Cyclical Ketogenic Diets Review

The 3-Week Ketogenic Diet

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The 3Week Ketogenic Diet 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.

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.

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 (< 50 percent, potentially 40 percent) combined with increased intake of mono-unsaturated fatty acids (olive-oil). In any case, saturated (animal) fat intake should be relatively small. As regards the type of carbohydrates, the polysaccharides (complex carbohydrates, such as starch) are absorbed more slowly and do not cause large fluctuations in the blood glucose levels, whereas large quantities of simple carbohydrates (such as common sugar) should generally be avoided because of the fast absorption rate and the effect on glycaemia. Small quantities of simple...

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)...

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...

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...

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...

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.

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...

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.

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...

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.

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.

Carbohydrates

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.

Basic Nutrition for People with Diabetes

Although foods contain many nutrients, it is easiest to categorize them in three groups carbohydrates, proteins, and fats. Carbohydrate foods include bread, potatoes, rice, crackers, cookies, sugar, fruit, vegetables, and pasta. When digested, carbohydrates provide fuel for energy. Your meal plan will include carbohydrates, proteins and fats in amounts that will promote good diabetes control

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...

Alphaglucosidase inhibitors

These are drugs that block the action of an enzyme in the intestine that breaks down complex carbohydrates into simple sugars that can be absorbed. Taking alpha-glucosidase inhibitors results in a slowing of the rise in glucose after meals. The carbohydrates are eventually broken down by bacteria lower down in the intestine, producing a lot of gas, abdominal pain, and diarrhea the main drawbacks of these drugs. Because these drugs block the breakdown of complex carbohydrates, hypoglycemia occurring with acarbose or miglitol and sulfonylurea combinations must be treated with a preparation of glucose, not more complex carbohydrates.

Not all carbs are equal

Some carbs such as sugar, white rice and potatoes are high glycemic meaning they raise blood glucose very quickly. It might surprise you that rice and potatoes both have glycemic values higher than sugar. Ripe fruit is typically mid to high glycemic. On the other hand, there are very low glycemic carbohydrates like those found in artichoke, asparagus, spinach, broccoli, whole grains, beans, almonds, walnuts sunflower seeds and many other food choices. There are actually some carbs that can lower blood glucose. 1 4 teaspoon cinnamon (80 calories from carbohydrates) per day can help with both cholesterol and blood glucose, as can Stevia, vinegar (100 calories from carbohydrates) and lemon juice. Psyllium husk can add fiber, which will also help. Psyllium husk often has to be found in a health food store.

Food Labels and Fiber

The food labels on all packaged foods describe the serving size and how many grams of carbohydrates there are in each serving. One word of caution the food labels break down the carbohydrates into sugars and fibers. Since humans cannot digest fiber very well, the grams of fiber should be excluded from the carbohydrate estimation, especially if the fiber content is particularly high. If you are going to eat a food with 5 grams of dietary fiber or more, you should subtract the dietary fiber content from the total carbohydrate. For example, for a food in which the carbohydrate content is 31 grams per serving, and there are 6 grams of dietary fiber in that serving, calculate the insulin for 31 - 6 25 grams carbohydrate. For each meal, count the total number of carbohydrates in all the foods (typically anywhere from 30 to 105 grams), and then inject a dose of a fast-acting insulin analog (such as lispro, aspart, or glulisine see Chapter 6) based on the amount of carbohydrates. For example,...

Comments on figure

These curves show once again the significant effect that carbohydrates have in raising my BG level, whereas protein and fat have a small effect. For example, if we incorporate this data with that shown in figure 5-1, it is clear that an egg omelet with sausages would raise my BG very little. The highest curve, which includes the effect of pumpernickel bread, includes significantly more carbohydrates than I would normally have for breakfast, but it is given as an example. Pumpernickel bread was selected because it has a reduced glycemic index, which is a measure of a substance's effect on the BG level over a 2- or 3 -hour period. As noted before, different individuals would have different response curves, although the relative effects may be similar.

Transient Performance Effects

Carbohydrates raise the BG level quickly. From my November 1996 test with an 18-gram stimulus (12 grams of glucose + 6 grams of creamer carbohydrates), there was an average rate of rise of about 3.1 mg dL per minute. The peak BG level was reached in about 32 minutes. For the nondiabetic person tested, the average rate of rise of BG was similar, 2.9 mg dL per minute, but the peak BG level was reached sooner, after only 23 minutes. Carbohydrates with a lower GI would cause the rate of rise to be lower, and a range of say 7 to 1 is feasible for practical meals. Thus an average rate of change in BG levels ranging from about 3.1 to 0.44 mg dL per minute seems feasible for carbohydrate inputs. Protein raises the BG level slowly. Using data incorporated in figures 1-1 and A-5 it was estimated that 18 grams of protein will raise my BG level by about 0.15 mg dL per minute. Comparing with the results for 18 grams of carbohydrate it is found that carbohydrates will raise my BG level from 3 to 20...

What are the main sources of nutritional components of food and what is their caloric value

The main sources of nutritional components of food are carbohydrates, proteins and fats. Carbohydrates are generally separated into simple (monosaccharides, disaccharides simple sugars ) and complex ones (polysaccharides, e.g., starch), based on the number of monosaccharide units in their chemical composition. The structural component of proteins is amino-acids. Fats constitute a heterogeneous group of substances with the main characteristic that they are insoluble in water. They are separated into simple fats (cholesterol, fatty acids) and complex ones (triglycerides glycerin with three molecules of fatty acids , cholesterol The caloric value of the nutritional components is as follows for carbohydrates, 4 calories (kcal) per gram for proteins, also 4kcal g and for the fats, 9kcal g. It should also be stressed that the thermogenetic action of these nutritional components differs. The thermogenetic action is the energy that is spent by the body for the digestion, absorption and...

Why were these medicines created

During the process of digestion, monosaccharides pass from the mucosal to the serosal surfaces of the small intestine and enter the mesentery venous and the portal system. Monosaccharides are the form with which the food carbohydrates can be absorbed. The absorption occurs mainly in the upper half of the small intestine. Monosaccharides result from the hydrolysis of the complex carbohydrates, which are mainly a-glucose-bound residues, and form di-, oligo- and poly-saccharides, like sucrose, dextrins and starch. The split occurs in the brush border of the intestinal lumen, in the presence of special enzymes, the glucosidases (maltase, isomaltase, glucoamylase, dextrinase, saccharase). In individuals with DM, the regulatory mechanism of a sufficient and timely insulin secretion from the b-cell that controls the rapid postprandial rise of blood glucose is impaired. Also, as is known, the severity of hyperglycaemia can, in some degree, be controlled with the restriction of dietary...

