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.
Researchers from UCL analysed the results the latest results from the Health Survey for England.
Data from 8,200 adults and 2,000 children living in private households showed that diabetes has risen in men from 3% to 9% and from 2% to 6% in women since 1994.
Those from poorer households and those with obesity are much more likely to be affected than the slim and affluent. 16% from the poorest homes had diabetes compared to 7% in the highest income group. If you are of normal weight there is a 5% chance of diabetes, 9% if you are overweight and 15% if you are obese.
Obesity is a marker for poverty. 39% of women in deprived areas were obese compared to 22% from least deprived areas. The weight of children was closely correlated with their parents.
Professor Jennifer Mindell said,” Diabetes has become more common in both high and low income countries over the last few decades. It increases the risks of circulatory diseases and cancers. This year we have also seen a rise in serious infection and death such as with Covid-19. Obesity reduction would help all of these problems.”
The survey also asked about GP visits. 69% of men and 82% of women had consulted a GP in the previous six months. GP consultations are more common in older ages, especially among men and those who are overweight or obese. 84% said they went about their physical health problems, 11% for physical and mental problems and 5% for an emotional or mental health problem. Women tended to seek more help for mental health problems than men.
Echoing all the other parameters, consultations for mental health problems were more frequent in those with lower incomes. 25% consulted from the lowest income group compared to 15% from the most affluent group.
Elizabeth Fuller, Research Director at NatCen said, ” One in five women and one in eight men screened positive for a possible eating disorder. This can mean eating too much or too little, obsessing with weight or body shape, having strict routines around food or purging after eating. People who are obese, younger adults and women are more likely to be affected.”
The Times recently published a long list of exercise sites that you can get for free or pay for. Being a home exercise enthusiast I read this carefully and decided to try out the sites they listed as being FREE. These were my favourite ones. All had a variety of exercises eg low and high impact aerobics, walking, weights, rubber bands, stretching, relaxation and even dressing, hair and make up tips.
Top of the pops was Fabulous 50s. There are over a hundred workouts on this site. All are one to one, and set in beautiful Australia. This lady’s house is so clean, tidy, uncluttered that I was immediately pea green with envy. Of course, if I moved into her house, it wouldn’t stay that way for long. There is a fantastic range of exercises and from the ones I have tried, they were well produced and constructed, and even if you are a complete beginner, are pretty easily done. They range in time from 5 minutes to 30 minutes really giving you plenty of options no matter how hard pressed you are for time.
Mad fit, Lucy Wyndam-Read and Fitness Blender also are free and have multiple workouts in terms of types and durations. They seemed more tuned to the younger or fitter age group than Fabulous 50s and I have only done a few of them being 61 with some unfortunate back issues right now. They are not quite as beautifully produced as Fab 50s but they are free!
You will get adverts popping up during all these workouts. Now this is where you have to be careful because the marketing folks know who they are aiming at here and the top products seem to be wrinkle cream, make up and chocolate. It doesn’t matter how lucious it looks. Do not buy it. Because you will eat it.
Adriene is purely a yoga site. This is free too, and she sometimes has her dog with her. Again, there are a lot of different length and types of workout.
Now, if you have a smart phone, a tablet, a pc or a smart television, whatever your favourite form of home exercise is, and even if you only have five or ten minutes, you can workout for free at home.
Sam Feltham has done it again. This year’s conference is now available on you tube right now.
Last weekend there were many contributors from diverse fields including members of the public, doctors, academics, and the scientific journalist Gary Taubes who gave the opening talk about ketogenic diets.
The courses that particularly interested me were about the experiences of type one diabetics who had adopted the low carb approach, how to achieve change, and how to increase your happiness.
There are talks about eating addiction and eating disorders, statins, and vegetable oil consumption.
Much of the material will be familiar to readers of this blog. There are some new speakers and topics which do indicate that a grassroots movement in changing our dietary guidelines is gaining ground.
Adapted from Hodgkinson JA et al. Accuracy of blood pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross sectional, observational study in central England. Br J Gen Pract. 2020 June 2
More and more of us are checking our own blood pressure and telling our GPs what the result is over the phone or via skype. Home monitoring has been increasing in the last ten years and has greatly accelerated with the Covid pandemic making avoiding face to face consultations a virtue.
