Cyclical Ketogenic Diets Review

Keto Resource

Many people always desire to lose weight within a short period. Dieting is easy the first few days, but without a plan, one is subjected to peer pressure and can easily fall back on their program. Gaining weight is very easy for most people, but losing it is another task that needs patience as it does not happen overnight. The Keto 28 day challenge works towards helping individuals achieve their dreams by losing weight on shorter duration of time as compared to other diet plans. It focuses on making its users lose weight and become lighter. The reason why most people gain more weight even when they are on a new diet is the lack of a plan. Lacking a diet plan makes one to make bad choices when choosing the type of food to eat and the quantities that they take. It's time to take the 28 day Keto challenge to get back in shape and have that good and light body that you have always desired. The plan also makes an individual sleep better, wake up more rested, improve hair growth, and have more energy as compared to the earlier days without Keto. More here...

Keto Resource Summary


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The Role of Carbohydrates

Foods contain three main nutrients carbohydrate, protein and fat. Carbohydrates are necessary for good nutrition they provide important vitamins and minerals and give your body the energy to function properly, but they can raise your blood glucose level, so pay attention to how much of them you eat. It's best to space carbs throughout the day to get the energy you need without overwhelming your body's insulin supply. Since your body runs on carbohydrates, every meal and snack needs to contain some. Choices An Easy Way to Count Carbohydrates The total amount of carbohydrate you need daily is divided into sets of 15 grams each. One set of 15 grams of carbohydrate equals 1 Carbohydrate Choice. It's that simple all you have to count are carbohydrates.

Carbohydrates The Energy Source with the Biggest Impact on Blood Glucose

Most people who think of carbohydrate think of sugar, but there are many forms of carbohydrate. The following simple carbohydrates can be digested by enzymes in the stomach and intestine Other types of carbohydrate are complex carbohydrates including cellulose, the carbohydrate that forms the walls of plant cells and fiber. Neither of these complex carbohydrates can be digested, which means that they provide no calories. These are the important functions of all carbohydrates in the body In the following sections, I explain what you need to know about the use of carbohydrates in the diet of a person with type 1 diabetes, including some smart food choices and the relationship between carbohydrate amounts and insulin intake. Americans are eating less fat yet continue to get fatter. Analysis of the American diet shows that people haven't increased their protein intake, so they must be eating more carbohydrates. Carbohydrates can be turned into fat in the body, so if you consume excessive...

What is the fate of undigested carbohydrates and what undesirable effects can be produced by their presence in the

Undigested carbohydrates are removed with the stool. However, in the large intestine, the normal intestinal flora causes fermentation of the redundant carbohydrates and local excessive production of the products of this fermentation (lactic acid, hydrogen, carbon dioxide, etc.). As a consequence, those substances that are not absorbed cause flatulence, abdominal aches, diarrhoea or excessive production of gases. To some degree these complaints can be avoided with progressive increase of the dose and they generally subside completely after the first weeks or months. However, if a large quantity of sugar is consumed and the recommended diet it is not followed, the diarrhoea can be intense.

Chapter Carbohydrates

Too often Carbohydrates are blamed for weight gain, high blood glucose, and just about anything else wrong in our diet. Also, carbohydrates are discussed without a clear understanding of what they are and the important role Carbohydrates play in our diet. Carbohydrates are not all equal There are good carbohydrates and bad carbohydrates. There are high glycemic carbohydrates and low glycemic carbohydrates.

Calculating Carbohydrates Precursors of Glucose

When you eat a meal, the immediate source of glucose in your blood comes from the carbohydrates in that meal. One group of carbohydrates is the starches, such as cereals, grains, pastas, breads, crackers, starchy vegetables, beans, peas, and lentils. Fruits make up a second major source of carbohydrate. Milk and milk products contain not only carbohydrate but also protein and a variable amount of fat, depending on whether the milk is whole, lowfat, or fat-free. Other sources of carbohydrate include cakes, cookies, candies, sweetened beverages, and ice cream. These foods also contain a variable amount of fat.

Diabetes And Carbohydrates

Carbohydrates in the diet include monosaccharides and disaccharides, the starches and the indigestible carbohydrates, such as cellulose, pectins, gums, and psyllium. The American Diabetes Association (ADA) recommends the following terms sugars, starch, and fiber, whereas terms such as simple sugars, complex carbohydrates, and fast-acting carbohydrates should be avoided because they are not well-defined. Carbohydrates in the form of whole grains, fruits, vegetables, legumes, and low-fat milk are recommended. Normally, the diet contains 45-55 of total calories as carbohydrates. The minimal amount of carbohydrates needed for the brain to function is 130 g day, as set by the Food and Nutrition Board of the National Academy's Institute of Medicine in their 2002 Dietary Reference Intakes. Most people exceed this amount with median ranges of 200-300 g day for men and 180-230 g day for women. Although carbohydrates, like monounsaturates, do not have significant effects on cholesterol, they...

What is the recommended consumption of carbohydrates by diabetic individuals

According to current, but also older perceptions, particular preference should be given to the complex carbohydrates (starches) that are rich in dietary fibre (for more on dietary fibre see below). More specifically, foods like whole-grain bread and cereals, fruits, vegetables, legumes, etc. are preferred. These should constitute 50-55 percent of the total energy intake. Alternatively, a lower carbohydrate intake is allowed (

What are Carbohydrates

Carbohydrates come from a wide array of foods - bread, beans, milk, popcorn, potatoes, cookies, spaghetti, corn, and cherry pie. They also come in a variety of forms. The most common and abundant are sugars, fibers, and starches. The basic building block of a carbohydrate is a sugar molecule, a simple union of carbon, hydrogen, and oxygen. Starches and fibers are essentially chains of sugar molecules. Some contains hundreds of sugars. Some chains are straight, others branch wildly. Carbohydrates were once grouped into two main categories. Simple carbohydrates included sugars such as fruit sugar (fructose), corn or grape sugar (dextrose or glucose), and table sugar (sucrose). Complex carbohydrates included everything made of three or more linked sugars. Simple sugars were considered bad and complex carbohydrates good. The picture is much more complicated than that. The digestive system handles all carbohydrates in much the same way - it breaks them down (or tries to break them down)...

Carbohydratestarchy sugary foods

The days of low-carbohydrate diets are long gone or should be. There are still some patients who adhere to a crumpled and faded low-carbohydrate diet sheet. In insulin-treated patients, exercising vigorously, liver glucose release may not keep up with glucose uptake by muscles. The blood glucose can fall precipitously if the patient does not top up with sugar or glucose (see p. 118). Thus insulin-treated patients must understand that they can use sugar-containing foods when exercising. Regular exercise may eventually be fuelled mainly by unrefined carbohydrates. Over half the dietary calories should come from starchy carbohydrates. This is a lot of carbohydrate. Ideally it should be mixed with fibre. Insoluble fibre such as wheat bran and the fibres found in vegetables like celery and cabbage helps to bulk out the food and make it filling, for example wholemeal bread, wholemeal pasta, brown rice, and potatoes in their jackets. Soluble fibre such as that found in beans and pulses has a...

What Is The Scientific Basis For Recommending High Carbohydrate Intake

There is no doubt that the goal of increasing carbohydrate intake was actually to reduce fat consumption, especially saturated fat. People with diabetes were no longer dying of diabetic ketoacidosis but coronary heart disease. In fact, some experts suspected that the prescribed high-fat (and high saturated fat) diabetic diets might actually be partly responsible for the heightened risk of cardiovascular disease among people with diabetes. Several well-designed intervention studies in diabetic subjects were undertaken and showed that high-carbohydrate diets (55-70 energy) could result in lower blood cholesterol and TG levels with no deterioration in glycaemic control compared to traditional 'diabetic' diets containing less carbohydrate and more saturated fat (12-14, 21-25). Indeed, much to their surprise, HbA1c, glucose tolerance and fasting glucose were often improved following treatment with a high-carbohydrate diet. This implied that insulin sensitivity was improved on a higher...

Carbohydrates and the Glycemic Index

The diabetic associations such as ADA, CDA and others used to say there was no value in the glycemic index or glycemic load and that all carbohydrates should be treated the same. They are slowly recognizing the benefits of low glycemic food concepts in a diabetic diet plan and are grudgingly acknowledging its benefits for diabetics in controlling blood glucose. Current research shows a low glycemic load diet helps control blood glucose. I will give credit to the Canadians as they are far ahead of the US in accepting new ideas and treatments for both preventing and controlling type 2 diabetes. A new system for classifying carbohydrates calls into question many of the old assumptions about how carbohydrates affect health. This new system, known as the glycemic index, or glycemic load measures how fast and how far blood sugar rises after you eat a food that contains carbohydrates. The glycemic index is an important concept to understand for anyone wanting better glucose control. There...

