These are all abstracts from PubMed. I no longer have access to an academic database, so I haven't been able to read more than these freely-available summaries of research. I typed in things like diabetes+CHO and diabetes+hear* and here is an overview of what I got.
First of all, for
some stuff, maybe all diabetes is the same:
“Subjects with type 1 diabetes
mellitus (T1DM) eventually develop insulin resistance and other features of T2DM
such as cardiovascular disorders. The exact mechanism has been not been
completely understood. In this study, we … found that continuous exposure of
mice with non-obese diabetes to insulin … induced severe insulin resistance,
whereas untreated hyperglycemia for the same amount of time (2 weeks) did not
cause obvious insulin resistance. Insulin resistance was accompanied by
decreased mitochondrial production … increased … triglyceride content, and
elevated oxidative stress.” [J Biol Chem. 2009 Oct 2;284(40):27090-100]
Which runs smack up
against crap stuff like this:
“Type 1 diabetes is primarily an
autoimmune disease and type 2 diabetes is primarily a metabolic condition.
However, medical nutrition therapy is an integral part of management for both
types of diabetes to improve glycaemic control and reduce the risk of
complications… Specific strategies include a kilojoule controlled diet with
reduced saturated fat, trans fat and sodium; moderate protein; and high in
dietary fibre and low glycaemic index carbohydrates. Carbohydrates should be
spread evenly throughout the day and matched to medication.” [Aust Fam Physician. 2010 Aug;39(8):579-83]
Which in turn
directly contradicts what we already know about the effects of CHO on blood
sugar and thus health:
"Replacing dietary saturated fat
(SAFA) with carbohydrates (CHO), notably those with a high glycaemic index, is
associated with an INCREASE in cardiovascular disease risk in observational
cohorts" [Neth J Med. 2011] Emphasis
original
Fortunately some
researchers are willing to consider the preferences of the effected people,
rather than just the official guidelines. This is probably my favourite find in this list, for that reason:
“This systematic review focuses on
randomized controlled trials of low-carbohydrate diets compared with
low-fat/low-calorie diets... There was a higher attrition rate in the low-fat
compared with the low-carbohydrate groups suggesting a patient preference for a
low-carbohydrate/high-protein approach as opposed to the Public Health
preference of a low-fat/high-carbohydrate diet. Evidence from this systematic
review demonstrates that low-carbohydrate/high-protein diets are more effective
at 6 months and are as effective, if not more, as low-fat diets in reducing
weight and cardiovascular disease risk up to 1 year.” [Obes Rev. 2009 Jan;10(1):36-50]
So, what’s for
supper? Steak and salad, baby:
“This systematic review focused on
the effects of diets high in monounsaturated fat (MUFA) versus diets low in MUFA
on important risk factors of T2D (i.e. plasma glucose, insulin, homeostasis
model assessment of insulin resistance and glycosylated haemoglobin, HbA1c)…
Conclusions: In summary, this systematic review found that high MUFA diets
appear to be effective in reducing HbA1c, and therefore, should be recommended
in the dietary regimes of T2D.” [Ann Nutr Metab. 2011;58(4):290-6]
Okay, so where do we
get MUFAs? From Wikipedia:
“Monounsaturated fats are found in natural foods such as red meat, whole milk
products, nuts and high fat fruits such as olives and avocados. Olive oil is
about 75% monounsaturated fat. Canola oil and Cashews are both about 58%
monounsaturated fat. Tallow (beef fat) is about 50% monounsaturated fat and lard
is about 40% monounsaturated fat.”
