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patterns,\tself-esteem,\n\tand\tdepression.\tAdditionally,\tnone\tof\tthe\tinterventions\tresulted\tin\tsignificant\nweight\tgain\tor\tworsening\tof\tblood\tglucose\tlevels,\tcholesterol,\tor\tblood\tpressure.\tIn\ttwo\tof\tthe\nstudies,\tbiochemical\tmeasures\timproved\tsignificantly\tcompared\twith\tthe\tcontrol\tor\tdiet\tgroup.\tThe
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researchers\tdid\tnote\tthat\tthere\twere\tlimitations\tdue\tto\tthe\tinconsistent\tdefinitions\tof\tnondiet\napproaches\tand\tthe\n\tuse\tof\tvarious\tassessment\tinstruments\tto\tmeasure\toutcomes.\tHowever,\tthey\nconcluded\tthat\t“because\tof\tthe\tlong-term\tineffectiveness\tof\tweight-focused\tinterventions,\tthe
|
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psychological\timprovements\tseen\tin\tweight-neutral,\tnondiet\tinterventions\twarrant\tfurther\ninvestigation”\t(\nClifford\tet\tal,\t2015\n).\tIt\tis\timportant\tto\tkeep\tin\tmind\tthat\tpotential\tweight\ndiscrimination\tmay\thave\tan\teffect\ton\thealth\toutcomes.\n\tOne\tstudy\tfound\tthat\tweight\tdiscrimination,
|
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] |
One\tstudy\tfound\tthat\tweight\tdiscrimination,\nor\tnegative\tweight-related\tattitudes\ttoward\tindividuals\tat\thigher\tweights\tor\tobesity,\texacerbated\tthe\neffects\tof\twaist-to-hip\tratio\ton\tA1C,\tsuch\tthat\tpeople\twho\thad\thigher\twaist-to-hip\tratios\tand\treported\nweight\tdiscrimination\thad\tthe\thighest\tA1C\tlevels\t(\nTsenkova\tet\tal,\t2011\n).\tTherefore\tthe\tRDN\tshould
|
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] |
Tsenkova\tet\tal,\t2011\n).\tTherefore\tthe\tRDN\tshould\ncollaborate\twith\tindividuals\twho\thave\tdiabetes\tto\n\tintegrate\tnutrient-dense\teating\tpatterns\t(which\nmay\tor\tmay\tnot\tlead\tto\tweight\tloss)\tand\tregular\tphysical\tactivity\tand\tshould\tnot\tmake\tassumptions\non\teating\thabits\tand\tlifestyle\tpatterns\tbased\ton\tweight.\nBariatric\tsurgery
|
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] |
Bariatric\tsurgery\nBariatric\tsurgery\tcan\tbe\tan\teffective\tweight\tloss\ttreatment\tfor\tseverely\tobese\tpatients\twith\tT2DM\nand\tcan\tresult\tin\tmarked\timprovements\tin\tglycemia\t(\nSchauer\tet\tal,\t2014\n).\tThe\n\tADA\tstates\tthat\nmetabolic\tsurgery\tshould\tbe\trecommended\tas\tan\toption\tto\ttreat\tT2DM\tin\tappropriate\tsurgical
|
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candidates\twith\tBMI\tgreater\tthan\tor\tequal\tto\t40\tkg/m2\t(BMI\tgreater\tthan\tor\tequal\tto\t37.5\tkg/m2\tin\nAsian\tAmericans),\tregardless\tof\tthe\tlevel\tof\tglycemic\tcontrol\tor\tcomplexity\tof\tglucose-lowering\nregimens,\tand\tin\tadults\twith\tBMI\t35.0–39.9\tkg/m2\t(32.5–37.4\tkg/m2\tin\tAsian\tAmericans)\twhen\nhyperglycemia
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0.00015092725516296923
] |
hyperglycemia\n\tis\tinadequately\tcontrolled\tdespite\tlifestyle\tand\toptimal\tmedical\ttherapy\t(\nADA,\t2018\n).\nIn\t4434\tadults\twith\tT2DM,\tgastric\tbypass\tsurgery\tresulted\tin\t68.2%\tinitial\tcomplete\tdiabetes\nremission\twithin\t5\tyears\tafter\tsurgery\t(\nArterburn\tet\tal,\t2013\n).\tHowever,\t35.1%\thad\tredeveloped
|
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] |
Arterburn\tet\tal,\t2013\n).\tHowever,\t35.1%\thad\tredeveloped\ndiabetes\twithin\tthe\tnext\t5\tyears\tand\tthe\tmedian\tduration\tof\tremission\twas\t8.3\tyears.\tPredictors\tof
|
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relapse\twere\tpoor\tpreoperative\n\tglycemic\tcontrol,\tinsulin\tuse,\tand\tlonger\tdiabetes\tduration.\nMacronutrient\tpercentages\tand\teating\tpatterns\nAlthough\tnumerous\tstudies\thave\tattempted\tto\tidentify\tthe\toptimal\tpercentages\tof\tmacronutrients\tfor\nthe\teating\tplan\tof\tpersons\twith\tdiabetes,\treview\tof\tthe\tevidence\tshows\tclearly\tthat\tthere\tis\tnot\tan
|
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] |
ideal\tpercentage\tof\tcalories\tfrom\tcarbohydrate,\tprotein,\tand\tfat\tfor\tall\tpersons\twith\n\tdiabetes\t(\nEvert\net\tal,\t2014\n).\tMacronutrient\tdistribution\tshould\tbe\tbased\ton\tan\tindividualized\tassessment\tof\tcurrent\neating\tpatterns,\tpreferences,\tand\tmetabolic\tgoals.\tIn\taddition\tto\tmetabolic\tgoals,\tthe\tRDN\tshould
|
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] |
consider\tpersonal\tpreferences\t(including\ttradition,\tculture,\treligion,\thealth\tbeliefs\tand\tgoals,\neconomics)\twhen\tworking\twith\tindividuals\tto\tdetermine\tthe\tbest\teating\tpattern\tfor\tthem\n\t(\nADA,\n2018\n).\tIndividualization\tof\tthe\tmacronutrient\tcomposition\twill\tdepend\ton\tthe\tmetabolic\tstatus\tof\tthe
|
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individual\t(including\tlipid\tprofile,\trenal\tfunction)\tand/or\tpersonal\tfood\tpreferences.\nThe\tADA\talso\treviewed\tresearch\ton\teating\tpatterns\t(Mediterranean-style,\tvegetarian\tand\tvegan,\nlow-fat,\tlow-carbohydrate,\tand\tDietary\tApproaches\tto\tStop\tHypertension\t[DASH])\timplemented\tfor\ndiabetes\tmanagement
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diabetes\tmanagement\n\tand\tconcluded\tthat\ta\tvariety\tof\teating\tpatterns\tare\tacceptable\t(\nADA,\t2018\n).\nThe\tRDN\tmust\ttake\tinto\tconsideration\tpersonal\tpreferences\tand\tmetabolic\tgoals\twhen\nrecommending\tone\teating\tpattern\tover\tanother.\nAlthough\tnumerous\tfactors\tinfluence\tglycemic\tresponse\tto\tfoods,\tmonitoring\ttotal\tgrams\tof
