Presentation on theme: "SELF MANAGEMENT OF DIABETES"— Presentation transcript:
1 SELF MANAGEMENT OF DIABETES NUTRITION INTERVENTION&DIETARY GUIDELINESVasantha Narasimhan Ph.DEmeritus Professor of chemistrySkidmore College
2 Diabetes:: Some Stats and facts (Source: ADA and NIH) about 30 million cases in USA in 201221 % of people over 65 have diabetesThe 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 causeDiabetes 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.AlHuman 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 thatWith a few healthy dietary and attitude changesYou can answer “NO” to the above questions!!
5 (CHEMICALS IN FOOD THAT NOURISH THE BODY) Food providesNUTRIENTS(CHEMICALS IN FOOD THAT NOURISH THE BODY)MACRONUTRIENTS MICRONUTRIENTS* CARBOHYDRATES * VITAMINS* FATS * MINERALS* PROTEINS(Energy, growth) (Help proper metabolism of macronutrients,maintain healthy cells)
7 Maintain blood glucose within healthy limits PancreasINSULINHeartLiverEnergy use &StorageAs glycogenBlood glucoseEnergy useBrainROLE OF INSULINMaintain blood glucose within healthy limitsMuscleOther organs
8 Insulin not doing its job right What can go wrong?CONDITIONSCAUSESRESULTSNO Insulin madedamage to pancreas, genetic defect in making insulin etcTYPE 1 DIABETESNot enoughinsulin madesluggish pancreas due to overwork, cell defects etcTYPE 2 DIABETESInsulin not doing its job right“Insulin resistance”, organs not responding to insulinUSUAL SYMPTOMSFrequent 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 factorsAge/ethnicityObesity/overweightSedentary life styleHigh fat/high carb. dietsHigh Blood PressureHigh 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 ofblood sugarblood cholesterol and triglyceridesblood pressurebody weightYou can reach there with small,step by step lifestyle changes.
12 Acceptable blood values (suggested by National Diabetic Education Program) Fasting Blood sugar: mg/dlPost-prandial sugar: mg/dlHemoglobin A1C (Hb A1C) under 7.0Total cholesterol: under 200 mg/dlHDL (“good cholesterol”) over 40 for men/over 50 for womenLDL(“ bad cholesterol”) under 100Triglycerides under 150 mg/dlBlood Pressure: below 130/80Body Mass Index : under 27
13 HbA1C tells us about average blood sugar levels over a 12 week period. GluHbA1CControlled diabetes, not much glucose, not much HbA1CUncontrolled diabetes, more glucose, much more HbA1C
15 Steps towards a healthy “you”…… Medications and monitoring as prescribedPhysical activity goals!Dietary GoalsHealthy 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 activityStop negative thoughts!Keep a record of your progress!Reward Yourself!
17 Diet & Nutrition GoalsTotal calorie controlCARB counting/Glycemic IndexDiabetes food pyramidSimple common sense dietary habits
18 Calorie Counting source: National Institute of Health 2008 profile/ activity levelCalories/dayNumber of servings*/daySmall/F/ moderateMedium/F/sedentary, low6 carbs, 3 fats, 1 proteins,2 dairy,3 veggies, 2 fruitsLarge/F/moderateSmall/M/ moderateMedium/M/sedentary8 carbs,4 fats,2 proteins,2 dairy, 4 veggies, 3 fruits,Medium/M/highLarge/M/ModerateLarge/F/high10carbs,5 fats, 3 proteins2 dairy, 4 veggies, 4 fruitsServings: Carbs- 1 slice bread, 1 roti , ½ cup cooked rice, 1 cup cooked pastaDairy: 8 ozProtein : 4 oz.cooked meat. ½ cup cooked lentils/beans/dhalFat: 1 teaspoonVeggies: 1 cup raw or ½ cup cookedFruits: ½ cup diced , ½ of whole fruit ( apple, pear etc)
20 Now for some practical ways to watch your diet and nutrition……… When you eat- frequency and scheduleHow much you eat- portions and sizesHow you eat- rates and combinationsWhere you eat- at home or outWhat you eat- choice of foods
22 How much you eat………. Portion control Be conscious of how much you put in your plateWhen you start your new “diet” , record what you eat each day at least for 10 days.“Plate method” is recommended by ADAMilk or yogurt1 servingFruit1 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 THISUSE THISProcessed/ polished grainsWhole grainsWhite breadWheat or rye breadFried snacks, chipsBaked snacks and chipsRegular dairy productsLow fat/no fat dairy productsRed meatFish, poultry , lentils, beansCanned fruits, fruit juicesFresh or frozen fruitsWhite or yellow potatoesYams, sweet potatoesSugary dessertsLow fat dairy based dessertsSalty and sugary snacksPeanuts, almonds, walnuts,Always read nutrition labels to see amount oftotal carbs and sugar!
26 Can I include rice in my meals?? Of course you can! 1-2 carb servings can be rice dishesGlycemic Index is a method nutritionists use to study the effect of foods on diabetes.GI score ranges from with pure glucose being 100GI < 55 low, medium and over 70 highIRRI has rated 235 varieties of rice based on GI
27 Sticky rice (japanese,thai) 90 Brown Rice55 ✔Swarna (Ponni) rice56 ✔Samba Masoori rice57 ✔Basmati rice✔Long Grain riceMedium Grain rice69Sticky rice (japanese,thai)90over 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 gheeUse 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 GIPastas made with durrum wheat better than multigrain ones.Larger the size of pasta, less GI“al dente” lower GI/overcooking higher GIGhee 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/dayGhee (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 & TGPeanut 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/piesLow fat, low sugar cakes/piesCheese cake/vanilla cakeDark chocolate cake chocolate mousseFruit Pies, tartsFresh frozen fruits with nonfat whipped creamSugar 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 sweetsPlain 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 varietiesModerate use ( 1 serving/day)Carrots, beets, yams, sweet potatoesBananas, pears, apples, peaches, melons, papayaVery limited/occasional use ( >3 servings/week)Potatoes, Taro root (Arvi) other root veggiesMangoes, 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 foodsDon’t be rigid and narrow in your choicesAllow for “cheatings” occasionally, butremember to get back on track soonMost of all, be self confident and positiveAlways 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!