Teerawong (Kan) Kasiolarn, ND, LAc, MSAc, is a certified naturopathic doctor and licensed acupuncturist.
Did you know that in 2012, the U.S. reported 1.7 million new diagnoses of diabetes? The American Diabetes Association notes that approximately 29.1 million Americans – 9.3% of our population has diabetes. Of the 29.1 million, 8.1 million are undiagnosed. And, 86 million Americans aged 20 and older are pre-diabetic.
Chronic diseases and conditions – like type 2 diabetes, heart disease, and obesity – are among the most common, costly and preventable of all health problems. According to the CDC, about half of all U.S. adults – 117 million people – have one or more chronic health conditions. The statistics are alarming! So, what can we do to change?
We believe that chronic diseases are not causes; they are effects. Dr. David Katz – Founding Director of the Yale University Prevention Research Center, the Integrative Medicine Center at Griffin Hospital, and a globally recognized healthcare professional for his expertise in nutrition, weight management, and the prevention of chronic disease – says that “Nearly 80% of the mayhem results from bad use of our feet, our forks, and our fingers. If we did not smoke, ate well, and were physically active, we could eradicate up to 80% of all chronic disease in the world today.”
So, here’s the 411 on pre-diabetes & diabetes. Please take special note of the many ways you can lower your risk for developing type 2 diabetes.
Before we get into the different types of diabetes, you’ll need to understand a few key terms – “hyperglycemia” being one of them. Hyperglycemia is the scientific term for “high blood glucose,” also known as “high blood sugar”. 1 Hyperglycemia occurs mainly in people who have pre-diabetes and diabetes mellitus.“Insulin” is another key term to understand. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. As you’ll learn below, those who are diabetic are either insulin resistant or deficient. When glucose builds up in the blood instead of going into the cells, it can lead to diabetes complications, including diseases in the eyes, heart, kidneys, nerves, brain, feet, and skin. Therefore, if you have diabetes, blood glucose monitoring – or, regularly checking blood sugar levels – is essential.
- Pre-Diabetes refers to those who have blood glucose levels that are higher than normal, but are not high enough to be diagnosed as full-blown diabetes. Recent research has shown that some long-term damage to the body – especially the heart and circulatory system – may already be occurring during pre-diabetes. People with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. Many people with pre-diabetes are also diagnosed with Metabolic Syndrome, which contributes to full-blown diabetes and heart disease. Unfortunately, studies indicate that most people with pre-diabetes develop type 2 diabetes within 10 years.
- Type I or insulin-dependent diabetes mellitus (IDDM) occurs when the pancreas does not secrete enough insulin. IDDM is associated with complete destruction of the insulin manufacturing beta-cells of the pancreas; hence, these patients require lifelong insulin to regulate their blood sugar levels. About 10% of all diabetics are type I, which has also been called juvenile-onset diabetes since onset typically occurs in children and adolescents.
- Type 2 Diabetes is the most common form of diabetes – and it’s preventable! In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin (Insulin Resistance). Diabetes increases your risk for many serious health problems. For example, people with diabetes have a 2 – 4-fold increased risk of cardiovascular disease and stroke. It’s also the leading cause of kidney failure, accounting for 44% of new cases in 2008.2
Common symptoms of diabetes include:
- Frequent urination
- Unusual thirst
- Extreme hunger
- Unusual weight loss
- Extreme fatigue and Irritability
- Frequent infections
- Blurred vision
- Cuts/bruises that are slow to heal
- Tingling/numbness in the hands/feet
- Recurring skin, gum, or bladder infections
There are essentially 3 diagnostic blood tests that can determine if you have blood sugar problem:
- Hemoglobin A1C – or, the A1C test – measures how much blood sugar sticks to the red blood cell (RBC), which provides us with your average blood sugar level for the past 2-3 months.5 Hemoglobin, a protein found inside red blood cells, links up with sugars like glucose. Its job is to carry oxygen from the lungs to all of the cells in the body. When diabetes is uncontrolled, you end up with too much glucose in the bloodstream. This extra glucose enters your red blood cells and links (or, glycates) with molecules of hemoglobin. The more excess glucose in your blood, the more hemoglobin glycates. The A1C test measures the percentage of glycated hemoglobin, or HbA1c, in the blood. The optimal range of the A1C test goes from 4.5% – 5.7%. Pre-diabetes often occurs when the A1C test ranges between 5.8 – 6.4%. An A1c test of +6.4% typically indicates a diabetes diagnosis.
- Fasting Plasma Glucose (FPG) is a snapshot of the blood glucose at a specific time and day after 12 hours of fasting. Optimally, your FPG should range between 75 mg/dL – 89 mg/dL. Pre-diabetes – or, Impaired Fasting Glucose (IFG) – yields a FPG of 100-125 mg/dL. A FPG above 125 mg/dL is considered to be diabetic.
