CHOLELITHIASIS

INTRODUCTION
Cholelithiasis refers to the fom1ation of gallstones within the gallbladder or bile ducts. Gallstones
are solid particles that can develop due to an imbalance in the composition of bile, a digestive fluid
produced by the liver and stored in the gallbladder. Bile is necessary for digesting fats in the small
intestine.
Gallstones can vary in size from tiny grains to larger masses. They can be made up of different
substances, including cholesterol, bilirubin (a waste product), and calcium salts.
There are two main types of gallstones:
➔ Cholesterol Stones: These are the most common type of gallstones and are primarily composed
of cholesterol. An imbalance in the amount of cholesterol and bile salts in the bile can lead to
the formation of these stones. o
➔ Pigment Stones: These stones are smaller and darker in color, usually brown or black. They
are made up of bilirubin, a waste product formed when red blood cells are broken down.

AETIOLOGY OF CHOLELITHIASIS:
The etiology (causes) of cholelithiasis is multi factorial and involves a combination of genetic,
environmental, and lifestyle factors. Here are some key factors that contribute to the development
of gallstones:
➔ Imbalance in Bile Composition: Bile is a digestive fluid produced by the liver and stored in the
gallbladder. Gallstones can form when there is an imbalance in the composition of bile, leading
to excessive amounts of cholesterol, bilirubin, or other components. Cholesterol stones are the
most common type and are formed when there is an excess of cholesterol in bile, which can
crystallize and form stones.
➔ Obesity: Obesity is a significant risk factor for cholelithiasis. Obesity can lead to an increased
production of cholesterol by the liver and reduced gallbladder emptying, both of which
contribute to stone formation.
➔ Rapid Weight Loss: Rapid or substantial weight loss, especially through crash diets or weight
loss surgery, can increase the risk of gallstone formation. When the body breaks down fat
rapidly, it releases excess cholesterol into the bile, which can lead to stone formation
➔ Diet: A diet high in saturated fats, refined sugars, and low in fiber has been linked to an
increased risk of gallstones. Conversely, a diet rich in fruits, vegetables, whole grains, and
healthy fats may help reduce the risk.
➔ Genetics: There appears to be a genetic predisposition to gallstone formation. If family
members have a history of gallstones, an individual's risk may be higher.
➔ Gender and Age: Women are more susceptible to gallstones than men, and hormonal factors,
such as pregnancy, hormonal contraceptives, and hormone replacement therapy, can increase
the risk. The risk also increases with age.
➔ Certain Medical Conditions: Conditions that affect bile production, secretion, or flow, such as
cirrhosis, certain blood disorders, and certain genetic conditions. can increase the risk of
gallstone formation.
➔ Sedentary Lifestyle: Lack of physical activity and a sedentary lifestyle can contribute to
gallstone development.
➔ Medical Interventions: Prolonged use of ce1iain medications, such as those that lower
cholesterol (cholesterol-lowering drugs), and rapid intravenous feeding can increase the risk
of gallstones.
➔ Ethnicity: Certain ethnic groups, such as Native Americans and Hispanics, have a higher
prevalence of gallstones.

COMPLICATIONS IN CHOLELITHIASIS:
➔ Biliary Colic: This is a common symptom of cholelithiasis, characterized by sudden and
intense pain in the upper abdomen or right upper quadrant. It typically occurs when a gallstone
obstructs the cystic duct or gallbladder neck, causing the gallbladder to contract and push
against the obstruction. Biliary colic can last for several hours and may be triggered by fatty
or greasy foods.
➔ Acute Cholecystitis: If a gallstone becomes lodged in the cystic duct and obstructs the flow of
bile, it can lead to inflammation of the gallbladder. This condition is known as acute
cholecystitis and is associated with symptoms such as severe abdominal pain, fever, nausea,
vomiting, and tenderness in the right upper abdomen. If left untreated, acute cholecystitis can
progress to a more serious infection.
➔ Cholangitis: When a gallstone obstructs the common bile duct, it can cause a bacterial infection
in the bile ducts, leading to a condition called cholangitis. Symptoms of cholangitis may
include fever, jaundice (yellowing of the skin and eyes), abdominal pain, and chills.
Cholangitis is a medical emergency and requires prompt treatment with antibiotics and
potentially procedures to remove the obstruction.
➔ Gallstone Pancreatitis: In some cases, a gallstone can migrate from the gallbladder and become
lodged in the pancreatic duct, causing inflammation of the pancreas (pancreatitis). This can
lead to severe abdominal pain, nausea, vomiting, and potentially life-threatening
complications.
➔ Gallstone Ileus: Rarely, a large ga11stone can erode through the gallbladder wall and enter the
intestine, causing an obstruction known as gallstone ileus. This can lead to symptoms like
abdominal pain, nausea, vomiting, and bowel obstruction.
➔ Gallbladder Empyema: In severe cases of acute cholecystitis, the gallbladder can become
filled with pus, leading to a condition called gallbladder empyema. This requires urgent
medical attention and may necessitate surgical removal of the gallbladder.
➔ Gallbladder Cancer: While the risk is relatively low, long-standing inflammation of the gallbladder due
to gallstones can increase the risk of developing gallbladder cancer over time

