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.

Amylose and amylopectin. There are two sorts of starch in food— amylose and amylopectin—and researchers have discovered that the ratio of one to the other has a powerful effect on the G.I. factor of a food.

Amylose is a straight chain molecule, like a string of beads. These tend to line up in rows and form tight compact clumps that are harder to gelatinise and therefore digest.

On the other hand, amylopectin is a string of glucose molecules with lots of branching points, such as you see in some types of seaweed. Amylopectin molecules are therefore larger and more open and the starch is easier to gelatinise and digest.

Thus foods that have little amylose and plenty of amylopectin in their starch have higher G.I. factors e.g. Calrose rice and wheat flour. Foods with a higher ratio of amylose to amylopectin have lower G.I. factors including Basmati rice and all sorts of legumes.

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Nobody can really tell why you get diabetes. We know that you probably were born with a tendency or chance to get diabetes and you got this tendency through nobody’s fault. Being born with a tendency to diabetes is like being born with a tendency to be tall or short, to have a particular hair colour or eye colour or a particular shaped nose or a tendency to go bald when you are a young man. We all of us inherit things from our parents as they did from their parents. A tendency to get diabetes is just one of those things. Why it should have come out when you are a child rather than when you become an adult nobody can tell at present. Possibly it was just bad luck. Certainly there is no reason to suppose it was anything that you did or your parents did or did not do, that brought it on. Sometimes people who do not know anything about it claim that a child gets diabetes from eating too much sugar. This is not so: perhaps if it were, almost everybody that you know would have diabetes.

Can you ‘catch’ diabetes like you ‘catch’ chickenpox?

No. It is quite impossible to ‘give’ diabetes to anybody else. It is not infectious and we do not think of it as a disease.

I was told I got diabetes from a shock. Could this be so?

Nobody can get diabetes just from a shock. It may be possible for someone who has a tendency to diabetes, and who was going to get it sooner or later, to develop it after some stress or strain like a shock. In this case perhaps the shock has brought the diabetes on.

Can the pancreas start functioning properly again?

Yes, for a short time. After a child first gets diabetes and has been stabilized it is common for the pancreas to function again, and that is why the dose of insulin may be quite small in the early stages. Children in general, however, require steadily increasing doses of insulin, and after a few years it is usual for the pancreas to stop working altogether. When this happens, the pancreas does not function again. It seems that the pancreas has a better chance of functioning again in older teenagers and young adults than young children. The reason for this is not yet clear.

In what way is diabetes in childhood and adults different from that of older people?

Adults, particularly young adults, may develop the same kind of diabetes as children. Older adults are more likely to develop a different type of diabetes, one that does not depend on insulin treatment and therefore is called Non-Insulin Dependent Diabetes.

Although there are many ways in which diabetes is similar in children and adults there are also many differences. When a young person first gets ill with diabetes, he may lose weight and become extremely thirsty. This sort of illness is not so common in older people, many of whom are overweight when they develop diabetes.

Children are also more likely to develop ketones when they are ill, and although some adults do not require insulin for treatment, almost all children do. One of the major differences appears to be that when a young person develops diabetes his pancreas fails to produce enough insulin and eventually produces none at all, whereas in an old person the pancreas may produce insulin, but there is something wrong with the way in which it is produced or the way in which the body can use it. This explains why a child has to have insulin injections to replace the insulin which the pancreas should be making. On the other hand, an adult may be able to take tablets which can affect the way in which the body uses its own insulin or which may stimulate the pancreas to produce insulin more effectively.

What is meant by the term ‘honeymoon period’?

There is usually a time after diabetes is first stabilized when the pancreas makes a partial recovery. At this time it makes some of the insulin needed by the body, so the dose of insulin you inject can be quite small. When this happens, diabetes is usually fairly easy to control (provided you are not given too much insulin) because the body’s own insulin does a lot of the work for you.

This is a phase of partial recovery, and is sometimes called the honeymoon period. It is not a bad term, as it is like the holiday after a marriage and at the start of a lifetime of marital adjustment. Like all honeymoons, it eventually comes to an end – weeks, months or sometimes even years later. Then you have to work at a comfortable relationship with your diabetes.

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