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A Word on Non-Nutritive Sweeteners

Non-nutritive sweeteners (NNS) include: Aspartame,(Nutrasweet,Equal), Saccharin (Sweet’NLow), Sucralose (Splenda), and Stevia (Truvia, PrueVia).

NNS do not add calories, nor do they add nourishment. In theory these sweeteners should support blood glucose control and weight management but there has been some controversy.
For example, some studies indicate that persons who drink more than twenty-one diet sodas per week are twice as likely to become overweight or obese as people who do not drink diet sodas. The main issues include compensatory overeating, effects on the way we taste food and unknown effects of years of use. 

Remember to look at food labels; ‘sugar free’ is not necessarily healthy. Please use NNS in moderation.

Diabetes and Insulin

Has your diabetes physician recommended that you start insulin? This may be for one of several reasons:

  • The available oral medications do not adequately control your blood glucose.
  • You have type 1 diabetes or latent autoimmune (slow onset type 1) diabetes.
  • Intensive control is necessary for you, for example in hospital.
  • Diabetes is naturally progressive.

Talk to your diabetes physician about insulin today.

What is insulin?

Insulin is a hormone released by beta cells within the pancreas. Insulin helps with the entry of glucose into cells where it is used for energy. For persons with type 1 diabetes mellitus (DM) there is an absolute insulin deficiency requiring injected insulin. At least 30% of persons with type 2 DM may also require injected insulin. This depends on how much insulin the pancreas produces and the level of insulin resistance.

There are generally two categories of insulin: long-acting and short-acting. The latter is used to quickly correct a high blood glucose level and to cover meals, whereas the former acts for 18 to 24hrs to control blood glucose.

Does insulin cause weight gain?

Yes. The body has been using fat for energy prior to correction by insulin administration, therefore a few pounds are restored when diabetes health is restored.

Won’t insulin use cause hypoglycaemia?

The symptoms of hypoglycaemia include sweating, palpitations, weakness/dizziness, confusion, syncope and anxiety. These symptoms may occur below 70mg/dl but this may vary between persons with diabetes, depending on the duration of diabetes.

Your dose of insulin is adjusted carefully by your diabetes physician to achieve optimal blood glucose levels. Hypoglycaemia can occur if there is a change in your routine, specifically, skipping a meal, or more vigorous activity or exercise than usual. Take a snack before exercise and avoid skipping meals or using excess alcohol.

 

Addressing the concerns:

Hypoglycaemia:

Hypoglycaemia can be defined as low blood glucose.
The levels at which low blood glucose causes symptoms may vary from person to person; generally this may be around 70mg/dl.
The symptoms may include perspiration, tremor, anxiety, dizziness, behaviour that can be confused with drunkenness, blurred vision, confusion. Less commonly coma and death can occur.
One of the most common causes of hypoglycaemia is skipping a meal while on insulin.
Medications (tablets) that may cause hypoglycaemia: Glyburide, Glipizide, Glimepiride, Nateglinide.
Have glucose tablets or a snack on hand to treat hypoglycaemia if you take  insulin or these medications.

Diabetes and Depression

Depression must be managed adequately because this disorder may affect one’s decision making; memory and ability to self-manage. A person with depression may be unable to function effectively at work or at home and therefore may not be able to handle basic self management such as:

  • following diet and exercise routines,
  • performing home blood glucose monitoring,
  • refilling prescriptions,
  • visits to diabetes physician
  • taking medications as prescribed,
  • maintaining other healthy habits such as not smoking or drinking excessive alcohol.

Major depression and other such illnesses also increase the risk of diabetes because of the link between emotional stressors and hyperglycaemia.

Persons with depression should be screened for diabetes and persons with diabetes should be screened for depression.

Twice as many women as men may be depressed, but men have a greater likelihood of mortality. Research has shown that depression is linked to early death in persons over age 65 with diabetes.

50% of adolescents with both Type 1 and Type 2 diabetes may have emotional challenges that result in depression or anxiety and we need to be vigilant so that we can assist these younger patients. Likewise, older persons may experience complications or disability and may incur greater expense with treatment; these factors may increase depressive symptoms and discouragement.

After medical treatment of depression and improvement of quality of life and symptoms, further intervention is necessary to improve glucose control and weight loss, however the underlying illness must be the focus of initial treatment.

The good news about diabetes is that although it is a chronic illness, the incidence of complications is decreasing due to ever advancing intensive treatment options.

Stay positive.