SIGN AND SYMPTOM OF CHOLELITHIASIS:

➔ Abdominal Pain: The most common symptom of cholelithiasis is a sudden, intense pain in
the upper right or middle of the abdomen. This pain is often referred to as biliary colic and can
be triggered by the movement of gallstones within the gallbladder. Pain Radiating to the Back
or Shoulder: The abdominal pain may radiate to the back or between the shoulder blades.
➔ Nausea and Vomiting: Nausea and vomiting can occur, particularly if the pain is severe.
➔ Indigestion and Gas: Some people may experience bloating, gas, and discomfort after eating,
especially high-fat or greasy foods.
➔ Jaundice: If a gallstone obstructs the bile duct, it can lead 'to jaundice, a yellowing of the skin
and eyes due to the buildup of bilirubin in the blood.
➔ Fever and Chills: In cases of inflammation or infection of the gallbladder (cholecystitis) or the
bile ducts (cholangitis), fever and chills can develop.
➔ Changes in Stool Color: Pale or clay-colored stools may occur due to the lack of bilirubin
reaching the intestines.
➔ Dark Urine: The presence of excess bilirubin in the bloodstream can lead to darker urine.
Intolerance to Fatty Foods: Some individuals with gallstones may have difficulty digesting
fatty foods and may experience discomfort or bloating after consuming them.
➔ Sudden Intense Pain: If a gallstone blocks the flow of bile from the gallbladder, it can lead to
a sudden and severe increase in symptoms, including pain, nausea, and vomiting. This is
known as a gallbladder "attack."

DIAGNOSTIC TEST FOR CHOLELITHIASIS:

Some common diagnostic tests that might be used to assess cholelithiasis:

➔ Ultrasound: This is often the first-line imaging test for diagnosing cholelithiasis. It uses sound
waves to create images of the gallbladder and can detect the presence of gallstones.
➔ Abdominal CT scan: A computed tomography (CT) scan can provide detailed cross-sectional
images of the abdomen, including the gallbladder and surrounding structures. It may be used
if the ultrasound results are inconclusive or if there are complications.
➔ HIDA Scan: A hepatobiliary iminodiacetic acid (HIDA) scan is used to assess the functioning
of the gallbladder and bile ducts. A radioactive dye is injected into your veins, and a special
camera tracks its movement through the liver, gallbladder, and small intestine .This test can
help diagnose cholecystitis (inflammation of the gallbladder) or bile duct obstructions.
➔ Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure involves
inserting a flexible tube (endoscope) through the mouth and down into the duodenum to access
the bile ducts. Contrast dye is injected, and X-ray images are taken to visualize the bile ducts
and detect any blockages.
➔ Magnetic Resonance Cholangiopancreatography (MRCP): This is a non-invasive imaging
technique that uses magnetic resonance imaging (MRI) to create detailed images of the bile
ducts and pancreas. It can help identify gallstones and other abnormalities.
➔ Blood Tests: Blood tests, such as liver function tests and a complete blood count (CBC), can
provide information about the overall health of the liver and detect signs of inflammation or
infection.
➔ Laparoscopy: In some cases, a surgical procedure called laparoscopy might be performed. It
involves making small incisions in the abdomen and inserting a tiny camera to directly
visualize the gallbladder and surrounding structures.
➔ Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure involves inserting
a flexible tube (endoscope) through the mouth and down into the duodenum to access the bile
 ducts. Contrast dye is injected, and X-ray images are taken to visualize the bile ducts and detect
any blockages.
➔ Magnetic Resonance Cholangiopancreatography (MRCP): This is a non-invasive imaging
technique that uses magnetic resonance imaging (MRI) to create detailed images of the bile
ducts and pancreas. It can help identify gallstones and other abnormalities.
➔ Blood Tests: Blood tests, such as liver function tests and a complete blood count (CBC), can
provide information about the overall health of the liver and detect signs of inflammation or
infection.
➔ Laparoscopy: In some cases, a surgical procedure called laparoscopy might be performed. It
involves making small incisions in the abdomen and inserting a tiny camera to directly
visualize the gallbladder and surrounding structures.

