Food and Diabetes for Individuals Taking Insulin

Transcription

1 Department of Nutrition and Dietetics Diabetes Centre: St Helens Hospital Marshalls Cross Road St Helens WA9 3DA Food and Diabetes for Individuals Taking Insulin Patient Information Leaflet

2 Contents Page Introduction... 1 Variety... 2 Carbohydrates... 3 Fibre... 5 Sugar... 8 Diabetic Products... 9 Fat A Healthy Weight Protein Salt Food Labels Alcohol Hypoglycaemia Illness Exercise and Diabetes Functional Foods Frequently Asked Questions Dietitian s Recommendations Suggested Daily Meal Plan... 42

3 Introduction To help you to control the glucose and fat levels in your blood, and also help manage your blood pressure, follow the healthy eating guidelines detailed below. Healthy eating is suitable for most members of your family and the foods that are recommended are readily available in local shops or supermarkets. The healthy eating guidelines are: Try to eat a variety of foods Eat three regular meals each day Include starchy carbohydrates as part of your diet Eat foods which are high in fibre Reduce your intake of foods and drinks with a high sugar content Avoid special diabetic foods Cut down on the amount of fat in your diet Choose a healthier type of fat Try to achieve and maintain a healthy weight for your height Try to use less salt and salty foods Drink alcohol in moderation only Try to eat a variety of foods The foods that we eat are made up of several different nutrients protein, fat and carbohydrate. It is important that you have the correct balance of these nutrients in your diet. The diagram below shows the types and proportions of foods you need to achieve a well balanced diet. 1

4 Eat three regular meals each day Produced with kind permission of the Food Standards Agency By eating three regular meals each day you can reduce large fluctuations in your blood glucose levels. This should help you maintain stable blood glucose levels. Include starchy carbohydrates as part of your diet Carbohydrate can be divided into two groups sugary foods and starchy foods. Sugary foods, such as sweets and ordinary fizzy drinks are high in calories and contribute to tooth decay. Consuming large quantities of these can lead to weight gain and raise your blood glucose levels. Starchy foods, for example bread, potatoes, rice, pasta, cereals, couscous or chapatti should make up the main part of your regular meals. Some varieties of starchy food are broken down into glucose more slowly. By choosing these foods you can help to prevent large fluctuations in your blood glucose levels. For example try the following: granary, oat grain, rye or soya and linseed based breads basmati rice pasta or noodles rolled oats sweet potato, boiled new potatoes Weetabix, Crunchy bran, All Bran cereals However, the most important factor in helping you control your blood glucose level is the amount of carbohydrate you eat. The larger your serving, the higher your blood glucose level will rise. 2

5 If you are taking insulin and you skip meals or eat less starchy food than you normally would, your blood glucose levels may drop too low i.e. hypoglycaemia (hypo) see page 12. You can ask your diabetes team about a carbohydrate counting programme, which teaches you about a flexible approach to adjusting your insulin to your carbohydrate intake. Eat foods which are high in fibre People with diabetes do not need to eat more fibre than those in the general population. However, most people in the UK do not eat enough fibre. Foods that contain fibre are cereals, grains, seeds, pulses, fruit and vegetables. There are two main types of fibre: Insoluble fibre is found in wholegrain products. It helps to protect your bowels and is useful if you are trying to lose weight (because it helps fill you up). Soluble fibre is found in oats, peas, beans, lentils, barley and fruit and is particularly beneficial for people with diabetes. It can help to lower blood cholesterol levels and slows down the rate at which glucose is absorbed into the blood stream. Ways to increase your fibre intake Try wholemeal, granary, rye or oat grain breads. Include high fibre oat, wheat or bran based cereals such as Porridge, No Added Sugar Muesli, Weetabix, Shredded Wheat, Bran Flakes, All Bran, Fruit n Fibre, Oat Crisp, Oatibix. Use peas, beans, lentils and barley more often. Try adding them to casseroles, stews, soups and curries. Aim to include a total of five to nine portions of fruit and vegetables daily (in addition to potatoes). As well as being high in fibre, fruit and vegetables also contain vitamins and minerals which help to protect against heart disease. Fresh, frozen, dried and tinned varieties can be used, but watch out for the salt content of tinned vegetables. Tinned fruit in its own juice is a healthier choice than those in syrup. Examples of portions of fruit and vegetables are: A medium banana or apple A slice of melon Two plums A handful of grapes A small bowl of salad Three heaped tablespoons of vegetables 3

