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Supplements used for Diabetics

Mrs Sushila Sharangdhar,
A registered Dietician, with hands on experience and an impressive client list. Currently attached with a number of organisations.

Diabetes is a disease characterized by high blood glucose and either insufficient or ineffective insulin, depending on the type of Diabetes.

Type 1 diabetes also known as insulin dependent diabetes or juvenile onset diabetes occurs around the ages of 8 to 12 years but can occur at any age. The disease has a strong genetic link. The pancreas cannot synthesize insulin thereby altering the body’s metabolism. The person must be injected with insulin to assist the cells in taking up the needed fuels from the blood.

Certain parameters like body measurements (BMI or Body Mass Index > 25) can put a person at risk for developing diabetes if there is a genetic predisposition. Another guide is waist to hip ratio:

Waist divided by hip=Should not be >1 in men
Waist divided by hip=Should not be >.8 in women

Type 2 diabetes is characterized by high blood glucose and insulin resistance. This disease usually begins after the age of 20.However the widespread incidence of inactivity and obesity in our population is being shown to precipitate this condition even earlier. The mean age of diagnosis in children and adolescents is approximately 13.5 years, majority diagnosed in mid puberty. Youths with type 2 diabetes often have a BMI of over 25kg/m. In the initial stages the pancreas produces insulin. The person may actually have higher than average insulin levels but the cells respond less sensitively to it either because they have diminished in number or in function thus making the individual insulin resistant.

Consequently the blood glucose levels rise stimulating the pancreas to produce insulin, exhausting the cells and reducing their ability to function. In obesity, the higher body fat necessitates higher insulin production; however insulin receptors are reduced in number and function resulting in insulin resistance. Age, diet, lifestyle and genetic factors have been implicated in the development of the disease.

Symptoms of diabetes include frequent urination (polyuria), excessive thirst (polydipsia), extreme hunger (polyphagia), unusal weight loss ,increased fatigue, irritability and blurred vision.

Criteria for diagnosis: - symptoms of diabetes together with random (any time of day) plasma glucose concentrations of>200mg/dl.
- Fasting plasma glucose (at least 8-10hrs following no calorie intake)>126/dl
- Two hour plasma glucose. 200mg/dl during an oral glucose tolerance test.

Criteria for impaired glucose levels: - Fasting plasma glucose levels of <126mg/dl can be considered to be in the impaired blood glucose range.

Complications of diabetes

Acute complications: Acute problems may emerge in both type 1 and type 2 diabetes. The sustenance of life in type 1 patients is dependant on insulin injections. If the patient stops taking insulin or the insulin requirements increase (due to illness or fever) diabetic coma can develop. The patient develops vomiting, may have abdominal pain and becomes dehydrated. Breathing becomes difficult, and there may be a fruity smell to the breath. if untreated, unconsciousness and death may occur. Appearance in urine of large amounts of glucose along with a substance called ketone is an indication that this complication has occurred. This condition is called ketoacidosis. When this is suspected you must contact your doctor immediately.

Patients with type 2 diabetes who neglect to control high blood sugar (hyperglycemia) may loose excessive amounts of water and salts, often leading to “dehydration coma”, which can be fatal.

Skin problems too are common in patients with poorly controlled diabetes and therefore it is important to maintain good control and good personal hygiene. Persons with diabetes are at a much greater risk of infections.

Chronic complications: Diabetes often affects other organ systems, the complications slowly progress over a period of time, hence these complications are generally referred to as long term complications. Diabetes related complications include:

-diseases of small blood vessels and other parts of the eye resulting in retinal degeneration and blindness. If detected early the damage can be limited.

-diseases of large blood vessels such as atherosclerosis.

-Uncontrolled diabetes often affects the kidneys leading to kidney failure.

-diseases of the nerves resulting in loss of sensation, increased infections stemming from unnoticed injuries and gastrointestinal problems.

NUTRITION
The normal Indian diet is ideal for a diabetic. However, the nutrient intake has to be tailor made to the Individual based on the age, sex, weight, height, physical activity and physiological needs of the patient. It is always better to prescribe and formulate a suitable individual diet.

Basic diet advice AVOID simple carbohydrates like sugar, sweets, jiggery, honey, etc., as they tend to cause a sharp rise in the blood glucose levels.

Total calories Total calories allowed to an individual will depend on the present weight and the targeted optimal weight.

Usually, the prescribed diet should contain 30 calories/kg optimal body weight. The total calories prescribed should also take into account the activity levels of the patient, as well as special circumstances like pregnancy and lactation, etc.

