Diabetes mellitus is a clinical syndrome characterised by hyperglycaemia, due to deficiency or diminished effectiveness of insulin. The disease is chronic and affects the metabolism of carbohydrate, protein, fat, water and electrolytes. A fair percentage of the cases may be due to over production of other hormones which are antagonistic to Insulin - e.g. glucagon, hormones of the pituitary, adrenaline and thyroid or due to increased production of substances which inactivate insulin e.g. - insulinase and insulin antagonists present in plasma. Diabetes is often found to be associated with other conditions such as blood pressure, obesity, hypercholesterolaemia, cardiovascular disease, kidney disorder and the nervous system.
Diabetes takes two main forms. Insulin dependent diabetes mellitus (IDDM, formerly referred to as juvenile onset diabetes) usually develop at any age and often occurs where there is a family history of any form of diabetes. Non Insulin dependent diabetes mellitus (NIDDM, as its former description late onset diabetes --implies tends to be much more common among older people. IDDM stems from an in ability of the pancreas to produce Insulin because of damaged or destroyed cells. This form of diabetes must be treated regularly with insulin injections. In susceptible individuals it can be sparked by viral infections such as a previous attack of mumps or German measles.
NIDDM that affects some 15 percent of the population over the age of 50, apparently results from impaired secretion of insulin or a resistance to the hormone by the body`s tissues. It can often be treated by diet alone although some sufferers need medication. Weight reduction is very important for diabetes because obesity increases their resistance to insulin. It is essential for both groups of diabetics to eat regularly to prevent low blood sugar levels. Some insulin treated diabetics need to eat every 2 to 3 hours and may also require snacks between meals.
Dietary control is very important in the treatment of diabetics. A regulated program of exercise and attention to personal hygiene are important to the total program. Diabetics needs a carefully planned diet depending on the type of diabetics, individual needs, body weight, age, sex, any other disease, and how physically active the person is.
There are two types of diets measured and unmeasured. In measured diets the portion of food may be measured either by weighing with scales or more simply by using household measures. Measured diets are required for patients who require insulin or an oral hypoglycaemic agent and also for those who are over weight and require a reducing regimen. Unmeasured diets - If insulin or oral hypoglycaemic agents are not required and obesity is not marked, it may not be necessary for the patient to follow such an accurate diet. Many patients develop the disease when they are already middle aged or elderly and have a mild type of diabetes often associated with moderate obesity for such patients an unmeasured diet may be adequate.
Nutritional needs: Dietary control is an integral part of management for the diabetic. The diet should always provide the essentials of good nutrition and adjustments must be made from time to time for changing metabolic needs For example during growth, pregnancy, lactation or modified activity.
Proteins: Since diabetics in general are in negative nitrogen balance they should receive about twice as much protein as normal subjects. The proteins should be of high biological value and provide about 20 - 25 % of the calories in the diet. A diet high in protein is good for diabetics because
It supplies the essential amino acids needed for tissue repair.
Protein does not raise the blood sugar during absorption, as do carbohydrates.
It does not supply as many calories as fats.
Carbohydrates: The daily intake of carbohydrate should provide about 40 % of the calories to prevent ketosis. Several studies shown that raising the carbohydrates intake does not adversely affect blood glucose levels, glucose tolerance, or insulin requirements provided that total calorie are not increased.
Fats: After protein and carbohydrates levels have been established the fat allowance makes up the remaining calories for most diets.30 - 35 % of the calories as fat is satisfactory. Foods high in saturated fat and cholesterol should be limited.
Fiber Foods those are rich in fibre can reduce the rate of glucose absorption, lower blood sugar rise, decrease urinary glucose excretion, slower stomach emptying and delay intestinal transit time. Fiber also contributes to satiety and consequent decreased food intake helps reduce weight. This fiber containing complex carbohydrates that are slowly digested and absorbed such as pulses, brown rice, bread, chapathy will produce less rise in blood sugar and less excretion of urinary sugar than an equivalent amount of carbohydrates taken as sugar in tea.
The fiber particularly the gums, pectin's when ingested with a diet are reported to reduce post prandial glucose levels (after food) in blood. Studies have shown that gum present in fenugreek seeds (it contains 40 % gum) is most effective in reducing blood glucose and cholesterol levels as compared to other gums. These types of dietary fiber are often recommended for the management of certain types of diabetes.
Calculation of Diabetic Diet
Let us assume that a diet is to be planned for a person who is 25 years old and 165 cm tall. According to her height her desirable weight is 60 kg.
Calories required for per kg body weight is 30.
60 x 30 =1800kcal / day.
20-25 % of total calories
1800 x 20% = 360 kcal.
360kcal /4 = 90gm / day
40% of total calories
1800 x 40% = 720 kcal
720 / 4 = 180 gm / day
Total calories - calories from protein and carbohydrates