TREATMENT FOR CHOLELITHIASIS:

➔ Watchful Waiting: If you have gallstones that are not causing symptoms. your doctor may
recommend a "watchful waiting" approach. This means monitoring your condition and
addressing any symptoms that may arise.
➔ Dietary Changes: For some people, dietary modifications can help manage symptoms and
prevent further gallstone formation. Reducing the intake of high-fat and high-cholesterol foods
might be recommended.
➔ Medications: Certain medications may be prescribed to dissolve cholesterol-based gallstones
or to manage symptoms. Ursodeoxycholic acid (UDCA) is one such medication that can be
used to dissolve small cholesterol gallstones.
➔ Laparoscopic Cholecystectomy: This is the most common surgical treatment for gallstones.
It involves the removal of the gallbladder through small incisions using a laparoscope. It's
usually recommended if you're experiencing frequent or severe symptoms, or if complications
are present.
➔ Open Cholecystectomy: In some cases, traditional open surgery might be necessary,
especially if there are complications or if laparoscopic surgery is not feasible.
➔ Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure is used to
remove gallstones that are causing blockages in the bile ducts. It combines endoscopy with X-
ray imaging.
➔ Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive procedure uses shock
waves to break gallstones into smaller pieces, which can then pass out of the body more easily.

MEDICAL NUTRITION THERAPY IN CHOLELITHIASIS:

➔ Low-Fat Diet: Since gallstones often form due to imbalances in bile composition, it's
important to limit dietary fat intake, especially saturated and trans fats. A low-fat diet helps
reduce the stimulus for the gallbladder to contract and release bile, which can help prevent
gallstone formation and alleviate symptoms.
➔ Healthy Fats: Include sources of healthy fats, such as avocados, nuts, seeds, and olive oil, in
moderation.
➔ High-Fiber Diet: A diet rich in dietary fiber helps regulate bowel movements and prevent
constipation. This can be beneficial in reducing the risk of gallstone formation. Include whole
grains, fruits, vegetables, and legumes in your diet.
➔ Moderate Protein Intake: Aim for moderate protein intake from lean sources such as poultry,
fish, legumes, and low-fat dairy products. A void excessive consumption of high fat meats.
➔ Hydration: Drink plenty of water throughout the day. Staying hydrated supports overall
digestion and helps prevent concentrated bile, which can contribute to stone formation.
➔ Limit Rapid Weight Loss: Avoid crash diets or rapid weight loss, as this can lead to the
breakdown of fat cells and an increased release of cholesterol into the bile, potentially
promoting gallstone formation.
➔ Portion Control: Be mindful of portion sizes to avoid overeating, as larger meals may trigger
gallbladder contractions.
➔ Limit Cholesterol Intake: Reduce intake of high-cholesterol foods, such as organ meats, egg
yolks, and full-fat dairy products.
➔ Avoid or Limit Certain Foods: Some individuals may need to avoid or limit foods that trigger
symptoms, such as fatty, fried, and greasy foods.
➔ Regular Meals: Aim for regular mealtimes and avoid skipping meals, as this can contribute
to irregular gallbladder contractions.
 CASE
STUDY
CHOLELITHIASIS

1. NUTRITIONAL SCREENING ON ADMISSION

I. PATIENT PROFILE:
NAME:ABC
AGE:79yrs.
GENDER:M
DOA: 6-06-2024
DOD: 10-06-2024

2. ANTHROPOMETRIC MEASUREMENT:

Weight (kg) 85 kg
Height (cm) 157 cm
BMI (kg/m 34.5 kg/m2
Physical Activity Sedentary

3. BIOCHEMICAL DATA
Diagnostic: Left upper limb advance ischemia -gangrenous forearm and hand -
secondary to the electric burns with associated neurovascular injury

Surgery: Left upper limb-- below elbow amputation and debridement

Blood investigations:

