Nutrition in diabetes mellitus.

Diet is very important in the treatment of diabetes mellitus. An energy deficit of about 500 Kcal per day is recommended for most overweight diabetic patients in order to progressively achieve a weight loss.--According to the most recent recommendations of the Nutrition Study Group of the European Association for the Study of Diabetes, 60 to 70% of the total daily energy should be covered from a combination of carbohydrates and monounsaturated fatty acids with a cis-configuration. The percentage of energy contributed by each may vary according to individual preferences and clinical characteristics. It is, also, important to reduce the intake of saturated and trans unsaturated fatty acids (< 10% total energy). Protein intake should not exceed 20% total energy intake. Rich in fibre and/or antioxidant carbohydrate containing foods (fruits, vegetables, legumes) or those with a low glycaemic index are strongly recommended. Moderate amounts of foods rich in omega 3-fatty acids (mainly oily fish) should be regularly consumed.

Risk factors for lower extremity arterial disease in non-insulin-dependent diabetic persons.

The relationship of lower extremity arterial disease to the different risk factors for atherosclerosis in non-insulin-dependent (Type 2) diabetes mellitus is a matter of continuing investigation. The present study was conducted on a random sample of 193 non-insulin-dependent diabetic patients in order to compare the frequency and severity of some known risk factors for atherosclerosis among such persons with and without indications of lower extremity arterial disease. Conventional risk factors for atherosclerosis (smoking, existence of hypertension, total plasma cholesterol, HDL-cholesterol, and triglycerides) were assessed. In addition body mass index, waist-to-hip ratio, body fat mass, and albumin excretion were determined. Criteria for the presence of lower extremity arterial disease were an ankle brachial pressure index < 0.89 and/or the existence of intermittent claudication. Age, length of diabetes, and waist-to-hip ratio appeared to be factors significantly related to lower extremity arterial disease in most cases. Blood lipids, body mass index, HbA1 (except in males), smoking, and type of antidiabetic treatment were not significantly related to disease. The multivariate analysis confirmed the significant contribution of the duration of diabetes (p = 0.002), and waist-to-hip ratio (p = 0.024) and further showed a significant relation with triglycerides (p = 0.020). Thus, lower extremity arterial disease in non-insulin-dependent diabetes mellitus is significantly related to a long duration of diabetes and to central body fat distribution (but not to body mass index), as well as to triglyceride levels.

Metabolic effects of honey (alone or combined with other foods) in type II diabetics.

The metabolic effects of honey - alone or combined with other foods - were investigated in type II diabetics using 2 protocols: A) 33 g honey and 50 g bread (same amounts of carbohydrate) were given on alternate days to 12 patients. Blood levels of glucose, insulin and triglycerides were determined in venous samples before and every 30 min after meal ingestion (for a total of 3h). Areas under glucose curves were equal, although honey - compared to bread - resulted in higher blood sugar concentrations at 30 min (p less than 0.01) and lower at 90 min (p less than 0.05). B) Another 19 type II diabetics consumed on separate days 3 different meals: H (30 g honey), HA (30 g honey, 100 g almonds), HB (30 g honey, 125 g cheese, 10 g bread, 10 g butter). HA and HB contained the same amount of fat, but were different in fiber. No significant differences in the areas under glucose curves were observed. However, meal H produced earlier hyperglycemia than HA and HB (30 min: p less than 0.01). Insulin levels were higher after HB compared to H (p less than 0.05). Meals HA and HB were followed by higher triglyceride levels than H (p less than 0.05). It is concluded that: 1) honey and bread produce similar degrees of hyperglycemia in type II diabetics. 2) Fat-rich foods added to honey do not alter the total hyperglycemic effect but result in higher triglyceride and insulin serum concentrations.