Blood pressure checks are done to diagnose and monitor hypertension but are also a matter of routine for contraceptive pill checks, hormone replacement therapy checks, and diabetes checks.
This study was conducted on just under seven thousand general practice patients in the Midlands of England.
Those who used home blood pressure monitors had them tested against a reference monitor and those who were not within 3 mm Hg were considered to have failed. This is a pretty strict test. The cuffs were also assessed.
In all 76% of the monitors passed on the monitors and cuffs. 86% passed the monitor tests. The monitors that failed mainly tended to over estimate the blood pressure.
In general monitors that have been validated (should say so on the monitor) were more accurate than those that were not. Monitors that cost more than £10 were more accurate than those over £10. Monitors that were under four years old were more accurate than those that were older.
The authors say that BP monitors are very likely to be accurate if they have been validated and are over 4 years old.
Adapted from Efficacy and safety of low and very low carb diets for type two diabetes remission. Systemic review and meta-analysis by Goldenber JZ et al. BMJ 2021;372:m4743
My comment: Now, we all know this, but there still is a great deal of resistance to the idea that cutting out sugar and especially starch from your diet, can put type two diabetes into remission. Lately there has been a lot more emphasis that very low calorie diets are good for diabetes remission, but let’s face it, starving yourself is no fun at all, and eventually, even if you do manage to keep to a very low calorie diet for many months, you need to do something to maintain that remission, rather than yo-yo back into diabetes. This is why I was pleased to see this report in the BMJ.
This study looked at randomised controlled trials that evaluated low carb diets for at least 12 weeks in adults with type two diabetes. Their definition was less than 130 g of carb a day or 26% of the diet from carbohydrates. A very low carb diet was defined as less than 50g of carb a day or 10% of dietary carbs a day.
They wanted to see if remission was achieved. This was deemed to be a HbA1c of less than 6.5% or a fasting blood sugar of less than 7.0 mmol/L with or without the use of diabetes medication. They also looked at weight loss, HbAIc, fasting glucose and adverse events.
Compared to control diets, low carb diets produced remission at six months in 57% versus 31% in the control diets.
The population studied were 1,357 people aged 47 to 67 years of age and most were overweight or obese. 23 studies were looked at and 14 of these included patients who were on insulin. There was very little in the way of adverse consequences.
Adapted from HIIT provides multiple advantages in patients with type 1 diabetes. Diabetes in Control May 23 2020 by George McConnell Pharm D candidate. LECOM School of Pharmacy.
Lifestyle changes are hard. Many type one diabetics lead sedentary lives. They have a big fear of hypoglycaemia from exercise. Another complaint is that they don’t have enough time. High intensity interval training has been gaining popularity over the last few years due to its low time commitment. HIIT improves vascular function without the reductions in blood sugar that are often associated with moderate intensity exercise.
One study looked at what happened at home. Eleven type 1s completed six weeks of HIIT at home. A session was one minute of HIIT followed by one minute of rest. The goal was to get to 80% or more of their predicted maximum heart rate from the formula 220- age. The exercise component was two thirty second body weight exercises with no rest in between. There were 18 exercises and 9 suggested pairings but the participants were allowed to choose what they did of these exercises. They were to exercise on three days of the week, starting at six minutes and building up by two sessions every two weeks. They had heart rate monitors that could be downloaded so they and the researchers could see their results. They were to exercise only when their blood sugar was between 7 and 14 mmol/L.(126-252mg/dL). Blood sugars, insulin and ingested carbohydrates were measured.
Adherence was 95% and pulse targets were achieved. Glucose levels remained the same during and one hour after exercise. Carbs were ingested in 6% of the sessions. Insulin was needed after only 3 of the 188 sessions. There was no severe hypoglycaemic episodes. After six weeks there was a mean decrease of 13% in their daily short acting insulin doses. There were no significant changes to the mean blood glucose concentration or to BMI.
Home exercise means that there is no commute or gym fees. It was a bit sad that there was no weight loss despite the strict adherence to the regime by these motivated participants.
