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.
The United Nations has stated that there has been a fall in global mortality for children under the age of 5 between 2000 and 2022 from 76 deaths in every thousand live births to 37 in every thousand live births. This is a drop of 51%, a result that they consider remarkable.
Still, 4.9 million in total under the age of 5 died in 2022. The UN aim to get these deaths below 25 for every thousand children born alive. 134/200 countries are already at this target but sub-Saharan Africa and Southern Asia are still struggling. The causes of death are mainly pneumonia, gut and other infections, malaria, prematurity, birth asphyxia and trauma.
Cambodia, Malawi, Mongolia, Rwanda, Sao Tome and Principe and Uzbekistan have managed to achieve a 75% reduction in mortality since 2000. They instituted widespread interventions to improve sanitation, clean water and hygiene and improved primary healthcare systems.
Chad, Niger, Nigeria, Sierra Leone and Somalia have child mortality risks over 100 per thousand live births. They don’t have the widespread healthcare, food supply and political stability necessary.
High quality antenatal care, nutrition, skilled health care, immunisation, management of childhood illnesses and efficient referral systems for severe illness are necessary.
In October we had our class reunion from Glasgow University Medical School some 42 years after we qualified. We met for dinner at the iconic Central Hotel Glasgow for dinner.
It was an evening full of nostalgia and it was great to see old classmates, several who had come from as far away as New Zealand and Malaysia to meet up again. Our very hard, and long working hours as junior doctors, forged deep friendships and common bonds of respect. 120 to 145 hours a week was usual, and pay was one third of the basic rate after the first 40 hours of work.
We have had several reunions over the years and I’m fortunate to have attended all of them. I graduated when I was 22, on the younger side, since I went to university from 5th year rather than the more common 6th year at secondary school. At university, some students, perhaps looking for more academic or science based careers, also added science degrees and graduated later than 1982.
We had reunions at various life stages: early parent-hood around our mid thirties, settled in our careers, around our mid forties, around the age of early retirement in our mid 50s, and now with almost everyone retired in our mid 60s.
This was for me, the happiest reunion, because I was finally completely retired from medical practice. At the last reunion, around half of the doctors who had become GPs had retired. Although I was extremely envious of their new found freedom, I was determined to avoid the unfair financial penalty on our pensions and vowed to continue till the age of 60. Due to having a portfolio career, I did a step-wise reduction, stopping forensic/custody work when I was 61 and legal work when I was 63.
It took just over a year after that, before I was finally free of court appearances, follow up reports, and case decisions. It took many months to finally declutter my house and to dispose of my case reports and paperwork. Retirement is an event or series of events, but it is also a process.
The doctors who are still working were mainly in laboratory based roles, where patient contact is very limited, or in medical politics, education or academia, where there has been a long and competitive climb to the top. Some surgeons and consultants who have well established private practices are also continuing. There were very few NHS doctors still at “the coalface”. And to those few that are, I warmly salute you! There are real staffing problems and access to experienced doctors is so necessary.
It was uplifting to hear of the achievements of so many doctors. One Mauritian doctor had set up the first renal service with dialysis and transplants there. Not only had he spent years away from home as a student in Scotland: he had to return to London for years to gain the expertise to develop services and train people in Mauritius. My experience of Mauritius has sadly only been from watching romantic comedies on Netflix, but I do know where I would rather have been!
One woman had become the first female head of the medical school and head of the university Senate. This was smashing a few glass ceilings. This was all while working as a GP and bringing up a family.
Several doctors had great achievements in sports medicine. A daughter of one, gained a medal in the recent Paris games. Another has taken young women players on football matches abroad and attended Wimbledon as an events doctor. Some have been well known football and rugby club doctors.
When it comes to sports, there were several accomplished sailors and one woman who seemed quite normal in her 20s but who has transformed into Wonder Woman. She can swim, cycle, sail and do almost anything better than any man.
It doesn’t always work out for the sporty ones. One man had a terrible accident and sustained punctured lungs and seven fractures. He lived to tell the tail and is even back skiing. (He must be mad).
One woman had six children while working as a GP for over 30 years. One man had married three times. That’s optimism for you!
There had been huge successes in transplant and other surgery techniques from within our year group. One man had become the head of the NHS in England and you will have seen him on the television. Several doctors had fallen in love with people of different nationalities and moved to the other side of the world. Others were in Europe and Scandinavia, but not only changed countries but languages too.
Several people who started in one field or another changed medical careers completely. GP to Palliative care, GP to Psychiatrist, Surgeon to Radiologist, Surgeon to Politician, Psychiatrist to Research Fellow. It is difficult to change to careers in medicine because essentially you have to start right at the bottom of the heap again in another field of study, apprenticeship and exams.
