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Sweet Surrender
Dr Pratap S Desai
calls diabetes ‘a sweet disease that can turn really sour’. He tells
Reema Sisodia about the causes of the ailment and how to control it
Pranav Malhotra (name changed), assistant vice president,
Citibank, was in a marathon meeting for over four hours when he started experiencing
a feeling of uneasiness, dryness in the month and also started sweating despite
being in an air conditioned conference room. He was suffering from hypoglycaemia,
caused due to long gaps in food intake, which affects patients with diabetes.
And he’s not the only one suffering from this ailment. Many such cases
are on the rise especially amongst new age corporates.
 People
suffering from diabetes or having a genetic record of diabetes, need to first
get their act together. Negligence of this serious disorder is a crime as this
sweet sickness can turn sour, putting you off-balance.
Recent statistics reveal that more than 40 per cent
of business travellers suffer from ‘Diabetes Mellitus’. Most of them
are in the age group of 35 to 45 and alarmingly, the percentage is rising and
also affecting the younger age group. Diabetics who are frequent travellers
are a peculiar case in point as they are constantly changing countries and time
zones, which results in erratic food schedules and patterns, lack of proper
diet and irregular treatment and follow-ups. On the other hand, to fight diabetes
one needs to follow a strict diet, take regular medicines, follow a set pattern
for food intake and exercise regularly. Hence, though the cause of diabetes
is primarily hereditary in nature, it’s the above mentioned mis-match that
aggravates the disorder.
While travel cannot be eliminated or avoided, certain
measures and regimentation is an absolute must.
Diet
Modification of diet is the most important aspect in
the therapeutic plan for patients. Diet therapy consists of the following:
- Maintenance of proper nutrition.
- Total number of calories ingested.
- Individual food sources that make up these calories.
- Distribution of calories throughout the day.
- Balance food intake with drug therapy.
- A good mix is:
5-20 per cent calories from proteins.
7 per cent calories from saturated fats or equal to 7 per cent calories from
polyunsaturated fats.
55-60 per cent calories from carbohydrates.
300 mg cholesterol per day.
Principles of a ‘Health Diet’
- Low fat.
- No simple sugars.
- High fibre.
- Small frequent meals.
- No fasting, no feasting.
- No fried, fast foods.
- No white food: maida, sugar, salt.
 Selection,
moderation and restriction are the key words in planning. The entire success
of dietary modification in a diabetic subject depends on the judicious selection
of carbohydrates, adequate protein intake and a determined restriction of total
fat intake. Attainment of optimal body weight results in marked reduction of
hyperglycaemia and increase in target cell response to insulin.
Ideal body weight (IBW) of a person can be calculated
by the following formula:
IBW (in kg) = Height in cm - 100 (for men) and - 105
(for women).
The obese and the overweight must be encouraged to
reduce weight. An energy deficit of 500 Kcal daily, will help the patient reduce
500 gm every week.
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| The perfect amount of energy (calories) to
be consumed is 25-30 kcal per kg of ideal body weight (IBW).
Carbohydrates
 Must
comprise 55-60 per cent of total calories. Encourage consumption of complex
carbohydrates, ie. mainly grains, cereals, pulses, beans, vegetables,
and salads. Avoid simple and refined carbohydrates like sugar, honey,
maida and jaggery. Avoid bakery products or deep fried items.
Protein
Must comprise 0.8 g/kg of body weight, supplement
for pregnancy, lactation and growth. Include a small quota of animal proteins
- fish, chicken, milk and yogurt. Avoid cattle meat (red) and egg yolk.
Fats
Must comprise 20-25 per cent of total calories.Total
fat intake in the form of cholesterol per day 300 mg.
When prescribing fat in the diet one should
take into account the invisible fat in the diet which nearly contributes
to 50 per cent of the required fat. None of the available oils are ideal,
therefore blending is recommended.
The choice of cooking oil should be as follows:
- Use an oil which has a moderate quantity
of Linoleic acid like groundnut, oil, rice bran or sesame.
- Use any of the above oils with alpha linoleic
acid containing oil like mustard and soya bean oil.
Dietary Fibres
 Must
comprise 30-40 g/day, preferably from natural sources. Avoid loss from
refining and processing. Indian diet is rich in fibre and generally does
not require addition of fibre supplements. However most modern diets are
deficient in fibre due to westernisation.
Fruits
Consume one fresh fruit per day. Avoid juices.
Ideal fruits are citrus fruits, orange, sweet lime, guava, apple, papaya
and watermelon. They provide vitamins and fibre. One portion contains
about 40-50 unit calories.
Common Salt
Up to 6 g/day. Reduce intake to 4 g/day in
afflicted with hypertension, renal failure and heart problems.
Tobacco/ Smoking
Avoid smoking and use of tobacco in any form.
Condiments and spices
Include in diet plan. Provide antioxidants,
trace elements, minerals and omega-3 fatty acids.
Alcohol
Avoid if possible. If not, drastically restrict
it. It is utilised as carbohydrates, one gm of alcohol provides seven
calories. Alcohol may exacerbate neuropathy, dysipiedmia, obesity and
may worsen the control of diabetes and cause hyperglycemia.
Artificial sweeteners
Use of aspartame in limited quantity is acceptable.
The maximum permitted consumption range from two-four mg/kg/day. Avoid
in pregnancy and lactation.
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(Pratap Desai is a consulting physician and diabetes specialist.)
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