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GLYCAEMIC INDEX – A Key Factor In Diabetes

Management

PRESENTED BY

Ms. Mayuri Madhavrao Choudhary

Diabetes Mellitus

• Diabetes – Greek – means “ to siphon ’’.• Mellitus – Latin – means “ sweet like honey ’’.

Excessive water comes out of the body of a person as if it were being siphoned from the mouth through the urinary system out of the body.

Other definitions of Diabetes

• A group of metabolic disorders in which a person has high blood sugar , either because the body does not produce insulin, or what produced is not enough, or because cells do not respond to the insulin as it is not effective.

( Wikipedia )

• A chronic metabolic disorder that prevents the body to utilize glucose completely. ( Srilakshmi,2009 )

• A disorder of carbohydrate metabolism characterized by high blood sugar level ( hyperglycemia ) and high level of sugar in urine ( glycosuria ) . ( Shubhangini Joshi,2005 )

Glucose in blood

Types of diabetes

• Type I ( IDDM ).• Type II ( NIDDM ).• Malnutrition related diabetes

mellitus.• Gestational diabetes.

Prevalence of diabetes

Year 2000 Year 2030

Source : WHO, report 2011 (http://www.who.int/diabetes/facts/world_figures/en/index)

Dietary management in diabetes

S. No. Nutrient Current consensus guidelines

1 Carbohydrates 50-60 % of total energy

2 Proteins 10-15 % of total energy

3 Fats

Total fat < 30 % of total energy

Saturated fatty acids

< 10 %

Trans fatty acids < 1 %

PUFAs 5-8 %

MUFAs 10-15 %

Source : National Consensus Dietary Guidelines For Healthy Living and prevention of obesity, diabetes and related diseases (2009)

Source : Diet and Diabetes – NIN (1993) Nutrition and Dietetics – Shubhangini Joshi (2005) Dietetics – Srilakshmi (2009)

Foods to be avoided and permitted

Foods to be avoided

Foods to be eaten in

moderation

Foods permitted

Simple sugars, syrups, sweets, dried fruits, cake, candy, alcohol and alcoholic beverages, soft drinks, sweetened juices etc.Organ meats like liver , brain , kidney etc.

Fats, cereals, pulses, meat, egg, nuts, roots, fruits etc.

Green leafy vegetables, lemon, clear soups, onion, mint, spices, salad, plain coffee or tea, skimmed and buttermilk etc.

Historical aspects of the dietary management of diabetes

Source : Human nutrition and dietitics (Garrow J.S.2000)

Just in……

In all affairs it’s a healthy thing now and then to hang a question mark on the things you have long taken for granted……

- Bertrand Russell

Glycaemic Index

Definition – The area under the curve for the increase in blood glucose after

the injection of 50 gm of carbohydrate in the food during the 2 hr post prandial period relative to the same amount of carbohydrate from a reference food (i.e.glucose) tested in the same individual under the same conditions and using the initial blood glucose concentration as a baseline.

In simple words, the glycaemic index is a way of ranking carbohydrate containing foods according to the extent to which they raise blood sugar levels after eating.

Formula – Incremental area of the test food

GI = --------------------------------------------- x 100

Incremental area of the glucose

More perfectly…..Example:Example:

Ice-creamIce-creamGI = 39GI = 39 Only 39% of ice-

cream’s carbohydrates turn into blood glucose in the first 2 hours.

The rest will convert to blood glucose over the next several hours.

Method of evaluation of Glycaemic Index

50 g of carbohydrate feeding.

Checking glucose level at regular intervals.

GI calculations by using formula.

Source: Rizkalla et al. (2002) British journal of Nutrition 88, suppl. 3,s255-s262

Glycaemic load

Definition – Glycaemic load is the factor which determines

to what extent eating a food rises the blood sugar level providing a measure of total glycaemic response to a particular food or a meal.

Formula – GL = ∑ (amount of food consumed X

carbohydrate content of food X GI )Given by – Willett et al. (2002)

Factors influencing glycaemic index value

Nature of starch (straight chain, branched chain).

Physical form of the food (liquid, solid, semisolid etc.)

Type of fiber (soluble, insoluble)

Cooking method (boiling, steaming, roasting, baking etc. )

Processing techniques (germination, soaking, fermentation etc.)

Combination of foods (rice and dal, chapati with veg etc.)

Nutrient composition of food (protein content, fat content etc.)

Effect on

because of the nature of starch …

TITLE– Glycaemic index of food: A physiological basis for carbohydrate exchange

Jenkins et al. (1981)

Objective – To determine the effect of different foods on the blood glucose level.

Methodology –

Foods and sugars for testing = 62

Reference food – glucose.

n = 5-10 healthy fasting volunteers.