CARBOHYDRATES • Carbohydrates should constitute around 60-70% of the total calories.
• The carbohydrates should be in the form of complex polysaccharides (starch) and contain adequate amount of fibers.
• The widespread misconception that carbohydrates (in any form) should not be eaten by diabetics should be removed. Carbohydrates in the form of simple sugars need restriction.
• Most traditional Indian diets usually meet with this requirement.

PROTEINS • Protein intake should be approx. 0.8 gms/kg ideal body weight; this usually comprises around 12-18% of the calorie intake.
• The requirements for proteins may be increased in catabolic states, pregnancy, lactation and in some elderly patients.
• Protein intake may need to be restricted in patients with nephropathy.

FATS • Fats should be restricted to around 20-25% of the total calories.
• One should preferably take equal amounts of saturated, mono-unsaturated and polyunsaturated fats.
• It is a misconception to feel that polyunsaturated fats are safe and can be taken freely.
• Many foods contains fats; this "invisible fat" should be taken into account when estimating the total fat intake.
• It is advisable to restrict the total intake of cooking fats to less than 6% of the total energy intake; in simple terms, food should be cooked in the least amount of oil or ghee; if feasible, food should be preferably be grilled, steamed or broiled, micro waved, rather than fried.
• The total intake of cholesterol should be restricted to around 300 mg per day.
• The fat intake may need to be further modified if associated dyslipidemia is present.

ESSENTIAL FATTY ACIDS
• Recent evidence suggests that attention must be paid to the intake of essential fatty acids (EFAs) such as omega-6 (w6) and omega-3 (w3) fatty acids.
• These EFAs make to be derived from food and cannot be made in the body.
• Not only must they be eaten in adequate amounts, but the relative ratio is around 4:1.
• Indian diets usually contain too much of w6 fatty acids and little, if any, of w3 fatty acids. This is due to the fact that most foods are rich in w6 fatty acids and poor in w3 fatty acids which is mostly found in fish.
• Indian diets usually give a ratio of around 40:1.
• The disproportionate ratio is made worse by the use of the so called "safe" cooking oils such as safflower oil and sunflower oil, in which the ratio is around 150:1!
• If this ratio is to be brought down to near optimal levels, then it would be essential to do a RETHINK about the advised mode of cooking media, and possibly revert to our traditional cooking media, which although they may not contain w3 fatty acids, also are poor in w6 fatty acids.
• Although these traditional cooking media like mustard oil, coconut oil and ghee may be relatively high in their saturated fat content, their poor content of w6 fatty acids allows a more optimal w6/w3 intake, especially when associated with increased w3 intake in the form of fish or w3 supplements.
• The saturated fat content of these cooking media are offset by the benefits of the more optimal w6/w3 intake, especially if the total use of the cooking media is minimized.
• This change over to some of the more traditional cooking media, accompanied by the use of as little as possible of the cooking medium, allows a diet with a ratio of around 8:1 which is close to optimal.

SALT INTAKE • Salt restriction is necessary in patients with associated hypertension, cardiac failure and fluid overload.

FRUITS • These can be eaten by diabetics in moderate amounts. Raw and partially ripe fruits are preferable.

ALCOHOL • If consumed, alcohol should be used in moderation.
• It should be avoided in all diabetics who are overweight and on hypocaloric diets, on biguanides, or in those who have high triglyceride levels. All other contraindications to alcohol intake also apply to diabetics.
• In those diabetics, who are allowed alcohol, this should be restricted to less than 5% of the total calories. Generally, this is equivalent to about 45 ml of whisky or related alcoholic drinks.
• Wine, sherry and beer are best avoided.

Diet Supplements
• An increasing number of dietary supplements specially formulated for diabetes patients are available in the market.
• These should not be recommended for routine use by diabetics.
• But such supplements may be of help in many special circumstances.
• When prescribed, one must be aware of the precise contents, as many food supplements called as diabetic foods are not calorie free and mislead patients into thinking that such diabetic foods can be taken in any quantity.