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carbohydrates,\twhether\tby\tuse\tof\tcarbohydrate\tcounting\tor\texperienced\tbased\testimation,\tremains\ta\nkey\n\tstrategy\tin\tachieving\tglycemic\tcontrol\t(\nEvert\tet\tal,\t2013\n).\tWhile\tsome\tevidence\tsuggests\tthat\tthe\ntype\tof\tcarbohydrate\teaten\tmay\tinfluence\tblood\tglucose\tlevels,\tthe\ttotal\tamount\tof\tcarbohydrate
|
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eaten\tis\tthe\tprimary\tpredictor\tof\tglycemic\tresponse.\tDay-to-day\tconsistency\tin\tthe\tamount\tof\ncarbohydrate\teaten\tat\tmeals\tand\tsnacks\tis\treported\tto\timprove\tglycemic\tcontrol,\tespecially\tin\npersons\ton\teither\n\tMNT\talone,\tglucose-lowering\tmedications,\tor\tfixed\tinsulin\tregimens.\tIn\tpeople
|
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] |
with\tT1DM\tor\tT2DM\twho\tare\ton\tinsulin\tpump\ttherapy,\tinsulin\tdoses\tshould\tbe\tadjusted\tto\tmatch\ncarbohydrate\tintake\t(\nEvert\tet\tal,\t2013\n).\nCarbohydrate\tcounting\n\tis\tan\teating\tplan\tmethod\tbased\ton\tthe\tprinciple\tthat\tall\ttypes\tof\ncarbohydrate\t(except\tfiber)\tare\tdigested,\tand\tthat\tthe\tmajority\tof\tcarbohydrates\tare\tabsorbed\tinto
|
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the\tbloodstream\tas\tmolecules\tof\tglucose.\tCarbohydrate\tfoods\tinclude\tstarches,\tsuch\tas\tbreads,\ncereals,\tpasta,\trice,\tbeans\tand\tlentils,\tstarchy\tvegetables,\tcrackers,\tand\tsnack\tchips;\tfruits\tand\tfruit\njuices;\tmilk,\tmilk\tsubstitutes,\tand\tyogurt;\tand\tsweets\tand\tdesserts.\tOne\tcarbohydrate\texchange\t(or
|
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] |
serving)\tis\ta\tportion\tof\tfood\tcontaining\t15\tgrams\tof\tcarbohydrate\t(see\t\nAppendix\t18\n).\nIt\tis\timportant\n\tfor\tthe\tRDN\tto\tensure\tthat\tthe\tindividual\twith\tdiabetes\thas\tan\tunderstanding\tof\nwhich\tfoods\tcontain\tcarbohydrates\tand\tthe\trelationship\tbetween\tcarbohydrate\tintake\tand\tblood
|
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glucose\tlevels.\tIt\tis\tequally\timportant\tfor\tthe\tRDN\tto\tavoid\tvilifying\tcarbohydrates,\twhich\nunfortunately\toccurs\ttoo\tfrequently\tin\thealth\tcare\tcenters\tthat\twork\twith\tpatients\twho\thave\ndiabetes.\tThe\tRDN’s\trole\tshould\tinclude\n\thelping\tthe\tindividual\tunderstand\tthat\tcarbohydrates\tare
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helping\tthe\tindividual\tunderstand\tthat\tcarbohydrates\tare\npart\tof\ta\thealthy\tdiet,\tand\tcollaboratively\tcreate\tan\teating\tplan\tthat\tlists\tthe\tnumber\tof\tcarbohydrate\nchoices\trecommended\tfor\tmeals\tand,\tif\tdesired,\tsnacks.\tIndividuals\tare\tencouraged\tto\tkeep\tprotein
|
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and\tfat\tfood\tsources\tas\tconsistent\tas\tpossible\tbecause\tthey\tdo\tnot\tgreatly\taffect\tblood\tglucose\tlevels\neven\tthough\tthey\trequire\tinsulin\tfor\n\tmetabolism.\nThere\tare\ttwo\tmain\teating\tplans\tusing\tcarbohydrate\tcounting.\tThe\tfirst\tuses\tinsulin-to-\ncarbohydrate\tratios\tto\tadjust\tpremeal\tinsulin\tdoses\tfor\tvariable\tcarbohydrate\tintake\t(physiologic
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] |
insulin\tregimens).\tNote\tthat\tthe\tinsulin-to-carbohydrate\tratio\tis\ttypically\tcalculated\tby\tdividing\t500\nby\tthe\ttotal\tdaily\tdose\tof\tinsulin.\tFor\texample,\tif\ta\tpatient\tis\ttaking\t50\tunits\tof\tinsulin\tper\n\tday,\tyou\nwould\tdivide\t500\tby\t50\tto\tget\t10.\tThis\tmeans\tthat\t1\tunit\tof\trapid-acting\tinsulin\twill\tcover\tthe\tspike
|
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0.07728516310453415,
-0.030094288289546967
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in\tblood\tglucose\tafter\tthe\tpatient\teats\t10\tgrams\tof\tcarbohydrate.\nThe\tsecond\teating\tplan\tis\tfollowing\ta\tconsistent\tcarbohydrate\teating\tplan\twhen\tusing\tfixed\tinsulin\nregimens.\tTesting\tpremeal\tand\tpostmeal\tglucose\tlevels\tis\timportant\tfor\tmaking\tadjustments\tin\teither\nfood\tintake\tor\tmedication\n\tto\tachieve\tglucose\tgoals.\nCarbohydrate\tintake
|
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to\tachieve\tglucose\tgoals.\nCarbohydrate\tintake\nAs\tnoted\tearlier,\tblood\tglucose\tlevels\tafter\teating\tare\tdetermined\tprimarily\tby\tthe\tspeed\tof\tdigestion\nand\tabsorption\tof\tglucose\tinto\tthe\tbloodstream\tand\tthe\tability\tof\tinsulin\tto\tclear\tglucose\tfrom\tthe\ncirculation.\tLow-carbohydrate\tdiets\tmay\tseem\tto\tbe\ta\tlogical\tapproach\tto\tlowering\tpostprandial
|
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] |
glucose.\tHowever,\tfoods\tthat\tcontain\tcarbohydrates\n\t(whole\tgrains,\tlegumes,\tfruits,\tvegetables,\tand\nlow-fat\tmilk)\tare\texcellent\tsources\tof\tvitamins,\tminerals,\tdietary\tfiber,\tand\tenergy\tand\tare\nencouraged\tover\tother\tsources\tof\tcarbohydrates\t(namely\thighly\tprocessed\tcarbohydrate\twith\tlow
|
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] |
fiber,\tadded\tsugars\tand\tfats,\tor\thigh\tsodium)\tto\timprove\toverall\tnutrient\tintake\t(\nADA,\t2018\n).\nThe\tlong-held\tbelief\tthat\tsucrose—also\tknown\tas\tcommon\ttable\tsugar—must\n\tbe\trestricted\tbased\non\tthe\tassumption\tthat\tsugars\tare\tmore\trapidly\tdigested\tand\tabsorbed\tthan\tstarches\tis\tnot\tjustified.
