Jan 06 2010

About Diabetes, A Simple Explanation

Category: ExplanationJimR @ 9:30 pm

An explanation

Although the main focus of this blog-site is, by definition, on diabetic foods and diabetic food lists, there is much general information regarding diabetes that is worth dealing with here. Information that may be of interest especially to anyone recently diagnosed as having diabetes. And that includes simple explanations of diabetic topics that I myself wanted to find out about when I first became a “diabetic”.

Diabetes is a serious non-infectious chronic and progressive disease affecting about 25 million persons in North America. By chronic and progressive we mean that it is of long duration and tends to grow worse over time. There are three main types of diabetes, known as type-1, type-2, and gestational diabetes, but we will concentrate here on type-2 diabetes the version that occurs in more than 90 percent of all diabetes cases. A brief description of type-1 and gestational forms of diabetes is given elsewhere on this site.

Diabetes is the condition in which too much glucose is circulating in the bloodstream.
This occurs because of an impaired mechanism that normally operates in the body in a series of steps prompted by signals from other organs that react when food enters the stomach after eating.

The procedure involves an organ called the pancreas that produces insulin, a hormone that has the ability to join with glucose in the blood as it travels to the organs and cells of the body. Glucose is a simple sugar, a carbohydrate, and is the major source of energy needed by all the cells of the body in the performance of their metabolic functions. Some cells, such as brain cells and red blood cells, depend solely on the delivery of glucose from the blood stream.

If we think about that for just a moment, we can understand why our diabetic condition, with its impaired ability to deliver glucose to our brain and other cells, is so serious and that we must take appropriate actions to minimize the negative effects.

When we eat food it passes into our stomachs where digestion takes place and the mechanical and chemical actions of digestion process the food and produces the many nutrients, including glucose that is mainly obtained from the carbohydrate content of the foods we have eaten. The nutrients are absorbed through the walls of the intestines and pass into the bloodstream that will then distribute them to all the organs and cells of the body.

The body can keep a constant supply of glucose for the cells by maintaining a constant level of glucose in the blood. When needed it is there for the cells and when, after eating, an excess builds up and an over-supply occurs, the body, through its marvelous mechanisms, stores the excess glucose in the liver and muscles by converting the glucose into glycogen, which is a long chain of glucose molecules. If glucose levels become low, the stored glycogen is available for conversion back to glucose and at the same time the body stimulates the brain to urge you to eat more food.

But the glucose cannot get into the cells without assistance, assistance that is provided by a hormone called insulin that is mainly produced by another organ, the pancreas. The pancreas also produces a hormone called glucagon (not to be confused with the previously mentioned glycogen, and it is confusing I know) but glucagon plays an opposite role to insulin, It comes into play when the glucose levels begin to get too low and then assists in the conversion back to glucose of the previously mentioned stored glycogen in the liver and muscles.

The actions of both of those hormones, insulin and glucagon, work constantly to keep glucose concentrations in the blood to within an acceptable ranges for good health. In the case of the diabetic that balance is impaired and the glucose levels are not maintained within the appropriate ranges.

Insulin performs several important functions, one of which is to carry glucose molecules and conduct them to receptors that are on the outer membrane of cells where the unique structure of the insulin molecule complements the unique structure of the receptors, allowing them to “dock”, that is, to join together, and thereby the glucose is released and enters into the cell, another almost miraculous process of life.

In diabetics, this system does not work properly if at all
For several possible reasons, in persons suffering from diabetes the system does not operate in the way described above. Sometimes the pancreas does not produce enough insulin and sometimes the receptors of the cells become desensitized and do not react properly to the presence of insulin, not permitting the absorption of glucose into the cells and sometime it is a combination of both of those conditions.

Because of this the glucose stays in the bloodstream, and insulin too, both of which are unhealthy conditions. And too high a level of glucose in the blood, by definition, is diabetes.

So it is worthwhile to learn about certain foods and whether they are appropriate, as a diabetic,  to eat as an everyday item. A single favorite treat,  such as a muffin eaten at snack time each day by many people, is probably too much of a burden for the diabetic. That and a few others may have to be left off the diabetic food list, perhaps to be included only occasionally when in good control of blood sugar levels.

