Pharmacy Blog » Diabetes

KEY POINTS: CLASSIFICATION, DIAGNOSIS, AND SCREENING FOR DIABETES

admin — Mon, 23 May 2011 11:30:17 +0000

In 1995, the classification of diabetes mellitus was changed, with the major categories being type 1 (immune-mediated or idiopathic) and type 2 diabetes mellitus.

Diagnostic criteria for gestational diabetes mellitus (GDM), impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and diabetes mellitus were updated.

The major change was lowering the fasting plasma glucose from > 140 mg/dl to > 126 mg/dl for the diagnosis of diabetes mellitus. Pre-diabetes is defined by either IFG (110-125 mg/dl) or IGT. People with pre-diabetes are at a high risk for the development of diabetes and coronary heart disease.

Screening for the presence of diabetes is best done by measuring the glucose concentration in a specimen of venous plasma, taken after an overnight (> 8 hours) fast.

Fingerstick glucose testing is not accurate enough to use for screening.

Screening should be confined to members of high-risk groups

Two recent major studies have indicated that the onset of type diabetes in people with IGT may be delayed by intensive lifestyle changes (diet and exercise). One study showed that metformin therapy was effective. => These studies indicate that increased use of glucose tolerance testing in people at high risk for diabetes should be used in the future because therapy may decrease the risk of diabetes.

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DIABETES THROUGH THE AGES

admin — Tue, 18 Jan 2011 10:47:19 +0000

The oldest written reference to diabetes is found in the Ebers papyrus, which was written in ancient Egypt about 1500 B.C. The Egyptian physicians suggested treatments for polyuria (frequent urination—one of the most obvious signs of diabetes) that included eating wheat grains, grapes, honey, and berries.
The ancient Greek physician Aretaeus of Cappadocia gave diabetes its name, which is the Greek word for “siphon.” About a.d. 100 he described the disease as “a melting down of the flesh and limbs into urine.” Diabetes was rare in his time, and for its sufferers, he wrote, “Life is short, disgusting, and painful.” Listing such symptoms as burning thirst and incessant urination, he suggested a diet of milk, gruel, cereal, and wine.
Diabetes was also well known to medical specialists in ancient China, Japan and India. For example, Susruta, a doctor in India around 400 B.C., wrote about a disease in which people produced “honey urine,” “like an elephant’s in quantity.” He noted that the urine of a person with diabetes attracts flies. Other ancient Indian writers described such symptoms as thirst, fatigue, and skin boils. They reported that diabetes is a disease most often found among the rich and self-indulgent, who are fond of eating to excess; they also suggested that the disease might be hereditary. But they had no cures to offer.
In the West, Roman physicians added the Latin word mellitus (meaning “sweet” or “honeyed”) to the name of the disease. But then came the Dark Ages, when much of the old knowledge was lost.
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THE G.I. FACTOR AND WEIGHT REDUCTION: HOW CAN THE G.I. FACTOR HELP?

admin — Fri, 08 May 2009 13:51:46 +0000

One of the hardest parts of trying to lose weight can be feeling hungry all the time, but this gnawing feeling is not necessary when you are losing weight. Carbohydrates are natural appetite suppressants. And of all carbohydrate foods, those with a low G.L factor are amongst the most filling and prevent hunger pangs for longer.

In the past, it was believed that protein, fat and carbohydrate foods, taken in equal quantities, satisfy our appetite equally. We now know from recent research that the satiating (making us feel full) capacity of these three nutrients is not equal.

Fatty foods, in particular, have only a weak effect on satisfying appetite relative to the number of kilojoules they provide. This has been demonstrated clearly in experimental situations where people are asked to eat until their appetite is satisfied. They over-consume kilojoules if the foods they are offered are high in fat. When high carbohydrate and low-fat foods are offered, they consume fewer kilojoules, eating to appetite. So, carbohydrate foods are the best for satisfying our appetite without over satisfying our kilojoule requirement.

When we eat more carbohydrate, the body responds by increasing its production of glycogen. Glycogen is stored glucose, the critical fuel for our brain and muscles. The size of these stores is limited, and they must be continuously refilled by carbohydrate from the diet. Good glycogen stores ensure a well-fuelled body and make it easier to exercise. Even when we are not exercising, the body will use a mixture of carbohydrate and fat, attempting to match the carbohydrate : fat ratio of the fuel mixture to that which has been eaten in the diet.

Because fat is less satisfying to our appetite, it is easy to over-consume fatty kilojoules. That is why reducing the dietary fat intake is a far more effective means of achieving weight control while satisfying the appetite than restricting carbohydrate intake. By eating a high carbohydrate diet it will be easier to lower your fat intake, and by choosing that carbohydrate from low G.I. foods, you make it even more satisfying.

What’s more, even when the kilojoule intake is the same, people eating low G.I. foods may lose more weight than those eating high G.I. foods. In a South African study, the investigators divided overweight volunteers into two groups: one group ate a low kilojoule, high G.I. diet and the other, a low kilojoule, low G.I. diet. The amount of kilojoules, fat, protein, carbohydrate and fibre in the diet was the same for both groups. Only the G.I. factor of the diets was different. The low G.I. group included foods like lentils, pasta, porridge and corn in their diet and excluded high G.I. foods like potato and white bread. After 12 weeks, the volunteers in the group eating low G.I. foods had lost, on average, 9 kilograms—2 kilograms more than people in the group eating the diet of high G.I. foods.

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