Diet therapy for diabetes mellitus: How to eat happily?

Diet therapy for diabetes mellitus: How to eat happily?

Controlling Diet for Diabetes Treatment

According to the Ministry of Public Health's data, currently, in Thailand, more than 2.4 million people aged over 35 suffer from diabetes, with more than half of them unaware of their condition. Most of them visit doctors due to other symptoms such as infected wounds, fatigue, and weakness, without realizing they have diabetes.

Easy-to-understand 3 categorization of food for diabetic patients is as follows:

1. Foods that should be avoided

• All types of sugar such as cane sugar, palm sugar, rock sugar, honey, sweetened drinks, various desserts
• Milk products such as sweetened condensed milk, sweetened flavored milk, sweetened yoghurt, sour cream
• Blended fruit, soaked fruit, and dried fruit, such as dried banana, dried longan, longan in syrup, and canned fruits
• Foods prepared with saturated fats such as animal fats, sausage, three-layer pork, coconut milk, coconut cream, margarine, and cream.

2. Foods that can be consumed but should be limited in quantity

• Rice and flour-based foods such as bread, taro, pumpkin, and other similar foods. These foods contain less carbohydrate than sugar and provide protein, vitamins, minerals, and dietary fiber. Diabetic patients should consume them according to their work and activities. Consuming too little rice may cause a low blood sugar level. It is recommended to choose rice with high dietary fiber content such as brown rice or riceberry.
• Fruits have different amounts of carbohydrates. The sweeter the fruit, the higher the sugar content. For example, durian, sweet tamarind, longan, grapes, rambutan, and ripe mangoes contain high amounts of sugar. Diabetic patients should choose fruits that are not too sweet and consume them in an appropriate amount per day. For example, 3 servings per day with 7-8 pieces per meal.

3. Food that can be consumed "unlimitedly”

• Stems, leaves, and green leafy vegetables of all kinds should be eaten every day, every meal. Eat a variety of colors. These foods are low in calories and high in fiber, which slows down sugar absorption. In addition, fiber also helps absorb sugar into the bloodstream at a moderate pace, so the body can use the sugar appropriately. Examples include white cabbage, Chinese watercress, kale, morning glory, water convolvulus, sponge gourd, pumpkin, cucumber, watermelon, long beans, and bean sprouts. They can be eaten as fresh or cooked vegetables, but not recommended in the form of blended vegetable juice, especially those with leftover vegetable fibers as it reduces fiber intake.

• The World Health Organization recommends consuming at least 400 grams of fruits and vegetables per day, equivalent to 4-6 servings. If the vegetables are cooked, the amount should be doubled. Research has found that consuming at least 400 grams of fruits and vegetables per day can reduce the risk of heart disease by 33% and cancer by 50%, compared to those who do not meet the recommended intake.

How should people with diabetes eat?

People with diabetes should learn about the types and quantities of food they eat, and consume a balanced diet consisting of the 5 food groups: grains or other starchy foods, lean meats, eggs, low-fat milk, green and yellow vegetables, and fruits with low sugar content in recommended amounts. As for fats, it is recommended to choose vegetable oils such as soybean oil, sunflower oil, and peanut oil for cooking instead of saturated fats such as lard, coconut milk, and butter. Stir-frying is preferred over deep-frying to avoid using too much oil.

The diet for diabetes patients is not significantly different from the regular diet for non-diabetic individuals, but patients with diabetes must pay attention to the amounts of each type of food they consume, especially foods that contain sugar, starch, and fat, which can affect their blood sugar and blood fat levels.

The amount of rice or other types of starch that a diabetic person consumes is not significantly different from that of a non-diabetic person, but a diabetic person must pay attention to the amounts of each type of food they consume, especially foods that contain sugar, starch, and fat, which can affect their blood sugar and blood fat levels.

