The treatment of all diabetic patients, involves some dietary adjustments to maintain a satisfactory control of the disease. By regulating the amount and the time of food intake, particularly of carbohydrates, and by dove-tailing the dose of oral hypoglycemic agent, an attempt is made to keep the blood glucose concentration within the normal range throughout the day and night.
Before a diet is prescribed knowledge about a patient’s normal food pattern is important. Modification in diet is advised in such a way that drastic changes in a patient’s normal meal pattern are minimized. This is done to ensure that the patient is willing to cooperate and there are less chances of his neglecting the prescribed diet.
The first step that a physician usually takes while preparing any dietary regimen for a diabetic is to map out a time-table of his day including a description of the usual meals. The total daily requirement of calories is decided next. Care is taken that the diet that is prescribed must be nutritionally adequate for the patient’s needs, and it is therefore, estimated for each individual patient after considering various factors such as age, sex, actual weight, desirable weight, level of activity, current occupation and available financial resources.
An approximate range of calories recommended for the various groups of patients might be as follows:
- An obese, middle-aged or elderly patient with mild diabetes: 1000-1600 kcal daily.
- An elderly diabetic but not overweight: 1400-1800 kcal daily.
- A young, active diabetic: 1800-3000 kcal daily.
The body weight is maintained at or slightly below the ideal for the patient’s height. Thus the calorie range of group 2 may be extended if it is not sufficient to maintain weight, and young patients in group 3 who are overweight may have to reduce their daily intake to below 1800 kcal.
Next the proportion of calories derived from carbohydrate, protein and fat is allocated.
In most diabetic diets, the percentage of calories derived from carbohydrate is about 50%, from protein 15% and from fat 35%.
General principles that are followed while a diet is planned for a diabetic are as follows:
As already mentioned carbohydrates form 50% of the total energy intake of which simple carbohydrates form 20% and complex carbohydrates form the rest of the carbohydrate requirement.
The daily intake of carbohydrates that is recommended is in the range of 100 g to a maximum of 240-300 g. The upper limit is important due to the fact that under normal circumstances it is difficult to achieve satisfactory blood glucose levels throughout 24 hours with a daily carbohydrate intake greater than this amount. If the daily intake of carbohydrate is 240 g, approximately 50 g will usually be provided by each of three main meals and 30 g by each of three snacks.
A simple method by which you can calculate your optimum carbohydrate content is to allocate a figure equivalent to one-tenth of the total calories plus approximately 30-50 g to carbohydrate. For example, if you have been prescribed a diet of 1800 kcal by your physician, it should contain about 210-230 g of carbohydrates.
All the carbohydrates eaten should be in the form of starch. Easily absorbable carbohydrates such as glucose and sucrose should generally be avoided because they produce a sudden rise in the blood glucose.
Dietary fiber is usually enhanced to an intake of 25-30 g per day. A high intake of fiber will increase satiety and reduce constipation and may help to lower the blood lipid and glucose levels.
About 30% of total energy intake is made up of fats. Of this about 25% should be obtained from saturated fatty acids, 50% from monounsaturated fatty acids and 25% from polyunsaturated fatty acids such as nuts, olive oil, fish etc. The daily consumption of fat may usually lie in the range of 50-150 g.
Because diabetic patients have an increased risk of death from ischemic heart disease which is related to the amount of saturated fat in your diet, you should restrict the total amount of fat even if you are not obese.
Plasma lipids, especially cholesterol, should be checked regularly and care should be taken to not exceed the cholesterol intake beyond 150 mg per day.
Omega 3 Fatty Acids
These have been found to lower serum cholesterol moderately and serum triglyceride levels markedly. They are available as fish oils and are found to decrease platelet aggregation. These are helpful in decreasing the risk of cardiovascular complications in diabetics. The intake of fish oils must not exceed 4 g per day.
The consumption of proteins in a diabetic diet is largely determined by social and economical considerations. Consumption of protein in diabetic patients will promote satiety and so will help them to keep more strictly to their carbohydrate allowance.
You should take every effort to increase the protein intake in your diet and try to ensure that some protein is eaten at each main meal.
Proteins both from plant and animal sources should form 10-20% of the total energy requirement. The daily consumption of protein will usually lie in the range of 60-110 g.
However in diabetics who have developed diabetic nephropathy, the protein intake is reduced. Preferable sources of protein are fish, chicken, soya etc.
