Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Food choice wikipedia , lookup
Saturated fat and cardiovascular disease wikipedia , lookup
Adipose tissue wikipedia , lookup
Low-carbohydrate diet wikipedia , lookup
Human nutrition wikipedia , lookup
Abdominal obesity wikipedia , lookup
Thrifty gene hypothesis wikipedia , lookup
Diet-induced obesity model wikipedia , lookup
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