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Archive for the ‘Diabetes’ Category

WHAT IS TYPE I DIABETES: THE SUGAR-URINE DISEASE

The name “diabetes mellitus” describes two striking symptoms of the disease. People with uncontrolled diabetes usually have a constant, urgent thirst. Though they drink huge quantities of liquids, the fluid seems to run right through them, for they also have a continual need to urinate. Indeed, it often seems that more fluid comes out than went in. So the first part of the name, meaning a siphon or drain, seems quite appropriate.
The urine of a person with diabetes contains sugar, which is the reason for the “mellitus” part, from the Latin word for honey. Most people today just talk about “diabetes,” but physicians prefer to use its more precise, full name, diabetes mellitus. In this way they avoid confusion with another much rarer disease called diabetes insipidus, in which great quantities of urine are also produced, but it does not contain sugar.
There are actually two main types of diabetes mellitus. Type I diabetes used to be called “juvenile diabetes,” because it most often (but not always) occurs in children, teenagers, and young adults. This form is also called insulin-dependent diabetes mellitus (IDDM), because the bodies of people with this condition produce little or no insulin, and they must receive insulin injections every day in order to live. Type II diabetes or non-insulin-dependent diabetes (NIDDM) usually strikes people after the age of thirty-five or forty. These people’s bodies do produce insulin, but their body cells cannot use it properly. This kind of diabetes can generally be controlled with diet and exercise, or with drugs that lower the amount of sugar in the blood.
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SCOPE AND IMPACT OF DIABETES IN THE U.S.: HEALTH RESOURCE UTILIZATION – SOME GOOD NEWS

There is some good news, however. A slight decline in direct costs (from $45.2 billion to $44.1 billion) occurred between 1992 and 1997. This decline was in the face of the increasing prevalence of diabetes and a steady, modest increase in the rate of inflation, both of which should have increased direct costs. The decrease in direct costs was most likely due to a dramatic decrease in the mean length of hospital stay and to a shift in site of service to the outpatient arena. In 1992, 20.2 million inpatient days were attributed to diabetes; this figure decreased about 31% to 13.9 million days in 1997. Inpatient costs decreased from $37.2 billion in 1992 to $27.5 billion in 1997. Concomitantly, there was a large increase in outpatient expenditures and home health care for people with diabetes. Intensive glycemic regulation in type 1 and in type 2 diabetes was shown to delay progression of microvascular complications at a reasonable cost.
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RISK FACTORS FOR DIABETES DEVELOPMENT

Diabetes tends to run in families, and a tendency toward being overweight, coupled with inactivity, dramatically increases a person’s risk. Older persons and mothers of babies weighing over 9 pounds also run an increased risk. Approximately 80 percent of all patients are overweight at the time of diagnosis. Weight loss and exercise are important factors in lowering blood sugar and improving the efficiency of cellular use of insulin. Both can help to prevent overwork of the pancreas and the development of diabetes. African Americans, Hispanics, and American Indians have the highest rates of type II diabetes in the world – much higher than that оf Caucasians. The reasons for this increased risk are not clear.
People who develop diabetes today have a much better prognosis than did those who developed diabetes just 20 years ago. Our present understanding of the role that stress, illness, alcohol, smoking, and other lifestyle characteristics may play in the development of diabetes can aid in prevention and earlier diagnosis. Recognizing your risks and taking steps to reduce the likelihood of developing this problem are a good start.
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THE G.I. FACTOR: THE EFFECT OF SUGAR ON THE G.I. FACTOR

Table sugar or refined sugar (sucrose) has a G.I. factor of only 60-65. This is because it is a disaccharide (double sugar) composed of one glucose molecule coupled to one fructose molecule. Fructose is absorbed and taken directly to the liver where much of it is slowly converted to glucose. So, the blood sugar response to pure fructose is very small (G.I. factor of 20). Thus when we consume sucrose, in effect we have consumed only half as much glucose. This explains why the blood sugar response to 50 grams of sucrose is approximately half that of 50 grams of pure maltose (where the molecules are all glucose).

