Managing Diabetes
Disclaimer: This booklet is for informational purposes only and is not intended to be a substitute for professional medical
advice,diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any
questions you may have regarding a medical condition. This booklet is developed by Medulla Communications Pvt. Ltd.
with an unrestricted educational grant from sanofi-aventis ltd.
Sanofi India Limited (Formerly Aventis Pharma Limited): 54/A, Sir Mathuradas Vasanji Road,
Andheri (E), Mumbai 400 093, INDIA. Tel.: (91-22) 2827 8000
IN.GLA.12.12.16
With
Diet & Exercise
Eating healthy with diabetes
When you find out you have diabetes there are so many things to learn! One of the first
things you may want to know is - what can I eat? Choosing healthy foods can help you
control your blood glucose. A daily meal plan is an important part of your diabetes
management, along with physical activity, blood glucose checks, and often diabetes
medications.
You can take care of yourself and your diabetes by learning…....
What to eat?
How much to eat?
When to eat?
Key Message: There is no one meal plan that works for everybody with diabetes. But we
can only guide you towards adopting a healthier eating habit.
Let’'s Start!
Balance your plate1,2
Milk or
yogurt
Fruit
Starch
Non-starchy
vegetables
Protein
The plate method is a useful visual guide and will help you plan your meals easier than
never before
It encourages you to eat a variety of different foods and includes servings from all food
groups in each meal
1
How to follow the plate method:
Fill 1/4 of the plate with cereal / starchy foods
Fill 1/2 of the plate (approximately 1 cup) with non-starchy vegetables
Cereals / starchy foods
Non starchy vegetables
Per serving size: 30g / 1 cup (cooked)
Group A: Greens & leafy vegetables
Per serving size: 1 cup / 100g (cooked)
Cauliflower (phool gobi), cucumber (kakdi), brinjal
(baigan), green and red chillies (mirch), lady’'s
finger (bhindi), tomato, padwal, turai, all leafy
vegetables e.g. cabbage (bandh gobi), spinach
(palak), lettuce (salad), radish tops (muli sag),
fenugreek (methi), arvi leaves.
Flour (atta) from wheat, jowar, bajra; chapati,
rotala, bhakri. Rice, khichdi, macaroni, noodles,
spaghetti, breakfast cereals like wheat-flakes,cornflakes
Biscuits (non-sweet)
Per serving size: 2-3 nos
Whole-wheat bread
Per serving size: 1 slice
Group B: All other vegetables
Potatoes (boiled)
Per serving size: 1 cup / 100g (raw)
Per serving size: 1 small / 50-75g
Carrot (gajar), onions (pyaaz), green peas (mutter),
raw mango (keri), beetroot.
Add a serving of fruit and dairy products to complete the meal
Fill 1/4 of the plate with protein foods
Milk & milk products
Fruits
Pulses & legumes
Per serving size: 30g (1/2 cup cooked)
Milk (skim)
Per serving size: 50-75g / ½cup
fresh, frozen or canned fruit
E.g. Bengal gram whole (channa), black gram dal (urad),
cowpea (chowli), field-bean (val), green gram whole (moong),
green gram dal (moong dal), lentil (masoor) or any other
pulse (dal); cooked
Meat / Chicken (without skin) / Fish - any; fresh or frozen
Per serving size: 1 ounce (30gm) / 1 medium-size fish fillet
or chicken or meat piece
Egg
Per serving size: 1 no.
Nuts & oilseeds
Per serving size: 15g / 1 Tbsp.
Milk (powdered)
E.g. Groundnuts, walnuts, almonds, pistachios, sesame (til),
garden cress seeds (haliv)
Peanut butter
Per serving size: 30g / 2 Tbsp.
2
Per serving size: 1 cup / 240ml
Group I: should be consumed in
moderate amounts
Per serving size: 1/4 cup / 35ml
Watermelon (Tarbuz; Kalingar),
Papaya (Papita) , Sweetlime
(Mausambi), Orange (Santra),
Peach, Figs (Anjir), Strawberry
Curds (skim)
Per serving size: 1 cup / 240ml
Cottage cheese (paneer)
Group II: should be consumed
sparingly
Per serving size: 30g
Cheese (low-fat)
Guava (Amrood), Apple, Pineapple
(Ananas), Grapes (Angoor), Mango
(Aam), Jamun, Pomegranate (Anar),
Litchis,Custard apple (Sitaphal)
Per serving size: 40g / 1 cube
Ice-cream (low-fat & sugar-free)
Per serving size: ½ 1/2 cup / 70g
3
Handy reminders for estimating portion sizes3,4
•
For each meal:
Hand symbol
•
Equivalent
•
You can achieve better blood glucose control by evenly spacing carb foods through the
day and by eating about the same amount at each meal or snack
You can stay within your blood glucose targets & enjoy a greater variety of meal and
snack choices
It is a good meal planning tool for anyone with diabetes
Get Set Ready…... Start Counting!!
