Diabetic Diet: Is Determining Glycemic Load Better Than Counting Carbs?

To count carbs or discount them ‒ the debate continues. Being type 2 insulin dependent, I’m trying to make sense of the differing conclusions of two studies that have been published recently. It’s hard to say what these studies really show ‒ it can get confusing with all the information out there ‒ especially when pilaf (pilao) is on Sunday’s lunch menu!

Dr. Andrea Laurenzi of San Raffaele Vita-Salute University in Milan suggests that diabetes patients may benefit from counting the number of carbohydrates in their diet. In a small study ‒ published online in the America Diabetes Association journal Diabetes Care ‒ the Milan researchers looked at 61 adults on insulin pump therapy and found that those who learned to count carbs had a small reduction in weight and waist size after 6 months. Additionally, they reported gains in quality of life and an improvement in blood sugar levels.

On the other hand, Jiansong Bao at the University of Sydney in Australia, says the number of carbs alone might not be the best way to go. Writing in the American Journal of Clinical Nutrition, he feels that how many carbs you eat might be less important for your blood sugar than your food's glycemic load, a measure that also takes into account how quickly you absorb those carbs.

Dr. Sanjeev Mehta, of the Joslin Diabetes Center and Harvard Medical School in Boston says while Laurenzi’s findings do not prove that carb counting is the answer for people with type 1 diabetes, it is widely recommended that people on insulin try to estimate the carbohydrate content of their meals to help calculate their insulin doses. Indeed, a few other studies too have suggested that carbohydrate counting can help people with type 1 diabetes control their blood sugar levels.

There are books and online resources available for people who are interested in learning how to count carbs. However, some people have difficulty learning or sticking with the method, Mehta noted, and benefit from help from a professional, such as a dietitian or certified diabetes educator.

Mayo Clinic nutritionist Katherine Zeratsky, R.D., L.D. explains counting carbohydrates is a method for controlling the amount of carbohydrates you eat at meals and snacks. This is because they have the greatest impact on your blood sugar. Eating consistent amounts of carbohydrates every day helps you control your blood glucose level.

But carbohydrates aren't the only dietary consideration when you have diabetes. You need to also limit fat and cholesterol and control the number of calories you consume. The best way to do this is to control portion sizes, she says.

“Eating a healthy diet helps you control your diabetes and reduces your risk of diabetes-related conditions, such as heart disease and stroke. So, just because a food contains no carbohydrates doesn't mean that you can eat it in unlimited amounts,” she cautions.

However, Bao claims the so-called glycemic load of a food, which also takes into account how quickly it makes the blood sugar rise, might work better. Foods with soluble fiber, such as apples and rolled oats, typically have a low glycemic index, one of the contributors to glycemic load. Foods with a low glycemic index cause the blood sugar to rise slowly, and so put little pressure on the pancreas to produce insulin.

The glycemic load is calculated by multiplying the amount of carbs in grams per serving by the food's glycemic index divided by 100. (The glycemic index for a variety of foods can be found here.)

The Sydney researchers say their findings also suggest that eating foods with high glycemic loads could be linked to chronic disease like type 2 diabetes ‒ which does not require insulin injections ‒ and heart disease by raising blood sugar and insulin levels.

The researchers took finger-prick blood samples from 10 healthy young people who ate a total of 120 different types of food ‒ all with the same calorie content. They also had two groups of volunteers eat meals with various staples from the Western diet, such as cereal, bread, eggs and steak. And the glycemic load repeatedly trumped the carb count in predicting the blood sugar and insulin rise after a meal.

A Reuters report quotes Dr. Edward J. Boyko ‒ a diabetes expert at the University of Washington in Seattle who wasn't involved in the Sydney study ‒ saying it wasn't certain the findings would hold up in people who aren't completely healthy, adding, long-term effects and other nutrients in the food might also be important for disease risk.

"It would just be speculation whether a dietary change like this would help people with type 2 diabetes." The most important problem, Boyko points out, remains pure and simple overeating. "The excess weight is the main thing we ought to focus on…The simplest message would be, eat less."

