DIABETES and NUTRITION
The food that we eat is digested and provides our body with a variety of nutrients and energy measured in kilojoules. Carbohydrate foods are broken down into glucose which is the main source of energy for our bodies. Proteins are broken down into amino acids which are needed for growth and repair of the body. Fats are broken down into triglycerides which are used for energy and a variety of functions within the body for example hormone production and for keeping cell membranes healthy.Following the digestion of food, glucose (from carbohydrates) is absorbed from the small intestine into the blood stream. In response to the increased blood glucose levels, the pancreas releases insulin into the blood stream to assist with transporting the glucose into the cell. This causes the blood glucose levels drop to normal levels again, and so the process repeats itself after each meal.The rise in your blood glucose levels is determined by the amount of glucose entering the blood stream. This depends on the rate of digestion of the food and amount of food eaten, as well as the rate of clearance from the blood into the body’s cells, via insulin.In people with diabetes the amount of insulin released is inadequate and clearance of glucose into the cells is significantly delayed.
The THREE basic nutrition components that affect your blood glucose levels on a daily basis are:
The current generation of insulin and other diabetes medications, give people with diabetes flexibility with regard to the timing of meals and snacks. However, it is still recommended that you eat three regular meals per day. This offers the best way to control the size of your meals, and thus your blood glucose and energy levels throughout the day. Regularly skipping meals can cause your blood glucose levels to drop too low. This may cause you to compensate by overeating at the next meal, or needing to snack inappropriately between meals. Depending on the size of your meals, the type of medication you use, your lifestyle and appetite, you can enjoy snacks between meals. Snacking is recommended if the meals are more than 5 to 6 hours apart. When you are overweight be aware not to snack inappropriately due out of the power of habit and the visibility and availability of food.
The quantity of foods (portion sizes) you should eat is individual and varies from person to person. The factors that play a role in determining what portions you should eat depends on your weight status, activity levels, the type of medication you use, your gender, age and level of glycaemic control (blood sugar control).
The best way to gain knowledge on how many portions you need to consume of the different foods on a daily basis is to consult a registered dietician. She can calculate a practical nutritionally balanced eating plan taking your lifestyle as well as the above mentioned factors in consideration.
Contact the Association of Dietetics in SA (ADSA) for a registered dietician in your area www.adsa.org.za
If you are following an insulin regime of injecting before each meal (basal bolus) you can learn to adjust the amount of insulin you need to inject for a meal according to the amount of carbohydrate you plan to enjoy in a meal. This is called carbohydrate counting. You need to learn the amount of carbohydrate all foods contain and develop your own carbohydrate: insulin ratio. As this can provide you with more flexibility towards the size and composition of your meals, it needs to be done under the supervision of a registered dietician.
Including low GI carbohydrates usually high in fibre to the expense of high GI starches usually low in fibre (made from white flour) is recommended. (See list for high fibre, low GI sources) This contributes to improved blood glucose control and consequent improved appetite and weight control.
Whole grains such as rolled oats, barley, brown wild rice, bulgur wheat, pearl wheat (stamp koring) quinoa, health / rye breads, whole grain cereals, legumes (lentils, dry beans, chick peas) contain not only fibre but additional nutrients important towards lowering cholesterol and weight loss
The quantities of starch we eat affect the blood glucose control levels just as much as the type of starches we select into our diet. Thus even when selecting high fibre low GI starches it is advisable to always keep your starch portion SMALL A quarter of your plate should be filled with whole grains, a quarter with lean proteins and half of your plate should be filled with all types of vegetables. All types of vegetables and fresh fruit consumed in controlled have a low GI and you should try to include five portions of vegetables and fruit (combined) into your diet on a daily basis. If you are not overweight and following a basal bolus insulin regime you can increase your starch and fruit portions and adjust your insulin to cover the amount of carbohydrates you anticipate to consumed in the meal.
As protein foods contain fats the main objective is to select protein foods lean to lower the total saturated fat content of the diet. (See list for lean protein sources) Including proteins into the diet enable you to keep the quantity of starches small that enhance glycemic control.
Dried beans, peas and lentils are not only low-fat sources of protein, but also contain soluble fibre that has a cholesterol-lowering effect. Replacing some animal proteins with legumes can help to lower your intake of saturated fats. The high soluble-fibre content in legumes is also responsible for a slower digestion and absorption of carbohydrates, which contributes to an improved blood glucose response after a meal.
