Balanced Diet Chart for Blood Sugar Management " Diabetics "
1. Introduction
It has been said that "the only way to treat Type II diabetes is by tackling the cause head on: insulin resistance" (Wingenfeld, 2006). Type II diabetes is a complex metabolic disease that is primarily characterized by insulin resistance. It is a common belief that diabetes is a disease in which there is too much glucose in the blood, or that rather, diabetes is caused by eating sugar. Although some aspects of these statements are true, diabetes is more complex than this. There are several types of diabetes, ranging from how the diabetes has developed to age factors and medical components. According to the World Health Organization (1999), "diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar." It is true that insulin regulates the level of glucose in the blood. High levels of glucose in the blood can damage many areas of the body, leading to many complications. This is why diabetes is a serious disease. Whether diagnosed with gestational diabetes, Type I, Type II, or pre-diabetes, a healthy diet is crucial in controlling blood sugar and managing diabetes.
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People with diabetes have the same nutritional needs as anyone else. The basic principles of healthy eating still apply. However, it is imperative for diabetics to understand that there is no such thing as a diabetic diet. Limiting the intake of sugary foods and food high in sugar is often considered a diabetic diet; however, this is a common misconception. Although there is a kernel of truth in this statement, it's the portion size and frequency of the sugary food or drinks that ultimately affect blood sugar levels. Every person, regardless of if they have diabetes or not, should aim for a well-balanced diet. A well-balanced diet is one that is rich in nutrients and low in fat and calories. Too much fat and too many calories can lead to weight gain and obesity, and these are both factors that can worsen diabetes. Weight control is an important factor for diabetics as Type II diabetes is strongly linked to both genetic and lifestyle risk factors, including a high body mass index (over 25) and inactivity. Weight loss, if overweight, can have beneficial effects and for some people will improve the management of their diabetes without medication. A good understanding of the nutritional value of food and best combinations of healthy food choices are key aspects to the dietary management of diabetes.
1.1. Understanding Diabetes
In diabetes, blood glucose levels are elevated because glucose cannot enter the cells, due to a lack of insulin or insulin resistance. The inability to metabolise glucose means the body is forced to use fat for energy, resulting in an abnormal metabolism of fat and protein. High blood glucose levels can cause damage to blood vessels, which can in turn lead to damage of the eyes, kidneys, heart, and nervous system. This is why it is essential for diabetics to keep blood glucose levels as close to normal as possible.
The reason for elevated blood glucose levels in diabetes is a failure of glucose to enter the body's cells. When food is eaten, it is broken down by the digestive system into a form of sugar called glucose, which is the main source of fuel for our bodies. The bloodstream absorbs the glucose, which is then transported to all the cells in the body. For glucose to enter the cells, insulin must be present. Insulin acts as a key, unlocking special channels in the cell membrane to allow glucose to pass from the bloodstream into the cell.
Diabetes is not a single disease but a group of disorders with a common set of symptoms. All forms of diabetes are characterised by elevated levels of blood glucose, a result of an inability of the body to either produce or use insulin, disturbances of carbohydrate, fat and protein metabolism, and damage to blood vessels.
1.2. Importance of Diet for Diabetics
Nutrition plays a crucial role in diabetes control. The diabetic must take great care in dictating the amount and the content of what he or she eats on a daily basis. This is because eating has the largest effect on blood sugar levels. Foods that are broken down quickly into sugar within the bloodstream have the highest effect on blood sugar level. These foods contain the highest levels of glucose and can be either simple sugars or complex carbohydrates. Simple sugars have the highest ratio of glucose to complex carbohydrates but both have a greater effect on glucose levels than protein or fat. Diabetics need to control which of these foods and how much they eat at any one time to ensure that their blood sugar remains at a satisfactory level. Taking regular blood sugar level readings before and after meals is one way of working out which foods and which quantities are best for keeping glucose levels within the satisfactory range while minimizing the amount of insulin used.
