FOOD AND NUTRITION

RESEARCH INSTITUTE
Nutritional Handbook for
Persons with Diabetes
(2008)

Food and Nutrition Research Institute

General Santos Avenue, Bicutan, Taguig City, Philippines
Telephone Nos.: 837-1839, 837-2071 to 82 local 2296,
8378113 to 14 loc. 318
Fax No.: (632) 837-3164
E-mail: mvc@fnri.dost.gov.ph, mar_v_c@yahoo.com
Website: http://www.fnri.dost.gov.ph
 Diabetes Nutritional Handbook
Republic of the Philippines
Department of Science and Technology
FOOD AND NUTRITION RESEARCH INSTITUTE
General Santos Avenue, Bicutan, Taguig City, Philippines
Telephone Nos.: 837-1839, 837-2071 to 82 local 2296, 8378113 to 14 loc. 318
Fax No.: (632) 837-3164
E-mail: mvc@fnri.dost.gov.ph, mar_v_c@yahoo.com
Website: http://www.fnri.dost.gov.ph

FNRI Management Committee

Director Mario V. Capanzana, PhD

Chief Science Research Specialist Zenaida v. Narciso, PhD

Technology Diffusion and S&T Services Division
(TDSTSD)

Scientist III & Chief Science Research Specialist Celeste C. Tanchoco, DrPh
Nutrition and Food R&D Division (NFRDD)

Chief Administrative Officer Ferdinand B. Oamar, DPA

Finance & Admininstrative Division (FAD)

Chief Science Research Specialist Imelda A. Agdeppa, PhD

Nutritional Assessment and Monitoring Division
(NAMD)

Supervising Science Research Specialist Teresita R. Portugal

Food Quality and Safety Section (FQSS)
& Food Analytical Service Laboratory (FASL)

Supervising Science Research Specialist Joyce R. Tobias

Nutrition and Food Research & Development Section
(NFRDS)

Planning Officer IV Teresa S. Mendoza, MSPH

Secretariat, MANCOM

Senior Science Research Specialist Cynthia S. Nones

& FANEA President

HANDBOOK COMMITTEE MEMBERS

Chairman Rodolfo F. Florentino, MD, PhD

Director,* FNRI

Technical Working Group Celeste C. Tanchoco, RND, MPH

Supervising Science Research Specialist*
MND, FNRI-DOST

Arlene S. Natividad, RND

Science Research Specialist
MND, FNRI-DOST

*At the time of handbook development

63
Diabetes Nutritional Handbook

FOREWORD

Diabetes education, or teaching a person with diabetes about his condition is an integral component of the medical
therapy of diabetes, the others being diet, exercise and medication. This handbook was developed primarily for in-
dividuals with diabetes. It contains basic information about diabetes – its nature, its treatment and important factors
to achieve diabetes control – in a way that most people will understand and appreciate. Although some technical
terms are used, they are terms that a person with diabetes will encounter when reading even popular literature on
the subject. A glossary of technical terms is included in an appendix.

In this handbook, the food lists in Appendix are based on the 1994 edition of “Food Exchange Lists for Meal Plan-
ning.” Appendices B and C give the food exchange equivalents of some commonly used alcoholic beverages and
non-alcoholic beverages, respectively.

It is hoped that this handbook will be useful not only to individuals with diabetes but also to members of their families
because they play an important role in the total care of the patient.

(Sgd.) RODOLFO F. FLORENTINO, M.D., Ph.D.

Director*
Food and Nutrition Research Institute

*At the time of book development

64
 Diabetes Nutritional Handbook

ACKNOWLEDGEMENT

We are most grateful for the encouragement and unfailing support of our co-workers, colleagues and physicians, and
all those who, in one way or another, helped in making this handbook possible.

We wish to thank the members of the Food and Nutrition Research Institute Technical Committee for their valuable
comments and suggestions and for their patience in reviewing the manuscript.

We wish to acknowledge a debt of gratitude owed to Dr. Augusto Litonjua, Mrs. Sanirose Orbeta, Mrs. Rhodie Imperio
and Mrs. Imelda Cardino for sharing their technical expertise and for their careful reviews of the manuscript.

A special word of thanks to Mrs. Velona Corpus for her painstaking editorial and technical assistance; to Mrs. Minnie
Quemuel for her critique; to Miss Alma Gammad for helping us prepare the evaluation questionnaire; and to Miss
Gwendelyn Serrano, Arnel Orea and Evelyn Baldemor for the layout and illustrations.

We express our appreciation to Dr. Ricardo Fernando for his unceasing interest in the nutritional aspect of diabetes
care.

We are also indebted to all the diabetic patients who inspired us in developing this handbook.

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Diabetes Nutritional Handbook

TABLE OF CONTENTS

Foreword 64
Acknowledgement 65
Introduction 67
What is Diabetes? 67
What is Insulin? 67
Medical Management of Diabetes 67
Role of Diet in Diabetes Management 67
Importance of Weight Control 67
Calories 68
Carbohydrates 68
Protein 68
Fat 68
Cholesterol 68
Fiber 68
Artificial Sweeteners 68
Salt 68
Vitamin and Mineral Supplements 69
The Food Exchange Lists 69
Measuring and Weighing Foods 69
Processed Food 69
Meal Plan 69
Foods to Avoid 70
Free Foods 70
Guidelines for Special Situations 70
When eating away from home 70
When you are sick 70
If You Must Drink 70
Exercise 71
Medications for Diabetes 71
Do All Persons with Diabetes Need Insulin Injections? 71
What are Oral Hypoglycemic Drugs? 71
Blood Sugar Testing 72
Personal Hygiene 72
Acute Complications of Diabetes 72
Chronic Complications of Diabetes 72
Appendices 73
Appendix A Food Exchange Lists 73
Rice Exchange 74
Meat Exchange 74
Low Fat Meat and Fish Exchanges 74
Medium Fat Meat and Fish Exchanges 75
High Fat Meat and Fish Exchanges 75
Processed Meat, Fish, Poultry Products, Beans 76
Milk Exchange 76
Vegetable Exchange 77
Fruit Exchange 77
Fat Exchange 78
Appendix B Alcoholic Beverages 79
Appendix C Beverage List 79
References 79
Glossary 80

