The Effectiveness of Virgin Coconut Oil on the Decrease of Blood Glucose Levels on Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) was medical complication that occurs during pregnancy and caused preterm labor. Efforts reduce blood glucose levels and improve pancreatic performance must be safe both for mother and fetus. The research aimed to prove VCO can reduce blood glucose levels in GDM. The research design was quasi-experimental with one group pre-test and post-test. The research started on March to September 2020. The population was pregnant mother with GDM from two hospitals in Mojokerto East Java. The sample was 46 respondents with purposive sampling. The treatment given was VCO at a dose of 5 ml, 6 times a day and lowcarb diet. The instrument used to measure the fasting blood glucose was glucose stick. The data was analyzed with paired t-test. The result showed blood glucose levels before intervention average of 155.19 mg/dL and after 153.50 mg/dL. The t-test value 14.442 and p value 0.000 which meant that VCO and low carb diet was more effective in reducing blood glucose levels on GDM. The administration of VCO with a low carb diet is an effort to restrict glucose intake in the body without hypoglycemia. It is safe to use for both mother and fetus as an alternative non-pharmacological therapy on GDM and prevent preterm labor

Self-Control at Meals in Order Not to Gain Weight and Its Relationship with Food Cravings in Low-Carb Dieters

Aims: This study’s objective was to verify the level of food cravings and cognitive restraint in women who reported having followed a low-carb diet. Methods: The volunteers filled out the binge eating scale, the cognitive restraint subscale, the food cravings trait and state questionnaires, and the food frequency questionnaire. This study has also compared participants according to the self-reported practice of a low-carb diet. Parametric tests were used to compare the groups and Pearson’s correlations between some variables of interest (p > 0.05 adopted). Results: According to the question regarding the practice of the low-carb diet, 39 participants had tried a low-carb diet in the last six months (46.2% of these with binge eating) and 48 did not (16.7% with binge eating). Dieters showed higher levels of binge eating, cognitive restriction, and food cravings (trait and state). Dieters consumed less rice and bread but did not present lower consumption of sweets. Correlations showed that for dieters who ‘Consciously hold back at meals in order not to gain weight’, it was negatively associated with ‘Intention and plans to eat’, ‘positive reinforcement’ and ‘relieving negative states’ and food cravings scores. Conclusions: Despite the higher levels of cognitive restriction in dieters, they are negatively correlated with food craving factors and negatively associated with the consumption of sweets.

Beliefs and Experiences of Individuals Following a Zero-Carb Diet

The adoption of carbohydrate-restrictive diets to improve health is increasing in popularity, but there is a dearth of research on individuals who choose to severely restrict or entirely exclude carbohydrates. The present study investigated the beliefs and experiences of individuals following a diet that severely limits, or entirely excludes, dietary carbohydrates, colloquially known as a ‘zero-carb’ diet, for at least 6 months. Zero-carb dieters (n = 170) recruited via a social networking site completed an online qualitative survey prompting them to discuss their motives, rationale, and experiences of following a low-carb diet. Transcripts of participants’ responses were analyzed using inductive thematic analysis. Results revealed that participants’ decision to follow a zero-carb diet was driven by health concerns and benefits. Participants expressed a strong social identity and belongingness to online zero-carb communities. Participants reported strong intentions to follow the diet indefinitely. Shortcomings of the diet centered on experienced stigma; lack of support from healthcare providers and significant others; limited access to, and high cost of, foods; and limited scientific data on the diet. Further research into the benefits and shortcomings of zero-carb diets across settings and populations is warranted, and guidelines for healthcare professionals on how to support individuals following a zero-carb diet are needed.

