Diet Plan for a Diabetic Patient
A diabetic diet plan simply means eating the healthiest foods in moderate quantities and following regular meal schedules. The diabetic diet plan is a healthy eating plan that is naturally rich in nutrients and low in fat and calories. The diabetic diet plan should not be complicated and you do not need to give up all your favorite foods.
Diabetes is a chronic condition, marked by high levels of blood glucose. It is caused by deficient production of insulin or resistance to its action. In Type 1 diabetes, the body does not produce sufficient insulin. In Type 2 diabetes (the most common type) the body develops resistance to insulin action due to excess body fat. Type 2 diabetes occurs commonly without symptoms. Even after diagnosis, the majority of diabetics tend to not keep their blood glucose under control because they do not feel ill. However, high blood glucose leads to many complications.
Diabetes-related complications include diabetic nephropathy, neuropathy, retinopathy, and peripheral vascular disease. It also increases the risk of coronary heart disease and stroke. It can also lead to pregnancy-related complications, both for the mother and the fetus or new-born baby. All these can be prevented through proper diet and a healthy lifestyle combined with medications prescribed as and when required.
Therefore understanding the basis of a diabetic diet and adhering to it as a family and community are extremely important. A diabetes diet should be not be viewed as restrictive that that is prescribed for the sick. It must be viewed as a healthy diet appropriate for everyone to remain healthy.
The Goals of the Diabetic Diet
- Achieve normal blood glucose either on dietary management along with oral medication and/or insulin administration. The calorie intake (diet) will be just with medication insulin, exercise, and other variables for this purpose.
- Diabetes more prone to cardiovascular disease that the management is vital to prevent high blood pressure high cholesterol and must be addressed at all times.
- Proper weight management is essential while maintaining the optimal level and appropriate wait for height (body mass index BMI).
- Prevention or deadline for other complications of diabetes.
Diet Related and Other Issues
High blood sugar.
Describe the production of insulin leads to high blood sugar level
Overweight and Obesity
The majority of diabetics are overweight or obese. Those who are overweight are more prone to disease. It has been found that Asians develop diabetes with a BMI exceeding 25 kg/m rather than low as 30kg/m² observed among white Caucasians.
Some diabetics are underweight or even emaciated at the time of diagnosis due to poor control of diabetes.
Many diabetic patients develop atherosclerosis that blocks vital blood vessels at the time of diagnosis and remains prone to be affected by the disease.
Most people develop diabetes because of their unhealthy diet and lifestyle, stress, and inadequate physical activity.
Standard Dietary Requirements
- Carbohydrates should provide 55-60% of total daily calories (realistic goal is 50%).
- Fats should provide 20-25% daily calorie intake, Monounsaturated and polyunsaturated fatty acids especially omega 3 are preferred. Limit saturated fats to less than 7%.
- Proteins should provide 15-20% of daily calories.
Dietary Guideline for Diabetic
Diabetics have the same nutritional requirements as everyone else. But those who are overweight require a reduction in carbohydrates to even as low as 33% which needs to be individualized.
Timing of meals
- Meals should not be skipped and 3 meals plus 2 snacks should be taken regularly.
- Include Carbohydrates in every meal and spread it evenly throughout the day as even distribution helps to prevent high and low fluctuations of blood glucose.
- Encourage eating at regular intervals which helps control hunger and prevents overeating at the next meal.
Quality of Carbohydrates
Select foods with complex carbohydrates & low glycemic index (GI) which have plenty of fiber, antioxidants, and phytochemicals. Increased fiber intake by whole grains has been associated with improved insulin sensitivity
- Rice preferably parboiled or minimally milled, other whole-grain cereals (corn, millet, etc.) and legumes are preferred.
- Starchy vegetables and fruits can be used in limited quantities while non-starchy vegetables using freely.
- Whole grain cereals are preferred to whole grain flour as the latter tends to increase blood sugar.
Whole rice flour and whole wheat flour preparations are preferred to refined flour.
Kurakkan flour has high GI and avoids overeating.
Refine sugars such as sugar, jaggery, treacle, sweets, cakes, & biscuits sweetened drinks, fizzy drinks, cola drinks, energy drinks, etc. should be avoided as they can give rise a sudden increase of blood glucose levels, as well as excess energy intake, could lead to overweight and obesity.
It is preferable to have tea without sugar; patients will gradually adapt to enjoy foods and drinks with low or no sugar.
