PATIENT ENQUIRY

How to Treat Diabetes


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What Is?
What is Diabetes
How to Treat Diabetes
Natural Treatments for Diabetes

What is diabetes and what are the different types of diabetes?

Diabetes is a serious medical condition in which the body cannot adequately control blood sugar levels because it lacks insulin, or does not respond properly to insulin.

Diabetes is a serious medical condition in which the body cannot adequately control the blood sugar level because it does not have enough insulin, or does not respond properly to insulin.

Diabetes mellitus is a group of metabolic disorders in which a person has high blood glucose levels. The resulting problem is hyperglycaemia – the medical term for high blood glucose. The foods we eat provide us with a sugar called glucose. The body produces insulin to transfer glucose into cells for energy.

Unfortunately, diabetes is fast becoming a worldwide chronic disease. Diabetes is Australia’s sixth most prevalent cause of death.

Different pathogenic processes result in several different forms of diabetes, including inadequate insulin production, impaired cellular response to insulin, increased hepatic glucose output, or a combination of all three.

The end-effect of diabetes is a lack of glucose within cells, which increases fatty acid catabolism for energy production, which leads to increased intracellular production of ketoacids. The resultant fall in intracellular pH inhibits the citric acid cycle, causing reduced ATP production and sodium pump activity, which alters the transmembrane sodium-potassium balance.

This alteration induces intracellular fluid retention, impedes cellular metabolism, and interferes with the activity and regulation of other hormones.

What are the different types of diabetes?

Type 1 diabetes or insulin-dependent diabetes

Type 1 diabetes is an autoimmune disease that usually develops before 40 years of age. The body destroys insulin-producing beta cells in the pancreas. A person with Type 1 diabetes can’t produce insulin and so needs daily insulin injections for the rest of his or her life, to regulate blood sugar levels.

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Type 2 diabetes or noninsulin-dependent diabetes

Type 2 diabetes develops as the end result of many years of insulin resistance and hyperinsulinaemia (too much insulin), or because either the pancreas does not produce enough insulin or the body’s cells ignore the insulin, which is called insulin resistance. Both problems lead to abnormally high blood glucose levels.

Find out more

Other less common types of diabetes

Type 3 diabetes, also called Tropical diabetes, occurs in the non-Caucasian populations of tropical Asia and Africa and appears to be related to malnutrition. Early nutritional deficiency impairs pancreatic development and growth, made worse by eating cassava and/or betel nut. In tropical diabetes, the loss of blood sugar control is related to both impaired insulin production and peripheral insulin resistance. Unlike Type 1 diabetes, although insulin circulates in the blood the levels are too low to stabilise blood glucose levels and a degree of insulin resistance occurs, similar to Type 2 diabetes.

Secondary

Secondary Diabetes
Secondary diabetes means an impaired control of blood sugar levels caused by a variety of hormonal disorders that interfere with insulin activity, hepatic glucose release, and/or peripheral glucose dispersal. These disorders include:

  • Acromegaly– excessive production of growth hormone, usually secondary to a pituitary adenoma, which secretes too much growth hormone
  • Hypothyroidism– impaired production of thyroid hormone reduces metabolic activity and enhances insulin resistance
  • Cushing’s Disease – excessive cortisol production secondary to adrenal cortical hyperplasia and/or adenoma
  • Cushing’s Syndrome – excessive glucocorticoid steroidal activity secondary to excessive and or prolonged steroid therapy
  • Polycystic ovary syndrome – a genetic disorder of steroid synthesis in women associated with excessive androgen activity and insulin resistance
  • Gestational diabetes –elevated fasting blood glucose levels during pregnancy, due to insulin resistance. Gestational diabetes requires urgent treatment because placental function is impaired. Women who develop Gestational Diabetes have latent genetic predisposition to Type 2 diabetes and require on-going surveillance for Type 2 diabetes after their baby is born.
  • Pancreatic damage – impaired insulin production occurs secondary to pathological destruction of pancreatic tissue in chronic pancreatitis, haemochromatosis, and cystic fibrosis, and usually requires insulin therapy similar to Type 1 diabetes.

Gestational Diabetes

Gestational diabetes can develop in pregnant women and usually disappears once the baby is delivered. However, a woman who developed gestational diabetes has a much higher risk of developing Type 2 diabetes and needs careful surveillance of blood sugar levels.

A healthy diet, regular exercise and a maintaining a healthy weight all prevent Type 2 diabetes developing later in life.

