CARBOHYDRATE MANAGEMENT IN

DIABETES MELLITUS
A

Project
Submitted to the
Bundelkhand University
In Partial fulfillment of the degree of
Bachelor of Pharmacy

2023-2024

UNDER THE SUPERVISION

Guide by Submitted by:

Dr. DEVENDER SINGH BHANU PRATAP SINGH
Assistant Professor B. Pharm 4th Year
Institute of Pharmacy Roll No. 201251016026
B.U. Jhansi (U.P)
 INSTITUTE OF PHARMACY

BUNDELKHAND UNIVERSITY,
JHANSI

2023-2024

CERTIFICATE

This is to certify that the project report entitled ‘’CARBOHYDRATE

MANAGEMENT IN DIABETES MELLITUS” submitted in partial fulfillment
of the requirement for the degree of Bachelor of Pharmacy, Institute of
Pharmacy, Bundelkhand University, Jhansi is a bonafied work carried out
by BHANU PRATAP SINGH during the academic session 2023-2024.

Date; H.O.D.
Dr. PEEYUSH BHARDWAJ
Head of department
Institute of pharmacy
B.U, JHANSI
 INSTITUTE OF PHARMACY
BUNDELKHAND UNIVERSITY, JHANSI

2023-2024

CERTIFICATE

This is to certify that the project report entitled ‘’CARBOHYDRATE

MANAGEMENT IN DIABETES MELLITUS” submitted in partial fulfillment of the
requirement for the degree of Bachelor of Pharmacy, Institute of
Pharmacy Bundelkhand University, Jhansi is a bonafied work carried out
by Bhanu Pratap Singh during the academic session 2023-2024.

Date: Guide by

Dr. DEVENDER SINGH

Assistant Professor
Institute of Pharmacy
Bundelkhand University, Jhansi
 INSTITUTE OF PHARMACY

BUNDELKHAND UNIVERSITY,

JHANSI

2023-2024

DECLARATION
I hereby declare that this project entitled “CARBOHYDRATE MANAGEMENT IN
DIABETES MELLITUS” is prepared by me under the direct guidance and
supervision of Dr. DEVENDER SINGH Institute of pharmacy,
Bundelkhand University, Jhansi. The same is submitted to Bundelkhand
University, Jhansi in partial fulfillment of requirement for the award of the
degree of Bachelor of Pharmacy. I further declare that I have not
submitted this project previously for the award of any degree or diploma
to me.

BHANU PRATAP SINGH

 ACKNOWLEDGEMENT

I got excellent opportunity to carry out my project under the supervision of Dr.
DEVENDER SINGH Institute of Pharmacy Bundelkhand University, Jhansi,
who supervise this project work and whose expert guidance, supervise timely
suggestion, explicit decision, deep personal interest and attention which they
show keenly has been a privilege for me.

I owe special thanks for the motivation, inspiration and support in boosting my
moral without which I would have been in vain.

BHANU PRATAP SINGH

 INDEX
Content Page Number
v Carbohydrate 01 – 03
v Diabetes Mellitus 04 – 09
• Abstract
• Introduction
• Etiology and Classification of DM
v Carbohydrate Management In 10 - 11
Diabetes Mellitus
v Carbohydrate and lipid metabolism 11 - 12
in pregnancy: normal compared
with gestational diabetes mellitus
v Plant-Derived Supplementary 13
Carbohydrates, Polysaccharides
and Oligosaccharides in Management
of Diabetes Mellitus
v The role of carbohydrate in 14 - 17
diabetes management
• Sources of carbohydrate
• Dietary requirements for carbohydrate
• Current recommendations for carbohydrate
• Quantity of carbohydrate in diabetes
v Carbohydrate quality in diabetes 18 -19
• Fibre and whole grains
• Glycemic Index
• Carbohydrate counting
v Conclusion 20 - 21
v Reference 22 - 28
 CARBOHYDRATES

Ø The most prevalent biomolecules on earth are

carbohydrates. In the majority of non-photosynthetic
organisms, the main energy-yielding mechanism is the
oxidation of carbohydrates.

Definition:
Carbohydrates are polyhydroxy aldehydes, polyhydroxy
ketones, or molecules that hydrolyze to produce these
chemicals. The empirical formula for carbohydrates is
(CH2O)n.

