Dietary management
Goals of Medical nutrition therapy
1.
To achieve and maintain
near normal glycemia
2.
To achieve and maintain
optimal lipid profile , total cholestrol <150, triglyceride </= 120, HDL
>50, LDL < 100
3.
To achieve and maintain
normal blood pressure levels around 120-130 to 80-85 mmhg
4.
To adjust the nutrient
intake to restore and maintain ideal body weight to avoid dyslipidemia, cardio
vascular disease, hypertension and nephropathy. During childhood and pregnancy
adjustment for growth should be provided
5.
For elderly patients,
provision for proper nutrition and psychosocial needs
Diabetes Mellitus Type 2 – First step
dietary management therapy + Exercise 50 % come under control.
Optimum daily intake needs in
calorie intake per kg of desirable body weight.
Sedentary Moderate Heavy
Obese 20 25 30
Standard wt 30 35 40
Underweight 35 40 45
Total Calorie Intake :
Most important step while
prescribing a diet
BMI( Basal Metabolic Index) =
Weight in kg / Height in metre square
BMI between 22-25 ideal
Ideal body weight = Height in
cm-100
Features of dietary management therapy :
-dietary management is not a
reduction in diet , but modulation to suit particular need of individual . This
concept will reduce psychological resistance against disease
-patient and spouse counselled
together
-dietary articles prescribed in
terms of weight
-better to prescribe foods in form
of primary food articles like rice, meat, fish and others
-make understand reduction in food
will not be beneficial
-quantity to diet and timing are
important since other aspects of management such as medication and exercise are
timed in relation to the diet
-vast majority of treatment
failure can be avoided by proper dietary instructions
-need for strict adherence
stressed during follow up
-patient should be involved in the
formulation of the diet and such a participating instruction assures better
compliance
-carbohydrates must make up 50-60%
of the calories for good metabolic control, include more legumes, pulses, green
leafy vegetables
-fats should make up 20-25% of
total calories, saturated and mono & poly unsaturated fats should be
equally distributed
-dietary cholestrol < 300
mg/day
-invisible fat : cereals, legumes,
seeds, they contribute to 5 to 10 % of total energy intake
-milk & milk products 40 to 45
% of total fats
-milk fat is a saturated fat
-proteins 12-20%, must include
lean meat and fish, strict protein restriction in renal failure
-dietary salt < 6gm/day, for
hypertensives 3gm/day
-avoid smoking/alcohol completely
A SAMPLE DIETARY CHART ADVICED BY
A DIABETES CLINIC
Morning 6 am : Tea / Coffee / Milk
200ml without fat and sugar.
Morning 8 am : Idli / Dosa /
Chapathi / Upma / Pongal / Kichadi / Ada / Appam / Rice Puttu with Saambar 1
cup
Morning 11am : Butter milk /
Coffee / Tea / Fat removed Milk 200ml + Marie biscuit / Dhal / Popcorn / Vada /
Rusk / Cucumber salad- any one of these
Lunch 1 pm : Rice , with lots of
vegetables and green leafy vegetables,
Sambar 1 cup, Rasam 1 cup, Butter Milk 1 cup
Non veggies : 100 gm fish or two pieces,
100gm chicken or two pieces, 100gm mutton or three pieces, egg white of one
whole egg, only once in a week
Avoid : Egg yolk, fried fish,
liver, brain, chest region of chicken, head of fish
Tea time 5pm : Coffee / Tea / Milk
200ml with Whole wheat mixed or Multi grain bread or same as said for 11 0’clock
without sugar.
Night 8pm : same as breakfast or
lunch
Night 10pm : 200ml of fat removed
milk without sugar.
Exercise therapy
Endocrine / Physiological
responses during exercise
-suppression of insulin release
directly as well as through epinephrine
-symphathetic system activation
which inhibits insulin release and stimulates lipolysis
-non insulin dependant glucose
uptake in periphery
Benefits of exercise
-lowers blood glucose
concentration
-improves insulin sensitivity
-reduce triglycerides, increase
HDL, reduce LDL
-reduce BP
-reduce body weight
-cardio vascular conditioning
-improves sense of well being and
quality of life
Risks of unsupervised Exercise
-hypoglycemia may be caused due to
over exercise, physical strain, untimely food, fasting, redcution in food as a
part of dietary management etc
-symptoms of hypoglycemia are
blurred vision, headache, confusion, giddiness, dizziness, increased craving
for food, increased sweating, tremor, shivering
-hyperglycemia after very strenous
exercise especially in poorly controlled patients
-precipitation or exacerbation of
cardiovascular disease and acute cardiac events like arrythmias, sudden death
and cardiac failure
-worsening of DM complications
Pre exercise check list for DM
-Duration and Intensity of the
exercise must be planned with proper consultation of the diabetologist
-Review DM medications
-TMT/ Stress ECHO to rule out CAD
and also to know individuals exercise tolerance capacity
-Ophthalmic fundoscopy to rule out
proliferative retinopathy
-Biothesiometry to detect extent
and severity of sensory loss
-Check blood glucose if < 100
mg/dl advice pre exercise snacks, 100-250 mg/dl can proceed with exercise, >
200 mg/dl check urinary ketones if positive, insulin should be started
For average middle aged DM patient
-walk 3km on level ground over a
period of 45 mts
-swim for 30 mts at an average
speed without cardiac distress
-cycle on level ground at 8 km/hr
for 30 mts
Foot care in DM
-wash both the foot regularly in
luke warm water with baby soap
-clean the foot clearly with bath
towel making sure there is no water between the toes
-keep the toe nails clean, don’t allow
them to get septic, cut the nails carefully
-always keep the moisture of the
foot, don’t allow them to dry,apply suitable moisturising lotion and massage
gently for some time, don’t allow moisture to stay between the toes
-always use suitable foot wears
which are gentle and comfortable and clean, and use alwys clean socks
-when going outside don’t walk on
naked foot especially around the fields and gardens, foot is a must every where
-check the foot wear for ant sand
particles or thorn that may injure the foot
-walking around your house or
garden with all vigour is necessary to maintain the blood circulation to the
foot
-always keep your foot little
higher than body level while at sleep to ensure suficient venous drainage
-while sitting for longer time don’t
sit with putting legs over another legs
-immediately consult your doctor
if you find any of these symptoms : numbness, prickling sensation,
parasthesiae, tingling, oedema, foot crack, ulcers, corns, change in colour of
skin and blisters
-if possible wear a different foot
wear in morning and evening
-using canvas shoes with extra
insole or MCR chappals are more helpful
-use always those shoes that are
slightly bigger than you size
Also :
-Bath twice daily
-Over sweating areas apply talcum
powder
-Dental hygiene is must
-Itching and skin diseases must be
dealt with more seriosity
-If no proper control measures are
taken DM might affect kidneys, heart, vessels and eyes.
