Diabetes occurs at such an alarming rate that it is believed to be nearing epidemic proportions worldwide. Nutrition and Diabetes: Pathophysiology and Management is a comprehensive resource that examines the metabolic aberrations found in obesity that eventually lead to the development of diabetes. By focusing on the role diet has in the cause and management of obesity and diabetes, it provides a scientific basis for the different approaches used in their treatment. The text is divided into three sections for easy reference. Section I, Pathophysiology and Treatment of Obesity, includes chapters on the neuroendocrine regulation of food intake, achieving healthy body weight through diet and exercise, and surgical and nonsurgical weight loss techniques. Section II, Pathophysiology and Treatment of Diabetes, presents discussions on Type 2 diabetes in childhood, the management of Type 2 diabetes in underrepresented minorities in the U.S. and in developing countries, and the issue of diabetes in pregnancy. Section III, The Role of Oxidative Stress in the Pathogenesis and Treatment of Diabetes and Its Complications, outlines oxidative stress in relation to Type 1 diabetes, glycemic control in Type 2 diabetes, and the vascular complications of diabetes mellitus. The text presents these topics in a comprehensive yet accessible manner, making Nutrition and Diabetes: Pathophysiology and Management an important resource for those interested in acquiring the latest information on nutrition's essential role in the cause and management of diabetes.
Author(s): Emmanuel Opara
Edition: 1
Year: 2005
Language: English
Pages: 497
Front cover......Page 1
Foreword......Page 6
Preface......Page 10
Editor......Page 12
Contributors......Page 14
Table of Contents......Page 18
Pathophysiology and Treatment of Obesity......Page 22
Introduction......Page 24
Neuroendocrine Regulation of Food Intake......Page 26
II. Appetite and Satiety......Page 27
A. Neuropeptide Y......Page 28
C. Hypocretins/Orexins......Page 29
B. Cocaine- and Amphetamine-Regulated Transcript......Page 30
VI. Peripheral Signals in the Regulation of Food Intake......Page 31
C. Leptin......Page 32
2. Leptin and Insulin Action......Page 33
A. Insulin......Page 35
B. Pancreatic Polypeptide......Page 36
A. Ghrelin......Page 37
C. Glucagon-Like Peptide-1......Page 38
IX. Conclusions......Page 39
References......Page 40
I. Introduction......Page 48
A. GIP......Page 49
B. GLP 1......Page 51
A. GIP - The Obesity Hormone?......Page 52
IV. The Enteroinsular Axis in Diabetes......Page 54
A. Type 2 Diabetes Mellitus......Page 55
VI. Conclusions......Page 58
References......Page 59
Achieving a Healthy Body Weight: Diet and Exercise Interventions for Type 2 Diabetes......Page 64
II. Health Benefits of Diet and Exercise......Page 65
III. Lifestyle Interventions: Indications and Goals......Page 66
2. Calorie-Reduction Diets......Page 67
4. Low Carbohydrate and Other Nontraditional Dietary Approaches......Page 69
B. Exercise Interventions......Page 70
2. Resistance training......Page 72
IV. Concluding Comments on Maintenance of Weight Loss and Improved Fitness......Page 73
References......Page 74
I. The Metabolic Syndrome......Page 78
II. Overview of Current Controversies with Definition of the Metabolic Syndrome......Page 79
III. Cross-sectional Studies of the Importance of Physical Fitness and Exercise to the Diagnosis and Etiology of Metabolic Syndrome......Page 81
IV. Metabolic Syndrome and Exercise......Page 84
A. Exercise-Training Effects on Blood Pressure......Page 85
C. Exercise-Training Effects on HDL Cholesterol......Page 87
