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.
