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HEALTHY EATING AND LIFESTYLE
Nutrition and Diabetes

People with diabetes do not require a 'special diet'. The principles of nutrition for people with diabetes are the same principles recommended by the Australian Nutrition Foundation for all Australians.
These principles on dietary guidelines are:

1. Enjoy a wide variety of nutritious foods.
2. Eat plenty of breads and cereals (preferably wholegrain), vegetables (including legumes), and fruits.
3. Eat a diet low in fat and, in particular, low in saturated fat.
4. Maintain a healthy body weight by balancing physical activity and food intake.
5. If you drink alcohol, limit your intake.
6. Eat only a moderate amount of sugars and foods containing added sugars.
7. Choose low-salt foods and use salt sparingly.
8. Encourage and support breastfeeding.
9. Eat foods containing calcium. This is particularly important for girls and women.
10. Eat foods containing iron. This is particularly important for girls, women, vegetarians and athletes.

Healthy eating and keeping active will help to control blood sugar levels, which are vital links in the control of diabetes. If you follow the guidelines it will be easier for you to:

• Keep blood sugar levels within a healthy range 3.5 to 8 mmol/L.
• Keep blood fats (cholesterol and triglyceride) at a normal level.
• Maintain a healthy weight .

KEY POINTS

• Healthy Eating is a vital link in the control of diabetes.
• Eat 3 regular meals each day to help control blood glucose levels.
• Select foods that are low in fat.
• Avoid foods that have large amounts of added sugar.
• If you are an uncomfortable weight for your height it is important to reduce weight. When you are too big your body will not be able to make enough insulin that works properly and blood sugar levels will be too high. Losing weight can help your insulin work better, it can also improve your blood pressure and cholesterol level if they are not already in an acceptable range.
• Regular exercise is important.

Carbohydrates

Carbohydrates are needed to keep you healthy and active. Carbohydrates are digested down in your gut to form sugar which is then absorbed into the bloodstream to provide energy for the body.

People with diabetes have difficulty using the sugar to release energy, the sugar builds up in the bloodstream causing high blood sugar levels, which if left untreated can cause damage to the kidneys, nerves, eyes and feet.

The body requires a certain level of sugar in the blood at all times. Your blood sugar level rises and falls during the day. The rises occur after you eat, the falls result as insulin does its job. The idea is to keep your blood sugars in the normal range as much as possible. (3.5 mmol/L to 8 mmol/L)

How To Make Carbohydrates Work For You
There are two types of carbohydrates, they both affect your blood sugar levels.

• Simple Carbohydrates (fast acting)

These are concentrated sugars, low in nutritional value, with little or no fibre and high in kilojoules / calories or energy content. Eating these foods, should be kept to a minimum. They are however useful in treating hypoglycaemia.

• Complex Carbohydrates (slow acting)

The 'slow' carbohydrates enable you to more easily control your blood sugar level eg. bread, pasta, apple, baked beans.

KEY POINTS

• Count, measure and space your carbohydrates
• A serve of carbohydrate contains 

15 grams of carbohydrate

eg. 1 slice of bread, 1 medium apple, 1/2 cup baked beans, 1/4 cup rolled oats.

• Make carbohydrates the main part of each meal and between meal snacks.
• Spacing carbohydrates helps to keep your blood sugar levels in the normal range. Some people also need tablets or insulin injections.
• Time your meals at regular intervals to make sure your next meal or between meal snack comes before your blood sugar drops too low or your blood sugar gets too high.
• Your blood sugar level will vary throughout the day.
• The number of serves of carbohydrate you will need depends on your lifestyle and will be worked out with your Dietitian.

Glycaemic Index

The Glycaemic Index Of Foods

The glycaemic index of foods is a system which can help predict how a food will affect blood sugar levels after being eaten.

Many dietary factors affect the rate at which carbohydrate is absorbed. These factors include, the type of fibre and sugar or starch within the food, processing, cooking and the presence of other nutrients or substances.

