Diabetes mellitus -Type 2 and It's dietary management By: Ms.Ummeayman Rangwala, FoodTechnologist, PFNDAI The nations fourth largest killer after heart disease, cancer and stroke is diabetes mellitus. China and India the emerging superpowers are thought to be the major victims of such diseases, which are associated with unhealthy lifestyle. World Health Organisation (WHO) and International Diabetes Federation (IDF) have ranked India - No.1among the top 10 countries in people with diabetes, followed by China & USA. India already has 35m diabetics, the largest number for any country, and by '25, WHO estimates the figure to go up to 73.5m. Diabetes is becoming a major threat to global public health, as it is regularly getting worse due to an increasing trend towards unhealthy diet & sedentary lifestyle. Diabetes Mellitus and its major types Diabetes Mellitus, a serious chronic disease, characterised by abnormalities in the metabolism of carbohydrate, protein and fat is caused by lack of insulin that is produced by β-cells of pancreas. Insulin is a carrier of glucose from the bloodstream to cells that rely on glucose for energy. When the pancreas does not produce enough insulin or when the body is unable to effectively use the insulin it produces, there is an accumulation of sugar in the blood and the condition of diabetes mellitus arises. Pancreatic damage by viral infections or due to genetic factors disables β-cells to produce insulin and leads to type 1 diabetes, also known as IDDM (Insulin dependent diabetes mellitus) as the patient has to rely on an exogenous source of insulin for survival The other type of diabetes mellitus is type 2, also known as NIDDM (Non Insulin Dependent Diabetes Mellitus). This condition can be managed with lifestyle measures alone, but oral drugs and insulin are often required to achieve a good metabolic control. The third type of diabetes is gestational diabetes mellitus, develops during some cases of pregnancy but usually disappears after pregnancy. Type 2 diabetes mellitus "Prevention is better than Cure", Type 1 diabetes is unpreventable, it can only be controlled by insulin injections, thus we will focus mainly on type2 diabetes mellitus which is the most preventable form of diabetes and 95% diabetics have this condition. Type2 diabetes is the most frequently spotlighted because it is essentially preventable by dietary control and exercise. Research has shown that during pre-diabetes if an action is taken to manage blood glucose, type 2 diabetes can be delayed or prevented from ever developing. But the dilemma is that almost a third of people with diabetes do not even know that they are suffering with diabetes because like its partners in crime, high blood pressure, high cholesterol, high blood sugar is not associate with obvious symptoms. Very general symptoms, which include excessive thirst, constant hunger, excessive urination, weight loss for no reason, rapid hard breathing, vision changes, drowsiness occur suddenly and many have no symptoms at all, they are diagnosed after many years of onset. Early diagnosis and effective management can prevent type 2 diabetes. It is very important to control diabetes as uncontrolled diabetes over a long term can lead to blindness, impotence, kidney damage, poor circulation and nerve damage which may lead to amputation of limbs, heart disease and strokes. Diabetes can be diagnosed with a simple blood test .If the Fasting Blood Glucose (Taken 10 or more hours after the last meal) is more than 110mg% and if the post parandial blood glucose (taken 2 hours after a full meal) is more than 140mg%, the person is diabetic. Blood glucose can be monitored at home using a glucometer. Dietary Considerations for Diabetics Death can result from hypoglycaemic coma in diabetics and therefore utmost care should be taken in diet. Diabetics should always eat according to the plan. The desired end is a positive health, a regeneration of the body, and not merely an absence of symptoms. This is why it is important to remember to take food at correct, regular time. For those who are on oral drug therapy along with diet therapy, it is important to remember that they do not have to take extra medicine for extra food. Patients taking insulin or anti-diabetes tablets should be careful of their doses as hypoglycaemic or low blood glucose level can occur if the patient skips or delays a meal, does excessive physical exertion, or is ill and stressed Although sugar has been labelled as a taboo for diabetics, it's more important to keep an eye on the total carbohydrate intake rather than on just the amount of sugar consumed. They can consume a modest amount of sugar, but this must substitute their carbohydrate intake and not be added onto it. A large intake of sugar laden processed and packaged foods should be avoided, as these are causative agents of obesity, which is considered as a major risk factor leading to diabetes and its complications. Obesity results from an imbalance between energy intake and energy expenditure. It is characterised by pathological accumulation of triglycerides thereby promoting insulin resistance in muscles, liver and other tissues. In type 2 diabetes, the ability of insulin to inhibit lipolysis is impaired that leads to increased FFA secretion into plasma, which induces insulin resistance. According to ADA (American Dietetics Association), for type 2 diabetics the calories are restricted to 25-30 cal/Kg to bring down weight to normal range. Fats are restricted to 20 percent of total intake and adequate complex carbohydrates rich in dietary fibers should form about 60-65% of total intake. An intake of 25gm /100kcal or 40g dietary fiber per day from a variety of food sources is desirable .It provides physical barrier which protects carbohydrates from the digestive effects of enzymes. Fiber also releases a gastrointestinal insulin secretion namely GIP which enhances glucose-induced insulin secretion .It is also associated with improved peripheral insulin action by increasing insulin receptor binding. This way the oral drug or the insulin requirements are considerably reduced. With the increase awareness of diabetes and importance of reduced blood sugar (glucose) levels, the consumers are now interested in only managing their blood sugar levels. Some consumers are choosing foods based on their glycemic impact, this ignorance of consumers has given a