Alternative medication for type 1 diabetes 101,how to get rid of dry mouth and bad breath remedies,insulin therapy for type 1 diabetes mellitus quizlet - Good Point


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Science, Technology and Medicine open access publisher.Publish, read and share novel research. 1) found a higher intake of cholesterol, total fat and saturated fat in Eastern Europe compared to Southern or North-Western Europe. 1) reported a higher intake of cholesterol, total fat and saturated fat in Eastern Europe compared to Southern or North-Western Europe. 3) a significant increase in energy adjusted total and LDL-cholesterol levels was associated with higher intakes of total fat, saturated fat and cholesterol. Table 4 summarizes the nutritional recommendations as well as the lifestyle recommendations for type 1 and type 2 diabetic patients. In 2010, the fixed-dose combination drugs accounted for 56% and plain active ingredient drugs accounted for 44% of HIV medication sold. Klik-systemet betyder ops?tning af ventiler uden skruer og muliggor nedtagning af ventil for rengoring. Mean fiber intake in 1102 individuals with type 1 diabetes across Europa (Toeller M, Soedamah-Muthu 2011). One study (Riley MD& Dwyer T 1998) found no significant association between energy adjusted monounsaturated fat intake or energy adjusted polyunsaturated fat intake and microalbuminuria, but reported a positive association between usual dietary saturated fat intake and microalbuminuria. They also found more frequent acute and chronic complications (including nephropathy) in Eastern Europe people. They also found more frequent acute and chronic complications (including retinopathy) in Eastern European people.
Higher fiber intake had a protective significant effect against CVD in type 1 diabetic women but not in men. This was associated with a higher prevalence of CVD, although after adjusting for dietary fiber intake, these associations were attenuated.
They also found more frequent acute and chronic complications (including CVD) in Eastern European people. These recommendations are for all diabetic patients in general, based in the majority of cases on evidence from type 2 diabetic patients. In 2013, about 34 million people around the world were suffering from HIV but due to advances in medication, it is considered a manageable chronic condition.
In type 1 diabetic men it leads to positive changes of the serum cholesterol pattern (higher HDL, lower LDL, lower ratio total cholesterol:HDL cholesterol).
The recommended intake is <10% of the total energy intake which was only achieved by a small minority (14%) (Toeller M et al.
Although, antiretroviral therapy has made living with HIV much more manageable, there are many in the developing world that still have no access to sufficient medical treatment.
1988) found a significant positive association between total fat intake and microalbuminuria.
No association between energy adjusted MUFA and energy adjusted PUFA and microalbuminuria was found.
The results of the post hoc analyses should be interpreted carefully, since it is a retrospective analysis which can generate hypotheses but not prove them. CarbohydratesThe ‘Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes’ (DNSG EASD) guidelines for persons with type 1 and type 2 diabetes (Table 4) recommend that the most appropriate intake of carbohydrates consists of vegetables, legumes, fruits, wholegrain foods and naturally occurring foods rich in fiber. Recommendation was only achieved in 0.4% of the type 1 diabetic population (Toeller M et al. Alcohol has favourable effects on HDL-cholesterol, inflammation and inhibition of platelet aggregation (Beulens et al.
HIV antiviral volume is decreasing as fixed-dose combination therapy becomes more prominent. Toeller2[1] Division of Human Nutrition, Wageningen University, Wageningen, Netherlands[2] Department of Endocrinology, Diabetology and Rheumatology, Heinrich-Heine-University Duesseldorf, Germany1. 2009) found an increased risk of CVD in type 1 diabetic patients eating high amounts of fat and saturated fat. Data from the EURODIAB Prospective Complication Study on saturated fatty acid intake measured at baseline by 3-day food diaries and presented by each center is given in Figure 2. IntroductionDiabetes mellitus is with 220.000 deaths per year the eighth leading cause of death in high income countries (World Health Organization (WHO) 2008). They found that excess fat intake may contribute to hyperfiltration in type 1 diabetic patients. AlcoholIn cross-sectional analyses of the EURODIAB Prospective Complications Study (Beulens et al. Carbohydrates were negatively correlated with CHD risk factors (higher total cholesterol, LDL cholesterol, obesity, poorer glycaemic control). Cross-sectional data of the EURODIAB Complications Study showed an inverse association between fiber and LDL cholesterol and a positive association between fiber and HDL cholesterol.
