MEAL PLANNING FOR DIABETICS

                     MEAL PLANNING FOR DIABETICS

Introduction:

• Diabetes is a lifestyle disorder along with lifelong disorder.
• Controlling blood sugar level is the major task for the patients.
• Medicines or insulin are however controlling it yet dietary management is very essential to control the blood sugar levels along with healthy life.
• Meal planning needs to done as per food preferences, lifestyle, usual eating times, & ethnic & cultural background.
• An assessment regarding weight loss, weight gain or maintenance of weight of patient is taken into consideration.
• Sometimes it is difficult for a patient to accept the diagnosis of diabetes resulting in no restrictions in eating.

Caloric Requirements:

• It is planned as per energy needs, caloric requirements as per age, sex, height & weight of patient.
• The planned caloric requirements should maintain he healthy weight of the patient.
• A reduction in 500-1000 calories from regular meal pattern is made for effective weight management of patient.
• These caloric requirements are distributed in macronutrients.
• In some cases patients may be underweight, in such a situation meal planning should be done with a aim of gaining weight followed by weight maintenance.
• The meal planning needs to be done to promote healthy growth & development.

Carbohydrates:

• The caloric requirements should be more from carbohydrates than fats.
• ADA recommends 50-60% calorie source needs to be carbohydrates.
• Once digested 100% carbohydrates are converted into glucose.
• Hence the servings of CHO must be done considering the other macronutrients.
• Carbohydrate counting & counting grams of carbohydrates are common for type 1 & type 2 diabetes.
• In each serving 15g carbohydrate is served along with other macronutrients.
• Sugars & starches need not be eliminated  rather should be taken moderately.
• Breads, pasta, rice, potato, etc are included in meal planning of diabetics.
• ADA nutritional guidelines recommend to eat all carbohydrates in moderate amount to avoid high PPBS values.
• Reduction of foods high in carbohydrates should be done upto 10% of totaly calories.

Fats:

• 20-30% caloric requirements can be obtained from fats.
• Saturated fats should be limited to 10% of toatl calories.
• Dietary cholesterol can be reduced upto 300mg/day to avoid high cholesterol levels in blood.

Proteins:

• 10-20% caloric requirements need to be get from proteins.
• Animal & nonanimal meals can be included.
• Cultural value & preference along with fat content in food needs to be considered.
• In the patients developing renal complications due to diabetes, the protein intake needs to be reduced further.
• Whole grains & legumes are some of the protein sources that reduces saturated fats & cholesterol in the body.

Fibres:

• High fibre diet can reduce the need of insulin & maintain blood glucose levels.
• Soluble fibres obtain legumes oats & fruits are having tendency to reduce the blood glucose level.
• However there digestion leads to a gel which slows down the GI motility & causes regurgitation.
• Insoluble fibres obtain from whole grains, vegetables & breads are associated with providing bulk to the stool & preventing constipation.
• Both the types of fibres are having weight loss potential.
• The only risk of high fibre diet is hypoglcemia.
• Hence dose of oral drugs & insulin needs to be adjusted to manage hypoglycemia.
• Fluid intake needs to be very adequate along with fibre rich diet to prevent flatullence, nausea, abdominal fullness & other symptoms.

 

Food guide pyramide:

Guidelines for dietary recommendations:

• Combining starchy food along with fat & protein containing food tends to lower glycemic response due to slow absorption.
• Raw & whole foods have more hypoglycemic values than chopped or cooked.
• Whole fruits should be taken instead of its juices to allow fibre content in the body.
• Foods high in sugar should be taken with high fibre or protein rich diet to increase the hypoglycemic value as the later foods have slow absorption rate.

Alcohol consumptions:

• Patients with diabetes do not need to give up on alcohol.
• But alcohol needs to be taken into moderate amounts to prevent hypoglycemia.
• Alcohol is avoided or restricted in diabetes patients especially patients taking insulin as it produces major hypoglycemia.
• In addition excessive alcohol can impair the ability of patient to recognize & treat hypoglycemia.
• Alcohol consumption may lead to excessive weight gain & hyperlipidemia.
• Patients treated with Diabinese can have disulfiram like reactions after ingesting alcohol.

Sweetners:

• Moderation in amount of sweetner used is encouraged .
• Nutritive sweetners contains calories.
• It contains fructose, sorbitol & xylitol which are not calorie free.
• These are often called "sugar free" foods as they cause less blood glucose elevation than sucrose.
• Non nutritive sweetners have no or minimal calories.
• They are used in food products & are available for table uses.
• Saccharin, aspartame, sunette, sucralose are non nutritive sweetners having sweetness more than sugar.
• These are used in baked foods, nonalcoholic beverages, chewing gums, coffee, frostings & frozen dairy products.

Food Labels:

• Food labels with "no sugar" or "sugar free" label will provide calories equivalent to sugar if they are made with nutritive sweetners.
• Patients must look at ingredients to assess the health value as some food may contain animal fats which are contraindicated in diabetics with hyperlipidemia.
• Due considerations in dietary & food habits help to manage the lifestyle with diabetes.