Sometimes,
even when you think you’re doing everything right, your blood
sugars may not respond as you expect. Often this will be due to one
or more of the biologic curiosities that affect diabetics. The purpose
of this chapter is to acquaint you with some real phenomena that can
confound your plans, but which you can frequently circumvent if you
are aware of them.
DIMINISHED PHASE I INSULIN RESPONSE
Figure 1–2, page 44, illustrates the normal, nondiabetic blood
insulin response to a meal containing carbohydrate and protein. When
glucose from dietary carbohydrate enters the bloodstream, beta cells
of the pancreas respond—or should respond—immediately by
releasing stored insulin granules. These granules may have been stored
for many hours in anticipation of what is known as a glucose challenge.
This rapid release is called phase I insulin response.
The nondiabetic body will utilize this immediate release of insulin
to prevent blood sugar from increasing significantly. As we discussed
in Chapter 1, one of the hallmarks of type 2 diabetes is the diminished
ability to do this. Therefore, blood sugars will shoot up after eating
(carbohydrates in particular) and will be brought back into line only
slowly by phase II insulin response (the release of newly manufactured
insulin). This blood sugar rise can be minimized, primarily by dietary
manipulation, but for some diabetics by diet and/or oral agents or injected
insulin.
A possible but unproven explanation for diminished or absent phase
I insulin response in diabetics is that the beta cells are still capable
of making insulin but not capable of storing it. In this model, insulin
would be released almost as soon as it is made. This inability to store
insulin could also explain the inappropriate release of insulin that
often occurs when blood sugar is already low in very early type 2 diabetes.
Such individuals may experience blood sugars that are both too high
and too low in the same day—even without medication. An alternate
explanation is that the sensitivity of the beta cells to changes in
the blood sugar diminishes, so that they respond inadequately to such
changes.
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PHENOMENA PECULIAR TO DIABETES THAT CAN AFFECT BLOOD SUGAR
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We would like to thank the publisher Little Brown and Company and Dr.
Richard K. Bernstein, for allowing us to provide excerpts from Diabetes
Solution.
Copyright © 2003 by Richard K. Bernstein, M.D.
All rights reserved. No part of this book may be reproduced in any form
or by any electronic or mechanical means, including information storage
and retrievalsystems, without permission in writing from the publisher,
except by a reviewer who may quote brief passages in a review.
Author’s Note
This book is not intended as a substitute for professional medical care.
The reader should regularly consult a physician for all health-related
problems and routine care.
For information on how you can purchase Diabetes Solution,
go to www.Diabetes-solution.net
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