EDUCATION OF THE DIABETIC PATIENT

1. EDUCATION OF THE DIABETIC PATIENT Dr NADIA TASAWER

3. DIABETIC DIET • Diabetic Diet for diabetics is simply a balanced healthy diet which is vital for diabetic treatment, however, a lot of people have the misconception that these diet consist only diabetic foods.  • The regulation of blood sugar in the non-diabetic is automatic, adjusting to whatever foods are eaten. But, for the diabetic, extra caution is needed to balance food intake with exercise, insulin injections and any other glucose altering activity. • This helps diabetic patient to maintain the desirable weight and control their glucose level in their blood. It also helps to prevent diabetes patient from heart and blood vessel related diseases. • Research shows that regardless of the makeup of the diet, eating just enough calories to maintain an ideal weight is the most effective dietary strategy to prevent the onset of diabetic.

4. Diabetes Guidelines You can take good care of yourself and your diabetes by learning • what to eat • how much to eat • when to eat Making wise food choices can help you • feel good every day • lose weight if you need to • lower your risk for heart disease, stroke, and other problems caused by diabetes

5. Good Glucose Goals - Desirable Blood Sugar LevelsTime of Test    Person without diabetes     Person with diabetesBefore meals           Less than 115 mg/dl                80 to 120 mg/dl __________________________________________________________Before bedtime        Less than 120 mg/dl               100 to 140 mg/dl • Recommended daily food portion: •           Daily calories count :    carbohydrates       - 50% to 60%                                            protein                  - 12% to 20%                                            fat                        - not more than 30% • Spacing meal throughout the day, help a person avoid extremely high or low blood glucose levels. • Diet undertaken with the supervision of a doctor. • In take of food which help lower blood cholesterol. • Use Exchange lists in planning diabetic diet.

7. Diabetic Food List • Diabetic Food List • A Registered Dietitian assesses the nutritional needs of a person with diabetes and calculates the amounts of carbohydrate, fat, protein, and total calories needed per day. He will then convert this information into recommending the list of food a diabetic can eat in the daily diet. • Recommended daily food portion: • Daily calories count :    carbohydrates     -  50% to 60% •                                        protein                 - 12% to 20% •                                       fat            - not more than 30% (with no more than 10 percent from saturated fats)

8. Recommended Diabetic Food Intake: • Low Glycemic Index - doesn't create rapid peaks and troughs in blood glucose levels. • Complex high-fiber carbohydrates - Scientific evidence show that diet high in dietary fiber is protective against diabetes. Fiber is capable of slowing down the digestion and absorption of carbohydrate and increasing the sensitivity of tissues to insulin, thereby preventing rise s in blood sugar. It is advisable to restrict the intake of refined carbohydrates and avoid high fat foods. •       Example  : Oats, cereals, legumes, wholegrain products, dried beans, peas, lentils, fruits, vegetables. • Alpha-lipoic acid - Is a vitamin like antioxidant that enhances the glucose uptake and improves diabetes nerves damage of diabetes patient. • Omega 3 - Protect against the hardening of arteries. •             Example : Cold water fish like salmon, tuna, mackerel, herring). • Omega 6 fatty acid - Protect against the development of diabetes neuropathy. •             Example : Blackcurrant oil, primrose oil, borage oil). • Artificial sweeteners - such as aspartame and saccharin.

9. Restricted and to avoid : • Refined and simple carbohydrates - such as sucrose, glucose or fructose, white rice, white bread, table sugar, sweets, honey, corn-syrup. • High fat food. • Alcohol - Higher quantities alcohol can cause health problems like liver damage and increase the risk of heart disease. • High sodium food - such as salty fish

10. Diabetic Food Pyramid

11. Grains and StarchesSituated at the base of the pyramid, these are foods contain mostly carbohydrates. Bread, cereal, rice, and pasta are food in this group mostly made of grains, such as wheat, rye, and oats. Starchy vegetables like potatoes, corn, and peas also belong to this group, along with dry beans such as black eyed peas and pinto beans. Starchy vegetables and beans are in this group because they have about as much carbohydrate in one serving as a slice of bread. As for beans and starches,  they are group together because they affect blood glucose in the same way. • Recommended serving: 6 -11 servings per day.

12. Vegetables • Vegetables are full of vitamins, minerals,  fiber, and naturally all of them are low in fat. Vegetables that should be at the top of your food list should be dark green and deep yellow vegetables,such as spinach, kale, broccoli, romaine lettuce, carrots, cucumbers, chilies and peppers. Try to get fresh or frozen vegetables rather than canned vegetables because they have less sauces, fats and salt added. • Recommended serving: 3 - 5 servings per day. • FruitsFruits are fabulous because they provide important vitamins, minerals, and fiber. Fruits also contain carbohydrates. Most dietitians recommend consuming whole fruits rather than juices because of the fiber contained. Avoid fruits and fruit juices that contain sweeteners or syrups added. This group includes blackberries, grapefruit and tangerines, cantaloupe, strawberries, oranges, apples, bananas, peaches, pears, and apricots. • Recommended serving: 2 - 4 servings per day

13. Milk Milk products contain a lot of protein and calcium as well as many other vitamins. When looking at milk or yogurt, try to choose low-fat or nonfat milk products for the great taste and nutrition without the saturated fat. • Recommended serving: 2 - 3 servings per day. Meat and Meat Substitutes Includes in these group are beef, chicken, turkey, fish, eggs, tofu, dried beans, cheese, cottage cheese and peanut butter.  Meat and meat substitutes are great sources of protein and many vitamins and minerals. Nutritionists usually recommend fish and poultry over red meat, because it's less fatty. Keep your portion sizes small and trim away all the visible fat off meat. Baking, roasting or grilling is preferable to frying. • Recommended serving: 2 - 3 servings per day.

