Beauty Health for Life

Antioxidants fight oxidative stress. And oxidative stress is thought to increase the risk for type 2 diabetes. You might think that the more antioxidants you take, the less your risk for diabetes. This study found that more is not necessarily better, and may in fact raise the risk for diabetes:

Reactive Oxygen Species Enhance Insulin Sensitivity, Cell Metabolism, October 2009

Mice that were fed a high-fat diet, but that lacked an enzyme that acts like an antioxidant (glutathione peroxidase), were less likely to develop insulin resistance - a precursor to diabetes - than normal mice who had this enzyme. When the enzyme-deficient mice were given an antioxidant (N-acetylcysteine), they became more insulin resistant.

Oxidized compounds may be beneficial by acting as signals - inhibiting the action of enzymes that can slow the action of insulin.

This study found that, at least in mice, antioxidants promote insulin resistance.
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Nicely done video by Diabetes.co.uk:

Exubera^TM, the powdered inhalable insulin being developed by Pfizer and Sanofi-Aventis was reviewed last Thursday by the FDA’s Endocrinologic & Metabolic Drugs Advisory Committee. The committee backed the drug (and its delivery system: inhalation) as a substitute for some injections.

The FDA has yet to approve it, but often heeds recommendations of its advisory committees. FDA approval may be a year away.

Exubera^TM is the first inhalable insulin to make it this far in the route to FDA approval. Novo Nordisk (with Aradigm) and Eli Lilly (with Alkermes) also have inhalable drugs in development.

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Pfizers press release:
FDA Advisory Committee Recommends Approval of Exubera® for Use in Adults with Type 1 and 2 Diabetes

Novo Nordisk and Aradigms press release:
Aradigm Announces Novo Nordisk Presentation of Data of AERx Insulin Diabetes Management System at the American Diabetes Association Annual Meeting

Eli Lilly and Alkermess press release:
Lilly and Alkermes Initiate Phase 3 Safety Study for Inhaled Insulin

It isnt just carbohydrates people with diabetes need to be vigilant about. Its the fat too.

A new study from the Joslin Clinic in Boston found that patients with type 1 diabetes required more insulin coverage for a higher-fat meal compared to a lower-fat meal. The meals were prepared in the Clinics kitchen and had identical carbohydrate and protein, but different fat content - 60 grams vs. 10 grams. The carbohydrates in the meals had similar glycemic indexes.

Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes, Diabetes Care, April 2013

It was a small study of crossover design, meaning each participant consumed both the high-fat meal and the low-fat meal.

"RESULTS Seven patients with type 1 diabetes (age, 55 ± 12 years; A1C 7.2 ± 0.8%) successfully completed the protocol. [The high-fat] dinner required more insulin than [the low-fat] dinner (12.6 ± 1.9 units vs. 9.0 ± 1.3 units; P = 0.01) and, despite the additional insulin, caused more hyperglycemia.

CONCLUSIONS This evidence that dietary fat increases glucose levels and insulin requirements highlights the limitations of the current carbohydrate-based approach to bolus dose calculation. These findings point to the need for alternative insulin dosing algorithms for higher-fat meals and suggest that dietary fat intake is an important nutritional consideration for glycemic control in individuals with type 1 diabetes."

Joslin accompanied their study with this short video:

"When people ate a higher fat meal, their blood sugars were higher for longer and required more insulin."

Why does dietary fat lead to higher blood glucose? It is thought that fat contributes to insulin resistance:

"Dietary fat and free fatty acids (FFAs) are known to impair insulin sensitivity and to enhance hepatic glucose production. ... Interventions that lower [free fatty acid] levels in nondiabetic and type 2 diabetic individuals lead to both improved insulin sensitivity and glucose tolerance."

Saturated fat may be more problematic:

"Studies in nondiabetic individuals indicate that saturated fats cause more profound insulin resistance than monounsaturated and polyunsaturated fats. By design, the [high-fat] dinner meal in the current study was predominantly saturated fat."

And:

"Pizza is widely recognized to cause marked late postprandial hyperglycemia in patients with type 1 diabetes."

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