Integrated Approach To Diabetes Type II

Diabetes Type II is one of the fastest growing health threats in the US today. It not only threatens adults but our children as well. To be grim for a moment, every 20 seconds someone in the US is diagnosed with Diabetes. Contrast this with the diagnosis being made every 10 minutes in the UK. Of course both of these stats are dismal but you can see who is clearly winning this dubious race. However, my focus here is not going to be on statistics (that was just to get your attention). What conce
s me more than anything else is the perception that there is a distinction between “borderline Diabetes and Diabetes Type II. Somehow there is a misconception out there that if one identifies themselves as a borderline diabetic then they are not susceptible to the complications and risk that very frequently accompanies the diagnosis and therefore the former is not a serious health threat. In my opinion, this myth is perpetuated because of the common held belief that Diabetes is solely about blood sugar levels. Therefore, if your blood sugar isn’t “that high” then you have much less to worry about.

In my opinion, Diabetes is a complex imbalance in the body that involves not only blood sugar imbalance but also Hormonal and Neurotransmitter imbalances as well. Some of the hormones involved are insulin, cortisol, glucagon and norepinephrine (a neurotransmitter responsible for alertness and focus). Let us briefly explore the role of Insulin in order to make our point. Insulin helps to modulate blood sugar (most of us are familiar with this concept). Think of Insulin as a key that fits into the lock of many doors in our cells. These cells are present in our kidneys, muscles, brain, heart etc. Insulin opens the door so glucose can enter into the cells to be transformed into energy. Excess glucose is stored in the liver for future energy demands. If the Liver reservoir gets full, then glucose is converted to fat and stored in fat cells. Large meals and meals loaded with carbohydrates stimulate excess insulin release. If our cells are constantly bathe in high levels they in turn may start tuning out and stop listening to Insulin (Insulin Resistance). Insulin resistance may then progress to the official diagnosis of Diabetes. However the complications many of us associate with Diabetes begin to happen well before fasting blood sugar levels are elevated.

Insulin resistance is now considered to be an inflammatory state and is associated with increased risk of heart disease, obesity, hypertension, Parkinson, Alzheimers, strokes and other inflammatory conditions. Insulin resistance also contributes to the building of abdominal fat. This fat has been found to produce more inflammatory substances. These create more inflammation, depress the immune system leading to increased risk of infection and further exacerbate insulin and so it goes. The point that needs to be made here is that Insulin levels can be elevated without a corresponding increase in the fasting level of glucose. Insulin resistance can be present without abnormal fasting glucose levels. The journal of Clinical Endocrinology & Metabolism in 2004 Vol.90 suggests that complications associated with diabetes are present even without the official diagnosis of Diabetes. The suggestion is that glucose tolerance test may provide additional valuable information. This is not a foreign concept. In fact we do this study everyday for pregnant women as we realize that fasting sugar levels alone may miss potential glucose intolerance. In my opinion, we now need to extend this to the general population especially since we are facing obesity, glucose intolerance epidemic.

Does this mean that you do not have to be conce
ed about the level of your blood sugar? Of course not! We are aware that high sugar levels can damage cells and impair their function. We just need to be aware of the complexity of this process and not just attribute it to abnormal blood sugar levels. We need to address and identify diabetes and insulin resistance earlier so that we can maximize treatment and response. Our treatment approach needs to focus on returning balance to the body and not simply improving blood sugar levels. Orthopedic Surgeon Dr. Nathan Hill states that he often suspects diabetes in patients when their ability to heal is impaired. “Many times this is the first inkling that the patient has that he/she may have diabetes”, states Dr. Hill. He goes on to say that the reply he receives most often is- but my blood sugar is normal. This is a good example of complications before blood sugar elevation.

We know that obesity and diabetes are on the rise so lets be proactive. Get a comprehensive evaluation that may include a glucose tolerance test. This test may take up to three hours and helps the practitioner to evaluate not just your blood sugar level but also how your body handles a carbohydrate load. This is a more telling test for Insulin Resistance than a fasting glucose or even a HbA1C. A nutritional evaluation to evaluate minerals and other nutrients that have been implicated in poor blood sugar control may also help individualize and maximize your plan. Since the common held believe that Diabetes and other chronic illnesses have a strong stress related component is now being supported in the literature, it would make sense to put together a plan that addresses these issues. This comprehensive plan would include lifestyle changes (exercise, stress management and nutritional planning and diet adjustments), supplements (many diabetics have nutritional deficiencies) and if needed (dare I say it) strategic pharmaceutical intervention. After all, as my Grandmother used to say, don’t throw the baby out with the bath water.

Finally, let me reinforce that medications and/or supplements do not compensate for lifestyle changes. A finish study has shown that lifestyle interventions reduce the risk of Diabetes by greater than fifty percent (>50%). Continuing to introduce gasoline (keeping the same lifestyle) into a fire while attempting to put it out accomplishes very little.