Diabetes Everyday

Living your best life with diabetes. Toby Smithson provides professional guidance with personal experience.

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Diabetes and Carbohydrates- What You Need To Know!

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Estimated reading time: 4 minutes

Carbohydrates – friend or foe of people with diabetes (or a little of both)? This video is the first of a series that will answer that question for you.

Carbohydrate……what reaction do you have when you hear that word……fear, anger, rebellion, sadness, longing….or maybe you’re not sure why you should have any reaction at all. Well, diabetes and carbohydrates are tightly linked,…in fact, we’re all closely linked to carbohydrates in ways you may not even imagine. Stay tuned.

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Toby’s Advice- Diabetes, Blood Pressure and Potash

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If you’re a gardener I’ll bet that title and photo got your attention. Potash is a common component of fertilizers, used to provide potassium to plants. Potassium (chemical symbol K) is important for us humans too, and in generous quantities compared to other “micronutrients.” Potassium helps nerves carry signals, works to facilitate muscle contraction (including your heart muscle), and plays a key role in balancing the fluids in your body. In this regard, potassium helps counteract sodium, and is a key nutrient for helping maintain normal blood pressure.

The DASH Diet, developed by the National Institutes of Health to reduce high blood pressure, recommends we get 3 times more potassium than sodium- 4700 mg/day potassium to 1500 mg/day sodium in the most effective blood pressure lowering plan. Getting adequate potassium is important to diabetes in part because managing blood pressure is so important to diabetes. Diabetes and high blood pressure are in a photo finish for the first and second leading causes of kidney failure, so managing blood glucose and blood pressure are both incredibly important.

Dietary potassium has an important direct relationship with diabetes too. Some studies have shown, for instance, that low levels of potassium negatively impact blood glucose levels, but getting adequate potassium presents an interesting challenge. Why? Because many foods rich in potassium are also rich in carbohydrate. Two familiar potassium powerhouses- potato and banana- have 5 or 6 grams of carbohydrate per ounce. Other rich sources of potassium include white beans, apricots, yogurt and hard shell squashes- all also carbohydrate containing foods.

Dark, leafy greens like spinach and some fish, salmon in particular, will provide potassium too, but we should not avoid the carbohydrate foods that give us potassium. Making room in your eating plan for potassium rich carbohydrate foods is one way that putting some thought into your meals can pay off big time. There’s plenty of room for those carbs if you manage other nonessential carbohydrates carefully. Make sure you get enough potassium – it’s a powerful nutrient where long term diabetes health is concerned.

1% Reduction in A1C- A “Big Deal”

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We’ve heard a lot about “the 1%”, referring to the very wealthy, in the recent US political campaign, and opinions are divided. There’s another 1% in the field of diabetes care about which opinions are divided, and that relates to HbA1C. HbA1C, or simply A1C, is a measure which estimates average blood sugar levels over a period of a few months, and relevant organizations have set target values where the risk for diabetes complications is reduced. The American Diabetes Association, for instance, establishes an A1C target value of 7%, corresponding with average blood glucose levels of approximately 150 mg/dl (8.3 mmol/l).

The relationship of A1C to heart and cardiovascular diabetes complications has not been clear, however, with different studies showing different results. Recent “real world” data from a large Swedish observational study presented this Fall to the conference of the European Association for the Study of Diabetes by Dr. Katarina Eeg-Olofsson of the University of Gothenburg suggests that reducing A1C has a marked impact on the risk for heart and cardiovascular events. A study group of more than 12,000 patients selected from the Swedish National Diabetes Registry (with no history of heart disease) were followed by researchers who noted changes in A1C over time and correlated those changes to heart disease, cardiovascular disease and death. About 6800 subjects showed A1C reductions over the course of the study from an average of 7.8% to a final average of 7.0%. Conversely, about 5500 subjects showed stable or increasing A1C from an average of 7.8% to a final average of 8.4%.

