Download FOOD AND NUTRITION RESEARCH INSTITUTE Nutritional

FOOD AND NUTRITION
RESEARCH INSTITUTE
Nutritional Handbook for
Persons with Diabetes
(2008)
Food and Nutrition Research Institute
General Santos Avenue, Bicutan, Taguig City, Philippines
Telephone Nos.: 837-1839, 837-2071 to 82 local 2296,
8378113 to 14 loc. 318
Fax No.: (632) 837-3164
E-mail: [email protected], [email protected]
Website: http://www.fnri.dost.gov.ph
Diabetes Nutritional Handbook
Republic of the Philippines
Department of Science and Technology
FOOD AND NUTRITION RESEARCH INSTITUTE
General Santos Avenue, Bicutan, Taguig City, Philippines
Telephone Nos.: 837-1839, 837-2071 to 82 local 2296, 8378113 to 14 loc. 318
Fax No.: (632) 837-3164
E-mail: [email protected], [email protected]
Website: http://www.fnri.dost.gov.ph
FNRI Management Committee
Director
Mario V. Capanzana, PhD
Chief Science Research Specialist
Technology Diffusion and S&T Services Division
(TDSTSD)
Zenaida v. Narciso, PhD
Scientist III & Chief Science Research Specialist
Nutrition and Food R&D Division (NFRDD)
Celeste C. Tanchoco, DrPh
Chief Administrative Officer
Finance & Admininstrative Division (FAD)
Chief Science Research Specialist
Nutritional Assessment and Monitoring Division
(NAMD)
Supervising Science Research Specialist
Food Quality and Safety Section (FQSS)
& Food Analytical Service Laboratory (FASL)
Supervising Science Research Specialist
Nutrition and Food Research & Development Section
(NFRDS)
Planning Officer IV
Secretariat, MANCOM
Senior Science Research Specialist
& FANEA President
Ferdinand B. Oamar, DPA
Imelda A. Agdeppa, PhD
Teresita R. Portugal
Joyce R. Tobias
Teresa S. Mendoza, MSPH
Cynthia S. Nones
HANDBOOK COMMITTEE MEMBERS
Chairman
Rodolfo F. Florentino, MD, PhD
Director,* FNRI
Technical Working Group
Celeste C. Tanchoco, RND, MPH
Supervising Science Research Specialist*
MND, FNRI-DOST
Arlene S. Natividad, RND
Science Research Specialist
MND, FNRI-DOST
*At the time of handbook development
63
Diabetes Nutritional Handbook
FOREWORD
Diabetes education, or teaching a person with diabetes about his condition is an integral component of the medical
therapy of diabetes, the others being diet, exercise and medication. This handbook was developed primarily for individuals with diabetes. It contains basic information about diabetes – its nature, its treatment and important factors
to achieve diabetes control – in a way that most people will understand and appreciate. Although some technical
terms are used, they are terms that a person with diabetes will encounter when reading even popular literature on
the subject. A glossary of technical terms is included in an appendix.
In this handbook, the food lists in Appendix are based on the 1994 edition of “Food Exchange Lists for Meal Planning.” Appendices B and C give the food exchange equivalents of some commonly used alcoholic beverages and
non-alcoholic beverages, respectively.
It is hoped that this handbook will be useful not only to individuals with diabetes but also to members of their families
because they play an important role in the total care of the patient.
(Sgd.) RODOLFO F. FLORENTINO, M.D., Ph.D.
Director*
Food and Nutrition Research Institute
64
*At the time of book development
Diabetes Nutritional Handbook
ACKNOWLEDGEMENT
We are most grateful for the encouragement and unfailing support of our co-workers, colleagues and physicians, and
all those who, in one way or another, helped in making this handbook possible.
We wish to thank the members of the Food and Nutrition Research Institute Technical Committee for their valuable
comments and suggestions and for their patience in reviewing the manuscript.
We wish to acknowledge a debt of gratitude owed to Dr. Augusto Litonjua, Mrs. Sanirose Orbeta, Mrs. Rhodie Imperio
and Mrs. Imelda Cardino for sharing their technical expertise and for their careful reviews of the manuscript.
A special word of thanks to Mrs. Velona Corpus for her painstaking editorial and technical assistance; to Mrs. Minnie
Quemuel for her critique; to Miss Alma Gammad for helping us prepare the evaluation questionnaire; and to Miss
Gwendelyn Serrano, Arnel Orea and Evelyn Baldemor for the layout and illustrations.
We express our appreciation to Dr. Ricardo Fernando for his unceasing interest in the nutritional aspect of diabetes
care.
We are also indebted to all the diabetic patients who inspired us in developing this handbook.
www.TheFilipinoDoctor.com l Sign up and open your clinic to the world.
65
Diabetes Nutritional Handbook
TABLE OF CONTENTS
Foreword
Acknowledgement
Introduction
What is Diabetes?
What is Insulin?
Medical Management of Diabetes
Role of Diet in Diabetes Management
Importance of Weight Control
Calories
Carbohydrates
Protein
Fat
Cholesterol
Fiber
Artificial Sweeteners
Salt
Vitamin and Mineral Supplements
The Food Exchange Lists
Measuring and Weighing Foods
Processed Food
Meal Plan
Foods to Avoid
Free Foods
Guidelines for Special Situations
When eating away from home
When you are sick
If You Must Drink
Exercise
Medications for Diabetes
Do All Persons with Diabetes Need Insulin Injections?
What are Oral Hypoglycemic Drugs?
Blood Sugar Testing
Personal Hygiene
Acute Complications of Diabetes
Chronic Complications of Diabetes
Appendices
Appendix A Food Exchange Lists
Rice Exchange
Meat Exchange
Low Fat Meat and Fish Exchanges
Medium Fat Meat and Fish Exchanges
High Fat Meat and Fish Exchanges
Processed Meat, Fish, Poultry Products, Beans
Milk Exchange
Vegetable Exchange
Fruit Exchange
Fat Exchange
Appendix B Alcoholic Beverages
Appendix C Beverage List
References
Glossary
66
64
65
67
67
67
67
67
67
68
68
68
68
68
68
68
68
69
69
69
69
69
70
70
70
70
70
70
71
71
71
71
72
72
72
72
73
73
74
74
74
75
75
76
76
77
77
78
79
79
79
80
Diabetes Nutritional Handbook
NUTRITIONAL HANDBOOK
FOR PERSONS WITH DIABETES*
INTRODUCTION
This handbook on diabetes is designed to help you in
planning your meals – what to eat, how much to eat
and when to eat – in accordance with your physician’s
prescription. It is intended to enlighten you on the nature
of diabetes, the important factors in maintaining control
and what to do when complications occur. It also includes
the importance of personal hygiene and some guidelines
for special situations.
The contents of this handbook will allow you to understand diabetes better and how to manage it in such a way
that you can enjoy a healthy and active life.
What is diabetes?
Diabetes mellitus, commonly referred to simply as diabetes, is a condition wherein the body is not able to use sugar as it should because the pancreas does not produce
enough insulin, or the available insulin is not effective.
When diabetes is not treated, blood sugar level rises, a
condition called hyperglycemia. As more sugar overflows into the urine (glycosuria), other symptoms occur
such as extreme thirst and hunger, weight loss, blurred
vision, and general weakness.
There are two major types of diabetes mellitus: insulin
-dependent (IDDM or Type I) and non-insulin dependent (NIDDM or Type II). The latter usually occurs in
overweight adults.
What is Insulin?
Insulin is one of the hormones produced by the pancreas.
It helps keep your blood sugar at the right level. Too much
production of insulin causes hypoglycemia or low blood
sugar level, while too little insulin brings about hyperglycemia or high blood sugar level. When the body cannot
produce enough insulin as is typical in insulin-dependent
diabetes, insulin from other sources must be injected.
MEDICAL MANAGEMENT OF DIABETES
The overall objectives in the management of diabetes
is to control blood sugar level at all times and prevent
complications. Good management of diabetes rests on
a balance of three interrelated factors: diet, exercise,
and insulin or oral hypoglycemic agents (diabetes medicines). A proper diet is the most important factor in the
management of diabetes. In addition, regular exercise
is indispensable in its successful management. Medications help lower blood sugar. Insulin medications are
injected while oral hypoglycemic drugs are taken by
mouth. Your physician will prescribe the appropriate
medication for you.
bringing the weight down to a desirable level, maintaining
that weight by eating an appropriate diet, and exercising
regularly. Insulin or oral drugs are used if diet therapy and
exercise fail to achieve control of the blood sugar level.
Whether your diabetes is managed by the diet and exercise alone, or with anti-diabetic medications, you should
be properly informed about diabetes. This will help you
understand its management. In fact studies have shown
that teaching patients with diabetes about this leads to
better control. Diabetes education is therefore considered
the fourth cornerstone of the medical therapy of diabetes
(the others being diet, exercise and medication).
Education involves accepting your condition and the fact
that you have to live with it through the rest of your life,
understanding the disease, knowing basic principles of
its treatment, being aware of the acute and chronic complications of poor control, and appreciating the rewards
of good control.
Learning to live with diabetes successfully requires determination and self-discipline. If you adhere closely to your
physician’s orders, stick to your diet, exercise regularly,
sleep and rest properly, and pay attention to personal
cleanliness, there is no reason why you should not live
a healthy and satisfying life. Your attitude towards your
ailment affects your physical health, thus, it is necessary
to keep a positive outlook.
ROLE OF DIET IN DIABETES MANAGEMENT
People with diabetes have different nutritional needs,
based on their body size, physical activity, laboratory
findings, medications used, and other factors, including
lifestyle. Thus, there is no one “diabetic diet” that is appropriate for all persons with diabetes. Your diet must be
planned for you, and with you, by a dietitian in accordance
with your doctor’s prescription.
