Dietary Plan for Diabetes

Information about Dietary Plan for Diabetes

Published on March 29, 2015

Author: drmustansar

Source: authorstream.com

Content

DIETARY PLAN FOR DIABETIC PATIENTS: DIETARY PLAN FOR DIABETIC PATIENTS What is Diabetes?: What is Diabetes? Slide5: Diabetes mellitus , often simply referred to as  diabetes —is a group of metabolic diseases characterized by high blood sugar (glucose) levels, that result from defects in insulin secretion, or action, or both. Slide6: N ormally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates, insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime. Types of Diabetes: Types of Diabetes Type 1 Diabetes: Type 1 Diabetes Type 1 diabetes was also called insulin dependent diabetes mellitus (IDDM), or juvenile onset diabetes mellitus. In type 1 diabetes, the pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin. Abnormal antibodies have been found in the majority of patients with type 1 diabetes. The patient with type 1 diabetes must rely on insulin medication for survival. Type 2 Diabetes: Type 2 Diabetes Type 2 diabetes was also referred to as non-insulin dependent diabetes mellitus, or adult onset diabetes mellitus. In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body's needs, particularly in the face of insulin resistance. In many cases this actually means the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells). Slide12: In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised. Gestational Diabetes: Gestational Diabetes Gestational Diabetes: Gestational Diabetes Diabetes can occur temporarily during pregnancy. Significant hormonal changes during pregnancy can lead to blood sugar elevation in genetically predisposed individuals. Blood sugar elevation during pregnancy is called gestational diabetes. Gestational diabetes usually resolves once the baby is born. However, 25%-50% of women with gestational diabetes will eventually develop type 2 diabetes later in life, especially in those who require insulin during pregnancy and those who remain overweight after their delivery. SECONDARY DIABETES: SECONDARY DIABETES Secondary Diabetes: Secondary Diabetes "Secondary" diabetes refers to elevated blood sugar levels from another medical condition. Secondary diabetes may develop when the pancreatic tissue responsible for the production of insulin is destroyed by disease, such as chronic pancreatitis, trauma, or surgical removal of the pancreas. Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids , and several forms of monogenic diabetes Clinical Features: Clinical Features Complications: Complications Acute Complications: Acute Complications Acute complications of diabetes are severe and can lead to coma. They are directly related to blood glucose levels and include: Diabetic ketoacidosis , this more common in Type I diabetes and is caused by the breakdown of fatty acids into ketones when there is not enough glucose stored in the cells for energy Hyperglycemic Hyperosmolar Non- Ketotic Syndrome (HHNS) usually associated with insulin deficiency and dehydration Hypoglycemia due to too much insulin/oral medication is used or too little glucose. All three of these conditions are emergencies and failure to treat quickly can lead to coma and/or death Chronic Complications: Chronic Complications Consistently high blood glucose levels can cause a hardening and thickening of the blood vessels which can lead to many other diseases. Cardiovascular disease involves both the large and small blood vessels that supply blood to your heart. Cerebrovascular disease involves the blood vessels that supply oxygen and nutrients to your brain. Diabetic Retinopathy is caused by a blockage of blood vessels within the eye that leads to the blood vessels leaking into the retina. This eventually leads to blindness. Slide22: Pathological changes within the kidneys can lead to Diabetic Nephropathy or Kidney Failure Diabetes can also cause damage the peripheral nervous system (arms & legs) causing Diabetic Neuropathy . This leads to loss of nerve function that either results in constant pain or loss of feeling. Erectile Dysfunction is also a chronic condition associated with diabetes. Causes are a combination of vascular and neurological damage. Chronic Complications Complications Summary: Complications Summary Acute Hyperglycemia Diabetic Ketoacidosis Respiratory Infections Hyperosmolar Nonketotic State Diabetic Coma Chronic Usually involves complications related to blood