Supplements used for
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
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
- 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 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
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.
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
-diseases of small blood vessels and other parts of the eye resulting in
retinal degeneration and blindness. If detected early the damage can be
-diseases of large blood vessels such as atherosclerosis.
-Uncontrolled diabetes often affects the kidneys leading to kidney
-diseases of the nerves resulting in loss of sensation, increased
infections stemming from unnoticed injuries and gastrointestinal problems.
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 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 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.
• 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 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
• The fat intake may need to be further modified if associated dyslipidemia
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
• 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
• 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
• 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 restriction is necessary in patients with associated hypertension,
cardiac failure and fluid overload.
• These can be eaten by diabetics in moderate amounts. Raw and partially
ripe fruits are preferable.
• 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
• 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.
• 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
Supplements are for those people who find difficulty to eat ordinary foods
• are worried about not eating properly, for example, because of swallowing
• 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:
Composition:Each 50gms provides protein 9.5gms,fat 11.5gms,carbohydrates
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
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
Primary Indications - RESOURCE Diabetic
• Diabetes mellitus
• Glucose intolerance
• Stress-induced hyperglycemia
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.
Each can(237ml) provides
Dietary Fiber (Soy)............3.4g
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.
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
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
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
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
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
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
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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