Managing diabetes is a process of balancing the intake of nutrients, energy expended and the dose and timing of insulin injections or oral anti-diabetic agents. A diabetic has basically the same nutritional needs as a normal person with the exception that their diet must be more structured in order to prevent hyperglycemia. Dietary management for adult diabetics are based on guidelines established by the American Diabetes Association (ADA) in 2002. These include:
• Maintain as near normal blood glucose levels as possible by balancing food intake with insulin or oral glucose.
• Achieve optimal serum lipid levels.
• Provide adequate calories to maintain or attain reasonable weights, and to recover from catabolic illness.
• Prevent and treat the acute complications of insulin treated diabetes, short term illnesses, and exercise related problems; or the long term complications of diabetes.
• Improve overall health through optimal nutrition, using dietary guidelines for Americans and the food guide pyramid.
According to the ADA carbohydrates need to be individualized to each diabetic’s specific needs. The amount of carbohydrate and monosaturated fat should make up 60 to 70 percent of the daily diet. Carbohydrates contain 4 kilocalories per gram ingested.
Diabetics can get their carbohydrates primarily from plant sources such as grains, fruits, and vegetables, milk, and some other dairy products. Carbohydrates are divided into simple sugars and complex carbohydrates. Research has shown that sugars do not actually digest faster then complex carbohydrates which in the past was believed to increase the chances of hyperglycemia. It has been found that fruits and milk have a lower glycemic response than most starches, and the glycemic response of sucrose (sugar) is similar to that of bread, rice and potatoes.
Using sugar as part of the diabetic diet does not impair blood glucose control in people with diabetes as long as the sugar and sugar containing foods are substituted gram for gram for other forms of carbohydrates. Fructose from fruits and vegetables actually produce a smaller rise in plasma glucose than sugar and most starches, making it a good choice as a sweetening agent if used in moderation because of its potential to adversely affect serum cholesterol and LDL cholesterol.
The recommended daily protein intake is 15 to 20 percent of total daily kilocalorie intake. Protein has 4 kcal per gram. Sources of protein eaten should be low in fat, low in saturated fat, and low in cholesterol. The amount of protein recommended is less then most people normally consume during the day, the reason for such a low amount is to help prevent or delay possible renal (kidney) complications. It may be hard for the newly diagnosed diabetic to adhere to these protein restrictions immediately so the best course of action is to gradually decrease protein intake over a longer period of time.
Dietary fats should be low in saturated fat and cholesterol. Saturated fats should not be higher than 10 percent of the total calories eaten per day and dietary cholesterol should be no more 300 mg per day. Fat contain 9 kilocalories per gram eaten. There are many sources for the different types of at that include:
• Saturated fat. These come from animal meats (meat and butter, fats, lard, bacon), cocoa butter, coconut oil, palm oil, and hydrogenated oils.
• Polyunsaturated fat. Sources are oils of corn, safflower, sunflower, soybean, sesame seed, and cottonseed.
• Monosaturated fat. We can get these from peanut oil, olive oil, and canola oil.
Another reason for the diabetic to limit fat and cholesterol consumption is to help prevent atherosclerosis, a disease that diabetics are more susceptible to.
Dietary fiber is helpful in treating and preventing gastrointestinal disorders such as constipation and colon cancer. It also creates a feeling of fullness and large amounts have been shown to be beneficial for serum lipids. Soluble fiber is found in beans, oats, barley and some vegetables and fruits including peas, corn, zucchini, cauliflower, prunes, pears, apples, bananas, and oranges. Insoluble fiber found in many of the same foods also helps to increase intestinal motility and helps give a feeling of fullness.
The optimum amount of fiber eaten per day should be in the 20 to 35 gram range. Any increase in fiber consumption should be done gradually as it can lead to nausea, diarrhea or constipation, and increased gas and flatulence. This is particularly true if fluids are not also increased at the same time.
The amount of sodium most people consume each day exceeds by far the amount the body actually needs. 1000 mg of sodium per 1000 calories per day is the recommended daily intake and it should not exceed 3000mg per day. For the diabetic increased sodium consumption can increase the risk of hypertension, a condition that can be a problem with those with diabetes. It is recommended that all diabetics avoid table salt and processed foods that are high in sodium.
Any diabetic diet plan will restrict the amount of refined sugars that are eaten. Because of this restriction many diabetics turn to artificial sweeteners in their foods and drinks. All the non-nutritive artificial sweeteners used in the United States have been approved for use by the FDA. This category of sweeteners includes the following:
• Saccharin – Sweet & Low
• Aspartame – NutraSweet, Equal
• Acesulfame potassium – Sunnette.
These artificial sweeteners have little to no calories and produce little change in blood glucose levels when eaten.
Diabetics also use nutritive sweeteners, including fructose, sorbitol, and xylitol. The caloric content of these sweeteners is much the same as table sugar but they do not cause as great a rise in blood glucose levels.
For the diabetic it is recommended that if they do choose to drink alcohol that they do it in moderation. Consumption of alcohol can increase the hypoglycemic affects of insulin and oral medications. For men the ADA recommends that they consume no more than two drinks per day. For women the recommendation is one drink per day. The following is a list of guidelines for alcohol as recommended by the ADA.
• The signs of intoxication and hypoglycemia are similar; thus, the person with type 1 diabetes is at an increased risk for an insulin reaction.
• The two oral hypoglycemic agent’s chlorpropamide and tolbutamide can interact with alcohol and lead to headache, flushing, and nausea.
• Liqueurs, sweet wines, wine coolers, and sweet mixes contain large amounts of simple carbohydrates.
• Light beer is the recommended alcoholic drink.
• Alcohol should be consumed with meals and added to the daily food intake. In most instances, the alcohol is substituted for fat in calculating the diet. A drink with 1.5 ounces of alcohol is the equivalent of two fat exchanges.
Following these ADA guidelines is an important part of managing diabetes. Failure to do so can lead to a host of complications that in some cases can be life threatening.