Con­trol­ling di­a­betes.

Woman's Era - - News - Dr Sonal Agar­wal

Di­a­betes is fast grow­ing health prob­lem mostly in ac­tive phase of life, About 1.5 crore Indians are es­ti­mated to be suf­fer­ing from the dis­ease and the num­ber is ris­ing. Di­a­betes is a life­long dis­ease which oc­curs ei­ther due to the de­fi­ciency of In­sulin hor­mone or be­cause of it be­com­ing in­ef­fec­tive on the tis­sue. In­sulin reg­u­lates the en­try of glu­cose in most of the cells of the body, be­sides reg­u­lat­ing many other metabolic pro­cesses. In di­a­bet­ics blood glu­cose and fat lev­els in blood in­creases and pro­tein of tis­sues are lost, lead­ing to mus­cle wast­ing, weak­ness. Long-term di­a­betes can dam­age many or­gans of the body, caus­ing blind­ness, kid­ney fail­ure, gan­grene in limbs, im­po­tency, nerve dam­age and many other se­ri­ous prob­lems like re­peated in­fec­tions, neu­ropa­thy, etc. In di­a­bet­ics, risk of heart dis­eases (angina, heart at­tack), high blood pres­sure, stroke (paral­y­sis), etc in­creases many­folds but by con­trol­ling the blood glu­cose level we can pre­vent the se­ri­ous con­se­quences of the dis­ease. For con­trol­ling it, the pa­tient needs to change their life­style, eat proper diet, should ex­er­cise and con­sume drugs or In­sulin in­jec­tion reg­u­larly.


Diet has a vi­tal role in pre­ven­tion and treat­ment of di­a­betes. Pa­tients who fol­low the diet pre­scribed re­port, im­prove health and achieve bet­ter con­trol of blood glu­cose and liq­uid lev­els have lesser chances of com­pli­ca­tions. A di­a­betic needs all the nu­tri­ents as any other healthy per­son. So, they should con­sume well­bal­anced meals which will im­prove their im­paired me­tab­o­lism. Diet of di­a­bet­ics should de­pend upon their taste, habits, cus­toms, be­lief, cul­ture, eco­nomic sta­tus and phys­i­cal ac­tiv­i­ties. If weight is nor­mal or pa­tients are un­der weight, usu­ally no re­stric­tion of calo­ries are re­quired. They can eat ap­prox­i­mately 30 calo­ries per kg. of weight, out of which 10-15 per cent calo­ries must be pro­vided by pro­teins, 20-25 per cent by fats and rest 60-65 per cent by car­bo­hy­drates with ad­e­quate starch and dex­trins which cause slow rise in blood glu­cose should be taken in ad­e­quate amount. For di­a­bet­ics, no food is ab­so­lutely banned, but they have to count the calo­ries in them. Fats are rich source of en­ergy and they can in­crease the pace of ath­er­o­scle­ro­sis. So, fats should be con­sumed, in min­i­mum amount of min­er­als, vitamins and water. Sim­ple car­bo­hy­drates viz, glu­cose, ta­ble sug­ars, fruc­tose, mal­tose, (grapes, honey), which can cause rapid rise in blood glu­cose level should be avoided. So, avoid ta­ble sugar, sweets, choco­lates, cakes, soft drink, ice cream, honey, etc. If wish to eat, do it oc­ca­sion­ally in very small amount. Com­plex car­bo­hy­drates such as amount. Fats should pro­vide only 20 to 25 per cent of to­tal calo­ries re­quired. Di­a­bet­ics should con­sume more PUFA and Mono un­sat­u­rated fats found in veg­eta­bles oil and fishes and con­sume less amount of sat­u­rated fats present in meat, mut­ton, ghee, veg­etable ghee, but­ter, cream, egg yolk, full cream milk. They should add small amount of Omega-3 fatty acids in diet found in soy­abean, wal­nut, cold-water fishes. Di­a­bet­ics should also con­sume min­i­mum amount of choles­terol (less than 300 mg/day). Di­a­bet­ics diet must con­tain 10 to 15 per cent of calo­ries de­rived from pro­tein. If pa­tient’s kid­neys are dam­aged, they should re­strict pro­tein in­take. In di­a­bet­ics, re­quire­ment of min­eral, vitamins and other mi­cro-nu­tri­ents re­main the same as adults. Di­a­bet­ics must eat meal con­tain­ing plenty of fi­bres at least 30g daily found in whole­grain ce­re­als, brown bread, fruits, veg­eta­bles. Di­a­bet­ics should con­sume small fre­quent meals at fixed time in­stead of large two meals, i.e. 3 ma­jor meals, break­fast, lunch, din­ner and 2 snacks, i.e. even­ing tea and bedtime snacks. They should main­tain tim­ing of their meals. Di­a­bet­ics should not miss the meal and should not ob­serve fast­ing. Di­a­bet­ics can eat the same food as cooked for whole fam­ily, but they have to eat in fixed amount and there is no need to cook food sep­a­rately for them. They should con­sume plenty of flu­ids, at least 8-10 glasses of water daily. Di­a­bet­ics should avoid cig­a­rette, to­bacco, al­co­hol. If they have to drink, they should do in very small amount oc­ca­sion­ally and never on empty stom­ach. When plan­ning the diet for di­a­bet­ics, con­sid­er­a­tion of their

