In the last ten years, the number of cases of diabetes in North America has gone up exponentially. We all know of somebody, among our close circle of friends or relatives, who has diabetes. So, by reading this article, you may be able to help yourself or somebody you know with controlling diabetes.
Type I diabetes (about 10% of cases) which is due to a lack of natural insulin production, will not be covered here. Type II diabetes (about 90%) is due to a lack of sensitivity of the body’s cells to insulin. This used to be called adult onset diabetes, but it is now striking people ever younger in this new diabetes epidemic we are experiencing due to society’s increasingly sedentary lifestyle, poor food choices and higher incidence of overweight and even obesity. This article is directed to this large majority of diabetic people of all ages, but some of the insights can also be utilized by type 1 diabetics aiming for better blood sugar levels.
The majority of people suffering with diabetes are classified as having type II diabetes. Here it is not a lack of insulin, but a lack of sensitivity of the insulin receptors to handling the insulin that is produced, often in large quantities. The pancreas has to work harder to double or triple the insulin to try to make connecting with the receptors successful. But there comes a certain point where the body cannot work overtime continuously and the body gives up and the sugar in the blood stream remains high.
Harmful effects of high blood sugar
High sugar in the blood, if it is not absorbed and processed or stored, in cells,will become poisonous to the tissues in which it comes into contact. Cells will become denatured, deformed or stuck together (cross-linked) from being bathed in sweet sticky blood. This is especially true with the inside lining of the artery wall and therefore “rusting” starts. Most of the complications for controlling diabetes are blood glucose level related. The blocked blood vessels give rise to all types of symptoms and organ deterioration; because reduced blood flow fails to deliver sufficient nutrients and oxygen.
Another mechanism of injury by diabetes is the high level of insulin. Insulin is both a friend and an enemy. It is a friend in that it helps put the glucose away to drop blood sugar to a normal level. However, excessive insulin has several disadvantages when it comes to controlling diabetes. It acts as an appetite stimulant, causing many diabetics and normal people to overeat. Most type II diabetics who have high floating insulin in the body, stimulated by medications, tend to overeat and become overweight. When the glucose in the blood can’t get into muscle cells because they are already full as there has been insufficient exercise to use up what’s there already, the glucose has no where else to go but into fat cells.
The second problem is that the insulin production stimulated by medication sometimes overshoots, and low blood sugar symptoms develop such as dizziness, low energy, sleepiness, and sweatiness. Often it takes more eating to relieving these symptoms. It comes as no surprise that type II diabetics often become overweight.
The high insulin level actually damages the artery walls, as does a high homocysteine level. They cause hypertrophy of the lining around the artery wall. This stimulates liver production of cholesterol to create patching material. The hypertrophy of the artery wall will result in the progressive blockage of the artery from plaque buildup. This reduced blood circulation results in practically all of the complications of diabetes affecting the limbs (cold extremities), eyes (retinopathy) and brain (stroke), giving rise to everything from ulceration of the legs which can lead to amputation, retinopathy which can lead to blindness, nerve damage which can be excruciatingly painful, to strokes, heart attacks, and even death
Medications for Diabetes
Glyburide is an insulin stimulant, and will enable the pancreas to kick out more insulin. Most doctors like Glyburide because it is fairly easy to get good compliance from the patient and their average blood sugar levels come down. Type II diabetics already have high outputs of insulin into the system and kicking more insulin out of the pancreas will cause more hunger. The problem becomes self defeating, as they experience more hunger, they eat more food, and they will have higher sugar, and then the doctor will end up prescribing heavier doses of this group of medications.
There is a limit to how much the pancreas can put out. When diabetics get caught up in this vicious cycle, many doctors will end up prescribing insulin to deal with the problem. But the patient will continue on this vicious cycle even more. If any of your friends have type II diabetes and have been on insulin, I would ask them whether they have gained weight since they started on insulin.
Hypoglycemia (low blood sugar) is the most dangerous aspect of diabetes – people can die from it. Any diabetic who is on insulin must be very careful.
Another major medication that doctors prescribe is called metformin (generic)/Glucophage (brand name). It helps controlling diabetes by the mechanism of preventing sugar from being released from where it is stored in the liver. Metformin also has some benefits, such as lessening the insulin resistance of the cells. Although this is a reasonably good medication, doctors are less inclined to prescribe it because it must be taken at least three times a day. This makes compliance difficult, especially with newly diagnosed patients where notable symptoms have not shown up yet. If the patient feels well, then they don’t see their diabetes as that much of a problem. The main common side effect of metformin is diarrhea and nausea.
The newest medications for controlling diabetes are Actos, and Avandia. Avandia makes the cells more sensitive to insulin. Although this is along the right principle, it unfortunately is very expensive and the average cost is more than $200 per month. It is not covered by the Ontario government senior’s drug plan. There are also some concerns that Avandia they may contribute to heart failure problems.
