Diet in diabetes mellitus
Diabetic diet: energy for a healthy weight, complex low-GI carbohydrate spread evenly through the day, high fibre, low saturated fat, and no added sugar.
Aim and principles of the diet
Aim: To plan, prepare and calculate a diet for an overweight man with type 2 diabetes on oral medicines. Principles: The diet aims to keep blood glucose near normal, reach a healthy weight, protect the heart and kidneys, and prevent hypoglycaemia. Energy is set for desirable weight (about 25-30 kcal/kg IBW, less if overweight). Carbohydrate gives about 50-60% of energy, mostly complex, high-fibre and low glycaemic index (whole wheat, millets, parboiled or hand-pounded rice, pulses, vegetables); sugar, jaggery, honey and sweets are avoided. Carbohydrate is spread evenly over 3 meals and 2-3 snacks at fixed times, matched to the medicines; a bedtime snack helps prevent night-time hypoglycaemia in patients on insulin or sulphonylureas. Protein is about 1 g/kg (about 15% of energy). Fat stays below 30% of energy, with saturated fat below 7-10%, no trans fat and limited cholesterol, because heart disease risk is high. Fibre (25-40 g), especially soluble fibre from methi seeds, oats and pulses, slows glucose absorption. Whole fruits are allowed in measured portions, but not juices. Salt below 5 g, no alcohol, and regular exercise complete the plan.
Nutrient prescription: Mr. D, 50 y, 170 cm, 72 kg, type 2 diabetes on oral medicines
| Nutrient | Prescription | Basis and source |
|---|---|---|
| BMI and IBW | BMI 24.9; IBW 63 kg | 72 ÷ 2.89; (170 − 100) × 0.9 |
| Energy | About 1800 kcal | 30 kcal/kg × 63 = 1890, reduced a little because he is overweight |
| Protein | About 68 g | About 15% of energy (1800 × 0.15 ÷ 4); about 1.1 g/kg IBW |
| Carbohydrate | About 225-270 g (50-60% of energy) | Complex, low GI; no added sugar (Indian consensus dietary guidelines, 2011) |
| Fat | Below 30% of energy (below 60 g); saturated fat below 7-10% | Heart protection |
| Fibre | 25-40 g | Including soluble fibre |
| Meals | 3 meals and 3 snacks at fixed times, including bedtime milk | Matches medicines; prevents lows |
Foods to include and avoid
| Food group | Choose | Avoid or limit |
|---|---|---|
| Cereals | Whole-wheat phulka, ragi, oats, broken wheat, parboiled or hand-pounded rice in measured portions, pesarattu | White bread, maida, large rice portions, puffed rice and rice flakes in large amounts |
| Pulses | All dals, whole grams, sprouts, sundal | None (count them as carbohydrate too) |
| Milk | Double-toned or skimmed milk, low-fat curd, buttermilk | Sweetened milk, condensed milk, khoa sweets |
| Vegetables | Plenty of greens, gourds, beans, salads; starchy roots counted as cereal | Large amounts of potato, yam, sweet potato; fried vegetables |
| Fruits | Guava, apple, orange, papaya, pear in measured portions (whole fruit) | Fruit juices; mango, sapota, grapes and banana in large amounts; dried fruits |
| Sugars and fats | Measured oil in rotation; a few nuts | Sugar, jaggery, honey, sweets, soft drinks, vanaspati, fried snacks, alcohol |
Sample one-day menu: type 2 diabetes (Mr. D)
| Time | Menu | Approx. amount (raw) |
|---|---|---|
| 6.30 am | Tea without sugar | Double-toned milk 100 mL |
| 8.00 am | Pesarattu (2) with ginger-tomato chutney | Whole green gram 30 g + rice 30 g; vegetables 30 g; oil 5 g |
| 11.00 am | Guava and buttermilk | Guava 100 g; buttermilk 150 mL |
| 1.00 pm | Parboiled rice, phulka (2), tur dal, greens poriyal, salad, low-fat curd | Rice 90 g; atta 50 g; tur dal 30 g; greens 100 g, oil 6 g; raw vegetables 100 g; low-fat curd 100 g |
| 4.00 pm | Tea without sugar, groundnut sundal, apple | Double-toned milk 100 mL; groundnuts 15 g; apple 100 g |
| 7.30 pm | Phulka (3), fish curry (or 30 g paneer), vegetable | Atta 75 g, oil 3 g; fish 50 g, oil 5 g; vegetables 150 g, oil 5 g |
| 9.30 pm | Bedtime milk | Double-toned milk 100 mL |
Worked calculation: Mr. D's diabetic diet
Mr. D, 50 years, 170 cm, 72 kg, a sedentary clerk, has type 2 diabetes on oral medicines. Find his BMI, IBW, energy and protein, and check the menu.
- BMI = 72 ÷ (1.7 × 1.7) = 72 ÷ 2.89 = 24.9: overweight by the Asian cut-off (23-24.9).
