People who suffer from diabetes mellitus, and therefore require
insulin, can use this measurement unit to compare the bloodsugar-effectiveness of carbohydrates in different foods.
According to German dietary regulations, one bread exchange
unit (1 BEU) corresponds to a quantity of food that contains 12
grams of digestible and, therefore, blood-sugar-effective
carbohydrates – present in different forms of sugar and starch.
The carbohydrate exchange unit is also used alongside the bread
exchange unit. This, however, refers to 10 grams of carbohydrates.
So-called carbohydrate exchange tables allow people with
diabetes to check how many grams of food (containing
carbohydrates) correspond to one bread exchange unit or one
carbohydrate exchange unit.
They can then use this to determine the necessary quantity of
insulin or to create their own individual dietary plan. One BEU
can correspond, for example, to the carbohydrate content of the
following foods: 25g bread, 65g potatoes, 100g apples, 250g milk.
The blood glucose level is the amount of glucose
(sugar) present in the blood of a human or animal. The
body naturally tightly regulates blood glucose levels as
a part of metabolic homeostasis.
The mean normal blood glucose level in humans is
about 5.5 mM (5.5 mmol/L or 100 mg/dL, i.e.
Glucose levels are usually lowest in the morning,
before the first meal of the day (termed "the fasting
level"), and rise after meals for an hour or two by a few
millimolar. The normal blood glucose level (tested
while fasting) for non-diabetics, should be between 70
and 100 milligrams per deciliter (mg/dL)
Carbohydrates are the most important providers of energy for the body.
1 gram of carbohydrates has 4,1 kcal of energy. About 45 – 60% of the daily
total energy should come from carbohydrates.
Contrary to fat and protein carbohydrates increase blood sugar levels (except
dietary fibres). Digestion of carbohydrates leads to sugar (glucose) which
will higher the blood sugar.
Insulin-dependent diabetics have to make sure that the intake of
carbohydrates matches the insulin dose to avoid hypo- or hyperglycemia.
The calculation of the carbohydrates is done in some countries like Austria or
Germany in Bread Units (BE). But also in other countries carb counting gets
more and more popular.
One Bread Unit of a certain food contains about 10 – 12g carbohydrates.
It is useful for diabetics to prefer food which leads only to slow increase
of blood sugar – we are talking about Glycemic Index. This Glycemic
Index helps to judge different kind of food after its blood sugar increasing
The speed of the increase of blood sugar depends on composition of a
meal and now it is prepared. Food low in dietetic fibres or intensively
cooked leads to quick increase of blood sugar whereas food which has not
be cooked or is rich in fibres leads to slow increase of blood sugar.
Food with high Glycemic Index (75 – 100%): glucose tablets, honey,
softdrinks, fruit juices, white bread, starch flour, cornflakes. Food with
middle Glycemic Index (50 - 75%): potatoes, rice, noodles, mixed bread,
Food with low Glycemic Index (30 – 50%): whole meal products,
vegetables, fruits, legumes, milk products..
The glycemic index(GI)
provides a measure of how
quickly blood sugar levels
(i.e., levels of glucose in the
blood) rise after eating a
particular type of food. The
effects that different foods
have on blood sugar levels
The glycemic index estimates
how much each gram of
available carbohydrate (total
carbohydrate minus fiber) in
a food raises a person's blood
glucose level following
consumption of the food,
relative to consumption of
pure glucose.Glucose has a
glycemic index of 100.
GRAPH DESCRIBING THE RISE OF
BLOOD SUGAR AFTER MEALS
7. NORMAL FOOD PYRAMID
DIABETES FOOD PYRAMID
The glycemic index (GI) is a measure of the power of foods (or
specifically the carbohydrate in a food) to raise blood sugar (glucose)
levels after being eaten
The GI value of a food is determined by feeding 10 or more healthy people a portion
of the food containing 50 grams of digestible (available) carbohydrate and then
measuring the effect on their blood glucose levels over the next two hours. For each
person, the area under their two-hour blood glucose response (glucose AUC) for this
food is then measured. On another occasion, the same 10 people consume an equalcarbohydrate portion of glucose sugar (the reference food) and their two-hour blood
glucose response is also measured. A GI value for the test food is then calculated for
each person by dividing their glucose AUC for the test food by their glucose AUC for
the reference food. The final GI value for the test food is the average GI value for the
Foods with a high GI score contain rapidly digested carbohydrate, which
produces a large rapid rise and fall in the level of blood glucose. In
contrast, foods with a low GI score contain slowly digested carbohydrate,
which produces a gradual, relatively low rise in the level of blood
Since insulin helps glucose get into cells where energy is made, insulin is vital to
fueling the body. However, too much insulin secretion over long periods of time
can cause problems. Research shows that prolonged exposure to elevated levels of
insulin can cause:
high "bad" LDL cholesterol
Low "good" HDL cholesterol
high blood pressure
risk of developing or exacerbating type 2 diabetes
When a certain combination of these disease-promoting factors is present all at
once, the constellation of symptoms is called Metabolic Syndrome. The presence of
these symptoms also raises a person's risk of cardiovascular disease, diabetes, and
prostate or breast cancer.
When insulin levels stay high, our endocrine system can start out on a rollercoaster
ride in which the body tries to adjust to its perpetually high insulin level with
changes in other hormone levels that can leave us both tired, hungry, and on a
course toward increased risk of cardiovascular disease and type 2 diabetes.
Short-acting insulin covers
your insulin needs during
meals. It is taken about 30
minutes to an hour before a
meal to help control blood
This type of insulin takes
effect in about 30 minutes to
one hour, and peaks after
two to four hours. Its effects
tend to last about five to
“The biggest advantage of
short-acting insulin is that
you don't have to take it at
each meal. You can take it at
breakfast and supper and
still have good control
because it lasts a little longer
A hypoglycemia (short: hypo) has a tight relation to the diabetes therapy and can
catch every diabetic treated with insulin or blood-sugar lowering oral drugs
If blood glucose is lower than 60 mg/dl (3.3 mmol/l) the body – especially the
brain - lacks sugar and therefore energy. Typical warning symptoms can occur at
blood sugar values of 80 mg/dl (4.4 mmol/l) or higher if blood glucose goes down
very quickly. Hypoglycaemia can developed within some minutes.
Injection of a too high dose of insulin or intake of too much of an oral drug
Patient forgot to eat
Increased activity without additional intake of carbohydrates
High consumption of alcohol
The symptoms are different, depending on how fast or how low sugar levels
Increased frequency of the heart
Low concentration level, dizziness
Hyperglycemia means for every diabetic a long-term menace of his health as high
blood glucose levels over a longer period of time leads to damage of blood vessels
The risk is high if the blood sugar level before meal is frequently above 120 mg/dl or
above 160 mg/dl 2 hours after meal.
A hyperglycemia develops slowly (hours).
Too high amounts of blood sugar elevating foods
Insulin dose too small
Less activity than usual
Some medication (e.g. cortisol)
Gain in weight
Unindented weight los s
Chronic hyperglycemia imposes damage (glucose
toxicity) on a number of cell types and is strongly
correlated with the myriad of DM-related
Tissues most vulnerable to the effects of prolonged
elevated plasma glucose levels include pancreatic β
cells and vascular endothelial cells.
The ensuing β-cell dysfunction promotes decreased
insulin synthesis and secretion, further perpetuating
the associated hyperglycemia. As for the vascular
endothelium, chronic hyperglycemia is strongly
correlated with many DM-related microvascular
complications, including retinopathy, nephropathy,