Deficiency is rare but can be depleted by alcoholism, long-term diarrhea, liver or kidney disease, and severe diabetes; a deficiency is also often tied to high insulin levels and glucose intolerance that can lead to type 2 diabetes
Phosphorus
Lack of appetite, weight loss, or even obesity; it may cause irregular breathing, mental and physical fatigue, and nervous disorders
Trace Minerals (Microminerals)
Chromium
Even slight deficiencies can lead to problems with metabolizing glucose and upset the function of insulin levels
Copper
Although rare, deficiencies include low blood levels in children with edema or iron deficiency anemia; in adults, it may lead to general weakness, impaired respiration, and skin sores
Fluoride
Poor tooth development and dental caries (cavities)
Iodine
Enlarged thyroid (goiter) and hypothyroidism (low secretion of thyroid hormones); can lead to hardening of the arteries, obesity, sluggish metabolism, dry hair, slow mental reactions, rapid pulse, heart palpitations, tremors, nervousness, and irritability
Iron
Most common is iron-deficiency anemia; can lead to constipation, brittle nails or ridges in nails, lethargy, apathy, pallor, reduced brain function, headaches, and heart enlargement; can cause unusual food cravings (such as for ice, clay, and other non-food items; see sidebar)
Manganese
Mostly affects glucose tolerance, resulting in the inability to remove excess sugar from the blood by oxidation and/or storage, causing diabetes ; can cause atherosclerosis; severe deficiencies can cause paralysis, convulsions, blindness, and deafness in infants; in adults, can cause dizziness, ear noises, and hearing loss
Molybdenum
Excessive deficiencies may cause fast heartbeat, increased rate of breathing, and visual problems
Selenium
May cause premature aging; major deficiencies may cause cataracts, liver necrosis, and growth retardation; low levels have been associated with several types of cancers, including bladder and colon cancers
Zinc
May show up in a diet high in grains and cereals and low in animal protein; it can cause retarded growth, delayed sexual maturity, and cause wounds to take longer to heal; it can cause brittle nails, and white spots on the nail may be a sign; it can also cause irregular menstrual cycles in teenage women and painful knee and hip joints in teens of both genders
Electrolytes
Chloride
A deficiency can cause hair and tooth loss, poor muscular contractions, and impaired digestion; it also usually means there is a deficiency of sodium in the body
Potassium
An abnormal decrease (hypokalemia) or increase (hyperkalemia) affects the nervous system, and both can increase the chance for arrhythmias (irregular heartbeats); both can also affect the kidneys
Sodium
A major deficiency can cause intestinal gas, weight loss, poor memory, short attention span, difficulty in concentrating, muscle weakness, low blood sugar , and heart palpitations
Bicarbonate
Listed in most research as an electrolyte; difficult to determine a deficiency in some cases, and deficiencies are often connected to other conditions, such as kidney disease, respiratory function, and metabolic conditions
What is iron-deficiency anemia?
Iron-deficiency anemia is also called hypochromic anemia.
It occurs when the amount of hemoglobin in the red blood cells is reduced and, as a result, the cells become smaller.
Because of this, the oxygen-carrying capacity of the blood is reduced.
Those at risk are usually women of child-bearing years (especially pregnant or lactating), older infants, children, and people with certain dietary restrictions, such as those with diabetes, the elderly, low-income people, and minorities.
It is also estimated that one in four college women is deficient in iron, most often from menstruation and not eating as healthfully while in school.
Can a person with diabetes become anemic?
Yes, just as with non-diabetics, the lack of iron in people with diabetes can lead to anemia.
In fact, it is estimated that 25 percent of people with diabetes are anemic.
It is thought that anemia occurs in people with diabetes because the erythropoietin, the hormone that controls the production of red blood cells, is produced in the kidneys.
Since one complication of diabetes is kidney damage, the two conditions are often found together.
In addition, if a person with diabetes has anemia, his or her blood glucose levels can be affected, with some reports of blood glucose test results being 20 percent too high.
This is why it is important, especially for people with type 1 diabetes and their health care providers, to be aware of this combination.
Anemia occurs when one’s blood is deficient in red cells. Since diabetics often have damaged kidneys, leading to lower amounts of erythropoietin, they may produce fewer red blood cells and become anemic.
What is potassium and its connection to glucose in the body?
Potassium, along with sodium, is a very necessary mineral that helps to regulate the body’s balance of fluids.
It is also necessary for our metabolism, helps in the transmission of nerve impulses, and is needed for muscle function.
Further, it regulates the transfer of nutrients to the cells and functions in the chemical reactions within the cells.
It is important to our bodies’ sugar levels, helping to convert glucose into glycogen so it can be stored in the liver.
Potassium also helps stimulate the kidneys to eliminate our toxic body wastes and acts with sodium to help normalize our heartbeats.
The Handy Diabetes Answer Book
DIABETES AND FOOD
MAJOR FOOD COMPONENTS AND DIABETES
What are some targets recommended by the American Diabetes Association in terms of food components?