Data from the EURODIAB Prospective Complication Study on fiber intake measured at baseline by 3-day food diaries and presented by each center is given in Figure 1. The even lower saturated fatty acid recommendation of <7% total energy of the ADA was not achieved by any of the centers (Figure 2). Because of this favourable effects we expect a beneficial effect on CVD, however to date no association was found between alcohol and CVD in type 1 diabetes patients (Bishop et al. Furthermore higher intakes of fat and protein were associated with greater odds of coronary artery calcium (CAC), which is a strong predictor for coronary events approximating CVD risk.
All centers indicated in Figure 2 exceed the recommendation of <7% saturated fat of the total energy intake. Worldwide approximately 285 million people had the disease in 2010 and this number will increase till 438 million in 2030 (World Diabetes Foundation (WDF) 2010). 2004) a progression of nephropathy with greater saturated fatty acid (SFA) consumption and lesser polyunsaturated fatty acid consumption (PUFA) was demonstrated. The opposite was true for carbohydrate intake, higher intake was associated with a reduced odds of CAC.In conclusion a higher intake of total fat as well as saturated fat is positively correlated with CVD or CVD risk factors (atherosclerosis and CAC in these studies) and a higher intake of carbohydrate is negatively correlated with CVD or CVD risk factors.
Type 1 diabetic patients from Italy had the lowest intake of saturated fatty acids, but this intake was still too high (Figure 2). One study reported an association between lifestyle risk factors (including alcohol) and atherosclerosis, which is often the underlying cause of CVD (Bishop et al. Furthermore dietary fiber is independently related to a lower risk for CVD in type 1 diabetic women.
Keeping in mind that these samples are clinic based and not population based and that these figures may not exactly reflect the current nutritional intake, however it gives an indication of the status on fiber intake. Also the association between alcohol and diabetic nephropathy and diabetic retinopathy was only observed in cross-sectional studies. 1992) examined whether alcohol consumption was associated with type 1 diabetic retinopathy. Since all these studies were cross-sectional, they could only look at the intake of certain nutrients and the prevalence of CVD or CVD risk factors at a certain time point. There were only a few studies examining the effect of MUFA or PUFA on chronic complications in type 1 diabetic patients. Diabetes also has a great economic impact on the individual, nation healthcare system and economy (International Diabetes Federation (IDF) 2010). Eight studies reported an association between physical activity and CVD risk factors (Kriska AM et al. They could not conclude if these are related to each other and if the nutrients are responsible for the lower or higher prevalence of CVD. Unfortunately, this positive effect of fiber on CVD and CVD risk factors was only found in cross-sectional studies.
Physical activityThere are no specific guidelines concerning physical activity for type 1 diabetic patients.
They found that dietary n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid) are inversely associated with the degree but not with the incidence of albuminuria in type 1 diabetes (Lee CC et al.
These conclusions are based on post-hoc analyses and a cross-sectional study respectively and should therefore be interpreted carefully.
2010).In conclusion these prospective studies are consistent with the cross-sectional studies about the detrimental effect of saturated fat on type 1 diabetic nephropathy. 1991) examined the relationship between physical activity and the occurrence of retinopathy in type 1 diabetic patients.


Randomized controlled trialsTwo randomized controlled trials reported an association between macronutrients and CVD (Table 2), but demonstrated conflicting conclusions. Further research in prospective studies or randomized controlled trials is needed to ascertain the role of fiber in CVD.
