Diabetes Mellitus

The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic factors passed on in families), and environmental factors involved. Research has shown that some people who develop diabetes have common genetic markers.

Type I Diabetes

In Type 1 diabetes, the immune system, the body's defense system against infection, is believed to be triggered by a virus or another microorganism that makes it destroy the cells in the pancreas that produce insulin.

Type 2 Diabetes

In Type 2 diabetes, age, obesity, and family history of diabetes play a role.

In Type 2 diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin produced and it may not work as effectively. Symptoms of Type 2 diabetes can begin so gradually that a person may not know that they have it. Early signs are tiredness, extreme thirst, and frequent urination. Other symptoms may include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not unusual for Type 2 diabetes to be detected while a patient is seeing a doctor about another health concern that is actually being caused by the yet undiagnosed diabetes.

Individuals who are at high risk of developing Type 2 diabetes mellitus include people who:

• Are obese (more than 20% above their ideal body weight)
• Have a relative with diabetes mellitus
• Belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian)
• Have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs (4 kg)
• Have high blood pressure (140/90 mmHg or above)
• Have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride level greater than or equal to 250 mg/dL
• Have had impaired glucose tolerance or impaired fasting glucose on previous testing.

Medications Impairment

Several common medications can impair the body's use of insulin, causing a condition known as secondary diabetes. These medications include treatments for high blood pressure (furosemide, clonidine, and thiazide diuretics), drugs with hormonal activity (oral contraceptives, thyroid hormone, progestins, and glucocorticorids), and the anti-inflammation drug indomethacin. Several drugs that are used to treat mood disorders (such as anxiety and depression) can also impair glucose absorption. These drugs include haloperidol, lithium carbonate, phenothiazines, tricyclic antidepressants, and adrenergic agonists. Other medications that can cause diabetes symptoms include isoniazid, nicotinic acid, cimetidine, and heparin.

Type 1 diabetes is usually treated with a combination of diet and insulin.

For type 2 diabetes, proper diet and medication, often taken orally, is prescribed.

Lifestyle Changes

• Weight loss: Many people with type 2 diabetes are overweight. Being overweight increases the need for insulin and can even make healthy people pre-diabetic (weight loss reverses this problem). Excess abdominal weight makes the body less sensitive to insulin.
• Exercise: Exercise helps decrease body fat and improves insulin sensitivity. People who exercise regularly are less likely to develop type 2 diabetes than are sedentary people, and exercisers with type 1 require less insulin. However, exercise can induce low blood sugar or even occasionally increase blood sugar. Therefore, diabetics should never begin an exercise program without consulting a healthcare professional.
• Alcohol: Moderate drinking by healthy people improves glucose tolerance. However, alcohol has been reported to worsen glucose tolerance in the elderly and in diabetics. People with diabetes should limit alcohol intake to two drinks per day.
• Quit smoking: Diabetics who smoke are at higher risk for diabetes-linked problems. Smokers are more likely to become diabetic than are non-smokers.
• Self-Monitoring issues - self monitoring of glucose

Dietary changes that may be helpful

• Carbohydrates: Eating carbohydrate-containing foods, whether high in sugar or high in starch (such as bread, potatoes, processed breakfast cereals, and rice), temporarily raises blood sugar and insulin levels. The blood sugar-raising effect of a food, called its "glycemic index," depends on how rapidly its carbohydrate is absorbed. People eating large amounts of foods with high glycemic indices, have been reported to be at increased risk of type 2 diabetes.
  
  However, diets high in total carbohydrates do not necessarily increase the risk of type 2 diabetes and some studies have found no independent relationship between sugar intake and the development of glucose intolerance.
  
  Most doctors recommend that diabetics reduce their intake of sugar from snacks and processed foods, and replace these foods with high-fiber, whole foods. more details ...
• Fiber High-fiber supplements, such as psyllium, guar gum (found in beans), pectin (from fruit), oat bran, and glucomannan (from Amorphophallus konjac), have improved glucose tolerance in some studies. Good results have also been reported with 1-3 ounces of powdered fenugreek seeds per day. Although the research is inconclusive, most doctors advise people with diabetes to eat a diet high in fiber. Focus should be on fruits, vegetables, seeds, oats, and whole-grain products.

  Note: Diabetics with unrecognized kidney failure could develop serious complications from a high-fiber (and therefore high-potassium) diet.

