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Diabetes Update: Glycemic Index

Number 69; April 1, 2004

By David Mendosa


This newsletter keeps you up-to-date with new articles, Web pages, and books that I have written.

  • I list and link most of these on my Diabetes Directory at www.mendosa.com/diabetes.htm and in the site’s menu.

  • From time to time Diabetes Update may also include links to other Web pages of special interest.

Updates:

  • Meters
    Blood glucose meter technology is the fastest developing diabetes field. I seem to be updating my meters page almost every day. This month saw several important developments.

    Two meter manufacturers just sent me new or updated meters. The newest meter on the market in the EasyGluco, manufactured in Korea for US Diagnostics Inc. in New York City. Its specs aren’t bad — accurate results in 9 seconds with just a three microliter drop of blood. But what sets it apart from most other meters is the price. This system is value priced with a box of 50 strips selling for $17.95. The starter package including the meter, lancing device, 150 test strips and 150 lancets, is $49.95. The URL is
    http://www.usdiagnostics.net/index.php

    Meanwhile, Deb Edgecombe, associate product manager for the Accu-Chek Advantage, sent me their newest Accu-Chek Advantage meter. It has several new or improved features, including expanded memory to 480 values, 7,14, and 30 day averaging, downloading 3 ways: IR key; stereo jack cable; Accu-Chek Advantage cable, hypo indicator at a self-set level, and event marker.

    “The event marker on the Accu-Chek Advantage is an asterisk that I liken to a rubber band on your wrist,” Deb replied to my question about it. “It’s just a little flag that help you remember something was going on when you tested your blood sugar at that particular time. Much less sophisticated than [some] other meters, but on the other hand, much simpler!”

    The “other meters” that Deb referred to are the Accu-Chek Complete, the One Touch Profile, and One Touch UltraSmart. The Complete has eight programmable time blocks. Until the release of the UltraSmart, Profile was the only meter on the market that uses event markers help you flag test results with activities that affect blood glucose levels. These three meters offer a major advantage to anyone who tracks his or her blood glucose levels with diabetes software. Only when you key your readings to your activities — particularly meals and exercise — will the trends in your blood glucose levels make sense.

    Some 13 companies currently market a wide range of blood glucose meters. That’s a lot more than were available just five or ten years ago. But an astounding 50 plus companies have websites detailing their forthcoming non-invasive or minimally-invasive meters.

    One of the most recent such sites is that of DexCom, which is developing the first long-term implantable sensor for continuous monitoring. The March 2004 issue of Diabetes Care reported its first published results in “Improved Glucose Excursions Using an Implantable Real-Time Continuous Glucose Sensor in Adults With Type 1 Diabetes.” Full Disclosure: As of January 18, 2006, I own stock in DexCom (ticker symbol DXCM).

    Other new sites range from as far away as Israel to as close to home as the Central Coast of California. OrSense Ltd. in Rehovot, Israel, stops the flow of blood at the index finger by pressuring it gently, and then examining it with an optical probe using sophisticated algorithms. GluMetrics LLC in Marina, California, has developed a novel optical glucose sensor that glows in the presence of glucose. This technology can be used to measure blood sugar without the typical use of enzyme-based chemical reactions.

  • Protein Drinks
    In my review of Lucy Beale’s great new cookbook, The Complete Idiot’s Guide to Low-Carb Meals, in the previous issue of Diabetes Update, I mentioned in passing that Catherine and I usually have protein powder shakes for breakfast. Several people wrote to ask about them.

    Even though we don’t like a big breakfast, we love these shakes so much that we drink a big 16-ounce glass full each morning. They give us a high-protein start on the day with few carbs. In fact, we get less than 1 gram carb from the protein powder. The fruit that we add to it, however, adds somewhat more.

    Catherine likes frozen raspberries best. But I prefer frozen organic wild blueberries, for three reasons: taste, fewer carbs, and high ORAC value.

    ORAC? That’s the abbreviation of oxygen radical absorbance capacity, which quantifies the antioxidant capacity of foods. Dr. Guohua Cao, a physician and chemist at the Jean Mayer Human Nutrition Research Center on Aging at Tufts University, in Boston, developed the standardized ORAC assay, which measures the degree to which a sample inhibits the action of an oxidizing agent and how long it takes to do so.