Diabetes: Is the ADA Shifting its Stance About Carbs?

Carbohydrates are a very touchy subject with diabetics. And for me at least, understanding carbs in a diabetic diet is more difficult than quantum mechanics (or double-entry accounting if you’re not a science type). Diabetologists and dieticians, too, have differing views. I found this article by LAURA DOLSON very instructive and am reproducing it here for those who may have missed it. You can find the lively discussion that followed the article’s publication here.

You may be surprised to know that for the past couple of decades, the American Diabetes Association has been sort of a cheerleader for carbs. Yes, I'm talking about the organization who's mission it is to promote education and research in ways aimed at preventing diabetes and alleviating the suffering of diabetics.

What is diabetes? It is essentially a disorder of the body's ability to process carbohydrates. This includes Type 1 and Type 2 diabetes, pre-diabetes, metabolic syndrome, insulin resistance, and all the other points on the diabetes spectrum. (The Endocrine Society suggests that anyone with a fasting blood glucose of 89 or above is at risk for damage to their health.)

In light of this, you'd think that limiting carbohydrate intake would be a priority in educating people about handling these disorders. And yet, the ADA jumped right onto the Food Pyramid bandwagon and began to advise people to get at least 55% of their calories from carbohydrate, such as in the Food Pyramid for Diabetes (see illustration above).

In 2008, they made one exception: diabetics trying to lose weight could follow a low-carb diet for up to one year; this was later loosened further to two years. But still they did not recommend a low-carb diet for health, blood sugar control, or preventing progression of the diabetes.

Now, in the March 2011 edition of the ADA magazine "Diabetes Forecast" are three rather remarkable articles. The first is called The "ADA Diet" Myth, which claims that there is no such thing as the ADA Diet! (Who else was having this hallucination?) Instead, Stephanie Duncare, director of nutrition and medical affairs for the ADA says, "For more than 15 years now, ADA has recognized that people with diabetes should eat in a way that helps them reach their blood glucose, cholesterol, blood pressure, and weight goals. For some, this means a relatively higher-carbohydrate diet, and for others, the diet may be lower in carbohydrate". Well, hallelujah to that, especially if the goal is "normal blood glucose" (normal meaning "a blood glucose level that will not cause further damage in the pancreas").

Even more bold is an article called, "Are Carbs the Enemy?" which attempts to cover the debate. They first present a sort of wimpy pro-carb stance. This section of the article has a notable absence of anything to do with science, instead relying on statements such as "Gone are the days of 'diabetic diets' that were meager and confining" and "as long as people eat less or cover their carb intake with medications, they can keep blood glucose levels in check with a healthy diet" ("healthy" in this case meaning "high-carb").

The article then goes on to describe a low-carb approach, citing Dr. Richard Bernstein. This section cites actual evidence, and makes what I think is a much stronger case for controlling blood glucose by limiting carbohydrates. The article goes on to a section on saturated fats which is much more balanced than usual, and then the normal "we don't have the long-term studies". The article concludes with the statement: "In the end, the best diet is the healthy one you're able to follow."

The only thing I would add is that people need support in making those changes, and as far as I can tell they are still leaving an awful lot up to the individual to figure it out for themselves. There has been quite a defeatist attitude coming from the organization that is supposed to be helpful - along the lines that it is asking just too much of people to cut carbs in any significant way. Are dietitians now actually going to support people in finding a diet that achieves as close to a normal blood glucose as possible? It would be a very big change if this happened any time soon.

But wait, there's more! A follow-on short piece called "Eating With Diabetes: 3 Approaches" lists the low-carb approach first, and then follows with "Moderate-Carb" and "Vegan/High-Carb". The weird thing is that the three approaches are described as "less than 10% carb", "40-50% carb" and "75% carb". What about people who normalize their blood glucose with 20% carb or 30% carb? Why not just say, "it's a spectrum disease, with a spectrum of carb that will treat it effectively"? In any case, I don't want to complain too loudly, because this is SO great to see in an ADA publication!