Also, a dietary adjustment, as recommended by dietitians and health care professionals may alleviate the diabetic conditions to some extent.  But even the adoption of a new dietary regimen may not be sufficiently effective and medications may need to be prescribed. For many, including myself, that becomes a path to increased medications and potential problems – but we will deal with that elsewhere together with other aspects of diabetes.

Meanwhile, for information on a variety of other topics dealing with diabetes, in addition to this site, you can check out my companion sites at Normal Blood Sugar Levels and Diabetes and Diabetic Menu Guide.

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Jan 06 2010

Diabetes, the diagnosis and after

Category: ExplanationJimR @ 9:23 pm

About Diabetes, for those recently diagnosed as diabetic

First the diagnosis

From my own experience of being a diabetic for many years, and having faced the several situations and questions that confront you now, and those that will occur in the future, I offer here a few comments and observations that will, I hope, provide some general guidance for you in these early times. And there is abundant information available on the internet when you know where to look.

After first hearing the diagnosis “You are a diabetic” it comes as quite a shock, however gently conveyed. When you learn from your doctor that you have diabetes, most often type-2 diabetes, it is unlikely you will know much about the disease. The diagnosis will probably come after a blood test and a follow up visit to your doctor and being then told of the situation. You may be pre-diabetic, a condition in which the glucose levels in your blood are rather high but not yet into the diabetic range.  Or your condition may be confirmed as diabetes, which means that the levels of glucose in your bloodstream do exceed the level considered as acceptable. As is explained elsewhere, the glucose in the blood is a normal situation and the result of the food you have recently consumed.

Your physician will explain the facts of diabetes and give advice on the subject, and tell you what you have to do and the life style changes you may have to make to manage your newly identified disease condition. These might include such things as diet, exercise, and possibly medications that will be prescribed if eventually your actions are unable to control your blood sugar levels and your diabetes worsens over the course of time, as is often the case with diabetic patients, perhaps a short time later or in some cases after several years.

There may be referrals to dietitians to help establish an appropriate dietary routine that incorporates your own personal food and life-style tastes and is tailored to your current health and physical condition(s). There are other health care professional who will advise and help you navigate your path through the complications of diabetes if they occur, but that will probably be later if the condition deteriorates.

The early reaction to learning of your diabetic condition
But after that early meeting you will probably leave the doctor’s office with many thoughts, questions and uncertainties still whirling around in your head. In the ensuing days there may be the desire to learn more about the disease, the causes, the treatments, the cures. Actually there is no cure right now according to mainstream medical practitioners, although reference will be made here to that group of qualified, respected and quite well known physicians who disagree and provide their solution in reversing diabetes.

You soon learn that much of the day-to-day control and management of the diabetic condition is in your own hands. It is left to you to find out about many aspects of the disease, you may wonder about the role of insulin and glucose and blood testing and alternative dietary approaches, what foods and beverages, including alcohol are acceptable and when to consume them while always attempting to stay as low on the scale of being diabetic as possible.

For much more on diabetes, check out the List of  Topics on our companion website at Normal Blood Sugar Levels and Diabetes.

And additional diabetes related material can be found at Diabetic Menu Guide

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Jan 06 2010

Establishing Food Plans – Considerations

Category: ExplanationJimR @ 9:12 pm

Different approaches to establishing food plans

The objective of a dietary plan or diabetic food list for the diabetic person is primarily to aid in the control the amounts of glucose in the bloodstream and to keep the glucose levels within as narrow a range as possible so that they do not exceed acceptable levels by too great an amount.

There will be spikes in blood glucose levels after eating a meal or snack that will vary based on the type of food eaten and its carbohydrate content and the speed in which the resulting glucose is produced when digestion of the food takes place. That is why it is good to know, when compiling a diabetes food list, which foods are the source of the highest carbohydrate content and are the speediest broken down to glucose,  so that they can be eliminated or at least limited in quantity. Those can be identified by reference to the Glycemic Index and Glycemic Load index avail able elsewhere on this site.