Diabetes causes metabolic disruption

Metabolic disruption

The end-effect of diabetes is lack of glucose within cells, which increases fatty acid catabolism for energy production, which leads to increased intracellular production of ketoacids. The resultant fall in intracellular pH inhibits the citric acid cycle causing reduced ATP production and sodium pump activity, which alters the transmembrane sodium-potassium balance.

This alteration induces intracellular fluid retention, impedes cellular metabolism, and interferes with the activity and regulation of other hormones. Patients with diabetes present with the classic symptoms of polyuria (excreting too much urine), thirst, fatigue and weight loss. Although other disease processes may also cause these symptoms, diabetes is the most common cause, and patients with these symptoms should have appropriate blood and/or urine tests.

Hyperglycaemia is the hallmark of diabetes. Elevated blood glucose, a fasting level above 8.0 mmol/L or above 14 mmol/L during a Glucose Tolerance Test (GTT), is diagnostic of diabetes. The presence of glucose in the urine (glycosuria) is suggestive of diabetes, but this can also occur during pregnancy or as a result of infection.

In Type 1 diabetes, overt insulin deficiency causes substantial impairment of glucose metabolism, with markedly enhanced fatty acid metabolism and ketoacidosis, which may be severe enough to induce coma. Increased protein tissue catabolism can lead to substantial lean weight loss. This metabolic disruption is associated with a range of compensatory changes in production of other hormones, such as cortisol, glucagon, and catecholamines, and causes marked changes in serum and cellular electrolyte balance, with loss of calcium, magnesium, potassium, and sodium.

In Type 2 diabetes the presentation is less clear, because insulin insufficiency is only relative and insulin levels are generally elevated. Therefore, the metabolic alterations are a combination of mild cellular glycopenia (reduced glucose) and the hormonal and metabolic effect of hyperinsulinaemia (high insulin). The high insulin levels interfere with lipid metabolism, cause increased hepatic conversion of glucose to fatty acids, and increase free fatty acid flux, while reducing adipocyte lipolysis. This leads to weight gain, which further enhances insulin resistance and deteriorationin glycaemic control.

Hyperinsulinaemia reduces DHEA production, through direct inhibition of the steroid synthesis enzyme 21-lyase, thereby reducing protein synthesis. The effect is the opposite of the usual protein-sparing effect of physiological insulin production and increases lean weight loss and augments insulin resistance. The damaging alterations in lipid and protein metabolism increases metabolic acidosis and affects electrolyte balance, leading to excessive loss of intracellular potassium and magnesium, which contributes to further impaired cell metabolism.

The hyperinsulinaemic alteration in lipid metabolism increases VLDL lipoprotein synthesis, while reducing HDL lipoprotein production. This enhances the development of cardio-vascular diseases. The metabolic effects of hyperglycaemia alter vascular endothelial function, which causes increased glycation of tissue protein and nucleic acid molecules. This leads to impaired capillary circulation, microvascular dysfunction and increased ‘aging’ of neuronal, vascular, and ophthalmic structures.

Other conditions related to diabetes

Prediabetes

Before a person develops Type 2 diabetes, he or she almost always has prediabetes, or impaired glucose metabolism, characterised by impaired fasting glucose or impaired glucose tolerance.

A person with prediabetes has a blood sugar level that is higher than average, but not high enough to be classified as Type 2 diabetes. Without intervention, prediabetes will worsen to become Type 2 diabetes, which is preventable. With healthy lifestyle changes, such as choosing healthier foods, making time for regular exercise, and maintaining an optimal weight for your age and height, a person can maintain normal blood sugar levels. Losing as little as 5–10% of your body weight and maintaining an optimal weight, can help reduce the risk.

Speak with your doctor before starting any significant increase in physical activity to ensure your overall fitness is adequate.
The risk factors for prediabetes are the same as for Type 2 diabetes.

Insulin resistance

Insulin resistance occurs when the effect of insulin is reduced either because of impaired activation of the downstream enzyme pathways or due to inefficient insulin binding to cellular insulin receptors.

Insulin resistance is present in the majority of people with impaired glucose tolerance, everyone with Type 2 diabetes, and approximately 25% of non-obese individuals with normal glucose tolerance.

Obesity is substantially associated with the development of insulin resistance but recent studies query whether or not it is the prime causal factor, reporting that not uncommonly people with low or normal BMI also exhibit insulin resistance or impaired insulin sensitivity.

Slim or average weight people do accumulate excessive intra-abdominal fat deposits, but to a lesser extent than obese persons. This intra-abdominal fat accumulation is associated with the development of insulin resistance. Obesity, secondary to too much food and too little exercise, is a major cause of insulin resistance. However, recent work suggests that central fat deposition may be an effect of reduced insulin sensitivity, rather than a cause.

