DIETS FOR DIABETICS WITH SPECIAL NUTRITIONAL REQUIREMENTS

Dietary Information for the Insulin-dependent Diabetic

Most of the food we eat contains some form of carbohydrate. There is carbohydrate in milk, starch, grain, fruit, vegetables and refined sugars and syrups. Only the meat and fat groups a do not contain significant amounts of carbohydrates.

The amount of carbohydrates eaten is usually based on the total daily caloric intake. Approximately 40 per cent of the total daily caloric intake is eaten as carbohydrate calories. A simple way to understand this would be to take the caloric intake and multiply the calories by 4/10. This figure would be the total carbohydrate calories for the day. To compute the grams of carbohydrate available daily, divide the total carbohydrate by four because 4 calories are produced per gram of carbohydrate. Let us say that a patient was allowed 1,500 calories for the day. He would be allowed 600 carbohydrate calories, or 150 grams of carbohydrate. The best and most logical way of deciding the amount of carbohydrate in grams to be eaten at each meal would be to divide the total daily grams of carbohydrate allowed by three, as most people eat at least three meals a day. This means that the patient is allowed 50 grams of carbohydrate for breakfast, 50 for lunch and 50 for dinner. The 50 grams of carbohydrate can be ingested in any form desired. However, most people like to choose several different types of carbohydrate foods to provide variety. (NOTE: It is important for the insulin-dependent diabetic to eat the same amount of carbohydrate at breakfast, lunch and dinner every day.)

The diet for the insulin-dependent diabetic should be designed for the patient on an individual basis with consideration for the patient's individual likes, dislikes and life style. The most important factor in any diet is that it be nutritious. By nutritious we mean that essential nutrients are provided in adequate amounts to allow for proper growth and body repair. The diet for the insulin-dependent diabetic should supply the minimum amount of calories that will enable him to maintain normal body weight. Most insulin-dependent diabetics are diagnosed at an early age and periodic adjustments in the diet are encouraged to allow for continued body growth and development. Meals should be eaten at about the same time every day in order to conform with a regular insulin schedule. If snacks are desired, they should also be eaten at the same time each day. It is not a good idea to decide to have a snack one day, and skip it the next day.

The more consistent the mealtimes, snack times and carbohydrate contents of the meals, the easier it will to regulate the blood sugar levels.

Exercise and the Insulin dependent Diabetic

As we have mentioned before, care for the diabetic includes adequate diet, certain amounts of insulin and daily exercise. Each element in the care of the patient is dependent one on the other for regulation of the blood sugar. Exercise and insulin work together to lower the blood sugar level, while food increases the blood sugar level.

It is not unusual for the daily activities to vary and a certain amount of flexibility is encouraged. It is definitely not necessary to avoid all rigorous activities. A problem arises if after slight activity is performed, an insulin reaction or low blood sugar results.

If strenuous activity like mountain climbing, skiing, tennis, sprinting, swimming, etc., is planned, it is a good idea to test your urine before going. If the urine test is negative, eat a snack before going (a small sandwich and a piece of fruit would be adequate). It is advisable in all cases to bring along canned juice, preferably grape, apple or fruit nectars because they contain a more concentrated amount of sugar which is more readily absorbed by the body. It is also necessary to have crackers, cookies or bread so that one can prevent or alleviate hypoglycemic reactions (low blood sugar).

A large percentage of the diabetic population is overweight. It should be understood that obesity is not responsible for the occurrence of diabetes. It may, however, cause the inborn tendency for diabetes to manifest itself.

The main objective of a dietary regime for the overweight diabetic is a significant reduction in body weight toward the normal. It is also important for the diabetic to excrete only a minute portion of the daily food intake as glucose in the urine. The nutritional principles are the same for the overweight diabetic as for the overweight non-diabetic. Both groups are advised to eat less food, and to avoid those foods which contain simple sugars such as candy, cake, syrups and rich desserts. The main reason for avoiding these foods is that they contain sugars which are rapidly absorbed into the bloodstream, thereby causing a rapid rise in the blood sugar. It seems more advisable for the overweight diabetic to take his carbohydrate requirement in the form of small amounts of starchy foods like potatoes, rice, noodles, corn, bread, crackers, cereals and dried beans since these _foods take a longer time to digest and their products, therefore, enter the bloodstream at a slower pace.

It is also advisable for the overweight diabetic to eat at about the same times every day and to eat approximately the same amount of carbohydrate at breakfast, lunch and dinner. If snacks are desired throughout the day, the patient should eat less at the previous meal. For example, if a snack is desired at ten o'clock in the morning, that food should be subtracted from breakfast, and so on throughout the day. It is important however, to be consistent; if you have a snack at ten o'clock in the morning one day, continue to have it every day.

The overweight diabetic should consume the same amount of protein as the non-overweight diabetic. In view of the danger of atherosclerosis, a limited fat intake is recommended. Generally, only about 30 per cent of the total daily calories should be eaten as fat calories.

A restriction in dietary sodium has been shown effective the management of edema associated with congestive heart failure, hypertension and some kidney diseases. We use the term "sodium-restricted" diet here rather than "salt-free" as the latter is a misnomer. Almost everything you eat contain sodium, and to follow a "salt-free" diet implies that you eating nothing at all.

The lists on Sodium Point List have been prepared to aid in the selection of foods that are lower in sodium. Instead of listing the sodium content of each food item in milligrams, a point system will be used, as it has been found to be more convenient by doctors and nutritionists. The points of sodium contained in each food item represent the milliequivalents of sodium.

There are several dietary levels of sodium that are prescribed for certain diseases. The average American diet contains approximately 8 grams of sodium or 346 milliequivalents or 346 points. A thousand milligrams of sodium or 43 milliequivalents is considered a restricted sodium diet; a moderate sodium restriction is approximately 2,000 milligrams or 87 milliequivalents; and 4,000 milligrams or 173 milliequivalents are considered a maintenance diet for people with mild hypertension and renal impairment.