Nutritional management of diabetes

1. NUTRITIONAL MANAGEMENT OF DIABETES
NEELAM SINGH

2. RISK FACTOR

3. Chronic Complications
Retinopathy
Cardiovascular
diseases
Neuropathy
Nephropathy
Nervous
system

4. Why Change Eating Habits?
To prevent complications of diabetes
By keeping control of :
Blood glucose
Weight
Cholesterol
Blood pressure
To improve health:
By making healthy food choices
By being physically active

5. FOOD COMPONANTS
Macro-nutrients
• Carbohydrates
• Protein
• Fat
Micro-nutrients
• Vitamins
• minerals
WATER
Required in
larger
amounts
Required in
smaller
amounts

6. Glucose — a sugar — is a fuel that provides energy
for your body

7. Insulin resistance

8. CARBOHYDRATES
These foods are starchy or sweet.
Important source of energy.
Functioning of central nervous system,
kidneys, brain and muscles.
55%-65% of carbohydrate required daily.
.

9. Types of Carbohydrates
There are three main types of carbohydrate in food:
Starches
Sugars
Fiber

10. STARCH
Foods high in starch include:
• Starchy vegetables like peas, corn, beans
• Roots and tubers like potatoes, yam, colacassia, tapioca
• Pulses
• Grains like oats, barley, wheat, rice, jowar, bajra,ragi .
• Grain-based foods like bread, cereal, pasta, and crackers
The grain group can be broken down even further into whole
grain or refined grain.

11. Whole grain versus Refined grain.

12. • White bread
• Pasta
• White rice
• Maida products lke romalli roti,
nan, pav ,bun etc.
• Processed snack food
• Whole grains
• Brown rice
• Millets like Jowar, Bajra, Ragi
• Whole wheat
• Whole barley
• Oats
• Muesli etc.

13. Sugar
It’s another type of carbohydrate. Also referred to as simple or fast-acting
carbohydrate.There are two main types
Naturally occurring sugars
• Milk sugar also known as lactose.
Include low fat milk in moderation
• Fruit sugar also known as fructose.
Include fruits with skin, seeds & pulp
• Limit high calorie fruits and fruit
juices.
Added sugars (Avoid)
• Fruit canned or preserved in heavy syrup
• Sugar added to make a cookies, pies,
candy, pudding, sweets, jams, jellies,
chocolates, ice cream, aerated drinks
fruit juices etc.
• These sugars listed on the food label
like, high-fructose corn syrup, dextrose,
sucrose, corn sweetener and corn syrup

14. FRUITS
Fruits are good sources of vitamins, minerals, fiber and antioxidants but must be
taken only in recommended allowance and at particular time
Frequently: (Everyday) Occasionally
(1-2 times / week)
Rarely
(once /month)
Apple – 1 small Orange( 1 medium) Banana (1/2 small),
Water melon (200gm/1 slice) Pineapple (1 slice) Custard apple (1 small)
Guava (1 medium) Peach(1 medium) Mango (1 small)
Papaya (2-3 slices) Pear (1 small) Grapes (½ small cup
Muskmelon (1 slice) Sweet lime (1 medium size) Sapota (1 small),
Amla (4-5 no). Pomegranate ( ½ small) wood apple (1 small )
Figs (2) Strawberries/ black berries/
raspberries ( ½ cup )
Jackfruit (3 pieces)
Apricots –(2 no)
Plums & Prunes ( 2-4 no)
Litchi ( 3-4 no)

15. FIBER
Fiber is another carbohydrate that plays a critical role in digestion. Good sources of
dietary fiber include:
 Beans like Soya bean, kidney beans, lima beans.
 Cereals like whole wheat , bajra, barley, oats,museli, jowar, ragi, bran.
 Pulses like Bengal gram dal , peas dried, horse gram, sprouts.
 Fruits like guava, cape gooseberry, figs, amla, pomegranate
 Vegetables like drumstick, peas, green beans, broccoli, lady's finger, green leafy veg.
 Seeds like fenugreek, flaxseeds, coriander seeds.
 Soluble fiber present mostly in oatmeal, nuts, beans, apple,citrus fruits, apricots
various berries .
 Adults need to eat 25 to 30 grams of fiber each day
Helps in reducing blood cholesterol levels , reduces risk of heart disease, obesity a
type -2 diabetes, maintain proper bowel function and reduces constipation

