Table of Contents
Diabetic Balanced Diet
Hemoglobin Volume Test?
Introduction – I am a Type 1 diabetic
Diabetes has caused many changes in my life style over the years but some of the necessary adjustments were made easier through simple explanations of the factors involved. Being a Chemist has also facilitated my understanding of these concepts. The purpose of this writing is to review some of the basic fundamentals and to present simple relationships aiding the diabetic in his/her understanding of what is happening to them. Over the years, I have successfully aided many of my friends and acquaintances with simple suggestions about how they should think about and handle their diabetes. However, let me say right up front that your physician should be totally involved. Regular laboratory testing and doctor appointments are absolutely necessary. What follows are simple descriptions and suggestions which are put forward in a very simplified manner.
I was diagnosed as a diabetic back in 1974 at the age of 38. In those days, you could test your urine for sugar and ketones by dipping a stick. If the stick changed to the wrong color you were in trouble. Mine did and during the subsequent office visits, my physician also put pressure on my gall bladder and caused excruciating pain. My fasting blood sugar level was three times normal and I displayed the common symptoms, i.e., fatigue, frequent urination, eyes sensitive to light, etc. Since an enlarged gall bladder was also suspected, I was admitted to the hospital. The doctor started me on insulin treatments immediately to lower the blood stream sugar level. He called me the “side effect” kid and chose to put me on insulin shots instead of a new drug.
Of course, that initial hospital stay was very important. Because the nursing staff could keep me under constant surveillance, it was only a couple of days before I was taught about “insulin reactions”. It was customary to bring the meal tray into the room and a shot of rapid acting insulin would be given before eating. Well, they brought in the lunch tray and gave me the shot during a phone conversation to an employee at work. It wasn’t very long before I began sweating and became weak in the knees. I quickly excused myself from the phone conversation, sat down, and drank the juice to get some sugar. It was the first and most important thing I learned in the hospital. In fact, my doctor had said that he was going to see to it that I had that experience while in the hospital.
The second most important learning experience during that hospital stay concerned diet and I’ll never forget the main points made by the dietician. She taught me the importance of a “balanced diet” and clued me in about the effect alcohol has on your blood sugar. It was the first and last time that I ever heard that alcohol lowers the blood sugar. In fact, she cautioned me to not think that I could or should control my diabetes with alcohol. But, on the other hand, if you are taking insulin to lower your blood sugar level and have some alcohol, you may suffer from too low a blood sugar level unexpectedly. It’s a fact.
Being diagnosed as a diabetic was a startling experience but all of sudden hard work was not to blame for all of my symptoms. So, I was fortunate to be diagnosed and I still admire my physician for putting me on an insulin regimen. I now take 4 to 6 insulin shots a day but lets cover some diabetic basics before I tell you anymore about me.
The level of sugar in the blood stream depends upon many things but there are three main items; 1) How much and what we eat, 2) How much exercise we get, and 3) Amount and type of medicine taken. Of course, of the three, food intake is the only one that increases the blood sugar level. Let’s discuss this factor first.
Diabetic Balanced Diet
The food we eat is made up of sugars, carbohydrates, proteins, and fats. For ages, we’ve been encouraged to eat a balanced diet. But what should that term, balanced diet, mean to a diabetic? It means you should select foods that when digested spread the amount of sugar put into the blood stream over time. Don’t eat a diet that will cause large spikes in the blood stream sugar level, e.g., just carbohydrates. This is especially true if you are a Type 2 diabetic trying to avoid taking insulin shots. It is a matter of selecting when and what you eat so that when your digestive tract does its work the amount of sugar released into the blood stream stays relatively low. To do this you must understand the simple facts given below:
1) If your digestive tract is doing its job, carbohydrates, proteins, and fats all end up as sugar in the blood stream.
2) Simple sugars, e.g., apple juice, take less than a minute to enter the blood stream.
3) Carbohydrates, e.g., spaghetti noodles, are next with a peak in the 1 to 2 hour time frame.
4) Proteins, e.g., meat, peak in 2 to 4 hours.
5) Fats, e.g., bacon fat, are last with some still being metabolized into sugars the next day from an evening meal.
The term metabolism is often used for the digestive function. The graph is intended to show the relative times that sugars from the four sources would be expected in the blood stream. [Note: the blood sugar levels plotted are arbitrary and intended to show the time spread only.] Of course, each person would have their own metabolic rates and the actual situation is much more complicated but the fact remains that a spreading of the blood stream sugar level over time is desired. So, when you pick the foods for your balanced diet from the food groups, don’t forget the diabetic balanced diet concept.
I’d like to make a point about exercise lowering your blood sugar level next. Of course, exercise does use energy stored in the cells of the body and insulin is needed to transfer the blood sugar from the blood stream into the cells. So, be aware that exercise can not lower your blood sugar unless the insulin is there to transfer it into the cells in the first place.
Rarely do diabetics understand why they often encounter the frequent urination symptom. Perhaps they even think that drinking excess liquids causes this symptom. In reality, even with the best control, it is impossible to eat the same thing, at the same time every day or have exactly the same level of mental and physical activity. Therefore, unless all the other factors are changed to account for the resultant blood sugar changes it is likely that your blood sugar level may occasionally exceed the “adrenal threshold”. The graph illustrates this phenomenon. When the blood sugar level exceeds the adrenal threshold, the kidney attempts to remove the excess sugar from the blood stream and send it to the bladder.
