If you are a diabetic, your doctor or nutritionist may have told you that your diabetic diet must contain adequate carbohydrates, despite the fact that diabetes is a disease all about your blood sugars being too high and carbohydrates raise your blood sugars, because "your brain has to have 130 grams of glucose" every day. While it is true that your brain is a unique organ that can only burn glucose, other organs being able to use nutrients for energy, your body can get those 130 grams from foods that will not raise your blood sugars.
In the "old days," the only way most diabetics could measure their blood sugars was with little strips of paper they dunked in their urine. If the paper turned blue, then blood sugars were too high and they needed insulin. If the paper did not turn color, then blood sugars were not too high, but there was no way to tell whether they were normal or low.
To protect their diabetic patients against the dangers of hypoglycemia and insulin shock, they recommended every diabetic eat carbohydrate. Hypoglycemia can be immediately fatal, as in the case of a diabetic in insulin shock driving into a utility pole. High blood sugars were fatal only slowly, so eating carbs was better than not.
In modern times, however, diabetics can measure their blood sugars more precisely, so the old "insurance" of eating carbs with every meal is not necessary (unless, of course, you are taking too much insulin or too much medication). The human brain can get the glucose it needs in many ways that do not require eating sugary, carb-loaded foods.
The liver can convert up to 58 per cent of the protein you eat into glucose, slowly enough that it does not raise blood sugars, but fast enough to provide energy to the brain. About 10 oz (280 grams) of protein foods every day is enough to provide your brain with the energy it needs. If you just eat a measly half-ounce (15 grams) of carbohydrate at every meal, say a great big salad or one slice of bread, you still get all the carbs you really need. And if you eat the salad instead of the bread, you keep your blood sugars low while getting other important nutrients.
If you eat all the carbs recommended by the American Diabetes Association diet, you will go through a daily cycle of sugar high (as all the "healthy" carbs are converted to glucose) followed by adrenal crash, every single time you eat. Keeping your carbs to a minimum, even less than the 130 grams recommended by doctors before glucose meters or the 400-500 grams on the ADA diet, will keep your blood sugars and your brain on an even keel throughout the day.
Monday, December 29, 2008
Is Gestational Diabetes Really Diabetes?
Sometimes when women are diagnosed with high blood sugars during pregnancy, that is, with gestational diabetes, their doctors are so casual that they could wonder whether gestational diabetes is really diabetes. After all, some doctors say, you will probably be fine after you deliver, just keep your sugars in control for the time being. The problems is that uncontrolled blood sugars during pregnancy can be the first sign of a kind of diabetes that is neither type 1 nor type 2 called LADA.
While obstetricians will insist that expectant mother's keep their blood sugars in check, after delivery the follow up care for women who have gestational diabetes is usually minimal. There might be one HbA1C reading to make sure it's below 7, and maybe a finger stick or two to make sure the fasting sugars aren't too high. One or two "clean" tests and the diabetes case is closed.
The problem is that women who get gestational diabetes tend to be "blood sugar impaired," but not fully diabetic. Some research published in late 2008 found that women who have diabetes during pregnancy have most but not all of the same genes found in type 2 diabetics of both sexes. They will have normal fasting blood sugars because their beta cells get around to churning out enough insulin to take care of the glucose released from food at night, but they do not make enough insulin to keep blood sugar levels low in the 2-3 hours after meals.
High post-prandial, or "after-meal," sugars can do just as much damage as high fasting sugars, but most doctors never test for them. Over time they can poison the remaining beta cells so that they stop making insulin, leading to diabetes that is only detected after it has done damage.
And, just as some women who have an Rh+ blood type have trouble bearing an Rh- baby, sometimes pregnancy triggers a series of autoimmune reactions that cause a kind of diabetes known as LADA (latent autoimmune diabetes in adults). It's something like juvenile diabetes in adults (and I have it, myself, obviously not because I got pregnant, which would no doubt get me an appearance on Oprah). Both men and women can get the condition, initiated most often by pregnancy in women or a viral infection in men.
Fasting blood sugars are fine because the pancreas retains its ability to produce some insulin, slowly. It just can't produce enough insulin quickly to keep blood sugars down after meals. The problem is, those high blood sugars after meals eventually "burn out" beta cells so blood sugars are high all the time.
If you are a new mother who had gestational diabetes, what should you do? To make sure you don't have LADA or type 2 diabetes that just happened to begin when you became pregnant, test your blood sugars about 2 hours after you eat, at least 3 or 4 times. If you get a reading of over 200 mg/dl (11 mM), first, make sure you didn't just happen to have sugar on your hands. But if you get two readings over 200 mg/dl, see your doctor about follow-up care.
