Dr. Z's Diet

 

 Diet For Diabetic Patients  

 

 

Nothing is more confusing and frustrating for diabetic patients than their diet.

 

There are several reasons for this complex problem.

 

Most physicians don't get appropriate training in nutrition for diabetic patients. From their residency training days, they remember just one lesson: Diet for all diabetics is an 1800 calorie diet. Chances are that you will be placed on this famous 1800 calorie diet if you happen to be admitted in a hospital. This 1800 calorie diet is too high for most people over the age of 50. No wonder many diabetic patients start having high blood glucose values during their hospital stay.

 

Many dietitians prescribe a diet consisting of three regular meals and three snacks, regardless of your type of diabetes or treatment of diabetes.

 

Most dietitians teach you to consume X-many calories from carbohydrates, X-many from fat and X-many from protein. It’s just not very practical. Try going to a restaurant and figuring out the percentages of carbohydrate, fat and protein before you order your food. If you’re like most people, you’ll skip the hassle and end up eating “whatever” for that meal.

 

Many diet programs for diabetics are very generic and do not tailor towards individual needs.

 

 

Diet for a diabetic person should be individualized based upon the following principles:

 

 

The diet for a Type 1 diabetic patient is different from a Type 2 diabetic patient.

 

The diet for an obese person is different from that of a lean person.

 

The diet for a 70 year old patient is different from that of a 30 year old patient.

 

Daily caloric requirement reduces drastically as we age, especially after the age of 40.

 

The diet for a sedentary person is different from that of an active person.

 

Diet for a Type 2 diabetic patient on oral drugs is different from someone who is on insulin injections.

 

Diet will also vary depending upon the type of oral drugs you're taking. Diet of a Type 2 diabetic on insulin injections is different from a Type 1 diabetic who is on insulin.

 

Also diet will vary depending upon the insulin regimen. Diet for a diabetic on an insulin pump is different from the one who is on insulin injections.

 

 

 Diet for a Type 2 Diabetic patient

 

 

This diet is for a typical adult, overweight, sedentary, Type 2 diabetic patient, who is on oral anti-diabetic drugs.

 

1. Reduce the size of your portion. Contrary to your parent's teaching, you do not have to finish all the food on your plate. In fact, learn to leave some food on your plate!  Use smaller plates. This psychological trick helps with satisfaction of the size of your portion. Serving size is especially huge in American restaurants. In general, when you're eating out, cut the serving in half before you start eating and ask for a doggy bag. This will serve as another meal.

 

2. Eat three regular meals per day. Try to have a garden vegetable salad before lunch and dinner. This serves as good, low-caloric stomach filler. Dinner should be the lightest meal of the day and lunch the heaviest meal of the day. Eat dinner at least 3 hours before bedtime. Walk for at least 30 minutes before dinner. You can either just go for an evening walk or use a stationary bike. A recumbent stationary bike is particularly useful if you have neuropathy in your feet.

 

3. No snacks. Avoid snacks especially when you’re watching TV or working on a computer. If you have a craving to put something in your mouth, drink black tea or regular coffee. Caffeine is a good appetite suppressant. If you have a huge appetite, drink caffeinated tea or coffee about half an hour before your meal to help control your hunger. If you absolutely must have a snack, then try something like popcorn (without butter), carrot sticks or other raw vegetables.

 

4. Reduce  Carbohydrates. Reduce the amount of bread, rice and pasta in your diet. Bread includes white bread, whole wheat bread, sour dough bread, French or Italian bread, donuts, bagels, croissants, pastries, hamburger buns, rolls, pita, pies, Indian naans, tortillas, tacos, enchiladas and many more similar bakery products. Rice includes white, brown as well as wild rice. Certain foods cause a marked increase in blood glucose and should be avoided. These foods include cereals, pizza, french fries, donuts, waffles, pancakes, pastries, fruit juices and desserts.  

 

5. No sodas, no fruit juices. Fruit juices are loaded with natural as well as regular sugar. Water, tea and coffee should be your beverages. In a restaurant setting, order water for your drink. Many people order a soda or a dessert in a restaurant under peer pressure. Remember your metabolism has not changed because you are in a restaurant. Avoid beer and hard liquors as these contain a large amount of calories and  carbohydrates.

 

6.Fruits are a good source of vitamins and fiber. However, most fruits, especially the sweet ones, are loaded with natural sugar and usually cause marked elevation in blood sugar in diabetics. Therefore, limit your fruit intake to one to two fresh fruits a day. Certain fruits cause a more rapid rise in blood glucose than the others. These fruits include bananas, grapes, oranges, watermelons and mangoes. You may have a small apple, pear, pomegranate, plum, a few strawberries, blackberries, blueberries, raspberries, kiwi fruit and grapefruit. .  

 

7. Eat more proteins. Eat egg white, lean meat, non-fried chicken, turkey, fish and legumes. Enjoy steaks and ribs. Have eggs in the breakfast in stead of cereals. You can have 2-3 egg whites and one egg yolk per day. Use cheese in small amount as it can increase your LDL cholesterol. Use regular milk. Have some plain yogurt.

