Diabetes

Diabetes mellitus (DM) refers to a syndrome where high sugar is present in the blood, which can cause abnormalities in the tissues of the body, especially the cardiovascular and nervous system. The high blood sugar can be from 2 causes: the inability of the pancreas to secrete insulin, the hormone responsible for the uptake of sugar form the blood into the cells (DM Type I) or the inability of the cells to respond to insulin (DM Type II), also termed Insulin resistance. For both conditions a similar set of symptoms exist, however the causes are completely different.

DM Type I is primarily discovered in childhood, thus the term Juvenile Onset Diabetes is synonymous with DM Type I, as is Insulin Dependent DM, as insulin needs to be given as there is no other way for the cells to absorb sugar. In these individuals the lack of insulin from the pancreas is due to the pancreases cells responsible, the beta cells, being damaged by an immune mediated (autoimmune) reaction. This may be due to an environmental cause, or an early or congenital exposure to certain viruses. There is an increasing body of research suggesting that prevention of DM by the avoidance of cow’s milk. Exposure to cow’s milk rather than mother’s milk in infancy in combination with a viral exposure can create an immune process where antibodies are made against the beta cell of the pancreas. DM Type I individuals need to take insulin for life.

DM Type II, also known as Non-Insulin Dependent DM, in contrast, is usually diagnosed as an adult and is strongly associated with obesity and diet. In response to the obesity and a high sugar diet, the beta cells of the pancreas secrete more and more insulin, which the body responds to less and less. Not only can there be excess sugar in the blood but there is excess insulin as well. With 4% of the population medically diagnosed with Diabetes mellitus, it has become the 7th leading cause of death in the U.S. and the incidence is rising. The good news is that 90% of non-insulin dependent diabetics will be cured by achieving their optimal weight and eating a balanced diet.

Complications from DM can occur, especially if the condition has been unchecked. One of the main ways for this is that the high blood sugar in the blood leads to the sugar molecules attaching to tissues and causing abnormalities. Heart disease affecting not only the heart but the blood vessels is common and can lead to coronary artery disease, skin breakdown and infections. Eye changes may be seen by a physician through an ophthalmoscope, but can develop into diabetic retinopathy. Changes in the blood vessels of the kidney can cause a decrease in kidney function. Neuropathy, a condition that cause sensory defects in the hand and feet can frequently lead to poor healing of wounds, and in some cases, amputation.

Other forms of diabetes include Gestational Diabetes, glucose intolerance that happens during pregnancy; Secondary Diabetes, which occurs as a side effect of medications or in a complication of another disease state, and Impaired Glucose Tolerance, which may be a Prediabetic condition.

Symptoms

The name of this set of symptoms comes from the Greek; diabetes means “passing through” and mellitus means “honey.” In other words, “honey passing through,” or high levels of sugar in the urine, was what the ancient doctors first observed. The disease is characterized by high levels of sugar in the blood, which “spills over” into the urine. This is due to kidney damage that occurs in about one third of all DM Type I individuals and a small percentage of DM Type II individuals. In addition to sugar in the urine there may be excess amounts of urine, high thirst and a strong hunger; this fits one of the classic symptoms triads in medicine: polyuria, polydipsa and polyphagia – big urine, big thrist and big hunger.

The quality of life of type 2 diabetic patients with chronic and severe hypoglycemia is adversely affected. Characteristic symptoms of tiredness and lethargy can become severe and lead to a decrease in work performance in adults and an increase of falls in the elderly. The most common acute complications are metabolic problems and infection. The long-term complications are macrovascular complications (hypertension, problems with cholesterol, myocardial infarction, stroke), microvascular complications (retinopathy, nephropathy, diabetic neuropathy, diarrhea, neurogenic bladder, impaired cardiovascular reflexes, sexual dysfunction), and diabetic foot disorders.

Diagnosis and Pharmaceutical Interventions

Diagnosis of DM is made by elevated blood glucose (sugar) after an overnight fast on at least 2 occasions. Blood glucose must not be higher than 7 mmol per liter. (126 mg/dl). An oral glucose tolerance test may also be performed, which is the serial measurements of blood glucose in response to a high sugar meal.

Another laboratory test that is useful in monitoring the progression of the condition, and less for diagnostics is hemoglobin bA1, a cell marker that can show how severe the glycosalation of the red bloods cells is. HbA1c should not exceed 8.0 percent.

Medications

Oral Glucose-Lowering Drugs: In the United States, five classes of oral agents are approved for the treatment of type 2 diabetes. By conventional standards, oral therapy is indicated in any patient with type 2 diabetes in whom diet and exercise fail to achieve acceptable glycemic control. Although initial responses may be good, oral hypoglycemic drugs may lose their effectiveness in a significant percentage of patients. The drug categories include sulfonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and meglitinides.

