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Diabetes mellitus (DM) refers to a syndrome where high sugar is present in the blood, which can cause abnormalities in the tissues of the body, especially the cardiovascular and nervous system. The high blood sugar can be from 2 causes: the inability of the pancreas to secrete insulin, the hormone responsible for the uptake of sugar form the blood into the cells (DM Type I) or the inability of the cells to respond to insulin (DM Type II), also termed Insulin resistance. For both conditions a similar set of symptoms exist, however the causes are completely different. DM Type I is primarily discovered in childhood, thus the term Juvenile Onset Diabetes is synonymous with DM Type I, as is Insulin Dependent DM, as insulin needs to be given as there is no other way for the cells to absorb sugar. In these individuals the lack of insulin from the pancreas is due to the pancreases cells responsible, the beta cells, being damaged by an immune mediated (autoimmune) reaction. This may be due to an environmental cause, or an early or congenital exposure to certain viruses. There is an increasing body of research suggesting that prevention of DM by the avoidance of cow's milk. Exposure to cow’s milk rather than mother’s milk in infancy in combination with a viral exposure can create an immune process where antibodies are made against the beta cell of the pancreas. DM Type I individuals need to take insulin for life. DM Type II, also known as Non-Insulin Dependent DM, in contrast, is usually diagnosed as an adult and is strongly associated with obesity and diet. In response to the obesity and a high sugar diet, the beta cells of the pancreas secrete more and more insulin, which the body responds to less and less. Not only can there be excess sugar in the blood but there is excess insulin as well. With 4% of the population medically diagnosed with Diabetes mellitus, it has become the 7th leading cause of death in the U.S. and the incidence is rising. The good news is that 90% of non-insulin dependent diabetics will be cured by achieving their optimal weight and eating a balanced diet. Complications from DM can occur, especially if the condition has been unchecked. One of the main ways for this is that the high blood sugar in the blood leads to the sugar molecules attaching to tissues and causing abnormalities. Heart disease affecting not only the heart but the blood vessels is common and can lead to coronary artery disease, skin breakdown and infections. Eye changes may be seen by a physician through an ophthalmoscope, but can develop into diabetic retinopathy. Changes in the blood vessels of the kidney can cause a decrease in kidney function. Neuropathy, a condition that cause sensory defects in the hand and feet can frequently lead to poor healing of wounds, and in some cases, amputation. Other forms of diabetes
include Gestational Diabetes, glucose intolerance that happens during
pregnancy; Secondary Diabetes, which occurs as a side effect of
medications or in a complication of another disease state, and Impaired
Glucose Tolerance, which may be a Prediabetic condition. Symptoms The quality of life of type 2 diabetic patients with chronic and severe hypoglycemia is adversely affected. Characteristic symptoms of tiredness and lethargy can become severe and lead to a decrease in work performance in adults and an increase of falls in the elderly. The most common acute complications are metabolic problems and infection. The long-term complications are macrovascular complications (hypertension, problems with cholesterol, myocardial infarction, stroke), microvascular complications (retinopathy, nephropathy, diabetic neuropathy, diarrhea, neurogenic bladder, impaired cardiovascular reflexes, sexual dysfunction), and diabetic foot disorders. Diagnosis and Pharmaceutical Interventions Diagnosis of DM is made by elevated blood glucose (sugar) after an overnight fast on at least 2 occasions. Blood glucose must not be higher than 7 mmol per liter. (126 mg/dl). An oral glucose tolerance test may also be performed, which is the serial measurements of blood glucose in response to a high sugar meal. Another laboratory
test that is useful in monitoring the progression of the condition,
and less for diagnostics is hemoglobin bA1, a cell marker that can
show how severe the glycosalation of the red bloods cells is. HbA1c
should not exceed 8.0 percent. Oral Glucose-Lowering Drugs: In the United States, five classes of oral agents are approved for the treatment of type 2 diabetes. By conventional standards, oral therapy is indicated in any patient with type 2 diabetes in whom diet and exercise fail to achieve acceptable glycemic control. Although initial responses may be good, oral hypoglycemic drugs may lose their effectiveness in a significant percentage of patients. The drug categories include sulfonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and meglitinides. Sulfonylureas, including first generation (e.g., tolbutamide) and second generation (e.g., glyburide) sulfonylureas, enhance insulin secretion from the pancreatic beta-cells. A significant side effect is hypoglycemia. Sulfonylurea therapy is also usually associated with weight gain due to hyperinsulinemia, which has been implicated as a cause of secondary drug failure. Biguanides include the drug metformin, which was originally derived from a medicinal plant, Galega officinalis. Metformin reduces plasma glucose via inhibition of hepatic glucose production and increase of muscle glucose uptake. It also reduces plasma triglyceride and LDL-cholesterol levels. Side effects include weakness, fatigue, shortness of breath, nausea, dizziness, lactic acidosis, and kidney toxicity. Alpha-glucosidase inhibitors include the drug acarbose. This drug category decreases postprandial glucose levels by interfering with carbohydrate digestion and delaying gastrointestinal absorption of glucose. The major side effects are gas, bloating, and diarrhea. Thiazolidinediones
are represented by troglitazone, rosiglitazone and pioglitazone.
