DIET OF DIABETICS
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.
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.
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
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