As white fish contains significant less saturated fat as red meat and fatty fish contains essential fats with health benefits make fish is an excellent protein source to include into your diet. Find tasty innovative ways to prepare fish.
Fats play an essential role in your diet and support many metabolic functions in the body. The fats that increase blood cholesterol levels and decrease the insulin sensitivity of the cells originate from animal sources. These fats are solid at room temperature and are saturated of nature (see list of unhealthy fats). Unsaturated fats from plan origin especially mono unsaturated fats does not increase cholesterol, keeps your cells healthy and sensitive to insulin. It is thus recommended that you replace all saturated fats in your diet with unsaturated fats. Tran’s fats are a type of fat the food industry sometimes use when manufacturing baking items as well as in Fast foods. Tran’s fats do have the same unhealthy qualities than saturated fats and should be avoided
All types of fats are calorie dense and can contribute to weight increase if consumed fats without discretion. It is thus important to control the amounts of healthy fats include into your daily diet.
The essential fatty acids we found in fatty fish such as sardines, pilchards, mackerel and salmon have numerous health benefits that protects you against heart disease. It is recommended that you include a minimum of three portions of fatty fish per week into your diet.
A high salt intake can aggravate high blood pressure. Avoid adding salt to food after cooking. Cook with adding the minimal salt to food by using a variety of herbs and spices. Use salty condiments such as soy sauce and Worcester sauce sparingly.
|FOOD GROUP||INCLUDE – LOW /SUGAR, LOWER CALORIE FOODS.||EXCLUDE/ LIMIT HIGHER FAT/SUGAR, HIGHER CALORIE FOODS|
Diary and dairy products
|Skim or low fat milk in liquid or powder form. Skim milk powders Low fat buttermilk, natural (plain) low fat yoghurt. Low fat and fat free fruit yoghurts. Low fat Ideal milk. Artificial sweetened fruit and flavoured yoghurts||Condensed and evaporated milk. Full cream natural (plain) yoghurt. Milkshakes, Flavoured milk drinks. Yogi sips. Dairy blend powders. Full cream buttermilkFat free milky drinks containing sugar. .Smoothies|
Avocado pears, all types of nuts, peanuts, peanut butter (sugar free) olive oil, olives, canola oil, canola margarine, olive oil margarine.
Vegetable oils: sunflower oil, Low oil or no oil salad dressings. Homemade salad dressings prepared with above mentioned oils, lemon juice and herbs. Polyunsaturated, “lite margarine`s “in a tub. Olive oil margarine, Low oil mayonnaise
All types of seeds: sunflower seeds, linseeds, sesame, and pumpkin seeds.
|Hard cooking fat, hard (brick margarine) bacon, full fat mayonnaise and cream Coconut oil coconut milk coconut cream, cream, ice cream, coffee and tea creamers. Butter, butro and lard (Holsum) ghee|
Fish: All types – smoked, fresh or frozen (not fried in oil). All types of tinned fish (oil drained) e.g. tuna chunks, sardines, salmon. Pilchards in tomato sauce. Pickled fish. All white fish e.g. hake, kingklip, and haddock. All oily fish e.g. yellow tail, salmon, I and J lite and crispy oven baked fish. Seafood: Crab, oysters, mussels, shrimps, prawns, calamari( grilled not fried)Poultry: Chicken and turkey without skin – not fried.Legumes: Beans, peas, chick peas and lentils (cooked/canned)
Red meat: lean beef, lean pork, lean veal, extra lean mince meat (remove all visible fat before cooking or eating).
Lean cold meats: lean ham, silver side, pastrami and lean roast beef.
Organ meats: Liver, kidneys (not fried).
Lean biltong ( fat removed)
Eggs: Boiled, poached, omelette, scrambled – limit to two to four eggs per week.
Cheese: low fat cottage cheeses – all flavours. Ricotta cheese. Medium fat hard cheese e.g.low fat feta, “reduced fat cheese” slimmers choice”. All cheeses fat content should be lower than 13 g fat per 100g cheese. (Restrict the use of hard cheese to 2 x per week).
Soya products: soya mince (frozen/ dry) soya patties, Tofu- fat should be less than 10 g per 100g product.
|Fish: Covered in crumbs, flour and egg or dough. Deep fried in oil Oven baked fish portions – battered or crumbed.
Chicken: chicken and turkey with skin. Fried crumbed chicken e.g. Kentucky.
