Diet is told oldest and most important treatment for diabetes. The primary goal of therapy for person with Insulin-dependent diabetes mellitus are the maintenance of appropriate body weight and the prevention of hypoglycemia and hyperglycemia. The patient reaches these goals by consuming meals with an appropriate caloric content at regular intervals in co-ordination with the timing of insulin injections and the level of physical activity. Individuals with Insulin- dependent diabetes are usually young and lean, their caloric intake should be adequate to support normal growth and development.
Eighty to ninety percent of individuals with non-insulin dependent diabetes mellitus are over-weight and the goal-of dietary therapy is weight loss. For many of these person, restriction of caloric intake and increased physical activity will produce a moderate weight loss that may be sufficient to control blood glucose levels and make insulin or oral medication unnecessary. It is very essential that person suffering from diabetes should never take sugar or thing containing sugar. They should avoid sweets or those vegetables or fruits which contain sugar.
The caloric intake should achieve and maintain a desirable weight in the person with diabetes. The calorie prescription is an important element of nutritional management and should be carefully considered. Caloric requirements for person with diabetes are not different from those for person without diabetes, if the person with diabetes is not losing calories through glycosuria. Caloric needs vary with the patients age, sex, and activity level. The recommended caloric level is based on an individuals desred weight and her activity patterns.
For infants, children and adolescents, the caloric needs associated with normal growth and sexual maturation must be carefully considered and growth rated should be vigilantly followed.
Individuals whose diabetes is under good control appear to have the same protein requirement as non diabetic individuals. When insulin levels are normal, protein is considers in the body and the use of amino acids for glucose synthesis is limited. How ever, individuals with poorly controlled diabetes may have increased needs for protein because it may be used by the liver to synthesis. There is non evidence that individuals with diabetes and renal insufficiency should avoid eating excessive amount of protein.
Carbohydrates should comprise 55 to 60% of caloric intake of the diabetic patients, with the form and amount of carbohydrate determined by individual eating patterns and the levels of blood glucose and lipids achieved. Unrefined carbohydrates should be substituted for refined carbohydrates to the extent possible. A diet in which approximately 60% of the total calories are from carbohydrates is recommended for individuals with diabetes because it results in a reduction in dietary fat particularly saturated fat thought to be beneficial in reducing cardiovascular risk. Recommendations for increased carbohydrate consumption are now coupled with the recommendation that foods high in fiber, especially soluble fiber be encouraged.
Consumption of total fat saturated fat and cholesterol by individuals with diabetes should be restricted. Total fat comprise less than 30% of total calories and the amount of cholesterol should be less than 300 mg/ day. A diet low in total fat, saturated fat and cholesterol is recommended for individual with diabetes to help decrease the risk for coronary heart disease. Sodium intake should be restricted. Concern about sodium is primarily directed at individuals with congestive heart failure or high blood pressure. Since people with diabetes are frequently hypertensive, it has been deemed prudent to make modest restrictions in their sodium intake. Alcohol use should be restricted entirely in persons with diabetes and insulin induced hypoglycemia, poor control of blood sugar or blood lipids or obesity. The use of alcohol may need to be restricted in over weight persons and the use of excessive alcohol consumption by a person who is fating or skipping meals can lead to hypoglycemia and may pose a serious risk for persons taking insulin. Injection of alcohol may raise fasting and postprandial levels of triglycerides. Since person with diabetes are at increased risk for cardiovascular disease, injection of alcohal should be avoided. It also recommended that pregnant women should avoid intake of alcohol. Peripheral neuropathy is a frequent complication of diabetes and neuropathic effects of alcohol may be additive with those of diabetes.
Special consideration for dietary management in the elderly: As person age, greater attention needs to be paid to their nutritional status and the dietary recommendations and advice. The provision of optional nutrition for the elderly is a major concern. Even without the complication presence of diabetes. Unfortunately, the nutritional needs of the elderly and particularly of the elderly with diabetes have not been considered. Only in recent years has this problem drawn the special attention it deserves. In general, the elderly have a higher percentage of the body fat, a lower lean body mass, and lower caloric requirement. The eating patterns in the elderly can be influenced. By the many physical, mental and emotional factors that affect them. Impaired vision, smell, hearing, taste, decreasing dexterity and memory, loneliness, illness and use of many medications, limited financial resources and transportation can all cause problem with eating. Poor teeth and gums or ill-fitting dentures are wide spread problems in the elderly and commonly lead to their consumption of softer foods high in sugar and fat. Foods containing greater amount of fiber such as fry fruits, whole grains cereals or breads can be more difficult for them to chew Depressional and physical limitations can limit their access to food.
In general it is probably best to keep the diabetic diet regimen of the elderly simple, balanced meals that fit long-standing eating habits, life-style and the physical and psychological needs of the individual. The nutritional needs of children with diabetes do not differ from those of children who do not have diabetes, not do they require special foods or different amount of vitamins or minerals. The total intake of energy and nutrients must balance the daily expenditure of energy and satisfy the requirements of normal growth. The energy content of the meal plan is based on the child age, sex, height, weight, stage of sexual development and level of physical activity when insulin is given.
