patients with diabetes mellitus have a list of foods that they should eat and avoid other things. A single mistake can lead to terrible complications among diabetic patients regarding the way they eat.
The list of complications of Diabetes is so long and so serious. Let’s see the diet modification of diabetes and how to prevent the disease.

• Dietary modification in DM:
The dietary treatment aims to control the disease and permit normal growth and activity. The guidelines used to determine basic nutrition requirements include physical assessment, health and diet histories and laboratory report.

1. Nutrient balance in diabetic patients:
Carbohydrates provides 50 to 55% of the daily caloric requirement containing good amount of fiber and less refined sugar.
Protein provides 15 to 20% of the daily intake of calories.
Fat provides 30% of caloric intake from polyunsaturated fats and limited in cholesterol.

2. Caloric requirements:
Factors affecting caloric need include:
1) Basal metabolism.
2) Activity.
3) Physiological stress such as growth, spurt or pregnancy.
4) Weight (normal, overweight or thin).
5) Sex.
There are many ways to calculate daily caloric needs of diabetic patient:
A. If the patient is obese or elderly patient, the caloric need is calculated by multiplying desirable body weight by 15 kcal per kg.
B. If the patient is a sedentary patient, the caloric need is calculated by multiplying desirable body weight by 20 kcal per kg.
C. If the patient is of light activity, the caloric need is calculated by multiplying desirable body weight by 30 kcal per kg.
D. If the patient is hard activity, the caloric need is calculated by multiplying desirable body weight by 35 kcal per kg.

3. Nutrient distribution:
The physician will prescribe the percentage of the needed calories from carbohydrates, fat and protein and distribute them into three meals and three snacks to avoid fluctuations in blood glucose.

4. Nutrition counseling and patient compliance in diabetes:
A. Explanation of the disease and role of diet in controlling it.
B. The patient should be provided with as much information as possible including:
1) Food exchange lists that offer a variety of food choices.
2) Diet plans written or in picture form.
3) Scheduled meal times and frequency.
C. Special dietary measures to prevent or delay onset of atherosclerosis, reduced fat intake and increased fiber intake.
D. Why can exercise program is adjunct to diet therapy.
E. How to recognize symptoms of hypoglycemia or hyperglycemia and what to do about them.

5. Prevention:
A. Primary prevention:
1) Physical exercise.
2) Eating healthy balanced diet.
3) Avoidance of obesity.
4) Avoidance of stress.
5) Controlled use of drugs that may cause diabetes mellitus.
6) Vaccination against viral infection such as rubella.
B. Secondary prevention:
1) early case finding by applying screening tests (urine test of glucose) and confirmed by blood glucose level testing.
2) Proper control of diabetes.
3) Health education of diabetic patients on proper care of the skin, foot and diet instructions.
4) Annual screening for retinopathy (one of the most common complications of diabetes mellitus) is recommended because blindness can be prevented by early treatment.

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