Now, to be sure, the ADA is not yet changing their basic stance. Nowhere on the latest update of the diabetes.org Web site is it stated that diabetics should follow a low-carb diet. On the other hand, there is no longer anything I can find that says to eat over half of calories from carbohydrate, either. The former food pyramid, as far as I can tell, has vanished, and there are several hints that low-carb eating is becoming a bona-fide option.

There are statements such as, "Understanding the effect of carbohydrate on blood glucose levels is key to managing diabetes. The carbohydrate in food makes blood glucose levels go up." Although diabetics are still advised that "a place to start is at about 45-60 grams of carbohydrate at a meal.", (yikes) it goes on to say to adjust from there. Even though this is not what most of us would call a low-carb diet, for most people it is a reduction from their previous advice.

[Side note: I also notice it doesn't actually say 45-60 g/meal is a good place to start. If that actually controls someone's blood glucose, that's great, but I would think that in the cases where it doesn't, it would be more disheartening to subsequently take more carb away. Why not start lower, and then add? Also, most likely, the person for whom this works is losing weight - a phase which doesn't last forever.]

To me this looks like the beginnings of a real change in approach from the ADA. The Titantic may actually be turning around! This could make a difference to the health of millions of people, and nothing could make me smile more than that.

By Laura Dolson/about.com
Image courtesy about.com

Bran Cuts Death Risk in Type 2 Diabetes Mellitus Patients

Type 2 diabetes mellitus in many cases can be prevented by following a modified lifestyle. Studies have suggested that even those who have acquired the disease may well control or even reverse their condition by following a healthy diet.

For example, eating whole grain cereal particularly bran supplemented foods may help reduce risk of premature death in women with type 2 diabetes mellitus, a new study recently published in the journal Circulation suggests.

The study led by Meian He Ph.D. and colleagues from Harvard School of Public Health in Boston Massachusetts found eating high amounts of bran was not only associated with significantly reduced risk of death from all causes, but also from cardiovascular disease (heart disease and stroke) or CVD in women with type 2 diabetes mellitus.

Bran is a hard outer layer of cereal grains such as rice, corn, oats, barley, millet and wheat and consists of combined aleurone and pericarp. It is full of dietary fiver and omegas and contains high amounts of starch, protein, vitamins and dietary minerals.

Type 2 Diabetes mellitus is a health condition that can lead to serious complications including bladder control problems for women, heart disease and stroke, nerve damage, eye disease, erectile dysfunction, foot problems, and kidney failure.

Whole-grain consumption has early been associated with lower risk of heart disease and stroke and mortality in the general population, according to the background in the study report.

The study was meant to determine the association of whole grain, cereal fiber, bran and germ with all-cause and CVD-specific mortalities in women with type 2 diabetes mellitus.

For the study, 7,822 U.S. women with type 2 diabetes mellitus enrolled in the NUrse' Health Study were followed for up to 26 years during which 852 all-cause deaths and 295 CVD deaths were identified. Subjects' dietary intakes and potential confounders were assessed regularly with questionnaires.

The subjects were divided into five groups based on their intakes of whole grain, cereal fiber, bran and germ. After adjusted for age, the highest intakes of whole grain, cereal fiber, bran and germ were associated with a 16 to 31 percent reduction in the risk of death from all causes compared to the lowest intakes.

After further adjustment for possible lifestyle and dietary risk factors, only bran intake was correlated with reduced risk.

Specifically, women in the group with the highest intake of bran were 28 percent less likely to die from all causes compared to those in the group with the lowest intake. This is an inverse association with higher intake leading to lower risk of all-cause death.

Bran intake was also inversely associated with CVD-related death with the highest intake linked with 45 percent reduction in the risk of heart disease and stroke or CVD compared to the lowest intake.

The researchers concluded "Whole-grain and bran intakes were associated with reduced all-cause and CVD-specific mortality in women with diabetes mellitus. These findings suggest a potential benefit of whole-grain intake in reducing mortality and cardiovascular risk in diabetic patients."

Previous studies have suggested Mediterranean diet, green leafy vegetables, breastfeeding,brown rice, plant-based diet, soy foods, black tea, vitamin D, L-carnitine, turmeric, selenium,bitter melon, fish oil, psyllium fiber and drinking coffee may help prevent type 2 diabetes mellitus.

