Diabetes And Diet Management

The silent killer, diabetes mellitus or diabetes, in which a person has elevated blood sugar levels, is one among the most prevalent chronic disorders since globally (as of 2012) nearly 346 million people are diabetic. The increase in blood sugar levels may be due to either the inadequacy of insulin production or non-response of body cells to the insulin produced. The classical symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

Types of Diabetes Mellitus:

  1. Type 1 diabetes:

In this type of diabetes, the body fails to produce insulin and so the person would be in a position to inject insulin or wear an insulin pump. This type of diabetes was previously known as ‘Insulin dependent diabetes mellitus’ (IDDM) or ‘juvenile diabetes’.

  1. Type 2 diabetes:

This form of diabetes occurs as a result of, a condition in which the body cells fail to utilize insulin properly (insulin resistance) or there would be insulin deficiency. This type of diabetes was previously known as ‘Non-Insulin dependent diabetes mellitus’ (NIDDM) or ‘adult-onset diabetes’

  1. Gestational diabetes (GDM):

GDM occurs in pregnant women without previous occurrence of diabetes. This type of diabetes usually resolves after delivery.

Other types of diabetes mellitus include congenital diabetes (due genetic defects of insulin secretion), cystic fibrosis-related diabetes, steroid induced diabetes (due to high doses of steroid induced) and several forms of monogenic diabetes.

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Management of diabetes mellitus:

Management of diabetes is focused mainly on keeping blood glucose levels under control or close to normal range without causing either hypo or hyperglycemia. This can be achieved by a combination of appropriate medications, diet and certain lifestyle modifications.

Nutritional management:

Nutritional care and proper dietary practices are often said to be the foundation of diabetes care. According to American Diabetic Association,(ADA, 2012), the following are the recommendations for nutritional management of diabetes.


  • Carbohydrate content of the diet for diabetic people should provide less than 60–70% of energy intake. However, the metabolic profile and need for weight loss also should be considered when determining allowances.

  • Foods containing complex carbohydrate (coarse cereals, millets and whole grains) should be included in a diabetic diet. People with diabetes should be encouraged to choose a variety of fiber-containing foods such as legumes, fiber-rich cereals (>5 g fiber/serving), fruits (like guava, apple etc) and vegetables (like green leafy vegetables, ladies finger etc).

  • Since the glycemic effects of carbohydrates must be taken care of, the total amount of carbohydrate in meals or snacks is more important than the source or type of carbohydrates.

  • Non-nutritive sweeteners can be used within limits as suggested by the Food and Drug Administration (FDA).

  • Individuals who are on intensive insulin therapy should adjust their pre-meal insulin doses based on the carbohydrate content of meals as per the practitioner’s suggestion.


  • Protein should constitute around 15-20% of total energy intake of diabetic persons. This can vary depending upon the renal function of the person.

  • High protein foods like legumes, pulses etc should be included in the diet.

Dietary Fat:

  • Less than 10% of energy intake of diabetic person should be derived from saturated fats. For individuals (i.e., persons with LDL cholesterol ≥100 mg/dl) saturated fat intake must be even more lowered to <7% of energy intake.

  • Dietary cholesterol (foods like red meat) intake should be <300 mg/day. For individuals (i.e., persons with LDL cholesterol ≥100 mg/dl) it should be <200 mg/ day.

  • Intake of trans- unsaturated fatty acids (deep-fried foods) should be minimized.

  • Two to three servings of fish (per week) should be recommended for dietary n-3 polyunsaturated fat.

  • Polyunsaturated fat rich foods (like flax seed, walnut etc) intake should be ∼10% of energy intake.

Micronutrients (Vitamins and Minerals):

  • Routine intake of vitamin or mineral supplements is generally not recommended for people with diabetes except in cases of people with inadequate food consumption or other special needs.

  • Daily vitamin and mineral requirements should be obtained from a nutritionally-balanced diet.

Dietary and life-style modification tips for diabetes management:

  • Small frequent meals must be taken in order to maintain the proper blood glucose levels.

  • Adequate fluid intake is recommended (1.5-2 lit/day) in order to prevent dehydration.

  • Rice or starchy food intake must be restricted to once a day. High sugary foods must be avoided.

  • Whole fruits must be eaten instead of fruit juices.

  • Physical activity must be a part of daily routine and should remain as active as possible.

  • Alcohol intake and smoking must be limited. According to ADA (2012), if individuals choose to drink alcohol, daily intake should be limited to one drink for adult women and two drinks for adult men. One drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of distilled spirits.

Medical nutrition therapy for diabetic people should be individualized, with consideration and preferences given to the individual’s usual food and eating habits, metabolic profile, treatment goals, and desired outcomes. Dietary treatment or practices must be followed under the guidance of a registered dietician (RD). Medication, dietary restrictions and life-style modifications must be strictly followed in order to cope up with the effects of diabetes and to lead a disease-related stress free life.