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Diabetic Meal Plan

Introduction

Diabetic meal is a healthy eating plan which consists of balance nutrition in the right amount of calorie requirement. It is a healthy diet for anyone! The aim of a diabetic meal is to help people with diabetes attain quality of life. In addition, it also helps to achieve life expectancy similar to general population by reducing or avoiding diabetes complication.

However, food is proven as one of the major influences on blood sugar levels in people with diabetes. Therefore, more attention has to be considered to some of the food components, particularly the carbohydrates.

Does A Perfect Meal Plan Exist?

Rationally, the objective of all diabetic meal plans is to achieve better control of blood sugar levels. It should be planned to balance the insulin and carbohydrate intake. Besides, it should also be plan to keep cholesterol at the desired level. In meal planning, consideration should be given on the current eating habits, medication and weight management of patient with diabetic.

The diet plan should be individualised with special consideration for the Type 1 Diabetes, Type 2 Diabetes and pregnancy. This is because the method that works best for one person may not be the best for another. Every plan has to be on trial basis followed by evaluation of blood glucose and adjusted as necessary.

Basically, people with diabetes may do well with smaller and more frequent meal. Snack serving may not be required for people who took oral medication and also those on rapid acting insulin. However, those who are on insulin may require a bed time snack to prevent night time hypoglycemia. In addition, those who are on morning intermediate-acting insulin may also require afternoon snack.

Meal Planning Strategies

In meal planning strategies, there are few factor has to be taken into consideration. The basic nutrition advice is as below :

1)  Timing of meals and snacks (no more than 4 hours without eating)

2)  Limiting refined carbohydrates and added sugars

3)  Get a variety of healthy food choices :

  • Complex carbohydrates such as whole grain bread
  • Fibre, which is found in beans, whole grains, fruits and vegetables
  • Lean protein, such as chicken (without skin) or fish
  • Lots of vegetables – especially the green, leafy ones
  • A limited amount of heart-healthy fats, such as olive, peanut or canola oil, walnuts, almonds and flax seed

4)  Watch portion sizes and read labels, follow plate method

5)  Keep a food journal

6)  Learn to make lifestyle changes and not diet for a short period of time

Individualised meal planning should include optimisation of food choices to meet recommended dietary allowances (RDAs)/dietary reference intakes (DRIs) for all micronutrients.

Here are few choices of meal plan for people with diabetics as well as the non-diabetics. A diabetic diet is a healthy diet for everyone!

Diabetic Meal Plan1Source: Blog PSIPUM

Choice A : Constant Carbohydrate Meal Plan

 This meal plan is inclusive of counting grams of carbohydrate (link to healthy eating for diabetes) a person with diabetic needs daily. The carbohydrate is then distributed evenly at mealtimes. In the constant carbohydrate meal plan, consistency in keeping the amount of carbohydrate for each meal including snack everyday is the key. The types of carbohydrate may vary from day to day. The objective is to match a relatively consistent dose of insulin.

Choice B : Carbohydrate Counting Meal Plan

Carbohydrate counting is a type of meal planning which involves in giving a matching dose of medication with the grams of carbohydrate taken daily. Blood glucose may go up or too low if carbohydrate ingested does not suitable with what the medication can handle.

One carbohydrate serving is equal to 15 grams of carbohydrate. People with diabetes can get help from a dietitian to figure out the counting plan that meets the specific needs. A common plan for an adult normally consists of three to four carbohydrate choices for main meals and one to two for snacks.

One will be taught about carbohydrate counting in three levels :

1 Basic •          Scope : Learn about carbohydrate exchanges

•          Target : Carbohydrate consistent intake, with normal blood sugar levels

•          Useful for all types of diabetes

2 Intermediate •          Scope : Learn to identify patterns in blood glucose levels

•          Target : To adjust medication/food/activities based on blood glucose patterns from daily records

•          Useful for people taking part in diets, using glucose-lowering medicines and insulin who can implement basic level

3 Advanced •          Scope : Learn about carbohydrate to insulin ratio

•          Target : To be able to adjust insulin dose using a carbohydrate/insulin ratio

•          Advantage – flexibility of food and insulin regimen with tight glucose control

•          Useful for people on intensive insulin therapy people who have mastered insulin adjustment and supplementation

This meal plan is most useful for people who take multiple daily injections of insulin. This is because it allows greater freedom and flexibility in food choices. People with diabetes can pick almost any food with the knowledge of grams carbohydrate on it, the fit into the meal plan.

People with diabetes should discuss the insulin regime with doctors prior to adjusting them. Insulin to carbohydrate ratio is 1:15. For example, for a carbohydrate ratio of 1:15, 1 unit of rapid acting insulin would be given for each 15 grams carbohydrate eaten. If the meal consists of 60 grams of carbohydrates, 4 units of insulin would be given.

Carbohydrate counting plan may not be suitable for everyone. Therefore, exchange meal plan may be used.

Choice C : Exchange Meal Plan

 The Exchange System classify foods into three broad groups : carbohydrate, meat and fat listing items contain similar macronutrient composition. This equality allows the exchange of food on each list.

If a certain number of exchanges from each of various lists are eaten day, regularity is easier to achieve.

Patients need to be familiar with the macronutrient content of the food as well as the serving size on each exchange list. Most vegetables can be considered free foods if their energy contribution is minimal when eaten in moderation. This Exchange Meal Plan, is sometimes used for type 2 diabetes

Healthy Plate Method

 Often, when people are diagnosed with diabetes, they don’t know where to begin. One way is to change the amount of food you are already eating. This is called Healthy Plate Method, to keep carbohydrate in a safe portion. This is another way of eating smart for people with diabetes.

