In managing diabetes the patient holds the key. Physicians and others can explain effects and make recommendations, but as yet there is no magic pill to cure diabetes. Once diabetic patients accept responsibility for their care, however, I believe good blood glucose (BG) control is possible for many.
The body includes numerous complex chemical control systems, many of which are adaptive. One of the body's systems controls BG levels when ingested food is converted into glucose. The hormone insulin is produced by beta cells in the pancreas and helps transport glucose into various body cells. Type 2 diabetes, also known as non-insulin-dependent diabetes mellitus (NIDDM), occurs when inadequate insulin is produced, or the body's cells have a reduced ability to use the insulin that is produced (insulin resistance), or combinations of these two limitations. Ways of combating these limitations are addressed.
In engineering it is common to characterize the performance of a machine by establishing what happens to the output for various inputs while other parameters remain nearly constant. The same characterization process can be applied to the human body. I am a 68-year old research engineer who has had type 2 diabetes for more than 7 years. By simply treating my body as a machine and determining input (food) to output (BG level) I was able to characterize my basic glucose control system and from that knowledge take steps to maintain good BG control. Tests on a single diabetic person have limited statistical significance because of individual variations; however, as with any machine, some of the basic issues are readily defined.
Subjecting the body to various food inputs and measuring the resulting BG level versus time is here defined here as a substance response test. This method can be used by the patient to evaluate his or her own glucose response to specific stimuli using a simple BG meter. The results for any one patient are unique; however, some general conclusions can be drawn from my specific results. For example, I found that carbohydrates had a rapid and major impact on my BG levels, whereas protein had a smaller and much slower effect. Fat seemed to have no direct effect. The results agree perfectly with the low-carbohydrate diet recommendations of R. K. Bernstein, M.D. [1]. I also found that fiber reduced the rate at which the BG level increased, and fat when present in a large amount reduced the effects that the carbohydrate in bread had on my BG level.
Knowledge of my test results should help others gain a better understanding of how their own bodies may respond to different food inputs; and the test procedure I use has widespread application. However, results from my experiments will likely be somewhat different from those with type 1 diabetes and different from those with more severe type 2 diabetes. Thus your results may vary. My tests highlight some of the fundamental dietary issues that those with diabetes must address in controlling their BG level each and every day. It is much more than simply counting calories.
The numerous experiments reported (a) show the dramatic effects of diet and different foodstuffs, (b) highlight the concept of glycemic index, and (c) show deteriorating BG responses when good control is not maintained. The graphs are powerful aids to learning; from them I was able to characterize my body's response to food and then maintain good BG control. Using the test results in this book I reduced my hemoglobin A1c measurement (HbA1c), which reflects long-term average BG levels, from 9.0% in 1993 to 5.4% in 1997.
At the outset I needed some sort of baseline reference to determine the extent of my diabetes and to gauge any changes that occurred. A goal for the body's BG response was obtained from tests on a nondiabetic person, and then a search was made for substances that might help me, a type 2 diabetic person, to emulate that response. Tests were made on over-the-counter and prescription substances; however, some substances caused unacceptable gastric upsets, and nothing was found to improve my basic body performance. Much more helpful results were obtained by determining responses to different foodstuffs.
The key for excellent control of my diabetes is in the data presented here. I hope these results are equally helpful to others and their medical advisors.
CONTENTS
PREFACE
ACKNOWLEDGMENTS
1.0 INTRODUCTION
- 1.1 Interpreting the graphs
2.0 MEASURING TECHNIQUES
- 2.1 Home tests
2.2 Laboratory tests
3.0 EXPERIMENTAL METHODS
- 3.1 Changing the body's performance
3.2 Changing the body's dietary input
4.0 EXPERIMENTS TO CHANGE THE BODY'S PERFORMANCE
5.0 EXPERIMENTS VARYING THE BODY'S DIETARY INPUTS
- 5.1 Experiments with equal calorie inputs
5.2 Experiments with various inputs and amounts
5.3 Response to snacks
5.4 Response to different breakfast meals
5.5 Short-term exercise effects
5.6 Effects of one type of "fast food," with and without wine
5.7 Effects of beer, wine, and distilled spirits
5.8 Foods that reduce blood sugar
5.9 Effects of improved blood glucose control on glucose tolerance tests
5.10 Effects of bread in consecutive and single meals
5.11 Comparing whole-wheat and pumpernickel bread
5.12 Effects of 7 years of type 2 diabetes on response to the same input
6.0 ANTICIPATING THE EFFECTS OF DIFFERENT FOODS
7.0 OTHER FACTORS
8.0 BLOOD ASSAYS
9.0 SUMMARY AND CONCLUSIONS
10.0 ON-LINE DIABETES SUPPORT GROUPS
11.0 MORE DATA ON SGI (Substance Glycemic Index)
- 11.1 Purpose and Benefits of the SGI
11.2 Individual Foods
11.3 Applying the SGI Table
11.4 Effects of Composite Foods
11.5 Combining Two Substances
11.6 Different Portion SGIs
11.7 Meal Glycemic Index
12.0 KEEPING A CHECK ON YOUR PROGRESS
13.0 TECHNICAL ASPECTS OF THE SGI
14.0 SOME LOW SGI RECIPES
APPENDIXES A-1 through A-6
REFERENCES
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