6 Stick to one portion of fruit at a time, as eating more than this will raise your blood glucose levels significantly. Try wholegrain crackers and biscuits, oatcakes or rye crisp breads. Use wholemeal pasta. Adding bran to your foods is not necessary. Instead choose foods which are naturally high in fibre. When you increase your fibre intake it is important to drink plenty of extra fluids. You should drink at least eight cups of non-alcoholic fluids daily. Reduce your intake of foods and drinks with a high sugar content Foods and drinks that are high in sugar can increase your blood glucose levels quickly, particularly if they are eaten on their own. They may also increase your triglyceride (one of the fats found in your blood) levels and tend to be high in calories, which can contribute to weight gain. When you have diabetes it is not necessary to avoid sugar completely, as lower sugar versions of most sweet products are available, e.g. plain biscuits, low sugar desserts and No Added Sugar squash. If you have sugary food occasionally, it is better to have it after a meal for dental health. Remember that the more sugar or carbohydrate you eat, the higher your blood glucose levels will go. Some high fibre foods contain a small amount of sugar e.g. baked beans and some high fibre breakfast cereals. These foods will not greatly affect your blood glucose levels. Remember to check labels on low fat yoghurts and desserts as they often contain larger quantities of sugar. A word of warning! Special diabetic foods should be avoided. They are usually quite expensive. Many of these products contain a sweetener called sorbitol, which, in large quantities, can cause stomach ache or diarrhoea and can increase your blood glucose level. They usually have the same amount of calories and fat as ordinary foods. If you are overweight, it is still important that you limit your intake of the lower sugar alternatives mentioned on the next page. 4

7 High sugar foods Sugar, glucose, dextrose, fructose, sucrose, glucose syrup Ordinary fizzy drinks, squashes and cordial Ordinary marmalade and jams, honey, syrup, lemon curd and chocolate spreads Tinned fruit in syrup or light syrup Ordinary tinned puddings, yoghurts and desserts Cream filled or chocolate biscuits Shop bought cakes Suitable alternatives Artificial sweeteners containing saccharin or aspartame e.g. Hermesetas, Canderel, Sweetex, Sweet n Low, Splenda, Truvia Sugar free versions e.g. low calorie, diet, slimline squash and fizzy drinks, sugar free flavoured water, No Added Sugar squash Reduced sugar jams and marmalades, pure fruit spreads Tinned fruit in own juice Low sugar rice pudding or custard, (tinned or made with skimmed milk and an artificial sweetener), sugar free desserts and jelly, low sugar and low fat fromage frais or yoghurt Plain biscuits such as Rich Tea, Garibaldi, Oatcakes, Digestives, Ginger Nuts, Morning Coffee or Hob Nobs Currant loaf, tea-bread, wholemeal scones, malt-loaf Cut down the amount of fat in your diet Reducing the amount of fat you eat will cut down on the amount of calories you are eating. This will help you to achieve a healthy weight for your height. There are two main types of fat in foods, saturated and unsaturated fat. Both types of fat contain the same amount of calories therefore it is important to reduce the total amount of fat in your diet if you need to lose weight. Ways to reduce the total fat in your diet Grill, steam, poach, microwave, braise or casserole instead of frying or roasting with fat. Cook meat on a rack and allow fat to drain off. Low fat sauces can be made by mixing cornflour with semi-skimmed milk or vegetable stock. Choose lower fat spreads instead of ordinary margarine or butter and use a smaller amount. Use skimmed or semi-skimmed milk. Limit cheese to approximately 4oz/115g per week. Choose low fat or reduced fat varieties e.g. cottage cheese, Edam, Shape, Philadelphia light or Dairylea light. Look for very low fat/virtually fat free yoghurts or fromage frais (however, check the sugar content). 5

