Healthy Diet and Regular Exercises help in primary,secondary and tertiary prevention of diabetes .

1. DOSTI
DARE TO DREAM
DARE TO FLY
DARE TO FAIL
DARE TO SUCCEED

2. LIFE STYLE
MODIFICATION AND
DIABETES
Dr. Jagruti Shah
Preventive Diabetologist
Founder DOSTI

3. GOALS OF THERAPY
• Relieve symptomsRelieve symptoms
• Maintain near normal body weightMaintain near normal body weight
• Achieve & maintain normal physical well beingAchieve & maintain normal physical well being
• Achieve blood glucose level of 70 – 140 mg/dlAchieve blood glucose level of 70 – 140 mg/dl
• Achieve normal glycated haemoglobin levelsAchieve normal glycated haemoglobin levels
• Achieve normal lipid levelsAchieve normal lipid levels
• Improve / maintain quality of lifeImprove / maintain quality of life
• Prevent / delay complicationsPrevent / delay complications

5. Diabetes with a Tomato figure increases
Risk of heart disease by 2.5 times in men
And 8 times in women.
Choose the way
You want to look

6. IDEAL BODY WEIGHT
1. For male = Ht. In cm – 105
2. For female= Ht. In cm - 107
HOW TO CALCULATE IDEAL BODY WEIGHT ?HOW TO CALCULATE IDEAL BODY WEIGHT ?

7. OPTIMAL BODY WEIGHTOPTIMAL BODY WEIGHT
Body Mass Index ( BMI) =Weight in Kg
-------------------------
Height in meters2
Values Good Fair Poor
Indian Women <21 21-25 >25
Indian men <23 23-27 >27
. BMI < 19 signifies Under nutrition
. BMI > 30 signifies Gross Obesity.

8. WAIST – HIP (W-H) RATIO
Normal Values
Indian Men : < 0.90
Indian Women : < 0.80
(Waist and Hip are measured in centimeters.)

9. It’s not just size. Shape runs in
families, too. If your parents
carried extra weight in their hips
and thighs, you are likely to find
it there, too. If they carried
weight around their waistlines,
you may well have inherited that
trait.

10. However,a trait that runs in a family is
not necessarily genetic, hardwired forever
in to your chromosomes. The fact is, we
give our children a lot more than
DNA .We also give them recipes.We pass
on our tastes for foods, ideas about the
role of food in the family, and
innumerable meal time traditions. So
what looks like a genetic pattern may
really be habits passed from generation to
generation.

11. Human diseases arise as a result
of The interaction between
Heredity, Mobility,Environment
& Food.
•It is Impossible to change Heredity.
•It is difficult to change one’s Environment .
•But it is relatively easy to change one’s Food
Habits and increase exercise.

12. Diet in Diabetes has undergone
lots of changes in concepts in last
one decade, from calories
restricted diet to nutritionally rich
diet. The traditional Lacto-
vegetarian diet with changing
outlook towards consumption of
fruits, fat & fibre can not only
help in primary prevention of
diabetes but also in reduction of
micro & macro-vascular
complications and hence morbidity
& mortality

13. Fruits are loaded with nutrition. They are
rich in vitamins (esp. vitamin C) and some
minerals, as well as fiber and other
micronutrients like phytochemicals.
Phytochemicals are biologically-active
compounds with health-giving properties
that scientists believe may help protect us
against diseases like cancer. Examples
include: bioflavonoids (citrus fruits),
bromelain (pineapples), resveratrol (red
grape juice), ellagic acid (raspberries,
blueberries), d-limonene in citrus peel. So
for a lower glycemic response and healthy
nutrition, eat more fruit - especially fresh.

14. GUAVA
Is a good source of lycopene, beta-carotene, and vitamin
C, and is an excellent source of soluble fiber. Current
research suggests that consumption of guava fruit may
reduce LDL (the "bad") serum cholesterol. Another health
benefit attributed to guava is its antimicrobial potential in
combating certain bacteria such as Staphylococcus aureus
and beta-streptococcus group A. Guava is employed as a
natural medicine by people who live in the tropics as a
treatment for diarrhea.

15. PAPPAYA
1.Has more carotene compared to other
fruits.
2.Contains very less calories.
3.Will ensure a good supply of vitamin A
and C.
4.Is an excellent aid to digestion.
5.Can be prescribed for dyspeptic patients.
6.Is an ideal food for invalids.
7.Can be used as tenderizer in cooking.
8.Is reported to speed up healing.

20. Visible Fats Vegetables Oils
Animal fats
Invisible Fats Cereals, pulses nuts, oil
seeds, Milk

21. INVISIBLE FAT
The total fat content determined in
cereals may vary from 2 to 5 per 100g.
Considering the amount of cereals
consumed it is estimated that fat
present in cereals in our diets can meet
more than 50% of our essential fatty
acid requirement. Cereals together with
pulses can nearly meet the EFA
requirement of an adult.

