The best diet for optimal blood sugar control & health
Author: kaitiscotland
I am a Scottish doctor who is working to improve the outcomes for people who have diabetes using a low carb diet, and advanced insulin techniques when necessary. Professionally I provide expert witness reports in the clinical forensic and family medicine areas and I also provide complementary therapies. I enjoy cooking, cinema, reading, travel and cats.
A French study of over 100,000 people asked them to record 24 hour food questionnaires at regular intervals. Foods were analysed for preservatives and the results over time compared. People were followed up for over 7 years and the incidence of cancer was compared.
4,226 people developed cancer, mainly breast, prostate, colorectal and other cancers. Higher preservative ingestion was related to increased cancer incidence. The results tend to suggest that people would be likely better off avoiding processed food and make their own minimally processed food.
Food preservatives are extensively used in the modern food industry to inhibit microbial growth and slowing the chemical changes that lead to spoilage. Nitrates and nitrites that are added to processed meats have long been a concern as they are proven to cause cancer in animals. The NutriNet-Sante study showed a modest raise in cancer incidence (1.16) comparing the lowest intakes of various preservatives and the highest intakes.
There has been a recent move towards more natural preservatives eg rosemary extract, and this indeed gave a lower risk of colorectal cancer in the study. Researchers think that higher intake of fruit and vegetables can mitigate the risk of cancer from eating such products as processed meats.
Preservatives offer clear benefits by extending shelf life, lowering food costs, and may be more affordable to many people. The harms could be offset to some extent by setting stricter limits on the use of preservatives, clearer labelling, and listing all additives on these labels. Public health messages already advise limiting alcohol and processed meat, but could go further to include highly processed foods.
After observing the pregnancies and outcomes of 1.6 million it is best to be in the normal weight range if you can, before becoming pregnant.
The researchers found that 6% of women were underweight, 53% had normal weight, 19% were overweight and 22% had obesity.
Babies born to women who gained too little weight in pregnancy tended to have lower birth weight, have lower chances of caesarean delivery, large for gestational weight babies, macrosomia, higher rates of pre-term birth, small for gestational age infants, low birth weight and respiratory distress.
Gestational weight gain above recommended levels tended to result in higher birth weight, higher rates of caesarean delivery, hypertensive disorders of pregnancy, large for gestational age infants, macrosomia, neonatal intensive care admission, lower rates of pre-term birth and small for gestational age infants.
Observational studies suggest that a higher pre-pregnancy body mass index has a greater impact on pregnancy outcomes and childhood weight than gestational weight gain. Studies of siblings show that maternal obesity at the onset of pregnancy, excessive gestational weight gain and short interpregnancy intervals are all independently associated with obesity in the offspring. Maternal and child health are deeply intertwined across the life course.
Currently about 40% of pregnancies are unplanned, so not all women are open to optimising their weight before pregnancy starts. The Healthy Life Trajectories Initiative and Healthy Adaptation to Pregnancy, Postpartum and Parenthood system aim to improve matters before and between pregnancies.
Cholecystectomy is a commonly undertaken operation for the relief of gall stone pain. In the US 700,000 of these are done, now usually by laparoscopy.
A few years ago a trial was done that randomised patients with uncomplicated, symptomatic gall stone colic to either immediate operation or restricting the operation only to people who had severe recurrent attacks. After a year, symptoms were the same in each group.
After another five years, results have found that the restrictive strategy results in a small reduction in the operation rate, without any increase in complications.
However, whether operated on or not, two thirds of the patients get remission of the pain while one third do not.
My comment: Presumably it would be worthwhile finding out what is the actual cause of the recurrent pain.
It is taken for granted that a parent will usually stay with a young child in hospital, but this was not always allowed. Mary Lindsay changed that.
She was born in 1926 and died in March 2025 of heart failure after a long career as a paediatrician.
In the early 50s visiting hours for parents of children were severely restricted. This was due to the idea that parents brought germs with them into the hospital and that their presence upset their children. At the time, the emotional development of children was ignored by the medical profession. Mary opposed this view. The first consultant that provided beds for mothers in children’s wards was Dr Dermod McCarthy in Amersham Hospital with whom she worked. He was the only doctor to change his practice after seeing a film about it.