There are three major classes of carbohydrates:

o Monosaccharides
Simple sugars, or monosaccharides, are made up of a single
polyhydroxy aldehyde or ketone molecule. The six-carbon
sugar D glucose, which is commonly referred to as dextrose,
is the most prevalent monosaccharide in nature.
o Oligosaccharides
Short chains of residue-like monosaccharide units, or
oligosaccharides, are connected by distinctive links known as
glycosidic bonds. Disaccharides, which contain two
monosaccharide units, are the most prevalent. as in sucrose
(cane sugar).

o Polysaccharides
The sugar polymers known as polysaccharides, some of
which comprise hundreds or thousands of units, are
composed of more than 20 monosaccharide units. Consider
starch.
Polysaccharides are of two types based on their function and
composition. Based on
function, polysaccharides of two types storage and
structural.
A. Storage polysaccharide - starch.
B. Structural polysaccharide - cellulose.

01
General properties of carbohydrates
• Carbohydrates serve as a source of stored energy, fuel, and
metabolic intermediates.
• The structural framework of DNA and RNA, the genetic
material, is made up of the sugars ribose and deoxyribose.
• Cell walls of bacteria and plants are made of polysaccharides,
such as cellulose.
• Proteins and lipids that are connected to carbohydrates play
significant roles in cell interactions. (1)

Physical Properties of Carbohydrates

• Stereoisomerism is the property of compounds with the same
structural formula but different spatial arrangements.
Example: In terms of the penultimate carbon atom, glucose
contains two isomers. They are D- and L-glucose, respectively.
• The rotation of plane polarized light that produces (+) and (-)
glucose is known as optical activity.
• Diastereoisomers are configurational variations of glucose's
C2, C3, or C4 atoms. Mannose and galactose are examples.
• The spatial arrangement with regard to the first carbon atom
in aldoses and the second carbon atom in ketoses is known as
annomerism.

02
 Biological Importance
• The main source of energy for many animals, including
humans, is carbohydrates. The glycolysis/cycle Kreb's
breaks down glucose to produce ATP.
• The source of energy storage is glucose. Animals store it
as glycogen, whereas plants store it as starch.
• Instead of using proteins as a source of energy, stored
carbohydrates are used.
• Carbohydrates are intermediates in biosynthesis of fats
and proteins.
• The brain gets its energy from carbohydrates, which also
help in the control of nerve tissue. (2)

Important Monosaccharides

1. Trioses: Glyceraldehyde 3- phosphate and

dihydroxyacetone phosphate are intermediates
during glucose oxidation in living cells.
2. Tetroses : Erythrose 4-phosphate is formed during
glucose oxidation in living cells.
3. Pentoses : - D-ribose is a component of many
4. nucleosides and nucleotides and ribonucleic acids
(RNA). - 2-deoxyribose is a component of
deoxyribonucleic acid (DNA).
5. Hexoses : - D-glucose ( grape sugar) is the main sugar
present in blood and is present in all animal and plant
cells, honey and fruits. It enters in the formation of
many disaccharides and polysaccharides. It is also
termed dextrose because it is dextrorotatory. –
6. D-fructose (fruit sugar) is present in honey, fruits and
semen. It is a component of sucrose and inulin. It is
also termed levulose because it is levorotatory.
7. D-galactose is a component of lactose which is
present
in milk. It is also found in glycosaminoglycans
(GAGS), glycolipids and glycoproteins.

03
 DIABETES MELLITUS

ABSTRACT:
• Diabetes mellitus (DM) is a chronic metabolic condition
marked by excessive blood glucose levels brought on by
inadequate or ineffective insulin production. However, there
are several DM varieties Out of them, type 1 diabetes
mellitus (Type 1 DM) and type 2 diabetes mellitus (Type 2
DM) are now acknowledged as severe global health issues
that are spreading quickly around the globe and posing one
of the biggest risks to human health in the twenty-first
century. According to the International Diabetes Federation
(IDF), emerging nations like India are already at the top of the
diabetic league. Today, type 2 diabetes, which is
characterized by insulin resistance and hyperglycemia, affects
more than 90% of diabetic patients.

• Numerous epidemiological and clinical research show a

connection between long-term microvascular and
macrovascular issues that arise as the illness advances and
eventually lower the quality of life for diabetes patients who
have hyperglycemia.

• Therefore, throughout the early stages of the disease, blood

glucose levels must be under control. Through a combination
of diet, exercise, and modern therapeutic agents like insulin
formulations, sulfonylureas, metformin, acarbose,
thiazolidine-2,4-diones, glucagon like peptide-1 analogues,
and dipeptidyl peptidase-4 or IV inhibitors, the primary goal
of DM treatment has been to improve glycemic control.