Clinical classification of insulin resistance

Insulin resistance category 1

A patient will demonstrate changes in weight and body composition and the blood glucose and insulin levels are generally in the high-normal range or only slightly elevated. Blood lipids are usually within the normal range, though the HDL cholesterol may be in the low end of the range, and there is no major evidence of oxidative stress.

Insulin resistance category 2

A patient will demonstrate overt, though mild, insulin resistance with frankly abnormal insulin and glucose levels and significant changes in blood lipid levels. Often elevated triglycerides and lowered HDL cholesterol and borderline high hypertension will also be present.

Insulin resistance category 3

A patient will demonstrate Syndrome X with hypertension, overweight and abnormally elevated insulin, glucose, and blood triglyceride levels. Evidence of oxidative stress may also be present.

What is reactive hypoglycaemia?

A person with abnormally low blood sugar levels within hours of eating has reactive hypoglycaemia, also called postprandial hypoglycaemia. Signs and symptoms of reactive hypoglycemia may include hunger, weakness, shakiness, sleepiness, sweating, light-headedness, anxiety and confusion. A person with this condition can usually control the symptoms by eating smaller meals more often, choosing low GI carbohydrates and a well-balanced diet, avoiding alcohol on an empty stomach, and making time for regular exercise.

What are the symptoms of diabetes mellitus

Over time, high blood sugar can cause serious health problems. Diabetes is a common and cause of ill health in all communities, and can cause significant heart and vascular disease. Diabetes mellitus can also damage the eyes, kidneys, and nerves.

A patient with high blood sugar will present with the classic symptoms of passing more urine, excess thirst, fatigue, and weight loss. As the disease progresses, a patient with diabetes might experience blurred vision, skin and gum infections, skin damage that won’t heal, or numb feet and hands.

Although other disease processes may also cause these symptoms, diabetes is the most common cause, and patients with these symptoms should have appropriate blood or urine tests

How do doctors diagnose diabetes mellitus?

Early detection of diabetes will enable early treatment and better medical outcomes. The symptoms of diabetes might occur very suddenly if a person has Type 1 diabetes and require medical attention.

A patient with undiagnosed or poorly controlled Type 1 diabetes may present with an acute ketoacidosis and acute circulatory collapse, particularly when the patient has an acuteinfection. Despite recent weight loss, this type of patient is usually overweight and has chronic disease complications, such as hypertension, arteriosclerosis and neuropathy.

A person with Type 2 diabetes might have no symptoms at all.By the time Type 2 diabetes develops, impaired insulin sensitivity and reduced B-cell function has been present for many years. Small vessel changes usually will have occurred in the small vessels of the limbs, heart and kidneys, which could lead to future health complications.

A blood or urine test will show if blood sugar levels are within the normal range.

Diabetes is diagnosed when:

  • Symptoms are present and fasting blood test result is at or above 8.0 mmol/L or above 14mmol/L during a Glucose Tolerance Test
  • HbA1c blood test result is ≥ 6.5% (48 mmol/mol), or
  • There have been no symptoms and two abnormal blood glucose tests on separate days.

The presence of glucose in the urine is suggestive of diabetes, but this can also occur during pregnancy o as a result of infection.

A thorough history and the severity of symptoms will enable a doctor to differentiate between Type 1 and Type 2 diabetes.

If blood glucose levels are ambiguous or normal, a doctor might order an oral glucose tolerance test to determine if a person has an impaired fasting glucose or impaired glucose tolerance, which is associated with pre-diabetes.

How you can prevent the development of diabetes mellitus

A person at risk of Type 2 diabetes can delay and even prevent onset by following a healthy lifestyle, which includes maintaining an average weight, low cholesterol levels and normal blood pressure, regular physical activity, and healthy food choices. A person who smokes cigarettes should speak with his or her doctor about how to quit.

Nearly 66% of Australians are overweight or obese, which is a key factor in the recent increase in Type 2 diabetes. Up to 60% of Type 2 diabetes cases could be delayed, even prevented, through a healthier lifestyle that includes nutritious foods and regular physical activity. Maintaining an appropriate weight for height and age and reducing waist circumference, which reflects the amount of stored abdominal fat, are two key factors in developing Type 2 diabetes.

You can assess your risk of developing diabetes mellitus using the online tool developed by Diabetes Australia. Assess your risk MORE

How to treat diabetes

In conventional medicine, the management of diabetes is usually based on a combination of caloric restriction and increased exercise, in order to reduce body fat-weight, decrease pharmacological therapy, and control blood sugar levels.

