Medication

Oral Antidiabetic Agents

These are the drug which reduces blood glucose level and are effective orally. These are used ONLY FOR THE TREAMENT OF TYPE 2 DIABETES.

They are mainly of two types
  • Insulin Secretogogues: These drugs squeeze the beta cells and increases secretion of insulin from beta cells. Examples are Sulfonylureas, Meglitinides, etc.
  • Insulin sensitizers: These drugs reduce insulin resistance and decreases insulin requirement as well as blood glucose levels. Examples are Metformin, Pioglitazone etc

View Chart

Refer the table for details of Oral Antidiabetic Drugs. Your doctor will choose right drug for you.

When does doctor prescribe OADs to diabetic patients?
  • If the patient is having mild to moderate hyperglycemia i.e. FPG is 200 to 250 mg/dL doctor may prescribe single or combination of oral antidiabetic agent.
  • If the patient is having severe hyperglycemia i.e. FPG is more than 250 mg/dL doctor may prescribe insulin along with oral antidiabetic agents.

Points to remember while on OHA
  • Never take anyone else's diabetes pills
  • Learn the name of your medicine, dosage & how often to take it especially in relation with meal times
  • In case of missed dose, extra dose should not be taken next time
  • If meal not eaten, the dose should be skipped

The purpose of oral medications is to lower blood glucose. Therefore, the person taking them must eat regular meals and engage in only light to moderate exercise, to prevent blood glucose from dipping too low.


Insulin

Insulin is produced by beta cells of pancreas in our body. Production of insulin can be done in industry by using various techniques. It is gold standard for the treatment of diabetes. Patients of type 1 diabetes are dependent on Insulin for survival. While majority of patients of type 2 diabetes will require insulin for the control of blood glucose level some time in their life.

Insulin assists the uptake of glucose from the blood into the cells of tissues. This prevents abnormal high blood glucose level during periods of food intake and provides energy to cells.

Types of insulin:

Insulin can be classified into four different types depending upon the source of insulin. They are
  • Bovine: Insulin obtained from beef pancreas.
  • Porcine: Insulin obtained form pork pancreas
  • Human Insulin: They are obtained by recombinant technology in which we use Yeast or E. Coli for the production of insulin.

Insulin analogues: They are obtained by altering the sequence of amino acids in human insulin.

Out of this human insulin and insulin analogues are the most widely used insulin.

Depending on the duration of action insulin is also classified as Short acting, Intermediate acting, and long acting insulin. Also preprations containing combination of various proportion of short acting and intermediate insulin is available.

Insulin strength is measured in international units (IU). The formulations of insulin are available in 40 IU/ml and 100 IU/ml strength.

Refer the table for the details of different type of insulin available. Following table gives examples of types of insulin available.

Preparation Onset (hours) Peak (hours) Effective Duration (hours)
Short acting
Lispro <0.25 0.5-1.5 3-4
Aspart <0.25 0.5-1.5 3-4
Regular 0.5-1.0 2-3 3-6
Intermediate acting
NPH (Neutral protamine Hagedorn) 2-4 6-10 10-16
Long acting
Glargine 4 -- 24
Detemir 3-4 hours 6 to 8 hours up to 14 hours
Combinations
30/70 (i.e. 30% regular + 70%NPH) 0.5-1 Dual 10-16
50/50 (i.e. 50% NPH, 50% regular) 0.5-1 Dual 10-16
Lispro 75/25 (75% protamine lispro + 25% Lispro) 0.5-1 Dual 10-14
Biphasic Aspart (BIAsp 30/70) 0.5-1 Dual 10-14

When does doctor advise insulin to a diabetic patient?

  1. Severe fasting hyperglycemia at diagnosis i.e. FPG between 250 to 300mg/dL
  2. Type 2 diabetic patients failing to achieve target glucose control with oral antidiabetic drugs i.e. FPG >130mg/dL
  3. Diabetic patients with complications like ketoacidosis.
  4. Diabetic patients having illness and undergoing surgery.

Your doctor will choose the best time for initiation of insulin for you.
Stability and storage of insulin:

  1. Insulin is stored in a refrigerator at approximately 35 to 46°F (Approx. 2 to 8°C). Unopened and stored in this manner, these products maintain potency until the expiry date on the package label. (Applicable for Vials, cartridges and pens loaded with cartridges).
  2. However, all of the available insulin products may be left unrefrigerated between 59°F and 86°F (15 to 30°C) for up to 28 days and still maintains potency.
  3. Try to keep insulin away from direct heat and out of direct sunlight, but if you are using ice, also avoid freezing the insulin.
  4. Avoid excess agitation (handle carefully).
  5. Prefilled syringes should be kept upright in position.
  6. Single pass of insulin through airport surveillance instrument DOES NOT affect stability. REPEATED PASS THROUGH AIRPORT SURVELIENCE INSTRUMENT OR EXCESS EXPOSURE TO RADIATION MAY ALTER INSULIN POTENCY.

