Healthy eating in proper amounts at fixed times is called diet. The diabetic diet is a planned healthy diet. It helps everyone. Diet controls the amount of sugar and cholesterol in your blood. In a diet plan for diabetes the things that are considered are sex, age, height, weight, physical activity and nature of diabetes. Dietitians also consider the blood pressure and cholesterol levels while planning diets for diabetic patients. By studying these factors dietitians assess the nutritional needs for each patient. Nutritional need means number of calories required by an individual in a day. This need varies from person to person; the general range of calorie requirements is between 1200-1800 calories per day.

The exchange meal plan is a diet plan which helps to plan your meal by balancing carbohydrate, protein and fat intake per day. In diabetes, blood glucose level is generally not within normal range. Glucose is a sugar released from carbohydrates, if we want to control diabetes then we need to control glucose level and hence we have to limit carbohydrate intake. With the help of exchange plan you can decide the type of food to be taken in the diet, the amount of food and also the time to eat.

The exchange meal planning is more flexible than others as in this plan you can make variations in your daily meal plan. There are some factors that you should always keep in mind while planning a diabetic diet. Include more amounts of vegetables and fruits in your meal. Instead of large meals take small meals at regular intervals. Do not exceed fiber intake beyond 1.4 oz in a day. Replace bakery products with whole cooked cereals.

The exchange system contains six lists of foods and each list contains foods having same amount of calories. You have to include the right amount of servings from each food list to control your diabetes. The serving size means size of food after it is cooked or prepared. The six basic groups in the exchange system are vegetables, fruits, starches, milk, meat and fats. Each group contains various foods with the same amount of calories. Since each group contains same calorie count foods, the effect of these foods on the blood glucose level is similar. You can exchange the foods within a group as they have the same effect on blood sugar levels.

Based on your individual needs your dietitian recommends you a certain number of daily exchanges from each food group. For example to meet 1800 calorie requirement per day you can include four exchanges from vegetable group, three exchanges from fruit group, none exchanges from starch group, two exchanges from milk group, six exchanges from lean meat and four from fat group. These numbers of exchanges are per day means you have to distribute these exchanges throughout the day. While planning the diet with the help of exchange system always keep in mind that you cannot exchange the food of one group with food of another group always exchange the foods within the group.

The exchange system also provides list of free foods having less than 20 calories and these foods can be consumed without much worry.

Drink lots of water because it is calorie free and helps to flush away the toxins. Did you know that flavored carbonated water has no calories, sugar, body, sweetener, color or preservatives?

Retrospective analysis of a US health-care plan claims database reveals patients with diabetes hospitalized for a cardiovascular (CV) event incur higher costs and resource use than their counterparts without diabetes.

Excess medical expenses and reduced productivity due to diabetes represent a significant economic burden for the US health-care system.

As CV complications are generally the most costly component of medical care in patients with diabetes, Robert Straka (University of Minnesota College of Pharmacy, Minneapolis, USA) and colleagues compared real-world costs associated with initial and subsequent CV events in patients with and without the disease.

The authors identified 29,863 patients hospitalized for a CV event between January 2001 and June 2005 from a large US managed-care population. Of these, 5501 (18.4%) patients had a history of diabetes.

Direct medical costs and resource use for all CV events combined were determined for patients with or without diabetes. The researchers also calculated costs and resource use by type of CV event, eg, coronary artery bypass graft, myocardial infarction, or ischemic stroke.

Mean direct medical costs per patient for the initial CV hospitalization and for the first recurrent CV hospitalization were similar for patients with and without diabetes.

However, during the follow-up period, patients with diabetes experienced a higher incidence of subsequent CV events than the non-diabetic cohort for each event type.

As a result, medical costs for CV care during the follow-up period were consistently higher in the diabetic cohort with mean total direct medical costs per patient of US$8805 (€5964) versus $6982 (€4729) in year 1, $13,860 (€9390) versus $10,056 (€6813) in year 2, and $16,149 (€10,942) versus $12,163 (€8241) in year 3.

The cost difference between diabetic and non-diabetic patients remained significant after adjusting for age, gender, and other potential confounders.

Patients with diabetes also experienced longer periods of inpatient cardiovascular hospitalization than those without the disease with a mean of 3.3 versus 1.8 days.

“Taking into account expenditures for the initial cardiovascular hospitalization plus all CV events during the follow-up period, the incremental per-patient cost attached to CV events in patients with diabetes was $10,131 (€6865) over 3 years,” write the authors.

“The real-world cost estimates described here will aid the development of future economic models that assess the impact of health-care initiatives aimed at this growing diabetic population,” they conclude in the journal Cardiovascular Diabetology.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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The pathologic changes that lead to myocardial insulin resistance in Type 2 diabetes and left-ventricular dysfunction (LVD) are distinctly different, report researchers in the European Heart Journal.

“Whole body insulin resistance is a predominant feature of non-insulin-dependent diabetes mellitus and, although less well recognized, it is also a feature of LVD and congestive heart failure,” write Paolo Camici (Imperial College, London, UK) and co-workers.

Despite the increasing global burden of diabetes, the pathophysiology of tissue- and disease-specific insulin resistance remains unclear.

Camici and colleagues therefore studied skeletal and cardiac muscle biopsies from nine patients with Type 2 diabetes and eight patients with LVD, and seven control volunteers who had neither of these conditions, all of whom were waiting for routine cardiac surgery. Glycemic control and myocardial glucose uptake were also studied using euglycemic-hyperglycemic clamping techniques and positron emission tomography.

Analysis revealed that the expression of insulin receptor substrate (IRS)-1 was significantly decreased compared with normal in skeletal muscle tissue from patients with LVD, while the activity of cardiac IRS-1 P13K was significantly increased both in patients with LVD and those with Type 2 diabetes.

In addition, expression of the glucose transporter (GLUT)-4 was significantly decreased in the sarcolemma of patients with Type 2 diabetes and significantly increased in the sarcolemma of patients with LVD. Despite this, insulin-stimulated glucose uptake was lower than usual in those with LVD.

“The results of the present study provide some novel findings of the mechanisms underlying whole body and myocardial insulin resistance in patients with Type 2 diabetes or LVD,” conclude the authors.

However, the researchers say that their study is limited by the fact that they “compared glucose utilization measured during euglycaemic??”hyperinsulinaemic clamp in vivo, with molecular analysis carried out ex vivo on samples obtained at the time of surgery.”

The investigators say they cannot explain why the increased GLUT-4 expression observed in patients with LVD was accompanied by decreased insulin-stimulated glucose uptake, but hypothesise that this may be due to “elevated adrenergic signaling in the failing heart, which is been shown to affect some components of insulin signaling.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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