T Vegetable Fritto Misto

This dish from Cetrella in Half Moon Bay, California (see Appendix A), calls for significant amounts of milk and white flour, but not to worry. Because they're used only to coat the vegetables, neither provides a significant amount of calories or carbohydrates. The flour and milk help create a thick, crispy coating on the veggies when they're sau-t ed. Though canola oil is a wonderful source of monounsaturated, heart-healthy fat, it's still very dense in calories, so be thrifty here When the veggies are finished, drain them well on paper towels to get rid of some of the excess oil. You may also want to pair these veggies with a light entr e, such as fish or chicken, both low-calorie, lean sources of protein.

Effect On Carbohydrate Metabolism

When AGIs are given orally, they reduce the digestion of carbohydrates in the upper half of the small intestine, so that a larger proportion is digested in the lower part and in the colon (Fig. 2). The rise in postprandial hyperglycemia is immediately diminished when AGIs are taken with the first bites of a meal (20). The amount of carbohydrate reaching the colon, and the alpha-glucosidase activity in the lower small intestine, determines the frequency and severity of gastrointestinal side effects, such as meteorism, flatulence, and diarrhea, due to fermentation gases and short-chain fatty acids (21). The quantity of undigested carbohydrates reaching the colon can be determined by measurement of breath hydrogen. The therapeutic effects, as well as side effects, therefore strongly depend on the amount and type of carbohydrates in the diet. It has been shown that acarbose is more effective in a diet rich in starch, because it has its strongest effect on glucoamylase (22). There is a...

Other tips for managing carbohydrate intake

There's a lot to know about the way that carbohydrates affect blood glucose in addition to the grams of carbohydrates eaten (see the previous section). Carbohydrates aren't usually eaten alone, and as I mention earlier in the chapter, the other foods eaten with them play a role in how rapidly the carbohydrates are absorbed and raise blood glucose. Check out these facts about how carbohydrates work with other foods 1 When your child eats carbohydrates that tend to be swallowed in larger pieces like rice and pasta, absorption is slowed by the need to break down those pieces in the intestine. His blood glucose rises more slowly. 1 When your child eats carbohydrates with fat, the fat slows down the movement of food through the intestine, so the blood glucose rises more slowly.

Exercising with Diabetes

A good idea is to have some carbohydrates available during exercise in case blood sugar needs to be raised quickly. Eating carbohydrates helps to prevent hypoglycemia. And exercising with a partner who knows what to do in case of a diabetic emergency can add a safety factor as well as make exercise more fun.

Key points of the guidelines

A PCF ratio of 20-50-30 will work for most type-2 diabetics. PCF Ratio is the amount of calories derived from Protein, Carbohydrates and Fats. All foods are composed of one or more of these three nutrient values. Most foods have all three in their makeup. If the 20-50-30 ratio does not work for a particular diabetic then the carbohydrates should be reduced further but probably not less than 40 . Far more important than the total grams of carbohydrates is the type of carbohydrates. (More on this later) All carbohydrates should be low glycemic carbohydrates. Many researchers from around the world are showing that different carbohydrates affect blood glucose differently. Low Glycemic carbohydrates raise the blood glucose of a diabetic much slower than high glycemic carbs. The Glycemic Index will be discussed later in this book

What Else Might Help

A person with diabetes must recognize that he or she has a potentially terminal disease, but one that usually can be modified and even reversed through diet. A relatively low glycemic diet, such as the AntiInflammation Syndrome Diet Plan, can moderate the spikes in glucose and insulin that result from refined carbohydrates and sugars. Protein will stabilize glucose and insulin levels, and the fiber in vegetables will have a similar effect because it blunts the absorption of carbohydrates.

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...

Realizing the role of glucose

The body has three sources of energy protein, fat, and carbohydrates. I discuss the first two sources in greater detail in Chapter 8, but I'll tackle the third one now. Sugar is a carbohydrate. Many different kinds of sugars exist in nature, but glucose, the sugar that has the starring role in the body, provides a source of instant energy so that muscles can move and important chemical reactions can take place. Table sugar, or sucrose, is actually two different kinds of sugar glucose and fructose linked together. Fructose is the type of sugar found in fruits and vegetables. Because fructose is sweeter than glucose, sucrose, a combination of fructose and glucose, is sweeter than glucose alone as well. Therefore, your taste buds don't need as much sucrose or fructose to get the same sweet taste of glucose.

Sweet Potatoes A La Orange

Arrange the sweet potatoes in a shallow baking dish. Combine the margarine and cinnamon. Pour over the potatoes. Arrange the apricot halves on top. Cover the dish and bake at 425 degrees for about 15 minutes. Add orange slices and serve. 4 servings. Exchanges 1 bread, 1 fruit, 1 fat calories 185 carbohydrates 23 gm protein 3 gm fat 7 gm sodium 79 mg.

The Optimal Mix Of Dietary Carbohydrate And Fat For

Favour high-carbohydrate diets with a low glycaemic response. It is the authors' belief that promoting diets that actively limit carbohydrate over fat sends out the wrong lifetime educational message. Clinical studies suggest that it is the type of carbohydrate and fat rather than the absolute amount that dictates the glycaemic and metabolic responses to a meal. As a degree of gastric stasis is common in pregnancy, the glycaemic response of many carbohydrates is blunted. The American Diabetic Association (62) recommend limiting carbohydrate to 40 of the total energy content by increasing dietary fat to 40 . This advice is based on clinical studies showing women with GDM have better glycaemic control when consuming less than 45 , rather than more than 45 , of their calorie intake as carbohydrate (72,73). The American approach gives no acknowledgement to the fact that different ingested carbohydrates have different glycaemic responses as measured by their glycaemic index (74). British...

Low Glycemic Load Low Glycemic Index Foods

High-fiber fruits and vegetables (not including potatoes), Pearled barley, Bran cereals, Many legumes (including chick peas, kidney beans, black beans, lentils, pinto beans), Scotch oats, steel cut oats and whole grains. Nuts, seeds and other foods are also low glycemic. These are the best Carbohydrate choices for most people and especially diabetics. They are slower to be absorbed therefore causing less insulin spiking. I have condensed a list of low glycemic carbohydrates from the Glycemic Index Database maintained by the University of Sydney. A condensed edited list is included later in this book.

AGlucosidase inhibitors

Acarbose and miglitol are the two agents in the a-glucosidase inhibitor (AGI) class of antihyperglycemic compounds. AGIs reduce the rate of digestion of polysaccharides in the proximal small intestine. When used before meals, they delay the absorption of complex carbohydrates and blunt postprandial hyperglycemia, resulting in modest reductions in A1C. They are not associated with weight changes or hypoglycemia. AGIs are infrequently used in the USA. The main limitations to their widespread use are the need for frequent dosing, poor tolerability due to frequent gastrointestinal side effects, and only modest antihyperglycemic effects.

