What is Diabetes Mellitus?
Diabetes mellitus is a chronic disorder of carbohydrate, fat, and protein metabolism characterized by fasting elevations of blood sugar (glucose) levels and a greatly increased risk of heart disease, stroke, kidney disease, retinopathy, and loss of nerve function. Diabetes can occur when the pancreas does not secrete enough insulin or if the cells of the body become resistant to insulin. Hence, the blood sugar cannot get into the cells, which then leads to serious complications.
Diabetes is divided into two major categories: Type 1 and Type 2. About ten percent of all diabetics are Type 1 and about 90% are Type 2. Type 1 is associated with complete destruction of the beta-cells of the pancreas, which manufacture the hormone insulin. Type 1 patients require lifelong insulin for the control of blood sugar levels. Type 1 results from injury to the insulin-producing beta-cells, coupled with some defect in tissue regeneration capacity. In Type 1, the body’s immune system begins to attack the pancreas. Antibodies for beta-cells are present in seventy-five percent of all cases of Type 1, compared to one-half percent to two percent of non-diabetics. It is probable that the antibodies to the beta-cells develop in response to cell damage due to other mechanisms (chemical, free-radical, viral, food allergy, etc.). It appears that normal individuals either do not develop as severe an antibody reaction, or are better able to repair the damage once it occurs.
Type 2 historically has had an onset after 40 years of age in overweight individuals but is today even seen in children due to the obesity epidemic present in all age groups in America as well as those exposed to high levels of POPs (persistent organic pollutants). Initially, insulin levels are typically elevated in Type 2, indicating a loss of sensitivity to insulin by the cells of the body. Obesity is a major contributing factor to this loss of insulin sensitivity. Approximately 90% of individuals categorized as having Type 2 are obese. Achieving ideal body weight in these patients is associated with restoration of normal blood glucose levels in many cases. Even if Type 2 has progressed to the point where insulin deficiency is present, weight loss nearly always results in significant improvements in blood glucose control and dramatic reductions in other health risks such as cardiovascular disease.
There are other types of diabetes such as gestational diabetes – a type of diabetes that affects about 4% of all pregnant women. About 135,000 cases of gestational diabetes occur each year in the United States. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. After pregnancy, 5% to 10% of women with gestational diabetes develop Type 2 and that number increases to 20% to 50% chance of developing diabetes in the 5 to 10 years after pregnancy.
Prediabetes and Metabolic Syndrome
Prediabetes (formerly called “impaired glucose tolerance”) is categorized by fasting glucose being 100-125 mg/dl and/or postprandial glucose of 140-199 mg/dl. It is the first step in insulin resistance and estimated to affect 57 million Americans. Many people with prediabetes will go on to develop full-blown Type 2 despite the fact that prediabetes is usually reversible and, in most cases, diabetes can be completely avoided through dietary and lifestyle changes. Factors implicated in contributing to prediabetes, insulin resistance, and the progression to Type 2 include: a diet high in refined carbohydrates, particularly high fructose corn syrup; elevated saturated fat intake; over-eating due to increased portion sizes of food; increase in inflammatory markers; lack of exercise; industrial pollution; abdominal weight gain; hormonal imbalances; inadequate sleep; and nutrient deficiencies.
Research increasingly indicates that prediabetes is accompanied by serious health risks especially an increased risk for cardiovascular disease (CVD). Prediabetics often meet the criteria of the metabolic syndrome. The metabolic syndrome (MetS) is a cluster of factors that together carry a significantly greater risk for CVD and developing Type 2 that include:
- Greater waist to hip ratio
- Two of the following:
- Triglycerides > 150 mg/dL
- HDL-C < 40 mg/dL for men, < 50 mg/dL for women
- Blood pressure ≥ 130/85 mmHg
- Fasting plasma glucose (FPG) ≥ 100 mg/dL
Other types of diabetes include:
- Secondary diabetes (a form of diabetes that is secondary to certain conditions and
- Syndromes, such as pancreatic disease, hormone disturbances, drugs, and malnutrition)
- Gestational diabetes (glucose intolerance that occurs during pregnancy)
- Impaired glucose tolerance (a condition that includes prediabetic or borderline diabetes); individuals with impaired glucose tolerance have blood glucose levels and glucose-tolerance test (GTT) results that are intermediate between normal and clearly abnormal
The following criteria are used for diagnosing diabetes:
- Fasting (overnight): serum glucose (blood sugar) concentration greater than or equal to 126 mg/dl on at least two separate occasions
- Following ingestion of 75 g of glucose: serum glucose concentration greater than or equal to 200 mg/dl at two hours post-ingestion and at least one other sample during the two-hour test
What causes Diabetes Mellitus?