8 Choose a healthier type of fat The total amount of cholesterol in your blood is made up of LDL and HDL cholesterol. HDL cholesterol is 'good cholesterol which helps to protect your heart. LDL cholesterol is bad cholesterol which increases your risk of heart disease. Saturated fats Saturated fats cause the bad LDL cholesterol level to rise. Foods high in saturated fat include: Lard Ghee Full cream milk Cream Cheese Mayonnaise Butter and some types of margarines (check the label) Fatty meats and meat products like sausages, burgers, pies, pasties Shop bought cakes and biscuits Savoury snacks Fried foods Unsaturated fats Unsaturated fats are either monounsaturated or polyunsaturated. These types of fats are healthier than saturated fat but they still contain lots of calories so be careful with the amount you use. The better choice would be monounsaturated fats. Monounsaturated fats Sources of monounsaturated fats include: Olive, rapeseed or peanut (groundnut) oil Some vegetable oil (labelled high in monounsaturates) Spreads labelled high in monounsaturates including Bertolli (previously known as Olivio), Olive Gold, Pure Olive and other supermarket olive oil based spreads Nuts, but try to get the unsalted varieties Avocado pear, olives Polyunsaturated fats Sources of polyunsaturated fats include oily fish, corn, sunflower, safflower and soya oils and spreads. 6

9 Oily fish contain Omega 3 oil which helps protect the body against heart disease. Very good sources of this type of oil are herring, kippers, mackerel, pilchards, salmon, sardines and trout. One portion of oily fish is approximately 5oz/140g or a small tin of fish. People with diabetes should try to have two servings of oily fish per week. Although oily fish are good for our health, they can contain low levels of pollutants that can build up in the body. For this reason there are recommendations for the maximum number of portions of oily fish we should be eating each week (a portion is about 5oz/140g). Up to two portions of oily fish Girls and women who might one day have a baby Women who are pregnant or breastfeeding Four portions of oily fish Other women Men and boys If you do not like oily fish, look out for other sources of Omega 3, such as linseeds, walnuts, rapeseed and soya oil. Many Omega 3 enriched foods are available, such as eggs, yoghurts, spreads, bread and orange juice (see page 16 for more information on Omega 3 enriched foods). Try to achieve and maintain a healthy weight for your height There are many benefits to losing weight if you are overweight. Carrying extra weight round your waist can make your diabetes harder to control. Studies show that weight loss can lead to improvements in your overall blood glucose control as well as help to lower your LDL cholesterol level and your risk of developing heart disease. By losing a small amount of weight you can also reduce your blood pressure and the risk of some types of cancer. Even losing just 5-10% of your body weight will significantly improve your general health and wellbeing. Losing weight gradually kilogram (kg) or 1-2 pounds (lbs) per week is most effective. Ask your Dietitian for more help and support with this if you need it. Protein foods Protein foods include meat, fish, poultry, eggs, nuts, beans, lentils and vegetarian alternatives e.g. soya, Quorn. Most people can obtain all of the protein that their body needs from two servings per day. A serving is 3oz/85g meat or 5oz/140g fish. It is important that you do not consume excessive quantities of protein rich foods. By consuming more than two servings per day, it is likely that you will gain weight. High protein diets are often promoted as a way to lose weight. The long term effects of high protein diets are currently unknown and therefore these diets are not recommended. 7

10 Try to use less salt and salty foods Most of us eat too much salt. A large amount of salt in your diet can lead to high blood pressure and can stop your blood pressure tablets from working effectively. Ways to lower your salt intake: Use the smallest amount of salt in cooking and try to avoid adding salt at the table. Experiment with pepper, herbs and spices to flavour your foods instead of salt. Use less tinned, packaged and processed foods. Crisps, salted nuts, soups, salted meats e.g. bacon and gammon, and stock cubes/sauces contain large quantities of salt. Avoid using salt substitutes e.g. Losalt, Selora, Ruthmol. Compare foods and choose those that are lower in salt whenever you can. See section Food labels (page 19) for more information. You are likely to find it easier if you gradually cut down on the amount of salt that you use. Food labels There are different ways you can check the labels on food products that you buy. Ingredients list Most packaged foods have to show an ingredients list in order of weight. The nearer the ingredient is to the top of the list, the greater the amount in the product. Examples Product One Whole wheat Wheat germ Wheat flour Vegetable oil Sugar Salt This product is high in fibre as both wheat and wheat germ are high up the list. Sugar and oil are low on the list so amounts will be less. Product Two Wheat Brown sugar Oats Honey Vegetable oil Salt This product is high in sugar as brown sugar is the second ingredient and honey adds to the sugar content. 8

