The Down and Dirty of Diabetes

With the incidence of diabetes rising in the United States, it is becoming a major health concern as diabetes causes an increase in both morbidity and mortality. The United States is currently spending more than $100 billion annually in the cost of diabetic care. Twenty to twenty five million Americans are thought to have insulin resistance, which is a precursor to the development of diabetes. The average annual healthcare cost for a single diabetic and United States is approximately $12,000 per year. Diabetes is responsible for more than 30 million doctor visits per year, making it one of the leading health concerns that we have today.

Diabetes is a disease related to oxidative stress and free radical damage within the body. This results in high levels of inflammatory chemicals, nutritional deficiencies, and lazy chemical pathways. As we continue to eat more fast food and prepackaged foods in United States, reduce our level of exercise, and utilize insecticides and pesticides as well as added hormones in our food processing, the risk of a metabolic breakdown resulting in diabetes increases. Diabetes takes on many different faces: the first is known as prediabetes. Approximately fifteen million American people have prediabetes; also called hyperglycemia, insulin resistance, or hyperinsulinemia. Pre-diabetic blood sugars range between 100 and 125mg/dL. Blood sugar must get into the cell to work efficiently in producing energy. Our pancreas manufactures insulin that drives blood sugar into our body cells. In a prediabetic state, the insulin simply cannot open the door of the cell allowing the blood sugar in. Blood sugar then hangs out in the bloodstream where it is turned into triglycerides by the liver and stored as fat in the body. New testing is now available called a Pre-DX (or diabetic risk score analysis) to assess your level of risk in developing diabetes. This analysis includes biomarkers of glucose, hemoglobin A-1 C, insulin, ferritin, inflammatory markers and hormones that allow us to determine diabetic risk. After complete analysis of these markers, patients are given a risk score which allows the physician to implement both nutrition and exercise therapy designed to prevent of the development of diabetes mellitus. Prediabetes can also lead to metabolic syndrome. Metabolic syndrome is a diagnosis related to insulin resistance, abnormal blood lipids, obesity, and hypertension. In this state, oxidative stress markers such as homocysteine are often elevated.

The second form of diabetes is called diabetes type II. This form of diabetes is rapidly rising in America. Our pediatric population rarely developed type II diabetes in years past; however, now this is a common clinical diagnosis. Prediabetic individuals often go on to type II diabetes, and this is now the most common form of diabetes in the United States today. In diabetes mellitus type II, fasting blood sugars remain at or above 126 mg/dL. As excess sugar builds up in the bloodstream, it is converted to high cholesterol and high triglycerides. The continual rise in insulin is what makes a person gain weight. In this situation weight gain is not as much related to fat intake as it is to sugar intake. Diabetes mellitus type II is about inflammatory chemicals and free radical damage which gives us low levels of protective antioxidants. This type of diabetes affects the body’s cholesterol, the hormones, and the circulation. In type II diabetes are brain misinterprets a “feel-full” hormone called leptin. Leptin tells our brain that we need to stop eating. If your brain cannot respond to this hormone properly, you will keep eating and eating giving a greater rise to blood sugars, fat storage, and weight gain.

Type I diabetes( also known as juvenile diabetes) affects approximately three million Americans and occurs more frequently in children and adolescents. In this form of diabetes, the insulin producing cells in the pancreas called the beta cells, become damaged and unable to produce insulin. This is usually related to some type of autoimmune disease affecting the pancreas. In type I diabetes, blood sugar will remain elevated unless insulin is given to the patient through injections. Lack of insulin can be life-threatening.

Diabetes type I.5, also called latent autoimmune diabetes in adults (LADA), is becoming more prevalent and is related to autoimmune diabetes in adults where there is a development of antibodies against the pancreas. This type of diabetes often takes years to develop it is often misdiagnosed unless the patient undergoes a C-peptide assay. C-peptide markers give information about endogenous insulin production from the pancreas. This is a definitive test to distinguish between type I and type II diabetes. In type II diabetes, insulin levels are often high in the level of C-peptide will be normal to high as well. Type I diabetes does not have adequate insulin and C-peptide levels are low.