22. VISIBLE FAT
The desired n-6/n-3 ratio 4/1 or lower
can be maintained by combination of
oils like Mustard oil, Olive oil, Ricebran
oil ,sesame oil Groundnut oil &soyabean
oil.
Also desired saturated fat /
polyunsaturated fat ratio can be
maintained by adding small quantity of
pure ghee or coconut oil. Since 50% of
fat requirements are met from invisible
fats, for a person on 2400 Kcal, 15-
20gms of visible fat will be enough.

23.  defense against infection
N-6 Fats
 bloodblood pressure affect HDL
adversely

24. • Blood viscosity
• Lower blood pressure
• Fibrinolytic activity
• Prevent inflammation arthritis ,migraine
headache
• Required for normal insulin action
N-3 FatsN-3 Fats

25. Sources of n-6Sources of n-6
fatsfats
Sources of n-3Sources of n-3
fatsfats
Foods itemsFoods items
whole grains likewhole grains like
rice,wheat,pulsesrice,wheat,pulses
chana,chanadalchana,chanadal
millets,like bajramillets,like bajra
maiza,spices,egg.maiza,spices,egg.
Fish,green leafyFish,green leafy
vegetables, rajmahvegetables, rajmah
urad dal, mehti saeds,urad dal, mehti saeds,
linseeds (alsi)linseeds (alsi)
walnauts.walnauts.
Cooking oilsCooking oils
Safflower oil,Safflower oil,
sunflower oil,cornsunflower oil,corn
oil,till oil,oil,till oil,
oil,groundnut oil.oil,groundnut oil.
Fish oil,linseedFish oil,linseed
oil,mustard oil.oil,mustard oil.

26. Fat or oil Linoleic Linolenic Total Pufa
w-6 w-3
gm/100 gm gm/100 gm Gm/100 g
Safflower oil 74 0.5 74.5
Soyabean oil 52 5.0 57.0
Cotton Seed Oil 50.3 0.4 50.7
Maize Oil (corn) 50.0 2.0 52.0
Sesame Oil (gingelly) 40.0 0.5 40.5
Rice Bran 33.0 1.6 34.6
Groundnut Oil 28.0 0.3 28.3
Mustard oil 13.0 9.0 22.0
Olive oil - - -
Vanaspati 3.4 - 3.4
Ghee (Butter Fat) 1.6 0.5 2.1
Cocnut oil 2.2 - 2.2
POLYUNSATURATED FATTY ACID CONTENTPOLYUNSATURATED FATTY ACID CONTENT

27. Fish is a rich source of long chain n-3 PUFA
which are biologically more active than their parent
member namely alpha linolenic acid in producing several
health benefits. Those who have a taste for fish are advised
to take about 100 - 200 gm of fish twice a week.
Fish is a good source of proteins and it
constitutes about 17 - 20 %. Fish proteins are good sources
of all essential amino acids. Fish protein beings rich in
lysine and threonine supplement effectively with cereal
proteins. Small fish eaten along with bones are a rich
source of calcium.
Salt-water fish is rich in iodine, phosphorous and
calcium. Fish also contain mineral copper. Vitamin A and
D is also present

28. Fish
 Fish may be eaten 2-3 times a week. Both
fatty Lean fish ar desirable. It is also all right
to take shellfish like clams, mussels and
scallop. Avoid crabs, prawns, lobsters and
shrimps
 Prefer fatty fish, which have dark flesh
(Muscle). Depth of Colour reflects the
amount of oil present in the flesh. Lean fish is
pale. Their fat is concentrated in liver,
instead of muscle.

29. • Prefer deep sea fish over coastal fish to
Minimize chances of eating fish,
contaminated.
with industrial and other environmental
toxins.
• Choose fresh fish over canned fish or fish
packed in oil.
Have at least 2-3 servings of fish per week
Select a low fat cooking method.

30.  In general, cold-water sea fish are fatty.
Examples of fatty fish are Tuna,
Salmon,
Mackeral, Black pomfret and trout
 Indigenous fatty fish are Hilsa, Katla,
Puruva and seer .

31. IS IT GOOD TO BREAK A MEAT HABIT
1 . Preventing and reversing heart disease
2 . Easy weight loss
3 . Preventing Alzbeimer’s Disease
4 . Preventing cancer
5 . Preventing osteoporosis
6 . A cleaner food supply

32. FLAXSEEDS
A BOON TO OUR LIFE
Unique feature of flax seed is the high ratio of alpha
linolenic acid (Omega-3) to linolenic acid (Omega-6),
Flaxseed oil is 15% Omega-6, but 55% Omega-3.
100 grams of flaxseeds provide :
Energy 450kcal
Protein 20 gms0
Fat 431 gms
Fiber 28 gms

33. FLAXSEEDS
Linolenic acid and alpha linolenic acid found in
flax are important for :-
1) They are responsible for forming s group of
hormone like compounds called
prostaglandin's.
2) They make cell membrane permeable, which
helps in protection of cells against invading
bacteria, toxins, infection and viruses.
3) Flaxseeds contain substances called lignans,
which are equally important in boosting the
immune system in many ways.
4) It is also a good source of fibre.