16. Understanding Carbohydrates
Which of the following contain Carbohydrates?
A.Starch, fruit, milk, starchy vegetables
B.Cheese, steak, chicken
C. Olive oil, butter and fish

17. Understanding Carbohydrates
Which of the following will most quickly raise your blood glucose?
A. Potato
B. Diet soda
C. Fruit juice

18. Understanding Carbohydrates
How much carbohydrate do you need each day?
A.10% of your daily calories
B. 55-65% of your daily calories
C. 90% of your daily calories

19. Understanding Carbohydrates
To best meet your blood sugar goals after meals, what strategy works
best?
A. Drink regular sodas instead of diet sodas
B. Eat fewer non-starchy vegetables
C. Divide carbohydrates between 3 meals a day, choose more complex (rather
than simple) carbohydrates, stay within your daily carbohydrate allowance
and do not skip meals

20. PROTEINS
These are body building foods
They help in:
Growth
Tissue repair
Supporting the immune system
20%-25% protein required daily.
Sources :
• Meat, poultry, milk/milk products, pulses, dry beans, soy nuts.

21. CHOOSE RIGHT PROTEIN
• Avoid red meat, egg yolk as they are high in saturated fat.
• Choose low-fat or lean meats and poultry
• Select some seafood that is rich in omega-3 fatty acids, such as salmon, trout,
sardines, anchovies, herring, Pacific oysters, and mackerel.
• Cook meat, poultry and fish using low-fat cooking methods like baking, broiling
and roasting.
• Good vegetarian protein sources are soy products, tofu, nuts, seeds, sprouts
and beans.
• Choose unsalted nuts and seeds to keep sodium intake low.
• Choose low-fat or fat-free milk, yogurt, and other milk products

22. Understanding protein
Proteins are found in which foods ?
A. Sugar and fruit
B. Beef, poultry, eggs and dairy products
C. Butter, margarine and olive oil

23. Understanding protein
As a person with diabetes, how much protein do you need each
day?
A.The same amount as people without diabetes - about 20% of daily calories
B. Less protein than people without diabetes - about 5% of daily calories
C. More protein than people without diabetes - about 45% of your daily calories

24. Understanding protein
All of these are steps to choosing leaner proteins, except:
A. Choose low-fat or lean meats and poultry
B. Include hot dogs, ribs, sausage and bacon in your diet
C. Avoid red meat, egg yolk .
D.Trim visible fat from meat and remove skin from poultry

25. FATS
These foods are oily or fatty.
• Source of energy.
• Insulation and padding
• Source of essential fatty acids .
• Absorption of vitamins.
• 20-25% of fat required daily
SOURCES
vegetable oil , lean meat ,nuts , fish, seeds.

26. BAD FATS
Saturated fats
Higher intakes have been shown to be
associated with higher levels of total and
LDL cholesterol (positive risk factors for
heart disease)
Examples:
• Full-fat meats , cheese and whole milk,
coconut, or palm oils
Trans Fatty Acids :
Consuming too many of these fats has been shown
to raise LDL cholesterol and increase risk for heart
disease
Examples of Foods:
• Baked goods (cookies, cakes, frosting,
crackers, donuts, pastries, and croissants)
• Packaged snack foods (chips, crackers, snack
mixes)
:

27.  Used in the body for physiological and
structural functions
 The body makes cholesterol and
humans do not need to consume this in
their diet
 Higher intakes have been shown to
raise blood levels of LDL cholesterol (a
positive risk factor for heart disease)
 Varying levels can be found in different
animal products: meat, seafood,
poultry, eggs, dairy products

