Diabetes, Type 2
What is type 2 diabetes?
Also called adult-onset diabetes, type 2 diabetes is a metabolic disorder resulting from the body's inability to properly use or ultimately make enough insulin, the hormone that helps regulate sugar, starches and other foods the body uses for energy. It is the most common form of diabetes, accounting for 90 to 95 percent of all cases. Type 2 diabetes is nearing epidemic proportions in the United States as a result of a greater prevalence of obesity and sedentary lifestyles. The upswing is also due to the increasing number of older people in the population.
What are the symptoms?
Many symptoms of diabetes such as excessive thirst or irritability, can seem unimportant, which is one of the reasons why the disease often goes undiagnosed. However, early detection is very important because it can reduce the odds of developing the dangerous complications of diabetes.
Common symptoms include:
- Frequent urination
- Excessive thirst
- Extreme hunger
- Unusual weight loss
- Increased fatigue
- Blurry vision
If high blood sugar levels are not brought under control via treatment type 2 diabetes (and type 1 diabetes as well) can lead to a number of serious complications:
- Eye damage: People with diabetes have a 40 percent higher than normal risk of developing glaucoma, increased pressure within the eye that can lead to vision loss. They are also 60 percent more likely than normal to develop cataracts, which cloud the lens of the eye, blocking light and blurring vision. They are also at risk of diabetic retinopathy, damage to the retina that is the leading cause of impaired vision in the United States.
- High blood pressure: This disorder occurs at twice the normal rate among diabetics.
- Heart disease: Deaths from heart disease among diabetics are two to four times the normal rate.
- Stroke: Deaths from stroke are three to five times higher than normal in people with diabetes.
- Nerve damage (neuropathy): This can affect the ability to feel heat, cold or pain from a foot injury or a blister. Others may experience persistent tingling and discomfort. In addition, the skin on the feet can dry out and crack because of damage to nerves that control production of oil and moisture in the feet. People with diabetes are also more prone than normal to calluses, foot ulcers and poor circulation in the feet (the ulcers and poor circulation can lead to the need for amputation). Between 60-70 percent of diabetics have some degree of neuropathy.
- Kidney damage: High blood sugar can overtax the kidneys, the organs that filter waste products from the blood. As a result, over time the kidneys can lose their filtering ability, causing waste products to build up in the blood. This can lead to kidney failure. Treatment is a kidney transplant or regular dialysis, the use of a machine to filter the blood. Kidney damage can be diagnosed via blood and urine tests.
- Peripheral arterial disease: Here, blood vessels in the legs are narrowed or blocked, reducing blood flow to the legs and feet. This condition increases the risk of heart attack and stroke.
What are the causes?
Unlike type 1 diabetes, type 2 is not autoimmune in origin. Instead, it stems from the body's inability to properly use or ultimately make enough insulin. The risk for developing type 2 diabetes increases with age and increased body fat percentages, and is higher than normal among African Americans, Hispanics, Native Americans, Asian Americans, Native Hawaiians and Pacific Islanders.
How is it diagnosed?
One of four different blood tests can be used to diagnose type 1 diabetes:
- Glycated hemoglobin (A1C) test. A measurement of the percentage of blood sugar attached to hemoglobin, the oxygen carrying protein in red blood cells. The higher the blood glucose, the more hemoglobin will have sugar attached. The A1C test indicates average blood sugar levels for the past three months.
- Random blood sugar test: Here, a blood sugar level of 200 mg/dL (milligrams per deciliter of blood) or higher suggests diabetes, regardless of when you last ate. If you also have any symptoms of diabetes (see above), this test can confirm that you have diabetes.
- Fasting blood sugar test. Here, blood is tested after an overnight fast. A blood sugar reading that is 126 mg/dL or higher on two separate tests indicates diabetes.
- Oral glucose tolerance test. This measuresblood sugar levels after an overnight fast. First, you have to drink a sugary liquid. Blood sugar levels are then tested periodically for the next several hours. After two hours, a blood sugar level of more than 200 mg/dL indicates diabetes.
What is the conventional treatment?
Treating diabetes relies on regular blood sugar monitoring in order to keep levels in your target range. In addition, everyone with diabetes has to learn how to respond to sudden changes in blood sugar. These can occur in response to what you,ve eaten, your physical activity, medication you may have taken, whether you,ve consumed alcohol, whether you have developed a cold or some other illness, as well as changing levels of stress in your life. In women, hormonal fluctuations throughout the menstrual cycle can affect blood sugar levels.