D. Exercise-Training Effects on Fasting Plasma Glucose......Page 88
E. Exercise-Training Effects on Insulin Sensitivity......Page 90
F. Exercise Training Effects on Waist Circumference......Page 91
VI. Rationale for Including Cardiorespiratory Fitness in Metabolic Syndrome......Page 92
References......Page 94
I. Introduction......Page 100
II. Muscle Mitochondria and Uncoupling Protein in Obesity......Page 101
A. Blunted Muscle Insulin-Signal Transduction in Obesity......Page 102
C. Relationship of Skeletal-Muscle Insulin Resistance and Intramyocellular Lipid Accumulation......Page 104
IV. Lipid Metabolism in Obesity......Page 106
A. Fatty-Acid Oxidation in Skeletal Muscle......Page 107
B. Fatty-Acid Transport into Skeletal Muscle......Page 109
C. Metabolic Inflexibility Associated with Obesity......Page 110
References......Page 112
II. Definition......Page 120
III. Relationship Between Obesity and Diabetes......Page 121
IV. Challenges of Lifestyle Change in the Management of Obesity......Page 122
V. The Role of Exercise in the Management of Obesity......Page 124
VI. The Role of Drugs......Page 125
VII. Conclusion......Page 126
References......Page 127
I. Introduction......Page 132
A. History......Page 133
1. Patient Selection......Page 135
2. Laparoscopic Adjustable Gastric Banding......Page 136
3. Gastric Bypass......Page 138
4. Biliopancreatic Diversion......Page 140
IV. Laparoscopic Bariatric Surgery......Page 141
References......Page 142
A. Roux-en-Y Gastric Bypass......Page 146
III. Predictors of Complications......Page 147
A. Phase One Complications (One to Six Weeks)......Page 148
B. Phase Two Complications (Six Weeks to Two Months)......Page 149
C. Phase Three Complications (2 to 12 Months)......Page 151
References......Page 153
Pathophysiology and Treatment of Diabetes......Page 156
Introduction......Page 158
Epidemiology, Risks, and Health-Care Expenditures for Diabetes and Its Complications......Page 160
II. Prevalence of Diabetes......Page 161
III. Defining Impaired Glucose Tolerance, Insulin Resistance, and Diabetes Mellitus......Page 163
IV. Diagnostic Criteria for Diabetes Mellitus......Page 164
B. Posttransplantation Diabetes......Page 166
C. Association of Obesity with Diabetes......Page 167
F. Effects of Alcohol and Cigarettes......Page 168
H. Diabetes and Mental Health......Page 169
A. Coronary-Vascular Disease......Page 170
B. Peripheral Neuropathy and Peripheral Vascular Disease......Page 171
C. Cerebrovascular Disease......Page 172
F. Retinopathy......Page 173
VIII. Level of Health Care......Page 174
References......Page 175
I. Introduction......Page 182
III. Blood-Glucose Regulation......Page 183
IV. Interrelationships of Nutrient Metabolism and the Effect on Glucose Homeostasis......Page 184
V. Design of Treatment for Type 2 Diabetes Based on Nutrient Interactions......Page 186
A. Limiting Availability of Fatty Acids......Page 187
B. Inhibition of Fatty-Acid Oxidation......Page 188
C. Inhibition of Gluconeogenesis......Page 189
D. Uncoupling of Energy During Fatty-Acid Oxidation......Page 190
E. Nutritionally Based Therapeutic Approach......Page 191
VI. Conclusion......Page 193
References......Page 194
Type 2 Diabetes in Childhood: Diagnosis, Pathogenesis, Prevention, and Treatment......Page 198
II. Diagnosis of Type 2 Diabetes in Children......Page 199
III. Risk Factors and the Pathogenesis of Insulin Resistance and Type 2 Diabetes......Page 201
A. Diet......Page 205
B. Exercise......Page 206
A. Presenting Manifestations and Acute Complications......Page 207