Alpha Glucosidase Inhibitors

Alpha-glucosidase inhibitors (AGI), including miglitol and acarbose, work by inhibiting enzymatic degradation of complex carbohydrates, thus slowing their intestinal absorption. The effect of AGI is essentially limited to reduction of postprandial hyperglycemia, but this may be sufficient for some older patients with mild diabetes. However, many older patients are intolerant to the gastrointestinal side effects (bloating, flatulence), which may limit the drug's usefulness. AGIs have also been reported to reduce the development of diabetes in a middle-aged high-risk population with IGT (60), but effectiveness among older patients has not been reported.

How are the boluses determined

The boluses (once only administration) of insulin that are administered before the meals (meal bolus) are often set as insulin needs per unit of carbohydrates. They are determined so that two hours after their administration and the meal, the insulin user has blood glucose values that are within targets. Special easy mathematical calculations are taught to the users to help individualize these needs. Usually 12-15 g of carbohydrates require one unit of insulin, but there are differences from person to person as well as in the morning or in the afternoon. Pump users should be educated at great length about their needs for insulin depending on the amount of carbohydrates of the meal, and they should be able to predict this amount with adequate precision.

Carbohydrate Degradation and Glycemic Index

Once food has entered the body the gustatory sense and stomach will signal the arrival of nutrition via the nervous system. Since most people in the western hemisphere do have a regulated daily routine, they are somewhat conditioned with regard to meal times. Even before the first morsel, hormones are secreted ready to digest the next meal. Depending on the source of carbohydrates the circulating glucose will be released at a different velocity. Therefore, blood glucose will also rise in dependency to the origin of carbohydrates in connection to all carbohydrate-degrading enzymes as well as hormones regulating the intestinal uptake of glucose. Because of this, the glycemic index plays an important role in respect to the peak of blood glucose levels. The glycemic index of a meal is defined by the area under the curve of a 2-hour blood glucose response following the uptake of a predetermined portion of carbohydrate. Food rich in easily degradable carbohydrates release glucose much...

Anticipating The Effects Of Different Foods

Substance response tests demonstrate the significantly greater glucose-raising effect caused by any type of carbohydrate compared with protein. However, carbohydrates vary among themselves. The glycemic index (GI) gives a way to compare different carbohydrates within different foodstuffs 8 . The higher the GI, the quicker that carbohydrate is converted to glucose and the higher one's BG level will rise. A wide range of GI data are provided by Rick Mendosa in his web site (www.mendosa.com gilists.htm). Typical numbers that relate to equal amounts of carbohydrate, not equal amounts of food, are reproduced with permission in the abbreviated list below. Tests with different foods convinced me that I needed to define the effects of different amounts and types of food, not just carbohydrates. This led to a method for characterizing the glucose-raising effect of food in which the effects of any type of food such as carbohydrate, protein, and fat, are compared with a reference food such as 60...

Nutrition and meal planning in gestational diabetes

Distribution of carbohydrates is important at meals and snacks (Table 2). As pregnancy progresses, hormone levels continue to rise causing insulin resistance and making carbohydrates less tolerable in the morning. Women may need to limit their carbohydrate intake at breakfast to 15-30 g and divide the rest of the carbohydrates throughout the day. Fruit juice and sweetened beverages should be discouraged as portion sizes are limited, and they can have a profound glycemic effect on postprandial blood glucose.

Low Carbohydrate Diets

Given that very-low-fat diets typically are high in carbohydrates, it is interesting that in recent years, low-carbohydrate (low-carb) diets have become extremely popular. Two of the most popular low-carbohydrate diets are the Atkins and the South Beach Diets. The books that describe these diets are currently among the bestselling books in the country. The Atkins Diet has been through several versions, but all of them encourage eating red meat, which is rich in saturated, unhealthy fat. More recent high-fat diets have begun to emphasize foods that have healthier forms of fat. Nevertheless, the low-carb diets must include relatively higher fat and protein content. It may seem peculiar even perverse that these weight loss programs would recommend a high-fat-content diet, considering that most of the evidence (reviewed in Chapters 1 and 2) strongly supports high-fat diets as being part of the cause of the epidemic of obesity and diabetes. But the low-carb, high-fat programs are based on...

Country Style Chili

Add kidney beans, canned tomatoes, tomato sauce, salt, chili powder, paprika, and cayenne pepper. Simmer 1 2 hour. While simmering, cook frozen mixed vegetables according to directions. Add mushrooms and cooked vegetables to chili and simmer for an additional 1 2 hour. 6 servings. Exchanges 1 starch, 1 bread, 2 lean meat and 2 vegetables calories 246 carbohydrates 24 gm protein 23 gm fat 7 gm.

Lipid Metabolism In Pregnancy

There is no change in either basal carbohydrate oxidation or nonoxidizable carbohydrate metabolism but there is a significant 50-80 increase in fat oxidation during pregnancy both in the basal state and also during an euglycemic hyperinsulinemic clamp (11). These data underline the importance of the switch from carbohydrate to fat metabolism in pregnancy that is potentially regulated by placenta-produced leptin. During fasting, pregnancy is a state of accelerated starvation with increased maternal reliance on lipids rather than on carbohydrate for energy demands (62). These maternal responses to pregnancy have the result of sparing carbohydrates and amino acids for the fetus. Decreased PPARg expression, and hence signaling through its target genes, has been suggested to be the mechanism by which fat catabolism is enabled (63).

Safety And Side Effects

AGIs are the safest oral antidiabetics, but are associated with a rather high frequency of gastrointestinal side effects because they inhibit digestion of carbohydrates. With > 1 million patients having taken acarbose for > 1 year, no serious adverse event has been reported. As antihyperglycemic agents they carry no risk of causing hypoglycemia. When given in combination with oral insulin secretagogues, the frequency of hypoglycemic episodes was reduced (52) and there was no increase in hypoglycemias observed in insulin-treated patients (54). A minor weight loss is observed in monotherapy with AGIs, and the weight gain caused by sulfonylureas is reduced if AGIs are added to this treatment regimen (52). Gastrointestinal side effects frequently noted by patients are meteorism, flatulence, diarrhea (Table 4) or simple abdominal discomfort (7). Gastrointestinal complaints exhibit strong interindividual and regional differences, depending on nutrition habits, diet compliance, and...

