Chapter V The Diabetic DietDIET IN THE TREATMENT OF DIABETES The Diabetic Diet In the spring of 1994, the American Diabetic Association issued new guidelines in nutrition for people with diabetes. The guidelines state that people with diabetes may substitute sugar-containing food for other carbohydrates as part of a balanced meal plan. This means that the eating guidelines for people with diabetes can now be more varied. The beliefs up to 1994 were that people with diabetes should avoid foods that contain “simple” sugars and replace them with “complex” carbohydrates such as those found in potatoes. The May 1994 issue of Diabetes Care supports the theory that simple sugars are more rapidly digested and absorbed than starches, causing high blood sugar levels., Because of this theory, the emphasis over the past four years has evolved so that many patients are being taught to focus on how many total grams of carbohydrate they can eat throughout the day at meals and snacks and still keep their blood sugars under control. This means that the patient who has worked with a dietitian and their diabetic treatment team to figure out how many grams of carbohydrate they may eat throughout the day can decide at any given meal what they will eat. Diabetics that are not on insulin need to focus on keeping the amount of carbohydrate they eat consistent throughout the day. Those on insulin can decide both what and how much to eat at a given meal as long as it does not exceed the daily allotment. The patient needs to learn how to spend their grams of carbohydrates over the course of the day. Patients are able to use regular home blood sugar monitoring to keep track of the effects of their meals and activity levels on their blood sugars. By working with their health care team to make adjustments in their food intake, exercise program and medication, patients are able to keep their blood sugars at close to normal as possible. Before the development of exogenous insulin, diabetes was treated strictly by diet. Diet is an essential factor in the overall control of the diabetic program. Developing a personal meal plan to help the patient attain appropriate glucose, cholesterol, and triglyceride levels is a vital goal for the diabetic educator, dietician, and doctor. A well-developed diet for Type 2 diabetes helps in the achievement and maintenance of correct weight and produces a balance between the foods eaten and the insulin produced by the body. Type I diabetics must follow a comprehensive meal plan to ensure aa balance between injected insulin and the foods eaten. The diabetic diet is a well-balanced meal plan designed to meet the individual needs, tastes, and activity level of the individual patient. The better the diet is understood the more flexible the patient may enjoy. What is a calorie? A calorie is a unit of heat used to define the energy-producing content of a specific food. Calculation of a patient’s daily caloric intake depends on many factors including age, height, weight, activity level, metabolism, growth needs and life style. If the body takes in more calories than is needed to produce energy, the excess calories are stored as body fat. Losing weight is achieved by consuming fewer calories than the body needs for the usual activity level and by increasing exercise. Exchange System The exchange system provides a quick way to estimate energy, carbohydrates, protein and fat content in any food or meal. The ADA has devised an exchange food group system that classifies food into six exchange lists. These exchange lists include starch, meat, vegetables, fruit, milk and fat. Food from each exchange is defined so that one serving of each food contains approximately the same amount of carbohydrates, protein, fat and energy or calories. Serving sizes vary for different choices on each exchange list. Many vegetables are considered “free” foods, including celery, lettuce, spinach, cabbage, cucumbers and zucchini. Free foods are foods and drink that have less than 20 calories per serving and less than 6 grams of carbohydrate per serving. When eaten in moderation, 1-2 servings per meal, free foods do not need to count in calculations. If one consumes 8 servings of a free food (160 calories), it is equivalent to one English muffin. Free foods have high water content. When the are cooked they lose the water and become more concentrated. Water loss occurs as heat breaks down the membranes of the cells that compose the food product. As the membranes break, the content of the cell, including water, leaves, forming a more concentrated food item. Therefore, cooked free vegetables have smaller portion sizes. The following chart shows the amounts of carbohydrates, protein, fat and calories in one serving from each exchange list. Table 12: EXCHANGE LISTS
TABLE 13: SAMPLE 1500-CALORIE ADA DIET
STARCH/BREAD LIST The general rule when selecting a starch food is:
Table 14: SAMPLE OF EXCHANGE LISTS
DRIED BEANS/PEAS/LENTILS
STARCHY VEGETABLES
BREAD
MEAT LISTS Each item is considered one exchange, which is usually 1 ounce of meat containing 3 to 8 grams of fat and from 55 to 100 calories. TABLE 15: LEAN AND MEDIUM-FAT MEAT AND MEAT SUBSTITUTES
VEGETABLE LIST In general, the serving size is ½ cup for cooked vegetables and vegetable juices or 1 cup for raw vegetables. One exchange is considered one serving size and contains about 25 calories and 2-3 grams of dietary fiber. Table 16: VEGETABLES
FRUIT LIST Each fruit is considered one exchange and contains about 60 calories. Fresh, frozen, and dried fruits contain about 2 grams of fiber per serving. Table 17: FRUIT
FRUIT JUICE
MILK LIST Each item of milk is one exchange and contains trace amounts to 8 grams of fat and from 90 to 150 calories Table 18: SKIM AND LOW-FAT MILK
LOW-FAT MILK
WHOLE MILK
FAT LIST Each item in the fat exchange is considered 1 exchange and contains about 45 calories. All fats are high in calories and must be measured carefully. Table 19: UNSATURATED FATS
SATURATED FATS
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