11 Nutrition Information Some foods have a nutrition label, which tells you how much of certain nutrients they contain. This can be useful. However, when comparing food labels, consider how often and how much of the food you may eat. Nutritional information per 100g per 25g serving Energy 1560 kj 390 kj 367 kcal 92 kcal Protein 7.3g 1.8g Carbohydrate 82.7g 20.7g of which sugars 8.9g 2.2g Fat 0.8g 0.2g of which saturates 0.3g 0.1g Fibre 3.6g 0.9g Sodium 1.1g 0.3g Energy: Kilojoules (kj) and calories (kcal) are measures of energy in foods. To maintain a healthy weight the amount of calories eaten must balance the amount of energy used. Protein: Is needed for growth and repair, most people can obtain all of the protein that their body needs from two servings per day. Carbohydrate: This includes all the sugars and starches in food. Sugars: Includes both natural and added sugars. You should cut down on the amount of sugar you eat. Fat: Try to eat less fat and choose foods containing mono or polyunsaturates rather than saturates. Fibre: High fibre foods help fill you up and soluble fibre helps keep blood glucose levels stable. Sodium: Indicates how much salt is in foods. To find out how many grams of salt are in your food multiply the amount of sodium per portion by 2.5, for example if the label states that a serving contains 0.3g of sodium, it contains 0.75g of salt. 9

12 What s a lot and what s a little? (All values per 100g) A lot A little Sugar 15g or more 5g or less Fat 20g or more 3g or less Saturates 5g or more 1.5g or less Fibre 3g or more 0.5g or less Salt 1.5g or more 0.3g or less Sodium 0.6g or more 0.1g or less Traffic light labelling Many supermarkets and manufacturers are now using traffic light labelling to help you make your choice when shopping. It highlights the grams of fat, saturated fat, sugar and salt per serving, and often also gives you the percentage of the reference intake (a guideline for the appropriate amount of particular nutrients needed for good health). Examples of traffic light labelling: Red = high (enjoy once in a while) Amber = medium (OK most of the time) Green = low (the more green lights, the better) Be aware of the portions mentioned on the label if you have more than the suggested portion, the levels of salt, fat and sugar will be higher! 10

13 Take alcohol in moderation Having diabetes does not mean that you have to avoid alcohol completely, unless your Doctor has advised you to do so for other reasons. Alcoholic drinks are high in calories which can contribute to weight gain and continuous heavy consumption can lead to other health problems. It is therefore important that you take alcohol in moderation. Men should have a maximum of three to four units of alcohol per day and women no more than two to three units per day. You should also aim to have some alcohol free days every week. One unit of alcohol is: half a pint of standard strength beer, lager or cider (3.5% Alcohol by volume (ABV)) one pub measure (25 millilitres (ml)) of spirits or aperitif one glass (125ml) of wine (8-9% ABV) You can be more at risk of hypoglycaemia when drinking alcohol, and for up to 24 hours afterwards. Therefore it is important that you have extra starchy food with or after drinking alcohol and that you drink in moderation. The amount of food you will require varies depending on the quantity that you drink and whether you are dancing the night away! Guidelines for alcohol Never drink on an empty stomach. Try to have something starchy beforehand e.g. your evening meal or cereal or two slices of toast. If you drink beer or lager, choose ordinary ones, preferably with an alcohol content of less than 5% ABV. Low sugar/diet beers tend to be higher in alcohol and are best avoided. Many low alcohol/alcohol free drinks are high in sugar, hence it is best to have them only occasionally. Choose diet, sugar free or slimline mixers with drinks. If you drink wine or sherry, choose medium or dry varieties. Some alcoholic drinks are very high in sugar, such as Alco pops and cider, so they are best limited to occasionally. Try alternating alcoholic drinks with a soft drink. Putting your glass down between each sip may also help. 11

