Health education

1. Diet and Diabetes
Dr.S.Sethupathy,M.D,Ph.D.,
Professor of Biochemistry,
Rajah Muthiah Medical College
Annamalai University

2. Diabetes Mellitus
A syndrome characterized by disordered
metabolism of carbohydrates, lipids and
Proteins ,
Hyperglycemia ,
resulting from either low levels of the
Insulin or resistance to insulin’s effects

3. Complications of DM
Coronary heart disease
Stroke
Nephropathy
Retinopathy
Gangrene

4. Diet
Diet is the cornerstone of all therapeutic
regimens for type 2 diabetes.
Proper dietary choices are important for all
people with diabetes.
Unfortunately, dietary habits are the most
difficult to change.
Diet in Diabetes should not be a complete
deviation from the normal diet.

5. Carbohydrates:
60% of the calories from carbohydrates. The
intake of carbohydrates can be divided in to 4-5
equal parts. One-third (33%) of the diet- lunch
,another one-third during dinner (33%). 25% is
served during breakfast and the rest (9%) during
evening tea or at bedtime.
Proteins:
15-20% of the total calories be derived from
proteins. Meat and meat products, milk, pulses
legumes and nuts are all rich in proteins.

6. Fats:
15-25 % of the calories be derived from fat. (less of
saturated fats (ghee, butter, vanaspati etc.), and more of
PUFA –poly-unsaturated oils (sunflower, safflower oils)
and MUFA- mono-unsaturated oils (palm oil, olive oil
etc.)
Vitamins and Minerals: Available in green leafy
vegetables, fresh fruits, milk, cereals, nuts etc.
Dietary Fibre:
Present in cereals, legumes, fruits and vegetables.
Intake of 25 g of fibre per 1000 calories for a diabetes
diet.

7. Aim of Dietary management
To control the blood
sugar and to maintain an
adequate nutritional
status and also satiety.

8. Essential fatty acids
The omega-3 fatty acid through marine
food sources
The omega-6 fatty acid
omega-3/omega-6 balance needed for
cardiovascular health.
Consumption of vegetable oils leads to a
high ratio of omega-6 / omega-3 fatty
acids.

9. Protein
Dietary sources of protein include
meats,soy products, eggs,grains,legumes
and dairy products.
Plant protein better ,
No cholesterol

10. Fiber
Whole grains, fruits and vegetables are
rich in dietary fiber.
Fiber prevents constipation and colon
cancer.
Soluble fibers in whole grains, may help
lessen insulin spikes and reduce the risk
of diabetes.

11. Other nutrients
Other micronutrients include antioxidants
and phytochemicals
One of the principal classes of
phytochemicals are poly phenol
antioxidants which are beneficial to the
CVS and Immune system

12. Factors to be considered
Types of Diabetes
Type 1 and 2
Other Risk Factors
Obesity
Smoking
Alcohol
Physical activity

13. Prescription of diet
What is the calorie need?
Protein intake needed?
Vitamins ,minerals,fibre needed?
Combination of food items?
Palatability?
What is the frequency of meals?

14. BMI
Weight in Kg / Height in meter 2 ( W/ H2 )
Non obese 20 – 24.9
Over weight 25 – 29.9
Obese Gr 1 30 – 34.9
Obese Gr 2 35 – 39.9
Obese Gr 3 >40

15. To Maintain normal body weight
Calorie intake
For overweight individuals- 10% - 20% lesser
than actual daily requirement
For underweight. - 10% more than actual daily
requirement

16. Daily energy needs
BMR - Practically Speaking
24 kcal per kg body weight per
day

17. Calculation(For 60 kg,Moderate )
BMR 24 X 60 = 1440 kcal
Activity (40% of BMR) = 576 kcal
_____________________________
Sub total = 2016 kcal
Need for SDA (10%) = 201 kcal
_____________________________
Total = 2217 kcal
2200 kcal(rounded)

18. Major energy sources
Carbohydrates should provide 45 – 65% of total daily
calories.
Best choices are vegetables, fruits, beans, and whole
grains.
Fats should provide 25 – 35% of daily calories.
Limit saturated fat (red meat, butter) to less than 7% of
daily calories.
Limit trans-fats to less than 1% of total calories.
Protein should provide 12 – 20% of daily calories
Patients with kidney less than 10% of calories.
Fish, soy, and poultry are better protein choices than
red meat.

19. Energy groups
Carbohydrate 60% - 1320 kcal
Fats 28% - 616 kcal
Proteins 12% - 264 kcal
Total - 2200 kcal

20. Food Groups
I 1 Cereals
2 Legumes and pulses
II 3 Roots and tubers
4 Green leafy Vegetables
III 5 Fruits
IV 6 Milk products
V 7 Poultry, Fish and Meat products
8 Fats and oils
9 Spices and condiments

21. Cereals
Moisture 10 – 15 %
They contain 7- 10 % proteins
Fibre rice1% wheat 1.2% Ragi 3.6%
Fats 1-2%
Energy 350 kcal.
Make at least half of your grain servings
as whole grains, such as 100% whole-
wheat bread, brown rice, and oatmeal.

