Understanding Diabetes: A Closer Look at Carbohydrate Metabolism

Diabetes, characterized by chronically elevated blood sugar levels, is primarily a disease of carbohydrate metabolism, distinct from fat or cholesterol issues. This condition arises when the pancreas fails to produce enough insulin or when the body becomes resistant to insulin's effects.

Upon consuming carbohydrates like pasta or vegetables, the digestive system breaks them down into glucose, a simple sugar that enters the bloodstream to fuel cells. The beta cells in the islet of Langerhans respond to rising blood sugar levels by releasing insulin. This hormone facilitates the transfer of sugar into liver and muscle cells for storage, preventing excessive blood sugar levels.

Research indicates that sustained high blood sugar levels increase the risk of developing diabetes. Recent studies emphasize the multifaceted factors influencing diabetes, including genetic predispositions and lifestyle choices. Advances in diabetes management have introduced innovative treatment options, such as continuous glucose monitoring systems and personalized insulin delivery.

In modern medicine, the focus extends beyond glycemic control to encompass holistic approaches, including diet modification, regular exercise, and medication tailored to individual needs. By addressing the underlying mechanisms of carbohydrate metabolism, medical professionals aim to enhance patient outcomes and mitigate the long-term complications associated with diabetes.
Understanding Diabetes: A Closer Look at Carbohydrate Metabolism

Green tea can reduce the risk of developing diabetes

In comparison to black tea and oolong tea, green tea (GT) contains greater quantities of cate-chins, which are strong antioxidants in vitro and in vivo. The presence of high amount of polyphenols in green tea makes it very important in the prevention of different diseases.

Green tea extract has many naturally occurring biological components of which polyphenolic epicatechins (ECs) are predominantly active. These include (–)-epigallocatechin-3-gallate (EGCG), (–)-epigallocatechin (EGC), (–)-epicatechin-3-gallate (ECG), and (–)-EC. The EC and EGC are catechol catechins, EGC and EGCG are pyrogallol catechins, and ECG and EGCG are gallate catechins.

So far green tea was shown to have many impacts in carbohydrate metabolism. Epidemiologic studies have shown that the consumption of green tea may reduce bodyweight and fat accumulation by improving glucose and lipid metabolism, and it has also been shown that green tea extract and EGCG ameliorate hyperglycemia and insulin resistance in humans and animals.

Green tea is considered as an alternative medicine for diabetes mellitus. The pathology of diabetes mellitus is caused by reactive oxygen species that activate the non-enzymatic glycation of proteins (leads to structural and functional changes), the aldose reductase pathway (causes sorbitol accumulation) and oxidative stress (results in protein, DNA and lipid damage).

Polyphenols in green tea reduce carbohydrate digestion and absorption in the intestine by inhibiting carbohydrate digesting enzymes and inhibiting glucose transporters across the intestine.

The anti-oxidant effect of green tea is because of its polyphenol cathechine components to scavenge ROS. Catechins from tea suppress the absorption of glucose from the small intestine by inhibiting α-glucosidase activity.

They are also shown to increase secretion of insulin by pancreatic β cells and protect cytokine induced inflammatory damage of these cells. Increasing insulin activity and maintaining glucose homeostasis are other mechanisms by which green tea is involved in carbohydrate metabolism.
Green tea can reduce the risk of developing diabetes 

Properties of glucose

D-Glucose, the most abundant carbohydrate and the most abundant organic compound (if all its combined forms are considered), belongs to the class of carbohydrates called monosaccharides. Monosaccharides are carbohydrate molecules that cannot be broken down to simpler carbohydrate molecules by hydrolysis, so they are sometimes referred to as simple sugars.

Glucose(C6H12O6), also called dextrose is a hexose -- a monosaccharide containing six carbon atoms. Five of the carbons plus an oxygen atom form a loop called a "pyranose ring", the most stable form for six-carbon aldoses. In this ring, each carbon is linked to hydroxyl and hydrogen side groups with the exception of the fifth atom, which links to a 6th carbon atom outside the ring, forming a CH2OH group. This ring structure exists in equilibrium with a more reactive acyclic form, which makes up 0.0026% at pH 7.

