Aims of a healthy diabetic diet
By Renate Drousch
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| Diabetes Mellitus: Aims of a healthy diabetic diet |
The
two parts of the diet are what you eat and how much. A healthy diet provides
energy for daily activity and maintains the right body weight for height. It is a lifelong eating plan. It is important that people continue to enjoy their food and that the treatment of their
diabetes is adjusted to their usual
eating pattern and not vice versa. New patients start enthusiastically and then lapse, so weight
may fall and then rise again within a year.
Aims of a healthy diabetic diet
•
Physically healthy
•
Feeling well
•
Energy for life and exercise
•
Well-balanced diet
•
Good day-to-day glucose control
•
HbA1c 48–58 mmol/mol (6.5–7.5 %) without hypoglycaemi (tailor to patient)
•
Total cholesterol < 4 mmol/l
•
LDL cholesterol < 2 mmol/l
•
Triglyceride < 2.3 mmol/l
•
BMI* 18.5–24.9 kg/m2
•
Waist circumference
•
< 102 cm in men (< 92 cm in Asian men)
•
< 88 cm in women (< 78 cm in Asian women)
•
Alcohol in moderation if desired
•
Low salt
*BMI
unhelpful in very muscular people.
BMI
upper limit in Asian/African-Caribbean or Chinese people = 23 kg/m2
Dietitian
Every
patient should see a dietitian on diagnosis of diabetes and annually thereafter. The diabetic diet is an integral part of treatment and medical staff must ensure that patients realize this. Patients
may wrongly assume that there is no
need to worry about diet if they are taking their diabetes tablets or insulin. All those caring for people with
diabetes should be aware of dietary
requirements and be able to answer questions about food. Advise patients to keep a week’s food diary (using
your local format) to help their
discussions with the dietitian.
Which diet is best for glucose control in people with diabetes?
We
don’t know. Everyone should eat a generally healthy diet as described and have the right amount of calories to reach or maintain a healthy weight. There have been many dietary studies in diabetes. A
review of literature from 2001–10 found
that whether the diet had very low, low, moderate, or high carbohydrates (CHO), high or low glycemic index
(GI) CHO, or had high- or low-fibre
content did not produce consistent results on blood glucose levels compared with the relevant control group.
(Diabetes Care 2012; 35:434–45;
doi: 10.2337/dc11-2216).
What to eat?A healthy balanced daily diet
People without diabetes should eat this way too.
People’s needs
vary, so each person should have a personalized eating plan.
• Include:
• Starchy CHO foods such as bread, potato, pasta, rice,
cereals
spread throughout the day. These should be high in fibre and
not cooked or
dressed in fat.
• Five to seven portions of fruit or vegetables per day
(which can
include pulses, beans, or fruit juice, but each only
once a day).
• Two small portions of meat, fish, or pulses for
protein. Remove skin
and fat, and do not cook or dress
in fat.
• Three portions of low-fat dairy foods: milk (skimmed/semi-skimmed),
cheese (matchbox size), yoghurt (small pot).
• Alcohol in moderation.
• Exclude:
• Most sugar and fat. Use low-sugar or low-fat options.
• Calorie content of foods is:
• Fat: 9 kcal/g
• Protein: 4 kcal/g
• CHO: 3.8 kcal/g
• Alcohol: 7 kcal/g
• The standard unit is a kilocalorie.
Food also contains water, fibre,
micronutrients (e.g. vitamins and minerals), and
inedible waste
such as pips or pith.
Consider using the Food Standards Agency Eatwell
plate: see
The segments on the plate occupy:
• Bread, rice, potatoes, pasta, and other starchy foods:
33 %
• Fruit and vegetables: 33 %
• Milk and dairy foods: 15 %
• Meat, fish, eggs, beans & non-dairy sources of
protein: 12 %
• Foods and drinks high in fat and/or sugar: 8 % (try to
reduce this
segment in people with diabetes)
18 yr olds need more calories a day (3000 for a man, 2500 for a
woman)
than 45 year olds (2500 man, 2100
woman). Pregnancy (last trimester) adds about 200 calories a day, lactation about 300.
Prepared foods are often highly calorific. Fat and
sugar make food taste
good and act as cheap bulking
agents in manufactured prepared foods. Home cooking can also be calorific; a roast lunch may
contain over 1000 calories.
Food labels
In packaged foods, ingredients are listed by weight,
with the first one listed
contributing the biggest proportion
to that food by
weight. Beware manufacturers’
values (e.g. calories ‘per portion’)
as the portions are often small.
Values are also shown per 100 g
(Table next).
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| Diabetes Mellitus: Aims of a healthy diabetic diet |
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