finger 4.95 Guava 5.18
French bean 3.23 Banana
(Pisang Mas)
4.26
( sa g as)
Cabbage 2.86 Papaya 2.50
Bitter gourd 2 75 Mango 2 04Bitter gourd 2.75 Mango 2.04
Eggplant 2.55 Starfruit 1.88
Bayam 2 26 Pineapple 1 69Bayam 2.26 Pineapple 1.69

57. LIST OF HIGH-FIBER FOODS
Dietary fiber (g / 100 g edible portion)
Beans Fiber
(g)
Others Fiber
(g)
S b 5 5 All b b k 26 7Soy beans 5.5 All bran break-
fast cereal
26.7
K hit 4 5 W t bi 12 7Kacang hitam 4.5 Weetabix 12.7
Kacang
merah
3.9 Sesame seed 12.3
merah
Kacang hijau 3.7 Peanuts 9.3
T h 2 9 S fl d 9 0Tempeh 2.9 Sunflower seed 9.0
Kacang kuda 2.6 WM bread 8.5
Dal kuning 1.5 Seaweed (hai-tai) 7.4

58. MENU PLAN OF 21 G FIBER INTAKE
(1,500 KCAL)( )
Suggested Foods Fiber (g)
Breakfast 2 pcs 5.0
(60 g)
Morning 60 g 0.3g
Tea
g
Lunch ½ cup 2 7Lunch ½ cup
cooked
each
2.7
0.4
5.1
Afternoon 60 g 1 2Afternoon
Tea
60 g 1.2
Di ½ 1 5Dinner ½ cup
cooked
each
1.5
2.5
2.5
Total Fiber 21.2

59. PROTEIN IN DIABETES
MANAGEMENTMANAGEMENT
Recommendations:Recommendations:
12 – 20% of total calories (normal renal function).
< 10% of total calories (diabetic nephropathy)< 10% of total calories (diabetic nephropathy)
RDA: 0 8 g good quality protein / kg body wt / dayRDA: 0.8 g good-quality protein / kg body wt / day.
HBV protein which provide all 9 essential amino
acidsacids.
Recommended as part of bedtime snack toRecommended as part of bedtime snack to
maintain blood sugar during the night.

60. GOOD QUALITY PROTEIN
Fish
Include fish at least 3 times / weekInclude fish at least 3 times / week.
Most healthy fish: deep sea fish (high in omega-3)Most healthy fish: deep sea fish (high in omega-3)
e.g. salmon, mackerel, sardines (fresh), may
improve TG, anti-inflammatory.
However incidence of mercury toxicity hasy y
harmful effects to heart (found in shark, tuna &
swordfish)

61. GOOD QUALITY PROTEIN
Soy and soy products
Contain vitamin, mineral and isoflavone
(phytochemical): may help lower cholesterol
Also rich in dietary fiber.
Best sources of soy protein are soy products:y p y p
e.g. soy bean curd, soy bean milk

62. Poultry
- Choose poultry without skin & fat,
avoid wings & feet.
Meat
- Choose lean cuts of meat.
Legumes & Lentils (LBV Protein)g ( )
- good sources of fiber
- contain CHOcontain CHO

63. MILK & DAIRY PRODUCTS
Natural sugar (lactose)
Good sources of calcium
Low G.I. foods
Generally allow 1 – 2 exchanges / day
Choose low fat variety.

64. MILK & DAIRY PRODUCTS
Carbohydrate
(g)
Protein
(g)
Fat
(g)
Energy
(kcal)
Skim 15 8 Trace 90Skim
Low Fat 12 8 5 125
Whole (full cream) 10 8 9 150Whole (full cream)
1 exchange / serving
Fresh / UHT Milk 1 cup (240 ml)Fresh / UHT Milk 1 cup (240 ml)
Powdered milk 4 rounded tablespoons
Yogurt (plain, low fat) 3/4 cup (180 ml)
Cheese, cheddar 2 thin slices (30 g)

65. FISH, MEAT, EGG & BEANS
Each exchange contains 7 g protein, 1 – 4 g fat, and 35 – 65 kcal

66. Each exchange containsac e c a ge co ta s
7 g protein, 1 – 4 g fat, and 35 – 65 kcal

67. DIETARY FAT & CHOLESTEROL
Major risk factor for CVDj
50% of diabetic are dyslipidemic50% of diabetic are dyslipidemic
Cardiovascular risk forCardiovascular risk for
diabetic is equivalent to
non-diabetic withnon-diabetic with
pre-existing CVD.