vessels Eye complications Diabetic retinopathy Cataracts Glacoma Diabetic Nephropathy Diabetic Neuropathy Management: Management Slide26: Diet in Diabetes Slide27: Nutritional therapy is the first line treatment in type II diabetic patients, and oral ant diabetics drugs should be started only after the patient has had adequate dietary training and sufficient time to practice an energy restricted diet (e.g. after three months) Slide28: The Aims of Dietary Treatment Abolish the primary symptoms of diabetes achieve and maintain an agreed target body weight Maintain blood glucose and lipids as near normal levels as possible Minimize the risk of hypoglycemia in those treated with oral hypoglycemic agents or with insulin Minimize the long term macro vascular and micro vascular complications of diabetes. British Diabetic Association Slide29: Nutritional Principles 1 - Provision of Essential Nutrition The diet should supply all essentials nutrients The nutritional need of children, adolescents, adults , pregnant and lactating women and the elderly should be taken into account. 2 - Adaptation to Metabolic Problems Food intake should be modified in diabetic patients to compensate for metabolic disturbances. 3 - Prevention & Cardiovascular complications The specific risk of cardiovascular morbidity and mortality in diabetics means that dietary advise should include guide-lines recommended for those at high risk of cardiovascular risks. It’s important to reduce problems commonly associated with type II diabetes (e.g. Central obesity, Hyper Insulinaemia, Dyslipoproteinaemia and hypertension Slide30: Nutritional Recommendations for Individuals with diabetic Mellitus Energy Adequate to achieve to maintain a desirable body weight. Fat Restricted to 30 – 35% of total energy Saturated fatty acids less than 10 % of total energy Monounsaturated fatty acids 10 – 15% of total energy Polyunsaturated fatty acids > 10% of total energy Proteins 10 – 15% of total energy 0.8 g /kg body weight in adults , higher in children, pregnant & lactating women and elderly Restrict in patients with early signs of nephropathy (microalbuminuria) Slide31: Nutritional Recommendations for Individuals with diabetic Mellitus Carbohydrates About 50% of total energy, preferably in foods with high complex carbohydrates and fiber contents and with low glycaemic index. Alcohol Should be avoided in overweight patients & in those with hypertriglyceridaemia, and / or hypertension. Slide32: Diet Charts Slide33: Diet-calorie charts for patients with diabetes mellitus To control diabetes, the best remedy is to control eating habits. The unit for measurement of energy in foods is calorie In diabetes 60 to 70% of calories should come from carbohydrates. 20% from proteins and less than 20% from fats. Salt intake should not be more than 5gm a day. Physicians advise strict diet management for patients with diabetes mellitus particularly type 2 diabetes. Diet calorie charts help diabetic patient to make their meals according to their caloric requirement. Slide34: Daily Caloric Requirement for Diabetic Patients Required calories if patient is overweight = weight in kg x 20 Required calories if patient has average weight = weight in kg x 30 Required calories if patient is underweight = weight in kg x 40 After calculating your caloric requirement a diabetic patient can prepare his meal according to the following chart. Slide37: Breakfast 8:00 am 72g extra large egg 120g fat bacon 70g mushrooms (these soak up fat) 15g lard 75g banana 70g single cream (in drink) C= 24.5g: P=37g: F=67.2g 781 cals Lunch 1:00 pm 300g fat pork chop 40g carrots 70g runner beans 60g squash 50g onion Butter on vegetables C=16g : P=57g : F=90g 1098 cals Evening 6:45pm 140g brie cheese 75g apple 50g cream (in drink) C=13.9g : P=31g : F=45.9g 593 cals Totals for the day Carbs Protein Fats Grand total 54.4g 125g 203.1g Calories: 217.6 500 1827.9 2545.5 kcals Percentages of calories: 8.6% 19.7 71.7% 100% DIABETIC PLATE PLAN: DIABETIC PLATE PLAN DIABETIC PLATE/NUTRITUION PLACE MAT: DIABETIC PLATE/NUTRITUION PLACE MAT Points to Remember!!!! : Points to Remember!!!! Avoid roots and tubers Avoid sugar, glucose, jams, honey, sweets etc Avoid fried foods. Include salads BUT no salad dressings Include plenty of green leafy vegetables. Quantity of oil should be restricted. Avoid alcohol. Include food rich in fiber . Avoid fruits such as mango, banana, chickoo , custard apple etc Slide41: DIABETICS AND FAT INTAKE REDUCE UNHEALTHY