SELF MANAGEMENT OF
DIABETES
NUTRITION INTERVENTION
&
DIETARY GUIDELINES
Vasantha Narasimhan Ph.D
Emeritus Professor of chemistry
Skidmore College
Diabetes:: Some Stats and facts
(Source:
ADA and NIH)
• about 30 million cases in USA in 2012
• 21 % of people over 65 have diabetes
• The total estimated health care cost of
diagnosed diabetes in 2012 is $245 billion,(
$176 billion in direct medical costs and $69
billion in reduced productivity)
• Food habits/Life style main cause
• Diabetes related heart diseases, strokes, kidney
diseases and neuropathy on the rise.
• Certain ethnic groups more prone to diabetes
Division of internal medicine, UCSF, Division of Geriatric Medicine, USC
Cardiology and endocrinology divisions, U.Al
Human nutrition, endocrinology and internal medicine dept., UT Southwest Med.Center.
??????Oh,My God!!!!?????
• Do I have to give up my favorite foods and go on a
“diabetic diet”?
• I love dinner parties- should I say goodbye to them?
• I love eating out. No more of that???
• Will I be an “invalid” from now on and worry about my
health constantly??
• The goal of my talk today is to emphasize that
With a few healthy dietary and attitude changes
You can answer “NO” to the above questions!!
Food provides
NUTRIENTS
(CHEMICALS IN FOOD THAT NOURISH THE BODY)
MACRONUTRIENTS
* CARBOHYDRATES
* FATS
* PROTEINS
(Energy, growth)
MICRONUTRIENTS
* VITAMINS
* MINERALS
(Help proper metabolism of macronutrients,
maintain healthy cells)
FOOD
Mouth
stomach
Glucose
Amino acids
Fatty Acids
Intestine
“ Waste”-
Fibers
Vitamins
Minerals
Blood Stream
Pancreas
INSULIN
Heart
Liver
Energy
use &
Storage
As
glycogen
Blood
glucose
Energy
use
Brain
ROLE OF INSULIN
Maintain blood glucose
within healthy limits
Muscle
Other organs
What can go wrong?
CONDITIONS
NO Insulin made
CAUSES
RESULTS
damage to pancreas,
genetic defect in
making insulin etc
TYPE 1 DIABETES
Not enough
insulin made
sluggish pancreas
due to overwork, cell
defects etc
TYPE 2 DIABETES
Insulin not doing
its job right
“Insulin resistance”,
organs not
responding to insulin
TYPE 2 DIABETES
USUAL SYMPTOMS
Frequent urination, excessive thirst, irritability, tingling & burning sensation in
limbs, hunger pangs, lack of concentration, sometimes unexplained weight loss
Risk factors for diabetes
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Genetic/hereditary factors
Age/ethnicity
Obesity/overweight
Sedentary life style
High fat/high carb. diets
High Blood Pressure
High fat levels in blood
If you are at risk or
you have been diagnosed as diabetic…….
• Don’t Panic !
• Set your GPS to take control of your health! Then
follow through!
• Your destination should be “A healthy you” with
acceptable values of
blood sugar
blood cholesterol and triglycerides
blood pressure
body weight
• You can reach there with small,
step by step lifestyle changes.
Acceptable blood values
(suggested by National Diabetic Education Program)
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Fasting Blood sugar: 80-120 mg/dl
Post-prandial sugar: 140-170 mg/dl
Hemoglobin A1C (Hb A1C) under 7.0
Total cholesterol: under 200 mg/dl
HDL (“good cholesterol”) over 40 for men/over 50 for
women
•
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LDL(“ bad cholesterol”) under 100
Triglycerides under 150 mg/dl
Blood Pressure: below 130/80
Body Mass Index : under 27
HbA1C tells us about average blood sugar levels
over a 12 week period.
Glu
HbA1C
Controlled diabetes, not much glucose,
not much HbA1C
Uncontrolled diabetes, more glucose,
much more HbA1C
Body Mass Index chart (BMI)
Steps towards a healthy “you”……
Medications and
monitoring as prescribed
Physical activity goals!
Dietary Goals
Healthy Life style
changes
Physical activity goals
• Set goals-(lose 10 lbs? increase strength? be active? )
• Follow the “F.I.T.T.” principle to become fit!
Frequency, Intensity, Time, Type of activity
• Stop negative thoughts!
• Keep a record of your progress!
• Reward Yourself!
Diet & Nutrition
Goals
Total calorie control
CARB counting/Glycemic Index
Diabetes food pyramid
Simple common sense dietary habits
Calorie Counting
source: National Institute of Health 2008
profile/ activity level
Calories/day Number of servings*/day
Small/F/ moderate
Medium/F/sedentary, low
1200-1600
6 carbs, 3 fats, 1 proteins,
2 dairy,3 veggies, 2 fruits
Large/F/moderate
Small/M/ moderate
Medium/M/sedentary
1600-2000
8 carbs,4 fats,2 proteins,
2 dairy, 4 veggies, 3 fruits,
Medium/M/high
Large/M/Moderate
Large/F/high
2000-2400
10carbs,5 fats, 3 proteins
2 dairy, 4 veggies, 4 fruits
Servings: Carbs- 1 slice bread, 1 roti , ½ cup cooked rice, 1 cup cooked pasta
Dairy: 8 oz
Protein : 4 oz.cooked meat. ½ cup cooked lentils/beans/dhal
Fat: 1 teaspoon
Veggies: 1 cup raw or ½ cup cooked
Fruits: ½ cup diced , ½ of whole fruit ( apple, pear etc)
10%
20
%
30%
40%
Now for some practical ways to watch
your diet and nutrition………
When you eat- frequency and schedule
How much you eat- portions and sizes
How you eat- rates and combinations
Where you eat- at home or out
What you eat- choice of foods
When you eat…………
How much you eat……….