The top three barriers to exercise in type 1s are given as lack of time 91%, fear of hypos 27%, and a lack of motivation 18%, so these quick, high intensity exercise sessions can provide a solution to these barriers. It is convenient, quick, requires no equipment, does not adversely affect blood sugar levels and can increase motivation to exercise. It only took 60 minutes a week overall.
Practice pearls:
HIIT at home is quick and does not need gym attendance.
HIIT is good for busy people taking an hour a week.
HIIT reduces short acting insulin doses.
HIIT does not cause significant hypos, but blood sugar levels should still be checked.
HIIT sadly does not cause weight loss.
Scott Sam N et al. A multidisciplinary evaluation of a virtually supervised home based high intensity interval training intervention in people with type one diabetes. Diabetes Care. ADA. 1 Dec 2019.
Adapted from Cancer replaces heart disease and stroke as leading cause of death in people with diabetes. Pearson-Stuttard J et al. Lancet Diabetes Endocrinol 4 Feb 2021 and Six adiposity markers predict incidence and mortality for 24 cancers. Parra-Soto S et al BMC Med 11 Jan 2021
People with type one and two diabetes have been told for decades that cardiovascular disease in the form of heart attacks and strokes are the most likely way that the Grim Reaper is likely to call on them. New research however shows that cancer is now the leading cause of death.
The study was conducted by Imperial College London. Between 2001 and 2018 the cardiovascular causes have been superceded by cancer as the main diagnosis causing death in a total of nearly 314 thousand people.
Also, the death rates are a third less than previously, so diabetics were living longer, and dying of cancer instead of cardiovascular disease. Other causes that were still fatal included dementia, liver disease and respiratory disease. These were more common in the diabetic population compared to the non diabetic population.
People with diabetes still tended to die at earlier ages than the general population, but the gap is narrowing. Dementia and liver disease were twice as high compared to the general population for instance.
The lead author Dr Jonathan Pearson-Stuttard said, ” Improvements in risk factors such as smoking and blood pressure, along with improvements in medical treatments have contributed to large falls in deaths from heart disease and stroke. The improvements have been even greater in those with diabetes. This has resulted in vascular conditions accounting for around 25 percent of all deaths in those with diabetes compared to 45 per cent 20 years ago.”
” In contrast improvements in cancer death rates have been much more modest, with improvements in those with diabetes lagging behind the general population. Added to this, the UK lags behind the EU in terms of cancer survival rates.”
The authors want people to know that if they have diabetes they have higher rates of cancer, dementia and liver disease compared to the general population.
If you are overweight the cancers that you are more likely to get, in no particular order, are:
My comment: Although this is not the most cheerful of posts, the good news is that diabetics are living long enough to die of diseases of older age such as cancer and dementia.
1 tablespoon extra virgin olive oil, plus extra for the grill pan
1/2 tablespoon fresh lemon juice
1/2 teaspoon dried oregano
1/4 teaspoon coriander
1/4 teaspoon paprika
1 clove garlic, minced
Kosher salt and freshly ground black pepper
1 pound chicken tenders, about 8
Directions
Mix the yogurt, oil, lemon juice, oregano, coriander, paprika, garlic, 1/4 teaspoon salt, and 1/4 teaspoon pepper in a medium bowl until fully blended. Add the chicken and mix to coat. Cover and refrigerate for 2 to 4 hours.
Now make your cucumber sauce, Tzaziki and put it in the fridge as well.
When you are about one hour before your meal take out the chicken mini fillets and allow to reach room temperature, about 30 minutes, then fry in olive oil till cooked. They can be kept warm in the oven.
Cucumber Sauce
Ingredients
1 cup plain Greek yogurt
1 peeled and seeded cucumber, finely diced
1 1/2 tablespoons freshly squeezed lemon juice
1 tablespoon chopped fresh dill or 1 teaspoon dried
1 clove garlic, grated
¼ cup feta cheese
Kosher salt
Directions
Combine the yogurt, cucumber, lemon juice, dill, garlic, feta cheese, and 1/4 teaspoon salt in a medium bowl. Chill, covered, for at least 30 minutes to let the flavors blend.