2. Components of a Balanced Diet for Diabetics
Carbohydrates should form the major part of the diabetics diet. Their contribution to blood sugar levels is significant. They are broken down to glucose relatively quickly. As diabetic patients cannot remove the sugar quickly due to lack of insulin, it will cause high blood sugar levels. They need to space out the intake of carbohydrates throughout the day to keep energy levels up and maintain blood sugar levels. If you take insulin, you will have to match your intake of carbohydrates with your insulin dose. Simple carbohydrates which tend to raise blood sugar levels quickly should be substituted with complex carbohydrates. Simple carbohydrates are sugars so this means sugar itself, sweets, biscuits, cakes and all foods containing sugar. Complex carbohydrates raise blood sugar levels more slowly and are less likely to cause high blood sugar. They include pasta, rice, cereals and bread. When changing from simple carbohydrates to complex carbohydrates, it is not an excuse to eat more. You will still need to control the portion size. Proteins have little direct effect on blood sugar levels. However, a steady intake of protein is essential to prevent muscle breakdown. If a patient is losing weight or muscle mass then it is a sign that their diabetes is not under good control. They will therefore need to increase the intake of protein and possibly their insulin dose. This is common in type 1 diabetes where the body still cannot use sugar as an energy source, and so breaks down its own muscle and fat. High fat levels in the blood are also a catalyst for muscle breakdown, increasing the risk. This is a complex issue which is beyond the scope of this article, but essentially controlling blood fat levels is done by maintaining good control of blood sugar levels, and the intake of good fats (unsaturated). If muscle mass has decreased, an increase in food intake will mean an increase in insulin dose.
2.1. Carbohydrates
So for people with diabetes, is there a right amount of carbohydrate to eat? Unfortunately, there is no one-size-fits-all answer to this question. The amount of carbohydrate that can be tolerated varies from person to person. It can even vary for an individual person at different times. Factors that impact on tolerance to carbohydrate include age, weight, gender, level of physical activity, type of medication being used, and the degree of blood sugar control. Because of the variability of carbohydrate tolerance, flexibility in the amount of carbohydrate consumed at meals and snacks is important. People who control their diabetes with diet alone have more flexibility than those who use insulin. Insulin is a potent hypoglycemic agent: whenever it is taken, its action is the same, to lower blood glucose. If people with diabetes who use insulin are to keep their blood sugar under control, they need to match their insulin doses to the amount of carbohydrate in their meals and snacks. This can be challenging and may require assistance from a dietitian who has expertise in diabetes and carbohydrate counting.
Remember you should generate text only for section "2.1. Carbohydrates".
Carbohydrates (C) having the maximum effect on the blood sugar is the most controversial nutrient in the diabetic meal planning. It can raise blood sugar higher and faster than protein or fat. The total amount of carbohydrate in meals is a stronger predictor of blood sugar response than the glycemic index is. The effect of this increased of sugar on C metabolism and diabetes is different in people with type 1 diabetes and type 2 diabetes and for this reason recommendations regarding the amount of carbohydrate to consume are a little different for the two types of diabetes. However, the vast majority of dietary guidelines for diabetics are focused on the C content of the meals.
2.2. Proteins
It is recommended that for people with diabetes, 12-20% of the energy intake should be from protein. Ideally, the choice should be lean meats, fish, and dairy produce, so the quality of the fat in the diet is not increased. High protein plant foods should also be included, such as pulses and tofu, with care taken with the fat content of these choices. Red and processed meats are associated with an increased risk of CHD and type 2 diabetes, so the intake of these should be reduced.
However, it is also well known that the increase of protein in the diet leads to an increase in blood glucose levels. If the amount of carbohydrate in the meal is reduced to compensate for the protein, this can have a negative effect and lead to hypoglycemia. The key is to find the right balance and to spread the intake of protein evenly throughout the day. High protein intake does increase renal load, and there is evidence to suggest it can cause damage to the kidneys in those that have kidney disease. High intake may also cause leaching of calcium from the bones and an increase of saturated fat in the diet.
