It is interesting to note in the December, 1988 issue of the Journal of the American College of Nutrition, that a section has been reserved for reports dealing with diet and diabetes. Among these current reports deal with dietary and activity patterns and their relationship to metabolic control in type II diabetes (adult onset). One of these reports, a 1988 review on atherosclerosis and diabetes discusses the role of management by stating that "the cornerstone of diabetic management, a combination of diet and exercise, perhaps gains added importance when viewed from the perspective of hyperinsulinemia (high insulin levels). Weight loss and reduction in obesity decrease circulating insulin levels and improve glucose uptake the the peripheral (circulation). Exercise increases the number of insulin receptors, again allowing for a decrease in circulating endogenous insulin. A secondary advantage of this combination is that it allows the reduction of concomitant pharmacologic therapy, which in itself often exacerbates hyperinsulinemia". [Stolar, MW. Metabolism 37;2:S-1:1-9, 1988.] This article states information that was first in Prevention back in 1967, in an article entitled: Pills or Diet for Diabetics? [Dec. 1967, pg. 51]. The authors suggest that proper dietary intervention may be better able to aid in diabetes management without the side effects of some oral hyperglycemic medications.

Another report from the same journal [Stuart, CA et al. Metabolism 37:802, 1988] discusses the effects of inactivity (bed rest for one week) on insulin resistance. It seems that inactivity for this little of time can cause substantial resistance in the insulin cells within the muscles.

Two studies on the effects of dietary fiber on blood glucose control [Hanander, B, et al. American Journal of Clinical Nutrition - 47:852, 1988, and Simpson, RW et al, American Journal of Clinical Nutrition 48:104, 1988] show that improvements in triglycerides and fasting plasma glucose with high fiber diets. Again, in a 1970 article from Prevention [Diet can help a Diabetic. Aug. 1970, pg. 61], high fiber foods such as raw vegatables and nuts, along with oatmeal and lentils are included in a diet plan for persons with diabetes. These simple recipies recommended more than twenty years ago are now being touted by authorities as optimum diets to follow for diabetes patients [Tietyen, J: Oat Cuisine. Diabetes Forecast. 41;5:52, 1988, and ]. The trend for this repetition seems to stem from the fact that the one hand may not see what the other is doing. This phenomenon is perhaps due in part that the medical and scientific community has for many years disregarded work by holistic individuals as "non-scientific", and therefore not worthy of consideration for practical application to many sub-populations of patients who were in need of nutritional counseling and guidance.

Today there are many more persons who are concerned about the quality of their food, and diets in general. Natural and organic foods seem to be more popular in many parts of the country. Concerns over chemical sprays and additives are drawing more and more public attention, and in some cases public outcry. One instance is the Alar chemical controversy in the fall of 1989. Consumers stopped purchasing apples after an EPA report linking Alar with cancer.

The area of exercise as it relates to diabetes management dates back many years. However, much of the information dispursed to diabetic patients comes from magazines that mearly outline programs and highlight information. It is up to the individual to impliment their own program. Personal guidance and follow-up care are rarely available. Ask anyone with diabetes who works out at a local gym or community club if there are any staff members there who know about exercise and diabetes, or what to do in case of a diabetic emergency, and they will tell you that, again, they are pretty much on their own. Until more information is desseminated to physical educators and health club employees, it will still be risky business to exercise in public facilities.

What then, if anything is new for the diabetic patient who is concerned about health and improvement of their metabolic condition? The first is home glucose montoring, which became available about five years ago. With this small box, and special reagent strips, diabetic patients may know what their blood glucose levels are at any time during the day, and with that information they would be able to inject extra insulin if needed, or simply eat food to bring low blood sugar levels up to a more normal state. This fairly recent advancement in diabetes health care is very significant in helping diabetic people keep their blood sugar levels under good control, thus avioding some of the long-term medical complications associated with both high blood sugar (hyperglycemia), or high insulin levels (hyperinsulinemia).

The core of quality treatment is no different than it was when Prevention ran its articles some twenty years ago. For the majority of persons in this country, the primary treatment, as well as prevention of type II diabetes mellitus probably lies in the foods we eat, and the physical activites we participate in. It comes down to a matter of choices. Choosing to read information about exercises that are good for keeping in shape without excessive risk of injury, and looking up nutritious recipies that use a variety of ingredients, but are not high in sugar or fat. It seems from the amount of scientific information presented recently that the cycle has come full circle, and now that some of the recommendations from many years back have added meaning, and perhaps should be taken more seriosly by both health professionals, and diabetes patients themselves.