If you can't keep your blood sugar at desirable levels with a healthy diet and regular exercise, one or more of these drugs may be prescribed:
- Metformin: To lower glucose production in the liver.
- Glipizide, glyburide and glimepiride: To prompt the pancreas to produce and release more insulin.
- Pioglitazone: To block the action of enzymes that break down carbohydrates or sensitize body tissues to insulin.
- Insulin: Some people with type 2 diabetes need insulin injections if they are unable to manage their blood sugar levels with lifestyle changes and drug treatment.
Physicians may also recommend weight loss surgery for patients whose body mass index is greater than 35. After surgery, blood sugar levels return to normal in 55 to 95 percent of diabetics, depending on the type of procedure performed.
What therapies does Dr. Weil recommend for type 2 diabetes?
The good news about type 2 diabetes is that many cases can be put into complete remission through lifestyle changes. Even if the condition is not reversed, lifestyle changes can dramatically reduce the need for supplemental insulin or other medication. Careful blood sugar monitoring is required to track progress. Here are his recommendations:
- Lose weight if you are overweight. Excess body fat causes the body's cells to become resistant to insulin.
- Eat small, frequent meals to keep blood sugars in a healthy range. Consuming large meals can flood the bloodstream with glucose and insulin.
- Keep refined starches and sugars to a minimum: Choose foods that rank low on the glycemic index, an indicator of how quickly different carbohydrates lead to an increase in blood sugar. Low ranking carbohydrates include sweet potatoes, winter squash and beans. You should also be aware of glycemic load in assessing food choices. This is a measure of how many grams of carbohydrate a normal serving contains.
- Keep trans-fats to a minimum. Instead, consume moderate amounts of monounsaturated oils, such as extra virgin olive oil and some nut oils.
- Eat fish several times a week. Emphasize wild, cold-water fish that are high in omega-3 fatty acids, such as Alaskan salmon and sardines. Other sources of omega-3s are walnuts and freshly ground flaxseeds. Alternatively, take omega-3 supplements. Dr. Weil recommends taking two to three grams daily. Look for a supplement derived from molecularly distilled fish oils, which are free of mercury, PCBs, and other contaminants.
- Eat generous amounts of non-starchy vegetables. Examples include cucumbers, bell peppers, dark leafy greens, zucchini, eggplant, squash, asparagus, broccoli, cabbage, Brussels sprouts, beans, radishes and spinach.
- Increase your magnesium intake. Research has shown that magnesium-rich foods or magnesium supplements may be helpful for people with diabetes because it can help promote healthy insulin production. Dr. Weil recommends eating magnesium-rich foods every day. These include spinach, tofu, almonds, broccoli and lentils. Pumpkin seeds and sunflower seeds are also good sources of magnesium. If you take a magnesium supplement, magnesium glycinate is a good form, with less of a laxative effect than other forms of magnesium. Take 400 mg daily.
- Increase your activity level. Aerobic activity improves insulin sensitivity in muscle cells, which allows more glucose to enter the cells. Aim for 30 minutes a day.
- Work with a physician and a nutritionist: These health care professionals can help you develop a healthy, personalized diabetic diet.
Dr. Weil also recommends the following supplements:
- Chromium. This trace element plays a role in blood sugar regulation by working with insulin to help transport glucose into cells. Take up to 1,000 micrograms of GTF chromium daily.
- Alpha lipoic acid (ALA). An antioxidant, ALA can enhance the uptake of glucose into cells and help inhibit glycosylation (the abnormal attachment of sugar to proteins, which hinders their normal functioning). It also helps promote and maintain eye health, and perhaps prevent and treat diabetic peripheral neuropathy. Start with 100 mg per day.
- Coenzyme Q10. This powerful antioxidant may help maintain a healthy heart. Take 60-100 mg of a softgel form with your largest meal.
The following botanicals may also help. Consider using them in standardized extract form and follow the dosage directions on the packages:
- Asian bitter melon (Momordica charantia. Bitter melon, a vegetable resembling a wrinkled cucumber, may also have therapeutic value if eaten as ingredient in foods such as stews and stir-frys. It is available in Asian-food markets.)
- Ayurvedic Gurmar (Gymnema sylvestre)
- Blueberry (Vaccinium myrtillus)
- Prickly-pear cactus (Opuntia spp)
Diabetics who are taking prescribed medications for any condition should let their physicians know when they're experimenting with these remedies. As sugar metabolism improves, dosages of medications may need to be adjusted.