Saturday, February 25, 2012

Are you losing the Afternoon Snack Battle by not using the right weapons

I was reading a fellow blogger  thoughts on her struggles with controlling her afternoon desire for a snack or two. She basically feels that she does not have enough will power to control this urge.

I Think there is more to this problem than weak will power. 
She may be fighting a  battle, not of her choosing , with the wrong weapons .

Her will power is hobbled  by dysfunction of her Alpha cells  ( produces Glucagon ) and Beta cells (produces insulin and amylin) in her pancreas further complicated by a deficiency go GLP-1 from the intestine.

My question . Is she giving her will power the support it needs to do a better job ?

Lunch with:

A Person Without Diabetes

Her friend without diabetes can eat anything she wants for lunch and the food will very quickly leave the stomach  and trigger the release of GLP-1 from her intestine. Her blood glucose will will increase and trigger an immediate quick release of insulin  and suppression of glucagon  that allows the glucose level to peak in about 1 hour and return back to new normal baseline within 2 hours and stay there until she decides to eat again which can be 2 hours or 8 hours and it really doesn't matter because her liver is gas tank filled with glucose and its output is carefully regulated by glucagon.

A Person With Type 2 Diabetes

Our friend with Type 2 Diabetes can eat the same meal at lunch and may have a different outcome. Eating the meal is no problems but dysfunction exist from there on . Her stomach may or may not empty correctly , her alpha cells  are dysfunctional and inappropriately releasing glucagon  causing her liver to release glucose resulting a higher glucose  at the start of her meal, her beta cell have sluggish and  inadequate insulin release contributing to the problem . This is further complicated by inadequate  GLP-1 from the intestine.

 The outcome of all of this is that she starts her meal with a higher glucose, her insulin arrives to little to late , glucose spills into the urine and then the late arriving insulin arrives and causes a low glucose reading and an intense desire to eat  in the afternoon.

Choose A better weapon and win the battle 

Please read my  Feb. 13 2012 blog  ,New medication, High Cost : Hypoglycemia to the Rescue  , for more detail on the medications discussed below.

 Food choices  ( the amount and type of carbohydrate )and portion size play a role along with with her choices of medications.

 Incorrect insulin use and sulfonylureas make the problem worse .

 Glycophage( metformin ) helps improve insulin function with low risk of hypoglycemia

GLP-1 agonist such as Byetta(exenatide ) Victroza ( liraglutide )  slow stomach emptying , improve insulin and glucagon release , help with weight loss without the risk of hypoglycemia and protect your beta cells.

 DPP-4 inhibitors have similar effects of the GLP-1 agonist without helping with weight loss.

 The right medicine may give your will power  a little R&R

Have fun , Be Smart and Defeat Diabetes
David Calder, MD

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Your comments and questions are appreciated. David Calder,MD