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Majority of Indian diabetics belong to NIDDM and diet plays an important role in the
management of NIDDM. In IDDM also with insulin therapy diet modification helps in control of hyperglycemia as well as prevention of hypoglycemic attacks.
1. Principles of diet in DM
The aim of nutrition in diabetes meliitus is to give a balanced diet. Keep BMI below 25,
keep the glycosylated Hb below 8 and, help in preventing long term complications of diabetes. While planning diet it is not the restriction of a particular food which is important but to select proper food. In meal planning patients' food habits, palatability, acceptance of food are all to be considered.
After knowing the ideal weight of a patient, calories are calculated. The total calories are
translated into 50% carbohydrate, 20% protein and 30% fats. Minimum fibre requirement is 40 gm/1000 cal.per day. Out of 30% fats, 10% each has to come from polyunsaturated, mono unsaturated and staturated fats.
2. High carbohydrate diet
This diet has the following advantages as polysaccharide has more fibres and improve
glucose tolerance, they have low glycemic index, increases insulin sensitivity. Disadvantages of high carbohydrate diet are that hyperglycemia increases and may increase triglyceride particularly with refined carbohydrate diet.
3. Fat in diet
Use of non atherogenic fat namely monosaturated fats like olive oil and corn oil leads to
decrease in LDL and increase in HDL, omega 3 fatty acid is present in fish oil and decreases VLDL, and cholesterol. We have to watch for invisible fats, which contribute 5- 10% of fats through milk, cereals, legumes and seeds. Avoid ghee and hydrogenated oil.
4. In our country there is a difference between urban and rural diet. Rural diet is staple,
rich in fibres, poor in cholesterol and fat. Rural persons are non obese partly because of increased physical activity. Where as urban diet is diabetic prone as it is rich in fat, sugar, cholesterol and persons are less active and more obese.
5. Vegetarian diet is good to diabetics because it is cholesterol poor, rich in fibres and low
in fat.
6. Glycemic index of foods and its usefulness in diabetics. Glycemic index is calculated by:
Blood glucose after food equivalent to 75 gms of glucose
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Blood glucose following 75 gms of glucose.
Foods which are having high glycemic index should be avoided by diabetics as they will
produce more fluctuations and increase in blood glucose. Potato (70) whole bread (72), banana (62), sucrose (59) have high glycemic index and are to be avoided.
7. Role of glucomannan: in diabetes
It is an ultra high molecular polysaccharide. It traps irreversible glucose, cholesterol,
triglycerides, and prevents their absorption. It is beneficial and reduces blood sugar, cholesterol, decreases weight, correct constipation and satisfies appetite.
8. Beverages and diabetes
Soda water, lemon water, black tea or coffee without milk and sugar have no calories.
Soft drinks, fruit juice, yield calorie and are to be restricted.
Alcohol provides 7 calories per grams. The problem with .alcohol in a diabetic is multiple.
In addition to calories, neuropathy, hypoglycemic attacks occur with increasing frequency. With oral hypoglycemic agents like chlorpropamide risk of facial flushing increases. Along with biguanide risk of lactic acidosis increases.
9. Sweetening agents
Used in diabetics can be nutritive like sorbito (4 cal/gm) and non nutritive with zero calories
like saccharin, aspartate and cyclomate. Sorbitol can also cause GI upset and diarrhoea. Diabetic foods containing sorbitol are to be taken in measured quantity.
10. Dietarty innovations in Indian diet
Sprouted grams and beans in breakfast can be used which is rich in vitamin E and fibre.
Vitamin E is an antioxidant. Bitters like karela, neem, betal and other substances like methi have 10-20% blood glucose lowering effect and can be encouraged in diet of a diabetic. Condiments have more micronutrients and fibre. Green chillies are rich in vitamin C.
11. Diet modification in CCF/CRF and hypertension
In CCF and hypertension sodium chloride restriction (less than 3 gms) is advised. In
diabetic nephropathy going in for CRF with increasing urea level reduce protein content of food. Give high biological protein foods like eggs, Restriction of water intake depending upon urine output has to be done.
12. Free radical injury
Role of free radical in beta cell damage and macro and micro vascular chronic
complications are well known. Can routine use of anti oxidants like vitamin C, vitamin E, and beta carotene be of help iii preventing the complications of diabetics.
Can supplement of superoxide mutate enzyme which removes the free radical can be a
therapeutic modality for preventing diabetic
complications?
These are some unanswered questions in diabetes management.
REFERENCES
1. Diet in diabetes mellitus. M. Viswanathan Page 39-44. Hand book of diabetes mellitus.
New Medi, wave Published by Lupin laboratories.
2. Diet - CJ Mistry. Practice of diabetes mellitus Edited by M.M.S. Ahuja 1983, Vikas
Publishing House.
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