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.
Weight loss drugs have considerable advantages but as use grows unexpected side effects are occurring too.
For the child bearing years, usually 15-45 years of age, weight loss drugs seem to render oral contraceptives less effective.
Therefore, should you wish to delay or prevent conception, it is best to add a barrier method such as condoms or a diaphram to the combined or progestogen only pill.
Should a pregnancy occur, the weight loss drugs need to be stopped because there is insufficient knowledge about how these drugs can affect a developing baby. Animal studies indicate that there could be adverse fetal outcomes.
For those in older age groups, it has been found that people with diabetes have twice the likelihood of developing neovascular age related macular degeneration, than diabetics not on weight loss drugs.
An Australian study has shown that people with both type one and type two diabetes are hospitalised for injury more often than the general population.
Most of these injuries happened due to falls.
People using insulin have 60% more chance of being hospitalised for injury. Type two diabetics who take sulphonylureas have also a raised risk.
My comments: These findings tend to indicate that hypoglycaemia is a cause of falls. There could also be other reasons. I recall visiting a woman who had two broken wrists. She had fallen in the street and had fallen off the kerb. I asked why she thought she fell. She said, “I can’t feel my feet.” As a fractured hip in older age is a major reason for losing independence it is important for diabetics to aim for as best blood sugar control as appropriate for them, but also to take care to reduce hypoglycaemia.
Vincent Marks was a pioneering researcher into insulin and hypoglycaemia who became an important expert witness in cases against nurse Beverly Allitt, who was convicted of several child murders, and Claus Von Bulow, who was acquitted of the attempted murder of his wife.
Vincent Marks was born in 1930 and died of metastatic thyroid cancer in 2023.
The Von Bulow case centred around the cause of the coma suffered by his wife, Sunny. She spent 27 years in a coma prior to her death. It was alleged that her husband had injected her with insulin. She had considerable wealth compared to him. The “sleeping beauty murder” was the first major trial to be televised. Events were described in the book, Reversal of Fortune, and a film starring Jeremy Irons and Glen Close followed. Jeremy received an Oscar for his performance.
Vincent was a professor of clinical biochemistry and head of clinical biochemistry and metabolic medicine in Royal Surrey County Hospital in Guildford. His laboratory was the first to offer insulin assays to NHS hospitals throughout the UK.
A sample from Nottingham revealed that children had low blood sugar and high insulin levels and this revealed the deliberate harm done to children by nurse Beverly Allitt.
Vincent was the first to develop a method to accurately measure blood sugar at low concentrations. Up until then some patients had been given erroneous diagnoses of neurological disorders when they really had hypoglycaemia.
In 1995 Vincent retired from clinical medicine in order to devote his time to teaching medical students and post-graduates. He published widely including Insulin Murders, which spanned 50 years of legal cases.
Vincent was born in a London pub which was owned by his father. He had an elder brother John, who also became a doctor. During the war, he was evacuated to a farm in Devon. Although brought up in Judaism, he became a Humanist.
His wife Averil and he were married for 66 years, had two children, six grandchildren and four great grandchildren.
A study in Lancet Public Health has found that every year spent in a classroom improves life expectancy, while not attending is as deadly as smoking or heavy drinking.
Researchers from Norway and the USA examined data from 59 countries including Brazil, China, the UK, and the USA. They found that all cause adult mortality fee by 2% for every year in full time education.
Compared to no formal education, if you reached college or university level education, your total mortality fell by 34%. But not attending school was equivalent to smoking 10 cigarettes a day or drinking 5 or more alcoholic drinks a day for ten years. The effects were similar in rich and poor countries regardless of sex, social class or demography.
Money is part of this effect. Education leads to higher lifetime earnings and that in turn improves housing and diet. It also helps you access and understand information that can guide you to make better life choices.
For women, higher educational levels reduce maternal and child deaths, better child health and lower fertility rates. Educated women tend to use contraception, marry later, have fewer children and be better informed about their children’s needs.
Most doctors agree that taking a medical history from a patient not only improves rapport but is essential to accurate diagnosis.
History taking is a skill that takes time and practice. Part of this is knowing when to delve more deeply and when you can take things at face value or leave parts out. Now, AI assistants have been trained to do it too.
A randomised, controlled, double blind trial was done with actors, simulating the patients, the Articulate Medical Intelligence Explorer, and primary care physicians. To keep everyone blinded as to who was “the doctor”, text chat was used instead of face to face interviewing.
The AI machine was as good as the doctors.
My comment: I could see this being very useful in clinical practice as a way of reducing consultation times and prioritising urgency of appointments.
Around a third of US adults have impaired glucose tolerance also known as pre-diabetes. Many of the men also have low testosterone levels. This is known to cause fat accumulation, insulin resistance and type two diabetes.
Testosterone therapy is known to improve muscle mass, reduce fat mass, and improve insulin sensitivity. One would imagine that giving men who have low testosterone and pre-diabetes, hormone replacement therapy, would reduce the onset of type two diabetes.
For unknown reasons, doing this didn’t work.
In men over the age of 45 with low testosterone and pre-diabetes, testosterone gel was no more effective than placebo in reducing the onset of type two diabetes after two years. (13.5% in the active group and 15.7% in the placebo group.) Glycaemic control also failed to improve.
The trial also found out that testosterone replacement therapy also didn’t reduce fractures in hypogonadal men, even though skeletal mass is known to improve with testosterone.
My comment: I’m sure the researchers were disappointed to see this result. My practice was to treat these men with TRT and I am baffled as to these results, as treatment is usually very well tolerated.
Adapted from BMJ 17 Feb 2024Effect of exercise for depression Noetel M. Sanders et al.
We all know that exercise is beneficial in many ways. Researchers were specifically interested in what types, durations and intensity were helpful in treating major depressive disorder.
Sanders and Gallardo-Gomez performed a systematic review and network meta-analysis. The methods allowed such moderators such as intensity, dose, age, and sex to be assessed. 218 studies covering over 14 thousand people were studied.
Compared to active controls, moderate reductions in depression were found for walking or jogging, yoga, strength training, mixed aerobic exercise, and tai chi or qigong. Effects were proportional to the intensity of the exercise. Strength training, walking and yoga appeared to be the most liked and adhered to forms of exercise.
The effects seemed proportional to the intensity of the exercise, were higher when people exercised in groups. The effects were as good as psychotherapy or using drugs.
A Korean study of more than 7 million people determined at baseline if they had type two diabetes or not, and whether they had a normal liver, a mild fatty liver or severe fatty liver. They then followed them up for over 20 years to see what effects were seen on all cause mortality, or cardiovascular disease (myocardial infarction or ischaemic stroke).
In the non diabetic population 21.2% had mild fatty liver and 10.2% had severe fatty liver. In the type two diabetes population, 34% had mild fatty liver disease and 26.73% had severe fatty liver disease.
They found that even mild fatty liver disease increased cardiovascular mortality and all cause mortality in type two diabetics. As the degree of fatty liver increased, so did the rates of death for all cause and cardiovascular disease.
6.5% of the studied Korean population had type two diabetes. Weight loss through lifestyle modifications (diet and exercise) remains the cornerstone of management of type two diabetes, fatty liver and cardiovascular disease, but is difficult to achieve and even harder to maintain.
Newer weight loss drugs have shown promise in treating type two diabetes and in reducing fatty liver, but are expensive and may need to be continued for many years.
Diabetes Diet 