Making Healthy Carb Decisions with Type 1 Diabetes

The new year brings resolutions for many of us. I'd encourage you to put this on your resolution list: make appointments to see all your physicians, which includes primary care, ophthalmologist, gynecologist, urologist, endocrinologist, cardiologist, dentist, periodontist, and all others you have been told that you should see on a yearly basis.

Carbohydrate Confusion Leads to Unhealthy Choices
The December Diabetes Care journal has an interesting article titled "Emphasis on carbohydrates may negatively influence dietary patterns in youth with type 1 diabetes" by Sanjeev N. Mehta, MD, MPH et al.

In this study, researchers found that parents and children sometimes put too much emphasis on carb quantity at the expense of diet quality. In interviews with 35 people with type 1 diabetes aged 8 to 21 years and their parents, the researchers found that some preferred packages of processed foods to "whole" foods like fruits, whole grains, and legumes because the carb content was readily available on the product label.

In addition, some parents limited their children's intake of healthy choices like fruit and whole grains because of their carbohydrate content. This was despite the fact that parents and kids usually believed that fruits and vegetables were generally healthy foods while "junk food" and fast food should be limited.

Carb counting remains an "important tool" for adjusting insulin doses, reported the researchers. "However, healthful nutrition involves more than just carbohydrates," the researchers also pointed out. A "healthy" diet is one that is moderate in calories and includes enough protein, unsaturated fats (the good kind of fat), healthy carbohydrates, vitamins, and minerals, among other nutrients.

The researchers concluded that families and children with type 1 diabetes should meet with nutritionists at the time of diagnosis and then about once a year to get specific information on healthy eating.

You can review the abstract of this study here.

Artificial Sweeteners Make it Easier to Eat Less?
Yahoo News presented an interesting article from Dr. Rebecca J. Brown and colleagues from the National Institute of Diabetes and Digestive and Kidney Disease. They found that combining artificial sweeteners with sugar boosts the stomach's secretion of a hormone that makes people feel full and helps control blood sugar.

Since there are a lot of people using artificial sweeteners on a daily basis, it seems necessary to investigate the associated effects on metabolism and weight.

There is some evidence that artificial sweeteners may trigger secretion of glucagon-like peptide- 1(GLP-1). GLP-1 is released from the digestive tract when you eat. It signals to the brain that you're full. It's supposed to curb appetite and calorie intake.

In the study, ten minutes before consuming a glucose load, study participants drank either two-thirds of a diet soda containing an artificial sweetener or the same amount of carbonated water. In both cases, blood glucose levels increased, and the increases were the same for both groups. However, here's where it gets interesting: the researchers found that the people in the diet soda group secreted significantly more GLP-1 than the carbonated water group.

Future research is needed to understand the significance of enhanced GLP-1 secretion. The researchers concluded that studies should be conducted in people with type 2 diabetes and other abnormalities in metabolism.

You can read more about this study here.

Gum Disease and Its Connection to Diabetes
Finally, you may have wondered why we suggested that you make an appointment with a periodontist (a gum specialist), but the Journal of Public Health Dentistry had an article sharing information that 90% of people with gum disease are at risk for diabetes.

The study was led by Dr. Sheila Strauss, Co-director of Statistics Management Core for New York School of Dentistry and Nursing. The study used data from 2,923 adult patients in the 2003-2004 National Health and Nutrition Examination Survey who had not been diagnosed with diabetes. The survey was conducted to assess the health and nutrition status of adults and children in the United States.

Using guidelines established by the American Diabetes Association, Dr. Strauss determined that 93% of subjects who had periodontal disease (compared to 63% percent of those without the disease) were considered to be at high risk for diabetes and should be screened for the disease. The guidelines recommend that diabetes screening should be done in people who are 45 years old or older who have a body mass index of 25 and at least one additional risk factor.

In Dr. Strauss's study, these additional risk factors—such as high blood pressure and a first-degree sibling with diabetes—were reported in a significantly greater number of subjects with periodontal disease than in subjects without the disease.

Dr. Strauss shared that dentists could screen patients for diabetes by evaluating them for risk factors such as:

  • being overweight
  • belonging to a high-risk ethnic group (African-American, Latino, Native American, Asian-American, or Pacific Islander)
  • having high cholesterol
  • having high blood pressure
  • having a first-degree relative with diabetes
  • having had gestational diabetes mellitus
  • or having given birth to a baby weighing more than nine pounds

Alternatively, dentists could use a glucometer to evaluate blood samples from inflammation in the gums.

Read more about the study here.

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