Almost all foods you eat are converted by your body
into sugar. Some foods such as table sugar and other
kinds of sugars are absorbed into the blood more rapidly
than others. For this reason, you should avoid foods that
contain large amounts of sugar. Some doctors may allow
small amounts of sugar when diabetes is well controlled.
But unless allowed by your doctor, it is best NOT to add
sugar to any food you eat.
It is best to distribute food throughout your waking hours
since a large amount of food taken at one time will cause
your blood sugar level to increase abruptly.
Since you are more likely to develop hypertension and
heart disease than non-diabetics, limit your intake of fatty
foods, fried foods, added fats and oils as well as salt and
foods with high salt content.
In insulin-dependent diabetes, the pancreas produces little or no insulin at all. In order to control the level of blood
sugar, three things must be done: eat an appropriate and
prescribed diet, exercise regularly, and inject insulin daily.
By following your diet conscientiously, you will get better
results in the treatment of your diabetes and you will be
able to enjoy life more fully.
In non-insulin-dependent diabetes, the pancreas produces
some insulin but either it is not enough, or it is not working
properly. This type can sometimes be controlled merely by
Importance of Weight Control
*This handbook is orginally intended for nutritional counseling; thus, it cannot stand alone.
An important goal of dietary management is the maintenance of reasonable body weight because this is es-
Learn to access drug info on your cellphone. Send PPD to 2600 for Globe/Smart/Sun users.
67
Diabetes Nutritional Handbook
sential for good blood sugar control. Your body makes
and/or uses insulin best when you are at your desirable
weight. If you are overweight, try to lose the excess weight
until you reach the desirable weight. The doctor or the
dietitian, together with you can decide on an appropriate
or reasonable weight goal.
On the other hand, if you are underweight, work for weight
gain until your weight goal is reached.
Excess body weight puts stress on the body’s ability to
make insulin and increases the body’s requirement for
insulin. On the other hand, an underweight person with
diabetes may be prone to develop nutritional deficiencies.
After you have reached your weight goal, continue to
weigh yourself regularly. A sensible diet coupled with
a program of regular exercise will help you attain and
maintain normal weight.
Calories
The calorie is the measure of the energy we get from food.
When you take in more calories than what you need for
energy, the excess is stored as body fat and you gain
weight. When you take in less than your energy requirement, your body will use its own tissues to provide the
needed energy, and you will lose weight.
People with diabetes should therefore watch their calorie
intake. For children, it should be enough to promote normal growth and development; for adults, it should be just
enough to meet their energy needs so that they will maintain a desirable or reasonable weight, while pregnant and
lactating women should take in extra calories for the developing fetus and for breastmilk production, respectively.
Your doctor will tell you how much calories you can have
and the dietitian will help you plan a diet based on the
doctor’s prescription.
Carbohydrates
Carbohydrates are our main sources of calories. Carbohydrates may be complex, such as the starch in cereals,
tubers and some vegetables, or simple, such as the sugar
in fruits and table sugar itself. All carbohydrates are digested into and absorbed as sugars. Thus, the amount
of carbohydrate in your diet must be regulated.
Protein
Protein is essential for growth in children and for maintenance of tissues in adults. Pregnant women need extra protein for the growing baby inside her womb, while lactating
women must eat more protein for breastmilk production.
People with diabetes must avoid too much protein because they are prone to develop kidney complications.
Fat
Fats are concentrated sources of calories. Filipinos in
general do not have too much fat in their diets. But if
68
you are one of those who are fond of fried foods, pork,
sauces, salad dressings like mayonnaise, and other high
fat foods, you better cut down your intake of these foods.
A high fat intake can lead to a high level of cholesterol
(hypercholesterolemia) in the blood, and this in turn can
lead to hardening of the arteries (atherosclerosis). These
are common complications of diabetes.
Cholesterol
Cholesterol in the blood comes from the cholesterol in
the food we eat and the cholesterol produced by the
body itself. As mentioned above, a high level of blood
cholesterol increases the likelihood of cardiovascular
complications.
Fiber
Fibers are plant materials that cannot be digested in the
gastrointestinal (GI) tract. They are provided in the diet
primarily by cereals, fruits, vegetables, and legumes.
Fiber or bulk in the diet favors normal elimination and
promotes regular bowel movement.
Certain fibers may also help control blood sugar levels by
delaying absorption and increasing the body’s sensitivity
to insulin. For these reasons, eating a fiber-rich diet has
obvious advantages for diabetics like you. However,
experts now believe that it is not necessary to take in
the large amounts they used to recommend, 40 grams
per day which is about four times the amount in the
average Filipino diet. They recommend eating 5 serving
of fruits and vegetables everyday to get the amount of
fiber you need.
Artificial Sweeteners
Artificial sweeteners are substances that are used in
place of sugar because they have little or essentially no
calories and, consequently, no significant effect on blood
sugar levels and total caloric intake. Saccharine and
aspartame are the artificial sweeteners that have been
used widely. Acesulfame-K is also approved for use as
a sugar substitute.
The use of artificial sweeteners, however, should be
moderate especially by children and pregnant women
and only upon the advice of the physician.
Cyclamates are also artificial sweeteners but at present,
their use is not approved by the US Food and Drug
Administration.
Other sweeteners are: fructose, sorbitol, xylitol, and mannitol. They have the same number of calories as sugar
and have no advantage over regular table sugar.
Salt
Too much salt in the diet can worsen hypertension which
is common in people with diabetes. So, limit the amount
of salt you add to your food and avoid salty foods like
ham, bacon, tocino, and salty condiments like patis, toyo
and bagoong.
Diabetes Nutritional Handbook
Vitamin and Mineral Supplements
If you eat a varied and balanced diet everyday, you may
not need supplements, However, if your calorie prescription is less than 1400 calories per day, it will be good to
take in vitamin and mineral supplements.
The Food Exchange Lists
The Food Exchange Lists are groups of foods that will
help you choose the right kind and amount of foods. The
Exchange Lists allow variety in your diet and will give you
almost unlimited choices of foods.
Foods are listed under six main groups, namely: rice,
meat, milk, vegetable, fruit and fat. One portion of a particular food, called an exchange, is approximately equal
in calories and in the amount of protein, fat and carbohydrates to foods in the same group. They also contain more
or less similar amounts of vitamins and minerals.
Foods in any one group can be substituted or exchanged
with other foods in the same group although the sizes of
the serving portion may not be the same. Foods in one
group, however, cannot be traded for foods in another
group. For example, one piece of galunggong may be substituted for one slice of tenderloin because they are both
in the meat group, but one piece of galunggong cannot be
substituted for two slices of bread because galunggong
is in the meat group and the bread is in the rice group.
Always refer to the Food Exchange Lists at the end of
this handbook (Appendix A) when planning your meals.
Measuring and Weighing Foods
The measures and weights of food in the Exchange Lists
are for the edible portion or E.P. (raw or cooked) or the
portion that is customarily eaten. It is important to eat the
right serving sizes of foods in your meal plan. Each portion
of food should be measured accurately until you become
familiar with size of portions. Use a standard measuring
cup and set of measuring spoons. All measurements
should be level.
In this revised edition, as purchased or A.P. weights have
been included for the rice and fruit exchanges. A.P. refers
to the form of the food as purchased from the market that
still includes the peel or skin, seeds, etc. (refuse) or the
parts that are not usually eaten.
It will be useful to have a small scale for weighing some
foods. However, it is not entirely necessary as the lists
give the measures of food equivalent to one exchange.
Processed Food
When using processed food not listed in the Exchange
Lists – canned food, cured or processed food, ask your
dietitian about them. READ LABELS and avoid those with
added sugar, or with too much fat or salt.
Meal Plan
Your meal plan below is a guide which shows the number
of exchanges (food choices) you can eat at each meal
and snack.
The Food Exchange Lists help you plan your meals so
that you can keep your diabetes under control. You can
avoid monotony in your diet by varying the choice of foods
within a particular food group.
Your meal plan has been computed especially for you.
It can be adjusted if it is not working out for you. Consult
your dietitian regularly to review your meal plan and adjust
it according to your varying needs.
YOUR MEAL PLAN
Total Rice Exchanges Calories
Meat Exchanges grams Carbohydrate
Lean Meat grams Protein
Medium- grams Fat
fat Meal High-Fat
Meat
Milk Exchanges
Vegetable Exchanges
Group A Vegetables
Group B Vegetables
Fruit Exchanges
Fat Exchanges
Meal Pattern
Sample Menu
Breakfast
Fruit
Meat
Rice
Fat
Milk
Household
Measure
AM Snack
Lunch
Meat
Vegetable
Fat
Rice
Fruit
PM Snack
Supper
Meat
Vegetable
Fat
Rice
Fruit
Midnight Snack
www.TheFilipinoDoctor.com l Sign up and open your clinic to the world.
69
Diabetes Nutritional Handbook
Foods to Avoid
All foods containing large amounts of added sugar such
as sweets and desserts should be avoided. Exceptions
are special circumstances such as preparing for strenuous activity or recovering from insulin reaction, since
sugar causes a relatively rapid increase in blood sugar.
The following foods should be avoided unless worked
into your meal plan.
