1. SELF MANAGEMENT OF DIABETES
NUTRITION INTERVENTION
&
DIETARY GUIDELINES
Vasantha Narasimhan Ph.D
Emeritus Professor of chemistry
Skidmore College

2. Diabetes:: Some Stats and facts (Source: ADA and NIH)
about 30 million cases in USA in 2012
21 % 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 cause
Diabetes related heart diseases, strokes, kidney diseases and neuropathy on the rise.
Certain ethnic groups more prone to diabetes

3. Division of internal medicine, UCSF, Division of Geriatric Medicine, USC
Cardiology and endocrinology divisions, U.Al
Human nutrition, endocrinology and internal medicine dept., UT Southwest Med.Center.

4. ??????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 that
With a few healthy dietary and attitude changes
You can answer “NO” to the above questions!!

5. (CHEMICALS IN FOOD THAT NOURISH THE BODY)
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)

6. stomach Intestine Blood Stream Mouth Fibers FOOD Glucose Amino acids
Fatty Acids
Enzymes
Vitamins
Minerals
“ Waste”-
Fibers
Blood Stream

7. Maintain blood glucose within healthy limits
Pancreas
INSULIN
Heart
Liver
Energy use &
Storage
As glycogen
Blood glucose
Energy use
Brain
ROLE OF INSULIN
Maintain blood glucose within healthy limits
Muscle
Other organs

8. Insulin not doing its job right
What can go wrong?
CONDITIONS
CAUSES
RESULTS
NO Insulin made
damage to pancreas, genetic defect in making insulin etc
TYPE 1 DIABETES
Not enough
insulin made
sluggish pancreas due to overwork, cell defects etc
TYPE 2 DIABETES
Insulin not doing its job right
“Insulin resistance”, organs not responding to insulin
USUAL SYMPTOMS
Frequent urination, excessive thirst, irritability, tingling & burning sensation in limbs, hunger pangs, lack of concentration, sometimes unexplained weight loss

9. Risk factors for diabetes
Genetic/hereditary factors
Age/ethnicity
Obesity/overweight
Sedentary life style
High fat/high carb. diets
High Blood Pressure
High fat levels in blood

11. If you are at risk or you have been diagnosed as diabetic…….
Don’t 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 weight
You can reach there with small,
step by step lifestyle changes.

12. Acceptable blood values (suggested by National Diabetic Education Program)
Fasting Blood sugar: mg/dl
Post-prandial sugar: mg/dl
Hemoglobin A1C (Hb A1C) under 7.0
Total cholesterol: under 200 mg/dl
HDL (“good cholesterol”) over 40 for men/over 50 for women
LDL(“ bad cholesterol”) under 100
Triglycerides under 150 mg/dl
Blood Pressure: below 130/80
Body Mass Index : under 27

13. HbA1C tells us about average blood sugar levels over a 12 week period.
Glu
HbA1C
Controlled diabetes, not much glucose, not much HbA1C
Uncontrolled diabetes, more glucose, much more HbA1C

14. Body Mass Index chart (BMI)

15. Steps towards a healthy “you”……
Medications and monitoring as prescribed
Physical activity goals!
Dietary Goals
Healthy Life style changes

16. Physical activity goals
Set goals-(lose 10 lbs? increase strength? be active? )
Follow the “F.I.T.T.” principle to become fit!
Frequency, Intensity, Time, Type of activity
Stop negative thoughts!
Keep a record of your progress!
Reward Yourself!

