A Guide To Nutritional Supplements For Patients With Diabetes
Nearly 21 million people in the United States have diabetes, according to the Centers For Disease Control and Prevention (CDC). Approximately 6.2 million of these people are not aware they have the disease. The CDC also estimates that over 40 million people have pre-diabetes, a condition that increases the risk of developing type 2 diabetes. Over 20 percent of adults 60 years of age and older have diabetes. “Diabetes is the leading cause of adult blindness, limb amputation, kidney disease and nerve damage,” notes Frank Vinicor, the Director of the CDC’s diabetes program.1 Podiatrists see patients with diabetes on a fairly regular basis. While podiatric physicians do not treat the systemic disease of diabetes, the resultant vascular and neurological complications can certainly come into play with lower extremity complications from the disease. These patients present many challenges when it comes to managing the multi-system effects of diabetes. The diabetic patient population also presents a greater risk of postoperative complications due to vascular and neurological pathology directly attributed to diabetes. Most of the diabetic patients whom podiatrists see are already under the care of their family practitioner or internist when it comes to medications and diet. However, there is a group of patients that we see as podiatrists who may not be diagnosed with diabetes but have some of the disease characteristics that could affect a surgical outcome. There are also patients with diabetes who are under the care of their primary care physicians but do not have good blood glucose control. As podiatric physicians, it behooves us to make sure we do everything in our power to assist these patients in their disease management as it affects their lower extremities. Accordingly, let us take a closer look at self-management tools (see “The Glycemic Index: A Valuable Tool For Self-Management” below) and nutritional supplements that podiatrists can recommend to help these patients maintain better blood sugar control and better peripheral vascular perfusion. The Glycemic Index: A Valuable Tool For Self-Management To prevent diabetic complications, podiatrists may be able to help patients with diabetes by educating them about new clinical information on recommended diets. The glycemic index is one measure people with diabetes can use to help control blood glucose. Jenkins developed the index 25 years ago to measure the rise of blood glucose after consumption of a particular food.2 Researchers determined these glycemic index ranges over a period of time, using multiple types of whole foods. The idea is that the higher the glycemic index number, the greater the rise in insulin as a result of the similar rise in blood sugar. Therefore, the lower the glycemic index of the particular food, the lower the blood glucose level and the corresponding insulin response. While the glycemic index offers a guideline for dietary recommendations for people with either diabetes or hypoglycemia, it should not be the only guideline for maintaining normal blood sugar and insulin levels. For example, while high fat foods like ice cream and sausage may have a low glycemic index, these are not good choices for people with hypoglycemia or diabetes as researchers have shown that a diet high in fat impairs glucose uptake. In the past, many physicians have recommended that patients with diabetes avoid fruits and fructose, which is the primary form of sugar found in fruits. However, recent research challenges this concept. The ingestion of fructose does not cause a rapid rise in blood sugar levels. It needs to be changed to glucose in the liver in order for the body to utilize it fully. Blood glucose levels do not rise as rapidly after fructose consumption compared to other simple sugars. Therefore, there is not a corresponding rise of insulin as there would be with the ingestion of other simple sugars. Fructose, from whole fruit, has a glycemic index of 20 while glucose has a glycemic index of 100. Certainly, the glycemic index has important clinical relevance and can be used as a tool to provide information to patients concerning foods that may rapidly elevate their blood sugar.