Diabetes

Diabetes is a chronic health condition in which the body is either unable to produce insulin, produces too little insulin, or becomes resistant to insulin, resulting in the improper breakdown of sugar (glucose). As a result blood sugar levels rise to a dangerous level.

It is a serious condition that needs controlling and maintaining to avoid complications

Description

When a person eats sugars and starches, the body changes them rapidly into a sugar called glucose.

Glucose is the main source of body energy. Your liver produces some glucose and you get the rest through the above digestion process. It is absorbed from the intestine and is metabolized and used immediately where it is needed by all cells in the body via glucose transportation, and the rest is stored in the muscles and liver as glycogen for future requirement.
In diabetes, the mechanism that controls the amount of glucose in the blood breaks down. The blood glucose level rises to dangerously high levels as a result, causing symptoms and damage to the body.

Glucose is transported by a signal produced by insulin. After transportation insulin triggers its correct dispersion.

Insulin is a hormone (part of the endocrine system) produced by beta cells (islets of Langerhans) in the pancreas. It manages how much glucose the liver produces and helps glucose to be taken up by the cells where it is used as energy. Insulin acts as a key to unlock the cells so that blood sugar can be stored in them. High blood sugar levels can be related to not enough keys (insulin), or an inefficient lock (cell entry point), or both.

(National Library of Medicine (NLM))

Diabetes is actually a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both, resulting in either hypo- (abnormally low blood sugar) or hyperglycaemia (an elevated concentration of glucose in the blood).

The primary types of diabetes include type 1 diabetes and type 2 diabetes.

Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. It occurs most usually from childhood or teen years.

Type 2 diabetes consists of a resistance to insulin produced by the body. Obesity is a heavy contributor to its development, as is type 1 diabetes and high (imbalanced) cholesterol levels.

Insulin resistance occurs when the body fails to respond effectively to the insulin already produced by the pancreatic beta cells.

Type 2 diabetes usually affects adults following a trigger. This could be another illness or the effects of obesity, for example.

Other forms of diabetes…

Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy where a woman is not able to increase their secretion of insulin. Gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the fetus. Genetics and obesity are major contributing factors.

Gestational diabetes is usually asymptomatic and not necessarily life threatening to the mother. This condition is associated with an increase in neonatal morbidity, neonatal hypoglycaemia and jaundice.

It is characterized by excessive hunger, thirst, and the need to urinate, it is a mild condition and often goes unnoticed, but it is important to treat because elevated blood sugar levels can damage the fetus.

It has been found to respond well, and even to resolve, with a combination of diet, exercise and appropriate supplementation where necessary.

Secondary diabetes is named due to it forming as a result of other particular conditions, such as pancreatic disease, hormone disturbances, drug overuse and malnutrition.

Impaired glucose tolerance is a condition that shows blood glucose levels that are intermediate between normal and clearly abnormal.

Diabetes is often under diagnosed, being more likely to be recorded as one of the major complications of circulatory problems and heart disease (arthersclerosis, stroke, or high blood pressure), kidney disease, retinopathy (damage to the retina), blindness, nerve damage and even foot ulcers (heart attacks and strokes are more common in diabetics due to the increased risk of clogging of blood vessels). Diabetic skin lesions are also a possible long term effect.

Rather the opposite is actually true….

In all forms of diabetes, high levels of blood glucose increase the risk of the above, what are now known to be diabetes-related complications (rather than diseases in their own right).

Diabetic retinopathy is a damage to the retina of the eye that can eventually lead to blindness. It often has no early warning signs. In general however, a person is likely to notice blurred vision, which in some cases will get worse during the day.
As new blood vessels form at the back of the eye as a part of proliferative diabetic retinopathy (PDR) process they can bleed and further blur vision. In extreme cases a person may only be able to tell light from dark in that eye.