Adding Good Carbohydrates

Carbohydrates from fruits, vegetables, and grains should give you the bulk of your calories. For optimal health, get your grains intact from foods such as un processed whole grains, brown rice, whole grain pasta, and other possibly unfamiliar grains like quinoa, whole oats, and bulgur. Not only will these foods help protect you against a range of chronic diseases they can also please your palate and your eyes. I think a common mistake made by many is to lump all carbs together and treat them the same. I use 50 calories from carbohydrates but that includes the 30 grams of soluble fiber, which is a carbohydrate but many systems don't even count. All my carbohydrates are from low glycemic choices.

Counting carbohydrates

People with type 1 diabetes and those with type 2 diabetes who take insulin may find the technique of counting carbohydrates to be the easiest for them. You still need to know how much carbohydrate you should eat in a given day. You divide the total into the meals and snacks that you eat and then, with the help of your doctor or certified diabetes educator, you determine your short-acting insulin needs based upon that amount of carbohydrates and the blood glucose that you measure before that meal. You can make this calculation a little easier by using constant carbohydrates, which means that you try to choose carbohydrates so that you are eating about the same amount at every meal and snack. This approach makes determining proper amounts of insulin less tricky just add or subtract units based upon your blood glucose level before that meal. A few sessions with your physician or a certified diabetes educator can help you feel more comfortable about counting carbohydrates.

The low carbohydrate group

These diets are based on the claim that carbohydrates promote hunger. By reducing or eliminating them, you lose your hunger as you lose your weight. The first of them, the Atkins Diet, promotes any kind of protein, including protein high in fat. Naturally, other diets were developed promoting very little carbohydrate but less fatty protein. Here are your choices Atkins Diet This plan allows any quantity of meats, shellfish, eggs, and cheese but doesn't permit high-carbohydrate foods like fruits, starchy vegetables, and pasta. Small quantities of the forbidden foods are added in later. The program does recommend exercise but doesn't suggest changes in your eating behavior. South Beach Diet This diet restricts carbohydrates while the recommended proteins are low in fat, unlike the Atkins Diet. Daily exercise is an important component, but the plan doesn't suggest any changes in eating behavior. Over time some carbohydrate is reintroduced into the diet. Zone Diet In this diet, you have...


Carbohydrates22'23 are the body's main energy source 50-55 per cent of the daily caloric intake should be provided by them. It is important that people with either type 1 or type 2 diabetes consume the right amount of carbohydrates, as they are the primary energy source for the central nervous system which depends on blood glucose. Carbohydrates also have the role of 'protein sparer', preventing the use of proteins for energy purposes, allowing them to perform their real role in tissue building and as metabolic primers for fat metabolism. The amount of carbohydrates in the diet regulates the levels of the intermediate products of fat metabolism, ketones. If the amount of carbohydrates is too low or unavailable, fat is oxidized for energy purposes with an increase of ketones Diet and diabetes prevention and control 131 Table 7.3 Classification of major dietary carbohydrates From a biochemical point of view, carbohydrates are divided into three groups sugars, oligosaccharides and...

Eat Carbohydrates

For athletes with diabetes, it is recommended that 55 to 60 percent of the total daily kilocalories should be carbohydrates. Endurance athletes (such as long-distance runners or cyclists) should consider eating a carbohydrate-rich meal (1 to 2 grams of carbohydrate per kilogram of body weight) about three to four hours before exercising to maximize pre-exercise glycogen stores. If the exercise is unplanned, eat 20 to 30 grams of carbohydrate immediately before you exercise.

No Carbohydrates

Some popular diets, particularly the Atkins diet, treat carbohydrates as if they are evil, the root of all body fat and excess weight. While there is some evidence that a low carbohydrate diet may help people lose weight more quickly than a low fat diet, no one knows the long-term effects of eating little or no carbohydrates. Equally worrisome is the inclusion of unhealthy fats in some of these diets. If you want to go the lower carb route, try to include some fruits, vegetables, and whole grain carbohydrates every day. They contain a host of vitamins, minerals, and other phytonutrients that are essential for good health and that you can't get out of a supplement bottle.

Optimizing Your Bolus Insulin Dose

Once you are satisfied with your basal glucose control, you can look at the bolus insulin. Before you can do this, you have to know how to count carbohydrates (see Chapter 8). The way you assess your bolus ratio for carbohydrates is to eat your usual meal and give the calculated dose of insulin. Then check your blood glucose after the meal and find out how high it goes you are trying to keep it below 180 mg dl. Check three times, and if the glucose goes much higher than 180 consistently, you need to increase the ratio. For example, if you gave 1 unit for 15 grams carbohydrate at breakfast, try using 1 unit per 12 grams of carbohydrate, and check again. Sometimes, if you change the ratio, you find that your peak after the meal is below 180 mg dl, but then you go low later on. If this happens, you have a number of options Why do you have a correction insulin bolus The correction insulin is to correct the drift upward in your glucose levels because the basal insulin is not perfect. The...

Nutrients That Can Help

Line issue people cannot take a simple pill to compensate for bad eating habits. At best it is naive to believe that supplements (or medications) can combat a diet full of high-calorie, high-carbohydrate refined foods. Persuasive research by Harvard Medical School scientists has shown that diets rich in refined carbohydrates and carbohydrate-dense vegetables and grains increase CRP levels and inflammation. In the study, potatoes, breakfast cereals, white bread, muffins, and white rice were most strongly associated with elevated CRP levels. As with diabetes, it is essential that a person exercise the responsibility to choose healthier foods, such as those recommended in the Anti-Inflammation Syndrome Diet Plan. Such a diet should emphasize nutrient-dense lean meats (such as chicken and turkey), fish, and vegetables, while deem-phasizing calorie-dense sugary foods and grain-based carbohydrates. The simple rule is to get as much diverse nutrition as possible in every bite of food. That...

Comments on figure

The cranberry Balance bar (distributed by Bio-Foods Inc) contains 21 grams of carbohydrate, 14 grams of protein, 6 grams of fat, and 3 grams of fiber for a total of 180 calories. These ingredients have a nominal calorie content in the ratio of 40 carbohydrates, 30 protein, and 30 fat, as recommended in the Zone diet proposed by Barry Sears, Ph.D. 5 . Not all apples will show the same response, and each person must evaluate his or her own response to determine what part these snacks can play in the diet.

Diabetes and Family Life

Ever since he had been diagnosed with type 2 diabetes 2 years ago, Richard had a hard time staying on track. Most of the time he ate about the right amount of carbohydrates, but he still needed to lose about 25 pounds. He knew he was eating too many fatty foods, and he couldn't resist potato chips, which always seemed to be in the house. To Richard, that seemed to be a big part of the problem. His family never really understood that he needed help to manage his diabetes. If anything, they seemed to be undermining all his efforts.

Monitoring Glucose Levels

When you have diabetes, your glucose levels fluctuate much more than those of people without diabetes. In people without diabetes, fasting glucose levels in the morning are usually between 60 and 100 mg dl. Before each meal, the levels are below 100 mg dl. The peak values one to two hours after a meal are in the 120s and usually stay below 140, even after a meal rich in carbohydrates.

Holiday Prune And Raisin Roll

Place roll on baking sheet, lightly sprayed with Pam. Shape roll into circle or horse shoe. Brush top of roll with evaporated skim milk. Slit top of roll with sharp scissors until some the filling shows through. Bake at 400 degrees for 20-30 minutes or until brown. 35 servings. Exchanges 1 starch bread, 1 2 fruit calories 109 carbohydrates 21 gm protein 2 1 2 gm fat 2 gm.

Frozen foods and diet meals

Diet meals can be a good choice if you want to save time in preparation. The frozen diet meals are low in calories and often low in salt and fat as well. Most diet meals have no more than 350 kilocalories and usually taste good. If you have type 1 diabetes and need to count carbohydrates, they're listed on the box. Low-carbohydrate foods are also being made by many of the food manufacturers. See our discussion of the various types of diets in Chapter 3 for ways that these foods can fit in your nutrition plan.

Treatment of hypoglycemia

1 Try to eat a snack of carbohydrates and protein every hour if you are doing prolonged exercise, such as playing a baseball or soccer game that lasts several hours. (For example, half a turkey sandwich would work well.) And carry jelly beans at all times, just in case six or seven are all you need to combat mild symptoms of hypoglycemia.

