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By Adam Garcia
A NEW Type of Diabetes-Slow Onset Type 1
Type 1.5 is one of a number of names now applied to those who are diagnosed with diabetes as adults, but who do not immediately require insulin for treatment. They are often not overweight and have little or no resistance to insulin. When special lab tests are done, they are found to have antibodies, especially GAD65 antibodies that attack their beta cells. This sort of diabetes is sometimes called Slow Onset Type 1, Type 1.5, or Latent Autoimmune Diabetes in Adults or LADA.
About 20% of people diagnosed as Type 2 actually have Type 1.5. They are often diagnosed as Type 2 because they are older and will initially respond to diabetes medications because they have adequate insulin production. The usual treatment is diet, exercise, and standard Type 2 medications.
Since insulin resistance is minimal or non-existent, medications designed to reduce insulin resistance such as Avandia and Actos are not effective. Other medications that stimulate the pancreas to produce insulin, slow digestion of carbohydrates, or reduce excess glucose production by the liver are often effective in controlling the blood sugar for a few years.
One study in Italy, published in the October, 1998, issue of Diabetes, found that 84% of the people diagnosed as Type 2 had insulin resistance, but the other 16% did not, suggesting these individuals had Type 1.5. Several other studies have shown similar results, and these studies also often show the presence of antibodies, especially those against glutamic acid decarboxylase or GAD, characteristic of Type 1 in this group of people diagnosed with Type 2.
Knowing your diabetes type can give you a better understanding of the changes that may occur to you as you age and your disease progresses. For example, if you have had insulin-resistant diabetes for several years that has become harder to control on a sulfonylurea medication and your C-peptide level, a lab test that measures insulin production, is now low, the addition of insulin will be needed. But if your control is poor and your C-peptide is normal, adding another oral agent and paying closer attention to your food and exercise choices may be all that’s needed.
In the late 1990’s, Dr. David Bell wanted to see if he could eliminate insulin use in a group of people with Type 2 diabetes who were already on insulin by using a combination of oral medications. These people often had been put on insulin without first trying oral medications because today’s array of medications was not available when they were diagnosed.
Dr. Bell first tested C-peptide levels and chose only those who had normal levels. 100 of the 130 people with adequate C-peptide levels in his study was able to discontinue insulin use altogether and control their diabetes on various doses of glyburide and metformin. He found that their overall control, measured by their HbA1c levels, was actually better on two oral medications than it had been previously on two daily doses of insulin.
Researchers have determined that the Type 2 patients most likely to control their blood sugars on combination oral agents are those least overweight (BMI of 30 or less), with shortest duration of diabetes, and C-peptide levels normal or only slightly low.
As insulin production falls, insulin becomes necessary to maintain control. One clue that people have Type 1.5, rather than Type 2, is their appearance, which is more likely though not always slender and physically fit. They often do not have other signs of Type 2 diabetes, such as low HDL or high blood pressure. Fortunately, in these early stages, diabetes treatment is not significantly different for Latent Autoimmune Diabetes in Adults or LADA compared to truly insulin-resistant Type 2 patients. The only exception is that drugs designed to increase insulin sensitivity like the glitazones do not work because insulin sensitivity is normal.
One major benefit to this type is that when their blood sugars are controlled, people with Type 1.5 usually do not have the high risk for heart problems more often found with the high cholesterol and blood pressure seen in true Type 2 diabetes.
If you have any questions about this topic or a comment please leave a reply below or email us at diabeticcookbook@gmail.com.

This recipe has been converted to a sugar free recipe from recipetips.com. It is an excellent sugar free dessert for the diabetic person and can fit into any diabetic meal plan. If you remember correctly, dragonfruit has an added health benefit to Type 2 Diabetics. It lowers blood glucose levels.