While obstetricians will insist that expectant mother's keep their blood sugars in check, after delivery the follow up care for women who have gestational diabetes is usually minimal. There might be one HbA1C reading to make sure it's below 7, and maybe a finger stick or two to make sure the fasting sugars aren't too high. One or two "clean" tests and the diabetes case is closed.
The problem is that women who get gestational diabetes tend to be "blood sugar impaired," but not fully diabetic. Some research published in late 2008 found that women who have diabetes during pregnancy have most but not all of the same genes found in type 2 diabetics of both sexes. They will have normal fasting blood sugars because their beta cells get around to churning out enough insulin to take care of the glucose released from food at night, but they do not make enough insulin to keep blood sugar levels low in the 2-3 hours after meals.
High post-prandial, or "after-meal," sugars can do just as much damage as high fasting sugars, but most doctors never test for them. Over time they can poison the remaining beta cells so that they stop making insulin, leading to diabetes that is only detected after it has done damage.
And, just as some women who have an Rh+ blood type have trouble bearing an Rh- baby, sometimes pregnancy triggers a series of autoimmune reactions that cause a kind of diabetes known as LADA (latent autoimmune diabetes in adults). It's something like juvenile diabetes in adults (and I have it, myself, obviously not because I got pregnant, which would no doubt get me an appearance on Oprah). Both men and women can get the condition, initiated most often by pregnancy in women or a viral infection in men.
Fasting blood sugars are fine because the pancreas retains its ability to produce some insulin, slowly. It just can't produce enough insulin quickly to keep blood sugars down after meals. The problem is, those high blood sugars after meals eventually "burn out" beta cells so blood sugars are high all the time.
If you are a new mother who had gestational diabetes, what should you do? To make sure you don't have LADA or type 2 diabetes that just happened to begin when you became pregnant, test your blood sugars about 2 hours after you eat, at least 3 or 4 times. If you get a reading of over 200 mg/dl (11 mM), first, make sure you didn't just happen to have sugar on your hands. But if you get two readings over 200 mg/dl, see your doctor about follow-up care.
What Can You Do About Retinopathy?
If you have been diagnosed with diabetic retinopathy, what can you do?
The standard medical recommendation for diabetic retinopathy is laser coagulation surgery. What most diabetics do not realize until after the procedure is, laser surgery tiny blind spots in the filed of vision of the affected eye. As its name suggests, laser coagulation coagulates the proteins in targeted blood vessels. Those areas of the retina no longer receive light, and there is also reduction in night vision and color perception.
But there is a reliable, non-surgical approach. The very best thing any diabetic can do to reduce the risk of and even reverse retinopathy is to keep blood sugars down. This means, preferably, keeping blood sugars low not just every morning, but after meals, too.
The United Kingdom Prospective Diabetes Study, running from 1977 to 1997, studied 5,200 people with type 2 diabetes. By the standards of the time, diabetics who kept their blood sugars down to an average of 165 mg/dl (corresponding to an HbA1C of about 7) were considered to achieving “tight control.” Just keeping HbA1C, however diabetics managed to do it, reduced the risk of both diabetic changes to the retina and kidney disease by 25 per cent.
And if diabetics also managed to keep their blood pressure down to an average of 144/82, which by current standards is still “high,” the risk of diabetic changes to the retina dropped by 47 per cent. A much better approach to treating diabetic retinopathy is “tight control” of blood sugars. Nothing you can do does more for eye health that controlling both blood sugars and blood pressure.
And nothing in blood sugar control, at least from the standpoint of preserving vision, is more mportant than avoiding corn syrup and other high-fructose sweeteners. Especially during times of emotional stress, adrenalin-related hormones and high levels of fructose in the bloodstream can synergize to induce high blood pressure, high cholesterol, and high triglycerides, all of which are harmful to the eye. Fresh fruit has one advantage over fructose sweeteners: The fructose in fruit is absorbed more slowly because of the fibers and pectin in the fruit. Diabetics who cannot tolerate fructose sweeteners may be able to tolerate small amounts of fruit.
Some supplements also help. The most useful supplements are inexpensive and free of side effects.
The cells of the retina use magnesium to store energy in the form of ATP, and without magnesium, they cannot use glucose. Diabetics of European descent who have retina damage usually are magnesium-deficient, but diabetics of African descent who have retina damage usually are not. This means that not everybody will be helped by taking a magnesium supplement.
Magnesium citrate and magnesium tartrate are best absorbed. Don’t overdose. Magnesium supplements, like the namesake Milk of Magnesia, can cause diarrhea.
