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Management of Diabetes
The main modes of treatment of diabetes are:
  •  Diet
  •  Exercise
  •  Drugs
  •  Education
Dietary Management of Diabetes

Dietary management of diabetes is the most important aspect of Diabetes therapy. It involves planning a diet that has variety moderation and most importantly balance.

Food Exchange Lists
The diet for diabetic patients should be prescribed in terms of exchange lists. Food exchange lists are a group of measured foods of the same calorific value and similar protein, fat and carbohydrate can be substituted for one another in a meal plan. These can help patients

a) Restrict food intake according with drug intake so that both hyper and hypoglycemia can be prevented.
b) To have variety in diet for greater adherence.
c) Easy learning of principles of diet
Carbohydrate:
  • Carbohydrate restriction impairs insulin sensitivity and reversed by high carbohydrate diet.
  • High carbohydrate and high fibre diet improve insulin binding and increase in monocyte insulin receptor binding.
  • High carbohydrate diet is likely to elevate serum triglycerides.
  • Hence carbohydrate should be maintained to 55 – 60% of the total calories.
  • Most carbohydrates are in the form of polysaccharides like cereals, beans etc.
  • Rapidly absorbed forms of CHO; mono and disaccharides such as sweets, chocolates and sweetened drinks, etc.
  • Several studies have shown that raising the carbohydrate intake does not adversely affect FBS, glucose tolerance, or insulin requirements provided the total calories given does not increase.
Glycemic index is the indexing of the glycemic response of a fixed amount of available carbohydrate from a test food to the same amount of available carbohydrate from a standard food consumed by the same subject. The standard food can be glucose or white bread. The blood glucose area after consumption of the test food was expressed as a percentage of the standard.
Proteins: 
 A diet high in protein (20 % of kcals) is good for health of diabetics because it supplies the essential amino acids needed for tissue repair.
  • Protein does not raise blood sugar during absorption as do carbohydrates and supply less than half the amount of calories given by fats.
  • Consumption of protein along with carbohydrate will lower the blood glucose concentration due to amino acid stimulation of insulin secretion this helps compensate for the defect in glucose mediated insulin secretion.
  • It also helps satiety and helps both types of diabetics to adhere to carbohydrate allowance.
  • 1g/ Kg body weight protein is adequate but more can be given reducing the carbohydrate and fat proportionally. Among IDDM children 1– .5 g/Kg body weight is recommended.
Fat :
  • Low fat diet increases insulin binding and also reduces LDL and VLDL levels thereby reducing the incidence of atherosclerosis.
  • Fat content should be 15 – 25 % of the total calories of the diet and lower in saturated fatty acids.

Vitamins and Minerals

Vitamin supplementation may be helpful to overcome oxidative stress and deficiency. Diets rich in vitamins especially Vitamin C and E, antioxidants in fruits and vegetables, minerals and especially magnesium & zinc.
Dietary sodium have a role in the development of insulin resistance & maintaining blood pressure
Chromium supplementation decreases insulin requirement for insulin or OHA.

Dietary Fibre
It lowers
  • Insulin requirements
  • Increased peripheral tissue insulin sensitivity
  • Decrease cholesterol & triglyceride values
  • Aid in weight control
  • Lowers blood pressure
Soluble fibres such as pectins, gums, hemicellulose (in fruits) increase intestinal transit time, delay gastric emptying slow glucose absorption and lower serum cholesterol.

Insoluble fibres such as cellulose and lignin (vegetables, grains) decrease intestinal transit time, increase fecal bulk, delay glucose absorption and slow starch hydrolysis.

High fibre diets promote weight loss. They increase satiety, delay gastric emptying by releasing certain gut hormones.
Tips for a diabetic to Eat and Stay Healthy
  • Diet needs to be modified depending on drugs taken, frequency and quantum.
  • No fasting! No feasting!
  • Small and frequent meals. No skipping meals especially breakfast.
  • Salads, soups ( not cream), buttermilk  can be taken freely
  • Consume whole fruits instead of fruit juices
  • Consume foods rich in fibre
  • Mixture of oils is preferred as opposed to use of one kind of oil.
  • Simple sugars like sugars, jaggery, honey and sweets and fats like oils, Butter, ghee, vanaspati, butter, malai, animal fatare restricted
  • Avoid Alcohol
  • High protein intake recommended to promote insulin production
  • Vitamins and minerals should be supplemented if required
  • Sodium intake no more than 6 g a day if the patient is not hypertensive
  • Junk food, fried foods like fried farsan, puri, sev, namkeen, cold drinks etc to be avoided
  • Include as much whole grains, legumes fruits and vegetables as opposed to processed ones
 
 
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