Protein is an essential component of a well-balanced diet and is vital in the workings of the human body. In the digestive system, the protein is broken down into amino acids and used to repair and build body tissues among many other very important functions. A deficiency in protein may cause a decrease in muscle mass, impaired functioning of the immune system, weakening of the heart and respiratory system, and death may occur in severe cases. Protein also has an effect on satiety, with meals higher in protein reported to increase satiety.
2.3. Fats
The effect of dietary fats on diabetics is a cause of concern. It is known to reduce cell sensitivity to insulin. High fats in the diet are also linked to complications such as cholesterol, heart diseases, and obesity. The fats that one must restrict are animal fats, hydrogenated fats in processed foods, and packaged foods. Coconut oil, palm oil, cocoa butter, and vanaspati are rich sources of saturated fats which are known to increase LDL cholesterol. So it is wise to avoid these.
Fats are a concentrated source of energy. One gram of fat gives 9 kcal. Though ingestion of fats increases the glucose level to some extent, fats need not be completely avoided. They have to be restricted to 10-15% of the total calories. Fats are of different types - saturated and unsaturated, mono unsaturated and poly unsaturated. Out of these, unsaturated fats are considered better than saturated fats. Usage of oils high in mono unsaturated fats like groundnut oil and mustard oil is found to lower the risk of heart disease. These fats increase the HDL cholesterol and have little or no effect on the total cholesterol. So it would be appropriate to change over to these oils. Soybean oil and sunflower oil are high in poly unsaturated fats. These fats lower the LDL cholesterol but have no effect on the HDL cholesterol. So, it is advisable to use oils high in mono unsaturated fats. Fish is also a good source of mono unsaturated fats.
2.4. Fiber
Fiber is an important component of a balanced diet for diabetics. It is a type of carbohydrate that the body cannot digest. It is found in plant-based foods, and there are two types: soluble and insoluble. Soluble fiber partially dissolves in water and forms a gooey mass in the stomach. It is thought to lower cholesterol and glucose levels. Foods high in soluble fiber include oats, fruit, vegetables, dried beans and peas. Insoluble fiber retains most of its structure in the gut. It adds bulk to the stool and appears to help food pass more quickly through the stomach and intestines. This may help prevent gastrointestinal disease. Foods high in insoluble fiber include wheat bran, vegetables, and whole grains. On the whole, fiber is a good regulator for the digestive system and helps to prevent chronic diseases, a common problem for diabetics who have difficulty digesting carbohydrates. High-fiber diets are linked to a reduction in heart disease, but such diets for diabetics also require good control of blood glucose levels, since high blood glucose levels decrease the body's capability of utilizing fiber. Diabetics who have poor blood glucose control and who also eat a high-fat, low-fiber diet have a higher risk of developing diabetic retinopathy. This is because the lipid levels in their blood increase. Fiber intake is essential, but it needs to be part of an overall, healthy diet if diabetics are to gain further benefits.
3. Meal Planning for Diabetics
The fundamental goal in meal planning for diabetics is controlling blood sugar levels. This can be done in many ways, such as portion control, selecting foods with a low glycemic index, meal timing, and watching the types of foods that are consumed. Portion control is important for all diabetics because consuming too much food in one sitting can cause a spike in blood sugar levels. Many diabetics already are aware that they have hyperglycemia, but it is important for small reminders about how an excessive amount of food leads to this. Eventually diabetics can train their bodies to eat sensible portions of food by using a planned plate method. The plate method is a way of portion control that involves using portion-sized plates. Half of the plate should be filled with non-starchy vegetables, one quarter with protein, and the other quarter with a whole grain or starchy food. After the meal has been put together, one can take a look at their plate and consider if it looks like a sensible portion and rearrange food accordingly. This is a very useful way for diabetics to learn about portion control and what food types cause higher blood sugar levels. Glycemic index (GI) is a ranking from 1 to 100 that is given to foods based on how much they raise blood sugar levels. A low GI is considered 55 or less and it is recommended that diabetics consume food that falls into this category. Choosing low GI foods can improve long-term blood sugar control and lower the risk of heart disease. Diabetics should aim to eat plenty of non-starchy vegetables, beans, and fruits, but try to avoid starchy and sweet fruits and vegetables that have a high GI. When serving a carbohydrate, it is wise to choose whole grain pasta, rice, or bread as they have more nutritional value and a lower GI.
