Readers:
I just wanted to wish you a safe, happy and healthy 4th
of July.
I have two interesting articles for you. First, REM Sleep-
related Osa Linked with Diabetes and then, Diet Reduces
Insulin Need In Gestational Diabetes.
Also, a great recipe for the holiday weekend: Red, White,
and Blue Trifle. Delicious!
Regards,
Steve
Visit the Diabetic Update Forum and post your comments at:
Diabetic Update Forum
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REM Sleep-related Osa Linked with Diabetes
NEW YORK (Reuters Health) – There is a statistically
significant association between type 2 diabetes and
obstructive sleep apnea (OSA) during REM sleep, results
of a study indicate.
In comments to Reuters Health, principal investigator Dr.
Kamran Mahmood said, “Type 2 diabetes is a multifactorial
disorder. REM-related OSA and its metabolic effects need
to be investigated in more depth, and this can provide
another unique avenue for intervention and control of
type 2 diabetes.”
Mahmood from the University of Illinois in Chicago and
colleagues evaluated a multi-ethnic sample of 1008 patients
– including Caucasians (16.9 percent), African Americans
(66.9 percent) and Hispanics (14.9 percent) — for OSA
using polysomnography, an evaluation of brain waves and
other body functions during sleep.
OSA occurs when the soft palate narrows during sleep
closing off the airways causing breathing to stop for
a few seconds or more. Normal breaths resume with a snort
or choking sound and the sleeper temporarily wakes up.
These continuous interruptions throughout the night cause
drowsiness during the day. Among other effects, OSA
increases the risk of heart disease.
Rapid eye movement (REM) sleep, one of the two major phases
of sleep, is when dreaming occurs. As the name implies,
it is characterized by rapid eye movement, but other than
lung movements, no other body muscles move during this
phase of sleep. It is thought to be necessary for memory
consolidation.
The prevalence of type 2 diabetes was 30.1 percent in
patients with OSA compared to 18.6 percent in patients
without OSA, the investigators report in the June 15
issue of the Journal of Clinical Sleep Medicine.
According to the study team, patients with OSA – defined
as an apnea-hypopnea index of 5 or more per hour
(measurement of OSA severity) — had a significantly
increased unadjusted odds ratio for type 2 diabetes but
this association became non-significant in analyses
controlled for BMI, age, and other variables.
Middle-aged participants with OSA had 2.8-times higher
odds for type 2 diabetes compared to younger or middle-
aged participants without OSA, after controlling for
variables.
Additionally, the adjusted odds ratio for type 2 diabetes
was 2.0 in patients with REM sleep-related OSA, defined
as a REM apnea-hypopnea index of 10 or more per hour,
compared to patients without OSA.
“We believe that REM-related OSA is a marker of early OSA,
especially in women and patients younger than 55 years,”
Mahmood noted in a prepared statement. “Generally, OSA is
worse in REM sleep compared to non-REM sleep because of
neurologically mediated impairment of skeletal muscles of
upper airway and ventilation. This may be the reason for
closer association of REM-related OSA and type 2 diabetes.”
SOURCE: Journal of Clinical Sleep Medicine, June 15, 2009.
Copyright Reuters Limited. All rights reserved.
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Diet Reduces Insulin Need In Gestational Diabetes
NEW YORK (Reuters Health) – A low-glycemic index diet can
significantly reduce the need for insulin in women with
gestational diabetes, without compromising maternal or
fetal outcomes, according to a new study.
Researchers have known that women with gestational diabetes
can reduce postprandial glycemia, a spike in blood sugar
that can occur just after a meal, by eating mixed meals
based on low-glycemic index foods. This diet is “commonly
advised as treatment for women with gestational diabetes
mellitus,” Dr. Robert G. Moses and co-investigators write
journal Diabetes Care. “However, the efficacy of this
advice and associated pregnancy outcomes have not been
systematically examined.”
A low-glycemic diet includes starchy foods such as
potatoes, bread, and grain products, the investigators
maintain. Also, the more processed a food is, the more
glycemic it will be.
To further investigate, Moses, at the South Eastern Sydney
and Illawarra Area Health Service in Wollongong, New South
Wales, and his team studied 62 women with gestational
diabetes who were about 30 weeks pregnant. Gestation
diabetes is diabetes that develops during pregnancy and
often disappears after delivery, but tends to signal an
increased risk for diabetes and cardiovascular disease
later in life. The condition may also increase
complications of pregnancy.
Thirty-one women were randomly assigned to the low-glycemic
index diet and 32 were assigned a high-fiber/low-sugar diet
(the high-glycemic index diet). Both diets recommended a
minimum carbohydrate intake of 175 grams per day, with only
the choice of the type of carbohydrate foods varying.
Women on the low-glycemic index diet were counseled on the
energy and nutrient balance of various foods, and were
asked to avoid certain foods including white bread and
processed commercial breakfast cereals. Women in the high-
glycemic index diet group were just advice to avoid sugar
and increase high-fiber, with “no specific mention of the
glycemic index.”
At an average of 32 weeks, 9 women in the low-glycemic diet
(29 percent) and 19 (59 percent) in the high-glycemic diet
required insulin, a statiscally significant difference.
However, instead of receiving insulin, the women on the
high-glycemic index diet were switched to the low-glycemic
index diet instead. The 9 patients no longer met the
criteria for needing insulin. Both groups on the modified
diet achieved a similar glycemic index value by the final
visit at 35 to 37 weeks of gestation.
“Overall,” the authors report, “there were no significant
differences in obstetric and fetal outcomes between the
two groups.”
SOURCE: Diabetes Care, June 2009.
Copyright Reuters Limited. All rights reserved.
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Diabetic Recipe
Red, White, and Blue Trifle
(makes 8 servings)
2 packages 1 ounce each (30 g) sugar-free instant vanilla
pudding mix
4 cups( 960 ml) skim milk
1 pint (290 g) blueberries
2 cups (480 g) sugar free, fat free whipped topping
12 “butter” or vanilla cookies, nonfat, no sugar added
1/4 cup (60 ml) Marsala wine
8 tablespoons (120 g) no sugar raspberry jelly
1 pint (288 g) strawberries
fresh mint
1. Prepare the pudding mix with the milk as per package
directions.
2. Place 2 tablespoons (30 ml) blueberries on the bottom
of each of 8 crystal wine glasses. Cover with some of the
prepared pudding and 2 tablespoons (9 g) whipped topping.
Crumble 1 cookie on top and sprinkle with 1 teaspoon (5 ml)
Marsala wine. Top with 1 tablespoon (15 g) jelly.
3. Cover with thinly sliced strawberries, more of the of
the pudding, and 2 tablespoons (9 g) whipped topping. Top
with crumbled 1/2 of a cookie and 1/2 teaspoon (2.5 ml)
wine. Refrigerate until ready to serve. When ready to
serve, garnish with mint.
Per serving: 163 calories (3% calories from fat),
5 g protein, 1 g total fat (0.2 g saturated
fat), 33 g carbohydrates, 2 g dietary fiber,
2 mg cholesterol, 394 mg sodium
Diabetic exchanges: 2 carbohydrate (1 bread/starch, 1 fruit)
Copyright Diabetic-Lifestyle.
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