ROSLIANIE BINTI ROSELYML-5092013

People who suffer from diabetes mellitus, and therefore require insulin, can use this measurement unit to compare the blood-sugar-effectiveness of carbohydrates in different foods.

According to German dietary regulations, one bread exchange unit (1 BEU) corresponds to a quantity of food that contains 12 grams of digestible and, therefore, blood-sugar-effective carbohydrates – present in different forms of sugar and starch.

The carbohydrate exchange unit is also used alongside the bread exchange unit. This, however, refers to 10 grams of carbohydrates. So-called carbohydrate exchange tables allow people with diabetes to check how many grams of food (containing carbohydrates) correspond to one bread exchange unit or one carbohydrate exchange unit.

They can then use this to determine the necessary quantity of insulin or to create their own individual dietary plan. One BEU can correspond, for example, to the carbohydrate content of the following foods: 25g bread, 65g potatoes, 100g apples, 250g milk.

The blood glucose level is the amount of glucose (sugar) present in the blood of a human or animal. The body naturally tightly regulates blood glucose levels as a part of metabolic homeostasis.

The mean normal blood glucose level in humans is about 5.5 mM (5.5 mmol/L or 100 mg/dL, i.e. milligrams/deciliter)

Glucose levels are usually lowest in the morning, before the first meal of the day (termed "the fasting level"), and rise after meals for an hour or two by a few millimolar. The normal blood glucose level (tested while fasting) for non-diabetics, should be between 70 and 100 milligrams per deciliter (mg/dL)

Carbohydrates are the most important providers of energy for the body. 1 gram of carbohydrates has 4,1 kcal of energy. About 45 – 60% of the daily total energy should come from carbohydrates. Contrary to fat and protein carbohydrates increase blood sugar levels (except dietary fibres). Digestion of carbohydrates leads to sugar (glucose) which will higher the blood sugar. Insulin-dependent diabetics have to make sure that the intake of carbohydrates matches the insulin dose to avoid hypo- or hyperglycemia. The calculation of the carbohydrates is done in some countries like Austria or Germany in Bread Units (BE). But also in other countries carb counting gets more and more popular. 

One Bread Unit of a certain food contains about 10 – 12g carbohydrates. It is useful for diabetics to prefer food which leads only to slow increase of blood sugar – we are talking about Glycemic Index. This Glycemic Index helps to judge different kind of food after its blood sugar increasing effect. The speed of the increase of blood sugar depends on composition of a meal and now it is prepared. Food low in dietetic fibres or intensively cooked leads to quick increase of blood sugar whereas food which has not be cooked or is rich in fibres leads to slow increase of blood sugar. Food with high Glycemic Index (75 – 100%): glucose tablets, honey, softdrinks, fruit juices, white bread, starch flour, cornflakes. Food with middle Glycemic Index (50 - 75%): potatoes, rice, noodles, mixed bread, muesli Food with low Glycemic Index (30 – 50%): whole meal products, vegetables, fruits, legumes, milk products..

GRAPH DESCRIBING THE RISE OF BLOOD SUGAR AFTER MEALS

The glycemic index(GI) provides a measure of how quickly blood sugar levels (i.e., levels of glucose in the blood) rise after eating a particular type of food. The effects that different foods have on blood sugar levels vary considerably.

The glycemic index estimates how much each gram of available carbohydrate (total carbohydrate minus fiber) in a food raises a person's blood glucose level following consumption of the food, relative to consumption of pure glucose.Glucose has a glycemic index of 100.

NORMAL FOOD PYRAMID

DIABETES FOOD PYRAMID

The glycemic index (GI) is a measure of the power of foods (or specifically the carbohydrate in a food) to raise blood sugar (glucose) levels after being eaten

EXAMPLE: The GI value of a food is determined by feeding 10 or more healthy people

a portion of the food containing 50 grams of digestible (available) carbohydrate and then measuring the effect on their blood glucose levels over the next two hours. For each person, the area under their two-hour blood glucose response (glucose AUC) for this food is then measured. On another occasion, the same 10 people consume an equal-carbohydrate portion of glucose sugar (the reference food) and their two-hour blood glucose response is also measured. A GI value for the test food is then calculated for each person by dividing their glucose AUC for the test food by their glucose AUC for the reference food. The final GI value for the test food is the average GI value for the 10 people.

