- Living with Diabetes
Diet and Type 1 Diabetes
In Type 1 diabetes your immune system mistakenly destroys the cells in your pancreas which produce insulin. The body treats these cells as invaders and attacks them as a result over a period of time the pancreas stops producing insulin or makes inadequate insulin. People having type 1 diabetes replace this insulin by injecting it into the body with a syringe or a pump. An absence of insulin causes a rise in blood glucose levels higher than normal usually referred to as hyperglycemia (higher than normal blood sugar).
Management of type1 diabetes includes insulin administration, diet, physical activity, self-monitoring of blood glucose and avoiding hypoglycemia (lower than normal blood sugar) and diabetic ketoacidosis (DKA, presence of ketone bodies in the blood and urine). Diet and physical activity are critically important in managing the ABCs of diabetes (A-HbA1C, B- blood pressure, C-cholesterol).
The goals of diet management of type 1 diabetes include; supplying optimum nutrition to maintain good health, to provide adequate calories for maintaining ideal body weight, normal growth and development (in children), maintaining optimal blood sugar control and blood lipid levels and to minimize acute and chronic complications of diabetes mellitus.
This are mainly of two types – simple and complex. Those, which are readily utilized by the body are samples carbohydrates, which can increase the blood glucose level quickly. Some examples of simple carbohydrates are sugar, honey etc. Complex carbohydrates are those which contribute bulk (e.g. fibre) in the diet thus delaying the rate of digestion, like wheat, dhal etc. A diabetic person has to give preference to complex carbohydrate in order to stabilize his blood sugar.
When planning a meal plan for type 1 diabetes factors like weight, age, sex, physical activity, economic, social and cultural backgrounds should be considered. A qualified dietitian or nutritionist can help you with this. A good blood sugar control can be achieved by eating a consistent amount of food at the same time every day and taking your medications. Skipping meals or delaying your meals often puts you at risk for low blood sugar levels.
Carbohydrates and Type 1 Diabetes
The main source of energy in the diet is carbohydrates. Carbohydrates rich foods are those with a good amount of starches, sugars, soluble fibers for example grains, vegetables, fruits, dairy products. Fats and oils do not contain carbohydrates. Carbohydrates have a direct impact on blood sugar levels where as protein or fats have no impact. Most Indian vegetarian diets are rich in carbohydrates. Therefore, eating a consistent amount of carbohydrate will help in controlling blood sugar.
As the name suggests it is counting the grams of carbohydrates to be eaten during a meal. Dietitians determine the amount of carbohydrates required by you based on your normal eating habits, current body weight, activity level and nutritional goals. Anywhere between 55-65% of the total caloric intake can be achieved through carbohydrates.
Once a dietitian arrives at this figure the carbohydrates are then divides for each major and minor meal consumed based on personal preferences, meal timing and insulin regimen. Food labels now-a days provide the amount of carbohydrates per serving size. It is sensible to keep a record of foods eaten and the pre and post sugars to understand the variations during the initial stages of insulin therapy.
Serving size and grams of fiber also are taken into consideration during carbohydrates counting. Consuming more than one serving will increase the number of carbohydrates and the dose of insulin required to normal the blood sugars. One should therefore multiply the number of servings by the grams of carbohydrates. If a food has >5gms of fiber per serve, then subtract the grams of carbohydrates from fiber.
It helps to know foods that have 15g of carbohydrates per serving. Given below are examples of foods having 15g of carbohydrates,
|Cereals||Amount (g)||Fiber (g)|
|Rice raw milled||20||-|
|Wheat flour (Whole)||23||-|
|Redgram dal (tur dal)||30||-|
|Green gram (whole, cherupayar)||30||1.2|
|Bengal gram (kadala)||25||1|
|Green leafy vegetables||150||3|
|Roots and tubers||50||.5|
Once you know this one can easily exchange foods giving the same carbohydrates count. For e.g.: 100gms of an apple can be exchanged 2/3rd cup of upma or 2/3rd cup of rice.
People on intensive insulin therapy can adjust their insulin dose based on the grams of carbohydrates that can be ingested and their pre meal sugars. This dose is obtained by dividing the number of carbohydrates to be consumed by the number of carbohydrates covered by one unit of insulin (insulin to carbohydrate ratio). Doses of insulin is then adjusted on the basis of this. These are now available in automated insulin pumps.
For example, if the insulin: carbohydrates ratio is 1:10, then for every 10gms of carbohydrates you would need 1unit of insulin. If you ate a meal with 80gms of carbohydrates, you would require 8units of insulin and so on.