Reversal of type 2 diabetes to normal metabolic control by either bariatric surgery or hypocaloric diet allows for the time sequence of underlying pathophysiologic mechanisms to be observed. In reverse order, the same mechanisms are likely to determine the events leading to the onset of hyperglycemia and permit insight into the etiology of type 2 diabetes. Within 7 days of instituting a substantial negative calorie balance by either dietary intervention or bariatric surgery, fasting plasma glucose levels can normalize. This rapid change relates to a substantial fall in liver fat content and return of normal hepatic insulin sensitivity. Over 8 weeks, first phase and maximal rates of insulin secretion steadily return to normal, and this change is in step with steadily decreasing pancreatic fat content. The difference in time course of these two processes is striking. Recent information on the intracellular effects of excess lipid intermediaries explains the likely biochemical basis, which simplifies both the basic understanding of the condition and the concepts used to determine appropriate management. Recent large, long-duration population studies on time course of plasma glucose and insulin secretion before the diagnosis of diabetes are consistent with this new understanding. Type 2 diabetes has long been regarded as inevitably progressive, requiring increasing numbers of oral hypoglycemic agents and eventually insulin, but it is now certain that the disease process can be halted with restoration of normal carbohydrate and fat metabolism. Type 2 diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intraorgan fat.
A newer class of diabetes medication, SGLT2 includes three medicines: canagliflozin, dapagliflozin, and empagliflozin. These drugs remove extra sugar from your body by blocking it from the kidneys. It also causes your body to be more sensitive to insulin. The most common side effects caused by SGLT2 are vaginal yeast infections and urinary tract infections.
Researchers are discovering more about the causes of type 2 diabetes but as yet there are no clear avenues for a cure. With this said, there has been success in reversing the development of type 2 diabetes. Methods which result in a significant loss of weight have been successful in helping people to control blood glucose levels and have allowed some people to come off their diabetic medication. Methods such as bariatric surgery and very low calorie diets have been successful in allowing patients to reduce dependency on medication.
The gastric bypass that Benari got, for instance, resculpts the digestive system. Surgeons seal off a large part of the stomach using staples, leaving behind a small upper pouch, while rerouting part of the small intestine to the new pouch, bypassing the rest. The net result is that less food can fit in the stomach, and there’s much less time for that food to be turned into calories before it exits the body. The vertical sleeve gastrectomy, the most popular surgery in recent years, only tinkers with the stomach, using staples to turn it into a small banana-shaped organ. (There are less permanent procedures, such as the lap band, but these have fallen out of favor due to their ineffectiveness).
Cinnamon has the ability to lower blood sugar levels and improve your sensitivity to insulin. A study conducted at Western University of Health Sciences in Pomona, Calif. found that the consumption of cinnamon is associated with a statistically significant decrease in plasma glucose levels, LDL cholesterol and triglyceride levels. Cinnamon consumption also helped increase HDL cholesterol levels. (15)
Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.
“Diabetes type 1 is very different from your standard disease. Insulin requirements vary greatly from one day to another and there is no way patients can know what they need,” Roman Hovorka, Professor at the University of Cambridge, explained to me during an interview. His research group is working on the development of an algorithm that can accurately predict insulin requirements for a specific patient at any moment.
Many people have heard about type 2 diabetes, but its common precursor, prediabetes, doesn’t get as much attention. Prediabetes is estimated by CDC to affect 86 million Americans (51% of whom are 65 years and older), and an estimated 90% of people with prediabetes don’t even know it. According to the CDC, 15-30% of these individuals will develop type 2 diabetes within five years. In other words, as many as 26 million people that currently have prediabetes could develop type 2 diabetes by 2020, effectively doubling the number of people with type 2 diabetes in the US.
Conventional: A dietary pattern that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health. Carbohydrate intake should be monitored using carbohydrate counting or experienced-based estimation. The Recommended Dietary Allowance for digestible carbohydrates is 130 g/day, which will provide a sufficient amount of glucose needed to fuel the central nervous system without reliance on glucose production from protein or fat. Using foods with a low glycemic index that are rich in fiber and other important nutrients is encouraged.