Insulin which has been frozen must not be used after thawing.

Too high storage temperatures may lead to a gradual decrease in biological potency. Certain visible changes may also appear, depending on the rise in temperature and the period of storage. Clear, soluble insulin may precipitate and give the preparation a cloudy appearance. Cloudy insulin suspensions may become granular or clumped. The combination of high temperature and prolonged shaking or vibration will speed up the process just described.

A classic example is the insulin user who, on a warm and sunny day, places his insulin in the glove compartment of his car while driving a long distance. This must be avoided.

In conclusion, losses in potency are usually gradual and seldom drastic. However, certain conditions can make insulin useless within a relatively short time: Freezing, direct sunlight, and the combination of high temperature and vibrations.

Points to remember for the storage and stability of insulin:

  • Store the insulin in a cold place, preferably a refrigerator between 2°C and 8°C. Avoid freezing.
  • Do not expose insulin to heat and direct sunlight.
  • When traveling by air, place the insulin in a handbag, not in the check-in luggage due to risk of temperatures below the freezing point.

INSULIN DELIVERY DEVICES

Insulin Syringes
You will get two types of insulin syringes in the market viz. 40 IU syringe and 100 IU syringe.

In 40 IU syringe 1 ml is divided into 40 equal parts. Therefore minimum amount of insulin which you can inject with this syringe is one IU. You can use this syringe for injection of insulin preparation having 40 IU/ml strength only.

In 100 IU syringe 1 ml is divided into 100 equal parts. Therefore minimum amount of insulin which you can inject with this syringe is one IU. You can use this syringe for injection of insulin preparation having 100 IU/ml strength only.

Insulin Injection with a Syringe:

  • Wash hands with soap and water. Remove protective tamperproof cup (must be removed the first time a vial is used). Clean the rubber stopper on the vial with an alcohol swap. When using an insulin suspension (cloudy insulin), roll the vial between the hands until all the liquid is uniformly white and cloudy.
  • Remove any caps from the syringe and needle.

Drawing up the insulin dose from a vial with syringe:
Remember always to carefully read the instructions while preparing for the injection.

  • To facilitate the withdrawal of insulin, air should be injected into the vial. Start by pulling out the plunger to the number of insulin units needed back.
  • Put needle through the rubber stopper of insulin vial. Push plunger down, putting air into the vial. Leave needle in vial.
  • Turn vial and syringe upside down and hold together in one hand at eye level. Pull plunger down to any unit marker slightly beyond the needed dose of insulin. This pulls insulin into the syringe.
  • Check syringe for air bubbles. If any present, flick syringe firmly with finger. Now push plunger up to unit marker for the insulin dose. This pushes bubbles out and leaves the correct amount of insulin in the syringe.
  • Take needle out of vial for injection.
  • Make a skin fold and inject the insulin (subcutaneous injection).

Injection Technique with a Syringe:

  • Clean injection area (avoid frequent alcoholic swabs) and make a skin fold. Holding syringe like a pencil, quickly push needle all the way into the skin fold perpendicular to skin surface.
  • Push plunger all the way in to inject insulin beneath folded skin (subcutaneous tissue layer). Release skin and hold syringe in place for ten seconds to help ensure that the full dose is received.
  • Remove syringe. If slight bleeding occurs, gently press finger over the area for a few seconds to stop the bleeding. Do not rub injection area (this may cause insulin to be absorbed too quickly).
  • Syringe/needle disposal
    • Place syringes, needles, lancets in a metal container with a screw-on tightly or tightly secured lid.
    • Please consult your local laws and regulative for the disposal of syringe needle and lancet.

Use of Insulin Delivery Device Wosulin pen Royale

Insulin Pumps:
Insulin pumps are often worn in a small fancy-pack around your waist, although other options exist. They are programmable, and can be set to deliver a constant amount of insulin throughout the day (the basal rate) as well as larger amounts after meals and snacks (boluses). Insulin is delivered from the pump into a small catheter placed in your abdomen that is replaced every 3 days. The advantage of a pump is that it more closely mimics the way the body would naturally release insulin. And, of course, it's more convenient. You no longer have to inject yourself with insulin several times a day.

Principle of insulin pumps:
An insulin pump is made up of a pump reservoir (like a regular syringe, but bigger) filled with insulin, a small battery operated pump and a computer chip that allows the user to control exactly how much insulin the pump delivers. It is all contained in a plastic case about the size of a beeper.

The pump reservoir delivers insulin to the body by a thin plastic tube called an "infusion set." Infusion sets come in 24 inch and 42 inch lengths and have a needle or soft cannula at the end, through which the insulin passes. The needle or cannula is inserted under the skin, usually on the abdomen. The process of putting the infusion set in place is called "insertion," and is very much like giving a standard insulin injection. The infusion set is changed approximately every two to three days.