14 Hypoglycaemia Hypoglycaemia (hypo) means that the level of glucose in the blood has dropped too low (usually less than 4mmol/litre). Hypos can happen very quickly and may occur if you: Have taken too much insulin Have missed or delayed a meal or snack Have done more exercise than usual (without eating additional carbohydrate) Drink alcohol without taking extra food Have eaten less carbohydrate than you normally would If you do not include carbohydrate with your meal The symptoms of a hypo vary but may include: Sweating Trembling Tingling lips Blurred vision Dizziness Pale appearance Confusion Feelings of intense hunger Loss of co-ordination Mood changes Hypos can be mistaken for a drunken appearance; therefore it is a good idea to carry some form of identification saying that you have diabetes. If you are experiencing a hypo it is important that you take the following steps to bring your blood glucose level back to normal: Stop whatever you are doing and check your blood glucose level Immediately take some sugary food (quickly absorbed carbohydrate). Suitable examples which contain 15-20g carbohydrate include: Four to five glucose tablets or 100ml Lucozade or 150ml (small glass) cola or Three heaped teaspoons sugar 5 jelly babies / 9 jelly beans These should bring your blood glucose levels back to normal within a few minutes. If there is no improvement in your blood glucose level after 15 minutes, take another portion of the foods/drinks listed above. 12

15 As soon as you feel better, it is important that you take additional longer acting carbohydrate to keep your blood glucose level steady. Examples of these include: two to three plain biscuits a sandwich or slice of toast a bowl of high fibre cereal a piece of fruit your next meal if it is due If you do not take this extra carbohydrate, it is likely that you will have another hypo soon after the original low blood glucose level. Severe hypo s If you find that your blood glucose level has dropped extremely quickly without you realising it, you may benefit from getting a friend or relative to give you: Glucogel or Dextrogel a thick glucose gel that can be squirted into the side of the mouth. This gel can be bought from chemist shops or obtained on prescription from your GP. It is absorbed very quickly from the mouth and therefore does not need to be swallowed to work effectively. You need 1 ½ to 2 of the 25 g tubes to treat a hypo. As soon as you feel better it is important that you take additional starchy food as suggested earlier. Glucagon a hormone injection which a friend or relative can be taught to give you. It is used to treat very severe hypos that occur without warning. Glucagon raises blood glucose levels by releasing stored glucose from the liver. The Diabetes Nurse Specialist can provide you with additional information about this. Things to remember: Always carry a quickly absorbed sugary food or drink around with you. Glucose tablets are ideal. Always carry some form of identification that explains that you have diabetes. Inform your friends/relatives of how to treat a hypo. In the case of a severe hypo leading to unconsciousness, they will need to phone an ambulance immediately. Food or drink should not be put into the mouth of someone who is unconscious. Try to identify the causes of any hypos and try to prevent them from happening in the future. 13

16 If you have a hypo at the same time every day, it may be because you require a change to your insulin dose. Contact your Diabetes Nurse Specialist or GP to discuss this. Illness What to do if you are feeling ill: If you become ill, your blood glucose levels may become unsteady. Once you are better your blood glucose levels will return to your usual range. If you are ill, your blood glucose levels can rise even though you may not be eating or drinking anything. For this reason, it is extremely important that you never stop taking your insulin. In order to monitor your diabetes, you should check your blood glucose levels at regular intervals (ideally at least every four hours). It is important that you try to take regular carbohydrate foods to help stabilise your blood glucose levels. If you cannot eat your normal starchy foods, you should try to replace your meals with the following foods/drinks: a bowl of cereal soup and a slice of bread milky drinks or puddings ice cream yoghurt If you are unable to manage these, you should take small quantities of fruit juice, ordinary fizzy drinks, lucozade or hot sweetened drinks at regular intervals (e.g. every two hours). In addition to these, you should also try to drink four to six pints of sugar free fluids throughout the day. Ketones If your blood glucose level is over 15mmol/litre or if you are vomiting, it is important that you check your urine for ketones. Ketones are substances that are produced when your body is short of insulin. A shortage of insulin means that your body cannot get glucose into your cells so you start to use your fat stores to give you energy. This can be dangerous if not treated immediately. If your blood or urine contains ketones, it is important that you consult your GP or Diabetes Nurse Specialist for advice. 14

