DIET AND HEALTH DIRECTIVES

‘Tea
T & sympathy
th are nott enough!’
h!’

There is a need for right

Di t and
Diet dHHealth
lth di
directions
ti for
f
Indians living with diabetes

by Shivali & Shaily Chauhan, Nutritionist & Dietitian

DIET & HEALTH DIRECTIVES

CIPLA Nutrition Education Initiative

Initiative, August 03
03,2008
2008

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DIET AND HEALTH DIRECTIVES

Diabetes
What is Diabetes?

•Diabetes is a disease in which the body

does not produce or properly use insulin.

• Insulin is a hormone that is

needed to convert sugar, starches, and
other
th food
f d into
i t energy needed
d d for
f daily
d il life.
lif

• The actual cause is unknown

unknown, but genetics,
genetics
obesity, and lack of exercise appear to play roles.

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DIET AND HEALTH DIRECTIVES

T
Types off diabetes
di b t

• Type
T pe 1:
1 Pancreas doesn’t produce insulin
(“juvenile diabetes”). ~5-10% of population.

• Type 2: Cells don’t respond to insulin or not enough

insulin is produced, strongly linked to obesity (“adult
onset”). Majority of population are diagnosed
with diabetes have type 2
2.

• Gestational Diabetes: occurs during

g pregnancy
p g y
~ 4% of the pregnant women per year.

• Pre-Diabetes: Blood gglucose levels are between normal &

high levels ~ Affects 41 million population.

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DIET AND HEALTH DIRECTIVES

SIGN & SYMPTOMS

Pol phasia excessive eating

Polyphasia-

Polyuria-
y excessive urination

Polydypsia - excessive fluid intake

Poor wound healing

Blurred vision

Irritability

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DIET AND HEALTH DIRECTIVES

How do you know if you have

diabetes?

FASTING GLUCOSE LEVELS

– Hypoglycemic: <70 mg/dl

– Normo-glycemic: 70-110 mg/dl

– Hyperglycemic: >110 mg/dl

-- Prediabetes: 100 -125 mg/dl

-- Diabetes: > 126 mg/dl

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Criteria for Diagnosis

off Pre-diabetes
P di b t (IFG/IGT)
IGT-110
IGT 110 - 126 mg/dL
Fasting: 110- 126 mg/dL
2-h: 140-200 mg/dL

Current Criteria for

Diagnosis of Diabetes
Symptoms
y p of diabetes and a casual
plasma glucose ≥ 200 mg/dl

FPG ≥ 126 mg/dl

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 DIET AND HEALTH DIRECTIVES

Diabetes Model Overview

Burden of Diabetes
Cost
( Per person Diabetes)

Unhealthy Days
Total Prevalence ( Per person Diabetes)
( People with Diabetes)

Prediabetes Diabetes
onset Di
Diagnosis
i
onset Death
People with People with People with
People with diagnosed
Normal undiagnosed
Blood sugar Diabetes diabetes
diabetes

Obesity in Prediabetes Diabetes

general
g Diabetes
detection & Management
population detection
management

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 DIET AND HEALTH DIRECTIVES

Diabetes Model Overview

This larger view takes us

Burden of Diabetes
beyond standard Cost
epidemiological models and ( Per person Diabetes)
most intervention programs

Unhealthy Days
Total Prevalence ( Per person Diabetes)
( People with Diabetes)

Prediabetes Diabetes
onset Di
Diagnosis
i
onset Death
People with People with People with
People with diagnosed
Normal undiagnosed
Blood sugar Diabetes diabetes
diabetes

Obesity in Prediabetes Diabetes

general
g Diabetes
detection & Management
population detection
management

Standard Boundary – Ref – NHIS, NHANES,

CENSUS SHIVALI SHAILY
DIET AND HEALTH DIRECTIVES

Prevalence/Epidemic

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Diet is an essential part of

the management of
Diabetes.

Diet is based on healthy eating princ iples

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DIET AND HEALTH DIRECTIVES

Basic Principles of Diabetic Diet

Ensure your regular meals

- Base
B l on complex
meals l carbohydrates:
b h d t
Brown Bread, Cereal
Enco rage high fiber/
Encourage fiber/whole
hole meal versions
ersions

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DIET AND HEALTH DIRECTIVES

Aim for rec ommended 5 portions

of fruit and veg etables/ day:

Spread fruit throughout day.

Limit fruit juice.

What is a portion?

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DIET AND HEALTH DIRECTIVES

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DIET AND HEALTH DIRECTIVES

Cut down on sugar and

sugary foods:
f d

Aim for low sugar diet,

Not a sugar free diet
diet.

Instead of sweet cakes/ biscuits offer plain,

high fiber biscuits, fruit whole wheat Loaf.

D nott effect
Do ff t bl
blood
d glucose
l levels.
l l
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DIET AND HEALTH DIRECTIVES

Caution!

Fruit sugar (fructose) when used as

a sweetener will still affect
Blood Sugars in the same way as
normal sugar!!

