Effectively Dealing
With Diabetes
November 1998 -- Nutrition Notes

By: Andrea Platzman, R.D.
Contributing Editor

  Heart disease, blindness, limb amputation and kidney failure are some of the complications impacting people with diabetes mellitus, a disease affecting more than 16 million Americans.  Diabetes mellitus results from a defect in the production of insulin by pancreatic beta cells. Without insulin, the body cannot utilize glucose, its principal energy source. As a result, the level of glucose circulating in the blood is elevated and the level of glucose absorbed by the body tissues is reduced.  Two types of diabetes exist: insulin-dependent diabetes mellitus (IDDM), also known as juvenile-onset diabetes mellitus, and non-insulin-dependent diabetes (NIDDM), also known as adult-onset diabetes mellitus. An individual suffering from the former will require insulin injections since his pancreas produces almost no insulin. However, people with NIDDM often produce adequate insulin, but their cells can't use it because their bodies have trouble metabolizing glucose.Whatever works  "The 'diabetic diet' no longer exists," says Hope Warshaw, R.D., C.D.E., author of the American Diabetes Association Guide to Healthy Restaurant Eating. "The 1994 American Dietetic Association nutrition recommendations state a 'whatever-works approach' to diabetes control." Whether the person with diabetes is following an exchange-system approach or a carbohydrate-counting system, protein should provide 10% to 20% of daily calories with the remaining 80% to 90% distributed between fat and carbohydrates and less than 10% from saturated fat. Calorie distribution can vary and depends on desired glucose, lipid and weight outcomes. "People with diabetes need to work with qualified dietitians to develop an individualized meal plan that fits into their life and diabetes-treatment goals," Warshaw recommends.  Soluble fiber, such as gums, mucilages, pectins and oat bran, become gel-like and stop the rise in blood glucose after a meal because they slow down gastric emptying. Since soluble fibers also can prove helpful in treating hyperlipidemias often associated with diabetes, it is recommended that individuals with either IDDM or NIDDM consume 40 grams of fiber or 25 grams per 1,000 calories per day - higher than the recommended 20 to 35 grams per day for nondiabetics.  A study published in the September 1998 issue of Metabolism, "Reversal of Diet-Induced Obesity and Diabetes in C57BL/6J Mice," indicated a complete reversal of NIDDM in obese mice when switched to a low-fat diet. The results - which were observed after 17 weeks - indicate that dramatically restricting fat might prove an effective treatment for some human patients, particularly in the early stages of NIDDM, researchers say.Switching sweets  Using alternative sweeteners is acceptable in managing diabetes. However, education is necessary. Fructose, though metabolized well, contributes 4 kcal per gram to the diet and counts as one fruit exchange.  Saccharin contains no calories, but may impart an aftertaste in many food products. Aspartame, though intense in sweetness, loses its taste when heated. Acesulfame K, 130 to 200 times sweeter than sucrose, is heat-stable and not metabolized by the body. Sucralose - a new, high-intensity sweetener derived from sucrose - passes through the body virtually undigested and will be available in more products this year.  Unlike the mentioned high-intensity sweeteners, polyols are carbohydrates that replace sugars. "Polyols have been used extensively for decades to replace sugar in a variety of applications," says Ross Craig, commercial development manager, Cultor Food Science, Inc., Ardsley, NY. These ingredients have been used in the development of many food products for people with diabetes, particularly chocolate and nonchocolate confections, frozen dairy and baked products.  FDA allows the use of the following polyols: maltitol, hydrogenated starch hydrolysates, sorbitol, xylitol, isomalt, lactitol, mannitol and erythritol. "Because polyols have fewer calories, they may help people with diabetes achieve their weight goals," says Lyn Nabors, executive vice president, Calorie Control Council, Atlanta, GA. "Polyols also have a lower glycemic index than do sugars. Therefore, polyol-sweetened snacks may be useful for those with diabetes. However, be aware that calories vary among the polyols. For instance, erythritol, recently approved for use in the United States, contains only 0.2 calories per gram.  "Polyols are safe," Nabors says. "In fact, an expert committee of the World Health Organization has carefully reviewed the polyols and concluded that they are safe for human consumption. However, in excessive amounts, there may be a laxative effect in sensitive people."  Polyol tolerance depends on many factors, including an individual's body mass and metabolism, regular dietary habits, whether they are consumed as part of a meal or snack, and how much is eaten at each time, according to Craig. "Rather than focus on any specific polyol, it is more relevant to consider the overall polyol loading," he says. "In this case, it is generally accepted that up to 15 grams per serving will avoid the possible laxative effect."Free-radical exposure  People with diabetes are exposed to higher levels of free radicals in their systems. Preliminary research shows that antioxidants (vitamin C, vitamin E and beta-carotene) might help diabetics. Zinc and selenium, often found in the antioxidant formulation, are recommended for their infection-fighting abilities.  Magnesium assists in glucose transport and has a role in glucose oxidation. Frequent urination increases magnesium loss, which can alter insulin sensitivity, often resulting in a required supplementation of 400 mg daily of this mineral. Most people with diabetes have approximately 30% less circulating vitamin C than nondiabetics, since high levels of blood sugar block the vitamins' uptake, causing a deficiency.  Supplementing with 200 to 600 µg daily of chromium picolinate can help control diabetes. Chromium, a mineral, helps to increase the efficiency of insulin. Picolinate, an amino acid, allows the body to utilize chromium more readily.  Andrea D. Platzman is a registered dietitian who is a consultant to the food industry, and regularly writes for nutrition publications. She earned a master's degree in nutrition from New York University, and has a culinary and business background.Back to top