Newly Diagnosed Type Diabetes

She will also describe how to have a balanced diet and tell you about the best sources of fast-acting carbohydrates that can be used to treat low glucose levels. Usually, newly diagnosed people with type 1 diabetes still make insulin, and initially, low doses of insulin are required and glucose control is relatively easy. This is called the honeymoon phase. During this period, the glucose levels go up with meals only, so you can start treatment with an insulin pen of a fast-acting insulin analog before each meal using insulin pens that allow you to inject half-unit doses of insulin. The initial ratio might be 1 unit of insulin for 30 to 45 grams carbohydrate. If your glucose is high, you may need additional insulin to bring down the number this is called correction insulin. The ratio for correction might be 1 unit of insulin for every 75 mg dl blood glucose over a target of 150. For example, if your premeal blood glucose was 225 and you were going to eat 30...

Lipoprotein Glycation Oxidation and Glyco Oxidation

In diabetes, increased nonenzymatic glycosylation affects any protein exposed to elevated levels of glucose. Glucose is covalently bound, mainly to lysine residues in protein molecules forming fructose-lysine. Subsequently, further reactions occur, mainly in long-lived proteins, leading to the development of unreactive end-products, many of which are cross-linked, brown or fluorescent (133). The most common description for these end-products is AGE. Only a few are well-recognized structures such as carboxymethyllsine (134) and pentosidine (135). Others have been identified in model systems and by immunological techniques in vivo, such as pyrraline (136) and crosslines (137). The formation of these end products and the accompanying increase in protein fluorescence are mediated by free radical oxidation (138). Thus, because glycation and oxidation are involved, the products are also called glyco-oxidation products. Recently, it has been recognized that some of the AGEs are derived from...

Chocolate Almond Biscotti

Biscotti are a great treat, and now you can enjoy them homemade, and without all the calories and sugar. This rendition of the Italian biscuit (courtesy of Heather Dismore) is easy to make and takes no time. It's also half the calories and carbohydrates of the usual crusty cookie. See these treats in the color section.

Getting type diabetes

In developing countries, where people often don't get enough food, those whose genetic makeup enables their bodies to use carbohydrates in a very efficient manner have an advantage over the rest of the population because they can survive on the low food and calorie supplies. However, if these people later receive ample supplies of food, their bodies are overwhelmed and they're likely to become fat and sedentary and develop diabetes. This fact may explain why people in developing countries are the most at risk to develop type 2 diabetes. Population studies show that the incidence of diabetes is greatest in developing countries such as China and India.

How is gestational diabetes diagnosed

If an abnormal result is found in the 50 g oral glucose tolerance test, a second oral glucose tolerance test follows, either with 100 g glucose (three hours) or with 75 g glucose (two hours). There is no unanimous agreement whether an increased intake of carbohydrates for three days should precede the test, although this has been proposed. Diagnostic criteria for gestational diabetes, depending on the method used, are shown in Table 10.1.

Keeping A Check On Your Progress

To see how my diabetes is progressing I devised a home-based test that determines my response to 12 grams of pure glucose. The glucose is ingested at a time when BG level would normally be relatively stable. In my case this is in the early morning fasting position. After eating the glucose I plot BG level versus time and then calculate the AUC, incremental area under the glucose versus time curve, over a period of 90 minutes. Typically I reach a peak BG level after about 30 minutes. I use the AUC number to see how my response to the glucose stimulus has changed. I first started this test procedure in 1997, at a time when my BG meter was calibrated to read whole blood. Also I included a drink of hot decaffeinated tea in which carbohydrates were added from a nondairy creamer. Later I switched to a BG meter calibrated in terms of plasma and I also eliminated the nondairy creamer that added to the carbohydrate stimulus. My results, recalibrated to be on the same whole blood basis, are...

Continuous Subcutaneous Insulin Infusion Csii Therapy Using An External Insulin Pump

External insulin pumps have gained popularity because of increased flexibility of dosing, improved glycemic control and a lower incidence of hypoglycemia when compared with traditional insulin injection methods (5,6,45-48). However, CSII requires that patients count carbohydrates, SMBG frequently and carefully control caloric intake to avoid hypoglycemia and excessive weight gain. Failure to deliver rapid-acting insulin (due to pump malfunction, catheter occlusion or catheter disconnection) can lead to hyperglycemia and ketoacidosis within several hours, because of the small depot of sc insulin (two to four units) during typical basal CSII therapy (25,33,45).

Pharmacological Management

A-Glucosidase inhibitors such as acarbose, although generally less effective hypoglycaemic agents, may have some value in the management of the obese Type 2 diabetic patient. Although they generally have a neutral effect on weight, some studies suggest they cause modest weight loss and are thought to act by reducing the energy available from carbohydrates by delaying fermentation in the gut (86).

Geoffrey Boner and Mark E Cooper

Type 2 diabetes mellitus, as manifested by resistance to the action of insulin, was always thought to be a disease of middle-aged to elderly adults. Over the last few years, it has become increasingly prevalent in young adults and even in children.2 The incidence and prevalence vary among the different ethnic groups. However, there is a sharp increase in the number of patients with type 2 diabetes mellitus in all ethnic groups.3-5 This rapid increase in the incidence and prevalence of the disease is associated with the exposure of large populations to the dietary habits and sedentary lifestyles of the developed nations. The increase in calorie intake, mainly derived from carbohydrates and animal fat, with a decrease in physical activity, has led to excessive obesity and increasing resistance to insulin action.6,7 In fact, the increase in type 2 diabetes mellitus has been described as having reached epidemic proportions.4-7

Experiments Varying The Bodys Dietary Inputs

This section describes my responses to various foodstuffs. It consists primarily of graphs that are labeled to indicate the substances under test. Each test is briefly discussed. The actual data points are given and connected by straight lines. In some of the graphs this gives rise to small perturbations, rather than a smooth curve. No explanations are attempted for these perturbations. They are believed to be real and not simply the result of meter errors. However, it is easy to visualize a smooth curve interpolated between the points to give the average BG, which is the prime interest. The main focus of the work took place over a period of about 12 months and involved testing many different foodstuffs. There is a chronological factor to be considered in the results because as time progressed I observed improvements in my glucose system response because of the integrated effects of a different diet. Thus, for example a BG response in November 1996 will not appear as favorable (low)...

Meal replacement therapy

Many companies offer meal replacement techniques in an effort to reduce weight. Such therapies can be based on standard low energy intakes but are nutrient complete (e.g. Slimfast) or are based on low-carbohydrate intakes (e.g. Modifast, Cambridge Diet, etc.). The success of such treatments remains to be confirmed and appropriate trials in this area are sadly lacking, especially in the management of type 2 diabetes. Recently 'Diet Trials' on BBC television examined in detail meal replacement therapies and found these to be as good as but no better than other weight loss strategies when compared to no therapeutic approach. (Truby, personal communication.)

Composition Of Specialist Feeds For The Management Of Hyperglycaemia

Coulston has recently reviewed the clinical experience of modified enteral formulas for managing diabetic patients. Most of the evidence used to support the use of specialised enteral feeds in diabetic management has been extrapolated from the general diabetic literature and is aimed at avoiding hyperglycaemia (11). Promotional literature from the different nutritional companies is primarily based on dietary guidelines and not based on clinical studies. Although some studies have looked at the glycaemic effect of different liquid formulas given as oral test meals (high-fibre, low-carbohydrate, standard formula) (13), long-term studies are lacking. Only short-term studies have been carried out using specialised oral diets in which carbohydrate content is reduced by increasing MUFA content. These short-term studies have been undertaken either as single test meals or over short periods of time involving relatively few subjects.

How Well Do They Really Work

Research comparing the low-carb, high-fat Atkins Diet the high-protein, moderate-carb Zone Diet the very-low-fat, high-carb Ornish diet and the low-fat Weight Watchers diet has shown that each of these helps people lose weight. Why Because each one helps people take in fewer calories. 2. Abbreviations as follows p protein, c carbohydrates, f fat program.) In this study, all of the diets lowered cholesterol levels however, the Ornish diet reduced the LDL cholesterol (bad cholesterol) by 10 percent, whereas the Atkins Diet reduced LDL cholesterol by 2 to 3 percent. Other recent studies have compared the low-carb, high-fat Atkins Diet (20 to 30 grams carbohydrates per day) to a moderately low-fat diet (25 to 30 percent fat and 500-calorie-per-day deficit). The results may remind you of the story of the tortoise and the hare. At six months, those assigned to the Atkins Diet had lost more weight than those assigned to the low-fat diet. Yet at one year, there was no significant difference...