- The Oral Glucose Tolerance Test (OGTT) is often used to screen pregnant women for gestational diabetes between 24 – 28 weeks of pregnancy. The test can also be used if type 2 diabetes is suspected. If you are scheduled for a OGTT, you will be required to fast for at least 8 hours prior to the testing. For the test, you will be asked to drink a liquid containing a certain amount of glucose, usually 75 grams. The test can take up to 3 hours as your blood will be taken 3 times – before drinking the solution and two times following. Normal test results should yield the following ranges: 60-100 mg/dL (Fasting), <200 mg/dL (1 hour after), <140 mg/dL (2 hours after). A reading between 140 – 200 mg/dL typically indicates pre-diabetes or impaired glucose tolerance. A reading >200 mg/dL indicates a diabetes diagnosis.
If you’ve been recently diagnosed with type 2 diabetes, you will be asked to make some positive lifestyle changes to better manage your condition. Weight loss, a diabetic diet, and regular exercise will be essential. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, your provider may consider treatment with insulin.
Based on what is known, medications for type 2 diabetes are designed to6:
- Increase the insulin output by the pancreas (i.e. Sulfonylureas and Meglitinides),
- Decrease the amount of glucose released from the liver (i.e. Metformin),
- Increase the sensitivity (response) of cells to insulin (i.e. Thiazolidinediones),
- Decrease the absorption of carbohydrates from the intestine (i.e. Acarbose), and
- Slow the emptying of the stomach to delay the presentation of carbohydrates for digestion and absorption in the small intestine (i.e. Exenatide).
Therapeutic Lifestyle Changes (TLC) should be the first line therapy to control blood sugar. A TLC program consists of three key elements: clinical nutrition, exercise, and weight management. Even when pharmaceutical treatment is indicated for certain patients, a TLC Program should still be adopted.
- Clinical Nutrition. Type 2 diabetes is a preventable disease, even if you have a strong family history. The frequency of diabetes is highly correlated with a diet rich in highly refined carbohydrates and a very low dietary fiber content. Proper nutrition is essential for both diabetes prevention and management. To better control your blood glucose levels, you should strive to eat a balanced, whole foods diet and reduce all factors that increase your insulin levels. Your diet should also help you to achieve and maintain an optimal body weight. This will in turn help to prevent heart an vascular diseases, which are frequent complications of diabetes. A balanced, whole foods diet that will optimize insulin control in both IDDM and NIDDM should include protein, healthy fats, and non-starchy vegetables. I encourage you to speak with a registered dietitian and/or naturopathic doctor for more information and guidance.
- Exercise. Both IDDM and NIDDM patients are encouraged to participate in an exercise program. Regular exercise – combining both aerobic and weight-bearing activities – can enhance insulin sensitivity, reduce the need for supplemental insulin, improve glucose tolerance, decrease total serum cholesterol and triglycerides, increase HDL (healthy) cholesterol levels, and help with weight loss. Carrying excess weight increases your risk of developing metabolic syndrome, which increases your risk for both diabetes and heart disease. Maintaining a healthy weight and muscle mass can help the body to use glucose more efficiently, reducing risk of developing diabetes. As mentioned above, a typical therapeutic exercise program should include a combination of both aerobic exercise (i.e. brisk walking, elliptical, biking, running, etc.) for 30 minutes, 5 times weekly and weight-bearing exercise for major muscles (i.e. biceps, triceps, abdominals, quadriceps, hamstrings, etc.) 2-3 times weekly.
- Dietary Supplements. Certain dietary supplements – like chromium, zinc, magnesium, naturally mixed vitamin E, natural vitamin D3, and biotin – can also help you to achieve optimal blood sugar levels. For example, clinical studies have shown that chromium supplementation can decrease fasting blood glucose levels, improve glucose tolerance, lower insulin levels, decrease total cholesterol and triglyceride levels, and increase HDL (Healthy) cholesterol levels in diabetics. Marginal chromium deficiency is common in the United States as being physically inactive and consuming refined sugars and white flour products can deplete chromium levels. No recommended dietary intake (RDI) has been established for chromium, but a minimum of 200 micrograms each day appears to be necessary for optimal sugar regulation. Dosages used in studies range from 100 – 500 micrograms, twice daily. Zinc is an important component of insulin metabolism. Zinc has been shown to improve insulin levels and wound healing in both type 1 and type 2 diabetics. A typical dosage is 30 mg per day of zinc picolinate. Before experimenting with dietary supplements, it is important that you consult with a naturopathic doctor for a personalized supplementation program.
- American Diabetes Association. Hyperglycemia (High blood glucose). http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html Accessed on 2/11/12.
- American Diabetes Association. Diabetes Statistics. http://www.diabetes.org/diabetes-basics/diabetes-statistics/?cr=redcpcgglearnmoreaboutprediabetes&gclid=CK7fgOq5ma4CFYXd4AodexSeJg Accessed on 2/11/12.
- com. Hyperglycemia and Diabetes. http://www.medicinenet.com/hyperglycemia/article.htm Accessed on 2/11/12.
- Ferry, Robert. eMedicineHealth. High Blood Sugar (Hyperglycemia). http://www.emedicinehealth.com/high_blood_sugar_hyperglycemia/article_em.htmAccessed on 2/11/12.
- American Diabetes Association. A1C. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/ Accessed on 2/11/12.
- Mathur, R., Shiel, W., & Marks, J. MedicineNet. Diabetes Treatment. http://www.medicinenet.com/diabetes_treatment/article.htm#tocp Accessed on 2/11/12.
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