Although the exact cause of Type 1 diabetes is unknown, current theory suggests an autoimmune process leads to destruction of the insulin-producing beta-cells in the pancreas. Antibodies for beta-cells are present in seventy-five percent of all cases of Type 1 diabetes, compared to one-half percent to two percent of non-diabetics. The antibodies to the beta-cells appear to develop in response to cell destruction due to other mechanisms (chemical, free-radical, viral, food allergy, etc.).
Approximately ninety percent of individuals with Type II diabetes are obese. Obesity is a major contributing factor to this loss of insulin sensitivity. In most cases, achieving ideal body weight is associated with restoration of normal blood sugar levels in these patients. In other words, achieving ideal body weight is often a “cure” for type 2 diabetes.
What dietary factors are important in Diabetes?
Diabetes, perhaps more than any other disease, is strongly associated with Western culture and diet as it is uncommon in cultures consuming a more “primitive” diet. However, as cultures switch from their native diets to the “foods of commerce,” their rate of diabetes increases, eventually reaching the same proportions seen in Western societies.
Dietary modification and treatment is fundamental to the successful treatment of both Type I and Type II diabetes. All simple, processed, and concentrated carbohydrates must be avoided. Low glycemic load foods should be stressed and saturated fats should be kept to a minimum. Since diabetics have a higher incidence of death from cardiovascular disease (60-to-70 percent, versus 20-to-25 percent in people without diabetes), the dietary recommendations given in ATHEROSCLEROSIS are equally appropriate here.
Weight loss, in particular a significant decrease in body-fat percentage, is a prime objective in treating the majority of Type 2 diabetics; it improves all aspects of diabetes and may result in cure. For recommendations to promote weight loss see OBESITY.
For both Type 1 and Type 2 diabetics, there are some specific foods that have been shown to produce positive effects on blood sugar control. These foods include olives, soybeans and other legumes, nuts, artichokes, bitter melon, garlic, Jerusalem artichokes, mangoes and onions. These foods all have a low glycemic index and glycemic load and are high in fiber.
Cinnamon may also be helpful in controlling blood sugar levels. According to research, cinnamon might be acting as an insulin substitute in type 2 diabetes. A double-blind study of 60 people with type 2 diabetes revealed a significant decrease in fasting serum glucose (18-29%), triglyceride (23-30%), LDL cholesterol (7-27%), and total cholesterol (12-26%) levels after taking cinnamon for 40 days. The effective dosage was as little as 1 gram per day of cinnamon (roughly ¼ teaspoon).
What nutritional supplements should I take for Diabetes Mellitus?
Along with Dr. Lyon and Natural Factors, I have created the WellBetx – a family of nutritional and herbal products designed to address special nutritional needs of people with diabetes. The WellBetX products are designed to be used in conjunction with proper dietary, lifestyle, and medical treatment of diabetes. WellBetX is not designed to “treat” diabetes, instead it is designed to support the proper utilization of blood glucose and insulin as well as deal with some of the nutritional challenges and deficiencies that many diabetics suffer from. The various WellBetX products are designed to impact one or all of the following goals:
- Reduce after meal elevations in blood sugar levels.
- Provide optimal nutrient status.
- Improve insulin function and sensitivity.
- Prevent nutritional and oxidative stress.
The WellBetX product line consists of the following formulas:
- PGX with Mulberry – A proprietary fiber blend with remarkable properties in supporting blood sugar control along with a special extract of mulberry leaves.
- WellBetX Meal Replacement Drink Mix with PGX – A delicious way to improve blood sugar levels and promoting satiety.
- WellBetX Complete Multi for Glucose Balance – a high potency formula that provides optimal levels of nutrients to support people with diabetes.
- Herbal Glucose Balance – A unique formula of herbal extracts with scientific support for their role in promoting human health.
- Berberine – An alkaloid from goldenseal, barberry bark, and Oregon grape root has shown impressive results in supporting blood sugar control, blood pressure, and blood lipid levels.
- RxOmega-3 Factors with Borage Oil – A pharmaceutical grade fish oil with the added benefits of GLA from borage oil.
How do I know if the recommendations are working?
If you have diabetes and utilize nutritional and herbal support, you must monitor blood sugar levels, especially if you are on insulin or have relatively uncontrolled diabetes. Typically insulin and drug dosages will have to be altered after employing natural medicines. Under no circumstances should a person suddenly stop taking insulin or oral diabetic drugs without consulting their physician.
It is important to monitor blood sugar levels because poor blood sugar control dramatically risk of developing the complications of diabetes. The availability of home glucose monitoring kits makes it easier now than in the past to monitor blood sugar levels, resulting in a major improvement in the care of diabetes. Another major improvement is the measurement of the level of glycosylated hemoglobin (HgbA1c), which allows monitoring of blood sugar levels over a long period of time. I recommend periodic measurement-every three months in poorly controlled diabetes, and every year in well-controlled cases. If a diabetic can keep their HgbA1c between 6 and 7%, the risk for developing any complication of diabetes is dramatically reduced.