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Big breakfast or big dinner? Yet another meal-timing study

Eating the exact same meals, but in a different order could help stabilize blood sugar.

Study under review: High-energy breakfast with low-energy dinner decreases overall daily hyperglycaemia in type 2 diabetic patients: a randomised clinical trial

Introduction

Diabetes is a disease characterized by unregulated blood sugar levels. Like many things in the body, blood sugar must be maintained in an appropriate range. Too low (hypoglycemia) can lead to mild symptoms like shakiness and dizziness, or in severe cases, coma, as the brain fails to get enough energy. Too high (hyperglycemia) can cause long-term damage to organs and limbs, or acute short-term symptoms such as cardiac arrhythmias and seizures. Diabetes is classified as either type 1 or type 2; 90-95% of diabetes cases in the US are type-2 diabetes. In this form of the disease, the body still produces insulin, which is the primary hormone that regulates blood sugar, but the cells no longer react properly to it. This differs from type 1 diabetes, where the insulin-producing cells in the pancreas are damaged and no longer produce sufficient insulin to maintain blood sugar levels in the appropriate range.

Aside from injected insulin for type 1 diabetes and several medications for type 2 diabetes, another way to control blood sugar levels is through the diet. People with diabetes have to carefully plan the content and spacing[1] of their meals in order to prevent blood sugar levels from spiking too high or dropping too low, by ensuring that their glucose levels are balanced by their insulin doses. Meal timing is critical for someone with diabetes, and this study was designed to look at the effects of different calorie contents at different times of the day, and how that relates to blood sugar levels and hormone levels. The effects of meal timing on various markers of blood sugar control have been previously studied in healthy volunteers[2] and in animal models[3], but not in people with diabetes. The aim of this study was to expand that research to the type 2 diabetes population.

There are four important molecules discussed in this study that are related to blood sugar maintenance: glucose, insulin, C-peptide, and glucagon-like peptide 1 (GLP-1). Glucose[4] and insulin[5] go hand-in-hand. After you eat a meal, carbohydrates are converted to glucose, the primary simple sugar that your body uses for energy. Insulin is a hormone that regulates glucose levels and allows the circulating glucose to enter cells in the body to be used for energy. It’s released by the pancreas, usually in response to elevated glucose levels.

Insulin production is a multistep process that begins with the synthesis of a biologically inactive preproinsulin molecule. The signal portion of the molecule is removed, leaving a proinsulin molecule which consists of an alpha sequence, a beta sequence, and a c-peptide[6] sequence in between. Once the proinsulin protein is folded correctly and the alpha and beta sequences are linked, the c-peptide molecule is removed. It typically reflects native insulin levels in the body, and is used as a marker to determine if functional insulin is being made. The concentration of c-peptide can be used to differentiate between insulin that the body is making and supplemental insulin that is being injected. GLP-1[7] is a hormone that aids in the maintenance of proper blood sugar levels, by increasing the release of insulin and lowering the release of glucagon, which is a hormone that causes the liver to produce and release glucose. It is quickly broken down by the body, so both total and intact levels are measured.

Diabetes is a disease that prevents the body from regulating blood sugar levels properly. Most cases of diabetes in the United States are type 2, where the pancreas still produces insulin but the body no longer responds properly to it. Timing and content of meals is critical to maintenance of healthy blood sugar levels for people with diabetes.

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Other Articles in Issue #08 (June 2015)