34. Flax Seed Oil
Extensive research has demonstrated
the health benefits of essential fatty
acids in
reducing the risk of heart attack. Flax
seed oil is often used in weight loss
supplements because of its positive
effects in burning fat. Flax seed Oil is
one of Nature's richest plant sources of
essential fatty acids (EFAs) which are
necessary for health and must be
supplied by the diet.
Flax seed oil health benefits

36. RICE BRAN OIL Unsaturated fatty acid
about 80% in rice bran oil out of which 40-45% is
oleic acid (an important monounsaturated fatty
acid) is effective in lowering the cholesterol level in
human blood.
Oryzanol a mixture of ferulic acid esters of
sterol and triterpene alcohols found 0.5-2% in rice
bran oil acts as natural antioxidant, lower the
cholesterol level in the blood, effective in reducing
menopausal symptoms, to stimulate the nerves and
relieving various complaints caused by malfunction
in the nervous system.
Vitamin E is a high value substance. It
improves the blood circulation and reduce oxygen
demand of human body reduce aging. In rice bran
oil, it acts also as a natural antioxidant that
protects the occurrence of rancidity in oil without

37. FATTY ACID COMPOSITION OFFATTY ACID COMPOSITION OF
COMMON OILSCOMMON OILS
OILOIL ω-3ω-3 ω-6ω-6 MUFAMUFA SATURATEDSATURATED
PUFAPUFA PUFAPUFA FATFAT
Flax 58 14 19 9Flax 58 14 19 9
Soybean 7 50 26 15Soybean 7 50 26 15
Canola 7 30 54 7Canola 7 30 54 7
Safflower 0 75 13 12Safflower 0 75 13 12
Sunflower 0 65 23 12Sunflower 0 65 23 12
Corn 0 59 24 17Corn 0 59 24 17
Olive 0 08 16 16Olive 0 08 16 16

39. Fibre Advantages
• Delays gastric emptying
• Provides sense of satiety.
• Holds water-stools are soft, readily eliminated.
• Gets fermented in large intestine.
• Good source of vitamin minerals antioxidants, n-3
fatty acids.
• Effective in reducing Blood sugar and Lipid values.

40. Fibre Advantages
Fibre helps in slimming since it is bulk forming
but not containing much of calories. .
3. Coronary heart diseases are low in people who
consume high fibre diet.
4. High fibre has a beneficial effect on dental
caries since the fibre requires more chewing
that promotes salivary flow and prevents
food stagnation

41. Sources of Fibre Components
Cellucose Hemicellulose Lignin
Insoluble Whole wheat
Flour
Vegetables
Bran
Whole grains
Mature
Vegetables
Wheat, fruits
with Edible
seeds such As
strawberries
Soluble Gums,
Oats,Legumes
Guar,Barlay,
Vegetables
Pectins,Apples
Citrus fruits
Strawberriess

42. • Free radicals are like
Robbers which are
Deficient in energy.
• Free radicals attack
And snatch energy
From the other cells to
Satisfy themselves
WHAT ARE FREE RADICALS?

43. Free radicals are produced during various metabolic
Activities carried out inside our body.
Our body also gets exposed to free radicals present in
Environment. For eg.
 Sunlight, Automobile exhaust.
 Cigarette smoke,Alcohol consumption.
 Emotional Stress.
 Exposure to heavy metals like mercury, cadmium, lead Etc.
HOW ARE FREE RADICALS PRODUCED?HOW ARE FREE RADICALS PRODUCED?

44. HOW ARE THEY
HARMFUL?
Free radicals cause
The damage to the
Blood vessels.
This injury leads to
Deposition of LDL
(Bad Cholesterol) in
blood vessel and blocks them.

45. HOW DOES BODY PROTECTS ITSELFHOW DOES BODY PROTECTS ITSELF
FROM FREE RADICALS?FROM FREE RADICALS?
Antioxidants are the substances
produced inside our body that
prevents the damage done by free
radicals.
Antioxidants provide energy to the
free Radicals and prevents the cells
from the Damage done by free
radicals.

46. WHICH ANTIOXIDATNS WILL PROTECT
MY Body
The antioxidants available from the food thatThe antioxidants available from the food that
prevent our body from the damage of freeprevent our body from the damage of free
radical are :radical are :
Vitamin EVitamin E Vitamin CVitamin C ZincZinc SeleniumSelenium

47. HIGH VITAMIN “C”
VEGETABLES FRUITS
Drumstick leaves 220 mg
(shevaga pan,saijan patta)
Cabbage 124mg
(kobi,band gobee)
Drum stick 120mg
(shevaga sheng,saijan-ki-phalli)
Guava 212 mg
(peru,Amrud)
Cashew fruit 180 mg
(kaju)
Amla (anvla) 600 mg
Korukkapalli 108 mg
(chinch,singhri)
(All the values are per 100 gms. of edible portion)