Cakes
Candy
Chewing gum
Fruits, canned, frozen or
cooked with sugar
Fruits, glazed
Fruit drinks (artificial)
Fruit ices
Fruit juices, sweetened
Gelatin, sweetened
Honey
Ice cream
Jam Jelly
Marmalade
Milk, chocolate or
condensed
Milkshakes
Molasses
Pastries
Pies
Popsicles
Pudding
Softdrinks
Sweet rolls
Sugar
Syrup
Vegetables, glazed
Free Foods
The following foods contain negligible amounts of carbohydrate, protein, or fat, and may be used without calculation into the meal plan unless specifically prohibited
by the physician. These foods may be used with other
foods in the diet.
Bagoong
Bouillon (fat-free soup)
Carbonated drinks,
sugar free
Carbonated water
Candy, hard, sugar-free
Chili powder
Cinnamon
Clear broth
Coffee
(no cream and sugar)
Curry
Drink mixes, sugar-free
Fish sauce
Flavoring extract
Garlic
Gelatin (unsweetened)
Gum, sugar-free
Herbs
Hot pepper, sauce
Kalamansi
Kamyas
Karamay
Lemon
Mustard
Onion
Oregano
Paprika
Pepper
Pickle, dill or sour
(unsweetened)
Pimiento
Spices
Soy sauce
Tomato juice
Tomato paste
Tomato sauce
Tonic water,
sugar-free
Tea
Vinegar
Worcestershire
sauce
Guidelines for Special Situations
A. When eating away from home
Be familiar with your meal plan. As long as you know your
prescribed meal plan and how to make substitutions, you
should have no trouble when you eat away from home.
Know the amount of foods prescribed for you. Eat only the
foods allowed in your diet. Watch the size of your serving
portions. Select simply prepared foods instead of those
that are fried or with sauce or gravy. It is best to choose
70
foods that are roasted, baked, broiled, and boiled. Avoid
foods prepared with sugar and with too much fats.
Anticipate the effects of a late meal, such as when eating
out, by eating something beforehand. For example, if you
do not know whether supper will be served at your usual
hour or later, eat one Rice Exchange from your supper
meal plan before you leave and then omit something
equal to one Rice Exchange when dinner is served.
For those taking insulin, follow your physician’s instructions on how to adjust your insulin and meals to meet
time changes. Stick as closely as possible to your regular
meal plan and meal time schedule.
B. When you are sick
Any illness may temporarily make the control of your
blood sugar difficult. An illness may either increase or
decrease blood sugar levels. It is essential that you
should know how to deal with any illness when it arises.
Monitor your blood sugar more closely when you are sick
and adjust insulin and other medications accordingly (but
call your physician first).
Follow your meal plan as closely as possible. Eat foods
at regular intervals, close to your usual meal times, if possible. Small frequent feedings may be easier when you
are sick. Try to eat all the carbohydrates your diet allows.
If your appetite is poor, select other foods within the same
group or take them as fluids if you cannot eat solids. If
your condition does not improve, call your physician.
C. If You Must Drink
ALCOHOLIC BEVERAGES ARE BETTER
AVOIDED BY THE DIABETIC PATIENTS
Alcoholic beverages are almost as fattening as fat. They
are high in calories but low in nutritional value, therefore,
they should be used sparingly, and should be regarded
as part of your caloric intake. These beverages should
not be used if you are reducing weight because frequent
intake of alcoholic drinks increases weight.
Alcohol may be used in moderation by a person with
diabetes whose blood sugar is well controlled. Alcohol,
however, may be harmful to other diabetic persons. Alcohol may hasten the effect of insulin or hypoglycemic
tablets. Pregnant women should not take alcoholic drinks
because they endanger the developing fetus.
If your physician allows you to drink, you should ask
your dietitian to include alcoholic drinks in your meal
plan. Also, plans must be developed to cope with any
eventuality since alcohol may interact with some of your
medications.
If alcohol is allowed, it should be taken slowly and only
with food shortly before or after meals because alcohol
lowers blood sugar and eating well helps avoid hypoglycemia. Drinks that contain carbohydrates (drinks made with
sweetened mixes, sweet wines, liquors) should be avoided.
The symptoms of low blood sugar are similar to those of
alcohol intoxication. Thus, if you drink away from home,
Diabetes Nutritional Handbook
it is advisable to be with friends, who know that you have
diabetes, or wear an identification card that is visible so
that in case the initial symptoms of very low blood sugar
develop, these are not mistaken for drunkenness and
treatment for such condition may be administered.
For more information on the food equivalents of some
alcoholic beverages, see Appendix B.
EXERCISE
Exercise, when done regularly is beneficial because it
burns body sugar quickly, thus, lowering blood sugar
levels. It improves circulation helps obese people lose
weight, eases tension and makes one feel good and
look fit. However, before beginning an exercise program,
check with your physician first, particularly if you haven’t
exercised for some time, if you have complications, or if
control of blood sugar is poor.
Exercise may also prevent or retard cardiovascular diseases and its complications, which is common among
the 40-year-old and above diabetics. Your chance of
developing the other coronary risk factors such as hypercholesterolemia, obesity and hypertension is minimized. In
addition, the ability to withstand stress may be enhanced
through exercise.
Exercise, in certain instances, can lead to unfavorable
reactions. If your blood sugar is very high, a further
increase in blood sugar can occur and you are more
prone to develop dehydration when exercising during
warm days.
If you are allowed to exercise, consider the following
pointers:
•Before starting an exercise program, have your diabetes
control evaluated by a physician and request clearance
for heart disease, hypertension, kidney disease and
severe eye problems.
•Follow a graded, slowly increasing exercise program.
•Exercise must be regular since the benefits of exercise
are temporary.
•Wear appropriate and comfortable footwear during
exercise especially when this entails running.
•Do not take alcoholic beverages prior to exercising
because they may increase the risk of developing
hypoglycemia.
For those who are taking insulin, the following should be
additionally considered:
•Monitor blood sugar in order to assess the need for
insulin or food intake adjustment during exercise.
•Avoid exercising during the height of insulin action.
•Do not exercise the limb or part of the body where insulin
was injected.
•Always have identification cards and easily absorbable
carbohydrates such as candies should exercise-induced hypoglycemia or low blood sugar occur.
Here are some additional information if you have complications:
•Kidney disease may be aggravated since exercise
decreases blood flow to the kidneys and increases
protein excretion.
•Severe eye problems may worsen as exercise can lead
to eye hemorrhage.
You may need to make some changes in your meal plan
when you begin an exercise program. Check with your
dietitian or physician about this. You may need to eat
more when you do longer and more strenuous exercises.
The size of snack that is best varies for different persons.
Ask your physician or dietitian for specific guidelines. If
a reaction develops while you are exercising, STOP,
and take some form of carbohydrate which is quickly
absorbed by the body like sugar, candy or any sweetened fruit juice.
MEDICATIONS FOR DIABETES
Do all persons with diabetes need insulin injections?
People with IDDM need insulin injection because their
bodies are not producing enough of this important hormone. Some people with NIDDM may also need insulin
if their blood sugar level is not controlled by diet, exercise
and/or medicines taken by mouth (oral hypoglycemic
drugs).
There are several types of insulin preparations available.
Your physician will tell you the type and amount of insulin
you need and the time to take your insulin.
If you are taking insulin injections, the time and amount
of food you eat should be consistent and should match
your activity and the action of insulin prescribed by your
physician. There should always be a balance between
the effects of insulin and food so that the blood sugar
will not be too high nor too low at any time to cause
hyperglycemia or hypoglycemia. Bedtime snacks and
between-meal feedings will help keep this balance.
When taking insulin, you may have to change your diet in
some circumstances. Ask your dietitian or physician how
to adjust your meal plan when you do strenuous exercise,
when you are ill, or if you have low blood sugar.
Here are some reminders if you are using insulin:
1.Eat at the same time each day.
2.If you skip a meal, ask you physician how to adjust
insulin.
3.Never omit your insulin injections at the prescribed
time and amount.
4.Always carry candy with you to counteract hypogly­
cemia, if it occurs.
5.Keep an extra vial of insulin handy so you do not run
out when you need it most. Keep extra syringes and
needles in case of breakage.
6.Follow your physician’s instructions carefully when
sterilizing equipment, cleaning and injection sites,
measuring and mixing insulin preparations and rotating
the injection sites.
What are oral hypoglycemic drugs?
Oral medications are drugs taken by mouth. Drugs taken
by mouth stimulate the release of insulin in the body or
induce the tissue to use the available insulin better are
known as oral hypoglycemic drugs. These drugs are not
insulin, nor contain insulin. They are useful for diabetics
whose pancreas still produces some insulin as in non-
Learn to access drug info on your cellphone. Send PPD to 2600 for Globe/Smart/Sun users.
71
Diabetes Nutritional Handbook
insulin-dependent diabetes (Type II). They are used in
Type II diabetes when blood sugar cannot be controlled
by diet alone or by diet and exercise.
And, as a last but very important reminder, you are
advised not to smoke as nicotine will narrow the blood
vessels and will impair blood circulation.
Regularity of meals and snacks is desirable when taking
oral hypoglycemic agents. Hypoglycemia may occur with
skipping of meals or decreasing food intake.
ACUTE COMPLICATIONS OF DIABETES
BLOOD SUGAR TESTING
Monitoring your blood sugar level can be very useful in
keeping track of your diabetes. It is a way of testing how
well blood sugar is controlled by your diet, exercise and
medication program. If your blood sugar level is hard to
control or if you are concerned with strict control, self
blood glucose monitoring is very helpful.
You can measure your own blood sugar using the fingerprick method and a special strip of paper (Dextrostix, Glucostix or Visidex). Your physician will tell you when and
how often to test your blood sugar level. Your physician
will also teach you how to adjust your diet or activities to
keep the blood sugar level as close to normal as possible.
