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In most medium-to-long-term studies, diets high in sucrose (versus diets high in starch) have been found to be compatible with good blood glucose and lipid control (10). While there are lingering concerns that extremely large amounts of sugars may have undesirable effects on blood triglycerides, this is not the case for the typical amounts of sucrose found in western diets (16). The most recent recommendations for people with diabetes in the USA (2) state: 'Scientific evidence has shown that the use of sucrose as part of the meal plan does not impair blood glucose control in individuals with type I or type II diabetes.'
There is remarkably little information in the literature concerning blood glucose and insulin responses to chocolate products in people with diabetes. Peters et al. (17) compared the responses in type 1 diabetic patients to an isocaloric meal in which chocolate cake was substituted for baked potato. The glucose response and urinary excretion of glucose were no different between the two meals. However, potato has one of the highest GI values (GI = 7090) and the chocolate cake appeared to be no better.
Gee et al. (18) compared the glucose and insulin responses to conventional sucrose-sweetened chocolate with fructose- and isomalt-based chocolates in people with type 2 diabetes. Isomalt is a sweet disaccharide that has no glycemic effect when consumed as a pure compound. Fructose when consumed alone produces only one-third of the glycemic and insulin effects of sucrose (10). All three chocolates provoked a sustained rise in blood glucose, the highest levels occurring after the conventional chocolate. The isomalt chocolate gave one-third less glycemia while the fructose-based product was not significantly different to that of the conventional chocolate. Insulin responses correlated with the level of glycemia, but there were no statistically significant differences between any of the formulations. These results give us no comparison of chocolate with other foods but nonetheless have interesting implications. They indicate that it is not just the sucrose in conventional chocolate that is responsible for all the glycemia or insulin demand. The isomalt-based chocolate might have been expected to produce little glycemia because the remaining carbohydrate was a small amount of lactose derived from milk. The high insulin response to all three chocolate products also indicates that the fat and protein in chocolate have marked stimulatory effects on insulin secretion. It is possible, therefore, that certain amino acids and fatty acids in chocolate provoke exceptional insulin responses.
Since there is an excellent correlation between responses in diabetic and non-diabetic subjects (19), studies in healthy subjects may be used as a guide to the
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