Several endocrinopathies, including acromegaly, Cushing

syndrome, glucagonoma, hyperthyroidism,
hyperaldosteronism, and somatostatinomas, have been
associated with glucose intolerance and diabetes mellitus,
due to the inherent glucogenic action of the endogenous
hormones excessively secreted in these conditions.
Conditions like idiopathic hemochromatosis are associated
with diabetes mellitus due to excessive iron deposition in the
pancreas and the destruction of the beta cells.

04
 INTRODUCTION

Aretaeus of Cappadocia is credited with creating the word

diabetes (81-138 A.D.). It comes from the Greek word
"diabainein," which literally translates as "going through" or
"syphon," and refers to one of the main signs of diabetes:
increased urine output.Mellitus, a term from Latin meaning
"honey," was added to the condition by Thomas Willis in 1674 in
relation to the sweet taste of urine caused by the presence of
glucose. Ancient Indian Vedic medical texts referred to it as
Madhumeha, or honey urine, and categorised it as such.
The condition was known as "sweet pee illness" by the ancient
Indians, who diagnosed diabetes by monitoring whether ants
were drawn to a person's urine. Diabetes mellitus (DM) is a
long-term metabolic condition defined by high blood glucose
levels brought on by insufficient or impaired insulin production.
The metabolism of carbohydrates, lipids, and proteins is
disturbed by both of these variables. In addition, type 1 and
type 2 diabetes are increasingly acknowledged as severe global
health issues that are spreading quickly across the globe and
constituting one of the biggest risks to human health in the
twenty-first century.

GLOBAL PREVALENCE OF DM :
Global population expansion, ageing, urbanization, an increase
in obesity, and physical inactivity are all contributing factors to
the incidence of DM. According to the IDF, there are now 366
million individuals worldwide who have diabetes, or 8.3% of the
adult population. By 2030, there will be 552 million individuals
on the planet, or 9.9% of all adults. According to a literature
analysis, the top ten nations in the world for the number of
individuals with diabetes between 2010 and 2030.

05
developing nations, such as India, which is already at the top
of the diabetes league. According to estimates, one in five
diabetics worldwide will be Indian. The economic cost of
diabetes in India is among the greatest in the world as a
result of these staggering statistics. However, the disease's
consequences, which raise morbidity and death, are what
really burden society.
ETIOLOGY AND CLASSIFICATION OF DM:
Primary (idiopathic) and secondary kinds, juvenile-onset and
maturity-onset types, and insulin-dependent and non-
insulin-dependent types—the former categorization systems
of DM—have grown out of date. However, DM are divided
into many categories based on a general knowledge of its
genesis.

TYPE 1 DIABETES MELLITUS:

10% of instances of DM are type 1 cases. It is characterized
by the loss of insulin-producing beta cells in the pancreatic
islets of Langerhans, which results in an insulin deficit.
Juvenile onset diabetes (JOD) or insulin-dependent
diabetes mellitus were the prior names for it (IDDM).
However, based on the underlying etiology, the new
classification further divides type 1 DM into two subgroups
without taking into account either age or insulin reliance;
Type 1 DM: Autoimmune destruction of -cells, which
typically results in insulin insufficiency, is its defining
feature. Although people under the age of 30 are more
frequently affected with type 1 DM. However, autoimmune
destruction of -cells can occur at any age, therefore the
label JOD is no longer appropriate. In actuality, type 1A DM
affects 5–10% of persons who develop diabetes after the
age of 30.

06
Type 1B It is characterised by insulin insufficiency and a
propensity to go into ketosis, although people with this
condition don't have any autoimmune signs. Insulin
replacement treatment is essential for people with type 1
diabetes to remain alive.
Pathogenesis of Type 1 DM :
Numerous studies have been done on the immune-mediated
pathophysiology of type 1A DM. Type 1B DM is still
idiopathic.
Genetic susceptibility :Multiple genes are inherited in Type
1A DM, which increases the disorder's risk;
(i) It has been noted that among identical twins, there is a
50% probability that the second twin will also have type 1A
DM, albeit not always.
(ii) The susceptibility gene, namely HLADR3, HLADR4, and
HLADQ locus, is situated in the human leukocyte antigen
(HLA) area of chromosome 6 in around 50% of people with
genetic propensity to type 1A DM. It appears that in
people with HLA-associated vulnerability, beta cells behave
as autoantigens, activating CD4+T lymphocytes and
causing the immune system to destroy pancreatic beta
cells. (7)

