How to design a Diabetic diet

How do you design a Diabetic diet

1. First fix the number of Calories you will need per day. 20Kcal/Kg of Ideal Body weight (for sedentary life)

Add 5Kcal/Kg extra for underweight persons or if they lead a moderately active life.

Reduce Calories by 5 Kcal/Kg body weight if overweight.

2. Fix the Constituents of Diet:

Carbohydrates – 55-60%

Proteins – 20-30%

Fats – 20-30%

Fibre 25-35 fibre

        Take about half or a little more of the calculated calories as Carbohydrate (boiled or brown rice is preferred over white rice, whole wheat chappathi is preferred over maida rotis and Naans. Take all the

proteins that you would like, add oils to your food (1-2 tablespoons per meal. Take 300-400 gm of vegetable as salads daily. Remember to incorporate as many colours in the salad as possible.

Note: Carbs and Proteins give 4Kcal/gm and fats and oils give 9Kcal/ gm. Therefore if you are advised 1500Kcal of food per day, you will need to take 900 Kcals and 225 gm of Carbs (60% of 900).You can add about 30ml of oil to your meals (2 tbs) and take the remainder of calories as proteins (which would contain fat also).

   3. How are the calories divided between the meals?

Morning meal 40% (Breakfast 25% and 11 AM snack 15%)

Lunch 35% (Lunch 30% and Tea time snack 5%)

Dinner 25% (Dinner 20% and late night snack 5%)

Food is to be taken in 5-6 meals a day.

Roughly 2/3rd of the assigned calories should be taken at meal time

and 1/3rd as an In-between meal snack. If you are used to taking

        3 idlis for breakfast, take 2 at 8AM and 1 at 11AM.

Important terms explained

Simple carbohydrates: are those that are digested very quickly to yield glucose molecules such as fruits, milk and milk products, sugars, sweets, syrups and soft drinks.

Complex carbohydrates: are those that take a longer time to get digested and release glucose slower such as peas, beans, whole grain, vegetables and whole grain bread.

Glycaemic Index: refers to the ranking of food according to how they raise blood glucose levels. They are classified into

Low GI foods – <45

Mid GI foods – 46-59

High GI foods ->60

What are the determinants of Gylcaemic Index?

The following factors are important

how refined the carbohydrates are

how the food is cooked

how quickly it is digested and absorbed – like rice

how much simple carbohydrate it contains

how much of fibre it contains

how much of fat and proteins it contains – fats slow down gastric emptying and proteins stimulate Insulin secretion and reduce blood glucose levels.

So a Diabetic person must avoid or eat very sparingly High GI foods, eat moderately of Medium GI foods and eat plenty of Low GI foods.

4. Foods that don’t require Insulin for metabolism in the body are Fats and Proteins. So you could have a steak or add oil to your food without having to worry about your blood sugar levels. A diabetic person needs to reduce the intake of Rice, wheat and other cereals and tuberous vegetables such as Potatoes, Carrots, beetroot, Colacasia, tapioca etc (Onions and Radish are ok). Unlimited green vegetables of all types must be taken.

5. Getting into the habit of weighing the food would go long way in understanding how much and what type of foods affect the blood sugars. A simple kitchen scale can be bought for as less as Rs.350/-.

General Advice for Diabetic patients regarding their Diet and food intake!

2. Have small frequent meals, 5-6 meals per day.

3. Have a heavy breakfast, lighter lunch and a very light dinner. Fit in 2 low carbohydrate snacks at 11PM and 5PM. The snacks could have a high protein or fat content!

4. Know how much to eat (total calories per day) and how much of each food item to eat at each meal. (Count your Idlis and estimate the amount of rice eaten)

5. Never overeat and avoid deserts. Have a fixed helping of Rice and count of Chapattis.

6. Snack on nuts, sprouts and salads.

7. You don’t need to reduce your intake of Oil and meat unless you have high blood cholesterol levels.

8. Supplementing an optimal diet is “compulsory” for all Diabetic patients as the reduced food intake doesn’t allow adequate micronutrient intake. Please contact your doctor for a suitable vitamin supplement.

9. If you are eating out, have a large salad before starting your main course. Share your main course with someone else and avoid the desert completely if possible. You can have all the non-veg kebabs you want.

10. If you are a vegetarian, have just one helping rice or a limited number of breads (Chappatis/Rotis etc)

11. Always avoid Calorie dense foods e.g., a piece of cake has more calories than a Idli!

Useful tips:

1.Eat before you are hungry so you are not tempted to overeat.

2. One way to eat more without running the risk of increasing your blood sugars is to add your Rasam/Sambar to your Salad and to eat your salad before your main course.

3. You should increase your intake of salads especially if you are always feeling hungry. Metformin as advised by your doctor would also reduce your appetite.

4. Take veggies of as many different colours as possible every day.

5. Your fruit intake should be limited especially if your blood sugars are elevated. Fruits must be taken as an in between meal snack and not as desert after a meal.

Food that are bad for an Diabetic

While I might have touched upon this topic, I think that it would be worthwhile to reinforce it to you. The food that must be avoided are:

Sweets – chocolates, Indian sweets, ice creams etc

Sugar and sugar containing foods

Beverages – all juices, fizzy drinks (unless zero calorie)

Tubers – Potato, Beet root, Carrots, Tapioca and others

High GI foods

Calorie dense foods – Cakes, pies, tarts, pastries or anything nice by any other name!  

How do you adjust your meals according to your blood sugar values?

Your doctor may ask you to check your sugars before a meal and 2 hrs after. You will also need to measure the exact amount of food that you consume in terms of (katori/cup) or pieces of bread. If your post meal sugars are high, you may have to reduce the helpings of rice/bread and increase intake of vegetables or fats with your meal. In time, you will know exactly how much or how little you can take to keep your post meal sugar values under control.

Common targets for Diabetics

Fasting Blood Sugars – 90-110mg/dL

Post prandial Sugars – 140-160 mg/dL for those under 60.

160-180 mg/dL for those between 60-75 yrs

                 180-200 mg/dL for those >75 yrs of age.

200-250 mg/dL for those with frequent hypoglycaemia

HBa1c values – <7% for those <65 yrs of age

7-7.5% for those 65-70 yrs of age

7.5-8% for those 70-80 yrs of age

8-8.5% for those >80 yrs of age.

Useful Links:

Food exchange list –https://www.iitk.ac.in/hc/food-exchange-listhttp://A Dieter’s manual – ouricc.org/wp-content/uploads/2014/06/Indian-Food-Calorie-Chart.pdf