The diabetic diet will not be dealt with in detail. However, the rules and principles necessary to bear in mind when composing the diet are outlined here.
Historically all recommended dietary regimes have resulted from scientific knowledge and social norms of the day. As new scientific data emerge, the opinions about proper nutrition and diet continue to evolve (and further minor adjustments may occur in the coming years too).
The diabetic diet today is, in most aspects, very similar to the balanced diet recommended to the general non-diabetic population. The leading principles of the diet are namely:
1. Appropriate energy intake (keeping body weight within its ideal limits)
2. Energy consumption divided among the 3 basic food groups in a certain proportion:
A. saccharides: 50 – 60%
B. fats: less than 30%
C. proteins: 10-20%
3. Adequate vitamins, minerals and trace elements.
Since diabetes is a disease connected with saccharides, special attention must be paid to them in the diet. Fats and proteins consumed in normal food do not particularly influence final glycemia values and should be taken into account only as they contribute to total energy intake (and there might be a possible danger of becoming overweight). However special care must be taken with foods that look like proteins but contain flour, consequently also saccharides. Sausages and other smoked meat foods often fall into this category.
Saccharides are present:
1. in grains and corn (in flour and starch) and in all products made from them
2. in potatoes and all products from potatoes
3. in fruit
4. in milk and diary products
5. in all products sweetened by sugars
6. in beans, peas and lentiles (in other vegetables only in a neglectful amount)
What is a diabetic diet?
A diabetic diet is a framework for a dietary programme for patients in which
- the total amount of energy per day depends on the estimated energy requirements
- the total amount of saccharides is divided into 6 meals a day (3 main meals, 2 snacks and a second dinner before bedtime – the snacks and the second dinner are aimed at minimising the risk of hypoglycemia in the times when consumed.)
- most saccharides are of starch nature, therefore they are gradually released from the digestive track and glycemia does not increase so quickly after a meal and may be better regulated by the insulin medication.
Types of a diabetic diet (the recommendations of the Czech Diabetologic Society)
|
The diet type |
Saccharides (g/% of total energy) |
Proteins (g/% of total energy) |
Fats (g/% of total energy) |
Total energy (kcal / kJ) |
|
A |
175 / 48 |
75 / 21 |
50 / 31 |
1,500 / 6,300 |
|
B |
225 / 52 |
75 / 17 |
60 / 31 |
1,800 / 7,500 |
|
C |
275 / 52 |
75 / 14 |
80 / 34 |
2,200 / 9,150 |
|
D |
325 / 54 |
85 / 14 |
85 / 32 |
2,500 / 10,400 |
Each patient with newly detected Type 1 Diabetes Mellitus is given a specific set of guidelines for a diabetic diet which takes into account the patient‘s daily energy consumption. The patient should then modify his eating habits to match these guidelines. In the beginning, the patients are encouraged to weigh the foods the meals are prepared from and to carefully consider their menu at home, or when selecting meals in a canteen or a restaurant. The aim of this dietary regime is to take in an already known and in an ideal case constant as to the time (that means regularly repeated) amount of saccharides in individual meals. This is one of the prerequisites how to maintain a well compensated diabetes when supplying a constant amount of insulin.
This would be an ideal condition but we know that it is hard to achieve.
Are there any possibile ways of managing saccharides?
Insulin dose estimate in relation to the amount of taken saccharides.
Patients with recently detected diabetes are encouraged to refrain from eating a variety of saccharides until they get used to their disease and are able to identify most of its secrets. More experinced diabetics are able to deal with the changes in saccharide dose more easily, knowing the tricks.
It cannot be generally stated by how many units to increase the dose if the amount of saccharides in the main meal (lunch) increases by 20g for instance. Some sources recommend increasing the insulin dose by 1 unit for every extra 10g of saccharides consumed. It is only a general recommendation, however, and each patient must adjust the dose according to their own experience. One recommendation is to increase the dose by the mentioned 1 unit and then measure the glycemia level after approximately 1.5 hrs and to proceed accordingly depending on the result. It is worth mentioning that the necessary dose increase is higher in the morning than in the afternoon (due to higher morning cortisone levels).
The following considerations may be of help.
If the usual amount of saccharides at dinner is for example 50g and if the patient applies 10 units of insulin, then if the amount of saccharides at lunch increases by 10g, the needed increase is by approx. 2 units (10units/50g = 0.2 units/1g of saccharides). It is however necessary to verify a correct approach based on this reflexion by the resulting glycemia value after about 1.5 hrs after the meal.
Let’s bring a simple example for illustration: the patient is used to taking 4 slices of Czech dumplings with his luncheon meal and takes 8 units of insulin for this amount of saccharides. If the patient wants to take 1 more slice by consulting the tables he/she would realise that 1 slice contains approximately 10g saccharides (total weight being 32g out of which 30% is saccharides which is approximately 10g). If there were no other saccharides included in the meal, then the dose increase would be by 2 units of insulin (8 units supplied for 4 pieces of dumplings so 2 units for one - the amount by which it is necessary to increase the total amount). It was very easy to calculate the increase in the dose in this case, even without the use of the tables. In the case of rice for instance, the situation is more complicated and we cannot do without the tables and weighing or at least estimating the weight of rice.
Note:
When calculating the energy content of foods, the diabetics may come across several expressions. The most usual one is the energy content in kcal (kilocalories) or kJ (kilojoules). To simplify things the term exchange unit is used instead. An exchange unit is the amount of food containing 10g of saccharides. We may then say that 70g of rasberries contain 1 exchage unit of saccharides (meaning 10g) and that they may be replaced by 100g of apricots containing also 1 exchange unit of saccharides (10g). Please be aware however that some sources use bread units. A bread unit is the amount of food containing 12g of saccharides. To further complicate the matter, it must be noted that in some sources an exchange unit containing 12g of saccharides may be used. It is, therefore, necessary to carefully find out what exchange unit is used in the literature so as to avoid misinterpretation or unnecessary errors.
Relevant tables are included in a number of educational publications some of which are listed in Literature. There are also extensive relevant PC programmes or even mobile phone applications that can help with exchange unit calculations.