Autoimmune factors: Type 1A DM have shown several

immunologic abnormalities:
1. antibodies against insulin and glutamic acid decarboxylase
found in islet cells.
2. Insulitis is a condition when there is a lymphocytic
infiltration in and around the pancreatic islets.
3. Transfer of type 1A DM from a sick animal by injecting T
cells to a healthy animal provides more evidence for the
role of T cell-mediated autoimmunity.
Fatty Acids, Storage Lipids, Membrane Lipids, and Sterol and
Prenol Lipids will follow the LIPID MAPS classification
scheme to review the current state of knowledge
concerning the biosynthesis, breakdown, and functions of
specific lipid classes in C. elegans.

07
 TYPE 2DIABETES MELLITUS
Mature onset diabetes (MOD) or non-insulin dependent
diabetic mellitus (NIDDM) of the obese and non-obese types
were prior names for type 2 DM. In accordance with MOD,
type 2 DM primarily affects elderly people. However, it now
also affects obese teenage children. Therefore, the word MOD
is incorrect. Furthermore, many type 2 DM patients are not
actually NIDDM because they also need insulin treatment to
manage hyperglycemia. There is no loss or just a slight
reduction in beta-cell mass in type 2 diabetes; the level of
insulin in the blood is low, normal, or even high; and there is
no anti-beta-cell antibodies that can be seen. Type 2 diabetes,
which is characterised by insulin resistance and hyperglycemia,
affects more than 90% of diabetic individuals. Today, a number
of epidemiological and clinical studies show a connection
between hyperglycemia and long-term microvascular and
macrovascular complications, including neuropathy,
retinopathy, nephropathy, myocardial infarction,
atherosclerosis, coronary artery disease, stroke, and lower limb
amputation. As the disease progresses, these complications
gradually worsen the quality of life for diabetic patients.
Therefore, throughout the early stages of the illness, blood
glucose levels must be controlled. Additionally, a variety of
additional pathophysiologic disorders, such as dyslipidemia,
hypertension, hyperuricemia, elevated plasminogen activator
inhibitor type-1 (PAI-1), an aberrant fibrinolytic system, and
abdominal obesity are all associated with this metabolic illness.
Through a combination of diet, exercise, and current
pharmaceutical drugs such insulin formulations, sulfonylureas,
metformin, acarbose, TZDs, GLP-1 analogue, and DPP-4 or IV
inhibitors, the primary goal of treatment for type 2 DM has
been to improve glycemic control.
Pathogenesis of Type 2 DM :
The pathophysiology of type 2 DM has been linked to a variety
of variables. However, there is no connection between
autoimmune symptoms and HLA association.
Plasma membrane lipid composition differs among various
tissues, as does lipid composition of endoplasmic reticulum
(ER), mitochondria, and other cellular organelles
Roles for specific lipids have often been identified in forward
or reverse genetic screens, which offer unbiased
determinations of functions of specific lipid classes

08
• Genetic factors: Type 2 diabetes mellitus has a greater
genetic base than type 1 diabetes mellitus. The most
crucial element in the emergence of type 2 DM is
multifactorial inheritance, despite the lack of distinct and
consistent genes. There is approximately 80% chance of
developing diabetes in other identical twin, if one twin has
the disease. A person is more likely to get diabetes if one
parent has type 2 diabetes. However, the risk increases to
40% in the offspring if both parents have type 2 diabetes.
• Constitutional factors: Environmental variables that
contribute to and influence the phenotyping of the illness
include obesity, hypertension, and degree of physical
activity.
• Insulin resistance: Insulin resistance is the diminished
capacity of target tissues for insulin to work (especially liver,
muscle and fat). It is one of the most noticeable metabolic
characteristics of type 2 diabetes and is brought on by both
genetic predisposition and fat. In order to maintain
adequate glucose tolerance in obese patients, insulin levels
normally rise. as compared to lean controls, obese insulin-
resistant people secrete three to four times more insulin at
baseline and throughout the course of a 24-hour period.
• TYPE 3 DIABETES MELLITUS :
In addition to the two primary kinds of DM, type 3 DM
accounts for 10% of cases and has a recognised unique
etiologic fault. Consequently, it is also known as various
particular forms of diabetes. One of the most significant in
this category of recognised particular etiologic abnormalities
is MODY, which is marked by autosomal dominant
inheritance, early onset of hyperglycemia (typically 25 years),
and decreased insulin secretion. Several uncommon illnesses
with significant insulin resistance are caused by mutations in
the insulin receptor.
• TYPE 4 DIABETES MELLITUS :
The term "gestational diabetes mellitus" (GDM) refers to the
onset or first identification of pregnancy-related glucose
intolerance, which is often seen in the third trimester. About
4% of all pregnancies have it. Obesity, glycosuria, and a
diabetes-positive family history are risk factors for GDM. If
GDM occurs during pregnancy, the woman has a 50% chance
of later acquiring type 2 diabetes as well as a 50% chance of
doing so again during a subsequent pregnancy.
09
CARBOHYDRATE MANAGEMENT IN DIABETES
MELLITUS
Due to its defining characteristic of hyperglycemia, diabetes
has long been thought of as a disorder of carbohydrate
metabolism. Indeed, the aetiology of the acute symptoms of
diabetes such polydypsia, polyuria, and polyphagia is
hyperglycemia. Chronically high blood glucose levels are also
thought to contribute to the long-term consequences of
diabetes (retinopathy, nephropathy, and neuropathy).
Additionally, macrovascular disease, which is linked to the
development of coronary artery disease and is the main
cause of death in people with diabetes, may be exacerbated
by hyperglycemia. (7)
Thus, controlling blood glucose levels in order to reach near-
normal blood glucose levels is a key objective in the
management of diabetes.