Von Willebrand Factor

Interestingly, the concentration of vWF significantly decreases in patients who consume a diet high in monounsaturated fat (77), although no changes were observed in patients placed on a high-carbohydrate diet. Whether or not the effects of monounsaturated fat are secondary to their ability to decrease susceptibility of LDL to oxidation in vitro and presumably in vivo is not known, but it should certainly be considered because of the numerous reports connecting oxidized LDL to endothelial dysfunction.

Endogenous Inhibitor of Nitric Oxide

There is evidence that serum levels of ADMA appear to be dynamically regulated. One group reported that plasma ADMA increased with the administration of a high-fat diet in patients with type 2 DM (97). This was also associated with a temporally related impairment of endothelial vasodilation. Experimental hyperhomocysteinemia increases ADMA levels, and is associated with impairment of flow-mediated vasodilation (98). On the other hand, Paiva's group recently found that although higher plasma levels of ADMA were associated with lower glomerular filtration rate in subjects with type 2 diabetes, but, as a whole, diabetic subjects had lower plasma levels of ADMA than healthy controls (99). Hence, whether ADMA is a true pathological contributor to diabetic vasculopathy, or just a marker of vascular disease in this diverse patient population remains to be conclusively defined.

Adaptation of pCell Mass to Insulin Resistance Mechanisms of Growth and Proliferation

Although changes in P-cell function are observed under conditions of increased secretory demand, the volume of P-cells also increases. In rodents fed a high-fat diet for 12 months to induce obesity and insulin resistance, islet size increases as a result of an increase in the number of P-cells rather than a change in P-cell size, and new islets do not form 36 . NEFAs rather than glucose may mediate this increase in P-cell mass for review, see 30, 37 . In contrast, human studies suggest that P-cell volume is increased by about 50 in healthy obese individuals, which, however seems to be more dependent on hypertrophy of existing cells than proliferation 38, 39 . Interestingly, in the long-term increased dietary fat feeding study in rats, P-cell mass increased but glucose-induced insulin release did not, which indicates a dissociation between P-cell mass and the secretory function 36 . Increased signaling by insulin and or insulin-like growth factor 1 (IGF-1) could also underlie the...

An integrated analysis

Detailed analysis of the interactions between intake, activity and obesity in humans is difficult because of the flaws in the assessment of lifestyle behaviours. However, a study conducted under controlled conditions in a whole-body calorimeter provides a quantitative insight into the vulnerability of the homeostatic mechanisms which regulate body weight. Here, a group of lean young men were exposed to a low or high fat diet, together with sufficient exercise to maintain habitual activity levels or required to remain sedentary in a 2 x 2 design (Murgatroyd et al., 1999). The results show that energy balance was close to zero on the low-fat diet with habitual activity. The imposition of a sedentary behaviour pattern or the provision of a high-fat diet each created net energy gains (of +2.55 and +1.07MJ day, respectively). However, when imposed together, the two effects appeared to be more than additive, creating a positive imbalance of +5.13 MJ d. This amounts to almost 50 per cent of...

Complications Of Diabetes In Highrisk Populations Acute Metabolic Complications

Patients with this entity known as ketosis-prone type 2 diabetes, exhibit initial profound impairment in insulin secretion and action, which resolves with correction of DKA and hyperglycemia using insulin therapy. After a 10-year follow-up period, 40 of patients with ketosis-prone diabetes have remained well controlled without insulin (10). This finding is of significant therapeutic implication in ethnic minority patients with type 2 diabetes. The precise etiology of acute severe but transient p-cell failure is uncertain. Postulated mechanisms include glucotoxicity, lipotoxicity and genetic predisposition. A genetic association between glucose-6-phosphate dehydrogenase deficiency and ketosis-prone type 2 diabetes has been reported (11).

Diabetic Ketoacidosis

Increased catecholamine and catabolic hormone levels combine with an absolute or relative insulin deficiency to cause lipolysis and ketoacidosis (DKA). Clinically significant ketosis and acidosis can occur even when blood glucose levels are only modestly elevated. Many cases of DKA have occurred in patients with plasma glucose concentrations 300 mg dL. Euglycemic DKA (100 mg dL glucose range) has been reported in surgical patients (2). Patients with DKA caused by a medical etiology often present with symptoms resembling an acute surgical abdomen. Surgery should be delayed until the underlying cause is identified, because abdominal symptoms often resolve following hydration and improved metabolic control (31). Although much more common in patients with type 1 diabetes, DKA can occur in type 2 diabetics with insulin resistance and limited endogenous insulin production (14,15,16,17).

Other Risks Of Intensified Insulin Therapy Diabetic Ketoacidosis and Hyperinsulinaemia

Although severe hypoglycaemia was indisputably the major metabolic side-effect of intensive insulin therapy in the DCCT, concerns have been expressed that some intensive treatment regimens may also increase the risk of developing ketosis. This was primarily related to the use of CSII (with insulin pump therapy) and was thought to relate to the absence of any intermediate-acting or background insulin in the event of pump failure. In insulin pump therapy, soluble or fast-acting analogue insulin is delivered steadily by a slow infusion of very low doses throughout the day. The insulin delivery is accelerated before meals to deliver boluses, akin to giving intermittent subcutaneous injections of short-acting insulin. Because the basal insulin is delivered in a very low volume and there is no depot of intermediate-acting insulin in the subcutaneous tissues to act as a reservoir, an interruption in the delivery of insulin can rapidly lead to hyperglycaemia and even ketosis, especially if...

Specific Metabolic Changes Associated With Type Diabetes

Dietary factors, insulin adjustments and blood glucose values are so interdependent in women with Type 1 diabetes that one should not consider any one in isolation. Women with Type 1 diabetes have an absolute deficiency of insulin and their glycaemic control is totally dependent on exogenous insulin and dietary intake. The metabolic and physiological changes occurring in early pregnancy make these women especially vulnerable to hypoglycaemia, and this is further compounded if food intake falls due to pregnancy-induced nausea or vomiting. In later pregnancy, due to the increase in maternal lipolysis during the post-absorbative and fasting periods, ketoacidosis may develop rapidly. To minimise metabolic complications one needs to continually match and adjust the insulin doses to the carbohydrate intake. Maternal ketosis, as assessed by urine strips, is usually an indication for an increase in both dietary carbohydrate and insulin treatment.

Management of diabetic ketoacidosis during pregnancy

Diabetic ketoacidosis (DKA) is an acute complication that has an impact on neonatal outcome. Although the prevalence of DKA during pregnancy has decreased over the past 20 years, it is still an a medical emergency, which, untreated, can result in fetal demise (125, 126). A frequent cause of DKA during pregnancy is inappropriate decrease or cessation of insulin treatment (126). Other causes include underlying infection, or the use of obstetric interventions such as tocolytic agents or corticos-teroids (127, 128). The common symptoms of DKA in nonpregnant women with diabetes including emesis, dehydration, and ketosis are also characteristic of DKA during pregnancy. Significant hyperglycemia may not always be present (129). However, the osmotic diuresis and resulting decrease in circulating volume can reduce uterine perfusion, thereby placing the fetus at risk. Management of DKA during pregnancy is similar to the treatment of DKA in nonpregnant women with diabetes. The patient will...

The Range Of Diabetes In Youth

Scheme for diabetes mellitus as a non-autoimmune, idiopathic form of Type 1 diabetes. In the third NHANES study, conducted between 1988 and 1994, 13 of 2867 subjects aged 12-19 years were considered to have diabetes based on insulin treatment (n 9), treatment with oral agents, or elevated fasting glucose levels. The overall prevalence of diabetes in this age group was therefore calculated to be 4.1 per 1000, with an estimate that at least 31 of these subjects had Early 2 (10). The NHANES-3 estimate, while based on an extremely small number of cases, included non-Hispanic whites, African Americans and Mexican Americans in the sampling frame. On the other end of the age range, Zimmet and colleagues defined a syndrome, latent autoimmune diabetes of adults (LADA), to distinguish lean, ketosis-prone individuals with diagnosis of diabetes in adulthood that progressed more or less rapidly to insulin dependence (11). Taken as a whole, these developments undermine the conventional practice of...

