Nutrition is the cornerstone of good health for everyone.
For those with diabetes, a common challenge is food – the type of food and the amount eaten. While eating well should be everyone’s objective, it is important to remember that food is crucial in diabetes management.
There is no “forbidden” food, but food choices are important. The easiest method to illustrate good choices is to create one’s own plate by drawing an imaginary line on the plate comprising the different food groups, with the objective of consuming large portions of non-starchy foods and a small portion of starchy foods.
New foods within each food category can then be tried without affecting the general objective.
General advice on food is available from the doctor, and specific information for the particular needs of an individual are available from a dietitian, to whom referrals should, ideally, be made at the initiation of treatment, and from time to time depending on the clinical situation.
Food portions vary with individuals. Depending on a person’s requirements and nutritional goals such as weight loss, blood glucose control or fasting, advice on the amount of each food group will vary.
The food groups are fruits and vegetables; dairy products; proteins; starchy foods; and foods high in fat and/or sugar.
Fruits and vegetables are low in calories and fat, have large amounts of vitamins, minerals and fibre, and are useful in protecting against high blood pressure, heart disease, stroke and certain cancers.
The objective is to consume at least five portions daily – a portion being roughly what fits into the palm of the hand. Fresh fruits and vegetables are preferred. The choice of a variety of colours will provide a useful mix of vitamins.
Dairy products like milk and yoghurt contain calcium, which helps to keep the bones and teeth strong. They are also a good source of protein.
As some are high in fat, lower-fat alternatives have to be chosen, but it is important to be aware of any added sugar.
The objective is to consume three portions daily – a portion being roughly equivalent to 200ml of milk.
Meat, fish, eggs and beans are foods that are high in proteins. These are required for building and replacing muscle cells. They also contain iron needed for red blood cell production.
Omega-3 oils found in oily fish like sardines and mackeral can also help protect against heart disease. The alternatives for vegetarians are tofu, soya, beans, pulses and lentils.
The objective is to consume some proteins daily and two portions of oily fish weekly.
Starchy foods like rice, bread and pasta contain carbohydrates which are broken down into glucose, which is then used as an energy source.
Carbohydrates that are slowly absorbed in the gut are preferred as they will affect blood glucose less, and they also help keep one feeling full for a longer time. Starchy foods are low in fat. High-fibre ones like wholemeal and wholegrain also help in regular bowel action.
The objective is to consume some starchy foods daily, especially the wholegrain types.
Depending on the goals of treatment, some diabetes patients may be advised to estimate the amount of starchy foods consumed, spread the intake during the day and/or choose healthier foods.
Foods high in fat and sugar are not required by the body. However, they may be taken if controlled. Sugary drinks and food increases the blood glucose; so they should be substituted with low-calorie alternatives.
The intake of saturated fats can be reduced by replacing lard, butter and ghee with unsaturated fats like olive and sunflower oils. The objective is to avoid foods that are high in fat and sugar.
Excessive salt intake may contribute to high blood pressure, which leads to heart disease and stroke. It is also advisable to avoid or reduce the consumption of processed foods.
The body enters into a fasting state about eight hours after the last meal.
Individuals may fast for a longer time for religious or cultural reasons. The bodily changes during fasting depend on the duration of the fast.
Initially, the body will use stored glucose as an energy source.
Later, stored body fat will be broken down to provide energy. Although the use of stored body fat will, in the long run, lead to weight loss, which in turn, can lead to better glucose control, it is not advisable to use fasting as a method of losing weight.
When fasting, eating patterns will vary. It is essential not to overeat and to stick to a balanced diet.
Fasting diabetics are advised to eat foods like rice, chapatti and dhal more slowly, together with fruits and vegetables, just before commencing the fast.
This will help keep one feeling full longer and keep blood glucose levels more stable during the fast.
Upon breaking fast, it is important to consume only small amounts of foods that are high in sugar and fat as excess will lead to weight gain.
It is important to avoid dehydration by drinking plenty of water and sugar-free drinks. If one has diabetes and a sweet tooth, sweeteners should be used instead of sugar.
If the fast is broken for any reason, the normal meals should be continued for the rest of the day. The fast can be made up at a later date.
Blood glucose levels need to be checked more frequently as they may drop too low (“hypoglycaemia”), especially if one is on diabetic medications and/or there is illness.
If there are symptoms of hypoglycaemia, e.g. sweats, shaking and disorientation, the fast has to be broken immediately and treatment (glucose tablets, sugary drinks, followed by a snack) commenced.
With fasting, the risk of high blood glucose levels (“hyperglycaemia”) may increase due to the change in eating patterns. This may lead to a serious complication called ketoacidosis.
The symptoms of hyperglycaemia include increased thirst, passing large amounts of urine and/or marked tiredness. Immediate medical attention should be sought whenever such symptoms arise.
Prior to the commencement of fasting, it is advisable to discuss with the doctor about medications and the maintenance of good blood glucose control.
The time, type or dose of medication may have to be altered, e.g. insulin users will require less insulin before commencing fasting and the insulin type may need to be changed.
The risk of aggravating diabetic complications such as poor vision or heart or kidney disease is increased by fasting and consideration needs to be given whether fasting is advisable.
Dr Milton Lum is a member of the board of Medical Defence Malaysia. The views expressed do not represent that of organisations that the writer is associated with.