A person who has diabetes thinks that he/she has a “severe” disease (temptation), precisely because he/she does not know what to eat. Nutrition has to be learned, patiently with calculation and self-control. There is no forbidden or allowed food. The most important thing is to master the quantity. For proper nutrition, mathematics is needed.
Here’s what a person with diabetes needs to know:
- What is my optimal weight?
- How many calories should I take per day?
- Daily intake of sugar units (carbs)?
- Daily intake of fat?
- How many grams of carbohydrates are covered by 1 unit of bolus insulin?
- How much does 1 unit of bolus insulin reduce blood sugar level?
1. What should be my ideal weight?
Ideal body weight (BW) is an accurate calculation. For example: A man is 175 cm tall. He weighs 85 kg. His ideal BW should be 70 kg. However, there is also a term “allowed body weight”, which indicates the BW that does not yet have to endanger health. Another 10% is added to the ideal BW. So, the allowed BW for our 175 cm man is 77 kg. How much is he overweight? Well, 8 kg. He should “take off” that much to be handsome – and healthy.
An example of a woman who is 157 cm tall and weighs 53 kg. Everyone tells her she looks good, but she is not satisfied. What is the calculation? Her ideal BW is 47 kg. BW allowed is: 47 + 5 kg (always round) is 52 kg. So, she has 1 kg of overweight! It may not be visible, but the woman feels it!
Some people say that this is very discouraging and that age should be considered. Yes, the following applies to older people: BW – 100. The problem is the term “older”. From what age should it be considered? From 65 or earlier? In any case, the calculation changes. Our man should ideally weigh 75 kg, and his allowed BW would be 82 kg. Well, in that case he is only 3 kg overweight. And, what about our woman? If she were over 65 years of age, her ideal body weight would be 57 kg. That would be too much!
Each of us knows which is his/her “most” ideal BW. The person then feels healthy and attractive. The most important thing is to be honest with yourself and to determine “your BW”.
2. How many calories should I take per day?
This is about energy needs, so that a person can function and at the same time lose, gain or maintain BW.
So, if you calculated that you have more kilograms than you would like to have, then multiply your weight by 18. You will get a total of kcal (kilo calories) that you are “allowed” to intake by food during the day, without changing your usual activities. Gradually, by ingesting that same amount of calories via food day by day, you will begin to lose weight. However, if you start exercising, you will reach your desired weight, in a faster and healthier way.
Not everyone loses weight the same way!
16 weeks of diet with 1200 kcals: the average weight loss is about 9 kg; for some people it is only 6.5 kg and for others 16.7 kg.
Also, not everyone gains weight the same: If you relax and start consuming 1000 kcal “more” than usual, during 8 weeks: the weight gain is from 1.4 kg to 7.2 kg!
3. Daily intake of sugar units (carbs)?
This is about the food containing carbohydrates – which raise blood sugar levels. Rounded, 1 sugar unit (also called carbohydrate – carb) is 12 g. Since each gram of carbohydrates has 4 kcal, then 1 sugar unit has 48 kcal.
There are numerous illustrations that vividly show you how much 12 g of carbs is.
If a person takes 25 g of bread (or 1 small cake of puff pastry, ½ roll or a small croissant) and 200 ml of yogurt for breakfast, he/she has taken in 2 carbs. That’s about 96 kcal – or, around 100 kcal.
1 sugar unit is found in: 2 WASA breads, 35 gr proja (corn bread), 5 salty crackers, half a bag of Smoki, 1 shallow plate of cooked beans, half a medium-sized boiled corn, 4 tablespoons of muesli, etc. It’s best to look for pictures online – that’s the best way to learn. In English, 1 sugar unit is called CARB. The counting of sugar units is carb counting.
Of course, everyone is interested in fruit. It is well known that fruit intake raises blood sugar. 1 sugar unit is found in: half a banana, half a small grapefruit, half an orange, a small tangerine, a small apple, one slice of pineapple, 1 kiwi, 2 small apricots, 2 figs, 1 thin slice of melon or watermelon, 4 plums, 15 grapes , 10 strawberries, 10 cherries, a cup of blueberries, raspberries, currants, blackberries. There is no “forbidden fruit”. There is a forbidden amount of fruit.