Meanwhile, half way across the world, S. Haripriya and S. Premakumari from Pondicherry University and Avinashilingam University for Women in India conducted a small trial and proved that eating wheat bran help type 2 diabetes mellitus patients better control their condition.

The trial involved 30 patients aged 45 to 50. Half were assigned 20 grams of wheat bran, which consisted of 42.8 percent dietary fiber, each day for a 6-month period. And another group of 15 diabetics were not given any bran supplements.

For the trial, blood samples were collected at baseline and at the end of the trial to analyse biochemical factors including serum fasting glucose levels, postprandial glucose levels, and glycosylated hemoglobin levels or HbA1C in all the type 2 diabetes mellitus patients.

In the group of diabetes mellitus patients receiving wheat bran supplements, compared to the levels at baseline, the fasting glucose levels at the end of the trial were reduced by an average of 22.8 mg/ml. Controls did not experience any significant change.

Those on the bran supplement also reduced serum postprandial glucose levels by 39.80 mg/ml and the glycosylated hemoglobin or HbA1C by nearly 2 percent while controls did not have any significant change.

HbA1C is considered the most reliable index of long term diabetes control. Blood sugar tends to fluctuate from day to day and even from hour to hour while HbA1C reflects a true average index of glucose control for a period of 2 to 3 months.

Both groups of diabetes mellitus patients at baseline had 8.39 to 8.45 percent, a level of HbA1C considered by the definition of American Diabetic Association under unsatisfactory control.

After the supplementation trial, diabetes mellitus patients reduced the index by 1.96 percent, pushing the index down to 6.41 percent, a level which is considered under good control.

Diabetes: Do Alternative Treatments Work?

There's something about Type 2 diabetes that inspires creativity, innovation and promises from the alternative medicine industry. People who want to control their blood sugar without medications can choose from a huge variety of pills and elixirs. "I hear new claims on a nearly daily basis," says Dr. Daniel Einhorn, clinical professor of medicine at UC San Diego and the president of the American Assn. of Clinical Endocrinologists. "There's a constant market for new products."

Many current products take an herbal approach to blood sugar control. The liquid supplement Sugar Crush from NaturEra, for example, combines common sage, cinnamon, hibiscus and fenugreek, among other ingredients.

The product comes in two varieties, regular Sugar Crush and the milder Sugar Crush Daily. Users are instructed to drink 2.5 milliliters of regular Sugar Crush mixed with a glass of water right before breakfast and dinner every day. Sugar Crush Daily is recommended as a prelude to lunch and bedtime. After two or three months, users are told that they can stop taking Sugar Crush and stick with two doses of Sugar Crush Daily, one before each of the two largest meals of the day. Sugar Crush isn't yet sold in stores — company President Uri Man says it will be widely available starting in March — but you can buy a 125 ml bottle of either variety online for $89.95. https://shop.buysugarcrush.com/ProductDetails.asp?ProductCode=SUGARD2//

If you prefer more simplicity in your supplement, you could always try one of several products offering Cinnulin PF — an extract of cinnamon bark made by Integrity Nutraceuticals — as their sole active ingredient. Each capsule of Cinnulin PF from iVitals contains 125 milligrams of the extract. Users are instructed to take one capsule before breakfast and one before dinner for best results. A bottle of 120 capsules, available only online, costs about $30.

Nature's Way sells a supplement called Blood Sugar that contains, among other things, 133 mg of cinnamon bark extract, 100 micrograms of chromium and 33 mg of extract of the tropical South Asian herb Gymnema sylvestre per capsule. Users are instructed to take three capsules twice daily. You can buy a bottle of 90 capsules, available at many health food stores, for about $15.