Management after the Hyperglycaemic Coma

The aim is to select a treatment regimen which will achieve plasma glucose levels as normal as possible with low risk of side-effects, such as hypoglycaemia or weight gain. To do this it is necessary to separate out the subjects with Type 1 diabetes. The guidelines for an outpatient in the author's unit state that diabetes is Type 1 if either there is significant ketosis, or the individual has two of the features suggesting Type 1 diabetes (Gale and Tattersall 1990a) in Table 5.3.

Genetic Associations With Diabetes

A study of African American women reported that HLA-B41 and -DR2 were positively associated with risk of insulin-requiring gestational diabetes mellitus, and with risk of developing Type 2 diabetes in those with previous gestational diabetes (75). This report is interesting in light of the findings that older, ketosis-prone blacks with 'Flatbush' diabetes described by Banerji et al. showed a higher than expected frequency of the Type 1-associated HLA alleles (47). Evidently the

Intermediate Syndromes Double Diabetes

Ketosis, and had C-peptide levels intermediate between those of the 'true' Type 1s and the Type 1 diabetic patients. Thus, even in a carefully defined population, correctly distinguishing Type 1 from atypical or early-onset Type 2 diabetes can be difficult based on clinical data alone.

Initiation of Pharmacologic Therapy

Success of MNT is measured by weight gain and glycemic control. Blood glucose levels drop rapidly and dramatically in response to MNT. A 2 week trial to obtain and maintain fasting blood glucose 95 mg dL and postprandial blood glucose 120 mg dL is reasonable. Women with FPG level 95 mg dL have significantly higher levels of insulin production than those with glucose 95 mg dL. This suggests that women with fasting glucose 95 mg dL may not have adequate insulin secretion(78). Fasting glucose 95 mg dL, together with increased body weight, predicts failure of diet therapy and, therefore, a more limited trial (1 week) of diet therapy may be indicated (79). MNT is limited by the occurrence of starvation ketosis, and when MNT fails to attain normoglycemia in the absence of ketonuria in an adequate timeframe, pharmacologic therapy becomes necessary. The guideline for the indications for insulin use in GDM varies slightly from differing governing bodies.

How can hyperglycaemia be treated

Ifyour blood sugar is over 240 mg dl, check for ketones in your urine. Contact the doctor immediately if ketones are present as this may indicate that you are developing diabetic ketoacidosis, a serious complication of diabetes that is discussed below. Do not exercise ifyour blood sugar is this high, because exercise can cause an increase in both blood glucose and ketone levels.

Ed Prestwood Bs Ma Founder and President Cyber Soft

The NutriBase Nutrition Facts Desk Reference - 950 pages 7 1 2 x 9 1 8 format. This large format volume provides information for 40,000+ food items. Data includes (Food Name, Description, Serving Size, Calories, Protein, Carbohydrates, Total Fat, Total Saturated Fat, Calories from Fat, Calories from Fat, Sodium, Cholesterol, Total Dietary Fiber,), 13 vitamins and minerals plus 5,000+ menu items from 60+ restaurants. Published by the Avery, a member of Penguin-Putnam, Inc. Copyright by CyberSoft, Inc. All rights reserved. The NutriBase Guide to Protein, Carbohydrates, and Fat - 704 pages 5 1 2 x 8 1 4 format provides information for Food Name, Description, Serving Size, Calories, Protein, Carbohydrates, and Total Fat. With information for over 40,000 food items, you're sure to find the information you need. Published by the Avery, a member of Penguin-Putnam, Inc. Copyright by CyberSoft, Inc. All rights reserved. The NutriBase Guide to Carbohydrates, Calories, and Fat - 700 pages 5 1 2...

Hyperglycemic Hyperosmolar State Definition and Epidemiology

The term hyperglycemic hyperosmolar state is used because (1) ketosis may be present and (2) there may be varying degrees of altered sensorium besides coma (13). Like DKA, the basic underlying disorder is inadequate circulating insulin, but there is often enough insulin to inhibit free fatty acid mobilization and ketoacidosis. Figure 2 illustrates the differences in the underlying abnormalities seen in DKA and HHS.

Hyperosmolar Hyperglycaemia

Hyperosmolar hyperglycaemia (HH) is generally the fulminant result of poorly treated type 2 diabetes or delayed diagnosis of previously unknown type 2 diabetes. HH is less frequent than DKA, but mortality is higher and remains close to 15 in many centres 1,20 . As implied hyperosmolality is the primary clinical problem and there will be hyperglycaemia of 35-40 mmol L and an effective serum osmolality of 320 mOsm kg (Table 1). HH most often occurs in frail patients in combination with other potentially fatal conditions. Strict differentiation between DKA and HH can be difficult, because some degree of ketosis may be present in HH and because, for example, lactic acidosis, respiratory and renal failure may also be present. In practise this dilemma is mainly ornamental, since diagnostic and therapeutic efforts follow the same principles.

Applying the SGI Table

Once you establish your own SGI factors you have a unique view of how specific foodstuffs affect your own body. In some cases one can anticipate the SGI value from a similar type of food. For example the SGI for cabbage is expected to be similar to that for cauliflower. If there is any doubt then a test is recommended. Occasionally I introduce a completely new type of food into my diet. If it is a high-carbohydrate food, I first consult the basic GI data 8 and page 15. Personal SGI testing requires a certain commitment of time, but then so does diabetes control in general. I now have an adequate database to predict results such that I only need to test once a day, unless something unusual happens to my meal plans.

Earlyonset Type Diabetes Temporal Trends Ethnicity And Distinctive Features

Attending a diabetes clinic had Type 2 diabetes the prevalence for African diabetics under the age of 35 at the same clinic was 16 . Mohan et al. (4) described 219 patients from a total clinic population of 4500 in southern India (prevalence 5 ), who were ketosis resistant, had onset

Can Weight Loss and Exercise Improve NAFLD

Dietary composition may be another important but frequently overlooked aspect related to excessive hepatic fat deposition, as been suggested in single case reports (361) and small case series (n 5) (362) in which low-carbohydrate diets were of particular benefit to rapidly reduce steatosis and elevated ALT in subjects with NAFLD. Recently, Ryan et al. (363) examined the effect of two hypocaloric diets containing either 60 carbohydrate 25 fat or 40 carbohydrate 45 fat (15 protein) for 16 weeks in 52 insulin-resistant obese subjects. While both diets resulted in significant decreases in weight, insulin resistance, and serum ALT concentrations, the low carbohydrate diet improved all three parameters significantly more than the high carbohydrate diet. Reduction of steatosis and of plasma triglycerides concentration by low carbohydrate diets is likely related to downregulation of hepatic sterol regulatoryelement-binding proteins (SREBP) activity by the amelioration of chronic...

Species of Plants Reported to Be Used Traditionally to Treat Diabetes

(Marles and Farnsworth, 1995) Reduces glucose levels in blood of alloxan-treated mice (Alarcon-Aguilar et al., 2002) Extracts lower blood glucose (Marles and Farnsworth, 1995) Extracts lower blood glucose (Marles and Farnsworth, 1995) Decreases hyperglycemia in vivo (Roman Ramos et al., 1992) Reported to be hypoglycemic (Masso and Adzet, 1976) Cnicin lowers blood glucose (Marles and Farnsworth, 1995) Extracts from leaves and flowers lower blood glucose in rats (Ivorra et al., 1989) Extracts lower blood glucose (Marles and Farnsworth, 1995) Extract lowers blood glucose (Marles and Farnsworth, 1995) Extracts from flowers lower glucose in glucose induced rats (Handa et al., 1989) Extracts lower blood glucose (Marles and Farnsworth, 1995) Extract lowers blood glucose (Marles and Farnsworth, 1995) Used to treat diabetes (Marles and Farnsworth, 1995) Used to treat diabetes (Marles and Farnsworth, 1995) Chicory contains carbohydrates called fructans that modulate levels of insulin and...

Preventing and treating hypoglycemia

Another way to minimize the occurrence of hypoglycemia is to keep as regular a schedule for your child as you possibly can. If he wakes up at around the same time, eats at around the same time, eats around the same amount of carbohydrates, and exercises around the same amount each day, you'll know how much insulin to give him. Very few people can do this because life intervenes with parties, travel to different time zones, meals eaten away from home, and sleeping late on the weekends. But fear not I explain how to live well with type 1 diabetes in Part IV.

Obesity and Type Diabetes in Children

1 Lifestyle changes Parents must set an example of good dietary and exercise habits. Some studies suggest that if parents go first, children will follow. The best diet is one that emphasizes a variety of vegetables, some fruits and small amounts of protein with minimal processed carbohydrates like candy and pastries. The best exercise is what you will continue to do regularly.