The current Australian dietary guidelines recommend a diet high in fibre, complex carbohydrate foods like whole grains, fruit and vegetables, and legumes. Complex carbohydrate foods should make up approximately 50-60% of total intake, preferably from lower GI foods, which are absorbed more slowly, have a cardio-protective activity, and help prevent or delay the onset of diabetes.

The goals of treatment are to improve insulin sensitivity by reducing fat intake, losing weight, and increasing physical exercise, which all improve insulin sensitivity and peripheral glucose dispersal.

A person can control blood sugar and insulin levels by limiting the quantity and improving the quality of dietary carbohydrates, in order reduce the insulin response to meals and reduce post-meal blood glucose concentration.

Prevent and retard development of complications by improving body fat-weight and blood lipid levels, to reduce the vascular pathology associated with insulin resistance and diabetes, while high dietary antioxidant intake retards oxidative damage in blood vessels, brain, and retinal tissues.

Too much food and too little exercise means dietary energy and fat intake exceeds physical exercise requirements – or eating more food for energy than a person’s level of physical activity needs. The excess energy is stored as body fat, which leads to excess body weight and obesity.

Recent research shows that dietary nutrient intake, physical exercise, gene-related IRS activity, and beta cell function are all involved in the development of insulin resistance, obesity, and diabetes.

Type 1 diabetes is treated with insulin, regular exercise, and a diabetic diet. Type 2 diabetes is treated first with weight reduction, and then medication, a diabetic diet, and regular exercise.

Alternative dietary management

During the past two decades, there has been increasing evidence that human physiology is genetically unsuited to a diet that contains a high level of carbohydrates, particularly those foods that exhibit a high Glycaemic Index. Dietary consumption of refined and simple carbohydrates, above 40% of dietary energy, has been shown to induce a strong insulin response, hyperinsulinaemia that apparently encourages intra-abdominal and systemic fat deposition and inhibits lipolysis.

Many people with certain genotypes, common throughout all communities but also clustering strongly within certain ethnic populations, appear to have an enhanced insulin response to high dietary carbohydrate consumption and become progressively more insulin resistance. This process appears to be enhanced by a concomitant low intake of dietary fibre, omega-3-fatty acids and plant-derived antioxidants, and high intake of saturated fatty acids and trans-fatty acids.

Adherence to a diet that complies with the recommended Australian and American standards may reduce insulin resistance and body fat-weight, especially when combined with an exercise program. However, contemporary studies indicate that the insulin response to such meals remains elevated, despite good blood sugar control, and lean-weight loss continues, thereby further impairing insulin sensitivity.

Thus, attention has returned to the use of low-carbohydrate, high-protein diets, with additional supplementary antioxidants, EFAs and minerals, to reduce insulin responses and control blood sugar levels. Preliminary clinical case reports and small studies indicate that this form of diet produces good fat-weight loss, obviates lean-weight loss, and improves hyperinsulinaemia response to meals.

However, as these low-carbohydrates may induce ketosis, especially in diabetic patients, they are generally avoided in orthodox treatment programs, but are particularly useful in achieving good blood sugar control and improving insulin sensitivity, when employed by knowledgeable practitioners.

If low-carbohydrate diets are employed, careful monitoring of patient response is required, with daily measuring of blood glucose and urinary ketone levels. Diabetic medication, particularly insulin, will need to be adjusted downwards to avoid hypoglycaemia episodes.

How to treat Type 1 diabetes

Type 1 diabetes

No cure for Type 1 diabetes is available, but a tailored medical program will enable a patient to control blood sugar levels.

Regular exercise, weight control, and managing a healthy diet can help control diabetes. A person with diabetes needs to monitor blood glucose levels and take medicine as prescribed.

Regular physical activity helps regulate blood sugar levels and aids circulation to the lower legs and feet.

In order to prevent complications, a person with diabetes should maintain a healthy blood pressure level, keep cholesterol levels low, regularly check feet for infections, get eye health checked each, and visit a dentist every six months.

How to treat Type 2 diabetes

Type 2 diabetes

Excess consumption of total energy (relative to daily and physical exercise), saturated fats, and refined or high glycaemic index (GI) carbohydrates, with insufficient intake of dietary fibre and unsaturated fats, enhances the development of obesity, insulin resistance, and Type 2 diabetes. Eating too much food can be countered by regular physical exercise, which improves glucose uptake and raises basal metabolic rate.

