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 ?
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