One of the new kids on the block is called diabetes type III. There are studies showing that insulin is produced by the brain as well as the pancreas. This confirms the connection between impaired glucose metabolism and impaired thinking. Type III diabetes could be the underlying causative factor in some people currently diagnosed with Alzheimer’s disease. As a person becomes insulin resistant, both blood sugar and insulin rise in the bloodstream, but the insulin in the brain falls below normal levels. This causes a breakdown within the chemicals of the brain and proteins accumulate called beta amyloid protiens. These are destructive compounds to the brain and are often seen in patients with Alzheimer’s disease.

The risk factors associated with diabetes or any underlying blood sugar disease include the following:

Increasing age increases the risk of diabetes. Since both diabetes and many other degenerative diseases are based on free radical damage, growing older simply allows more free radical damage to occur. This is why intermittent detoxification protocols as well as excellent nutrition is vital in the prevention of diabetes and chronic disease.

Being overweight and having abdominal obesity also increases your rate of diabetes. Your BMI (which measures your weight in relation to your height), is closely associated with the measurement of underlying body fat. An adult with a BMI between 25 and 30 is considered to be overweight, while an adult with a BMI greater than 30 is considered to be obese. Certainly in looking at the waist/ hip ratios, there is good correlation to the development of diabetes as well. Higher weights may be acceptable in individuals who exercise and have more muscle mass. Individual such as bodybuilders should utilize other methods to determine total body fat as BMI calculations are often inaccurate.

Lack of exercise is also an important risk factor in the development of diabetes. Exercise allows the insulin to become more effective and also places our body in greater demand for energy which requires blood sugar. It has been shown that just one hour of exercise per day for one week starts to increase the beta cell function in insulin sensitivity.

Heredity is important in the development of diabetes. If you have a family member who has been diagnosed with diabetes, you are at greater risk as well. This risk can be reduced by lifestyle modification.

Sleep habits are important in diabetic risk. Sleep deprivation has been shown to impair both glucose tolerance and the effective insulin. Sleep deprivation has been linked to hypertension, depression, and cardiac disease as well.

Thyroid conditions also can cause diabetes. As your metabolism becomes sluggish with low thyroid, you cannot burn fat properly and your insulin begins to rise. Autoantibodies against the thyroid can lead to thyroid abnormalities as well. These antibodies (known as TPO antibodies), have been reported in a large percentage of people with type I diabetes.

So what can be done in the prevention and treatment of diabetes mellitus? Exercise and nutrition is foundational in both the treatment and prevention of diabetes. Reducing refined carbohydrates is important and replacing these with complex carbohydrates is often beneficial. Avoiding high fructose corn syrup is certainly important. I asked my patients to stay away from artificial sweeteners such as Aspartame, Splenda, and Saccharine, and replace with Stevia or Xylitol. Nicotine should be avoided as it increases insulin resistance. Caffeine should be limited as this also increases insulin and increases stress hormones. Supplementation that has been shown to be beneficial include chromium, lipoic acid, magnesium, vitamin D, taurine, and arginine. Chromium will help decrease the craving of carbohydrates. It is inexpensive and highly effective. Alpha lipoic acid helps in the metabolism of fat and helps protect against diabetic neuropathy. Vanadium has been shown to enhance insulin sensitivity. Vitamin D supplementation is often required and I often attempt to achieve vitamin D levels greater than 70 in my diabetic patients. Good quality multivitamin and trace metals mineral supplementation is important. Hormonal balance is also important in diabetes, and testosterone has shown to be quite effective in insulin resistance. Glucose control is critical and should be monitored and regularly when treating diabetes. Then use of insulin and/or pharmaceuticals is often necessary.

Diabetes is a metabolic condition that begins with simple metabolic alterations and leads to a full-blown disease. Understanding your risk factors, modifying your lifestyle, and becoming an active component in your metabolic health, can greatly reduce your risk of the development of this dreadful disease. Proper nutrition and exercise is the mainstay in prevention, and knowing your risk is extremely beneficial in prescribing lifestyle modification. Do you know your diabetic risk? Get tested and find out!

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