A cereal / starch serving & fruit serving is equal
to a closed fist
•
•
•
Meat or protein alternative is equal to the palm of
the hand
Count only the foods that contain carbohydrate
Use either the portion sizes shown above, or calculate the carbohydrate grams or
choices
If you are using a packaged food with a Nutrition Facts label, count the number of total
carbohydrate”(grams) based on the serving size listed on the label
How much carbohydrate do you require?
•
Your Registered Dietician (RD) can help decide how much carbohydrate you need. The
amount depends on your age, weight, activity, and diabetes medications if needed.
How do I count carbs?
Vegetables should be enough to fill two open
hands
•
Carbs can be counted by using either carb servings / choices or by carb grams
How to count carb choices?5
Fats & oils should be not more than the tip of the
thumb (1 Tbsp.)
Which foods contain carbohydrates?5
TO COUNT CARB SERVINGS:
Grams of
Carb
0 to 5g
Fruit, fruit juices (or any food that contains
fruit or fruit juices)
Count as the following
Carb Servings
Milk, ice cream, yogurt (or any food that
contains milk)
Do not count
Breads, cereals, crackers, grains, pasta, rice
6 to 10g
1/2 carb serving or choice
(Note: These portion estimates are based on a woman’s hand size. Hand sizes vary, but it is a good
approximation)
11 to 20g
1 carb serving or choice
Starchy vegetables (such as corn, potatoes,
peas or beans)
21 to 25g
1 1/2 carb servings or choices
Non-starchy vegetables
Carbohydrate counting (carb counting):
26 to 35g
2 carb servings or choices
Sweets (such as cake, candy, cookies, pie)
Sugary foods (such as regular soda, fruit
drinks, sherbet)
•
Why carb counting?
Carbohydrate (starch and sugar) is the main nutrient in food that raises your blood
sugar levels
Consult your registered dietician / nutritionist for specific amounts of carb choices to be
included for every meal and snack as per your requirements
Remember: 15g of carb = 1 carb serving or carb choice
4
5
Be a carbohydrate detective - Reading a nutrition label6
Nutrition Facts
Enjoying
sweet taste, without the calories
•
Check the serving size:
Is that how much you
plan to eat?
•
Diabetics with a sweet tooth, no more need to compromise on their sweet buds
They can try non-nutritive sweeteners (artificial sweeteners)
Serving size 1 cup (228g)
This number (228g) is
the weight of the
product, not the amount
of cabohydrate in the
serving
Serving per container 2
Amount per serving
Calories 250
Calories from fat 110
% Daily value*
Total Fat 12g
18%
Saturated fat 3g
10%
Sodium 470mg
20%
Total carbohydrate 31g
10%
Dietary fiber 0g
0%
Sugars 5g
Get enough of these
nutrients
Count total carbohydrate
Don't count the sugars
separately as it is
already accounted under
total carbohydrates
Protein 5g
Key message: Sugar-free Does Not Mean to Use Freely
•It's true you may have less control over how foods are prepared and what ingredients are
used when you eat out, but you can control which foods you choose and how much you
eat.
7
Healthy versus Unhealthy food choices
15%
Cholesterol 30mg
When in Doubt,Read the Nutrition Label & make wiser choices
Choose wisely-While eating out
Trans fat 3g
Limit these nutrients
Consult your RD for deciding on a dosage; type of sweetener suitable for you
Food group
Green zone
Yellow zone
Red zone
Rice
Steamed rice
Pulao
Fried rice / biryani
Bread
Whole wheat bread
White bread
Croissants & cakes
Noodles
Indian breads
Potatoes
Steamed noodles
Deep fried noodles
Chapatti
Plain naan
Baked potato
Butter naan / puri
French fries
Vitamin A
4%
Vitamin C
2%
Salad
Green salad
Salad with mayonnaise
Calcium
20%
Sauce
Tomato-based
Cream-based
Iron
4%
Fish
Steamed fish
Fish curry
Fried fish
Grilled chicken
Pan-fried
Butter chicken
Whole fruit
Unsweetened fruit juice
Sweetened fruit juice
*Percent Daily Values are based on a 2,000 calorie diet. Your Daily
Values may be higher or lower depending on your's calorie needs.