The Claims

The Sugar Crush website says that the products "are the world's first liquid, clinically tested, completely natural dietary supplements which help maintain healthy glucose levels." Man, the NaturEra president, says that company studies have found that the supplements, which are already very popular in Israel, have been shown to reduce blood sugar levels by up to 40% in just 30 days. The company has not yet published any studies in medical journals, although it did present results at a recent meeting of the American Diabetes Assn. and the American Assn. of Diabetes Educators. (Both the ADA and the AADE declined to comment on Sugar Crush or any other specific products.) Adds Man, "99% of the other [diabetes] products on the market haven't been proven to do anything."

The iVitals website doesn't expressly claim that Cinnulin PF can help treat diabetes. Instead, the site says the product "may support healthy glucose levels in healthy individuals." Tim Romero, president of Integrity Nutraceuticals, says cinnamon reduces blood sugar levels by making cells more sensitive to insulin, the hormone that helps cells take in blood sugar.

The website for Nature's Way Blood Sugar hardly makes any claims beyond the name of the supplement. The site simply says that the product contains "chromium which is an important factor for insulin." A spokesperson for the company declined to answer any questions about the ingredients or potential benefits of the product.

The Bottom Line

There's no doubt that diet — including supplement choices — can affect blood sugar levels. But Einhorn says there's still no herbal supplement with a scientifically proven track record for helping people with diabetes really get their blood sugar under control. "It would be very attractive to have natural treatments," he says. "But the scientific evidence that they work is very slim."

Richard Anderson, a research chemist with the U.S. Department of Agriculture's Diet, Genomics and Immunology lab in Beltsville, Md., has a more optimistic view of the potential of herbs and supplements, especially cinnamon and chromium. Anderson says research in his lab — including human trials of Cinnulin PF — suggests that each of these ingredients can increase the body's sensitivity to insulin.

A 2006 study of 22 people with pre-diabetes published in the Journal of the International Society of Sports Nutrition found that taking 500 mg of Cinnulin PF a day for 12 weeks reduced fasting blood glucose — a measure of blood sugar after one hasn't eaten for eight hours that is used to diagnose pre-diabetes or diabetes — by about 8%.

And in 2007, researchers at UC San Francisco reported in the journal Pharmacotherapy that cinnamon might have "modest" effects on blood sugar, but they also warned that the spice shouldn't be used as a substitute for standard treatment of diabetes, including exercise, a healthy diet and prescription drugs.

Anderson cautions that some claims about diabetes remedies may be overblown. To his mind, it's "hard to believe" that Sugar Crush could reduce blood sugar levels by 40%. He adds that, although cinnamon and chromium are generally safe, it would be risky for anyone to switch medications for herbs without first talking to his or her doctor.

Einhorn, meanwhile, thinks it would be unwise to expect anything from an herbal diabetic product. "I'm surprised that anyone from the USDA said that these things have any therapeutic value," he says.

Einhorn adds that there are exactly two proven and reliable ways to control blood sugar without resorting to prescription medications: regular exercise and a healthy diet.

Limiting Salt Lowers Blood Pressure and Health Risks in Diabetes

For patients living with diabetes, reducing the amount of salt in their daily diet is key to warding off serious threats to their health, a new review of studies finds.

In the Cochrane review, the authors evaluated 13 studies with 254 adults who had either type 1 or type 2 diabetes. For an average duration of one week, participants were restricted to large reduction in their daily salt intake to see how the change would affect their blood pressure.

“We were surprised to find so few studies of modest, practical salt reduction in diabetes where patients are at high cardiovascular risk and stand much to gain from interventions that reduce blood pressure,” said lead reviewer Rebecca Suckling. “However, despite this, there was a consistent reduction in blood pressure when salt intake was reduced.”

Suckling is part of the Blood Pressure Unit at St. George’s Hospital Medical School, in London.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Patients with diabetes need to be extra cautious to maintain their blood pressure at an acceptable range of less than 130/80 mmHg. However, in the 2003-2004 period, 75 percent of adults with diabetes had blood pressure greater than or equal to 130/80 mmHg or used prescription hypertension medications, according to the American Diabetes Association (ADA).

High salt intake is a major cause for increased blood pressure and, in those with diabetes, elevated blood pressure can lead to more serious health problems, including stroke, heart attack and diabetic kidney disease. The ADA also reports that diabetic kidney disease is the leading cause of chronic kidney disease, accounting for 44 percent of new cases in 2005.