rou­tine, eat­ing habits, food pref­er­ence for par­tic­u­lar food, reli­gion, cus­toms eco­nomic sta­tus must be kept in mind. Don’t iso­late the pa­tient’s meal from rest of the fam­ily as far as pos­si­ble as di­a­betes is life­long dis­ease. Sep­a­rate meals daily can’t be fol­lowed eas­ily. Oc­ca­sion­ally, di­a­bet­ics also have other dis­eases like high blood pres­sure, angina, kid­ney dys­func­tion. Due con­sid­er­a­tion must be given to th­ese dis­eases when plan­ning the meals. The calo­rie re­quire­ment of di­a­bet­ics de­pend upon their weight, ac­tiv­i­ties, pres­ence of stress of ill­ness and type of di­a­betes. Usu­ally obese di­a­bet­ics need about 1500 calo­ries food and young di­a­bet­ics who are lean they re­quire about 2000 calo­ries meals daily. The amount of diet also de­pends upon their life­style and level of ac­tiv­ity. Di­a­bet­ics diet should pro­vide 6065 per cent of to­tal calo­ries re­quire­ment from car­bo­hy­drates. So, there is no need to re­strict the quan­tity of car­bo­hy­drates con­trary to pop­u­lar be­lief. Lesser amount of sim­ple sugar should be con­sumed. Small amount of ta­ble­sugar can be con­sumed in small amount which are present in fruits. Di­a­bet­ics can use sugar sub­sti­tutes as sweet­ener like sugar-free, sac­cha­rin. Meal plan for di­a­bet­ics must be of pa­tient’s own choices which is more likely to be ad­hered and achieves bet­ter com­pli­ance. All pa­tients must know al­ter­na­tive food which they can eat. It will avoid monotony in meals is more im­por­tant if pa­tients are tak­ing In­sulin in­jec­tions, food should be eaten about half hour af­ter in­sulin in­jec­tions. If di­a­bet­ics have a bout of acute ill­ness like fever, cold, cough, prompt treat­ment should be un­der­taken. Stress of ill­ness in­creases se­cre­tion of Epinephrine and Nor epinephrine, Glucagon which in­creases blood sugar level to dan­ger­ous level, caus­ing loss of glu­cose from body, Ide­ally, dur­ing acute ill­ness. Dur­ing acute ill­ness blood mon­i­tor­ing should If pa­tients are obese, their calo­rie re­quire­ment is 20-25 calo­ries per kg of weight daily. If mal­nour­ished or un­der weight ad­di­tional 500 calo­ries can be con­sumed (35-45 cal/kg) daily till weight be­comes nor­mal. If weight is nor­mal they can eat food con­tain­ing 30 cal/kg of weight. diet. It will en­able the pa­tients to eat out­side and in par­ties. Di­a­betic should weigh var­i­ous food items, es­pe­cially cha­p­at­ties in be­gin­ning for one to two weeks to have an idea about their calo­rie value. They should con­sume 1/ 5 of re­quired calo­ries at break­fast, 2/ 5 of calo­ries at lunch, 1/ 5 calo­ries at sup­per and 1/ 5 calo­ries at even­ing meals and small amount at bedtime. Meals for di­a­bet­ics must be timed and spaced at reg­u­lar in­ter­val, con­sist­ing of three meals and two snacks. Turn­ing of be done ev­ery 4 hourly till symp­toms sub­side. The pa­tients should in­crease their fluid in­take and should be given 15g of car­bo­hy­drate, at ev­ery spac­ing one to two hours’ in­ter­val. Some time back, diet for di­a­bet­ics which used to be ad­vised was star­va­tion with no car­bo­hy­drates, but over last few decades the con­cept has changed. Now, the ad­vice is eat a nor­mal bal­anced diet with va­ri­ety of foods. Quan­tity and qual­ity should be bal­anced and to­tal calo­ries suited to ideal body weight. If proper diet is eaten in about thirty per cent of di­a­bet­ics blood sugar can be con­trolled and they will not re­quire any drug or In­sulin in­jec­tion. We

The Earth pro­vides enough to sat­isfy ev­ery man’s needs, but not ev­ery man’s greed.

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