Carbohydrates are the dietary element that have the biggest

impact on blood glucose levels. However, the postprandial
blood glucose level can also be influenced by other
macronutrients in the food, such as fat and protein. For
instance, dietary fat delays the peak glycemic response to the
consumption of a food containing glucose by slowing down
the absorption of glucose. (8)
Additionally, even though glucose is the main factor that
triggers the release of insulin, protein and amino acids when
consumed along with carbohydrates increase the amount of
glucose that is cleared from the blood.
Diabetes patients have higher blood glucose levels when they
are fed or fasting. Insulin resistance, inadequate insulin
production, or a combination of both are to blame for this
aberrant metabolic response. Although dietary carbohydrates
raise postprandial glucose levels, completely cutting off
carbohydrates won't make blood sugar levels return to the
normal range. Furthermore, dietary carbohydrates are a
crucial part of a balanced diet. For instance, glucose serves as
the main source of energy for the brain and central nervous
system, and diets high in carbohydrates are crucial providers
of numerous nutrients, including fibre and water-soluble
vitamins and minerals. (9)
10
Because of the aforementioned, low-carbohydrate diets are
not advised for the control of diabetes. Recently, the National
Academy of Sciences-Food and Nutrition Board advised that
diets should contain between 45 and 65 percent of calories
from carbohydrates, with an adult minimum intake of 130
grammes per day. (9) The impact of a food on blood glucose
levels depends on both the amount (in grammes) and kind of
carbohydrates in it. The kind of carbohydrate (such as starch
versus sucrose) in a food does not always precisely predict
how it will affect blood sugar levels. (10,11)

Carbohydrate and lipid metabolism in

pregnancy: normal compared with
gestational diabetes mellitus

Pregnancy-related changes to lipid and carbohydrate

metabolism ensure that the growing foetus receives nutrients
continuously despite irregular maternal food intake. Women
who develop gestational diabetes mellitus may experience an
accentuated level of these progressive metabolic changes
(GDM).

• CARBOHYDRATE METABOLISM DURING NORMAL

PREGNANCY
Early in pregnancy, peripheral (muscle) sensitivity to insulin,
hepatic basal glucose production, and glucose tolerance are
all normal or slightly improved. (12-14) The first trimester is
more sensitive than the second and third trimesters to the
blood glucose-lowering effects of exogenously administered
insulin, according to the hyperinsulinemic-euglycemic glucose
clamp technique and computer-assisted intravenous glucose
tolerance test.

• Increased carbohydrate use

Studies have revealed that carbohydrates contribute more to
oxidative metabolism in late pregnancy, which is consistent
with the increased rate of glucose appearance. In late
pregnancy compared to postpartum, the 24-hour respiratory
quotient (RQ), as determined by respiration calorimetry, is
much higher, resulting in a drop in carbohydrate oxidation as
a percentage of nonprotein energy expenditure from late
pregnancy to 6 mo postpartum from 66% to 58%. (15)

11
Pregnancy (282 g/d) and postpartum (210 g/d) both have
significantly higher absolute rates of carbohydrate oxidation.
RQs are also higher during pregnancy when basal metabolic
rate and sleeping metabolic rate are measured.

