Diabetes mellitus is a heterogeneous syndrome which necessitates continuous medical care and patient’s education to prevent acute complications and minimise or prevent the risk of long-term complications. This could be achieved by proper and standard medical care.
The goal in the management of diabetes is to render the subject symptom free, restore normal blood glucose level, achieve the ideal body weight and ensure normal growth and maturation. To realise these objectives, the diabetic require medical care which includes clinical examination, laboratory evaluation and management plan.
Management Plan
The triad of insulin, exercise and diet has been the basis for treatment of diabetes for the past 60 years. There is no uniform management plan which is applicable to all. Each situation requires individualised treatment.
The factors to be considered in planning the treatment are the degree of metabolic derangement, age, dependency, occupation, the ability to learn and comply and the socioeconomic status. A comprehensive management plan would include:-
• Individual counselling (with objectives of normalisation of body weight)
• Exercise regimes (to improve metabolic control)
• Medications (depending on type of diabetes)
• Lifestyle adjustment (to reduce associated complaints)
• Education and counselling
• Proper relaxation are the key factors in long term protection
Dietary Management of Diabetes
Diet is the cornerstone of therapy for all patients with diabetes mellitus and must be tailored in terms of type of diabetes, energy needs, social and ethnic background and lifestyle. Dietary modification is the mainstay of treatment for Non-Insulin-Dependent Diabetes Mellitus (NIDDM). A large population of patients with NIDDM, who comply with dietary advice, will show improvement in the major metabolic abnormalities associated with this condition, to an extent that will obviate the need for oral agents and insulin.
In Insulin-Dependent Diabetes Mellitus (IDDM), the role of diet is twofold; firstly, to help minimise the short-term fluctuations in blood glucose (especially to reduce any tendency towards hypoglycemia); secondly, to reduce the risk of long-term complications by helping to achieve optimal glycemic control. Thus diet treatment is one of the most important aspects of diabetic education. Dietary Goals
• Provide good nutrition
• Achieve normal weight and growth
• Decrease abnormal metabolism
• Delay or prevent diabetic complications
Dietary Aims for the Control of Diabetes
Following the discovery of insulin in 1921, it became possible to define rational dietary aims. The main approach is to encourage a sensible eating pattern within the framework of the food habits. The first two goals, i.e., to reduce the abnormality and complications, requires consideration of proper balance of all the constituents of food (carbohydrates, proteins, fats, fibre, alcohol, sweeteners, vitamins and salt).
Nutritional Requirement
Tailoring the diet to the individual need is probably the most important task in the dietary management of diabetes. In doing so, the dietitian must consider the activity level, the work schedule, meal schedule, food preferences and other factors. Individualised nutritional plan should be compatible with the food habits and the lifestyle of the patient. Last but not the least, is the patient’s motivation to follow the diet plan.
There are three basic nutrients in the food which provide energy to the body. These include:-
Nutrients / gm Energy in Calories
Carbohydrate – 4
Fat – 9
Protein – 4