DIABETES AND PREGNANCY
The nutritional requirements of a diabetic pregnancy are essentially the same as those of a non diabetic pregnancy. In addition, pregnancy does not significantly change the basic tenets management of diabetes. The remarkable decreases in the morbidity and mortality rates among infants born to women with diabetes are thought to be due in large part to the emphasis that has been placed on rigid control of material glucose levels throughout the course of pregnancy and on the avoidance of ketonuria. During pregnancy levels of carbohydrates of 30 to 40% of total caloric intake are recommended.
Recent studies suggest that increased consumption of dietary fiber might improve many clinical conditions, including diabetes. Some studies have demonstrated that diets containing higher amount of fiber and carbohydrates are associated with lower levels of blood glucose and serum lipids. The water soluble fibers such as cellulose, lignin, grain breads, cereals and wheat bran affect gastro intestinal transit and have little impact on plasma glucose, insulin or cholesterol levels.
Diets very high in carbohydrates and fiber consistently improve glucose tolerance, decrease fasting levels of plasma glucose, lower insulin needs and decrease serum cholesterol concentrations.
THE YOGIC DIET
In the science of yoga, diet is of great importance in the development and promotion of health and prevention of disease. Half of India is undernourished, the order half is eating the wrong food leading to a spurt in diseases like diabetes. People need guidelines on the right diet. All articles of food must be chewed thoroughly before they are swallowed. The first fundamental yogic Principal is to masticate, grind and churn every mouthful. Proper digestion is mainly responsible for healthy nervous system. Our ill health is also due to methods of handling and cooking foods. It is said , Heaven sends us goods foods but the devil-sends us bad cooks. Peeling, Soaking, Roasting, frying and over-cooking story the vitamin content and enzymes of foods. It is said hunger is the best sauce. We must eat when we are hunger. Even simplest dishes become delicious when taken under the spell of hunger. Yogic diet is not queer. It is one which contains different type of simple and natural food in such quantities that the need for energy, amino acids, vitamins, minerals, fats, carbohydrates and other nutrients is met for maintaining physical and mental health. Diet directly or indirectly influence the mind. Just as when curd is churned, its fine particles from butter. Similarly when foods is consumed, the fine particles from the mind. Food, emotions and mind do influence each other. Yogic diet aims at harmonious development, physical, mental and spiritual. It is nutritious, vegetable, simple and easy to digest. A yogic diet increases effiaency, stamina, vim and vigour. Lord Krishna says to Arjuna, Verily, yoga is not for him who eateth too much, nor who abstaineth to excess. Yoga killeth all pain for him who is regulated in eating and amusement, regulated in performing action, regulated in sleeping and waking. Yoga practitioners avoid all narcotics, alcohol, drugs, and smoke that stimulate the senses. Yogic diet is sattvik diet and lays stress on fresh, simple, whole some and nutritious diet. It includes among other things fruits, milk, butter, cheese, wheat, salad, ghee, soya beans, green and yellow vegetables curd, lemon, oranges, rich in protein and vitamins. High blood sugar or glucose level over time can lead to deposits of fatty materials on or inside blood vessel walls. This may affect blood flow, and increase the change of clogging or cause arteries to lose elasticity. According to yogic diet principles for a diabetes patient, daily carbohydrate intake should be 45 to 55% of total caloric intake. Foods like oats, unpolished rice, pulses, beans and legumes, fruits like guava, apple should be preferred. Fat should provide not more than 20% of total energy. The protein intake should be as per body weight. A 60 kg man needs 60 gms of protein daily which can be obtained from wheat flour, dal, and milk. For a patient of diabetes sugar, alcohol, drugs are harmful. In diabetes boiled, steamed, roasted, grilled, poached is recommended over frying as it reduces the fat content in the food.
ROLE OF YOGA
Ancient India has gifted the world a great treasure in the ideology and technology of yoga. This art and science of healthy living-physically, emotionally, morally, intellectually and spiritually has been handed down to us from time immemorial. Hiranyagarbha of the earliest vedic period is said to be the first being to reveal yoga. Yoga is the sum and substance of a conceptual science to aid the progress of evolution and therefore it is eternal. Even gods could not have achieved their divinity without the knowledge of yoga. Such is the unique place that yoga enjoys in the cultural history of India.
The rigveda reveals what yoga is like when it refers to it as a vehicle a means by which a deity and through him the object in view can be achieved. It suggests yoga as a communication link or a bond between the individual and the universe and between microcosm and macrocosm. In this context the popular definition of yoga as an instrument for achieving all objects of life is significant. The unique process of knowing and achieving which is yoga is obviously different from the material science and therefore to many yoga is something extra-mundane, metaphysical miraculous or mystical. Yoga is for all living beings. We are however concerned with the human being especially the modern man at the present stage of evolution, let us then approach man as we see him in his day-to-day life and them answer.