Ingredients
For Sugar Cookie Dough:
1 cup unsalted butter, softened
1 cup SPLENDA® Sugar Blend
2 large eggs
2 teaspoons vanilla extract
4 cups all-purpose flour
1 teaspoon baking powder
½ teaspoon salt
For Pizza:
8 ounces fat-free cream cheese
½ cup powdered sugar (See Additional Information)
1 tablespoon lemon juice
3 dragon fruit, peeled and sliced
3 kiwi, peeled and sliced
1 cup strawberries, hulled and cut in half
¼ cup sugar-free apricot glaze
Directions
For Sugar Cookie Dough:
For Pizza:
Additional Information
Since this is a converted sugared recipe, we do not have the carbohydrates or any nutritional information for this recipe. However, it is a diabetic friendly recipe. For a sugar free powdered sugar recipe click here.

By Adam Garcia
Sample Menus and Calorie Intakes
This is not in any way a prescription as to how much you should eat. Your personal physician, diabetes educator, and/or dietitian must determine that. These sample diabetic meal plans are merely a composite from the diabetic meal plans already published in the three cookbooks from Joslin Diabetes Center, along with input from the American Diabetes Association.
In order to use these meal plans, you will first need to know at what calorie level you should be eating. On the average, most start out at an 1800 ADA diet. However, many things are taken into consideration; age, weight, gender, and activity level to name a few.
According to the American Diabetes Association and the American Medical Association, good eating habits along with being physically active, and diligence in taking your prescribed medications/insulin is an important part of diabetes self-management. Since these plans are based on food exchanges, you’ll need to consult an exchange list at the back of most diabetic cookbooks to see specific amounts allowed for each choice.
Generally speaking:
· 1 carbohydrate exchange provides 80 calories, 15g carbohydrates, 3g protein, and a trace fat-this includes foods from the bread/starch, fruit, milk, and vegetable groups (a serving of non-starchy vegetables provides 25 calories, 5g carbohydrates, 2g protein, and 0 fats)
· 1 protein exchange provides 7g protein and varying numbers of calories and grams of fat, depending on whether the choice is very low-fat, low-fat, medium-fat, or high-fat choices
· 1 fat provides 45 calories, 0 protein, 0 carbohydrates, and 5g fat
Remember these all correspond to servings (weight) of the food you are going to eat – - that’s why you need to consult with your personal physician, diabetes educator, and/or dietitian to learn how to use an exchange list.
Sample 1,200 Calorie Meal Plan
Breakfast:
2 1/2 carbohydrate (1 bread/starch, 1 fruit, 1/2 milk)
1 protein
1 fat
Total Carbohydrates: 37 grams
Lunch:
2 1/3 carbohydrate (1 bread/starch, 1 fruit, 1 vegetable)
2 protein
1 fat
Total Carbohydrates: 30-35 grams
Dinner:
3 1/2 carbohydrate (2 bread/starch, 1 fruit, 2 vegetable)
2 protein
2 fat
Total Carbohydrates: 45-55 grams
Afternoon OR Evening Snack:
1 1/2 carbohydrate (1 bread/starch, 1/2 milk)
Total Carbohydrates: 22 grams
Sample 1,500 Calorie Meal Plan
Breakfast:
3 1/2 carbohydrate (2 bread/starch, 1 fruit, 1/2 milk)
1 protein
2 fat
Total Carbohydrates: 52 grams
Lunch:
4 carbohydrate (2 bread/starch, 1 fruit, 1/2 milk, 1 vegetable)
2 protein
1 fat
Total Carbohydrates: 60 grams
Dinner:
4 carbohydrate (2 bread/starch, 1 fruit, 1/2 milk, 1 vegetable)
2 protein
1 fat
Total Carbohydrates: 60 grams
Afternoon OR Evening Snack:
1 1/2 carbohydrate (1 bread/starch, 1/2 milk)
Total Carbohydrates: 22 grams