3.1. Portion Control
Portion control is one of the easiest ways to manage blood glucose levels and lose weight. Reducing portion sizes helps you balance the amount of glucose from the food eaten with the amount of insulin your body produces. It also keeps your blood glucose from going too high right after meals. You can use the plate method to help you measure portion sizes. You can do this by using a 9-inch plate and putting a green salad or a non-starchy vegetable on half the plate. Then divide the other half of the plate into two equal sections, one section for a starchy food and the other for a meat or meat substitute. Add an 8 oz glass of milk or a piece of fruit to go along with the meal. This method is effective because it uses a common item (a dinner plate) to measure portion sizes. If you are dining out, ask for a take-home container and put half of your meal inside before eating. With these methods, it makes it easy to have the right portions of food and to not overeat. Another way to help is to know the serving sizes of the foods you eat frequently. You can measure out the serving size and put it in a dish and put the dish in with the package so next time you can just fill the dish to know the right serving size. This way of portion control is also an effective method.
3.2. Glycemic Index
The glycemic index (GI) is a relative ranking of carbohydrates in foods according to how they affect blood glucose levels. Carbohydrates with a low GI value (55 or less) are more slowly digested, absorbed, and metabolized, and cause a lower and slower rise in blood glucose and insulin levels. There is now a significant amount of evidence that low GI foods can help with control of glucose levels in people with diabetes. Lower GI diets can also help to improve levels of cholesterol, HDL cholesterol, and triglycerides. It is not known whether the GI has an effect on blood pressure. The results from a number of studies show that by eating a diet with a lower average GI, people can reduce the long-term risk of developing diabetes, heart disease, and some cancers. This is relevant to the broader community because these are the commonest causes of illness and death in the modern world. The impact of the GI on quality of life for people with diabetes is substantial. High GI foods can produce a rapid increase in blood glucose and insulin levels. After a meal, this can result in a rapid return of hunger. Low GI foods produce a slower, lower rise in blood glucose and insulin levels. It appears that a high GI diet is associated with an atherogenic lipid profile and an increased incidence of coronary heart disease. These results have given rise to the hypothesis that the type and amount of carbohydrate in the diet are linked to the development of CHD. This hypothesis is supported by findings from prospective cohort studies and from secondary analyses of large randomized trials of diet and drug therapies designed to prevent further heart disease. Low-GI diets are associated with higher HDL cholesterol concentrations. The most convincing data come from studies that have used HDL cholesterol as an endpoint. High HDL cholesterol concentrations are protective against a range of diseases, including diabetes, heart disease, and Alzheimer's disease. Low-GI (that is, sugar-free) and intact whole grain (lower GI) cereal products have been consistently associated with reduced risk of coronary disease in large prospective cohort studies. Data comparing the effects of these products on disease endpoints are still required, but it is reasonable to recommend the use of these foods to help prevent heart disease, provided the amount of carbohydrate is taken into account when adjusting other components of the diet. A more recent analysis of data from the Nurses' Health Study has confirmed that higher GI diets increase the likelihood of developing type 2 diabetes in both non-obese and obese adults. This report included whole grain foods in the definition of low GI. This is consistent with findings from the large, epidemiologic cohort studies in the United States and the follow-up studies of diet in the above-mentioned trials.