There is no doubt that the types of food we eat influences metabolic control, through complex interactions that affect carbohydrate and lipid metabolism. Diets high in saturated fats and refined carbohydrates, with high GI, enhance gastrointestinal mucosal transport of glucose and pancreatic insulin secretion, thereby inducing abdominal fat deposition and elevated insulin production.

The progressive impact of aging also enhances the development of Type 2 diabetes by increasing free radical genesis and protein catabolism. Insulin sensitivity is part of the aging process. As we age we produce less Growth Hormone and anabolic steroids, and chronic lifestyle stress leads to sympathetic neuronal hyperactivation and rising cortisol synthesis. A systematic reversal of these environmental factors can improve insulin sensitivity and prevent Type 2 diabetes.

Early identification of high risk for Type 2 diabetes

Recently, the focus of diagnosis has shifted to the early identification of those persons with a high risk of developing Type 2 diabetes, which means the detection and treatment of insulin resistance before the onset of metabolic changes and hyperglycaemia.

There are many clinical features that indicate an individual has a high risk of developing insulin resistance and/or has impaired insulin sensitivity. Many of these features are easily defined from the history, physical examination and routine laboratory tests and, if present, should initiate more formal investigations.

The clinical features suggestive of insulin resistance include:
Increased body-fat weight:
Overweight (BMI> 25) and obesity (BMI> 30)
Body fat percentage above 15% in males and 25% in females
Increased fats stores despite exercise and/or restricted energy diet

Body shape and central fat deposition (pot-belly):
Apple shape or endomorphic (cow-pony) body-shape
Waist:hip ratio > 0.9 in males and > 0.8 in females and/or
Umbilical girth > 90cm in males and > 88cm in females

Dietary imbalance:
High consumption of saturated fats and refined carbohydrate foods
Low dietary consumption of fibre and omega-3-fatty acids
Symptoms of reactive hypoglycaemia – sleepiness after meals, shakiness before meals or when hungry, addiction to carbohydrate-rich foods, insomnia relieved by “midnight snacks”, frequent mood swings, severe irritation or aggression

Lifestyle and genetic indicators:
Family history of Type II diabetes, cardiovascular disease and hypertension
Indigenous ethnicity – particularly genetic heritage derived from the following ethnic populations: Australian Aboriginal, Pacific Islander, Asian Indian, Pima Indian (Mexican), Canadian Indian (Oji-Cree), Southern Italian, Sardinian and Finland
Low exercise level, particularly with sedentary employment
Cigarette smoking

Excess alcohol – men and women should drink no more than two standard drinks per day Clinical and laboratory features indicative of Syndrome X:
Borderline elevated blood pressure (systolic BP > 135 mm Hg and diastolic BP > 80 mm Hg)

Recurrent intestinal or vaginal candidiasis (yeast infection)
Excessive mood swings or cognitive decline
Unexplained decline in energy levels and vitality
Symptoms in women for polycystic ovariansyndrome include excessive body hair, irregular or absent menstrual cycle (oligomenorrhoea), painful periods and acne

Blood test results associated with diabetes:
Elevated fasting triglyceride level > 2.5 mmol/L
Fasting blood glucose level > 5.5 mmol/L
Elevated serum uric acid > 0.42 mmol/L
Reduced HDL lipoprotein levels < 0.9 mmol/L

A combination of these indicates insulin resistance and the patient should visit their local doctor for formal investigation.

Nutritional medicine treatment for diabetes

A nutritional medicine specialist can control progress of the disease and prevent the development of complicating disease, through an understanding of genetic and nutritional factors that induce and maintain diabetes.

A nutritional medicine specialist can control progress of disease and prevent the development of complicating disease, through an understanding of the genetic and nutritional factors that induce and maintain diabetes.

The main treatment methods are lifestyle interventions designed to reduce excess body fat and improve body composition, through regular moderate exercise and dietary intervention.

Exercise

Exercise should combine mild aerobic and anaerobic weight resistance, approximately 3–4 times a week for 40–50 minutes. Regular exercise has been repeatedly shown to improve muscle cell insulin resistance, improve peripheral glucose dispersal, and aid in weight loss, in particular central abdominal fat deposits.

Dietary intervention

Maintain a diet that improves the nutritional quality of dietary fats, reduces insulin response, and reduces inflammation. The daily calorie intake should be reduced to 500 kilocalories or 2092 kilojoules.

Change the carbohydrate:protein:fat ratio of food eaten to approximately 60:20:20

The carbohydrates eaten should include only unrefined low-GI carbohydrates and whole fruits

Reduce saturated fat intake and increase the dietary intake of olive oil, flax seed oil, and EPA from fish.