|
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owing\tto\tthe\nefficiency\tof\tthe\thuman\tdigestive\ttract\tin\treducing\tstarch\tpolymers\tto\tglucose.\tStarches\tare\trapidly\nmetabolized\tinto\t100%\tglucose\tduring\tdigestion,\tin\tcontrast\tto\tsucrose,\twhich\tis\tmetabolized\tinto\nonly\tapproximately\t50%\tglucose\tand\tapproximately\t50%\tfructose.\tFructose\thas\ta\tlower\tglycemic
|
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response,\twhich\thas\tbeen\tattributed\tto\tits\tslow\trate\tof\tabsorption\tand\tits\tstorage\tin\tthe\tliver\n\tas\nglycogen.\tSucrose-containing\tfoods\tcan\tbe\tsubstituted\tfor\tisocaloric\tamounts\tof\tother\tcarbohydrate\nfoods.\tHowever,\tas\tfor\tthe\tgeneral\tpopulation,\tcare\tshould\tbe\ttaken\tto\tavoid\texcess\tenergy\tintake
|
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and\tto\tavoid\tdisplacing\tnutrient-dense\tfood\tchoices\t(\nLudwig\tet\tal,\t2018\n).\tThe\tADA\tadvises\tthat\npeople\twith\tor\tat\trisk\tfor\tdiabetes\tavoid\tsugar-sweetened\tbeverages\t(soft\tdrinks,\tfruit\tdrinks,\tenergy\nand\tvitamin-type\twater\tdrinks\tcontaining\tsucrose,\thigh-fructose\tcorn\tsyrup,\tand/or\tfruit\tjuice
|
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] |
concentrates)\tto\treduce\tthe\trisk\tof\tworsening\tthe\tcardiometabolic\trisk\tprofile\tand\tto\tprevent\tweight\ngain\t(\nADA,\t2018\n).
|
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] |
Glycemic\tindex\tand\tglycemic\tload\nThe\t\nglycemic\tindex\t(GI)\n\tof\tfood\twas\tdeveloped\tto\tcompare\tthe\tphysiologic\teffects\tof\tcarbohydrates\non\tglucose.\tThe\tGI\tranks\tcarbohydrate\tfoods\taccording\n\tto\thow\tthey\taffect\tblood\tglucose\tlevels\t(for\nexample,\tthe\tGI\tof\tglucose\t=\t100;\tthe\tGI\tof\twhite\tbread\t=\t70).\nThe\testimated\t\nglycemic\tload\t(GL)
|
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] |
The\testimated\t\nglycemic\tload\t(GL)\n\tof\tfoods,\tmeals,\tand\tdietary\tpatterns\tis\tcalculated\tby\nmultiplying\tthe\tGI\tby\tthe\tamount\tof\tavailable\tcarbohydrate\t(divided\tby\t100)\tin\teach\tfood\tand\tthen\ntotaling\tthe\tvalues\tfor\tall\tfoods\tin\ta\tmeal\tor\tdietary\tpattern.\tFor\texample,\ttwo\tslices\tof\twhite\tbread
|
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] |
with\ta\tGI\tof\t75\tand\t30\tg\tof\tcarbohydrate\thas\ta\tGL\tof\t22.5\t(75\t×\t30/100\t=\t22.5)\t(see\t\nAppendix\t28\n\tfor\nGI\tand\tGL\tof\tfoods).\nThe\tADA\tconducted\ta\tsystematic\treview\tof\tGI\tand\tGL\tdiets\tin\tthe\tmanagement\tof\tdiabetes\tand\nfound\tthat\tstudies\tlonger\tthan\t12\tweeks\treport\tno\tsignificant\timpact\tof\tGI\tor\tGL,\tindependent\tof
|
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weight\tloss,\ton\tA1C.\tHowever,\tmixed\tresults\twere\treported\tregarding\tfasting\tglucose\tlevels\n\tand\nendogenous\tinsulin\tlevels.\tIf\tGI\tor\tGL\tis\tproposed\tas\ta\tglycemia-lowering\tstrategy,\tthe\tRDN\tcan\nadvise\tadults\twith\tdiabetes\tthat\tlowering\tthe\tGI\tor\tGL\tmay\tor\tmay\tnot\thave\ta\tsignificant\teffect\ton\nglycemic\tcontrol.\nFiber\tand\twhole\tgrains
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] |
glycemic\tcontrol.\nFiber\tand\twhole\tgrains\nThere\tis\tevidence\tto\tsuggest\tthat\tdietary\tfiber\tintake\tmay\tlead\tto\tdecreased\tall-cause\tmortality\tin\nindividuals\twith\tdiabetes\t(\nEvert\tet\tal,\t2014\n).\tAdditionally,\n\ta\tmeta-analysis\treviewing\t15\tstudies\tthat\nexamined\tthe\trelationship\tbetween\tfiber\tand\tdiabetes\tfound\tthat\tan\tintervention\tinvolving\tfiber
|
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] |
supplementation\tfor\tT2DM\tcan\treduce\tfasting\tblood\tglucose\t(FBG)\tand\tA1C.\tCompared\twith\tthe\nplacebo,\tindividuals\twho\tconsumed\tdietary\tfiber\tas\tan\tintervention\thad\tan\toverall\tmean\tdifference\tof\na\tdecrease\tin\tA1C\tof\t0.26%.\tWhile\tthis\tevidence\tis\tpromising,\n\tone\tof\tthe\tlimitations\tis\tthat\tthe
|
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one\tof\tthe\tlimitations\tis\tthat\tthe\nstudies\tused\ta\tvariety\tof\tgrams\tof\tfiber\tper\tday\tin\ttheir\tinterventions,\tfrom\tas\tlow\tas\tan\tadditional\t4\ng/day\tto\t40\tg/day\t(\nPost\tet\tal,\t2012\n).\nAs\twith\tthe\tgeneral\tpopulation,\tconsuming\t25\tg\tfiber\tper\tday\tfor\tadult\twomen\tand\t38\tg\tper\tday\tfor\nadult\tmen\tis\tencouraged\t(\nEvert\tet\tal,\t2014
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adult\tmen\tis\tencouraged\t(\nEvert\tet\tal,\t2014\n).\tIt\tis\talso\trecommended\tthat\tindividuals\twith\tdiabetes,\nalong\twith\tthe\tgeneral\n\tpopulation,\tconsume\tat\tleast\thalf\tof\tall\tgrains\tas\twhole\tgrains.\nGrams\tof\tfiber\t(and\tsugar\talcohols)\tare\tincluded\ton\tfood\tlabels\tand\tare\tcalculated\tas\thaving\tabout