Or you may use the guidelines on page 71.
Do not be discouraged by a few positive tests. Perfect
control at all times is hard to achieve. HOWEVER, A
HIGH BLOOD SUGAR LEVEL is a warning sign. CALL
YOUR PHYSICIAN if your blood sugar is consistently
high or unexpected.
PERSONAL HYGIENE
One complication common in persons with diabetes is
skin infections and wounds that do not heal properly.
You are more likely to develop infections when your
blood sugar level is high. In diabetes, there is also poor
blood circulation which makes infection a special danger.
For this reason, you need to take special care to avoid
conditions that will lead to infections and wounds. You
should take proper care of your eyes, teeth, skin and
feet. This is important because any infection can easily upset diabetes control. Taking a bath regularly and
keeping the skin constantly clean and soft are some tips
to avoid infections. You must also get enough rest and
sleep to stay healthy.
You have to take special care of your feet because poor
blood circulation sometimes means less sensation than
usual in your feet. You may not notice cuts and other
problems as soon as these occur.
Here are Ten Commandments of proper foot care*:
1. Never apply heat of any kind to the feet.
2. Never soak the feet.
3. Never cut the toe nails; only file them.
4. Never wear ill-fitting shoes.
5. Never assume that sensation or circulation is normal
at the feet.
6. Never use strong colored medicines on the feet.
7. Minimize development of calluses or corns by wearing comfortable shoes.
8. Never perform bathroom surgery on the feet.
9. Never go barefoot.
10. Never keep the feet too dry or too moist.
*Victoria Correa-Santiago, “Thou Shalt Take Care of Thine Feet.” Diabetes
Watch 4 (December 1987):4.
72
There will be times when your blood sugar level may
become either too high (hyperglycemia) or too low
(hypoglycemia). It is important for you to learn all you
can about these complications, why they happen, when
they may be expected, and most important, how you
feel when an emergency is coming, and how to treat it.
Knowing how you feel when your blood sugar is becoming
higher or lower than normal will help you avoid serious
emergencies, even life threatening emergencies.
IMPORTANT
THE CAUSES, SYMPTOMS AND TREATMENT FOR
THESE TWO CONDITIONS ARE DIFFERENT
INSULIN
REACTION
(LOW
BLOOD SUGAR)
CAUSES
too much insulin
too much exercise
too little food or
omission of food
DIABETIC
KETOACIDOSIS
(HIGH
BLOOD SUGAR)
too little insulin or
skipping an insulin
injection
too much food
intercurrent infection
SYMPTOMS
Onset
Skin
Behavior
Breath
Breathing
Vomiting
Tongue
Hunger
Thirst
Pain
sudden
pale, moist
weak, irritable
normal odor
normal to rapid
absent
tingling, moist
present
absent
headache
gradual
dry, flushed
drowsy
fruity odor
fast, deep
present
dry
absent
present
abdominal
TREATMENT
Eat or drink anything sweet. If available: milk + 2 teaspoons sugar.
THIS IS A MEDICAL
EMERGENCY AND
SHOULD ONLY BE
TREATED IN THE
HOSPITAL.
CHRONIC COMPLICATIONS
OF DIABETES
Complications may happen in persons who have had
uncontrolled diabetes for a long time. These include
damage to the retina of the eyes (retinopathy), the blood
vessels (angiopathy), the nervous system (neuropathy),
and the kidneys (nephropathy). Strict control of blood
glucose levels may help reduce, delay or prevent these
problems.
Diabetes Nutritional Handbook
APPENDICES
Food
APPENDIX A
FOOD EXCHANGE LISTS
RICE EXCHANGE
The list shows the kinds and amounts of rice, rice
equivalents, bread and bakery products to use for one
rice exchange.
Each exchange in this list contains approximately 23
grams of carbohydrate, 2 grams of protein and 100
calories.
Your diet plan contains
exchanges from
the rice exchange list distributed as follows:
Breakfast Morning LunchAfternoonSupper Bedtime Snack
Snack
Snack
Food
Wt. (g) Measure
E.P.
I. Rice and Rice Products
1. Rice, cooked
2. Rice gruel (lugaw)
+ Thin consistency
++ Medium consistency
+++ Thick consistency
3. Suman sa lbos
80
1/2 cup, packed
705
435
250
60
4-1/2 cups
3 cups
1-1/2 cups
1(8x4x2 cm)
1. Bread
Pan amerikano
40
Pan de bonete
40
Pan de leche
40
Pan de limon
40
Pan de monay
40
Pan de sal
40
Rolls
40
(hotdog/hamburger)
Whole wheat bread
45
Food
Corn/rice curls & the like 25 1-1/4 cups
Corn, boiled
120 65 1 (12 x 4 cm)
Corn flakes
25 1 cup
Baby corn
90 1 cup
Corn, canned
145 1 cup
4. Noodles, cooked
Bihon, macaroni 75 1 cup
Sotanghon, spaghetti
5. Rootcrops
Sweet potato
91 80 1/2 of 11 cm long
x4-1/2 cm diameter
Cassava 115 85 1(5 cm long x 4-1/2 cm
diameter) or 1-cup
Gabi
130 100 2 (6 cm long x 4 cm
diameter each
or 1 cup
Potato
195 165 2-1/2 of 7 cm long x 4
cm diameter each or
1-1/3 cups
Ubi
155 130 1 (8-1/2 cm long x 4-1/2
cm diameter)or
1-1/3 cups
Tugi 135
2 (11x3 cm each)
6. Beans and Nuts
Chestnuts, 55 40 11 pieces large or 20
roasted
(kastanyas, pieces small
binusa)
7.Others
Cornstarch 25 5 teaspoons
Flour, all purpose 25 3 tablespoons
Sago, cooked
120 1/2 cup, cooked
Ice cream, dietetic
90 1/3 cup(unsweetened)
III.Processed Rice and Bakery Products
II. Rice Equivalents
Wt. (g) Measure
A.P E.P
Wt. (g)
A.P E.P
2 slices
(9x8x1 cm each)
1 (6 cm diameter base
x 7 cm thick)
1 (3x8x8 cm)
1 (6x5x4 cm)
1 (10x9x4 cm)
3 (5x5 cm each)
1 (11x4x3 cm)
2 (11-1/2x8-1/2x1
cm each)
Measure
2. Bakery Products
Cookies
Galyetas de patatas
30
3. Corn and Corn Products
Binatog
90
+ 1/2 cup cooked rice + 5 cups water
++ 1/2 cup cooked rice + 3 cups water
+++ 1/2 cup cooked rice + 2 cups water
10 (4x4x1/2 cm
diameter each)
Food
Wt. (g) Measure
E.P
Canton 100 1 cup
Corn chips (cheese flavor) 40
1-1/3 cups
Cornick 35 1/2 cup
Crackers
35
8 (5x4x1/2 cm each)
Doughnut, plain
(no sugar) 45 1/2 of 9x3 cm
French fries 65 1 cup
Instant noodles 40 1/2 of 80 gm. pack
(chicken/beef flavor)
Miki 100 1 cup
Oatmeal, raw 30 5 tablespoons
Oatmeal, cooked
+ thick consistency
185 1 cup
++ thin consistency 255 1-1/2 cups
Pan de coco 40 1 (7x6 cm)
Potato chips 45 1-1/2 cups
Salted crackers 30 8 (5x4x1/2 cm each)
Salted popcorn 35 2 cups
Skyflakes 35 4 pieces
Sunflower biscuit 40 9 (7-1/2x4-1/2 cm each)
1/2 cup
+5 tablespoons raw oatmeal + 1 cup water
++5 tablespoons raw oatmeal + 1-1/2 cups water
www.TheFilipinoDoctor.com l Sign up and open your clinic to the world.
73
Diabetes Nutritional Handbook
MEAT EXCHANGE
Each serving of meat and substitutes on this list contains
about 8 grams of protein. The amount of fat and number
of calories varies depending on what kind of meat or
substitute you choose.
The list is divided into three sub-groups based on the
amount of fat and calories; lean/low fat meat, medium
fat meat and high fat meat. One meat exchange of each
of these includes:
Carbohydrate Protein Fat Calories
(grams)
(grams)(grams)
Lean/Low
Fat Meat
and Fish
Medium Fat
Meat and
Fish
High Fat
Meat and
Fish
-
8
1
41
-
8
6
86
-
8
10
122
The measure of the meat, fish or other meat exchange
does not consider the flour or fat used in the preparation.
If meat is fried, use the fat allowance in your diet. Soup
stock from meat (with fat removed) may be used with the
meat or vegetable to improve flavor. Trim off visible fat
and measure meat after it has been cooked.
A. LOW FAT MEAT AND FISH EXCHANGES
Your diet plan contains
exchanges from
the lean meat list distributed as follows:
Breakfast Morning LunchAfternoonSupper Bedtime Snack
Snack
Snack
Food
Wt. (g) Measure
E.P
Cooked
1. Lean Meats
30 1 slice, matchbox size
(5x3-1/2x1-1/2 cm)
Beef, carabeef,
chicken meat
(laman)
30 1 slice, matchbox size
(5x3-1/2x1-1/2 cm)
74
2.
Variety meats/internal organs
Blood (dugo)-pork, beef,
Chicken
35 3/4 cup
Gizzard 35 3/4 cup
(balun-balunan)
- chicken
Heart (puso) - pork, 35 3/4 cup
beef, carabeef
Liver (atay)1-pork, 35 3/4 cup
beef, carabeef, Your meal plan tells you how many exchanges from each
subgroup you can have.