The group where A1C values improved over the course of the study showed a more than 40% decreased risk for these common diabetes cardiovascular complications. It is important to note that the only variable between the two groups was the trajectory of the subjects’ A1C values over the course of the study period. However, other potentially confounding factors between the groups such as BMI, age, duration of diabetes, gender, etc. matched relatively closely. Further evaluation of these observations is ongoing, but the benefit of reduced average blood glucose was profound in the broad assessment.We’ve heard a lot about “the 1%”, referring to the very wealthy, in the recent US political campaign, and opinions are divided. There’s another 1% in the field of diabetes care about which opinions are divided, and that relates to HbA1C. HbA1C, or simply A1C, is a measure which estimates average blood sugar levels over a period of a few months, and relevant organizations have set target values where the risk for diabetes complications is reduced. The American Diabetes Association, for instance, establishes an A1C target value of 7%, corresponding with average blood glucose levels of approximately 150 mg/dl (8.3 mmol/l).

The relationship of A1C to heart and cardiovascular diabetes complications has not been clear, however, with different studies showing different results. Recent “real world” data from a large Swedish observational study presented this Fall to the conference of the European Association for the Study of Diabetes by Dr. Katarina Eeg-Olofsson of the University of Gothenburg suggests that reducing A1C has a marked impact on the risk for heart and cardiovascular events. A study group of more than 12,000 patients selected from the Swedish National Diabetes Registry (with no history of heart disease) were followed by researchers who noted changes in A1C over time and correlated those changes to heart disease, cardiovascular disease and death. About 6800 subjects showed A1C reductions over the course of the study from an average of 7.8% to a final average of 7.0%. Conversely, about 5500 subjects showed stable or increasing A1C from an average of 7.8% to a final average of 8.4%.

The group where A1C values improved over the course of the study showed a more than 40% decreased risk for these common diabetes cardiovascular complications. It is important to note that the only variable between the two groups was the trajectory of the subjects’ A1C values over the course of the study period. However, other potentially confounding factors between the groups such as BMI, age, duration of diabetes, gender, etc. matched relatively closely. Further evaluation of these observations is ongoing, but the benefit of reduced average blood glucose was profound in the broad assessment.

Blood Sugar Control Shows Huge Impact on Long Term Health

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An observational study from the University of Gothenburg in Sweden has shown that reducing A1C levels by less than 1%, to a target of 7%, had a huge effect on the incidence of death from cardiovascular causes as well as the occurrence of heart-related “events” and cardiovascular events. Observing more than 18,000 individuals having diabetes for an average of 8 years, selected from the Swedish National Diabetes Register, researchers divided the study population into those showing A1C reduction (average from 7,8% to 7.0%) and those showing an A1C increase (average 7.7% to 8.3%). Patients having a history of cardiovascular disease, congestive heart failure, or atrial fibrillation were excluded from the study completely.

After correcting for age, diabetes duration, sex, blood pressure and blood pressure treatment, lipid status and lipid-lowering treatment, HbA1c, albuminuria, BMI, and changes in those risk factors and treatments over time there remained a substantial 45% decreased risk for cardiovascular related death among the group exhibiting better glycemic control. Better glycemic control also reduced the risk of fatal and nonfatal heart events by 39% and fatal/ nonfatal cardiovascular events by 37%.

The researchers were looking to address the debate about whether glycemic control is related to poor cardiovascular outcomes.

1% A1C Reduction = 45% Reduction in Cardiovascular Death in Swedish Study

An observational study from the University of Gothenburg in Sweden has shown that reducing A1C levels by less than 1%, to a target of 7%, had a huge effect on the incidence of death from cardiovascular causes as well as the occurrence of heart-related “events” and cardiovascular events. Observing more than 18,000 individuals having diabetes for an average of 8 years, selected from the Swedish National Diabetes Register, researchers divided the study population into those showing A1C reduction (average from 7,8% to 7.0%) and those showing an A1C increase (average 7.7% to 8.3%). Patients having a history of cardiovascular disease, congestive heart failure, or atrial fibrillation were excluded from the study completely.

After correcting for age, diabetes duration, sex, blood pressure and blood pressure treatment, lipid status and lipid-lowering treatment, HbA1c, albuminuria, BMI, and changes in those risk factors and treatments over time there remained a substantial 45% decreased risk for cardiovascular related death among the group exhibiting better glycemic control. Better glycemic control also reduced the risk of fatal and nonfatal heart events by 39% and fatal/ nonfatal cardiovascular events by 37%.

