Sugar ? No sugar !!
This is one of the most common rhetoric we all hear in our daily lives that having diabetes simply means NO sweet tooth for the diabetic people.
Unfortunately, in our traditional setup of health care professionals its very easy to say not to take sugar anymore to a person who is taking sugar for ages and if the person is a bit concern about his diet then a generalized “traffic light” restricted diet plan is given.
Here, i am not encouraging to take refined table sugar to anyone whether a person has diabetes or not but just want to change the traditional perception about diet in diabetes.
Diabetes is unfortunately spreading like an epidemic in Pakistan despite the fact that the graph of poverty and joblessness has increased.People with diabetes often ask what’s the use of controlling diet when this diabetes is more sincere than my life partner.
Here’s the point where you can step in towards the right direction if you understand that our goal is optimal blood control by any means that includes diet and exercise or its combination with medicine or insulin.
Managing diabetes is basically balancing the tricycle of your life that is adherence to diet, lifestyle modification and right choice of medicine or insulin. Let’s zoom in the first two balancing wheel of our life’s tricycle.
In terms of life style modification diabetes is changing your casual civilian lifestyle to a well balanced discipline military lifestyle. It does not include merely a routine half an hour brisk walk and that’s it. It means changing your perception.. using stairs in the presence of lift, switching tv channels manually, deliberate effort to create opportunities for walk like going masjid that is bit far from your home, or avoid using car while going to near by tuck shops, using manual machinery grinders & egg beaters etc.
It may seem unrealistic in such busy scheduled life. But believe me, the felling of fitness is far beyond from these deliberate “time wasting” activities. You may inculcate them gradually in your life as mentioned earlier, its all changing your perception in your own way.
Your diet is actually treating or deteriorating your optimal blood glucose control. Your diabetologist or diabetes educator is the one who will tell you, your optimal blood glucose control that varies with age, medical complication and duration of diabetes and self blood glucose monitoring (SMBG) and most essentially foot care advice.
The terms of carb, there are three basic theories which are generally practice in managing diabetes, one is carbohydrate to insulin ratio and second the glycemic index of food and glycemic load of food. Foods low on the glycemic index (GI) scale tends to release glucose slowly and steadily. Foods high on the glycemic index release glucose rapidly but it doesn’t tell you how high your blood sugar could go when you actually eat the food so a separate value called glycemic load will give a more accurate picture of a food’s real-life impact on blood sugar.
The glycemic load is determined by multiplying the grams of a carb in a serving by the glycemic index, then dividing by 100. A glycemic load of 10 or below is considered low; 20 or above is considered high.Like a cup of milk glycemic index is 31 while its glycemic load is just 4, similarly in almost 2 tbsp (25 gms) honey GI is 61 while it GL is 12 !
Carb to insulin ratio really works well in people with type 1 diabetes and for those who need intensive glycemic control like in Gestational diabetes or prior to surgery. Its basically a hit and trial method that’s why its personalized and effective. It gives the feeling of empowerment of managing diabetes. In simple terms it means how many units of insulin a person is needed for 1 choice (15 gms) of carb. Once you got an estimated figure then you may multiply with total number of carb choices in one meal. The insulin primarily that works in CHO:Insulin is bolus regime like short or ultra short acting insulin. Here, i would suggest that a diabetes specialist dietitian who will help you to count carbohydrate and to calculate your carb requirement by keeping in view your body requirements and insulin dosage and type.
Carbohydrate that contains high quantity of dietary fiber always prevent hyperglycemic peaks. Resistant starch found in oats, legumes etc also works magically. Rule of thumb is to avoid refined food. Fruits and vegetables with edible skin, lentils with skin, wheat with bran , oats cereal in breakfast , psyllium husk before meal and a good serving of fresh salad without mayo dressing will play pivotal role in weight management and optimal diabetes control.
Meal timings and frequency of meals plays an integral role in diabetes management. Generally ( 6 meals 3 main meals and 3 snacks ) with proper distribution of macro nutrients are advisable for avoiding hypo and hyper glycemia.
Huge data is questioning now on requirement of meat on daily basis. Any how two serving of meat/day is required in an average 1500 to 1800 kcal diet plan. Intake of red meat on daily basis is not recommended. White meat preferably fish is recommended more than any other protein in meat form due to its type of fat and protein. Method of cooking food really kills or enhance its nutrient efficacy in our body.
Fats and oils group is the foremost in managing diabetes.Metabolic syndrome directly affects medical nutrition therapy. Unfortunately the silent killer that is uncontrolled diabetes may cause multiple co-morbids like cardio vascular diseases, hyper tension, stroke, renal failure and obesity. Insulin resistance one of the major cause of having type 2 diabetes and its directly related to the consumption of dietary fat. People with diabetes sometimes in their good faith takes diet products like confectioneries (diet sweets) but always ignore its fat content.
Mono unsaturated fatty acids (MUFA) in your diet is highly recommended for a healthy life style and for diabetes and cardiac disorders. Though like other Fats MUFA also provides 9 calories/gram but it can help to reduce LDL (bad cholesterol levels) in your blood which can lower your risk of heart disease and stroke. MUFA is found in Olive oil, canola oil, peanut oil etc. Never be attracted from colorful brands of oil for your food as it directly and “secretly” effects your health. Combination of olive and canola oil is much cheaper for daily cooking if olive cannot be afforded for sole cooking medium. For an average 1500 to 1800 kcal diet plan around 5 tsp oil is recommended in a day for one “healthy” person .A well balanced diet plan for people with diabetes must be follow by every family member for healthy living.
Debate between Margarine vs butter is quiet old now. High levels of trans fats which raise levels of LDL (bad cholesterol) and lowers levels of HDL (good cholesterol) in margarine give edge to “optimal” usage of butter over margarine.
As for alternative sweeteners , six high-intensity sweeteners are FDA-approved as food additives in US: saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotame, and advantame but as their generally recognized as safe (GRAS) value changes with clinical trials taking very limited amount of alternative “Natural” sugar alternative like honey and brown sugar which tends to increase blood glucose but at least they have no “hidden” known or unknown risk factors would be recommended as per your personalized diet prescription.
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