However, it was shown that the guidelines for type 2 diabetic patients are also applicable for type 1 diabetic patients. In type 1 diabetes the body does not produce insulin (American Diabetes Association (ADA) 2010).The disease has a strong genetic component, inherited mainly through the HLA complex but the exact cause is unknown. They found no association between physical activity (sports and leisure physical activity) and occurrence of retinopathy.4. DNSG EASD do not recommend a low carbohydrate diet for type 1 and type 2 diabetic patients (Table 4). Several randomized controlled trials (Table 3) showed that physical activity (endurance sports; on average 2 times a week 60 minutes) improves physical fitness as well as endothelial function in type 1 diabetic patients (Lehmann R et al. Most likely there is an environmental trigger in genetically susceptible people that causes an immune reaction.
Diet, lifestyle and cardiovascular diseaseEight studies reported an association between macronutrients and CVD in type 1 diabetic patients.
2009), the authors concluded that a diet lower in carbohydrate and higher in MUFA might be preferable to a diet higher in carbohydrate and lower in MUFA for type 1 diabetic patients. 2009) to recommend a diet higher in MUFA and lower in carbohydrate for nonobese type 1 diabetic individuals to reduce CVD risk factors is doubtful.
The body's white blood cells mistakenly attack the insulin-producing pancreatic ?-cells (U.S.
This was solely based on the positive effect on triglyceride (TG) levels and plasminogen activator inhibitor 1 levels (PAI-1) in the first diet. It is more acceptable to avoid too much foods high in fast available carbohydrates, foods high in fat and cholesterol. Their conclusion is based on PAI-1 and VLDL levels, which are not such a good predictors for atherosclerosis (and by extension CVD) as TG levels are. A significant decrease in PAI-1 was found after 6 months in the lower carbohydrate and higher MUFA diet.
An earlier quote (Helgeson 2006) expressed this precisely: ‘families of adolescents with diabetes may be more concerned that the sugar in candy is going to translate into high blood glucose levels today than that the fat in potato chips will translate into cardiovascular disease in 10 years’. Furthermore, the small study population of 30 subjects limits the power of their conclusions. Especially the improvement in endothelial function is important since endothelial dysfunction is an early sign of atherosclerosis, which is often the underlying cause of CVD. In order to make accurate recommendations concerning MUFA and PUFA intake for type 1 diabetic patients more research with more participants (preferably in a prospective study) is needed. Also a positive effect on lipid related cardiovascular risk factors was found in one study (Lehmann R et al. A lower level of PAI-1 means less inhibition and more degradation of blood clots, which means a lower chance of developing atherosclerosis. This ‘food’ trigger explains why type 1 diabetes is less common in people who were breastfed and in those who first ate solid foods at later ages (Sadauskaite-Kuehne V et al.
In the other diet group there was an increase in TG levels, also this increase was not significant.
Although the evidence is gained from randomized controlled trials, the conditions of these trials are really disappointing. MacronutrientsData on the relationship between macronutrients and incident CVD is lacking in patients with type 1 diabetes. 2010) found that dietary n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid) are inversely associated with the degree but not with the incidence of albuminuria in type 1 diabetes. This involves acute complications, like hyperglycaemia and hypoglycaemia which can lead to a coma, but also chronic complications (National Institute for Public Health and the Environment (RIVM) 2007).
Chronic complications can be subdivided into macrovascular and microvascular complications. Physical activityThere were no prospective studies on physical activity and type 1 diabetic nephropathy. It decreases lipopolysaccharide-induced nuclear factor-kB (NF-kB ) activation and monocyte chemoattractant protein (MCP)-1 expression in human renal tubular cells (Lee CC et al. Cardiovascular disease is the major macrovascular complication and includes mainly myocardial infarction and stroke (American Diabetes Association (ADA) 2010).
Cross-sectional studies on fat and fiber in relation to CVDIn more detail, one cross-sectional study (Overby NC et al. The risk for cardiovascular disease, is 4-8 times higher for people with type 1 diabetes (Soedamah-Muthu SS et al.
1991) found the lowest occurrence of diabetic nephropathy in people being 7+ hours a week physically active (sports and leisure physical activity).3. 2006) found a higher than recommended percentage of energy intake from fat and saturated fat among type 1 diabetic patients compared with healthy same-age control subjects and a lower than recommended intake of fiber.
Mainly because of the higher atherosclerotic risk due to more and bigger very low-density lipoprotein (VLDL) particles in the last diet.
