Introduction of diabetes

Diabetes is a metabolic disorder that is characterized by high blood glucose and either insufficient or ineffective insulin. 5.9% of the population in the United States has diabetes, and diabetes is the seventh leading cause of death in our country. Diabetes is a chronic disease without a cure, however, with proper management and treatment, diabetics can live a normal, healthy lives.

Insulin

Insulin is a hormone secreted by specialized cells in the pancreas in response to (among other things), increased blood glucose concentration. The primary role of insulin is to control the transport of glucose from the bloodstream into the cells. After consuming a meal, insulin enhances the uptake of the energy nutrients (amino acids, glucose, and fatty acids). Insulin helps maintain blood glucose within normal limits and stimulates protein synthesis, glucose synthesis in the liver and muscle, and fat synthesis.

Without insulin, or when insulin is ineffective, glucose regulation falters and the metabolism of energy-yielding nutrients changes. In diabetes, there is too much glucose in the blood. When glucose builds in the blood instead of going into the cells, it can cause two problems:

• Your cells may become starved for energy
• Over time, high glucose blood levels may harm your kidneys, heart, eyes or nerves

There are two main types of diabetes, Type I and Type II, described below.

Type I Diabetes
(a.k.a. Juvenile Onset Diabetes, Insulin-Dependant Diabetes)

Insulin-dependant is caused by damage to the pancreas. The pancreas contains beta cells, which make insulin. With Type I diabetes, the deficiency of insulin is due to a decline in the number of beta cells the pancreas contains. It appears that certain genes make Type I diabetics more susceptible, but a triggering factor (usually a viral infection) sets it off. In most people with Type I diabetes, the immune system makes a mistake, attacking the beta cells and causing them to die. Without the beta cells, you cannot produce insulin. Glucose then builds up in the blood and causes diabetes.

Type I diabetes exhibits the following warning signs:

• Losing weight without trying
• An increased need to urinate
• Increased hunger
• Increased thirst
• Trouble seeing
• Feeling tired and/or
• Going into a coma

For Type I diabetics, treatment usually consists of a healthy diet, exercise, and insulin shots to replace the insulin that your body no longer produces. Most insulin-dependent diabetics test their blood at least four times per day to monitor their blood’s glucose level. This is necessary to keep their blood glucose within certain limits. If blood glucose is not monitored, and if insulin levels are not kept in check, three things may happen:

1. Ketoacidosis – occurs when your blood glucose levels are highly elevated, by either eating too much or taking too little insulin, by stress or illness. In this case, there is too little insulin in the blood. Your body then begins breaking down fat for energy, producing chemicals called ketones. Ketones can make you throw up, have difficulty breathing, cause excessive thirst, cause dry, itchy skin, or even cause coma.

2. Hypoglycemia – occurs when blood glucose levels become too low. It can be cause by taking too much insulin, eating too little, skipping meals, eating at the wrong time, exercising too intensely or for too long, or by drinking alcohol on an empty stomach. If your blood glucose is too low you may feel hungry, confused, tired, shaky or nervous.

3. Complications – elevated glucose levels in the blood over time can hurt your organs. Diabetes can damage kidneys, eyes and nerves, and makes heart and blood vessel disease more likely. Diabetics can defend themselves from complications by keeping their glucose levels under control.

Type II Diabetes
(a.k.a. Adult Onset Diabetes, Non-Insulin-Dependent Diabetes)

Type II diabetes is the most common form of diabetes, with about 90% of diabetes falling into the Type II category. With Type II diabetes, glucose builds up in the blood – not because not enough insulin is present, but probably because cells lose their insulin receptors and become less sensitive to insulin. Type II diabetes usually (though not always) occurs in individuals who are over 40 years of age who are overweight.

Type II diabetes produces mild symptoms, and can be controlled with a healthy diet, exercise and weight loss. Type II diabetics should also monitor their glucose levels to be sure they are maintaining healthy levels. In some cases, weight loss, diet and exercise are not enough to control the glucose levels. In those cases, your physician may control your diabetes by prescribing diabetes pills or insulin shots.