Sample 1,800 Calorie Meal Plan
Breakfast:
3 1/2 carbohydrate (2 bread/starch, 1 fruit, 1/2 milk)
1 protein
2 fat
Total Carbohydrates: 52 grams
Lunch:
3 1/2 carbohydrate (2 bread/starch, 1fruit, 2 vegetable)
2 protein
1 fat
Total Carbohydrates: 45-55 grams
Dinner:
6 carbohydrate (4 bread/starch, 1 fruit, 1/2 milk, 1 vegetable)
3 protein
2 fat
Total Carbohydrates: about 80-85 grams
Afternoon OR Evening Snack:
2 1/2 carbohydrate (2 bread/starch, 1/2 milk)
Total Carbohydrates: 37 grams
Sample 2,000 Calorie Meal Plan
Breakfast:
5 1/2 carbohydrate (3 bread/starch, 2 fruit, 1/2 milk)
1 protein
2 fat
Total Carbohydrates: 80-85 grams
Lunch:
5 1/2 carbohydrate (3 bread/starch, 1 fruit, 1 milk, 1 vegetable)
2 protein
2 fat
Total Carbohydrates: 80-85 grams
Dinner:
5 1/2 carbohydrate (3 bread/starch, 1 fruit, 1 milk, 1 vegetable)
4 protein
2 fat
Total Carbohydrates: 80-85 grams
Afternoon or Evening Snack:
2 1/2 carbohydrate (2 bread/starch, 1/2 milk)
Total Carbohydrates: 37 grams
Sample 2,200 Calorie Meal Plan
Breakfast:
5 1/2 carbohydrate (3 bread/starch, 2 fruit, 1/2 milk)
1 protein
2 fat
Total Carbohydrates: 80-85 grams
Lunch:
5 1/2 carbohydrate (3 bread/starch, 1 fruit, 1 milk, 1 vegetable)
2 protein
2 fat
Total Carbohydrates: 75-80 grams
Dinner:
5 1/2 carbohydrate (3 bread/starch, 1 fruit, 1 milk, 2 vegetable)
4 protein
2 fat
Total Carbohydrates: 75-80 grams
Afternoon or Evening Snack:
3 1/2 carbohydrate (2 bread/starch, 1 fruit, 1/2 milk)
Total Carbohydrates: 52 grams
Sample 2,500 Calorie Meal Plan
Breakfast:
5 1/2 carbohydrate (3 bread/starch, 2 fruit, 1/2 milk)
1 protein
2 fat
Total Carbohydrates: 80-85 grams
Lunch:
5 carbohydrate (3 bread/starch, 1 fruit, 1/2 milk, 2 vegetable
3 protein
2 fat
Total Carbohydrates: 65-75 grams
Dinner:
8 carbohydrate (4 bread/starch, 2 fruit, 1 milk, 3 vegetable)
4 protein
3 fat
Total Carbohydrates: 110-120 grams
Afternoon OR Evening Snack:
3 1/2 carbohydrate (2 bread/starch, 1 fruit, 1/2 milk), 1 protein
Total Carbohydrates: 52 grams
You and your dietitian should work together to design a meal plan that’s right for you and includes foods that you enjoy. Also, your dietitian should take into consideration your cultural and financial environment to help establish your diabetic meals. A diabetes meal plan is a guide that tells you how much and what kinds of food you can choose to eat at meals and snack times. A good meal plan should fit in with your schedule and eating habits. The right meal plan will also help keep your weight where it should be. Whether you need to lose weight, gain weight, or stay where you are, your meal plan can help.
Next Week: Diabetic Diet Tips For Good Health. If you have any questions or comments on this particular subject you can email us at diabeticcookbook@gmail.com or leave us a reply below.

By Adam Garcia
A Dragonfruit A Day Helps Keep Your Endocrinologist Away!
Have you ever heard of a Pitaya Fruit? Neither did I, until a couple of days ago. It is commonly known as Dragonfruit and comes off of a cactus tree (See Below). It is also called Pitahaya Fruit and Strawberry Pear. According to the information I read on Foodlywise.com, it is one of the most wonderful and highly nutritious fruits on the market today. In fact, it even has a nutritional benefit which helps to lower blood glucose levels in Type 2 diabetics. Dragonfruit is a great fruit to incorporate into a diabetic meal plan and lots of diabetic recipes can include dragonfruit. While dragonfruit is not a Type 2 diabetes cure, it offers diabetics a substantial health benefit towards lower blood glucose levels.