Panagiotis Tsapogas

The physician who makes the diagnosis and begins treatment is obliged to recommend to the newly diagnosed and insulin-treated patient with Type 1 DM that he temporarily interrupt both car and motorcycle driving, until both doctor and patient are as certain as possible that the risk of hypoglycaemias is minimal. Driving per se has effects that can cause a reduction of blood sugar levels. In a study, patients with Type 1 DM who were submitted to a driving-simulation test, needed more glucose infusion, presented more autonomic nervous system symptoms, had more tachycardia and more often needed to receive carbohydrates, than control subjects (also with Type 1 DM) who simply watched a driving videotape. Moreover, the perception of hypoglycaemias differs from person to person and so it is essential that the patient knows this complication of treatment with insulin. Hypoglycaemia inhibits the correct estimation of the risk from driving. When DM is under control and the patient is...

What is the Glycaemic Index and what is its importance

Food carbohydrates (CHOs) differ in their ability as regards digestion and absorption from the intestine. This depends on various factors, related to the carbohydrates themselves (nature of starch, etc.), the cooking method of the food, its fibre, fat and protein content, as well as other factors -intrinsic or extrinsic to the intestine - that influence the gastrointestinal motility and function. Therefore, consumption of equal quantities of CHOs that are contained in different foods will cause a different glycaemic response in the blood. The concept of the Glycaemic Index (GI) was developed to provide a numerical classification of the postprandial increase of the blood glucose level after the intake of various CHO-containing foods. The GI denotes the mathematical expression of the increase in blood glucose that is achieved when the test food is compared (regarding glycaemia) with a reference food, when consumed in quantities that contain the same amount of CHO (initially the...

Glycemic Effect of Protein

Plasma as free amino acids and are transported to muscle and other tissue. Protein is not converted immediately into glucose and, as a result, does not immediately raise postprandial blood glucose levels. Consuming as much as 9 oz of protein in a mixed meal elevated postprandial blood glucose levels only slightly at 3-5 h after eating in persons with type 1 diabetes when compared to a standard meal with 3-4 oz of protein (39). Plasma glucagon levels appear to be stimulated by protein consumption in type 1 diabetes and mirror the delayed glucose elevation (40). Thus, increased hepatic glucose output, secondary to elevations in glucagon, during the latter half of the postprandial period appear responsible for the effect of protein when consumed along with carbohydrates. This attribute has led to the assumption that protein is required at every meal and in bedtime snacks to prolong the blood glucose response and prevent nighttime hypoglycemia. Little evidence exists to support or refute...

Competing against others

1 Follow the nutrition guidelines for any competitive sport Have him load up with carbohydrates for a few days before the competition so that there's plenty of stored energy in his muscles and liver. He also should be prepared to consume more carbohydrates throughout the competition at regular intervals.

How are doses of prandial insulin determined

One of the main advantages of the basal-prandial insulin regimens is, as already mentioned, the liberation of the schedule and the content of the diabetic's meals. The first objective is achieved thanks to the action profile of the newer insulin analogues. The liberation of the content of the meal is achieved thanks to the calculation of a suitable dose of 'prandial' insulin, depending on the carbohydrate content of the meal. A prerequisite for the application of a system of carbohydrate measurement is the right training of the diabetic in the basic principles of the diet, so he or she learns to calculate the number of 'equivalent' carbohydrates of each meal. Each 'equivalent' constitutes roughly 10-15 grams of carbohydrates. As an example, a slice of bread (30g) contains one equivalent. In the beginning, the patient is helped by special charts. The next step is the determination of the units of insulin that are required in order to absorb each equivalent, without disturbing the...

Type Diabetes and Type Diabetes Are the Same

This myth goes back to the time before insulin became available in 1921. At that time, there was nothing that could force glucose into the cells of the body where insulin was required, so the treatment was the elimination of all carbohydrates. The reasoning was that, if a patient didn't consume carbohydrates, then the blood glucose couldn't rise to the high levels that resulted in excessive urination, thirst, confusion, coma, and death. That approach worked for a time, but the liver is fully capable of making glucose from protein despite the fact that the glucose can't get into liver cells to be stored as glycogen once it's made. Today, there are probably more types of insulin available than are needed. A little injected insulin can take care of lots of sugar or other carbohydrates.

Right FoodCombination Diets

The right-food-combination diets do not focus on emphasizing or avoiding one type of food, such as fat or carbohydrates. Rather, they are based on other theories. Some of the popular right-food-combination diets are the Zone Diet, the Eat Right for Your Type Diet, and Dr. Phil's Ultimate Weight Solution. All of these diets can produce weight loss not because of their specific macronutrient composition but because they all have one common denominator they are each low in calories. Table 11.1 shows a sample daily menu for the low-carbohydrate diets, the right-food-combination diets, and the very-low-fat diets. Each of the diets restricts calories by restricting the consumption of specific food groups or one of the macronutrients (carbohydrate, protein, or fat). Each of the diets works because, in general, Americans eat too much food and too much of each of these macronutrients. Table 11.1 also shows the nutritional composition of each of the diets. As you can see, the Atkins Diet is...

Putting It All Together

What you need to know now any diet that helps you take in fewer calories than you are used to taking in will help you lose weight, no matter whether it is high or low in carbohydrates, fat, or protein. Healthy diet programs should contain a balance of protein, carbohydrate, and fat. The American Diabetes Association recommends a diet that includes 60 to 70 percent of calories from carbohydrates and monounsaturated fats combined, 15 to 20 percent of calories from protein, about 10 percent of calories from polyunsaturated fat, less than 10 percent of calories from saturated fat, and fewer than three hundred milligrams of cholesterol.

Blood Sugar and Insulin The Basics

You need to know a little about normal metabolism to understand how so many of us are developing prediabetes and then diabetes. Metabolism represents the body's processes that direct energy into storage, such as in fat, or into fueling normal growth, development, and physical activity. Carbohydrates (including complex starches and simple sugars), fat, and protein are the three nutrient groups in our diet that provide the energy and building blocks for metabolism and growth. Carbohydrates and fat provide most of the energy to keep our body's machinery working, including our muscles for locomotion and our vital organs such as brain, liver, heart, lungs, and kidneys. Carbohydrates are broken down in the intestine into smaller sugars that can be absorbed into the circulation. (See Figure 1.1.) Sugar or glucose is then transported from the blood across the cell wall and into the cell where it is broken down further, providing a major source of energy. Alternatively, sugar may be stored in...

Sweetly Poached Pears

Stir in raisins and cool syrup to room temperature. Serve pears in small glass compote bowls. Spoon raisins and syrup over and around pears. Serves 6. Per serving 187 calories, 48 gm carbohydrates, 1 gm protein, trace fat, 3 gm sodium. Exchanges 3 fruit. Cholesterol 9 mg per serving.

