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Diabetes Update: Glycemic Load

Number 15; June 21, 2001

By David Mendosa

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at

From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contributions are:

    For almost a week I have delayed this issue as I waited for the American Diabetes Association to put up my new column, scheduled for June 15. I can wait no longer and still have no idea when the ADA will be getting its act together. Right now the organization is in the midst of relaunching the site and everything seems totally screwed up. I will let you know when mycolumn eventually becomes available.

    on June 2, 2001

  • Painless Meters
    The second generation of blood glucose meters has arrived. If fingerstick meters comprised the first generation, alternative site meters that are essentially painless are the second generation. Four companies make five of these essentially painless meters. I have used all of them and report on these new meters in the current issue of Diabetes Wellness Letter. For your convenience this article is also on-line on my Web site at .

    on May 19, 2001

  • Exercise Lite
    The good news is maybe we don't need to exercise as hard as we previously thought to stay heart healthy. A new major study in JAMA, the Journal of the American Medical Association, shows that a light to moderate activity is associated with a lower risk of coronary heart disease. That activity is walking. The bad news is the related lifestyle tip: you need to buy a new pair of walking shoes. The URL is

Updates Include:

  • Free Journals
    The Free Medical Journals site links 650 free journals sorted by specialty. I had intended to include it in the previous issue of this newsletter. The URL is

  • Glycemic Load
    An article, "Glycemic Load, Diet, and Health" in the June 2001 issue of Harvard Women's Health Watch is an excellent introduction to the glycemic index and an extension of that concept named the "glycemic load," which is the glycemic index of a food times its carbohydrate content in grams. Harvard School of Public Health professor and researcher Walter Willett, M.D., developed the concept of the glycemic load, according to Professor Jennie Brand-Miller of the University of Sydney and the world's leading researcher of the glycemic index.

    "I think it makes a lot of sense," she wrote me this morning. "After all, if you eat a lot of carbohydrate and it's all high GI, then you would expect more undesirable effects than if you eat only a little CHO from high GI sources."

    The Harvard Women's Health Watch article explains the glycemic index more clearly than I ever could. These are the key sentences:

    Not all carbohydrates act the same. Some are quickly broken down in the intestine, causing the blood sugar level to rise rapidly. Such carbohydrates have a high glycemic index. Rapidly rising blood sugar levels have various adverse effects. A GI value tells you only how rapidly a particular carbohydrate turns into sugar. It doesn't tell you how much of that carbohydrate is in a serving of a particular food.

  • Women and Diabetes
    The New York Times on June 19 had a long, interesting article about women and autoimmune diseases. I was especially interested to see this particular statement:

    "...Even the less frankly "feminine" immune diseases like multiple sclerosis and Type 1, or juvenile, diabetes strike twice as many women as men."

    Since I never heard that before, I wondered if that was correct. So I looked around the Web and asked the experts. This is what I learned.

    As highly respected as Natalie Angier, who wrote the New York Times article, is, she is wrong, according to the most authoritative study I can find.

    "Prevalence and Incidence of Insulin-Dependent Diabetes" by Ronald E. LaPorte, PhD, Masato Matsushima, MD, and Yue-Fang Chang, PhD, Chapter 3 of Diabetes in America, 2nd edition, says:

    "The incidence of IDDM by sex is presented in Tables 3.8 and 3.9. In general, whites have a slight male excess, whereas non-whites have a slight female excess."

    Then, I wrote Dr. LaPorte, who is director, disease monitoring and telecommunications, at the WHO collaborating center and professor of epidemiology at the University of Pittsburgh. He replied this morning with a long message, including the following:

    "The information concerning the sex differences of type 1 diabetes was incorrect. In the past 10 years we have mapped out the world with our WHO multinational study for childhood diabetes. We have standardized incidence data from over 50 countries. The results in each county typically show no difference in the incidence. However in the very low risk countries (less than 3/100,000) there is a slight female excess, in contrast in the high risk countries like the US and others, (greater than 10/100,000) there is a slight male excess.

    "This difference is nothing like you see for thyroid, lupus, RA, etc.

    "However, there is indirect evidence as the peak of childhood diabetes occurs at puberty in almost all countries, with males having a slightly higher onset than females. Also, there is some evidence that pregnancy may propel an individual into type I diabetes. (this may be metabolic as the insulin requirements go up, if one has a damaged pancreas, then increased requirements could push one into diabetes).

    "HLA is strongly associated with Type I diabetes; there also is interesting data to suggest that HLA is associated with sex hormone levels." [HLA = Human Leukocyte Antigen, A genetic fingerprint on white blood cells and platelets, composed of proteins that play a critical role in activating the body's immune system to respond to foreign organisms.]

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