In the Cochrane review, the participants’ average salt intake was restricted by 11.9 grams a day for those with type 1 diabetes and by 7.3 grams a day for those with type 2.

The reviewers wrote that reducing salt intake by 8.5 grams a day could lower patients’ blood pressure by 7/3 mmHg. This was true for patients with both type 1 and type 2 diabetes. The reviewers noted that this reduction in blood pressure is similar to that found from taking blood pressure medication.

Suckling acknowledged that studies in the review only lasted for a week and that the type of salt restriction probably would not be manageable for longer periods.

“The majority of studies were small and only of a short duration with large changes in salt intake,” she said. “These studies are easy to perform and give information on the short-term effects of salt reduction.”

However, Suckling said, the review also found that in studies greater than two weeks, where salt was reduced by a more achievable and sustainable amount of 4.5 grams a day, blood pressure was reduced by 6/4 mmHg.

Diabetes specialist Todd Brown, M.D., of the Division of Endocrinology and Metabolism at Johns Hopkins University, said that practicing low-salt diets of these types is quite challenging for most patients with diabetes even though they know the health risks.

“The effects of salt on blood pressure are well known to health professionals and most patients, but what is less well known is where the salt comes from in our diet,” Brown said.

“The overwhelming majority comes from the processed foods that we eat,” he said. “If we are going to realize the benefits of sodium reduction on blood pressure and other health outcomes, we should focus less on the salt shaker and more on what we buy in the supermarket and at chain restaurants.”

Thank you Health Behavior News Service

Diabetes Treatment: How Much Insulin Do You Need?

If you have type 2 diabetes and your doctor thinks it might be a good time to start insulin therapy, there are two important factors to consider: How much insulin do you need to take? When do you need to take it? 

And both are very personal.

"You can't paint everyone with type 2 diabetes with the same brush," says Mark Feinglos, M.D., division chief of endocrinology, metabolism,\ and nutrition at the Duke University School of Medicine, in Durham, N.C. "You need to tailor the regimen to an individual's needs."

A person with type 2 diabetes might start off on half a unit of insulin per kilogram of body weight per day, especially if there is not much known about the nature of his or her diabetes. Still, it is not unusual to need more like one unit, says Dr. Feinglos. (One unit per kilogram would be 68 units per day for someone who weighs 150 pounds, which is about 68 kilograms.)

A lot depends on your specific health situation. People with type 2 diabetes suffer from insulin resistance, a situation in which the body loses its ability to use the hormone properly. Early in the course of the disease, the insulin-producing cells of the pancreas respond to insulin resistance by churning out even more of the hormone. Overtime, though, insulin production declines.

Taking insulin can help you overcome the body's insulin resistance, though many factors can affect your dosage. If your body is still sensitive to insulin but the pancreas is no longer making much insulin, for example, Dr. Feinglos says that you would require less insulin than someone who is really resistant to insulin.

"But the most important issue is not necessarily how much you need to take," he adds. "Rather, it's the timing of what you to take. Timing is everything."

One Shot A Day Or More?

If you wake up with high blood sugar in the morning, it's very likely that you will need at least a once-a-day injection combined with oral drugs, says Dr. Feinglos. Oral medication can lower your insulin resistance, and a long-acting, once-a-day insulin shot (usually taken at bedtime) can mimic the low level of insulin made by the pancreas. (And the shots may not be how you picture them -- painful and complicated. You can use pen-like injectors that have short, thin needles and that allow you to dial the amount of insulin you require, rather than draw it up from a vial using a syringe.)

If your blood sugar tends to spike after meals despite using medication and watching what you eat, you may have to take a dose of rapid-action insulin before every meal.

"There's controversy over how much better you can really do with additional shots," says John Buse, M.D., Ph.D., director of the Diabetes Care Center at the University of North Carolina School of Medicine, in Chapel Hill. "I don't see much improvement in overall glucose control in many patients with the rapid-acting insulin taken at meals. And it does promote weight gain and low blood sugar. Is the burden worth the benefit?"