Shortacting Insulins And Their Analogs

This regimen has the advantage of being a practical way for reducing postprandial excursions and is particularly effective in patients who cannot or will not count carbohydrates before the meal. It is also ideal for individuals who frequently eat on the run or at restaurants where the exact carbohydrate amounts may be unknown. It is dependent, however, on the patient checking their glucose 1-2 hours postprandially. Noncompli-ance increases when the interval for glucose checking is greater than 1 hour The other option for postprandial excursion control is to administer insulin before the meal (the pre-emptive approach). This method is preferred by most endocrinologists and requires carbohydrate counting. With the pre-emptive approach, the patient administers a short-acting insulin 15 minutes before the meal (analog insulin) or 30-45 minutes before the meal (human regular insulin). For this method, 1 U of insulin is used to cover 10-15 g of carbohydrates, as directed by the physician.

Taking the right doses

1 At 7 a.m., he takes a bolus to cover his breakfast carbohydrates, assuming he's eating within ten minutes. Suppose that he takes 1 unit before breakfast. for details on monitoring blood glucose). With the readings and knowing the amount of carbohydrates he's about to eat, you and your child can adjust the size of his boluses to achieve the levels in Chapter 10.

Tracers for the study of triglyceriderich lipoprotein kinetics Chylomicrons

Chylomicrons are large lipoprotein particles that are formed by the small intestine during fat absorption. The amount of lipid fuel that traverses the circulation in the form of chylomicrons obviously varies with dietary fat consumption. In individuals on high-fat diets, however, it can equal or exceed FFA flux (Miles et al. 2004). The triglyceride transported in chylomicrons is metabolised by LPL, which is widely distributed in tissues but is most abundant in adipose tissue and skeletal muscle (Eckel 1989). Nascent chylomicrons have a short residence time in the circulation, with a half life of approximately five minutes (Park et al. 2001). Chylomicron half life is prolonged at higher chylomicron triglyceride concentrations (Park et al. 2001).

Secretion and Action of Incretin Hormones in Physiology

Glp Receptor Physiology

The main functions of GIP are the glucose-dependent augmentation of insulin secretion during periods characterized by physiological hyperglycemia, the incretin function sensu strictu 8,9,18,66,67 . Animal experiments suggest that GIP receptors on adipose tissue are essential for adipocyte triglyceride storage after meal ingestion GIP receptor knock-out mice do not become obese when fed a high-fat diet 53 .

Clinical Evaluation Of Patients With Suspected Diabetic Enteropathy

When metabolized, the proteins, carbohydrates and lipids of the S. platensis or the medium chain triglyceride octanoate give rise to respiratory CO2 that is enriched in13C. Measurement of 13CO2 breath content (a reflection of the amount of biscuit remaining in the stomach) by isotope ratio mass spectrometry allows estimation of gastric emptying t1 2 (60).

Split Mixed Insulin Therapy

In addition to generating a nonphysiologic insulin profile, split-mixed therapy also affords the patient less flexibility in dose adjustment in response to the quantity and timing of meals and exercise. Changes to insulin dosing may need to be anticipated hours in advance of the event, as only two injections per day are given. Large changes in the basal component of each dose risk provoking hypoglycemia or hyperglycemia for example, increasing the prebreakfast NPH in anticipation of a high-carbohydrate breakfast may result in hypoglycemia before lunch. An alternate solution is to keep the timing and carbohydrate content of meals constant from day to day so that dose adjustment is not required.

What common situations during a journey can cause problems in the control of DM

Dietary habits should be maintained, as much as possible, during a journey. The food offered in the plane is sometimes inappropriate for diabetics, either because it is very low or very rich in carbohydrates. When travelling abroad, there is often no familiarization with the various local foods (content in carbohydrates) so a problem with glycaemic control can occur. Thus, in the beginning at least, it is wise to stick to international cuisine, if available, and to try unfamiliar foods in small quantities.

Carbohydrate And Dietary Fibre

The suggestion that refined carbohydrates, and sugars in particular, might be involved in the aetiology of Type 2 diabetes dates back to the writings of early Indian physicians. However, in the 1960s, Yudkin resurrected the suggestion that high intakes of sucrose may be particularly important in the aetiology of Type 2 diabetes when he drew attention to the positive correlation between intakes of sucrose and diabetes prevalence in 22 countries (11). But it has subsequently become clear that the correlations were heavily dependent upon which countries were selected for inclusion and that such geographic correlations do no more than provide clues for further research, they certainly do not imply causality. Over 40 studies have examined the role of sugars in the aetiology of Type 2 diabetes, with about half suggesting a positive association and a comparable number suggesting no association. Some have even suggested an inverse association between diabetes incidence and sucrose intake...

Fat Diversion from Adipose to Nonadipose Tissue and Lipotoxicity

In summary, adipose tissue storage and release of fatty acids, and particularly the control of these processes by insulin, is grossly abnormal in insulin resistant states. In the postabsorptive period, basal adipose tissue lipolysis is elevated, and suppression by insulin is diminished. In the postprandial period there is likely to be some diversion of fat away from adipose tissue depots and towards nonadipose tissues owing to less efficient fatty acid uptake and storage by insulin resistant adipocytes. FFA efflux from an enlarged and lipolytically active visceral fat depot may not contribute quantitatively to the majority of circulating FFAs, but because of its anatomical location and intrinsic properties appears to play an extremely important role in the manifestations of insulin resistance and type 2 diabetes. A high capacity for efficient triglyceride accumulation in adipose as well as nonadipose tissue may have presented a survival advantage in the past, during times of...

What are the effects of exercise in a diabetic person

Duration of exercise, glycaemic control before exercise, the kind and dose of insulin administered before the exercise session, the injection site and the temporal relation of the insulin injection with the last (before exercise) meal. Consequently, blood glucose levels can increase, decrease or remain unchanged. Specifically, plasma glucose tends to decrease if there is hyperinsulinaemia during the exercise session, if the exercise is prolonged ( 30 minutes) and if carbohydrates are not consumed before or during the exercise. Hyperinsulinaemia during exercise can be due to the fact that peak action of the administered insulin (short or medium duration) can coincide with the time of the exercise or because insulin injection was administered to an exercising part of the body, resulting in faster absorption. Blood glucose levels usually remain stable when exercise is of short duration and mild to moderate intensity and the appropriate quantity of carbohydrates is administered before or...

Perioperative Management Of The Type Diabetic Major Surgery

Patients with type 2 diabetes previously managed by diet, exercise, and oral hypoglycemic agents should have sufficient endogenous insulin production to avoid ketosis and excessive hyperglycemia. Subcutaneous insulin regimens may be considered when the clinician anticipates a brief period of fasting in a patient with well-controlled BG levels. Short-acting sulfonylurea agents are typically held the day of surgery while the longer-acting agent Chlorpropamide is held for 2 to 3 days prior to surgery. The biguanide Metformin is typically held prior to surgery in patients at risk for renal or hepatic dysfunction due to the uncommon occurrence of lactic acidosis. Glucose levels must be monitored frequently if oral hypoglycemia agents are continued up until the day of surgery (14,44,61,62). Post-operative type 2 diabetic patients that require 24 units of insulin per day can be converted to oral agents once tolerating food. A significant number of diabetic patients previously on oral agents...

Differential diagnosis

Hyperosmolar non-ketotic hyperglycaemic coma (see Chapter 3) is rare in children serum osmolality usually exceeds 300 mOsmol L and ketosis is absent. The mechanism is likely to be prolonged dehydration with relative insulin sufficiency it is more common in children with mental impairment. The management is similar to that of diabetic ketoacidosis, except that it has been recommended that insulin and fluids are given more slowly to prevent too rapid a fall in blood glucose and plasma osmolality.

Development of obesityrelated type diabetes

Weight increases, particularly in the adipose tissue depots when the amount of energy (calories) consumed exceed energy used for exercise and metabolic processes. This is known as 'positive energy balance' and the excess is stored as white adipose tissue (Frayn et al., 1995 Gregoire et al., 1998). It terms of the development of type 2 diabetes, this is largely observed as excessive consumption of nutrients, which are high in caloric content. Both excess consumption of macronutrients such as carbohydrates and lipids coupled with increasing adiposity lead to the progression of type 2 diabetes mediated principally via their negative influence on insulin action and intermediary metabolism (Hill and Peters, 1998 Kopelman and Hitman, 1998 Woods et al., 1998 Obici et al., 2002). The number of adipocytes (mature fat cells) within an individual, which are not fixed, alters adiposity and such hyperplastic growth can occur at any time as a response to overfeeding. This activity is potentially...

