Living with Diabetes

DIABETES MELLITUS

Manifestations of diabetes mellitus, the most common endocrine disorder, include polyuria, polydipsia, weakness, and weig loss, but some pts present with ketoacidosis or hyperosmolar nonketotic coma or rarely, with the long-term complications such as nephropathy or retinopathy.

immune-mediated pancreatic (3-cell destruction are typical insulin-dependent (IDDM) and develop ketoacidosis with( insulin therapy. Most pts are resistant to the action of insulin and do not secrete enough insulin to prevent hyperglycemia so called non-insulin-dependent diabetes (NIDDM) and can treated with diet, oral hypoglycemic agents. or insulin. Secondary forms of diabetes occur with chronic pancreatitis, pheoch mocytoma, acromegaly, Cushing's syndrome, and exogenc elucocorticoid administration. Hyperglycemia usually cause polyuria. polydipsia, polyphagia, and weight loss.

DIAGNOSIS This traditionally requires a fasting plasma glucose 7.8 mmol/L (140 mg/dL) on two occasions, although the American Diabetes Association has recommended lower the diagnostic level to 7 mmol/L (126 mg/dL) on two occasi< Alternatively, following ingestion of 75 g of glucose, the fine of a venous plasma glucose 11.1 mmollL (200 mg/dL) a 2 h and on at least one other occasion during the 2-h teE suggestive of the diagnosis. TREATMENT Once diagnosis is established, a diet should be instituted that includes an appropriate number of calories based on ideal body weight, adequate protein, and a carbohydrate intake of about 40-60% of total energy . Appropriate distribution of food intake is also important. When hyper glycemia in NIDDM cannot be controlled by diet, oral hypoglycemic agents may be administered . The usual practice is to prescribe sulfonylureas, increasinthe dose to the maximal level as required, and then to add metform a second drug when indicated. Troglitazone, which enhances insulin action, is used by some physicians as an adtional drug in NIDDM pts who do not have adequate response to insulin or maximal doses of oral agents (although it is approved by the FDA for the latter purpose).

Eating healthy helps you balance your blood glucose level and manage your diabetes.You don't have to give up all the food you like.But you need to eat on a regular schedule and follow some guidelines.Once you know what the goals of your meal plan are, you can meet these goals by making healthy choices when you shop and cook. The food pyramid is a tool to help you eat a wide range of healthy foods.If you eat the lowest number of servings for each type of food, you'll eat about 1,600 calories a day.The highest number of servings will give you about 2,800 calories a day.Your calorie needs are based in part on your height,gender,and activity level.Your health care provider can help you determine a calorie level that's right for you.

Food Pyramid goup Servings Nutrient in serving Healthy Choices Group per day serving Meats,meat- 2 to 3 21 grams of protein fish,white meat chicken or substitute and no carbohydrate; chicken or turkey and other protiens aim for red meat,reduced fat lean ones or fat-free Milk and 2 to 3 12 grams of carbo low-fat of far-free milk and byproducts hydrate8 grams of fat free withartificial sweete- protien;aim for low fat ner. Fruits 2 to 4 15 grams of Whole fresh fruits carbohydrates about 60calories and no fats Vegetables 3 to 5 5 grams of fresh vegetables or frozen carbohydrate vegetables without sauce and no fat butter,or margarin Breads,grains,and 6 to 11 15 grams of carbo- whole-grain breads and other starches hydrates,3 grams of cereals or tortillas,oatmeal, protien and up to bulgur,brown rice,dried bean 1gr fat lentils,peas,yams,and butternut squash,pumpkin.

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Carbohydrates counting

Carbohydrate (carb) counting can be very

when eating out or eating mixed dishes

When ordering pasta or rice at a restaurant it may be difficult to estimate exactly how much you are eating. The very first task when you start carb counting is to measure all the food you eat at home. One cup of cooked pasta or rice contains 45 grams of total car­bohydrate. After you measure out this portion size a few times, you will see what it looks like

on your plate and this will help you estimate portion sizes when eating out. You will soon realize that you are probably receiving 3 or more cups of cooked pasta when eating at

many restaurants.

It may be difficult to estimate the carb con­tent of meals that contain a variety of foods such as casseroles, lasagna, and chili. In gen­eral 1 cup of a casserole dish, such as tuna noodle casserole, can contain between 25-30 grams of total carbohydrate. One cup of chili contains approximately 25 grams carbohy­drate.

Section your plate

When you sit down for a meal, draw an imaginary line through the center of your plate. Draw a line to divide one section into

two:

- About one fourth of your plate should be filled with grains or starchy foods, such as rice, pasta, potatoes, corn, or peas.

- Another fourth should be protein (foods, like meat, fish, poultry, or tofu).

- For the other half of your plate, you can fill it with non-starchy vegetables, like broccoli, carrots, cucumbers, salad, tomatoes, and cauliflower.

Then, add a glass of non-fat milk, and a small roll or piece of fruit and you are ready

to eat!