It was with considerable sadness that we also remembered the doctors who have died. One died of cancer in his mid thirties, several have died of cancer and heart attacks around their early 50s.
As the years continue, I expect we will see a diminishing number of people coming back. Some will be happy to just be living their lives, some will find the journey and expense too daunting, some have family and health burdens of their own.
I remember the fresh, young, hard working, fun and idealistic people we once were, and I’m grateful to see that we got through our careers, had the families we wanted to have, and can have some time to ourselves at last.
Columbia University asked 5,000 participants about their personal factors and recovery time after Covid infection.
Median recovery time was 20 days, but more than one in 5 were still having symptoms at 90 days.
People who took a long time to recover tended to be women or to have pre-existing cardiovascular disease.
Those who had been vaccinated against covid-19 or who had been affected by the omicron variant were more likely to recover faster.
Speed of recovery was not linked to age, educational attainment, smoking history, obesity, diabetes, chronic kidney disease, asthma, chronic obstructive pulmonary disease or depressive symptoms.
Adapted from BMJ 15 June2024Global burden of type 1 diabetes in adults aged 65 years and older. 1990-2019.
The number of people from 21 regions and 204 countries was collated in this study. The number of older adults with type one diabetes increased from 1.3 million in 1990 to 3.7 million in 2019.
This was due to a decrease in deaths from type one diabetes in young people, who therefore had the fortune to be able to grow old. There is also an increasing amount of type one diabetes occurring in the population both young and old. The older population of people with type one diabetes are also living longer and in better health. This is mainly a tribute to better diagnosis and treatment.
The prevalence (the total number of people counted who have the condition) increased from 400 to 514 per 100,000 people.
Mortality decreased from 4.74 to 3.54 per 100,000 people.
Disability life adjusted years (DALYs) decreased from 113 to 103 per 100,000 people.
Mortality rates fell 13 times faster in countries with a high sociodemographic index compared to low to middle index countries. The measures included education level, per capita income and lowest fertility rates.
The countries with the most older people with type one diabetes were in high income countries such as North America, Australasia, and Western Europe.
The highest disability rates were found in southern sub-Saharan Africa, Oceania and the Caribbean. A high fasting glucose level remained the highest risk factor for disability among older adults.
Adapted from recipe in New York Times by Craig Claiborne and Pierre Franey July 2 2024
This dish is traditionally served with rice. Feel free to use any low starch vegetable combination. I have de-carbed the original recipe so that the flour has been omitted.
Total time about and hour and 30 minutes.
For 4-6 people.
Ingredients
I medium chicken cut into serving pieces or chicken breasts or thighs as you have available.
Salt to taste.
Ground black or white pepper
one ounce of butter
one banana shallot chopped finely
one clove of garlic chopped finely (Morrison’s have whole peeled cloves in jars)
one glass dry white vermouth
one chicken stock cube dissolved in a quarter cup of hot water (Starr, an Italian make are excellent)
I bay leaf
2 sprigs fresh Thyme or half a teaspoon of dried
about a cup of finely cut carrots in julienne strips
1 and a half cups of loosely packed leeks in julienne strips about 3 inches long
1/2 cup of double/heavy cream.
Method
Season the chicken with salt and pepper
Heat the butter in a frying pan and add the chicken skin side down. Fry only for about a minute without browning.
Add the onion and cook for another minute or two. Add the garlic. Cook for another four or five minutes turning the chicken to ensure even colour.
Add the vermouth, chicken stock, bay leaf and thyme. Cover and cook for 20 minutes.
Once the chicken is simmering, you can boil the carrots and leeks in two separate pans. These are finely chopped so only need one minute for the carrots and four for the leeks. (Or you can use a microwave vegetable steamer).
Now cook your rice or green vegetable accompaniment.
I cook rice in a plastic microwave steamer for 16 minutes or green vegetables in the same microwave container for 7 minutes. (Broccoli, Bok choi, cauliflower).
After the 20 minute simmer, add the carrots, leeks and cream.
Simmer for another two minutes and serve with either boiled rice (no carb restrictions) or green /low starch vegetables.
Some types of endometriosis can increase the risk of ovarian cancer by almost ten fold.
Endometriosis affects 11% of the female population and causes half of all cases of pelvic pain and female infertility.
A large cohort study from Utah found that women who were diagnosed with endometriosis were 4.2 times more likely to get ovarian cancer over their lifetime than those who had never been diagnosed.