Glucose is found in fruits and honey and is the major free sugar circulating in the blood of higher animals.

D-Glucose is both a polyalcohol and an aldehyde. It is classified as an aldose, a designation for sugars containing an aldehyde group. The ending -ose signifies a sugar and- ald signifies an aldehyde group.

Other properties of glucose including:
Can be either solid or liquid
Melting Point: 294.8˚F(146˚C)
Density: 1.54 g/cm³
Weight: 180.16 g/mol
Soluble in water and acetic acid
Sweet taste
No odor
Colourless and is also clear

In diabetes mellitus excess of glucose is converted to sorbitol. The osmotic effect of sorbitol is responsible for many of the complications of diabetes mellitus e.g. cataract formation in lens.
Properties of glucose

Coffee consumption reduced the risk of diabetes

According to a study from the University of California at San Diego coffee drinkers are less to develop pre-diabetes and type 2 diabetes than those who don’t sip.

Drinking as little as one cup of coffee daily reduced the risk of type 2 diabetes by 60 percent compared to people who never drink coffee.

Published in the November 2006 issue of Diabetes Care, the study revealed that coffee offered protection at the same, significant levels for those beginning the study with high fasting glucose levels, indicating pre-existing glucose intolerance, as it did for those with normal levels.

In fact, those with elevated glucose levels showed a lower risk of developing diabetes than those starting out with normal glucose tolerance.

In another study by University of Minnesota in 1997, the experts suspected that compounds and mineral in coffee beans may improve the sensitivity of insulin receptors and help the body process bloods sugar more efficiently.

Please note that these studies pertain to preventing diabetes. Unfortunately most people consume their coffee loaded with sugar and cream that are likely to raise blood sugar as well.

Uncovering the first evidence that coffee also reduces diabetes risk among pre-diabetics, the risk level came in even lower, at 0.31, for the subgroup with impaired glucose. That means pre-diabetics reduced their risk of developing the disease by almost 70%.

Diabetes is the fifth leading cause of death by disease in the United States. Diabetics are also at higher risk for heart disease, blindness, kidney failure, extremity amputations and other chronic conditions.

For diabetics 
However there’s a caffeine caution: caffeinated beverages can spike blood sugar for thirty minutes after consuming them, so some experts suggest to switching to decaf coffee if you have diabetes, of drinking tea which has considerably less caffeine than coffee.

In research findings published in mid 2004 in Diabetes Care researchers at the Duke University Medical Center in North Carolina found that caffeine interferes with the blood sugar control: they found a strong correlation between caffeine intake at mealtime and increased glucose and insulin levels among people with type 2 diabetes.
Coffee consumption reduced the risk of diabetes

Symptoms of hyperglycemia

Hyperglycemia can be defined as elevated serum glucose levels. It occurs naturally as the result of infection, illness, inflammation, and psychological stress. However, it is typically more severe in patents with type 1 or type-2 diabetes.

Hyperglycemia, if untreated, can develop into ketoacidosis which is very serious and can be fatal. The earliest signs of hyperglycemia may include:
*Headaches
*Increased thirst *Blurred vision
*Difficulty in concentrating
*Fatigue
*Frequent urination
*Blood glucose more than 10 mg/dL
*Weight loss
*Dry mouth or skin
*Slow healing of cuts and sores
*Excessive hunger
*Thickening of blood

Hyperglycemia is relatively common in hospitalized patients because of increased insulin demands and resistance during times of stress or illness, altered oral intake and altered medication regimens.
Symptoms of hyperglycemia

Sucrose

Sucrose also known as table sugar, cane sugar or beet sugar is made of one molecule of glucose and molecule of fructose. It provides 4 calories/g as do other carbohydrates.

Sucrose is used extensively in food processing for sweetness and flavor enhancement, and it also occurs naturally in many foods. It is a pleasant tasting substance that contributes of the sweetness in human diet.

Scientific evidence shows that the use of moderate amounts of sucrose does not impair blood glucose control in people with diabetes.

Sucrose

Once the glucose and fructose derived from the digestion of sucrose enter the bloodstream, blood sugar levels start to increase.

