Procedure Related to
Assessment and Care of
Patient with Diabetes
PRACTICAL 8 DIETARY
Mellitus
COUNSELLING
Structure
8.1 Introduction
8.2 Objectives
8.3 History of Food Habits
8.3.1 Point to keep in Mind
8.3.2 Draft Format for Collecting Diet History
8.4 Free Food Items
8.5 Restricted Food Items
8.6 Exchange Meal Plan
8.7 Sample of Diabetic Menu
8.8 Advices regarding Diet
8.9 Let us sum up
8.1 INTRODUCTION
In the Practicals 1, 2, 3, 4, you have learnt regarding history taking, anthropometric
measures, checking vital signs and checking blood pressure. You learned the procedure
to take history, check height, weight, waist measurement, temperature, pulse
respiration and blood pressure and advices to be given to the diabetic patient. In this
practical you will learn about dietary counselling. Dietary counselling is one of the
very important aspects of care. Dietary management is essential to control diabetes,
prevent complications and for the healthy long life of the patient.
In this practical you will learn about how to take diet history and record it; list of
food to be selected and restricted by a diabetic patient, planning menu and advices
to be given to diabetic patient regarding diet. This will help you to understand the
dietary pattern of diabetic patient and how to modify the meals within the choices
available and help the patient and family to plan meals with the help of the doctor or
dietician.
You can refer to various meal plans available in the hospitals or nursing home or
diabetic clinics at your place. Self help groups of diabetic patients can also help
other patients to learn about modification of diet to control blood sugar and maintain
nutritious status.
8.2 OBJECTIVES
After completing this practical you will be able to:
z collect the history of food habits of the diabetic patient and maintain the record;
z make a list of free and restricted food items for a diabetic patient;
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z plan a session on diet counselling for a diabetic patient and family; Practical Manual
z prepare model meal menus for the diabetic patient by use exchange list; and
z arrange health education session for the advices on diet to the diabetic patient
and family.
8.3 HISTORY OF FOOD HABITS
Main objective of diabetic diet is to provide adequate nutrition along with maintaining
normal blood sugar levels. Refer Theory Block 3 Unit 1 Life Style Modification and
Block 5 Unit 4 on Primary Prevention of Diabetes Mellitus.
The diet plan for a diabetic is based
on height, weight, age, sex, physical
activity, blood sugar level and
nature of diabetes. While advising
for diet, doctor or dietician has to
consider complications such as high
blood pressure, high cholesterol
levels. Hope it must be clear now
why history taking, checking of
height, weight, vital signs and blood
pressure is important.
In this section we will learn about food habits of the diabetic patient. It is important
to first collect the history of food habits. This will help you, to know the present food
habits of the patient and the family; this will help you to advice the patient and family
regarding, role of diet in controlling the blood sugar, weight and to maintain good
health status.
As you have collected history of the patient in Practical 1, in the same way collect
diet history in the format. This will help you to learn about the food items patient eat,
timing of the meal, and quantity of food taken during each meal, calories and fat
consumption.
It is easy to collect diet history if format is used to collect details. You can use the
format available in the hospital or you can modify any one as per your need. Before
you carry out an activity, it is necessary for you to go through the following points to
be kept in mind. These will be useful for you to collect history and maintain the
records for future reference.
8.3.1 Points to keep in Mind
Following points should be kept in mind while collecting diet history of a diabetic
patient:
z Explain to patient and family why you are collecting diet history.
z Take history from the patient.
z Collect information from family member, to verify the facts.
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Procedure Related to z Ask questions in a simple language which they can understand.
Assessment and Care of
Patient with Diabetes
z Amount of food items eaten to be recorded carefully, as each family measure is
Mellitus
different.
z Refer the standard nutritive value chart for calorie and fat intake.
z Record the history accurately, clearly, legibly.
z Keep the diet history record safely for future reference.
z Refer the patient to the doctor or dietician for menu planning and further advices.
8.3.2 Draft Format for Collecting Diet History
Let us look at the draft formats given below for collecting the diet history. You can
use the format available in your hospital.
Format - 1
DIET HISTORY FORMAT
Name Age Sex F M Address Occupation
Weight Height Blood Pressure Blood Sugar Time
Date Day
Type of Exercise Duration hr/mts
Time Food Item Amount Calories Fat
Total Total
Any comments / advises given
Signature and Name
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Practical Manual
DIET HISTORY FORMAT
Name Age Sex F M Address Occupation
Date Day
Weight Height Blood Pressure
Blood Sugar Time Time Time
Type of Exercise Duration hr/mts
Time Food Item Amount Calories Fat
Bed Tea
Breakfast
Total Total
Morning Snacks
Total Total
Lunch
Total Total
Afternoon Snacks
Total Total
Evening Tea
Total Total
Dinner
Total Total
Night
Total Total
Grand Grand
Total Total
Any comments / advises given
Signature and Name
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Procedure Related to
Assessment and Care of 8.4 FREE FOOD ITEMS
Patient with Diabetes
Mellitus Let us learn the concept of free food items for a diabetic patient. As you may have
to advice the patient to take food items from this group.
Free Food Items
z Patient can have unlimited servings of ‘free’ foods.
z Free foods don’t raise the blood sugar.
z Can be eaten as ‘free’ foods as often patient want.
z Contain minimal carbohydrate (less than 5 grams less than 20 calories per
serving).
z Patient eat a serving of a free food between a meal and a snack, the blood
sugar won’t be affected.
z Free food does not mean free of calories.
z Not more than 2-3 servings of food should be eaten in a day otherwise the
carbohydrates and calories in these food items would need to be considered
as a part of the food servings allowed in the diet plan.
8.5 RESTRICTED FOOD ITEMS
Let us now understand the concept of restricted food items for a diabetic patient.