(National Library of Medicine (NLM))

These conditions are also multi-generating, i.e. it has been proven that high blood pressure and high levels of blood glucose can themselves increase the risk of a person with diabetes progressing to other severe, potentially fatal complications such as kidney failure...

People with diabetes have an increased mortality rate due to all these consequent complications.

Left untreated (or undiagnosed), or mismanaged diabetes can easily lead to any or all of these long-term damages and major organ failures.

Further Type 1 and type 2 complications

Other complications related to immunity depletion include ulcers, gastrointestinal disorders, genitourinary and sexual dysfunctions. Complications with both type I and II occur when blood sugar levels are not properly controlled. Ketoacidosis (not taking enough insulin, allowing glucose to build up in the blood), and hyperosmolar nonketogenic coma (severe dehydration) are examples.

Complications can be acute and chronic. People with diabetes can suffer both high and low blood sugar episodes. Acute conditions resulting from one or either form of diabetes include:

Hypoglycaemia (or dangerously low blood sugar)

and

Hyperglycaemia (or dangerously high blood sugar).

These are both life-threatening and need to be managed and maintained.

Statistics

Over 194 million people suffer with diabetes worldwide. This global figure is estimated to reach 333 million by 2025 if current trends continue. This includes:

Around 18.2 million diagnosed Americans;
Approximately 1.8 million diagnosed in the UK;
18.1 diagnosed in India;
10.3 million diagnosed in China; and
13 million diagnosed in other Asian and island areas

Interestingly diabetes is more prevalent amongst black and Hispanic origins than in white people of all age groups. For those 65 years and older prevalence is greater across the board.

>> Further undiagnosed people are unaware they have the condition. In some countries this figure could be as much as 80%

>> Diabetes contributes to almost 250,000 deaths a year.

>> Diabetic mismanagement causes blindness in 19% of diabetics; kidney disease in 15%; and limb amputation in 17% of diabetics.

>> 70-90% of type 2 diabetes sufferers are overweight (a normal weight balance can contribute to a cure).

>> Adult-onset diabetes is thought to be accountable for almost ½ of all male impotence.

>> Diabetes increases the risk of developing heart disease by a staggering 300%!

Causes

A lowered natural resistance (immune system damage), and Disruption of natural biological and hormonal rhythms.

The common modern medical approach that matches drugs to symptoms does not completely address many of these factors. As a result, modern medicine often cannot fully remove the disorder and the condition becomes chronic.

Genetic factors are strongly implicated to put you in a high-risk category. However, diet, obesity, nutritional, environmental and other health factors - such as viral infections and autoimmune processes against pancreatic cells (where antibodies created to fight allergies and infections turn against their own body tissues) - are the main contributors and key elements for diabetes development.

Nutrition

TYpe 2 Diabetes is first and foremost a nutritional disease. Without correct nutritional intake and supplementation the immune system is unable to maintain its proper function. Viral (and other) infections invade, leaving the body weakened, triggering diabetes and associated complications.

Type 2 diabetes, for example, is usually a result of many years of abuse on the digestive system (usually leading to obesity), including high intake of junk foods, fats and preservatives.

Food allergies and sensitivities also lower insulin and increase autoimmune damage.

Optimum vitamins and minerals are the foundation of good health, together with carbohydrates, protein and other essential nutrients. Individuals with diabetes are often lacking in a significant number of these (e.g. most diabetics have low levels of chromium….)

Diagnosis

A glucose test following an overnight ‘fast’ (and usually 2 hours after drinking a sugar solution) can measure glucose levels accurately. A level of 110 or under is normal. Levels between 110-126 mg/dL would not be full diabetes, but would indicate impaired glucose tolerance (or a borderline reading)... a resistance to glucose.

A glucose level of 126 or more would indicate diabetes.

Type 1 diabetes can be diagnosed by testing body fluids and tissues for auto-antibodies to cells, to insulin, to glutamic acid decarboxylase (GAD65) and to tyrosine phosphatases (IA-2 and IA-2B).