Lean meats are suitable when the prescribed diet is very
low in fat and cholesterol. Medium fat meat exchanges
may be included if your diet allows a moderate amount of
fat. The high-fat meat exchange list contains other protein
foods with higher than the desirable cut-off levels or fat.
When choosing foods from this list, the appropriate allowance from the fat exchange list should be adjusted.
Lean pork
Tenderloin, well
trimmed (lomo)
30 1 slice, matchbox size
(6-1/2x3x1-1/2 cm)
Chicken
Leg (binti)
30
1
small leg (13-1/2 cm
long x3 cm diameter)
Breast meat (pitso) 30
1/4 breast -6 cm long
chicken
Lungs (baga)1 35 3/4 cup
- pork, beef,
carabeef
Omassum (librilyo) 35 3/4 cup
- beef, carabeef
Small intestine
35 3/4 cup
(bitukang maliit)
-pork, beef, carabeef
Spleen (lapay)1, 35 3/4 cup
pork, beef, carabeef
Tripe (goto) – beef 35 3/4 cup
Uterus (bahay guya)- 35 3/4 cup
pork, beef
3. Fish
Large variety
35 1 slice (7x3x2 cm)
(e.g bakoko, bangus,
dalag, labahita,
lapu-lapu, etc) Medium variety
Hasa-hasa, 35 1 (18x4-1/2 cm)
dalagang bukid,
Galunggong 35
1 (14x3-1/2 cm)
Hito 35 1/2 of 22x5 cm
Small variety
Sapsap
35 2 (10x5 cm each)
Tilapya 35 2 (12x5 cm each)
Tamban
35 2 (12-1/2x3 cm each)
Dilis
35 1/4 cup
4. Other Seafoods
Alamang, tagunton 30 1-1/4 tablespoons
Aligue: Alimango 15
1 tablespoon
Alimasag 50 3 tablespoons
Alimango1/Alimasag, 20 1/4 cup or 1/2 pc
laman medium
Lobster
30 2 tablespoons
Talangka
30 75 pieces A.P.
Shrimps: Puti
25 5 (12 cm each)
Sugpo
25 2 (13 cm each)
Suwahe
25 5 (12 cm each)
Octopus (pugita)
30 1/2 cup
Squid (pusit)
25 3(7x3 cm each)
Shells: Halaan
75 1/3 cup shelled or
3 cups with shell
Kuhol
50 1/2 cup shelled or
3 cups with shell
1
High in cholesterol. Omit or limit if your diet says “Low Cholesterol.”
Diabetes Nutritional Handbook
Susong Pilipit 65 1/3 cup shelled or
2 cups with shell
Paros
60 1 cup shelled or
2-2/3 cups with shell
5. 6. b. Pork
Leg (pata)
30 1 slice (4 cm diameter
x 2 cm thick)
Beans
Pigeons pea seeds, 55 1/3 cup
dried (kadyos,
buto, tuyo)
Cheese
Cottage cheese
60 1/3 cup
7. Processed foods
A. Fish products1
Dried:
Daing:
Alakaak, alumihan,
Bisugo, biyang puti
Lapu-Lapu
Sapsap
Tamban
Tanigi
Tinapa:
Bangos
Galunggong
Tamban
Tuyo:
Alamang
Ayungin, dilis,
sapsap, tunsoy
Pusit
Canned:
Salmon
Tuna in brine
2. Variety meats/internal organs
Brain (utak)2 - pork,
beef, carabeef
35 3/4 cup
20 1 (15-1/2x8 cm)
20 ¼ of 30 x 40 cm
20 3 (9x5 cm each)
20 1 (16x3 cm)
20 1 slice (16x6 cm)
35 1 slice (15x7x2 cm)
4. Egg
Chicken2 Quail’s egg2 Salted duck’s egg2
60 1 piece
70
9 pieces
60 1 piece
20 3 (11-1/2x8 cm each)
15 1 (8x1 cm)
40 1/3 cup flaked
30 1/3 cup flaked
B. Meat products
Tocino (lean), 45 1 slice (11x4x0.5 cm)
without sugar
B. MEDIUM FAT MEAT AND FISH EXCHANGES
Your diet plan contains
exchanges
from the medium-fat meat list distributed as follows:
Breakfast Morning LunchAfternoonSupper Bedtime Snack
Snack
Snack
Deduct one exchange from your fat allowance for every
exchange of medium-fat meat used in place of lean
meat.
1 slice, matchbox size
(5x3-1/2x1-1/2 cm)
Limit the intake of these salty foods, omit entirely if your diet prescription
says "Low Salt."
2
High in cholesterol. Omit or limit if your diet says “Low Cholesterol.”
1
25 1 medium or 2 small
35 2 heads
8. Processed Foods
a. Fish products
Sardines canned 45 1 (10x4-1/2 cm)
in oil/Tomato sauce
Tuna Sardines
50 1-1/2 of 6x4x3 cm each
Tuna spread, 30 2 tablespoons
canned
b. Meat products
Corned beef
40 3 tablespoons
Ham sausage 55 3 of 9 cm diameter
x 0.3 cm thick each
c. Bean products
Soybean cheese,100 ½ cup
soft (tofu)
Soybean cheese,60 1 (6x6x2 cm)
soft (tokwa)
C. HIGH FAT MEAT AND FISH EXCHANGES
Remember these items are high in saturated fat, cholesterol and calories and should be used only if your diet
allows at least two fat exchanges. Even then, use only
two to three times a week.
Deduct two exchanges from your fat allowance for every
exchange of high fat meat used in lieu of lean meat.
1. Medium Fat Meat
a. Beef
Flank (kabilugan) 30
brisket (punta y pecho)
6. Chicken
Wings (pakpak)
Head (ulo)
7. Beans
Soybean (utaw)
40 ½ cup
15 1/3 cup
Measure
3. Fish
Karpa
5. Cheese
Cheese, cheddar
35 1 slice (6x3x2 cm)
30 ¼ of 20x8 cm
30 1 (16x4 cm)
25 1 (16x5 cm)
Wt. (g)
E.P.
Cooked
Food
plate (tadyang)
chuck (paypay)
Food
Wt. (g) Measure
E.P.
Cooked
1. Pork
Ham (pigue) 35
2. Variety meats/internal organ
Tongue (dila – pork,
beef) 35
1 slice (3 cm cube)
¾ cup
Learn to access drug info on your cellphone. Send PPD to 2600 for Globe/Smart/Sun users.
75
Diabetes Nutritional Handbook
3.
Eggs
Duck’s egg1
Balut1
Penoy
4. Nuts
Peanuts, roasted 70 1 piece
65 1 piece
60 1 piece
25 1/3 cup
5. Cheese
Cheese, filled
50 1 slice (6x3x2-1/2 cm)
Cheese, pimiento 40 1 slice (6x3x2 cm)
flavored
6. Processed foods
Meat products Longanisa,
25 1 (12x2 cm)
chorizo style
Frankfurters
60 1-1/2 of 12x1/1/3 cm
Salami
50 3 slices of 8x8x1 cm
each
Vienna sausage
70 4 (5x2x2 cm)
D.PROCESSED MEAT, FISH, POULTRY PRODUCTS,
BEANS
Food
Wt. (g) Measure
E.P
Cashew, roasted
Century egg1
Cheese, native2
Cheese spread (no sugar)
Chicken spread (no sugar)
Chickpea seeds, boiled3
(garbanzos, buto, linaga)
Chili con carne4
Clam (tulya)3
40 1/3 cup
65 1 piece
60 2 slices (4x4x1 cm each)
55 4 tablespoons
70
5 tablespoons
65 ½ cup
105
1 cup
70 1/4 cup, shelled or
5-1/2 cups with shell
65 1/2 cup
Cow pea seeds (paayap, buto)3
Embutido (no sugar)2
60 2-1/2 slices
(5x1-1/2 cm each)
Fishball3
95 6 (3-1/2 cm
diameter each)
Hamburger (w/o sugar)2
50 2-1/2 (4-1/2x1
cm each)
Hotdog2
70 2 (10x4 cm each)
Lima beans, seeds, dried
75 ½ cup
(patani, buto)3
Lite hotdog
55 1 piece
Luncheon meat (w/o sugar) 55 2 slices
(9x5x1 cm each)
Meat loaf, canned 70 2 slices
(w/o sugar) (9x5x1-1/4 cm each)
Mung bean (munggo)4
75 ¾ cup
Murkon (w/o sugar)
60 2 slices
(5-1/2x1-1/2 cm each)
Oyster4
105 2/3 cup
Peanuts, boiled2
60 ½ cup
Peanut cracker (w/o sugar)
35 1/3 cup
Potted meat (w/o sugar)
75 5 tablespoons
High in cholesterol. Omit or limit if your diet says “Low Cholesterol.”
Deduct fat allowance by one exchange when using any of these items.
3
Deduct rice allowance by one exchange when using any of these items.
4
Deduct rice allowance by ½ exchange when using any of these items.
1
2
76
Salt water mussel (tahong)4
45
Spam2
55
Taho plain4
275
White kidney beans seeds, 55
dried (abitsuelas, buto,
puti, tuyo)4
¼ cup
3 slices
(8x5x1 cm each)
2-3/4 cups
1/3 cup
MILK EXCHANGE
Each exchange of milk on this list contains 12 grams of
carbohydrate and 8 grams of protein. The amount of
fat and number of calories very depending on what type
of milk you choose.