Eliminate trans-fatty acids, also called partially hydrogenated vegetable oils on food labels, from the diet. Eating too much trans fatty acids will lead to insulin resistance, because they interferes with cell membrane fluidity. Trans fatty acids reduce delta-6-desaturase activity, which then reduces DHGLA and PGE-1 production and leads to cell membrane fluidity. More about trans fatty acids. MORE http://www.mayoclinic.com/health/trans-fat/CL00032

Maintain a high-quality protein intake but, if using animal proteins, ensure that visible fat is removed prior to consumption. Increasing vegetable proteins, such as nuts and soy, has been reported to benefit blood lipid control and reduce arterial endothelial damage

Increase fibre intake, both soluble and insoluble, and incorporate more onion, garlic, legumes as part of a lipid management program

Limit alcohol (in some instances no alcohol). Alcohol can increase free fatty acid levels and, by inhibiting peripheral glucose utilization, lead to increased insulin production.

Limit or eliminate stimulants such as coffee and cocoa, as these foods stimulate the Sympathetic Nervous System and enhance basal catecholamine activity, thereby increasing blood glucose levels and insulin production

Limit intake of sodium in salt-sensitive hypertension as this disorder is associated with reduced insulin sensitivity. Salt-sensitivity affects 20-30 percent of patients with essential hypertension and about 15% of the general population

Stop smoking

The oxidative effects from smoking cigarettes enhance vascular endothelial damage, reduce arterial compliance, damage peripheral tissue perfusion, and impair hepatic HDL lipoprotein metabolism. All of these effects contribute to worse outcomes for people with diabetes or at risk for diabetes. MORE http://www.quitnow.gov.au

Nutrient supplementation for diabetes

Nutrient supplementation for diabetes

Nutrient supplementation will ensure an adequate intake of vitamins and mineral. Anti-oxidants are of particular benefit for patients with diabetes.

Ascorbate and Vitamin E improve vascular arterial endothelial function and integrity. Vitamin E and bioflavonoids have been shown to reduce tissue oxidative damage, triglyceride and cholesterol oxidation, and Hb-glycation (HbA1c) levels in people with diabetes.

Flavonoids can reduce the adverse effects of diabetes. Hessperidin and naringin reduce sorbitol accumulation and retard the development of cataract and retinitis in people with diabetes. Hesperidin, rutin and lycopene are particularly effective in reducing vascular oxidative damage.

Vitamin B6 offers some protection against peripheral neuropathy and protein glycosylation.

Pantethine, the active form of Vitamin B5,improves energy metabolism and significantly reduces blood cholesterol and triglyceride levels, while increasing HDL cholesterol level.HDL cholesterol levels greater than 6mg/dL are high; that’s good.

Inositol Nicotinate, or ‘no-flush’ Niacin, (changed from Inositol hexaniacinate)is an effective lipid-lowering agent, which reduces deaths from cardiovascular disease and improves cardiac and peripheral circulation. It may affect blood sugar regulation, and so its use in insulin resistance and diabetes patient needs to be carefully monitored.

Lipoic acid is an antioxidant that is essential for intracellular energy metabolism. Taking lipoic acid improves insulin sensitivity, as well as autonomic and peripheral neuropathy, which commonly occurs in patients with diabetes.

Acetyl-L-carnitine(was acetyl-carnitine) is broken down in the body to transport fatty acids into the mitochondria for breakdown. Actyl-carnitine improves diabetic neuropathy by improving depleted nerve myo-inositol levels and intraneuronal energy metabolism.

Readings
Will, J.C., Ford, E.S. and Bowman, B.A., 1999, “Serum Vitamin C concentrations and diabetes: findings from the third national health and nutrition examination survey, 1988-1994”, American Journal of Clinical Nutrition, v.70, pp. 49-52

Elam, M.B., Hunninglake, D.B., Davis, K.B., Garg, R., Johnson, C., Egan, D., Kostis, J.B., Sheps, D.S. and Brinton, D.A., 2000, “Effect of Niacin on Lipid and Lipoprotein Levels and Glycemic Control in Patients with Diabetes and Peripheral Arterial Disease: The ADMIT study, JAMA, v.284, i10, p.1263 (12)

Bursell, S., Clermont, A.C., Aiello, L.P., Schlossman, D.K., Feener, E.P., Laffel, L. and King, G.L., 1999, “High Dose Vitamin E Supplementation Normalises Retinal Blood Flow and Creatinine Clearance in Patients with Type 1 Diabetes”, Diabetes Care, v.22, i.8, p.1245(11)

Mineral supplementation for diabetes

Mineral supplementation for diabetes

A variety of mineral supplements improve insulin sensitivity either directly or indirectly and include:

Chromium improves insulin sensitivity and the glycaemic response to carbohydrate foods. The effective dose ranges from 50ugm to 500ugm daily.