66

NUTRITIONAL HANDBOOK
FOR PERSONS WITH DIABETES*
INTRODUCTION
This handbook on diabetes is designed to help you in
planning your meals – what to eat, how much to eat
and when to eat – in accordance with your physician’s
prescription. It is intended to enlighten you on the nature
of diabetes, the important factors in maintaining control
and what to do when complications occur. It also includes
the importance of personal hygiene and some guidelines
for special situations.
The contents of this handbook will allow you to under-
stand diabetes better and how to manage it in such a way
that you can enjoy a healthy and active life.
What is diabetes?
Diabetes mellitus, commonly referred to simply as diabe-
tes, is a condition wherein the body is not able to use sug-
ar as it should because the pancreas does not produce
enough insulin, or the available insulin is not effective.
When diabetes is not treated, blood sugar level rises, a
condition called hyperglycemia. As more sugar over-
flows into the urine (glycosuria), other symptoms occur
such as extreme thirst and hunger, weight loss, blurred
vision, and general weakness.
There are two major types of diabetes mellitus: insulin
-dependent (IDDM or Type I) and non-insulin depend-
ent (NIDDM or Type II). The latter usually occurs in
overweight adults.
What is Insulin?
Insulin is one of the hormones produced by the pancreas.
It helps keep your blood sugar at the right level. Too much
production of insulin causes hypoglycemia or low blood
sugar level, while too little insulin brings about hypergly-
cemia or high blood sugar level. When the body cannot
produce enough insulin as is typical in insulin-dependent
diabetes, insulin from other sources must be injected.
MEDICAL MANAGEMENT OF DIABETES
The overall objectives in the management of diabetes
is to control blood sugar level at all times and prevent
complications. Good management of diabetes rests on
a balance of three interrelated factors: diet, exercise,
and insulin or oral hypoglycemic agents (diabetes medi-
cines). A proper diet is the most important factor in the
management of diabetes. In addition, regular exercise
is indispensable in its successful management. Medica-
tions help lower blood sugar. Insulin medications are
injected while oral hypoglycemic drugs are taken by
mouth. Your physician will prescribe the appropriate
medication for you.
In insulin-dependent diabetes, the pancreas produces lit-
tle or no insulin at all. In order to control the level of blood
sugar, three things must be done: eat an appropriate and
prescribed diet, exercise regularly, and inject insulin daily.
In non-insulin-dependent diabetes, the pancreas produces
some insulin but either it is not enough, or it is not working
properly. This type can sometimes be controlled merely by
*This handbook is orginally intended for nutritional counseling; thus, it cannot stand alone.
Learn to access drug info on your cellphone. Send PPD to 2600 for Globe/Smart/Sun users.
Diabetes Nutritional Handbook
bringing the weight down to a desirable level, maintaining
that weight by eating an appropriate diet, and exercising
regularly. Insulin or oral drugs are used if diet therapy and
exercise fail to achieve control of the blood sugar level.
Whether your diabetes is managed by the diet and exer-
cise alone, or with anti-diabetic medications, you should
be properly informed about diabetes. This will help you
understand its management. In fact studies have shown
that teaching patients with diabetes about this leads to
better control. Diabetes education is therefore considered
the fourth cornerstone of the medical therapy of diabetes
(the others being diet, exercise and medication).
Education involves accepting your condition and the fact
that you have to live with it through the rest of your life,
understanding the disease, knowing basic principles of
its treatment, being aware of the acute and chronic com-
plications of poor control, and appreciating the rewards
of good control.
Learning to live with diabetes successfully requires deter-
mination and self-discipline. If you adhere closely to your
physician’s orders, stick to your diet, exercise regularly,
sleep and rest properly, and pay attention to personal
cleanliness, there is no reason why you should not live
a healthy and satisfying life. Your attitude towards your
ailment affects your physical health, thus, it is necessary
to keep a positive outlook.
ROLE OF DIET IN DIABETES MANAGEMENT
People with diabetes have different nutritional needs,
based on their body size, physical activity, laboratory
findings, medications used, and other factors, including
lifestyle. Thus, there is no one “diabetic diet” that is ap-
propriate for all persons with diabetes. Your diet must be
planned for you, and with you, by a dietitian in accordance
with your doctor’s prescription.
Almost all foods you eat are converted by your body
into sugar. Some foods such as table sugar and other
kinds of sugars are absorbed into the blood more rapidly
than others. For this reason, you should avoid foods that
contain large amounts of sugar. Some doctors may allow
small amounts of sugar when diabetes is well controlled.
But unless allowed by your doctor, it is best NOT to add
sugar to any food you eat.
It is best to distribute food throughout your waking hours
since a large amount of food taken at one time will cause
your blood sugar level to increase abruptly.
Since you are more likely to develop hypertension and
heart disease than non-diabetics, limit your intake of fatty
foods, fried foods, added fats and oils as well as salt and
foods with high salt content.
By following your diet conscientiously, you will get better
results in the treatment of your diabetes and you will be
able to enjoy life more fully.
Importance of Weight Control
An important goal of dietary management is the main-
tenance of reasonable body weight because this is es-
67
Diabetes Nutritional Handbook
sential for good blood sugar control. Your body makes
and/or uses insulin best when you are at your desirable
weight. If you are overweight, try to lose the excess weight
until you reach the desirable weight. The doctor or the
dietitian, together with you can decide on an appropriate
or reasonable weight goal.
On the other hand, if you are underweight, work for weight
gain until your weight goal is reached.
Excess body weight puts stress on the body’s ability to
make insulin and increases the body’s requirement for
insulin. On the other hand, an underweight person with
diabetes may be prone to develop nutritional deficiencies.
After you have reached your weight goal, continue to
weigh yourself regularly. A sensible diet coupled with
a program of regular exercise will help you attain and
maintain normal weight.
Calories
The calorie is the measure of the energy we get from food.
When you take in more calories than what you need for
energy, the excess is stored as body fat and you gain
weight. When you take in less than your energy require-
ment, your body will use its own tissues to provide the
needed energy, and you will lose weight.
People with diabetes should therefore watch their calorie
intake. For children, it should be enough to promote nor-
mal growth and development; for adults, it should be just
enough to meet their energy needs so that they will main-
tain a desirable or reasonable weight, while pregnant and
lactating women should take in extra calories for the de-
veloping fetus and for breastmilk production, respectively.
Your doctor will tell you how much calories you can have
and the dietitian will help you plan a diet based on the
doctor’s prescription.
Carbohydrates
Carbohydrates are our main sources of calories. Carbo-
hydrates may be complex, such as the starch in cereals,
tubers and some vegetables, or simple, such as the sugar
in fruits and table sugar itself. All carbohydrates are di-
gested into and absorbed as sugars. Thus, the amount
of carbohydrate in your diet must be regulated.
Protein
Protein is essential for growth in children and for mainte-
nance of tissues in adults. Pregnant women need extra pro-
tein for the growing baby inside her womb, while lactating
women must eat more protein for breastmilk production.
People with diabetes must avoid too much protein be-
cause they are prone to develop kidney complications.
Fat
Fats are concentrated sources of calories. Filipinos in
general do not have too much fat in their diets. But if
68
you are one of those who are fond of fried foods, pork,
sauces, salad dressings like mayonnaise, and other high
fat foods, you better cut down your intake of these foods.
A high fat intake can lead to a high level of cholesterol
(hypercholesterolemia) in the blood, and this in turn can
lead to hardening of the arteries (atherosclerosis). These
are common complications of diabetes.
Cholesterol
Cholesterol in the blood comes from the cholesterol in
the food we eat and the cholesterol produced by the
body itself. As mentioned above, a high level of blood
cholesterol increases the likelihood of cardiovascular
complications.
Fiber
Fibers are plant materials that cannot be digested in the
gastrointestinal (GI) tract. They are provided in the diet
primarily by cereals, fruits, vegetables, and legumes.
Fiber or bulk in the diet favors normal elimination and
promotes regular bowel movement.
Certain fibers may also help control blood sugar levels by
delaying absorption and increasing the body’s sensitivity
to insulin. For these reasons, eating a fiber-rich diet has
obvious advantages for diabetics like you. However,
experts now believe that it is not necessary to take in
the large amounts they used to recommend, 40 grams
per day which is about four times the amount in the
average Filipino diet. They recommend eating 5 serving
of fruits and vegetables everyday to get the amount of
fiber you need.
Artificial Sweeteners
Artificial sweeteners are substances that are used in
place of sugar because they have little or essentially no
calories and, consequently, no significant effect on blood
sugar levels and total caloric intake. Saccharine and
aspartame are the artificial sweeteners that have been
used widely. Acesulfame-K is also approved for use as
a sugar substitute.
The use of artificial sweeteners, however, should be
moderate especially by children and pregnant women
and only upon the advice of the physician.
Cyclamates are also artificial sweeteners but at present,
their use is not approved by the US Food and Drug
Administration.
Other sweeteners are: fructose, sorbitol, xylitol, and man-
nitol. They have the same number of calories as sugar
and have no advantage over regular table sugar.
Salt
Too much salt in the diet can worsen hypertension which
is common in people with diabetes. So, limit the amount
of salt you add to your food and avoid salty foods like
ham, bacon, tocino, and salty condiments like patis, toyo
and bagoong.
 Diabetes Nutritional Handbook
Vitamin and Mineral Supplements The Food Exchange Lists help you plan your meals so
that you can keep your diabetes under control. You can
If you eat a varied and balanced diet everyday, you may avoid monotony in your diet by varying the choice of foods
not need supplements, However, if your calorie prescrip- within a particular food group.
tion is less than 1400 calories per day, it will be good to
take in vitamin and mineral supplements. Your meal plan has been computed especially for you.
It can be adjusted if it is not working out for you. Consult
your dietitian regularly to review your meal plan and adjust
The Food Exchange Lists it according to your varying needs.
The Food Exchange Lists are groups of foods that will
help you choose the right kind and amount of foods. The
YOUR MEAL PLAN
Exchange Lists allow variety in your diet and will give you
almost unlimited choices of foods.
Total Rice Exchanges Calories
Foods are listed under six main groups, namely: rice, Meat Exchanges grams Carbohydrate
meat, milk, vegetable, fruit and fat. One portion of a par- Lean Meat grams Protein
ticular food, called an exchange, is approximately equal Medium- grams Fat
in calories and in the amount of protein, fat and carbohy- fat Meal
drates to foods in the same group. They also contain more High-Fat
or less similar amounts of vitamins and minerals.
Meat
Foods in any one group can be substituted or exchanged Milk Exchanges
with other foods in the same group although the sizes of Vegetable Exchanges
the serving portion may not be the same. Foods in one Group A Vegetables
group, however, cannot be traded for foods in another Group B Vegetables
group. For example, one piece of galunggong may be sub- Fruit Exchanges
stituted for one slice of tenderloin because they are both Fat Exchanges
in the meat group, but one piece of galunggong cannot be
substituted for two slices of bread because galunggong Meal Pattern Sample Menu Household
is in the meat group and the bread is in the rice group. Measure
Breakfast
Always refer to the Food Exchange Lists at the end of Fruit
this handbook (Appendix A) when planning your meals. Meat
Rice
Fat
Measuring and Weighing Foods
Milk
The measures and weights of food in the Exchange Lists
are for the edible portion or E.P. (raw or cooked) or the AM Snack
portion that is customarily eaten. It is important to eat the
right serving sizes of foods in your meal plan. Each portion
of food should be measured accurately until you become
familiar with size of portions. Use a standard measuring
cup and set of measuring spoons. All measurements
should be level. Lunch
Meat
In this revised edition, as purchased or A.P. weights have Vegetable
been included for the rice and fruit exchanges. A.P. refers Fat
to the form of the food as purchased from the market that Rice
still includes the peel or skin, seeds, etc. (refuse) or the Fruit
parts that are not usually eaten.
PM Snack
It will be useful to have a small scale for weighing some
foods. However, it is not entirely necessary as the lists
give the measures of food equivalent to one exchange.

Processed Food
Supper
When using processed food not listed in the Exchange
Lists – canned food, cured or processed food, ask your Meat
dietitian about them. READ LABELS and avoid those with Vegetable
added sugar, or with too much fat or salt. Fat
Rice
Fruit
Meal Plan

Your meal plan below is a guide which shows the number Midnight Snack
of exchanges (food choices) you can eat at each meal
and snack.