FATS: REDUCE UNHEALTHY FATS Instead of snacking on cheese, chips or crackers , enjoy a handful of nuts or seeds. Go for variety with sunflower, pumpkin seeds, almonds, cashews, pecans, and walnuts. Instead of cooking with butter or vegetable oil , use olive oil . Trim any visible fat off of meat before cooking and remove the skin before cooking chicken and turkey. Instead of frying , choose to grill, broil, bake, or stir-fry . Serve fish for 2 or 3 meals each week instead of red meat. Add avocado to your sandwiches instead of cheese. This will keep the creamy texture, but improve the health factor. When baking, use canola oil or apple sauce instead of shortening or butter. Find other ways to make soups creamy instead of using heavy cream. Try blending cooked potatoes in a soup, or adding a little cornstarch (mix with cold water then add to the soup). Then add a little swirl of good olive oil on top. Comparison: Comparison Best Choices Worst Choices Whole-grain flours, such as whole wheat flour White flour Whole grains, such as brown rice Processed grains, such as white rice Cereals containing whole-grain ingredients and little added sugar Processed grains, such as white rice Whole-grain bread White bread Baked potato or baked steak fries French fries Whole-grain flour or corn tortillas Fried white-flour tortillas Fresh vegetables, eaten raw or lightly steamed, roasted, or grilled Frozen vegetables, lightly steamed Canned vegetables with lots of added sodium Vegetables cooked with lots of added butter, cheese, or sauce Fresh cucumbers Pickles (only if you need to limit sodium otherwise pickles are a good choice) “SHOULDS AND SHOULD NOTS”: “SHOULDS AND SHOULD NOTS” Diabetics should:  not crave for sweet foods  never eat and drink together. eat very slowly and chewed properly. should not keep fast never eat to a full stomach. Continued….: Continued…. not eat forcefully  start eating with a relaxed state of mind not smoke or drink alcohol Not take raw vegetables and raw fruits together.  After a principal meal, they should not do any heavy work.  Diabetics should take 5-6 small, frequent meals rather than 3 big meals.  They should take 15-20 glasses of water daily to avoid constipation.  They should compensate for less salt. Slide47: Food Groups Examples of food STARCH Bread, pasta, grains, cereal, pretzels, tortillas, crackers and starchy vegetable (e.g. corn, potatoes, yam, lentil, beans) VEGETABLES Lettuce, broccoli, spinach, celery, carrot, chilies, peppers, tomatoes, cabbage, green bean, leafy vegetables and vegetable juice FRUITS Apple, strawberry, grapefruit, banana, orange, watermelon, peach, mango, guava, papaya, berries, fruit juice, canned fruits and dried fruits (e.g. raisins) MILK Milk, yogurt MEAT AND MEAT SUBSTITUTS Beef, pork, lamb, chicken, turkey, fish, canned fish, egg, tofu, peanut butter, cheese and cottage cheese FAT Fats: oil, butter, margarine, mayonnaise, salad dressing, cream cheese, bacon, avocado, olive Sweets: ice-cream, cake, cookies, doughnut, pie, syrup, honey. EXAMPLE DIET FOR DIABETICS: EXAMPLE DIET FOR DIABETICS Caffeine and blood sugar: What's the connection? : Caffeine and blood sugar: What's the connection? Drinking coffee reduces the risk of diabetes mellitus 2 due to presence of antioxidants. coffee without cream/sugar doesn't have any carbohydrates or calories. " Caffeine impairs insulin action but not glucose levels in young, healthy adults, but people with type 2 diabetes may experience a small rise particularly after meals," OR: OR Can we substitute honey for sugar????: Can we substitute honey for sugar???? Generally, there's no advantage to substituting honey for sugar in a diabetes eating plan Honey is sweeter than granulated sugar, so you might use a smaller amount of honey for sugar in some recipes. But honey actually has slightly more carbohydrates and more calories per teaspoon than does granulated sugar — so any calories and carbohydrates you save will be minimal. Are late-night snacks a no-no for people who have diabetes?: Are late-night snacks a no-no for people who have diabetes? Late-night snacks add extra calories, which can lead to weight gain and high sugar level. Use sugar free foods instead, A can of diet soda A serving of sugar-free gelatin Five baby carrots Two saltine crackers One vanilla wafer Or swap the snack for a piece of gum or hard candy. These "free" foods have few, if any, carbohydrates and calories, so they won't contribute to weight gain or increased