Carbohydrate foods which are digested and absorbed quickly have a high glycaemic index, resulting in a more rapid and higher rise in your blood sugar levels compared with low glycaemic index foods which are slowly digested and absorbed and so cause a more gentle rise in your blood sugar levels.

Determination of the glycaemic index of a food
Glycaemic Index Ranges

• Low Glycaemic Index Foods - below 50
• Moderate Glycaemic Index Foods - between 50 to 70
• High Glycaemic Index Foods - more than 70

Choosing Low Glycaemic Index Foods

• You should include a low glycaemic index food with each meal or at least in one meal daily to help regulate your blood sugars.
• There are many foods which have a low glycaemic index but are high in fat or are of low nutritional value eg. chocolate, potato crisps these are not recommended to be eaten on a regular basis.
• There are also many foods which have a high glycaemic index which offer many nutritional benefits (good source of vitamins and minerals) and should be included in your food plan eg. carrots, baked potato.
• You can combine or eat a high glycaemic index food with a food of a low glycaemic index which will result in a moderate rise in blood sugar.
• Use the Healthy Diet Pyramid as a guide to help you make the best food choices.

KEY POINTS

• A diet low in fat and high in carbohydrate and fibre assists in achieving good blood sugar control.
• Discuss how the glycaemic index may affect your diet and diabetes control with your Dietitian.

Fats

Fat provides heat, energy, the fat-soluble vitamins and fatty acids. Everyone needs a small amount of fat for health and growth. Fat is high in energy (calories, kilojoules) and has twice as many kilojoules/calories per gram than carbohydrate or protein.

Excess Fat causes:

• weight gain,
• inhibits the action of insulin, either your own body insulin or injected insulin, resulting in poor control of diabetes,
• increase the risk of complications resulting from narrowing of arteries, such as angina, heart attacks, strokes, circulatory problems in the feet and legs.

Type of Fats
There are different types of fat in food, some are better for health than others.

Monosaturated
Where found:- Avocado Olive oil, Canola oil, Canola margarine, Peanut oil, peanuts
Effect:- Helps reduce the risk of heart disease and levels of triglycerides

Polyunsaturated (2 types)
1. Omega - 6
Where found:- Safflower oil, Sunflower oil, nuts, seeds. wild game and very lean meat
Effect:- Helps lower blood cholesterol and prevent cholesterol build up in the vessels.
2. Omega - 3
Where found:- Fish, particularly fatty fish eg. Trout, Blue Grenadier, Trevally, Salmon & Tuna 3 times a week is recommended
Effect:- Lower blood pressure and reduce risk of thrombosis vessels.

Saturated
Where found:- Butter, animal fat, cream cheese, skin on chicken, palm oil, coconut oil, table & cooking margarine
Effect:- Raise blood cholesterol and linked to heart disease

Trans Fatty Acids
These unsaturated fatty acids which occur naturally in beef, lamb and dairy products (eg. butter) are the latest player in the fat controversy.

They are also formed when oils are converted into a spreadable form such as margarine.
Reducing saturated fat and trans fatty acid intake is important for keeping your blood cholesterol levels below 5.5 mmol/L.

Hints for reducing fat

• Trim fat from meat, skin from poultry
• Use trim lamb, beef shortcuts, new fashioned pork, lean cold meat, veal chicken (skinned), chicken breasts, fish (not fried), rabbit, venison and game meats.
• Choose low fat or fat reduced dairy foods eg., diet yoghurts, light ice cream, skimmed and reduced fat milks, low fat cheese.
• Use in small amounts poly or monounsaturated margarines and oils instead of butter and solid frying fats.
• Limit commercial pastries, cakes, biscuits, fried, crumbed or battered foods, most take-away foods.
• Use avocado or peanut butter sparingly as a spread instead of butter.
• Spread fat reduced butter or margarine as thinly as possible on bread or toast.
• Grill, dry roast (meat on rack), steam, boil or microwave whenever possible.