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Diabetes Nutritional Handbook
Foods to Avoid
All foods containing large amounts of added sugar such
as sweets and desserts should be avoided. Exceptions
are special circumstances such as preparing for strenu-
ous activity or recovering from insulin reaction, since
sugar causes a relatively rapid increase in blood sugar.
The following foods should be avoided unless worked
into your meal plan.
Cakes Marmalade
Candy Milk, chocolate or
Chewing gum condensed
Fruits, canned, frozen or Milkshakes
cooked with sugar Molasses
Fruits, glazed Pastries
Fruit drinks (artificial) Pies
Fruit ices Popsicles
Fruit juices, sweetened Pudding
Gelatin, sweetened Softdrinks
Honey Sweet rolls
Ice cream Sugar
Jam Syrup
Jelly Vegetables, glazed
Free Foods
The following foods contain negligible amounts of carbo-
hydrate, protein, or fat, and may be used without calcula-
tion into the meal plan unless specifically prohibited
by the physician. These foods may be used with other
foods in the diet.
Bagoong Karamay
Bouillon (fat-free soup) Lemon
Carbonated drinks,
sugar free Mustard
Carbonated water Onion
Candy, hard, sugar-free Oregano
Chili powder Paprika
Cinnamon Pepper
Clear broth Pickle, dill or sour
Coffee (unsweetened)
(no cream and sugar) Pimiento
Curry Spices
Drink mixes, sugar-free Soy sauce
Fish sauce Tomato juice
Flavoring extract Tomato paste
Garlic Tomato sauce
Gelatin (unsweetened) Tonic water,
Gum, sugar-free sugar-free
Herbs Tea
Hot pepper, sauce Vinegar
Kalamansi Worcestershire
Kamyas sauce
Guidelines for Special Situations
A. When eating away from home
Be familiar with your meal plan. As long as you know your
prescribed meal plan and how to make substitutions, you
should have no trouble when you eat away from home.
Know the amount of foods prescribed for you. Eat only the
foods allowed in your diet. Watch the size of your serving
portions. Select simply prepared foods instead of those
that are fried or with sauce or gravy. It is best to choose
70
foods that are roasted, baked, broiled, and boiled. Avoid
foods prepared with sugar and with too much fats.
Anticipate the effects of a late meal, such as when eating
out, by eating something beforehand. For example, if you
do not know whether supper will be served at your usual
hour or later, eat one Rice Exchange from your supper
meal plan before you leave and then omit something
equal to one Rice Exchange when dinner is served.
For those taking insulin, follow your physician’s instruc-
tions on how to adjust your insulin and meals to meet
time changes. Stick as closely as possible to your regular
meal plan and meal time schedule.
B. When you are sick
Any illness may temporarily make the control of your
blood sugar difficult. An illness may either increase or
decrease blood sugar levels. It is essential that you
should know how to deal with any illness when it arises.
Monitor your blood sugar more closely when you are sick
and adjust insulin and other medications accordingly (but
call your physician first).
Follow your meal plan as closely as possible. Eat foods
at regular intervals, close to your usual meal times, if pos-
sible. Small frequent feedings may be easier when you
are sick. Try to eat all the carbohydrates your diet allows.
If your appetite is poor, select other foods within the same
group or take them as fluids if you cannot eat solids. If
your condition does not improve, call your physician.
C. If You Must Drink
ALCOHOLIC BEVERAGES ARE BETTER
AVOIDED BY THE DIABETIC PATIENTS
Alcoholic beverages are almost as fattening as fat. They
are high in calories but low in nutritional value, therefore,
they should be used sparingly, and should be regarded
as part of your caloric intake. These beverages should
not be used if you are reducing weight because frequent
intake of alcoholic drinks increases weight.
Alcohol may be used in moderation by a person with
diabetes whose blood sugar is well controlled. Alcohol,
however, may be harmful to other diabetic persons. Al-
cohol may hasten the effect of insulin or hypoglycemic
tablets. Pregnant women should not take alcoholic drinks
because they endanger the developing fetus.
If your physician allows you to drink, you should ask
your dietitian to include alcoholic drinks in your meal
plan. Also, plans must be developed to cope with any
eventuality since alcohol may interact with some of your
medications.
If alcohol is allowed, it should be taken slowly and only
with food shortly before or after meals because alcohol
lowers blood sugar and eating well helps avoid hypoglyc-
emia. Drinks that contain carbohydrates (drinks made with
sweetened mixes, sweet wines, liquors) should be avoided.
The symptoms of low blood sugar are similar to those of
alcohol intoxication. Thus, if you drink away from home,

it is advisable to be with friends, who know that you have
diabetes, or wear an identification card that is visible so
that in case the initial symptoms of very low blood sugar
develop, these are not mistaken for drunkenness and
treatment for such condition may be administered.
For more information on the food equivalents of some
alcoholic beverages, see Appendix B.
EXERCISE
Exercise, when done regularly is beneficial because it
burns body sugar quickly, thus, lowering blood sugar
levels. It improves circulation helps obese people lose
weight, eases tension and makes one feel good and
look fit. However, before beginning an exercise program,
check with your physician first, particularly if you haven’t
exercised for some time, if you have complications, or if
control of blood sugar is poor.
Exercise may also prevent or retard cardiovascular dis-
eases and its complications, which is common among
the 40-year-old and above diabetics. Your chance of
developing the other coronary risk factors such as hyperc-
holesterolemia, obesity and hypertension is minimized. In
addition, the ability to withstand stress may be enhanced
through exercise.
Exercise, in certain instances, can lead to unfavorable
reactions. If your blood sugar is very high, a further
increase in blood sugar can occur and you are more
prone to develop dehydration when exercising during
warm days.
If you are allowed to exercise, consider the following
pointers:
• Before starting an exercise program, have your diabetes
control evaluated by a physician and request clearance
for heart disease, hypertension, kidney disease and
severe eye problems.
• Follow a graded, slowly increasing exercise program.
• Exercise must be regular since the benefits of exercise
are temporary.
• Wear appropriate and comfortable footwear during
exercise especially when this entails running.
• Do not take alcoholic beverages prior to exercising
because they may increase the risk of developing
hypoglycemia.
For those who are taking insulin, the following should be
additionally considered:
• Monitor blood sugar in order to assess the need for
insulin or food intake adjustment during exercise.
• Avoid exercising during the height of insulin action.
• Do not exercise the limb or part of the body where insulin
was injected.
• Always have identification cards and easily absorbable
carbohydrates such as candies should exercise-in-
duced hypoglycemia or low blood sugar occur.
Here are some additional information if you have com-
plications:
• Kidney disease may be aggravated since exercise
decreases blood flow to the kidneys and increases
protein excretion.
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Diabetes Nutritional Handbook
• Severe eye problems may worsen as exercise can lead
to eye hemorrhage.
You may need to make some changes in your meal plan
when you begin an exercise program. Check with your
dietitian or physician about this. You may need to eat
more when you do longer and more strenuous exercises.
The size of snack that is best varies for different persons.
Ask your physician or dietitian for specific guidelines. If
a reaction develops while you are exercising, STOP,
and take some form of carbohydrate which is quickly
absorbed by the body like sugar, candy or any sweet-
ened fruit juice.
MEDICATIONS FOR DIABETES
Do all persons with diabetes need insulin injections?
People with IDDM need insulin injection because their
bodies are not producing enough of this important hor-
mone. Some people with NIDDM may also need insulin
if their blood sugar level is not controlled by diet, exercise
and/or medicines taken by mouth (oral hypoglycemic
drugs).
There are several types of insulin preparations available.
Your physician will tell you the type and amount of insulin
you need and the time to take your insulin.
If you are taking insulin injections, the time and amount
of food you eat should be consistent and should match
your activity and the action of insulin prescribed by your
physician. There should always be a balance between
the effects of insulin and food so that the blood sugar
will not be too high nor too low at any time to cause
hyperglycemia or hypoglycemia. Bedtime snacks and
between-meal feedings will help keep this balance.
When taking insulin, you may have to change your diet in
some circumstances. Ask your dietitian or physician how
to adjust your meal plan when you do strenuous exercise,
when you are ill, or if you have low blood sugar.
Here are some reminders if you are using insulin:
1. Eat at the same time each day.
2. If you skip a meal, ask you physician how to adjust
insulin.
3. Never omit your insulin injections at the prescribed
time and amount.
4. Always carry candy with you to counteract hypogly­
cemia, if it occurs.
5. Keep an extra vial of insulin handy so you do not run
out when you need it most. Keep extra syringes and
needles in case of breakage.
6. Follow your physician’s instructions carefully when
sterilizing equipment, cleaning and injection sites,
measuring and mixing insulin preparations and rotating
the injection sites.
What are oral hypoglycemic drugs?
Oral medications are drugs taken by mouth. Drugs taken
by mouth stimulate the release of insulin in the body or
induce the tissue to use the available insulin better are
known as oral hypoglycemic drugs. These drugs are not
insulin, nor contain insulin. They are useful for diabetics
whose pancreas still produces some insulin as in non-
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Diabetes Nutritional Handbook
insulin-dependent diabetes (Type II). They are used in
Type II diabetes when blood sugar cannot be controlled
by diet alone or by diet and exercise.
Regularity of meals and snacks is desirable when taking
oral hypoglycemic agents. Hypoglycemia may occur with
skipping of meals or decreasing food intake.
BLOOD SUGAR TESTING
Monitoring your blood sugar level can be very useful in
keeping track of your diabetes. It is a way of testing how
well blood sugar is controlled by your diet, exercise and
medication program. If your blood sugar level is hard to
control or if you are concerned with strict control, self
blood glucose monitoring is very helpful.
You can measure your own blood sugar using the finger-
prick method and a special strip of paper (Dextrostix, Glu-
costix or Visidex). Your physician will tell you when and
how often to test your blood sugar level. Your physician
will also teach you how to adjust your diet or activities to
keep the blood sugar level as close to normal as possible.
Or you may use the guidelines on page 71.
Do not be discouraged by a few positive tests. Perfect
control at all times is hard to achieve. HOWEVER, A
HIGH BLOOD SUGAR LEVEL is a warning sign. CALL
YOUR PHYSICIAN if your blood sugar is consistently
high or unexpected.
PERSONAL HYGIENE
One complication common in persons with diabetes is
skin infections and wounds that do not heal properly.
You are more likely to develop infections when your
blood sugar level is high. In diabetes, there is also poor
blood circulation which makes infection a special danger.
For this reason, you need to take special care to avoid
conditions that will lead to infections and wounds. You
should take proper care of your eyes, teeth, skin and
feet. This is important because any infection can eas-
ily upset diabetes control. Taking a bath regularly and
keeping the skin constantly clean and soft are some tips
to avoid infections. You must also get enough rest and
sleep to stay healthy.
You have to take special care of your feet because poor
blood circulation sometimes means less sensation than
usual in your feet. You may not notice cuts and other
problems as soon as these occur.
Here are Ten Commandments of proper foot care*:
1. Never apply heat of any kind to the feet.
2. Never soak the feet.
3. Never cut the toe nails; only file them.
4. Never wear ill-fitting shoes.
5. Never assume that sensation or circulation is normal
at the feet.
6. Never use strong colored medicines on the feet.
7. Minimize development of calluses or corns by wear-
ing comfortable shoes.
8. Never perform bathroom surgery on the feet.
9. Never go barefoot.
10. Never keep the feet too dry or too moist.
* Victoria Correa-Santiago, “Thou Shalt Take Care of Thine Feet.” Diabetes
Watch 4 (December 1987):4.
72
And, as a last but very important reminder, you are
advised not to smoke as nicotine will narrow the blood
vessels and will impair blood circulation.
ACUTE COMPLICATIONS OF DIABETES
There will be times when your blood sugar level may
become either too high (hyperglycemia) or too low
(hypoglycemia). It is important for you to learn all you
can about these complications, why they happen, when
they may be expected, and most important, how you
feel when an emergency is coming, and how to treat it.
Knowing how you feel when your blood sugar is becoming
higher or lower than normal will help you avoid serious
emergencies, even life threatening emergencies.
IMPORTANT
THE CAUSES, SYMPTOMS AND TREATMENT FOR
THESE TWO CONDITIONS ARE DIFFERENT
INSULIN DIABETIC
REACTION KETOACIDOSIS
(LOW (HIGH
BLOOD SUGAR) BLOOD SUGAR)
CAUSES too much insulin too little insulin or
too much exercise skipping an insulin
injection
too little food or too much food
omission of food intercurrent infection
SYMPTOMS
Onset sudden gradual
Skin pale, moist dry, flushed
Behavior weak, irritable drowsy
Breath normal odor fruity odor
Breathing normal to rapid fast, deep
Vomiting absent present
Tongue tingling, moist dry
Hunger present absent
Thirst absent present
Pain headache abdominal
TREATMENT
Eat or drink THIS IS A MEDICAL
anything sweet. If EMERGENCY AND
available: milk + 2 SHOULD ONLY BE
teaspoons sugar. TREATED IN THE
HOSPITAL.
CHRONIC COMPLICATIONS
OF DIABETES
Complications may happen in persons who have had
uncontrolled diabetes for a long time. These include
damage to the retina of the eyes (retinopathy), the blood
vessels (angiopathy), the nervous system (neuropathy),
and the kidneys (nephropathy). Strict control of blood
glucose levels may help reduce, delay or prevent these
problems.
 Diabetes Nutritional Handbook