Red Meat: Fatty beef, pork, mutton and lamb. Meat drippings should not be used for making gravy.
Processed meats: polony, meat loaf’s e.g. olive loaf, salami, Beef and pork sausages e.g. Russians, Frankfurters, Vienna’s, Boerewors. Like it lean sausages, and polony. Fatty fried bacon, dry beef sausage (dry wors) Biltong with fat. Liver spreads, fried liver, liver pate, and liver sausages.
High fat cheeses: Cheddar, Tussers, and Gouda. Cream cheeses. Processed cheeses: cheese spreads and wedges. Low fat cream cheese e.g. Simon’s berg and regular cream cheese.
|Grains, Cereals, Breads||Porridges: Bokomo oats, rolled oats, oat bran, and whole grain breakfast cereals e.g. All Bran, Hi fibre Bran. Low GI low fat muesli, Pro nutro (original/ whole wheat)Heavy breads such as – health breads and seed loaves. Pumpernickel bread, rye breads, low GI breads.
Crackers: Pro-Vita, Rye Vita, Fin Crisp, Cracker mate lite.
Pasta made from durum wheat
Pearled wheat, “stamp koring “, corn on the cob, samp and beans, couscous. Quinoa, Rice – white, brown rice, wild rice, basmati rice, barley, bulgur wheat, Crushed wheat, Popcorn. Baby potatoes, sweet potato – boiled
Legumes: dried beans, peas, lentils, chick peas, soya beans
|Cereals: Weetbix, Corn flakes, Rice crispies, Puffed wheat, Sweetened breakfast cereals: Coco pops, Frosties. All white, brown, whole wheat bread and rolls. Maltabella porridge, all instant oats ( oatso easy) Mealie meal porridge “pap”
All baking products made from white bread and white cake flour: rusks, meat pies and sausage rolls, samoosas, cakes, pastries, focaccia breads, tramezini, pita breads, naan breads, wraps, roti’s, pizza’s. Scones, doughnuts, Chelsea and hot cross buns. All sweet biscuits and baking products containing cream, creamy fillings and icing sugar e.g. cup cakes, muffins.
Baked desserts, jelly, custard
Low fibre crackers e.g. rice cakes, cream
Crackers, Bacon kips, Tuc, Zap, Cheddar’s, etc.
Potatoes – baked, fried, mashed, Instant mash potato
Sushi rice, risotto rice
Non durum wheat pasta, samp, mealie rice. Instant noodles.
|Fruits||ALL fresh fruit. Dried fruit – in quantities prescribed by your meal plan only. Tinned fruit – canned in own juice “Natrulite, Weigh less”.||Fruit canned in syrup. All fruit juices.Candied fruit.|
|Vegetables||ALL fresh or frozen vegetables. Served raw as salads, steamed or fast boiled, stir fry or roasted.||Vegetables served with hard, margarine, butter or cream. Vegetables served with white or cheese sauces. Canned vegetables.|
|Miscellaneous||Drinks: Tea – Rooibos and herbal. Decaffeinated coffee. Ceylon tea Regular coffee, coco powder.Soda water. Mineral water. Diet fruit squashes (Lecol and Local Brooks – all flavours). Artificially sweetened diet cold drinks in controlled quantities.
All spices, herbs and condiments: Vinegar. Lemon juice, salt, pepper. Worcester and soy sauces, sweet chilli sauce, HP sauce. Beef, chicken and vegetable extract cubes or powders. Olive oil spray. Curry powder Condiments: chutney, tomato sauce, mustard – gherkins, pickles pepperdews. Vegetable and meat spreads: Marmite, Bovril. Fish paste.
|Drinks: Milo, Horlicks, Ovaltine, Hot Chocolate, Chai tea, Frezochino’s, Frappe, Chilla’s, Nesquick. Cold drinks: Energade. Ice teas, sugar based squash e.g. Oros. Sweetened frizzy drinks for e.g. Coke and Fanta, Ginger ale, Ginger beer.Flavoured waters. Vitamin waterAll types of sugar, free fructose, honey, jam, sweets, chocolates, all desserts. spreads like chocolate spreadsAll potato and corn crisps. Vegetable chips. Take away food: boerewors rolls, hamburgers, hot dogs, Russians and chips, Bunny chows “vet koek” Energy bars, cereal bars, Hi protein bars, health bars and nut and slimming bars. .|
This information was compiled by the dieticians of Nutritional Solutions www.nutritionalsolutions.co.za