|
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] |
half\tthe\tenergy\t(2\tkcal/g)\tof\tmost\tother\tcarbohydrates\t(4\tkcal/g).\tHowever,\tfor\tmost\tpeople\tit\tis\tnot\nnecessary\tto\tsubtract\tthe\tamount\tof\tdietary\tfiber\t(or\tsugar\talcohols)\twhen\tcarbohydrate\tcounting\n(\nEvert\tet\tal,\t2014\n).\tAdjustments\n\tin\tcarbohydrate\tintake\tvalues\tis\tpractical\tonly\tif\tthe\tamount\tper
|
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] |
in\tcarbohydrate\tintake\tvalues\tis\tpractical\tonly\tif\tthe\tamount\tper\nserving\tis\tmore\tthan\t5\tg.\tIn\tthat\tcase,\tcounting\thalf\tof\tthe\tcarbohydrate\tgrams\tfrom\tfiber\t(and\tsugar\nalcohols)\twould\tbe\tuseful\tin\tcalculating\tfood\tchoices\tfor\tfood\tlabels\tor\trecipes.\nNonnutritive\tand\thypocaloric\tsweeteners
|
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] |
Nonnutritive\tand\thypocaloric\tsweeteners\nReduced\tcalorie\tsweeteners\tapproved\tby\tthe\tFDA\tinclude\tsugar\talcohols\t(erythritol,\tsorbitol,\nmannitol,\n\txylitol,\tisomalt,\tlactitol,\tand\thydrogenated\tstarch\thydrolysates)\tand\ttagatose.\tAll\tFDA-\napproved\tnonnutritive\tsweeteners,\twhen\tconsumed\twithin\tthe\testablished\tdaily\tintake\tlevels,\tcan\tbe
|
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used\tby\tpeople\twith\tdiabetes,\tincluding\tpregnant\twomen.\tFurthermore,\tnonnutritive\tsweeteners\ncould\tfacilitate\treductions\tin\tadded\tsugars\tintake,\tthereby\tresulting\tin\tdecreased\ttotal\tenergy\tintake\n(\nADA,\t2018\n).\n\tHowever,\talthough\tthe\tuse\tof\tnonnutritive\tsweeteners\tappears\tto\tbe\tsafe,\tsome\tpeople
|
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report\tgastric\tdiscomfort\tafter\teating\tfoods\tsweetened\twith\tthese\tproducts,\tand\tconsuming\tlarge\nquantities\tmay\tcause\tdiarrhea,\tespecially\tin\tchildren.\nKeep\tin\tmind\tthat\tthe\tintake\tof\tnutritive\tsweeteners,\twhen\tsubstituted\tisocalorically\tfor\tother\ncarbohydrates,\twill\tnot\thave\ta\tsignificant\teffect\ton\tA1C\tor\tinsulin\n\tlevels;\thowever,\tthey\tcan\treduce
|
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] |
levels;\thowever,\tthey\tcan\treduce\noverall\tcalorie\tand\tcarbohydrate\tintake\t(\nADA,\t2018\n).\nProtein\tintake\nAccording\tto\tthe\tADA,\tthere\tis\tno\tevidence\tthat\tadjusting\tthe\tdaily\tlevel\tof\tprotein\tintake\t(typically\t1\nto\t1.5\tg/kg\tbody\tweight/day\tor\t15%\tto\t20%\ttotal\tcalories)\twill\timprove\thealth\tin\tindividuals\twithout
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diabetic\tkidney\tdisease.\tFor\tpeople\twith\tdiabetes,\tevidence\tis\tinconclusive\tto\trecommend\n\tan\tideal\namount\tof\tprotein\tintake\tfor\toptimizing\tglycemic\tcontrol\tor\timproving\tCVD\trisk\tfactors;\ttherefore,\ngoals\tshould\tbe\tindividualized\tto\treflect\tcurrent\teating\tpatterns.\tSome\tresearch\tdoes\tsuggest\tthat
|
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slightly\thigher\tprotein\tintake\t(20%\tto\t30%\tof\ttotal\tcalories)\tmay\tlead\tto\tincreased\tsatiety\tin\tpeople\nwith\tdiabetes.\nAlthough\tnonessential\tamino\tacids\tundergo\tgluconeogenesis,\tin\twell-controlled\n\tdiabetes\tthe\nglucose\tproduced\tdoes\tnot\tappear\tin\tthe\tgeneral\tcirculation;\tthe\tglucose\tproduced\tis\tlikely\tstored\tin
|
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] |
the\tliver\tas\tglycogen.\tWhen\tglycolysis\toccurs,\tit\tis\tunknown\tif\tthe\toriginal\tsource\tof\tglucose\twas\ncarbohydrate\tor\tprotein.\tAlthough\tprotein\tis\tjust\tas\tpotent\ta\tstimulant\tof\tacute\tinsulin\trelease\tas\ncarbohydrate,\tit\thas\tno\tlong-term\teffect\ton\tinsulin\tneeds.\tAdding\tprotein\tto\tthe\n\ttreatment\tof
|
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] |
treatment\tof\nhypoglycemia\tdoes\tnot\tprevent\tsubsequent\thypoglycemia,\tdue\tto\tthe\tpotential\tsimultaneous\trise\tin\nendogenous\tinsulin\t(\nADA,\t2018\n).\nFat\tintake\nEvidence\tis\talso\tinconclusive\tfor\tan\tideal\tamount\tof\ttotal\tfat\tfor\tpeople\twith\tdiabetes\tand\ttherefore
|
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] |
goals\tshould\tbe\tindividualized.\tThe\ttype\tof\tfat\tconsumed\tappears\tto\tbe\tmore\timportant\tthan\ttotal\tfat\nin\tterms\tof\tmetabolic\tand\tcardiovascular\n\trisk.\nMonounsaturated\tfatty\tacid\t(MUFA)-rich\tfoods\tas\ta\tcomponent\tof\tthe\tMediterranean-style\teating\npattern\tare\tassociated\twith\timproved\tglycemic\tcontrol\tand\timproved\tCVD\trisk\tfactors\tin\tpersons
|
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] |
