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Dietary Management of Type 2 Diabetes: A Personal Odyssey

Section of Endocrinology, Metabolism & Nutrition, and the Metabolic Research Laboratory, Department of Veterans Affairs Medical Center (F.Q.N., M.C.G.)
Department of Medicine (F.Q.N., M.C.G.)
Department of Food Science & Nutrition (M.C.G.), University of Minnesota, Minneapolis, Minnesota

View larger version (22K): [in this window] [in a new window]   Fig. 1. Regulation of glycogen synthase in liver. Glycogen synthase is converted from the inactive form, synthase D, to active synthase R forms, by a phosphatase, which is stimulated by glucose, fructose, and galactose in liver. The reverse reaction is catalyzed by kinases, which are stimulated by glucagon, epinephrine and vasopressin in liver.

View larger version (27K): [in this window] [in a new window]   Fig. 2. Pathways of glucose, galactose and fructose metabolism in liver. Glucose, galactose and fructose all serve as substrates for glycogen synthesis. In addition, as indicated in Fig. 1, all regulate the activity of glycogen synthase.

View larger version (26K): [in this window] [in a new window]   Fig. 3. Absorption of glucose, fructose, and galactose. Glucose (glu), fructose (fru) and galactose (gal) derived from ingested carbohydrate containing foods enter the portal vein and are carried to the liver. The liver rapidly clears fru and gal from the circulation and a large proportion is stored as glycogen. Glucose on the other hand goes through the liver into the peripheral circulation where it stimulates insulin secretion.

View larger version (31K): [in this window] [in a new window]   Fig. 4. Effect of 50 g starch or 50 g sugar ingestion on glucose and insulin area response in people with type 2 diabetes. The glucose (left) and insulin (right) area response to ingestion of 50 g of glucose, 50 g of carbohydrate as corn flakes and 50 g of carbohydrate as sucrose or lactose. Adapted from [44,45].

View larger version (25K): [in this window] [in a new window]   Fig. 5. Effect of meal carbohydrate composition on glucose response in 6 males with type 2 diabetes. The mean glucose excursions when subjects ingested the "American diet" are shown in the broken line and the low starch diet in the solid line. B, L, D, and S indicate the time that breakfast, lunch, dinner, and a snack were ingested. The net area responses are shown in the inset. Using the fasting glucose concentration as baseline, the area response to the low starch meals was only 5% of the response to the "American meals". Adapted from [47].

View larger version (20K): [in this window] [in a new window]   Fig. 6. Effect of an extended fast on blood glucose concentration in subjects with untreated type 2 diabetes. After an overnight fast of 11 hours, 7 subjects were fasted for 24 hours (closed circles; adapted from [50]). Four subjects continued the fast for another 24 hour fast, i.e. 48 hour fast (open circles).

View larger version (21K): [in this window] [in a new window]   Fig. 7. Glucose (left panel) and insulin (right panel) response to ingestion of 50 g protein in the form of very lean beef in 7 subjects with type 2 diabetes (broken line) and 8 subjects without type 2 diabetes (solid line). Adapted from [53,54].

View larger version (23K): [in this window] [in a new window]   Fig. 8. Effect of diet on plasma glucose concentration. Mean 24-hour glucose response at the beginning (control diet, open circles) and after 5 weeks of ingesting a LoBAG20 diet (closed circles) in 8 men with untreated type 2 diabetes. Inset: Net and total 24 hour integrated glucose area responses. Net area is calculated using the fasting value as baseline. Total area is calculated using zero as baseline. Adapted from [62].

View larger version (25K): [in this window] [in a new window]   Fig. 9. Effect of diet on serum insulin concentration. Mean 24-hour insulin response at the beginning (control diet, open circles) and after 5 weeks of ingesting a LoBAG20 diet (closed circles) in 8 men with untreated type 2 diabetes. Inset: Net and total 24 hour integrated insulin area responses. Adapted from [62].

View larger version (26K): [in this window] [in a new window]   Fig. 10. Effect of LoBAG diets on % total glycohemoglobin. Composite data on the effect of a control diet (top line, open circles) or diets with decreasing percentages of carbohydrate (LoBAG40, LoBAG30, LoBAG20) in people with untreated type 2 diabetes. Adapted from [61,62, 65].