A diabetic diet should include at least 20-35 g fiber daily in order to get the various benefits attributed to fiber intake. Diets which are high in soluble fiber (pectins, gums, storage polysaccharides and few hemicelluloses found in fruits, legumes, lentils, roots, tubers, oats and oat-bran) help to reduce serum levels of glucose and insulin.
The daily intake of sodium should not exceed 3000 mg sodium per day. This value is lower for individuals who suffer from associated hypertension, nephropathy or congestive heart failure.
Supplementation with vitamins and minerals is usually not needed if the dietary intake is balanced and adequate. It should not be used in place of a varied, balanced diet which can ensure adequate nutrients.
List of foods which should be avoided altogether by a diabetic
- Glucose, sugar, marmalade, jam, honey, treacle, syrup, sweets, tinned fruits, lemonade, chocolate, proprietary milk preparations, glucose drinks and similar foods which contain sugar as sweetener.
- Cakes, chocolate biscuits, sweet biscuits, puddings, thick sauces, pies, puddings.
- Alcoholic beverages unless taken in moderation and has been permitted by the physician.
List of foods that can be taken in moderation
- Breads of all types (including starch-reduced and slimming, plain or toasted, brown or white).
- Rolls, biscuits, scones and crisp breads.
- Potatoes, baked beans and peas.
- Breakfast porridge and cereals.
- All dried and fresh fruits.
- Macaroni, custard, spaghetti and foods that contain much flour.
- Thickened soups.
- Foods for diabetics.
List of foods which can be taken as desired
- All meats, fish, eggs.
- Meat extracts or clear soups, lemon or tomato juice.
- Coffee or tea.
- Cabbage, broccoli, Brussels sprouts, cauliflower, turnip, spinach, runner or French beans, leeks, onion, or mushrooms, cucumber, lettuce, tomatoes, radishes, spring onions, mustard, cress, parsley, asparagus, and rhubarb.
- Herbs, salt, spices, mustard and pepper.
- Saccharine preparations used for sweetening.
For obese diabetics’ margarine, butter, dried and fatty foods are restricted.
The important thing while eating any of the foods mentioned above is to take care of the total calorific value prescribed for a day.
Can diabetics include fruits in their diet?
Patient suffering from diabetes are often restricted from eating fresh fruits due to their high sugar content. Fortunately, there are various types of fruits which can be enjoyed by diabetic patients without a risk of adversely affecting their blood sugar levels. In fact some fruits may even improve glucose control and sensitivity to insulin if eaten in moderation.
Fruits which are goods for diabetic patients
As already mentioned that fiber intake should be increased in a diabetic diet. Therefore, fiber rich fruits are safe for diabetics. These fruits have a low glycemic index and do not increase the blood glucose levels abruptly as caused by foods which have a high glycemic index.
High fiber content in these fruits slows the absorption of sugar from the intestines into the blood stream. Those fruits which have an edible skin and edible seeds are the highest in fiber content because skin and seeds are the two parts of a fruit which contain maximum fiber content.
Some of these fruits with their approximate fiber content are:
Apples (2.5%), Pears (2.1%), Apricots (2.1%), Kiwifruit (2.1%), Strawberries (2.0%), Avocados (6.7%), Pomegranates (3.4%), Blueberries (2.7%).
Avocados are not only a rich source of fiber but also a very good source of monounsaturated fatty acids. A diet rich in monounsaturated fatty acids is usually recommended for diabetics due to its association with a reduced risk of developing cardiovascular complications.
Apart from avocados, apples and grapefruits are two very beneficial fruits for diabetics. Raw apples are shown to improve glycemic control and grapefruit promotes weight loss thereby reducing insulin resistance.
Fruits which are not so good for diabetic patients
Fruits which have a high content of glucose should be eaten in restricted amounts, as the high glucose content can cause an abrupt increase in the blood glucose levels. Such fruits are bananas, dates, grapes, pineapples and watermelon.
Fruit juices should be avoided by a diabetic patient as they have negligible fiber content and high sugar content. Moreover, packed fruit juices tend to contain additional sugar making them even more dangerous than carbonated drinks.
Similarly dried fruits and canned fruits in syrup tend to be high in sugar content and can have a detrimental effect on the blood glucose levels; therefore they should be avoided or eaten in small amounts.