You may need to count the carbohydrates or exchanges in your meal, so you can be sure your insulin and exercise are on target.

Health Issues

Choose Carefully when shopping Read labels. Limit products high in corn syrup, molasses, honey, or ingredients end­ing in "ose" (like fructose, sucrose, and dex­trose). These are all types of sugar.

Look for foods that are low in fat. Avoid products packed in oil, fried food, fatty meats, and foods prepared with creamy sauces or butter.

To avoid being tempted by unhealthy snacks, avoid the candy and snack food aisles.

Cook Wisely

When you cook, try to cut down on sugar and fat. If you have high blood pressure, cut down on salt as well.

Instead of frying, broil, bake, or grill. Instead of cream-based sauces or sugary glazes, flavor foods with vegetable puree, lemon or lime juice, or herb seasonings. Remove skin from chicken and turkey before you serve it.

Glycemic Index of foods

It is a good idea to get to know and under­stand the Glycemic Index, because choosing foods with a low GI rating more often than choosing those with a high GI may help you get a better control.

The Glycemic Index is a scale that ranks car­bohydrate-rich foods by how much they raise blood glucose levels compared to glucose or white bread.

The glycemic index should not be your only criterion when selecting what to eat. The total amount of carbohydrate, the amount and type of fat, and the fiber and salt content are also important dietary considerations. The glycemic index is most useful when deciding which high-carbohydrate foods to eat. But don't let the glycemic index lull you into eating more carbohydrates than your body can han­dle. The number of grams of carbohydrate we consume is awfully important. Make sure you know the carbohydrate content of the foods you eat by studying the nutritional information on the package

When you eat food that contains carbohy­drates, the sugar (glucose) from the food breaks down during digestion and gives you energy. After you eat, your blood glucose level rises; the speed at which the food is able to increase your blood glucose level is called the "glycemic response." This

glycemicresponse is influenced by many factors, includ­ing how much food you eat, how much the food is processed or even how the food is pre­pared (for example, pasta that is cooked al dente - or firm - has a lower glycemic response than pasta that is overcooked). Factors such as variety, cooking, and process­ing may effect a food's GI.

Foods that raise your blood glucose level quickly have a higher GI rating than foods that raise your blood glucose level more slow­ly. In general, the lower the rating, the better the quality of carbohydrate.

Try to choose low and medium GI foods more often than high GI foods. A GI of 55 or less ranks as low, a GI of 56 to 69 is medium, and a Cl of 70 or more ranks as high.

You can predict the glycemic index of a mixed meal. Simply multiply the percent of total carbohydrate of each of the foods by its glycemic index and add up the results to get the glycemic index of the meal as a whole.

If you choose a high GI food, combine it with a low Cl food, for an overall medium GI meal. For example, half a bagel (high GI) with a bowl of chili (low GI) , or corn flakes cereal (high GI) topped with a spoonful of All Bran (low GI) and some strawberries (low Cl(.

Tips to help you lower the Glycemic Index of your daily meals:

Try to choose at least one low Cl food at each meal

Limit the amount of processed, refined starchy foods, as they tend to be low in fibre and other nutrients and have a higher GI.

Try new foods that have a low GI. Experiment with beans, legumes and lentils by including them in dishes such as chili, soups and salads.

Choose parboiled, brown or white rice mere often than instant rice.

Eat pasta, rice, yams, lima beans or baked potatoes more often than mashed, boiled or instant potatoes. Eating potatoes cold, as in a salad, reduces their GI

Use vinaigrette instead of a creamy salad dressing. It's lower in fat, plus the acidity of the vinegar slows digestion, lowering the meal's GI.

Watch your portion sizes; the bigger the portion, the more it will increase your blood glucose, regardless of its GI rank.

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Diabetes Eating Plan

Eating with diabetes is not a life sentence to a rigid and

 restrictive menu plan.Instead, nutritional management of 

diabetes is a lifestyle change balancing moderation,

carbohydrate control,and healthy food choices.For people 

with diabetes facing weight issues,dietary changes are

 typically a balance of calorie and carbohydrate control(along 

with an appropriate exercise plan)

Diabetic must pay close attention to their dietary intake, 

portion sizes, and meal frequency.What you eat,or more 

specifically the carbohydrates (or carbs) in the food you eat, 

are the body's main source of glucose.

Diabetes does not mean that these carbohydrate containing 

foods must be completely cut out of diet,in fact, many of these 

foods contain nutrient that are essential to good health.

 However ,their intake must be carefully controlled and other 

blood glucose lowering tools such as exercise should be used

 to balance out their effects.For most people, special treats 

such as a slice of birthday cake can be an occational 

indulgence as long as portions are controlled and they're 

figured into the overall daily carbohydrate and calorie 

allowance.

Recent studies of large numbers of people with diabetes 

show that those who keep their blood sugar under tight 

control best avoid the complications that this disese can lead 

to.The experts agree that what works best for people with 

diabetes-and probably everyone-is regular exercise, little 

saturated and trans fat and a high-fiber diet.