And what does the DAILY INTAKE OF CARBS look like?
This is shown in the table. Daily intake, again, depends on whether you are normally fed, lean or obese.
This is just an “orientation” – an idea. Today we live fast. There is no time for a person to think about snacks.
Many people have 2 meals. Today, there are “modern” insulins that help a person individualize in every way. Just remember 10 – 14 – 18.
Example for 14 sugar units:
- Breakfast : roll + yogurt
- Snacks: fruit or 100-150 ml of fruit juice
- Lunch: soup, salad, 2 smaller servings of mashed potatoes, 2 servings of green peas, 100 g of meat
- Dinner: 2 pancakes with cheese
4.Daily intake of fat?
Fats are calories. 1 gram of fat has 9 kcal! Fats do not raise blood sugar level, but increase weight.
Any weight gain brings, among other things, a health problem called insulin resistance. Insulin resistance severely impairs the “math” in diabetes.
You should avoid:
- Fatty meats (pork, duck, turkey) and processed meat products, as well as “skin”
- Full-fat cheeses
- Fatty fish
- Spreads, mayonnaise, salad dressings
- Snacks – You should buy “lean” meat. Remove all visible grease. Prepare grilled meat or cook it with vegetables. Best approximation for the amount of meat you should take for a meal is the size of your palm.
It’s not banned – that’s good news. You should think in terms of alcohol units.
An alcohol unit is a “measure” of an alcoholic beverage. Alcohol must be included in daily calories. 1 gram of alcohol has 7 kcal.
The allowed amount of alcohol is 3 alcohol units for men and 2 for women, per day.
6. How many grams of carbohydrates are covered by 1 unit of bolus insulin?
This is something that everyone, who uses bolus insulin, must calculate for him/herself. However, the calculation cannot be done if HbA1c is not in the target range, as determined by your doctor. For many patients it is 7%, or between 6.5 – 7.5%.
If your HbA1c is 7%, calculate your total daily insulin dose.
Then divide 500 by TDID (total daily insulin dose). You will get how many grams of carbohydrates are covered by 1 unit of bolus insulin, when you are well regulated.
A person weighs 50 kg, HbA1c 6.9%, has no hypoglycemia and uses 18 units of Levemir and 5 units + 8 units + 5 units of NovoRapid before main meals. When all these units of insulin are added up, the total daily dose is 36 units.
500 divided by 36 units = 13.8.
Always round = 14.
It means that 1 unit of the bolus covers 14 g of carbohydrates.
Why is this important? Bolus insulin must be determined before a meal! The doctor only prescribes an orientation of units, which serve to get a certain amount of insulin on prescription.
People are surprised that they are not well regulated, and they “correctly” use the prescribed dose of insulin. Here is an example – this same man calculated that:
For breakfast he has 50 g of carbohydrates – that is, 50 ÷ 14 = 3.57 ≈ 4. He needs 4 units of bolus insulin. For a 80 g carb lunch – he needs 6 bolus units (80 ÷ 14 = 5.7 ≈ 6). For dinner, that day, from 60 g of carbohydrates – 4 – 5 (60 ÷ 14 = 4.28 ≈ 4 or 5) units of bolus insulin are needed.
Knowing this calculation allows “flexibility” in insulin dose and meals. If, for the weekend, this person eats more, since he is at home, the bolus before meals will not be 4 + 6 + 5 units, but possibly 6 + 8 + 6 units.
It is also important to know:
- The ratio of insulin to carbohydrate is not the same for every meal.
- Often more insulin is needed in the morning hours, example: in the morning 1unit of insulin covers 10 g of carbohydrates and during the day 1unit of insulin covers 15 g of carbs.
7. How much does 1 unit of bolus insulin reduce blood sugar level?
The same rule applies here. The math is correct if you are well regulated with HbA1c ≈ 7%. Calculate TDID (total daily insulin dose).
- If HM insulin is used: 80 ÷ TDID
- If insulin analogues are used: 100 ÷ TDID
Example: the same person calculated the following:
- 100 ÷ 36 = 2.8
- 1 unit of bolus lowers glycemia by 2.8 mmol / l.