• Fish: Eating fish may provide some protection from diabetes.
• Vegetarian diet: Vegetarians are reported to have a low risk of type 2 diabetes. People with diabetic nerve damage who switch to a vegan diet (no meat, dairy, or eggs) have reported improvement after several days. Fats from meat and dairy may also promote heart disease, the leading killer of people with diabetes.
• Protein: Switching to a high- or low-protein diet should be discussed with a doctor.
• Fat: Diets high in fat, especially saturated fat, worsen glucose tolerance and increase the risk of type 2 diabetes. Saturated fat is found primarily in meat, dairy fat, poultry skins, and dark meat. In contrast, glucose intolerance has been improved by diets high in monounsaturated fats, such as those containing olive oil. However, people who are overweight need to be careful - olive oil is high in calories.
• Children & milk Most studies indicate that children with type 1 diabetes drink cow's milk at an earlier age than do other children. Some children who drink cow's milk produce antibodies to the milk; it has been hypothesized that these antibodies can cross-react with and damage the insulin-producing cells of the pancreas. more detail.
• Onion: Preliminary trials and at least one double-blind trial have shown that large amounts of onion can lower blood sugar levels in people with diabetes.

Key nutritional supplements

• Alpha lipoic acid (600 mg, one to three times per day): This powerful natural antioxidant has been shown to improve diabetic neuropathy and to improve insulin sensitivity.
• Brewer's yeast (9 grams per day): Medical reports indicate that chromium-rich brewer's yeast can be useful in treating diabetes.
• Chromium (200-1,000 mcg per day): Chromium has been shown to improve glucose tolerance in people with both type 2 and type 1 diabetes, apparently by increasing sensitivity to insulin.
• Evening primrose oil (EPO) (4 grams per day for six months): EPO has been found in double-blind research to improve nerve function and relieve pain symptoms of diabetic neuropathy.
• Glucomannan: For controlling the elevation of blood sugar, 500-700 mg of glucomannan per 100 calories in the diet has been used successfully in controlled research.
• Magnesium (300-1,000 mg per day): Diabetes patients tend to have low magnesium levels. Double-blind research indicates that supplementing with magnesium overcomes this problem. Magnesium supplementation may also help improve insulin production in elderly people with type 2 diabetes.

Other nutritional supplements

• Biotin: 9 mg per day for two months or 16 mg per day for three weeks.
• Coenzyme Q10 (CoQ10): 50-120 mg per day.
• L-carnitine: 0.5 mg per 2.2 pounds (1 kilogram) of body weight per day.
• Vitamin B1 (thiamine): 10-25 mg per day.
• Vitamin B6 for gestational diabetes only
• Vitamin C: 1-3 grams per day.
• Vitamin E: 900 IU of vitamin E per day.
• Zinc for deficiency
• See discussion of research on other nutrients

Key herbs

• Cayenne (Capsicum frutescens) (topical cream containing capsaicin for neuropathy): May be applied four times per day for severe pain. Use under a doctor's supervision.
• Fenugreek (Trigonella foenum-graecum): Powdered fenugreek seeds (1-3 ounces of powdered seeds per day) may improve glucose tolerance.
• Psyllium (Plantago ovata): Supplementing with psyllium (5 grams per day for 8 weeks) has been shown to be a safe and well-tolerated way to improve control of blood glucose and cholesterol.

Other herbs that may be helpful

• Aloe (Aloe vera): 1 tablespoon (15 grams) of aloe juice twice daily.
• American ginseng (Panax quinquefolius): 3 grams of American ginseng was found to lower the rise in blood sugar when given up to 40 minutes before the consumption of a drink high in glucose by persons with type 2 diabetes.
• Asian ginseng (Panax ginseng): 200 mg of ginseng extract per day.
• Bilberry (Vaccinium myrtillus) leaf (for control of blood sugar) or berry (for capillary fragility): An herbal extract of the berry in capsules or tablets standardized to provide 25% anthocyanosides can be taken in the amount of 240-600 mg per day.
• Bitter melon (Momordica charantia): One small melon can be eaten, or up to 100 ml of a decoction or 2 ounces of fresh juice can be drunk per day. Tinctures of bitter melon (5 ml two to three times per day) can also be used.
• Gymnema (Gymnema sylvestre): 400 mg per day.
• Hairy Basil (seed) and Holy Basil (leaf): Preliminary trials of holy basil (Ocimim sanctum) leaves and hairy basil (Ocimum canum) seeds have shown that these herbs may help people with type 2 diabetes control their blood sugar levels.
• See discussion of other herbs

Acupuncture

Acupuncture may be helpful in the treatment of diabetes, or complications associated with diabetes. Preliminary trials have suggested that acupuncture can lower blood sugar275 276 277 and improve insulin production278 in people with type 2 diabetes, but trials on long-term effects have not been concluded. In a preliminary trial, 77% of people suffering from diabetic neuropathy experienced significant reduction in pain following up to six acupuncture treatments over a ten-week period. Many were also able to reduce pain medications, but no long-term change in blood-sugar control was observed.279 Bladder control problems, a complication of long-term diabetes, responded to acupuncture treatment with a significant reduction in symptoms in both controlled280 and uncontrolled281 trials.

Discussion: Lifestyle

Weight Loss

Exercise

Alcohol Consumption

Smoking

Self Monitoring of Blood Glucose

Studies

See resources for Footnotes.