Overestimation of Carbohydrate Intake

One of the most common reasons for recurrent hypoglycemia is injecting too much insulin or taking too much oral medication for the amount of carbohydrates ingested. You may overestimate the amount of carbohydrate in the food or eat less than planned, or you may be delayed in eating after taking the insulin or medicine. For example, a number of times, I have had patients inject a dose of insulin in the car before they went to a restaurant. At the restaurant, the food did not come at the expected time, and so their glucose level went low. Another example is when patients are asked to fast for a lab test (such as a lipid profile) they do not realize that they should delay taking their insulin or diabetic medicine until after the test. Drinking alcohol in excess (see Chapter 8), especially on an empty stomach, can also cause hypoglycemia.

Foods For Occasional

The foods on this list can be included in your meal plan, despite their sugar or fat content, provided you maintain blood-glucose control. Average exchange values are listed for each item because these foods are concentrated sources of carbohydrates, the serving are small. Check with your dietitian for advice on how often and when you can enjoy these foods.

Diabetic Date Cake

Boil dates, oil, and orange juice for 5 minutes and cool add rest of ingredients. Mix all together and spread in oiled 8 x 8 inch baking dish. Bake at 350 degrees for 25 minutes. Cool before cutting. Yields 36 bars. Each bar 56 calories. 7 grams carbohydrates, 1 gram protein, 3 grams fat, 8 mg. cholesterol, 12 mg. sodium.

Sesame Lace Cookies

Baking sheet out of the oven for 3 minutes or until easy to lift with a thin metal spatula onto a cooling rack. These are very delicate so handle with care Makes about 2 dz cookies. Note If making cookies small, less baking time is necessary. Check after 5 minutes. Per serving 68 calories, 6 gm carbohydrates, trace protein, 5 gm fat, 44 mg sodium. Exchange 1 2 fruit, 1 fat. Serving size 2 cookies. Cholesterol 0 mg per serving.

Oral Hypoglycemic Pills and Illness

If you take oral hypoglycemic pills, you must watch for signs of low blood sugar during any illness that causes you to vomit or keeps you from eating and drinking normally. The hypoglycemic pills you took before your illness continue working to lower your blood sugar even when you do not increase it by taking in food. Try to replace missing carbohydrates by eating soup, crackers, or toast, or by drinking ginger ale or cola.

Acute control of blood glucose

Hypoglycaemia is a potential complication for the exercising diabetic. The risk of hypoglycaemia is highest when insulin levels reach a peak at the same time as activity is undertaken, as well as glucose availability from food intake during exercise. A number of considerations are important in order to prevent hypoglycaemia during exercise, these include the form and the location of the insulin administration. Regular physical activity participation would promote better glycaemic control to prevent hypoglycaemia, as the patient will be more able through improved experience to achieve glycaemic control. Chipkin et al. (2001) suggested that the following should be undertaken by the exercising diabetic blood glucose levels should be measured before, during and after exercise, easily absorbable carbohydrates should be available during exercise, extra carbohydrate should be taken for unplanned exercise and insulin dosages should be decreased by 50 per cent for planned exercise.

Protein And Renal Function

Persons with type 1 diabetes may attempt to substitute protein for carbohydrates to attenuate postprandial glucose response. A large cross-sectional study in type 1 diabetes found that protein intakes greater than 20 of total energy intake were associated with higher albumin excretions than < 20 dietary protein (43). Concern over the role protein intake plays in renal function suggests that consuming more than 20 protein in the diet is unwise. Furthermore, it is difficult to control total fat and saturated fat intake on a high-protein diet because saturated fat and cholesterol predominate in animal foods. Average protein consumption for most individuals is approx 10-20 of total calories, which coincides with recommended intake in diabetes (2). Attempts to reduce albuminuria with protein restriction have shown that even small reductions in protein intake reduce the rate of decline of glomerular filtration rate and albuminuria in persons with type 1 diabetes (44). Most studies find...

Handling blood glucose during your menstrual periods

Blood glucose control tends to be worse in women with premenstrual syndrome (PMS) one possible reason for the irregularity of the control is the constellation of symptoms that accompany PMS bloating, irritability, water retention, depression, and craving for carbohydrates.

Letting Legumes into Your Diet

It's tough to find a more perfect all-round food than legumes. They're rich in protein, low in fat (what fat they do have is the good fat), high in dietary fiber, and rich in complex carbohydrates and vitamins. Besides being healthy, they're inexpensive, very versatile, and easy to use. They store well when dried, and have a shelf life of a full year.

Excessive Weight Gain

Patients who are overweight often have peripheral in-sensitivity to insulin. They may, therefore, develop symptomatic hyperglycaemia and be diagnosed with diabetes at an earlier stage of their decline in beta-cell function than someone who has normal insulin sensitivity. Insulin may exacerbate weight problems for patients who are morbidly overweight and may also increase or aggravate existing insulin resistance. Very often these patients gain more weight than the expected 4 kg when started on insulin because of poor glycaemic control. This is a reflection that the original cause of the patient's hyperglycaemia may have a significant dietary component and is an indication for further strict dietetic advice, concentrating on avoidance of refined carbohydrates and reduced fat intake. Some patients

Recent Developments

Low-carbohydrate diets are not recommended for routine management of patients with diabetes.5 This is because carbohydrates are important sources of energy and carbohydrate-containing foods also contain other important nutrients. The concept of glycaemic load has emerged. This is a notional product of the amount of carbohydrate consumed and the availability of the carbohydrate. High glycaemic load predisposes to obesity and glucose intolerance. Low glycaemic index (GI) diets, in which the carbohydrate is slowly broken down and released, are currently very popular. A recent randomized, controlled trial of a low GI diet6 confirmed the potential of such diets to improve glycaemic control in patients with type 2 diabetes.

Longterm Weight Stabilization

The long-term result of any weight management program is critically dependent on the long-term strategy. Since a hypocaloric diet causes a decrease in energy expenditure, a return to previous eating habits will rapidly result in weight regain. Therefore, the patient has to recognize that long-term weight loss is only possible if a new energy balance is achieved at a lower level. To maintain a weight loss of about 10 kg a long-term reduction in energy intake of about 500kcal day is required to compensate for the reduction in total energy expenditure (57). To support weight stabilization and to prevent weight relapse the following strategies have proven useful a low-fat diet rich in complex carbohydrates, an increase in physical activity, social support from family and friends, group support and continued contact with trusted medical care professionals (28,33).