The pump is intended to be used continuously and delivers insulin 24 hours a day according to a programmed plan unique to each pump wearer. A small amount of insulin is given continually (the "basal rate"). This insulin keeps blood glucose in the desired range between meals and over night. When food is eaten, the user programs the pump to deliver a "bolus dose" of insulin matched to the amount of food that will be consumed.

The pump is not automatic! The user still has to decide how much insulin will be given. But pumps are the most accurate, precise, and flexible insulin delivery systems currently available. Using the results of blood glucose monitoring, the experienced pump user can use this tool to obtain excellent blood glucose control while living a normal lifestyle, free of the strict scheduling demands that are required by conventional insulin regimens.

Salient features of insulin pump:
  • Insulin pumps usually allow better control of your blood glucose, as well as some freedom from the daily routine of injecting insulin.
  • Waterproof/shockproof pouch is available, which allows you to take it into the shower or a swimming pool.
  • Most people keep the pump in a specially designed case to minimize cosmetic damage caused by bumps, perspiration, dirt and grime. To clean the pump, it should be washed with a damp cloth and mild soap. No other regular maintenance of the pump is required.
  • Pump has multiple built-in safety alarms to alert you if your pump stops delivering insulin, including alarms for low and depleted batteries, empty reservoir, and clogged infusion set. A series of safety checks are performed every minute, every motor stroke, and upon each programming change


Tips on how to use insulin pump:
  • Sterile technique
    • Wash your hands thoroughly with soap and water .
    • Another source for bacteria is the breath exiting the mouth and nose. Do not blow on the infusion site or anything else to dry it. Keep your reservoir and infusion set at eye level to avoid breathing on them.
    • The countertop on which the infusion set and equipment are placed before insertion can be another source for bacteria. Use a clean countertop and keep critical items like the infusion set safely in their sterile wrapping prior to insertion.
  • Insulin, tapes, dressing: Usually lispro insulin is preferred for use although it is not officially approved . Any standard insulin can be used with consultation of your doctor. Tapes, skin preparations, and transparent dressings can greatly aid safe pump operation. For dressings, a bio-occlusive dressing is preferred. They allow sweating but keep bacteria from passing through to the skin
  • Sites: For sites, most pumpers prefer the abdomen, but anywhere that has padding will do. Normal skin contains bacteria, so it's best to use a sterile prep on the new site prior to inserting the infusion set to reduce the chance for an infection. Bacteria move on the skin, so a wide swath is smart. This can greatly reduce the risk of an infection through the hole created by the infusion set.
  • Preventing infections: Bio-occlusive dressings are preferred for the skin. They allow sweating but keep bacteria from passing through to the skin. This can greatly reduce the risk of an infection through the hole created by the infusion set.
  • Use of infusion set: There are a wide variety of infusion sets available. Many have an adhesive surface that sticks to the skin.
  • Insert the infusion set: Once the infusion set is inserted, hold the infusion line gently against the skin until a safety loop is in place.
  • A safety loop is placed to the side away from the infusion set. Safety loops keep the infusion set from being pulled out when a pump is dropped or the line catches on something.


Approaches under development:

Implantable insulin pumps are surgically implanted, usually on the left side of the abdomen. The pump is disk shaped and weighs about 6 to 8 ounces. It delivers a basal dose of insulin continuously. Users deliver bolus insulin doses with a remote control unit that prompts the pump to give the specified amount of insulin.

An advantage of this method is that, like insulin produced naturally from the pancreas, the insulin from the pump goes directly to the liver to prevent excess sugar production there.

Alternate Medicine

Content







NORTH INDIA

  • Calories- 1400 kcal
  • Carbohydrates- 197g (57%)
  • Proteins- 62g(18%)
  • Fat – 30 g(20%)
  • Visible fat- 15g
Breakfast 1 glass milk (150ml) (low fat milk)
+ 3-4 almonds + 3-4 walnuts (optional, can be taken in early morning)
+ 2 brown bread slices
Or whole wheat porridge (40g)
Or 1 bowl oats (50g)
Or 2 veg paratha (20g each) no oil or ghee
Mid-morning 1 fruit  or 2 cookies or roasted  dal (15g)
Lunch + 1 bowl salad(tomato, onion , cucumber)
+ 1 katori cauliflowervegetable (100 g cooked)
+  2 chapatis (20g each)/  1 bowl rice (uncooked 40g)
+ 1 katoridal (uncooked 30g)
+1 katori curd (150g)/ 1 glass buttermilk/  1 katoriraita (add veges)
Mid evening 1 cup tea (without sugar)
+  1 wati roasted chivra/ roasted dal / sprouts (30g)
Dinner Same as lunch
or 1 bowl salad (tomato, onion, cucumber)
+ 1 katoriFrench beansvegetable (100g cooked )
+ 1 bowl rice ( uncooked 40g )
+ whole pulses (uncooked 30g) / 75g lean chicken/ grilled fish/low fat paneer
+ 1 bowl curd (125g) / 1 glass lassi (no sugar)(curd – 125g)
Bed time 1 cup milk (150 ml)(low fat milk)
Non vegetarians can exchange pulse/ curd for lean chicken/ grilled fish.


