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1. What are the different modes of non drug therapy available in diabetes meilitus?
a. Yoga b. Diet c. Exercise.
2. In which group of diabetics non drug therapy can be tried?
a. Obese NIDDM
b. Uncomplicated NIDDM with blood sugar below 200mgm
c. Uncomplicated DM without CAD & Retinopathy; Insulin dependent young
diabetics in addition to diet and exercise need insulin.
3. When exercise is contraindicated?
a. Coronary heart disease and myocardial infarct.
b. Retinopathy - Risk of haemorrhage
c. Uncontrolled diabetic meilitus ketosis is precipitated
by exercise. What are the benefits of exercise in D.M.?
4. Exercise improves the metabolism of a diabetic patient due to several factors.
a. There is an increase in the number of insulin receptors and sensitivity of insulin
receptors.
b. There is an elevation of 2-3 DPG levels in RBC and reduction of glycosylated
Hb.
c. Exercise improves the glucose tolerance in non Insulin dependant diabetic
patient.
d. In insulin dependant diabetes it reduces the dose of insulin.
e. Achieves better control, helps in reduction of dosage of drugs, weight
reduction, lower cholesterol and improves sense of well being.
5. What are the types of Exercise?
Best exercise for diabetic is stepwise increasing exercise plan of aerobic exercises. Brisk
walking, running, cycling, jogging, swimming, skipping and games like badminton and basket ball. These exercises are known as aerobic or isotonic or dynamic exercises. In these exercises major muscles are stretched and entire body is in motion.
In isometric or anaerobic or static exercises muscles contract against fixed object e.g.
weight lifting. These exercises are to be avoided in diabetics as they increase arterial pressure.
6. How long to exercise?
Ideally 30-45 nits without break. It should be strenous enough to raise the heart rate to
maximum rate for 10-15 mts. Daily exercise is preferable or else 3-5 days a week. Ideal time is on an empty stomach in the morning.
7. Enumerate exercises and give the amount of energy spent on exercises.
Calories Spent/mt.
1. Walking 3.6
2. Cycling 4.5
3. Jogging 4.5
4. Running 5.0
5. Swimming 5.0
6. Tennis 7.0
8. What is the role of Yoga in Diabetes Mellitus?
Diabetic patients after yoga demonstrated significant fall in fasting, & post prandial blood
sugar, reduction in HbALC. There was reduction in oral hypoglycemic drug dose or insulin. Lipid levels also came down. Mayurasana may be effective in stimulating the pancreas while pranayaama may be useful.
9. What is a glycemic index?
It is defined as the blood glucose response curve for each food expressed as the
percentage of area after taking the same amount of carbohydrate such as glucose potatoes and white bread. These produce large glycemic response than the white rice and corn. The same food taken in different forms produce varying glycemic response. The Glycemic index of wheat flour is lower when it is taken as chapatis than as white bread. In general the more the food is processed and digested quickly the higher the glycemic index.
10. Enumerate glycemic Indices of following foods?
White bread 69
Unpolished rice 66
Polished rice 72
Potatoes 70
Glucose 100
Raisins 64
Bananas 62
Oranges 40
11. What are the recommendations of WHO on diet for diabetes?
Carbohydrate consists of 50-60% of total energy:- Maximum derived from
polysaccharides. Sucrose should be below 5% of total carbohydrate. Total fibre is about 40 gm/1000 cal.
Fats: It should be 30% of total energy. Distribution of fat should be saturated 10%
polyunsaturated 10% monounsaturated 10%, intake of cholesterol to be less than 300 mgm. Protein intake has been recommended as 0.8gm per kg body weight and should constitute 20% total energy.
Sodium content should be less than 6gm/day in the presence of hypertension it should be
less than 3 gm/day. The primary goal of management in diabetes is to maintain ideal weight.
12. Advantages and disadvantages of high carbohydrate diet in diabetes?
Indian diet is mostly high carbohydrate diet (65 to 85% total calories. It is said that high
carbohydrate diet in the form of complex carbohydrate because of high fibre content improves glucose tolerance. They have low glycemic index. The bulk reduces caloric intake. The disadvantage is that the risk of high Triglyceredemia is there.
13. What type of fat is to be used in diabetes?
Diabetics should consume cooking oil from vegetable source (Corn oil, sunflower oil, soya
oil and linseed oil and should not use hydrogenated oils).
Fish oils rich in mega 3 fatty acids have wide metabolic effects and reduce VLDL,
cholesterol, blood pressure and depress Thrombaxane A2 formation. Inspite of this over all glycemic control may be impaired by fish oil.
It is felt of late that diet should contain polyunsatured fats. The ratio between PUFA
6/PUFA 3 should be ideally kept around 4. Diet should contain antioxidants.
Fats in Indian Diet
A.PUFA 6 (Large amount)
Vegetables oil Safflower oil Sunflower oils, Corn, Maize Seasame
Groundnut oil.
B. FUFA 3
Fish oil, Fish Mustard oil.
C. PUFA6/PUFA3
Ghee, Butter, Milk, Coconut oil.
Balanced
There is an overall increase in energy intake in relation to energy expenditure leading to
obesity which is mostly an urban phenomenon.
14. What are the merits of vegetarian diet?
a. Does not contain cholesterol
b. Has high fibre content.
c. Reduced risk of CAD.
15. What are the disadvantages of vegetarian food?
Lacks micronutrients, iron and reduction in immunological tolerance.
16. How sprouted lentils are useful?
Use of sprouted lentils, grains and beans increase fibre content and antioxidants
like Vit E.
17. What are invisible fats?
This is the fat present in cereals, legumes, seeds. It constitute 5-10% of total
energy intake.
18. What is the fat content of milk?
Milk and milk products contributes approximately 40-45% of total fat for energy. Milk
fat is saturated fat.
REFERENCES
1. Principles of diet for Indian -MM5 Ahuja JAPI Supplement. Page 12-13, 1993.
2. Who diet, Nutrition and prevention of chr.disease-technical Report series 797, P
171 WHO Geneva 1990.
3. Raheja B.S., Indian diet and heart disease Lancet 1986, ii, 228-9.
4. Sahay. B.K. Yoga and Diabetes JAPI 1986, 34, 645-648.
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