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Diabetic Nutrition

This brief description is not aimed at the medical profession. Rather, it is a layman’s guide to the current medical treatment of diabetes. Please consult your local Diabetes Association, diabetes magazine, or medical practitioner for further information.
 

1. Glucose control

Food consists of 3 major groups - carbohydrate, protein and fat.

We ingest carbohydrates in various forms, refined or unrefined. As this is a good and relatively cheap source of food/energy, it forms the staple diet of most societies. Examples of carbohydrates are starches like rice, maize, bread, pasta and simple carbohydrates like fruit and cane sugar.

The carbohydrates we eat/ingest are broken down to glucose in the gut. This glucose is then absorbed from the gut and into  the bloodstream where it provides the energy necessary for life. Once in the cells, it is  broken down to water and carbon-dioxide. Not all ingested carbohydrate or glucose is required immediately and any excess is stored in the liver as glycogen. The hormone insulin, which is manufactured in and released from the pancreas, regulates this balance. Beta cells. Other hormones also influence the amount of glucose in the blood but these have the opposite effect of insulin. They are adrenaline, cortisone, growth hormone and glucagon and are frequently associated with stress.

Glucose cannot enter the cells without the aid of insulin and so any increase in blood glucose levels stimulates the release of insulin.  One can picture the insulin molecule as a   ‘key’ which enters the bloodstream, reaches a cell and attaches to its own ‘keyhole’. This, in turn, opens the door for a set amount of glucose to enter the cell and be used as energy.

2. Diabetes, how it works

Diabetic people have high blood glucose levels due to not insufficient  insulin, no insulin, or resistance to insulin. Thus a wide range of scenarios might exist in a diabetic - from no insulin, to excessive insulin as seen early in type  II diabetes. The result is that excess glucose accumulates in the blood while the cells are starving for energy. An alternative means of energy production is activated by the cells  whereby protein (usually reserved for building only) and fatty acids are used as energy. Unfortunately this process has  side effects such as the over-production of acid..

Diabetes is divided into two  major groups:

Type I : diabetics, mostly under thirty years at age of onset,  have no insulin as the insulin-producing cells in the pancreas have been destroyed. They require insulin to survive.

Type  II : diabetics, usually over 40 years at age of onset, produce normal or more than normal amounts of insulin which doesn’t work well. Dietary adjustment and exercise, with or without pills or insulin, are required for control.

3. Oral medication for diabetes

Present oral treatment in South Africa is  divided into four  groups:

a. Biguanides (e.g. Metformin / Glucophage)

Only Metformin is still widely available. It stimulates the cells to be more susceptible to the effects of insulin. As a side effect it inhibits appetite. It does not cause weight gain, making it ideal for overweight, type II  diabetics. Metformin does not cause dramatic falls in blood glucose, thus no "hypos" or "low sugar attacks" occur. Unfortunately, this  also means that it is not a very potent weapon in the diabetic’s armament. It does, however, have  important side effects, so consult your medical practitioner before you start taking this drug and again regularly while taking it.

b. Sulphonylureas (e.g. Glimiperide /Amaryl, Glipizide / Diamicron and many more)

This is the  group of oral medicines most commonly used. They all stimulate the pancreatic insulin-producing cells to produce more insulin. Some manufacturers also claim that they make the body more sensitive to insulin. Unfortunately, all tend to increase appetite purely by their mode of action. The short-acting ones, and to a lesser extent the newer and longer-acting ones, may cause blood glucose to drop to dangerously low levels. It is wise  to take these pills with meals, or to eat regularly after having taken them.

c. Secretalogues (e.g. Repaglinide / Novonorm)

This promising drug is a recent introduction to South Africa.  It is short acting and need only  be taken before a meal.  It stimulates pancreatic insulin secretion. All practitioners involved in diabetic care anxiously await the outcome of trials on their first patients. 

d. Alpha glycosidase inhibitors (Glucobay / Acarbose)

This drug slows the breakdown and absorption of carbohydrates in the gut. It has not proved as effective as was hoped. A clear advantage, however, is the absence of  "hypos" or low blood glucose attacks.

4. Insulin

In South Africa we only use manufactured, human insulin  which is only available in  injection  form. However, progress is being made with  inhalation and nose sprays.

Commercially available insulin differ  only in:

Short-acting insulin (e.g.: Humalog, Actrapid, and HumulinR)

These start working within fifteen minutes to an hour of  injecting them into the skin. Action onset is almost as rapid as the beta cells of the pancreas, peaking at one to two hours and waning over two to six hours.  They are usually used  before the main meals of the day, thus mimicking the body’s own response to food. They may also be used to stabilize diabetic emergency situations such as like diabetic kept-acidosis. Care should be taken to have a meal shortly after taken these types of insulin.

Long-acting insulin (e.g.: Protaphane, HumulinN)

Action from one hour, slowly peaking at six to twelve , with gradual loss of effect to 24 hours. They provide diabetics with a predictable, low insulin level throughout the day.

Intermediate/mixed insulin (e.g.: Humalog Mix25, Actraphane)

These are mixtures of roughly  one-third short-, and  two-thirds long-acting insulin. Common insulin regimens:

P. Kriel (Medical doctor)

For more detailed information, please, contact your medical practitioner,  the SADA, or a diabetic educator.