APPENDICES
Food Wt. (g) Measure
A.P E.P
APPENDIX A
Corn/rice curls & the like 25 1-1/4 cups
FOOD EXCHANGE LISTS
Corn, boiled 120 65 1 (12 x 4 cm)
Corn flakes 25 1 cup
RICE EXCHANGE
Baby corn 90 1 cup

Corn, canned 145 1 cup
The list shows the kinds and amounts of rice, rice
4. Noodles, cooked
equivalents, bread and bakery products to use for one
Bihon, macaroni 75 1 cup
rice exchange.
Sotanghon, spaghetti
5. Rootcrops
Each exchange in this list contains approximately 23
Sweet potato 91 80 1/2 of 11 cm long
grams of carbohydrate, 2 grams of protein and 100
x4-1/2 cm diameter
calories.
Cassava 115 85 1(5 cm long x 4-1/2 cm
diameter) or 1-cup
Your diet plan contains exchanges from
Gabi 130 100 2 (6 cm long x 4 cm
the rice exchange list distributed as follows:
diameter each
or 1 cup
Potato 195 165 2-1/2 of 7 cm long x 4
Breakfast Morning Lunch Afternoon Supper Bedtime
cm diameter each or
Snack Snack Snack
1-1/3 cups

Ubi 155 130 1 (8-1/2 cm long x 4-1/2

cm diameter)or

1-1/3 cups
Tugi 135 2 (11x3 cm each)
Food Wt. (g) Measure
6. Beans and Nuts
E.P.
Chestnuts, 55 40 11 pieces large or 20
roasted (kastanyas, pieces small
I. Rice and Rice Products
binusa)

1. Rice, cooked 80 1/2 cup, packed
7. Others
2. Rice gruel (lugaw)
Cornstarch 25 5 teaspoons
+ Thin consistency 705 4-1/2 cups
Flour, all purpose 25 3 tablespoons
++ Medium consistency 435 3 cups
Sago, cooked 120 1/2 cup, cooked
+++ Thick consistency 250 1-1/2 cups
Ice cream, dietetic 90 1/3 cup(unsweetened)
3. Suman sa lbos 60 1(8x4x2 cm)
III. Processed Rice and Bakery Products
II. Rice Equivalents

Food Wt. (g) Measure
1. Bread
E.P
Pan amerikano 40 2 slices
(9x8x1 cm each)
Canton 100 1 cup
Pan de bonete 40 1 (6 cm diameter base
Corn chips (cheese flavor) 40 1-1/3 cups
x 7 cm thick)
Cornick 35 1/2 cup
Pan de leche 40 1 (3x8x8 cm)
Crackers 35 8 (5x4x1/2 cm each)
Pan de limon 40 1 (6x5x4 cm)
Doughnut, plain
Pan de monay 40 1 (10x9x4 cm)
(no sugar) 45 1/2 of 9x3 cm
Pan de sal 40 3 (5x5 cm each)
French fries 65 1 cup
Rolls 40 1 (11x4x3 cm)
Instant noodles 40 1/2 of 80 gm. pack
(hotdog/hamburger)
(chicken/beef flavor)
Whole wheat bread 45 2 (11-1/2x8-1/2x1
Miki 100 1 cup
cm each)
Oatmeal, raw 30 5 tablespoons
Oatmeal, cooked
Food Wt. (g) Measure
+ thick consistency 185 1 cup
A.P E.P
++ thin consistency 255 1-1/2 cups
Pan de coco 40 1 (7x6 cm)
2. Bakery Products
Potato chips 45 1-1/2 cups
Salted crackers 30 8 (5x4x1/2 cm each)
Cookies
Salted popcorn 35 2 cups
Galyetas de patatas 30 10 (4x4x1/2 cm
Skyflakes 35 4 pieces
diameter each)
Sunflower biscuit 40 9 (7-1/2x4-1/2 cm each)

3. Corn and Corn Products
Binatog 90 1/2 cup

+ 1/2 cup cooked rice + 5 cups water +5 tablespoons raw oatmeal + 1 cup water
++ 1/2 cup cooked rice + 3 cups water ++5 tablespoons raw oatmeal + 1-1/2 cups water
+++ 1/2 cup cooked rice + 2 cups water

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Diabetes Nutritional Handbook
MEAT EXCHANGE Lean pork
Tenderloin, well
Each serving of meat and substitutes on this list contains trimmed (lomo) 30 1 slice, matchbox size
about 8 grams of protein. The amount of fat and number (6-1/2x3x1-1/2 cm)
of calories varies depending on what kind of meat or Chicken
substitute you choose. Leg (binti) 30 1
small leg (13-1/2 cm
long x3 cm diameter)
The list is divided into three sub-groups based on the Breast meat (pitso) 30 1/4 breast -6 cm long
amount of fat and calories; lean/low fat meat, medium
fat meat and high fat meat. One meat exchange of each 2. Variety meats/internal organs
of these includes: Blood (dugo)-pork, beef,
Chicken 35 3/4 cup
Carbohydrate Protein Fat Calories Gizzard 35 3/4 cup
(grams) (grams) (grams) (balun-balunan)
- chicken
Lean/Low Heart (puso) - pork, 35 3/4 cup
Fat Meat beef, carabeef
and Fish - 8 1 41 Liver (atay)1-pork, 35 3/4 cup
Medium Fat beef, carabeef,
Meat and chicken
Fish - 8 6 86 Lungs (baga)1 35 3/4 cup
High Fat - pork, beef,
Meat and carabeef
Fish - 8 10 122 Omassum (librilyo) 35 3/4 cup
- beef, carabeef
Your meal plan tells you how many exchanges from each Small intestine 35 3/4 cup
subgroup you can have. (bitukang maliit)
-pork, beef, carabeef
Lean meats are suitable when the prescribed diet is very Spleen (lapay)1, 35 3/4 cup
low in fat and cholesterol. Medium fat meat exchanges pork, beef, carabeef
may be included if your diet allows a moderate amount of Tripe (goto) – beef 35 3/4 cup
fat. The high-fat meat exchange list contains other protein Uterus (bahay guya)- 35 3/4 cup
foods with higher than the desirable cut-off levels or fat. pork, beef
When choosing foods from this list, the appropriate allow-
ance from the fat exchange list should be adjusted. 3. Fish
Large variety 35 1 slice (7x3x2 cm)
The measure of the meat, fish or other meat exchange (e.g bakoko, bangus,
does not consider the flour or fat used in the prepara- dalag, labahita,
tion. lapu-lapu, etc)
Medium variety
If meat is fried, use the fat allowance in your diet. Soup Hasa-hasa, 35 1 (18x4-1/2 cm)
stock from meat (with fat removed) may be used with the dalagang bukid,
meat or vegetable to improve flavor. Trim off visible fat Galunggong 35 1 (14x3-1/2 cm)
and measure meat after it has been cooked. Hito 35 1/2 of 22x5 cm
Small variety
Sapsap 35 2 (10x5 cm each)
A. LOW FAT MEAT AND FISH EXCHANGES Tilapya 35 2 (12x5 cm each)
Tamban 35 2 (12-1/2x3 cm each)
Your diet plan contains exchanges from Dilis 35 1/4 cup
the lean meat list distributed as follows:
4. Other Seafoods
Breakfast Morning Lunch Afternoon Supper Bedtime Alamang, tagunton 30 1-1/4 tablespoons
Snack Snack Snack Aligue: Alimango 15 1 tablespoon
Alimasag 50 3 tablespoons

