Diabetes Type I, II - Diet, Diabetic Treatment, Glycosylation - Pg 2

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Diabetes Type I, II - Diet, Diabetic Treatment, Glycosylation - Pg 2
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Diabetes Type I, II - Diet, Diabetic Treatment, Glycosylation - Pg 2
Reprinted by permission from Bill Faloon of The Life Extension Foundation

The greater the level of blood glucose, the higher the production of glycosylated hemoglobin.  An HbA1c score of 7 or less is the goal. (Non-diabetics usually score below 6.)  Glycosylation is the chemical reaction that takes place when the body's proteins are exposed to elevated glucose levels.  The products of glycosylation are called AGEs, or advanced glycosylation end-products.  Such "cross-links" have been thought to be irreversible and create accelerated arterial aging. Some diabetic treatment options are discussed below.

Type I (IDDM)
As its name clearly states, this form of diabetes requires regular and frequent subcutaneous injections of insulin to sustain life and prevent or delay long-term complications.  Today's insulins are pure forms of the hormone without the minor problems of the older pork and beef varieties.  Syringes are now extremely short and sharp (higher gauge), making injections relatively painless.

Insulin comes in short and long-term release forms, which are combined in a typical regimen.  The most common are R (regular) with an onset after 1/2 to 1 hour and a life of approximately 6 hours, and NPH/L (lente), slower release forms with an onset after approximately 3 hours, and a life of up to 24 hours.  Insulins also come in very slow release forms (not commonly used) and several mixtures of R and L in one bottle.

The most important advances in insulin therapy are the implantable pump (which releases insulin internally at the patient's remote-control direction) and Lispro (marketed as Humalog), a rapid release insulin that begins working within minutes and can be taken at the same time as a meal is served.  Lispro's quick availability means that the critical problem of having to wait for several hours to reduce a high blood sugar level has now been partially solved.  A high reading can be reduced to relatively normal levels in well under an hour.  The active Type I diabetic can now limit the time his/ her body suffers the damages of hyperglycemia by a significant amount.

It is important to realize that taking insulin does not remove the need to maintain proper dietary practices.  Poor dietary control can overwhelm any insulin regime.  Diet will be discussed below.

Type II (NIDDM)
The first treatment of Type II diabetes is always diet.  In many cases, diet alone (with concomitant weight loss) may be the only thing needed to restore acceptable blood sugar levels.  Even if medication is prescribed, and even if insulin is added, the patient must be aware of, and practice, dietary restraints.

Type II medications are of several classes, and may be combined in treatment:

Sulfonylureas.  These drugs were once the primary pharmaceutical treatment and still are used heavily (though Metformin/Gluco-phage now is the most widely prescribed pill).  The sulfonylureas (Diabenese, for example) work by stimulating pancreatic production of insulin.  They do contain the possibility of inducing hypoglycemic (low blood sugar) reactions, and the user must be prepared to counter such responses with sugar, juice, glucose tablets, etc.  This also demands that meals be taken at the correct times.  This class of drugs has a history of significant side effects, primarily cardiovascular.

Glucosidase Inhibitors.  Drugs such as Precose work by delaying the absorption of digested carbohydrates.  This lowers the load placed on an inefficient metabolic system.  The glucosidase inhibitors are taken with each meal and pose no risk of hypoglycemia since they do not artificially elevate insulin levels.

Biguanides (Metformin).  Marketed as Glucophage, this multi-action drug is the most widely prescribed Type II medication.  It works by (1) reducing hepatic (liver) glucose production, thus stopping the body from adding to the blood's glucose levels, (2) reducing intestinal absorption of glucose, and (3) increasing insulin sensitivity, thus increasing glucose uptake.  Because Glucophage does not increase the production of insulin, it also does not cause hypoglycemia.  Side effects are usually minor gastric upsets such as nausea or diarrhea.

Rezulin.  The newest Type II drug is Rezulin.  This medication works directly on the core problem of this form of diabetes, the cells' resistance to insulin.  Despite its effectiveness, Rezulin apparently has caused liver damage and death in enough people to have been removed from the market.

Insulin.  Some Type II patients find that diet and oral medications cannot control their blood sugar satisfactorily.  In these cases, insulin may be added to the oral drugs, or may replace them entirely.

Medicines for common diabetic treatment problems.  There are numerous specialized pharmaceutical treatments for such diabetes complications as hypertension, high cholesterol, claudication (pain in the legs from vascular blockage) and impotence, as well as techniques for vision impairment, vascular blockage, and post-cardiac insult conditions.

Self-Treatment and Management of Diabetes
Of all the disorders common to human beings, diabetes is the one most affected by the patient's management.  Not only does each person's fate directly rest on self-diagnosis and self-medication, but he/she controls the impact of the disorder on multiple bodily systems.  A diabetic's diet, exercise, stress levels, personal habits, emotional states, and choice of vitamin, mineral, and other supplements taken will determine his/her immediate and eventual fate.

