Treatment Plan—Type 2 Diabetes
Diabetes diagnoses have been on the rise for more than a decade. In 2000 alone, more than a million adults between the ages of 18 and 79 had the disease, according to the Centers for Disease Control and Prevention. Type 2 diabetes may account for 90 percent to 95 percent of all diagnosed cases of diabetes.
Type 2 diabetes, often called adult-onset diabetes or noninsulin-dependent diabetes mellitus, is a chronic disorder of carbohydrate, fat, and protein metabolism characterized by high blood sugar levels. This increase in blood sugar levels results from defects in insulin production, insulin function, or both. Insulin is a hormone that helps control blood glucose levels. Glucose is the main form of sugar in the body. When the body cannot control its glucose levels, it has a hard time converting food into the energy the body needs to function. Unlike in type 1 diabetes, people with type 2 diabetes may produce healthy or even high levels of insulin. But be-cause their cells do not use it effectively, blood glucose levels rise. This condition is called hyperglycemia, and it is dangerous if untreated.
Symptoms, causes, & risk factors
Symptoms of type 2 diabetes usually develop slowly over time. Many people never have any symptoms. Common symptoms are usually linked to high blood glucose levels and can include excessive hunger and thirst, fatigue and weakness, frequent urination and an increase in the amount of urine passed, nausea, and visual problems.
What causes type 2 diabetes? Obesity is a major contributing factor; in fact, about 90 percent of adults and children with type 2 diabetes are obese. Type 2 diabetes is more common in people with a family history of the disease. It’s also more common among African Americans, Hispanic Americans, Pacific Islanders, Asian Americans, and Native Americans. Other risk factors for type 2 diabetes include being older than 45, having a high density lipoprotein (HDL) level equal to or less than 35 mg/dL or a triglyceride level equal to or greater than 250 mg/dL, having high blood pressure (140/90 mmHg or higher), and being sedentary. Diets skewed in favor of refined, fiber-depleted carbohydrates are thought to induce diabetes in susceptible people as well.
Type 2 diabetes greatly increases risk of heart disease, arteriosclerosis (hardening of the arteries), hypertension, stroke, and kidney disease. It can lead to loss of nerve function, hearing, and sight. People with diabetes are two to three times more likely to die prematurely of arteriosclerosis than those who don’t have the condition. Diabetics with high homocysteine levels also have higher mortality rates.
In most cases, healthcare providers recommend diet and lifestyle modifications to control blood glucose levels. Often, changing eating habits to include more whole foods and fewer processed carbohydrates helps by bringing blood sugar levels under control and reducing weight. Daily exercise also helps normalize blood sugar levels and promotes weight loss.
Sometimes drug therapy is warranted, though. A person with type 2 diabetes may need oral medication such as sulfonylureas or thiazolidinediones. These medications can work by stimulating the pancreas to make more insulin, helping cells use insulin and glucose better, keeping starches that are eaten from being broken down into glucose, and reducing the amount of glucose released by the liver. But the overall rate of achieving adequate control using sulfonylureas is said to be 20 percent to 30 percent at best. In addition, these drugs can cause side effects. In one study, researchers evaluated the long-term effects of tolbutamide, a sulfonylurea, and found it to increase the death rate from heart attacks or strokes 2.5 times compared with those who controlled their diabetes with diet alone. Sulfon-ylureas can cause hypoglycemia, as well as allergic skin reactions, headache, fatigue, indigestion, digestive upset, and liver damage.
Several natural therapies show promise for controlling blood sugar levels. Talk to your healthcare provider to see which ones might complement your diabetes control strategy. The following have the strongest evidence of efficacy.
Alpha-lipoic acid (ALA), a powerful, natural antioxidant, has been shown in preliminary double-blind trials to improve insulin sensitivity and the symptoms of diabetic neuropathy. The doses used were 600–1,200 mg of ALA daily.
Chromium, an essential trace element, holds promise for treating various types of diabetes, including type 2. Chromium supplements appear to increase insulin sensitivity. Improved glucose tolerance with lower or similar levels of insulin have been reported in more than 10 chromium supplementation trials. Chromium picolinate is considered the most stable and effective form. Doses range from 200–1,000 mcg daily. Supplementing with chromium or brewer’s yeast can potentially enhance the effects of drugs for diabetes, so use them together only under a healthcare provider’s supervision.
Fenugreek (Trigonella foenum graecum) seeds are about 50 percent fiber, which, in conjunction with the phytochemicals present in the herb, helps lower blood sugar levels. Results of several double-blind studies show fenugreek to effectively lower glucose levels and also low-density lipoprotein (LDL) and triglycerides. Researchers used 15–25 grams of fenugreek powder, a dose that can cause flatulence, but standardized, lower-dose fenugreek fiber products are now available.
Glucomannan is a water-soluble dietary fiber derived from konjac root (Amorphophallus konjac). It delays stomach emptying, which causes a more gradual absorption of dietary sugar. This effect can reduce the typical post-meal blood sugar elevation associated with diabetes. Researchers showed that people with diabetes had lower post-meal blood sugar levels when they were given glucomannan in their food, and that overall diabetic control is improved with glucomannan-enriched diets. The dose for blood sugar control is 500–700 mg of glucomannan per 100 dietary calories.
Numerous other nutritional and botanical medicines are promising for treating diabetes and its associated conditions. These treatments include various antioxidants, B vitamins, magnesium, essential fatty acids, bitter melon (Momordica charantia), Gymnema sylvestre, and ginkgo (Ginkgo biloba). Discuss any complementary medicine you plan to try with your healthcare provider.
Diet & lifestyle
The cornerstones of diabetic treatment plans, dietary and lifestyle modifications can often bring the condition under complete control. Recommendations typically include a limit on carbohydrate consumption, but other protocols are proving more effective. Aim for a diet rich in vegetables, whole complex carbohydrates, and fiber and low in fat, animal products, and simple or refined carbohydrates. This type of diet has consistently proven to be more effective than oral hypoglycemic agents and other dietary regimes.
Daily exercise is also vitally important. It enhances insulin sensitivity, improves glucose tolerance, reduces LDL cholesterol and triglyceride levels, increases HDL cholesterol, and promotes weight loss. Find an activity you enjoy and make it part of your daily prescription.