It is packed with Vitamin C, fiber, and other micro nutrients. In fact, dragonfruit has almost 1g of fiber per 100g of the fresh fruit. Expect to see 10g or more of dietary fiber per 100g of the dried pitahaya fruit. Along with fiber, Dragonfruit has almost 50% of the recommended daily Vitamin C intake requirements in 100g of the dried fruit. You can also eat pitaya fruit as a good natural source of anti-oxidants which helps to prevent the dangers of free radicals which can cause cancer and other undesirable health detriments. Don’t worry about your cholesterol level or fats within Dragonfruit. These are mostly the healthy mono-unsaturated fats because there are so many seeds in the edible part of the fruit. There can be literally thousands of the small black seeds in any given dragonfruit, and like most seeds and nuts they have both fats and protein in them while the flesh of the fruit itself has virtually none. It would be literally impossible to remove the seeds from dragon fruit unless you pressed it through a strainer, as the seeds are very small and mixed evenly in the flesh. Fortunately, Dragonfruit is low in cholesterol and has little to no unhealthy cholesterol producing fats.
The dragonfruit cactus fruit is perhaps most common as the red dragon fruit (the red pitaya cactus fruit has red flesh or pulp, See Below). This is Hylocereus undatus, to be precise. This delectable and nutritious dragonfruit is the fruit of the vine-like cactus plant. Interestingly, the dragonfruit cactus blooms only at night and only a few times each year, blooming with beautiful huge fragrant blooms. Because of the night blooming, pollination is by nocturnal creatures such as moths and bats rather than the more common pollinators of the day such as bees. Pollination by fruit bats is actually a very important natural process, in spite of a lot of people’s aversion to the fuzzy little creatures! Since the dragonfruit cactus plant only comes to fruiting after a successful pollination – even self pollinating dragonfruit plants can fail to create dragonfruit cactus fruits when they don’t get the help of these essential nocturnal creatures to enable them to pollinate properly.

Sometimes it seems the number of ways people choose how to eat dragonfruit are about as many as there are people who enjoy eating pitaya cactus fruit. If you are someone who enjoys eating dragonfruit fresh, you can spoon the dragonfruit flesh out of the skin like you are eating a papaya. You can slice the dragonfruit, blend dragonfruit in a smoothie, eat dragonfruit with lemon or lime, and add dragonfruit to a fresh fruit salad. Some people prefer eating fresh dragonfruit chilled. That’s just how people like eating dragon fruit fresh! How to eat dragonfruit dried, that’s another story. Explore How to Eat Dragon Fruit at Foodlywise.com for more.
See next week’s recipe for a delectable Dragonfruit Pizza recipe. If you would like to discuss more on this subject please email me at diabeticcookbook@gmail.com or leave a reply below.

This tasty recipe comes from Diabetes Forecast, September 2008 issue. It only takes about fifteen minutes to cook and prepare four servings. However, the Greek yogurt and the jalapeno are not included into the nutritional analysis of this recipe, so you will have to add it to your total carbohydrates, if added.
Ingredients
4 small (6-inch) whole-wheat tortillas
2 tsp. canola oil
½ cup diced onion
3 garlic cloves, minced
2 scallions, minced
½ cup sliced red pepper
1 Tbsp. seeded and diced jalapeno pepper
(optional, not included in nutritional analysis)
½ tsp. cumin
7 egg whites
3 whole eggs
¹⁄³ cup fat-free milk
¼ tsp. dried oregano
Salt and pepper to taste
Garnish
½ cup hot or mild salsa
¼ cup nonfat Greek yogurt
(optional, not included in nutritional analysis)
Directions
Additional Information
Nutrition Facts – Serving size: ½ cup of filling; Starch exchanges: 1; Vegetable exchanges: 1;
Lean meat exchanges: 2; Fat exchanges: 0.5
Amount Per Serving – Calories: 225 Calories From Fat: 65 Total Fat: 7 grams; Saturated Fat: 1.7 grams Cholesterol: 160 milligrams Sodium: 565 milligrams (without added salt) Total Carbohydrate: 24 grams Dietary Fiber: 3 grams; Sugars: 6 grams Protein: 15 grams
By Adam Garcia
Composition of the Nutrients – Carbohydrates, Proteins, and Fats
The amounts of the nutrients are of more concern rather than the actual foods that are included in a diabetes meal plan. Diabetic people must be more concerned of nutrients like carbohydrates, proteins, and fats, but other aspects such as total fiber amount are also of great importance. Let us discuss how to handle these aspects in diabetes meal planning.