Supplements are for those people who find difficulty to eat ordinary foods and.
• are worried about not eating properly, for example, because of swallowing difficulties
• have already lost weight because of their illness and are worried about further weight loss
• are losing weight as a result of treatment
• During convalescence
But these products are meant to supplement the diet and not replace ones ordinary food. It is best to try to keep eating some ordinary foods, alongside the supplements, if at all possible. Some of the supplements available in the market are:
Nutrocal DM(Wockhardt)
Composition:Each 50gms provides protein 9.5gms,fat 11.5gms,carbohydrates 23.5gms
Available in 400gms tin/50gms sachet.
1 sachet or 10 scoops diluted with 175ml water or milk provides 236 calories

Uses: Diabetic patients during convalescence, coma, surgical post-operative period, transition from total parenteral to oral solid food or suffering from malnutrition, febrile illness, trauma, burns, severe blood infections, loss of appetite.

Resource Diabetic (novartis)


RESOURCE Diabetic is a balanced liquid formula with fiber specifically formulated for persons with diabetes.

Each 50gms provides
Calories 250
Protein g 15
Carbohydrate g 23.4
Fat g 11.1
Fiber g 3
Sodium mg (mEq) 276 (12.0)
Potassium mg (mEq) 320 (8.2)
Vitamin A IU 1200
Vitamin C mg 100
Thiamine mg 0.3
Riboflavin mg 0.34
Niacin mg 4
Calcium mg 276
Iron mg 3.6
Vitamin D IU 80
Vitamin E IU 33
Vitamin B6 mg 0.4
Folic Acid mcg 80
Vitamin B12 mcg 1.2
Phosphorus mg 220
Iodine mcg 30
Magnesium mg 80
Zinc mg 3.0
Copper mg 0.4
Biotin mcg 60
Pantothenic Acid mg 2.0
Vitamin K mcg 16
Chorine mg 110
Chloride mg (mEq) 220 (6.2)
Manganese mg 0.4
Selenium mcg 14
Chromium mcg 24
Molybdenum mcg 15
L-Carnitine mg 25
Taurine mg 20
M-Inositol mg 200

1 sachet (50gms) to be diluted with 200ml water or milk

Ingredients - RESOURCE Diabetic

French Vanilla Flavour:
Water, hydrolyzed corn starch, sodium and calcium caseinates, high oleic sunflower oil, partially hydrolyzed guar gum, soybean oil, soy protein isolate, Benefiber, soy fiber, calcium phosphate tribasic, potassium citrate, artificial flavor, monoglycerides, magnesium chloride, cellulose gel, sodium ascorbate, sodium citrate, m-inositol, choline chloride, soy lecithin, potassium hydroxide, cellulose gum, alpha tocopheryl acetate, carrageenan, L-carnitine, taurine, sucralose, ferrous sulfate, zinc sulfate, niacinamide, copper gluconate, calcium pantothenate, manganese sulfate, pyridoxine hydrochloride, beta carotene, BHA/BHT (to preserve freshness), thiamine hydrochloride, vitamin A palmitate, riboflavin, chromium acetate, folic acid, biotin, potassium iodide, sodium molybdate, sodium selenite, phytonadione (vitamin K1), cholecalciferol (vitamin D3), cyanocobalamin (vitamin B12).

Primary Indications - RESOURCE Diabetic
• Diabetes mellitus
• Glucose intolerance
• Stress-induced hyperglycemia


Glucerna(Abbott laboratories)
Glucerna Shakes is a specialized form nutrition with added fiber designed for people with diabetes or abnormal glucose tolerance. Used under the supervision of a physician, this complete source of liquid nutrition is a reduced carbohydrate, modified fat, fiber containing food that can be used both as a supplement or as a sole source of calories and dietary intake for certain individuals. To help make maintaining healthy blood sugar levels a bit easier on a day-to-day basis, Glucerna Shakes contain a balance of calories, carbohydrates, fats, vitamins, and minerals that most diabetics need as they control their disease. The simple carbohydrates (fructose) work together to release glucose into the bloodstream at a slower rate than other standard sources of liquid nutritional supplements, such as regular Ensure. It can be used alone in patients on tube feedings, or for oral consumption by diabetics who need an occasional meal supplement or replacement.

Nutritional facts:
Each can(237ml) provides

Calories...........................237
Total Fat.........................12.9g
Sodium.........................220mg
Potassium....................370mg
Carbohydrates...............22.8g
Dietary Fiber (Soy)............3.4g
Protein...........................9.9g

Vitamin A 1500 IU,Vitamin C 50 mg,Calcium 170 mg,Iron 3.0 mg,Vitamin D 67 IU,Vitamin E 7.5 IU,Vitamin K 14 mcg,Thiamin 0.38 mg,Riboflavin 0.43 mg,Niacin 5 mg,Choline 100 mg,Vitamin B6 0.5 mg,Folate 100 mcg,Vitamin B12 1.5 mcg,Biotin 75 mcg,Pantothenic Acid 2.5 mg,Chloride 340 mg,Phosphorus 170 mg,Iodine 25 mcg,Magnesium 67 mg,Zinc 3.8 mcg,Selenium 12 mcg,Copper 0.34 mg,Manganese 0.84 mg,Chromium 20 mcg,Molybdenum 25 mcg.