NORTH INDIA

  • Calories- 1600 kcal
  • Carbohydrates- 240g (60%)
  • Proteins- 63g (16%)
  • Fats – 45 (25%)

Breakfast
1 cup tea (without sugar)
1 cup milk (100ml) (low fat milk)
+ 3-4 almonds + 3-4 walnuts
+ 2 brown bread slices
Or whole wheat porridge (45g)
Or 1 bowl oats (50g)
Or 2 veg paratha (20g each) no oil or ghee
Mid morning 1 fruit  or 2 cookies or roasted  dal (15g)
Lunch + 1 bowl salad (tomato, onion, cucumber)
+ 1 katorivegetable (100 g cooked)
+  3chapatis (20g each)/  1 bowl rice (uncooked 45g)
+ 1 bowl dal (uncooked 30g)
+1 bowl curd (150g)/1 glass buttermilk/  1 katoriraita (add veges)(curd – 150g)
Mid afternoon 1 fruit (medium)
Mid-evening 1 cup tea (without sugar)
+  1 wati roasted chivda/ roasted dal / sprouts (30g) or 3 cookies
Dinner Same as lunch
or 1 bowl salad (tomato, onion, cucumber)
1 katori cauliflower veg ( 100g cooked )
+1 bowl rice ( uncooked 60g )
+ whole pulses (uncooked 30g) / 75g lean chicken/ grilled fish/low fat paneer
+ 1 bowl curd (150g) / 1 glass lassi (no sugar)(curd – 150g)
Bed time 1 cup milk (150 ml)(low fat milk)


NORTH INDIA

  • Calories- 1800 kcal
  • Carbohydrates – 278g (62%)
  • Proteins- 72g (16%)
  • Fats -48 g (24%)
  • Visible fat- 15 g

Breakfast
1 cup tea (without sugar)
1 glassmilk (200ml) (low fat milk)
+ 3-4 almonds + 3-4 walnuts
+ 2 brown bread slices
Or whole wheat porridge (45g)
Or 1 bowl oats (50g)
Or 2 veg paratha (20g each)
Mid morning 1 fruit  or 2 cookies or roasted  dal (15g)
Lunch + 1 bowl salad (tomato, onion, cucumber)
+ 1 ½ katoriBhindivegetable(150 g cooked)
+  4 chapatis (20g each)/ 2 bowl rice (uncooked 80g)
+ 1 bowl dal (uncooked 30g)
+1 bowl curd (150g)/1 glass buttermilk/  1 katoriraita (add veges)
Mid afternoon 1 fruit (medium)
Mid-evening 1 cup tea (without sugar)
+  1  wati roasted chivra/ roasted dal / sprouts (30g)
Dinner Same as lunch
Or 1 bowl salad (onion, tomato, cucumber)
+ 1 ½  katori French beans vegetable (150 g cooked)
or 1 bowl rice ( uncooked 60g )
+ whole pulses (uncooked 30g) / 75g lean chicken/ grilled fish/low fat paneer
+ 1 bowl curd (150g) /1 glass lassi (no sugar)(curd – 150g)
Bed time 1 cup milk (150 ml)(low fat milk)


NORTH INDIA

  • Calories- 2000 kcal
  • Carbohydrates- 303 g (62%
  • Proteins- 79g (16%)
  • Fats- 51 g (23%)
Breakfast 1 cup tea (without sugar)
1 glass milk (200ml) (low fat milk)
+ 3-4 almonds + 3-4 walnuts
+ 3 brown bread slices
Or whole wheat porridge (60)
Or 1 bowl oats (60g)
Or 3 veg paratha (20g each)
Mid morning 1 fruit  or 2 cookies or roasted  dal (15g)
Lunch + 1 bowl salad (tomato, onion, cucumber)
+ 1 ½ katoricabbage vegetable (150 g cooked)
+  4 chapatis (20g each)/ 2 bowl rice (uncooked 80g)
+ 1 bowl dal (uncooked 30g)
+1 bowl curd (150g) /1 glass buttermilk/  1 katoriraita (add veges)
Mid afternoon 1 fruit (medium)
Mid-evening 1 cup tea (without sugar)
+  1 ½  wati roasted chivra/ roasted dal / sprouts (30g)
Dinner Same as lunch
Or 1 bowl salad (tomato, onion, cucumber)
1 ½ katoricabbage vegetable (150 g cooked)
or 1 bowl rice ( uncooked 60g )
+ whole pulses (uncooked 30g) / 75g lean chicken/ grilled fish/low fat paneer
+ 1 bowl curd (150g) / 1 glass lassi (no sugar)(curd – 150g)
Bed time 1 cup milk (150 ml)(low fat milk)