The amount of rice or other types of starch that a diabetic person consumes, such as noodles and bread, should be appropriate for their body weight and physical activity, such as women of normal weight who perform light to moderate physical activity, can consume 2-3 small servings of rice per meal, and men who are not overweight and perform light to moderate physical activity can consume 3-4 small servings of rice per meal.

1 ladle of rice =1 slice of bread or 1 serving of noodles or 1 serving of dumplings.

**A ladle of rice refers to rice cooked in an electric rice cooker, measured appropriately. For people with diabetes, it is important to choose appropriate foods and plan meals. 

When selecting meals, it is recommended to choose a variety of foods and plan accordingly. Rice should be portioned according to past intake. If you want to eat both rice and bread or other types of flour, reduce the amount of each. Choose rice that is low in fat and high in vegetables, such as boiled, grilled, spicy, and stir-fried dishes. Choose lean meat and remove fat and skin. Avoid dipping sauces that are sweet or use only small amounts.

People with diabetes may occasionally eat sweets, but they should choose sweets that are low in sugar and plan to reduce rice and fatty foods, including avoiding fruit in that meal, in order to control blood sugar levels.

For example, if you eat a small piece of cake (1 x 1 inch) or a sweet that has syrup, such as sesame candy or candied water chestnuts, take only half a cup and reduce rice by about 1 serving from what you normally eat. Do not skip rice and eat only sweets, as it will make it difficult to control blood sugar levels. Also, avoid sweets that are very sweet.

For example, sweet treats such as caramelized bananas, gold-dipped bananas, sweet sticky rice with coconut milk, and traditional Thai desserts should be consumed in moderation by individuals with diabetes. It is recommended that they only indulge a little and not frequently, preferably when their blood sugar levels are within a healthy range. As for beverages, plain water or soda should be chosen instead of sugary drinks, fruit juice, and alcoholic beverages. If consuming alcoholic drinks, it should be in small amounts, such as no more than 2 glasses of beer or wine. For those who still crave sweetness, artificial sweeteners can be used to add flavor without increasing blood sugar levels.

Carbohydrate Counting

Carbohydrates are foods that are mainly composed of starch, which when consumed, are converted into sugar in the bloodstream. They are found in four main types of foods: grains, fruits, milk/yogurt, while vegetables and meat have fewer carbohydrates and therefore have less of an impact on blood sugar levels.

One carbohydrate serving is about 15 grams of carbohydrate, and can be found in foods such as: one cup of cooked rice, half a cup of sticky rice, one slice of bread, one apple, 240 ml of milk, one tablespoon of granulated sugar.

The average recommended intake for diabetic patients is:

• no more than 5 carbohydrate servings per meal for men 
• no more than 4 carbohydrate servings per meal for women. 

*Note: The above quantities are just averages and each patient's carbohydrate needs may vary. Therefore, it is recommended to consult a dietitian or nutritionist for appropriate amounts.

Carbohydrate exchange means that foods with the same amount of carbohydrates can be exchanged for each other.

Calculating daily carbohydrate requirements:

(Daily energy requirement) ×50÷100= ______kcal = kcal÷4=_______grams per day

(1 gram of carbohydrate provides 4 kcal of energy)

(The energy distribution ratio is 50% carbohydrates, 30% protein, and 20% fat)

*Patients can refer to food exchange tables to determine nutritional values. 1 gram of protein provides 4 kcal of energy.

Calculating protein requirements for the general population is 0.8-1 gram per kilogram of body weight per day, for example, a person weighing 50 kilograms would need 40 grams per day. One portion of meat contains 7 grams of protein.

*Patients with diabetes should consume low-fat animal proteins, such as fish, lean meats, and chicken breast. One gram of fat provides 9 kcal of energy.

Calculating daily fat requirements:

(Daily energy requirements) × 30 ÷ 100 = _______ Kcal.

Kcal ÷ 9 = _______ grams per day

1 tablespoon of oil contains 15 grams of fat, providing 135 Kcal of energy.

*Diabetic patients should choose healthy fats to consume, such as coconut oil, rice bran oil, and soybean oil