- IBW = (170 − 100) × 0.9 = 63 kg.
- Energy = 63 kg × 30 kcal/kg = 1890; take about 1800 kcal because he is overweight.
- Protein = about 15% of energy = 1800 × 0.15 ÷ 4 = 67.5, about 68 g (about 1.1 g/kg IBW).
- Carbohydrate = 50-60% of 1800 kcal = 225-270 g, spread over 6 meals.
- Approximate values used (kcal and g protein per 100 g raw unless stated; rounded from Indian food composition tables, mainly IFCT 2017 and the older Nutritive Value of Indian Foods; a few, such as toned milk, are estimates): double-toned milk 45 and 3 per 100 mL; whole green gram 325 and 23; rice 355 and 8; mixed vegetables 30 and 1.5; oil/ghee 900; guava 50 and 1; buttermilk 15 and 0.8 per 100 mL; atta 320 and 10.5; tur dal 330 and 22; greens 35 and 3; low-fat curd 45 and 3; groundnut 570 and 25; apple 60 and 0.3; fish 100 and 17.
- Cereals (rice 120 g, atta 125 g): 826.0 kcal, 22.7 g protein, 17.4 g fibre.
- Pulses (whole green gram 30 g, tur dal 30 g): 196.5 kcal, 13.5 g protein, 7.8 g fibre.
- Milk and milk products (double-toned milk 300 mL, buttermilk 150 mL, low-fat curd 100 g): 202.5 kcal, 13.2 g protein, 0.0 g fibre.
- Egg and fish (fish 50 g): 50.0 kcal, 8.5 g protein, 0.0 g fibre.
- Vegetables (mixed vegetables 280 g, greens 100 g): 119.0 kcal, 7.2 g protein, 12.4 g fibre.
- Fruits (guava 100 g, apple 100 g): 110.0 kcal, 1.3 g protein, 8.5 g fibre.
- Oil, nuts and coconut (oil/ghee 24 g, groundnut 15 g): 301.5 kcal, 3.8 g protein, 1.4 g fibre.
- Energy = 826.0 + 196.5 + 202.5 + 50.0 + 119.0 + 110.0 + 301.5 = 1805.5 kcal.
- Protein = 22.7 + 13.5 + 13.2 + 8.5 + 7.2 + 1.3 + 3.8 = 70.2 g.
- Fibre = 17.4 + 7.8 + 12.4 + 8.5 + 1.4 = 47.5 g.
- Compare with the prescription: energy 1805.5 ÷ 1800 × 100 = 100%; protein 70.2 ÷ 68 × 100 = 103%.
- Fibre values used (g per 100 g raw, approximate): atta 11, rice 3, dals 9, whole green gram 17, vegetables 3, greens 4, guava 6, apple 2.5, groundnut 9. About 48 g fibre, with soluble fibre from whole green gram, dal and fruit.
- Each group is rounded to one decimal and the totals are the sums of those rounded figures; all values are approximate.
IBW 63 kg; prescription about 1800 kcal and 68 g protein. The menu gives about 1806 kcal (100%), 70 g protein (103%) and about 48 g fibre, with no added sugar.
Preparation and serving tips, and result
- Use parboiled or hand-pounded rice in a measured portion, and fill half the plate with vegetables.
- Add ragi, oats or soaked methi seeds to dosa and idli batter, and use more dal in the batter to lower the glycaemic index.
- Never skip meals; keep the same meal times every day, matched to the medicines.
- Keep 3 teaspoons of sugar or glucose ready for hypoglycaemia; do not use sugar otherwise.
- Cook with little oil, avoid frying, and flavour with spices instead of sugar.
- Result: The diabetic diet gives about 1806 kcal, 70 g protein and about 48 g fibre with no added sugar, meeting Mr. D's prescription.
In the diet kitchen, diabetic trays are among the most common. They come from the normal menu with no sugar in tea or payasam, a measured rice portion, more vegetables and a whole fruit instead of a sweet. Labelling the tray 'diabetic' and sending meals on time matters, because a late meal after tablets or insulin can cause hypoglycaemia.
Short answer: “What is glycaemic index?” The rise in blood glucose after eating a food with 50 g available carbohydrate, compared with glucose (taken as 100). Low 55 or less; medium 56-69; high 70 or more.
Short answer: “What is glycaemic load?” GL = GI × available carbohydrate in the portion (g) ÷ 100. Low 10 or less; medium 11-19; high 20 or more.
Essay: “Plan a diet for an adult with type 2 diabetes and calculate its nutritive value.” BMI, IBW; energy 25-30 kcal/kg; carbohydrate 50-60% complex and low GI; protein about 15%; fat below 30% with low saturated fat; fibre 25-40 g; no added sugar; 6 meals at fixed times with a bedtime snack; foods to choose and avoid; Indian menu; calculation; result; hypoglycaemia advice.
Diabetic plate '½ ¼ ¼': half vegetables, a quarter whole-grain cereal, a quarter dal or protein; same time, same amount, no sugar.