with\tT2DM.\tControversy\texists\ton\tthe\tbest\tratio\tof\tomega-6\tto\tomega-3\tfatty\tacids;\thowever,\npolyunsaturated\tfatty\tacids\t(PUFAs)\tand\tMUFAs\tare\trecommended\tas\tsubstitutes\tfor\tsaturated\tfatty\nacids\t(SFAs)\n\tor\ttrans\tfatty\tacids.\tThe\tamount\tof\tSFAs,\tcholesterol,\tand\ttrans\tfat\trecommended\tfor
|
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people\twith\tdiabetes\tis\tthe\tsame\tas\tfor\tthe\tgeneral\tpopulation.\nThere\tis\tevidence\tfrom\tthe\tgeneral\tpopulation\tthat\tfoods\tcontaining\tomega-3\tfatty\tacids\thave
|
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beneficial\teffects\ton\tlipoproteins\tand\tprevention\tof\theart\tdisease.\tTherefore\tthe\trecommendations\nfor\tthe\tgeneral\tpublic\tto\teat\tfish\t(particularly\tfatty\n\tfish)\tat\tleast\ttwo\ttimes\t(two\tservings)\tper\tweek\tis\nalso\tappropriate\tfor\tpeople\twith\tdiabetes.\tHowever,\tevidence\tfrom\trandomized\tcontrolled\ttrial
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(RCTs)\tdoes\tnot\tsupport\trecommending\tomega-3\tsupplements\tfor\tpeople\twith\tdiabetes\tfor\tthe\nprevention\tor\ttreatment\tof\tCVD\t(\nADA,\t2018\n).\nAlcohol\nSmall\tamounts\tof\talcohol\tingested\twith\tfood\thave\tminimum,\tif\tany,\tacute\teffect\ton\tglucose\tand\ninsulin\tlevels.\n\tIf\tindividuals\tchoose\tto\tdrink\talcohol,\tdaily\tintake\tshould\tbe\tlimited\tto\tone\tdrink\tor
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] |
less\tfor\tadult\twomen\tand\ttwo\tdrinks\tor\tless\tfor\tadult\tmen\t(1\tdrink\t=\t12\toz\tbeer,\t5\toz\twine,\tor\t1.5\toz\ndistilled\tspirits).\tEach\tdrink\tcontains\t15\tgrams\tof\talcohol.\tThe\ttype\tof\talcoholic\tbeverage\tconsumed\ndoes\tnot\tmake\ta\tdifference.\tThe\tsame\tprecautions\tthat\tapply\tto\talcohol\tconsumption\tfor\tthe\tgeneral\npopulation
|
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] |
population\n\tapply\tto\tpersons\twith\tdiabetes.\tAbstention\tfrom\talcohol\tshould\tbe\tadvised\tfor\tpeople\twith\na\thistory\tof\talcohol\tabuse\tor\tdependence;\tfor\twomen\tduring\tpregnancy;\tand\tfor\tpeople\twith\tmedical\nproblems\tsuch\tas\tliver\tdisease,\tpancreatitis,\tadvanced\tneuropathy,\tor\tsevere\thypertriglyceridemia\n(\nADA,\t2018\n).
|
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] |
(\nADA,\t2018\n).\nModerate\tto\thigh\talcohol\tconsumption\tmay\tplace\tpeople\twith\tdiabetes\twho\ttake\tinsulin\tor\t\ninsulin\nsecretagogues\n\t(medications\tthat\tincrease\tinsulin\tproduction)\tat\tincreased\trisk\tfor\tdelayed\nhypoglycemia\t(\nADA,\t2018\n).\tConsuming\talcohol\twith\tfood\tcan\tminimize\tthe\trisk\tof\tnocturnal
|
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] |
).\tConsuming\talcohol\twith\tfood\tcan\tminimize\tthe\trisk\tof\tnocturnal\nhypoglycemia,\tor\tlow\tblood\tsugar\tthat\toccurs\tovernight\twhen\tan\tindividual\tis\tasleep.\tEducation\tand\nawareness\tof\tdelayed\thypoglycemia\tafter\tconsuming\talcoholic\tbeverages\tis\timportant.\tAlcoholic\nbeverages\tshould\tbe\tconsidered\tan\taddition
|
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beverages\tshould\tbe\tconsidered\tan\taddition\n\tto\tthe\tregular\tfood\tand\tmeal\tplan\tfor\tall\tpersons\twith\ndiabetes.\tNo\tfood\tshould\tbe\tomitted,\tgiven\tthe\tpossibility\tof\talcohol-induced\thypoglycemia\tand\nbecause\talcohol\tdoes\tnot\trequire\tinsulin\tto\tbe\tmetabolized\t(\nADA,\t2018\n).\tExcessive\tamounts\tof
|
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] |
ADA,\t2018\n).\tExcessive\tamounts\tof\nalcohol\t(three\tor\tmore\tdrinks\tper\tday)\ton\ta\tconsistent\tbasis,\tcontribute\tto\thyperglycemia,\twhich\nimproves\tas\tsoon\tas\talcohol\tuse\tis\tdiscontinued.\nSmall\n\tamounts\tof\talcohol,\tin\tparticular\tred\twine,\tmay\tbe\tsafe\tand\tpotentially\tdecrease
|
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] |
cardiometabolic\trisk.\tOne\tlong-term\tRCT\tsuggested\tthat\tamong\twell-controlled\tpeople\twith\tdiabetes,\ninitiating\tmodest\twine\tintake,\tespecially\tred\twine,\tas\tpart\tof\ta\thealthy\tdiet\tis\tprobably\tsafe\tand\nmodestly\tdecreases\tcardiometabolic\trisk\t(\nBlomster\tet\tal,\t2014\n).\tHowever,\tchronic\tingestion\tof\nalcohol\tdoes\traise\tblood
|
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] |
).\tHowever,\tchronic\tingestion\tof\nalcohol\tdoes\traise\tblood\n\tpressure\tand\tmay\tbe\ta\trisk\tfactor\tfor\tstroke\t(\nO’Keefe\tet\tal,\t2018\n).\nMicronutrients\tand\therbal\tsupplements\nThe\tevidence\texamining\tthe\teffect\tof\tdietary\tsupplements\ton\tblood\tglucose\tregulation\tare\tmixed;
|
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0.012308215722441673,
-0.03817030042409897,
-0.03607822209596634,
-0.05733482539653778,
-0.005019122734665871,
0.07902245968580246,
-0.04589274898171425,
-0.07435213029384613,
