Dear Dietitian

Q1: I was recently diagnosed with diabetes and was told that carbohydrate will raise my blood sugar level. Should I abstain from taking carbohydrate in my diet and what kind of foods contain carbohydrate?

A: It is commonly perceived that people with diabetes are not allowed to take any sugar or sugary foods. But the culprit is not only sugar but also carbohydrates which include rice, breads, biscuits, noodles, pasta, starchy vegetables such as potatoes, yam, tapioca or even various kinds of fruits. Carbohydrates taken in large amounts at the same time will affect a patient's blood sugar level and create a spike.

However, people with diabetes need not have to abstain totally from eating carbohydrate foods. This is because carbohydrates are the main source of energy for the body, especially brain cells, to carry out metabolic activities and help with your concentration. Moreover, carbohydrate foods contain other nutrients such as fibre. vitamins, minerals and phytochemicals.

People with diabetes should, therefore, adopt a healthy eating pattern based on the Singapore Healthy Diet Pyramid way of eating and incorporate moderate amounts of carbohydrate foods such as whole grain cereal-based products. brown rice. oatmeal, legumes, fruits, vegetables and low fat milk as part of their daily diet.

Q2: What about carbohydrate counting and carbohydrate exchange? Is it useful for people with diabetes to learn and practise carbohydrate counting?

A: People with diabetes, especially those on insulin therapy. should be aware of carbohydrate exchange which is commonly used for carbohydrate counting in order to provide a wider range of food choices, flexible eating patterns and better blood sugar control. One carbohydrate exchange is equivalent to 15g of carbohydrate. The following are some examples of foods with serving portions which contain one carbohydrate exchange (15g carbohydrate):

According to the American Diabetes Association (ADA) Guidelines 2006, the total carbohydrate intake should not be less than 130g per day. People with diabetes should consult a dietitian to learn about carbohydrate counting. The following 3Ds steps will be done by your dietitian for carbohydrate counting and its distribution:

1. Define your total energy requirement based on your weight, height. age, daily diet, physical activity and other specific medical conditions.

2. Determine your total carbohydrate intake per day, which is usually 50 to 5S% of your total energy requirement.

3. Distribute the total carbohydrate intake into separate meals or snacks throughout the day based on your insulin dosage and carbohydrate exchange serving portion.

For example:
1. Carbohydrate counting and distribution for a 1800kal daily meal plan

2. Total carbohydrate intake per day: 50% of I800kal = 900kcal = 225g carbohydrate (1 g carbohydrate = 4kcal) = 15 carbohydrate exchange (1 carbohydrate exchange = I 5g).
 

3. Distribute throughout the daily meals or snacks by using 15 carbohydrate exchange as following table:

Q3: How about the carbohydrate content of our local hawker foods?

A: People with diabetes should be aware of the carbohydrate content of local hawker foods if they always eat out, so that they will be aware of portion control and the calories content for those common hawker foods. The following table is a list of common hawker foods with its calories, amount of carbohydrate and carbohydrate exchange.

   Source. Singapore Food Composition Table 2004. Health Promotion Board.

   *CHO= Carbohydrate; CHO ex. = Carbohydrate exchange

 This issue's resident dietitian is  Mr. For Wei Chek, Dietitian at National Healthcare Group Polyclinics (NHGP). Email your questions for Dear Dietitian to editor@diabetes.org.sg  or fax  the questions addressed to the Editor, Diabetes Singapore, Diabetes Society of Singapore. Fax: 6553 1801