Diet
There is no special diet for persons with type 1 diabetes (T1D). They can have all the healthy foods available to mankind. In other words “diet” for those with T1D is nothing but a return to healthy eating (we say “return to” because most of us have started consuming a lot of undesirable “junk foods” only to pamper our taste buds).
However, there is one very important difference: before developing T1D your pancreas automatically produced insulin in the correct amount each time you ate and in exact proportion to the carbohydrate (and to some extent protein and fat) content of the food you had eaten. This ensured that the post-meal blood glucose never rose above 140 mg% irrespective of what you ate. After developing T1D, you now have to manually inject insulin (each time you plan to eat) in an amount calculated to cover the grams of carbohydrates (carbs for short) that you plan to eat. There are 2 ways of doing this. One method is to have a fixed amount of carbs from day to day for a given meal, in which case the pre-meal or bolus insulin doses would be fixed, and, to avoid monotony in the meals, you can learn “carb exchanges”. The second method is to learn “advanced carb counting”: meals need not be fixed; you only need to count the carbs in whatever item or items you plan to eat and then using a ratio (the insulin-carb ratio or ICR) calculate the bolus insulin for that meal; this method gives even more flexibility in meals.
Only very few individuals who have T1DM would need a special diet: those who are obese, those who have high blood pressure, those with high lipid (LDL cholesterol / triglyceride) levels, those with early kidney damage and those who have celiac disease.
Nutritional needs
“Healthy eating” is an integral part of management of T1D. The diet should always provide the essentials of good nutrition and adjustments must be made from time to time for changing metabolic needs as for example, during growth, pregnancy, lactation or modified activity.
Protein
Since diabetics in general have negative-nitrogen balance, they should receive about twice as much protein as normal subjects. The proteins should be of high biological value and provide about 20–25% of the calories in the diet. A diet high in protein is good for diabetics because
- It supplies the essential amino acids needed for tissue repair
- Protein does not raise the blood sugar during absorption, as do carbohydrates
- It does not supply as many calories as fats
Carbohydrates
The daily intake of carbohydrate should provide about 40% of the calories to prevent ketosis. Several studies have shown that raising the carbohydrates intake does not adversely affect blood glucose levels, glucose tolerance, or insulin requirements, provided that the total calorie intake is not increased.
Fats
After protein and carbohydrate levels have been established, the fat allowance makes up the remaining calories for most diets. 30–35% of the calories as fat is satisfactory. Foods high in saturated fat and cholesterol should be limited.
Fiber
Foods that are rich in fiber can reduce the rate of glucose absorption, lower blood sugar rise, decrease urinary glucose excretion, slower stomach emptying, and delay intestinal transit time. Fiber also contributes to satiety, and consequent decreased food intake helps reduce weight. Fiber containing complex carbohydrates that are slowly digested and absorbed such as pulses, brown rice, bread, chapatti, will produce less rise in blood sugar and less excretion of urinary sugar than an equivalent amount of carbohydrates taken as sugar in tea.
Fiber such as gum included with the diet is reported to reduce post-prandial glucose levels (after food) in blood. Studies have shown that gum present in fenugreek seeds (it contains 40% gum) is most effective in reducing blood glucose and cholesterol levels as compared to other gums. These types of dietary fiber are often recommended for the management of certain types of diabetes.
Calculation of Diabetic Diet
Calories
60 x 30 = 1800 kcal/day
Protein
20-25% of total calories
1800 x 20% = 360 kcal
360 kcal/4 = 90gm/day
Carbohydrate
40% of total calories
1800 x 40% = 720 kcal
720/4 = 180 gm/day
Fat
Total calories - calories from protein and carbohydrates
1800 - (360 + 720) = 720 kcal
720/9 = 80 gm fat/day
The bottom line
Use the Healthy Eating Plate and Healthy Eating Pyramid that are based on the latest and best science.
The Healthy Eating Plate
The Healthy Eating Pyramid
The Healthy Eating Pyramid is a simple, trustworthy guide to choosing a healthy diet. Its foundation is daily exercise and weight control, since these two related elements strongly influence your chances of staying healthy. The Healthy Eating Pyramid builds from there, showing that you should eat more foods from the bottom part of the pyramid (vegetables, whole grains) and less from the top (red meat, refined grains, potatoes, sugary drinks, and salt).
When it’s time for dinner, most of us eat off of a plate. So think of the new Healthy Eating Plate as blueprint for a typical meal: Fill half your plate with produce—colorful vegetables, the more varied the better, and fruits. (Remember, potatoes and French fries don’t count as vegetables!) Save a quarter of your plate for whole grains. A healthy source of protein, such as fish, poultry, beans, or nuts, can make up the rest. The glass bottle is a reminder to use healthy oils, like olive and canola, in cooking, on salad, and at the table. Complete your meal with a cup of water, or if you like, tea or coffee with little or no sugar (not the milk or other dairy products that the USDA’s MyPlate recommends; limit milk/dairy products to one to two servings per day). And that figure scampering across the bottom of the placemat? It’s your reminder that staying active is half of the secret to weight control. The other half is eating a healthy diet with modest portions that meet your calorie needs—so be sure you choose a plate that is not too large.
