Diabetes, Type 2

Diabetes can be broken down into 2 main types, Type 1, also known as insulin resistant, and Type 2, or insulin dependent. What’s the difference? In type 2 diabetes, cells in your body become less responsive to insulin thus your body is not able to use up glucose in the way that it should. In type 1 diabetes, your body doesn’t produce the insulin it needs to use up glucose thus treatment is solely insulin as your body is dependent on an outside source.

Where does this all start?

Type 2 diabetes is characterized by 2 processes, insulin resistance and decreased insulin secretion by beta-islet cells in the pancreas. It is essentially a ‘lifestyle disease’ meaning there are many risk factors that contribute to the progression of diabetes. These include but are not limited to: obesity, sedentary lifestyle, diet high in refined sugars, fats, carbohydrates and processed foods, genetics/family history, and stress.

Determining the cause of insulin resistance is like asking what came first, the chicken or the egg? For examples, certain factors such as obesity or abdominal fat trigger insulin resistance however insulin resistance and the resulting increased levels of glucose and insulin in the blood can lead to weight gain and lean muscle loss. Regardless of the starting point, goals of treatment are to regulate blood sugar levels and prevent complications.

How does insulin work and what does insulin resistance mean?

Insulin is a hormone secreted by the beta-islet cells in the pancreas. Think of insulin as a key that opens the door for glucose to enter a cell. Its primary function is to allow glucose to enter cells so it can be utilized as a source of energy. Once glucose enters the bloodstream, insulin is secreted by the pancreas and it binds to or ‘unlocks’ an insulin receptor located on the surface of the cell. Binding of insulin to its respective receptor allows GLUT4 receptors to move from inside the cell to the surface of the cell. These receptors are needed to bind to glucose to bring them in to the cell so it can be used. When this ‘key’ stops working effectively, glucose can’t go where it needs to thus remains in the blood. In response to insulin not working, the pancreas releases more insulin to try to open the lock. As a result, hyperglycemia (increased glucose levels in the blood) and hyperinsulinemia (increased insulin levels in the blood) occur.

Stress also plays a vital role in the development of diabetes. Increased serum cortisol levels stimulate a pathway called gluconeogenesis, or the production of glucose which again results in increased glucose and thus insulin levels in the blood.

How is type 2 diabetes diagnosed?

Majority of testing for diabetes involves blood tests. The main tests done are HbA1c levels, fasting plasma glucose levels, 2-hour plasma glucose levels and random plasma glucose levels. A diagnosis of diabetes can be confirmed if the following levels are reached:

• HbA1c – 6.5% or higher
• Fasting plasma glucose – 7.7 mmol/L or higher
• 2-hour plasma glucose – 11.1 mmol/L or higher
• Random plasma glucose – 11.1 mmol/L or higher

Repeat testing may be needed to confirm results.

Treatment

As mentioned previously the aim of treatment is to regulate blood sugar levels and prevent the above listed complications. The conventional approach to glycemic control involves pharmacological intervention with the most common drug being Metformin. Metformin is classified as a biguanide and works by inhibiting production of glucose by the liver resulting in lower base line and post-prandial glucose levels, or levels after meal consumption. It also improves insulin sensitivity and absorption of glucose in the intestines. There are many other groups of drugs including sulfonylureas and they stimulate insulin secretion from the pancreas.

Alternative treatments can be used independently of medication depending on severity of the patients’ diabetes or in conjunction with pharmaceuticals.

Diet & Lifestyle

Dietary intervention along with medication has proven to be very effective in managing diabetes. By incorporating whole foods, healthy fats, antioxidants and specific vegetables such as bitter melon, blood sugar levels can be maintained at a sustainable level. Specific diets such as an anti-inflammatory diet, Mediterranean diet or the DASH diet have shown to have positive outcomes on diabetes and coinciding conditions such as high blood pressure and high cholesterol.

There are several supplements and herbs that have been shown to improve insulin sensitivity, increase insulin and glucose uptake, lower fasting blood glucose, post-prandial glucose and HbA1c. Effective treatment also includes addressing systemic symptoms such as improving circulation, protecting arteries, reducing free radicals, decreasing inflammation and managing cortisol levels

Supplements

• N-acetyl cysteine
• Fish Oil
• Chromium
• Vitamin B12 + B6, Vitamin E, Vitamin D
• Magnesium
• ALA

Botanicals

• Ginkgo biloba
• Silybum marianum
• Gymnema sylvestre
• Trigonella foenum-graecum
• Aesculus hippocastanum
• Cinnamomum cassia
• Curcuma longa
• Eluthrococcus senticosus

Acupuncture has also been shown to be effective in increasing circulation and preventing neuropathies and ulcers.