Portion control
• Be conscious of how much you put in your plate
• When you start your new “diet” , record what you eat
each day at least for 10 days.
• “Plate method” is recommended by ADA
Milk or
yogurt
1 serving
Fruit
1
servin
g
How and where you eat………
• Take a minimum of 20 minutes to finish your meal.
The hormone that gives the sensation of fullness
takes 20 mins to take effect.
• Place all the components of your meal in small
serving dishes on the table.
• Never eat on the run! Be conscious of what you put in
your mouth! Sit at the table and enjoy your meal.
What you eat……..
Choosing the right foods
• You don’t have to carry around tools like
charts, counters, weighing tools etc.!
• Just simple common sense substitutions and
choices will do the trick.
• Make choices based on simple available
information in paper and on internet.
Some examples of Simple Substitutions
INSTEAD OF THIS
USE THIS
Processed/ polished grains
Whole grains
White bread
Wheat or rye bread
Fried snacks, chips
Baked snacks and chips
Regular dairy products
Low fat/no fat dairy products
Red meat
Fish, poultry , lentils, beans
Canned fruits, fruit juices
Fresh or frozen fruits
White or yellow potatoes
Yams, sweet potatoes
Sugary desserts
Low fat dairy based desserts
Salty and sugary snacks
Peanuts, almonds, walnuts,
Always read nutrition labels to see amount of
total carbs and sugar!
Can I include rice in my meals??
• Of course you can! 1-2 carb servings can be rice
dishes
• Glycemic Index is a method nutritionists use to
study the effect of foods on diabetes.
• GI score ranges from 1-100 with pure glucose being
100
• GI < 55 low, 56-69 medium and over 70 high
• IRRI has rated 235 varieties of rice based on GI
Brown Rice
55 ✔
Swarna (Ponni) rice
56 ✔
Samba Masoori rice
57 ✔
Basmati rice
58
✔
Long Grain rice
58
✔
Medium Grain rice
69
over Cooking (Mushy) increases
GI 5-8 pts)
Siimmer over low heat (+1)
Rice cooker (+1)
Boiling and straining (+6 to 8)
Pressure cooker ( +6 to10)
Use with 1 isp ghee
Use with protein
(kichadi!)
Sticky rice
(japanese,thai)
90
(-5 to 8)
How about rotis and pastas???
• Whole wheat based rotis over white “nan”
• Chapati flour with1% rye/bajri flour + 1% besan ---lowers GI
• Pastas made with durrum wheat better than
multigrain ones.
• Larger the size of pasta, less GI
• “al dente” lower GI/overcooking higher GI
• Ghee on roti and olive oil on pasta- lowers GI
What about fats and oils??
• Total “Non-fat” meals are not so good if you are trying
to control your blood sugar.
• Fat helps to release the sugar from carbs slowly into
blood----- less sugar spikes and yo-yo’S!
• 4 -5 servings ( 4-5 tsps) of fat/day
• Ghee (clarified butter) (ayurvedically adviced)
• Sesame oil preferred over olive oil
(J,clinical.nutr. 2011, J.nat.med. 2012)
Efficacy of oral diabetic medicines.  B.P & TG
•
Peanut oil preferred over corn or canola oil
Can I include dessert in my meal plan???
Occasionally yes!
Instead of this
have this!
Rich, creamy sugary cakes/pies
Low fat, low sugar cakes/pies
Cheese cake/vanilla cake
Dark chocolate cake chocolate mousse
Fruit Pies, tarts
Fresh frozen fruits with nonfat whipped cream
Sugar based ,fried desserts
(e.g : gulab jamun, jalebi, ladu)
Dairy based, baked, steamed desserts
(e.g Ras malai, ras gulla, Kheer)
Fruit sorbets ( 2 scoops)
Nut cakes and sweets
Ice cream or kulfi ( ¾ to 1 scoop)
Plain nuts with fruits
Finally, a word or two about fruit and
veggie choices.
OK to choose in plenty (3-4 servings a day)
• Green leafy veggies, cruciferous veggies, Karela, egg plant.
• Berries, orange varieties
Moderate use ( 1 serving/day)
• Carrots, beets, yams, sweet potatoes
• Bananas, pears, apples, peaches, melons, papaya
Very limited/occasional use ( >3 servings/week)
• Potatoes, Taro root (Arvi) other root veggies
• Mangoes, watermelon
Karela( bitter gourd)
(momardica charantia)
• Polypeptide-P ( insulin mimic)
• Charantin (  uptake of glucose by cells)
• α-lipoic acid (anti-neuropathy agent)
Methi ( Fenugreek)
(Foenum Graecum)
• 4-hydroxy isoleucine
(facilitates insulin secretion,
Slows down absorption from intestine)
Tips to succeed in your dietary goals….
☛Use Variety and diversity in choosing foods
☛Don’t be rigid and narrow in your choices
☛Allow for “cheatings” occasionally, but
remember to get back on track soon
☛Most of all, be self confident and positive
☛Always remember you control your
diabetes, don’t let diabetes control you!
Some useful websites
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www.diabetes.org
(american diabetic assn)
www.diabetescare.net
www.ndep.nih.gov (national diabetes education)
www.fda.gov
www.cdc.gov/diabetes
Thank you all for your patient listening!