Quantity of Carbohydrates
- An average Diabetic needs 1500-1800 total calories per day.
- However calorie requirement may vary depending upon age, sex, and activity level, and body weight.
- Fifty percent (50%) of total calories should come from carbohydrates. (800 calories = 200 grams of carbohydrates)
Patients with diabetes should control their carbohydrate intake for achieving normal blood sugar levels. Carbohydrate intake can be monitored by the following methods
Food plate method
The food plate method is a convenient method of controlling carbohydrates. Patients can prepare his/her plate according to their own food choices while selecting a variety.
Mark an imaginary line in the middle of the plate. Re-divide one side into half giving 3 sections as illustrated in diagram 1.
Fill the largest section with non-starchy vegetables.
E.g. greens, spinach, lettuce, cabbage, carrot, beans, broccoli, cauliflower, tomato, onion, cucumber, beets, mushrooms, turnip (Rabu, nokhol), ladies finger, and any other non-starchy.
Place the starches in one of the small portions.
- Whole grains, whole grain rice, other grains.
- Whole grain high fiber cereal preparations
- Pulses & legumes
- Starchy vegetables, jack fruit, breadfruit, potatoes, manioc, sweet potatoes & other yams
Next, on the other small section, place the nutritional sources of protein
- lean cuts of meat e.g. meat, mutton, etc.
Alternatively, it also can be supplemented with soya and other pulses, particularly for vegetarians.
Drink 1-2 glasses of milk (nonfat or low fat) a day.
Half a cup of fruits can be eaten at each meal.
Carbohydrate counting or meal exchange method
The primary tool for managing blood glucose is carbohydrate counting Balancing total carbohydrate intake with adequate physical activity and medicine constitute the main thrust of controlling blood sugar levels.
Combining carbohydrate counting with a glycemic index may provide an additional benefit for achieving proper blood glucose (fine-tuning).
This is a meal planning technique for managing the blood glucose level. Before the counting of carbohydrates, patients should know the content of carbohydrates in one serving of a particular food.
- Select a variety of starchy foods of your own choice and the amount of each food can be counted using the food table.
- Patients can consume 45-60 grams of carbohydrates for each meal and total consumption for a day should be around 200 grams.
- A serving of carbohydrates is 15 grams.
- The number of carbohydrates needs per serving will vary with their activity level.
- While counting carbohydrates, ignore the protein and fats of these foods.
Meal planning with Glycemic Index (GI)
- The response of food on blood glucose levels is known as the Glycemic index. This is only a measure of carbohydrates.
- A food with a GI of above 70 is considered high and foods below 55 have a favorably low GI and foods in between are considered as medium GI.
- Meal planning with Glycemic Index involves choosing foods with low or medium GI.
- The inclusion of low GI food and medium GI food in the diet helps reducing blood sugar. When consuming high GI food, their quantity.
Fats are calorie-dense and should be consumed in moderation and further limited by those who are overweight.
Patients with diabetes are at a higher risk of coronary heart disease and other vascular diseases. Therefore the amount of food containing fat and oil should be restricted.
They should limit mainly the food containing saturated fats
- Choose only nonfat or low-fat dairy products
- Remove visible fat off meats and skin of a chicken before cooking
- Choose only lean meats
- Limit butter, cheese, and other saturated fats
- Use minimum oil for cooking or tempering
- Limit consumption of deep-fried foods, which contains more hidden oils and trans fat
- Avoid foods containing trans-fat such as margarine, cookies, pastries, and various bakery products, etc.
- Use low fat or fat-free cooking methods.
E.g. Boiling, steaming, broiling, baking, roasting, grilling, and as salads (raw)
- Using non-stick pans and cooking sprays could help to minimize the amount of oil.
- Though coconut oil is a saturated oil, it mainly consists of small chain & medium-chain fatty acids which tend to get easily burnt for energy. Therefore coconut oil can be consumed in moderation. As coconut oil delivers a minimal amount of Tran’s fats, it can be used for deep frying purposes. However, a number of deep frying foods should be strictly limited to reduce total fat intake.
- Coconut/coconut milk – a family of 5 can use a coconut a day.
Include food containing healthy fat in a diabetic diet as unsaturated fats are heart-healthy and decrease insulin resistance.