EAST INDIA

  • Calories- 1400 kcal
  • Carbohydrates- 193 g (55%)
  • Proteins-58.2 (16.5%)
  • Fats – 44.4 (28%)
Breakfast 1 cup milk (150 ml)
+ 1 egg white
+ 1  medium bowl Moori
or  1 ½ slice bread
0r  3 Tbsp oats / 3 Tbsp muesli/ 3 Tbsp wheat flakes /
Or 2 rotis (20g each)
Any cereal – 45 g
Mid morning 1 fruit (medium)
Lunch 1 bowl salad(tomato, onion, cucumber)
+ 1 katori bhindi vegetable (100g cooked)
+ 2 rotis (20 g each) or 1  bowl rice (40g  uncooked )
+ 1 wati dal (30g uncooked) / pulse / 75 g grilled/ panfried fish or lean chicken
+ 1 katori curd (150g)
Snack ¾ bowl roasted grams / sprouts/ 2-3 Marie biscuits
Dinner Same as lunch
Bed time 1 cup milk (150ml)


EAST INDIA

  • Calories- 1600 kcal
  • Carbohydrates-235 g (58%)
  • Proteins- 62 g (16%)
  • Fats – 45g (25%)
Breakfast 1 ½ cup milk (150 ml)
+ 1 egg white
+ 1  medium bowl Moori
or  1 ½ slice bread
0r  3 tbsp oats / 3 tbsp muesli/ 3 tbsp wheat flakes /
Or 2 rotis (20g each)
Any cereal – 45g
Mid morning 1 fruit (medium)
Lunch 1 bowl salad(tomato, onion, cucumber)
+ 1 bowl cauliflower vegetable (100g cooked)
+ 3 rotis (20 g each) or 1 ½   bowl rice (60g  uncooked )
+ 1 wati dal / pulse / 75 g grilled or panfried fish or lean chicken
+ 1 katori curd (150g)
Mid afternoon I fruit (medium)
Mid evening ¾ bowl roasted grams / sprouts/ / 2-3 marie biscuits
Dinner Same as lunch
Bed time 1 cup milk (150ml)


EAST INDIA

  • Calories- 1800 kcal
  • Carbohydrates-269 g (60%)
  • Proteins- 71 g (16%)
  • Fats – 55.3g (28%)
Breakfast 1 ½ cup milk (150 ml)
+ 2 egg white
+ 2 medium bowl Moori/ chire
or  3 slice bread
0r  4 Tbsp oats / 4 Tbsp muesli/ 4 Tbsp wheat flakes /
Or 3 rotis (20g each)
Any cereal – 60g
Mid morning 1 fruit (medium)
Lunch 1 bowl salad(tomato, onion, cucumber)
+ 1 ½ katori cluster beans (gavar) vegetable (150g cooked)
+ 3 rotis (20 g each) or 1 ½   bowl rice (60g  uncooked )
+ 1 wati dal (30 g uncooked ) / pulse / 75 g grilled or panfried fish or lean chicken
+ 1 katori curd (150g)
Mid afternoon I fruit (medium)
Mid evening ¾ bowl roasted grams / srouts/ / 2-3 marie biscuits
Dinner Same as lunch
Bed time 1 cup milk (150ml)


EAST INDIA

  • Calories- 2000 kcal
  • Carbohydrates (61.5%)
  • Proteins- 79g (16%)
  • Fats – 51 g (23%)
Breakfast 1 glass milk (200ml)
+ 2 egg white
+ 3 medium bowl Moori/ chire
or 4 slice bread
0r  5 ½ Tbsp oats / 5 ½  Tbsp muesli/ 5 ½  Tbsp wheat flakes
Or 4 rotis (20g each)
Any cereal – 80 g
Mid morning 1 fruit (medium)
Lunch 1 bowl salad(tomato, onion, cucumber)
+ 1 ½ bottle gourd (dudhi) vegetable (150g cooked)
+ 4 rotis (20 g each) or 2  bowl rice (80g  uncooked )
+ 1 wati dal / pulse (30g uncooked ) / 75 g grilled or panfried fish or lean chicken
+ 1 katori curd (150g)
Snack 1bowl roasted grams (45g) / sprouts/ 2-3 marie biscuits
Any cereal or pulse – 45 g
Dinner Same as lunch
Bed time 1 glass milk (200ml)

