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ETIOLOGIC CLASSIFICATION OF DIABETES: DIAGNOSTIC CRITERIA

Diabetes Mellitus
There are three ways to diagnose diabetes:
1. Symptoms of diabetes with a casual (any time of the day) plasma glucose >=200 mg/dl.
2. Fasting plasma glucose (FPG) >= 126 mg/dl on at least two occasions. Fasting = no caloric intake for at least 8 hr.
3. 2 hour plasma/glucose (PG) > 200 mg/dl after 75 gm of oral glucose in water oral glucose tolerance test (OGTT).
Impaired Glucose Tolerance
Diagnostic test: 75 gm glucose orally Time     Plasma glucose (mg/dl)
Fasting   < 120 mg/dl 2 hour    140-200 mg/dl
Etiologic Classification of Diabetes
1. Type 1 (Beta cell destruction, usually leading to insulin deficiency)
• Immune-mediated
• Idiopathic
2. Type 2 (may range from predominantly insulin resistance with relative insulin deficiency to , a predominantly insulin secretion defect, with insulin resistance).
3. Other specific types
• Genetic defects of beta cell function
• Genetic defects in insulin action
• Diseases of the exocrine pancreas
• Endocrinopathies
• Drug or chemical-induced
• Infections
• Uncommon focus of immune-mediated diabetes
• Genetic syndromes sometimes associated with diabetes
• Others
4. Gestational diabetes mellitus (GDM)
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THE G.I. FACTOR: WHY IS BEING OVERWEIGHT A PROBLEM ANYWAY?

If you are overweight you are at increased risk of a range of health problems. Among these are heart disease, diabetes, high blood pressure, gout, gallstones, sleep apnoea (snoring) and arthritis. Along with this list of physical side effects of being overweight, there are an equal number of emotional and psychological problems.

The proportion of overweight people in our society is increasing, despite the expanding weight-loss industry and an ever increasing range of ‘diet’ or ‘lite’ foods. It is clear that the answer to preventing people from becoming overweight is not a simple one. Nor is losing weight easy to do. The G.I. factor can make it easier, however. It tells you which foods satisfy hunger for longer and are the least likely to make you fat. When you use the G.I. factor as the basis for your food choices:

• there is no need to overly restrict your food intake,

• there is no need to obsessively count kilojoules,

• there is no need to starve yourself.

Learning which foods your body works best on is what using the G.I. factor is all about.

It is worthwhile taking control over aspects of your lifestyle that have an impact on your weight. You may not create a new body from your efforts, but you will feel better about the body you’ve got. Eating and exercising for your best performance is the aim of the game.

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DIABETS: REFINED CARBOHYDRATE FOODS, SWEETENING AGENTS AND DIETARY PRODUCTS

Refined carbohydrate foods

These foods include sugar and foods with very high sugar content, and are unsuitable to include in the diet.

Sugar – White, brown, raw, icing, castor, coffee crystals etc.

Commercial flavoured milks – e.g. Big ‘M’

Flavoured mineral water

Glucose Powder

Jam, marmalade, lemon butter, sweet spreads

Honey, Golden syrup, treacle

Lollies, chocolates, toffee etc.

Powdered drinks, e.g. Fruit Saline, Tang

Sauces e.g. tomato, mint, barbecue

Soft drinks and cordials (ordinary sweetened)

Sugar coated breakfast cereals

Sweet desserts, jelly crystals

Sweetened condensed milk

Sweetened tinned fruits, glace fruit

Sweet Sherry, liqueurs, port, stout, sweet wines

Tonic water

Toppings and syrups

Sweetening agents & dietary products

Excessive use of any type of sweetening agent is unnecessary and not recommended. Try to educate your child to prefer less sweet foods. Why not learn to have unsweetened tea and coffee? Sweetening agents can be divided into two (2) groups.

1. Energy – Free Sweeteners

These sweeteners do not provide any energy (kjoules/calories) and include agents such as saccharin and cyclamate. They are usually purchased in liquid or tablet form – e.g. Sugarine, Sucaryl, Hermesetas, Nutrasweet, Equal.

Saccharin and Cyclamate are frequently used in the manufacture of low calorie or low joule dietary products which are suitable for people with diabetes.

Aspartame also has very low energy content.

2. Energy Providing

These sweeteners provide the same amount of energy (kjoules/calories) per gram as sugar (sucrose). However they do not influence blood glucose levels in the same way.

Those commonly used in the manufacture of dietary products include fructose, sorbitol, and mannitol.

Products prepared with these sweetening agents are often labeled ‘Carbohydrate Modified’.

The use of products containing fructose, sorbitol, mannitol in the diet must be limited for the following reasons:

a. When taken in excess fructose, sorbitol, mannitol may cause diarrhea.

b. Excessive intake may interfere with glucose metabolism.

c. Many carbohydrate modified products are high in fat – e.g. chocolate and should be only used occasionally.

d. The total energy content is often very similar to products prepared with sugar (these products are not low in energy [kjoules/calories] and are not recommended for use by the overweight diabetic).

Examples of products sweetened with fructose, sorbitol or mannitol include:

(Ingredients are generally printed on the label.)

Carbohydrate Modified Jams e.g. Mrs. Trewins

Diabetic Chocolate

Blizzards or SL’s – all flavours

Sugarless Chewing Gum

Diabetic/Carbohydrate Modified Biscuits

Carbohydrate Modified Ice-cream

The carbohydrate exchange list provides information for the inclusion of a variety of normal biscuits and ice-cream, making these products unnecessary.

Note: A small range of powdered sweeteners using a combination of mannitol and cyclamate is available e.g. Sweetaddin and Slim Line. In moderation they are suitable for use in cooking except where weight control may be a problem. A substitution of 1/3-1/2 cup for 1 cup sugar is generally satisfactory.

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