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SELF MANAGEMENT OFDIABETES NUTRITION INTERVENTION & DIETARY GUIDELINES

Vasantha Narasimhan Ph.DEmeritus Professor of chemistrySkidmore College

Diabetes:: Some Stats and facts (Source: ADA and NIH)

about 30 million cases in USA in 201221 % of people over 65 have diabetes The total estimated health care cost of diagnosed diabetes in 2012 is $245 billion,( $176 billion in direct medical costs and $69 billion in reduced productivity)Food habits/Life style main causeDiabetes related heart diseases, strokes, kidney diseases and neuropathy on the rise.Certain ethnic groups more prone to diabetes

Division of internal medicine, UCSF, Division of Geriatric Medicine, USCCardiology and endocrinology divisions, U.AlHuman nutrition, endocrinology and internal medicine dept., UT Southwest Med.Center.??????Oh,My God!!!!?????Do I have to give up my favorite foods and go on a diabetic diet?I love dinner parties- should I say goodbye to them?I love eating out. No more of that???Will I be an invalid from now on and worry about my health constantly??The goal of my talk today is to emphasize thatWith a few healthy dietary and attitude changesYou can answer NO to the above questions!! Food provides NUTRIENTS(CHEMICALS IN FOOD THAT NOURISH THE BODY)

MACRONUTRIENTS MICRONUTRIENTS * CARBOHYDRATES * VITAMINS * FATS * MINERALS * PROTEINS (Energy, growth) (Help proper metabolism of macronutrients, maintain healthy cells) Mouth

stomach IntestineAmino acidsFatty Acids Vitamins Minerals Waste- Fibers Blood StreamFOODGlucose EnzymesBlood glucose

LiverMuscleHeartBrainOther organsPancreasINSULINEnergy useEnergy use &Storage As glycogenROLE OF INSULINMaintain blood glucose within healthy limits

What can go wrong?NO Insulin madedamage to pancreas, genetic defect in making insulin etc

TYPE 1 DIABETESNot enough insulin made sluggish pancreas due to overwork, cell defects etc

TYPE 2 DIABETESInsulin not doing its job right Insulin resistance, organs not responding to insulin TYPE 2 DIABETESFrequent urination, excessive thirst, irritability, tingling & burning sensation in limbs, hunger pangs, lack of concentration, sometimes unexplained weight loss CAUSES RESULTS CONDITIONSUSUAL SYMPTOMSRisk factors for diabetesGenetic/hereditary factorsAge/ethnicityObesity/overweightSedentary life styleHigh fat/high carb. dietsHigh Blood PressureHigh fat levels in blood

If you are at risk or you have been diagnosed as diabetic.Dont Panic ! Set your GPS to take control of your health! Then follow through!Your destination should be A healthy you with acceptable values of blood sugar blood cholesterol and triglycerides blood pressure body weightYou can reach there with small, step by step lifestyle changes.

Acceptable blood values(suggested by National Diabetic Education Program)Fasting Blood sugar: 80-120 mg/dlPost-prandial sugar: 140-170 mg/dlHemoglobin A1C (Hb A1C) under 7.0Total cholesterol: under 200 mg/dlHDL (good cholesterol) over 40 for men/over 50 for womenLDL( bad cholesterol) under 100Triglycerides under 150 mg/dlBlood Pressure: below 130/80Body Mass Index : under 27

HbA1C tells us about average blood sugar levels over a 12 week period.

Controlled diabetes, not much glucose, not much HbA1CUncontrolled diabetes, more glucose, much more HbA1CHbA1CGluBody Mass Index chart (BMI)

Steps towards a healthy youPhysical activity goalsSet goals-(lose 10 lbs? increase strength? be active? )Follow the F.I.T.T. principle to become fit! Frequency, Intensity, Time, Type of activityStop negative thoughts!Keep a record of your progress!Reward Yourself!

