In this report, super LCD and standard LCD were
provided to the patient, and his general diabetic condition was improved. This
case showed clinical efficacy of LCD (Figure 1). In recent decade, diabetic
diet therapy has been in focus, where LCD has been more prevalent [16]. LCD is
recognized for lowering blood glucose and body weight [17]. In addition to LCD,
authors have continued to report several diabetic matters with anti-diabetes
agents [18]. These include MTT, continuous blood glucose monitoring (CGM) and
glucagon-like peptide 1 receptor agonist (GLP-1RA) and others [19,20].
For his diabetic variability, blood glucose was
measured and monitored 45 minutes after breakfast. Simultaneously, carbohydrate
amount in the breakfast was calculated and the relationship between them was
analysed (Figure 2). Several MTT reports were found, in which beta-cell
function was studied using a standardized liquid diet [21]). Similar to MTT,
oral glucose tolerance test (OGTT) has been widely used [22]. We proposed a
method using 70g of carbohydrate food similar to 75g of glucose [23]. In fact,
we proposed a breakfast loading test using Japanese style breakfast with
carbohydrate 70g [24]. This method was used to examine the changes in blood
glucose, insulin, and c-peptide responses [25].
In this case, the difference in blood glucose increase
with respect to carbohydrate intake was examined for three consecutive periods
(Figure 3a-c). The results showed that the slope of the regression curve of 3c)
became flatter than that of 3a). This result supposed that insulin secretion
responsive to glucose loading may be increased. When insert x= 50 (gram of
carbohydrate amount), the result of y becomes, 204, 191, 168 mg/dL,
respectively. In contrast, by inserting x=20 to Figure 3b and 3c, y will become
153 and 152 mg/dL, respectively, which is almost same. From this estimated
calculation, it may be supposed that LCD continuation would bring improved
insulin secretion for >30-50g of carbohydrate. It is rather usual that
healthy person and diabetic patients have breakfast with carbohydrate amount
about 40-80g per meal. The case has continued standard LCD for several months,
and then the pancreas may be in rest for a while leading to improved insulin
response. Consequently, continuing LCD may have beneficial effects of
increasing insulin secretion and also improving the ability of self-remedy
situation by oneself.
This case has investigated the relationship between
post-prandial blood glucose and carbohydrate amount in the breakfast.
Carbohydrate is usually included in staple food, such as bread, rice and
noodles [26]. According to the textbook
of Harper’s biochemistry, it has been reported that 1g of carbohydrate taken
per os will increase blood glucose 1mg for healthy subjects, 3mg for T2D
patient and 5mg/dL T1D patient [27].
Some limitations are present in this case report. The
relationship with post-prandial glucose and carbohydrate intake would be
important, which is the theme of this presentation. However, such results do
not necessarily show the precise glucose value like computer or the electric
experiments. The reason includes the ingestion and absorption of glucose in the
intestine. Further studies will be required for MTT research. In summary, this
article presented the combined research of LCD and MTT in diabetic patient. The
results would become at least some meaningful reference for diabetic detail
research in the future.