According to the American Diabetes Association’s nutritional guidelines, targets are suggested for the many food components. The following lists those food components and the amounts that are recommended daily:
Recommended Amounts of Food Components
Component
Daily Recommended Amount
Saturated fat
Less than 7 percent of total daily calories
Trans fat
Very minimal amounts, if any
Cholesterol
Less than 200 milligrams per day
Protein
Around 15 to 20 percent of total daily calories
Fiber
At least 14 grams per 1,000 calories a day
Sodium
No more than 2,300 milligrams per day
This amount is highly debated; for more about the controversy surrounding the intake of sodium, see this chapter.
Do some foods fight diabetes?
Yes, some foods, too many to mention in this text, seem to help fight diabetes, although the “help” from these foods is often controversial.
Although many health care professionals do not advocate its constant use, vinegar has been shown to improve insulin sensitivity, and it may stop the after-meal spikes in a person’s blood glucose levels, too.
In one study, participants with type 1 diabetes drank a vinegar-water solution or plain water five minutes before eating a carbohydrate-heavy meal.
Participants who drank the vinegar mixture cut their rise in blood glucose levels by almost 20 percent in comparison with those who drank only water.
Even as little as 2 tablespoons of vinegar with a meal helped to stop spikes in blood glucose levels.
In addition, lemon juice may have the same effect.
It is thought that both vinegar and lemon juice have acid, which slows down a person’s digestion, so the body absorbs sugar in the food more slowly.
Another possible food contender to help diabetes is the white button mushroom.
Found commonly in most grocery stores, these mushrooms are funguses filled with nutrients (vitamins C, D, B2 [riboflavin], and folate), fiber, and many antioxidants, all of which are thought to help lower blood glucose levels in people with diabetes.
If a little vinegar is consumed before a meal with carbs in it, blood glucose will rise less.
WHAT ARE FOOD EXCHANGES?
What are “food exchanges” in the context of food and diabetes?
Food exchanges put together groups of foods that have a similar combination of carbohydrates, fat, protein, and calories.
The “exchange” comes from the idea that a person can exchange one food serving for another, depending on the carbohydrate amount.
According to the Diabetes Teaching Center in San Francisco, foods with a similar amount of carbohydrates per serving size are grouped together (remember, serving size is different from portion size; for more, see this chapter).
This way, people can manage the amount of carbohydrates they eat in a meal.
How does a person use the exchange list?
To use the exchange list, a person chooses various foods based on their carbohydrate, fat, protein, or calorie content.
This is a good way to keep blood glucose levels more stable and make meal planning easier.
There are also exchanges for fats and proteins, although most people with diabetes concentrate on counting carbohydrates to manage their condition.
For example, one carbohydrate exchange is equal to 12 to 15 grams of carbohydrate.
This group is generally broken down into bread/starch, meats and meat substitutes, fruit, milk, fats, and vegetables.
When a meal plan reads “2½ carbohydrate 2 exchanges” (equal to 1 bread/starch, 1 fruit, ½ milk), it means a person can have, for instance, a slice of bread, a fresh peach, and a half cup of nonfat yogurt, or the equivalent carbohydrate exchanges if the other food sources (bread/starch, fruit, and milk) are also equivalent to 2½ carbohydrate exchanges. (For a short list of food exchanges, see Appendix A.)
DIABETES AND GLYCEMIC NUMBERS
What is a glycemic index?
The glycemic index (GI) is an important tool for diabetics as it gives a numerical ranking to foods based on the rate of their conversion to glucose in the body. The scale is from one to 100, with pure glucose (sugar) being the standard at 100. The lower numbers represent a low rise in blood sugar after a certain food is consumed; the higher numbers represent a more rapid rise in blood sugar after a certain food is consumed.
Why do some health care professionals not agree with using the glycemic index?
Although the glycemic index (GI) does prove to be a useful tool, it is not a perfect system.
One reason is that the GI ranking applies only when you eat something on an empty stomach, and most people eat many foods together at a meal.
Another reason is that the GI doesn’t take into consideration how much a person actually consumes.
It is based on a serving of food that contains 50 grams of carbohydrates minus the fiber, then measuring the person’s blood glucose levels over two hours.
Because of these inherent problems, the glycemic load was developed.
What is a glycemic load?
Not all foods will immediately give you a boost, even if the item has a high glycemic index.
What also becomes important to a person with diabetes is the glycemic load, or the body’s response based on the glycemic index and the amount of whatever carbohydrate is consumed.
For example, even though a piece of candy has a high glycemic index, if it is small, it will have a relatively small glycemic response.
According to the Harvard School of Public Health, where the idea of the glycemic load was developed, the glycemic load is equal to the glycemic index over 100, then multiplied by the net carbohydrates (that is, equal to the total carbohydrates minus the dietary fiber).
Thus, people with diabetes eat both low-glycemic-index foods and restrict their carbohydrates in order to control their diabetes. (For information about foods and their glycemic index and load, see Appendix B.)