Alimango1/Alimasag, 20 1/4 cup or 1/2 pc
laman medium
Lobster 30 2 tablespoons
Talangka 30 75 pieces A.P.

Food Wt. (g) Measure Shrimps: Puti 25 5 (12 cm each)

E.P Sugpo 25 2 (13 cm each)
Cooked Suwahe 25 5 (12 cm each)
Octopus (pugita) 30 1/2 cup

Squid (pusit) 25 3(7x3 cm each)
1. Lean Meats 30 1 slice, matchbox size Shells: Halaan 75 1/3 cup shelled or
(5x3-1/2x1-1/2 cm) 3 cups with shell
Beef, carabeef, Kuhol 50 1/2 cup shelled or
chicken meat 3 cups with shell
(laman) 30 1 slice, matchbox size
(5x3-1/2x1-1/2 cm) 1
High in cholesterol. Omit or limit if your diet says “Low Cholesterol.”

74
 Diabetes Nutritional Handbook

Susong Pilipit 65 1/3 cup shelled or plate (tadyang)
2 cups with shell chuck (paypay)
Paros 60 1 cup shelled or
2-2/3 cups with shell b. Pork
Leg (pata) 30 1 slice (4 cm diameter
5. Beans x 2 cm thick)
Pigeons pea seeds, 55 1/3 cup
dried (kadyos, 2. Variety meats/internal organs
buto, tuyo) Brain (utak)2 - pork,
6. Cheese beef, carabeef 35 3/4 cup
Cottage cheese 60 1/3 cup
3. Fish
7. Processed foods Karpa 35 1 slice (15x7x2 cm)
A. Fish products1
Dried: 4. Egg
Daing: Chicken2 60 1 piece
Alakaak, alumihan, Quail’s egg2 70 9 pieces
Bisugo, biyang puti 20 1 (15-1/2x8 cm) Salted duck’s egg2 60 1 piece
Lapu-Lapu 20 ¼ of 30 x 40 cm
Sapsap 20 3 (9x5 cm each) 5. Cheese
Tamban 20 1 (16x3 cm) Cheese, cheddar 35 1 slice (6x3x2 cm)
Tanigi 20 1 slice (16x6 cm)
Tinapa:
Bangos 30 ¼ of 20x8 cm 6. Chicken
Galunggong 30 1 (16x4 cm) Wings (pakpak) 25 1 medium or 2 small
Tamban 25 1 (16x5 cm) Head (ulo) 35 2 heads
Tuyo:
Alamang 15 1/3 cup 7. Beans
Ayungin, dilis, Soybean (utaw) 40 ½ cup
sapsap, tunsoy 20 3 (11-1/2x8 cm each)
Pusit 15 1 (8x1 cm)
Canned: 8. Processed Foods
Salmon 40 1/3 cup flaked a. Fish products
Tuna in brine 30 1/3 cup flaked Sardines canned 45 1 (10x4-1/2 cm)
in oil/Tomato sauce
B. Meat products Tuna Sardines 50 1-1/2 of 6x4x3 cm each
Tocino (lean), 45 1 slice (11x4x0.5 cm) Tuna spread, 30 2 tablespoons
without sugar canned
b. Meat products
Corned beef 40 3 tablespoons
Ham sausage 55 3 of 9 cm diameter
B. MEDIUM FAT MEAT AND FISH EXCHANGES x 0.3 cm thick each
c. Bean products
Your diet plan contains exchanges Soybean cheese, 100 ½ cup
from the medium-fat meat list distributed as follows: soft (tofu)
Soybean cheese, 60 1 (6x6x2 cm)
Breakfast Morning Lunch Afternoon Supper Bedtime soft (tokwa)
Snack Snack Snack
C. HIGH FAT MEAT AND FISH EXCHANGES

Remember these items are high in saturated fat, choles-
terol and calories and should be used only if your diet
Deduct one exchange from your fat allowance for every allows at least two fat exchanges. Even then, use only
exchange of medium-fat meat used in place of lean two to three times a week.
meat.
Deduct two exchanges from your fat allowance for every
Food Wt. (g) exchange of high fat meat used in lieu of lean meat.
E.P. Measure
Cooked Food Wt. (g) Measure
E.P.
1. Medium Fat Meat Cooked
a. Beef
Flank (kabilugan) 30 1 slice, matchbox size 1. Pork
brisket (punta y pecho) (5x3-1/2x1-1/2 cm) Ham (pigue) 35 1 slice (3 cm cube)

2. Variety meats/internal organ

1
Limit the intake of these salty foods, omit entirely if your diet prescription Tongue (dila – pork,
says "Low Salt."
2
High in cholesterol. Omit or limit if your diet says “Low Cholesterol.”
beef) 35 ¾ cup

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Diabetes Nutritional Handbook
Salt water mussel (tahong)4 45 ¼ cup
3. Eggs
Spam2 55 3 slices
Duck’s egg1 70 1 piece
(8x5x1 cm each)
Balut1 65 1 piece
Taho plain4 275 2-3/4 cups
Penoy 60 1 piece
White kidney beans seeds, 55 1/3 cup
dried (abitsuelas, buto,
4. Nuts
puti, tuyo)4
Peanuts, roasted 25 1/3 cup
MILK EXCHANGE
5. Cheese
Cheese, filled 50 1 slice (6x3x2-1/2 cm)
Each exchange of milk on this list contains 12 grams of
Cheese, pimiento 40 1 slice (6x3x2 cm)
carbohydrate and 8 grams of protein. The amount of
flavored
fat and number of calories very depending on what type
of milk you choose.
6. Processed foods
Meat products
The list is divided into three sub-groups based on the
Longanisa, 25 1 (12x2 cm)
amount of fat and calories: whole milk; low fat/skimmed
chorizo style
milk and very low fat milk. One milk exchange of each
Frankfurters 60 1-1/2 of 12x1/1/3 cm
includes:
Salami 50 3 slices of 8x8x1 cm
each
Carbo-
Vienna sausage 70 4 (5x2x2 cm)
hydrates Protein Fat Calories
(G) (G) (G)
D. PROCESSED MEAT, FISH, POULTRY PRODUCTS,
BEANS
Whole Milk 12 8 10 170
Low Fat/
Skimmed Milk 12 8 5 125
Food Wt. (g) Measure
Very Low Fat Milk 12 8 Tr 80
E.P

Your diet plan contains exchanges from milk
Cashew, roasted 40 1/3 cup
group distributed as follows:
Century egg1 65 1 piece
Cheese, native2 60 2 slices (4x4x1 cm each)
Breakfast Morning Lunch Afternoon Supper Bedtime
Cheese spread (no sugar) 55 4 tablespoons
Snack Snack Snack
Chicken spread (no sugar) 70 5 tablespoons

Chickpea seeds, boiled3 65 ½ cup

(garbanzos, buto, linaga)
Chili con carne4 105 1 cup
Clam (tulya)3 70 1/4 cup, shelled or
Milk is an almost complete food, hence, it is considered
5-1/2 cups with shell
one of our most important foods. It contains plenty of
Cow pea seeds 65 1/2 cup
good quality minerals particularly calcium and vitamins
(paayap, buto)3
as well a carbohydrates, fat and protein.
Embutido (no sugar)2 60 2-1/2 slices
(5x1-1/2 cm each)
The milk allowance in the meal plan can be used as a
Fishball3 95 6 (3-1/2 cm
drink, can be added to cereals, or mixed with coffee or
diameter each)
tea and other foods.
Hamburger (w/o sugar)2 50 2-1/2 (4-1/2x1
cm each)
As a beverage, milk is the most nourishing for the young
Hotdog2 70 2 (10x4 cm each)
and for adults.
Lima beans, seeds, dried 75 ½ cup
(patani, buto)3
Food
Wt. (g) Measure
Lite hotdog 55 1 piece
E.P
Luncheon meat (w/o sugar) 55 2 slices