17 What happens if you are vomiting? If you are taking tablets to treat your diabetes in addition to your insulin, it is important to remember that vomiting can interfere with the absorption of the tablets. It can also affect your blood glucose levels if you are losing your meal through vomiting. If you are concerned contact your GP or Diabetes Nurse Specialist. Consult your Doctor if: your condition takes a long time to improve your blood glucose levels remain constantly high your blood glucose levels are very low you are concerned Exercise and Diabetes Regular exercise is important for people with diabetes. It can lead to a reduction in your blood pressure, help to lower your weight and cholesterol level, and improve your blood glucose levels. Exercise does not have to involve going to a gym or exercise classes. Activities such as gardening, brisk walking, swimming, cycling and dancing have a similar effect if done regularly. Ideally you should aim to do some activity that makes you feel warm and slightly out of breath for 30 minutes, 5 days per week. If you have been unable to do exercise for some time, it is advisable that you consult your GP before commencing exercise. It is important that you balance your insulin dosage and your food intake when you exercise. You can alter either your insulin dose or your food intake or a combination of both to control your diabetes during planned exercise. If you are trying to lose weight, you are likely to benefit from adjusting your insulin. Discuss this with your Diabetes Nurse Specialist who will work out the best system for you. If you have high blood glucose levels of 15mmol/litre or more and ketones in your urine or blood, you should: Either delay exercise or not exercise. Any vigorous activity will increase your blood glucose levels and ketone levels further. Discuss this with your Diabetes Nurse Specialist who will be able to advise you on the appropriate action. 15

18 Guidelines for food during exercise Additional physical activity will cause your blood glucose levels to drop. The type and quantity of food that you require will vary between individuals and depending on the type of exercise that you are doing. Everyone reacts differently to exercise so it is important to establish a plan that works for you. Gentle exercise e.g. walking to work may not require any extra food, but it is still important to take hypo treatment with you, in case you need it. Short periods of strenuous exercise e.g. squash, sprinting - Requires extra food before and after the activity - Before exercise take quickly absorbed carbohydrate e.g. glucose tablets or ordinary fizzy drink - After exercise take slowly absorbed carbohydrate e.g. fruit, plain biscuits, cereal bar or a sandwich Prolonged exercise e.g. golf - Requires additional slowly absorbed carbohydrate food prior to exercise e.g. a banana, extra bread, biscuits or a cereal bar Prolonged exercise of an intense nature e.g. football, rugby, long cycle rides, hill walking - Requires extra food before, during and after exercise - Before exercise - take slowly absorbed carbohydrate e.g. a banana, extra bread, potatoes, pasta or rice - During exercise you may need top ups from glucose tablets or small quantities of high sugar drinks. Isotonic sports drinks containing less than eight grams (g) carbohydrate per 100ml can be a suitable option - After exercise, you are likely to require extra slowly absorbed carbohydrate foods Your blood glucose levels can continue to drop for many hours after you have done extra physical activity. It is important that you monitor your blood glucose levels before and after exercise to enable you to balance your food intake with exercise to keep your blood glucose levels steady. Always ensure that you have some glucose tablets or a sugary drink with you when you exercise. If exercising alone, or with people who do not know that you have diabetes, always carry some form of diabetes identification with you. Exercise can affect the absorption rate of insulin. It is better to avoid injection sites that will be used a lot during exercise e.g. if going cycling avoid injecting in your leg. Functional Foods Functional foods are foods which provide health promoting benefits over and above their basic nutritional value. Plant Sterols and Stanols Many foods, such as spreads and yoghurts, are enriched with plant sterols and stanols, e.g. Flora Pro-Active, Benecol and Danacol. 16