Avoid Diabetic foods e.g. jams, chocolates and cream biscuits:

– Contain sweeteners such as sorbitol - laxative affect
– Expensive
p and unnecessary y

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DIET AND HEALTH DIRECTIVES

Food Labeling
Nutrition Information
NUTRIENT PER SERVING PER 100 g
ENERGY 351 Kcal 234 Kcal
PROTEIN 100 g 7.0 g
CARBOHYDRATES 28.2 g 18.8 g
of which sugars 3.0 g 2.0 g
of which starch 25.2 g 16.8 g
FATS 21 2 g
21.2 14 2 g
14.2
of which saturates 7.6 g 5.1 g
of which mono- 10.9 g 7.3 g
saturates
of which poly – 2.7 g 1.8 g
unsaturates
FIBRE 1.6 g 1.1 g
SODIUM 0.6 g 0.4 g
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DIET AND HEALTH DIRECTIVES

Food Labeling

A Littl
Little NUTRIENT AL
Lott
2g SUGAR 10g
g
3g FAT 20g
g
1g SATURATED 5g
FATS
0 5g
0.5g FIBER 3g

FOOD ITEM – NUTRIENT CONTENT vs. FOOD ITEM – NUTRIENT CONTENT

Cocoa – Sugars - 9.0g vs. Drinking Chocolate - Sugars – 26.4g

Instant Light Malted drink – Sugar – 11.3g vs. Malted drink – Sugar – 21.5g
Instant Light Chocolate milk – Sugar – 7.2g
7 2g vs.
vs Hot Chocolate – Sugar – 16.0g
16 0g

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DIET AND HEALTH DIRECTIVES

Steps to a healthier U –
OBESE DIABETIC

• Weight loss is desirable

• Encourage to cut down on fatty food

e.g. chips, pastry, crisps, cheese & fried foods

• Encourage low-fat food options e.g. semi-skimmed milk, low-fat spread

• Offer fruit/ diet yoghurt as pudding/ dessert

• Snacks not essential

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DIET AND HEALTH DIRECTIVES

Steps to a healthier U –
MALNOURISHED DIABETIC

Encourage small frequent meals

and
d low
l sugar puddings
ddi and
d snacks
k :

-- Glass of milk/ milky drinks

– Crackers and cheese
– Toast, butter and reduced sugar jam
– Breakfast cereals, crisps or nuts
– Diet yoghurt or low sugar milk pudding
– Plain biscuits, fruit cake, malt loaf
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DIET AND HEALTH DIRECTIVES

Caution with
supplement drinks

Examples: Fortisip, Fortijuic e,

Ensure plus,
plus Enlive

• High in sugar
• Milky supplements better choice
• Do not give full carton all at once

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DIET AND HEALTH DIRECTIVES

Special Occasions

Birthdays or other significant celebrations

Small amount of ordinary pudding/ cake is okay

Eat it at end of main meal!

As long as special occasions are not everyday!!

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Alcohol

Alcohol in moderation can be included,

no more than:

– 1-2 units/ week for women

– 2-3 units/ week for men
• Never drink alc ohol on an empty stomac h

• Remember to use ‘diet’ mixers

• Caution with sweet liquors

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DIET AND HEALTH DIRECTIVES

Key Points

• Ensure regular meals

• Base meals on complex carbohydrates

• Aim for 5 portions of fruit and vegetables

• Cut down on sugar and sugary foods

• If in doubt read food label

• Encourage relatives to bring low sugar foods

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Standards of Care ABC’s

A - A1C
B - Blood Pressure
C - Cholesterol
D – Diabetes /Dental Exam/Diet
E - Eye Exam/Exercise

F - Foot Exam
G - Glucose monitoring
H - Heart Health
I - Indications for specialties
p
K - Kidney
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DIET AND HEALTH DIRECTIVES

Recommended
G l
Goals

Gl c emic c ontrol
Glyc
– A1C < 7.0%
– Fasting BS 80-110mg/dl
80 110mg/dl
– Non-fasting < 180mg/dl
Blood Pressure <130/80

Lipids
– LDL Cholesterol <100mg /dl
– Trig
g lyc
y erides <150mg
g /dl
– HDL Cholesterol >40mg /dl
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DIET AND HEALTH DIRECTIVES

Exercise

Examples of Exercise:

– Aerobic: Walking, Swimming, Bicycling, Jogging

-- Strength: Weight/Resistance

– Flexibility: Yoga

Exercise can control blood

sugars and lower you risk of
heart disease!
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DIET AND HEALTH DIRECTIVES

Three Key Parts To Any

Exercise Program

– FREQUENCY: Exerc ise at least 3-

5 days per week

– TIME: Exerc ise for at least 20-30 minutes

at a time (Start out g radual)

– INTENSITY: This means how hard you work during exercise.

You should feel like you are working harder than usual but
still be able to carry on a conversation

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DIET AND HEALTH DIRECTIVES

Exercise Tips

Type 1: do not exerc ise if sug ars

< 70 or > 300 or if ketones are present

Type
yp 2: do not exerc ise if sug
g ars < 70 or >350

Exerc ise c an c ause low blood sug ars

several hours after exerc ise

Sc hedule exerc ise 45-60 minutes after eating

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DIET AND HEALTH DIRECTIVES

Further Guidelines

Keep a daily log

Wear Medic al ID
Modify Caloric Intake
Drink plenty of fluids
Carry fast ac ting sug ar
Exerc ise with a partner
Do NOT injec
j t into area where exerc ise is involved

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DIET AND HEALTH DIRECTIVES

You
ou have
a e got to ta
takeea
an
active role in
monitoring &
measuring your
health.

Waiting for the system to

help you just won’t
work.
work

So Let
Let’s
s Get started
started…
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DIET AND HEALTH DIRECTIVES

Support
pp

Family
Friends
Multi-disciplinary Team

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Summary
y for Success

Knowledge
Individualize
Start
Support

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DIET AND HEALTH DIRECTIVES You will learn that
A nutrition
ut t o message
essage is
s
more than just 5 A Day
DIET DIRECTIVE

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DIET AND HEALTH DIRECTIVES

HEALTH DIRECTIVE

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DIET AND HEALTH DIRECTIVES

Resourc es/Referenc es

Americ an Diabetes Assoc iation:

www.diabetes.org
Center for Disease Control:
www.c dc .g ov/diabetes

Clinic al Diabetes:
http://clinical.diabetesjournals.org
Diabetes is South:
www.sddiabetes.net
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DIET AND HEALTH DIRECTIVES

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