The researchers were looking to address the debate about whether glycemic control is related to poor cardiovascular outcomes.

High Fat Diet Compromises Pancreatic Beta Cell Function

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A study published online on August 14 in Nature Medicine has identified a pathway that links high-fat diets to a series of molecular events responsible for the onset and severity of Type 2 diabetes. The team discovered that Type 2 diabetes may begin with pancreatic beta cells.

The study was led by Jamey D. Marth, Ph.D., director of the Center for Nanomedicine, which is a collaboration between the University of California, Santa Barbara, and Sanford-Burnham Medical Research Institute (Sanford-Burnham). This work was primarily funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). Co-authors include Kazuaki Ohtsubo at Sanford-Burnham and Mark Z. Chen and Jerrold M. Olefsky from the University of California, San Diego.

In general, diabetes is a malfunction of the body’s ability to manage glucose, a “simple” sugar.  Glucose is the body’s main source of fuel, primarily provided by eating carbohydrate-containing food.

In healthy people, pancreatic beta cells monitor the level of glucose in the blood and produce insulin to closely match rising blood sugar levels. This system to monitor and control blood sugar results in relatively stable and “normal” blood glucose levels. Type 1 diabetes results when these cells are attacked and destroyed by the bodies’ immune system. People with Type 1 diabetes must take insulin by injection to control the levels of the sugar glucose in the bloodstream.

In Type 2 diabetes, beta cells are not destroyed, but this system does not function efficiently to keep blood sugar levels “normal.” High blood glucose over the long term contributes to serious increases in risk for heart disease and other so-called “complications.”  Because overweight/ obesity is the strongest risk factor for developing Type 2 diabetes, much research has focused on a potential connection between Type 2 diabetes, obesity, and diet.

This study found that high levels of fat interfered with the ability of beta cells to sense and respond to blood glucose levels. Fat levels interrupted the production of a critical enzyme called GnT-4a glycosyltransferase, and in normal mice fed a high-fat diet beta-cell function was dysfunctional. Conversely, when researchers preserved the function of GnT-4a in obese mice, the onset of diabetes was prevented.

Researchers hope these findings may lead to alternative treatments for Type 2 diabetes. A study published online on August 14 in Nature Medicine has identified a pathway that links high-fat diets to a series of molecular events responsible for the onset and severity of Type 2 diabetes. The team discovered that Type 2 diabetes may begin with pancreatic beta cells.

The study was led by Jamey D. Marth, Ph.D., director of the Center for Nanomedicine, which is a collaboration between the University of California, Santa Barbara, and Sanford-Burnham Medical Research Institute (Sanford-Burnham). This work was primarily funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). Co-authors include Kazuaki Ohtsubo at Sanford-Burnham and Mark Z. Chen and Jerrold M. Olefsky from the University of California, San Diego.

In general, diabetes is a malfunction of the body’s ability to manage glucose, a “simple” sugar.  Glucose is the body’s main source of fuel, primarily provided by eating carbohydrate-containing food.

In healthy people, pancreatic beta cells monitor the level of glucose in the blood and produce insulin to closely match rising blood sugar levels. This system to monitor and control blood sugar results in relatively stable and “normal” blood glucose levels. Type 1 diabetes results when these cells are attacked and destroyed by the bodies’ immune system. People with Type 1 diabetes must take insulin by injection to control the levels of the sugar glucose in the bloodstream.

In Type 2 diabetes, beta cells are not destroyed, but this system does not function efficiently to keep blood sugar levels “normal.” High blood glucose over the long term contributes to serious increases in risk for heart disease and other so-called “complications.”  Because overweight/ obesity is the strongest risk factor for developing Type 2 diabetes, much research has focused on a potential connection between Type 2 diabetes, obesity, and diet.

This study found that high levels of fat interfered with the ability of beta cells to sense and respond to blood glucose levels. Fat levels interrupted the production of a critical enzyme called GnT-4a glycosyltransferase, and in normal mice fed a high-fat diet beta-cell function was dysfunctional. Conversely, when researchers preserved the function of GnT-4a in obese mice, the onset of diabetes was prevented.

Researchers hope these findings may lead to alternative treatments for Type 2 diabetes.