What changes should be made in the insulin regimen during periods of an acute illness

Basically, the intensive insulin regimen is followed, as it is, provided the patient is normally fed. If needed, the doses of 'prandial' and basal insulin are increased. Sometimes it may be necessary to administer rapid-acting insulin (or even better a rapid-acting insulin analogue) between meals. In this case, small doses are preferred. If the patient is unable to receive food, the dose of basal insulin is administered normally and, if needed, rapid-acting insulin is administered every 4-6 hours, or a rapid-acting analogue every 3-4 hours. At the same time, intake of carbohydrates in the form of liquid or semi-solid food (i.e., juice, refreshments, soups, puree, etc.) is recommended. Insulin dose is empirically determined each time as 1 10th of the usual total daily dose when blood glucose is > 150 mg dl (8.3 mmol L) and as 1 5th of the total daily dose when blood glucose is > 200 mg dl (11.1 mmol L) or urine ketones are present. When insulin is administered as a twice a day...

Calorie Restriction In The Obese Woman With

Maternal ketosis, induced by calorie restriction, has been implicated to impaired foetal neuro-physiological and cognitive development (66,67). While there is a general reluctance to recommend severe calorie restriction in pregnancy even in obese women, modest calorie constraint for those with GDM may be safe as these women are relatively protected against ketosis by their high hepatic glucose outputs (54,68,69). Theoretically maternal ketosis can be lessened during modest calorie restriction when small frequent meals containing slowly absorbed carbohydrates are taken, as such diets are associated with an attenuated insulin response that delays lipolysis and ketogenesis (70). We have previously reported that when the daily energy is restricted to 2025 kcal kg day for obese women with GDM (pre-pregnancy BMI > 28 kg m2) from the 24th week of gestation, weight gain is half that of women with a similar pre-pregnancy weight who receive no dietary intervention, and their risk of...

Glycemic response to foods

GI is a measurement of the increase of blood glucose within 2 h after eating a given amount of carbohydrate, 50 g compared to its response to a reference carb (glucose or white bread). The GI is a meal planning tool that ranks carbohydrates according to their effect on blood glucose when foods of equivalent carbohydrate are compared. Foods that ranked high on the scale cause a quick rise in blood glucose after eating, whereas foods that ranked low cause a gradual rise in blood glucose (3). GL takes into account the GI and the carbohydrate content of the amount of food eaten. The use of the GI and GL may be of some benefit for glycemic control but can be a cumbersome approach to use. Simplifying things by evaluating food records and identifying an individual's response to favorite carbohydrate foods may be more beneficial. Individuals may do best with simple guideline instructions like limiting high glycemic carbohydrate foods such as white bread, white rice, pastries, and...

Medical Nutrition Therapy

Caloric restriction is limited by the occurrence of ketosis, when the carbohydrate intake is insufficient. Early studies suggested that ketosis is associated with lower IQ scores in adolescents (64,65). There are no large randomized trials of optimum dietary therapy in GDM. Studies suggest that intensive dietary therapy should be tailored to postprandial glucose. A small study of 14 overweight women with GDM between 32 and 36 weeks gestation looked at the effect of carbohydrate intake on postprandial glucose (66). All women were treated without insulin and received 24kcal kg day. The calories were distributed such that they received 12.5 at breakfast, 28 at lunch, 28 at dinner, and the remainder in snacks. In order to maintain 1 h postprandial capillary whole blood glucose levels < 140 mg dL, carbohydrate intake needed to be < 45 at breakfast, < 55 at lunch and < 50 at dinner. Aggressive MNT, with < 33 carbohydrates at breakfast, < 45 at lunch and < 40 at dinner...

Dietary Treatment For Type Diabetes Mellitus

The total fat intake should not exceed 30 of total energy intake, and < 10 should come from saturated fats. Dietary cholesterol intake should be less than 300mg day. Intake of trans unsaturated fatty acids should be kept to a minimum. Carbohydrates, predominantly complex carbohydrates, should comprise > 50 of the total energy intake. Foods containing carbohydrate from whole grains, fruits and vegetables should be included in the diet. The total amount of carbohydrate in meals or snacks is more important than the source, type or glycemic index of the carbohydrate. Non-nutritive sweeteners are safe when consumed within acceptable daily limits. Consumption of simple sugars, e.g. sucrose, is acceptable in moderate amounts, as they do not cause acute hyperglycemia

The Dex Com Medtronic and Abbott Systems

These systems enable some patients to improve control without increasing the risk of hypoglycemia. The individual blood glucose values are not that critical what matters is that the system alerts you to the direction and the rate at which the glucose level is changing, allowing you to take corrective action. You learn how different foods get absorbed and how quickly your glucose rises after a meal. You can use this information to change the timing and the ratio of insulin for carbohydrates to control the glucose rise. The other main benefit is in alerting you to low glucose levels. Spouses and friends report that they especially appreciate the low glucose alerts. glucose monitor before making interventions such as injecting extra insulin or eating extra carbohydrates.

Dietary nutrient composition in type diabetes

There is considerable evidence in support of high fat, relatively low-carbohydrate (but high sugar), low-fibre diets of Western societies being a major aetiological factor in susceptible individuals. Excess dietary fat is more easily converted to adipose tissue lipid stores than carbohydrate (Flatt, 1985) diet-induced thermogenesis is less with fat than carbohydrates or protein thus inducing lower metabolic rates with high fat diets (Lean and James, 1988 Lean et al., 1989) dietary fat has minimal effects on both appetite and satiety (Caterson and Broom, 2001) hyperinsulinaemia has been associated with high fat intakes possibly through components of the hormonal enteroinsular axis (Grey and Kip-nes, 1971). The associated hyperinsulinaemia will favour further fat deposition and aggravate the insulin resistance of type 2 diabetes, increasing the associated metabolic dysregulation, e.g. dyslipidaemia (Figure 6.3). For the vast majority of type 2 diabetes patients therefore, diets based on...

Interventions to reduce maternal inflammation and insulin resistance

Changes in the types of dietary fat and carbohydrates consumed may be other ways to reduce maternal inflammation and insulin resistance. Decreases in total fat and saturated fat intakes and increases in dietary fiber are recommended for reducing the risk of type 2 diabetes mellitus in non-pregnant adults.37 Results from the limited number of studies of pregnant women suggest that similar changes in dietary fats and carbohydrates also effectively reduced the risks of glucose intolerance. Clapp randomized 12 pregnant women to a low or high glycemic index diet prior to conception.38 The amounts of carbohydrate consumed were similar in the two groups 56 of the total energy. The conventional dietary treatment of women with GDM is to reduce the amount of dietary carbohydrate and increase slightly the amount of fat. The preliminary data reviewed here suggest that it is more important to consider the types of carbohydrates and fats rather than the amounts. Increasing dietary fiber (or...