KEY POINTS

• Limit your intake of fat especially saturated fat.
• The small amount of fat in your diet should be polyunsaturated or mono-unsaturated fat.
• All fats have the same energy (kilojoule) content.
• Fat contains twice the energy (kilojoules) of protein or carbohydrate.
• 1 gram of fat = 37kilojoule (8.8 calories)

Alcohol....How Much Alcohol?
Enjoying a drink from time to time is pleasurable for many people, you can also enjoy an occasional drink keeping in mind to have only one or two standard drinks per day.
A standard drink is :

• Beer - 200 mls
• Wine - 120 mls
• Sherry or Wine - 60 mls
• Spirits eg; whiskey, brandy, etc. - 30 mls

Excess Alcohol

• Damages your body
• Can cause high blood pressure
• May increase triglyceride levels
• Can make you fat because it contains kilojoules/calories

Caution : Alcohol & Diabetes

• Alcohol without food can cause hypoglycaemia (for people on insulin and certain tablets)
• Alcohol makes it harder to recognise a "hypo"
• Alcohol makes it harder to recover from a "hypo"
• Alcohol can increase your risk of complications by increasing your blood pressure, your weight and your triglycerides

KEY POINTS

• Only drink when eating carbohydrate food (Never Drink Alcohol on an empty stomach).
• Have 2 alcohol free days per week.
• Stay within the standard drinks recommended.
• Drink reduced alcohol or lite beers (lower in alcohol, joule/calorie).
• Space your drink - have non-alcoholic drinks in between.
• Dilute with low joule/calorie mixer or mineral water.
• Avoid drinking when taking medication, exercising, driving or reducing weight.
• Alcohol is an extra and does not swap for your carbohydrate serves.
• Alcohol adds flavour to cooking - simmer for 5 minutes and the alcohol evaporates leaving the flavour.
• Use dry rather than sweet wines.

ALTERNATIVE SWEETENERS

Artificial Sweeteners

If you find it hard to go without sugar there are products which are suitable alternatives. The following are low joule sweeteners they are non-nutritive, they are kilojoule free or contain negligible kilojoules and have minimal effect on your blood sugar levels. They can offer increased variety and interest to your diet.

The types available are:

• Saccharine -tablet or liquid (eg. Sucaryl ), suitable for baking (some may find it has a metallic bitter after taste)
• Cyclamate -used in low joule and diet products
• Aspartame -powder or tablet (eg. Equal, Hermesetas, Nutrasweet)
• unsuitable for baking, can be added at the end of cooking
• Ascesulfame K -seen less often and used in combination with other sweeteners.
• Sucralose -made from sugar so tastes like sugar, suitable for cooking and baking. Splenda, Brand Sweeteners is made in tabletop granules and tablet format
• Alitame -can be used in cooking
  

WARNING:

• Aspartame or Nutrasweet must not be used by people with phenylketonurea
• Aspartame and Sucralose are the only suitable sweeteners to use during pregnancy

Other Sweeteners

Sucrose or Sugar is the most commonly used sweetener. It sends your blood sugars up and adds to your weight. It is best to cut this to a minimum.

Fructose, Maltose, Glucose, Lactose and Honey are used instead of sugar. They have the same effect as sugar (Sucrose). So keep to a minimum.

Sorbitol, Manitol and Xyletiol are used in foods marked 'carbohydrate modified'. They have the same calories as sugar so are best avoided.

KEY POINTS

• Artificial sweeteners add variety and interest to your diet.
• To be safe use only in moderation and vary the type you choose.

Label reading

It is important that the foods you eat fit the guidelines of a healthy diet which means selecting foods low in simple sugar, fat, salt and cholesterol, while being high in fibre.

Reading labels helps you to learn more about what you are eating and if the food fits the guidelines. It is a useful guide in deciding if a commercial food product is suitable for you.

Lets look at what the packaging tells us.