Visually divide your plate into 4 sections :

The American Dietetic Association states that no single, universal diabetes diet plan works for all persons. As a general rule, a healthy diabetes diet plan should consist of properly balanced portions of carbohydrates, protein and fat to help stabilize blood glucose levels.

  • Breakfast : a balance of half starchy foods, one-fourth fruit and one-fourth protein.
  • Lunch and dinner : fill ½ the plate with non-starchy vegetables (such as: green leafy vegetables, beans, cabbage); ¼ should contain meat or other protein (fish, lean meat, skinless chicken); ¼ contains starch (such as rice, chapatti). On the side, you can have a serving of fruit.

Diabetic Meal Plan2Source : Kementerian Kesihatan Malaysia

Keeping the portions small allows you to enjoy your favorites and manage blood glucose levels.

Healthy choice : choose whole grain food items over refined grain items, choose lean meat over fatty cuts of meat and non-fat or low-fat dairy products over whole-fat dairy products

Carbohydrate Exchange List

  • Cereals, grain products and starchy vegetables

 Each item contains 15g carbohydrate, 2g protein, 0.5g fat and 75kCal

Cereals, Grain & Bread
Rice, white unpolished (cooked) ½ cup or 1/3 cup chinese rice bowl
Rice porridge 1 cup
Kway teow, mee hoon, spaghetti, macaroni ½ cup or 1/3 cup chinese rice bowl
Mee, wet 1/3 cup
Idli 1 piece 60g
Putu mayam 1 piece 40g
Thosai, diameter 20cm ½ piece
Chappati, diameter 20cm 1/3 piece
Bread (wholemeal, high fibre, white/brown) 1 slice 30g
Plain roll 1 small 30g
Burger bun, Pita bread, diameter 6’’ ½ piece
Oatmeal, cooked ½ cup
Oats, uncooked 3 rounded tablespoons
Muesli ½ cup
Flour (white, rice, atta) 3 rounded tablespoons
Biscuits (plain, unsweetened) e.g. cream crackers 3 pieces
Small thin, salted biscuits (4.5 x 4.5cm) 6 pieces
Starchy vegetables
* Lentils, baked beans, canned 1/3 cup
(*contains more protein than otherfoodsin the list i.e. 5 g/serve)
Corn kernel, pead (fresh/canned) ½ cup
Sweet potato, tapioca, yam ½ cup (45g)
Breadfruit (sukun) 1 slice (75g)
Pumpkin 1 cup 9100g)
Corn on the cob, 6cm length 1 small
Potato 1 small (75 small)
Potato, mashed ½ cup
Waterchestnut 4 pieces
1 cup is equivalent to 200ml in volume

1 cup = ¾ Chinese rice bowl (11.2cm in diameter x 3.7cm deep)

Tablespoon refers to dessert spoon level (equivalent to 2 teaspoons)

  • Fruits

Each item contains 15g carbohydrate and 60kCal

Orange, apple, custard apple, starfruit, pear, peach, sapodilla, kiwi 1 medium
Banana 1 small (60g)
Hog plum 6 whole
Mangosteen, plum 2 small
Duku langsat, grapes,langsat, longan, water apple 8 pieces
Lychee, rambutan 5 whole
Pomelo 5 pieces
Papaya, pineapple, watermelon, soursop, 1 slice
Guava ½ fruit
Cempedak, Jack fruit 4 pieces
Prunes 3 pieces
Dates (kurma), dries 2 pieces
Raisin 20 g
Durian 2 medium seeds
Mango ½ small
  • Milk

This food contain varying amount of carbohydrate, fat and protein depending on which type of milk is chosen

CHO (g) Protein (g) Fat (g) Energy (kCal)
Skim (1% fat) 15 8 Trace 90
Low fat (2% fat) 12 8 5 125
Full cream 10 8 9 150

 Fresh cow’s milk

1 cup (240 ml)
UHT fresh milk 1 cup (240 ml)
Powdered milk (skim, full cream) 4 rounded tablespoons or 1/3 cup
Yogurt (plain / low fat) ¾ cup
Evaporated (unsweetened) ½ cup

Conclusion

Many people with diabetes are concerned about foods containing carbohydrate such as fruits, starches and grains. Therefore, some people practice low-carbohydrate diet and choose to avoid foods that they like most. A good diabetic meal plan is helpful to manage blood glucose at normal level and allows one to enjoy more food. In addition, everyone should eat as many non-starchy vegetables as possible for the nutrients they provide with only very small amounts of carbohydrate.

References

  1. Franz MJ et al; American Diabetes Association. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2003; 26 Suppl 1: S51-61.
  2. Gillespie SJ, Kulkarni KD, Daly AE. Using carbohydrate counting in diabetes clinical practice. J Am Diet Assoc 1998; 98(8): 897-905.
  3. Kathryn G (2011, May 15). American Diabetes Association: Create Your Plate. Message posted to http://www.livestrong.com
  4. Malaysians’ Dietitian Association. 2005. Medical nutrition therapy guidelines for Type 2 Diabetes.
  5. “Nutrition Recommendations and Interventions for Diabetes”. American Diabetes Association. Diabetes Care. 2008; 31(suppl 21):S61-S78.

Last reviewed : 03 December 2013
Writer : Pn. Hjh. Salha binti Mohamed Nor
Accreditor : Pn. Siti Mariam binti Tukimin

 

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