Role Of Sugar In Diabetic Treatment

Role Of Sugar In Diabetic Treatment

Dr. Prasad. M.V . MBBS

Dr. Prasad’s DCRC

Kenichira, Wayanad

 

Since time immemorial there is a belief among the Diabetic patients that they must abstain from consuming direct sugar. Also most medical practitioners advice their patients to avoid sugar and carbohydrate in their diet in order to maintain normal glucose levels. It is time to rethink this old-fashioned general practice.

In earlier times, a rise in blood sugar level was diagnosed as diabetes and the actual cause like reduced insulin production, insulin resistance or reduced insulin sensitivity was not interpreted correctly. Foods that caused a sudden spike in blood sugar levels were avoided (mainly sugar products) as that was the only proven solution found to maintain normal blood sugar levels. But this abstinence from sugar/glucose may suppress the already lazy pancreas in type-11 diabetes

Previously it was interpreted that the change in blood sugar values controlled the production and the release of insulin from the beta cells of pancreas, but now it is proved that major share of insulin release is controlled by Incretins – (GIP & GLP-1) of the small intestine. (Incretins are gut hormones that are secreted from enteroendocrine cells into the blood within minutes after eating. One of their many physiological roles is to regulate the amount of insulin that is secreted after eating.) GIP is produced from the k.cells of the duodenum and proximal jejunum. GLP-1 is produced by the L-cells of the ileum and distal jejunum. (The best stimulant for Incretin hormone is oral glucose).

Incretin effect can be explained with a simple example, when an exhausted athlete is given some sugar/glucose, it will give an instant energy boost and he will be energized quickly, whereas any other slow carbohydrate foods will not have the same effect (will not energize the athlete quickly). This is because only insulin can restore the depleted glucose of the concerned skeletal muscles. Glucose is the sole substance which can stimulate the GIP of the duodenum so fast, and the stimulation of beta cells through this incretin activation will release maximum insulin which facilitate the transfer of blood glucose quickly into the muscles. Slow carbohydrate will take even hours to get converted to glucose, which will not provide the quick Incretin effect and the slow conversion gradually increase the blood sugar also, without providing the effect the fasting insulin presence in blood is explained by the presence of residual glucose present in the intestine after digestion and prior to absorption. Presence of glucose in stool, explains the continues GLP-1 stimulation causing the basal release of insulin in the fasting state. 

When an individual is less active and not involved in any heavy work or exercise, blood flow to all organs, and peripheral cells will be reduced due to the excess LDL-C accumulation in the blood vessel walls. This will lead to plaque formation which increases in size gradually, if the food we eat is not converted into energy.This is the same reason, at the age of 30 or 40, our current generation is having a decreased blood flow which contributes to many lifestyle diseases.The extra effort put by heart in pumping blood to all peripheral cells will explain the increase in blood pressure. The reduced flow of blood to pancreas through pancreatic artery will make the beta cells lazy as well as aged which leads to reduced production and release of insulin from pancreas. This gradually raises the blood sugar and symptoms arise.

If the blood sugar level is higher than normal range for an individual, their very first treatment plan is to cut down all sugar products and sweets from their diet. (which as per their belief system will help them maintain normal blood glucose level.) This will reduce the oral stimulation of Incretins and the already lazy beta cells will stop insulin production and release and will pertain to the basal release and production only, according to the slow incretin effect due to slowly digested glucose. After few months or years, lot of beta cells will be dormant or sleeping, leading to reduced production and release of  insulin.

The reduced blood flow to all peripheral cells and organs will result in BMR reduction, leading to reduced glucose demand in cells. Lack of exercise aggravates this and thus insulin resistance and reduced insulin sensitivity is well explained. This can be overcome only through regular exercise. Thus laziness of the beta cells can be tackled with continuous stimulation of Incretins. Continuous Incretin stimulation will increase the biosynthesis of insulin, reduce apoptosis of beta cells, increase the release of insulin and increase the beta cell mass. 

So, judicial blending of oral glucose and planned regular exercise can uplift the pancreas, reduce the insulin resistance and increase the insulin sensitivity. Regular exercise can also benefit physical fitness and overall health as it will prevent the aging process as well as onset of  many life style diseases. Diabetic patients can have a healthy living, if we practice the method after understanding the basic science, of exercise and incretin effect.