(9x5x1 cm each)
Whole milk:
Meat loaf, canned 70 2 slices
Milk, Evaporated, undiluted 125 ½ cup
(w/o sugar) (9x5x1-1/4 cm each)
Milk, evaporated, filled, 125 ½ cup
Mung bean (munggo)4 75 ¾ cup
undiluted
Murkon (w/o sugar) 60 2 slices
Milk, evaporated,
(5-1/2x1-1/2 cm each)
recombined undiluted 125 ½ cup
Oyster4 105 2/3 cup
Milk, fresh carabao’s 250 1 cup
Peanuts, boiled2 60 ½ cup
Milk, fresh cow’s 250 1 cup
Peanut cracker (w/o sugar) 35 1/3 cup
Milk, powdered 30 ¼ cup or
Potted meat (w/o sugar) 75 5 tablespoons
4 level tablespoons

Low Fat Milk

1
High in cholesterol. Omit or limit if your diet says “Low Cholesterol.” Powdered 30 ¼ cup or 4 level
2
Deduct fat allowance by one exchange when using any of these items.
3
Deduct rice allowance by one exchange when using any of these items.
tablespoons
4
Deduct rice allowance by ½ exchange when using any of these items. Lite Low Fat Milk 250 1 tetra-brick

76

Skimmed (Non-Fat)/Very Low Fat Milk:
Buttermilk: liquid 185 2/3 cup
: powdered 25 ¼ cup or 4 level
tablespoons
Long life skimmed milk 250 1 cup
Yoghurt 125 ½ cup
VEGETABLE EXCHANGE
Each group A vegetable contains negligible carbohy-
drates, protein and energy if 1 exchange or less is used.
When 2 exchanges are used, consider as one group B
vegetable. Each Group B vegetable exchange contains
3 grams of carbohydrate, 1 gram of protein and 16
calories.
Vegetables are important sources of vitamins and min-
erals. Include at least one serving of green or yellow
vegetable in the diet daily. Aside from their valuable
vitamin and mineral contents, vegetables are also good
sources of fiber. Fiber has been shown to lower blood
sugar levels.
Serve vegetables cooked or raw. If fat is added to the
presentation, count them as part of the fat allowance.
One vegetable exchange cooked with fat contains ap-
proximately one fat exchange. Vinegar, lemon, or tomato
juice may be used as salad dressings, as desired.
Leafy Vegetables:
1 exchange = 1 cup raw (25 g) or
(Group A Vegetables) ½ up cooked (45 g)
Non-Leafy Vegetables:
1 exchange = ½ cup raw (40 g) or
(Group B Vegetables) ½ cup cooked (45 g)
Your diet plan contains exchanges from
the vegetable groups distributed as follows:
Lunch Supper
Group A
Group B Water chestnut, canned 25 3 (2 cm diameter each)
Group A Vegetables
These vegetables contain negligible carbohydrate, pro-
tein, and energy if only one exchange or less is used.
As these vegetables are good sources of fiber, you are
encouraged to use more of these in your meal. Vegeta-
bles that have a * symbol are especially high in fiber.
Take these vegetables more often.
Acelgas (Chinese cabbage) Ampalaya fruit
Alagaw leaves Ampalaya leaves
Alugbati leaves Balbalulang (seaweed)
Baguio beans (abitsuelas) Mustard leaves
Bamboo shoot (labong) Okra
Banana heart (puso ng saging) Onion bulb
* Bataw pods, *Pako
Beets, Papaya green
Cabbage Patola
* Cassava leaves and tops Pepper fruit
Cauliflower Pepper leaves
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* Camote leaves Petsay
Celery Pokpoklo (seaweed)
Chayote fruit Radish
Chayote leaves *Saluyot
Cucumber Sigarilyas pods
Eggplant Spinach
* Gabi leaves Squash flowers
* Garlic leaves *Squash leaves
* Himbabao Stringbeans leaves
Kangkong (sitaw, dahon)
* Katuray flowers Sweet pea pods (sitsaro)
* Katuray leaves Talinum
Lettuce Tomato
Malunggay leaves Unsoy
Malunggay pods Upo
Mushroom, fresh
Group B Vegetables
Fresh:
Carrot *Pigeon pea pods
Coconut shoot (ubod) (kadyos, bunga)
* Cowpea pods (paayap, bunga) Rimas
* Kamansi *Singkamas pods (bunga)
* Langka hilaw Singkamas tuber
Lima bean pods (lamang ugat)
(patani,bunga) Squash fruit
Mungbean sprout (toge) Stringbeans pod
(sitaw, bunga)
* High in fiber.
Processed:
Food Wt. (g) Measure
E.P.
Asparagus tips 90 1 cup
Baby corn 15 2 (8 cm long x 5-1/2 cm
circumference each)
Green peas, canned 15 1 tablespoon
(Gisantes, nakalata)
Golden sweet corn, 20 2 tablespoons
canned
Mushroom, canned 110 1/3 cup
Tomato juice, canned 60 ½ cup undiluted
FRUIT EXCHANGE
Each item on this list contains about 10 grams of car-
bohydrate and 40 calories.
Fruits are valuable for their vitamin, mineral and fiber
contents. Include at least one exchange of fruits rich in
Vit. C daily in the diet. These are listed under Group A.
Fruits that have * symbol are good sources of fiber. Take
these fruits more often. Fruit juices have negligible fiber
content.
Fruits that are prepared or canned in syrup should not
be used even if the syrup is rinsed off. The label in
canned fruits and juices should state “no sugar added”
or “unsweetened”.
Fruits may cause an increase in blood sugar, thus,
77
Diabetes Nutritional Handbook
diabetic meal plans allow no more than 5 exchanges * Pear 118 85 1 (6 cm diameter)
a day. Pineapple 129 75 1 slice (10x6x2 cm)
or ½ cup
Your diet plan contains exchanges from Rambutan 139 50 8 (3 cm diameter each)
the fruit group distributed as follows: * Santol 127 75 1 (7 cm diameter)
Singkamas tuber 124 110 ½ of 9 cm diameter
Breakfast Morning Lunch Afternoon Supper Bedtime or 1 cup
Snack Snack Snack Siniguelas 78 50 5 (3 cm diameter each)
Star apple 123 65 ½ of 6 cm diameter
Tamarind ripe 34 15 2 of 6 segments each
* Watermelon 226 140 1 slice (12x6x3 cm)
or 1 cup
Food Wt. (g) Measure
A.P. E.P C. Canned, Drained

A. High Vitamin C Pineapple, crushed 60 3 tbsp., unsweetened

* Anonas 65 35 ½ of 5x8 cm D. Dried

Atis 70 45 1 (5 cm diameter)
Cashew 78 70 1 (7x6-1/2 cm) Champoy, salted 10 4 (2 cm diameter each)
Dalanghita 300 135 2 (6 cm, diameter each) Prunes, seedless 15 3 pieces, unsweetened
* Datiles 61 50 1 cup
* Guava 81 80 2 (4 cm diameter each) E. Juices, unsweetened 80 1/3 cup
Guwayabano 86 60 1 s l i c e ( 8 x 6 x 2 c m ) canned (orange,
or ½ cup pineapple, prune)
Kamachile 110 55 7 pods
Mango: F. Others
Green 90 65 1 slice (11x6 cm)
Ripe 103 60 1 slice (12x7 cm) Buko meat 100 ½ cup
or ½ cup cubed Buko water 1
80 1 cup
Papaya ripe 133 8 5 1 slice (10x6x2 cm)
or ¾ cup FAT EXCHANGE
* Strawberry 168 165 1-1/4 cups
Suha 160 90 3 segments Each exchange of fat contains about 5 grams of fat
(8x4x3 cm each) and 45 calories.
* Tiesa 41 30 ¼ of 10 cm diameter
Fat may be classified into monounsaturated, polyun-
B. Other Fresh Fruits saturated or saturated type. The fats found in animal
sources except marine oil consist of significantly large
Apple 86 65 ½ of 8 cm diameter number of saturated fatty acids which solidify at room
or 1 (6 cm diameter) temperature. Vegetable oils except coconut oil contain
* Balimbing 153 135 1-1/2 of 9x5 cm more unsaturated fatty acids and exist as liquid at room
Banana: temperature.
Bungulan 60 40 ½ of 15x4 cm
Lakatan 51 40 1 (9x3 cm) As a person with diabetes, you should modify your fat
Latundan 55 40 1 (9x3 cm) intake by taking in prescribed amounts of polyunsaturated
Saba 70 40 1 (10x4 cm) fats instead of saturated fats to control the development
* Chico 54 45 (4 cm diameter) of heart diseases.
Duhat 80 60 20 (2 cm diameter each)
Durian 150 30 1 segment of Your diet plan contains exchanges from the
6-1/2 x4-1/2cm fat list distributed as follows: ( exchanges
or 1-1/2 tablespoons should be selected from Group A).
* Grapes 69 55 10 (2 cm diameter each
or 4 (3 cm diameter each) Breakfast Morning Lunch Afternoon Supper Bedtime
Jackfruit ripe 118 40 3 segments Snack Snack Snack
(6 cm diameter each)
Lansones 103 7 0 7 (4x2 cm each)
Lychees 77 50 5 (3 cm diameter each)
* Mabolo 83 50 2/3 of 6 cm diameter
* Makopa 169 135 3 (4 cm diameter each) Food Wt. (g) Measure
Mango: E.P
medium ripe 90 65 1 slice (11x6 cm)
indian 140 8 0 1 (6 cm diameter) A. Saturated Fats
* Paho 92 70 9 small
* Mangosteen 212 55 3 (6 cm diameter each) Bacon 10 1 strip-10x3 cm
Marang 35 21 ½ of 12x10 cm Butter 5 1 teaspoon
Melon kastila 317 200 1 slice (12x10x3 cm) Coconut grated 20 2 tablespoons
or 1-1/3 cup Coconut cream 15 1 tablespoon