68. DIETARY FAT & CHOLESTEROL
Nutritional Recommendation:
25 35% f t t l d il l i1. 25 – 35% of total daily calories.
Li it t t d f t t 7 % t t l l i2. Limit saturated fat to < 7 % total calories
i i i i k f f l l i3. Minimize intake of trans fats, < 1 % total calories
4. Limit dietary cholesterol to < 200 mg / day

69. SATURATED FAT
Nutritional Strategies:
Identify sources of Saturated Fat (SFA) & ↓ intake.
- Found predominantly in animal products:
Butter
Lard
Ghee
Fatty meat
Full Cream Milk & Dairy Products
- Plant sources:
Coconut milk
Tropical oils such as
palm, coconut &
cocoa butter

70. STEPS TO REDUCE
SATURATED FAT INTAKESATURATED FAT INTAKE
Initially diet therapy : ↓ to 10 %, later 7 %y py ↓ ,
1. Avoid all high SFA foods.1. Avoid all high SFA foods.
2 Palm oil needs to be combined with MUFA /2. Palm oil needs to be combined with MUFA /
PUFA rich oil.
3. Coconut milk: If taken, limit to 2 tablespoons,
twice a week.

71. WHAT TO TELL YOUR PATIENTS
Avoid fried /
Steam the processed
foods. foods
Choose lean Choose low
meat. Trim off fat / skim
fats and skin. milk.
Stew, bake, Santan dish,
grill foods. once a weekg

72. STEPS TO REDUCE
SATURATED FAT INTAKE
To achie e < 7 % energ saturated fat diet:To achieve < 7 % energy saturated fat diet:
A id l il h MUFA / PUFA il1. Avoid palm oil, choose MUFA / PUFA oil.
N t ilk b d ll d2. No coconut milk based gravy allowed.

73. MINIMIZE TRANS FATTY ACIDS
What is trans fatty acids?
Manufactured fats created during hydrogenation
To keep vegetable oils solid at room temperature- To keep vegetable oils solid at room temperature
- To improves shelf life and stability of flavors
Even worse than saturated fat ! ! !
↓ HDL C- ↓ HDL – C
- ↑ LDL – C
H f l ff t th li i f t i- Harmful effects on the lining of arteries.

74. HOW TO LIMIT TRANS FATTY ACIDS?
Limit intake of :
Packaged foods: biscuits crackers cookies aferPackaged foods: biscuits, crackers, cookies, wafer,
chocolates, etc.
C i l b k d t g k t iCommercial bakery products e.g. cakes, pastries,
pies, puffs, doughnuts

75. HOW TO LIMIT TRANS FATTY ACIDS?
Limit Intake of:
Fast food: French fries fried chicken burgersFast food: French fries, fried chicken, burgers.
Instant noodles & instant soup
Chi & k g t t hi hiChips & crackers: e.g. potato chips, corn chips

76. HOW TO LIMIT TRANS FATTY ACIDS?
Use soft margarine instead of hard margarine
R d f d l b l f t f tRead food labels of trans fats:
- hydrogenated vegetable oil
i ll h d d bl il- partially hydrogenated vegetable oil
- vegetable shortening
- margarine

77. CHOOSE HEALTHIER FAT
POLYUNSATURED FAT (PUFA)
Two major type of PUFA:
1 Omega 3:  linolenic acids EPA DHA1. Omega – 3: -linolenic acids, EPA, DHA
 linolenic acids: plant precursor of DHA-linolenic acids: plant precursor of DHA
- flaxseed, canola, soybeans and certain nuts & seeds
( l t l d d i ki d )(walnut, almond, macadamia, pumpkin seeds)

78. POLYUNSATURATED FAT
Omega – 3 fatty acids: EPA & DHA
Found in deep sea fish: salmon mackerelFound in deep sea fish: salmon, mackerel,
herring, sardine, cod, tuna
Help suppress the synthesis of TG (↓ plasma TG)
3 or more serving of fish / week (except
commercially fried fish fillets)y )
Omega-3 supplement? – not enough scientificOmega 3 supplement? not enough scientific
evidence about dosage as well as side effects of
long term use.