Calculation of GI.

Table 1 : Glycaemic index of different foodsGrains, Cereal products

GI Dried legumes GI Dairy products GI

Bread (white) 69 Kidney beans 29 Ice-cream 36

Bread (whole meal) 72 Soya beans 15 Milk (skim) 32

Millet 71 Chick peas 36 Milk (whole) 34

Rice (brown) 66 Lentils 29 Miscellaneous GI

Rice (white) 72 Fruits GI Honey 87

Sponge cake 46 Apples 39 Peanuts 13

Breakfast cereals GI Banana 62 Potato crisps 51

All bran 51 Oranges 40 Tomato soup 38

Cornflakes 80 Orange juice 46 Sausages 28

Root Vegetables GI Raisins 64 Fish fingers 38

Beetroot 64 Sugars GI

carrots 92 Fructose 20

Potato 75 Maltose 105

Sweet potato 48 Sucrose 59

Glucose 100

Cont..Results – •No significant relationship between glycaemic index and dietary fiber.

•Low GI of legumes than cereals.

•Fat and protein showed a significant negative correlation with glycaemic index .

•A comparison of glucose, potato, bread, rice, and corn showed that the nature of starch itself may be the factor affecting GI

Conclusion

After this study, they concluded that the classification of foods according to their effects on blood glucose is useful due to the differences in response which exist.

The ability to prescribe a varied diet of low glycaemic index foods for diabetics is especially appropriate at a time when more emphasis is being placed on “ tight’’ blood glucose control in order to avoid long term complications.

TITLE – The glycaemic index of potatoes: the effect of variety, cooking method and maturity

Soh and Brand-Miller (1999)

Objective – To determine the impact of variety,

cooking method and maturity on the glycaemic index of potatoes.

Methodology –

• n = 10

• 8 potato meals (three varieties, four cooking methods, two states of maturity)

• Reference food - white bread.

• Period -10 weeks.

• Capillary blood samples were taken.

• Calculation of GI by using the formula.

Results

No significant difference was found among the three varieties of potato tested (P=0.38) or among the four different cooking methods (P=0.55).

GI was shown to be significantly lowered when a potato was eaten with the skin (69) rather than without the skin (98). Increasing maturity or ripeness of a food also tends to increase GI, and waxy small new potatoes were found to have lower GI values (79 and 80) than floury large old white potatoes (96; not significantly different). This may be because, as the potatoes mature , the extent of amylopectin branching in the starch increases, rendering it more digestible, and thus increasing the GI.

Conclusion

Potatoes, regardless of variety, cooking method and maturity, have exceptionally high GI values. New potatoes have relatively lower GI values which is attributed to differences in starch structure.

Effect on

because of the composition of food…

TITLE – Designing of low glycaemic chapati of dicoccum wheat for the effective management of diabetes

Mundra et al. (2010)

Objectives –1.To analyze the glycaemic index of chapati of dicoccum wheat developed with incorporation of few suitable hypoglycaemic ingredients.

1.To analyze sensory characteristics of the product to judge the suitability for the diabetics.

Methodology –

Dicoccum wheat – Milled to flour Methi seed powder – Overnight soaking followed by drying Whole bengal gram – Soaking→ germinating→ cooking→ drying →flour Bengal gram dal power –Roasting followed by cooking → drying → flour Spice mix – Cumin seeds, fennel seeds, omun seeds (roasting and crusting to a course powder)

Standardization – 4 percent of methi seed powder, 20 percent of cooked bengalgram flour, 4 percent of spice mix.

For glycaemic index – n = 9 healthy Age group – 40-50 years. Reference food – White bread Food for comparison – chapati prepared of only dicocuum flour. Calculation of GI.

The glycaemic index of the designed chapati

Dicoccum wheat products have been found beneficial for the management of diabetes. Enrichment of functional food ingredients like methi seed powder and pulse has brought the enriched chapati under low glycaemic index food successfully.

Effect on

because of the particle size…

TITLE –

Glycaemic responses to cereal-based Indian food preparations in patients with non-insulin-dependent diabetes mellitus and normal subjects

Asna and Shashikala (2000)

Objective –1. To evaluate glycaemic responses to six cereal

based preparations commonly consumed in south India.

Methodology –

Test foods – six conventional cereal based preparations i.e. chapathi, dosai, idali, pongal, poori and upittu with suitable accompaniments.

In vitro study carried out in the laboratory with specific procedure

For in vivo study - No. of subjects

Age group (yrs)

NIDDM 57 42-59

NORMAL HEALTHY

59 22-40

All the selected subjects remained on their usual diets, but fasted overnight before the study.

Reference food - Glucose

Total 6 groups (n= 8-10) received 50 g carbohydrate portions of one of the six foods on seperste mornings.