    Dr. Cao and his associates have tested more than 40 foods for their ORAC values. Dr. Cao and Ronald Prior have demonstrated that blueberries have the highest antioxidant capacity of the different fruits and vegetables tested, although it might appear at first glance that prunes and raisins might be higher.

    The Drs. Eades in their book, The Protein Power LifePlan, have a most interesting section entitled "You Deserve ORAC Today" (pp. 120-123). They show the 10 fruits and 10 vegetables highest in oxygen radical absorbance capacity. While prunes rate highest with 5770 ORAC units per 100 grams and raisins are second with 2830, they say essentially that it’s comparing apples and oranges, because by having the water removed they are denser than other foods and that really the food highest in ORAC is blueberries, 2400.

    In March 2000 I wrote Dr. Cao to ask him about this interpretation. He replied the next day, “The information that the Drs. Eades present is correct.”

    The following table comes from “Can Foods Forestall Aging?” by Judy McBride, Agricultural Research, February 1999:

    Top Antioxidant Foods
    ORAC Units per 100 Grams
    Fruits Vegetables
    Prunes 5,770 Kale 1,770
    Raisins 2,830 Spinach 1,260
    Blueberries 2,400 Brussels sprouts 980
    Blackberries 2,036 Alfalfa sprouts 930
    Strawberries 1,540 Broccoli florets 890
    Raspberries 1,220 Beets 840
    Plums 949 Red bell pepper 710
    Oranges 750 Onion 450
    Grapes, red 739 Corn 400
    Cherries 670 Eggplant 390

    The ORAC value of blueberries is only one of three reasons why I prefer blueberries in my shake. One of the two other reasons — taste — is subjective. You preferences may differ as much from mine as my wife’s do. But the third reason, carbs, is objective. The half-cup of blueberries in my drink adds only 7 available carbs.

    We sweeten our drink with Splenda, which adds essentially zero carbs. A heaping tablespoon of ground flax meal doesn’t add any carbs either, while providing Omega 3 fatty acid and fiber.

    The protein powder that we buy comes from the Protein Factory in Brick, New Jersey. This company has excellent prices, top quality, and a wide variety (the downside is that they seem slow to ship and the powder comes in a heavy plastic bag instead of regular containers). I prefer their breakfast formula, unflavored but sweetened with Splenda. It has only one gram of carbohydrate per half cup, and we use about half of that amount per drink.

    I suppose that you could use water to make this drink, but that has never sounded appetizing enough for me. Catherine uses Lactaid (milk with its lactose broken down into glucose and galactose), but it has the same number of carb grams as regular milk, 13 grams per cup. I prefer to use Westsoy Unsweetened Soymilk, because it has only 1 gram of available carbohydrates per cup.

    All together I get less than 9 grams of available carbohydrate in my breakfast shake. That’s close to the 6 grams of carbohydrates for breakfast recommended by Dr. Richard K. Bernstein in the strictest low-carb diet.

    Neither Catherine or I look for variety in our breakfast shake. But one friend of mine has experimented a lot more, because his wife likes variety. Instead of blueberries or raspberries they add:

    1. Chocolate peanut butter — using chocolate powder and peanut butter
    2. Maple spice — using maple (no stevia) and cinnamon
    3. Almond spice (same as above with no maple)
    4. Coffee — usually made with chocolate as well
    5. Vanilla — good with a little nutmeg

    Just one more tip: Don’t even try to make these shakes with a hand-held (stick) blender. We have tried several, but none are strong enough to do it easily. Instead, use a good countertop blender.

  • Lacto-fermentation
    My recent article on Acidic Foods also generated a lot of email. I thought that messages from Kay Schmidt in Washington state were so interesting that we edited them into a single online update to the article. Kay says that using lacto-fermentation (pickling using whey instead of vinegar) lowers the carb contents of certain foods so much that it has little or no effect on blood glucose.
Diabetes Supplies:
  • BD Insulin Syringe with the BD Ultra-Fine II Short Needle
    Becton Dickinson is the leader in syringes and lancets. Never the cheapest, it is usually the quality producer. Again, it takes the market lead with the first 31 gauge syringe needles. Earlier, it introduced 31 gauge pen needles.