Carbohydrates And The Diabetes Meal
Carbohydrates are directly important to a diabetic person. There are two – sugar is a carbohydrate and starch is the other form of carbohydrates. The total amount of carbohydrates that is consumed per day by a diabetic person is of grave concern. That is because, if the amount of carbohydrates is too high, then the blood sugar level increases; and if it is too low, then the blood sugar level decreases.At the same time, there is a lot of dispute about the exact amount of carbohydrates that a diabetic person must consume. There is wide speculation about how much is better – should 40% of the total calorie intake be in the form of carbohydrates, or is 75% a better option? The American Diet Association suggests an amount between 60 and 70%. In reality, the amount of carbohydrate will depend on the insulin dosage that the diabetic person gets. If the person is on a high insulin dose, then more carbohydrates can be metabolized in the body. A concept of carbohydrate counting, where people are actually advised to calculate the amounts in grams of carbohydrates they are taking per day, is usually advised by diabetic meal planners. This enables people to consume any carbohydrate food, provided they do not exceed the carbohydrate limit per day that is assigned to them based on their insulin dosage.
There are some suggestions that can be considered universal in diabetes meal planning. The strongest of them is that carbohydrate foods must always be taken in small quantities, and they should be distributed throughout the day, to allow for metabolism. Ideally, 60% of the carbohydrate quantities must be divided between lunch and dinner, 30% must be kept for breakfast and 10% must be kept in reserve for some carbohydrate product taken during the day, such as milk.
Protein And The Diabetes Meal
Enough medical literature exists to suggest that proteins are probably the best macronutrient for the diabetic population. Protein is the second major nutrient we all need for building muscle and an overall healthy metabolism, but in the United States we consume more protein each day than we need. Protein should make up 10 to 20 percent of total daily calories. While up to 10 percent of the protein eaten may be converted into blood sugar, most of it is not.
Proteins are the natural choice of the body when faced with diabetes. In uncontrolled diabetes, muscle protein is broken down into amino acids to be converted into glucose by the liver. If left to fend for itself, this can create turmoil within the body. Proteins have to supply enough energy to substitute for carbohydrates and proteins are broken down faster than they are made. The body eventually ends up with a protein insufficiency, a situation with subtle, yet far-reaching effects on normal body functions. Importantly, for diabetics, a protein deficit has been shown to impair resistance to infections. Replenishing the depleting protein stores is a vital requirement of all diabetic meal plans.
The importance of proteins in a diabetic has been well documented. The American Associations of Clinical Endocrinologists have made it clear that not much evidence exists to indicate that diabetic people need to reduce their intake of dietary proteins. It is in fact believed that this is one nutrient that does not increase blood glucose levels in both diabetics and healthy subjects.
Fats And The Diabetes Meal
Fat is the third necessary nutrient needed for good health, but should not exceed 30 percent of total daily calories. The caloric density of fat is important to remember. Like protein, very little dietary fat can be converted into sugar by the body, but the calories themselves get turned into excess body weight if you’re not burning off those extra calories with regular exercise. The amount of fats that diabetic people consume in a day becomes important, because weight is an important concern.Ideally, the diabetes diet must contain fats only in low amounts, and where they are needed for cooking other foods. Eggs and meat are permissible to an extent, but the most acceptable fatty foods are fishes like salmon, which contain a high amount of polyunsaturated fatty acids. The total amount of fats in the diabetes meal plan must not go beyond 150 grams in a day.
A high level of fats in the diabetes meal will cause problems such as obesity, which could bring on many other complications of its own. As is well-known, obesity and diabetes make a fatal combination. In addition, fats when increased beyond limits in a diabetic diet will cause problems such as heart attacks, strokes and blindness.
Diabetes Meal Planning – Vegan Diets
Vegan diets are receiving a lot of publicity in controlling diabetes, but as expected, they are meeting with their own share of skepticism. Vegan diets are being considered especially beneficial in the control of Type 2 Diabetes. However, people who are adhering to vegan diets must make sure that they are meeting their protein requirements with the right kinds of vegan foods.