Self-Testing and Sugar Management
Regular, home blood-glucose testing is at the core of diabetes control.  Many years of research have proven, beyond a doubt, that the higher a person's average blood sugar, the more damage he/she will suffer.  Reciprocally, the better the control, the fewer the complications (Morgensen, 1998; UK Prospectives Diabetes Study Group, 1998).  Thus, it is not only how high blood sugar gets, but also how long it stays there.  Testing your blood sugar frequently will help keep levels normalized and prevent high levels from remaining high.  Physicians refer to this as "covering" a high sugar with additional insulin.  If a diabetic "covers" a high reading with the new rapid-acting insulin (Lispro), the amount of time the body suffers damage may be significantly reduced.

In addition to glucose testing, diabetics should test for the presence of ketones in the urine if blood sugar exceeds 240 mg/dl.  (Ketoacidosis is not a danger for Type II diabetics.)  Diabetics should test even more frequently during periods of illness or injury, when blood sugar levels tend to rise dramatically, even in the absence of any food intake.

While glucose self-testing obviously is critical for those with IDDM, many Type II patients would benefit as well.  They could respond to high sugars in a variety of ways, at the instructions of their physicians.  These patients could be allowed to adjust their medications, reduce their next meal, or in some cases, add a small amount of insulin.  When "covering" is not an option, having self-testing data allows the physician to adjust a patient's program properly.  Even those Type II patients who are extremely well-controlled should test on a less frequent basis because of the numerous agents and events capable of elevating blood sugar.

Diet
As has been mentioned, even with well-designed medication regimes, diet is critical in many ways.  On the most basic of levels, many diabetics must perform a delicate balancing effect with caloric/carbohydrate intake and medicine.  This becomes even more important when the medications used have peaks of effectiveness (see below).

As also mentioned previously, diet and weight loss may be the only treatment required with Type II diabetes.  Bringing intake down to the body's diminished digestive capacity is often the answer to this medical disorder.

More specifically, the following dietary recommendations may be made:

Eat a cardiac patient's diet.  Because degradation of the cardiovascular system is the root problem in diabetes, and so much of the resulting pathology is either in the heart and blood vessels or in organs with inadequate vascular supply, the basic rules of the cardiac diet should be followed.  Diabetics typically have elevated cholesterol and high blood pressure.  Therefore, fat intake should be kept low, and saturated fats should be avoided.  Meals high in fiber and emphasizing complex carbohydrates are suggested.  If blood pressure is not normal (120 over 80) or lower, salt intake should be reduced.  Raw vegetables (as in salads) are recommended.  They are absorbed slowly and low in calories.

Eat Smaller Meals
Even when properly medicated, it is difficult for the body of a diabetic to process large amounts of food at one time.  Excessive food intake can cause blood sugar elevations.  Smaller meals (5 per day -- 200-300 calories every 3 hours) are ideal and reduces the demand on an inadequate insulin supply system.

Eat only small to moderate amounts of protein.  Diabetes is a major cause of kidney disease.  High-protein diets are difficult for the kidneys to process.  The logical response is to restrict protein intake.  Since proteins and fats are paired in red meats, it is recommended that sources of red meat be avoided as much as possible.  Unfortunately, for many years diabetics were prescribed a diet in which carbohydrates were replaced with large amounts of proteins and fats.  The long-term data concerning typical diabetes complications (with high incidences of vascular and renal disease) undoubtedly reflect that diet's errors.

Meals should be timed to match the dosage curves of diabetes medications.  All insulin and some oral drugs have periods of onset and peak activity.  Diet plans should adjust to these pre-set times.  If a patient cannot arrange to eat the appropriate amount of food at the correct times, then some accommodation must be made, for example, by altering medication times or adding a small meal to delay hypoglycemic reactions.

Become familiar with the Glycemic Index (Thomas et al., 1994).  This is an extremely useful tool to help regulate metabolic activity for diabetic treatment.  The Glycemic Index lists the relative speed at which different foods are digested and raise blood sugar levels.  Each food is compared to the effect of the same amount of pure glucose on the body's blood sugar curve.  Glucose (simple sugars) itself has a Glycemic Index rating of 100.  Foods that are broken down and raise blood glucose levels quickly have high ratings.  The closer to 100, the more that food resembles glucose.  The lower the rating, the more gradually that food affects the blood sugar level.  The Glycemic Research Institute (202-434-8270) publishes rating of hundreds of different foods, and issues a seal of approval on foods which elicit low responses.  Here is a list of some common foods and their Glycemic Index ratings:

Baked potatoes, 95; White bread, 95; Mashed potatoes, 90; Carrots, 85; Chocolate candy bar, 70; Corn, 70; Boiled potatoes,70; Bananas, 60; White pasta, 55; Peas, 50; Unsweetened fruit juice, 40; Rye bread, 40; Dairy, 35; Lentils, 30; Fresh fruit, 30; Soy, 15; Green vegetables, Tomatoes, <15.

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More Information:  Type 2, Exercise, Blood Sugar | Dietary Troubles - Obesity, Diabetes, Heart Disease | Diabetes & Vitamin D
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