28. GOOD FATS
• Oils are the major source of monounsaturated fats
(MUFAs) and polyunsaturated fats (PUFAs) in the diet
• PUFAs contain some fatty acids that are necessary for
health—called "essential fatty acids”
Omega-6 PUFAs (liquid vegetable oils)
Omega-3 PUFAs ( soybean oil, canola oil,
walnuts, flaxseed, fish)
• Vitamin E
A powerful antioxidant that has may reduce the risk
of heart disease and cancer

29. CHOOSE RIGHT FAT
Keep total fat intake between 20 - 30 percent of calories .
Most fats should come from sources of PUFA & MUFA such
as fish, nuts, and vegetable oils
Consume less than 10 percent of calories from saturated
fatty acids
Consume less than 300 mg/day of cholesterol
Keep trans fatty acid consumption as low as possible
When selecting and preparing meat, poultry, dry beans,
and milk or milk products, make choices that are lean,
low-fat, or fat-free.

30. Understanding Fats and Oils
The blood cholesterol particle often referred to as "bad cholesterol“ are
A.Triglyceride
B. HDL
C. LDL

31. Understanding Fats and Oils
Bad" fats (the unhealthy types of fat found in your diet that increase
your risk for heart disease), include:
A. Monounsaturated and omega-3 fats
B. Saturated, hydrogenated and trans fats
C. Polyunsaturated fats

32. Understanding Fats and Oils
Sources of heart healthy "good“ fats include:
A.Olive oil, nuts, avocados and salmon
B. Bacon, hot dogs and liver
C. Butter, cheese and coconut oil

33. FUNCTIONAL FOODS HELPFUL IN DIABETES
 Neem
 Cinnamon
 Garlic
 Bitter gourd
 Fenugreek / flaxseeds

34. Tips for making smart food choices
• Bran can be added in your flours to reduce the GI and increase fiber.
• Whole wheat breads , Multi-grain breads with broken grains are healthier than refined flour
breads.
• Majority of vegetables are low in glycemic index and can be liberally used in day to day life.
On must always eat variety of vegetables than repeating the same ones every day.
• Include brown rice over white rice.
• You can enjoy the whole wheat varieties of pastas and noodles .
• Salads should be a compulsory part of both main meals , this provides fiber and helps in slow
release of glucose in the blood stream.
• You can have sweets and mango (1-2 pieces ) during mid meals / In between 2 meals
• It is always better to avoid eating sweets and fruits along with the meal , this may lead to
sugar spikes in the blood .

35. EXERCISE
Exercise improves your mood.
Exercise combats chronic
diseases.
Exercise helps you manage
your weight.
Exercise strengthens your heart
and lungs.
Exercise promotes better sleep.
Exercise can be fun!!!

36. MYTH: You must avoid sugar at all costs.
Fact: The good news is that you can enjoy your favorite treats as long as you
plan properly and limit those hidden sugars in many packaged foods. Dessert
doesn’t have to be off limits, as long as it’s a part of a healthy meal plan or
combined with exercise.
MYTH: A high-protein diet is best.
Fact: Studies have shown that eating too much protein, especially animal
protein, may actually cause insulin resistance, a key factor in diabetes. A
healthy diet includes protein, carbohydrates, and fats. Our bodies need all
three to function properly. The key is a balanced diet.
Myths and facts about diabetes and diet

37. Myths and facts about diabetes and diet
• MYTH: You have to cut way down on carbs.
Fact: Again, the key is to eat a balanced diet. The serving size and the
type of carbohydrates you eat are especially important. Focus on whole
grain carbs since they are a good source of fiber and they are digested
slowly, keeping blood sugar levels more even.
• MYTH: You’ll no longer be able to eat normally. You need special
diabetic meals.
Fact: The principles of healthy eating are the same—whether or not
you’re trying to prevent or control diabetes. Expensive diabetic foods
generally offer no special benefit. You can easily eat with your family and
friends if you eat in moderation.