Diabetes Prevention and Management

Type 2 Diabetes is a fast growing epidemic. Underlying reasons include poor nutrition (overabundance of processed foods), reduced physical activity, increased stress levels and sleep deprivation, all factors contributing to increased waistline. In order to understand more about preventing diabetes, it is important to understand the disease process, and in particular, the core defect which is termed “insulin resistance”.

According to the American Diabetes Association, 7% of the U.S. population or 20.8 million people (adults and children) have diabetes and this number is rapidly expanding as the obesity problem in America escalates. Among these diabetics, only an estimated 14.6 million have been diagnosed. One third of diabetics don’t even know they have diabetes. Many more have insulin resistance and prediabetes and are completely unaware. Adverse consequences such as coronary artery blockage and heart attacks start in the prediabetic stage, one of the main reasons why we need to be proactive in identifying individuals with insulin resistance and prediabetes, so we can help them prevent not only diabetes, but cardiovascular disease as well.

In order to determine whether or not a patient suffers from a glucose metabolism problem, we perform the gold standard test - the Oral Glucose Tolerance Test (OGTT). We combine the glucose testing with insulin levels to determine the level of insulin resistance and how hard the pancreas is working. A fasting glucose will only tell you if the blood sugar in the morning is high and often times will miss patients with prediabetes (impaired glucose tolerance). During an OGTT, the 2 hour post-challenge glucose higher than 200 is diagnostic of diabetes, between 140-199 is prediabetes and < 140 is normal.

Whether you are interested in diabetes prevention, or you are already diabetic seeking more holistic management strategies, the Center for Optimal Health is the ideal setting for you. Our integrative approach delivered by our team will address your needs as a whole person, utilizing both cutting edge science and natural holistic methods to reduce diabetes risk and its complications.

Summary of Diabetes Prevention Studies

DREAM evaluated the medications Rosiglitazone (Avandia) and Ramipril (Altace) in over 5000 subjects with IGT (Impaired Glucose Tolerance) or IFG (Impaired Fasting Glucose). Rosiglitazone reduced the development of diabetes by 60%. Rosiglitazone and Ramipril respectively helped 71% and 16% of these people return to having normal glucose levels.

TRIPOD looked at Troglitazone (Rezulin – removed from market due to liver toxicity concerns) in the prevention of diabetes development in Hispanic women with history of gestational diabetes. This group of women has a very high risk of developing Type 2 Diabetes – 70% risk over 5 years. Non-Hispanic women with history of gestational diabetes have approximately 50% chance of developing Type 2 Diabetes within 5 years. Troglitazone was very effective – it cut the risk of developing diabetes by more than half (risk reduced by 56%).

DPP (Diabetes Prevention Program) compared lifestyle changes to Metformin (Glucophage, Fortamet, Glumetza) for preventing progression from IGT to Type 2 Diabetes. While Metformin was more effective in younger and more overweight subjects, lifestyle modification (termed “Therapeutic Lifestyle Change” – TLC) was effective for all age groups and across all weight categories. The DPP TLC program consisted of frequent sessions with a case manager, including:

• At least 16 sessions during first 24 weeks
• Instruction in diet, exercise, and behavior modification
• To achieve and maintain weight-loss goals by fat reduction, then calorie reduction
• Goals
  • 7% loss of body weight and maintenance of weight loss
  • 150 minutes per week of moderate intensity physical activity
• At least monthly contact thereafter

STOP-NIDDM was a Canadian and European trial looking at the medication Acarbose (Precose) for diabetes prevention. Not only was Acarbose found to be effective in reducing progression from IGT to diabetes, it was also found to reduce cardiovascular events.

The classics were the Da Qing Study done in China and the Finnish Diabetes Prevention Study both of which showed diet and exercise to be effective in preventing diabetes (risk reduced by 42% and 58% in each respective study).

View a slide show on Diabetes Prevention...

Insulin Resistance 101

There are two main types of diabetes. Type 1 diabetes is an autoimmune condition in which one’s own antibodies attack the pancreas, the organ that makes insulin. Insulin’s job is to let our cells take in glucose from the bloodstream for use. The subsequent destruction of the cells that make insulin leads to insulin deficiency and, ultimately, a complete reliance on an external source of insulin to sustain life. Antibody testing is done in many newly diagnosed diabetes to differentiate between a type 1 and type 2 diabetic, when there is a suspicion of autoimmune disease.

Type 2 diabetes has more recently been characterized as a disease of endothelial function. Due to certain genetic vulnerabilities and/or lifestyle factors, such as excess weight, stress, sleep disorders, and a sedentary lifestyle, the body is unable to efficiently use its own insulin, a phenomenon known as insulin resistance. The pancreas tries to compensate by releasing higher levels of insulin in order to maintain normal blood glucose levels. This chronic overwork of the pancreas can lead to a decline in pancreas function over a period of many years. When one’s pancreas function can no longer overcome the excess demand for insulin, the blood sugars start to rise, and the person is now diabetic. In addition to being the core defect leading to type 2 diabetes, insulin resistance causes multiple other problems including high triglycerides and low HDL levels (with small dense LDL), hypertension, sleep apnea, polycystic ovarian syndrome, gout and heart disease.

In order to prevent type 2 diabetes, it is vital to understand that blood sugar problems travel along a continuum. A lot of people initially develop signs such as low blood sugar (reactive hypoglycemia), which can manifest as afternoon fatigue, mood changes, and mental fogginess. Abdominal weight gain is a key finding in insulin resistance. When blood sugars are severely elevated, the classic symptoms of diabetes – excessive thirst and urination - ensue.

At the Center for Optimal Health, our multidisciplinary team identifies factors leading to insulin resistance and evaluates an individual’s diabetes risk through a lifestyle questionnaire as well as thorough bloodwork, and addresses those concerns in an integrative and holistic manner.