Magnesium supplements will not do you any good if you do not get your B vitamins. Vitamin B6 (pyridoxine) is essential for transporting magnesium into the cell.
Vitamin C supports the production of collagen that keeps the blood vessels in the retina in their normal courses. The retina uses vitamin C to make collagen and hang blood vessels in much the same manner as carpenters hang sheet rock on a wall. All diabetics are at risk for vitamin C deficiency even if they get a lot of vitamin C foods in their diets, but just 100 milligrams a day can be enough to slow down retina changes.
The jury is still out on vitamin E. Researchers at the Joslin Diabetes Center and Harvard found that really high doses of vitamin E in the form of alpha-tocopherol, up to 1,800 milligrams a day, could not just prevent retina changes, but even reverse them. The drawback is, taking that much vitamin E can interfere with various medications you take for your circulatory system. Ask your eye doctor before you start a high dose.
OPCs (oligomeric proanthocyanidins) like the ones found in grape seed extract protect collagen from injury from high blood pressure. They stop a collagen-destructive enzyme. Bilberry works in a simlar manner, and ginkgo may help color vision in milder cases.
The standard medical recommendation for diabetic retinopathy is laser coagulation surgery. What most diabetics do not realize until after the procedure is, laser surgery tiny blind spots in the filed of vision of the affected eye. As its name suggests, laser coagulation coagulates the proteins in targeted blood vessels. Those areas of the retina no longer receive light, and there is also reduction in night vision and color perception.
But there is a reliable, non-surgical approach. The very best thing any diabetic can do to reduce the risk of and even reverse retinopathy is to keep blood sugars down. This means, preferably, keeping blood sugars low not just every morning, but after meals, too.
The United Kingdom Prospective Diabetes Study, running from 1977 to 1997, studied 5,200 people with type 2 diabetes. By the standards of the time, diabetics who kept their blood sugars down to an average of 165 mg/dl (corresponding to an HbA1C of about 7) were considered to achieving “tight control.” Just keeping HbA1C, however diabetics managed to do it, reduced the risk of both diabetic changes to the retina and kidney disease by 25 per cent.
And if diabetics also managed to keep their blood pressure down to an average of 144/82, which by current standards is still “high,” the risk of diabetic changes to the retina dropped by 47 per cent. A much better approach to treating diabetic retinopathy is “tight control” of blood sugars. Nothing you can do does more for eye health that controlling both blood sugars and blood pressure.
And nothing in blood sugar control, at least from the standpoint of preserving vision, is more mportant than avoiding corn syrup and other high-fructose sweeteners. Especially during times of emotional stress, adrenalin-related hormones and high levels of fructose in the bloodstream can synergize to induce high blood pressure, high cholesterol, and high triglycerides, all of which are harmful to the eye. Fresh fruit has one advantage over fructose sweeteners: The fructose in fruit is absorbed more slowly because of the fibers and pectin in the fruit. Diabetics who cannot tolerate fructose sweeteners may be able to tolerate small amounts of fruit.
Some supplements also help. The most useful supplements are inexpensive and free of side effects.
The cells of the retina use magnesium to store energy in the form of ATP, and without magnesium, they cannot use glucose. Diabetics of European descent who have retina damage usually are magnesium-deficient, but diabetics of African descent who have retina damage usually are not. This means that not everybody will be helped by taking a magnesium supplement.
Magnesium citrate and magnesium tartrate are best absorbed. Don’t overdose. Magnesium supplements, like the namesake Milk of Magnesia, can cause diarrhea.
Magnesium supplements will not do you any good if you do not get your B vitamins. Vitamin B6 (pyridoxine) is essential for transporting magnesium into the cell.
Vitamin C supports the production of collagen that keeps the blood vessels in the retina in their normal courses. The retina uses vitamin C to make collagen and hang blood vessels in much the same manner as carpenters hang sheet rock on a wall. All diabetics are at risk for vitamin C deficiency even if they get a lot of vitamin C foods in their diets, but just 100 milligrams a day can be enough to slow down retina changes.
The jury is still out on vitamin E. Researchers at the Joslin Diabetes Center and Harvard found that really high doses of vitamin E in the form of alpha-tocopherol, up to 1,800 milligrams a day, could not just prevent retina changes, but even reverse them. The drawback is, taking that much vitamin E can interfere with various medications you take for your circulatory system. Ask your eye doctor before you start a high dose.
OPCs (oligomeric proanthocyanidins) like the ones found in grape seed extract protect collagen from injury from high blood pressure. They stop a collagen-destructive enzyme. Bilberry works in a simlar manner, and ginkgo may help color vision in milder cases.
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