I have recently written about the metabolic syndrome and insulin resistance, but when does it become diabetes? Is it unavoidable? What is diabetes anyway?
What is Diabetes?
Diabetes Mellitus means literally ‘passing through like a siphon’ (diabetes-) ‘sweetness’ (mellitus), and is so named because early physicians recognised that the copious urine passed was very sweet, due to all the sugar.
Diabetes insipidus is another disease in which copious amounts of urine are also passed, but it is not sweet (i.e. insipid). It has nothing to do with glucose, and is due to a defect in the ability to contain water in the body, due to disease in either the kidneys or pituitary gland.
There are 2 kinds of Diabetes Mellitus, (DM for short) called Type 1 or insulin dependant, and Type 2. We will look at them 1 at a time, so let’s start with the commonest, Type 2 diabetes.
Both diseases centre around the pancreas, a large gland in the upper abdomen, which is also responsible for the production of several digestive enzymes.Certain cells in the pancreas, ß (beta) cells, located in small islands in the organ (called islets of Langerhans after the first man to describe them,) are responsible for producing insulin.
INSULIN: Its main function is to regulate the amount of sugar, or glucose, circulating in the blood, which it does by allowing the glucose (sugar) to pass from the blood into the cells of the body. In addition, insulin instructs the fat cells to convert glucose and fats in the blood into more fat, to be stored until needed, and so insulin regulates fat storage. It also regulates the storage of Glycogen, the body’s emergency fuel supply, in the muscles and liver, and stimulates the part of the brain responsible for eating and hunger. It is essential for growth in the young.
If the pancreas produces too much insulin, as happens in Insulin resistance, or ‘pre-diabetes’, it leads to high blood pressure by stimulating the kidneys to retain salt and water, arteriosclerosis (hardening of the arteries), and stimulation of cholesterol production by the liver.
GLUCOSE is a natural sugar, and the form in which most sugars are transported in the blood. It is the building block of most carbohydrates, and the fuel used by all cells in the body for normal activity. Too much glucose in the blood leads to damage to the vessels, especially in the eyes, kidneys and extremities, leading to blindness, kidney failure, and gangrene respectively.
What is Type 2 Diabetes?
In Type 2 Diabetes (DM2) people produce sufficient, or even too much, insulin until late in their disease, but the insulin does not work properly. This is called insulin resistance; too much insulin produced by the pancreas, but it is unable to fulfill its function of moving the sugar from the blood into the cells. (Hyperinsulinemia:– hyper = too much – insulin – emia = in the blood.) Eventually the pancreas becomes exhausted, or burnt out, and ceases producing insulin, which interestingly seems to occur far more rapidly in patients of African origin.
What are the Causes?
DM2 and insulin resistance are associated with obesity, particularly abdominal (apple shaped) obesity, and poor diet in 80% cases, and are thus preventable, and treatable. It is increasingly being seen in young people due to poor diet and lack of physical activity. DM2is slow in onset, often found by chance, and blood sugar levels are often only slightly elevated. In fact it is estimated that only 50% of people affected are diagnosed.
An individual may be insulin resistant without being diabetic, if he/she has not yet reached the stage where his/her blood sugar has risen to diabetic levels.
How is it diagnosed?
Many type 2 diabetics are only found by chance by testing the blood sugar, and the disease is often present for months or years before it is found. Symptoms include recurring skin, bladder or vaginal infections, itching, thirst, weight loss, fatigue and vague unwellness. It is wise to ask your Dr or Pharmacy sister to check your sugar with a simple finger prick if you have any doubt about your sugar level. A fasting glucose should be less than 6mmol/l after a 4 hour fast; up to 7mmol/l is called impaired fasting glucose. If you have eaten within the previous 4 hours, your glucose should not be above 11 mmol/l. Any higher is suspicious of diabetes, and the test should be repeated. Should it again be raised then diabetes can be diagnosed.
Serum insulin is not regularly measured because it is expensive, and we can judge whether an individual has the problem from the other factors.
Some people only develop signs of diabetes under certain conditions, e.g. pregnancy, on courses of steroids, etc. Such people are demonstrating that they are prone to the disorder, and need to be particularly careful in later life. This also applies to mothers who give birth to high birth weight babies. Many of these women have a faulty glucose metabolism, which only manifests itself later. Prevention is better than cure!
What is the usual Treatment?