Ingredient Listing

Ingredients are listed in order of quantity so that the main ingredient is listed first and the smallest ingredient appears last.
Whole Wheat, Raw Sugar, Salt, Malt, Extract, Vitamins, (Niacin, Thiamine, Riboflavin), Mineral (Iron), No artificial flavourings or colourings
Sugar is near the top of the list, it is a major ingredient, so the product should not be used. Malt Extract is also on the list and is another form of sugar.
Alternative Names

Sugar, fat and fibre often appear on labels under different names, learn to recognise these ingredients

The Nutrition Panel

Serve Size- it is important to check the serve size as these can vary between products.

look at the "per 100g" column, every nutrition panel will have this column so it is easy to compare products

Energy- can be measured in Kilojoules (kj) or calories (cal) and is a measure of the total amount of energy that product will provide.

Fat- use the following as a guide for Fat per 100g serve

Regular cheese usually does not have the fat content listed, you can therefore presume that the produce is high in fat.

Carbohydrates
Total -This figure includes both sugars and starches

Sugars-Compare this figure with the total carbohydrate and you can see how much of the total carbohydrate is sugar. Select foods with lower sugar content
Sugar per 100ml serve

Dietary Fibre-

Fibre keeps our intestine healthy and helps protect against things such as intestinal cancer. High fibre products are low in sugar.
Fibre per 100g serve

Sodium (salt)

Choose products which are labelled "salt reduced" or "no added salt". Also check the ingredient list look for MSG, sodium bicarbonate, sea salt, garlic salt or stock.
Sodium (salt per 100g serve)

Nutrition Claims

"Cholesterol Free" These foods are not necessarily low in fat. For example, vegetable oil contains no cholesterol but is high in fat and energy.

"Lite" Can mean anything from low in sugar, salt or fat to simply light in texture or flavour eg. Lite Olive Oil is not light in fat only light in flavour.

"Oven Baked" or "Toasted" Usually have added fat to the product

Products Low in Fat and Energy

Foods labelled
-Low joule/low calorie
-Skim
-Non-fat
-Low fat
-Fat reduced

KEY POINTS

• Non-fat, skim and low joule products are the best choice for a low fat, low energy meal plan.
• High fibre products tend to be low in sugar.

Example Meal Plan

Breakfast:

Porridge and low fat milk
Fresh fruit
Beverage

Mid Morning:

Beverage

Lunch:

Salad sandwich made from Ploughman's loaf
or baked beans on grainy bread
Fresh fruit
Beverage

Mid Afternoon :

Beverage

Dinner:

Sweet potato soup
Lean meat, basmati rice and stir fry vegetables
Yoghurt and diced pears
Beverage

Supper:

Beverage

Drinks/Beverages:

Tea, coffee, plain mineral water, water

2.11 Shopping list guide

The following list of products can be used as a shopping guide for people with diabetes as they meet the low fat, high carbohydrate guidelines with some products having a low glycaemic index.

The following foods are lower in fat and kilojoules than normal varieties But still contain some added fat so should be included only in moderation in your diet:

The following contain some added sugar but are low in fat.

Bulla - Lite 'n' Natural
Dairy Bell - Reduce Fat Ice cream
Peters - "light" Ice cream
Streets - Blue Ribbon "Light"
Oak - Light Ice cream
Weight Watchers - Sweet Celebration

2.12 Eating out

You can "eat out" and try a variety of foods without upsetting your blood sugars. Eating away from home need not be a problem.
The following hints will help make eating out enjoyable:

• Have a good knowledge of the food groups.
• Know your number of serves of carbohydrates.
• Always carry emergency carbohydrates.
• Insulin or tablets should be taken at the restaurant to avoid hypoglycaemia. The restaurant may be busy or service slow.
• Check restaurant menus before making a reservation or entering a restaurant.
• If practical let the restaurant know the importance of timing for you. 

Information prepared by:-
Lynne E Gannon, Podiatrist, Diabetes Educator
Eileen Holbery, Dietician, Diabetes Educator
Richard Moore, General Practitioner
Meni Stefanovski, Community health nurse, Diabetes Educator
West Heidelberg Community Health Centre, Vic (1996)