17. Diet & Nutrition Goals
Total calorie control
CARB counting/Glycemic Index
Diabetes food pyramid
Simple common sense dietary habits

18. Calorie Counting source: National Institute of Health 2008
profile/ activity level
Calories/day
Number of servings*/day
Small/F/ moderate
Medium/F/sedentary, low
6 carbs, 3 fats, 1 proteins,
2 dairy,3 veggies, 2 fruits
Large/F/moderate
Small/M/ moderate
Medium/M/sedentary
8 carbs,4 fats,2 proteins,
2 dairy, 4 veggies, 3 fruits,
Medium/M/high
Large/M/Moderate
Large/F/high
10carbs,5 fats, 3 proteins
2 dairy, 4 veggies, 4 fruits
Servings: Carbs- 1 slice bread, 1 roti , ½ cup cooked rice, 1 cup cooked pasta
Dairy: 8 oz
Protein : 4 oz.cooked meat. ½ cup cooked lentils/beans/dhal
Fat: 1 teaspoon
Veggies: 1 cup raw or ½ cup cooked
Fruits: ½ cup diced , ½ of whole fruit ( apple, pear etc)

19. 10%
20%
30%
40%

20. Now for some practical ways to watch your diet and nutrition………
When you eat- frequency and schedule
How much you eat- portions and sizes
How you eat- rates and combinations
Where you eat- at home or out
What you eat- choice of foods

21. When you eat…………

22. How much you eat………. Portion control
Be conscious of how much you put in your plate
When you start your new “diet” , record what you eat each day at least for 10 days.
“Plate method” is recommended by ADA
Milk or yogurt
1 serving
Fruit
1 serving

23. How and where you eat………
Take 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.

24. What you eat…….. Choosing the right foods
You don’t 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.

25. Some examples of Simple Substitutions
INSTEAD OF THIS
USE THIS
Processed/ polished grains
Whole grains
White bread
Wheat or rye bread
Fried snacks, chips
Baked snacks and chips
Regular dairy products
Low fat/no fat dairy products
Red meat
Fish, poultry , lentils, beans
Canned fruits, fruit juices
Fresh or frozen fruits
White or yellow potatoes
Yams, sweet potatoes
Sugary desserts
Low fat dairy based desserts
Salty and sugary snacks
Peanuts, almonds, walnuts,
Always read nutrition labels to see amount of
total carbs and sugar!

26. Can I include rice in my meals??
Of course you can! 1-2 carb servings can be rice dishes
Glycemic Index is a method nutritionists use to study the effect of foods on diabetes.
GI score ranges from with pure glucose being 100
GI < 55 low, medium and over 70 high
IRRI has rated 235 varieties of rice based on GI

27. Sticky rice (japanese,thai) 90
Brown Rice
55 ✔
Swarna (Ponni) rice
56 ✔
Samba Masoori rice
57 ✔
Basmati rice ✔
Long Grain rice
Medium Grain rice 69
Sticky 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)

28. How about rotis and pastas???
Whole wheat based rotis over white “nan”
Chapati flour with1% rye/bajri flour + 1% besan ---- lowers GI
Pastas made with durrum wheat better than multigrain ones.
Larger the size of pasta, less GI
“al dente” lower GI/overcooking higher GI
Ghee on roti and olive oil on pasta- lowers GI

29. 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-yo’S!
4 -5 servings ( 4-5 tsps) of fat/day
Ghee (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

30. Can I include dessert in my meal plan??? Occasionally yes!
Instead of this have this!
Rich, creamy sugary cakes/pies
Low fat, low sugar cakes/pies
Cheese cake/vanilla cake
Dark chocolate cake chocolate mousse
Fruit Pies, tarts
Fresh 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 ( ¾ to 1 scoop)
Nut cakes and sweets
Plain nuts with fruits

31. Finally, 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 potatoes
Bananas, pears, apples, peaches, melons, papaya
Very limited/occasional use ( >3 servings/week)
Potatoes, Taro root (Arvi) other root veggies
Mangoes, watermelon ,

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

33. Tips to succeed in your dietary goals….
Use Variety and diversity in choosing foods
Don’t be rigid and narrow in your choices
Allow for “cheatings” occasionally, but
remember to get back on track soon
Most of all, be self confident and positive
Always remember you control your diabetes, don’t let diabetes control you!

34. Some useful websites www.diabetes.org (american diabetic assn)
(national diabetes education)
Thank you all for your patient listening!