Precipitation of Euglycemic DKA (euDKA) From the Initiation of SGLT2 Inhibitor (SGLT2i) and 0-Carb Diet Inpatient

Background: SGLT2i are increasingly prescribed for their cardiorenal benefits. Nationally renowned endocrinologists have begun to actively discuss the need for guidelines on safe use of SGLT2i inpatient, with the most common indication being treatment for advanced heart failure (HF). However, no consensus has been reached to date. While in the hospital, patients with HF who are taking SGLT2i are at an increased risk for developing euDKA due to volume depletion, critical illnesses, and restricted dietary intake. We present a case of euDKA inpatient in a man admitted for HF treated with empagliflozin (EMPA). Clinical Case: A 54-year-old man with HF and non-ischemic cardiomyopathy was admitted for decompensated HF. The patient was also newly diagnosed with T2D on admission when he presented with an elevated blood glucose (BG) of 395 mg/dL (n 62–125 mg/dL) and an elevated A1C of 13.6% (n 4–6%). Cardiologists initiated EMPA 25 mg PO daily on hospital day (HD) 2, in addition to MDI insulin. On HD3, a 0-carb diet was started for a planned FDG PET/CT scan to assess the etiology of cardiomyopathy. With an extremely limited food selection, the patient became largely fasting between HD3-6 while awaiting the PET scan, eating only eggs once a day. On HD6, patient developed chest pain and hypotension and was found to be in euDKA with AKI. Labs were notable for arterial pH 7.14 (n 7.35–7.45), CO2 12 meq/L (n 22–32 meq/L), anion gap (AG) 23 (n 4–12), BG 238 mg/dL (n 62–125 mg/dL), beta-hydroxybutyrate 7.29 mmol/L (n <0.30 mmol/L), and an acute rise in creatinine from 0.8 to 1.4 mg/dL (n 0.51–1.18 mg/dL). In addition to stopping the EMPA, the patient required treatment with IV insulin and fluids for 24 hours, with resolution of euDKA, hypovolemia, and AKI. Patient was safely discharged on HD14 on MDI insulin and metformin. Conclusion: While euDKA is increasingly recognized outpatient and perioperatively, it is under-recognized in the hospital setting. A study reported 94 patients at one center using SGLT2i inpatient experiencing no euDKA (1). However, hospitalized patients taking SGLT2i remain vulnerable to euDKA, especially with concurrent critical illnesses, volume depletion and restricted dietary intake. Zero-carb intake triggers energy production by ketosis, which greatly amplifies the risk of euDKA on SGLT2i. There are currently no guidelines for safe use of SGLT2i inpatient. When using SGLT2i inpatient, we advocate for clinicians to closely monitor patients’ symptoms and AG twice a day and consider holding SGLT2i with prolonged fasting of >24 hours to readily prevent, diagnose and treat euDKA. We recommend educating clinicians on the side effects associated with SGLT2i, developing EMR alerts, and involving endocrinologists with inpatient use of SGLT2i in high-risk patients. References: (1) Palermo, N.E. et al. Use of SGLT2 Inhibitors in Hospitalized Patients in an Academic Center. Diabetes 2020; 69(S1):1200-P.

Clinical Picture at Attendance and Response to Flexible FamilyBased Low-Carb Life Style Change in Children With Obesity

Aim: The study aims 1) to determine the clinical status of obese children at the admittance to the pediatric endocrinology referral center 2) to investigate the efficiency and compliance of the low-carb diet in a pediatric population with or without exercise, metformin Material and Methods: All subjects with the complaint of obesity and BMI percentile >95 were recruited from January 2012-August 2014. We evaluated basal retrospectively, recommended low carbohydrate family-wide eating practice and exercise to all, and metformin to selected cases, and recorded Self-reported adherence at first, third, sixth, and twelfth months. Results: Thirty-six subjects used metformin with a higher ratio of weight loss (90.0%, p=0.010) without a difference in the number of lost kilograms. In 160 cases without metformin; diet only, exercise only, and both diet and exercise groups lost weight significantly according to neither diet nor exercise group (OR:12.08, 95% CI 3.93-41.66, p<0.001; OR:3.04, 95% CI 1.18-7.84, p=0.022 and OR:32.80, 95% CI 7.14-150.77, p<0.001 respectively). Exercise plus diet (95.3%, p=0,002) and only diet (88.9%, p=0,023) were even more efficient than exercise alone (65.5%). In the twelfth month, 13.8% were on follow-up. Conclusion: Obesity gives rise to metabolic complications in the very early stages. A low carbohydrate diet proved to be acceptable and useful. Long-term consistency remains a challenge.