The first hint that type 2 diabetes is a fully reversible syndrome came from bariatric surgery. Almost a quarter century ago, Pories et al. (12) demonstrated that blood glucose levels normalized in obese people with type 2 diabetes undergoing bariatric surgery and that 10 years later, almost 90% remained free of diabetes. The phenomenon was more recently tested in a randomized prospective study comparing gastric banding with intensive medical therapy for type 2 diabetes (13). This least invasive type of surgery was most suitable for the randomized study, although it was associated with lower rates of diabetes reversal than other procedures. Mean fasting plasma glucose fell to normal levels in the surgically treated group but declined only modestly in the intensive medical treatment group despite oral agents and insulin (Fig. 1) (13). Remission of diabetes was related to the degree of weight loss rather than to group allocation and was achieved in 73% of the surgical group and 13% of the intensive medical treatment group because surgery was more effective in achieving weight loss as previously described (14). Type 2 diabetes can be reversed by applying a surgical procedure that diminishes fat mass.
A 2012 review of ginseng in animals and human beings found that not only does ginseng reduce insulin resistance, it also lowers HbA1C levels. It’s been used in traditional Chinese medicine for centuries as one of the most potent herbs for blood sugar control. Indian ginseng, also called Ashwagandha, offers fantastic all round benefits. Scientists are also researching the connection between diabetes and Alzhiemer’s. Panax Ginseng is a type of ginseng that is able to help with both diabetes and Alzheimer’s.
Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent.
Indian gooseberry is one of the richest sources of vitamin C. When mixed with bitter gourd juice, its efficacy manifolds, and it can prove to be a highly effective concoction against diabetes. The mixture arouses the islets of Langerhans, that is, the isolated group of cells that secrete the hormone insulin in the pancreas. Just consume one tablespoon of Indian gooseberry juice mixed with one cup of bitter gourd juice daily for 8 to 12 weeks. It is recommended to take it first thing in the morning, if possible. The mixture has also been found to trigger insulin production. All in all, a great herbal remedy for diabetes.
Nature’s Answer Plant Based Magnesium is naturally derived from Icelandic Red Algae and Seawater for maximum bioavailability (absorption and usability by the body). Synthetic forms of magnesium are poorly absorbed and utilized by the body and lack the necessary cofactors for proper functioning. Nature’s Answer Plant Based supplement is rich in trace minerals which help the body process and get maximum benefit from the magnesium.
Known as gurmar, or “sugar destroyer,” in Aryuvedic medicine, Gymnema has consistently shown benefits in patients with diabetes. The most active part of Gymnema seems to be gymnemic acids, and many products list the percentage each capsule contains. Analyses of the herb for diabetes have shown it may be helpful in lowering high blood sugar levels. It can delay glucose absorption from the intestine. It was shown to regenerate pancreatic tissues, allowing more insulin to be produced, and help regulate insulin secretion. It also increases the utilization of glucose by the cell, reducing insulin resistance and decreasing appetite, especially for sweets. I usually use it in capsules, or in liquid form in some patients. Due to Gymnema having a very similar shape to glucose, it can fit into the taste bud receptors for sugar; it thus has unbelievable power to actually prevent the taste of sweets in the mouth for up to 1.5 hours. When I have a patient who is still struggling to not eat cake and cookies and so forth at parties or celebrations (or just in general), I will give her a tincture of Gymnema sylvestre. This is one of my favorite herbs for diabetes. In capsule form doses of 400 to 2,400 mg a day are recommended.
After two months under the care of the naturopath, John returned to his primary care doctor to discover that his hemoglobin A1c had dropped from 8.9% to 4.9%—a nondiabetic range. For eight months and counting, he’s been off all his diabetes medication. His last A1c reading was 5.1%. With the help of his naturopath, John seems to have reversed his diabetes.
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Despite the encouraging findings, more research will be necessary to confirm that S. oblonga is an effective treatment for type 2 diabetes and to determine whether it offers any long-term health benefits. The researchers also want to look into the question of whether or not S. oblonga can prevent type 2 diabetes. They suggested that an extract could be added to a food or beverage for easy use.
The prevalence of prediabetes is also on the rise, as it’s estimated that almost 34 million U.S. adults were prediabetic in 2015. People with prediabetes have blood glucose levels that are above normal but below the defined threshold of diabetes. Without proper intervention, people with prediabetes are very likely to become type 2 diabetics within a decade.
Another non-insulin injection for people with diabetes is exenatide (Byetta). This medication, originally derived from a compound found in the saliva of the Gila monster, triggers insulin release from the pancreas when blood glucose levels rise. Exenatide is meant to be used along with oral diabetes drugs. It is dosed twice daily and should be injected within an hour of the morning and evening meals. Recently, the FDA warned that exenatide may increase the risk of severe even fatal pancreatitis (inflammation of the pancreas) and that the drug should be discontinued and not restarted if signs and symptoms of pancreatitis develop (severe abdominal pain, for example). It is not for use in people with type 1 diabetes.
