Question

How can you best provide education to a 40 year old individual who is obese and a newly diagnosed diabetic patient who has to make solid adjustments to her food intake and portion sizes? What will you suggest?

Answer 1

The suggestions can be divided into

1. Diet
2. Exercise

The patient needs to modify her diet as follows

1. Energy requirement
   • Most patients of diabetes are overweight
   • It is important for them to maintain a calorie deficit
   • This can be achieved by calculating the caloric requirement ( based on the activity level). Then subtract this value by 500. The resultant value should be the target caloric intake.
   • The macronutrient should provide this target caloric intake in a specific proportion.
     • Carbohydrates should provide = 50 -60% of the total caloric intake
     • Protein - 10 - 15% of the total caloric intake.
     • Fats - 15 - 30% of the total caloric intake
2. Carbohydrates -
   • Consume complex carbs over simple carbohydrates
   • Example of complex carbs - whole wheat, Pulses, legumes, brown rice, guava, grapefruit, apple, strawberries - these types of carbs has a low glycemic index.
     • They do not spike your blood sugar levels.
     • They give you a feeling of satiety and prevent craving.
   • Example of simple carbs - sugar, toffy, candies, sweetmeats. - avoid these types of simple carbs as they increase your blood sugar quickly.
   • Include dietary fibers like carrots, radishes, cucumbers, green leafy vegetables.
     • They keep your blood sugar levels in check.
     • They keep your bowel movement regular.
     • They prevent the absorption of fats.
3. Fats -
   • Saturated fatty acids should be < 10%.
   • If the serum LDL level is >100mg/dl, the saturated fatty acid levels should < 7%
   • Include foodstuff containing mono-unsaturated fatty acids (10-15% of total energy content) - Olive oil, canola oil, peanut oil, sesame oil, avocado, almonds
   • Include foodstuff containing polyunsaturated fatty acids - Corn oil, soya bean oil, sunflower oil, fish - anchovy, sardine, mackerel, salmon.
   • Avoid reheating cooking oil - it increases the levels of trans fat
   • Preferred cooking oil - olive oil, rice bran oil, canola oil ( they are all rich in polyunsaturated fatty acids)
   • NO cooking oil is perfect. Use a mixture of oils for cooking
4. Protein-
   • total daily intake is 1g/kg body weight per day
   • Veg protein sources - tofu, soy, cottage cheese, milk, Quinoa
   • Non-veg sources - Fish, chicken, beef, turkey
5. Limit salt intake -
   • < 5 gm of table salt ( < 2gm sodium)
   • Avoid foodstuffs with preservatives.
   • Using rock salt in the diet reduces the incidence of hypertension
6. Reduce alcohol consumption
   • Woman - 1 drink/ day ( 30 ml whisky/gin/ vodka or 120 ml of wine or 300 ml of beer )
   • Man - 2 drinks/ day
   • If serum cholesterol is > 500 mg/dl or there is liver dysfunction - Stop alcohol completely.
7. Avoid eating out. Fast foods than to have a higher level of salt ( sodium) increases the risk of hypertension.
8. Prepare your meals in advance. Carry lunch boxes if you are traveling to avoid eating outside
9. Carry glucose biscuits, toffy, candy in your purse, handbag while traveling to deal with a hypoglycemic attack.

Exercise - It is a good idea to start exercising

1. 60 mins of exercise at least 3 times a day
2. The exercise regime should include weight training and cardio.
3. Carry glucose biscuits, toffy, candy in your gym bag to deal with a hypoglycemic attack.
4. Consume plenty of fluids. ( if you have renal disease, you may have to restrict your fluid intake)