Management in Insulinrequiring Diabetes

Kcl Infusion

It can be appreciated that this system is highly flexible and simple. However, it is very 'high tech', and requires expensive equipment which may not always be available. There is also a potential for metabolic 'disaster' if one of the lines comes adrift thus interruption of glucose will lead to dangerous hypogly-caemia and cessation of insulin will conversely lead to hyperglycaemia and possibly ketosis.

Overcoming the Manifestations of Syndrome X

Dietary recommendations to reduce CHD have until quite recently been based upon the principle that hypercholesterolemia (more specifically, an elevated LDL cholesterol level) is the only CHD risk factor that needs to be addressed. The result has been almost total emphasis on the use of low-fat-high-carbohydrate (CHO) diets. More to the point, advice to replace saturated fat (SF) with CHO in order to lower LDL cholesterol concentrations continues to be given, regardless of how insulin resistant the individual. Unfortunately, this dietary approach will make all of the manifestations of syndrome X worse. The greater the CHO content in an isocaloric diet, the more insulin must be secreted in order to maintain glucose homeostasis. This poses no danger to insulin-sensitive individuals, but low-SF high-CHO diets will significantly increase the already high day-long plasma insulin concentrations in patients with syndrome X. As a consequence, fasting plasma TG concentrations will increase, as...

Case Study About Osteomyelitis

This explains the post-prandial hypoglycaemia, at the time when insulin lispro exerts its peak activity, whereas there is no respective absorption of glucose from the food. Also, in non-diabetics, one can frequently find low blood sugar levels 35 hours after a meal rich in carbohydrates. This hypoglycaemia is due to hypersecretion of insulin and possibly denotes these people are potential diabetics (decreased initial first phase of insulin secretion, together with delayed hypersecretion at a second phase, comprise a premature detectable abnormality of carbohydrate metabolism in these people).

Effects of PPARy Ligands Independent of Changes in Blood Glucose Levels

Transcription Factors Ppar

Increase in oxidative stress is observed in renal glomeruli and a variety of the vascular and nonvascular tissues exposed to hyperglycemia (99-101). Emerging evidence suggests that oxidative stress may contribute to the development of diabetic complications, possibly through activating DAG-PKC pathways. As stated before, D-a-tocopherol can inhibit the diabetes-induced activation of DAG-PKC pathway in addition of its antioxidant properties (102). Troglitazone, which has D-a-tocopherol moiety, has potent antioxidant effects in suppression of phosphoenolpyruvate gene expression in vitro and in scavenging reactive oxygen species in vivo (103). It also normalizes the decrease of plasma lipid hydroperoxide concentration and increase of superoxide dismutase activity in Otsuka Long-Evans Tokushima Fatty rats, a type 2 diabetes animal model, and improves decreased skin blood flow in STZ-induced diabetic rats (81,104,105). Pioglitazone also can reduce renal oxidative stress in alloxan-induced...

The interaction of insulin resistance and Bcell function

Type 1 diabetes is the form of the disease caused primarily by (-cell destruction. This condition is characterized by severe insulin deficiency and dependence on exogenous insulin to prevent ketosis and to preserve life it was called insulin-dependent DM. The natural history of this disease indicates that there are preketotic, non-insulin-dependent phases both before and after the initial diagnosis. Although the onset is predominantly in childhood, the disease may occur at any age. About 5 to 10 of patients with cystic fibrosis have diabetes based on fasting glucose levels, but the prevalence of glucose homeostasis abnormalities has been described in up to 34 62,63 . The clinical course of these patients is characterized by a slow progression from normal glucose tolerance to impaired glucose tolerance and ultimately fasting hyperglycemia 62,63 , with no tendency to ketosis. Patients frequently become glucose intolerant at times of illness. This is presumably caused by limited insulin...

Transplantation Of Kidney And Pancreas Case Study

From the recordings of her daily measurements, it is deduced that her DM is very unstable. All measurements range between 30mg dl (1.67mmol L) and 450mg dl (25.0mmol L) and no relation can be found between the units of consumed carbohydrates and the units of the insulin analogue injected before each meal. The patient reports that she was never able to control her blood sugar. Furthermore, she complains of severe gastroparesis symptoms and intense flatulence, which impede every effort to control her blood sugar, despite the use of prokinetic gastrointestinal medicines. A recent gastroscopy reveals bile-stained fluids in the stomach and food residuals, atrophy of the gastric and the duodenal mucosa and first degree oesophagitis in the distal part of the oesophagus. In the past she tried to manage the

AGlucosidase Inhibitors and Sulfonylurea

Introduced in 1996, miglitol and acarbose are currently approved for monotherapy and in combination with sulfonylureas, insulin, metformin, and the TZDs. Miglitol and acarbose do not cause malabsorption but delay the digestion of carbohydrates with subsequent absorption shifted to the more distal parts of the small intestine and colon. Miglitol and acarbose can be very effective in blunting postprandial plasma glucose elevations, allowing the P-cells enough time to increase insulin secretion. a-Glucosidase inhibitors should be taken with the first bite of food. Gastrointestinal effects of bloating, flatulence, diarrhea, and stomach pain can occur early in therapy and diminish with time. These agents are ideally suited for those patients who ingest significant amounts of complex carbohydrates as adjunctive therapy to sulfonylureas and insulin sensitizers. Although they work on two different mechanisms in controlling postprandial sugar, sufficient data does not yet exist to give a...

Insulin Resistance Vs Betacell Dysfunction

Investigators next turned to cross-sectional and natural history studies of 6-cell function versus insulin resistance. They confirmed that insulin resistance is already present when glucose values are within the normal glucose tolerance range (49,50). There are a number of potential reasons in some people this is presumably owing to a genetic abnormality that affects insulin sensitivity, and in others lifestyle factors, such as obesity, lack of exercise, high fat diets, aging, etc., may play a major role. Thereafter, insulin resistance is relatively unchanging. Therefore, a change in the degree of insulin resistance could not explain blood glucose values progressing from normal to IGT to diabetes. Instead, worsening 6-cell function is causative. These natural history studies observed a biphasic pattern initial hyperinsulinemia, with blood glucose values maintained in the normal range or only mildly impaired, and, subsequently a falling insulin level ( P-cell failure ), resulting in...

Determining the cause

1 Too large an injection of insulin When you give insulin to your child (or take it yourself), you have to choose a dose that takes care of the carbohydrates in the meal he's about to eat as well as the level of carbohydrates already in his blood. Choosing the correct dose isn't easy. (I explain the basics of taking insulin in Chapter 10.)

Effects of FFA on Hepatic Glucose Metabolism

Feeding a high fat diet has been shown to increase basal HGP in overnight fasted rats (166). In addition, in the same model, prolonged elevation of FFAs increased HGP despite elevation of insulin secretion and higher insulin levels (151). From these observations it appears that the auto-regulation is not effective when glycogen stores are depleted. It may be hypothesized that elevated FFAs induce hepatic insulin resistance in the basal state, with impaired insulin-mediated suppression of glycogenolysis as a consequence. Along the same line, reduction of FFAs by nicotinic acid in type 2 diabetic subjects did not lead to reduced gluconeogenesis (167), and net HGP was increased owing to absence of induction of the glycogenolytic pathway. Thus, altered hepatic auto-regulation was paralleled by, and likely owing to, impairment of insulin sensitivity.

Growth Puberty And Diabetes Insulin Deficiency And Resistance

A contrasting but frequent observation, particularly among adolescent girls with diabetes, is a tendency for excessive weight gain (20,21), which may be related to a combination of overinsulinization and dietary excess, especially involving fat and carbohydrates. Eating disorders are certainly more common among adolescent girls with diabetes (22), but estrogen-regulated fat deposition may play a role.

Dietary Prescription and Monitoring

The goal of dietary management for the type 1 diabetic woman is to maintain nor-moglycemia (54). Moreover, in the type 1 diabetic woman, the food and the insulin must match. The diet shown in Table 5 demonstrates a frequent small-feedings schedule designed to avoid postprandial hyperglycemia and preprandial starvation ketosis, as well as to promote an average weight gain of 12.5 kg in accord with the Committee on Maternal Nutrition (55). In the obese type 1 diabetic woman ( 120 of ideal body weight), fewer calories per kilogram of total pregnant weight are needed to prevent ketosis yet provide sufficient nutrition for the fetus and mother (about 24 kcal kg 24 h). Recently, it has been reported that when overfeeding of the pregnant woman completely suppresses ketone production, there is an increased risk of macrosomia (56).