• Gestational diabetes mellitus

GDM is described as "varying severity carbohydrate

intolerance with onset or first detection during the current
pregnancy.“ (16) GDM is a diverse ailment in which age,
weight, and genetic background all affect how severe the
condition is. A later onset of type 2 diabetes is possible in
GDM-positive women. With the use of a particular monoclonal
antibody, women with GDM only had a 1.6% incidence of islet
cell antibodies.
In non-obese women who were prone to and acquired GDM,
carbohydrate metabolism has been examined using an
intravenous glucose tolerance test and a hyperinsulinemic-
euglycemic clamp with [6,6-2H] glucose before conception and
in early and late gestation. (18)

Similar fasting glucose appearance rates are attained in obese

GDM patients; however, their insulin concentrations are raised
when compared to pregnant non-diabetic control participants.
(19) The amount of oxygen used, the amount of carbon
dioxide produced, and RQ are comparable between GDM
patients and control people.

Fatty acids from worm populations are commonly analyzed

using acidic methylation to produce fatty acid methyl esters,
which are separated from each other by gas chromatography
(GC), and detected with either mass spectrometry (MS) or
flame ionization detection (FID) (Watts and Browse 2002). This
is a sensitive method, because use of a polar column such as
SP-2340 or Omegawax aids in the separation of fatty acyl
isomers with identical chemical composition but different
double bond positions. Because C. elegans synthesizes and
accumulates several isomers of 18:1 and 20:4, it is important
to use authentic standards to distinguish among isomers
during analysis.
12
Plant-Derived Supplementary Carbohydrates,
Polysaccharides and Oligosaccharides in
Management of Diabetes Mellitus

The deregulation of insulin and glucose metabolism is a

characteristic of the chronic heterogenic disease known as
diabetes mellitus.
Dietary carbohydrates were looked into, particularly those
with fibre that have positive effects on managing
hyperglycemia. In clinical studies, the most prevalent
oligosaccharides, such as sucrose, fructooligosaccharide,
galactooligosaccharide, isomaltooligosaccharide, and
xylooligosaccharide, were able to regulate insulin and
glycemic metabolism.
The management of glucose and insulin metabolism in both
healthy and diabetic patients has been shown to be
significantly improved by a number of plant-based
oligosaccharides and polysaccharides.

Plant-based oligo- and polysaccharides have promising

hypoglycemic potential that is comparable to or even
superior to that of current synthetic drugs without any
negative side effects.

Diabetes mellitus is a chronic heterogenic disease

characterized by the deregulation of the metabolism of
insulin and glucose. The aim of this review has been to
evaluate the efficacy of medical plant-based carbohydrates,
excluding monosaccharides, to manage glycemic response in
clinical trials. Methods: The range of literature presented was
compiled by searching electronic databases, including
Scopus, PubMed and Cochrane library, from their inception
through to June 2018. Only clinical-based studies were
considered for this review. Dietary carbohydrates were
investigated, especially those containing fiber possessing
beneficial effects in the management of
hyperglycemia.management of glucose and insulin
metabolism in healthy and diabetic patients.

13
 The role of carbohydrate in diabetes
management

There is substantial discussion about the function of dietary

carbohydrates in diabetes, particularly in regards to the
appropriate carbohydrate kinds and levels.(22) This
review's objective is to examine these concerns in regard to
adult clinical practise, taking into account both general
public recommendations and clinically supervised advice
provided as part of therapeutic patient education.

• Sources of carbohydrate
The majority of the daily carbohydrate intake in the UK, like
in many other nations, comes from cereal and cereal
products, primarily from white bread, pasta, and rice.(23)
Sugars, preserves, confectionary, and non-alcoholic
beverages are the main sources of free sugar, each
accounting for around 25% of our daily intake.(24)

Percentage contribution of food groups to average daily

carbohydrate intake (male and female, aged 19–64 years).
(Adapted from National Diet & Nutrition Survey data

14
Patients and the general public might not comprehend the
term "carbohydrate," and new study indicates that dietary
practises in persons with diabetes use a "sugar-centric"
approach, further demonstrating that the term
"carbohydrate" is not well understood.(25) In truth, sugar is
not the primary source of carbohydrates in the diet.(26) The
correlation between blood glucose and sugar intake,
however, is presumably what causes the relationship
between sugar and diabetes. Although rises in blood glucose
will be influenced by the amount of sugar consumed.(27)