SOUTH INDIA

  • Calories- 1400 kcal
  • Proteins - 52 gms (15%)
  • Carbohydrates- 195gms (56%)
  • Fats – 51 g (23%)
  • visible fat- 15g
Breakfast 1cup tea/ milk/ coffee (without sugar)
+ 1 egg white
+ 3 small idlis + 1 wati sambhar / 1 ½ medium dosa + sambhar / 1 wati pongal + ¾ wati sambhar/  1 katori puttu + ½ wati channa masala/ 1 ragi roti + ¾ wati sambhar
Mid morning 1 cup milk (200ml) or buttermilk (300 ml)
Lunch 1 bowl salad (tomato, onion, cucumber)
+ 1 katorivegetablekurma (cooked)
+ ½ bowl rice/ 1 bowl pulao/ 1 bowl bissibelabhat/ 1bowl lemon tamarind rice  (uncooked  rice- 40g)
+ 2 wati rasam/ 2 wati sambhar/1 wati dal(pulses-30g)
+ 1 wati curd (150g)
Mid afternoon 1 fruit
Mid evening 1 cup tea/ milk / coffee(  without sugar)
+ ½ k Pakoda/ 1 veg cutlet (not fried)/ 1 meduvada/ 1 masala vadai/ ½ k sundal(rajma/cowpea/ Bengal gram/ green gram) /2 small idlis+ 1 watisambhar
Dinner 1 bowl salad (tomato, onion, cucumber)
+  1katori vegetable poriyal (cooked)
1 bowl curd rice/ ½ bowl tomato rice/ 1 adai
+ 1 wati curd
(uncooked rice- 40g)


SOUTH INDIA

  • Calories- 1600 kcal
  • Proteins- 58 g (14%)
  • Carbohydrates- 243 (60%)
  • Fats – 45g (25%)
  • visible fat – 15g
Breakfast 1 glass tea/ milk/ coffee (without sugar)
+ 1 egg white
+ 4-5  small idlis + 1 wati sambhar / 2 medium dosa + 1 watisambhar / 1 ½ katori pongal + ¾ wati sambhar/  1 ½  katori puttu + ½ wati channa masala/ 1 ½  ragi roti + ¾ wati sambhar
(Any cereal- 60g)
Mid morning 1 cup milk (150 ml) or 1 glass buttermilk (curd-100g)
Lunch 1 bowl salad (tomato, onion, cucumber)
+ 1 katori French beans vegetable (cooked)
¾  bowl cooked rice/ 1 ¼   bowl pulao/ 1 ¼   bowl bissibelabhat
(raw rice- 60g)
+ 2 wati rasam/ 2 wati sambhar/1 wati dal(any pulses-30g)
+ 1 wati curd (150g)
Mid afternoon 1 fruit
Snack 1 cup tea/ milk / coffee(  without sugar)
+ ½ k Pakoda/ 1 veg cutlet/ 1 medu vadai/ 1 masala vadai/ ½ k sundal(rajma/cowpea/ Bengal gram/ green gram) / 2 small idli + 1 watisambhar
(any cereal or pulse – 30g)
Dinner 1 bowl salad (tomato, onion, cucumber)
+ 1katoridudhivegetable
+ 1 ½   bowl curd rice/ ¾   bowl tomato rice/ 2 adai
(uncooked rice- 60g)
+ 1 wati curd (150g)
Or same as lunch
Bed time 1 cup milk (150 ml)


SOUTH INDIA

  • Calories- 1800 kcal
  • Proteins- 61 g (13%)
  • Carbohydrates- 280 g (61%)
  • Fats-49 g (24%)
  • Visible fat- 15g
Breakfast 1 glass tea/ milk/ coffee (without sugar)
+ 2 egg white
+ 4-5  small idlis + 1 wati sambhar / 2 medium dosa + sambhar / 1 ½ katori pongal + ¾ wati sambhar/  1 ½  katori puttu + ½ wati channa masala/ 1 ½  ragi roti + ¾ wati sambhar
(Any cereal- 60g)
Mid morning 1 cup milk(150 ml) or 1 glass buttermilk (curd-150g)
Lunch 1 bowl salad (tomato, onion, cucumber)
+ 1 katorigavar vegetable (cooked )
+ 1bowl rice/ 1 ½  bowl vegetable pulao/ 1 ½ bowl bissibelabhat (raw rice- 75g)
+ 2 wati rasam/ 2 wati sambhar/1 wati dal(any pulses-30g)
+ 1 wati curd (150g)
Mid afternoon 2 fruits (medium)
Snack 1 cup tea/ milk / coffee(  without sugar)
+ ½ k Pakoda/ 1 veg cutlet/ 1 medu vadai/ 1 masala vadai/ ½ k sundal(rajma/cowpea/ Bengal gram/ green gram) / 2
Any cereal or pulse- 30g
Dinner 1 bowl salad (tomato, onion, cucumber)
+ 1katori bhindi vegetable
+ 2 bowl curd rice/ 1 ½ bowl tomato rice/ 3 adai
(uncooked rice- 75 g)
+ 1 wati curd (150g )
Or same as lunch
Bed time 1 cup milk (150 ml)