Test Values Range

Hemoglobin 11 13-17gms%
PCV 34.8 40-50%
TLC 6740 4000-100000cells /cumm
RBC 3.6 4.5 – 5.5 million/cumm
Platelet 2.2 1.5-4.1 lakhs/cumm
Serum Creatinine 0.4 0.66-1.25mg/dl
Serum Sodium 136 137-145mmol/l
Serum Potassium 3.4 3.5-5.1mmol/l
Serum chloride 103 94-110mmol/L
 Blood Urea 10 10-40mg/dl
Vitals:

Parameters On Admission Normal Range

Temperature (degree F) 98.6 98.6
Blood pressure (mmHg) 120/80 120/80
Pulse rate (bpm) 82 80

Other Investigations:

Investigation Interpretation
2D echo Sclerotic aortic valve
Abdominal ultrasound Over distended gall bladder with thick sludge
with increased wall thickness.
Calculus in the distal region
Endoscopic retrograde Dilated common bile duct with large square
cholangiopancreatography shaped stone
Liver function test:
Test Values Range
Total bilirubin 1.4 0.1-1.2 mg/dl
Alkaline phosphatase 126 44-147IU/l
SGOT 18 8-45units/l
SGPT 11 7-56 u/l
Total proteins 6.3 6-8.3gms/dl
Albumin 3 3.4-5.4g/dl
Globulin 3.3 6.4-8.3g/dl
A/G ratio 0.9 1.1-2.5 g/dl

4. CLINICAL DATA
• Present complaints: A bdomen pian in the right hypochondrium from the last few
days.
• Past medical history: No co – morbidities
• Surgery: Laparoscopic cholecystectomy+ common bile duct exploration
• Final Medical Diagnosis: Cholelithiasis with choledocholithiasis
MEDICATION TREATMENT

Medication Dosage Mechanism of Route Time

action
Tab oflox 200mg It is used to treat Oral Twice
cystitis, urinary
tract infection.
Tab. Pantodac 40mg It is used to treat Oral Before
heart burn, acid breakfast
reflux.
Tab. Dolo 650mg It treats Oral Twice
headaches, fever
and body pain.
Tab. Zofer 4mg Controls nausea, Oral -
vomit.
Syp. Duphalac 20ml It is used to treat Oral Once at night
constipation
Movicol sachet 1 sachet It is used to treat Oral Once at night
constipation

DIETARY HISTORY
- 24hrs- Home recall
Timings Meal Menu Quantity
8am Early morning Milk 1cup
Idly 2 serving
9am Breakfast Tomato chutney
Egg 1no.

Vegetable salad 1cup

2pm lunch Rice 2serving
Dal tadka 1cup
 French bean fugath 1cup
Buttermilk 1cup
4pm Snack Tea 1cup
8pm Dinner Phulka 3no.
Spinach dal 1cup
Cabbage curry 1cup

DETAILED 24 HOUR DIETARY HOME RECALL

Meal Food item Ingredients Qty Energy Protein Fat CHO

(g/ml) (Kcal) (g) (g) (g)
Early Milk Skim milk 100ml 29 2.5 0.1 4.9
morning
Sub total 29 2.5 0.1 4.9

Idly Rice 40g 147 7.3 1.0 28.4

Black gram 20g 65 4.6 0.3 10.2
dal
Breakfast Tomato Tomato 100g 20 0.9 0.4 2.7
chutney Onion 20g 10 0.2 - 0.9
Oil 2.5ml 22 - 2.5 -

Sub total 264 13 4.2 42.2

Vegetable salad Carrot 50g 11 0.5 0.1 4.8
lunch Cucumber 50g 9 0.4 0.1 1.5

Rice Rice 60gm 214 3.4 0.2 46.9

Dal tadka Red gram dal 30g 99 6.8 0.5 16.6

Onion
Oil 10g 5 0.1 - 0.5
2.5ml 22 - 2.5 -
 French bean French beans 100g 12 2.5 0.3 2.7
fugath Onion
Oil 20g 10 0.2 - 1.9
5ml 45 - 5 -

