In the US, as well as a number of other places around the world, the number of people living with diabetes continues to rise at an astounding rate. Our sedentary lifestyle, coupled with the typical western diet rich in sugars, bad fats and low fiber suggest that this problem will continue to grow. Once rare in children, metabolic system, and what typically was considered adult-onset diabetes, is showing up in children under ten. There are those who speculate that the treatment costs for diabetes will eventually bankrupt our healthcare system. Treatment and outcomes have improved in the last decade and people are living longer with the disease. Unfortunately, these treatments are costly, especially as the disease progresses and complications like heart disease, kidney failure, neuropathy, and Alzheimer's disease begin to arise – all outcomes that increase significantly in the diabetic patient.
Diabetes comes in various forms, types 1, 2 and 3.
Type 1 diabetes
Type 1 diabetes Mellitus is also often called insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes. In this disease the body makes little or no insulin. The sugar in the blood cannot pass into the cell due to the lack of insulin. As a result the blood sugar rises to a high level and is dumped into the urine via the kidneys. Patients with Type 1 must take insulin shots to live. Only about 10% of diabetic patients have Type 1.
The following symptoms are typical: frequent urination, weight loss despite food intake, changes in behavior, frequent eating and drinking and fatigue. The blood sugar levels are usually quite high (above 120).
There is a "honeymoon period" that lasts from 3-6 months after diagnosis with type 1 when it may be possible to reverse or "cure" type 1. As far as FAIM is aware, these "remissions" have only been achieved through various types of complementary and alternative approaches, not drugs. Much has been debated about a pathogenic origin of diabetes type 1 and the auto-immune effect.
FAIM believes it would be interesting to research the possible link between “leaky gut syndrome” and the autoimmune response which results to see if this is related to subsequent type 1. For years the medical community claimed that “leaky gut syndrome” was an adult disease, but practitioners are seeing this syndrome in children as well.
Type 2 diabetes
'Type 2 diabetes mellitus is referred to as non-insulin dependent diabetes (NIDDM) or adult onset diabetes. In this disease, insulin is still made in the pancreas in normal to increased amounts. However, the cell receptors for the insulin on the cell wall become resistant and do not allow the insulin to do its job. Type 2 accounts for approximately 90% of all diabetes cases.
For some people, diet and weight loss are all that is needed for treatment. There are also medications that help the cell receptors accept the insulin for proper function. Epidemiology shows that the following risk factors seem relevant: over 40 years of age, overweight, family history, stress, high blood pressure, African-American heritage, and gestational diabetes.
It is harder to diagnose Type 2 diabetes because the symptoms develop over a long period of time. They include: blurred eyesight occasionally, fatigue, frequent infections, wounds that take a long time to heal, sexual dysfunction, itchy skin, tingling of the hands and feet and increased thirst and increased urination. With this type of diabetes, blood sugar levels may not always be elevated.
Insulin Resistance can be a precursor to Type 2 diabetes. It is also called Syndrome X or Metabolic Syndrome. Again, it is a case where the cell exhibits reduced sensitivity to insulin. It is a major risk factor in the development of heart disease and if left untreated it typically progresses into Type 2 diabetes. It is estimated that 20-40% of the population has Insulin Resistance. Common factors include: low levels of HDL cholesterol, overweight especially around the waist, high blood pressure, dysfunctional blood clotting, and elevated uric acid levels. The suggestions from the American Diabetes Association in the treatment Insulin Resistance included: control blood pressure, improve cholesterol levels, reduce carbohydrate intake in the diet, lose weight and exercise.
Type 3 diabetes
Type 3 diabetes relates to patients who suffer from two types simultaneously. Indeed, type 3 diabetes – also known as hybrid or double diabetes – is a new and dangerous phenomenon. The phenomenon is known as "double diabetes" or "hybrid diabetes." It is harder to diagnose and significantly more difficult to treat. Basically, people have the insulin resistance of type 2, but their pancreas is not working (or they might already have type 1) so they typically become insulin dependent.