48. HIGH VITAMIN “A”
Vegetables Fruits
Coriander leaves 15,000 μg Mango 2,210 μg
(kothimbir,hara dhania) (Amba,Aam)
Curry leaves 21,000 μg Orange 2,240 μg
(kadhi limb,gandhela) (Santre,Narangi)
Drumstick leaves 42,000 μg Papaya (ripe) 2,740 μg
(shevaga pan,saijan patta) (Papita)
Mint (pudina) 18,950 μg
Spinach (palak) 9,440 μg
Carrot (gajar) 8,840 μg
Tomato ripe 3,010 μg
(All values are μg per 100g of edible portion)

50. FOODS CONTAINING HIGH “SELINIUM”
VEGETABLES
1. Brussels sprouts (Chotee gobee) 212 mg
2. Celery leaves (Ajwan-ka-patta) 102 mg
3. Drumstick leaves (Saijan-patta) 137 mg
4. Fenugreek leaves (Methi sag) 167 mg
5. Mint (Pudina) 84 mg
6. Cauliflower (Phulgobi) 231 mg
7. Drumstick (Shevaga sheng,Saijan-ki-phali) 137 mg
8. Pink Beans (Barli) 182 mg
(All values are mg. per 100 gms. of edible portion)

53. FOODS CONTAINING HIGH “CALCIUM”
VEGETABLES FRUITS
Cauliflower Green 626 mg Lime 90 mg
(phool gobee) (neembu,musumbe)
Curry leaves 830 mg Lemon 70 mg
(kadhi limb,gandhela) (limbu)
Drumstick leaves 440 mg
(shevaga pan,saijan patta)
Carrot leaves 340 mg
(gajar pan,gajar sag)
(All the values are per 100 gms. of edible portion)

57. BIOACTIVE PHYTOCHEMICALS IN
FOODS
1.A large array of chemical substances
which influence cell metabolism and
thereby exert significant effects on health
/ disease processes.
2. Known to be capable of playing not only
a ‘health-promoting’, but also a ‘disease-
preventing ‘role.
3. Bioactive chemicals in foods fall into
three broad (overlapping) categories;
antioxidants, detoxifying agents, and
blocking / suppressing agents.

58. 1. Ripe tomato contains very good
amount of vitamin A
2. Both ripe and unripe have large
amount of vitamin C but more in unripe
one.
3. It is low in calories, advisable to
weight reducing diet preferably raw as
salad.
4. Tomato may help to prevent some
forms of cancer by lessening the damage
caused by free radicals.
5. Tomato by preventing platelet
clots helps to cut down deaths from
heart diseases and strokes.
6. Role of tomato in stone
formations is controversial.

59. Some common foods containing
Bioactive substances.
Cabbage, Carrots, Onions,
Cauliflower, Tomato, eggplant, Green
leafy vegetables,celery
methi , Amla, citrus fruit, Guava,
Sesame, Sunflower oil, palm oil
Chillis, Cloves, Ginger, Garlic,
Peppers turmeric

60. Turmeric extract
A herb from ginger family
exhibits a high degree of
protection against lipid free radical
damage .
It can suppress the mutation of
common carcinogens such as
cigarette smoke.
It balances LDL cholesterol
levels and helps to stop clogging of
arteries by inhibiting pletelet
deposition .

61. TURMERIC
1.Its antiseptic property is been proved scientifically.
2.It is used in treating arthritis due to its anti-inflammatory
property.
3.Turmeric is used to relieve digestive problems like ulcers,
dysentery.
4.It has protective action on liver.
5.Turmeric helps by lowering serum cholesterol and by
preventing the formation of the internal blood clots improves
circulation and prevents heart disease and stroke.
6.Turmeric can be taken as a drink other than adding to dishes
to help prevent all problems. Use one teaspoon of turmeric
powder per cup of warm milk every day. It is also used as a paste
for local action.
Fresh or dry turmeric is used for saline gargles
to relieve and prevent sore throats

62. METHI -FENUGREEK SEEDS
1. Fenugreek seeds helps to control blood sugars.
2. It reduces high serum cholesterol.
3. This seeds relieves constipation may be because the
seeds contain a gum which when mixed with water
expands in the gut and adds bulk to the stool.
4. It can be prescribed to nursing mothers to increase
their milk production.
5. Since fenugreek seeds contain chemicals (diosgenin
and estrogens isoflavones) similar to the female sex
hormone oestrogen is considered as a potent
menstruation promoter (menstrual discomforts),
minimise symptoms of menopause.

64. Fenugreek
* Fenugreek (Methi) is thought to
-delay gastric emptying
-slow carbohydrates absorption
-inhibit glucose transport.
* It has been shown to increase erythrocyt
insulin receptors and improve peripheral glucose
utilization,thus showing potentialpancreatic as
well as extrapancreatic effects
* The main side effects are flatulence and
diarrhoea,which subside after a few days.
Hypersensivity reactions have also been reported.