Having seen that there are 2 different forms of Diabetes, we can understand that the treatment of Types 1 and 2 also differs.
The first step in treatment of DM2 is diet, both to encourage weight loss, and to reduce the load on the pancreas. In some cases this is sufficient to return the blood glucose to normal. The client must be made aware that regain of weight or a return to poor dietary habits will result in relapse of the disease. The main dietary change is avoidance of refined sugars, since these are what the body can no longer process. By avoiding factory processed foods, and eating food that is naturally produced (avoid anything wrapped in cellophane!) sugar intake can be reduced and blood sugar too. Any diabetes therapy must include dietary management. Diabetics cannot cope with excess sugar, (yet we see them being told to eat bread and jam!) So the best dietary advice for any diabetic is to eat as little as possible of slowly absorbed (i.e. low GL) carbohydrates, e.g. whole wheat bread, fresh fruit and veg, and to avoid all refined and processed foods. The diet should be built around a portion of protein and vegetables at each meal, with fruit once or twice a day at most. The diet should be as natural i.e. non processed as possible, and again, my old maxim applies: the shorter the journey between the ground and your plate the better. It does not have to be expensive; beans and pulses can form a large part of the protein side and contribute fibre at the same time. Tinned fish is affordable and versatile. Vegetables are also cheap, and can be grown successfully at home with a little effort.
If dietary management is insufficient, there are 3 therapies available:
Drugs to make the insulin work better, to encourage glucose absorption from the blood stream. The commonest of these is Metformin (Glucophage).This is most suitable for overweight diabetics, and is the treatment of choice in any degree of insulin resistance. At times, patients who are not actually diabetic but are predisposed to becoming so, take Metformin as a preventative, for example in Polycystic Ovary Syndrome.
Drugs to make the pancreas produce more insulin. These are a group called sulphonamides, and their names usually end in –ide, e.g. Chlorpropamide, Glibenclimide, and Glicizide.
Unfortunately, these medicines also cause weight gain, and they make the poor pancreas work even harder, until it burns out.
There is now a new class of oral anti diabetic agents; the one available in RSA is called ACTOS, or Pioglitazone. These drugs also improve the action of insulin, and so do not exhaust the pancreas in the way that the sulphonamides above do. There are several safety concerns and the original drug was removed from the market due to an excess of cardiovascular ‘events’(mishaps). There is also some concern that it may cause bladder cancer.
Insulin by injection becomes necessary when maximum combinations of the above medicines do not produce sufficient control.
What the patient can do.
Many of the complications of diabetes are related to circulation, so prevention should be aimed at helping maintain a healthy circulatory system. To this end smoking is an absolute no for diabetics, and exercise is essential.
What other treatments are available?
There are several herbs known to improve the sensitivity of the cells to insulin, and so reduce the effects of insulin resistance:
Oats and oat bran should be eaten in preference to commercial cereals, and can also be made into oatcakes.
Cinnamon: 1 teaspoon a day.
Chromium, Curcumin and Gymnema sylvestre all improve blood sugar and reduce insulin resistance.
A recent trial showed that supplementation with Coenzyme Q10 200mg daily improved glucose control in type 2 diabetics.
Other useful supplements in established diabetics are:
B vitamins which both help reduce insulin resistance and also protect the nerves against damage (neuropathy).
Magnesium and Myoinositol also protect the nerves from damage.
α-lipoic acid, an anti-oxidant that is a non-prescription dietary supplement has shown benefit in a randomized controlled trial that compared once-daily oral doses of 600 mg to 1800 mg compared to placebo, although nausea occurred in the higher doses.
Methylcobalamin, a specific form of Vitamin B-12 found in spinal fluid, has been studied and shown to have a significant effect, taken orally or injected, in treating and improving diabetic neuropathy.
In more recent years, Photo Energy Therapy devices are becoming more widely used to treat neuropathic symptoms.
Heat, therapeutic ultrasound, hot wax and short wave diathermy have all been used in neuropathy.
Vitamin E and omega 3 oils help protect against heart disease & nerve damage.
Zinc promotes wound healing.
Bilberry protects eyes.
Ginkgo biloba helps poor circulation and nerve damage.
- Protein Power by Eades and Eades
- Dr Bernstein’s Diabetes solution by Richard R Bernstein MD
- New Nutrition by Dr W Serfontein