• Dietary requirements for carbohydrate

Since the body can produce all the necessary glucose, there
is no direct physiological need for eating carbohydrates.(28)
Nutritional advice shouldn't be based solely on one nutrient,
especially because many of the less processed carbohydrate
sources have a low glycemic index, high fibre content, and
are nutritious sources of vitamins and minerals. Due of this,
they are highly valuable as food.(29) not only in terms of
preventing and controlling diabetes, but also in terms of
general health. Since glucose must be produced from amino
acids or glycerol if it cannot be obtained from the meal, even
if carbohydrate is not a dietary necessity, it is nonetheless
necessary. As a result, it is impossible to analyse a person's
demand for carbohydrates without also taking into account
their needs for fat and protein. As a result, dietary advice
should be based on foods and eating habits.(30)

• Current recommendations for carbohydrate

The Scientific Advisory Committee on Nutrition (31) recently
revised the general population recommendations and made
minor adjustments to the recommendations, as shown in
Table.

15
It is important to keep in mind that these guidelines might not be
appropriate for those who have diabetes, as current evaluations
indicate that there isn't enough evidence to support a
recommended percentage of total energy coming from
carbohydrates.(32,33) The SACN research does note, however,
that there is also no evidence linking an increase in the
proportion of carbohydrates taken as energy with a risk of type 2
diabetes. The SACN guidelines support diets that include more
minimally processed and whole grain sources of carbohydrates
and fewer highly refined types. The recommendations to
increase fibre intake and promote the consumption of whole
grains are based on research suggesting that doing so may
reduce the risk of developing cardiovascular disease(29,34) and
some malignancies, including colon cancer.(35)

• Quantity of carbohydrate in diabetes

There is insufficient research on the ideal carbohydrate intake for
maintaining glycaemic control in people with type 1 and type 2
diabetes. The disparities in total energy intake of participants
following the various diets (with carbohydrate restriction
frequently producing a bigger relative energy deficit)(36) and the
wide range of definitions of "low" and "high" carbohydrate are
confounding factors in many individual research. This makes it
impossible to say with certainty that any changes in glycaemic
control were caused by the decrease in carbohydrate intake.
There have been a number of recent reviews that have looked at
the impact of different macronutrient ratios (carbohydrate,
protein, and fat) on weight loss and blood glucose control in type
2 diabetes,(32,33,37) but none of them have been able to show
that any particular ratio is superior to another in terms of
glycaemic control.
It is important to keep discussing the low-carbohydrate diet
controversy. Confusion can result from the fact that "low
carbohydrate" can refer to a wide variety of carbohydrate
consumption. The term "low carbohydrate" has been used to
indicate anything that has only a little bit less than the advised
amount, such as 50% of total energy or less. However, a
common definition is now developing, as shown in Table.

16
• Based on 2000 kcal diet.

Van Wyk et al.(33) discovered that participants in several

trials were unable to maintain the recommended quantity of
carbohydrates, and that the "high" and "low" groups
frequently converged with as little as an 8 g difference in
daily carbohydrate intake across groups. This may also explain
why there hasn't been a clear consensus on the amount of
carbohydrates, and it's a crucial insight concerning whether
patients will accept diets that are especially high or low in
carbohydrates.
The effect of modifying the proportion of carbohydrates on
the amount of other macronutrients, particularly fat,
presents another difficulty when contemplating low-
carbohydrate diets. If the diet's carbohydrate intake is
significantly lowered, a replacement must be found.
Proponents of low-carbohydrate diets often prefer fat to
protein since fat will encourage higher ketone synthesis
whereas protein can be synthesised back into glucose, which
may not enhance glycaemic management. (41) There is no
solid evidence to support the idea that ketones reduce
cardiovascular risk or improve glycemia, despite the fact that
this has been hypothesised to have extra metabolic
advantages in type 2 diabetes. Additionally, there is no proof
that eating a high-fat diet, which includes consuming more
saturated fat, lowers the risk of cardiovascular disease.
Reviewing the data supporting low saturated fat intakes
nonetheless finds a lack of evidence in favour of intakes of
saturated fats below 10% of total energy. New research
suggests that diets high in unsaturated fat, like the
Mediterranean diet, which contains 40% of calories from fat
(of which about half are from monounsaturated fats) and
10% of calories from saturated fat.