Sulfonylureas, including first generation (e.g., tolbutamide) and second generation (e.g., glyburide) sulfonylureas, enhance insulin secretion from the pancreatic beta-cells. A significant side effect is hypoglycemia. Sulfonylurea therapy is also usually associated with weight gain due to hyperinsulinemia, which has been implicated as a cause of secondary drug failure.

Biguanides include the drug metformin, which was originally derived from a medicinal plant, Galega officinalis. Metformin reduces plasma glucose via inhibition of hepatic glucose production and increase of muscle glucose uptake. It also reduces plasma triglyceride and LDL-cholesterol levels. Side effects include weakness, fatigue, shortness of breath, nausea, dizziness, lactic acidosis, and kidney toxicity.

Alpha-glucosidase inhibitors include the drug acarbose. This drug category decreases postprandial glucose levels by interfering with carbohydrate digestion and delaying gastrointestinal absorption of glucose. The major side effects are gas, bloating, and diarrhea.

Thiazolidinediones are represented by troglitazone, rosiglitazone and pioglitazone. These expensive oral agents work by improving insulin sensitivity in muscle and, to a much lesser extent, in the liver. These drugs decrease plasma triglyceride levels, but such decrease may be associated with weight gain and an increase in LDL-cholesterol levels. Liver toxicity is a concern requiring monthly monitoring of liver function. Since troglitazone (Rezulinâ) is more toxic to the liver than rosiglitazone and pioglitazone (having resulted in dozens of deaths from liver failure), in March 2000 the FDA asked the manufacturer of Rezulin to remove the product from the market.

Meglitinides (drug name Repaglinide) augment insulin secretion, but weight gain, gastrointestinal disturbances, and hypoglycemia are possible side effects.

Insulin Therapy: Insulin is usually added to an oral agent when glycemic control is suboptimal at maximal doses of oral medications. Weight gain and hypoglycemia are common side effects of insulin therapy. Vigorous insulin treatment may also carry an increased risk of atherogenesis.

Lifestyle and Dietary Modifications

Diabetes prevention is the best form of therapy for those at risk for DM Type II. This includes improving the diet and regular exercise aerobic exercise as well as managing weight and avoiding obesity. The general consensus on treatment and prevention of type 2 diabetes is that diet management is at the forefront of therapy options.

Eating carbohydrate-containing foods, whether high in sugar or high in starch (such as bread, potatoes, processed breakfast cereals, and rice), temporarily raises blood sugar and therefore insulin levels. This blood sugar-raising effect of a food, called its “glycemic index,” depends on how rapidly its carbohydrate is absorbed. Many starchy foods have a glycemic index similar to sucrose (table sugar). People eating large amounts of foods with high glycemic indices (such as those mentioned above), have been reported to be at increased risk of type 2 diabetes. Beans, peas, fruit, and oats have low glycemic indices, despite their high carbohydrate content, due mostly to the health-promoting effects of soluble fiber.

Glycemic Index

Having high quality protein sources that may be near or equal to the amount of fat ingested (for example, 30 % of the diet is from protein and 30% is from fats) can provide superior glucose control when compared to a lower protein high carbohydrate diet. A high fiber diet also improves glucose control versus low fiber diet. Dietary reduction of saturated fat is beneficial in reduction of insulin resistance, except at total fat intakes > 37% of calories. Fish is a good source of dietary fat and may slightly improve glucose control.

Vegetarians have been reported to have a low risk of type 2 diabetes. When people with diabetic neurological damage switch to a vegan diet (no meat, dairy, or eggs), improvements have been reported after several days. Vegetarians also eat less protein than do meat eaters. The reduction of protein intake has lowered kidney damage caused by diabetes and may also improve glucose tolerance. Switching to either a high- or low-protein diet should be discussed with a doctor.

Diets high in fat, especially saturated fat, worsen glucose tolerance and increase the risk of type 2 diabetes, an effect that is not simply the result of weight gain caused by eating high-fat foods. Saturated fat is found primarily in meat, dairy fat, and the dark meat and skins of poultry. In contrast, glucose intolerance has been improved by diets high in monounsaturated oils, which may be good for people with diabetes. There is often difficulty in changing the overall percentage of calories from fat and carbohydrates in the diets of people with type 1 diabetes. However, modifying the quality of the dietary fat is achievable. In adolescents with type 1 diabetes, increasing monounsaturated fats relative to other fats in the diet is associated with better control over blood sugar and cholesterol levels. The easiest way to incorporate monounsaturates into the diet is to use oils containing olive oil. However, those who are overweight need to be aware—olive oil is high in calories.