Aug 15, 2020 Editor: Steve Freed, R.PH., CDE Author: Sameen Khan, Pharm.D. Candidate, USF College of Pharmacy
Stress hormones triggered by noise exposure affect insulin secretion and sensitivity, leading to increased hyperglycemia risk.
Studies have reported an association between exposure to high noise levels and the activation of stress hormones such as cortisol, which reduces pancreatic insulin secretion and decreases insulin sensitivity throughout the body, leading to increased risk of developing type 2 diabetes. This association is alarming for those with occupations that cause high levels of loud noise exposure regularly. Concerns have been validated by researchers; for example, in a 2011 cross-sectional study, which linked noise-induced hearing loss with impaired fasting glucose levels. Also, the 2014 U.S. national survey associated elevated body mass indexes (BMI) with patients that self-reported occupational noise exposure.
A 2012 retrospective cohort study investigated the incidence of hyperglycemia in machinery and equipment manufacturing workers exposed to increased noise levels over one year. Researchers recruited study participants from four job sites, excluding those with a history of diabetes or who were unable to follow up with researchers after one year, culminating in 905 total study participants. A health examination was performed at the commencement of the study, which required that participants undergo an overnight fast so that baseline fasting plasma glucose levels could be determined. Noise exposure levels were determined through a walkthrough survey that utilized a personal noise dosimeter to report sound levels in decibels from the working hours of 08:00 to 17:00, excluding 12:00 to 13:00. An eight-hour time-weighted average (TWA) was then calculated. Participants were then classified into “high” (≥ 85 decibels), “medium” (70-85 decibels), and “low” (<70 decibels) exposure groups. The study’s primary endpoints were diagnosis of prediabetes, initiation of hypoglycemic medication, or end of the one-year study period.
Demographics between the exposure groups varied considerably. Those in high occupational noise exposure jobs were mostly male and had lower educational levels than those in the low-exposure groups. Only 23.25% of those in the high exposure group had an education level of greater than 12 years, while 82.4% of those in the low exposure group did. Smoking was more common as sound exposure increased. The high-exposure group had the highest incidence of smoking and reported 38.9% as smokers, the medium-exposure group had 28.6% smokers, and of the low-exposure group, only 15.9% were smokers. Statistical analysis utilizing the Cox proportional hazard regression model found that participants exposed to high levels of noise defined in the study as ≥ 85 decibels were at significantly higher risk of developing hyperglycemia than their low (<70 decibels) noise exposure counterparts. The high exposure group had a 1.80 risk ratio for developing hyperglycemia, reported with a 95% confidence interval (1.04-3.10) compared to the low exposure group.
Awareness that high levels of noise exposure are a risk factor for hyperglycemia is an essential step in combatting it, particularly for those for whom it is unavoidable due to it being a byproduct of their occupation. Hearing-protective devices are critical in reducing the risk of developing hyperglycemia, which could lead to a chronic condition such as type 2 diabetes. This study‘s greatest strength was in the retrospective cohort design, which provided information based on a longitudinal follow-up of workers exposed to various noise levels. However, it did have limited knowledge of noise exposure that workers may have had outside of work, and was limited to one year. Additionally, researchers only measured the pre-prandial blood glucose levels. They did not measure postprandial levels, and these levels were only taken at the beginning and end of the study. The study would have benefited by having more measurements to correlate noise exposure to blood glucose levels strongly. For this reason, researchers recommend using animal models to study the impact of noise on hyperglycemia further.
Practice Pearls:
Noise levels greater than or equal to 85 decibels are highly correlated with an increased incidence of hyperglycemia.
Those in jobs with high noise level exposure are likely to be males, smokers, and have a lower education status than those in jobs with reduced noise exposure.
Hearing protective devices may be used to help protect against the development of diabetes.
Chang, Ta-Yuan, et al. “Occupational Noise Exposure and Its Association with Incident Hyperglycemia Retrospective Cohort Study.“ Nature, 22 May 2020, doi:10.2139/ssrn.3284860.
Sameen Khan, Pharm.D. Candidate, USF College of Pharmacy