-0.035747431218624115,
0.13999833166599274,
0.029064754024147987,
0.028881369158625603,
-0.03965524211525917,
0.05247735232114792,
0.0653553381562233,
-0.07624918222427368,
-0.050603341311216354,
0.07392727583646774,
0.004307994153350592,
-0.033898256719112396,
-0.011433967389166355,
0.1261887401342392,
-0.005750742275267839,
-0.025239063426852226,
-0.023815356194972992,
-0.01032736524939537,
0.02545977383852005,
0.03976355865597725,
-0.0056335642002522945,
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0.06603706628084183,
0.0642092153429985,
0.09746123105287552,
-0.048057395964860916
] |
therefore\tthe\tADA\tdoes\tnot\tendorse\tthe\tuse\tof\troutine\tvitamin\tor\tmineral\tsupplementation\tin\tpeople\nwith\tdiabetes\t(compared\twith\tthe\tgeneral\tpopulation)\twho\tdo\tnot\thave\tunderlying\tdeficiencies\n\t(\nADA,\n2018\n).\nThere\tis,\thowever,\tsome\temerging\tevidence\tthat\tsuggests\tcertain\tsupplements\tmay\tbe\thelpful\tin
|
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] |
lowering\tblood\tsugar\tlevels.\tThese\tinclude\tcinnamon,\tchromium,\talpha-lipoic\tacid\t(ALA),\tand\nberberine.\nA\t2013\tsystematic\treview\tand\tmeta-analysis\tfound\tthat\tcinnamon\tdoses\tof\t120\tmg/day\tto\t6\tg/day\nfor\t4\tto\t18\tweeks\treduced\tlevels\tof\tFPG,\ttotal\tcholesterol\t(–15.60\tmg/dL),\tLDL\tcholesterol\n\t(–9.42
|
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] |
(–9.42\nmg/dL),\tand\ttriglycerides\t(–29.59\tmg/dL)\twhile\tincreasing\tlevels\tof\tHDL\tcholesterol\t(1.66\tmg/dL).\nHowever,\tdespite\tthe\treductions\tobserved\tin\tFBG,\tno\tsignificant\teffect\ton\themoglobin\tA1C\t(HbA1C)\nlevels\t(–0.16%)\twas\tseen\t(\nAllen\tet\tal,\t2013\n).\nA\tnarrative\treview\tpublished\tin\tthe\t\nJournal\tof\tthe\tAcademy\tof\tNutrition\tand\tDietetics
|
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] |
Journal\tof\tthe\tAcademy\tof\tNutrition\tand\tDietetics\n\thad\tsimilar\nfindings.\tThe\treview\tanalyzed\t11\tRCTs\tand\tfound\tthat\n\tall\tthe\tstudies\treported\tsome\treductions\tin\nFPG\tduring\tthe\tcinnamon\tintervention.\tOf\tthe\tstudies\tmeasuring\tA1C,\tvery\tmodest\tdecreases\twere\nalso\tapparent\twith\tcinnamon,\twhereas\tchanges\tin\tthe\tplacebo\tgroups\twere\tminimal\t(
|
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Costello\tet\tal,\n2016\n).\tIt\tis\timportant\tto\tuse\tcaution\twhen\tcombining\tcinnamon\t(in\tpill\tform)\twith\tother\tblood\nglucose-lowering\therbs\tand\tsupplements,\tas\ttaking\tcinnamon\twith\tsome\n\tantidiabetes\tdrugs\tmay\ncause\thypoglycemic\teffects.\nChromium\tis\tan\tessential\ttrace\tmineral\trequired\tby\tthe\tbody\tin\tsmall\tamounts.\tSome\tresearch
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] |
suggests\tthat\tthe\tmineral\tmay\tbe\tused\tto\timprove\tglycemic\tcontrol\tfor\tdiabetes\t(types\t1\tand\t2),\nprediabetes,\tPCOS,\treactive\thypoglycemia,\tmetabolic\tsyndrome,\tand\tother\tglucose\tregulation\ndisorders\t(\nNatural\tMedicines\tDatabase,\t2018\n).\tOne\tstudy\texamined\n\tthe\teffects\tof\t42\tμg\tCr/day\tof
|
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] |
).\tOne\tstudy\texamined\n\tthe\teffects\tof\t42\tμg\tCr/day\tof\nchromium\tsupplementation\tin\ta\tsmall\tnumber\tof\tpeople\twith\tnewly\tdiagnosed\tdiabetes.\tAfter\t3\nmonths\tof\tchromium\tsupplementation,\tthe\tcontrol\tgroup\texperienced\ta\tsignificant\treduction\tin\tFBG.\nAdditionally,\tA1C\tvalues\timproved\tsignificantly\tfrom\t9.51%\tto\t6.86%,\tindicating\tbetter\tglycemic
|
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] |
control.\tIn\tthe\texperimental\tgroup,\ttotal\tcholesterol,\ttriglycerides\tand\tLDL\tlevels\n\twere\talso\nsignificantly\treduced.\tThese\tdata\tdemonstrate\ta\tpossible\tbeneficial\teffect\tof\tchromium\nsupplementation\ton\tglycemic\tcontrol\tand\tlipid\tvariables\tin\tsubjects\twith\tnewly\tonset\tT2DM\t(\nSharma\net\tal,\t2011
|
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Sharma\net\tal,\t2011\n).\tIt\tshould\tbe\tnoted\tthat\tcell\tculture\tstudies\tsuggest\ta\tpossibility\tof\tDNA\tdamage\twith\nlong-term\tchromium\tsupplementation,\thowever\tthis\thas\tnot\tbeen\tshown\tin\tliving\torganisms\t(\nLinus\nPauling\tInstitute,\t2018\n).\nALA\tis\tan\tessential\tcofactor\tin\tmitochondrial\tenzymes\trelated\tto\tenergy\tproduction\tthat\tmay
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] |
improve\tglucose\tutilization\tin\tthose\twith\tT2DM\t(\nLinus\tPauling\tInstitute,\t2018b\n).\nOne\ttrial\trandomized\t105\tpeople\twith\tdiabetes\tto\ttwo\tgroups.\tThe\tfirst\twas\tinstructed\tto\ttake\ta\nsupplement\tcontaining\t600\tmg\tof\tALA\t(along\twith\tL-carnosine,\tzinc,\tand\tvitamins\tof\tgroup\tB).\tThe\nsecond\twas\tgiven\ta\tplacebo.
