Chapter
6
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.
Part 4 of 5
THE CHINESE RESTAURANT EFFECT
Many years ago a patient asked me why her blood sugar went from 90 mg/dl
up to 300 mg/dl every afternoon after she went swimming. I asked what
she ate before the swim. “Nothing, just a freebie,” she
replied. As it turned out, the “freebie” was lettuce. When
I asked her just how much lettuce she was eating before her swims, she
replied, “A head.”
A head of lettuce contains about 10 grams of carbohydrate, which can
raise a type 1 adult’s blood sugar about 50 mg/dl at most. So
what accounts for the other 160 mg/dl rise in her blood sugar?
The explanation lies in what I call the Chinese restaurant effect.
Often Chinese restaurant meals contain large amounts of protein or slow-acting,
low-carbohydrate foods, such as bean sprouts, bok choy, mushrooms, bamboo
shoots, and water chestnuts, that can make you feel full.
How can these low-carbohydrate foods affect blood sugar so
dramatically?
The upper part of the small intestine contains cells that release hormones
into the bloodstream when they are stretched, as after a meal. These
hormones signal the pancreas to produce some insulin to prevent the
blood sugar rise that might otherwise follow the digestion of a meal.
Large meals will cause greater stretching of the intestinal cells, which
in turn will secrete proportionately larger amounts of these hormones.
Since a very small amount of insulin released by the pancreas can cause
a large drop in blood sugar, the pancreas simultaneously produces the
less potent hormone glucagon to offset the potential excess effect of
the insulin. If you’re diabetic and deficient in producing insulin,
you might not release insulin, but you will still release glucagon,
which will cause gluconeogenesis and glycogenolysis and thereby raise
your blood sugar. Thus, if you eat enough to feel stuffed, your blood
sugar can go up by a large amount, even if you eat something undigestible,
such as sawdust.
The first lesson here is: Don’t stuff yourself. The second lesson
is:
There’s no such thing as a freebie.* Any solid food that you eat
can raise your blood sugar.
THE EFFECTS OF EXERCISE UPON
BLOOD SUGAR
Exercise can have varying effects upon blood sugar, depending upon a
number of variables, including the type of exercise, how vigorously
it’s performed, when it is performed, and what type of medication
you are using, if any. These effects are too varied and numerous to
discuss in this brief space. Please see Chapter 14,“Using Exercise
to Enhance Insulin Sensitivity,” if you are embarking on an exercise
program or find your blood sugars unpredictably affected by your existing
exercise program.
THE HONEYMOON PERIOD
At the time they are diagnosed, type 1 diabetics usually have experienced
very high blood sugars that cause a host of unpleasant symptoms, such
as weight loss, frequent urination, and severe thirst. These symptoms
subside soon after treatment with injected insulin begins.
After a few weeks of insulin therapy, many patients experience a dramatic
reduction of insulin requirements, almost as if the diabetes were reversing.
Blood sugars may become nearly normal, even with low insulin doses.
This benign “honeymoon period” may last weeks, months, or
even as long as a year. If the medical treatment is conventional, the
honeymoon period eventually terminates and the well-known roller coaster
of blood sugar swings ensues.
Why doesn’t the honeymoon period last forever? My experience
with patients indicates that it can, with proper treatment. But there
are several likely reasons why it does not with conventional treatment.
At this writing, however, they still remain speculative.
• The normal human pancreas contains many more insulin producing
beta cells than are necessary for maintaining normal blood sugars. For
blood sugar to increase abnormally, at least 80 percent of the beta
cells must have been destroyed. In early type 1 diabetes, many of the
remaining 20 percent have been weakened by glucose toxicity from constant
high blood sugars and by overwork.
• These beta cells can recover if they are given a rest with
the help of injected insulin. Even if they recover, however, they still
must work at least five times as hard to match the job of a normal pancreas
working at 100 percent capacity. Eventually, with conventional treatment,
this overwork causes them to break down.
• It is now believed that high blood glucose levels are toxic
to beta cells. Even a brief blood sugar increase after a high-carbohydrate
meal may take a small toll. Over time, the cumulative effect may wipe
them out completely.
• The autoimmune attack upon beta cells, the presumed cause of
type 1 diabetes, is focused upon several proteins. One is insulin, and
another is present on the special vesicles—or bubbles— that
are formed at the outer membrane of the beta cell. These vesicles contain
insulin. Normally, they burst at the surface of the cell, releasing
insulin granules into the bloodstream. The more vesicles created when
more insulin is manufactured, the greater the autoimmune attack upon
the beta cell. If less insulin is released, less of this protein is
exposed to attack.
Based upon my experience with the fair number of type 1 diabetics I’ve
treated from the time of diagnosis, I’m convinced that the honeymoon
period can be prolonged indefinitely. The trick is to assist the pancreas
and keep it as quiescent as possible. With the meticulous use of small
doses of injected insulin and with the essential use of a very low carbohydrate
diet, the remaining capacity of the pancreas, I believe, can be preserved.
* Except for noncaloric fluids that flow through the intestines without
causing distention.
Reprinted from Diabetes Solution New and Revised
2003 Chapter 6
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Biology Part 5
PHENOMENA PECULIAR TO DIABETES THAT CAN AFFECT BLOOD SUGAR
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Strange
Biology Part 4
PHENOMENA PECULIAR TO DIABETES THAT CAN AFFECT BLOOD SUGAR
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Strange
Biology Part 3
PHENOMENA PECULIAR TO DIABETES THAT CAN AFFECT BLOOD SUGAR
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Strange
Biology Part 2
PHENOMENA PECULIAR TO DIABETES THAT CAN AFFECT BLOOD SUGAR
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Strange
Biology Part 1
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.