If the pancreas, the organ responsible of producing insulin to control blood sugar levels, is healthy, blood sugar levels are not likely to increase too much after eating sucrose. A healthy pancreas can compensate for a high sucrose intake.

Very high sucrose intake may contribute to the development of obesity and hyperlipidaemia. Sucrose has many functional roles in foods which extend beyond its sweetness, including preservative, textural and flavor modifying qualities.
Sucrose

Vitamin C and diabetes

Vitamin C seems to be important in the immune system and in the manufacture and metabolism of neurotransmitters and hormones.

Numerous studies have shown that vitamin C plasma levels are about 30 percent lower in people with diabetes, as compared with people who do not have diabetes.

Insulin facilitates the transport of vitamin C into the cells. People with type 2 diabetes, however, are resistance to their own insulin and not enough insulin enters their cells.

So when there is an insulin deficiency, there will be a deficiency in intracellular vitamin C – thus the relative deficiency in vitamin C in many diabetics, even if they consume an adequate amount of vitamin in their diet.

This lead to a subclinical scurvy problem, which creates an increased tendency to bleed, poor wound healing, microvascular disease, heart disease, elevation of cholesterol and a depressed immune system.

In one study, researchers found that high doses of vitamin C markedly improved blood sugar regulation in people with non-insulin-dependent diabetes mellitus. In another study, it was observed that vitamin C enhanced glucose disposal by enhancing insulin sensitivity without affecting insulin secretion.

Vitamin C has also been shown to improve blood vessel dilation, which is often impaired in people with diabetes.

A large population-based study in England, published in 2000, showed that the people with the lowest long-term blood sugar levels had the highest levels of vitamin C and vice versa.
Vitamin C and diabetes

Wolfram syndrome

Wolfram syndrome is the inherited association of childhood-onset mellitus and progressive-onset optic atrophy.

This syndrome dates from the 1938 report by Wolfram and Wagener of a constellation of diabetes insipidus, diabetes mellitus, optic atrophy and sensorineural deafness, which gave rise to the acronym DIDMOAD.

Wolfram syndrome is inherited in an autosomal-recessive manner. The prevalence is believed to be approximately 1 in 500,000 children. A carrier of mutations causing Wolfram syndrome have a significantly higher chance of developing disturbances and may have a higher chance of developing diabetes and hearing impairment.

Wolfram syndrome is a heterogeneous condition, with two forms identified to date. These are designated Wolfram syndrome 1 and Wolfram syndrome 2 or WFS1 and WFS2 respectively.

Progressive optic atrophy is usually diagnosed before 12 years of age. Other clinical signs may appear at various ages before 25 years.
Wolfram syndrome

Gestational diabetes

Gestational diabetes mellitus is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Gestational diabetes begins during pregnancy and disappears following delivery.

Gestational diabetes affects approximately 7% of all pregnant women; 200,000 cases are diagnosed each year.

Any women might develop gestational diabetes during pregnancy. It is most common in obese women and in those over 30 years old.  Some factors associated with women who have an increased risk
*Obesity
*Family history
*Given birth previously to a large infant, or still birth or a child with a birth defect
*Having too much amniotic fluid

Unlike women with Type I diabetes, women with gestational diabetes have plenty of insulin. In fact, they usually have more insulin in their blood than women who are not pregnant.

However, the effect of their insulin is partially blocked by a variety of other hormones made in the placenta, a condition often called insulin resistance.

The complications of gestational diabetes are manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of gestational diabetes is made.
Gestational diabetes

Is mango good for diabetes?

A popular fruit, the mango is known for its saccharine sweet, juicy flesh when ripe.

Apart from its culinary uses, the mango is perceived to have great medicinal value. It is well known for its medical properties both in unripe and ripe states.

Eating mango everyday can help people fighting against high cholesterol as well as diabetes. A study conducted in 2006 at the University of Queensland, Australia indicates that ripe mangoes contain chemicals that act in manner similar to the drugs used for treating diabetes and cholesterol.

What is diabetes? Diabetes occurs for a number of reasons, but the ultimate cause of the high blood sugar that characterizes the disorder is either deficiency of the hormone insulin or a combination of insulin deficiency and resistance of the body tissues to its actions.