John Bowlby, a child psychiatrist, had presented A two year old goes to hospital to paediatricians at the Royal Society of Medicine in 1952. It was not well received. A professor of surgery wrote in The Lancet, “There is a lot of sloppy sentiment talked about this. If children are left alone for a day or two they forget all about their parents. The hours in hospital after a parent visits is chaotic. The children all cry and shriek and will not go to sleep”.
Various films were made demonstrating the improvements experienced by children when they were allowed to have a parent (usually the mother) with them. Mary appeared in Going to hospital with mother in 1958.
Mary, Dr MacCarthy, and ward sister Ivy Morris, conducted a study of 1,000 children who had been admitted with their parents, and demonstrated how much better they did, but it took till well into the 1960s before the movement to have parents with their children in hospital took off.
Mary was born in Belfast but moved to Dorset where her father was a headmaster. During WW2 she was evacuated to Northern Ireland. She qualified at Belfast in 1951. After experience in paediatrics, general practice, adult and child psychiatry, she became a consultant in child psychiatry in Aylesbury. Throughout her career she emphasised the importance of emotional well being in the physical health of children. In 1989 she was elected president of the Royal Society of Medicine (Paediatric Branch).
Mary married at the age of 75 becoming a step-mother to three children, who survive her.
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Adapted from BMJ 11 October 2025
About half of all patients with diabetes will develop a symmetrical polyneuropathy but several other atypical nerve conditions can also occur.
Treatment induced neuropathy of diabetes is an acute and severely painful small fibre neuropathy that occurs with a steep drop in glycated haemoglobin levels.
Radiculoplexus neuropathies include lumbosacral, cervical, and thoracic forms, in which pain and weight loss are followed by weakness and sensory loss in the distribution of a single anatomical region.
Monophasic cranial neuropathies are caused by non-inflammatory microvascular ischaemia and present acutely followed by slow improvement.
Compressive neuropathies are when nerves are compressed.
There is more chronic inflammatory demyelinating polyneuropathy in patients with diabetes than in the general population, but definitive diagnosis is difficult to ascertain when diabetes is also present.
Diabetes now affects 9.3% of the world’s population, and half of them have typical symmetric neuropathy. Carpal tunnel syndrome affects 20-30% of diabetics. Cranial neuropathies affect 1% of the population which is ten times higher than in the general population. Over a five year period, about 10% of diabetics will get a treatment induced neuropathy. Lumbosacral neuropathy will eventually affect 1% of diabetics. Chronic inflammatory demyelinating neuropathy affects 0.7 to 10.3 people for every 100,000 people. It is the rarest type.
Treatment induced neuropathy is associated with a high rate of damage to the retina and kidney. It is thought that neuronal ischaemia and the release of cytokines damage the small blood vessels to the nerves.
Prior high blood glucose is the main risk factor for this type of neuropathy. Pain, and autonomic symptoms occur such as low blood pressure, gut dysmotility and sexual dysfunction. The usual age of onset is 25 in type one diabetes and 51 in type two diabetes. The faster the rate in improvement in blood sugars, the higher the risk.
The usual presenting problem is pain in the arm or leg within six to eight weeks of rapid blood sugar correction. The pain is usually in the glove and stocking distribution. Unfortunately the pain is often difficult to treat even with modern drugs such as tricyclic antidepressants, SSRIs, gabapentinoids, and sodium channel blockers. The condition and pain usually stablise over three years if the blood sugars can be kept in control and stable. Foot ulceration can become a common problem if the condition becomes recurrent due to blood sugar swings.
Radiculoplexus neuropathy is caused by a vasculitis of affected nerve roots, plexus and individual nerves in the back. Most people have pain. Rapid glycaemic control can be a pre-disposing factor. Leg weakness, foot drop, numbness and autonomic symptoms can occur. It usually stays one sided.
