Diabetes Type I, II - Diet, Diabetic Treatment, Glycosylation - Pg 2
Reprinted by permission from Bill Faloon of The Life Extension Foundation
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)
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
Self-Testing and Sugar Management
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.
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
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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