Buttermilk Milk 50ml 15 1.2 - 2.4

Sub total 442 15.1 3.7 77.3
Snack Tea Milk 50ml 15 1.2 - 2.4
Sub total 15 1.2 - 2.4
Dinner Phulka Wheat flour 60g 213 7.5 1.9 40.6
Red gram dal 15g 49 3.3 0.2 8.3
Spinach dal Spinach 100g 24 2.1 0.6 2.0
Oil 2.5ml 22 - 2.5 -
Cabbage 100g 25 1.3 0.1 5.8
Cabbage curry Onion 10g 5 0.1 - 0.9
Oil 5ml 45 - 5 -

Sub total 383 14.3 10.3 21.1

Grand total 1133 46.1 18.3 147.9

Nutritional Calculation of Home Diet Recall:

➔ Energy:1133 Kcal
➔ Protein:46.1g
➔ Carbohydrate :147.9g
➔ Fat:18.3g

5-Days present Hospital recall:

DAY DATE TYPE OF DIET Energy Protein

DAY – 1 6 – 06 – 2024 NBM - -
DAY – 2 7 – 06 – 2024 Oral liquid diet 1000 -
DAY – 3 8 – 06 – 2024 Low calorie soft diet 1300 45
DAY – 4 9 – 06 – 2024 Low calorie normal 1300 45
DAY – 5 10 – 04 – 2024 Low calorie normal 1300 45

II. Nutritional Diagnosis (PES statement)

Inadequate energy intake (NI-1.2) related to level 1 trauma with 40% total body surface
 area burns as evidence by BMI of 20 kg/m2 and difference of 10 kg between actual body
weight and ideal body weight.

III. Nutrition Intervention:

Medical Nutrition Therapy

Adequate energy, adequate protein, low fat, adequate carbohydrates, high fibre, adequate fluids,
adequate vitamins diet is advised.

• Short Term Goals:

➔ Manage the symptoms

➔ Maintain weight
➔ Prevent complications.
• Long term goals:
➔ Avoid diet rich in fat

➔ Skip fad diets, if followed any.

➔ Be physically active.

DIETARY PRESCRIPTION:

ENERGY:
22 kcal/kg x Ideal body weight
22 x 57=1300 kcal/day
PROTEIN:
0.8gm/kg x ideal body weight
Total protein= 45gms
Protein percentage= 45x 4 divided by 1300 x 100
= 15% of total calories.
Fats- 15% of the total calories (moderately obese)
Total fat= 20gm
15/100 x 1300/9 = 20gm
Carbohydrates- 55% of the total calorie (moderately obese)
55/100 x 1300/4= 200gm
DIETARY ADVICE AT TIME OF DISCHARGE

The Prescribed Hospital Diet is HIGH CALORIE HIGH PROTEIN NORMAL DIET
SAMPLE MENU PLAN

Time Meal Menu Quantity

7am Early morning Milk 1cup

9am Breakfast Semolina upma 2serving
Egg white 1no.
11am Mid-morning Watermelon juice 1cup

2pm Lunch Vegetable salad 1cup

Rice 1cup
Bottle gourd dal 1cup
Ladies finger fugath 1cup
4pm Snacks Coconut water 1cup
8pm Dinner Tomato soup 1cup
Phulka 4no.
Ridge gourd curry 1cup
Potato fugath 1cup
9pm Bed time Buttermilk 1cup

FOOD EXCHANGE LIST

Food group Exchange No of Energy Protein Carbohydra Fat
grams Kcal Gm te gm Gm
Cereals and 6.6 660 19.8 132 5.3
3
millets
Pulses 1 30 100 6 15 0.7

Milk and
milk 2 1.5 105 4.5 7.5 4.5
products
Egg 1 50 85 7 - 7
Roots and
tubers 6 2.1 168 2.7 37.8 -
Green leafy - - - - -
-
vegetables
Other 4.6 128 7.8 - 0.9
6
vegetables
Fruits 2 2 80 - 20 -

Fats and oil 5 0.3 13 - - 1.5

Sugars 2 2 40 - 10 -

Nuts - - - - - -

Achieved 1379 47.8 222.3 19.9

RDA
Recommende 1300 45 200 20
d RDA

DETAILED HOSPITAL MENU PLAN:

Mealtime Food item Ingredients Qty Energy Protein Fats CHO

(g/ml ) (kcal) (g) (g) (g)
Early Milk Skim Milk 100ml 29 2.5 0.1 4.9
morning Sugar 5gm
20 - - 4.9

