Tuesday, November 25, 2008

Expert Opinion: Diabetes

(This month's expert opinion is from Dr. Jennifer Miller. Dr. Miller is a fellow of the American Academy of Pediatric and specializes in pediatric endocrinology, seeing patients with diabetes, growth, thyroid, and puberty issues.)

I take care of kids with both type 1 and type 2 diabetes mellitus and I think Element Bars are a great option for all my patients with diabetes.

For the patients with type 2 diabetes, the bars are great to optimize nutrition. Families
can make a high-fiber, low-fat bar (such as with a date base) for their children. These are great alternatives to fatty snacks which lack nutritive value.

For the children with type 1 diabetes, I think Element Bars offers so many great options. The high-fiber, low-fat bars are really good for everyone, but I actually think the high-protein, moderate to high fat bars are perfect for kids with type 1 diabetes, especially athletes. These children often battle hypoglycemia (low blood glucoses) which are at a minimum, annoying and invasive to sports, activities and everyday life, and in severe cases, are life threatening. Choosing a bar which has fat and protein, as well as carbohydrates, will allow for the blood glucose values to be maintained better throughout exercise.

In other situations, such as just for an everyday snack, these bars are perfect because families can control exactly how many grams of carbohydrate their child receives. This is important because most insulin regimens require knowing the amount of carbohydrate to know how to dose the insulin. Using customized energy bars with specific nutrition make-up can help the family take control of the situation, and customize the amount and type of carboyhydrate, fat, and protein the child eats.

In general, customizing your own Element Bar still requires making healthy choices. If you only add peanuts, peanut butter and chocolate, though you will have protein and fat, this might not be the healthiest bar. However, Element Bars offers many tasty AND nutritious options to choose from, so you don’t end up just eating candy bars, especially if you are a child with diabetes!

In the properly working human body, food is eaten, carbohydrates are broken down into simple sugars (or glucose), and insulin is secreted by the pancreas (small organ near the small intestines). Insulin helps the sugar get into the cells, so the cells can use the sugar for energy. Glucose is the primary fuel for cells in the body to use for energy. When you don't have diabetes (DM), there is always a little bit of insulin constantly secreted by the pancreas. It keeps the blood sugars low, while other "counter-regulatory hormones" (growth hormone, cortisol or stress hormone, and glucagon, another pancreatic hormone) keep the blood sugars high. This is kept in balance to maintain normal blood sugars.

When diabetes develops, there are 2 possible types of DM and each develops differently.

In type 1 DM, the body makes a mistake and tries to "fight off" the insulin-producing cells in the pancreas, with proteins called antibodies. this is like when the body fights off infection with antibodies, except in the case of DM and many other diseases, this is actually a mistake the body makes. It is called an auto-immune disorder. When 80-90% of the insulin-producing cells in the pancreas have been destroyed, symptoms of DM develop (increased thirst, increased urination, weight loss, nausea, vomiting). In this type of diabetes, the insulin needs to be replaced with multiple daily injections or insulin pump therapy.

In type 2 DM, the body continues to make insulin, but becomes "resistant" to the insulin, requiring more and more insulin to do the same job. Sometimes this type of DM can be controlled with diet, exercise and/or oral medications. Sometimes people with type 2 DM also need insulin injections.

When someone with diabetes is on insulin injections, the diet is monitored closely and carbohydrates are counted. Usually insulin is dosed based on the amount of carbohydrate in a meal or snack. Proteins and especially fats, accompanying carbohydrates, often keep the blood glucose elevated. This can be dangerous if it leads to elevated blood sugars, but can be helpful in athletes whose blood sugars otherwise decrease during exercise. Every person with DM responds differently to particular foods and activities.

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