19 Although plant sterols occur naturally in foods such as fruits, vegetables, vegetable oils and grains, it is difficult to take in the recommended amount of g per day. Studies show that using products enriched with sterols or stanols can reduce cholesterol levels by as much as 10% in two to three weeks as long as you consume g per day. These products should, however, not replace medication to reduce cholesterol, but be used in conjunction with these medications and a low fat diet. Omega 3 enriched foods Omega 3 fats have been shown to reduce heart disease and stroke. Certain foods, including some milk, eggs, yoghurts and yoghurt drinks, spreads and fish fingers have been enriched with Omega 3 fats. This enables those who dislike oily fish to obtain Omega 3 in their diet. (See page 14 for further information about Omega 3 fats). Frequently asked questions Q: Can I eat grapes and bananas? A: Yes! You can eat all types of fruit, including grapes and bananas. Although fruit contains sugar, it is a natural type of sugar, which is released into the bloodstream slowly. A portion of grapes (approximately grapes / small handful) or a medium banana can contribute towards your five portions of fruit and vegetables per day. Just be careful not to have too much fruit in one go, as this may increase your blood glucose levels significantly. Spread your fruit portions out throughout the day and stick to one portion at a time. Q: I am on tablets to lower my cholesterol levels. I have been told to avoid grapefruit and grapefruit juice. Why is that? A: Grapefruit and grapefruit juice have been shown to interfere with the process which normally breaks down the cholesterol tablets Simvastatin and Atorvastatin. This can lead to a build up of the tablets in the blood which in turn can increase the risk of severe side effects related to these medications. It is therefore best to avoid all sources of grapefruit or grapefruit juice. Q: Can I eat cereal bars? A: Cereal bars differ in composition. Some are very high in sugar, low in fibre and high in fat. These should be limited as special treats. Others, however, are high in fibre, low in fat and moderate in sugar and can be eaten more regularly. Check the labels of cereal bars and choose those which are higher in fibre and lower in sugar and fat. Ask your Dietitian for more information and see the section food labels on page 8. Q: Can I drink pure fruit juice? A: A small glass of pure fruit juice can contribute to one of your five portions of fruit and vegetables a day. Due to the amount of fruit going into one glass of fruit juice, 17

20 the fruit sugar concentration is quite high. It is therefore recommended not to have more than one small glass of fruit juice per day. Q: What is the glycaemic index? A: The glycaemic index (GI) is a ranking of carbohydrate foods based on the rate at which they raise blood glucose levels. Foods which break down and raise blood glucose levels quickly are assigned a high value. Foods which break down and raise blood glucose levels slowly are assigned a low value. There is evidence to show that GI affects blood glucose levels. Including low GI foods such as wholegrains, pasta, fruit, vegetables, beans and lentils, porridge oats and basmati rice in a healthy diet can help to improve your blood glucose control. However, the amount of carbohydrate you eat will have the most effect. Therefore GI should not be looked at in isolation. Various GI diets are available on the high street but are not recommended by Dietitians. Ask your Dietitian for more information on GI. It is important to be aware that the presence of fats in foods lowers the GI value and therefore the GI value alone cannot predict whether a food is a healthy choice. Q: My diabetes was treated with tablets, but I will now have to start taking insulin. Will insulin make me gain weight? A: Insulin as such does not cause weight gain. If your diabetes control has been above target, it is likely that your body has not been using glucose properly. It is possible that your body has tried to lower your blood glucose level by passing glucose out of your body in your urine. This may have led to weight loss or stopped weight gain. Taking insulin will help your body to use glucose properly. This may lead to weight gain, but it is however possible to avoid or reduce this weight gain by adapting your diet and by increasing your activity levels. Finally The aims highlighted below are those recommended specifically for you, by the Dietitian, to help you improve your diet: If you have any further questions, please do not hesitate to contact the Dietitians who will be happy to help you with your queries. 18

21 Suggested Daily Meal Plan: Breakfast High fibre cereal/porridge Milk (skimmed or semi-skimmed) Or: slices wholegrain or granary bread and low fat spread Grilled tomatoes or mushrooms if desired Mid-Morning: Lunch: Mid-Afternoon: Evening meal: Fruit or Lean meat or fish or chicken or turkey or egg or cheese slices of wholegrain/granary bread or potatoes or boiled Basmati rice or pasta Large portion of vegetables, salad, peas, beans or lentils Fruit or low fat/low sugar dessert Fruit or Lean meat or fish or chicken or turkey or egg or cheese slices of wholegrain/granary bread or potatoes or boiled Basmati rice or pasta Large portion of vegetables, salad, peas, beans or lentils Fruit or low fat/low sugar dessert Supper: This information has been produced by Registered Dietitians for the majority of the population taking into account ethnicity and religious beliefs. If you require further information regarding your own ethnicity and religious beliefs relating to your diet, other information can be provided on request from your Dietitian. At the time of publication the information contained within the leaflet was, to the best of our knowledge, correct and up-to-date. This leaflet can be made available in alternative languages/formats on request. Creation Date November 2004 Last Review January 2015 Review Date January 2018 Created by: Department of Nutrition and Dietetics AHP Secondary Care Service 19