To calculate carbohydrate choices using the above label:
Divide the number of grams of total carbohydrate by 15 (1 carb choice = 15 grams of
carb)
Total carbohydrate = 31g
Vegetables
Chicken
Fruit
Steamed vegetable
Sauteed vegetables
Deep fried vegetables
These constitute healthy food choices and should be eaten in recommended amounts
as they are high in fiber & low in fat content
These food choices should be consumed in moderate amounts as they are low in fiber
& contain moderate amounts of fat
These foods are rich in fat; refined carbohydrates & low in fiber content. Therefore,
should be consumed in very limited quantities
31 divided by 15 = 2.07 (round to 2)
So,1 cup (228g) of "X" food = 2 carbohydrate choices
6
7
Alcohol - Drink if you Must2,8
•As a rule, diabetics should avoid alcohol as it predisposes you to the dangers of suffering
from hypoglycemia (low blood sugar). But, it may be difficult in case of social drinkers.
Hence, strike a compromise by having alcohol in moderation.
Be active but how?
Suggestions for beginning an exercise program
First, doctor’s OK - American Diabetes Association (ADA)
suggests you get your doctor’'s OK to start with
How much is too much?
•Restrict yourself to just two small pegs (2oz, 60ml) / day
Find a few activities you enjoy
Unsweetened drinks are preferable to sweet wines
Start slowly
Find a partner or join an exercise group
Avoid having fried snacks with the drinks instead choose light protein snack like roasted
gram, salads
Be active in ten minute spurts
Take small steps towards being active the entire day
Key message: Don’'t forget to account your alcohol calories with your total calories
Exercise aerobically up to 6 times per week
Getting physically active in diabetes
Being active is a big part of living a healthy lifestyle
American
Diabetes Association (ADA) Recommendations (Duration, Frequency &
•
Intensity)
It offers many health benefits; constitutes an important part of diabetes management
plan
•
Regular exercise benefits both type 1 & type 2 diabetics
Check out the benefits of being active, how much activity is best for you and get a few
ti ps to get started now!
Benefits of exercise:9
Improves blood sugar control
People with diabetes should be advised to perform at least 150 min/week of moderateintensity aerobic physical activity (50–-70% of maximum heart rate)9*
In the absence of contraindications,people with type 2 diabetes should be encouraged
to perform resistance training (weight-training) three times per week10
*How to calculate your target heart rate,
•Target Heart Rate = (220 - –Age) x 0.6 to 0.8
Helps control your blood pressure and cholesterol
Reduces dosage or need for insulin / medications
Aids in weight loss
Improves overall cardiovascular fitness, strength, flexibility
Builds stronger bones and muscles
Relieves stress, reduces depression & anxiety
Improves quality of life & gives a sense of well-being
8
9
My Activity Pyramid - Your Way Towards Being Physically Fit11
Getting started, staying safe
If you’'ve been inactive for some time, you may not be able to exercise much at first. You’'ll
need to build up gradually.
Monitor your blood glucose before, during, and after exercise
Cut Down
on
Balancing activity & food intake
Watching TV.
computer games,
sitting ideal for more
than 30 minutes at
a stretch
To respond to your sugar readings; use the guide below:12
Before exercise: If your blood sugar is
below the recommended range
What to eat: Have a carbohydrate snack
before starting to exercise
During exercise: Check blood glucose levels
every 30 to 45 minutes
What to eat: Eat quick energy, low-fat snacks
after every 30-45 mins of strenuous exercise
After exercise: Your blood glucose levels
may continue to drop for several hours after
activity. That’'s why you might want to
continue monitoring at two-hour intervals
What to eat: Snack as per required to keep
your blood sugar in target range
2-3 times a week
Flexibility & strength training
stretching, yoga, push-ups, curl
ups, weight-lifting, playing
sports like tennis, squash, golf,
hiking
3-5 times a week
Aerobic exercises
(20+minutes)
brisk walking, swimming,
jogging, spot running
Take the stairs
Walk whenever you
can
Try cycling sometimes
Walk while you talk
on phone
Recreational activities
(30+minutes)
dancing, cycling, gardening,
martial arts, painting
Everyday
Be creative on finding ways
to fit in an exercise
schedule in your daily
routine. Take baby steps
towards it....
