Chapter I Introduction to Diabetes Mellitus

Chapter II Diabetes Mellitus

Chapter III Laboratory Tests and Monitoring

Chapter IV Insulin and Oral Antidiabetic Agents

Chapter VI Diabetic Foot and Wound Conditions and Treatment

Chapter VII Complications of Diabetes Mellitus

Chapter VIII The Family and Diabetes

Chapter IX Coping With Diabetes

References

Post Examination

Chapter V       The Diabetic Diet

UNDERSTANDING FOOD GROUPS

Although foods contain many nutrients, the three basic food groups are fat, proteins and carbohydrates.  It is important to have all three-food groups in a diet to have good nutrition.

Carbohydrates

It is important to count carbohydrates since carbohydrates intake leads directly to increased blood glucose levels.  Although foods containing carbohydrates have the most impact on blood sugars, the calories from all foods will affect blood sugar.

To make counting carbohydrates easy, one serving of starch, fruit, or milk contains 15 grams of carbohydrate or one carbohydrate serving, while three servings of vegetable contain 15 grams of carbohydrates.

The following is an example of carbohydrates calculated for an 1800-calorie diet.  Each gram of carbohydrate provides 4 calories.  A diabetic on an 1800-calorie diet should get 50% of these calories from carbohydrate.  A total of 900 calories or 225 Grams of carbohydrate (at 4 calories per gram) should be consumed over an entire day.  At 15 grams per exchange, this would equal 15 exchanges of carbohydrates per day.

Proteins

Protein foods are meat, poultry, fish, eggs, cheese, dried beans and legumes.  When digested, these foods are used to build and repair the body, but may also be used as fuel.  According to the American Diabetic Association, approximately 20% of the total number of calories should come from protein.

Fats

Fats are found in butter, margarine, cooking oils, cream nuts and many other foods.  When digested, fats are stored as fat cells and later used as fuel for energy.  No more than 30% of calories should come from fat.

A pound of fat is equal to 3,500 calories.  In order to lose one pound a week, caloric intake must be decreased by 500 calories a day times seven days to total 3,500 calories.

Types of Fats

• Triglycerides are neutral fats synthesized from carbohydrates found in the blood that may increase the risk of heart disease.

• Saturated fat is one that raises total blood cholesterol.  It is found in hydrogenated vegetable fats, coconut and palm oils, meat fat, whole milk, butter, ice cream and fatty cheese.

• Polyunsaturated fat is a vegetable fat that lowers total blood cholesterol.  It is liquid at room temperature found in cottonseed, soybean, sunflower and safflower oils.

• Monounsaturated fat is a type of unsaturated fat that lowers blood cholesterol.  It is found in olive oil and peanut oil and is liquid at room temperature.  Monounsaturated fatty acid is the most common of all food and tissue acids.

• Low-density lipoprotein (HDL) is a type of cholesterol that may protect against heart disease.

• Cholesterol is a fatty substance found in animal foods such as meat, poultry egg yolks, and high fat dairy products.  Cholesterol levels should be less than 200 mg./dl.

Fiber

Another important dietary consideration in a healthy diet is the amount of fiber consumed.  Fiber, also known as roughage, is the part of the plant food that the body cannot digest.  Increased amounts of fiber lower the concentration of plasma glucose.  Glycemic control may be improved by slowing the absorption of carbohydrates, thereby reducing carbohydrate induced elevations of the blood sugar.

Alcohol

Alcohol should be used only with meals or snacks and in moderation.  Alcohol can cause problems with control of diabetes.  It can lower blood sugar levels by blocking the release of glycogen or stored glucose, leading to a severe insulin reaction.

Oral diabetes medications when combined with alcohol can cause dizziness, flushing, and nausea.

Alcohol should be avoided especially if the disease is not under control, or if weight reduction is an issue.  Alcohol as the calories without the vitamins, minerals and other nutrients that are essential for maintaining good health.  Alcohol is equal to 7 calories per gram and stimulates the appetite.  The body digests alcohol as a far; therefore one fat exchange should be removed from the diet for every 45 calories in an alcoholic beverage.

POINTS TO REMEMBER

Eat a variety of foods.

By varying the foods eaten, there is a better chance of getting all the vitamins and minerals needed for a healthy diet.  This means eating from all food groups every day and choosing different foods from each group from day to day.