Restricted food items:
Food items rich in carbohydrate and fat. Means food items rich in sugar and starch
should be consumed in less quantity as you have learnt that carbohydrate are needed
for energy.
You can ask the doctor or dietician to give you the name of free and restricted food
items. Make a list and keep it with you.
8.6 FOOD EXCHANGE LIST
Exchange meal is a diet programme which balances the amount of carbohydrates
the patient can take per day. This helps in selecting the food item and its quantity.
Meal planning becomes easy and flexible. Patient can enjoy eating food with the
family and even during special occasions.
Exchange lists are groups of foods that contain roughly the same mix of carbohydrates,
protein, fat, and calories. Foods can be “exchanged” with others in a category meeting
the desired nutrition requirements. Keep in mind the food pyramid while selecting
the food items, review Unit 1 of theory block 3. Collect food exchange list given to
a patient and go through it.
The Food Pyramid
Easy way to plan your meals
Food Pyramid shows food groups and suggested servings. You should eat more of
72 the foods at the bottom of the pyramid and less of the ones on top. When you plan
your meals, remember that it is important to eat a variety of foods.
Cereals Practical Manual
The cereal group forms the base of the pyramid and a large portion of the food items
would are taken from this group of foods. Each serving in the cereal group contains
15 grams of carbohydrates, 3 gms of proteins, a trace of fat and gives about 80
calories.
Fats and Oils
This group comes at the top of the food pyramid. Items in this group should be used
less. Each serving in the fats and oils group contains 5 gms of fat and gives 45
calories. One serving is a teaspoon (5ml) of cooking oil.
Milk and Milk Products
Each serving of skim milk and skim milk based foods contain 12 gms of
carbohydrates, 8 gms of proteins and gives 80 calories. Each serving of whole milk
and whole milk based products contains 12 gms of carbohydrates, 8 gms of proteins,
8 gms of fat and gives 150 calories
Pulses and Dals
Each serving in this group contains 12 gms of carbohydrates, 6 gms of proteins and
1 gram of fat and gives approximately 80 calories. Each serving in the group is about
25 gms if uncooked and about 1 cup cooked or ½ cup cooked according to the
consistency.
Meat
Each serving of food items in the lean meat group contains 7 gms of proteins and 3
gms of fats and gives 55 calories. One serving in the meat group consists of items
weighing approximately 30gms.
Vegetables List
This comes above the base of the pyramid and more foods should be eaten from
this food group. Each serving in this group contains 5 gms of carbohydrates, 2 gms
of proteins and gives approximately 28 calories.
Fruits
This food group comes near the top of the food pyramid and the number of servings
should be less. Each serving in this group contains 15 gms of carbohydrates and
gives 60 calories.
8.7 SAMPLE OF DIABETIC MENU
Let the patient consult their doctor or a dietitian for planning the menu. The menu
should supply approximately 1200-1800 calories and consists of 50%-60%
carbohydrates 12%-20% protein and not more than 30% fats. A sample of diabetic
menu is given. You can collect 4-6 menus vegetarian and non-vegetarian) advices
by a doctor or dietician to a diabetic patient.
Menu Sample for Diabetic Patient – 1800 Calories Diabetic DietMorning1-
2 cups tea or coffee ( no added sugar)Breakfast2 wheat chapaties or bread pieces1
small piece of cheese (15 gms) 1 small piece of butter ( 5 gms.)½ cup cooked 73
Procedure Related to mixed vegetables or 1 egg ½ cup dahi ( skim milk)1 cup tea/coffee with a little milk
Assessment and Care of
Patient with Diabetes no sugarSnacks½ banana medium sizeLunch½ cup soup2 chapaties½ cup dal palauo
Mellitus or plain rice½ cup cauliflower sabzi or mutton½ cup bhindi sabzi½ cup tuhar dal ½
cup dahiSalad from Free foods List 1 ½ teaspoon oil/ghee for cookingEvening tea2
smal idlis1 ¼ cup water melon1 cup tea/coffee with little milk ( no sugar)Dinner2
chapaties1 cup cooked rice½ cup methi sabzi or chicken piece½ cup gawar phalli
sabzi1 cup arhar dal 1 cup dahi Salad from Free Food List1 ½ teaspoon oil/ghee
for cookingBed Time½ cup milk
8.8 ADVICES REGARDING DIET
Now let us learn what advices you as a health worker should give to the diabetic
patient and to the family members. It is important for you to involve family members
because patient is living in a family and common food items are purchased and
cooked. The person who cooks food should be advised regarding Dos and Don’ts
of a diabetic diet along with the patient:
z Choose right type of carbohydrate.
z Increase fiber in diet.
z Give meals frequently i.e. small meals.
z Have fixed meal timing.
z Do not miss meals.
z Use exchange list items.
z Stop eating before you feel full i.e. avoid over eating.
z Limit fatty foods, sugars, and sweets.
z Eat enough vegetables and whole grains.
z Drink lots of water.
z Modify cooking.
z Maintain normal weight.
z Regular exercise.
z Regular follow up and treatment.
z Maintaining blood glucose levels, blood pressure and blood lipids.
z Avoiding- alcohol & smoking.
Patient can control diabetes by:
z Eating a variety of healthy food items.
z Checking blood sugar regularly.
z Taking medication at the right time and correct dose.
z Regular exercise.
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z Inject insulin regularly as prescribed. Practical Manual
z Maintain weight, blood pressure, blood lipids.
z Regular follow up with doctor.
8.9 LET US SUM UP
In this practical you have learnt about collecting diet history, formats for diet history
and points to keep in mind. Free and restricted food items for diabetic patient.
Exchange list of cereals, pulses, milk, fruits, vegetables, meat. Sample of diabetic
menu and advises to be given to patient and the family regarding diet.
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