Many foods containing large amounts of refined sugar have G.I. factors close to 60. This is the average of glucose (G.I. = 100) and fructose ( G.I. = 20). This is lower than that of ordinary soft bread with a G.I. factor averaging around 70. Kellogg’s Cocopops™ which contains 39 per cent sugar has a G.I. factor of 77, lower than that of Rice Bubbles™ (83) which contains little sugar.

So, contrary to popular opinion, most foods containing simple sugars do not raise blood sugar values any more than that of most complex starchy foods like bread. The same is true of honey (G.I. factor of 58). Some types of honey have a much higher G.I. factor (87) than refined sugar (65), possibly because they are a mixture of honey and glucose syrup.

Sugars that naturally occur in food include lactose, sucrose, glucose and fructose in variable proportions, depending on the food. The overall blood sugar response to a food is very hard to predict on theoretical grounds because gastric emptying is slowed by increasing concentration of the sugars, whatever their structure.

Some fruits for example have a low G.L factor (cherries have a G.I. factor of only 22) while others are relatively high (watermelon has a factor of 72). It seems the higher the acidity and osmotic strength (number of molecules per ml) of the fruit, the lower the G.I. factor. Thus it is not possible to lump all fruits together and say that they will have a low G.I. factor because they are high in fibre. They are not all equal. See the tables in Part HI to compare fruits.

Many foods containing sugars are a mixture of refined and naturally occurring sugars. The overall effect on the blood sugar response is too hard to predict. This is why we need to test the G.I. value of sugary foods in real people before we make generalisations about their G.I. factor.

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LIVING WITH DIABETES: STORY OF INSULIN’S DISCOVERY

In 1921 Charles Best and Frederick Banting, both Canadians, came together in Toronto to work on an idea of Banting’s to try to isolate a substance from the pancreas of dogs that might be successful in treating diabetes. They worked in experimental laboratories in the University of Toronto, Department of Physiology.

Up to this time the problem was that the digestive juices also made by the pancreas tended to destroy the chemical substance that they were trying to extract. Their first stage was therefore to inactivate the part of the pancreas making digestive juices. They did this by tying the tube or duct leading from the pancreas to the intestines and this led to the degeneration of all the pancreas except the important islet cell tissues.

This pancreatic tissue they then ground up and extracted with fluids. This extract they then injected into dogs with diabetes.

The extract led to control of the diabetes in these dogs and the substance they had extracted they called ‘Isleton’ because it had been made from the islet cells. Later they changed the name to ‘Insulin’.

This happened in 1921, and during that eventful year they conducted many experiments to find out the best way to produce a potent and effective preparation of insulin which would be suitable for using on human patients with diabetes.

The first patient to receive insulin treatment was a boy called Leonard Thompson, who had developed diabetes two years earlier when he was 11 years old. He was now at the last stages of diabetes and was dying. He was given insulin that had been extracted from beef pancreas by Banting and Best’s method. As a result of this insulin, his condition dramatically improved and his diabetes was controlled. His life was saved, and a tremendous medical achievement was made. This demonstration of the success of the insulin in treating persons with diabetes led to the urgent work of finding a way to make insulin in large quantities commercially for the many diabetics requiring treatment. This was done, under Charles Best’s direction, in the Connaught Laboratories with the assistance and support of The Lilly Company of Indianapolis USA. So successful was this work that commercial quantities of insulin were being produced in 1922, the year after its first discovery.

One drawback of the early insulin was that it had to be given several times a day as it only acted for a few hours. Further research on insulin has been directed to perfect its production and to produce forms of insulin which have a prolonged action so that they need to be given only once or twice a day. Dr Hagedorn of Copenhagen in Denmark found that when insulin was combined with a protein chemical called protamine its action was prolonged. Further lengthening of insulin action has been achieved by combining this protein and insulin with the element zinc. Since then other research work has led to several newer and different forms of insulin with different ranges of activity. These different insulins make it possible for the doctor to choose a suitable insulin or combination of insulins to meet the varying needs of different patients.

Currently, research is going even further into the precise ways that insulin works to control the body’s use of glucose and fats and also to discover the basic cause of diabetes. When we know these things it may be possible to achieve one of our ultimate goals, which is to prevent people developing diabetes. We hope it will also lead to even better and easier ways of treating it.

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