Diet, lifestyle and retinopathyOnly two studies reported results for the association between macronutrients and type 1 diabetic retinopathy. They conclude that this higher intake of energy from saturated fat and this lower intake of energy from dietary fiber, vegetables and fruits could increase the risk of atherosclerosis, which is often the underlying cause of CVD. Furthermore the TG levels did not significantly differ between the two diets in this study.In conclusion, these trials show that the effect of carbohydrate or MUFA on cardiovascular disease risk factors in type 1 diabetic patients is still not elucidated.
The major microvascular complications are diabetic nephropathy, diabetic neuropathy and diabetic retinopathy (American Diabetes Association (ADA) 2010).
Furthermore two studies reported an association between alcohol consumption and diabetic retinopathy and one study reported an association between physical activity and diabetic retinopathy. Another study (Helgeson 2006) reported a higher than recommended percentage of energy intake from fat and saturated fat among type 1 diabetic patients, but they did not study associations with CVD or CVD risk factors. There are no firm recommendations regarding protein intake for type 1 diabetic patients with incipient nephropathy. An intake of 10-20% of total energy is recommended for patients with no evidence of nephropathy (Table 4). Their conclusions are based on PAI-1 and VLDL levels, which are not such a good predictors for atherosclerosis (and by extension CVD) as TG levels are.
The recommendation for protein intake is most important for patients with diabetic nephropathy.
So the studies are in agreement with the guidelines but more research in better performed randomized controlled trials is needed to confirm this positive effect of physical activity on CVD in type 1 diabetic patients. Furthermore, a negative association between carbohydrates and dietary fiber with retinopathy progression and risk factors was found. Furthermore none of these randomized controlled trials examined the potential positive effect of dietary fiber on CVD or the potential negative effect of saturated fat found in cross-sectional studies. Microalbuminuria can be seen as an early marker of diabetic kidney disease (Hovind P 2004). The 25-year cumulative incidences of any visual impairment and severe visual impairment are 13% and 3%, respectively.
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Finally the high incidence of lower extremity amputations also stresses how serious the complications of type 1 diabetes are.
The overall 25-year incidence of lower extremity amputations is 10.1% in 943 American type 1 diabetic patients (Sahakyan K et al. These complications account for the major morbidity and mortality associated with type 1 diabetes, so it is very important to treat them (Daneman D 2006).In type 1 diabetes, special attention is paid to balancing the insulin dose with episodes of activity and the quantity and timing of food intake to prevent acute episodes of hypoglycaemia and hyperglycaemia (Franz MJ et al. A hypothesis is that excessive protein intake causes renal vasodilatation and glomerular excessive perfusion leading to a raised glomerular transcapillary hydraulic pressure gradient ending in proteinuria and glomerular damage, conversely, will prevent kidney damage (Percheron C et al.
However, this could also be due to the kind of study (cross-sectional) and the fact that markers for CVD were used instead of CVD as endpoint. This is important because these acute complications can lead to a coma, but also because a high blood glucose concentration (glycosylated hemoglobin (HbA1c) ? 7%) in people with diabetes increases the risk for macrovascular as well as microvascular complications.
So, indeed protein restriction is beneficial for type 1 diabetic patients with established nephropathy. Other risk factors for these chronic complications are smoking, obesity, physical inactivity, high blood pressure and high cholesterol levels. Physical activityOf the eight studies that reported an association between physical activity and CVD there were five cross-sectional studies (Kriska AM et al. However, we have to mention that although this beneficial effect of a restricted protein intake was found in randomized controlled trials, the sample size of these trials were really small (maximum of 82 people). Also people with a longer history of diabetes have a higher risk (National Institute for Public Health and the Environment (RIVM) 2007).
Furthermore it is important to realise that the microvascular complications lie on the pathway between diabetes and cardiovascular disease.
Nephropathy for example is an important risk factor for cardiovascular disease in people with type 1 diabetes (Jensen T et al.
1987).Recent studies have shown that people with type 1 diabetes eat a more atherosclerosis-prone diet.