Diet & Nutrition GoalsTotal calorie controlCARB counting/Glycemic Index Diabetes food pyramidSimple common sense dietary habits

Calorie Countingsource: National Institute of Health 2008profile/ activity level

Calories/dayNumber of servings*/daySmall/F/ moderateMedium/F/sedentary, low 1200-16006 carbs, 3 fats, 1 proteins,2 dairy,3 veggies, 2 fruitsLarge/F/moderateSmall/M/ moderateMedium/M/sedentary1600-20008 carbs,4 fats,2 proteins,2 dairy, 4 veggies, 3 fruits,Medium/M/highLarge/M/ModerateLarge/F/high2000-240010carbs,5 fats, 3 proteins2 dairy, 4 veggies, 4 fruitsServings: Carbs- 1 slice bread, 1 roti , cup cooked rice, 1 cup cooked pasta Dairy: 8 oz Protein : 4 oz.cooked meat. cup cooked lentils/beans/dhal Fat: 1 teaspoon Veggies: 1 cup raw or cup cooked Fruits: cup diced , of whole fruit ( apple, pear etc)

40%30%20%10%Now for some practical ways to watch your diet and nutritionWhen you eat

How much you eat. Portion controlBe conscious of how much you put in your plateWhen you start your new diet , record what you eat each day at least for 10 days. Plate method is recommended by ADA

Milk or yogurt1 servingFruit 1 servingHow and where you eatTake a minimum of 20 minutes to finish your meal. The hormone that gives the sensation of fullness takes 20 mins to take effect.Place all the components of your meal in small serving dishes on the table.

Never eat on the run! Be conscious of what you put in your mouth! Sit at the table and enjoy your meal.

What you eat.. Choosing the right foodsYou dont have to carry around tools like charts, counters, weighing tools etc.! Just simple common sense substitutions and choices will do the trick.Make choices based on simple available information in paper and on internet.

Some examples of Simple SubstitutionsProcessed/ polished grainsWhole grainsWhite breadWheat or rye breadFried snacks, chipsBaked snacks and chipsRegular dairy productsLow fat/no fat dairy productsRed meat Fish, poultry , lentils, beansCanned fruits, fruit juicesFresh or frozen fruitsWhite or yellow potatoesYams, sweet potatoesSugary dessertsLow fat dairy based dessertsSalty and sugary snacksPeanuts, almonds, walnuts,INSTEAD OF THISUSE THISAlways read nutrition labels to see amount of total carbs and sugar!Can I include rice in my meals??Of course you can! 1-2 carb servings can be rice dishesGlycemic Index is a method nutritionists use to study the effect of foods on diabetes.GI score ranges from 1-100 with pure glucose being 100GI < 55 low, 56-69 medium and over 70 highIRRI has rated 235 varieties of rice based on GI

Brown Rice55 Swarna (Ponni) rice56 Samba Masoori rice57 Basmati rice58 Long Grain rice58 Medium Grain rice69Sticky rice (japanese,thai)90 over Cooking (Mushy) increases GI 5-8 pts)

Siimmer over low heat (+1)

Rice cooker (+1)

Boiling and straining (+6 to 8)

Pressure cooker ( +6 to10)

Use with 1 isp ghee

Use with protein(kichadi!)

(-5 to 8)How about rotis and pastas???Whole wheat based rotis over white nanChapati flour with1% rye/bajri flour + 1% besan ---- lowers GIPastas made with durrum wheat better than multigrain ones.Larger the size of pasta, less GIal dente lower GI/overcooking higher GIGhee on roti and olive oil on pasta- lowers GI

What about fats and oils??Total Non-fat meals are not so good if you are trying to control your blood sugar.Fat helps to release the sugar from carbs slowly into blood----- less sugar spikes and yo-yoS!4 -5 servings ( 4-5 tsps) of fat/dayGhee (clarified butter) (ayurvedically adviced)Sesame oil preferred over olive oil(J,clinical.nutr. 2011, J.nat.med. 2012) Efficacy of oral diabetic medicines. B.P & TG Peanut oil preferred over corn or canola oil

Can I include dessert in my meal plan??? Occasionally yes! Instead of this have this!