And, as a diabetic,
how should you handle your steak and salad? Well these guys can’t tell you, but
if you’re having a cheat night they have some tips:
“Our study examines the hypothesis
that in addition to sugar starch-type diet, a fat-protein meal elevates
postprandial glycemia as well, and it should be included in calculated prandial
insulin dose accordingly... pizza dinner, consisting of 45 g/180 kcal of
carbohydrates and 400 kcal from fat-protein … There were no statistically
significant differences involving patients' metabolic control, C-peptide,
glucagon secretion, or duration of diabetes… the significant glucose increment
occurred at 120-360 min, with its maximum at 240 min: 60.2 versus -3.0 mg/dL
(P=0.04), respectively... Conclusions: A mixed meal effectively elevates
postprandial glycemia after 4-6 h. Dual-wave insulin bolus, in which insulin is
calculated for both the carbohydrates and fat proteins, is effective in
controlling postprandial glycemia.” [Diabetes Technol Ther. 2011 Oct 20]
These folks are
likely pretty adamant that intermittent fasting is a bad idea for
diabetics:
“Basal insulin dose requirements in
patients with type 1 diabetes may be derived from the course of glucose
concentrations in the fasting state; i. e. by skipping meals. The present study
examined whether fasting tests could be replaced by carbohydrate-free meals…
Plasma glucose concentrations significantly increase in patients with type 1
diabetes following the intake of carbohydrate-free meals. Carbohydrate-free
meal-tests cannot replace skipping meal tests to determine the basal insulin
requirement in patients with type 1 diabetes.” [Exp Clin Endocrinol Diabetes. 2010 May;118(5):325-7]
There are some other
effects of increased blood sugar among diabetics that might interest you,
specifically hearing loss (who knew?):
“Induction of diabetes in … mice
promotes amplification of age-related peripheral hearing loss ... On the other
hand, initial results of effects from very high blood glucose level (T1DM) on
the auditory midbrain showed disruption of central inhibition, increased
response synchrony or enhanced excitation in the inferior colliculus.” (I don’t know if you want an excited
colliculus or not, but there you have it) [Hear Res. 2009 Mar;249(1-2):44-53]
“Wolfram syndrome, also named
"DIDMOAD" (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness),
is an inherited association of juvenile-onset diabetes mellitus and optic
atrophy as key diagnostic criteria. Renal tract abnormalities and
neurodegenerative disorder may occur in the third and fourth decade. The
wolframin gene, WFS1, associated with this syndrome, is located on chromosome
4p16.1. Many mutations have been described since the identification of WFS1 as
the cause of Wolfram syndrome. We identified a new homozygous WFS1 mutation
(c.1532T>C; p.Leu511Pro) causing Wolfram syndrome in a large inbred Turkish
family. The patients showed early onset of IDDM, diabetes insipidus, optic
atrophy, sensorineural hearing impairment and very rapid progression to renal
failure before age 12 in three females.” (I’ve never encountered the word “inbred” in an academic
journal article title before.) [Eur J Med Genet. 2011 Sep 23]
“The study subjects were workers in
one automobile manufacturing company. …The hearing thresholds at 4,000 Hz
frequencies for both ears were significantly higher in 2009 than those in 2005.
The changes in the hearing thresholds of the subjects with an impaired fasting
glucose (100-125 mg/dl) and diabetes (≥126 mg/dl) were greater than those of the
normal (<100 mg/dl) group. After adjusting for variables such as age, smoking
and alcohol history, environmental noise, hypertension and serum creatinine,
fasting glucose was found to be a significant variable. Impaired fasting glucose
(100-125 mg/dl) was significant (β=1.339, p=0.002) for the right ear, whereas it
was not significant (β=0.639, p=0.121) for the left ear.” [J Occup Health. 2011 Aug 4;53(4):274-9]
A whole whack of
diabetes experts got together and did a meta-analysis of trials and articles on
insulin injection, and put together a definitive guide. You can access the full
text for free here.
It looks quite long to print, or
you could buy the PDF, but the text seems to be there for your
perusal.
Lastly, here’s an interesting one
on the impact of parenting style on self-care behaviours of T1D
adolescents.
What interested you? What surprised you? What geeky googleholes have you fallen down lately?
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