For the best blood sugar control, patients need to keep the amounts eaten from the bread/starch the fruit group and the milk group about the same from day to day.  These are the high carbohydrate foods that have the most effects on blood sugar.  They are high in nutrition and important to eat but keeping amounts approximately equal from day to day will make diabetes control easier.

Maintain a healthy weight.

Staving at a healthy weight is important for all people with diabetes,.  Extra body fat makes it harder for people with Type 2 diabetes to make and use their own insulin.  For these people, losing some extra pounds can be a powerful tool for diabetes control, especially in the first few years after their diabetes is diagnosed.  People with Type 1 diabetes may have trouble keeping their weight high enough if their blood sugars are too high.

The right nutrition plan includes:

• Eating the right foods
• Eating the right amount of foods
• Balancing food intake with exercise and diabetes medicine

Doing these things will help protect the patient’s health, control the diabetes, and assist in maintaining healthy weight.

Choose a diet low in fat, saturated fat, and cholesterol.

Pure fats like oil, margarine, and butter are to be used sparingly.  They give very few vitamins and minerals.  For best health, they should be only a small part of nutrition.  Fats that are solid at room temperature indicate high fat saturation, which affects the cardiovascular system.

• Foods that are naturally low in fat can be made into high fat foods by the way they are cooked or served.  (For example potatoes are fat-free but French fries are high fat.)
• Many choices from the milk and meat sections (like whole milk, cheese, and spare ribs) are naturally high in animal fat.
• Choose low-fat protein foods like chicken turkey, and lean meat instead of high fat ones, like cold cuts, sausage, lamb patties, ground pork, or spareribs.
• Non-stick cooking spray should be used instead of butter, oil, or shortening to “grease” a pan before cooking.
• Limit high-fat add-ons like butter, margarine, oil, shortening, salad dressing, and gravy.
• Eat less fried food. Baked, broiled, steamed grilled or poached foods are better.
• Choose 1% low fat and non-fat dairy products
• Eat higher=fat cuts of red meat no more than three times a week.
• Loin or sirloin cuts tend to be leaner than other cuts.  Cut all visible fat from meat and poultry before cooking.  Keep serving sizes of meat small (about the size of the palm of the hand).
• Season food with low-fat flavorings with spices.  Try lemon or lime juice, flavored vinegars, low-calorie salad dressing, low-fat yogurt, or a small amount of wine instead of butter, margarine sour cream, or other high-fat choices.
• In order to estimate how much fat to eat each day, divide present or goal weight by three and this yields the recommended number of grams per day.  This will be about 25%-30% of the total energy needs of the average individual.

Choose a diet with plenty of vegetables, fruits, and grain products.

By choosing the high-carbohydrate whole grain foods, the patient can increase the intake of important vitamins and minerals as well as fiber.  Certain fiber may help lower blood fats, promote regular bowel movements, and slow the absorption of sugars after a meal.  To ge the most fiber in your diet:

• Eat fresh fruits and vegetables
• Eat the skins and peelings, if edible
• Choose whole grain breads and cereals
• Eat at least one meatless main dish that includes dried beans, peas, or lentils each week.

Use sugar in moderation.

High sugar foods, like desserts and regular soft drinks give very little nutritional value.  For best health, these foods should be only a small part of the overall food intake.

• Small amounts of high-sugar foods can be part of a healthy diet, even for people with diabetes.  Eating sugary foods should be considered carefully if weight or blood sugars are out of control.  When they are eaten, they should be a part of the dietary plan.
• Artificial non-caloric sweeteners in diet soft drinks, recipes, prepared puddings, gelatins and drink mixes provide diabetics with a sweet taste, but are less likely to contribute to weight or blood pressure problems.

Use salt and sodium in moderation.

Most Americans eat more salt than they really need.  For some people, extra salt adds to their risk for high blood pressure.  High blood pressure is more common in people with diabetes.  Uncontrolled high blood pressure greatly increases the risk for many health problems related to diabetes.  The following are some suggestions to help control salt intake.

• Use little or no salt at the table or in cooking
• Avoid foods canned, boxed or frozen with extra salt.
• Use herbs, spices, and salt=free seasonings mixes instead of salt.
• Use black, white, or red pepper to season food.
• Remember to choose food “close to nature.”  Less processed foods have less salt.
  

Table 20: MEAL PLAN CHART

It is often helpful to use a chart like this one to help make a meal plan that is nutritious and good for taking care of the diabetic patient.

Next: Chapter VI      Diabetic Foot and Wound Conditions and Treatment