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The New Glucose Revolution for Diabetes

The New Glucose Revolution for Diabetes


February 08, 2009

Review By: Doris J. Dickson
Type 1 Mentor

 

The authors of The New Glucose Revolution for Diabetes are:
 
  • Dr. Jennie Brand-Miller, Professor of Human Nutrition at the University of Sydney
  • Dr. Stephen Colagiuri, Professor of Metabolic Health at the University of Sydney and fellow of the Royal Australian College of Physicians
  • Alan W. Barclay, an accredited practicing dietician as well as Research and Development Manager at Diabetes Australia
  • Kay Foster-Powell, an accredited dietitian-nutritionist with extensive experience in diabetes management.
The authors’ goal in writing this book was to translate scientific diabetes-related evidence into a practical resource to assist diabetics with discovering what works best for them. They wanted to clearly and simply define what to eat and do in order to:
  • Reduce risk for developing diabetes
  • Improve cardiovascular health
  • Control blood sugar, blood pressure and blood fat levels
  • Maintain overall body health
To accomplish this, the authors organized the book into three sections:
  • Understanding Diabetes, Pre-Diabetes and the Metabolic Syndrome
  • What You Can Do
  • Living With Diabetes and Pre-Diabetes
The book also includes a detailed glossary of terms and a copy of the glycemic index nutrition tables.
 
Though the book touts itself as “the definitive guide to managing diabetes and prediabetes using the glycemic index,” the book could be considered more of a primer. It defines many of the basics of the disease through the eyes of the authors. The book covers the history of diabetes as well as an explanation of heart disease and metabolic syndrome. It also discusses exercise types, requirements, and some basic nutrition.
 
As expected, much of the book focuses on food. The book includes sample menus and recipes based on the authors’ interpretation of successful meal plans. There is a section on snacks and one describing how to recreate existing recipes in a more diabetes-friendly manner. The authors believe that in diabetes the aim in modifying a recipe is to remove fat and salt, increase fiber content, and lower the glycemic index of ingredients.
 
The authors focus primarily on high carbohydrate, low-fat meals and fail to consider that these meals make it difficult for non-insulin dependent type 2 diabetics to meet glycemic targets due to loss of phase 1 insulin production. The authors also neglect to consider that it is equally as difficult for insulin-dependent diabetics to avoid the risk of hypo and hyperglycemia caused by the large amounts of injected insulin needed to balance high-carbohydrate meals.
 
For example, one sample type 1 meal plan concentrates almost all the daily protein into dinner. However, breakfast is a commonly difficult meal for diabetics to navigate large amounts of carbohydrates. This sample breakfast includes a high carbohydrate/low-protein meal of muesli, fruit, and low-fat milk. Due to dawn phenomenon, corresponding glucose release and morning insulin resistance, most diabetics would have difficulty controlling their blood sugar with this breakfast combination.
 
Some suggestions are warranted and constructive including:
  • Reducing the amount of sugar in recipes
  • Decreasing serving sizes of rice or pasta-based meals
  • Limiting intake of cookies, crackers, bagels and muffins
  • Increasing vegetable intake
The section on managing type 1 diabetes is divided into age groups (infants and toddlers, school-age children, teenagers and adults). Each section contains a daily food guide, recipes with nutritional information and tips. The final chapters are dedicated to tips on eating out, dealing with special occasions, going to the hospital, celiac disease, vitamin supplements and herbal therapies.
 
The book lacks clear, concrete examples of how to incorporate the math of the glycemic index into carb counting, digestion and insulin regimens. In addition, much of the book mixes discussion of type 1, type 2, and pre-diabetes, frequently handling them as if they are one commonly-treated disease when in fact; due to variations in the disease, treatment is not the same. In fact, due to mandatory type 1 insulin injections (or pumping), food behavior and digestion, insulin resistance, residual insulin production and blood sugar testing variations many of the blanket statements made in this book require caution in implementation.
 
Take caution when reading statements made by the authors such as “although most chocolates have a relatively high sugar content, they don’t have a big impact on your blood glucose levels.” The fat content in milk chocolate slows down the digestion; however, people who make insufficient or no insulin will see their blood sugar rise. It might be at a slower rate than other carbohydrates but without sufficient insulin, blood sugar rises regardless of when food digests. Additionally, there are many references to “studies” but no mention of the study specifics or references to supporting material.
 
Another note of caution involves the recommendation that pregnant women coping with morning sickness can and should drink Gatorade as long as their blood sugar is not greater than 270. The authors make no note of the fact that blood sugar that high requires immediate intervention to avoid short and long-term complications, causes the fetus to overproduce insulin to compensate for the high level, and likely causes the expectant mother to feel sick simply because she is out of target.

Although this is a highly-recommended book and part of the New York Times best selling series, apply the concepts in this book with caution. It may not be suitable for all diabetics and may not assist all diabetics in achieving non-diabetic glycemic target levels.

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