Metabolic Response of Slowly Absorbed Carbohydrates in Type 2 Diabetes Mellitus (eBook)

1. Introduction1.1. Problem Statement and Aims1.2. Outline2. Background and Objectives2.1. Diabetes Mellitus2.1.1. Diagnostic Criteria2.1.2. Classification2.2. Glucose Homeostasis2.2.1. Role2.2.2. Regulatory Factors and Actions2.2.3. Regulation of Glucose Homeostasis2.2.3.1. Postabsorptive State2.2.3.2. Postprandial State2.2.4. Abnormal Glucose Homeostasis in Type 2 Diabetes Mellitus2.2.4.1. Pathogenesis2.2.4.2. Metabolic Alterations2.3. Glycemic Control2.3.1. Glycemic Goals of Therapy2.3.2. Low Glycemic Index Diet for Glycemic Control2.3.3. Isomaltulose2.3.3.1. Digestion2.3.3.2. Absorption2.3.3.3. Metabolism and Excretion2.3.3.4. Human Studies on Glucose Metabolism2.3.4. Co‐Administration of Carbohydrate and Protein2.4. Objectives3. Methods3.1. Subjects3.2. Study Design3.2.1. Isomaltulose/Sucrose‐Clamp Study3.2.1.1. General Methodology3.2.1.2. Experimental Procedure3.2.2. Isomaltulose‐Protein Study3.3. Analytics3.3.1. Measurement of Plasma Glucose Concentrations3.3.2. Measurement of Plasma Hormone Concentrations3.3.2.1. Insulin3.3.2.2. C‐Peptide3.3.2.3. Glucose‐Dependent Insulinotropic Peptide3.3.2.4. Glucagon‐Like Peptide‐13.3.2.5. Glucagon3.3.3. Measurement of Plasma Amino Acid Concentrations3.3.4. Measurement of Stable Isotope Ratios3.3.4.1. Plasma [6,6‐2H2]glucose and [13C]glucose Tracer‐to‐Tracee Ratios3.3.4.2. Breath 13CO23.4. Calculations3.4.1. Plasma Glucose Turnover3.4.1.1. Total Glucose Rates of Appearance3.4.1.2. Oral Glucose Rates of Appearance3.4.1.3. Endogenous Glucose Production3.4.1.4. Total Glucose Rates of Disappearance3.4.1.5. Splanchnic Glucose Uptake3.4.2. Insulin Sensitivity3.4.2.1. Fasting Insulin Sensitivity3.4.2.2. Postprandial Insulin Sensitivity3.5. Statistics3.5.1. Sample Size3.5.2. Statistical Analysis4. Results4.1. Isomaltulose/Sucrose‐Clamp Study4.1.1. Subjects’ Characteristics4.1.2. Plasma Glucose Concentrations4.1.3. Plasma Hormone Concentrations4.1.3.1. Insulin4.1.3.2. C‐Peptide4.1.3.3. Glucagon4.1.3.4. Glucagon‐Like Peptide‐14.1.3.5. Glucose‐Dependent Insulinotropic Peptide4.1.4. Breath 13CO24.1.5. Glucose Infusion Rates4.1.6. Plasma Glucose Turnover4.1.6.1. [6,6‐2H2]glucose and [13C]glucose Tracer‐to‐Tracee Ratios4.1.6.2. Total Glucose Rates of Appearance4.1.6.3. Oral Glucose Rates of Appearance4.1.6.4. Endogenous Glucose Production4.1.6.5. Total Glucose Rates of Disappearance4.1.6.6. Splanchnic Glucose Uptake4.1.6.7. One‐Compartment versus Two‐Compartment Models4.1.6.8. Fractional [6,6‐2H2]glucose Rates of Disappearance4.1.7. Insulin Sensitivity Index4.2. Isomaltulose‐Protein Study4.2.1. Subjects’ Characteristics4.2.2. Plasma Glucose Concentrations4.2.3. Plasma Insulin Concentrations4.2.4. Insulin Sensitivity Index4.2.5. Plasma Amino Acid Concentrations5. Discussion5.1. Methodology5.2. Glucose Absorption5.3. Plasma Glucose Concentrations5.4. Plasma Hormone Concentrations5.4.1. Insulin and C‐Peptide5.4.2. Glucagon5.4.3. Incretins5.5. Plasma Glucose Turnover5.5.1. Systemic Glucose Appearance5.5.2. Oral Glucose Appearance5.5.3. Endogenous Glucose Production5.5.4. Splanchnic Glucose Uptake5.5.5. Systemic Glucose Disappearance5.6. 13C‐Breath Test5.7. Insulin Sensitivity5.8. Glucose Infusion Rates5.9. Plasma Amino Acids Concentrations5.10. Limitations5.11. High Protein Diets in Type 2 Diabetes Mellitus5.12. Benefits of Low Glycemic Index Diet5.13. Conclusions and Outlook6. SummaryBibliographyAcknowledgment