14. Sweets, Fats • Sitting at the very top of the pyramid simply means that your body should have smaller amounts of them. Your body needs fat for some things, but it's smart to avoid eating too much of it. And although sugary foods like candy and cookies are simple carbohydrates that can give you quick energy, they are usually loaded with calories and don't offer much in the way of nutrients. In the right amount, though, fats, alcohol and sweets can spike up the flavor in meals and snacks. • Recommended serving: Use them sparingly. In other words, eat only a little bit and don't eat them very often.

15. Food Exchange List • Exchange lists are groups of foods that contain roughly the same mix of carbohydrates, protein, fat, and calories. Serving sizes are defined so that each will have the same amount of carbohydrate, fat, and protein as any other. Foods can be "exchanged" with others in a category while still meeting the desired overall nutrition requirements. Exchanges can be applied to almost any eating situation and make it easier to follow a prescribed diet. There are six exchange lists: • Vegetables • Starches and Breads • Fruits • Milk • Fat • Meats and Meat Substitutes

16. Exchange Lists and Nutrition

17. Have about 1,200 to 1,600 calories a day if you are • a small woman who exercises • a small or medium-sized woman who wants to lose weight • a medium-sized woman who does not exercise much Choose this many servings from these food groups to have 1,200 to 1,600 calories a day 6 starches 2 milk and yogurt 3 vegetables 2 meat or meat substitute 2 fruitup to 3 fats • Talk with your diabetes teacher about how to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines. Then make your own plan.

18. Have about 1,600 to 2,000 calories a day if you are • a large woman who wants to lose weight • a small man at a healthy weight • a medium-sized man who does not exercise much • a medium-sized to large man who wants to lose weight Have about 2,000 to 2,400 calories a day if you are • a medium-sized or large man who does a lot of exercise or has a physically active job • a large man at a healthy weight • a medium-sized or large woman who exercises a lot or has a physically active job

19. Choose this many servings from these food groups to have 2,000 to 2,400 calories a day 11 starches 2 milk and yogurt 4 vegetables 2 meat or meat substitute 3 fruitup to 5 fats • Talk with your diabetes teacher about how to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines. Then make your own plan

20. DIABETES AND EXERCISE • What you eat and when also depend on how much you exercise. Physical activity is an important part of staying healthy and controlling your blood glucose. Keep these points in mind: • Talk with your doctor about what types of exercise are safe for you. • Make sure your shoes fit well and your socks stay clean and dry. Check your feet for redness or sores after exercising. Call your doctor if you have sores that do not heal. • Warm up and stretch for 5 to 10 minutes before you exercise. Then cool down for several minutes after you exercise. For example, walk slowly at first, stretch, and then walk faster. Finish up by walking slowly again. • Ask your doctor whether you should exercise if your blood glucose level is high. • Know the signs of low blood glucose, also called hypoglycemia. Always carry food or glucose tablets to treat low blood glucose. • Always wear your medical identification or other ID. • Find an exercise buddy. Many people find they are more likely to do something active if a friend joins them

21. Herbs used in the Ayurvedic Treatment of diabetes Bitter Gourd This is perhaps the most well-known food in the treatment of diabetes. The seeds of the karela, as it is locally called, have charantin, which helps in reducing the sugars in the blood. As the name suggests, the bitter gourd is indeed bitter and difficult to eat. But it must be eaten in as much bitter form as possible (without sweetening) or its properties will be lost. Garlic Garlic contains allicin, which works at reducing the sugar level in the blood. It also brings about the disintegration of cholesterol in the body.

22. Jamun :The jamun is also known as the Indian plum(indian black berry). It has a specific action on the pancreas, which controls the conversion of starch to sugar. The seeds of the fruit have better effects than the pulp. • Neem :The neem or the Indian margosa tree is known for its medicinally useful bitter leaves and other parts. A paste of its leaves taken daily has excellent properties in reducing the sugar content of the blood. • Onion:Theonion has hypoglycemic (i.e. lowsugar) properties. Along with these properties, onion is also a mild aphrodisiac and it can promote the strength of the body. With all these properties, onion becomes a very valuable food in the treatment of diabetes.

23. Nutrition Label • All packaged foods are required to have nutrition labels with nutrition facts listed. These nutrition labels offers  useful and accurate nutrition information that enable consumers to make healthful food choices. • The nutrition fact list is particular important for diabetes patient in their healthful diet plan. It enable diabetes patient to translate an item into exchanges and follow a diabetic exchange diet, count carbohydrates, and maintain a healthy diet. So take the time to read them.

24. Understanding of Nutrition Label • Serving Size: Standardized size based on amounts people actually eat. Similar food products have similar serving sizes making nutritional comparisons easier. • % Daily Value: nutrient reference values, expressed as % Daily Values, that help consumers see how a food fits into an overall daily diet. This helps you to understand if the food has "a lot" or "a little" of the most important nutrients • Middle Section: The nutrients listed in the middle section are the ones most important to good health. This helps you to calculate your daily limits for fat, fiber, sodium and other nutrients. • Vitamins & Minerals: Only these vitamins and minerals are required on labels although the manufacturer has the option to include others too.

25. Diabetic foot • 10-15% of patients develop foot ulcers at some stage in their lives. • The four main threats to the skin and subcutaneous tissues are Infections Ischemia Abnormal pressure Contamination

26. Principal of diabetic foot • Inspect feet daily. • Seek early advice for any damage • Check shoes inside and out for sharp bodies/areas before wearing. • Use lace-up shoes with plenty of room for the toes. • Keep feet away from sources of heat( hot sand, hot water bottles, radiators, fires) • Check the bath temperature before stepping in.

29. Reading material and diabetic guide is provided to the students