Deep infiltrating endometriosis was associated with a 9.66 fold increased risk compared to superficial peritoneal endometriosis which gave a 2.82 increased risk.
In a separate Dutch study in 2021, Adenomyosis (related to Endometriosis) was also shown to increase cancer risk, the relative risk being 1.5.
My comment: The background risk of a woman developing ovarian cancer is 2%. Many women diagnosed with endometriosis will need surgery to remove it, to divide adhesions and in severe cases may opt for a hysterectomy. If they are having extensive surgery anyway removal of the ovaries seems a very good idea. Screening women for ovarian cancer has been tried and unfortunately has not been found to be successful. I wonder if studies in the subgroup of women with endometriosis is something that will happen in future.Adenomyosis is when the endometrial deposits are located in the uterine muscle and are found at hysterectomy.
A national Swedish cohort study of more than two million women has found that women who have experienced difficult pregnancies can be at higher risk of early death up to 46 years later.
Preterm delivery, small for gestational age, pre-eclampsia, hypertension and gestational diabetes, all were associated with increased mortality risks. The main causes of death were cardiovascular diseases, respiratory disorders and diabetes.
These factors were independent risks for premature mortality. Siblings of the women who had normal pregnancies were not at increased risk of earlier death.
Researchers suggest that women who have experienced these problems consider enhanced health checks, put effort into prevention and get treatment for chronic disease if diagnosed.
The EchoSOS phone app is an alert app that you load onto your phone PRIOR to a holiday abroad or before undertaking any sort of adventure activity particularly away from a city.
I found out about this from several readers of the Times who had responded in the comments section about the disappearance of a man in his sixties in a mountainous area of southern France. This follows on from the loss of several other tourists in Mediterranean countries over the summer.
One said that it had saved her life more than once.
It is a free app. You put in your personal details, contact numbers of relatives or friends, your blood group, medical history, allergies and medication. You then allow the app tracking and response permissions.
Should you have a medical or other emergency in your home, city, or outside location, you can press the emergency button. Obviously, you still have to have some sort of signal for this to work.
The app takes note of your details, your location and transfers this to the nearest emergency response number to your current location. This means that you should be able to speak to a relevant dispatcher without the palaver of finding emergency numbers.
Several tourists have died because they have not been able to contact emergency services or have not been able to give their locations if they did. For readers of this blog, many of whom have diabetes, the ability to contact emergency services fast and being able to be located precisely is of even more relevance.
Please pass this information on to anyone that you think will benefit.
Compared to people who sleep 7 to 8 hours each night, people who slept for five hours or less were more likely to develop type two diabetes. The risk increased in those getting 3-4 hours a night. This risk was present even when people eating a “healthy” diet were compared. This study was done in the UK Biobank participants.
It is already known that night shift workers have an increased rate of metabolic syndrome and cancer. They also have lower life expectancy rates.
If you are sleep deprived, you will also be aware that you tend to eat more, particularly carbohydrate containing foods.
For many people they don’t have a choice over whether they even get the chance to sleep. They may have long commutes, work shifts, work night shifts and have high noise levels when they are trying to sleep either by night or day. A new baby is a particular difficulty especially in the first year of life.
Socioeconomic deprivation is associated with poorer outcomes for many medical conditions. The scale of the problem for those with type one diabetes is stark. A UK study has shown that type ones are diagnosed with sight threatening diabetic retinopathy three times as commonly as those in the least deprived areas.
This could be due to many reasons. Food intake, attendance at clinics, care over injections, education, stress, leisure activities and support. It does point to the fact that changing what you do can make a substantial difference to health outcomes.80% of the money spent on diabetes is for treating the complications of diabetes rather than on prevention.
Time restricted eating has been hailed as having a wide range of benefits including weight loss and weight maintenance.
Popular methods include intermittent fasting, only eating in 8 or 12 hour windows of time, and avoiding food within three hours of bedtime. This is meant to reduce the insulin response to food.
A 12 week study followed 41 women whose average age was 59 years. The mean body mass index was 36. All had obesity and either pre-diabetes or diet controlled diabetes. The idea was to find out if they would lose more weight with time restricted eating (TRE).
The groups were told to either stick to an eating window of ten hours with 8% of calories eaten before 1pm or to eat in a usual eating pattern of 16 hours or more a day with at least half of the daily calories eaten after 5pm.
There was no difference in weight loss -2.3kg v 2.6kg and no change in glycaemic measures.
My comment: It would seem that if TRE makes it easier to stick to your chosen dietary regime then fair enough, but if you prefer to eat at intervals through the day then you won’t be missing out. Total calorie intake seems to make the difference.
Diabetes Diet 