So why does frequent urination result? Since sugar is not very soluble in water, the bladder sets all the gears in motion to tell the body, I am thirsty! The bladder has to get more water to dissolve the sugar and when it does, the bladder becomes full faster than normal.
If sticking your finger is too dramatic for you, you are in trouble! Having any form of diabetes demands that you know how your blood sugar level varies with your life style. I want to highlight a few test techniques that have been useful to me over the years and then discuss the 120-day test. So I’ll separate these two areas by calling them short term and long term tests.
There are a number of companies now supplying blood glucose monitors capable of determining the blood stream glucose level in 5 seconds from a very small quantity of blood. So what?
Let me ask a couple of questions.
a) What is your blood stream glucose level in 1 hour after eating 15 grams (1 Carb) of carbohydrate?
b) How much do you drop your blood stream glucose level if you use your medicine?
These are questions that you should be able to answer or at least have an idea about what the answer might be. I don’t care if you are a Type 1 or Type 2 diabetic or if you are on insulin or an oral drug different than insulin, these are basic questions.
Of course, to care about knowing the answer to these questions, you will have to pay attention to what you eat. I mean, read the labels to determine the Carb content. You also have to design an “experiment” knowing what is raising and what is lowering your blood sugar level. So how do you get some idea of what your body is doing?
First, don’t eat anything or take any medicine for 16 hours and check your blood sugar level (BSL). Then eat a measured amount of the food being tested and check the BSL at various times after the food is eaten. Depending upon the food and your body’s metabolic rate you should see a rise in BSL and then a lowering in BSL.
Second, take your medicine as you normally would and then do the same thing as done in the first example above to obtain a fasting BSL. Then perform the tests at the same times after eating the same thing to see the difference.
I would suggest that you try the above experiments on your most often eaten meal. We all have our favorite foods. I suspect that one experiment will be very enlightening.
Actually, since my pancreas is not producing insulin anymore, I can arrive at my Carb effect simply by drinking a coke and measuring the BSL in a few minutes. I raise my BSL by ~20 mg/dL for every Carb eaten (notice the ~ sign indicating approximately). I have also found that taking 1 unit of a rapid acting insulin will lower my BSL by ~20 mg/dL. So, I remember how much insulin to take by multiplying the Carb content in the food by 1. Remember, the number of Carbs is equal to the grams of carbohydrate divided by 15 since there are 15 grams of carbohydrates per Carb.
So what about proteins and fats? You’ll have to run experiments to determine how these foods are converted to sugars with blood sugar level measurements. Sure it ‘s more complicated, but it’s not impossible to figure out what happens when you eat a hamburger and French fries. Run the experiment!
One more point, don’t throw away the experimental results too fast. You will want to compare the new to the old when you suspect that changes have taken place. A measured change can precipitate action while well-intended comments, e.g., “I’m more tired this year”, is essentially meaningless during an office appointment.
So, my point here is — do not kid yourself. Do some simple measurements. If you don’t understand what happens, ask your physician. But remember, you should execute some experiments on BSL because you are unique.
If you are a diabetic, you have heard of the A1c test. The test is long term because it measures the glucose effect on hemoglobin molecules in the bloodstream that have an average life of 120 days. So instead of having an instant BSL test number, the A1c test presents the effect of glucose on hemoglobin molecules for the last 120 days.
There are many web sites available that explain various aspects of how glucose reacts with hemoglobin and what other factors enter into common diabetic symptoms. For example, the terms glycosolated hemoglobin and glycated hemoglobin describe different glucose-hemoglobin reactions because of an enzyme. I’ll let you conduct your own research on the intricacies of what glucose does in the blood stream but I do want to talk about the volume of the hemoglobin/glucose conglomerate.
Hemoglobin Volume Test?
Every diabetic has heard about the symptoms caused by reduced blood flow in our extremities, e.g., the effect of high blood sugar on our retinal capillaries? We expect the hemoglobin molecules to transport the oxygen to the cells and take away the carbon dioxide but what if the glucose molecules swell the hemoglobin molecules? Obviously, the circulation is reduced by the larger hemoglobin/glucose combination, especially in the very small capillaries, e.g., the retina.
A more significant test for diabetics, regarding hemoglobin, would be to measure the volume occupied by the hemoglobin/glucose conglomerate, i.e., the volume would include glucose molecules that are absorbed and reacted, not just the amount of hemoglobin (Hb) reacted with glucose represented by HbA1c. After all, it is the volume of the hemoglobin oxygen transporter that concerns us most, not how much glucose has reacted with the hemoglobin molecules.
In polymer chemistry, they call it “swelling”, i.e., when a solvent that “likes” a polymer is absorbed into the polymer and causes it to expand because the solvent likes the polymer more than the polymer likes itself. In our case, glucose is the solvent and the hemoglobin corresponds to the polymer. It’s a fact that glucose has many hydroxyl groups (-OH) that would be “liked” by various sites in the hemoglobin molecule. No one said it was simple.
I hope you’ve had food for thought. Take care of yourself.