© The Indian Express Pvt Ltd
Tags:
Journalism of Courage
One of my patients, Gopal, believed that skipping breakfast, eating light through the day and having one big meal at home would be good enough to control his calorie intake and, therefore, take care of his blood sugar levels. Except that it didn’t, with him reporting sugar lows and highs through the day, which ended up confusing his body’s ability to use insulin effectively. So what was his meal pattern?
Gopal skipped breakfast. He had a cup of tea and two biscuits at 9 am. Then, around 11 am, he would have a coffee or one fruit. For lunch, he would have a sandwich or a vegetable roll at his desk. But when he came home after work, he would have a heavy dinner by 7.30 pm, with rice, curry, vegetables, curd, rasam, sweet and a fruit. So, he was having small, light portions during the day, followed by one large meal in the evening. Which means his sugar levels would be very low during the day time and then spike when he had a heavy meal at the dinner, although he had it at the right time. This fluctuation is not good for long-term blood sugar control.
When you eat very little during the day time, your blood sugars fall, especially if you’re on medication or insulin. You tend to feel irritated, weak and tired. Then when you have a heavy meal, your blood sugars go up sharply. These ups and downs are called blood sugar swings. They can make it difficult to maintain stable glucose control.
Gopal admitted to feeling very tired and exhausted in the afternoons. On the other hand, a heavy meal after long gaps flooded his body with glucose, causing post-meal spikes. Over a period of time, daily fluctuations in blood sugars affect long-term control and increase the risk of diabetes complications in the eye, heart, kidney and feet.
Gopal, like most people with diabetes, thought that eating less could reduce his weight and bring down his blood sugar. Eating less isn’t the problem — it’s how and when you eat. Small and frequent meals that are spaced out properly with the correct portions are recommended. A balanced diet comprises appropriate proportions of carbs, healthy fats, proteins and fibre. Skipping a meal will produce hypoglycaemia, especially when you have diabetes medicines. Moreover, you tend to overeat at your next meal because you feel hungry. Heavy meals produce hyperglycaemia, making your medicines work harder to control your blood sugars. Besides, it will also increase your fasting blood sugars. At one point of time, medicines may lose their effect and you may need insulin.
Ideally, you should eat three smaller meals — a light breakfast, lunch and dinner — along with two small snacks like a fruit or fistful of nuts in between (if needed). Each meal should have the right balance of carbohydrates, protein, fibre and healthy fats. This prevents sudden hunger pangs, reduces overeating at night and keeps blood sugars stable.
I advised Gopal that he should start his day with four or five almonds. Then, between 8 am to 9 am, we recommended he have three small idlis with sambar, followed by a fruit at 11 am. We gave him the option of a small portion of rice, (preferably brown rice) or two small rotis with dal, curd and fibre-rich vegetables. For an evening snack, we advised him roasted chana (chickpeas), boiled moong dal, with coffee/tea (both without added sugar) or buttermilk. This helps plan a light dinner. For example, try to eat two rotis or wheat dosa with dal and vegetables.
Regular meals help manage the balance between food intake and diabetes medications, prevent extreme cravings and unhealthy choices, and maintain consistent energy and cognitive function.
(Dr Mohan is chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai)