How do I know how many calories there are?
It is best to read the declarations! If you buy a slice of pizza at a kiosk, you have no idea how many kcal it has. But, if you buy a frozen pizza that has yet to be baked in your oven, it is written on declaration how many calories are there in 100 g of that product. And then you start counting.
Taken as a orientation:
- BUREK with meat of 250 grams has about 659 kcal
- BUREK with cheese of 250 grams has about 616 kcal
- ROLLS of wheat flour 100 grams have about 256 kcal
- PIZZA SLICE – Capricciosa 150 grams has about 390 kcal
Where are the carbohydrates?
These foods have carbohydrates – sugars:
- Bread (1 slice) = potatoes 80 g = rice 15 g = spaghetti 20 g unboiled. Potatoes, rice, beans are considered substitutes for bread, not vegetables!
- Dairy products
- Sweets – This means – that you must know the “measure” for those food.
Are there some foods, which have carbohydrates, but which can be taken “without measure”?
YES – vegetables: lettuce, cabbage, cucumber, tomato, paprika, chard, spring onions, spinach, zucchini, mushrooms, leeks, celery. This vegetable (someone calls it – group A vegetables) has a lot of fiber, minerals and vitamins. It is best to take a portion of group A vegetables (salad) before a meal. The stomach fills up and satiety increases – and the calories are “zero”. Then you eat less of the food that follows.
However, carrots, peas, green beans, kohlrabi, broccoli, pumpkin, beetroot, have a little more carbohydrates, besides having fiber, minerals and vitamins too. They belong to group B vegetables. 200 g of group B vegetables have 1 sugar unit.
Which food has no carbs?
These foods mainly contain proteins and fats. However, they can raise blood sugar level if you exaggerate in quantity.
All proteins can be converted into carbohydrates in the liver and muscles.
The indication P means that ½ of the proteins in these foods is converted into carbohydrates after a few hours. For example, meat ≥ 300 grams of protein per meal raises sugar level!
What is the effect of fat on glycemia?
The fats from food slow down the evacuation of food from the stomach and delay postprandial hyperglycemia.
For example, if a meal contains more meat, glycemia will jump in 4-5 hours, not in 2-3 hours.
Ask yourself – Which foods in your diet has most sugar?
- Possible drinks – you drink it, and don’t notice…
- Or you can’t control yourself in fruit?
- That is why you need to remember some facts!
- “No sugar” – sugar is not added into the product.
- “Diet or Light”
- Sugar in the drink is replaced with a sweetener
- Drink has less calories
Why do some foods “slower” or “faster” raise blood sugar level?
Because they have different glycemic index.
Foods with a high glycemic index quickly raise blood sugar. These foods include:
- White bread, white rice, white pastries
- Biscuit covered with chocolate
- Corn flakes, muesli with candied fruit, with honey or chocolate
- Watermelon, dates, canned fruit
- Potatoes, mashed potatoes
These foods are useful in hypoglycemia – of course, you should not take them too much, even in case of hypoglycemia.
It is interesting to know that when a person is tired or under stress, he/she usually reaches for these kind of foods.
Foods with a medium glycemic index raise blood sugar level a little slower. Examples of such foods are:
- Whole grain bread, whole grain rice, corn bread, rice noodles
- Fiber biscuits
- Plain muesli with dried fruit
- Natural honey
- Pineapple, dried figs, grapes, melon, banana
- Sweet corn, beets
Foods with low glycemic index are desirable in the diet.
By the time they get to be digested and raise blood sugar level, they will already be used up for energy or physical activity.
There is a risk of hypoglycaemia here. You know how much carbs that food has, and therefore determine the bolus accordingly – insulin starts to work quickly, while the sugar from the food has not yet risen in the blood. Examples of foods with a low glycemic index:
- Nutrition is a process that is being learned and must be mastered
- Everyone reacts individually to certain food – measuring sugar 2 hours after a meal tells how you react to that food.
- Every person with diabetes is a mathematician and a graduated dietitian.