78

Coconut oil 5 1 teaspoon
Cream cheese 15 1 tablespoon
Latik 10 2 teaspoons
Margarine 5 1 teaspoon
Mayonnaise 5 1 teaspoon
Sandwich spread 15 1 tablespoon
Sitsaron 10 2 ( 5x3 cm each)
Whipping cream,
heavy/light 15 1 tablespoon
B. Polyunsaturated Fats
Oil (corn, marine, 5 1 teaspoon
soybean , rapeseed-canola, rice,
sunflower, safflower, sesame)
C. Monounsaturated Fats
Avocado 65 ½ of 12x7 cm
Peanut butter 10 2 teaspoons
Pili nut 5 5 pieces
Peanut oil, olive oil 5 1 teaspoon
Shortening 5 1 teaspoon
D. Processed Fat Product
Kropeck 20 4 (7-1/2x11-1/2 cm each)
APPENDIX B
ALCOHOLIC BEVERAGES
The list gives you information on some commonly used
alcoholic beverages. The last column tells you how many
rice and fat exchanges to deduct from your meal plan in
case alcoholic beverages are not included in you meal
plan and you use any of the listed beverages.
Alcoholic Wt. Energy Measure* Rice and fat
Beverages (g) Eq. (No. of Biomedical Nutrition Division. Food and Nutrition Research Institute. Food
exchanges)
Basi 170 185 1 glass-6 oz. 1 rice, 2 fat
Beer,
cerveza 320 163 1 bottle-11 oz 1 rice, 1 fat
Brandy,
cognac 30 75 1 brandy glass ½ rice, ½ fat
Daiquiri 56 124 1 cocktail glass 1 rice, ½ fat
Gin, dry 43 107 1 jigger ½ rice, 1 fat
Gin, ginebra 360 832 1 bottle-12 oz. 7 rice, 3 fat
High ball 240 170 1 glass 1 rice, 1-1/2 fat
Manhattan 56 167 1 cocktail glass 1 rice, 1-1/2 fat
Martini 56 143 1 cocktail glass 1 rice, 1 fat
Mint julep 240 217 1 glass 1 rice, 2-1/2 fat
Old fashioned 240 183 1 glass 1 rice, 2 fat
Rum 43 107 1 jigger ½ rice, 1 fat
Tom Collins 300 182 1 tall glass-10oz 1 rice, 2 fat
Tuba 240 89 1 glass ½ rice, 1 fat
Whisky,
scotch 43 107 1 jigger ½ rice, 1 fat
Wine, red 100 73 1 wine glass ½ rice, 1 fat
Wine,
champagne 100 85 1 wine glass ½ rice, 1 fat
(sweet and dry)
* unless specified: 1 glass=8 oz; brandy glass=1 oz.; cocktail glass=2 oz;
jigger = 1-1/2 oz; wine glass = 3/1/2 oz.
Learn to access drug info on your cellphone. Send PPD to 2600 for Globe/Smart/Sun users.
Diabetes Nutritional Handbook
Wine, port 100 160 1 wine glass 1 rice, 1 fat
Wine, rose 100 85 1 wine glass ½ rice, 1 fat
Wine,
vermouth,
French 100 108 1 wine glass ½ rice, 1 fat
Wine,
vermouth
Italian 100 170 1 wine glass 1 rice, 1-1/2 fat
APPENDIX C
BEVERAGE LIST
This list gives the nutrient composition of other com-
mercially available flavored milk drink, yoghurt/diet soft
drink.
Beverage Net
contents Measure Calories Pro Fat CHO
(mL) (g) (g) (g)
A. Yughurt Lite n’ Rite
Apricot 125 ½ cup 50 5 <1 6
Grape 100 7 tablespoons 40 4 <1 5
Natural 125 ½ cup 100 2 <1 20
Orange 100 7 tablespoons 40 4 <1 5
Strawberry 125 ½ cup 50 5 <1 6
B. Diet Cola 237 1 bottle 2 0.2 0 0.2
330 1 can 3 0.3 0 0.3
REFERENCES
American Diabetes Association. Diabetes in the Family. Maryland: Robert
J. Brady Co., 1982.
American Diabetes Association, Inc. and The American Dietetic Association.
Exchange Lists for Meal Planning. 1994.
Exchange Lists for Meal Planning. FNRI Publication No. 57-ND 8(3),
3rd revision. 1994.
Cardino, M.I.Q. “Are Diabetics Allowed Alcohol?” Diabetes Watch. 5(April
1988):1.
Claudio, V.S.; de Guzman, M.P; and Oliveros, M.S. Basic Diet Therapy for
Filipinos. Manila: Merriam and Webster, Inc., 1983.
Correa-Santiago, V. “Thou Shalt Take Care of Thine Feet. “Diabetes Watch.
4 (December 1987): 4.
De los Santos, E.T. “Why Exercise?... Its Benefits to the diabetic patient”
Diabetes Watch. 4(April 1987):2.
Dietetic Staff of Mayo Clinic. Meal Planning for Diabetes. Minnesota: Mayo
Foundation, 1983.
Fernando, R.E. Diabetes. Quezon City: New Day Publishers, 1981.
Living with Diabetes. Maryland: Channing L. Bete Co., Inc., 1978.
Marble, A.; Krall, L.; Bradley, R.; Christlieb, A.R and Soeldner, J.S., eds.
Joslin’s Diabetes Mellitus. Philadelphia: Lea and Febiger, 1985.
Medical and Applied Nutrition Division, Food and Nutrition Research
Institute. Foods Highest and Lowest in Various Nutrients Manila: FNRI
Publication No. 33, 1979.
National Diabetes Information Clearinghouse, National Institute of Arthritis,
Diabetes, and Digestive and Kidney Diseases, National Institutes of
Health. The Diabetes Dictionary. Maryland: Eli Lilly and Company.
79
Diabetes Nutritional Handbook
GLOSSARY
It will be very useful for you to read as much as you can
about diabetes. The following are some terms that you
will encounter in your readings.
A
ACESULFAME K – or ace K, a sweetener that has little
or no calories.
ACETONE – or ketone body, a chemical formed in the
blood when the body uses fat instead of glucose (sugar) for
energy. If too much acetone forms, it usually means that
the cells do not have enough insulin, or can not use the in-
sulin that is in the blood, to metabolize glucose for energy.
ACIDOSIS - too much acid in the blood. In a person with
diabetes, this is due to the accumulation of ketones.
ALBUMINURIA – presence of a protein called albumin in
the urine. It may be a sign of kidney disease, a problem
that can occur in people who have had diabetes for a
long time ago.
ALPHA CELL – a type of cell in the pancreas. Alpha cells
make and release a hormone called glucagons which
raises the level of glucose (sugar) in the blood.
A.P. – as purchased, weight of edible plus inedible por-
tion of food.
ARTERIOSCLEROSIS – hardening of the arteries, which
may be due to different causes. One is when fats build
up inside the walls of the arteries.
ASPARTAME – a sweetener that can be used in place
of sugar. It has very few calories.
ATHEROSCLEROSIS – a disease in which fat builds up
in the large ad medium-sized arteries. This buildup of fat
slows down or stops blood flow. This disease can happen
to people who have had diabetes for a long time.
B FATTY ACID – a basic unit of fats.
BETA CELL – a type of cell in the pancreas. Beta cells
make and release insulin, a hormone that controls the
levels of glucose (sugar) in the blood.
BLOOD GLUCOSE – the main sugar that the body makes
from the three elements of food – proteins, fats, and
carbohydrates – but mostly from carbohydrates.
BLOOD GLUCOSE MONITORING – a way of testing how
much glucose (sugar) is in the blood. A drop of blood from
the tip of a finger or the earlobe is placed on the end of
a special strip of paper. The paper strip has a chemical
on it that makes it change color according to how much
glucose is in the blood. A person can tell if the level of
glucose is low, high or normal in one of two ways. The first
is by comparing the end of the paper strip to a color chart
that is printed on the side of the test strip holder.
The second way is to use a machine (meter). The strip
is inserted into the meter and the level of glucose in the
blood is read.
C level for the two to three-month period before the test.
CHOLESTEROL – a fat-like substance found in the blood,
muscle, liver, brain, and other tissues in people and
animals. The body makes and needs some cholesterol.
80
Too much cholesterol may cause fat to build up in the
artery walls and cause a disease (atherosclerosis) that
slows or stops the flow of blood.
COMA – a sleep-like state; not conscious; can be due to
high or low level of glucose (sugar) in the blood.
D
DEHYDRATION – great loss of body water. This may
happen when a person has a very high level of glucose
(sugar) in the blood because the excess glucose is ex-
creted in the urine together with a large amount of water.
DEXTROSE – another name for glucose.
DIABETIC COMA – a severe emergency in which a per-
son is not conscious because the blood glucose (sugar) is
too high and the blood has too many ketones (ketoacido-
sis). The person usually has a flushed face, dry skin and
mouth, rapid and labored breathing, a fruity or acetone
breath odor, a rapid, weak pulse, and low blood pressure.
DIABETIC KETOACIDOSIS (DKA) – Severe, out of
control diabetes that needs emergency treatment. DKA
happens when the blood does not have enough insulin
because the person is ill, does not take large enough
dose of insulin, or gets too little exercise. The body starts
using stored fat for energy, and ketone bodies (acids)
build up in the blood.
E
E.P. – edible portion, weight of food without inedible portion.
F
FASTING BLOOD GLUCOSE – the amount of glucose
(sugar) in the blood after 8 hrs. or more of fasting. The
normal amount is 60-100 mg/dL or 3.3-5.5 mmoles/L. an
amount higher than 140 mg/dL or 7.7 mmoles/L means
the person may have diabetes.
FRUCTOSE – a simple sugar, it is changed to glucose
in the body.
G
GESTATIONAL DIABETES MELLITUS (GDM) – a type of
diabetes mellitus that can occur when a woman is preg-
nant. In the second half of pregnancy, the woman may have
glucose (sugar) in the blood at a higher than normal level.
However, when the pregnancy ends, the blood glucose
level returns to normal in about 95 percent of all cases.
GLUCAGON – a hormone that raises the level of glucose
in the blood. The alpha cells of the pancreas make gluca-
gons when the body needs more sugar in the blood.
GLYCOSURIA – presence of glucose (sugar) in the urine.
This happens when there is too much glucose (sugar)
in the blood.
GLYCOSYLATED HEMOGLOBIN TEST – a blood test
that measures a person’s average blood glucose (sugar)
H
HORMONE – a chemical released by special cells to tell