Magnesium insufficiency is a common finding in diabetes and insulin resistance and the American Diabetes Association now concurs that magnesium insufficiency may be causally related to insulin resistance.

Manganese is a key cofactor in enzymes of glycolytic pathways, manganese deficiency is causally associated with impaired glycoregulation and impaired insulin production.

Potassium depletion is common in diabetes and further enhances insulin resistance. Elevated blood potassium levels may occur due to impaired cellular sodium pump activity and supplementation must be monitored carefully.

Selenium is a key component of glutathione peroxidase. Selenium insufficiency is also very common in diabetes and insulin resistance and leads to inadequate glutathione recycling, with increased oxidative damage.

Vanadium mimics the action of insulin and enhances peripheral glucose dispersal, thereby reducing hyperinsulinaemia. However, supplementation must be carefully monitored. Animal studies show substantial long-term toxicity from vanadium salts.

Zinc insufficiency is common in insulin resistance and diabetes and zinc metabolism appears to be abnormal in these patients. Zinc is essential to the synthesis, storage and secretion of insulin and plays a vital role in neutralising intracellular oxidative damage.

Readings
Melander, O., Groop, L., and Hulthen, U.L., 2000, “Effect of Salt on Insulin Sensitivity Differs According to Gender and Degree of Salt Sensitivity”, Hypertension, v. 35, pp. 827-831

Stress management techniques for diabetes

Any form of stress management is useful in reducing sympathetic nervous system activity, which will stabilise internal hormonal balance and metabolic control. Prayer, communing with nature, internal relaxation methods, meditation, and support groups all reduce the effects of stress on the body. The most important of all seems to be improving the marital relationship and intimate connections with others.

Management of category 2 insulin resistance

Patients with more severe insulin resistance require more intensive exercise and greater attention to reducing carbohydrate intake and re-establishing control of lipid metabolism.

Exercise is most important at this stage of insulin resistance and should be closely integrated with dietary therapy. The easiest exercise for patients to perform is regular aerobic exercise, such as walking, though current studies suggest that regular resistance exercise may be more effective in rebuilding lean muscle mass and improving peripheral glucose dispersal.

Dietary intervention is focused on restriction of high-GI food and carbohydrates in general, while optimising lipid profile, decreasing LDL cholesterol and triglyceride levels, and increasing HDL cholesterol.

Calories from food need to be restricted and the carbohydrate:protein:fat ratio of food eaten should be adjusted to approximately 50:25:25. Total dietary fibre should be at least 20–35 gm per day. Omega-3-fatty acid rich foods should be encouraged, with at least 4-5 servings per week. Saturated fat intake should be reduced to less than 10% of total calories.

Nutrient supplements will usually be required, including:
Omega-3-fatty acids, such as EPA/DHA and alpha-linolenic acid (flaxseed oil)
Antioxidants – Vitamin C & E, Lipoic acid and N-acetyl-cysteine
Mineral supplements – chromium (50-300mcg/day), Zinc, Magnesium and Manganese

Management of category 3 insulin resistance

A patient with Syndrome X or Type 2 diabetes requires precise interventions integrated into lifestyle and medical treatment. The patients are usually on diabetic and hypertensive therapy and will often have compromised cardiovascular status.

Exercise should commence with mild aerobic walking exercise. As heart health improves and body weight improves, exercise intensity can be progressively increased, under medical supervision.Many GP divisions now run supervised cardiac rehabilitation exercise programs at little or no cost to patients.

A healthy diet is essential to managing diabetes

A healthy diet is essential to managing diabetes

A person with diabetes must modify his or her diet to achieve optimal blood sugar control.

Patients with Type 2 diabetes usually take medications that improve insulin sensitivity, such as metformin- and glitazone-type medications. Even in these patients, strict attention to restriction of dietary carbohydrate quantity and quality will improve effective control of blood glucose levels, compared with medication alone.

Daily measurement of blood glucose levels must be used to carefully monitor the impact of modifying carbohydrate intake. Carbohydrate intake needs to be adjusted upwards or downwards according to the degree of blood glucose control achieved. As blood glucose control improves, medication dosage may need to be reduced to prevent episodic hypoglycaemia.