Table : Mean blood glucose concentration after 30 min in normal and diabetic subjects

Food Mean blood glucose concentration (mmol/l){after 30 min}

NIDDM subjects Normal subjects

Chapati 11.3 + 0.7 5.4 + 0.7

Dosai 13.7 + 1.5 6.6 + 0.5

Idali 10.6 + 2 4.9 + 0.8

Pongal 13.3 + 1 6.2 + 1

Poori 8.3 + 1.1 5.4 + 0.5

Upittu 12 + 0.8 4.9 + 0.6

It is possible to identify food preparations in the habitual Indian diet having attributes of desired glycaemic effect, i.e. delayed peak rise, low glucose response curves.

The finer particle size of dosai and the higher degree of gelatinization attained in pongal probably contributed to increased digestion and absorption of glucose from these foods.

The glycaemic index concept is useful in classifying foods; however the importance of choice of carbohydrate and cooking method should be specified and appropriate dietary guidelines have to be formulated for diabetics.

Conclusion

Cross references for factors

affecting

Cross references Consumption of different carbohydrate foods is found to

elicit different glycaemic response in normal and diabetic subjects (Crapo et al. 1977; Jenkins et al. 1981,1983)

The cooking method and cooking time also determine the extent of starch gelatinization and affect the glycaemic response (Collings et al. 1981).

The slow – release nature of traditional foods is attributed to the presence of pulses contributing the viscous type fiber (Jenkins et al. 1982,1983)

Processing treatments are also known to alter the starch – fiber relationship , increase the accessibility of starch and thus abolish the effect on glycaemia ( Jenkins et al. 1982; Trianedes & O’Dea, 1986)

Cont.... The immediate glycaemic response to a food may be a

predictor of its effect in the long term (Jenkins et al. 1978)

Dietary fiber inhibits starch digestibility by increasing the viscosity of intestinal content and thereby slowing the absorption of carbohydrates from food (Dilwari et al., 1981 and Wolver 1990).

Milling, beating, shearing and refining of foods also affect cell and granule integrity. These processes also decrease particle size and promote absorption of water and breakdown by enzymes. The GI value of such food increases (Foster-Powell and Miller,1995)

Benefits of the

Benefits of GI

• Low GI diet help,1. In dietary management of diabetes. 2. People for weight management.3.To reduce the risk of heart diseases.4. To reduce hunger and enhance satiety.

Low in the weight management.

TITLE –

The effect of altered glycaemic index breakfasts on subsequent food intake and satiety in children aged 9-12 years.

By – Warren et al. 2003

Objective –

1. To study the effect of consuming breakfasts of varying GI on appetite and food intake.

Methodology

n = 38 Subject acted as their own control. 3 diets 3 groups, 3 days each diet (1. Low GI, 2. Low GI with sucrose

added and 3. High GI)

Results

Lunch energy intake was significantly lower after the low GI and the low GI with added sucrose breakfasts compared with after the high GI breakfast or habitual breakfast eaten at home.

No significant difference in satiation (i.e. feelings of fullness ) post breakfast , but satiety rating pre lunch were lower (i.e. hunger was greater) on two of the three experimental days after the high GI breakfast compared with other test breakfasts.

Conclusion Low GI diets may reduce food

intake and have a role to play in weight control and obesity management .

TITLE –

The effect of low and high GI meals on appetite, satiety and energy intake after 6 d low or high GI diet.

By – Norouzy et al. (2003)

Objective –

1. To determine the effect of consuming one low or high GI meal on appetite, energy and micronutrient intake.

Methodology

n = 11 Cross over study. Period of the study – 6 days. VAS (Visual Analogue Scales) was

completed after every 30 min.

Results

Appetite Satiety Fullness feeling

Prospective consumption

LOW GI 1788 2631 2518 2076

HIGH GI 2263 2180 2337 2451

Value in the table are median values for sumed VAS score

Table : median Summed VAS scores

Results Table : Mean nutrient intake

Energy (kcal)

CHO (g)

Fat (g)

Protein (g)

Fibre (g)

LOW GI

2930 324 106 177 46

HIGH GI

3268 338 110 178 47

Significantly lower energy intake during the low GI compared with the high GI period.No significant differences in individual micronutrient intake.

Conclusion Consumption of low GI foods

reduces appetite and increases satiety. This led to a reduction in energy intake but did not ulter the balance between the micronutrients.

The reduction in intake in potentially useful as part of a weight management programme.

Overall conclusion

Glycaemic index is a key factor in diabetes management.

Before prescribing the diet for a diabetic person one should consider the factors affecting the GI value.

Your questions and suggestions are welcomed !

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……….Glycaemic Index !