SOUTH INDIA

  • Calories- 2000 kcal
  • Proteins- 72 g(14%)
  • Carbohydrates – 305 g (61%)
  • Fats – 53 g (24%)
  • visible fat – 15g
Breakfast 1 glass tea/ milk/ coffee (without sugar)
+ 2 egg whites
+ 4-5  small idlis + 1 watisambhar / 2 medium dosa + sambhar / 1 ½ katoripongal + ¾ watisambhar/  1 ½ katoriputtu + ½ watichanna masala/ 1 ½ ragi roti + ¾ watisambhar
(Any cereal- 60g)
Mid morning 1 cup milk(200 ml) or 1 glass buttermilk (curd-200g)
Lunch + 1 ½  wati cabbage vegetable (150g cooked)
1 ½ bowl rice/ 2  bowl vegetable pulao/ 2 bowl bissibelabhat (raw rice- 75g)
+ 2 watirasam/ 2 watisambhar/1 wati dal(any pulses-30g)
+ 1 wati curd (200 g)
Mid afternoon 2 fruits (medium)
Snack 1 cup tea/ milk / coffee(  without sugar)
+ 1 k Pakoda/ 2 veg cutlet/ 2 meduvadai/ 2 masala vadai/ 1 k sundal(rajma/cowpea/ Bengal gram/ green gram)
Any cereal or pulse- 60g
Dinner 1 bowl salad (tomato, onion, cucumber)
+ 1 ½  katori vegetable poriyal (150 g  cooked)
2 ½  bowl curd rice/ 2bowl tomato rice/ 3  adai
(uncooked rice- 75 g)
+ 1 wati curd (200g)
Or same as lunch
Bed time 1 cup milk (150 ml)

WEST INDIA

  • Calories- 1400 kcal
  • Protein- 53 g (15%)
  • Carbohydrates – 203g (58%)
  • Total Fat– 44g
  • visible fat- 15g
Early morning 1 cup tea/ milk/coffee (without sugar)
Breakfast 1 cup milk (100ml)
+ 1 ½ wati pohe (add vegetables or sprouts)/ 1 ½ wati upma / 3-4 small idlis with 1 wati sambhar/ 1 ½  small dosa with 1 wati sambhar/ 2 small uttapam with 1 wati sambhar/ 2 veg paratha (each paratha- 20g) or 1 ½ paratha (each paratha- 30g) / 1 bowl oats porridge (40g)
Any cereal- 30 gms
Mid-morning 1 fruit/ 2 marie biscuit with 1 cup tea/ coffee( without sugar)
Lunch 1 big wati salad (tomato, onion, cucumber)
+ 1 wati bhindi vegetable (cooked 100g)
+ 2 chapatis  (30g each) or 3 chapatis (20g each) or 1 chapati with ¾ k rice or 1 big bhakri (60g each) or 2 small bhakris (30g  each) 0r 1 ½  medium katori rice
(Any cereal- 60g)
+ 1 wati dal/ sprouts/pulses ( uncooked dal- 30g )
+ 1 wati curd (100g)/ 1  glass buttermilk/ 1 wati raita (100g curd with vegetables)
Mid afternoon 3-4 almonds + 3-4 walnuts (optional, can be taken early morning)
Snack ¾ big wati roasted chana/ 1 big or 2 small veg pudla (Chana flour- 30g)/ 1 big or 2 small mix dal chila /sprout salad (pulses – 30g )/ open faced sandwich ( 1 slice bread with toppings)
Dinner Same as lunch


WEST INDIA

  • Calories- 1600 kcal
  • Protein-  61g (15.3%)
  • Carbohydrates – 232g (58%)
  • Total Fat – 49g
  • visible fat- 15g
Early morning 1 cup tea/milk/coffee(without sugar)
Breakfast 1 cup milk (100ml)
+ 2 wati pohe (add vegetables or sprouts)/ 2 wati upma / 5 small idlis with 1 wati sambhar/ 3 small dosa with 1 wati sambhar/ 4  small uttapam with 1 wati sambhar/ 3  veg paratha (each paratha- 20g) or 2 paratha (each paratha- 30g) / 1 bowl oats porridge (60g)
Any cereal- 60 gms
Mid-morning 1 ½ fruit / 3 marie biscuit with 1 cup tea/ coffee( without sugar)
Lunch 1 big wati salad (tomato, onion, cucumber)
+ 1 wati cauliflower vegetable (cooked 100g)
+ 2 chapatis  (30g each) or 3 chapatis (20g each) or 1 chapati with ¾ k rice or 1 big bhakri (60g each) or 2 small bhakris (30g  each) 0r 1 ½  medium katori rice
(Any cereal- 60g)
+ 1 wati dal (thick)/ sprouts/pulses (uncooked dal or pulse- 30g)
+ 1 wati curd (150g)/ 1  glass buttermilk/ 1 wati raita (150g curd with vegetables)
Mid afternoon 3-4 almonds+ 3-4 walnuts
Mid-evening ¾  big wati roasted chana/ 1 big or 2 small veg pudla (Chana flour- 30g)/ 1 big or 2 small mix dal chila /sprout salad (pulses – 30g )/ 1 open faced sandwich ( 1 slice bread with toppings)
Dinner Same as lunch