Program for Early Diabetics

One of the best defenses against mild to moderate type-2 diabetes and hyperinsulinemia is improved diet and exercise. Although the disease has a genetic component, many studies have shown that diet and exercise can prevent it (Diabetes Prevention Program Research Group 2002 Diabetes Prevention Program Research Group 2003 Muniyappa R et al 2003 Diabetes Prevention Program Research Group 2000). One study also showed that while some medications delay the development of diabetes, diet and exercise work better. Just 30 minutes a day of moderate physical activity, coupled with a 5 to 10 percent reduction in body weight, produces a 58 percent reduction in the incidence of diabetes among people at risk (Sheard NF 2003). The American Diabetes Association recommends a diet high in fiber and unrefined carbohydrates and low in saturated fat (Sheard NF et al 2004). Foods with a low glycemic index are especially recommended because they blunt the insulin response. The high-carbohydrate,...

There are some key differences between my approach and the standard approaches

The American Diabetic Association and Canadian Diabetic Association are more lenient with carb counting and types of carbs than I am. I draw from them and other sources like USDA food pyramid and others. I think they all have some good points, but also ignore some key issues. Unlike ADA, CDA, USDA etc. I recommend eliminating all high glycemic carbohydrates i.e. white rice, potatoes, breads from highly refined flours, sugar and any other high GI food. I draw heavily from the Low Glycemic sources and believe they are providing a valuable tool. Still I don't think Low GI is a total answer. I think most of the above sources focus too much on carbohydrates and ignore some other issues such as good fat bad fat and a proper level of protein and protein sources. I am not a low fat no fat advocate, but I do recommend eliminating as much as possible trans fats and cholesterol and strictly limiting saturated fats. I strongly advocate for a minimum of 1000 mg Omega 3 per day (EPA DHA) from fish...

The aGlucosidase Inhibitors

Acarbose (Precose) was approved for use in the United States in 1995 and miglitol (Glycet) was approved for use in 1996. Acarbose and miglitol do not decrease, but only delay the overall absorption of carbohydrates, thus producing a smaller postprandial peak in serum glucose concentrations, which results in a more prolonged carbohydrate absorption curve. This allows the P-cell to have a greater opportunity to match insulin responses to subsequent glucose demands, enabling the available insulin to better metabolize circulating glucose in the postprandial state. a-Glucosidase inhibitors are modestly effective in treating diabetes with hemoglobin A1-C reductions of 0.5-1 and can be particularly effective in patients who consume high-carbohydrate diets. Adverse effects of a-glucosidase inhibitors are gastrointestinal and include abdominal bloating, pain, diarrhea, and flatulence, occurring in up to 70 of patients. Although these adverse effects tend to dissipate in 4-6 weeks, they are to...

How We Turn Food into Fuel

The tissues in your body don't know a corned beef sandwich from an apple. That's because all foods are digested and converted into their elements sugars from carbohydrates, triglycerides and fatty acids from dietary fat, and amino acids from protein. These breakdown products travel in the bloodstream until they are either used for energy or growth or are stored. Some of the sugar that is not used immediately for energy can be squirreled away in the liver as a type of carbohydrate called glycogen. When the body needs energy, it reaches into these reservoirs. But liver glycogen stores are small and supply only enough energy to meet energy demands for six to eight hours.

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.

Testing For Autoimmune Diseases

In celiac disease, eating foods containing gluten (that is, those derived from wheat, oats, rye, and barley) cause an autoimmune damage to the wall of the small bowel. This damage leads to diarrhea, abdominal pain, tiredness, problems absorbing vitamins such as vitamin B12, poor weight gain, and decreased growth. It can also affect the absorption of carbohydrates, causing hypoglycemia. The treatment is a gluten-free diet. Screening for celiac disease is done when a diagnosis of type 1 diabetes is made, and then again if the child has problems such as growth failure or weight loss or gastrointestinal problems. The blood test that is done is called tissue transglutaminase IgA autoantibody. If the blood test is positive, then your child will need to see a gastroenterologist, who may do a small bowel biopsy to confirm the

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.

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.

What is the role and what are the principles of a proper diet in pregnancy

Allocation of calories generally consists of 50 percent carbohydrates, 20 percent protein and 30 percent fat. Most dietary programmes recommend three main dishes and three snacks a day, with individualization of the needs based on blood sugar measurements. Complex carbohydrates, such as those in vegetables, legumes and fruit, as well as foods rich in dietary fibres, are preferred because they cause less postprandial hyper-glycaemia. Foods with a low fat content should also be encouraged due to their lower calorie content and consequent lower tendency towards obesity. A snack at bedtime, which contains proteins and carbohydrates, is recommended, because during the night there can be lower insulin production resulting in fat oxidation (if no carbohydrates have been consumed) and ketone-body production (detected in the morning urine). Ketoacidosis of the mother has been associated with decreased intelligence index of the child later in life. Furthermore, women who use insulin should...

Response Tests for Calculation of Substance Glycemic Index

The BG level versus time curves shown in figure A-5 are typical of those used to determine the SGI (substance glycemic index). Starting at time zero, the test food is eaten and BG level is plotted against time until the peak has passed and BG has fallen back to near its starting level. For protein in which only small increases in BG may occur, the duration of the test will likely be longer than that for carbohydrates. The increase in area under the glucose versus time curve, from the time the food is eaten to the time when BG falls back to within 10 of its initial value, is here defined as the AUC. The SGI is a relative number and is the AUC of the test food expressed relative to the AUC obtained from eating a reference food. I use 60 grams of white bread as the reference food. To combat possible meter errors the initial fasting BG level is determined from the average of at least two BG readings. The AUC can be calculated by splitting the curve into trapezoidal sections and summing...

What are the quantity and type of recommended fat in the diet of diabetic individuals

Especially for saturated fat, however, it should not exceed 10 percent of the daily calories (< 8 percent if the LDL-cholesterol is increased). The poly-unsaturated fat should not exceed 10 percent of total calories. As was already mentioned, particular emphasis is placed today on the mono-unsaturated fats (main representative, olive-oil), which, together with carbohydrates, are recommended to constitute 60-70 percent of the total energy intake (mono-unsaturated fat may constitute 10 -20 percent of the total energy, on condition that the total fat intake does not exceed 35 percent). The dietary intake of cholesterol is also recommended to be decreased (no more than 300 mg daily - and no more than 200mg day for individuals with dyslipidaemia. The trans-fatty acids, which emanate from hydrogenated fats (fried oils, etc.), are very detrimental (equally as saturated fat) and should be avoided. The n-3 fatty acids, found mainly in fish or administered as dietary supplements, are...

