**11. References**

414 Type 1 Diabetes – Complications, Pathogenesis, and Alternative Treatments

take any vitamin D supplementation. Even more so, the risk was lower in children that took the highest dose (2000 IU daily) as compared to the lower dose of vitamin D. Children with suspected rickets had a 3 fold increased risk of developing insulin-dependent diabetes mellitus (Hypponen et al., 2001). The risk of developing islet auto-antibodies in the children of mothers that took vitamin D during pregnancy was decreased in the Diabetes Autoimmunity Study in the Young (DAISY) (Fronczak et al., 2003). It is unclear from these studies if the protective effect is due to the supplementation with extra doses of vitamin D

Two new interventional trials have been published in the last 2 years supporting the

A pilot study looking at patients with adult-onset latent autoimmune diabetes (LADA) demonstrated that supplementation with 1,25 dihydroxyvitamin D3 for 1 year resulted in

Aljabri et al conducted a prospective study in which patients with vitamin D deficiency were assigned to receive 4000 IU of vitamin D3 daily and had vitamin D 25 (OH) levels and hemoglobin A1c measured at baseline and at 12 weeks. The results revealed that the patients who achieved higher circulating levels of vitamin D 25 (OH) had a lower hemoglobin A1c

Other studies, however, did not find similar results. A study which examined the effects of supplementation with cod liver oil during the first year of life, found that the infants who were supplemented had a decreased risk of developing childhood-onset type 1 diabetes. However, this decreased risk of type 1 diabetes mellitus was not observed in the infants if the cod liver oil was supplemented during pregnancy or if the vitamin D preparations were supplemented during the first year of the infant's life. Since cod liver oil has a high content of vitamin D along with the long-chain n-3 fatty acids (eicosapentaenoic and docosahexaenoic), it is not clear if these effects are due to the high vitamin D content of the

Pittoco et al reported the results of an interventional trial in children with newly diagnosed type 1 diabetes, in which the patients were administered calcitriol or nicotinamide in order to preserve beta-cell function. Even though there was a decrease in the insulin requirements at 3 and 6 months in the calcitriol treated group, at the end of the first year there was no difference between the C-peptide levels or hemoglobin A1c between the two groups

Bizzarri et al investigated whether supplementation with calcitriol in recent onset autoimmune diabetes has a protective effect on the pancreatic beta cells and found that, at the doses used in the study, calcitriol did not confer protection against the autoimmune destruction of the beta cells (Bizzarri et al., 2010). In Germany, Walter et al supplemented newly diagnosed adult patients with 1,25(OH)2D3 for 18 months. At the end of the study there was no difference in the areas under the curve (AUC) for C-peptide, peak C-peptide, or fasting C-peptide after a mixed meal tolerance test between the treatment and the placebo

In conclusion, the data on the role of vitamin D in the pathogenesis of autoimmune diabetes mellitus is inconclusive. More studies, particularly, interventional trials, with vitamin D or

beneficial effect of vitamin D on the development of autoimmune diabetes.

beta cell preservation, as assessed by C-peptide levels (Li et al., 2009).

cod liver oil or due to the fatty acids (Stene et al., 2003).

or prevention of vitamin D deficiency.

(Aljabri et al., 2010).

(Pitocco et al., 2006).

groups (Walter et al., 2010).

**9. Conclusion** 


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**20** 

*Abbasia - Cairo* 

*Egypt* 

**Honey and Type 1 Diabetes Mellitus** 

*1Pediatric Department, Faculty of Medicine, Ain Shams University,* 

Type 1 diabetes mellitus is by far the most common metabolic and endocrinal disease in children (Peters & Schriger, 1997). The major dietary component responsible for fluctuations in blood glucose levels is carbohydrate. The amount, source (Jenkins et al., 1981; Gannon et al., 1989) and type (Brand et al., 1985) of carbohydrate appear to have profound influence on postprandial glucose levels. The chronic hyperglycemia of diabetes is associated with longterm damage, dysfunction and failure of various organs especially the eyes, kidneys, nerves,

The glycemic effect of any foodstuff is defined as its effect on blood glucose level postprandially. Both the glycemic index (GI) and the peak incremental index (PII) are used to assess the glycemic effect of different food stuffs (Jenkins et al., 1981). Jennie et al (2003) who studied the use of low glycemic index diets in the management of diabetes found that diets with low glycemic indices (GI), compared with conventional or high-GI diets, improved overall glycemic control in individuals with diabetes, as assessed by glycemic index, peak incremental index, reduced HbA1c and fructosamine. They concluded that using low-GI foods in place of conventional or high-GI foods has a clinically useful effect on postprandial hyperglycemia similar to that offered by pharmacological agents that target postprandial hyperglycemia. Similarly, the American Diabetes Association (2002) stated that

Honey is the substance made when the nectar and sweet deposits from plants are gathered, modified and stored in the honeycomb by honey bees. It is composed primarily of the sugars glucose and fructose; its third greatest component is water. Honey also contains numerous other types of sugars, as well as acids, proteins and minerals (White et al., 1962; White, 1980; White, 1975). The water content of honey ranges between 15 to 20% (average 17.2%). Glucose and fructose, the major constituents of honey, account for about 85% of the honey solids. Besides, about 25 different sugars have been detected. The principal oligosaccharides in blossom honeys are disaccharides: sucrose, maltose, turanose, erlose. Trace amounts of tetra and pentasaccharides have also been isolated (Bogdanov, 2010). The protein and amino acid content of honey varies from 0.05 to 0.3 %. The honey proteins are mainly enzymes (White, 1975). Honey also contains varying amounts of mineral substances ranging from 0.02 to 1.03 g/100 g (White, 1975). Among honey benefits are its anti-

heart and blood vessels (American Diabetes Association, 2001).

the use of low-GI foods may reduce postprandial hyperglycemia.

**1. Introduction** 

Mamdouh Abdulrhman1, Mohamed El Hefnawy2,

Rasha Ali1 and Ahmad Abou El-Goud1

*2National Institute of Diabetes, Cairo* 