Taking juice of mango is good for controlling diabetes. Research suggests some compounds in mangoes work by activating or inhibiting groups of receptors known as peroxisome proliferator-activated receptors. 

The tender leaves of the mango tree are also considered useful in diabetes.
Is mango good for diabetes?

What is diabetes insipidus?

Diabetes insipidus is a syndrome characterized by polyuria, thirst and polydipsia triggered by plasma hyperosmolarity.

In adults, the urine volume exceeds 2.5 L per 24 hours (>40 mL/kg per 24 hours), while in children the output is greater (>100mL/kg per 24 hours).

The term diabetes insipidus is derived from the Greek ‘diabainein’ meaning to pass through and from Latin ‘insipidus’ meaning tasteless.

Diabetes insipidus is confirmed in polyuric patients by the demonstration of insignificant antidiuresis or by the production of hypertonic urine following water restriction or hypertonic saline infusions.

Diabetes insipidus has multiple causes. It is usually due to a tumor (craniopharyngioma, lymphoma, pituitary tumor) or to an infiltrative, inflammatory or infectious process affecting the hyphothalamic-pituitary axis. Some experts believe diabetes insipidus may form of autoimmune disorder.

Diabetes insipidus may be also an inherited disease. Hereditary forms of diabetes insipidus are called familial neurohypophysial diabetes insipidus.

Diabetes insipidus can be divided into four different types pituitary, central, neurogenic or neurohypophyseal. It may occur abruptly in individuals of any age, although it is more common among adults.
What is diabetes insipidus?

Association between diabetes and obesity

Data from the United States from the Health Professional’s Follow-up Study in men and the Nurses’ Health Study in women illustrates the increasing risk of diabetes that obesity brings.

Where the populations have changed their lifestyle and become more obese an epidemic of type 2 diabetes has followed on. Environmental risk factors attributed to the global increase obesity include the consumption of high calorie, high fat foods and inadequate physical activity.

Abdominal obesity in humans is a genetically controlled phenotype that constitutes a major risk factor for the development of type II diabetes.

The three major defects are found in type II diabetes: impaired insulin secretion; diminished insulin action in skeletal muscle, liver and adipose tissue; and excessive hepatic glucose production, secondary to hepatic insulin resistance. Of these abnormalities, insulin resistance is a characteristic feature at is commonly seen in both type II diabetes and obesity.

Both diabetes and obesity confer an elevated risk of developing diseases, hypertension and stroke, which can complicate disease management.

In Asia Pacific region, the relative risk of type 2 diabetes increases as BMI above 23 and the association was found to be stronger on younger age. Weight gain in early adulthood is related to a higher risk and earlier onset of type 2 diabetes than is weight gain between 40 and 55 years of age.
Association between diabetes and obesity

Cardiovascular disease and diabetes

Cardiovascular disease is a common cause of morbidity and mortality in people with diabetes. About 75 percent of people with diabetes die from heart disease or stroke.

Abnormalities in the concentration of lipids and lipoprotein in plasma have been reported to occur in almost 30% of persons with diabetes.

The risk for cardiovascular disease is directly proportional to the concentration of low-density lipoprotein (LDL) cholesterol and inversely proportional to the concentration of high density lipoprotein cholesterol. 

Several epidemiologic studies have shown repeatedly that individuals with diabetes have a high risk of cardiovascular disease in individuals without diabetes.

These suggest that men have a 2-3 fold higher risk of cardiovascular mortality than non-diabetic people. The relative risk is greater for women who have a 4-5 fold higher risk of cardiovascular mortality than their non-diabetic counterparts.

Diabetes is also a poor prognostic factor post myocardial infarction (MI); diabetic patients have a higher inhospitable mortality and post discharge mortality than non-diabetic patients, and a higher risk of infarct-related complications.

Middle age people with type 2 diabetes have the same high risk for heart attack as people without diabetes who already have had a heart attack.

Type 1 which is characterized by an absolute loss of beta cells such that there is almost a total absence of insulin secretion, the patients have increased cardiovascular risk factors as a consequence of their hyperglycemia.

Patients with type 1 diabetes may develop nephropathy as a consequence of poor glycemic control. In the early stages of diabetic nephropathy, thickening of the glomerulus occurs.