B. Hypertension, Atherogenesis, and Cardiovascular Disease in Obesity and Type 2 Diabetes......Page 208
A. Lifestyle Intervention......Page 210
1. Drugs that Limit Nutrient Absorption......Page 211
2. Insulin Suppressors and Sensitizers......Page 212
3. Other Pharmacologic Approaches......Page 216
4. Recommendations Regarding Pharmacotherapy in Diabetes Prevention......Page 217
VIII. A Multifaceted Approach to Prevention of Complications......Page 218
References......Page 219
Management of Obesity- Associated Type 2 Diabetes......Page 226
A. Animal Studies......Page 227
B. Human Studies - Dietary Fat......Page 229
C. Human Studies - Dietary Carbohydrate......Page 230
A. Low-Fat Diets......Page 231
B. Modified Fat/High-Monounsaturated Fatty Acid (MUFA) Diets......Page 233
C. Low-Carbohydrate Diets......Page 234
D. High-Protein Diets......Page 239
1. Biguanides......Page 241
2. Sulfonylureas......Page 242
B. Insulin Therapy......Page 243
References......Page 244
Management of Type 2 Diabetes in Underrepresented Minorities in the U.S.......Page 248
II. Introduction......Page 249
A. Goals of Diabetes Management......Page 250
A. Undiagnosed Diabetes......Page 251
C. Socioeconomic, Cultural, and Psychological Barriers......Page 252
D. Provider Factors......Page 253
3. Awareness of Pseudohypoglycemia......Page 254
1. Nonpharmacological Measures......Page 255
A. Macrovascular Complications......Page 261
C. Special Focus on Kidney Disease......Page 262
D. Prevention of Lower-Extremity Amputation......Page 263
References......Page 264
I. Introduction......Page 270
II. Epidemiology......Page 271
A. The So-Called Tropical Diabetes......Page 272
B. Ketosis-Prone Atypical Diabetes Mellitus or Type 1B Diabetes......Page 273
B. Complications of Diabetes......Page 274
A. Organization of Diabetes Care......Page 275
C. Diabetes Education......Page 276
1. Dietary Management......Page 277
2. Physical Activity......Page 278
B. Insulin Therapy......Page 280
C. Management of Ketosis-Prone Diabetes......Page 281
VII. Cost of Diabetes Care......Page 282
References......Page 284
I. Introduction......Page 288
III. Pregnancy’s Impact on Diabetes......Page 289
C. Diabetic Retinopathy......Page 290
IV. The Impact of Diabetes Mellitus on Pregnancy......Page 291
V. Management of Gestational Diabetes......Page 293
VI. Type 1 and 2 Diabetes Mellitus......Page 296
VII. Pregnancy and Diabetes in Perspective......Page 299
References......Page 300
Web-Based Simulations for Dynamic Variations in Blood-Glucose Concentration of Patients with Type 1 Diabetes......Page 302
II. Models for Describing Dynamic Variations in Blood-Glucose Concentration......Page 303
A. Detailed Glucose Model......Page 304
B. Detailed Insulin Model......Page 306
C. Overall Model for Glucose and Insulin......Page 307
2. Pancreatic Insulin Release Model......Page 308
E. Exercise Model......Page 309
A. GLUCOSIM......Page 310
IV. Illustrative Case Studies......Page 312
B. Case 2: Insulin Injection to Subcutaneous and Intraperitoneal Areas......Page 313
C. Case 3: Comparison of Three Control Algorithms in the Presence of Various Meals and Exercise......Page 315
V. Conclusion......Page 316
References......Page 317
The Role of Oxidative Stress in the Pathogenesis and Treatment of Diabetes and Its Complications......Page 320
Introduction......Page 322
I. Introduction......Page 324
II. Glucose Uptake and ATP/ADP Regulation......Page 325
III. Connection of ROS Production in b-Cells with GSIS Mechanism......Page 327
IV. Manifestations of Oxidative Stress and Apoptosis......Page 329
V. Dual Role of the GSIS Mechanism......Page 330
VII. The GSIS-ROS Hypotheses and Repair Problems......Page 332