You and your dietitian should work together to design a diabetic meal plan that’s right for you and includes foods that you enjoy. Otherwise, it is possible that the diabetic person will come to abhor the diabetic menu and foods altogether, which is actually less beneficial to a diabetic person. A diabetes meal plan is a guide that tells you how much and what kinds of food you can choose to eat at meals and snack times. A good diabetic menu should fit in with your schedule and eating habits. The right menu will also help keep your weight where it should be. Whether you need to lose weight, gain weight, or stay where you are, your diabetic meal plan can help.
Next time we will be discussing sample menus and calorie intakes. Again, you can leave a question or comment below or if you wish to discuss this subject further email us at diabeticcookbook@gmail.com.

By Adam Garcia
CONSEQUENCES! (Part 2)
Well, it’s been two weeks since Consequences (Part 1) . So, I thought I would update you on my situation.
Dr. Miranda has debrided the wound twice in that time. The first time he took quite a bit of dead flesh away from the wound and believe me it hurt a lot, even with the local anesthetic. On the second occasion he decided to prescribe Santyl, which is a sterile enzymatic debriding ointment. Basically, it eats away the dead fleshy tissue from the wound so that the wound can properly heal. It allows the clean pink flesh to close upon the wound. He still needs to debride the wound, but instead of cutting large amounts of dead tissue; he scrapes away small amounts.
He also sent me to an infectious disease specialist whose name is Dr. Lam. Dr Lam decided that in his expert opinion; I should continue with the IV antibiotic – Cubicin, for another ten days. He also prescribed the antibiotic, Levaquin, which is in pill form for at home use. This was due to the fact that I still had signs of infection such as swelling and some redness.
If you remember the DIABETIC WOUND from before, which you can see in Consequences (Part 1), the wound was an inflamed gaping hole. Take a look at the wound today.

It is still a pretty large hole, but it is not as deep and most of the redness is gone. Notice the white soft tissue inside the wound. Compared to before, when the tissue was dead, this is a great improvement. It is healing quite nicely and the infection is nearly gone.
My blood sugar levels are starting to come under control, between 65 – 200 mg/dl. However, I have had a few instances of hypoglycemia. I have also adjusted my diabetic meal plan, which explains the bouts of hypoglycemia.
Again, these are the consequences associated with being an uncontrolled diabetic. If you wish to experience the same consequences, continue your bad habits of large carbohydrate meals. Remember, IT’S YOUR CHOICE! It’s better to keep track of your glucose levels, take your prescribed medication, and get daily exercise. If you get those levels down and change that lifestyle to a healthy one, you won’t have to experience these types of consequences. It is difficult, but not impossible. Remember, if you need some encouragement, some friendly advice, or just someone to talk to, email us at diabeticcookbook@gmail.com or leave us a comment. This is WHERE YOUR DIABETES WON”T CONTROL YOU!
We found this recipe from diabeticgourmet.com. It is an excellent side dish with any meal. It fits perfectly into any diabetic meal plan with just three grams of total carbohydrates per serving. My wife and I tried this with the All American Fried Chicken entrée and it went perfectly with it.
Ingredients
½ Pound asparagus stalks
1 ½ Large red peppers
1 ¾ T. Olive oil
½ t. Balsamic vinegar
¼ t. Fresh thyme leaves
Salt & pepper
Directions
Additional Information
Total Carbohydrates per serving – 3 grams.

By Adam Garcia
THAT’S RIGHT, WE ARE MOVING DIABETIC COOKBOOK!
As of May 01, 2009 diabetic cookbook will be moving to a new location on the web. We will now be Diabetic Cookbook Blog and you can find us by clicking here. If you have any questions about this transition you can email us here. Remember, these settings will not be available until May 01, 2009.
Until then, you can still go to http://diabeticcookbook.yrnot.com and send your questions and comments to diabeticcookbook@gmail.com. Comments can also be posted at each article or below normally.
We will have a new theme and the same format for all posts. Hope to see you soon at Diabetic Cookbook Blog