Demographic And Clinical Characteristics

Epidemiological data demonstrate that LADA accounts for 2 to 12 of all cases of diabetes (22,23). A prospective observation on the natural history of the ICA+ type 2 diabetes patients in Japan found that the characteristic findings in this country of slowly progressive insulin dependent diabetes included a late-onset, a family history of type 2 diabetes, a slow progression of p-cell failure over several years with persistently positive low-titer ICA, and incomplete p-cell loss (24). Similar presentations have been described in various other countries including Australia, Finland, New Zealand, the United States, Hong Kong, Korea, China, Mexico, and Sweden (25-28). The clinical onset of LADA may be less dramatic (25,29), the clinical recognition not always easy, and a type 2 diabetes phenotype not clear-cut as many as 50 of nonobese type 2 diabetes may be late-onset type 1 diabetes (24). The typical patient, however, is generally 35 years (age at onset 30-50 years), nonobese (lower body...

Dietary Modifications

The first priority for an individual with insulin resistance is to control carbohydrate intake whether they have progressed to type 2 diabetes or not. Food choices must perform a more comprehensive job in controlling insulin and glucose levels so the spiral to metabolic chaos does not occur. Studies report that a diet low in carbohydrates improves the metabolic profile of an individual when compared with a corresponding high glycemic index diet 40 .

Diseases Caused by Mutations of Glucose Transporters

The GLUT1-deficiency syndrome defines a group of disorders resulting from impaired glucose transport across blood-tissue barriers. In 1991, de Vivo et al. 24 described 2 children with infantile seizures, developmental delay and acquired microcephaly. Analysis of the cerebrospinal fluid (CSF) showed an unexplained hypoglycorrhachia (low glucose concentration in CSF) in the presence of normoglycemia (CSF blood glucose ratio

Carbohydrate And Insulin Sensitivity

Daly et al. (28) have recently reviewed the evidence and clinical implications of dietary carbohydrates and insulin sensitivity. This is a controversial area. Extensive studies in animals show a detrimental effect of diets very high in fructose or sucrose, particularly in association with induction of hypertrigly-ceridaemia. The more limited results in human studies show conflicting results, partly because of heterogeneity of design. Certain groups of subjects such as the elderly, sedentary subjects, those with established coronary artery disease, males and hyperinsulinaemic subjects may be more sensitive to very high intakes of sucrose and fructose than others.

Classification Of Diabetes

Type 1 diabetes (previously insulin-dependent diabetes mellitus (IDDM)) is characterized by p-cell destruction, usually leading to absolute insulin deficiency and associated with a usually juvenile onset, a tendency to ketosis and diabetic ketoacidosis, and an absolute need for insulin treatment. Most patients have type 1A diabetes, which is caused by a cellular-mediated autoimmune destruction of the p-cells of the pancreas, a minority have type 1B diabetes the precise etiology of which is not known.

Diagnosis and Clinical Presentation

Differential diagnoses include all other causes of acidosis. It should be emphasised that many acute medical conditions induce stress ketosis and may be associated with acidosis. DKA is a metabolic aci-dosis characterised by a high anion gap and varying degrees of respiratory compensation. It is therefore crucial to obtain measures of ketone body concentrations and arterial gas analysis. If there is a major discrepancy between the extent of the ketonaemia and the acidemia, then lactate measurements are warranted. Starvation ketosis and alcoholic ketoaci-dosis can usually be identified by clinical history. Other conditions causing metabolic acidosis include lactic acidosis and intoxication with sali-cylate, methanol, ethylene glycol (antifreeze) and paraldehyde. The clinical picture may be blurred whenever the acidosis is aggravated by renal failure or respiratory failure. In addition DKA may imitate other diseases. High levels of potassium may cause ECG changes suggestive of...

Possible Effects of Incretin Mimetics and DPP Inhibitors on pCell Mass

Not only GLP-1 and its analogues, but also the DPP-4 inhibitors have been shown to exert beneficial effects on P-cell mass and turnover. Along these lines, Pospisilik and colleagues reported a significant increase in P-cell mass in strepozotocin-induced diabetic rats following 7 weeks of treatment with the DPP-4 inhibitor P32 98 207 , and recently a significant increase in P-cell mass was reported after treatment with des-fluoro-sitagliptin in high-fat diet (HFD) streptozotocin (STZ)-induced diabetic mice 208 .

The Role of the Liver in Fasting and Postprandial Glycaemia

Blood glucose is determined by the rate of glucose appearance (Ra) and the rate of glucose disappearance (Rd). An increase in Ra or a decrease in Rd (or both) may result in hyperglycaemia. Glucose appearing in blood can derive from both ingested carbohydrates and the endogenously produced glucose from liver and kidneys. Most focus has been on the basal hepatic glucose production (HGP), as for several years HGP, alone, was claimed to determine fasting blood glucose values in the morning. This conclusion was based on the finding of a strongly positive correlation between the two variables - a correlation explained partly by the fact that HGP and fasting glucose are mathematically dependent and partly by the fact that the methods used for estimating HGP over-estimated HGP in parallel with the increase in blood glucose, strengthening the positive correlation 7 . Therefore, the importance of this correlation has been weakened, as the methodology was improved 8 . The improved methodology...

The Diabetes Damage Cascade

Common symptoms of diabetes include increased thirst and urination, unusual weight changes, irritability, fatigue, and blurry vision. Clinical abnormalities include hyperglycemia and glucose in the urine. The breath might smell sweet because of ketones in the blood (ketosis), which are naturally sweet smelling. Dark outgrowths of skin (skin tags) may also appear.

Diabetic Neuropathy In Western Medicine

John Rollo, a surgeon of the British Royal Artillery, was systematically studying diabetes. He was probably the first person to use the adjective mellitus (from the Latin and Greek roots for honey ) to distinguish the condition from the similar one but without glycosuria (in Latin, insipidus means tasteless). He was the first one to recommend a diet low in carbohydrates as a treatment for diabetes. Rollo summarized his therapeutic experience with diabetes in a book published in 1798 (11). His detailed clinical observations include symptoms consistent with diabetic autonomic neuropathy. His skin is dry. His face flushed. He is frequently sick, and throws up matter of a viscid nature, and of bitterish, and sweetish taste. After eating he has a pain of his stomach, which continues often half an hour He makes much urine, 10-12 pints in the 24 hours, to the voiding of which he has urgent propensities peculiarly distressing to him, and constantly dribbling (11).

How do the schemes with premixed insulin preparations work

In order for the blood sugar to get under control, the daily programme of the patients should be relatively stable, with only small divergences from day to day as regards the timing and content of meals and the level of physical activity. Patients who receive an insulin mixture that contains regular insulin in the morning, should usually eat a snack 2-3 hours after the injection to avoid hypoglycaemias (see Figure 28.4a). At the same time, lunch should be temporally placed when the peak of the morning intermediate-acting insulin begins (i.e., 5-6 hours after the morning injection). The administration of an insulin mixture in the evening before dinner, leads sometimes to night-time hypoglycaemia, especially if the dinner is consumed early, whereby the peak of the intermediate-acting insulin coincides with the early morning hours (1-3 a.m.) of high insulin sensitivity. This is avoided either by instructing the patients to receive a small quantity of carbohydrates (for example, a glass...

Conducting intensive insulin treatment

In intensive insulin treatment, you usually take a certain amount of longer-acting insulin at bedtime. I prefer insulin glargine because it produces a smooth basal level of glucose control over 24 hours. In addition, you take a dose of rapid-acting insulin before each meal. I prefer lispro because it is more convenient and less hypoglycemia occurs. The dose of lispro is determined by the expected grams of carbohydrates in the meal you're about to eat, as well as by your blood glucose at that moment. Your doctor should provide you with a list of how much insulin to take for a given situation. Each patient is different, and the dosage must be individualized. Using the carbohydrates in a meal to determine your insulin dose is called carbohydrate counting. The key to this system is to know the carbohydrates in your food. Here is where you make use of your friendly dietitian, who can go over your food preferences and show you how many carbohydrates are in them. The dietitian can also show...

When Sugar Management Goes Awry

Digestible carbohydrates are broken down in the intestine into their simplest form, sugar, which then enters the blood. As blood sugar levels rise, special cells in the pancreas churn out more and more insulin, a hormone that signals cells to absorb blood sugar for energy or storage. As cells sponge up blood sugar, its levels in the bloodstream fall back to a preset minimum. So do insulin levels.

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