|
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] |
second\twas\tgiven\ta\tplacebo.\n\tThe\tstudy\tfound\tthat\tafter\t3\tmonths,\tthere\twas\ta\treduction\tof\tFPG,\npostprandial\tglucose,\tand\tA1C\tin\tthe\tgroup\tthat\tsupplemented\twith\tALA\tcompared\tthe\tplacebo.\tThe\nstudy\talso\tobserved\ta\treduction\tof\tLDL\tcholesterol,\tand\ttriglycerides\tin\tthe\tALA\tgroup\t(\nDerosa\tet\tal,\n2016\n).
|
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] |
Derosa\tet\tal,\n2016\n).\nBerberine\tis\tan\talkaloid\tfound\tin\ta\tvariety\tof\tmedicinal\tplants,\tincluding\t\nHydrastis\tcanadensis\n(goldenseal)\tand\t\nBerberis\taristata\n\t(tree\tturmeric).\tIt\thas\tbeen\tused\tfor\tmedicinal\tpurposes\tin
|
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Chinese\tand\tAyurvedic\tmedicine\tand\tas\ta\tdye,\tthanks\tto\tits\tvibrant\tyellow\tcolor.\tIn\tone\tclinical\tstudy,\nberberine\tsignificantly\tlowered\tFBG,\tA1C,\ttriglyceride,\tand\tinsulin\tlevels\tin\tpatients\twith\tT2DM.\tThe\nFBG\tand\tA1C-lowering\teffects\tof\tberberine\twere\tsimilar\tto\tthose\tof\tmetformin\tand\trosiglitazone.\nLiver\tfunction\twas\timproved\tgreatly
|
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] |
Liver\tfunction\twas\timproved\tgreatly\n\tin\tthese\tpatients\tby\tshowing\treduction\tof\tliver\tenzymes\t(\nZiegler\net\tal,\t2011\n).\tIn\tanother\tstudy,\t36\tadults\twith\tnewly\tdiagnosed\tT2DM\twere\trandomly\tassigned\tto\ntreatment\twith\tberberine\tor\tmetformin\t(0.5\tg\tthree\ttimes\tper\tday).\tAfter\tthe\t3\tmonths,\tthe
|
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] |
hypoglycemic\teffect\tof\tberberine\twas\tsimilar\tto\tthat\tof\tmetformin.\tSignificant\tdecreases\tin\tA1C\n(9.5%\tto\t7.5%),\tFBG\t(10.6\tmmol/L\tto\t6.9\tmmol/L),\tpostprandial\n\tblood\tglucose\t(19.8\tmmol/L\tto\t11.1\nmmol/L),\tand\ttriglycerides\t(1.13\tmmol/L\tto\t0.89\tmmol/L)\twere\tobserved\tin\tthe\tberberine\tgroup\t(\nYin\net\tal,\t2008\n).
|
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] |
Yin\net\tal,\t2008\n).\nNote\tthat\tberberine\tmay\tbe\tcontraindicated\tduring\tlactation\tand\tpregnancy,\tand\tin\tchildren.\nAdditionally,\tit\tcan\tcause\thypoglycemia\tin\tindividuals\ton\tblood\tsugar-lowering\tmedications\t(insulin,\nAmaryl,\tetc.)\tand\tmay\tpotentially\tlower\tblood\tpressure.\n\tTherefore\tit\tshould\tbe\tused\twith\tcaution\tin
|
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] |
Therefore\tit\tshould\tbe\tused\twith\tcaution\tin\npeople\twith\tlow\tblood\tpressure\tor\tin\tpeople\ton\tblood\tsugar-lowering\tmedications.\tBerberine\tcan\talso\ninhibit\tactivity\tof\tenzymes\tthat\tbreak\tdown\tcertain\tdrugs\t(Neoral,\tSandimmune),\twhich\tcan\tlead\tto\nincreased\tblood\tlevels\tand\tincreased\trisk\tof\tadverse\teffects.\tOther\tpotential\tadverse\teffects\tinclude
|
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] |
nausea,\tbloating,\tconstipation,\tdiarrhea,\thypertension,\n\trespiratory\tfailure,\theadache,\tbradycardia,\njaundice,\tand\tparesthesias.\nEven\tthough\tthere\tis\tsome\temerging\tevidence\tto\tsuggest\tthat\therbal\tsupplements\tmay\thelp\twith\nblood\tglucose\tregulation,\tit\tis\timportant\tto\tremember\tthat\therbal\tproducts\tare\tnot\tstandardized\tand
|
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] |
vary\tin\ttheir\tcontent\tof\tactive\tingredients\t(see\t\nChapter\t11\n).\tThey\thave\tthe\tpotential\tto\tinteract\twith\nand\talter\tthe\teffect\tof\tother\n\tmedications.\tTherefore\tpeople\twith\tdiabetes\tshould\talways\treport\tthe\nuse\tof\tsupplements\tand\therbal\tproducts\tto\ttheir\thealth\tcare\tprovider/RDN.\nMetformin\tis\tassociated\twith\tvitamin\tB\n12
|
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Metformin\tis\tassociated\twith\tvitamin\tB\n12\n\tdeficiency.\tBecause\tof\tthis,\ta\trecent\treport\tfrom\tthe\nDiabetes\tPrevention\tProgram\tOutcomes\tStudy\t(DPPOS)\tsuggests\tthat\tperiodic\ttesting\tof\tvitamin\tB\n12\nlevels\tshould\tbe\tconsidered\tin\tpatients\ttaking\tmetformin,\tespecially\n\tif\tthe\tindividual\thas\ta\thistory\tof\nanemia\tor\tperipheral\tneuropathy.