To maintain glucose levels as evenly as possible throughout the day it is often suggested that meals should be of about the same size and interspersed with snacks, rather than any one meal being much larger than the others.

The essential nutrients needed by the body for its energy and maintenance are obtained from the carbohydrates, proteins, and fats in the foods consumed each day. Those foods are broken down to their nutritional chemical components in the digestion process and released through the walls of the intestine to be carried in the bloodstream to the many organs of the body where they are then selectively taken up as required into the body’s millions of cells.

When present, the carbohydrate fraction of the foods is the main source of glucose in the bloodstream and so it is the carbohydrate content of foods that is the major factor around which diabetic food plans are constructed. The more carbohydrates there are, the more glucose will end up in the blood stream. After a meal or snack, when glucose is produced, the impaired body mechanisms of the diabetic person in the production of insulin, needed to conduct the glucose into the cells that require it, and the desensitized sensors on the outer membranes of those cells, results in the unhealthy levels of the glucose remaining in the blood.

From that statement the question could be asked:
“Then why not reduce the amounts of carbohydrate to a minimum so that less glucose is produced to overload the bloodstream?”

That is a good question that would seem to require an answer in the affirmative. But the diabetic associations of most countries do not seem to concur.

The High Carbohydrate approach
The ADA (American Diabetes Association) and others recommend what can be considered a high carbohydrate diet of 50 to 60 percent Carbohydrates, 15 to 20 percent proteins, and 25 to 30 percent fats based on total calories consumed. A calorie is the unit applied to the measurement of energy provided by components of food.

The Low Carbohydrate approach
Although in the minority, many physicians advocate an “Anti-ADA” approach that, conversely, recommends a low carbohydrate content in meals to minimize the amount of glucose that can enter the bloodstream.

A number of books have been published by doctors providing details on diets that have successfully brought their patients to a reversal or near reversal of their diabetic condition or at least a very good control of their glucose levels. The carbohydrate content of those diets is low, from about 20 to 35 percent. There are many different versions, you’ve probably heard of the Dr.Atkins and South Beach Diets, but there are others, some less extreme than those.

The American Academy of Family Physicians defines low carbohydrate diets as:
“Low-carbohydrate diets restrict caloric intake by reducing the consumption of carbohydrates to 20 to 60 g per day (typically less than 20 percent of the daily caloric intake). The consumption of protein and fat is increased to compensate for part of the calories that formerly came from carbohydrates.”

It should also be noted that the American Diabetes Association, after carrying out their own clinical studies with patients on a low carbohydrate diet, agreed that the low carbohydrate was successful in achieving lower blood glucose levels. However, their stated opinion was that such a diet was not likely to be adhered to for a sufficiently long period of time and they therefore keep to their current recommendations regarding carbohydrates. For additional information on lower carbohydrate foods, see our companion site: Diabetic Menu Guide and the reference to low carbohydrate effectiveness can be found in our post :  Low Carbohydrate Approach.

There are other health concerns voiced by members of the medical and health care profession in which reservations are expressed regarding the adoption of a low calorie diet.

Caution:
All matters of diet, exercise, weight-loss, and especially any changes being contemplated, should be discussed with your doctor who will provide guidance on your treatment and should refer you to other health care professionals for more complete answers if necessary.

One other factor regarding carbohydrates is that they exist in several different forms that are usually classified as either “simple” or “complex”. The difference being in their chemical structure that results in a speedier breakdown to glucose for the simple form and a longer time for the complex forms. This makes the complex forms generally more favorable to include in a diabetic menu plan and a special index, known as the Glycemic Index, has been devised to rate the varying speeds of conversion of carbohydrates to glucose.

Vegetarian, Vegan, and Others
There are other dietary approaches that are effective in the management and control of blood glucose and that do not so much emphasize the carbohydrate content of foods. Among these are the Vegetarian and Vegan life styles that have many virtues from a viewpoint of nutrition. They concentrate on vegetables and fruits that are automatically low on the Glycemic Index, the speed in which their carbohydrate content is converted to glucose.

However, in North America, only a small percentage of the population follow a vegetarian or vegan regime, we are a meat-eating and fat-rich food consuming nation.

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