other cells what to do. For instance, insulin is a hormone
made by beta cells in the pancreas, and when released,
it tells other cells to use glucose for energy.
HYPERGLYCEMIA – too much glucose (sugar) in the
blood; a sign that diabetes is out of control.
HYPERINSULINISM – too much insulin in the blood.
This occurs when the body makes too much insulin on
its own or when a person takes too much insulin. Too
much insulin in the body may cause the blood glucose
(sugar) level to go too low.
HYPERLIPIDEMIA – too much fat (lipid) in the blood. This
happens when the body is not using nutrients – carbo-
hydrates, fats or proteins – properly. This occurs when
diabetes is out of control.
HYPOGLYCEMIA – too little glucose (sugar) in the blood.
This occurs when a person with diabetes has injected
too much insulin. Eaten too little food, or has exercised
without extra food. A person with hypoglycemia may feel
nervous, shaky, weak, sweaty, and have a headache,
blurred vision, and hunger. Taking small amounts of
sugar, juice, or food with sugar will usually help the person
feel better within 10-15 minutes.
I POLYUNSATURATED FATS – a type of fat that comes
IMPAIRED GLUCOSE TOLERANCE (IGT) – blood
glucose (sugar) levels higher than normal but below the
level of someone with diabetes.
INSULIN – a hormone that helps the body use glucose
(sugar) for energy. The beta cells of the pancreas make
the insulin.
INSULIN DEPENDENT DIABETES MELLITUS (IDDM)
- a chronic condition in which the pancreas makes a little
or no insulin. The body is then not able to use glucose
(sugar) properly.
INSULIN SHOCK – a severe condition that occurs when
the level of blood glucose (sugar) drops quickly. The signs
are shaking, sweating, dizziness, double vision, convul-
sions, and collapse. Insulin shock may occur after taking
too much insulin, too little food, or exercising without extra
food. Also called hypoglycemia.
J RISK FACTOR – anything that raises the chance that a
JUVENILE-ONSET DIABETES – former name of insulin-
dependent or type I diabetes.
N SACCHARIN – a sweetener that people use in place of
NEPHROPATHY – disease of the kidneys caused by
damage to the small blood vessels or to the units in
the kidneys that clean the blood. People who have
had diabetes for a long time may have this kidney
damage.
NON-INSULIN DEPENDENT DIABETES MELLITUS
(NIDDM) – the most common form of diabetes mellitus;
about 90 percent of the people with diabetes have this
kind. The body produces insulin but the insulin is not
working properly.
O U
OBESITY – the condition when people have 20 percent
(or more) extra body fat for their age, height, sex, and
bone structure. This increases the risk of a person with
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Diabetes Nutritional Handbook
diabetes to complications.
ORAL GLUCOSE TOLERANCE TEST (OGTT) – a test
to see if a person has diabetes.
ORAL HYPOGLYCEMIC AGENTS – drugs or medicines
(pills or capsules) that lower the level of glucose (sugar)
in the blood. They work for some people whose pancreas
still makes some insulin.
OVERWEIGHT – the condition when people have more
than 10-19 percent extra body fat for their age, height,
sex, and bone structure.
P
PANCREAS – an organ behind the lower part of the stom-
ach that is about the size of a hand. It makes insulin so
that the body can use glucose (sugar) for energy. It also
makes enzymes which may help the body digest food.
POLYDIPSIA – a great thirst that lasts for long periods
of time; a sign of diabetes.
POLYPHAGIA – very great hunger; a sign of diabetes.
People with this great hunger often loose weight.
from vegetables.
POLYURIA – having to urinate often; a common sign
of diabetes.
POSTPRANDIAL BLOOD GLUCOSE - the amount of
glucose (sugar) in the blood 1-2 hours after eating.
POTENTIAL ABNORMALITY OF GLUCOSE TOLER-
ANCE (PotAGT) – a term for people who have normal
blood glucose levels when tested for diabetes but who
are thought to be at a higher risk of diabetes than others
for a variety of reasons, such as having a family history
of the disease. PotAGT used to be called “prediabetes”
or “potential diabetes”.
R
RETINOPATHY – a disease of the small blood vessels
in the retina of the eye.
person will get a disease.
S
sugar because it has no calories.
SATURATED FAT - a type of fat that comes usually
from animals.
SELF BLOOD GLUCOSE MONITORING – a way a
person can test how nuch glucose (sugar) is in the blood.
Also called home blood glucose monitoring.
SUCROSE – the chemical name of the sugar we use
everyday; it is broken down to simpler sugars – glucose
and fructose during digestion.
UNDERWEIGHT – the condition when people have less
than 10 percent body fat for their age, height, sex and
bone structure.
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Diabetes Nutritional Handbook
Index of Product Classes Related to the Handbook
For the doctor's convenience, this index lists the therapeutic classifications discussed in or related to the Handbook.
Brands available in the PPD references are also listed under each of the classes. For product information, refer to
the PPD references (PPD, PPD Pocket Version, PPD Text, PPD Tabs, and www.TheFilipinoDoctor.com).

Insulins Vidagliptin + Metformin Prialta

Short-acting Insulins Galvusmet* Prialta-Met*
Actrapid HM Zeal
Apidra Solostar Meglitinides Zolid
Humalog Nateglinide ZolidPlus*
Humulin R (Regular) Starlix Zoliget*
Insuget-R Repaglinide Zypi
NovoRapid FlexPen Novonorm
Scilin R Diabetes-Related Food Supplements
Wosulin-R Sulfonylureas Ampalaya leaves
Intermediate-acting Insulins First Generation Amargozin
Humalog Mix 25 Chlorpropamide Glucontrol*
Humulin 70/30 Second Generation Jimm's Herbal Capsule*
Humulin N (NPH) Glibenclamide Banaba powdered leaves
Insuget-N/ Insuget 70/30 Daonil Diaban
Insulatard HM/Insulatard HM Flexpen Euglo Plus* Glucontrol*
Mixtard 30 HM/ Mixtard 30 HM Flexpen Euglodin Chromium picolinate
NovoMix 30 FlexPen Euglucon Diamaxin*
Wosulin-30/70 Glucovance* Glucontrol*
Wosulin-N Melix Natural Formula Chromium
Long-acting Insulins Orabetic Picolinate
Lantus/Lantus Solostar Sucron Exenatide
Levemir FlexPen Winthrop Glibenclamide Byetta
Gliclazide Food formula
Oral Hypoglycemics Clibite Diabetasol Nutrition Powder
Alpha Glucosidase Inhibitors Diamicron/Diamicron MR/ for Diabetics
Acarbose Diamicron MR 60 Glucerna
Glucobay 50/Glucobay 100 Dianorm Glucerna SR
Gluconase Gliget MR
Voglibose Glubitor/Glubitor-OD
Basen Gluconil
Glimepiride
Biguanides Acotril
Metformin HCl Aforglim 1/ 2/ 3/ 4
Ansures ER Arya
Azulix 1 MF* Azulix
Diafat Azulix 1 MF*
Euglo Plus* Diaberid
Fornidd Diaglim
Galvusmet* Euglim
Glucophage/Glucophage Forte Getryl
Glucophage XR Glimarex
Glucovance* Glimed
Gludin Glipiren
Glumet/Glumet-XR Glyper
Humamet Melix
Janumet* Mira
Metta SR Neoglim
Neoform 500 Solosa
Nidcor Solosamet*
Panfor SR-500/Panfor SR-1000 Sulfast 1/2/3/4
Pharex Metformin Syngly-4
Prialta-Met* Winthrop Glimepiride
Ritemed Metformin HCl Zoliget*
Solosamet* Glipizide
Winthrop Metformin HCl Glimax
ZolidPlus* Minidiab/Minidiab OD

Dipeptidyl Peptidase 4 (DPP-4) Thiazolidinediones

Inhibitor Pioglitazone
Saxagliptin Actos
Onglyza Diabetone
Sitagliptin phosphate Glitaz
Januvia Glitter 15/30
Sitagliptin phosphate + Metformin Glucozone
Janumet* Pharex Pioglitazone
Vidagliptin Piozar
Galvus Piozone

82