- Fish – a good source of unsaturated oil ideally fatty fish like Tuna (balaya, kelawalla), sardinella sp. (hurulla, kalawenna, sudaya), mackeral (bolla, kumbalawa)
- Fruits – Avocado, Durian
- Nuts – cashew nuts, peanuts, cottang, pumpkin seeds, and gingelly
- Un saturated oils such as gingelly oil, sunflower, olive, canola, and soya oil are preferable for cooking (tempering).
- Patients with diabetes have the same protein requirement as normal people (0.7-1 g/Kg of body weight)
- Proteins from plant sources are healthier in diabetes as animal protein delivers more stress on kidneys. Eating excess protein may increase the risk of developing diabetic nephropathy.
E.g. Pulses and legumes – grams, green grams, cowpea, dhal, and soya, etc.
- 2-3 servings of foods rich in protein are recommended for a day. Proteins should provide 15-20% of daily calories (proportion of serving of plant protein to animal protein is 2 to 1).
- Fish is a healthy option for diabetes and a source of Omega3 fatty acids which is proven to have an anti-inflammatory effect and helps to improve a person’s lipid profile.
- Skinless poultry is a safer option.
- Select only lean meat and remove visible fat. Limit red meat to once a week only.
- Two to three eggs can be consumed for a week. Eating only egg white is advisable for people with a high risk of atherosclerotic heart disease. Research warrants, that higher egg consumption associate with a high risk of coronary heart disease. Therefore egg consumption should be limited.
- Non-fat or low-fat milk is preferable for diabetics.
- Milk is a good source of calcium, vitamin A, D & B12. Two cups or two glasses (400ml) of milk will fulfill the daily calcium requirement to a certain extent.
- Milk products such as non-fat yogurt, curd, and cheese are good substitutes for milk. It is advisable to avoid the cream layer (fat layer) of curd if eaten regularly.
- Fruits play a significant role in the diabetic diet as fruits contain plenty of fiber and nutrients including vitamins, minerals, antioxidants, and phytochemicals, etc.
- Diabetics are advised to consume a minimum of two to three portions of fruits every day.
- Spreading the consumption of fruits throughout the day will avoid a sudden increase in blood sugar levels. A medium-size portion is considered safe.
- Fruits with a GI of 55 or lower enter the bloodstream slowly and diabetics can be allowed to eat a fair amount of these. Fruits such as mangoes, raisins, dates, watermelons, pineapples have medium to high GI. Therefore the portion size of these fruits should be reduced.
- Fresh fruits are preferable to fruit juices as fruit juices give rise to a sudden rise in blood sugar.
- Preserved fruit juice, dried fruits, and canned fruits which may have added sugar are best avoided.
- Fruits can be used before fully ripened.
- Vegetables are an important component of a diabetic diet because they are low in calories having high fiber & low GI.
- Diets rich in vegetables reduce the risk of chronic diseases & help to reduce the rate of absorption of sugars & lipids in the diet.
- Selecting a variety of vegetables preferably in different colors not only gives a wide variety of nutrients including antioxidants and phytochemicals but also enhances the pleasure of eating.
E.g. Greens- all sorts of green leaves, green beans, wing bean (dambala) and ladies fingers, etc.
- Red – beet root, tomatoes, red bell peppers, red onions, red thampala, red mukunuwenna, red dambala, etc.
- Yellow – carrot, pumpkin, yellow sweet potato, etc. Purple – purple cabbage, eggplant, dandinala, etc.
- White – garlic, onions, leeks, and mushrooms
Depending on the starch content, vegetables can be divided into two categories
Non-starchy vegetables Non-starchy vegetables include green leaves, lettuce, cucumbers, spinach, tomatoes, carrots, ladies fingers, pea, wing beans, pathola, vatakolu, Bitter gourd, etc.
A serving of 1% cups of non-starchy vegetables gives you 15g of carbohydrate
3-5 servings of non-starchy vegetables can be consumed for a day including 2-3 varieties.
Starchy vegetables Starchy vegetables include jack fruit, breadfruit, potatoes, sweet potatoes, manioc, corn, different types of yams (kiri ala, innala), ash plantains, green peas, etc.
Since starchy vegetables have approximately 15g of carbohydrate in half a cup, it can be consumed adding to the number of carbohydrates consumed (carbohydrates counting).
Patients with or at risk of Cardiovascular disease (CVD), should reduce sodium intake to less than 1550 mg sodium/day, (that is 4 tsp of salt) which is applicable for diabetics,
All diabetic patients can enjoy their meals provided they pay adequate attention to the number of calories consumed as well as ensuring consuming foods with other nutrients including fiber.