This includes a high intake of energy from saturated fat and a low intake of fiber, fruits and vegetables, which could increase the risk of the development of atherosclerosis. Further studies with a larger sample size are needed to find a cutoff point for protein intake which would still have a positive effect on diabetic nephropathy and its feasibility.
It has been demonstrated that 80%-90% of type 2 diabetes and coronary heart disease cases can be prevented by healthy lifestyle behavior with a focus on healthy diet and exercise.(Stampfer et al. The studies will be discussed in the following paragraphs by study design.One study (Kriska AM et al. 1991) examined the relationship between physical activity and the occurrence of CVD in type 1 diabetic patients. 2004) These studies suggest that there could be a potential role for diet in type 1 diabetes to reduce the risk of cardiovascular disease. They found the lowest occurrence of CVD in people being 4-7 hours a week physical active (sports and leisure physical activity). There are more studies suggesting that diet (including alcohol) can play an important role in treating the complications of diabetes (Franz MJ et al.
The other four cross-sectional studies examined an association between physical activity and CVD risk factors.
Several studies have reviewed nutritional recommendations for people with diabetes (Franz MJ et al. 2007) found that increased frequency of regular physical activity was associated with lower TG levels.
Furthermore they are general and not always specific for the different type of complications. 2007) found besides the positive association with TG levels also a positive significant association between regular physical activity and HDL cholesterol levels. An overview of the relationship between diet (including alcohol) and complications in type 1 diabetic patients is lacking. Also the effect of lifestyle (including physical activity and dietary patterns) on complications is still not elucidated for type 1 diabetic patients. Lack of physical activity together with an atherogenic diet could enhance development of complications especially in high risk type 1 diabetic patients.In the following paragraphs of this bookchapter the literature on associations between diet (including alcohol) and lifestyle and chronic complications in type 1 diabetic patients will be summarized. Impaired endothelial function is considered as an early sign of atherosclerosis, which is often the underlying cause of CVD. Since ‘diet’ and ‘lifestyle’ are broad terms the focus will be on macronutrients (carbohydrates (including fiber), proteins and fats (including cholesterol), alcohol, physical activity and dietary patterns.
2009) a significant inverse association between physical activity and CAC, a marker of coronary artery atherosclerosis, was demonstrated. In the final paragraphs all recommendations on diet and lifestyle in patients with type 1 diabetes will be put in perspective with the current literature.2.
In conclusion all these studies found a beneficial effect of physical activity on cardiovascular risk factors.
Diet, lifestyle and nephropathyEighteen studies reported an association between macronutrients and type 1 diabetic nephropathy.
However, since all these studies were cross-sectional, they could only look at physical activity and the prevalence of CVD or CVD risk factors at a certain time point. They could not conclude if these are related to each other and if physical activity was responsible for the lower prevalence of CVD.The three trials reporting an association between physical activity and cardiovascular disease risk factors (Table 3) were consistent in their conclusions. The other five focussed on other dietary macronutrients such as fat, cholesterol or carbohydrate in relation with nephropathy.
There were also three studies that reported results for protein as well as carbohydrate or fats and nephropathy. Furthermore one study reported an association between alcohol consumption and nephropathy in type 1 diabetic patients and one study reported an association between physical activity and nephropathy in type 1 diabetic patients.
2011) examined the association between physical activity and brachial artery flow-mediated dilation (FMD). Endothelial dysfunction is reflected by an impaired FMD response and is an early sign of atherosclerosis. ProteinOf the thirteen studies that reported an association between protein and nephropathy there were three cross-sectional studies (Toeller M et al. An increase in FMD was found in type 1 diabetic patients following an exercise training program (endurance sports; on average 2 times a week 60 minutes, Table 3).
2002) examined the impact of physical activity on lipid related cardiovascular risk factors (LDL cholesterol, HDL cholesterol and TG). They both found a decrease in LDL cholesterol levels in the training group, but only in one of these (Lehmann R et al.
These will be discussed in the following paragraphs by study design.The three cross-sectional studies were not consistent in their conclusions on the effect of protein on diabetic nephropathy.