3.3. Meal Timing
Furthermore, meal-timing is an important aspect to manage the diabetic condition. An analysis of the NHANES database showed that eating breakfast is associated with lower insulin resistance, as well as higher postprandial thermogenesis and physical activity level compared with omitting breakfast. Furthermore, it is plausible that spreading the caloric load over the day into smaller meals within an isocaloric diet might have some benefit on the plasma glucose and HbA1c concentrations. This, however, is a controversial issue. Although the few studies that have been conducted examining this relationship suggest benefit, other studies have shown conflicting results. One study looked at the effects of a late meal on glycemic response in a controlled diet of mixed macronutrient content in elderly non-insulin dependent subjects. Plasma glucose concentration was measured using an isotope dilution method at hour intervals throughout the day. Findings showed that the late meal resulted in higher plasma glucose concentrations in the late evening period. Thus it is difficult to draw a solid conclusion regarding the benefits of consuming smaller, frequent meals on glycemic control and weight management. However, it is logical that those being treated with insulin or insulin secretagogues would match their meal carbohydrate content and medication to reduce the risk of hypoglycemia which can be a serious event. A consistent carbohydrate intake pattern with respect to types of meals and timing relative to medication and physical activity is also desirable for glycemic control. This method has been incorporated into medical nutrition therapy interventions using diabetic exchange meal planning and has good evidence of benefit on glycemic control. In summary, timing of meals relative to medication and physical activity, taking into consideration the overall pattern of food intake has an important role in metabolic control and weight management for those with diabetes.
3.4. Snack Options
When selecting a snack, a person with diabetes should consider the difference between a snack and a treat. Snacks are foods that may help the person with diabetes prevent low blood sugar (hypoglycemia), whereas treats are foods that are intended for enjoyment. Snacks are likely to be lower in sugar and higher in nutrients such as protein and complex carbohydrates. People with diabetes should eat a snack if their last meal was more than 4-5 hours before. Also, if they are physically active or taking part in sport, they may need a snack to prevent a hypo during the activity or later on during recovery from the activity. Research done in people with type 2 diabetes has shown that consuming a nighttime snack that is high in carbohydrates has shown to increase the dawn phenomenon of diabetes. This is a rise in blood sugar between the hours of 4 am and 8 am. If you suffer from the dawn phenomenon, you may need to seek dietetic advice regarding decreasing high GI foods. Vigorous physical activity can cause a drop in blood sugar level; a person with diabetes should always monitor their blood sugar before an intense session and have a snack on hand in case it drops too low. If you find you need snacks to treat or prevent hypos, your diabetes medications or insulin may need adjusting, so seek advice from your doctor, diabetes educator, or dietitian.
4. Tips for Maintaining a Balanced Diet
One of my best tips for you to maintain a balanced diet is by reading food labels. This can help you make smarter food choices. Reading food labels tells you the specifics about what is in a food product. It provides valuable information such as serving size, calories per serving, total fat, saturated fat, cholesterol, sodium, total carbohydrate, dietary fiber, sugars, and protein. For diabetics, knowing the total carbohydrate is a very important part of meal planning and can affect your blood sugar control. You can pick and compare similar products and choose the one that is nutritionally better for you. For example, if you were to look at the total carbohydrate of different types of breakfast cereals, you can choose the cereal with lower total carbohydrate and sugars thus not spiking your blood sugar levels. Try to limit foods that have added sugars or sweeteners among the first few ingredients or have multiple ingredients ending in "ose". This usually means that the product is a source of sugar even when it is not listed as "sugar". This can also help limit the amount of sugar in your child's diet. By being aware of the types and amounts of fat you eat, you help yourself to a healthy weight and healthier blood glucose and blood fats. Remember, you want to choose foods that have more unsaturated or polyunsaturated fats than saturated fats. If you were to find a similar type snack such as crackers or granola bars, looking at the total fat and saturated fat can help you choose the better product. By looking at the specific details of what is truly in food products, you can make wise food choices that are better for controlling your blood sugars and preventing complications. The second tip compliments reading food labels which means it will also affect food choices. Healthy cooking methods can help diabetic patients choose the right foods to eat and also control their blood sugars with the right food preparation. Diabetics must know the importance of healthy cooking, as it has a direct hand in affecting the types of food and the nutritional value. By knowing and practicing good methods, it is possible to cook just about everything without adding unhealthy fat and it is also possible to have flavorful and exciting meals that are still good for your diabetes and health! This can be done by using various low-fat cooking methods, using herbs and spices to enhance the food's natural flavor, and using more citrus or acidic ingredients such as vinegar and tomatoes.
