Diabetes

Diabetes Overview:

Diabetes is a metabolic condition where insulin is either not produced in large enough quantities (type I), or the body has become insensitive to its effects (type II). This then leads to an impaired use of carbohydrates and an altered metabolism of both fats and proteins.

Diabetes is currently a major global threat to health and productivitym and is thought to become the number one burden of disease in America, Canada, and Australia within the next 5 years.

 

Aetiology:

+ Primary Diabetes

Primary diabetes includes both type I and type II diabetes, as well as prediabetes, KADA, MODY, gestational diabetes, PCOS, and metabolic syndrome.

+ Secondary Diabetes

Secondary diabetes is the result of pancreatic disease, such as cystic fibrosis or pancreatitis. Long term drug therapy (corticosteroids) or conditions involving an oversecretion of hormones that antagonise insulin secretion (such as acromegaly or cushings disease).

 

Blood Sugar Hormones

Hormone Produced By Action On Blood Sugar Action On Glycogen Action On Fat Actions On Amino Acids
Insulin Beta cells of the islets of Langerhans Decreases Increases Increases Increases
Glycogen Alpha cells of the islets of Langerhans Increases Decreases Decreases Decreases

+ Type I Diabetes

Type I diabetes is commonly referred to as juvelile onset diabetes because it generally shows up in the early stages of someones life. Another common term is IDDM or insulin dependant diabetes mellitus. This is because the problem is the result of a lack of insulin secretion by the pancreas leaving the person dependant on insulin injections to metabolise carbohydrates and maintain sugar levels.

Type I diabetes can be caused by a number of factors, including environmental, viral infection, and autoimmune disease. Whatever the cause, when damage occurrs to the beta cells of the pancrease, insulin demands are not met resulting in a hyperglycemia.

This condition accounts for about 10% of diabetes cases and can be fatal. Type I diabetes can lead to a significantly increased rsk of cardiovascular disease and autoimmunity.

Type I diabetes patients tend to experience microvascular complications such as diabetic nephropathy or diabetic retinopathy.

+ Type II Diabetes

Type II diabetes is commonly referred to as adult onset diabetes or non-insulin dependant diabetes mellitus (NIDDM). It's the result of lifestyle factors that lead to hyperglyemia, followed by hyperinsulinemia, and eventually insulin resistance.

This progressive disorder can be effectively managed with diet and lifestyle factors, but if not addressed will gradually begin to require medications and insulin therapy once pancreatic function begins to fail.

There are a number of serious complications that come along with type II diabetes, which generally affects the macrovascular system. This can include stroke, coronary artery disease, and peripheral artery disease.

+ LADA

(Latent Autoimmune Diabetes in Adults)

LADA is diagnosed by the presence of beta cell autoimmunity markers similar to type I diabetics. These people tend to be insulin deficient rather than insulin resistant. It may account for up to 10% of patients currently considered to have type II diabetes.

+ MODY

MODY does not have autoimmune features like LADA, but does have a strong epigenetic links such as obesity or gestational diabetes.

It is virtually identical to Type II adult onset diabetes.

+ Gestational Diabetes

Gestational diabetes is generally diagnosed in the third trimester, and is fairly common.

It's caused as a result of normal increases in maternal insulin receptor resistance during pregnancy. The increased resistance helps to prioritise the foetus over maternal tissue. Dysfunctions in this can cause excessive insulin resistance, leading to hyperglycemia.

This generally improves after pregnancy has finished, but can be an indication of increased chances of developing diabetes later in life. It can also speed the growth of the foetus, causing the baby to be abnormally large.

Glucose Metabolism:

blood glucose homeostasis.png
 

Symptoms For Type I Diabetes:

Hyperglycemia

Polyuria

Polydipsia

Unexplained weight loss

Fatigue

Neuropathy

Nocturnal Enuresis

Kussmaul Breathing

Chest Pain

Lethargy

Abdominal Pain

Vomiting

Coma

Blurred Vision

 

Symptoms For Type II Diabetes:

Hyperglycemia

Thirst

Polyuria

Blurred vision

Fatigue

Neuropathy

Frequent Infections

PCOS

 

Diagnostic Considerations:

 

Blood Testing:

HbA1c 6.5% or higher. 

Fasting blood glucose over 7.0 mmol/L

Prediabetic state considered at 5.5 - 6.9 mmol/L

2-hour plasma glucose over 11.1 mmol/L during an oral glucose tolerance test (with aglucose load of at least 75g dissolved in water). 

Random glucose over 11.1 mmol/L with symptoms of hyperglycemia. 

If both insulin and cortisol are high, consider Cushing's syndrome. 