What are the general nutritional principles in DM

The nutritional recommendations for diabetic patients have been the object of various studies, discussions and revisions over the last 80 years. Before the discovery of insulin in 1921, the nutritional recommendations concerned 'hunger-diets' and an almost complete deprivation of food. After the discovery of insulin, the fear that 'sugar is bad' in DM led to diets of low carbohydrate and high fat content, until it was realized that the high content of fat in the diet, and particularly saturated fat, was what really harmed diabetic patients and led to the complications of the disease, mainly from the cardiovascular system. Today the recommendations for DM have been re-evaluated and include a more liberal approach with regard to carbohydrates and mono-unsaturated fat (basically olive-oil), but more limited with regard to saturated (animal) fat. Also, the supply of plenty of dietary fibre in the diet is considered very important. A schematic depiction of the above items is presented in...

What are the advantages and disadvantages of an intensified insulin regimen

Apart from better control, the intensive basal-bolus insulin regimens give diabetics more comfort of movement, since they acquire more freedom as regards the schedule and content of their meals. Diabetics can have a meal whenever they want and in any quantity they want, on condition of course that they inject some insulin before the meal. The dose of insulin is adapted depending on the content of the meal in carbohydrates. These regimens are mainly applied to Type 1 DM, and as individuals with this type of DM are in the majority young and active, this freedom is an important motivation for selecting these types of therapeutic regimens.

Development Of Susceptibility Genes To Nephropathy

If an inherited susceptibility to diabetic nephropathy exists, it raises a number of questions about how such a trait came to be and why it should continue to be present in at least a third of patients with diabetes. Since the trait is so commonplace, it suggests primeval origins. Moreover, it must have been propagated widely because, in the absence of hyperglycaemia, it is not deleterious. It may even be that a theoretical survival advantage exists in a predisposition to diabetic nephropathy in the absence of hyperglycaemia.11 For example, genes which benefited preagriculturalist hunter-gatherers, adapted to life in a variety of habitats, may be counterproductive in sedentary people whose Westernized diet is characterized by high amounts of fat, refined carbohydrates, and salt, as well as being poor in fibre, nutrients and vitamins. It is also worth considering that genes which protect against perinatal mortality (the main cause of prereproductive death) also predispose to...

Diet And Insulin Therapy For

When starting on insulin women should be advised to take low glycaemic index carbohydrates at meal times and for snacks between meals and before bed. Fruit is ideal for snacks as it is low in fat and calories. Fruit, by being slowly absorbed, reduces the risk of hypoglycaemia while allowing postprandial glucose levels to be lowered without having to increase the insulin dose.

Current Dietary Recommendations As Applicable To The Older Person With Diabetes

If beneficial changes to the diet of an elderly person with diabetes are to be achieved, access to dietetic services is needed. The following topics should be considered body weight, physical activity and the specific micronutrient composition of the diet including carbohydrates, protein, alcohol, sodium, vitamins and minerals.

Carbohydrate counting

Using the amount of carbohydrates in a meal to determine your child's insulin dose is called carbohydrate counting. The key to this system is knowing the carbohydrate in your child's food. Here's where you make use of your friendly dietitian, who can go over his food preferences and tell you how many grams of carbohydrate are in them. The dietitian also can show you where to find carbohydrate counts for any other foods that your child may eat. p iElt By measuring your child's blood glucose frequently, you find out how different carbohydrates affect his blood glucose. He needs less insulin to control the carbohydrate sources that have a low glycemic index (I discuss the GI earlier in this chapter).

The Benefits of Exercise for People with Type Diabetes

Controlling the blood glucose more easily When a person with T1DM exercises, his insulin sensitivity increases. This means that less insulin is needed to handle the carbohydrates he consumes. This increased sensitivity can last for 24 hours after exercise. In my practice, the people who take the least total daily insulin are the heavy exercisers. They also tend to be in excellent diabetic control with low hemoglobin A1c levels.

The Prandial Insulin Response

Meals, particularly those incorporating carbohydrates and or other nutritional stimuli of insulin secretion may induce up to a 4- to 10-fold increase in insulin secretion when compared to the basal state, which usually lasts for 2 to 3 hours before returning to the baseline. Rise in BG concentration following intravenous administration of glucose cause a burst in secretion that peaks within 3 to 5 minutes and subsides within 10 minutes and is known as first phase insulin release (FPIR) (8,9). If the BG concentration remains high, then the rise in insulin secretion is sustained in a second-phase of insulin release. The average amount of insulin secreted per day in a normal human is about 40 U (287 nmol) (5).

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.

Sitting Down for Meals

Eating food with others is one of the pleasures of life. As an added advantage, it also slows the pace of your eating, which allows your brain to recognize when you're full so you stop eating at the appropriate time. By sitting down and eating more slowly, you slow the absorption of carbohydrates, thus slowing the rise in your blood glucose.

Treatment Of Postprandial Oh

Patients often have postprandial accentuation of OH. This can occur with any type of neurogenic OH, but is particularly common with diabetic autonomic neuropathy. It often occurs on the background of gastrointestinal autonomic neuropathy, highlighting the great importance of the splanchnic-mesenteric bed in orthostatic BP control. This is a large-volume (20-30 of total blood volume) capacitance bed that, unlike other venous beds, is exquisitely baroreflex responsive. Some patients with mild postprandial OH discover that the worsening can be reduced by frequent small meals, and some find that certain foods are most troublesome and should be avoided. Some patients report that hot drinks or hot food need to be avoided. Carbohydrates are especially troublesome. Ibuprofen, 400-800 mg, or indomethacin, 25-50 mg, with the meal is well-tolerated and should be tried. The next step is the administration of a vasoconstrictor such as midodrine, 10 mg. A problem with vasoconstrictors is the...

General Mechanisms for Potential Diabetes Treatments

Restriction of carbohydrate-containing foods is an obvious method of reducing alimentary absorption of carbohydrate. Foods that are high in soluble fiber (e.g., pulses) also slow absorption of carbohydrate (low glycemic index foods). Guar gum is a plant extract high in soluble fiber that has modest effects on glycemia in type 2 diabetes.62 Complex carbohydrates need to be digested by intestinal enzymes e.g., amylase to monosaccharide subunits before absorption by the intestinal brush border. Inhibition of certain disaccharidase enzymes found at the intestinal epithelium is the basis of the a1-glucosidase group of drugs, e.g., acarbose.63 Absorption of glucose from the intestinal lumen occurs by an active process by sodium-linked glucose transporters, which are also a potential drug target.

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