The carbohydrate:protein:fat ratio of food eaten should be adjusted to approximately 40:30:30, with only low GI carbohydrate included. Most foods contain several kinds of fat, such as monounsaturated, polyunsaturated, saturated and trans fats. Monounsaturated and polyunsaturated fats are helpful dietary fats but saturated and trans fats are potentially harmful.

The type of fats eaten should be heavily weighted in favour of the monounsaturated oils and the polyunsaturated omega-3-fatty acids. Both mono- and polyunsaturated fats can improve cholesterol and insulin levels, and lower blood sugar levels, which can be especially helpful for a person with Type 2 diabetes. Omega-3 fatty acids found in fatty fish have been found to decrease coronary artery disease, protect against irregular heartbeats, and help lower blood pressure.

High-dose combination antioxidant therapy is advised, as these patients inevitably demonstrate severe oxidative stress due to compromised antioxidant utilisation, the cause of which remains undefined.

Beneficial effects have been reported for supplementary vitamin E and ascorbate, lipoic acid, coenzyme Q10, n-acetylcysteine, glutathione and a variety of flavinoid compounds, such as polycatechins and lycopene.

Patients with persistent or severe hypertension or cardiovascular disease may benefit from additional supplementation with L-arginine, which improves endothelial nitric oxide production, decreases lipid peroxidation and reduces systemic blood pressure.

Understanding the Glycaemic Index (GI) of foods

The glycaemic index or GI ranks carbohydrates according to how their digestion affects blood glucose levels. The lower the GI, the slower the rise in blood glucose levels. A person with diabetes should have moderate amounts of carbohydrate and include high fibre foods with a low or intermediate GI.

By eating a diet with a lower GI, a person with diabetes can reduce his or her average blood glucose levels, which will reduce long-term, diabetes-related complications.

Increase the amount of low and intermediate GI foods, and reduce the amount of high GI foods.

  • Low GI foods are foods with a GI< 55
  • Intermediate GI foods are foods with a GI between 55–70
  • High GI foods are foods with a GI> 70

Glossary

Acetyl-carnitine – an amino acid (a building block for proteins) that is naturally produced in the body. It helps the body produce energy.
Candidiasis – yeast infection
Catabolic state – tissue break down into simpler compounds
Caucasian – white people
Citric acid cycle or Krebs cycle – a series of chemical reactions used by all aerobic organisms to generate energy through the oxidation of acetate derived from carbohydrates, fats, and proteins into carbon dioxide and chemical energy in the form of adenosine triphosphate (ATP)
Diabetic ketoacidosis – a buildup of ketones in blood due to breakdown of stored fats for energy; a complication of diabetes mellitus. If left untreated, ketoacidosis can lead to coma and death.
Enteroviral infections
Flavonoids – give plants their colouring and provide anti-allergic, anti-viral, anti-fungal, antioxidant, and anti-inflammatory benefits. Sources of flavonoids include parsley, onions, blueberries and other berries, green tea, bananas, citrus fruits, Ginkgo biloba, tumeric, and paw paw,
Glycaemic index – a measure of how quickly blood glucose levels increase after eating a specific food.
Glycation – result of typically covalent bonding of a protein or lipid molecule with a sugar molecule
Glycosuria – glucose in the urine
HDL cholesterol – high-density lipoprotein or ‘good’ cholesterol because it removes low-density lipoprotein (LDL) or ‘bad’ cholesterol from where it doesn’t belong
Hypercatabolic disorder – excessive metabolic breakdown of a specific substance of body tissue in general, leading to weight loss and wasting
Hyperglycaemia – high blood glucose
Hyperinsulinaemia – elevated insulin levels
Insulin – hormone that helps glucose enter cells to give them energy
Keto acids – organic compounds that contain a carboxylic acid group and a ketone group. The alpha-keto acids are important in cellular energy production, as they are involved in the Krebs cycle and in glycolysis.
Ketoacidosis– occurs when ketone levels become dangerously high. When not enough glucose is available the body burns fat for energy, which produces ketones.
Panthanine – the active form of Vitamin B5
Polymorphism – when two or more clearly different phenotypes exist in the same population of a species
Polyuria – when to much urine is excreted

Website links – Diabetes

Diabetes website links
Diabetes Australia :http://www.diabetesaustralia.com.au
Diabetes Queensland : http://www.diabetesqld.org.au
The Department of Health : http://www.health.gov.au/internet/main/publishing.nsf/content/pq-diabetes
Health Insite :http://www.healthinsite.gov.au/lookup/diabetes
International Diabetes Foundation : http://www.idf.org/diabetesatlas/5e/what-is-diabetes
Ife! Helping you prevent diabetes, heart disease, and stroke. http://www.diabeteslife.org.au