Either way, a once-a-day long-acting formulation is usually the best way to start, according to Dr. Buse. A standard initial dose might be 10 units. The dosage is then increased until blood sugar levels are lowered into the normal range.

"If a person still has substantial insulin secretion left in their pancreas, one shot a day is probably more than enough to top it off," agrees Robert Rizza, M.D., professor of medicine and executive dean of research at the Mayo Clinic, in Rochester, Minn. "But if you're really running out of insulin and can't store it between meals, then you may need to take both the long and short-acting injections."

Taking Insulin With Meals

If you do end up taking insulin at meals, the doctors agree that it is particularly important to match food intake with insulin, while also accounting for physical activity. (Exercise naturally lowers blood sugar, so if you're working out, you may need to take that into account.)

"Some people recommend matching insulin to carbohydrate counts," says Dr. Buse. "Others suggest eating a set serving of carbohydrates at each meal for a particular dose of insulin."

Even more crucial, according to Dr. Feinglos, is moderating food intake before insulin is ever initiated. "If you're not controlling the calories first, and just start giving insulin," he warns, "then all a patient is going to do is gain weight and get more insulin resistant and end up needing larger doses of insulin."

It Can Be A Vicious Cycle

"The relationship between food and exercise with medicine is so critical in diabetes," he adds. "If you just keep pouring medicine into the problem, it doesn't really solve it."

Nevertheless, a patient may do everything right -- eat well, work out and routinely take his or her medicine -- but still require more insulin over time due to the progressive nature of the disease. Adjustments can come through higher doses, increased frequency of injections, or both.

On a positive note, with improved diet and exercise, some patients are actually able to reduce their intake, even to the point of discontinuing insulin injections altogether.

"There are multiple ways to get to the same point," says Dr. Rizza. "The bottom line is to keep blood sugar normal."

Nestlé India Plans Collaboration To Help Manage Diabetes

Nestlé India has signed a memorandum of understanding with the National Diabetes, Obesity and Cholesterol Foundation (N-DOC) to develop nutrition initiatives aimed at helping to manage diabetes.The collaboration - which focuses on increasing consumers’ awareness and knowledge of their diets - will see Nestlé work with N-DOC to understand the impact of local diets and changing lifestyles on the increasing incidence of the disease in India.

Gary Tickle, Regional Business Head of Nestlé Nutrition, South Asia, said: “The Nestlé Nutrition Institute promotes science for better nutrition and N- DOC conducts culturally specific, basic and applied research in the areas of diabetes, obesity, and cholesterol disorders with the help of physicians and scientists. We see this as the beginning of a strong partnership.”

To kick off the announcement last week, a conference was organised by the Nestlé Nutrition Institute and N-DOC on ‘Nutrition Empowerment for Prevention and Management of Diabetes’ in Delhi. The conference was chaired by Professor Anoop Misra, Chairman of N-DOC, and Director and Head of the Department of Diabetes and Metabolic Diseases at the Fortis Group of Hospitals. Research presented suggested that lifestyle measures, physical exercise and good nutrition can all play a major role in managing, and in some cases even helping to prevent the disease.

Clinical nutrition with scientifically-formulated diets can help to provide balanced nutrition to people with diabetes while also delaying its possible long-term complications.

In many countries, including India, Nestlé HealthCare Nutrition already offers a range of nutritional solutions designed to help diabetic patients more effectively manage their disease and minimise its common side effects. Managing diabetes means keeping blood glucose levels in the target range, controlling blood lipids, managing weight as per guidelines and monitoring blood pressure to reduce the risk of complications.

Products formulated to assist in the dietary management of diabetes include Resource Diabetic, a complete, high-fibre diet with a flexible caloric density for oral supplementation or enteral feeding of patients with hyperglycaemia; Novasource Diabet, a complete balanced nutritional formula; and Boost Glucose Control, formulated with a unique balance of protein, fat and slow-digesting carbohydrates.

Nestlé has been using its expertise in science-based nutrition and food technology to develop products with a ‘health plus’ for everyday consumption ever since the company was established more than 140 years ago.