Foods with a high GI score contain rapidly digested carbohydrate, which produces a large rapid rise and fall in the level of blood glucose. In contrast, foods with a low GI score contain slowly digested carbohydrate, which produces a gradual, relatively low rise in the level of blood glucose.

Since insulin helps glucose get into cells where energy is made, insulin is vital to fueling the body. However, too much insulin secretion over long periods of time can cause problems. Research shows that prolonged exposure to elevated levels of insulin can cause: high triglycerides high "bad" LDL cholesterol Low "good" HDL cholesterol high blood pressure insulin resistance increased appetite obesity risk of developing or exacerbating type 2 diabetes

When a certain combination of these disease-promoting factors is present all at once, the constellation of symptoms is called Metabolic Syndrome. The presence of these symptoms also raises a person's risk of cardiovascular disease, diabetes, and prostate or breast cancer.

When insulin levels stay high, our endocrine system can start out on a rollercoaster ride in which the body tries to adjust to its perpetually high insulin level with changes in other hormone levels that can leave us both tired, hungry, and on a course toward increased risk of cardiovascular disease and type 2 diabetes.

Short-acting insulin covers your insulin needs during meals. It is taken about 30 minutes to an hour before a meal to help control blood sugar levels. 

This type of insulin takes effect in about 30 minutes to one hour, and peaks after two to four hours. Its effects tend to last about five to eight hours. 

“The biggest advantage of short-acting insulin is that you don't have to take it at each meal. You can take it at breakfast and supper and still have good control because it lasts a little longer

A hypoglycemia (short: hypo) has a tight relation to the diabetes therapy and can catch every diabetic treated with insulin or blood-sugar lowering oral drugs (sulfonyl urea). If blood glucose is lower than 60 mg/dl (3.3 mmol/l) the body – especially the brain - lacks sugar and therefore energy. Typical warning symptoms can occur at blood sugar values of 80 mg/dl (4.4 mmol/l) or higher if blood glucose goes down very quickly. Hypoglycaemia can developed within some minutes.Causes: Injection of a too high dose of insulin or intake of too much of an oral drug Patient forgot to eat Increased activity without additional intake of carbohydrates Diarrhoea High consumption of alcohol  The symptoms are different, depending on how fast or how low sugar

levels fall down Typical symptoms:

Shakiness Increased frequency of the heart Cold sweat Low concentration level, dizziness Balance disorders

Hyperglycemia means for every diabetic a long-term menace of his health as high blood glucose levels over a longer period of time leads to damage of blood vessels and nerves.

The risk is high if the blood sugar level before meal is frequently above 120 mg/dl or above 160 mg/dl 2 hours after meal.

A hyperglycemia develops slowly (hours). Causes:

Too high amounts of blood sugar elevating foods Insulin dose too small Less activity than usual Febrile diseases Some medication (e.g. cortisol) Pregnancy Gain in weight Stress, anger

Typical symptoms: Thurst Increased urination Weakness Tiredness Bad wound-healing Dry skin Impaired vision Unindented weight los s

Chronic hyperglycemia imposes damage (glucose toxicity) on a number of cell types and is strongly correlated with the myriad of DM-related complications.

Tissues most vulnerable to the effects of prolonged elevated plasma glucose levels include pancreatic β cells and vascular endothelial cells.

The ensuing β-cell dysfunction promotes decreased insulin synthesis and secretion, further perpetuating the associated hyperglycemia. As for the vascular endothelium, chronic hyperglycemia is strongly correlated with many DM-related microvascular complications, including retinopathy, nephropathy, and neuropathy.