# RKS: ALL ABOUT SUGAR & DIABETES –
Can Lessened Sugar Intake Slice Diabetes Risk?
1st March 2021
THE SUGARY MYTHS - DIABETES CO-RELATION
It is an established fact etched in textbooks, and considered an irrefutable truth that the common diabetes condition which starts in adulthood is Type 2 variety is a consequence of defect in action of insulin (medically referred to as 'insulin resistance' or 'diminished insulin sensitivity').
ABOUT INSULIN
But what is the action of insulin? If we are not diabetic then our normal blood glucose fasting and 2 hours post-food (prandial) will be less than 100 mg/dL of blood. When we eat food the carbohydrates consumed is all converted to glucose and enters the blood. As a result the levels of blood glucose can rise up to 140 mg/dL. But do we become diabetic? No way. The blood glucose is utilised for energy purpose, and primarily it fuels the muscles and brain - each consumes 20% of the total calories taken as food carbohydrates daily. This is made possible by insulin transporting the glucose, which is floating in blood, to muscles and brain and similar other parts. It is just like catching the hands of a blind man and leading him to his destination. On reaching the muscles, for example, insulin signals the nucleus of cell of the muscle to accept the glucose so as to utilize it to generate energy necessary for its contraction and thereby make various body parts and joints move. This is akin to the postman ringing the doorbell to alert someone to receive the parcel he has brought. Within 2 hours of food intake, the insulin will efficiently remove all the excess food-derived glucose that has entered blood and bring the levels down to the normal of less than 100 mg/dL.
So, how does one get the type 2 diabetes? It is simple - the insulin is not able to work efficiently. Meaning, its ability to transport glucose into the muscles and other body parts is compromised with the result the sugar level in blood remains higher than normal values even 2-hours after meals. Is the glucose levels high because of extra sugar consumed. No way - it is because of insulin not working properly.
Then why restrict sugar and sweets and desserts in diabetics who are on drug treatment? The same logic as applies for salt consumption in hypertensives, and even more baffling misperceptions are in existence pertaining to the consumed sugars' dreaded role in contracting diabetes.
DIABETES GRADES
If fasting blood sugar is 126 mg/dL, or 2 to 3-month average indicative A1c [referred to medically as glycosylated hemoglobin (HbA1c)] is 6%, or more, it is definite diabetes.
Diabetes stages:
• Pre- / Borderline Diabetes: A1c 5.7-6.5% (average blood glucose: 117-140 mg/dL)
• Mild Diabetes: A1c 6.5-9% (average blood glucose: 140-212 mg/dL)
• Moderate Diabetes: >9-12% (average blood glucose: 213-140 mg/dL)
• Severe Diabetes: >12% (average blood glucose: >299 mg/dL)
Borderline diabetes means the fasting blood glucose is between 100-125 mg/dL. One can compensate well enough for inefficient insulin working if there is borderline diabetes by cutting down on sugar and sweets. In such cases there may not be any need to start any drug medicine.
When the A1c readings exceed 7.5%, including the labelled mild diabetes individual, drug medication is compulsory - no amount of lifestyle changes or cutting down on carbs can exclusively otherwise assist normalising sugar levels.
SUGAR INTAKE & SWEETS & DESSERTS
When drugs are being taken by diabetics their role is to normalise the blood glucose irrespective of the readings. In a normal adult the diet provides 2000 calories (Kcal) daily of which 60% is supposedly derived from carbs. This means, since each gm of carbohydrates provide 4 Kcal, we are to be consuming approximate minimum of 300 gm per day. Let us scientifically understand the implication of consuming sweets and desserts.
(the above are reference figures; exact amounts may differ upon recipe variations)
... SCENARIO IN DIABETICS
Most dessert and sweets (including Indian mithais & popular English trifle pudding) and including ice creams as well as pastries contain 20-30 gm sugar per single piece or cup / usual sized serving of the same, which is <10% of daily consumption. The exceptions are mere 15% of listed sweets, ice cream, etc. whose content can vary between 10-25% when a standard portion consumed at one time is considered. In those having type 2 diabetes not only the production of insulin is actually higher in the early years, but the blood glucose level are expected to be kept under tight normal control by drugs. It is then very curious how an additional 30 gm additional glucose, taken once-in-a-while, could pose serious concerns in such diabetics.