|
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] |
if\tthe\tindividual\thas\ta\thistory\tof\nanemia\tor\tperipheral\tneuropathy.\nPhysical\tactivity/exercise\nPhysical\tactivity\tshould\tbe\tan\tintegral\tpart\tof\tthe\ttreatment\tplan\tfor\tpersons\twith\tdiabetes.\tExercise\nhelps\timprove\tinsulin\tsensitivity,\treduce\tcardiovascular\trisk\tfactors,\tcontrol\tweight,\tand\timprove
|
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] |
well-being.\tGiven\tappropriate\tguidelines,\tthe\tmajority\tof\tpeople\twith\tdiabetes\tcan\texercise\tsafely.\nIndividual\tactivity\tplans\twill\tvary,\tdepending\ton\tinterest,\tage,\tgeneral\thealth,\tand\tlevel\tof\tphysical\nfitness.\nThere\tare\ttwo\ttypes\tof\texercise:\taerobic\tand\tanaerobic.\tBoth\tare\timportant\tin\tpeople\twith
|
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] |
diabetes.\tAerobic\texercise\tconsists\tof\trhythmic,\trepeated,\tand\tcontinuous\tmovements\tof\tthe\tsame\nlarge\tmuscle\tgroups\tfor\tat\tleast\t10\tminutes\tat\ta\ttime.\tExamples\tinclude\twalking,\tbicycling,\tjogging,\nswimming,\tand\tmany\tsports.\tAnaerobic\texercise,\talso\tknown\tas\tresistance\texercise,\tconsists\tof
|
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] |
activities\tthat\tuse\tmuscular\tstrength\tto\tmove\ta\tweight\tor\twork\tagainst\ta\tresistive\tload.\tExamples\ninclude\tweight\tlifting\tand\texercises\tusing\tresistance-providing\tmachines.\nDespite\tthe\tincrease\tin\tglucose\tuptake\tby\tmuscles\tduring\texercise,\tglucose\tlevels\tchange\tlittle\tin\nindividuals\twithout\tdiabetes.
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individuals\twithout\tdiabetes.\n\tMuscular\twork\tcauses\tinsulin\tlevels\tto\tdecline,\twhile\tcounterregulatory\nhormones\t(primarily\tglucagon)\trise.\tAs\ta\tresult,\tthe\tincreased\tglucose\tuse\tby\tthe\texercising\tmuscles\nis\tmatched\twith\tincreased\tglucose\tproduction\tby\tthe\tliver.\tThis\tbalance\tbetween\tinsulin\tand
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control,\tplasma\tglucose,\tand\tinsulin\tlevels\tat\tthe\tstart\tof\texercise;\ttiming,\tintensity,\tand\tduration\tof\nthe\texercise;\tprevious\tfood\tintake;\tand\tprevious\tconditioning.\tAn\timportant\tvariable\tis\tthe\tlevel\tof\nplasma\tinsulin\tduring\n\tand\tafter\texercise.\tHypoglycemia\tcan\toccur\tbecause\tof\tinsulin-enhanced\nmuscle\tglucose\tuptake\tby\tthe\texercising\tmuscle.
|
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muscle\tglucose\tuptake\tby\tthe\texercising\tmuscle.\nIn\tpeople\twith\tT2DM,\tblood\tglucose\tcontrol\tcan\timprove\twith\tphysical\tactivity,\tlargely\tbecause\tof\ndecreased\tinsulin\tresistance\tand\tincreased\tinsulin\tsensitivity,\twhich\tresults\tin\tincreased\tperipheral\nuse\tof\tglucose\tnot\tonly\tduring\tbut\talso\tafter\tthe\tactivity\t(\nColberg\tet\tal,\t2016
|
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Colberg\tet\tal,\t2016\n).\tThis\texercise-induced\nenhanced\tinsulin\tsensitivity\toccurs\tindependent\tof\tany\teffect\ton\tbody\tweight.\tStructured\texercise\ninterventions\tof\tat\tleast\t8\tweeks\tin\tduration\tare\treported\tto\tlower\tA1C.\tExercise\talso\tdecreases\tthe\neffects\tof\tcounterregulatory\thormones,\twhich\treduces\tthe\thepatic\tglucose\toutput,\tcontributing\tto
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] |
improved\tglucose\tcontrol.\nPotential\tproblems\twith\texercise\nHypoglycemia\n\tis\ta\tpotential\tproblem\tassociated\twith\texercise\tin\tpeople\ttaking\tinsulin\tor\tinsulin\nsecretagogues.\tHypoglycemia\tcan\toccur\tduring,\timmediately\tafter,\tor\tmany\thours\tafter\texercise,\tand\nis\tmore\tcommon\tin\tpeople\twith\tT1DM\t(\nColberg\tet\tal,\t2016
|
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] |
is\tmore\tcommon\tin\tpeople\twith\tT1DM\t(\nColberg\tet\tal,\t2016\n).\tHypoglycemia\thas\tbeen\treported\tto\tbe\nmore\tcommon\tafter\texercise—especially\texercise\tof\tlong\tduration.\tThis\tcan\tinclude\tstrenuous\nactivity,\tplay,\tor\tsporadic\n\texercise.\tHypoglycemia\tin\tthis\tinstance\tis\ttypically\tdue\tto\tincreased\tinsulin
|
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sensitivity\tafter\texercise,\trequiring\trepletion\tof\tliver\tand\tmuscle\tglycogen,\twhich\tcan\ttake\tup\tto\t24\nto\t30\thours\t(see\t\nChapter\t22\n).\nBlood\tglucose\tlevels\tbefore\texercise\treflect\tonly\tthe\tvalue\tat\tthat\ttime,\tand\tit\tis\tunknown\tif\tthis\tis\na\tstable\tblood\tglucose\tlevel\tor\ta\tblood\tglucose\tlevel\tthat\tis\tdropping.\tIf\tblood\tglucose\n\tlevels\tare
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a\tgreater-than-normal\tincrease\tin\tcounterregulatory\thormones.\tAs\ta\tresult,\thepatic\tglucose\trelease\nexceeds\tthe\trise\tin\tglucose\tuse.\tThe\televated\tglucose\tlevels\talso\tmay\textend\tinto\tthe\tpostexercise
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state.\tHyperglycemia\tand\tworsening\tketosis\talso\tcan\tresult\tin\tpeople\twith\tT1DM\twho\tare\tdeprived\nof\tinsulin\tfor\t12\tto\t48\thours\tand\tare\tketotic.\tVigorous\tactivity\tshould\tbe\tavoided\tin\tthe\tpresence\tof\nketosis\t(\nADA,\t2018\n).\tIt\tis\tnot,\thowever,\tnecessary\tto\tpostpone\texercise\tbased\tsimply\ton\nhyperglycemia,
|
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] |
hyperglycemia,\n\tprovided\tthe\tindividual\tfeels\twell\tand\turine\tand/or\tblood\tketones\tare\tnegative.\nExercise\tguidelines\nThe\tvariability\tof\tglucose\tresponses\tto\texercise\tcontributes\tto\tthe\tdifficulty\tin\tgiving\tprecise\nguidelines\tfor\texercising\tsafely.\tFrequent\tblood\tglucose\tmonitoring\tbefore,\tduring,\tand\tafter\texercise
|
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