65. * Because of the coumarin constituents,
fenugreek may potentially enhance anticoagulant
activity of drugs or herbs that have antiplatelet
activity.
* It may inhibit corticosteroid drug activity,
interfere with hormone therapy,and potentiate
monoamine oxidase (MAO) inhibitor activity.

66. Methi - Fenugreek seeds contain 50% total
fibre, 20% soluble fibre and n-3 fatty acids
and are very effective in reducing blood
glucose, serum cholesterol and triglycerides .
Therefore, diabetics could be advised to take
25g of fenugreek seeds in three divided doses
along with breakfast, lunch and dinner.
Fermantation Idli, Dosa, Dhokla
Rice preparation
Dal preparation
Fodani
Atta

67. Garlic and Onion have
fibrinolytic action and reduce
platelet aggregation. In
addition, they have
hypolipidaemic actions. About
50 g onion and 1-3g of fresh
garlic are adequate in the daily
diet .
Agoene, a chemical
derived from garlic is also
known to prevent platelet
aggregation. The beneficial
effect of Garlic in heart
disease could be attributed to
these properties.

68. GARLIC
* Garlic contains the sulfur containing chemical
constituent, alliin,which must be covered to allicin
(the active form) by the enzyme allinase.
* Ajoene is formed by the acid-catalyzed reaction
of two allicin molecules.
* Allicin has antibacterial and antioxidant activity.
It may possibly increase blood levels of catylase
and glutathione peroxidase activity.

69. * Ajoene decreases the activity of factors needed
for lipid synthesis by reducing the thiol group in
coenzyme A and HMG.
* Ajoene has antiplatelet activity and interferes
with thromboxines synthesis and decreases
platelet aggregation.
* Garlic use may be associated with increased
serum insulin and improved liver glycogen
storage.
* Side effects include breath odor,mouth and GI
burning or irritation,heartburn,flatulence,and
rare topical reactions.

70. * For fresh garlic,the dose is one clove (4g)
taken once/day.

71. BITTER MELON
* It is a vegetable also known as karela.
* Bitter melon has been used to treat diabetes.
* Bitter melon contains several chemical
constituents like glycosides mormordin and
charantin.
* Charantin contains mixed steroids with
hypoglycemic activity.
* Another component is the peptide
polypeptide-p.
* Bitter melon also contains the alkaloid
mormordicine.

72. *Bitter melon also contains the alkaloid
mormordicine.
*Its seeds contain the abortifacients α-
mormorcharin and β-Mormorcharin as well as the
pyrimidine nucleoside vicine.
*Its hypoglycemic activity include charantin,
polyppeptide p.
*Other theoretical actions include extrapancreatic
activity, such as increased tissue glucose uptake,
liver/ muscle glycogen synthesis, and decreased
blood glucose synthesis through depression of the
enzymes glucose-6 phosphatase,fructose-1,and6
bisphosphatase, and enhanced glucose oxidation.

74. CARBOHYDRATES:
Generally in Indian diets, carbohydrates
provide 60-65% calories .
Ragi is rich in minerals, especially calcium.
Millets including ragi are rich in minerals
and fibre. Complex carbohydrates, present
in cereals and pulses have a low glycaemic
index and are better. . Rice and wheat have
similar glycaemic index.
1gm carbohydrates = 4.0 CAL

75. CARBOHYDRATES
Cereals and millets : The major cereals and
millets consumed in India are rice, wheat
(cereals), jower, bajra, ragi (millets) and
maize.
Cereals are also source of some nutrients
like Ca & Fe. However rice among the
cereals is poorer in these two minerals.
Hence diets based predominantly on rice
have lower Ca & Fe content.

77. PROTEINS:
The best quality protein is the one which
provides essential amino acid pattern very close
to the pattern of the tissue proteins. Egg
proteins, human milk protein, satisfy these
criteria .
Proteins from vegetable sources are
better than from flesh foods as they provide
fibre, and do not contribute cholesterol to the
diet. The added advantage is that progression of
renal disease is lower with vegetable proteins
than those animal foods .
A combination of cereal and pulse in the
ratio 5:1 has been found to give an optimum .
Sprouted pulses have more nutritive values and
more digestibility.

78. PROTEINS:
1gm of protein gives approx . 4cals.
Req.-0.8 g/kg body wt. Additional
Supplement for pregnancy,
lactation/growth.
Cereals contain 6-12 % protein
which is generally deficient in lysine and
provides more than 50% of daily protein
intake.
Soya, Rajama,Udad dal has more
nutritive values Include a small quota of
animal proteins (milk/yoghurt/fish).
Avoid meat, seafood crabs, lobster.

79. The germination of pulses increases its
nutritional content. The germinated pulses
have high vitamin C content than the
normal seed. Other vitamins that show an
increase are B complex vitamins and folic
acid.
Tannin and phytates, those adversely affect
the bioavailability of nutrient, are broken
down on germination. Like wise the
chlorophyll content also increases when the
sprouted shoots change from yellow to
green. Fermentation of the dhal to make
idli, dosa, and dhokla also enhances the B
vitamins and decreases the phytate content
and trypsin inhibitors.