Type II diabetes can cause three types of problems:

1. High Blood Sugar – high glucose levels in the blood are most likely when you’re sick or under a lot of stress. High blood sugar can cause you to have a headache, blurry vision, excessive thirst and an increased need to urinate, and cause dry, itchy skin. Though less of a problem with Type II diabetes, ketones can build up in the blood when Type II diabetics have symptoms of high blood sugar, or when they are sick.
2. Low Blood Sugar – When blood sugar falls to low you may feel tired, shaky, nervous, hungry or confused. It may be caused by taking too much diabetes medicine, eating too little or skipping meals, exercising too intensely or for too long, or from drinking alcohol without eating.
3. Complications – Elevated blood glucose over many years can hurt organs, including the eyes, kidneys, and eyes. It can also make heart and blood vessel disease more likely. The best defense against complications is a careful monitoring of blood glucose, a healthy diet and exercise.

Risks for Diabetes

• Individuals with parents or siblings with diabetes
• People over the age of 45
• People who are overweight
• People who do not exercise regularly
• People with low HDL cholesterol or high triglycerides
• Certain racial and ethnic groups (African Americans, Latinos, Asians and Native Americans)
• Women who had gestational diabetes or who had a baby weighing 9 pounds or more at birth.

Warning Signs of Diabetes

Type I: Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue Irritability

*Type II: Any of the Type I symptoms Frequent infections Blurred vision Cuts/bruises that are slow to heal Tingling/numbness in the hands or feet Recurring skin, gum or bladder infections *individuals with Type II diabetes often have no symptoms

 

Understanding Fat and Cholesterol

Blood Lipid Parameters:

The National Cholesterol Education program recommends that everyone over the age of 20 be tested for cholesterol at least once every 5 years.

The National Cholesterol Education Program
Blood Lipid	Desirable	Borderline	High
Total Cholesterol	< 200 mg/dL	200-239 mg/dL	>= 240 mg/dL
Low-Density Lipoproteins (LDL)	< 130 mg/dL	130-159 mg/dL	>= 160 mg/dL
High-Density Lipoproteins (HDL)	> 35 mg/dL (values >60 mg/dL are considered a negative risk factor)
Triglycerides	< 200 mg/dL

Lipids (Fats) Explained:

Fats, or lipids, can be divided into three general categories: Triglycerides, Phospholipids and Sterols.

• Triglycerides - (fats and oils) This is the main form of fat in the diet. Triglycerides provide us with energy, insulates, cushions and protects internal organs and helps our bodies use carbohydrates and proteins more efficiently. Triglycerides can be further divided into the following categories:
• Saturated fats - Usually solid at room temperature, saturated fats contain the maximum number of hydrogen atoms (saturated with hydrogen). Saturated fats are considered the most detrimental to health.
• Monounsaturated fats - Liquid at room temperature, monounsaturated fats include olive and canola oils. This type of fat tends to lower "bad" LDL cholesterol while leaving the "good" HDL cholesterol unchanged.
• Polyunsaturated fats - Liquid at room temperature, polyunsaturated fats include corn oil, safflower oil and sunflower oil. This type of fat tends to lower both "bad" LDL and "good" HDL cholesterol.
• Hydrogenated fats - This fat results from a process where hydrogen atoms are added back to polyunsaturated or monounsaturated fats to protect against rancidity . This procedure effectively causes hydrogenated fats to become saturated fats. Thus, if a food lists partially hydrogenated oils among its first three ingredients, it usually contains alot of trans-fatty acids and saturated fats.
• Trans-fatty acids - In nature, most unsaturated fats are cis-fatty acids. During hydrogenation, the molecular structure changes from cis- to trans-fatty acids. Trans-fatty acids increase "bad" LDL cholesterol and lower "good" HDL cholesterol, which may increase heart disease risk.
• Essential fatty acids - Essential fatty acids must be supplied by the diet. The body uses essential fatty acids to maintain the structural parts of cell membranes. They are also used as a component in the production of hormone-like substances (eicosanoids) that help regulate blood pressure, clot formation, and maintain the immune response.
• Linoleic Acid - The Omega-6 family. Common sources for these essential fatty acids are vegetable oils and meats. Most individuals can ensure an adequate intake of Omega-6 fatty acids by including grains, seeds, leafy vegetables, and small amounts of vegetable oils and meats in the diet.
• Linolenic Acid - The Omega-3 family. Linolenic acid is a major component of the communicating membranes of the brain, and is active in the eye's retina. It is essential for growth and development. Fish, in particular, is abundant in both Omega-3 and Omega-6 fatty acids.
• Phospholipids - (eg. lecithin) Phospholipids help transport fat-soluble vitamins, hormones and other substances through cell membranes. Because they can dissolve in both water and fat, they act as an emulsifier, helping to keep fats suspended in body fluids and blood. The liver can produce all the body's phospholipids from scratch, therefore it is not an essential nutrient.
• Sterols - Sterols include cholesterol, vitamin D and sex hormones. The are a component of bile, sex hormones (testosterone), adrenal hormones (cortisol) and are a structural component of cell membranes. 9/10 of the body's cholesterol is stored in cells.
  