4.1. Reading Food Labels
After a few shopping trips, you may find that certain food products that you buy and eat regularly have a better nutrient balance than others. By choosing options that have more of the nutrients you need and less of those you don't, at a moderate price, you have learned to use nutrients as a criterion for your food decisions.
The %DV column doesn't add up nutritionally as advantageous a 100% of the Daily Value is what you should aim for each nutrient every day. You have space to be extravagant with the higher fat, higher calorie or higher sugar foods but still aim to meet overall nutrient needs no higher no lower. High is 20% or more and Low is 5% or less. A good range is from 5% - 20%. Try to get meals and snacks to be mainly less. The two higher levels can be more flexible.
A food label can be very informative and can help you in making wise food choices. Reading the food labels can tell you what's in a food, how its nutrients compare with those of similar products, and whether the food contains a lot of a nutrient you may want to limit or only a little of a nutrient you may want to increase. Start with the list of nutrients. This will tell you the amount of each nutrient in a serving - in both actual terms and as a % of the Daily Value. This is especially helpful if you are counting calories or have a limit on a certain nutrient such as sodium or cholesterol.
4.2. Healthy Cooking Methods
One of the best cooking methods for diabetics is to broil, grill, microwave, bake, or stir-fry foods. Avoid frying as it adds extra fat and calories. When cooking, try to steam vegetables because this helps keep the most nutrients in them. Avoid overcooking your vegetables as this will cause the nutrient content to decrease. Try to consume meals that are freshly prepared and not too overcooked. This helps save nutrients and the lower calorie content is great for diabetics who are looking to lose weight too. When choosing food to eat, diabetics should avoid pre-packaged food. This food tends to have a lot of sodium, and at times trans-fats and saturated fats. By avoiding these foods, it will help reduce the risk of heart disease and high cholesterol. If the foods are unhealthy, then the fats used in the cooking process will be unhealthy too, so something like frozen fish will have been pre-battered in unhealthy fats. Instead, choose fresh fish and coat it in a tasty marinade and grill it in some tinfoil. This gives a much healthier and tasty solution.
Balanced diet for diabetics – Section 4.2 Healthy cooking methods
4.3. Regular Physical Activity
It will be a good idea to split the activity over the week, and various activities have different effects on blood sugar. On the days when you are not doing aerobic activity, try to include some heavy gardening, do 1-2 sessions of lifting weights, and pinch in some flexibility or stretching exercises. You can also break up your activity throughout the day with 10-minute sessions. Keep in mind your work schedule or mealtime to avoid inactive activity when your blood sugar levels are too high.
Regular physical activity can lower your blood sugar, which is very important in managing diabetes. Try to get at least 150 minutes of moderate or 75 minutes of vigorous aerobic activity per week, collectively spread over at least 3 days of the week, with no more than 2 consecutive days between each activity. Going for a 30-minute walk for 5 days in the morning and taking one day off will be a good measure, but make sure to be consistent and alter the duration and activity level to suit blood sugar level. This is a rough guidance, get activity when your schedule permits, and remember that any little bit helps, always better than none.
A regular physical activity is very important for people in general, but the benefits of physical activity for people with diabetes are like the damage-control exercise. In addition to general benefits of physical activity, managing life with type 2 diabetes independently means making decisions all day long to keep blood sugar in check - including decisions about physical activity (when to exercise, what to eat to manage blood sugar before, during, and after activity). Keep in mind while exercising that it is to help the body to lower blood sugar, so combining physical activity and exercise with the activities to monitor and manage blood sugar has more to do with trial and error, and there is no one-size-fits-all.