Management of Diabetes by Diet

Management of Diabetes by Diet : Management of Diabetes by Diet Rajni Kaul

Objectives : Objectives To understand the importance of diet therapy for diabetics Calculation of total energy expenditure Requirement of carbohydrates content Carbohydrates Exchange list

Slide 3 : Diabetes is a chronic & progressive disease that can cause long term complications. Rationale for Dietary management is to improve the overall health of the patient by attaining and maintaining optimum nutrition, maintain the ideal body weight & provide for normal physical growth in children and adequate nutrition during pregnancy & lactation.

Slide 4 : The main objective of diet therapy is to attain near normal glucose level & prevent the onset of complications. All therapeutic diets should be planned for individual patient taking into consideration of various factors like age, sex, activity, socio-economic status & the daily routine of the person

Slide 5 : This requires life long adjustment in diet, drugs & life style. It becomes more important for a diabetic to understand about diet therapy because most of the time the patient assumes responsibility for his /her treatment. Thus self management of Diabetes through education is essentially required.

Slide 6 : Management of blood glucose level involves: 1. Proper meal planning, 2.Timing of medications 3.Proper physical exercise. Patients with Type 1 diabetes require insulin therapy all their life. Type 2 diabetes is treated with diet therapy & exercise initially & later with hypoglycemic drugs. Diabetes management requires continuous monitoring to avoid complications.

Sources of glucose in the blood: : Sources of glucose in the blood: 100% digestible CHO gets converted to glucose. 58% protein is converted to glucose. Fats 10% converted is to glucose. Glycogen (liver’s emergency supply of CHO) converted to glucose when other sources are used up. Muscle tissue also contain glycogen that may be used in emergencies.

Important Factors : Important Factors The two most important factors in planning a diet for diabetics are to assess the; 1.Total energy requirement 2. Carbohydrates requirement These two factors are principally important for the success of a diabetic diet.

TOTAL ENERGY EXPENDITURE : TOTAL ENERGY EXPENDITURE TOTAL ENERGY EXPENDITURE (TEE) 1. REE- Resting energy expenditure 2 TEF - Thermic energy of food 3. EEPA- Energy expended on physical activity. TEE = REE+TEF+EEPA Any single factor can alter the total energy expenditure.

Slide 10 : REE (resting energy expenditure)—energy required to sustain normal body functions like circulation, respiration, synthesis of various compounds etc. Depends on body size , composition, age , growth, malnutrition etc TEF (Thermic energy of food)- energy expended to digest, absorb,& metabolize food. EEPA- (energy expenditure on physical activity )Most variable component of total energy expenditure; is the energy required for voluntary activities.

Calculation of REE : Calculation of REE 1.REE (Resting energy expenditure) 1 Kcal / kg/hour body weight for men 0.9 Kcal / kg/hour for women Energy for the whole day for a man = 1kcalxkg of body weightx24 will give the REE for the day

2.Physical Activity : 2.Physical Activity Sedentary / Moderate/ Heavy For sedentary 20 – 40% of REE energy requirement For moderate 70 - 75% of REE energy requirement For heavy 80 – 100% of REE energy requirement.

3.THERMIC ENERGY OF FOOD : 3.THERMIC ENERGY OF FOOD TEF=10 % OF REE+EEPA This means that TEF is dependent on REE & EEPA

Slide 14 : Example-to calculate TEE Supposing the weight of a man is 60kg & he is a sedentary worker. REE =1kcalx60x24=1440 Kcal EEPA= 20% of 1440 kcal=288kcal TEF=10% of REE+EEPA=1440+288=1728Kcal 10% of 1728=172.8or 173 kcal TEE=1440+288+173=1901 Kcal

CARBOHYDRATE : CARBOHYDRATE Complex CHO with more fiber are recommended. In the most widely used diabetic diets daily CHO intake provides 50 – 60% of the daily caloric requirement. Whole grain cereal, whole pulses, vegetables, leafy vegetables can be incorporated. Simple CHO are not recommended. (sugar, honey, jaggery, jams)

Dietary CHO in diabetes treatment : Dietary CHO in diabetes treatment Example: supposing a person requires 2000 Kcal 50% of the Kcal should come from CHO In simple words 1000 Kcal will come from CHO& if we divide it by 4 then it will give us the number of grams of CHO required . 1 gram of CHO gives 4 Kcal that is why we have divided it by 4. That means the person requires 250 Gms of CHO

Slide 17 : This 250 Gms can be divided into three main meals & three small meals for a NIDDM patient . For IDDM patient it can be divided according to the type & amount of insulin taken. That is why an exchange list of CHO is a must for a diabetic to do day to day adjustment.

FOOD EXCHANGE LIST : FOOD EXCHANGE LIST The exchange system permits flexibility in planning and preparation and allows measuring instead of weighing. Offers variety of food choices. Starch list, meat list, milk list, veg. list, fruit list of exchanges are charted out and explained to the patients. Standard 1 portion=15 grams of CHO

Sample CHO Distribution for a 2000 Kcal diet : Sample CHO Distribution for a 2000 Kcal diet

Slide 20 : Portion size of carbohydrate containing foods Bread, broken wheat cereal, rice pasta, noodles, 1 portion = 15grams of carbohydrates 1 slice of bread 1 tortilla 1/2 cup cooked porridge ½ cup cooked rice Fruits1 portion 1 small Banana 1 medium orange, apple

Slide 21 : Starchy Vegetables 1 small potato(100 gms), Colocacia-100 gms ½ cup baked beans Non starchy vegetables 3-6 gms of CHO 3servings equal to 1 exchange of carbohydrates Milk Products 1 portion =12grams of CHO 1portion =250 ml non fat milk

Slide 22 : These days it is mandatory to have nutrition labeling on all processed foods which gives a description of the nutrient content of a food and is intended to guide the consumer in food selection. So one can read & adjust the CHO content more accurately in a diabetic diets

Slide 23 : THANK YOU