17
The best method for enhancing glycemic control in type 2
diabetics who are overweight continues to be weight
loss.(44) By limiting energy intake, restricting carbohydrate
consumption frequently helps with weight management. (32)
Severe carbohydrate limitations are frequently justified by
the fact that all carbohydrates eventually break down into
glucose and that this has an impact on insulin levels.(39)
promoters of low carbohydrate diets, in particular, refer to
type 2 diabetes as a condition of carbohydrate intolerance.
There isn't much evidence to back this up, but it's likely that
energy restriction, which can be accomplished by controlling
portion sizes of all energy-dense foods, is how it works most
of the time.(45)

Carbohydrate quality in diabetes

Fibre and whole grains

Evert(46) came to the conclusion that diabetics should
consume the same amount of fibre as the general population
(30 g per day), however a subsequent review indicated that
larger intakes (up to roughly 42.5 g per day) reduced HbA1c
by 6 mmol/mol.(47) Given that many individuals fall short of
the daily recommended intake of 30 g, it may be claimed that
this goal is unattainable and that supplementation would be
necessary to meet this greater intake.

Glycaemic index
One recent meta-analysis revealed low GI diets resulted in a 2
mmol/mol(48) drop, and a Cochrane review stated the
potential benefit of low GI diets is a reduction in HbA1c of
about 5–6 mmol/mol.(49)

However, the studies are sometimes few in number, the

definitions of low GI diets vary, and sometimes even the
amounts of carbohydrates between groups change. The
review by Ajala et al.(49) questions the validity of the meta-
methodology analysis's as well as the methods .

18
• Maintaining a healthy body weight is frequently advised as a
way to prevent type 2 diabetes because obesity contributes
to a large portion of the risk for getting the condition. At this
moment, it is unknown how the glycemic index and glycemic
load relate to the onset of type 2 diabetes.

• Plant-based oligo- and polysaccharides have promising

hypoglycemic potential that is comparable to or even
superior to that of current synthetic medicines without any
negative side effects.

• Regarding carbohydrates for those with diabetes, there is no

established best practise. Dietary advice should contain
details on controlling blood sugar levels, managing weight,
and lowering cardiovascular risk in accordance with
guidelines for the general populace.

• Individualized guidance should be provided based on an

evaluation of the diabetic patient's clinical and personal
needs, ideally by a qualified dietitian with expertise in
diabetes.

• INTEREST in lipid and carbohydrate metabolism has

skyrocketed in recent years along with the human obesity
and diabetes epidemics. All animals must eat to survive and
reproduce, and dietary macronutrients are vital precursors
required to build cellular material for growth and
reproduction, even though overnutrition leads to a variety of
modern diseases in humans.

• Lipids are small organic molecules that are insoluble in water,

but are soluble in organic solvents. Biochemically, they
originate entirely or in part from carbanion-based
condensations of thioesters, forming fatty acids, which are
components of triacylglycerols (TAGs), phospholipids, and
sphingolipids; or by carbocation-based condensation of
isoprene units, forming isoprenol derivatives including sterols
(Fahy et al. 2009) (Figure 1).

19
 CONCLUSION
• The main objective of diabetes therapy is to control blood
sugar levels to be close to normal. As a result, dietary
strategies that reduce post-meal hyperglycemia are probably
crucial for reducing diabetic complications.

• In the management of diabetes, low-carbohydrate diets are

not advised. Despite being a significant factor in postprandial
glucose levels, dietary carbohydrates are also a significant
source of fibre, water-soluble vitamins, and energy.
Accordingly, 45–65% of total calories should come from
carbohydrates, according to the National Academy of
Sciences-Food and Nutrition Board. Furthermore, it is not
advised to limit total carbohydrate intake to less than 130 g
per day because the brain and central nervous system
absolutely need glucose for energy.

• Blood glucose levels are influenced by both the type and

amount (in grammes) of carbohydrates in a food. Monitoring
total gramme intake of carbohydrates, whether through the
use of exchanges or carbohydrate counting, continues to be
a crucial method in establishing glycemic control because it
is a strong predictor of glycemic response.

• An additional benefit beyond what is seen when total

carbohydrate is taken into account alone can be obtained by
using this technique, according to a recent study of the
randomised controlled trials that have studied the
effectiveness of the glycemic index on overall blood glucose
control.

• The importance of achieving/maintaining a healthy body

weight (especially in type 2 diabetes) in the management of
diabetes should not be overlooked, even though this
statement has mostly focused on the impact of
carbohydrates in the diet. In overweight/obese people with
type 2 diabetes, moderate weight loss improves control of
hyperglycemia and lowers risk factors for cardiovascular
disease.

20
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