80. -
SOYABEANS
-Soya bean contains 43 gms of protein per 100 gms, which is the
highest among the pulses.
-It also contains 19.5 gms of fat, 21gms of carbohydrate and provides
432 kcal per 100 gms. The protein of soya bean contains all the
essential amino acids in adequate amounts except methionine and
cystine. Since it has majority of essential amino acid it is one of the
best vegetarian food item as far protein content is concerned
-It is a good source of thiamine, niacin, folic acid and a fair source
of riboflavin.
-Soya bean contains a factor that inhibits the action of the digestive
enzyme trypsin and this factor can be destroyed by heat. Soya bean
should be cooked well for digestion and absorption.
Studies have shown that in type II hyper cholesterolemia patients
already on low lipid, low cholesterol diets, eight weeks substitution
of animal protein by soya bean protein reduced plasma cholesterol
by 23 to 25 percent.

82. GLYCEMIC INDEX
Complex carbohydrates which have to be
chewed,digested,assimilated and absorbed produce a
less steeper rise in post prandial glucose as
compared to simple sugars which are absorbed
rapidly and produce a steeper rise in glucose level.
Apart from food factors,“human factors”
also influence glycemic index.
* Dietary fiber derived from legumes and
pluses that is viscous (gel-forming) is
better than non-viscous dietary fiber
present in wheat and rice.

83. GLYCEMIC INDEX
Dilution of food by liquids also affects the
glycemic index by decreasing the viscosity of the fluid
film surrounding the intestinal villi and thus decreased
thickness of the rate limiting unstirred layer resulting in
an increase of glucose transport across the intestinal
mucosa.
Apart from fiber the presence of other
substances such as phytates and mineral elements can
influence the glycemic response of a given carbohydrate
source.
Apart from food factors that directly affect
glycemic index is also affected by other factors such as
GI motility,age,food volume etc.

84. POSITIVE HEALTH APPROACH
* Unrefined high fibre,high carbohydrate,
low fat,low glycemic
index diet must be encouraged for all.
* Glycemic Index Food :
ITEM %
Rajmah 20-29
soyabean 10-19

85. MODIFICATION
Chappatis
4Kg Wheat +
½ Kg Soyabin +
½ Kg Ragi +
¼ Kg Methi
Nutritionaly rich Chappatis
in iron ,calcium,n-3 fattyacids, proteins,
B -complex vitamins.

86. MEALS TO BEMEALS TO BE
 HIGH CARBOHYDRATES AND FIBER, BUTHIGH CARBOHYDRATES AND FIBER, BUT
 LOW IN FAT AND SALTLOW IN FAT AND SALT
PRINCIPLES OF MEAL PLANNINGPRINCIPLES OF MEAL PLANNING
NO SUGARS
SUGAR JAGGERY HONEY

88. GENES ARE NOT DICTATORS
Scientific research reveals that genes are not
dictators; they are committees. They do not give
orders. They make suggestions. Genes are not
rogue tyrants exerting despotic control over your
waistline.rather. they work in groups, often with
subtle effects, and you can nudge them in the
direction you want them to go. You can counteract
the fat genes and boost your thin genes.

89. We think of genes as unchangeable because, when it comes
to eye color or hair color, they really are decisive.. But the
genes that establish your size and shape are much more
flexible. They need to be able to adjust your appetite and
your calorie burning, depending on whether food . Your
capacity to shape and renew your body is not perfect, but
it is far greater than you may have imagined.the genes for
muscle mass only make suggestions. You control how the
genes are expressed.

90. The negative calorie foods
contain sufficient vitamins & minerals
that produce enzymes in quantities
sufficient to break down not only its
own calories, but additional calories
present in digestion as well. This is the
secret of The Negative Calorie Foods.
1. A 5 calorie piece of celery may
require 150 calories to digest, but resulting
in a net loss of 145 calories from our body
fat !! The more you eat, the more you lose
weight!!!

91. FREE FOODS
we can say that any food with fewer than 5 grams
of available carbohydrate in a 100 gram portion is
a free food. The rest of the portion is protein, fat,
fiber, ash, and water. This is similar but slightly
different from the concept used in the Dietary
Exchange Lists, which says, “Free foods are those
with either under 20 calories or 5 grams or less of
carbohydrates per serving.” Thus, a 100 gram
serving of one of your “free foods” will raise blood
sugar by about 50 mg/dl for most people with
diabetes.