Sub total 49 2.5 0.1 9.8

Breakfast Semolina Semolina 60gm 204 6.4 1.1 42.6

upma
Tomato 15gm 2 0.1 0.1 0.6

Onion 15gm 4 0.2 - 1.4

Oil 2.5ml 22 - 5 -
 Egg Egg 50gm 72 6.5 2 -

Sub total 304 13.4 8.2 44.6

Mid- Watermelon Watermelon 100ml 15 0.6 0.2 7.8

morning juice Sugar 5gm 20 - - 4.9

Sub total 35 0.6 0.2 12.7

Lunch Vegetable Carrot 50gm 11 0.4 0.2 1.7
salad Cucumber 50gm 9 0.4 2.1 0.1
Rice Rice 60gm 214 3.4 0.2 46.9
Bottle gourd Bottle gourd 100gm 10 0.5 0.4 1.7
dal Red gram dal 30gm 99 6.5 0.4 16.6
Oil 2.5ml 22 - 2.5 -
Ladies finger Ladies finger 100gm 18 2.1 0.2 3.6
fugath
Onion 25gm 12 0.3 - 2.3

Oil 2.5ml 22 - 5 -

Sub total 417 13.6 11 72.9

Snacks Coconut Coconut water 100ml 15 0.5 0.1 3.2
water
Sub total 15 0.5 0.1 3.2
Dinner Tomato soup Tomato 100gm 20 0.9 0.5 2.7
Onion 20gm 10 0.2 - 0.9
Phulka Wheat flour 80gm 248 6.2 0.4 38.4

Ridge gourd Ridge gourd 100gm 10 0.9 0.1 1.7

curry Onion 10gm 5 0.1 - 0.9
Oil 5ml 45 - 5 -

Potato fugath Potato 100gm 50 1.5 0.5 14.8

Onion 10gm 5 - - 0.9
Oil 2.5ml 22 - 2.5 -
 Sub total 415 9.8 9 60.3
Bed time Buttermilk Milk 50ml 15 1.2 - 2.4
Sub total 15 1.2 - 2.4
Grand total 1250 41.6 28.6 205.9

DISCHARGE DIET

Type Of Diet: High Calorie High protein diet

ONS: Penta sure 2.0 – 3 Times a day
Energy: 1250 kcal/day

Protein: 41 g/day

Carbohydrates: 205g/day

Fats: 28.6g/day
GUIDELINES:
➔ General recommendations
o Vegetables-250 grams/day
o Green leafy vegetables - 100 gms/day
o Fruits-2 no. s/day
o Milk-250ml/ day of tones milk Non-Veg- Twice a week
o Oil-4 teaspoons/day (20 grams/day)
o Salt-I teaspoon day (5 grams/day)
➔ Unhealthy-Better to be avoided
o Deep fried foods like Puri, Bajji, Pakoda, Vada, Samosa and ilk fat like Cream,
Butter, Ghee and Vanaspati Bakery foods, Pizzas, Burgers, Cookies, Pastries,
Chocolates, Sweets, Ice creams
o Alcohol, Salt snacks like Chips, Packed food/Canned food.
➔ Foods to be taken in moderation
o Vegetable oils: use in combination of different vegetable oils not more than- 4
spoons/20 grams per day / person.
o Fish and Skinless Chicken- 75gm twice a week. Preferably in Boiled/ Baked
/tea
o Grilled/Stewed form and not fried. 1
➔ Healthy-Take liberally
o All vegetables- preferably raw/ boiled form and not deep fried
o All fruits- preferably as full fruits and not juices Whole grains & legumes
➔ Other instructions:
o Avoid ragi, sago, Maida, com flakes, mango custard apple, banana, sapota,
jackfruit, fruit juices and coconut water
o Go for at least 45 min of exercise every day (at least 5 days a week).
o Maintain proper meal timings. Have small and frequent meals.
o Have lots of vegetables in each meal. Include sprouted grains everyday as a
pre-meal salad/intermediary snack. Prefer food preparation methods like
steaming/ pressure cooking, intermediary snack.
o Prefer Wheat/Jowar / Ragi / Maize based preparations and whole legumes like
Chana, Moong, Rahmah, Soya, Green peas to rice and dal s because of their
high fiber content.
o More complex carbohydrates than simple carbohydrates.
o Regular blood glucose monitoring is essential to track glucose levels and make
informed treatment decisions.
o Hemoglobin A I c (HbA le) tests are used to assess long-term glucose control.
o Fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) are also
used for diagnosis and monitoring.