VIII. Preservation of b-Cell Function and Islet Mass Versus Enhancement of GSIS: Mutually Exclusive Goals?......Page 333
IX. Conclusion......Page 335
References......Page 336
I. Introduction......Page 340
II. Oxidative Stress in Early Type 1 Diabetes......Page 341
A. Patients......Page 342
E. Early Changes in Peripheral-Nerve Function in Type 1 Diabetes......Page 343
F. Oxidative Stress in Early Diabetes......Page 345
G. Oxidative Stress and Peripheral-Nerve Function in Early Diabetes......Page 347
H. Effects of Diabetes on Nitric Oxide......Page 349
I. Hemodynamic Consequences of Nitrosative Stress......Page 351
J. Uric Acid and Autonomic Function in Type 1 Diabetes......Page 352
K. Oxidative Stress Versus Nitrosative Stress......Page 353
IV. Oxidative Stress and b-Cell Function......Page 354
V. Oxidative Stress in Chronic Diabetes......Page 356
VI. Antioxidant Defenses in Chronic Diabetes......Page 357
VIII. Summary......Page 358
References......Page 359
I. Introduction......Page 366
II. Association between Oxidative Stress and Type 2 Diabetes......Page 367
III. Role of Oxidative Stress in the Pathogenesis of Type 2 Diabetes......Page 369
IV. Studies of Antioxidant Supplementation for Glycemic Control in Type 2 Diabetes......Page 370
B. Vitamin C......Page 371
D. Glutathione......Page 372
F. Coenzyme Q10......Page 373
G. Trace Elements......Page 374
VI. Conclusion......Page 375
References......Page 377
I. Introduction......Page 382
III. The Pathophysiology of Oxidative Stress, Diabetes, and Vascular Injury......Page 383
A. Hyperglycemia......Page 384
B. Dyslipidemia......Page 386
C. Insulin Resistance......Page 387
IV. Diabetic Vascular Injury - Prothrombotic Environment......Page 388
2. Nephropathy......Page 389
3. Peripheral Vascular......Page 390
VI. Treatment: Oxidative Stress and Diabetes......Page 391
Acknowledgments......Page 392
References......Page 393
I. Introduction......Page 402
II. Overview of Mechanisms of Diabetic Injury in the Peripheral Nervous System (PNS)......Page 403
III. NO and Nitrosative Injury in the PNS......Page 405
V. Uncoupling Proteins and Oxidative Injury......Page 406
A. a-Lipoic Acid......Page 407
D. Growth Factors......Page 408
E. Other Potential Therapies that Reduce Oxidative Injury......Page 409
Acknowledgments......Page 411
References......Page 412
I. Introduction......Page 420
II. Oxidative Stress and Hyperglycemia......Page 422
III. Advanced Glycation End Products (AGE)......Page 425
IV. Medical Nutrition Therapy......Page 430
A. Sorbitol and Taurine......Page 431
B. Selenium, Thiamine, Vitamin C, Glutathione......Page 433
V. Conclusions......Page 435
References......Page 437
Pathophysiology and Management of Diabetic Gastropathy......Page 448
II. Physiological Basis for Gastric Smooth-Muscle Activity......Page 449
III. Pathophysiology of Diabetic Gastropathy......Page 450
V. Perspectives on Evaluation of Gastric Emptying......Page 452
VI. Contemporary Methods for Evaluation of Gastric Emptying......Page 453
C. Tracer Methods......Page 454
F. Electrogastrography (EGG)......Page 455
VII. Evaluation of Patients with Suspected Diabetic Gastropathy......Page 456
C. Optimizing Glycemic Control......Page 457
F. Cisapride......Page 458
I. Refractory Gastropathy......Page 459
References......Page 460
A......Page 470
B......Page 472
C......Page 473
D......Page 475
E......Page 478
F......Page 479
G......Page 480
H......Page 482
I......Page 483
L......Page 485
M......Page 486
N......Page 488
O......Page 489
P......Page 491
S......Page 493
U......Page 495
V......Page 496
Z......Page 497