This new disease is also sometimes referred to as "diabetes 1-1/2 ," or type 3 diabetes. What has been called double diabetes and can strike at any age. According to recent reports, physicians are seeing increasing numbers of patients with double diabetes, in which an individual has the symptoms of both type 1 and type 2 diabetes.
Testing for Diabetes Mellitus can be done with various blood tests. As mentioned above, blood sugar levels can be a valuable tool. A Glucose Tolerance Test can also be performed to identify Type 2. The patient drinks a large amount of a drink high in sugar and then blood is drawn at 1/2 hour, 1 hour and 2 hour intervals to determine the blood glucose level. HemoglobinA1C is also a good way to monitor blood sugar levels over time. Hemoglobin is a protein in the red blood cells that carries oxygen. When blood sugar is elevated, the sugar attaches to the hemoglobin and remains there for the life of the cell which is usually two to three months. This blood test indicates how often the blood sugars were elevated over that period. A third test is the Fructosamine Test. In this test the amount of sugar attached to albumin, a serum protein. This test indicated the blood sugar levels for the past two to three weeks.
Care and complications
It is important for diabetics to continually test their blood sugar and a blood glucose monitor can be used for this. The blood can be tested at breakfast, lunch, dinner and bedtime and more often in times of sickness.
Complications from diabetes can be reduced especially in patients who are teenagers through 40 when they keep their blood levels closer to normal. When this is not accomplished the patient may experience eye problems, especially if they smoke, including blurred or double vision, narrowed field of vision, floaters, pressure or pain in the eye or difficulty seeing when light levels are low. Kidney disease may result and can be diagnosed early on with a test called Microalbumin test. It is important to wear shoes that are properly fitted to avoid problems with the feet as a result of poor circulation. Heart attack and stroke are concerns so exercise and proper diet are essential. Dental problems can be seen, as well as thyroid disorders. It is important to pay close attention to your body to assess problem early on.
Diet and exercise are key
The patient with diabetes has many options available to improve their condition. One of the most important actions is to get education for diabetes care. Nutrition is key in managing diabetes. There is no perfect diet since everyone is an individual. Mostly common sense is involved to eat a diet that helps maintain healthy blood sugar levels. This can be accomplished by learning about glycemic indexes for foods and applying this to the diet and eating an appropriate number of calories to maintain a healthy weight.
A diet rich in organic fruits and vegetables, grains, moderate amount of protein and healthy fats is essential. It is helpful to eat meals and snacks at the same time daily to keep blood sugar levels consistent. Use the snacks at times between meals to avoid hypoglycemia where the sugar levels in the blood get too low. FAIM has several articles from guest writers outlining effective diets to follow for Type 2 diabetes. These articles include suggestions of herbs, supplements (including ALA and policosonol) and diets for success. See "A Constitutional and Dietary Approach to Diabetes" and Dr. Gabriel Cousens' work at the Tree of Life Rejuvenation Center.
Exercise is also key to successfully managing diabetes. It helps burn sugar, offers improved personal well being, lowers blood pressure, maintains fat levels in the blood, helps maintain blood circulation to the extremities and improves insulin sensitivity in the cell. Choose exercise programs that are enjoyable. Monitor blood sugar levels while exercising to avoid highs or lows. Have a snack during these activities and drink plenty of water. Doctors warn if the ketones are present in the urine, the patient should not exercise. As usual, before starting any exercise program the patient should check with their health care provider.
Currently it is estimated that 18 million Americans have diabetes and as mentioned above, at least 40% have metabolic syndrome, or what's considered pre-diabetes. As we become fatter, our bodies become more insulin resistant and higher levels of insulin are necessary to get the sugar out of the blood. As serious as the problem is in America, there are places where it is worse. Pacific Islanders, certain Native Americans and Hispanics have a much higher prevalence of the disease. In Nauru, west of Samoa fifty percent of all adults have diabetes and 78% of the oldest have diabetes, and this is in a people who had virtually no incidence of disease prior to World War II.
For additional information please review other articles FAIM has posted in the Diabetes section of the web site.