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Diet in diabetes
 
What food can we eat to keep the blood sugars under control?
 
     No other area causes as much confusion as the "diet" in diabetes. There are as many theories as there are doctors and nutrition experts! The only thing one needs to remember is that there are no absolute Dos and Donts. All types of food can and should be tried and had, the only variation is in how much and how often. If you arm yourself with some basic nutrition facts, choosing a heathy, tasty meal is easy.

     Also, nutrition in diabetes is not only about controlling blood sugars - it also needs to be low in fat, and high in fiber and protein, and we should be able to get adequate vitamins and minerals from it.
 
Some basic facts about nutrition
 
     We need food mainly for the energy our body derives from it. This is the main difference between plants and animals - the former can make their own food, while we depend on plants and other animals.
 
The Big Three
 
     Your body is like a car. It's a finely tuned machine, which requires good care so it runs well. There are three main parts of the car's care, or rather three kinds of nutrients that you need to have : carbohydrates, protein, and fat. ALL foods contain all 3 items along with vitamins and minerals. The amount of each contained by each food item determines if they are called carbohydrates, fats or proteins.
Carbohydrates
     Eating carbohydrates is like putting petrol or diesel in your car. It is the fastest source of energy. Carbohydrates are the body's main source of fuel. Carbohydrates are found in almost everything we eat. What we need to realise and remember is that everything we eat has carbohydrates, including vegetables. Some foods have only or mainly carbohydrates (like rice, wheat etc), while others (like egg, fruits, vegetables etc have limited amount of carbohydrates. Sugar is also a carbohydrate (as are honey, jaggery, and other sweeteners). Carbohydrate is the food that most immediately influences blood glucose levels, so most of our dietary advice focuses on this.
Proteins
     Proteins act like the tools a car mechanic uses. They repair and build tissue in your body. Proteins can also be used for fuel, but it takes double the time to change proteins to sugar. We get protein in meat, milk, nuts, and some kinds of beans.
Fats
     Fats are reserve fuel, like keeping an extra can of petrol in the car for emergencies. They also help you absorb certain vitamins and help the cells send signals to the rest of her body. Fat is basically concentrated energy. It has double the calories of carbohydrates or proteins. Too much can make you overweight. Fat is found in all foods (including rice), but some foods contain a large amount of fat - butter, oils, most meats, eggs, whole milk, chocolate, and any foods cooked in butter or oil. Fts are an essential part of any diet.
 
Don't Forget About Your Vitamins & Minerals
 
     So you're thinking, "What about vitamins and minerals?" Vitamins and minerals are substances your body needs to keep working well. They're mostly in carbohydrate and protein foods. The best way for you to get all the different vitamins you need every day is to have different kinds of foods, especially different kinds of fruits and vegetables.
 
Timing of meals
 
     For people with diabetes, when they eat is nearly as important as what they eat. Having small regular meals is the easiest on the body, but most of us do not have the luxury of doing this on a regular basis. One thing to definitely plan is to make sure that you eat within 20 minutes of taking any tablet or insulin for diabetes. This is essential, as otherwise the medicine starts working at a time when the blood sugars have not started to go up. This is can cause low blood sugars, a most unpleasant feeling. Make sure you are prepared for emergencies - you may be out at a meeting or at a function, or even in your doctor's office getting delayed. If it looks like your meal timing is going to be delayed - have a fruit or a healthy snack - peanuts, or even a snack bar. These things keep for a long time, so having small readymade packets of these in easy reach is essential.
 
Sugar & Sugar Substitutes
 
     For many years, people with diabetes were told to avoid sugar at all costs. It was thought that sugar would pass into the bloodstream faster and easier and would cause blood glucose levels to rise too quickly. More recent research has shown that all carbohydrates affect blood glucose levels the same way. A potato and a chocolate bar, if they have the same number of carbohydrates, have about the same affect on blood glucose levels.

     In terms of blood glucose control, all that matters is the number of carbohydrates in a food item. However, many sugary foods have a very high concentration of carbohydrates in a relatively small portion size. Look at the example of a potato versus the chocolate. The chocolate contains a lot of sugar, so it doesn't take a very big piece to equal the same number of carbohydrates as a fairly large potato.