Rich, creamy sugary cakes/piesLow fat, low sugar cakes/pies

Cheese cake/vanilla cakeDark chocolate cake chocolate mousse Fruit Pies, tartsFresh frozen fruits with nonfat whipped cream Sugar based ,fried desserts (e.g : gulab jamun, jalebi, ladu)Dairy based, baked, steamed desserts (e.g Ras malai, ras gulla, Kheer) Fruit sorbets ( 2 scoops) Ice cream or kulfi ( to 1 scoop) Nut cakes and sweets Plain nuts with fruitsFinally, a word or two about fruit and veggie choices.OK to choose in plenty (3-4 servings a day)Green leafy veggies, cruciferous veggies, Karela, egg plant.Berries, orange varieties

Moderate use ( 1 serving/day)Carrots, beets, yams, sweet potatoesBananas, pears, apples, peaches, melons, papaya

Very limited/occasional use ( >3 servings/week)Potatoes, Taro root (Arvi) other root veggiesMangoes, watermelon

,

Karela( bitter gourd)(momardica charantia)Polypeptide-P ( insulin mimic)Charantin ( uptake of glucose by cells)-lipoic acid (anti-neuropathy agent)Methi ( Fenugreek)(Foenum Graecum)4-hydroxy isoleucine (facilitates insulin secretion, Slows down absorption from intestine)

Tips to succeed in your dietary goals.Use Variety and diversity in choosing foodsDont be rigid and narrow in your choicesAllow for cheatings occasionally, but remember to get back on track soonMost of all, be self confident and positiveAlways remember you control your diabetes, dont let diabetes control you!

Some useful websiteswww.diabetes.org (american diabetic assn)www.diabetescare.netwww.ndep.nih.gov (national diabetes education)www.fda.govwww.cdc.gov/diabetes

Thank you all for your patient listening!

Type 2 diabetes is more common in African Americans, Hispanics/ Latinos, American Indians, and Asian Americans and Pacific Islanders.

For more information, visit us at www.diabetes.org or call 1-800-DIABETES

ARE YOU AT RISK FOR

TYPE 2 DIABETES?

If you scored 5 or higher:You are at increased risk for having type 2 diabetes. However, only your doctor can tell for sure if you do have type 2 diabetes or prediabetes (a condi-tion that precedes type 2 diabetes in which blood glucose levels are higher than normal). Talk to your doctor to see if additional testing is needed.

Add up your score.

Height Weight (lbs.)4 10 119-142 143-190 191+

4 11 124-147 148-197 198+

5 0 128-152 153-203 204+

5 1 132-157 158-210 211+

5 2 136-163 164-217 218+

5 3 141-168 169-224 225+

5 4 145-173 174-231 232+

5 5 150-179 180-239 240+

5 6 155-185 186-246 247+

5 7 159-190 191-254 255+

5 8 164-196 197-261 262+

5 9 169-202 203-269 270+

5 10 174-208 209-277 278+

5 11 179-214 215-285 286+

6 0 184-220 221-293 294+

6 1 189-226 227-301 302+

6 2 194-232 233-310 311+

6 3 200-239 240-318 319+

6 4 205-245 246-327 328+

(1 Point) (2 Points) (3 Points)

You weigh less than the amount in the left column

(0 points)

Diabetes Risk Test1

2

3

Write your score in the box.

4

5

6

7

How old are you?

Less than 40 years (0 points)4049 years (1 point)5059 years (2 points)60 years or older (3 points)

Are you a man or a woman?

Man (1 point) Woman (0 points)

If you are a woman, have you ever been diagnosed with gestational diabetes?

Yes (1 point) No (0 points)

Do you have a mother, father, sister, or brother with diabetes?

Yes (1 point) No (0 points)

Have you ever been diagnosed with high blood pressure?

Yes (1 point) No (0 points)

Are you physically active?

Yes (0 points) No (1 point)

What is your weight status? (see chart at right)

Adapted from Bang et al., Ann Intern Med 151:775-783, 2009.Original algorithm was validated without gestational diabetes as part of the model.

Lower Your RiskThe good news is that you can manage your risk for type 2 diabetes. Small steps make a big difference and can help you live a longer, healthier life.If you are at high risk, your first step is to see your doctor to see if additional testing is needed.Visit diabetes.org or call 1-800-DIABETES for information, tips on getting started, and ideas for simple, small steps you can take to help lower your risk.

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