DIABETES DIET

Monica Adhikari*
Consultant Dietician, Great Ormond Street Hospital, London.*
Normally the amount of glucose in our blood is carefully controlled by the hormone insulin, which helps the glucose to enter the cells where it is used as fuel by the body.

Diabetes is a common condition in which the amount of glucose (sugar) in the blood is too high because the body is unable to use to use it properly. This is because the body's method of converting glucose into energy is not working, as it should.

Children with diabetes
Most of the children will have type I diabetes meaning they can no longer produce insulin because the cells in the pancreas that produce it have been destroyed. Without insulin, the child's body cannot use glucose.
The onset of children's diabetes usually occurs in late childhood but can present itself from early infancy through to late adulthood.

What are the symptoms?
The symptoms develop in matter of days or weeks. They are as follows:

- Tiredness
- Thirst and frequent drinking (called polydipsia)
- Frequent urinating (called polyuria)
- Bedwetting (nocturnal enuresis)
- Loss of appetite and weight loss
- Infection on skin or around the mouth- particularly due to yeast (candida) or boils.

Diabetes cannot be cured but it can be treated effectively. The aim of the treatment is to keep the blood glucose level close to the normal range (4-7mmol,rising to no longer than 10mmol two hours after meal) so it is neither too high (hyperglycaemia) nor too low (hypoglycaemia)

Treating diabetes:
Most children with diabetes will be treated by combination of insulin and a balanced diet, with the recommendation of regular physical activity.
The diet for children with diabetes is based on balanced diet and variety in the diet.

Foods can be divided into five main food groups.

To eat the balanced diet the child should be aiming to eat food from all these groups in right proportion (as shown in the chart below)


Cereal Group Vegetable and fruit Group Milk and dairy Group Meat, fish and alternatives Foods containing Fat and Sugar
What is included - Bread
- Potato, sweet potato, yam (suran)
- Bhakri or rotla (Bajra, Jowar or rice flour)
- Rice
- Dhalia (broken wheat)
- Rava (suji)
- Rice flakes (poha)
- Chapatti or paratha
- Noodles
All fresh fruit and vegetables including leafy vegetables and dried fruits
Milk, cheese and yoghurts (Dahi) - Chicken
- Fish
- Mutton
- Nuts
- Beans, pulses/dal Soya beans or nutrela granules
- Butter
- Oil
- Ghee
- Cream
- Chocolates
- Cakes
- Wafers/crisps
- Ice cream
- Pastries
Main nutrients - Carbohydrates (starch)
- Fibre
- Some calcium and iron
- B vitamins
- Vitamin C
- Vitamin A
- Folates
- Fibre
- Calcium
- Protein
- Vitamin B122
- Vitamin A & D
- Iron- Proteins
- B Vitamins especially B12
- Zinc
- Magnesium (moderate amounts)
Fat provide some essential fatty acids.
Recommendations
- Eat a lot of them
- Helps to maintain blood glucose levels
- Try to avoid: frying them too often e.g.: potato chips, puri. Or applying too much ghee or oil or butter on bread, chapatti, rice or paratha.
- Eat a lot of them
- To Avoid: adding too much oil or ghee while making vegetables and to avoid adding sugar to fruits.
Children should have at least 500ml milk in whole day. Milk could be in form of yoghurts, milkshakes. To be included in each meal. At least have 2 servings in whole day.
 1 serving=1 katori of curry with chicken or dal or 1 katori of pulses or 1 egg or handful of nuts.
Should be included everyday but in small amounts.
 All sugary foods should incorporated along with meals or before physical activities when extra energy is required.


Some ideas for day's meal and meal pattern:

Eating Times: Meals and snacks should be eaten at regular intervals. The child needs to eat at regular times in order to maintain stable blood glucose levels. A missed meal or delayed meal or snacks could lead to lead to hypoglycaemia.

Physical Activity:
Physical activity should be an important part of child's day. Preparations are needed because all forms of physical activity, such as swimming, walking, running, playing cricket, use up glucose. If the child does not eat enough before starting an activity, their blood glucose level will fall too low and they will experience hypoglycaemia.

Before activity: It is important for the child to have an extra snack like (slice of toast or sandwich or thepla or khakra or plain biscuit or any fruit). If the activity is after lunch, it may be easier for child to have slightly larger meal.

