ROLE OF DIET IN THE MANAGEMENT

OF DIABETES
Bambang Suprapto
Department of Nutrition
Faculty of Medicine Sebelas Maret University

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WHAT IS DIABETES ?
TYPE 1 : ABSOLUTE INSULIN DEFICIENCY
TYPE 2 : RELATIVE INSULIN DEFICIENCY

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THREE TYPES OF PREVENTION

PRIMARY PREVENTION : is aimed to
prevent diabetes at the pre-diabetes stage;
SECONDARY PREVENTION : is aimed to
screen high risk groups for early detection and
prompt and effective management of diabetes;
TERTIARY PREVENTION : is aimed to
prevent complication and disability due to
diabetes
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STRATEGIES TO PREVENT COMPLICATION

STRICT METABOLIC CONTROL

EDUCATION
EFFECTIVE TREATMENT

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HYPERGLYCAEMIA IS THE MAIN FACTOR

IN THE GENESIS AND PROGRESSION OF:

MICROVASCULAR DISEASE :
nephropathy, retinopathy and neuropathy
MACROVASCULAR DISEASE : stroke,
coronary heart disease and peripheral
vascular diseases

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DIETARY STRATEGIES FOR

TYPE 1 DIABETES
INCREASED FREQUENCY AND NUMBER OF
FEEDINGS
MAINTENANCE OF DAY-TO-DAY CONSISTENCY
OF INTAKE OF CALORIES
MAINTENANCE OF DAY-TO-DAY CONSISTENCY
OF RATIOS OF CARBOHYDRATE, PROTEIN AND
FAT FOR EACH OF THE FEEDINGS, AND
TIME MEALS CONSISTENTLY

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DIET INT THE MANAGEMENT OF

TYPE 2 DIABETES
DIETARY METHODS ARE USED TO REDUCE
WEIGHT AND THE INTAKE OF QUICKLY
ABSORBED CARBOHYDRATE
DIET SHOULD ALSO AIM TO LIMIT THE
SATURATED FAT INTAKE
IF DIETARY MEASURES FAIL TO CONTROL
GLYCAEMIA AFTER A PERIODE OF
REASONABLE COMPLIANCE, DRUG THERAPY IS
PRESCRIBED IN ADDITION TO DIET
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THE SEQUENCE USED WHEN

DEVELOPING A DIABETIC DIET
ESTIMATING THE AVERAGE DAILY ENERGY NEED
CALCULATING THE ABSOLUTE INTAKE OF
CARBOHYDRATE
SPECIFYING THE TYPE OF DIETARY CARBOHYDRATE
ADJUSTING THE PATTERN OF INTAKE TO ACCOUNT FOR
THE TIMING AND TYPE OF INSULIN INJECTED AND
PATIENTS ACTIVITIES
SPECIFYING INTAKES OF N-3 FATTY ACIDS, VEGETABLES
AND FRUIT FOR METABOLIC, ANTIOXIDANT AND FIBRE
NEEDS

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GOALS OF DIETARY MANAGEMENT IN

DIABETES

TO IMPROVE THE OVERALL HEALTH OF THE PATIENT BY

ACHIEVING AND MAINTAINING OPTIMAL NUTRITIONAL STATUS
TO ACHIEVE AND MAINTAIN IDEAL LEVEL OF BODY FAT OR IDEAL
BODY WEIGHT
TO PROVIDE NORMAL PHYSICAL AND PSYCHOSOCIAL
DEVELOPMENT OF THE CHILD OR ADOLESCENT WITH DIABETES
TO PROVIDE FOR OPTIMAL HEALTH DURING PREGNANCY AND
GROWTH AND DEVELOPMENT OF THE FETUS
TO MAINTAIN PLASMA GLUCOSE AS NEAR THE NORMAL
PHYSIOLOGICAL RANGE AS POSSIBLE
TO PREVENT OR DELAY THE DEVELOPMENT AND PROGRESSION
OF DIABETIC COMPLICATIONS
TO MAKE DIETARY PLAN AS ATTRACTIVE AND REALISTIC AS
POSIBLE.

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ENERGY REQUIREMENT
TO DETERMINE THE BASAL ENERGY EXPENDED FOR 24
HOURS, THE PATIENTS IDEAL BODY WEIGHTIN
KILOGRAMS IS MULTIPLIED BY 4.5
IF THE PERSON IS YOUNG, TALL OR MALE, 100-200 CALORIES
ARE ADDED TO THE BASAL ENERGY REQUIREMENT
IF THE PERSON IS ELDERLY, SHORT OR FEMALE, 100-200
CALORIES ARE SUBSTRACTED FROM THE BASAL ENERGY
REQUIREMENT
LIGHT ACTIVITY REQUIRES 30 % ADDED TO THE
CALCULATED BASAL ENERGY REQUIREMENT
IF THE PATIENT IS OBESE, SUBSTRACT 500-750 CALORIES
FROM THE CALCULATED DAILY ENERGY REQUIREMENT

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GLYCAEMIC INDEX
IS A CLASSIFICATION OF FOODS
BASED ON THEIR BLOOD GLUCOSE
RESPONSE RELATIVE TO WHITE
BREAD OR GLUCOSE i.e. 100 x the ratio
of the glycaemic response (the area of
glucose elevation x time) to 50 g whitebread or glucose solution
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The glycaemic index for selected foods

100% : glucose
80-90% : carrots, honey, cornflakes, potato (mashed)
70-79% : bread (wholemeal), rice (white), potato, millet
60-69% : bread (white), rice (brown), banana
50-59% : spaghetti (white), sweet corn, sucrose
40-49% : spaghetti (wholemeal), potato (sweet), beans,
oranges, orange juice
30-39% : apple, ice cream, milk, yoghurt, tomato soup
20-29% : kidney beans, lentils, fructose
10-19% : soya beans, peanuts

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FIBRE
Fibre is any material that remain undigested
in the small intestine. It includes structural
fibres such as cellulose, hemicellulose and
lignin and soluble fibres such as gums and
mucilages;
The mean levels of glucosuria and
glycaemia decrease when diabetic patients
consume a high fibre diet
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THE POSIBLE MECHANISM OF THE EFFECT OF

FIBRE ON BLOOD GLUCOSE LEVEL
DELAYED GASTRIC EMPTYING
GEL FORMATION WITH SQUESTERING OF
GLUCOSE
ALTERED INTESTINAL TRANSIT TIME
INSULATION OF CARBOHYDRATE FROM
DIGESTIVE ENZYMES
INHIBITION OF DIGESTION OF COMPLEX
CARBOHYDRATE

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MEAL PLANNING WITH EXCHANGE LISTS

CALCULATE ENERGY REQUIREMENTS
CALCULATE CARBOHYDRATE, PROTEIN
AND FATS
CHOOSE APPROPRIATE FOODS FROM
THE EXCHANGE LISTS

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