Jan 13 2010

How to Manage the Diabetic Condition

Category: Content — JimR @ 4:44 pm

The “Plus” in this blog’s title of Diabetic Food List + Plus refers to those topics, other than food related, that are more general in subject content than would be found on the diabetes food list, but are important enough or may be of interest to my fellow diabetics. The following falls into the latter category.

For the Newly Diagnosed Diabetic -  Read this First
The cells of our body derive energy from sugars, in the form of glucose, obtained from our daily food intake, especially from the carbohydrate portion of those foods, Food also supplies the proteins and fats that, together with carbohydrate, are essential to the nourishment of the individual.

In a healthy person, the levels of glucose that circulate in the bloodstream, mainly as a result of the digestion of the food consumed, are maintained within a safe range by a series of chemical reactions that constantly take place in the body.

Diabetes, a serious disease, is the condition in which a person’s body is unable to properly regulate and control the levels of sugar in their bloodstream in the way that a healthy person does.

As yet, medical science has not been able to provide a cure for diabetes, To treat a patient suffering from diabetes, referred to as a diabetic, it is necessary to implement a regimen of dietary and exercise procedures that, together with prescription medications, can help control the blood sugar levels that otherwise will inevitably lead to major complications and increase the risk of several serious conditions, including cardiovascular disease, the leading cause of death in the diabetic population.

In addition to the large number of people who are known to be diabetic, there is also a large number of people who have the disease without knowing it, possibly because they have not had a recent, or perhaps any, medical checkup,

Important to note: Anyone who is known to be diabetic must be under the care of a physician.

Doctors monitor the diabetic condition of their patients, guided by the results of periodic blood tests, and will prescribe medication if deemed necessary. Aided by nutritionists or other health-care providers, the doctor will probably advise the steps that the patient should take to lower and control the blood sugar levels, also referred to as blood glucose levels, to within a close to normal range.

Five factors in the management of diabetes

The first factor: To be effective, the management of diabetes requires that an appropriate daily food plan be diligently followed, not special foods, but the right foods chosen from the vast amount and range of foods available. Available, that is, to the citizens in the developing world, and then again, diabetes is the growing disease of the developing Western World. There are few foods that are off-limits but quantity and quality must be taken into consideration.

The second factor is the requirement for regular exercise, not necessary at the athletic level but more than a casual stroll each day. Commonly suggested is to take a brisk walk for half an hour each day, or at least five times a week. Or it could be swimming or bicycle riding or whatever achieves at least that equivalent minimum amount of exercise.

The third factor involves weight-loss. If a diabetic person is overweight it increases the level of serious heart and other health risks. The first two factors, described above, can help reduce weight if properly applied, but before implementing any weight-loss program, a consultation with a doctor would be wise.

The fourth factor is that a once-a-day personal in-home blood test should be taken. The blood test is done with the aid of a simple and easy to use measuring device, just takes ten or twenty seconds to obtain a reading that indicates the amount of glucose in the blood stream. If done once each day then most likely it should be on rising, before breakfast or any food intake, in other words a fasting blood sugar level – as it is commonly referred to.

Monitoring the blood glucose levels at home each day enables the diabetic to know their condition and if necessary, make adjustments to their dietary plan and/or lifestyle in a best effort to correct blood sugar levels. This may require more daily blood tests than just the morning test. It is a fact of diabetes that much of its management is in the hands of the diabetic personally and requires frequent checks to try to gain control.

The fifth factor: Periodic attendance at the doctor’s office for checkups, and blood tests, known as the A1c or Hemoglobin A1C blood test. The blood for these tests, a simple painless procedure, is taken by a technician at a medical clinic, and are normally required every three or four months. These tests provide essential information of the estimated average glucose content existing in the blood over the prior period of about 3 months. This test result is possible because the life-span of blood cells, that are constantly manufactured by the body, is approximately 12 weeks, so some of the blood cells are just newly born while others will be of any age up to about 12 weeks. With the A1c blood test results available, the doctor can monitor and assess, and adjust if necessary, the treatment to best combat diabetes.

For a further explanation of blood tests, visit Blood Testing for Diabetics on my companion site where you will also find other items of interest to diabetics under the site name:  Normal Blood Sugar Levels and Diabetes.

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Jan 11 2010

The Glycemic Index and the Glycemic Load

Category: Explanation — JimR @ 9:21 pm

When considering various foods that you might wish to add to a diabetes food list, it can be helpful to know their Glycemic Index rating.