The increase in blood pressure and hyperlipidemia that result from diabetic nephropathy is responsible for a significant proportion of the increased risk. Diabetic nephropathy is a major predictor of premature death among Type 1 patients.
Cardiovascular disease and diabetes

Brussels sprout and diabetes

Diabetes is a metabolic disorder involving inefficient production and/or use of insulin.

Brussels sprout can be juiced and used to treat diabetes, as they strengthen pancreatic function and stimulate the production of insulin.

Diabetes can increase body’s requirements for both glutathione and lipoic acid. Lipoic acid increases glutathione levels by helping cells absorb a critical amino acid needed for its synthesis and it works to prevent stroke, heart attacks, peripheral nerve damage and cataracts as well as memory loss, cancer and aging effects.

Brussels sprout is a good source of alpha lipoic acid. Alpha-lipoic acid acts as a lipophilic free-radical scavenger. It can assist in repairing oxidative damage and regenerate endogenous antioxidants such as vitamin C, vitamin E and glutathione.

Lipoic acid supplements may normalize diabetes-induced kidney dysfunction and damage to nerve cells. where it additionally promote nerve fiber regeneration and stimulates a substance known as nerve growth factor.

Brussels sprouts is a good food source of vitamin E. Vitamin E improves the cardiovascular system in Type II diabetics. Vitamin E also helps to lower blood cholesterol.

Vitamin E needs increase with diabetes and this vitamin can help to decrease the amount of insulin required.
Brussels sprout and diabetes

Vitamin D and diabetes

Diabetes mellitus is a common disease in Western world, with an estimated prevalence of 4 to 5%.

An estimated 19 million people are affected by diabetes in the EU 25, equal to four per cent of the total population. This figure is projected to increase to 26 million by 2030.

In the US, there are over 20 million people with diabetes, equal to seven per cent of the population.

There is a suggestion has been made that vitamin D insufficiency is the fundamental feature of the metabolic syndrome, leading to is various clinical manifestations. There was a study in Netherlands shows that the lower the vitamin D level, the greater the intolerance to glucose.

In animal studies by the University of California at Riverside showed that vitamin D is necessary for the pancreas to release insulin. Vitamin D deficiency produces insulin resistance in tissues.

Vitamin D actually directly acts on the muscle and fat cells to improve insulin action by reducing insulin resistance.

Vitamin D directly improves insulin production and its action by improving the level of calcium inside the cells. Vitamin D deficiency has been shown to impair insulin synthesis and secretion in humans and in animal model of diabetes.

This vitamin needed to maintain adequate blood levels of insulin. Actually levels of vitamin D are associated with control of many things that cause complications in diabetes: higher levels of HDL-C, lower levels of LDL-C, and better blood pressure control.

Vitamin D would appear to have a potential role in the prevention of diabetes and the metabolic syndrome.

Vitamin D and diabetes

Fructose and Diabetes

Fructose is a monosaccharide which is abundant in nature. It is the sweetest naturally occurring carbohydrate.

Fructose is absorbed somewhat more slowly from the intestines and makes its way to the liver without causing the pancreas to release insulin.

Fructose undergoes no active absorption in the intestine mucosa but is slowly and incompletely absorbed by facilitated diffusion.

The liver does convert fructose to glucose, which goes into the bloodstream. Fructose also is converted to glycogen, lactate and to a small extent to triglyceride.

But because the process takes time and is without the ups and downs of sugar levels that may occur with sucrose, doctors have long allowed diabetics patients with ample natural to use fructose as a sweetener.

A high intake of fructose will increase the body fat. Fructose can also raise the blood glucose by stimulating glucose production in the lever.

One of the difficulties doctors already have is getting obese adult diabetics to avoid unnecessary calories.

Because fructose is a carbohydrate with just as many calories as sugar, many doctors see it as more of a problem than a solution.

The use of added fructose as a sweetening agent in the diabetic diet is not recommended.

However there is no reason to avoid fructose that occurs naturally in fruits and vegetables. It is a modest component of energy intake and should not be of concern.

Fructose from these sources usually accounts for only 3-4% of energy intake.

Fructose and Diabetes