Your healthcare practitioner should go through all the usual medical and genetic checks to give an indication of any high risk factors, your daily routines and any symptoms you may be experiencing.

A urine test will likely be requested initially to check for sugar content, and A blood test, for increased accuracy or confirmation.

You can also do ‘home tests’ (although they may be less accurate than a doctor’s test) by purchasing chemically treated glucose testing strips or electronic measuring devices.

NB: Any diabetic treatment should be started at the soonest possible opportunity, hence the importance of early and accurate diagnosis…Studies have proven that people who have begun therapy early (within 2½ years of diabetes development in the case of Type 1) have reduced their risk of complications, e.g. retinopathy, by up to 89% (as compared to only 70% in people who had a later diagnosis and therefore began treatment later).

Signs & Symptoms

In recent years underlying symptoms of undiagnosed or mismanaged diabetes have become widely ignored in favour of being treated / suppressed as conditions in their own right (e.g. heart disease and high blood pressure are symptoms and warnings of conditions like diabetes).

Hyperglycaemia and Hypoglycaemia

These are the 2 main features associated with diabetes.

Hyperglycaemia is an excessively high level of glucose in the blood, a feature of untreated or inadequately managed diabetes.

Symptoms that indicate a state of hyperglycemia, and a requirement for further investigation into the current diabetic management regime, include:

Excessive thirst and urination, as the excess sugar in your blood increases urine production.
Blurred vision, as high blood sugar levels lead to fluid build-up in the lens.
Weight loss, as your body burns fat for energy when it can’t process glucose.
Increased and/or unexplained fatigue, as your cells have no glucose to burn.
Increased hunger, as your body senses the lack of glucose.
Tingling or numbness in hands or feet, as high blood sugar levels damage or irritate the nerves.
Sexual problems, as high blood sugar causes impotence and changes in lubrication, and
Skin infections and unhealed wounds, as high blood sugar causes the immune system to work poorly.

To illustrate the signs more graphically.

Hypoglycaemia on the other hand is the opposite of this…indicating too low a level of glucose in the blood. This occurs when a diabetic has injected too much insulin, eaten too little food, or has exercised without extra food.

Symptoms of hypoglycaemia are split into 2 categories…Adrenergic and neurological….

Adrenergic symptoms include sweating, palpitations, nervousness and hunger, and are actually helpful signs as they are the first indications that your blood sugar levels have dropped below 60mg/dL, and that you need to immediately eat or drink something to raise your blood sugar immediately.

Neurological symptoms include headaches, lack of coordination, double vision, numbness, confusion and speech problems, and indicate that your blood sugar has dropped below 40mg/dL. Such neurological symptoms are often not noticed by the patient as they are already too confused to deal with them, therefore these are potentially dangerous signs and needs to be treated with emergency.

To illustrate the signs more graphically…….

(graphics courtesy of gainesvilletoday)

Hypoglycaemia can occur even in people that try to manage their medications carefully. It can be helped by better insulin management if this is relevant, or by changes of medication if they are the cause (e.g. oral sulfonylureas, Prandin and Starlix can all cause hypoglycaemia).

Without treatment hypoglycaemia can lead to seizures, coma and, in severe cases, brain damage and potential death. Some patients are trained to give themselves glucagon injections (to raise blood glucose levels rapidly) as well as insulin injections, in case of emergency.

Conventional Treatments

Particular attention should be paid to the health of common areas affected by diabetes (i.e. your nervous system, your kidneys and your eyes). Specific nutritional and supplemental advise should include the need to strengthen these areas and prevent any further deterioration.

It is notable that insulin and oral medication may be reduced (or even eliminated in some cases of type 2 diabetes) when the condition is stabilized by weight reduction, exercise, nutritional supplements and sensible food plans.

