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Eating with Diabetes Mellitus (Type 2 diabetes mellitus)

Updated: Jan 28

(In this article we are discussing only about type 2 diabetes)


Contents:


What is diabetes mellitus?

Diabetes is a metabolic disorder characterised by decreased ability or total inability of tissues to utilize carbohydrates (glucose). This disorder occurs 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. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessel.


Diagnosis of Diabetes Mellitus:


Fasting Blood Sugar:

Blood sample is taken after a fasting period of at least 8 hours. Typically the sample is collected early in morning in empty stomach before breakfast.


Random blood sugar test:

Random blood sugar can be tested during any time of the day irrespective of when the patient ate.


HbA1c:

This test estimates the average blood sugar level over the past 2 to 3 months.



Type of test

Normal range (mg/dl)

Prediabetes (mg/dl)

Diabetes (mg/dl)

Fasting blood sugar

80 to 99

100 to 125

126 and higher

Random blood sugar



200 and higher

HbA1c

Less than 5.7 %

5.7 to 6.4 %

6.5 and above



Prevalence of diabetes mellitus:

According to an ICMR study published in a medical journal 'LANCET' there are more than 101 million people living with diabetes and more than 136 million people are prediabetic.

The top 10 worst affected states and union territories are listed below.

States / UT

% of people with diabetes

% of people with prediabetes

Goa

26.4

20.3

Puducherry

26.3

25.8

Kerala

25.5

18.3

Chandigarh

20.4

15.6

Delhi

17.8

18

Tamil Nadu

14.4

10.2

West Bengal

13.7

23.5

Sikkim

12.8

31.3

Punjab

12.7

8.7

Haryana

12.4

18.2


Insulin Resistance


Insulin resistance is often referred as prediabetes. Insulin is the hormone that regulates blood sugar level. After we eat our blood glucose level increases and this stimulates cells of pancreas to release insulin. Without insulin our body cells cannot use glucose. Insulin acts a key and opens the gates of cells through which glucose can enter the cells of our body. Insulin resistance is a state of the body when the cells don't respond to insulin well and develop resistance to insulin. Hence the glucose do not enter the cells of the body and gets accumulated in blood stream leading to high glucose level in the blood. Due to high glucose level and insulin resistance, pancreas produces and releases more insulin into the blood to control glucose level in the blood and this results in high levels of circulating insulin. At one point the pancreas gets exhausts and stops producing insulin and this leads to diabetes mellitus.


Eating with diabetes mellitus:


Carbohydrates:

It's true that simple carbohydrates can spike blood sugar level but it doesn't mean that diabetic people should stop eating carbs. Carbs should still be a part of diabetic diet and 55 to 65% of calories of daily intake should in fact come from carbohydrates. But the type of carb really matters a lot. Instead of taking simple carbs, diabetics should take complex carbs. Complex carbs are rich in fiber and take time to get digested and release glucose slowly and hence prevents spiking of blood sugar level immediately after a meal. Complex carbs are also know for other health benefits. They feed good gut bacterias and promote gut health. Fiber present in carbs also prevents hypertension and other cardiovascular diseases and thereby promote overall well being.


Proteins:

1 gm of proteins per kg of body weight is recommended for diabetic patients. Adequate protein intake is very important to maintain ideal body composition and prevent lean muscle mass degradation. However people with existing kidney (renal) complications should not consume more than 0.8 gm of protein per Kg of body weight without consulting a dietician.


Fats:

WHO recommends total fat intake not more than 30% of calories of total calorie intake per day. However it's recommended not to exceed 20% of total calories from fat especial for obese diabetics with hypertension and other cardiac diseases. Vegetable oils should be prefered over animal fat. Animal fats are rich in saturated fatty acids and should be avoided or taken minimally. Consuming nuts and seeds can provide healthy fats and fibers to our body.


Fiber:

Diabetic people should aim consuming at least 25 gm of fiber per day. Every meal should have adequate fiber in it. Fiber is very essential to avoid sugar spikes in blood and helps in preventing other lifestyle diseases like hypertension. It also promotes gut health by feeding good gut bacterias.


Vitamins and minerals:


Diabetic people need same amount of vitamins and minerals as normal population and in few cases they need more. To keep up with vitamins and minerals requirement they are advised to take green leafy vegetables and low starch vegetables like eggplant (brinjal), Cabbage, cauliflower, broccoli etc.. Fruits with low glycemic index and glycemic load should be consumed in moderation. Fruits like Guava, papaya, citrus fruits are better choices for diabetics.


The Plate method:


Diabetic diet
The plate method

Easiest way to eat healthy with diabetes is by following the plate method. Divide the plate into 3 portions. Half of the plate should be filled with non starchy vegetables like broccoli, eggplant, cabbage, cauliflower and leafy vegetables. one quarter of the plate should be filled with protein sources like egg, chicken, fish, Paneer, tofu etc and other one quarter should be filled with foods rich in carbs like grains, pulses and cereals, yogurt, milk etc.


Summary:


Diabetes mellitus or Hyperglycemia is a metabolic disorder characterized by high sugar (glucose) in blood. The is caused due to lack of insulin or when the body is not responding to insulin effectively. Insulin acts as a key to open the doors of cells so that glucose can enter the cells from blood. There are more than 101 million people living with diabetes in India. Insulin resistance is considered as the predominant cause of type 2 diabetes. Diabetics also need the same amount of calories, vitamins and minerals as normal population. Contrary to a common myth that diabetics should not eat carbohydrates, the fact is 55 to 65% of daily calorie intake for diabetic people should come from carbohydrates. Diabetics should avoid simple carbs with high glycemic index and high glycemic load and take complex carbs like pulses, legumes, whole grains which are low in glycemic index and glycemic load. Non starchy vegetables can be taken liberally while fruits with low GI and GL can be taken moderately. Moderated amount of protein and fiber is also recommended for diabetics. By following 'The plate method' diabetics can manage to get essential amount of protein and fiber through diet. Divide the plate into three parts. Half of the plate should be filled with non starch vegetables, one fourth should be foods high in proteins and one fourth of the plate should contain complex carbs. Healthy diet rich in fiber and protein and life style modification to incorporate daily exercise routine are the keys to manage diabetes.





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