The list is divided into three sub-groups based on the
amount of fat and calories: whole milk; low fat/skimmed
milk and very low fat milk. One milk exchange of each
includes:
Carbohydrates
(G)
Whole Milk
12
Low Fat/
Skimmed Milk 12
Very Low Fat Milk 12
Your diet plan contains
group distributed as follows:
Protein
(G)
Fat Calories
(G)
8
10
170
8
8
5
Tr
125
80
exchanges from milk
Breakfast Morning LunchAfternoonSupper Bedtime Snack
Snack
Snack
Milk is an almost complete food, hence, it is considered
one of our most important foods. It contains plenty of
good quality minerals particularly calcium and vitamins
as well a carbohydrates, fat and protein.
The milk allowance in the meal plan can be used as a
drink, can be added to cereals, or mixed with coffee or
tea and other foods.
As a beverage, milk is the most nourishing for the young
and for adults.
Food
Wt. (g) Measure
E.P
Whole milk:
Milk, Evaporated, undiluted
125
Milk, evaporated, filled, 125
undiluted
Milk, evaporated,
recombined undiluted
125
Milk, fresh carabao’s
250
Milk, fresh cow’s
250
Milk, powdered
30
Low Fat Milk
Powdered
30
Lite Low Fat Milk
250
½ cup
½ cup
½ cup
1 cup
1 cup
¼ cup or
4 level tablespoons
¼ cup or 4 level
tablespoons
1 tetra-brick
Diabetes Nutritional Handbook
Skimmed (Non-Fat)/Very Low Fat Milk:
Buttermilk: liquid
185
2/3 cup
: powdered
25
¼ cup or 4 level
tablespoons
Long life skimmed milk
250
1 cup
Yoghurt
125
½ cup
VEGETABLE EXCHANGE
Each group A vegetable contains negligible carbohydrates, protein and energy if 1 exchange or less is used.
When 2 exchanges are used, consider as one group B
vegetable. Each Group B vegetable exchange contains
3 grams of carbohydrate, 1 gram of protein and 16
calories.
Vegetables are important sources of vitamins and minerals. Include at least one serving of green or yellow
vegetable in the diet daily. Aside from their valuable
vitamin and mineral contents, vegetables are also good
sources of fiber. Fiber has been shown to lower blood
sugar levels.
Serve vegetables cooked or raw. If fat is added to the
presentation, count them as part of the fat allowance.
One vegetable exchange cooked with fat contains approximately one fat exchange. Vinegar, lemon, or tomato
juice may be used as salad dressings, as desired.
Leafy Vegetables:
1 exchange
=1 cup raw (25 g) or
(Group A Vegetables) ½ up cooked (45 g)
Non-Leafy Vegetables:
1 exchange
=½ cup raw (40 g) or
(Group B Vegetables) ½ cup cooked (45 g)
Your diet plan contains
exchanges from
the vegetable groups distributed as follows:
Lunch
Group A
Group B
Supper
Group A Vegetables
These vegetables contain negligible carbohydrate, protein, and energy if only one exchange or less is used.
As these vegetables are good sources of fiber, you are
encouraged to use more of these in your meal. Vegetables that have a * symbol are especially high in fiber.
Take these vegetables more often.
Acelgas (Chinese cabbage) Ampalaya fruit
Alagaw leaves
Ampalaya leaves
Alugbati leaves
Balbalulang (seaweed)
Baguio beans (abitsuelas)
Mustard leaves
Bamboo shoot (labong)
Okra
Banana heart (puso ng saging)Onion bulb
*Bataw pods, *Pako
Beets, Papaya green
Cabbage
Patola
*Cassava leaves and tops
Pepper fruit
Cauliflower
Pepper leaves
*Camote leaves
Celery
Chayote fruit
Chayote leaves
Cucumber
Eggplant
*Gabi leaves
*Garlic leaves
*Himbabao
Kangkong
*Katuray flowers
*Katuray leaves
Lettuce
Malunggay leaves
Malunggay pods
Mushroom, fresh
Petsay
Pokpoklo (seaweed)
Radish
*Saluyot
Sigarilyas pods
Spinach
Squash flowers
*Squash leaves
Stringbeans leaves
(sitaw, dahon)
Sweet pea pods (sitsaro)
Talinum
Tomato
Unsoy
Upo
Group B Vegetables
Fresh:
Carrot *Pigeon pea pods Coconut shoot (ubod)
(kadyos, bunga)
*Cowpea pods (paayap, bunga) Rimas
*Kamansi
*Singkamas pods (bunga)
*Langka hilaw
Singkamas tuber
Lima bean pods
(lamang ugat)
(patani,bunga)
Squash fruit
Mungbean sprout (toge)
Stringbeans pod (sitaw, bunga)
* High in fiber.
Processed:
Food
Wt. (g) Measure
E.P.
Asparagus tips
90 1 cup
Baby corn
15
2 (8 cm long x 5-1/2 cm circumference each)
Green peas, canned
15
1 tablespoon
(Gisantes, nakalata)
Golden sweet corn,
20
2 tablespoons
canned
Mushroom, canned
110 1/3 cup
Tomato juice, canned
60 ½ cup undiluted
Water chestnut, canned 25 3 (2 cm diameter each)
FRUIT EXCHANGE
Each item on this list contains about 10 grams of carbohydrate and 40 calories.
Fruits are valuable for their vitamin, mineral and fiber
contents. Include at least one exchange of fruits rich in
Vit. C daily in the diet. These are listed under Group A.
Fruits that have * symbol are good sources of fiber. Take
these fruits more often. Fruit juices have negligible fiber
content.
Fruits that are prepared or canned in syrup should not
be used even if the syrup is rinsed off. The label in
canned fruits and juices should state “no sugar added”
or “unsweetened”.
Fruits may cause an increase in blood sugar, thus,
www.TheFilipinoDoctor.com l Sign up and open your clinic to the world.
77
Diabetes Nutritional Handbook
diabetic meal plans allow no more than 5 exchanges
a day.
Your diet plan contains
the fruit group distributed as follows:
exchanges from
Breakfast Morning LunchAfternoonSupper Bedtime Snack
Snack
Snack
Food
Wt. (g)
A.P. E.P
Measure
A. High Vitamin C
* Anonas
65 35 ½ of 5x8 cm
Atis
70 45 1 (5 cm diameter)
Cashew
78 70 1 (7x6-1/2 cm)
Dalanghita
300 135 2 (6 cm, diameter each)
* Datiles
61 50 1 cup
* Guava
81 80 2 (4 cm diameter each)
Guwayabano
86 60 1 s l i c e ( 8 x 6 x 2 c m )
or ½ cup
Kamachile
110 55 7 pods
Mango:
Green
90 65 1 slice (11x6 cm)
Ripe
103 60 1 slice (12x7 cm)
or ½ cup cubed
Papaya ripe
133 8
5 1 slice (10x6x2 cm)
or ¾ cup
* Strawberry
168 165 1-1/4 cups
Suha
160 90 3 segments
(8x4x3 cm each)
* Tiesa
41 30 ¼ of 10 cm diameter
B. Other Fresh Fruits
Apple
86 65
* Balimbing
153135
Banana:
Bungulan
60 40
Lakatan
51 40
Latundan
55 40
Saba
70 40
* Chico
54 45
Duhat
80 60
Durian
150 30
* Grapes
69 55
Jackfruit ripe
118 40
Lansones
103 7
0
Lychees
77 50
* Mabolo
83 50
* Makopa
169 135
Mango:
medium ripe
90 65
indian
140 8
0
* Paho
92 70
* Mangosteen
212 55
Marang
35 21
Melon kastila
317 200
78
½ of 8 cm diameter
or 1 (6 cm diameter)
1-1/2 of 9x5 cm
½ of 15x4 cm
1 (9x3 cm)
1 (9x3 cm)
1 (10x4 cm)
(4 cm diameter)
20 (2 cm diameter each)
1 segment of
6-1/2 x4-1/2cm or 1-1/2 tablespoons
10 (2 cm diameter each
or 4 (3 cm diameter each)
3 segments
(6 cm diameter each)
7 (4x2 cm each)
5 (3 cm diameter each)
2/3 of 6 cm diameter
3 (4 cm diameter each)
1 slice (11x6 cm)
1 (6 cm diameter)
9 small
3 (6 cm diameter each)
½ of 12x10 cm
1 slice (12x10x3 cm)
or 1-1/3 cup
* Pear
118 85
Pineapple
129 75
Rambutan
139 50
* Santol
127 75
Singkamas tuber 124110
Siniguelas
78 50
Star apple
123 65
Tamarind ripe
34 15
* Watermelon
226140
C. Canned, Drained
Pineapple, crushed
1 (6 cm diameter)
1 slice (10x6x2 cm)
or ½ cup
8 (3 cm diameter each)
1 (7 cm diameter)
½ of 9 cm diameter
or 1 cup
5 (3 cm diameter each)
½ of 6 cm diameter
2 of 6 segments each
1 slice (12x6x3 cm)
or 1 cup
60 3 tbsp., unsweetened
D. Dried
Champoy, salted
Prunes, seedless
10 4 (2 cm diameter each)
15 3 pieces, unsweetened
E. Juices, unsweetened 80 1/3 cup
canned (orange,
pineapple, prune)
F. Others
Buko meat
Buko water
100 ½ cup
1
80 1 cup
FAT EXCHANGE
Each exchange of fat contains about 5 grams of fat
and 45 calories.
Fat may be classified into monounsaturated, polyunsaturated or saturated type. The fats found in animal
sources except marine oil consist of significantly large
number of saturated fatty acids which solidify at room
temperature. Vegetable oils except coconut oil contain
more unsaturated fatty acids and exist as liquid at room
temperature.
As a person with diabetes, you should modify your fat
intake by taking in prescribed amounts of polyunsaturated
fats instead of saturated fats to control the development
of heart diseases.