blood sugar. Does alcohol and tobacco use increase the risk of diabetes? : Does alcohol and tobacco use increase the risk of diabetes? Yes, alcohol and tobacco use increases the risk of type 2 diabetes. moderate amount of alcohol lower the risk of diabetes Heavy alcohol use chronic inflammation of the pancreas Tobacco increase blood sugar levels and lead to insulin resistance Can We use artificial sweeteners if we have diabetes? : Can We use artificial sweeteners if we have diabetes? We can use most artificial sweeteners if you have diabetes, including: Saccharin (Sweet'N Low) Aspartame (NutraSweet, Equal) Acesulfame potassium (Sunett) Sucralose (Splenda) offer the sweetness of sugar without the calories Artificial sweeteners don't affect your blood sugar level. In fact, most artificial sweeteners are considered "free foods. Amount of fruit intake by diabetics???: Amount of fruit intake by diabetics??? 1/2 medium banana 1/2 cup (83 grams) cubed mango 1 1/4 cup (190 grams) cubed watermelon 1 1/4 cup (180 grams) whole strawberries 1/3 cup (80 grams) sapodilla (chikoo) 3/4 cup (124 grams) cubed pineapple Slide61: Special Considerations Slide62: Diet Plan for Gestational Diabetes Mellitus Slide63: Gestational diabetes mellitus: Gestational diabetes mellitus is a condition in which women without previously diagnosed diabetes mellitus exhibit high blood glucose levels during pregnancy, especially during the third trimester. it affects 3-10% women worldwide. Need for diet management Risks associated with GDM: Development of diabetes type 2 after pregnancy Babies with large gestational size leading to delivery complications Development of pre- eclampsia . Babies with childhood obesity and diabetes type 2 in later life Slide64: Diet Plan A pregnant women needs to eat right amount of carbohydrates fats and proteins during pregnancy. this requires more planning if she is taking insulin to control blood sugar during her pregnancy. D o carbohydrate counting K eep track of carbohydrates eaten each day Calorie Intake Most pregnant women require about 300 extra calories during second and third trimester to gain enough weight. This is equal to 16-17 calories per pound of body weight An extra 10 to 20g of proteins is needed 45-60% calories from carbohydrates 15-25% from proteins 20-30% from fats Slide65: Dietary guidelines 3 small to moderate size meals and 2-4 snacks every day. Don't skip meals Include high fiber foods Eat a good breakfast Limit intake of food and beverages that contain simple sugars Moderately increasing activity level is also a good way to help keep your blood glucose at normal levels Slide66: Diabetes & Ramadan Slide67: Diabetes mellitus affects people of all faiths. Muslims are no exception Many diabetic Muslims have a desire to fast during the month of Ramadan Fasting during Ramadan is neither patients right nor Islamic obligation, but only a privilege to be allowed by his physician, at the patient's request. DIABETES MELLITUS AND RAMADAN FASTING Slide68: Physiological effect of fasting Lowering of blood sugar Lowering of cholesterol Lowering of the systolic blood pressure  Infact, Ramadan fasting would be an ideal recommendation for treatment of mild to moderate, stable, non-insulin diabetes, obesity and essential hypertension Slide69: PSYCHOLOGICAL STATE OF DIABETES DURING RAMADAN In diabetics, stress increases the blood glucose by increasing the catecholamine level. Thus, Islamic fasting during Ramadan has a potentially beneficial effect with regard to diabetic control b/c it has a Tranquilizing effect on the mind Produce inner peace Decrease in anger & hostility Slide70: EDUCATIONAL PROGRAM FOR DIABETICS DURING RAMADAN It should be directed toward, (a) diabetic home management; (b) preparing them for Ramadan; (c) recognizing warning symptoms of dehydration, hypoglycaemia and other possible complications. Slide71: FASTING GUIDELINES TO DIABETICS Keeping in mind the pathophysiological changes in diabetic patients during Ramadan, we have provided a few guidelines on how to advise diabetic patients on fasting.   Advise not to miss the  sehri  (before sunrise) meal so as to avoid hypoglycaemia later in the day Try to have your sehri as late as possible Glycaemic foods should be taken into account Drink more water Avoid sweets & oily food Sweets taken in Ramadan,  kheer  (rice pudding),vermicelli & dates are sugary and may necessitate a change in drug therapy

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