Online health and medical information » Diabetes

OVERWEIGHT PEOPLE ARE DIFFERENT

admin — Mon, 17 Jan 2011 12:30:44 +0000

A great deal of scientific research suggests that overweight people differ in physical ways from their thinner counterparts. Their bodies respond differently to many foods they eat, producing an increased or recurring hunger, a seeming drive to eat, and a tendency to store fat.
More and wore scientific research suggests that many overweight people suffer from what is called a “food addiction,” caused not by some sort of character flaw or psychological problem, but by an imbalance in body chemistry.
The notion of a food addiction isn’t new—researchers have been attempting to understand food addiction and its relationship to overweight since 1947. And scientists are discovering more and more about food addiction and carbohydrate dependence. A review of Index Medicus reveals that roughly a thousand articles that appeared in1989 alone revealed new information about the processes that may underlie carbohydrate addiction.
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TYPE 2 DIABETES: A 70-YEAR-OLD WHITE WOMAN’S ILLUSTRATIVE CASE – THERAPY WITH THREE OR FOUR ORAL AGENTS WITH OR WITHOUT INSULIN

admin — Mon, 27 Dec 2010 11:42:36 +0000

A 70-year-old white woman was first seen in April, 1 998, when random blood glucose values by fingersticks were 285 and 273 mg/dl. About 6 years before her first visit, her primary care physician told her she had a “tendency towards diabetes” and should go on a diet. At the age of 50 she weighed 130 lb; her present weight was 185 lb. Her father had type 2 diabetes. She had three children, 48-50 years ago, with no knowledge of diabetes during pregnancy; all three infants weighed less than 8 lb at birth.
Physical examination: height, 67 inches; weight, 185 lb; BP, 140/86 mmHg. Except for obesity, the examination was normal.
This patient probably had type 2 diabetes for at least 6 years before she was first seen—a common issue in type 2 diabetes. Early recognition with intensive management of risk factors is critical for successful long-term care. When first seen, the patient had a seriously atherogenic lipid profile and uncontrolled diabetes. She appeared to respond to triple oral therapy for the hyperglycemia: metformin, sulfonylurea (or a meglitinide), and a thiazolidinedione. She had borderline elevation of hepatic enzymes that never reached the stop point of three times the upper limit of normal. Despite triple oral agent therapy, she progressed to insulin therapy; pancreatic beta-cell deficiency was documented by a low fasting C-peptide level. The present approach to intensive glycemic therapy is bedtime glargine insulin to produce FBG in the range of 80-110 mg/dl and daytime combination of metformin and a thiazolidinedione. This regimen has successfully reduced HbAlc to <7%.
Her other problems are suboptimal management of blood pressure and lipids. As is usually the case, she requires more than one antihypertensive agent for BP control. The slightly elevated LDL-C level should fall below 100 mg/dl with higher statin doses. She takes 81 mg of enteric-coated aspirin daily and works to keep her weight down by walking and watching caloric intake. Urinary microalbuminuria has been intermittently present and should be controlled by BP and glycemic control.
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THE G.I. FACTOR: WHY DO PEOPLE GET DIABETES?

admin — Fri, 08 May 2009 13:57:41 +0000

The most common type of diabetes (type 2 diabetes) is the result of insulin not working properly and usually affects people over the age of 40. Overeating, being overweight and not exercising enough are important factors (what we call lifestyle factors) which can lead to this type of diabetes, especially when there is someone else in the family with diabetes.

Many people who live in societies which are undergoing rapid westernisation are developing this type of diabetes. Why ?

To find the answer we need to look back in time. Our ancestors lived and evolved in a very cold climate. Over the last 700 000 years there have been many ice ages—the last ended only 10 000 years ago. During these ice ages there was very little plant food around and people had to hunt animals for survival. This gave them a lot of protein in their diet. In other words, during the ice ages our ancestors were carnivores (meat eaters). Their bodies adapted to this way of life to help them survive on this diet—and also to help them survive times when food was scarce.

As it turned out, this protein-based diet would also have protected them from developing diabetes. This is because the main way the body copes when there is not much carbohydrate (glucose) in the diet, is to make sure that the important parts, such as the brain, get what little glucose that is available. To do this the body makes very little insulin, because the brain can use glucose without insulin. Thus the body’s demand for insulin was very small.

Since the end of the last ice age there have been many changes to the type and amount of food that we eat. First, our ancestors began to grow food crops. Agriculture changed their eating pattern from one based on animal protein to one based on carbohydrate in the form of whole cereal grains, vegetables and beans. A dietary change like this would also have changed the sugar levels in their blood. While they ate a high protein diet, the sugar levels in their blood would not have risen significantly after a meal. When they starting eating carbohydrate regularly, the blood sugar level would have increased after meals. The amount by which the sugar levels in the blood increase after a meal depends on the G.I. factor of the carbohydrate. Crops such as wheat grain, which our ancestors grew, have a low G.L factor. They would not have caused much change in blood sugar levels, so there would have been no need to use up much insulin, either.

The second major change came with industrialisation and the advent of high speed steel roller mills. Instead of eating whole grain products, the new milling procedures broke up the grain into small particles, in fact it enabled us to produce flour so fine it resembled talcum powder. The end result was highly refined carbohydrate. We now know that breaking up natural grain seeds by milling leads to an increase in the G.I. factor of a food, and transforms a low G.I. food into one with a high G.I. factor. When this highly refined food is eaten it causes a greater increase in blood sugar levels. To keep the blood sugar levels normal, the body has to make large amounts of insulin. Many of the commercially packaged foods and drinks with which we now fill our shopping trolleys, have a high G.I. factor. All this strains the body’s insulin supplies.

Thirdly, the dramatic increase over the past 50 years in the quantity of high fat takeaway and fast foods that we regularly eat has made matters even worse. So to our already high G.I. foods, we have added a lot of fat as well. Eating a lot of fat will increase body weight, which in turn makes it harder for the insulin to clear the glucose from the blood. In other words the body becomes insulin resistant—resistant to the effect of insulin. Continually eating carbohydrate foods with a high G.I. factor places even more pressure on the body’s ability to keep producing large amounts of insulin to control the blood sugar levels. Add to this insulin resistance, and you have the perfect recipe for eventually exhausting the body’s insulin supply and developing diabetes. Recent studies from Harvard University have shown that diets with a high G.I. increase the risk of developing type 2 diabetes by two to three times.

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