Your diet plan contains
exchanges from the
fat list distributed as follows: (
exchanges
should be selected from Group A).
Breakfast Morning LunchAfternoonSupper Bedtime Snack
Snack
Snack
Food
Wt. (g)
E.P
Measure
A. Saturated Fats
Bacon
Butter
Coconut grated
Coconut cream
10
5
20
15
1 strip-10x3 cm
1 teaspoon
2 tablespoons
1 tablespoon
Diabetes Nutritional Handbook
Coconut oil
Cream cheese
Latik
Margarine
Mayonnaise
Sandwich spread
Sitsaron
Whipping cream,
heavy/light
5
15
10
5
5
15
10
1 teaspoon
1 tablespoon
2 teaspoons
1 teaspoon
1 teaspoon
1 tablespoon
2 ( 5x3 cm each)
15 1 tablespoon
Wine, port
Wine, rose
Wine,
vermouth,
French
Wine,
vermouth
Italian
100
100
160 1 wine glass
85 1 wine glass
1 rice, 1 fat
½ rice, 1 fat
100
108 1 wine glass
½ rice, 1 fat
100
170 1 wine glass
1 rice, 1-1/2 fat
B. Polyunsaturated Fats
BEVERAGE LIST
Oil (corn, marine, 5 1 teaspoon
soybean, rapeseed-canola, rice,
sunflower, safflower, sesame)
C. Monounsaturated Fats
Avocado
Peanut butter
Pili nut
Peanut oil, olive oil
Shortening
65
10
5
5
5
½ of 12x7 cm
2 teaspoons
5 pieces
1 teaspoon
1 teaspoon
APPENDIX C
This list gives the nutrient composition of other commercially available flavored milk drink, yoghurt/diet soft
drink.
Beverage
Net
contents Measure
(mL)
Calories Pro Fat CHO
(g) (g) (g)
A. Yughurt Lite n’ Rite
D. Processed Fat Product
Kropeck
20 4 (7-1/2x11-1/2 cm each)
APPENDIX B
ALCOHOLIC BEVERAGES
The list gives you information on some commonly used
alcoholic beverages. The last column tells you how many
rice and fat exchanges to deduct from your meal plan in
case alcoholic beverages are not included in you meal
plan and you use any of the listed beverages.
Alcoholic
Wt. Energy Measure*
Beverages
(g) Basi
170
Beer,
cerveza
320
Brandy,
cognac
30
Daiquiri
56
Gin, dry
43
Gin, ginebra
360
High ball
240
Manhattan
56
Martini
56
Mint julep
240
Old fashioned 240
Rum
43
Tom Collins
300
Tuba
240
Whisky,
scotch
43
Wine, red
100
Wine,
champagne
100
(sweet and dry)
Rice and fat
Eq. (No. of
exchanges)
185 1 glass-6 oz.
1 rice, 2 fat
163 1 bottle-11 oz
1 rice, 1 fat
75
124
107
832
170
167
143
217
183
107
182
89
½ rice, ½ fat
1 rice, ½ fat
½ rice, 1 fat
7 rice, 3 fat
1 rice, 1-1/2 fat
1 rice, 1-1/2 fat
1 rice, 1 fat
1 rice, 2-1/2 fat
1 rice, 2 fat
½ rice, 1 fat
1 rice, 2 fat
½ rice, 1 fat
1 brandy glass
1 cocktail glass
1 jigger
1 bottle-12 oz.
1 glass
1 cocktail glass
1 cocktail glass
1 glass
1 glass
1 jigger
1 tall glass-10oz
1 glass
Apricot
Grape
Natural
Orange
Strawberry
125
100
125
100
125
½ cup
7 tablespoons
½ cup
7 tablespoons
½ cup
B. Diet Cola
237
330
1 bottle
1 can
50
40
100
40
50
5
4
2
4
5
2 0.2
3 0.3
<1
<1
<1
<1
<1
6
5
20
5
6
0 0.2
0 0.3
REFERENCES
American Diabetes Association. Diabetes in the Family. Maryland: Robert
J. Brady Co., 1982.
American Diabetes Association, Inc. and The American Dietetic Association.
Exchange Lists for Meal Planning. 1994.
Biomedical Nutrition Division. Food and Nutrition Research Institute. Food
Exchange Lists for Meal Planning. FNRI Publication No. 57-ND 8(3),
3rd revision. 1994.
Cardino, M.I.Q. “Are Diabetics Allowed Alcohol?” Diabetes Watch. 5(April
1988):1.
Claudio, V.S.; de Guzman, M.P; and Oliveros, M.S. Basic Diet Therapy for
Filipinos. Manila: Merriam and Webster, Inc., 1983.
Correa-Santiago, V. “Thou Shalt Take Care of Thine Feet. “Diabetes Watch.
4 (December 1987): 4.
De los Santos, E.T. “Why Exercise?... Its Benefits to the diabetic patient”
Diabetes Watch. 4(April 1987):2.
Dietetic Staff of Mayo Clinic. Meal Planning for Diabetes. Minnesota: Mayo
Foundation, 1983.
Fernando, R.E. Diabetes. Quezon City: New Day Publishers, 1981.
Living with Diabetes. Maryland: Channing L. Bete Co., Inc., 1978.
Marble, A.; Krall, L.; Bradley, R.; Christlieb, A.R and Soeldner, J.S., eds.
Joslin’s Diabetes Mellitus. Philadelphia: Lea and Febiger, 1985.
107 1 jigger
73 1 wine glass
½ rice, 1 fat
½ rice, 1 fat
Medical and Applied Nutrition Division, Food and Nutrition Research
Institute. Foods Highest and Lowest in Various Nutrients Manila: FNRI
Publication No. 33, 1979.
85 1 wine glass
½ rice, 1 fat
National Diabetes Information Clearinghouse, National Institute of Arthritis,
Diabetes, and Digestive and Kidney Diseases, National Institutes of
Health. The Diabetes Dictionary. Maryland: Eli Lilly and Company.
*unless specified: 1 glass=8 oz; brandy glass=1 oz.; cocktail glass=2 oz;
jigger = 1-1/2 oz; wine glass = 3/1/2 oz.
Learn to access drug info on your cellphone. Send PPD to 2600 for Globe/Smart/Sun users.
79
Diabetes Nutritional Handbook
GLOSSARY
It will be very useful for you to read as much as you can
about diabetes. The following are some terms that you
will encounter in your readings.
A
ACESULFAME K – or ace K, a sweetener that has little
or no calories.
ACETONE – or ketone body, a chemical formed in the
blood when the body uses fat instead of glucose (sugar) for
energy. If too much acetone forms, it usually means that
the cells do not have enough insulin, or can not use the insulin that is in the blood, to metabolize glucose for energy.
ACIDOSIS - too much acid in the blood. In a person with
diabetes, this is due to the accumulation of ketones.
ALBUMINURIA – presence of a protein called albumin in
the urine. It may be a sign of kidney disease, a problem
that can occur in people who have had diabetes for a
long time ago.
ALPHA CELL – a type of cell in the pancreas. Alpha cells
make and release a hormone called glucagons which
raises the level of glucose (sugar) in the blood.
A.P. – as purchased, weight of edible plus inedible portion of food.
ARTERIOSCLEROSIS – hardening of the arteries, which
may be due to different causes. One is when fats build
up inside the walls of the arteries.
ASPARTAME – a sweetener that can be used in place
of sugar. It has very few calories.
Too much cholesterol may cause fat to build up in the
artery walls and cause a disease (atherosclerosis) that
slows or stops the flow of blood.
COMA – a sleep-like state; not conscious; can be due to
high or low level of glucose (sugar) in the blood.
D
DEHYDRATION – great loss of body water. This may
happen when a person has a very high level of glucose
(sugar) in the blood because the excess glucose is excreted in the urine together with a large amount of water.
DEXTROSE – another name for glucose.
DIABETIC COMA – a severe emergency in which a person is not conscious because the blood glucose (sugar) is
too high and the blood has too many ketones (ketoacidosis). The person usually has a flushed face, dry skin and
mouth, rapid and labored breathing, a fruity or acetone
breath odor, a rapid, weak pulse, and low blood pressure.
DIABETIC KETOACIDOSIS (DKA) – Severe, out of
control diabetes that needs emergency treatment. DKA
happens when the blood does not have enough insulin
because the person is ill, does not take large enough
dose of insulin, or gets too little exercise. The body starts
using stored fat for energy, and ketone bodies (acids)
build up in the blood.
E
E.P. – edible portion, weight of food without inedible portion.
F
ATHEROSCLEROSIS – a disease in which fat builds up
in the large ad medium-sized arteries. This buildup of fat
slows down or stops blood flow. This disease can happen
to people who have had diabetes for a long time.
FASTING BLOOD GLUCOSE – the amount of glucose
(sugar) in the blood after 8 hrs. or more of fasting. The
normal amount is 60-100 mg/dL or 3.3-5.5 mmoles/L. an
amount higher than 140 mg/dL or 7.7 mmoles/L means
the person may have diabetes.
B
FATTY ACID – a basic unit of fats.
BETA CELL – a type of cell in the pancreas. Beta cells
make and release insulin, a hormone that controls the
levels of glucose (sugar) in the blood.
FRUCTOSE – a simple sugar, it is changed to glucose
in the body.
BLOOD GLUCOSE – the main sugar that the body makes
from the three elements of food – proteins, fats, and
carbohydrates – but mostly from carbohydrates.