Tui Na is a traditional form of Chinese massage that uses hand manipulations, such as pulling, kneading, pushing, and grasping to stimulate acupuncture points and other parts of the body to create balance and harmony in the system. It can be used effectively in lieu of acupuncture in patients who have an aversion to needles, particularly pediatric patients.13
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The Chinese language includes two terms for diabetes. The traditional name, Xiao-ke, correlates closely with diabetes in most instances. Xiao-ke syndrome means “wasting and thirsting.” The more modern term, Tang-niao-bing, means “sugar urine illness.” Reference to diabetes by the traditional term appears in the earliest texts, including the first medical text in Chinese history, Huang Di Nei Jing, or The Yellow Emperor’s Inner Classic.
There are many drugs available to treat type 2 diabetes. Your diabetes care team can help you understand the differences among the types of medication on this long list, and will explain how you take them, what they do, and what side effects they may cause. Your doctor will discuss your specific situation and your options for adding one or more types of medication to your treatment.
In addition to walking and stretching exercises, try interval training cardio, like burst training, or weight training three to five days a week for 20–40 minutes. Burst training can help you burn up to three times more body fat than traditional cardio and can naturally increase insulin sensitivity. You can do this on a spin bike with intervals, or you can try burst training at home.
What can people with prediabetes do to avoid the progression from prediabetes to type 2 diabetes? The most important action people diagnosed with prediabetes can take is to focus on living a healthy lifestyle. This includes making healthy food choices, controlling portions, and increasing physical activity. Regarding weight control, research shows losing 5-7% (often about 10–20 lbs.) from your initial body weight and keeping off as much of that weight over time as possible is critical to lowering the risk of type 2 diabetes. This task is of course easier said than done, but sustained weight loss over time can be key to improving health and delaying or preventing the onset of type 2 diabetes.
Researcher Qizhi Tang, PhD, at the University of California, San Francisco, is studying the changes induced in beta cells by the shortage of oxygen and nutrients. Stem cell-derived islets have a low survival rate in the first few days after transplant due to the lack of adequate oxygen and nutrient supplies. However, the American Diabetes Association states, “Evidence suggests that beta cells can be trained to survive oxygen and nutrient shortages that they are exposed to before and after transplantation.”
But a prescription doesn’t have to be a life sentence. It may be that, through weight loss and physical activity, you can reduce your risk of diabetes, or prevent it from occurring. "The only evidence-based treatment that can 'cure' diabetes is weight-loss surgery,” says Gupta, “but weight loss in overweight or obese type 2 diabetes patients certainly helps with decreasing drugs.”
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In addition to their usual diabetes regimen -- a careful diet, regular exercise, and in some cases, medication -- 23 type 2 diabetic patients took either 3 grams of American ginseng or a placebo each day for eight weeks, at which point they switched treatments. The diabetic patients' fasting blood sugar levels dropped about 9% more when they took ginseng compared with when they took the placebo; glycosylated hemoglobin levels between the two groups differed by 4%, with the ginseng group being lower.
Some people with type 2 diabetes can manage their disease by making healthy food choices and being more physically active. Many people with type 2 diabetes need diabetes medicines as well. These medicines may include diabetes pills or medicines you inject under your skin, such as insulin. In time, you may need more than one diabetes medicine to control your blood glucose. Even if you do not take insulin, you may need it at special times, such as during pregnancy or if you are in the hospital.
Chinese herbs have specific functions (i.e., warming, heat-clearing, eliminating dampness, and cooling) and can be classified according to those functions. They are also classified according to four natures (cool, cold, warm, and hot) and five tastes (sweet, pungent, bitter, sour, and salty).4 Herbs may be prescribed individually or as part of a formula.
One of the biggest hits in type 2 diabetes treatment is glucagon-like peptide (GLP)-1 receptor agonists, which induce insulin production in beta-pancreatic cells while suppressing the secretion of glucagon. All big pharma have GLP-1 drugs on the market or their pipelines, including Sanofi, Eli Lilly, Roche, AstraZeneca and Boehringer Ingelheim. But Novo Nordisk is going a step further with the first oral version of a GLP-1 drug, which is now close to the market.