Blood Glucose Scores

Normal Impaired Glucose Tolerance (Prediabetes) Diabetes
Fasting BGL 3.0 - 5.5 mmol/L 5.6 - 6.9 mmol/L Over 7 mmol/L
Random BGL 3 - 6.1 mmol/L 6.2 - 11 mmol/L Over 11.1 mmol/L
OGTT 140 mg/dL 140 - 200 mg/dL Over 200 mg/dL on more than 1 occasion
HbA1c ... ... Over 6.5%
 

Diabetes Diagnosis

Type I Diabetes Type II Diabetes
Acute (Severe) Diabetic Keto-Acidosis (DKA) Hyperosmolar Non-Ketotic Acidosis (HHNS)
Subacute (Mild-Moderate) Fatigue, thirst, increased urination, weight loss. Fatigue, increased urination. More vague and tends to lack weight loss.
Asymptomatic ** Routine Screening ** Routine Screening
 

Diagnosis of Insulin Resistance

According to the American Association of Clinical Endocrinologists

BMI 25 or higher
Triglycerides 150 mg/dL or higher
HDL-C Men = 40 mg/dL or less
Women = 50 mg/dL or less
Blood Pressure 130/85 mm Hg or higher
Glucose Level 140 mg/dL 2 hours after administration of 75 mg glucose
 

Therapeutic Aims:

1. Lower Blood Sugar Levels

  • Hypoglycemics (Gymnema sylvestre, Galega officinalis, Trigonella foenum-graecum, Panax ginseng)

2. Regulate Insulin Production

  • Bitters (Momordica charantia, Berberis spp., Iris versicolor, Cynara scolymus)

3. Improve Glycaemic Control And Carbohydrate Metabolism

  • Blood Glucose Regulators (Panax ginseng)

4. Improve Energy levels

  • Nervine Stimulants ()
  • CNS Stimulants (Paullinia cupana)

5. Treat Cardiovascular System As Indicated

  • Cardiotonics (Crataegus oxycanthus)
  • Peripheral Vascular Tonics (Vitis vinifera, Vaccinum myrtillus, Gingko biloba, Aesculus hippocastanum)
  • Hypocholesterolemics (Cynara scolymus, Silybum marianum)
  • Aldose Reductase Inhibitors (Flavonoid rich herbs)

6. Lifestyle And Dietary Changes

  • Carbohydrate restrictions
  • Higher Protein and fat intake
 

Differential Diagnosis:

  • Metabolic syndrome
  • Diabetic ketoacidosis
 

Complications Of Diabetes:

  1. Heart attacks and strokes up to 4 times more likely
  2. Blindness as a result of retinopathy. Diabetes is the leading cause of preventable blindness in adults. 
  3. Kidney failure. Three times more common. 
  4. Amputations. 15 times more likely. 
  5. Depression and anxiety. Present in over 30% of those with diabetes. 
  6. Nerve damage
  7. Diabetic Ketoacidosis
 

Cautions:

Type I Diabetes:

  1. Diabetic ketoacidosis is a medical emergency requiring immediate hospitalisation.
  2. Hypoglycemia can occurr suddenly and if it is not managed effectively can lead to coma and death.
  3. Hyperosmolar, Hyperglycemic, Non-ketogenic Syndrome (HHONKS) is another medical emergency associated with type I diabetes.
  4. A diabetic woman who falls pregnant is at a greater risk of lising the baby.


Type II Diabetes

  1. Symptoms only start to appear after the condition has escalated to more advanced stages.
  2. Hypoglycemia can occurr in type II diabetic patients suddenly. If this condition is not managed effectively, coma and death can result. This condition is most common in those with insulin injections (type I or type II diabetics).
  3. A diabetic woman who falls pregnant is at a greater risk of lising the baby.
 

Herbs For Diabetes

  • Galega officinalis
  • Gymnema sylvestre
  • trigonella foenum-graecum
  • Cinnamomum spp. 
  • Berberis spp. 
  • Momordica charantia
  • Glycyrrhiza glabra
  • scutellaria baicalensis
  • Codonopsis pilosula
  • Eleutherococcus senticosus
  • Coleus forskolii
  • Fenugreek
  • Silybum marianum
  • Gingko biloba
  • Nigella
 

Type II Diabetes Formula

Herb Name Ratio Amount in mL
Glycyrrhiza glabra 1:1 15 mL
Scutellaria baicalensis 1:2 30 mL
Galega officinalis 1:2 40 mL
Panax ginseng 1:2 20 mL
Total 105 mL
 

Dietary Considerations:

  • Chromium
  • Zinc
  • N-Acetyl-Cystein
  • Magnesium
  • Vitamin B's
  • CoQ10
  • Omega 3
  • Vitamin C
  • Vitamin D
  • Vitamin E
  • Avoid caffeine and stimulants
  • Low GI diet
  • Increase fat and protein intake

Author:

Justin Cooke

The Sunlight Experiment

Updated: June 2018


Recent Blog Posts:

References:

  1. ...