Also,
Carry water and a carbohydrate source like glucose tablets, biscuits, sweets, candies
to prevent or treat a hypoglycemic episode
While you exercise, make sure you drink enough water-it’'s easy to get dehydrated
Get off the bus a
stop early
Use lunch hours/
tea/coffee breaks to
take a walk around
while at work
(Adapted from Badenhop DT. Prescribing exercise for patients with diabetes. In Regensteiner JG,Reusch J,
Stewart KJ, Veves A; editor. Diabetes & Exercise. New York: Humana press; 2009. P. 187-208.)
Always carry your diabetes identification card for people to know your status & help
you in times of need
Staying motivated
If you find it hard to stay motivated for exercise, try these ti ps:
Consider your interests - Choose things you enjoy
Diabetics are primarily advised aerobic exercises
Schedule it: Remember, you won’'t“"find"”time for exercise. You have to make it!
A combination of aerobics with weight-lifting may also help
Find a buddy: Exercising with family or friends is much more fun & a great way to build your
relationships
Use the My Activity Pyramid as a guide to know what activities you can indulge in &
how much to do
Set short- and long-term goals & don’'t forget to treat yourself with something special when you
reach a goal
Consult your physician for planning your exercise schedule
Track your progress: Write down how much you exercise every day in your logbook, or simply put
an "X"”on the calendar. This will probably help you feel more motivated to keep up the good work
10
11
My personal planner
Name:
References
Date:
Name of the Registered Dietician (RD) / Nutritionist:
Contact no:
1.
Brown MD, Lackey HD, Miller Kathleen, Priest Diane. Controlling calories-the simple approach. Diabetes
Spectrum 2001: 14(2),110-112.
2.
Chandalia HB,Modi SV. Nutrition Management of Diabetes In Conquest of diabetes By Diet & Exercise.
3rd ed. Mumbai: Uchita Graphics Ltd; 2008.
3.
Warshaw, H.S., Kulkarni, K. Complete Guide to Carb Counting 2nd Edition. Alexandria, VA: American
Diabetes Association, 2004; and Wondering How Much to Eat? Do the Hand Jive! Diabetes Spectrum
1999; 12:177-178.
4.
American Diabetes Association. Simple Ways to Make Everyday Choices for a Healthier Life. Available
from (http://www.diabetes.org/in-my-community/local-offices/miami-florida/assets/files/simple-ways-tomake-everyday.pdf)
5.
American Diabetes Association. Carbohydrate counting: The basics. Clinical Diabetes 2005: 23(3); 123124.
6.
American Diabetes Association. Taking a closer look at labels. Available from
(http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/taking-a-closer-look-at-labels.html) last
accessed on 13th June, 2011.
7.
Kapur K,kapur A. The signal system: an empowering tool for healthy food choices. Diabetes Voice 2005:
50 (2); 20-22.
8.
American Diabetes Association Clinical Practice Recommendations 2007,Nutrition Recommendations and
Interventions for Diabetes. Diabetes Care 2007,30(S1), p S54.
9.
American diabetes Association. Top 10 benefits of being active. Available from
(http://www.diabetes.org/food-and-fitness/fitness/fitness-management/top-10-benefits-of-being.html) last
accessed 13th June, 2011.
(Fill up the below details with help of your RD)
Total calories:
Carbohydrates (in grams):
Proteins (in grams):
Fat (in grams):
Number of carb choices:
Breakfast:
Mid-Morning:
Lunch:
Late Evening:
Dinner:
Bed-time:
(Indicate the no. servings in each meal against the respective food groups you are having
daily. This will help you to track your daily food intake)
Food group
Breakfast
(Time:……....)
Mid - morning
(Time:……....)
Cereals /
starchy foods
Lunch
(Time:……....)
Snack
(Time:……....)
Dinner
(Time:……....)
10. American Diabetes Association. Standards of medical care in Diabetes- 2011: position statement. Diabetes
care 2011: 34 (s1); s11-s61.
11. Badenhop DT. Prescribing exercise for patients with diabetes. In Regensteiner JG,Reusch J,Stewart KJ,
Veves A; editor. Diabetes & Exercise. New York: Humana press; 2009. P. 187-208.
Milk & milk
products
12. Australian Diabetes Council. Balancing food, activity & insulin. Available from
(http://www.australiandiabetescouncil.com/Resources/PDFs/NDSS-Information-Sheets/BALANCING2010.aspx) last accessed 13th June, 2011.
Meat, poultry,
Eggs, Fish
Non-starchy
vegetables
Fruits
Fats(oils,
butter, ghee)
SMBG
reading(g/dl)
My exercise goal:
Any specific comments:
12
13
Note
Note
Note