2000) failed to show a significant relationship between dietary protein intake and markers of early nephropathy, other than creatinine clearance. 1997) found a significant relationship between dietary protein intake and urinary albumin excretion rate (AER).
The relation between physical fitness and CVD was not examined.In conclusion the three trials show that physical activity improves physical fitness as well as endothelial function in type 1 diabetic patients. A higher AER was particularly found in people consuming more than 20% of their dietary food energy as protein.
A positive effect on lipid related cardiovascular risk factors was only found in one study (Lehmann R et al.
Dietary patternsTwo cross-sectional studies reported an association between dietary patterns, in this case the ‘Dietary Approaches to Stop Hypertension’ (DASH) diet, and CVD risk factors (Gunther ALB et al. 2001) total protein intake was not associated with the presence of microalbuminuria, but a diet including a high amount of fish protein seemed to decrease the risk.
Furthermore they could not confirm an association between a high total animal protein intake and having microalbuminuria.
No cross-sectional or prospective studies were found examining the effect of a Mediterranean diet or a Western diet on CVD in type 1 diabetic patients. 1991) found in their cohort study that a predominantly vegetarian diet (low in animal protein) may have an important beneficial effect on diabetic nephropathy without the need for a heavily restricted total protein intake. 2008) reported an association between adherence to the DASH diet and hypertension in type 1 diabetic patients. But they were not able to determine if the reduction in total protein intake rather than the reduction in the fraction of animal origin was primarily responsible for the fall in the fractional albumin clearance. They did not investigate a possible association between the DASH diet and CVD, but used hypertension as the main risk factor for CVD. 1998) cohort study showed that a low protein diet has a protective effect on the residual renal function in type 1 diabetic patients.In conclusion, these studies were not consistent in their conclusions on the effect of protein restriction on type 1 diabetic nephropathy. 2011) reported a possible association between the DASH diet and other CVD risk factors (total cholesterol, LDL cholesterol, HDL cholesterol, TG, LDL particle density, apolipoprotein B, body mass index (BMI), waist circumference, and adipocytokines) than blood pressure.
In one of these four this decline was greater in the low protein diet group than in the usual protein diet group, but this difference was not significant (Hansen HP et al. Unfortunately there were no studies found examining the effect of dietary patterns on CVD events.5.
Current recommendations on diet and lifestyle in patients with type 1 diabetes put in perspective Overall, fiber and saturated fat intake play an important role in type 1 diabetic patients, with a beneficial and detrimental effect on the chronic complications respectively.
Many researchers have shown the inappropriate intake of these nutrients in patients with type 1 diabetes. Among these 2 studies, one (Brouhard BH & LaGrone L 1990) found a decline that was significantly greater in the usual protein group. Also moderate alcohol intake and physical activity may have beneficial effects in type 1 diabetic patients. Another study showed a decline in GFR in the low protein diet group, but did not directly compare this with the usual protein group (Dullaart RP et al.
Most of the findings are consistent with the guidelines for type 1 diabetic patients (Table 4).The main limitations are the lack of prospective studies on diet and lifestyle in type 1 diabetics, lack of randomized controlled trials and the limited number of studies on dietary cholesterol, protein, carbohydrates, fat, fiber and no cardiovascular morbidity data. The available studies, with their limitations, all indicate that diet and lifestyle play an important role in preventing chronic complications of type 1 diabetes. 1994) reported an increase in GFR during the low protein diet, but this increase was not significant.
The rates of decline in both iothalamate and creatinine clearence were significantly slower in the patients in the study-diet group than in those in the control-diet group.
In three of these five trials there was a decline in albuminuria in the low protein diet group as well as in the usual protein diet group (Dullaart RP et al. Two of these three showed a significant greater decline in albuminuria in the low protein diet group than in the usual protein diet group (Dullaart RP et al. One of these (Brouhard BH& LaGrone L 1990) found a significant difference between the diet groups. 1988) type 1 diabetic patients with microalbuminuria consumed a significantly smaller percentage of total energy as carbohydrate compared with patients with normal albumin excretion.



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