79. POLYUNSATURATED FAT
Omega-6 fatty acids (linoleic acids)
- Most abundant PUFA in human diet.
- Found in sunflower, corn, soy,
safflower oils.
- Reduce both LDL-C & HDL-C
- High consumption may be associated with weight
gain in the abdomen (apple shape), risk factor forg ( )
heart disease

80. MONOUNSATURATED FATS
Mainly oleic acids (omega – 9)
↓ LDL – C, maintain HDL – C (neutral effect)
Found in olive oil, canola oil or blended oils &
margarine based on these oilsmargarine based on these oils

81. DIETARY CHOLESTEROL
When taken in excess will ↑ LDL – C
Elevation of blood cholesterol is less when
compare to SFA.compare to SFA.
< 200 mg dietary cholesterol daily< 200 mg dietary cholesterol daily
Dietary cholesterol is found mainly in animal foods.
By limiting saturated fats you will also limitBy limiting saturated fats you will also limit
dietary cholesterol

82. WHAT TO TELL YOUR PATIENTS
H t hi < 200 di t h l t l d il ?How to achieve < 200 mg dietary cholesterol daily?
A id ll N hAvoid all No more than
organ meat 2 egg yolk / week
No more than Choose skim /
2 exchanges / low fat
week products
Allow only lean cuts of meat
(no more than 2 exchanges per week)

83. SALT & HIGH SODIUM FOODS
Hypertension is common in diabetic.
An extra risk factor for CVD &
contributes to the progress ofcontributes to the progress of
kidney failure & eye blindness.
For hypertensive diabetic:
Li it di i t k t 2 3 g N / d- Limit sodium intake to 2 – 3 g Na / day
(6 – 8 g salt / day)

84. WHAT TO TELL YOUR PATIENTS
2 – 3 g sodium can be achieved by:
1 Cooking: allow only ¼ teaspoon salt / day1. Cooking: allow only ¼ teaspoon salt / day.
2 At the table: no added salt or sauces2. At the table: no added salt or sauces.
Ri h AVOID3. Rich sources: AVOID
(soy sauce, oyster sauce, cincaluk, budu,
belacan yeast / beef extract salted egg / fishbelacan, yeast / beef extract, salted egg / fish,
salted snack foods)
4. Moderate sources: Limited amount
(cheese dried prawn ikan bilis chilli / tomato(cheese, dried prawn, ikan bilis, chilli / tomato
sauce)

86. RESTRICT INTAKE OF HIGH SODIUM FOOD

92. ALCOHOL
Not encourage as part of the daily diet.
If adult diabetics choose to use alcohol, daily
intake should be limited to moderate amount:intake should be limited to moderate amount:
1 drink / day or less for women
2 drinks / day or less for men2 drinks / day or less for men
One drink is defined asOne drink is defined as
12 oz beer
5 oz wine5 oz wine
1.5 oz distilled spirits
Each contain ≈ 15 g alcohol

93. ALTERNATIVE SWEETENERS
Nonnutritive Sweeteners (calorie free)
1. Aspartame (200 X sweeter than sucrose)
break down under high heat- break down under high heat
(not suitable for cooking).
contraindicated in people- contraindicated in people
with phenlyketonuria.
2. Saccharin (300 X sweeter)
i bitt ft t t- give bitter aftertaste
- least expensive
f i f d i k b & f d- for sweetening soft drinks, beverages & foods

94. NUTRITIVE SWEETENER
1. Fructose (4 kcal / g)
Slightly sweeter than sucroseg y
Produce lower postprandial glucose response
Found in fruits, honey & vegetablesFound in fruits, honey & vegetables
Not recommended as sweetening agent
› may adversely affect plasma lipids› may adversely affect plasma lipids
› large quantity (> 50 g) taken at once may
cause diarrhoeacause diarrhoea.

95. NUTRITIVE SWEETENER
2. Sugar alcohols (2 kcal / g)
S bi l li l i lSorbitol, xylitol, mannitol
Produce lower postprandial glucose response
Appears to be safe but may cause diarrhea esp.
in children.
All Sugar Substitutes
N dNot encouraged
Help diabetic enjoy sweet treats once a while
Don’t appear to cause weight loss or
control blood sugar

96. DIABETIC FOODS
Easily available now.
Cannot be classified as ‘free food’
Contain calories & fat, even more than usual product
More expensiveMore expensive
Examples:
Diabetic Diet soft
jams drinksj
Diabetic chocolate Unsweetened
& sweets fruit juice
(use sorbitol)

97. Eating Well,
While Eating Right;
Eating Right isEating Right is
Half the FightHalf the Fight