DIABETES: TWENTY DOLLARS FOR TWO MAPLE BARS?A few years back—before diabetes and really having to watch my diet—Bill and I decided to work on our mutual weight problem by walking. So, at night we would walk to the Baskin-Robbins ice cream shop to have an ice cream cone night cap. And in the mornings we would walk to the Yum Yum Donut shop for our usual hot coffee and warm maple bars. On one particular morning, we had made it to Yum Yum’s in record time, and I reached in my sweater pocket for the twenty dollar bill I had brought along. Bill didn’t have his wallet with him, and I had left my purse at home because heavy purses aren’t much good on brisk walks.We ordered our usual, and when the girl brought it, I plunked my twenty down on the counter. She took my money and disappeared to the back room to get cream and more napkins. When she returned, she asked for two dollars and fifty cents. She didn’t speak very distinct English, but she made it clear she expected money. And I told her she had just picked up my twenty dollar bill when she had gone out back for more cream.It didn’t make any difference. All she could keep saying was that we owed her two dollars and fifty cents, and she didn’t seem to “understand” about the strange disappearance of my twenty dollar bill! By this time, people were coming in the door and standing in line, all waiting to order their coffee and donuts. Bill was getting annoyed with all this fumbling around and tried to come to my aid. After all, he had seen the girl pick up the twenty dollar bill I’d laid down. So had another lady who had been sitting near by.I thought, Who do you call at a time like this? Bill suggested cleaning out the cash register and PROVING she had taken our money. I also thought of calling the police but decided against it. They might not believe us, and we couldn’t prove we put the money on the counter.Very much embarrassed, we took the coffee and maple bars to a little table and sat down. I began planning on how we could leave if she still insisted we owed her money. We had no more money with us. And what if she called the police and said we couldn’t pay her for what we ordered? Bill already had taken a bite out of his maple bar, and we couldn’t return it . . .I tried to appear unobtrusive, glancing at a newspaper lying on the seat next to me and reading the signs on the window, but Bill kept muttering loudly, saying things like, “This is the most expensive donut and coffee I’ve ever had—TWENTY DOLLARS FOR TWO MAPLE BARS AND COFFEE!”We finished our maple bars and coffee and left without the girl trying to stop us. Bill kept yakking about it as we walked back home, wanting ME to call the main office of the Yum Yum Donut Shops and complain that they had taken our money. All the way back he fumed about paying twenty dollars for our small order. Suddenly I remembered that several years ago, in front of our church, I had FOUND a twenty dollar bill.”Hey, Bill, remember when I found that twenty dollar bill a few years ago by our church?”Bill didn’t remember. But I told him, “Why not look at it this way? That was the same twenty dollar bill we lost today, so really we got the maple bars and coffee for FREE!”Bill looked at me as if I were someone from outer space and continued being depressed about losing that much money. For a couple of weeks, his irritation over the whole episode left a heavy cloud over everything.With his melancholy temperament, he harbored ill feelings. He didn’t want to go back to the Yum Yum Donut Shop and preferred nourishing the idea that he had been done wrong. But I had decided I had more enjoyable things to do than worry about a lost twenty dollar bill, especially since, the way I looked at it, we really got the maple bars for free!*3\316\2*

The key message is that the physical state of the starch in the food is by far the most important factor influencing the G.I. value. That’s why the advances in food processing over the past two hundred years have had such a profound effect on the overall G.I. factor of the food we eat.

Particle size. Another factor that influences starch gelatinisation is the particle size of the food. Grinding or milling of cereals reduces the particle size and makes it easier for water to be absorbed and enzymes to attack. That is why cereal foods made from fine flours tend to have high G.I. factors. One of the most significant alterations to our food supply came with the introduction of steel roller mills in the mid-nineteenth century. Not only did they make it easier to remove the fibre from cereal grains, the particle size of the starch was smaller than ever before. Prior to the nineteenth century, stone grinding produced quite coarse flours that resulted in lower rates of digestion and absorption.

When starch is consumed in its natural packaging—whole intact grains that have been softened by soaking and cooking—the food will have a low G.I. factor. For example, cooked barley has a G.I. factor of only 25. Most cooked legumes have a G.I. factor between 30 and 40. Cooked whole wheat has a G.I. factor of 41.

The only whole (intact) grain food with a high G.I. factor is rice, specifically low amylose rice, such as Calrose rice at 83. These varieties of rice have starch which is very easily gelatinised during cooking and therefore easily broken down by digestive enzymes. This may help explain why we sometimes feel hungry not long after rice-based meals. However, some varieties of rice (Basmati, a long grain fragrant rice, and Doongara, a new Australian variety of rice) have lower G.I. factors because they have a higher amylose content than normal rice. Their G.I. factors are in the range of 54 to 64.

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Books can be misleading. Sometimes they have been written many years ago and not been properly brought up to date. This means that they do not contain recent knowledge and there is no doubt that we know a lot more about diabetes than we did in earlier days. Many of the problems which used to be encountered can now be helped and are no longer such a worry. If you do read something which seems alarming, you should discuss it with your doctor.

I have heard that diabetes can have ‘complications’. What are these?

A. These are seldom a worry in childhood, but it is true that some people, as they grow older, develop other problems of health due to their diabetes. Some of these could have been prevented, or would have been less troublesome, if the diabetes had been more carefully looked after. On the other hand, some problems may develop despite every care. Not everyone has these complications, and it is probable that as a result of the enormous amount of research in progress, we may one day be able to prevent them completely. The important complications that you may hear about are as follows:

1. Poor circulation in the legs with slow healing sores

You may also have heard of old people developing ‘gangrene’ of the feet. This can be a problem in old age but trouble can be avoided by proper care of the feet. This means keeping feet clean and dry and treating minor cuts and sores promptly and properly.

It is important to cut toe-nails correctly and have ingrowing toe-nails looked after properly. Always be sure shoes are a good fit. With these measures, and careful control of the diabetes, there is no reason why gangrene should ever develop.

2. Impaired vision or blindness

It is true that some persons with diabetes develop poor vision as they get older. We think that good diabetic control may help minimize this, and only a small number of people are likely to be seriously affected. There are some forms of treatment available for those with diabetes who show signs of eye complications, and sometimes these are very effective in preventing blindness. There is a lot of research work being done at present to study the way the blood vessels of the eye are affected by diabetes and how we can maintain good vision. The very early signs of eye problems can be detected by tests that photograph the back of the eye.

3. Kidney trouble

Once again, as with visual disorders, some people do get kidney disorders later in life as a result of diabetes. It would be surprising if modern research does not point the way in the next few years to the prevention of this.

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