These expensive oral agents work by improving insulin sensitivity
in muscle and, to a much lesser extent, in the liver. These drugs
decrease plasma triglyceride levels, but such decrease may be associated
with weight gain and an increase in LDL-cholesterol levels. Liver
toxicity is a concern requiring monthly monitoring of liver function.
Since troglitazone (Rezulinâ) is more toxic to the liver than
rosiglitazone and pioglitazone (having resulted in dozens of deaths
from liver failure), in March 2000 the FDA asked the manufacturer
of Rezulin to remove the product from the market. Lifestyle and Dietary Modifications Diabetes prevention is the best form of therapy for those at risk for DM Type II. This includes improving the diet and regular exercise aerobic exercise as well as managing weight and avoiding obesity. The general consensus on treatment and prevention of type 2 diabetes is that diet management is at the forefront of therapy options. Eating carbohydrate-containing foods, whether high in sugar or high in starch (such as bread, potatoes, processed breakfast cereals, and rice), temporarily raises blood sugar and therefore insulin levels. This blood sugar-raising effect of a food, called its “glycemic index,” depends on how rapidly its carbohydrate is absorbed. Many starchy foods have a glycemic index similar to sucrose (table sugar). People eating large amounts of foods with high glycemic indices (such as those mentioned above), have been reported to be at increased risk of type 2 diabetes. Beans, peas, fruit, and oats have low glycemic indices, despite their high carbohydrate content, due mostly to the health-promoting effects of soluble fiber. Having high quality
protein sources that may be near or equal to the amount of fat ingested
(for example, 30 % of the diet is from protein and 30% is from fats)
can provide superior glucose control when compared to a lower protein
high carbohydrate diet. A high fiber diet also improves glucose
control versus low fiber diet. Dietary reduction of saturated fat
is beneficial in reduction of insulin resistance, except at total
fat intakes > 37% of calories. Fish is a good source of dietary
fat and may slightly improve glucose control. Diets high in fat,
especially saturated fat, worsen glucose tolerance and increase
the risk of type 2 diabetes, an effect that is not simply the result
of weight gain caused by eating high-fat foods. Saturated fat is
found primarily in meat, dairy fat, and the dark meat and skins
of poultry. In contrast, glucose intolerance has been improved by
diets high in monounsaturated oils, which may be good for people
with diabetes. There is often difficulty in changing the overall
percentage of calories from fat and carbohydrates in the diets of
people with type 1 diabetes. However, modifying the quality of the
dietary fat is achievable. In adolescents with type 1 diabetes,
increasing monounsaturated fats relative to other fats in the diet
is associated with better control over blood sugar and cholesterol
levels. The easiest way to incorporate monounsaturates into the
diet is to use oils containing olive oil. However, those who are
overweight need to be aware—olive oil is high in calories. Smoking tends to
exacerbate the vascular complications of diabetes. People who smoke
who also have diabetes are at a greater risk for complications from
cardiovascular disease, kidney disease and other diabetes-linked
problems. Smokers are also more likely to develop diabetes; therefore,
it is important to quit smoking. Nutritional Factors Shown to be Beneficial Chromium Alpha-lipoic
acid Magnesium Cinnamon
(Cinnamonum verum) Niacin Biotin Antioxidants in general (vitamin E, vitamin C, flavonoids): improve many inflammatory markers associated with diabetes. Vitamin
B6 (Pyridoxine) Taurine Gymnema
(Gymnema sylvestre) Bilberry
(Vaccinium myrtillus) Ginkgo biloba Coenzyme
Q10 Zinc Vanadium Vitamin
E Fish oils Bitter melon
(Momordica charantia) Recommended NaturalMeds Products for Diabetes Magnesium
Malate 625 mg Vitamin
E Mixed tocopherols 400 IUs CoQ10
30 mg Omega
3 DHA
Alpha-
Lipoic acid 100 mg Chromium
GTF 200 mcg Vitamin
B6 50 mg Zinc
50 mg |
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