 

8. Eat more good fats. Diabetics are often low in HDL cholesterol (the good cholesterol). Fat phobia in the USA has further worsened this problem. We need good fats. These good fats are found in olive oil, avocado, salmon, other fat fish and nuts. Eat plenty of raw nuts such as almonds, walnuts, pecans, cashews, pine-nuts, pistachios and macadamias. Nuts are also excellent source of vitamins and minerals such as vitamin E and magnesium.

 

9. Plenty of vegetables. Eat plenty of vegetables as these are good source of complex carbohydrates (the good carbs), minerla, vitamins and fiber. However, reduce the amounts of potatoes, sweet potatoes, corn and beets as these can cause a significant rise in blood glucose.

 

10. Get involved in your food. Read labels on foods while you are in the grocery store. You'll be surprised how many food items contain sugar, fructose syrup and corn syrup. Avoid these food items. Try to prepare your meal yourself, at least over the weekend. Avoid buffets! When you opt for a buffet meal, you want to get the most for your buck (after all, you're only human), and you generally end up overeating. Try to eat at home as much as possible.

 

11. Keep a diary of food you eat and observe the result it has on your blood glucose by checking your blood glucose two hours after the meal. Soon you will learn which foods to eat and which ones to avoid. You will become the best dietitian for yourself.

 

12. Eat when you are hungry, not because you are sad or you are watching TV or you have to give company to your family members and friends. People often eat because of psycho-social reasons.That's why they continue to gain weight.

 

13. Be Aware of your eating habits. Eat slowly and enjoy every bite of your meal. Don't watch TV while eating. Many people overeat because they get too involved in watching a TV show or reading a newspaper and don’t keep track of their food intake.

 

14. Read these recommendations on a daily basis in order to remind your mind. Watch your conditioned mind and see how it tries to lure you to eat foods that you know you should not eat. Be aware of the inner voice such as," reward yourself, you deserve this bowl of icecream, eat whatever because you are on a vacation or in a party." The inner voice comes from your conditioned mind, which is the basis of your old, bad, illogical eating behavior. You need to rise above it simply by observing the inner voice, which actually is your enemy in the sense that it sabotages your health.

 

 

Practical suggestions for meals

 

Breakfast:

 

Egg white omelet using 2-3 egg whites only

 

OR 2-4 hard boiled eggs  (egg whites only)

 

1/2 to 1 cup of yogurt.

 

A cup of coffee or tea or milk

     

 

Lunch / dinner:

 

A cup of coffee or tea.

 

A bowl of vegetable soup.

 

A plate of grilled chicken and fresh garden salad (you may add salad dressing).

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.  

 

 

OR

 

 

A cup of coffee or tea.

 

A bowl of vegetable soup.

 

A small chicken or turkey or tuna sandwich. Discard  the top slice of bread, and make it an open sandwich.

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

OR

 

 

Grilled vegetables such as bell pepper, zucchini or eggplant Chicken or turkey strips stir fried.

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

OR

 

 

Steamed vegetables such as broccoli or cauliflower.

 

Grilled chicken or Steak.

 

A small baked potato (without butter or cream).

 

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

OR

 

 

Shrimp with vegetables, on a small bed of pasta.

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

OR

 

 

A bowl of soup

 

Fish, grilled or baked, especially Salmon.

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

OR

 

 

6 inch turkey or chicken Subway sandwich. Discard  the top slice of bread, and make it an open sandwich.

 

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

 

 

   Ethnic foods

 

 

 

Chinese:

 

A cup of won ton soup.

 

Beef or chicken or shrimp, cooked any Chinese style with a small portion of steamed rice such as ½ a cup.

 

Hot tea.

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.  

 

 

OR

 

 

Mongolian barbeque beef or chicken.

 

Hot tea.

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

 

 

Japanese:

 

2-3 sushi, avoid rice rolls.

 

Stir fried beef or chicken on a small bed of steam rice such as ½ cup.

 

Hot tea.

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

 

 

Mexican:

 

 

A cup of minestrone soup.

 

A plate of chicken or beef fajitas.

 

A cup of beans. (Do not eat tortilla, chips or nachos).

 

A fresh fruit such as a small apple

 

 or pear or plum or a few strawberries.

 

 

 

Indian/ Pakistani

 

Two pieces of Tandoori chicken.

 

A cup of dal.

 

Mixed vegetables

 

Hot tea (chai without sugar).

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

OR

 

 

Two Seekh Kebobs.

 

1/2 naan.

 

A plate of vegetable such as okra, spinach or cauliflower.

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.  

 

 

OR

 

 

1/2 naan.

 

A small portion of chicken or beef or lamb curry.

 

Hot tea.

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

 

 

Mid Eastern:

 

A small portion of chicken or beef kebob.

 

A small portion of rice (about ½ of a cup).

 

 A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

OR

 

 

A small portion of chicken shawarma.

 

A small portion of rice (about ½ of a cup).

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

 

 

Greek:

 

A small plate of Greek salad.

 

A small portion of Gyro meat (no cream or fries or rice).

 

A fresh fruit such as a small apple or pear or plum or a few strawberries.