The Glycemic Index, or GI for short, is a list of carbohydrate containing foods that have been rated for their speed of conversion to glucose, and the release of that glucose into the bloodstream, compared to a standard reference value of 100 assigned to pure glucose. Pure glucose being very speedily released into the bloodstream since it does not require any further chemical breakdown by the digestive-system as would other food items.

The higher the numerical grading of a food the faster it is absorbed into the bloodstream compared to other foods of lower numerical value. Examples of this would be the breakfast cereals:

All-Bran with an established GI of 42,
Shredded Wheat with a GI of 67, and
Corn flakes with a GI of 84,

indicating that the carbohydrates in Corn flakes are converted much more quickly into glucose than the other two cereals with All-Bran taking the longest time. A faster release of glucose causes a faster and higher spike in blood sugar elevation, something to be avoided, or at least minimized if possible, leading to the conclusion that All-Bran is a better cereal choice than the others to include on the diabetic food list.

But not all high GI foods are bad and there are times, such as before, during, and after exercising, when they are beneficial. The body reacts to the higher blood glucose by releasing insulin, a hormone that assists the body in building muscle, although we must always keep in mind that the diabetic person’s body has an impaired ability to deal with insulin and higher blood glucose. These matters would be better discussed and commented on by the diabetic’s doctor or qualified health team members.

Many foods, such as proteins and fats, do not contain significant amounts of carbohydrate and are not listed on the glycemic Index.

The glycemic index is a useful tool to aid in choosing carbohydrate containing food items to include in a diabetic food list, enabling an emphasis on those with lower index values. But the inclusion of low GI foods in a diabetic food plan is only one of several considerations in determining an appropriate dietary regimen to follow over the long term.

GI range of values

Low GI values are 55 or less
Medium GI values are 56 to 69
High GI values are 70 and above.

The Glycemic Load
But what if the carbohydrate food we eat is only part of a larger meal that is otherwise devoid of carbohydrates, perhaps a meal of mostly protein and fat, of meat, vegetables, fruits, that have little or no carbohydrate content? In that case, measuring by weight in terms of grams, the carbohydrates would  be only part of the total grams in the meal and from this an adjusted GI value can be obtained by applying a simple formula..

To cover that situation, there is an extension and enhancement of the glycemic index known as the Glycemic Load. The glycemic load derives a set of values from those of the GI by taking into account the quantity, or quantities, of carbohydrates that are actually in the total meal of food item.

It becomes more practical to consider the GL of a food item when it is only a relatively small portion of the food being consumed, even if it is has a high GI rating,.

For a simplified example: when  knowing that one cup of the 84 GI cornflakes weighs about 30 grams, we can easily calculate the proportion of the cornflakes to the weight of the total meal. When being considered as part of a larger breakfast meal of 120 grams weight, it would be 25 percent of the total and that becomes the glycemic load value. 25 percent of the 84 GI is 21, the GL value of the cornflakes in the breakfast.

GL ranges of values
A GL value of 21 is still rather high, the substitution of a lower GI cereal such as Bran flakes or oatmeal porridge  would achieve a much lower GI rating. A GL value below 10 is considered to be low and above 20 is high in the opinion of most nutritionists.

An important decision regarding carbohydrate consumption
A major decision rests on what percentage of carbohydrates will be included in the overall diabetic food plan, whether to follow the American Diabetes Association’s recommendations of a high ratio of carbohydrates, or the opposite approach of lower carbohydrates, or somewhere in between. This is a controversial subject for many health care practitioners and needs careful consideration and discussion elsewhere. There are strong advocates whose differing views are worth hearing, even though a diabetic patient mainly depends on his or her personal physician to provide guidance, much of the management of the diabetic condition is in the hands of the individual diabetic.

The food lists available from this blog-site do provide the nutrient content and information for many common food items, indicating whether high or low on the GI and some food groups in general are summarized. For a very complete listing of GI values the following resources are suggested – although doing the research can get rather complicated and time consuming:

1.  The University of Sydney, Glycemic Index Web site.

2.  David Mendosa, blogger and medical writer.

3. There is also a very good article and explanation by staff of the Linus Pauling Institute at Oregon State University. That explanation references the GI to cardiovascular disease, a major complication of diabetes, and to obesity, to cancer, and to gallbladder disease. With its comments on several other topics of interest, it is worth a read and can be reached at Linus Pauling Institute.

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Jan 06 2010

About Diabetes, A Simple Explanation

Category: Explanation — JimR @ 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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