Type 1 diabetes

Part of the treatment plan for type 1 diabetes almost always requires a daily injection of insulin. It is common to administer a combination of a short-acting insulin, such as Lispro or Aspart, together with a long-acting insulin, such as NPH, Lente, Glargine, Detemir, or Ultralente insulins.

Type 2 diabetes

As well as the possibility of insulin injections (though not as for type 1 diabetes), conventional treatment for type 2 diabetes will depend partly on how elevated your blood sugar is. If it is minimal you may be able to lower your blood sugar level without medication (e.g. by losing weight and/or exercising more). If it is high, oral medication such as Sulfonylurea or Biguanide may be advised to try to control your blood sugar level.There are numerous potential medications used in conventional diabetic treatment. There are also many serious side effects to be aware of.

Classes of diabetes drugs...

The main Classes of diabetic treatment drugs include sulfonylureas, biguarides, alpha-glucosidase inhibitors, thiazolidinediones and meglitinides... Sulfonylureas…
e.g. glimepiride (Amaryl); glipizide (Glucotrol (XL)); glyburide (DiaBeta, Glynase, Prestab, Micronase)

...acting to force your pancreas to make more insulin (it must already be producing some for this drug to work). Effective in Type 2 diabetes (not Type 1, as they do not work if the pancreas is producing NO insulin).

Studies have shown that these drugs have a tendency to lose effect with time, as pancreatic cells continue to be destroyed.

Common side effects include an upset stomach, weight gain, skin rash, itching, increased sensitivity to sunlight, changes in taste, headache and nausea/vomiting.

More serious side effects can include hypoglycemia, convulsions, unconsciousness and allergic reactions.

Biguarides…
e.g. metformin (Glucophage (XR))

…these drugs improve insulin's ability to move glucose into cells especially into the muscle cells. They also prevent the liver from releasing stored glucose. They are often prescribed for obese diabetics (i.e. people who have become resistent to insulin).

Common side effects include many gastrointestinal problems, nausea and vomiting, especially with alcohol, bloating, gas, diarrhea, possible dehydration, weakness, fatigue, dizziness, respiratory effects and a metal taste.

Biguanides are not used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients.

Alpha-glucosidase inhibitors…
e.g. acarbose (Precose); miglitol (Glyset)

...these block digestive enzymes digesting starches, resulting in a slower rise of blood sugar.

Side effects may include stomach problems, diarrhea, gas, bloating, abdominal pain, weakness and headaches. More serious side effects include yellowing of skin or eyes, dark urine, unusual abdominal pain, hypoglycemia.

These drugs are not recommended for people with inflammatory bowel disease, liver or kidney problems.

Thiazolidinediones…
e.g. pioglitazone (Actos); rosiglitazone (Avandia)

…increasing insulin sensitivity/decreasing body resistance to insulin action.

Side effects include liver problems, nausea, vomiting, stomach pain, lack of appetite, tiredness, yellowing of the skin or whites of the eyes, or dark-colored urine, weight gain, muscle pain, anemia, swollen ankles or legs, upper respiratory infections and sinusitis.

If you take birth control pills this drug may make them less effective.

News…

”Troglitazone (Rezulin), a thiazolidinedione that has been removed from the market in the United States and some European countries, has been shown to cause severe liver problems in a small number of people. At present the newer thiazolidinediones (rosiglitazone and pioglitazone) have not been shown to cause liver damage.

However, this may still be a risk.” (US Newswire)

Symptoms of liver damage include:

>> Nausea, vomiting, and abdominal pain
>> Fatigue
>> Loss of appetite
>> Jaundice, and
>> Dark urine.

Meglitinides…
e.g. repaglinide (Prandin)

…encourages the pancreas to produce more insulin after meals, i.e. more quickly than sulfonylureas.

NB: because it works fast, you must eat straight away and consume carbs-rich foods, or else blood sugar levels will fall too low.

Side effects include weight gain, body aches, constipation, diarrhea and hypoglycemia.