  Cholesterol - The liver manufacturers about 800-1500 mg. of cholesterol per day, which contributes much more to total body cholesterol than does diet. The liver can also make cholesterol from carbohydrates, proteins or fat. Only animal foods contain cholesterol. Excess cholesterol harms the body when it forms deposits on artery walls, leading to atherosclerosis and heart disease. Cholesterol can be further divided into HDLs and LDLs:

·         Low-Density Lipoproteins (LDL) - Considered "bad" cholesterol. It is produced in the liver and circulates through the body, transporting fat to the muscles, heart, fat stores and other tissues.

·         High-Density Lipoproteins (HDL) - Considered "good" cholesterol. It is produced by the liver to carry cholesterol and phospholipids from the cells back to the liver for recycling and/or excretion. Because HDLs represent cholesterol removal from arteries and blood to the liver for breakdown and disposal, it is considered "good" cholesterol. Therefore, high levels of HDL cholesterol is considered a negative risk factor for heart disease.

Approximate Cholesterol Amounts in Foods:

Food	mg/chol
Grains, vegetables, fruits	0
Whole Milk, 1 cup	30-35
Nonfat Milk, 1 cup	5-10
Cheese, 1 ounce	25-30
Butter, 1 tablespoon	10
Beef, chicken, or pork, 3 ounces	70-85
Liver, 3 ounces	410
Egg yolk	213
Egg white	0
Shrimp, 3 ounces	165
Fish, lobster, clams, 3 ounces	50-60

The table above shows the approximate amounts of cholesterol that can be found in common foods.

Note that current research indicates that food cholesterol does not appear to increase blood cholesterol as dramatically as does saturated fats. So while it is wise to watch your cholesterol intake, be sure to decrease your consumption of saturated fats as well.

How you can improve your Cholesterol Levels

• Reduce or maintain a desirable weight
• Exercise. Aerobic exercise four days per week for 30 minutes or more can increase the level of ("good") HDL cholesterol in your body
• Choose monounsaturated or polyunsaturated fats in small amounts in place of saturated fats
• Avoid saturated fats.
• Eat fish once or twice per week
• Avoid hydrogenated or trans-fatty acids
• Reduce consumption of high-cholesterol foods
• Consume more soluble fiber
• Graze. Eating 5 or more meals per day keeps insulin concentrations low and slows down the liver's synthesis of cholesterol

Note

16.7 Million People Around the Globe Die From Heart Disease Each Year

This year, more than 32 million people across the world will suffer a heart attack or stroke, and about 12.5 million of those incidents are fatal.2 Blood cholesterol levels have a lot to do with a person抯 risk of getting heart disease. In fact, the higher the blood cholesterol level, the greater the risk for developing heart disease.

Regular tracking of cholesterol and triglycerides is important for many reasons.

• Testing your numbers over time helps you make informed decisions.
• Checking your numbers gives you peace of mind. Why wait and worry?
• Tracking your levels lets you know if your heart health regimen is working.