     One option for enjoying more sweet foods is the use of sugar substitutes. Calorie-free sugar substitutes do not contain carbohydrates, so you can eat them without raising your blood glucose. However, some sugar substitutes do contain calories and carbohydrates. When choosing products with sugar substitutes, read the label. Even products labeled "sugar-free" can contain fats, carbohydrates, and proteins, which can affect blood glucose levels. Also, keep in mind that "fat-free" and "low-fat" products sometimes have a higher sugar content or special carbohydrates used as bulking agents. Always check the labels of products before you buy.

     There is no reason, however, for you to avoid all sugary foods. In the context of a healthy diet, an occasional cup of ice cream should cause no problems for diabetes control.

     You may run into people who still think that people with diabetes can't eat sugar. There is also a myth that a person can "bring on" diabetes by eating too much sugar. This is not true. Diabetes is brought on by a complex interplay of several factors - including getiing older, having certain genes, being overweight (particularly around the tummy) and not excercising.
 
What can I eat?
 
     Now that you have some basic nutrition facts, remember to plan all meals around the dictum "No added sugar, low fat and high protein and fiber".

     Please do not feel that having diabetes means a "life sentence" in terms of food choices. We can certainly choose healthy, tasty food. One should be aware as to why certain food choices are advised in diabetes and not blindly follow a "diet chart". The main aim of the food choices are to ensure that

    Blood sugars are kept under control.
    There is no extreme fluctuations in blood glucose levels through the day - meaning there is no extreme of high or low blood sugars.
    The weight is kept under control. Excess weight leads to poor blood sugar control, and increases risk of high blood pressure and high cholesterol.

     Please use the following information to make your own choices in food.

    No Sugar: Avoiding added sugar in food is important for 2 reasons - avoiding a blood sugar spike, and to avoid excess calories that can lead to weight gain. Remember that cutting out sugar on a daily basis in your diet can save you 2 kg of weight every year. Try and avoid sugar in your tea and coffee, sweets, chocolates, icecream, cool drinks, jams, cakes, biscuits. Honey and jaggery also contain sugar - so it is better had in moderation as everything else. So called health drinks may also contain sugar - please look at the label - if it containes sucrose or fructose, it may spike your sugar levels.
    Low fat: This again helps to reduce weight, and to reduce cholesterol levels to some extent. Avoid or minimise deep fried items like pooris, vadais, bondas, bajjis, chips, samosas and snacks like murrukku etc. Also be careful about the amount of ghee in food. Cheese alos contains a large amount of fat, so needs to be restricted.
    High fiber: Fiber is an important, and often neglected, part of our diet. The fiber found in fruits and veg is needed to control weight and blood sugars. Please have at least 1-2 fruits and 3-4 cups of vegetables daily. The following fruits are generally preferred in diabetes as they contain relatively less sugar: Apple, orange, musambi, guava, papaya (1 cup), pomegranate (1/2 cup seeds). The following fruits are higher in sugar, so should be taken rarely: mango, banana, sapota, watermelon, jackfruit, grapes. All vegetables are fine, again beetroot nd cooked carrots probably push up sugars faster. Potatoes - baked, not fried, has actually been found to be good for preventing a sudden rise in blood sugars.
    Do include at least 1-2 glasses of low fat milk and 1 cup of curd daily in your diet.
    Include a few nuts daily (3-4 pieces of badam / pista / walnuts).
    Dates and raisins are higher in sugars, try to have it less frequently. You can instead try prunes or apricots.
    Ready-made fruit juices contain concentrated sugar, even when it says "no added sugar". Try and have home-made fruit juice as much as possible, or dilute the store brought fruit juice with water or soda.
    Eating out: Choose sensibly when eating out. Have limited quantity of the carbohydrate (rice or chappati or bread), avoid deep fried things, have plenty of salads, dal, curd. Avoid dessert, go for the fruits. Avoid the juices and limit alcohol.
 
     Self monitoring of blood glucose: If you have the time, means and the will meaning the glucometer, you can plot your blood sugars based on what you eat all through the day. You may find that certain foods push up the blood sugars more thn expected, and that others are not as bad.