 

 

 

Diet for a Type 1 diabetic patient.

 

 

Type 1 diabetic patients are usually thin and relatively younger patients. Generally, they are physically active and quite often, are involved in sport activities.

 

As a rule, these patients are on insulin therapy. Either they take multiple insulin injections per day or are on an insulin pump. Various types of insulin are used when multiple daily insulin injections are used.  On the other hand, only one type of insulin (either Regular insulin or Humalog) is used in an insulin pump.

 

 

Diet for a Type 1 diabetic patient who in on an insulin pump  

 

 

The Insulin pump gives the patient full control regarding eating. They do not have to eat at a particular time of day. They eat whenever they want to eat. However it is a good practice to have your melas at regular times.

 

With the use of insulin pump, we try to mimick what nature does normally in people who do not have diabetes. Normally pancreas continues to produce a small amount of insulin all the time, whether we eat or not. This is what we call Basal production of insulin. In addition, pancreas produces a large amount of insulin when we eat to cover for for that meal.

 

In insulin pump, we set Basal rates to mimick basal insulin production. In addition, we give a Bolus before each meal to cover the pre-meal blood glucose value, plus the amount of carbohydrates in the meal. 

 

It is important to have a detailed instruction from your physician to calculate the dose of premeal bolus. This dose consists of two values: dose of insulin to cover the pre-meal blood glucose value plus the dose of insulin to cover for the carbohydrates in the planned meal. The former is based on the Insulin Sensitivity factor, which your physician calculates for you. The latter is based on the Insulin Carbohydares ratio, which is calculated by your physician. Learn how to count the carbohydrates in a meal. 

 

Learn to read food labels in the grocery store. If an increased level of activity is planned after the meal, the dose of Humalog or Novolog insulin should be decreased.

 

 

 

Diet for a young, lean Type 1 diabetic person who is on Lantus or Levemir, once a day and Humalog before breakfast,  lunch  and dinner.

 

 

 

Lantus or Levemir are long acting insulins. One injection of Lantus or Levemie lasts for about 24 hours and therefore, it is given once a day, usually at night. Unlike NPH insulin, Lantus and Levemir do not have any peaks. Therefore, hypoglycemia is less likely to occur.

 

Eat a balanced diet three times per day near the same time every day. Learn to count carbohydrates in a meal and read food labels in the grocery store.

 

Write down what you eat in a logbook and observe the impact it has on your blood glucose. Soon you will learn which foods to eat and which ones to avoid. 

 

  

 

 

Diet for a young, lean Type 1 diabetic person who is on three insulin injections per day.

(NPH and Humalog before breakfast, Humalog before lunch, Humalog and NPH before dinner.)

 

 

 

Remember NPH starts working in 2-3 hours, reaches a peak level in about 6-8 hours and has a duration of action of about 12-16 hours.

 

On the other hand, Humalog is a rapidly acting insulin. Humalog starts working within 15-30 minutes. Therefore, it should be taken just before your meal. Humalog peaks at about 1-2 hours and duration of action is only 3-4 hours.

 

Eat a balanced diet three times per day near the same time every day. Learn to count carbohydrates in a meal. Learn to read food labels in the grocery store.

 

Write down what you eat in a logbook and observe the impact it has on your blood glucose. Soon you will learn which foods to eat and which ones to avoid.

 

The dose of Humalog insulin is adjusted by the patient according to the type of meal, the level of blood glucose before the meal and the level of activity after the meal. A detailed sliding scale should be provided by your physician to guide you to cover the pre-meal blood glucose value. Additional units of Humalog are required to cover the amount of carbohydrates in the meal.

 

As a general rule, 1 unit of Humalog will cover 10-15 grams of carbohydrates. If an increased level of activity is planned after the meal, the dose of Humalog should be decreased.

 

 

 

Diet for a young Type 1 diabetic person who is on NPH and Regular insulin before breakfast, Regular insulin before lunch and Regular and NPH before dinner (or Regular insulin at dinner and NPH at bedtime).

 

 

 

Remember NPH starts working in 2-3 hours, reaches a peak level in about 6-8 hours and has a duration of action of about 12-16 hours.

 

On the other hand, Regular insulin starts working in about 1-2 hours, reaches a peak in about 3-4 hours and has a duration of action of about 6-8 hours.

 

Eat three regular meals and three snacks in between meals: a mid- morning snack, a mid- afternoon snack and a bedtime snack.

 

Meals and snacks should be about the same time every day.

 

Write down what you eat in a logbook and observe the impact it has on your blood glucose. Soon you will learn which foods to avoid.

 

The dose of Regular insulin is adjusted by the patient according the type of meal, the level of blood glucose before the meal and the level of activity after the meal. A detailed sliding scale should be provided by your physician to guide you to cover the pre-meal blood glucose value. Additional units of Regular insulin are required to cover the amount of carbohydrates in the meal.

 

As a general rule, 1 unit of Regular insulin will cover 10-15 grams of carbohydrates. If an increased level of activity is planned after the meal, the dose of Regular insulin should be decreased.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.

 

Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.

 

 

 

 

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