News…

Antidepressants May ‘Up’ Diabetes Risks

“If you are already at high risk of getting type 2 diabetes antidepressant drugs may boost that risk, according to newly reported research as part of the Diabetes Prevention Programme.

The American Diabetes Association have reported that initial investigations into particular antidepressant types (SSRIS, e.g. Prozac and Aropax) for their ability to CUT the risk of getting diabetes revealed that ANY kind of antidepressant actually BOOSTS risks of developing the disease.” (HealthDayNews, 06)

Examples of oral drugs used for blood sugar control…

Actos
(Pioglitazone)
An insulin sensitzer that is usually taken once a day to increase your sensitivity to insulin.

Side effects can include headaches, muscle aches, sore throat, nasal discharge and cold symptoms. More serious side effects can include an allergic reaction (difficulty breathing, closing of the throat, swelling of the lips, tongue, or face), hives, nausea, vomiting, abdominal pain, loss of appetite, unusual fatigue, yellowing of the skin or eyes and dark urine.

Signs of hypoglycaemia may also be experienced (i.e. headache, drowsiness, weakness, dizziness, fast heartbeat, sweating, tremors and nausea).

News…

Two Commonly Prescribed Diabetes Drugs May Cause Heart Failure and Fluid Build-up

“Two diabetes medications, taken by more than 6 million Americans, may lead to serious side effects including the onset of congestive heart failure.

Oral drugs such as Pioglitazone and Rosiglitazone can cause or exacerbate heart failure and pulmonary edema. Both medications among a class of drugs known as thiazolidinediones are used for the treatment of non-insulin dependent (type 2) diabetes mellitus.

Researchers report that from discontinuing with these medications and administering diuretics, sufferers no longer exhibited the signs and symptoms of congestive heart failure and pulmonary edema.

The Food and Drug Administration approved Rosiglitazone and Pioglitazone in 1999. The prescribing information indicates that the drugs should not be used by individuals with heart conditions, particularly in combination with insulin.” (Dallas newswire, 03; MayoClinic research excerpt, 03)
Amaryl
A sulfonylurea (increasing pancreatic insulin production) usually taken once a day.

Side effects can include an allergic reaction, chest pain, restlessness, irritability, muscle cramps, nausea, headache, confusion, seizures, skin rashes, itching, redness, irritation, easy bruising or bleeding, unusual weakness, stomach pain, low fever, loss of appetite, dark urine, clay-coloured stools and jaundice. Signs of hypoglycaemia may also be experienced.

Avandaryl
A combination of 2 medicines (rosglitazone and glimiperide) in one tablet.

Common side effects include backache, acute nasal, throat or sinus infections, the flu, fluid retention and anemia. Rare side effects can include discoloured skin, blurred vision, macular edema, chronic heart failure, inflammation of blood vessels, fluid in the lungs, hepatitis, skin redness, itching, hives, water retention, weight gain, allergy, low blood counts, sun-sensitive skin and diarrhea.

Avandia
An insulin sensitizer usually taken once or twice a day. Side effects include as for Avandaryl.

Byetta
A synthetic hormone that stimulates insulin secretion in response to blood glucose levels, usually given twice a day as an injection. Byetta is also known to slow down the exit of food from the digestive track so you feel full longer, helping to maintain weight.

Common side effects of Byetta include nausea and vomiting, diarrhea, feeling jittery, upset stomach, decreased appetite/food intake and/or body weight, and possible allergic reaction.

Glipizide
A sulfonlyurea.

Side effects include as for Byetta above, plus headache, back pain, joint pain, weight gain, increased sensitivity to sunlight, cough or fever. This medication can cause low blood sugar (hypoglycemia).

Glucophage
Bguanide (Metformin)
Encouraging the liver to stop producing too much glucose.

Common side effects include terrible stomach cramps and diarrhea on high doses, nausea, loss of appetite, increased abdominal gas and a metallic taste.

Glucovance
A fixed combination tablet.