    The 31 gauge syringe needles are 8mm or 8 5/16", which is 37 percent shorter than the standard 12.7mm needle. BD emphasizes that you should consult with your health care professional before using the short needle and carefully monitor your blood glucose when changing to a shorter needle. That’s because it is possible that your jab won’t reach the muscle tissue it needs.

    Because the needles are shorter, it is possible to make then almost vanishingly thin with a special surgical grade of stainless steel. Catherine just got some of new needles and marveled to me how painless they are.

    These syringes are available in three barrel sizes — 1 cc, ½ cc and 3/10 cc. People who use the 3/10 cc version of this syringe can choose between a barrel with full-unit markings and BD’s new 3/10 cc barrel with a unique half-unit scale, which could help you make small insulin doses more precise.

  • A Promising Treatment for Neuropathy
    The original part of my website is a series of 16 long pages consisting of nothing but descriptions of and links to relevant diabetes websites and other online resources. The meters page mentioned above is one of them. Another is my neuropathy page. This is one of only two of these pages dealing with complications (the other is retinopathy).

    The neuropathy page is the first page dealing with complications that I added. There are two reasons for that: (1) it is probably the most common complication of diabetes and (2) one of the most intractable.

    My neuropathy page links many treatments for neuropathy. They range from tricyclic antidepressants, antiseizure drugs, opiates, capsaicin, and transcutaneous electrical nerve stimulation (TENS) to many rather far-out ideas. Some of these work some of the time for some people, but none of them are consistently helpful. Therefore, the medical establishment falls back to saying that the best thing is to bring down your A1C level.

    But one treatment that is receiving more and more attention is the use of monochromatic infrared energy to increase blood circulation to the nerves and the surrounding tissues. Anodyne Therapy LLC in Tampa, Florida manufacturers the Anodyne Therapy System, an FDA-approved device that uses a single wave-length of near-infrared energy. The site lists some one thousand centers throughout the U.S. that offer this treatment.

    There are now three clinical studies reported in peer reviewed medical journals that demonstrate the effectiveness of the Anodyne Therapy System in treating sensory peripheral neuropathy. I list these in the bibliography below.

    But what about the cost? If you are being treated by a physical therapist, Medicare and most private insurance carriers will cover this therapy (after normal deductibles and co-payments).

    Bibliography

    1. Kochman AB, Carnegie DH, Burke TJ. “Symptomatic reversal of peripheral neuropathy in diabetes,” Journal of the American Podiatric Medical Association, 2002 Mar, 92(3):125-30. Abstract online at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11904323&itool=iconabstr

    2. Leonard DR, Farooqi MH, Myers S. “Restoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy,” Diabetes Care, 2004 Jan;27(1):168-72. Abstract online at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14693984&itool=iconabstr

    3. Prendergast JJ, Miranda MA, Sanchez M. “Improvement of sensory impairment in patients with peripheral neuropathy,” Endocrine Practice, 2004 Jan-Feb;10(1):24-30. Not yet online.
Announcements:

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Archives:

I now send out Diabetes Update once a month. Previous issues are online:

  1. Diabetes Update Number 1: Diabetes Genes of December 10, 2000
  2. Diabetes Update Number 2: DiabetesWATCH of December 18, 2000
  3. Diabetes Update Number 3: Starlix of January 3, 2001
  4. Diabetes Update Number 4: Native Seeds/SEARCH, Tepary Beans of January 17, 2001
  5. Diabetes Update Number 5: Insulin Makes You Fat of January 31, 2001
  6. Diabetes Update Number 6: Available and Unavailable Carbohydrates of February 15, 2001
  7. Diabetes Update Number 7: Dates of March 1, 2001
  8. Diabetes Update Number 8: Quackwatch of March 15, 2001
  9. Diabetes Update Number 9: The Cost of Insulin of March 30, 2001
  10. Diabetes Update Number 10: Sof-Tact Meter of April 2, 2001
  11. Diabetes Update Number 11: iControlDiabetes of April 16, 2001
  12. Diabetes Update Number 12: Cinnamon, Tagatose of May 2, 2001
  13. Diabetes Update Number 13: Glycemic Index of May 15, 2001
  14. Diabetes Update Number 14: Eat Your Carrots! of May 31, 2001
  15. Diabetes Update Number 15: Glycemic Load of June 21, 2001
  16. Diabetes Update Number 16: Homocysteine of July 2, 2001
  17. Diabetes Update Number 17: Chana Dal Tips of July 15, 2001
  18. Diabetes Update Number 18: Lag Time in AlternativeLand of August 2, 2001
  19. Diabetes Update Number 19: Fiber of August 15, 2001
  20. Diabetes Update Number 20: How Diabetes Works of August 30, 2001
  21. Diabetes Update Number 21: Insulin Resistance of September 14, 2001
  22. Diabetes Update Number 22: Trans Fats, Honey, CU of October 1, 2001
  23. Diabetes Update Number 23: Pedometer Power of October 15, 2001
  24. Diabetes Update Number 24: Is Glycerin a Carbohydrate? of October 31, 2001
  25. Diabetes Update Number 25: Kill the Meter to Save It of November 15, 2001
  26. Diabetes Update Number 26: Protein, Fat, and the GI of December 1, 2001
  27. Diabetes Update Number 27: Insulin Index of December 14, 2001
  28. Diabetes Update Number 28: Fructose of January 4, 2002
  29. Diabetes Update Number 29: Aspirin of January 14, 2002
  30. Diabetes Update Number 30: Stevia of January 31, 2002
  31. Diabetes Update Number 31: Gretchen Becker’s Book of February 19, 2002
  32. Diabetes Update Number 32: The UKPDS of March 4, 2002
  33. Diabetes Update Number 33: Financial Aid of March 18, 2002
  34. Diabetes Update Number 34: Pre-Diabetes of April 1, 2002
  35. Diabetes Update Number 35: More Glycemic Indexes of April 15, 2002
  36. Diabetes Update Number 36: Gila Monsters of April 30, 2002
  37. Diabetes Update Number 37: Is INGAP a Cure? of May 15, 2002
  38. Diabetes Update Number 38: Native American Diabetes of June 3, 2002
  39. Diabetes Update Number 39: FDA Diabetes of June 19, 2002
  40. Diabetes Update Number 40: Diabetes Support Groups of July 1, 2002
  41. Diabetes Update Number 41: New GI and GL Table of July 15, 2002
  42. Diabetes Update Number 42: Diabetes Sight of August 1, 2002
  43. Diabetes Update Number 43: DrugDigest of August 18, 2002
  44. Diabetes Update Number 44: Hanuman Garden of September 3, 2002
  45. Diabetes Update Number 45: Guidelines of September 16, 2002
  46. Diabetes Update Number 46: Trans Fat of October 4, 2002
  47. Diabetes Update Number 47: Nutrition.Gov of October 16, 2002
  48. Diabetes Update Number 48: Our Hearts of October 31, 2002
  49. Diabetes Update Number 49: Our Kidneys of November 15, 2002
  50. Diabetes Update Number 50: A1C<7 of December 2, 2002
  51. Diabetes Update Number 51: Diabetes Searches with Google of December 16, 2002
  52. Diabetes Update Number 52: e-Patients of January 2, 2003
  53. Diabetes Update Number 53: Email News of January 16, 2003
  54. Diabetes Update Number 54: Third Generation Meters of January 31, 2003
  55. Diabetes Update Number 55: Hypoglycemic Supplies of February 14, 2003
  56. Diabetes Update Number 56: Food Police of March 1, 2003
  57. Diabetes Update Number 57: Vitamins of April 1, 2003
  58. Diabetes Update Number 58: Lancets of May 1, 2003
  59. Diabetes Update Number 59: Accurate Meters of June 1, 2003
  60. Diabetes Update Number 60: Chromium of July 1, 2003
  61. Diabetes Update Number 61: Traveling of August 1, 2003
  62. Diabetes Update Number 62: My Book of September 1, 2003
  63. Diabetes Update Number 63: Hot Tubs of October 1, 2003
  64. Diabetes Update Number 64: Home A1C Testing of November 1, 2003
  65. Diabetes Update Number 65: Detemir of December 1, 2003
  66. Diabetes Update Number 66: Erectile Dysfunction of January 1, 2004
  67. Diabetes Update Number 67: Acidic Foods of February 1, 2004
  68. Diabetes Update Number 68: Net Carbs of March 1, 2004


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