92. Asparagus
Beet Root
Broccoli
Cabbage
Carrot
Cauliflower
Celery
Hot Chili
Cucumber
Garlic
Green Beans
Tomato
Watermelon
Lettuce
Onion
Radish
Spinach
Turnip
Lemon/Lime
Orange
Papaya

93. Green Tea, the common name for Carmellia Sinensis is
an herb that has been used for weight loss because of its
thermogenic attributes
Thermogenesis actually helps boost your body
temperature and burn excess calories. The primary
thermogenic component of Green Tea is caffeine. It also
has two other related components called theobromine and
theophylline that help to boost metabolism. Neither of
these components can be found in coffee. So although
coffee is similar, it does not have the thermogenic
properties of Green Tea.
Green Tea also contains antioxidants to help nuetralize
free radicals which can damage healthy cells.
Green Tea contains No calories, No carbohydrates, No
Protein, and No Fat. It also provides about 10 mg of

94. Prescription for Healthy Living
Achieving good metabolic
control
• Knowledge of meal planning
• Regularity of food intake
• Flexibility in food choices
• Adherence within recommended
caloric levels

95. SUCCESS OF DIET THERAPY
DEPENDS UPON
Regular diet assessment
Individualisation of Diet
Involvement of family

96. EXERCISEEXERCISE

97. EXERCISE
Important & integral part of
diabetes treatment for both
IDDM & NIDDM.

98. EXERCISE PLAN
DEPENDS ON
•Age
•General health
•Level of physical fitness

99. REGULAR EXERCISE
Benefits
 Controls weight
 Lowers blood sugar
 Reduces need for diabetes
medicines
 Lowers blood pressure
 Reduces stress
 Increases fitness
 Improves functioning of heart

100. GOOD EXERCISE PLAN
Contents
 Enjoyable activity
 Affordability
 Pacing of activities

101. Exercise, Excuses
• That sounds like hard work to me .
• I haven’t got time, I’m too busy.
• I need ralaxation, not exercise.
• I’d be too embarrassed.
• I’m too old for it.
• I’m fat, I’d rather diet .
• That sounds boring.
• I am too thin why exercise.

102. EXERCISE IS LIKE
“ INVISIBLE INSULIN”
•Most people with Type II diabetesMost people with Type II diabetes
and Type I diabetes need to modifyand Type I diabetes need to modify
insulin dose and/or food in takeinsulin dose and/or food in take
to account for exerciseto account for exercise..

103. RISK OF EXERCISE
• Strenuous exercise may potentiate.
• insulin’s – effect/hypoglycaemia.
• Arrhythmia, Myocardial ischaemia.
• Risk related to underlying.
• retinopathy & neuropathy.
• May aggravate diseases e.g. arthritis.

104. ADVICE ON EXERCISE FOR PATIENTS
WITH COMPLICATIONS
Complication
-Insensitive feet
-Active proliferative
Retinopathy
-Hypertension
Advice
-Use proper foot wear.
-Avoid strenuous
exercise & heavy lifting.
-Avoid strenuous exercise.

107. GETTING STARTED
 COMPLETE MEDICAL CHECK
UP
 CHOOSE AN ENJOYABLE
ACTIVITY
 START SLOWLY
 PACE ACTIVITY (Gradual
increase)

108. Routine Activity Caloric
Consumption Per Minutes
Relaxing in lying down position 1 cal
Sitting 1.2 cal
Standing 1.4 cal
Eating 1.4 cal
Talking 1.4 cal
Drying cloths 2.3 cal
Washing Hands – Face 2.5 cal
Walking 2.5 mile/hrs 3.6 cal
Bathing 4.2 cal
Climbing down 5.2 cal
Daily Activity

109. Specific Activity Caloric
Consumption
Per Minutes
Sewing cloths by hands 1.4 cal
Sweeping floor 1.7 cal
Polishing furnitures 2.4 cal
Wiping floor 3.6 cal
Ironing cloths (standing) 4.2 cal
Mopping 4.2 cal
Daily Activity (contd.)

110. Hobbies Caloric Consumption Per Minute
Painting (Sitting) 2.0 cal
Driving 2.8 cal
Horse riding (slowly) 3.0 cal
Cycling 5.5 mile/ Hrs. 4.5 cal
Golfing 5.0 cal
Dancing 5.5 cal
Swimming 20 yards/ minutes 5.0 cal
Skating 9.9 cal
Gardening 5.6 cal
Tennis 7.1 cal
Daily Activity (contd.)

111. SOME POPULAR ACTIVITIESSOME POPULAR ACTIVITIES

112. Hobbies Caloric Consumption Per Minute
Painting (Sitting) 2.0 cal
Driving 2.8 cal
Horse riding (slowly) 3.0 cal
Cycling 5.5 mile/ Hrs. 4.5 cal
Golfing 5.0 cal
Dancing 5.5 cal
Swimming 20 yards/ minutes 5.0 cal
Skating 9.9 cal
Gardening 5.6 cal

113. SOME POPULAR ACTIVITIESSOME POPULAR ACTIVITIES

114. How Far, How Fast, How Long ?
Distance = speed x time; Speed = Distance/Time
=Distance/Speed
Steps/ Min Min/ mile Miles/ hour
2.0
Ft/stride
2.5
Ft/stride
3.0
Ft/stride
90 70 60 30 2
110 90 75 24 2.5
130 105 90 20 3
155 120 105 17 3.5
175 140 120 15 4
200 160 135 13 4.5
220 175 145 12 5

115. TO FIND YOUR
TARGET HEART RATE
• 220-your age = maximum heart rate.
• Ask your doctor how hard you should
exercise (usually at 50-75% of
maximum heart rate).
• If you can’t talk or whistle while
exercise, slow down.