WEST INDIA

  • Calories- 1800 kcal
  • Protein- 69 g (15%)
  • Carbohydrates- 270g(60%)
  • Fat- 54.8g (27%)
  • visible fat – 15g

Early morning
1 cup tea/milk/coffee(without sugar)
Breakfast 1 glass milk (200ml)
+ 2 wati pohe (add vegetables or sprouts)/ 2 wati upma / 5 small idlis with 1 wati sambhar/ 3 small dosa with 1 wati sambhar/ 3-4  small uttapam with 1 wati sambhar/ 3  veg paratha (each paratha- 20g) or 2 paratha (each paratha- 30g) / 1 bowl oats porridge (60g)
Any cereal- 60 gms
Mid-morning 1 ½  fruit / 3 marie biscuit with 1 cup tea/ coffee( without sugar)
Lunch 3 chapatis  (30g each) or 4 chapatis (20g each) or 2 chapati with ¾ k rice or 1 ½ big bhakri (60g each) or 3 small bhakris (30g  each) 0r 2  medium katori rice (Any cereal- 90g)
+ 1 wati dal (thick)/ sprouts/pulses (uncooked dal or pulse-30g)
+ 1 ½  wati bhindi vegetable (cooked 150g)
+ 1 ½  big wati salad (tomato, onion,cucumber)
+ 1 wati curd (150g)/ 1  glass buttermilk/ 1 wati raita (150g curd with vegetables)
Mid-afternoon 3-4 almonds + 3-4 walnuts
Mid-evening 1 cup tea/milk/coffee (without sugar)
+ 1 ½ big wati roasted chana/ 1 ½ big or 3 small veg pudla(Chana flour- 45g)/ 1 ½   big or 3 small mix dal chila /sprout salad (pulses – 45g )/1 ½  open faced sandwich ( 1 slice bread with toppings)
Dinner 1 big wati salad (tomato, onion, cucumber)
+ 1 ½  wati cauliflower vegetable (cooked 150g)
2 chapatis  (30g each) or 3 chapatis (20g each) or 1 chapati with ¾ k rice or 1 big bhakri (60g each) or 2 small bhakris (30g  each) 0r 1 ½  medium katori rice
(Any cereal- 60g)
+ 1 wati dal (thick)/ sprouts/pulses
+ 1 wati curd (150g)/ 1  glass buttermilk/ 1 wati raita (150g curd with vegetables)


WEST INDIA

  • Calories- 2000 kcal
  • Protein- 75.6 (15%)
  • Carbohydrates- 305 (61%)
  • Fat- 54.5 (24%)
  • visible fat – 15g
Early morning 1 cup tea/milk/coffee(without sugar)
Breakfast 1 glass milk (200ml)
+ 2 wati pohe (add vegetables or sprouts)/ 2 wati veg upma / 8 small idlis with 1 wati sambhar/ 4  small dosa with 1 wati sambhar/ 5 small uttapam with 1 wati sambhar/ 4  veg paratha (each paratha- 20g) or 3 paratha (each paratha- 30g) / 1 bowl oats porridge (60g)+ ½ wati boiled pulse
Any cereal- 90 gms
Mid-morning 1 ½  fruit / 3 marie biscuit with 1 cup tea/ coffee( without sugar)
Lunch 1 ½  big wati salad (tomato, onion, cucumber)
+ 1 ½  wati cabbage vegetable ( cooked 150g)
+ 3 chapatis  (30g each) or 4 chapatis (20g each) or 2 chapati with ¾ k rice or 1 ½ big bhakri (60g each) or 3 small bhakris (30g  each) 0r 2  medium katori rice
(Any cereal- 90g)
+ 1 wati dal (thick)/ sprouts/pulses (uncooked dal or pulse- 30g)
+ 1 wati curd (150g)/ 1  glass buttermilk/ 1 wati raita (150g curd with vegetables)
Mid afternoon 3-4 almonds + 3-4 walnuts
Snack 1 cup tea/milk/coffee (without sugar)
+ 1 ½ big wati roasted chana/1 ½  big or 3 small veg pudla(Chana flour- 30g)/ 1 ½  big or 3 small mix dal chila /sprout salad (pulses –45g )/ 1 ½ open faced sandwich ( 2 slice bread with toppings)
Dinner Same as lunch
Diabetes Meal Plan