THE CARBOHYDRATE ADDICTION: THINKING ABOUT HUNGER

DIABETIC HEALTH: CONTROLLING DIABETES

Most physicians attempt to control diabetes with a variety of insulin-related drugs. Most of these drugs are taken orally, although self-administered hypodermic injections are prescribed when other treatments are inadequate. Recent breakthroughs in individual monitoring and the implanting of insulin monitors and insulin infusion pumps that regulate insulin intake “on demand” have provided many people with diabetes the opportunity to lead normal lives.
Newer forms of insulin that last longer in the body and have fewer side effects are now available. As we go to press, an insulin inhaler is being tested for possible widespread use. All of these treatments come at a price. On average, health care costs for diabetics are 10,000 to 20,000 dollars higher per year than for healthy patients. The direct cost of treating diabetes in the United States is 44 billion dollars per year. When indirect costs are added, the price soars to over 98 billion dollars.
Some people have found that they can help control their diabetes by eating foods that are rich in complex carbohydrates, low in sodium and high in fiber; by losing weight; and by getting regular exercise. Developing a routine for monitoring and controlling this disease can be stressful, particularly in the beginning. Some reports even suggest that diabetics may be at a greater-than-average risk for clinical depression. Attention to psychosocial needs is often an important aspect of diabetic health.
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DIABETES NOWADAYS

The word diabetes comes from a Greek word meaning fountain, so-named because the striking symptom of the disease is the pouring from the body of considerable amounts of urine containing sugar. Diabetes is not infectious. To some extent it is inherited, but it is a recessive and tends to breed out of the family. If a person with diabetes marries one who does not have the disease and whose family shows no record of the disease, there is no reason to expect that the children will have diabetes. If two people who are diabetic marry and their histories show a considerable number of cases among the ancestors, it is quite likely that their children will have this disease. Nowadays, a diabetic person who follows instructions as to hygiene and who is in contact with a physician who controls his diet and the use of insulin, can have a normal life-expectancy. He must, however, avoid overeating, avoid infections, test the urine for sugar frequently (at least twice a week) to make sure that the status of the disease is not progressing and take the necessary measures to avoid acidosis or coma. New drugs have been discovered which, taken by mouth, will lower blood sugar.
Juvenile diabetes was once invariably fatal. Children now have a normal life-expectancy, with proper treatment.
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GENETIC FACTORS OF DIABETES

Diabetes shows a strong familial aggregation and occurence of diabetes in several members of a family is a common observation. There is a high prevalence of diabetes in children, if both or one of the parents are suffering from diabetes (Type-2).
If Diabetes Chances of Development
in of Diabetes in Children
Both Parents……………………………………………………….. 99%
One parent & other parent from a diabetic family……. 70%
One parent………………………………………………………….. 40%
Any of the family member…………………………………….. 20%
Adapted from Vishwanathan et al. N.N.D.U. proceeding 1992
It is generally agreed that a diabetic should be advised, not to marry another diabetic and if married then not to have children. Secondly, it is advised that close relatives of the diabetes patient should also undergo periodical blood sugar and medical checkup to prevent and detect diabetes at an early stage.
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THE G.I. FACTOR: THE EFFECT OF FAT AND PROTEIN ON THE G.I. FACTOR

High fat foods that have a low G.L factor may appear in a falsely favourable light because increases in fat and protein tend to slow the rate of stomach emptying and therefore the rate at which foods are digested in the small intestine. High fat foods will therefore tend to have lower G.I. factors than their low-fat equivalents. For example, potato crisps have a lower G.I. factor (54) than potatoes baked without fat (85). Many sweet biscuits have a lower G.I. factor (55 to 65) than bread (70). But this is not a consistent finding. New boiled potatoes have a lower G.I. factor (62) than French fries (75), despite the latter’s fat content.

Remember, however, we need to eat a low-fat diet, not a high fat one. So, high fat foods of any sort, whether low or high in their G.I. factor, should only be eaten in limited amounts.

Why does pasta have a low G.I. factor? The starting point for making pasta is semolina or cracked wheat, not wheat flour. Durum wheat makes the best pasta because the grain is extremely hard and the wheat breaks cleanly into distinct small pieces. The large particle size of semolina means that starch gelatinisation is more difficult and thus enzyme attack is slowed down. The typical shape of pasta also appears to play a role in slowing down digestion. That’s why pasta of any shape and size has a fairly low G.I. factor (30 to 50). Cracked wheat and couscous used in Middle-Eastern cooking have intermediate G.I. factors.

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LIVING WITH DIABETES: HOW WAS INSULIN DISCOVERED?

The story of the discovery of insulin is a long and fascinating one and to some extent it is also the story of our understanding of diabetes itself.

As a medical condition, diabetes has been known to mankind for two thousand years and perhaps the very first known reference to diabetes is in an Egyptian papyrus thought to have been written about one thousand five hundred years ÂÑ.

Despite an awareness of diabetes and the fact that so many people have suffered from it, virtually nothing was known of the nature of the condition or its cause. Doctors had only known that it was associated with the passing of a large quantity of urine and excessive thirst and the name diabetes literally means ‘an excessive flow of fluid’.

It was not until the 17th century that an Englishman named Thomas Willis noted that the urine of persons with diabetes was sweet and tasted like honey or sugar.

Thus the name of the condition came to be ‘diabetes mellitus’, from the Latin word for honey. So it was that doctors came to realize that diabetes mellitus had something to do with sugar. The proof that this sweetness of the urine was in fact due to sugar was made by another Englishman, Matthew Dobson, and a century later. Dr Dobson also found that the blood of patients with diabetes was also sweet, and he came to the important conclusion that the sugar in the urine came because there was excessive sugar in the blood.

The next important advance was made by a French scientist, Claude Bernard. Bernard discovered that sugar was normally kept at a constant level in the bloodstream and that the regular source of sugar in the blood was derived from stores in the liver. The substance that acts as a sugar store in the liver we call Glycogen.

A most important step in our understanding of diabetes came in 1889 when a German laboratory worker called Minkowski found that removing a dog’s pancreas led to it getting severe diabetes. Thus the origin of diabetes was traced to the pancreas. This observation was taken further still in 1901 when Dr Opie in Baltimore, USA, noted that in those with diabetes certain tissue cells in the pancreas, the ‘Islets of Langerhans’, were degenerated.

In 1916 a British physiologist, Sir Edward Sharpey-Schafer, suggested that diabetes was due to a lack of a chemical substance produced by these ‘islet’ cells. This very important suggestion paved the way for the search for this chemical substance they produced.

From then on many people attempted to extract this substance from the pancreas. Dr Zuelzer, a German, treated some people with diabetes with such an extract, apparently with some response. However his experiments were not completely successful and many other people had tried the same thing and failed.

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