22. Pulses and legumes
Moisture 10 – 15 %
They contain 20 % proteins
Fibre 1-1.5 % whole 4.5%
Fats 1-5%
Energy 350 kcal.

23. Milk and milk products
Moisture 85 % Cheese 40%
Proteins 2-4 % Cheese 24%
Fat 4-6 % Cheese 25%
Energy 100 kcal. Cheese 400 kcal

24. Egg
Moisture 75 %
Proteins 13%
Fat 13 %
Energy 170 kcal %

25. Animal foods
Moisture 75 %
They contain 20 - 25% proteins
Fat 2-4% egg 13%
Energy 100 kcal %.

26. Roots and tubers
Moisture 80 – 90 % Tapioca 60%
They contain 1-2 % proteins
Fibre 1 %
Fats 0.2%
Energy 40-60 kcal , potato 100 ,sweet
potato 120 ,tapioca 160 .

27. Vegetables
Moisture 80 – 90 %
They contain 2- 8 % proteins
Fat 1%
Fibre 2% Curry leave 6%
Energy 20 -100 kcal.
Start every meal with vegetable salad
If you’re hungry, eat more fresh or
steamed vegetables.

28. Fruits
Moisture 80 %
They contain 2- 8 % proteins
Fat 0.5%
Fibre 1- 2% Guava 5%
Energy 30 -60 kcal.
Raisins 300kcal, Banana 110,dates 150,
Water melon 15,mango 75
Restrict dry fruits
Eat more fruits and drink less fruit juice.

29. Others
Fats and oils 900kcal%
Butter Sat Sunflower PUFA
Spices and condiments
Energy 200-350 kcal
Fibre 5-10 % Dry chillies 30%Coriander 32%
Proteins 5-20%

30. Sample daily diet plan
Rice 1.5 cups 270G – 945 Kcal P 27G
Pulses 0.5 cup 100 G -345 kcal P 20 G
Milk 250 ml 200G - 200 Kcal P 6 G
1 Egg 60 G - 100 kcal P 7 G
Oils 70ml 60g - 540 kcal --------
Meat 100 G - 100 kcal P 20 G
Total 790 G - 2230 kcal P 80G
Fruits and vegetables 0.5 - 0.75 kg

31. Weekly plan
Rice 1- 1.5 kg /person
Pulses 0.5 kg/person
Milk 2-3 liters/person
Oil - 0.2 L / person
Egg or meat or pulses
Meat 0.3 – 0.5 kg divided (5 times) /person
vegetables 1-5 -2 kg
Fruits 1.5 – 2 kg

32. High-carbohydrate/high-fiber diet
Low-fat diet
Western diet (higher consumption of red
meat, processed meat, French fries, high-
fat dairy products, refined grains, and
sweets and desserts) poses a high risk for
type 2 diabetes.

33. Diabetics
Restrict their daily calorie intake to 1500 or
less
Diet- 60 % carbohydrates, 25 % fat and 15
% protein to control blood sugar
The carbohydrate - slow digesting and
unrefined. Eg: Whole grains.
Decreasing fat intake, increasing fiber rich
foods.

34. Glycaemic index
Diets with low glycaemic index are
considered better for diabetics.
Wheat, carrots have high Glycaemic
Index, but have complex carbohydrates
and so good.
Milk has low Glycaemic Index but is bad
for diabetics because of high calories and
fat content.

35. GLYCAEMIC INDEX OF SELECTED FOODS
10 to 19 % – groundnuts and Soybeans.
20 to 29 % – lentils, kidney beans and fructose.
30 to 39 % – apple, tomato soup, skimmed milk, curd, yogurt and ice
cream.
40 to 49 % – Bengal gram, black gram, beans, dried peas, sweet potato,
whole meal oats and orange juice.
50 to 59 % – frozen peas, white noodles, potato chips and sweet corn.
60 to 69 % – white bread, beetroot, raisins, shredded wheat, sucrose,
banana and sprouted green gram.
70 to 79 % – potato, broad beans, whole meal bread, millets and white
rice.
80 to 90 % – honey, maltose, mashed potatoes, carrots and corn flakes
100 % – glucose.

36. Healthy eating habits
First switch over to eating more vegetables,
fruits, grains and beans
It is proved that high-carbohydrate, low-fat
diet with adequate protein and dietary fiber is
ideal for fighting diabetes.
Such diet provides more volume and is more
filling even if they are low in calories.
Diets low in saturated fat, reduce cholesterol,
help in weight control and keep diabetes away.
Starches, fruits, vegetables and milk products
are healthy foods although they raise blood
glucose levels more quickly than fats and meat.

37. Keeping active and eating
sensibly
We prefer bikes or cars to walking even shortest of
distances
We wait for elevators rather than taking the stairs
We prefer watching Television or playing computer
games than outdoor activities
Instead of simple, natural foods we prefer high calorie,
fat rich junk foods
So instead of losing weight we tend to put on.

38. Frequency of meals
Diabetic patients should strictly avoid
overeating.
They can take around five small meals a
day instead of few large ones.

39. Eat meals at regular time and intervals.
Avoid eating in the living room or bedroom.
Don’t talk, read or watch Television when you are eating.
Eat food slowly and chew it thoroughly.
When you crave for unhealthy snacks, distract your
mind.
Keep social activities and eating apart.
Before leaving for party, eat something healthy at home,
so that the hunger pangs are satisfied
Eat more fruits, vegetables and whole grains. All it
means is that you need to select foods that are high in
nutrition and low in calories. .

41. Take home message
Have small frequent meals
Avoid bulk meals
Consume more fibre rich vegetables and fruits
Restrict simple sugars
Have adequate dietary antioxidants(Citrus
fruits,carrots,spinach etc)
Restrict cream and fatty foods to keep body
weight under control
Adopt some feasible home remedies

42. Thank You
Rabbit diet for a healthy heart