BLOOD GLUCOSE MONITORING – a way of testing how
much glucose (sugar) is in the blood. A drop of blood from
the tip of a finger or the earlobe is placed on the end of
a special strip of paper. The paper strip has a chemical
on it that makes it change color according to how much
glucose is in the blood. A person can tell if the level of
glucose is low, high or normal in one of two ways. The first
is by comparing the end of the paper strip to a color chart
that is printed on the side of the test strip holder.
The second way is to use a machine (meter). The strip
is inserted into the meter and the level of glucose in the
blood is read.
C
CHOLESTEROL – a fat-like substance found in the blood,
muscle, liver, brain, and other tissues in people and
animals. The body makes and needs some cholesterol.
80
G
GESTATIONAL DIABETES MELLITUS (GDM) – a type of
diabetes mellitus that can occur when a woman is pregnant. In the second half of pregnancy, the woman may have
glucose (sugar) in the blood at a higher than normal level.
However, when the pregnancy ends, the blood glucose
level returns to normal in about 95 percent of all cases.
GLUCAGON – a hormone that raises the level of glucose
in the blood. The alpha cells of the pancreas make glucagons when the body needs more sugar in the blood.
GLYCOSURIA – presence of glucose (sugar) in the urine.
This happens when there is too much glucose (sugar)
in the blood.
GLYCOSYLATED HEMOGLOBIN TEST – a blood test
that measures a person’s average blood glucose (sugar)
level for the two to three-month period before the test.
H
HORMONE – a chemical released by special cells to tell
Diabetes Nutritional Handbook
other cells what to do. For instance, insulin is a hormone
made by beta cells in the pancreas, and when released,
it tells other cells to use glucose for energy.
HYPERGLYCEMIA – too much glucose (sugar) in the
blood; a sign that diabetes is out of control.
HYPERINSULINISM – too much insulin in the blood.
This occurs when the body makes too much insulin on
its own or when a person takes too much insulin. Too
much insulin in the body may cause the blood glucose
(sugar) level to go too low.
HYPERLIPIDEMIA – too much fat (lipid) in the blood. This
happens when the body is not using nutrients – carbohydrates, fats or proteins – properly. This occurs when
diabetes is out of control.
HYPOGLYCEMIA – too little glucose (sugar) in the blood.
This occurs when a person with diabetes has injected
too much insulin. Eaten too little food, or has exercised
without extra food. A person with hypoglycemia may feel
nervous, shaky, weak, sweaty, and have a headache,
blurred vision, and hunger. Taking small amounts of
sugar, juice, or food with sugar will usually help the person
feel better within 10-15 minutes.
I
IMPAIRED GLUCOSE TOLERANCE (IGT) – blood
glucose (sugar) levels higher than normal but below the
level of someone with diabetes.
INSULIN – a hormone that helps the body use glucose
(sugar) for energy. The beta cells of the pancreas make
the insulin.
INSULIN DEPENDENT DIABETES MELLITUS (IDDM)
- a chronic condition in which the pancreas makes a little
or no insulin. The body is then not able to use glucose
(sugar) properly.
INSULIN SHOCK – a severe condition that occurs when
the level of blood glucose (sugar) drops quickly. The signs
are shaking, sweating, dizziness, double vision, convulsions, and collapse. Insulin shock may occur after taking
too much insulin, too little food, or exercising without extra
food. Also called hypoglycemia.
J
JUVENILE-ONSET DIABETES – former name of insulindependent or type I diabetes.
N
NEPHROPATHY – disease of the kidneys caused by
damage to the small blood vessels or to the units in
the kidneys that clean the blood. People who have
had diabetes for a long time may have this kidney
damage.
NON-INSULIN DEPENDENT DIABETES MELLITUS
(NIDDM) – the most common form of diabetes mellitus;
about 90 percent of the people with diabetes have this
kind. The body produces insulin but the insulin is not
working properly.
diabetes to complications.
ORAL GLUCOSE TOLERANCE TEST (OGTT) – a test
to see if a person has diabetes.
ORAL HYPOGLYCEMIC AGENTS – drugs or medicines
(pills or capsules) that lower the level of glucose (sugar)
in the blood. They work for some people whose pancreas
still makes some insulin.
OVERWEIGHT – the condition when people have more
than 10-19 percent extra body fat for their age, height,
sex, and bone structure.
P
PANCREAS – an organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so
that the body can use glucose (sugar) for energy. It also
makes enzymes which may help the body digest food.
POLYDIPSIA – a great thirst that lasts for long periods
of time; a sign of diabetes.
POLYPHAGIA – very great hunger; a sign of diabetes.
People with this great hunger often loose weight.
POLYUNSATURATED FATS – a type of fat that comes
from vegetables.
POLYURIA – having to urinate often; a common sign
of diabetes.
POSTPRANDIAL BLOOD GLUCOSE - the amount of
glucose (sugar) in the blood 1-2 hours after eating.
POTENTIAL ABNORMALITY OF GLUCOSE TOLERANCE (PotAGT) – a term for people who have normal
blood glucose levels when tested for diabetes but who
are thought to be at a higher risk of diabetes than others
for a variety of reasons, such as having a family history
of the disease. PotAGT used to be called “prediabetes”
or “potential diabetes”.
R
RETINOPATHY – a disease of the small blood vessels
in the retina of the eye.
RISK FACTOR – anything that raises the chance that a
person will get a disease.
S
SACCHARIN – a sweetener that people use in place of
sugar because it has no calories.
SATURATED FAT - a type of fat that comes usually
from animals.
SELF BLOOD GLUCOSE MONITORING – a way a
person can test how nuch glucose (sugar) is in the blood.
Also called home blood glucose monitoring.
SUCROSE – the chemical name of the sugar we use
everyday; it is broken down to simpler sugars – glucose
and fructose during digestion.
O
U
OBESITY – the condition when people have 20 percent
(or more) extra body fat for their age, height, sex, and
bone structure. This increases the risk of a person with
UNDERWEIGHT – the condition when people have less
than 10 percent body fat for their age, height, sex and
bone structure.
www.TheFilipinoDoctor.com l Sign up and open your clinic to the world.
81
Diabetes Nutritional Handbook
Index of Product Classes Related to the Handbook
For the doctor's convenience, this index lists the therapeutic classifications discussed in or related to the Handbook.
Brands available in the PPD references are also listed under each of the classes. For product information, refer to
the PPD references (PPD, PPD Pocket Version, PPD Text, PPD Tabs, and www.TheFilipinoDoctor.com).
Insulins
Short-acting Insulins
Actrapid HM
Apidra Solostar
Humalog
Humulin R (Regular)
Insuget-R
NovoRapid FlexPen
Scilin R
Wosulin-R
Intermediate-acting Insulins
Humalog Mix 25
Humulin 70/30
Humulin N (NPH)
Insuget-N/ Insuget 70/30
Insulatard HM/Insulatard HM Flexpen
Vidagliptin + Metformin
Galvusmet*
Meglitinides
Nateglinide
Starlix
Repaglinide
Novonorm
Biguanides
Metformin HCl
Ansures ER
Azulix 1 MF*
Diafat
Euglo Plus*
Fornidd
Galvusmet*
Glucophage/Glucophage Forte
Glucophage XR
Glucovance*
Gludin
Glumet/Glumet-XR
Humamet
Janumet*
Metta SR
Neoform 500
Nidcor
Panfor SR-500/Panfor SR-1000
Pharex Metformin
Prialta-Met*
Ritemed Metformin HCl
Solosamet*
Winthrop Metformin HCl
ZolidPlus*
Sulfonylureas
First Generation
Chlorpropamide
Second Generation
Glibenclamide
Daonil
Euglo Plus*
Euglodin
Euglucon
Glucovance*
Melix
Orabetic
Sucron
Winthrop Glibenclamide
Gliclazide
Clibite
Diamicron/Diamicron MR/
Diamicron MR 60
Dianorm
Gliget MR
Glubitor/Glubitor-OD
Gluconil
Glimepiride
Acotril
Aforglim 1/ 2/ 3/ 4
Arya
Azulix
Azulix 1 MF*
Diaberid
Diaglim
Euglim
Getryl
Glimarex
Glimed
Glipiren
Glyper
Melix
Mira
Neoglim
Solosa
Solosamet*
Sulfast 1/2/3/4
Syngly-4
Winthrop Glimepiride
Zoliget*
Glipizide
Glimax
Minidiab/Minidiab OD
Dipeptidyl Peptidase 4 (DPP-4)
Inhibitor
Saxagliptin
Onglyza
Sitagliptin phosphate
Januvia
Sitagliptin phosphate + Metformin
Janumet*
Vidagliptin
Galvus
Thiazolidinediones
Pioglitazone
Actos
Diabetone
Glitaz
Glitter 15/30
Glucozone
Pharex Pioglitazone
Piozar
Piozone
Mixtard 30 HM/ Mixtard 30 HM Flexpen
NovoMix 30 FlexPen
Wosulin-30/70
Wosulin-N
Long-acting Insulins
Lantus/Lantus Solostar
Levemir FlexPen
Oral Hypoglycemics
Alpha Glucosidase Inhibitors
Acarbose
Glucobay 50/Glucobay 100
Gluconase
Voglibose
Basen
82
Prialta
Prialta-Met*
Zeal
Zolid
ZolidPlus*
Zoliget*
Zypi
Diabetes-Related Food Supplements
Ampalaya leaves
Amargozin
Glucontrol*
Jimm's Herbal Capsule*
Banaba powdered leaves
Diaban
Glucontrol*
Chromium picolinate
Diamaxin*
Glucontrol*
Natural Formula Chromium
Picolinate
Exenatide
Byetta
Food formula
Diabetasol Nutrition Powder
for Diabetics
Glucerna
Glucerna SR