Post surgical inflammatory neuropathy is typically defined as a neuropathy occurring within 30 days of a surgical event. It occurs in non diabetics too, but more often in diabetics.
Multiple mononeuropathies can also occur in diabetics. This tends to affect the lower arm or lower leg.
Figuring out what type of neuropathy is occurring may be done on clinical history and examination, electrodiagnostic testing, MRI scans, blood tests, lumbar puncture, and nerve biopsy.
Most neuropathies require good blood sugar control to improve, may worsen for a period of time before improvement, and may need drug or other treatments and supportive aids such as braces and wheelchairs. Sometimes residual motor deficits such as foot drop can persist long term.
For Facial mononeuropathy a short course of oral steroids starting within 72 hours of onset may improve recovery.
GLP-1 based treatment for diabetes, weight control, and fatty liver disease is rapidly increasing. These agents also rapidly reduce HbA1c levels. A study was done to specifically look at the effects on type two diabetics and polyneuropathy risk on these agents. One group got the weight loss injection and the other got metformin and insulin. Over five years there was no difference in neuropathy diagnoses.
A double blind randomised controlled trial of Vitamin D has shown significant reductions in progression of early multiple sclerosis.
An acute first episode such as optic neuritis or transverse myelitis is known as clinically isolated syndrome typical for multiple sclerosis (CIS).
316 people with CIS who had vitamin D levels below 100 nmol/L were randomised to 100,000 IU of colecalciferol or placebo every two weeks.
After two years the rates of disease activity, either clinically or on MRI were seen in 60.3% of those who had had the Vitamin D and 74.1% of the placebo group.
Last year I had good news for the slightly chunkier older adult regarding total mortality rates, and today I can cheer some of us up with a further study, this time regarding surgical outcomes.
A post operative series of 400 older adults who were getting major elective surgery reports that the mortality rate was lowest in the people who had BMIs of 25-30.
In the post operative period, 25 people out of 133 died whose BMI was in the normal range (20-25), but only one of the 128 patients in the overweight group died in the 30 days post operation. This is despite higher BMIs being associated with cardiovascular disease and type two diabetes as well as other chronic diseases.
Perhaps advice to lose weight before operations needs to be reconsidered if you are overweight but not obese.
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Adapted from BMJ 21 September 2024
Do you really need a gastroscopy? This is a very commonly performed and unpleasant procedure for the patient. Health Boards tend to have criteria to guide GPs as to referral. Despite this, pick up rates of serious pathology are low.
In the UK, 400,000 gastroscopy results were analysed. Only one in ten showed anything other than normal findings or minor pathology.
Only one in 100 gastroscopies showed malignancy.
In patients under 50, less than 1% had malignancy, regardless of symptoms.
Those most likely to have cancer were men, the over 50s, those who had problems swallowing, and those with weight loss.
Insulin is often prescribed for type two diabetes patients who need extra help with blood sugar control. Up until now, this has been injected once or twice a day. Patients are often reluctant to start insulin, however, due to concerns about the injections, dose adjustment and worries about hypoglycaemia. Once weekly insulin may be an attractive proposition for some patients.
Once weekly insulin has already been developed and has been shown to be no worse than insulin glargine or degludec. Due to potential hypoglycaemia, weekly insulin could be a problem, especially for type one patients. Nonetheless once weekly icodec has been approved for use in adults with diabetes in the Europe and Canada but it has been rejected in the US.
In trials of type two patients, once weekly insulin, used as a basal insulin, was popular with the patients, and the rates of severe hypoglycaemia were not different from those using other types of basal insulin.
Titrating up the dose in type two patients takes about 8 to 12 weeks, because the doses must be titrated cautiously. It is thought that people who are prone to experiencing ketoacidosis due to missed insulin doses, may have a lot to gain with a weekly schedule. Those who are aiming for looser blood sugar control, those with co-morbidities, and those whose insulin needs to be administered by a care giver also may benefit.
Neither insulin icodec or efsitora, the weekly insulins, are yet licenced for use in the UK at the current time. NICE will be examining the evidence and trying to determine what the place of weekly insulin should be in the NHS.
Diabetes Diet 