References:

1. American Diabetes Association…Principles of nutrition and dietary recommendations for individuals with diabetes ,mellitus.
2. Diet and Diabetes…T.C.Raghuram,Swaran Pasricha…NIN Hyderabad.
3. IDR…A mediworld publication.

Written By: Mrs Sushila Sharangdhar E-mail : dietitian1@rediffmail.com

Mrs. Sushila Sharangdhar's Brief profile: Graduated in Foods and Nutrition from S.N.D.T UNIVERSITY in the year 1980 MUMBAI. Post graduate diploma in dietetics from INSTITUTE OF HOTEL MANAGEMENT CATERING TECHNOLOGY AND APPLIED NUTRITION in the year 1981. Worked as a locum in various hospitals- NAIR, E.S.I.S, NANAVATI. Since March 1986 till jan 2002 (16 years) P.D.HINDUJA NATIONAL HOSPITAL AND MEDICAL RESERCH CENTRE CHIEF DIETICIAN. A REGISTERED DIETICIAN with INDIAN DIETETIC ASSOCIATION. MEMBER OF LOCAL EXECUTIVE COMMITTEE OF INDIAN DIETETIC ASSOCIATION. MEMBER OF ISPEN, ACASH.

Currently attached to: ICICI BANK BANDRA KURLA COMLEX, ICICI SECURITIES CHURCHGATE, ICICI PHONE BANKING ANDHERI INDIAN OIL CORPORATION PRABHADEVI, MARICO INDUSTRIES LTD. BANDRA, NOVARTIS THANE,  INSTITUTE OF HOTEL MANAGEMENT CATERING TECHNOLOGY AND APPLIED NUTRITION- RESEARCH GUIDE FOR POST GRADUATE STUDENTS, BFY INSTITUTE- started a part time nutrition and dietetics course since last 2 years, RADHIBAI WATUMAL GLOBAL HOSPITAL, SAIKRUPA CATERING SERVICES
Instrumental in starting unique projects e.g. SAFFOLA DIAL A DIETICIAN of MARICO INDUSTRIES.
Have been very active in promoting good health through nutrition and life style changes. This is achieved by organizing seminars, workshops and CONTINUOUS MEDICAL EDUCATION FOR the GENERAL PUBLIC, DOCTORS, ROTARY CLUB, LIONS CLUB ETC. CONDUCTED WORKSHOPS FOR PREGNANT WOMEN- 50 IN THE CITY OF MUMBAI. BEEN A SPEAKER FOR VARIOUS CONFERENCES

Main duties are: INDIVIDUAL DIET CONSULTATION, WRITING ARTICLES, GIVE T.V. AND RADIO PROGRAMMES, SCHOOL EDUCATION PROGRAMMES, MENU PLANNING FOR CORPORATE, WORKSHOPS/ TALKS FOR CORPORATES- LOWER TO HIGHER LEVEL, CONDUCTING CLINICAL TRIALS, PLANNING AND EXECUTING NOVEL PROJECTS, PREPARE EDUCATIONAL MATERIAL- LEAFLETS/ POWERPOINT'S/VISUAL AIDS ETC. DEPUTATION OF DIETICIANS, MARKETING OF HEALTH FOODS, TRAINING OF KITCHEN STAFF IN ASPECT OF NUTRITION AND HYGIENE. TRAINING OF DIETICIANS FOR SPECIAL PROJECTS

PREVIOUS CLIENT LIST: MAHINDRA AND MAHINDRA, WOCKHARDT, INDIAN OIL MANAGEMENT CENTRE OF LEARNING, SPECIAL STEEL LTD., ISPAT INDUSTRIES, RELIANCE INDUSTRIES, ASIAN HEART INSTITUTE, DR. BALABHAI NANAVATI HOSPITAL, COPPER CHIMNEY GROUP, BRAHMAKUMARI HOSPITAL-MOUNT ABU

Disclaimer: The views expressed in this health article are strictly those of the writer and 123oye does not take any responsibility for them. Kindly consult a Doctor before following any advice.

   

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