Measurement of blood sugar
Diabetic patients are encouraged to test their blood sugar level first thing in the morning on an empty stomach. It has the advantage of giving a common standard to compare the progress of a particular patient, but the downside is that it misses a lot of people who are borderline diabetic, and also it gives the “best” scenario of blood sugar when they have not eaten for 12 hours. This gives them a false sense of security. I remind my patients that they should test their blood sugar two hours after eating. This will give a lot of feedback about the effect of each type of food on blood sugar levels, and it will also remind the patient about how fully controlled they are.
Doctors use a special blood sugar test that can measure how good your long-term blood sugar control has been. In other words, they do have a way to check how much you have been cheating. If the blood sugar is frequently high for extended periods then molecules of sticky glucose will permanently adhere to red blood cells until they die off and are replaced with new fresh red blood cells. Blood cells live about 120 days if they are not destroyed earlier. This is an ongoing process, so the glycosylated hemoglobinblood test (HbA1C =hemoglobin A1c ) measures the percentage of your red blood cells that have glucose attached to them. The higher the test, the poorer your true blood sugar control.
Activity level or exercise makes a big difference
The insulin receptors are indeed floating molecules (glucose transporters). When the short term storage of glucose (called glycogen) in the muscle cells, that is there to fuel short bursts of activity, is depleted by exercise, the glucose transporters go toward the cell surface and become receptors to which insulin, helped by chromium, attaches to usher the glucose from the blood stream into the cell to replace the glycogen stores.
But when a person is inactive, these floating molecules will have receded to the inside of the cell. So the diabetic patient will notice that on the days that they have any activity, their blood sugar will be much lower. Unfortunately, low blood sugars stimulate hunger and cause eating behavior because feeling shaky and dizzy is not comfortable. Eating sweet food does reverse this but usually far too much. The vicious circle again. Since it is hard to adjust doses of medication up and down, it is best to plan for consistent levels of exercise. If the diabetic patient is adept at figuring out how to reduce insulin doses on days where unusual exercise is planned, then the added eating can be avoided and weight loss can be achieved.
For those people who find it difficult to motivate themselves to go to the gym to exercise, they will find that activity such as cleaning the house, going to the supermarket, will still produce much better blood sugar control than being a couch potato. Even walking 20-30 minutes twice a day will increase sensitivity to insulin and allow the medication doses to be reduced.
Diet is key to controlling diabetes
Everybody knows that they should avoid sugar, but there are still common food groups that people should pay attention to such as fruit. They already have a high amount of sugar in them, and so do fruit juice. One patient said, “I only use unsweetened fruit juice, ” but the word “unsweetened ” only means that they don’t add extra sugar. A diabetic person who feels virtuous consuming “unsweetened” food should be aware that it is close to misleading advertising because there is plenty of natural sugar in the product that will significantly raise blood sugar, so it is not a food to eat freely.
Diabetics are often misled into believing that they should eat foods rich in carbohydrates. However the carbohydrates metabolize into sugar once it is digested. They should actually cut down or avoid foods such as potatoes, all grains such as rice, cereal, etc. and everything that can be made into flour such as corn and wheat. Starch, although it may not be sweet to the taste, will become 100% sugar once it is digested. On the other hand, foods low in carbohydrates can improve the situation. You can double the intake of leafy vegetables, meat, cheese, egg, and fish without causing problems. In fact, there is no limit on the quantity of leafy vegetables. There is no evidence that dietary cholesterol in these foods contribute to blood cholesterol. Most people will find that their blood cholesterol will go down.
I have my diabetic patients make a diet diary, in which they log the correlation between the foods that they eat, and the blood glucose level two hours after eating. The results undeniably show them what these foods do to their blood sugar control.
Using EDTA Chelation seems to improve the condition of diabetes in my patients. One possible reason is that heavy metals may interfere with insulin binding to the insulin receptors because heavy metals have bound there instead. It’s like cleaning dirty spark plugs in a car to get better performance. Chelation therapy also has beneficial effects on the circulation system of diabetics.
There are many natural food supplements that can improve sugar control such as chromium, alpha lipoid acid, and an Indian herb called Gymnema Sylvestre. Most receptors require co-enzymes and chromium is the mineral that helps insulin do it’s job and most people are not getting enough of it in food and they fail to take it as a supplement until properly instructed.
In my office, I combine several of these approaches, together with a Chinese herb program. I went on a sabbatical to China to research controlling diabetes, and now I employ a very effective combination of Chinese herbs. This program along with Chelation is so successful, that the majority of my type II diabetic patients are able to both control their diabetes, and manage to get off of their medications.
Overall, conventional treatments for controlling diabetes have been far from adequate. By paying attention to all of the above, a diabetic person will discover their diabetes improves and they may be able to lose stubborn weight.
* Dr. Shiela Torabi provides top internal medicine care to the following communities: Seven Oaks, Grapevine, Visalia, Tulare, Shafted, Dela, Alame, Lamo, Edison.
* For up to a 1.5 hour visit, Dr. Sheila Torabi charges $525 per visit and she accepts Medicare and some private insurances. Please bring your previous labs to your appointment.