116. EXERCISE PRESCRIPTIONS
Fitness Level Intensity % of Maximum
(min./session) heart rate
Low 15-30 60-70
Moderate 30-45 70-80
High 30-60 70-80

117. Walking speed
(MPH)
Pace Calories Burned
(approx)
in 30 min in 1 Hr
2 Slow 120 240
2.5 Medium 140 280
3 Medium 160 320
3.5 Brisk 180 360
4 Brisk 210 420
4.5 Fast 250 500
Walking up
Moderate
incline
Brisk 300 600

118. SOME POPULAR ACTIVITIESSOME POPULAR ACTIVITIES

119. Yoga means "joined together".
The word comes from the
ancient Sanskrit root word yug,
which means "to unity".
YogaYoga

120. A yogi is one who consciouslyA yogi is one who consciously
unifies body, mind, emotions,unifies body, mind, emotions,
and spirit so that they workand spirit so that they work
together very well.together very well.

121. Asanas are a important part ofAsanas are a important part of
yoga. They are various bodyyoga. They are various body
postures designed for keepingpostures designed for keeping
the internal & external parts ofthe internal & external parts of
the body in good health. Asanasthe body in good health. Asanas
takes care of both the mind andtakes care of both the mind and
body to achieve completebody to achieve complete
physical and mental relaxation.physical and mental relaxation.

122. Pranayama
Pranayama is the gateway to deeper
relaxation and meditation. The regulation
of breath is the essence of Pranayama.
Pranayama, according to yogic scriptures,
is the gateway to deeper relaxation and
meditation. The Sanskrit word ‘Prana’
means breath of life force, while ‘ayama’
means regulation or control.

123. YOGA & DIABETES
(Studies from Vemana Research institute,
Secunderabad)
MECHANISM
• Exercise Effect
• Change in biochemical & hormonal profole
• Elimination of stress & instilling a sense of
disicipline

124. Group ‘A’
Naukasana
Bhujangasana
Shalabhasana
Group ‘B’
Halasana
Vajrasana
YOGA STUDIES
4 types of Pranayama for 30 minutes followed
by Shavasana for 15 minutes
Group ‘C’
Yogmudra
Shalabhasana
Group ‘D’
Dhanurasana
Ardhamatsyndrasana

125. EFFECT OF ASANAS
1. Exercise toleranc
- Significant reduction in the minute ventilation
- Oxygen consumption
2. Plasma cortisol
Non diabetic Asthmatic
Plasma cortisol in diabetic patient
3. Effect of lipik profile
FFA
LDL
VLDL
HDL

126. Benefits of Yogasana:Benefits of Yogasana:
It helps in controlling various diseases and
* It improves fitness of the body.
* It improves flexibility of various
joints by reducing stiffness.
* It increases immunity and helps in
improving the function of kidneys,
lungs, intestine, liver, and skin.
* It also helps in breaking down
excess fat and increases blood circulation.

127. POTENTIAL BENEFITS OF EXERCISE
• Improve glycemic control
• Helps in weight control
• Reduces psychological stress
• Improves insulin sensitivity
• Promotes cardiovascular fitness
• Increase energy

128. RISK OF EXERCISE
•Strenuous exercise may potentiate
•insulin’s – effect/hypoglycaemia
•Arrhythmia, Myocardial ischaemia
•Risk related to underlying
•retinopathy & neuropathy
•May aggravate diseases e.g. arthritis

129. MANY PEOPLE SEEM TO
THINK SUCCESS IN ONE
AREA CAN COMPENSATE
FOR FAILURE IN OTHER
AREAS. BUT TRUE
EFFECTIVENESS REQUIRES

130. FEMALES ( HOUSE WIVES) WORKING IN
KICHENS CAN PLAY MAJOR ROLE IN
PRIMARY , SECONDARY AND TERTIARY
PREVENTION OF DIABETES AND TOTAL
HEALTH OF FAMILY WITH LIFE STYLE
MODIFICATION ONLY.
HENCE FEMALES CAN IMPROVE THE
ECONOMIC BURDEN OF DIABETES TO THE
COUNTRY FROM KICHEN ONLY WITHOUT
GOING OUT FOR JOBS.
FEMALES SHOULD REALISE THIS SOCIAL
RESPONSIBILITY AND SOCIETY AND
FAMILIES SHOULD LEARN TO RESPECT
THAT.

131. NO ONE CAN CHEAT YOU
OUT OF ULTIMATE
SUCCESS BUT YOURSELF.

132. FAILURE IS DELAY BUT
NOT THE DEFEAT.
FAILURE SHOULD
CHALLENGE US TO NEW HEIGHTS.
GREATEST GLORY
CONSISTS NOT IN FAILING BUT
RISING EVERY TIME YOU MAY FALL.
WE LEARN WISDOM FROM
FAILURE MUCH MORE THAN
SUCCESS.