Side effects can include nausea, stomach upset, diarrhea, or weight gain. A serious allergic reaction to this drug is unlikely but can occur.

Glucotrol XL
Stimulating the release of insulin from the pancreas. Side effects are as for Glucovance above.

Glyburide
A sulfonylurea, working on the pancreas to increase insulin production. Side effects are as for Glucovance above.

News…

Diabetes Medications May Raise Sunburn Risks
“According to studies performed for the Medicine Shoppe International, Glyburide and Glipizide, common diabetes drugs, can cause photosensitivity reactions, increasing sunburn exposure and damage by a huge percentage.

Diabetic patients on either of these drugs are being urged to read drug labels and consult with their pharmacist or doctor before going out in the sun, and to increase sunscreen to SPF 30 or more, with zinc oxide.” (Washington Post, 06)
Glyset
A glucosidase inhibitor. Side effects include diarrhea, gas, upset stomach, or stomach pain. A serious allergic reaction to this drug is unlikely but can occur.

Metaglip
A combination tablet. Side effects are as for Glucotrol above.

Prandin
A short-acting insulin secretagogue (an agent that induces secretion). Side effects are as for Glucotrol above.

Precose
A glucosidase inhibitor.

Common side effects can include gas, diarrhea and stomach cramps. More rare side effects can include yellowing of skin or eyes from liver problems, blocked bowels, hepatitis, water retention, and allergic reaction.

Starlix
A short-acting insulin secretagogue. Side effects are as for Glucotrol above.

Insulin

Although insulin is needed for people with Type 1 diabetes, many people with Type 2 diabetes also often need to take insulin, either because of a worsening of their condition, or the successful action of current medication regimes stops.

Insulin must be taken by injection as if taken orally it would be broken down by digestive enzymes before it reaches the bloodstream. New studies are proving the effectiveness of an inhaled form of insulin too. The types of insulin usually used are: short-, intermediate- and long-acting.

Short-acting (or ‘regular’) insulin (usually denoted by an ‘R’ in the title, such as Humulin R or Novolin R, is known as a human insulin, because it is made to be similar to that produced in the body. This is the type of insulin that is injected around 30 minutes prior to eating, so that it is able to act on the food after it is eaten.

There are also rapid-acting insulins, known as analogue insulins, which have a modified structure which is designed to work faster than regular insulin. These are injected immediately before eating to begin acting on the food within a few minutes (it is therefore obviously very important to eat right after injecting).

Intermediate-acting insulins contain protamine (NPH insulin, e.g. Humulin N, Novolin N), or zinc crystals, which makes the liquid cloudy and slows insulin absorption.

Long-acting insulins (known as ultralente, and shown as a ‘U’ in the name, such as Humulin U), contain larger zinc crystals, further slowing insulin in the bloodstream.

Side effects of taking insulin can include a susceptibility to hypoglycaemia if insulin is overdosed, or if it is mistimed in conjunction with exercise and diet. Allergic reactions can occur, and eventual insulin resistance is even more common.

Natural Treatments

A diet emphasizing complex carbohydrates, fiber, whole grains, legumes and vegetables may help to reduce the requirement for insulin dependence by slowing and controlling glucose release.

It is also desirable to take professional supplementation that can further support a good diet. However, any such supplement should be addressing more than just blood sugar levels. It is important that ingredients also concentrate on whole organ and body protection, to strengthen against diseases of diabetic complication and indeed to greatly reduce risks of such complications.

Apart from the well known nutrients Chromium and Biotin and their benefits to Diabetics there are many more. Some of these are listed below with additional information.

Alpha-lipoic acid

An antioxidant able to neutralize free radicals before they cause oxidative damage, repairing damaged tissue and treating peripheral nerve damage. ALA also improves glucose metabolism (to help lower blood sugar) in diabetics by increasing insulin sensitivity. It is thought to be able to improve blood flow in the tiny blood vessels that supply nerves.