... SCENARIO IN NON-DIABETICS
It is even more baffling how there is general advice circulating to avoid sugars, and sweets, desserts and candies by normal non-diabetic individuals! Surprised that even the medical professionals - many of them - believe in the same myth!! (and accordingly philosophise.)
Unless one has insulin resistance, or is a pre-diabetic, the extra sugar load can never-ever burden the blood glucose readings. The pancreas pour 30-50 units of insulin daily into the blood in a normal individual and just one insulin unit can handle 20 gm glucose!
All of us, otherwise normal, just need to keep a yearly check on fasting and after food [2-hour postprandial (PP)] insulin levels, and insure it is within the normal defined range, to continue enjoying all the desserts, sweets and candies and what not, where-ever and whenever.
SUGAR-FREE MEDICINES, SWEETS, TOOTHPASTE, ETC.
What is more astonishing is that there is a huge market created for non-diabetic sweets, sugar-free liquid medicines - besides the sugar substitutes. If we put 1 teaspoon (tsp) sugar in 1 cup of tea or coffee, and we drink the same twice daily (as is the usual norm), we are only consuming an extra 10 gm of carbs (1 tsp = 5 g sugar). Then why resort to artificial sweeteners – unless one is gobbling lot many cups of tea / coffee each and every day.
On the same logical basis, the even more alarming equation is we require 1 tsp of liquid medicine once or twice daily, and to sweeten the same maybe mere 30-65 mg sugar would be needed – 0.0001-0.0003% of daily consumption of carbohydrates! Yet we all enquire with the doctors can the liquid medicine be safely taken in diabetes. So much for our mindset!
Look at the irony of sugar-free sweets. There is no change in carbohydrates (other than added sugar) and fat content. The only difference is substitution of added sugars with natural sugar substitutes such as stevia.
(Gulab Jamun. Pure Circle Stevia Institute. https://www.purecirclesteviainstitute.com/app/uploads/2018/05/Gulab-Jamun-with-Stevia-Before-After-Nutritionals-Indian-Dessert-PCSI-FINAL2016.pdf. Accessed on 28th February 2021)
Imagine the stretching of imagination of marketeers to make available sugar-free toothpaste – a foamy lather we never ever gulp, and grasp the gullibility of the ill-versed consumer who falls prey to such products’ advertising pitch!
ALL NUTRIENTS NEED TO BE RAVISHED SANS GUILT
Micronutrients apart, God has provided us with 3 proximate principles in nutrition: Proteins, Carbohydrates & Fats – all oxidisable to provide the body with energy. HE can never be astray. A balanced diet has been proposed to contain a judicious blend of these in defined proportions:
1. PROTEINS: 12-20% of total daily calories must come from proteins; the body changes 60% of proteins taken into glucose for providing calories.
2. FATS: About 30% of total daily calories is to be provided by fats; but only 10% of fats taken is converted to glucose.
3. CARBOHYDRATES: Balance 50-60% of total daily calories must accrue from intake of natural and added sugars; carbohydrates taken are all converted to glucose.
So the bottom line is don’t shun carbohydrates or stay away from the sweet goodies in our food unless of course one is a pre-diabetic. Even if you are a medicated diabetic remember the average 30 gm additional carbs as desserts, sweets, mithais, ice creams, pastries, etc. consumed occasionally can increase blood glucose by 90-120 mg/dL and for which mere two units of rapid acting insulin is enough to negate.
It is but a necessity to dissect medical and health-related facts more scientifically if one is to enjoy life albeit safely.
Stay Healthy.
but
Enjoy the Deserving Pleasures of Life.
DR R K SANGHAVI
Prophesied Enabler
Experience & Expertise: Clinician & Healthcare Industry Adviser
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