During activity: These should be a sugary drink or sweet nearly in case the child's blood glucose level drops too low, which could lead to hypo.

After activity: The child may need to eat some starchy food, such as sandwich or thepla but this will depend on timing of activity and level of exercise taken.

Sweeteners:
Artificial sweeteners are chemicals, which do not contain sugar and therefore contain no calories, they will not raise your blood glucose or affect your weight. They can be useful in diabetes in providing variety without upsetting your blood glucose control. They are intense and so you need to use only small amounts of them to sweeten foods and drinks. They come in different forms: tablet, granules (for sprinkling) and liquid. You can buy them from supermarkets and chemist. They do taste different from each other, so experiment to find one to your taste.

Are sweeteners safe?
Sweeteners like all food additives undergo rigorous safety assessments and evaluation. Based on these tests the Government sets "Acceptable Daily Intakes" (ADI) often based on adults or per kg body weight. However it is very difficult to set limits as people vary in their consumption and individual foods do not state the amount of sweetener present in the product. The current advice is that the products are seen to be safe, but by using a variety of different sweeteners you avoid having too much of an individual one.

How to use sweeteners?
- In drinks such as tea or coffee - 1 tablet = 1 teaspoon sugar <
- In a dessert such as custard - 3-4 tablets = 1 teaspoon sugar
- On cereal - 3-4 tablets = 1 teaspoon sugar

Sweeteners can be used instead of sugar when making milkshakes, khir, tea, coffee, and milk. 1 tablet will provide the same sweetness as 50g of sugar.
When making dishes such as milk puddings and custards add the sweetener at the end of cooking.

Eating sweets:
One can have sweets. If possible one should have with meals and have in moderation.
Also once a while treat is good.

Hypoglycaemia:
Hypoglycaemia is the most common short-term complications in diabetes and occurs when blood glucose levels falls too low. hypoglycaemic episode are especially likely to happen before meals. This can happen as results of:

- Too much insulin
- Not enough food to fuel an activity
- Too little food at any stage of the day
- A missed meal or delayed meal or snack
Cold weather
- The child vomiting.

How to recognize a hypoglycaemic episode:
Hypoglycaemic episodes happen quickly, but most children will have warning signs that will alert them.
These warning can include:
- Hunger
- Drowsiness
- Pallor
- Headache
- Sweating
- Glazed eyes
- Trembling or shakiness
- Lack of concentration
- Mood changes especially angry or aggressive behaviour.

Treating a Hypoglycaemic episode:

Immediately give something sugary e.g.:
- Sugar/rock sugar
- Fruit juice
- Glucose tablets
- Fizzy drinks (thumbs up, limca, goldspot, pepsi)

Hypostop, honey or jam can be massaged into child' s cheek if they are too drowsy to take anything themselves. Follow this with some starchy food to prevent the blood glucose from dropping again:

- Sandwich
- Fruit
- Thepla
- Khakra
- Piece of cake
- Two biscuits

Thus, for diabetes it is important to follow healthy eating and for tips for them are as follows:

- Eat regularly:
* To give your child to eat every 3-4 hrs.
* Do not skip meals or miss meals.

- Eat plenty of starchy foods:- Include starch portion at each meal for e.g. rice, Chapatti, paratha, bread, poha (rice flakes), Suji (rava), dahlia (broken wheat).

- Eat less fat:
* To avoid too much fried foods
*Eat plenty of fruits and vegetables

- Regular physical activity

- It is important to continue to take your insulin or diabetes tablets when you are ill even if you lose your appetite.

What should I eat when I am not feeling well?
If you can not manage to eat normal meals make sure you eat or drink some carbohydrate containing foods or drink regularly throughout the day. You may need to eat small amounts every hour or two, especially if your blood glucose is low.
Carbohydrate is contained in starches (such as bread, biscuits, rice, pasta, cereals, potatoes), milk, yoghurt, fruit, fruit juice, sugar and sugary foods.
Below are some examples of carbohydrate containing foods you could try:-

- glass (or small carton) of fruit juice
- pot of yoghurt, rice pudding or mousse
- glass of milk (OR milk shake, malted milk, or drinking chocolate)
- glass of Complan
- bowl of ice cream
- glass of lemonade
- mug of soup
- slice of toast

Drink plenty of fluids to avoid dehydration

Always remember: When going on a trip or holiday to take copy of the diabetes record card.





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