Questions remain about where the line should be drawn regarding alcohol intake. For healthy people, light drinking will not increase the risk of diabetes, and may even reduce the risk of developing type 2 diabetes; however, heavy drinking does increase the risk of developing diabetes and should be avoided. People with diabetes should limit alcohol intake to two drinks per day. Total avoidance of alcohol in people with diabetes who are not suffering from alcoholism, liver disease (e.g., cirrhosis), gastritis, ulcers, and other conditions made worse by alcohol might actually be counterproductive.

Lifestyle Modification

Most people with type 2 diabetes are overweight. Excess abdominal weight does not stop insulin formation but it does make the body less sensitive to insulin. Excess weight can even make healthy people pre-diabetic. Weight loss reverses this problem.

Exercise helps decrease body fat and improves insulin sensitivity. People who exercise are less likely to develop type 2 diabetes than those who do not. Exercise is useful in the prevention of type II diabetes, and can improve metabolic control in people living with the disease.

Smoking tends to exacerbate the vascular complications of diabetes. People who smoke who also have diabetes are at a greater risk for complications from cardiovascular disease, kidney disease and other diabetes-linked problems. Smokers are also more likely to develop diabetes; therefore, it is important to quit smoking.

Nutritional Factors Shown to be Beneficial

Chromium

Chromium is in glucose tolerance factor, a compound that is involved in all insulin regulating activities. Without chromium that action of insulin is limited and blood sugar will increase.
Dose: 200 mcg or more per day

Alpha-lipoic acid

Alpha lipoic acid is closely related to B vitamins, is a powerful antioxidant, and helps with insulin sensitivity. It can also prevent some of the neuropathy syndromes that frequently complicate diabetes.
Dose: 300-600 mg a day

Magnesium

Doses of magnesium has reduced insulin resistance in some clinical trials, and it has been observed that most diabetics have low levels of this mineral. Magnesium supplementation can also improve insulin production in elderly people with type 2 diabetes.
Dose: 300-500 mg a day

Cinnamon (Cinnamonum verum)

In higher amounts than what is normally ingested with the diet, cinnamon can improve glucose control and decrease insulin resistance.
Dose: 1-6 g / day

Niacin

Niacin is an essential component of glucose tolerance factor, needed all insulin regulating activities. Niacin, given in the form of niacinamide may protect pancreatic cells from damage.
Dose: 500 mg three times a day

Biotin

Biotin is a B vitamin required for glucose metabolism and supplementation can enhance insulin sensitivity
Dose: 5-8 mg / day

Antioxidants in general (vitamin E, vitamin C, flavonoids): improve many inflammatory markers associated with diabetes.

Vitamin B6 (Pyridoxine)

Pyridoxine can prevent the glycosylation (the attachment of sugar molecules) of tissues, and Vitamin B6 supplementation is also effective for glucose intolerance induced by birth control pills. . It can also prevent some of the neuropathy syndromes that frequently complicate diabetes.
Dose: 50-250 mg a day

Taurine

Taurine is an amino acid found in protein-rich food. People with type 1 diabetes have been reported to have low blood taurine levels, a condition that increases the risk of cardiovascular disease by altering blood viscosity.
Dose: 500 mg three times a day

Gymnema (Gymnema sylvestre)

Gymnema also improves the ability of insulin to lower blood sugar in people with both type 1 and type 2 diabetes. Gymnema is not a substitute for insulin, but insulin amounts may need to be lowered while taking gymnema to avoid hypoglycemia.
Dose: 400-600 mg a day

Bilberry (Vaccinium myrtillus)

Bilberry may lower the risk of some diabetic complications, such as diabetic cataracts and retinopathy.
Dose: 20-40 mg of an extract standardized to 25% anthocyanosides

Ginkgo biloba

Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic neuropathy.
Dose: 240 mg of the standardized extract a day

Coenzyme Q10

Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. People with type 2 Diabetes have been found to have significantly lower blood levels of CoQ10 compared with healthy people.
Dose 30-100 mg a day

Zinc

People with type 1 diabetes tend to be zinc-deficient, which may impair immune function and improve the poor wound healing that is observed in many people with DM.
Dose: 15-30 mg a day

Vanadium

Vanadyl sulfate, a salt form of vanadium, may improve glucose control in people with type 2 diabetes, though it may not help people with type 1 diabetes. Toxicity states can exist; it is advised to work with a complementary alternative practitioner when using Vandium.
Dose: 15-30 mg a day

Vitamin E

Vitamin E has been shown to reduce glycoslation and reduce damage to nerve tissue.
Dose: 400-800 mg a day

Fish oils

Fish oils help to reduce the cardiac complications for people with diabetes.
Dose: 3-6 grams a day

Bitter melon (Momordica charantia)

Extracts of the juice and fruit may improve blood sugar in people with Type II DM.
Dose: 3-5 grams a day

In The Media

Related Blog Posts