Insulin therapy is taken by diabetics who have type 1 diabetes mellitus, or IDDM, i.e., insulin-dependent diabetes mellitus. In this condition, body is not able to produce any insulin, therefore, it has to be administered externally. Patients with type 2 diabetes mellitus are either resistant to insulin or have relatively low insulin production, or both.
Who is at risk of developing prediabetes? A well-known paper published in the Lancet in 2010 recommends screening for type 2 diabetes (which would also screen for prediabetes) every 3-5 years in all adults over the age of 45, regardless of other risk factors. Overweight and obese adults (a BMI >25 kg/m2) are also at significantly greater risk for developing prediabetes, as well as people with a family history of type 2 diabetes.
The Food and Drug Administration (FDA) does not regulate herbs, minerals, animal products, and patent formulas that come into the United States from China. Herbal products are considered dietary supplements according to the Dietary Supplement and Health Education Act (DSHEA) of 1994; therefore, the manufacturers do not need FDA approval or evaluation for safety, purity, and efficacy before bringing their products to market. There have been reports of some formulas imported from China containing heavy metals such as lead and mercury and of others being deliberately adulterated with conventional Western pharmaceuticals, such as corticosteroids, anti-inflammatory agents, and benzodiazepines.16
Depending on the severity of diabetes, an individual can keep control on his/her disease using diet alone, diet & oral hypoglycemic drugs, and diet & insulin. While a mild diabetic can practice disease control with diet alone, a severe diabetic might need to practice diet control along with insulin administration. Whatever the method of controlling diabetes, routine and reliability should be strictly pursued. A person suffering from diabetes should have limited amount of carbohydrates and fats along with moderate amount of protein in the diet. High-fiber diet like vegetables, whole wheat products, oats, whole legumes prove to be more beneficial. Let us have a look at what all should be had and what all should be avoided.
Herbal prescriptions for diabetes are formulated or prescribed based on the patient’s predominant symptoms. For instance, a patient presenting primarily with excessive thirst (lung Yin deficiency) might be given a single herb, such as radix panacis quinquefolii; or a combination of herbs in a patent formulation such as yu chuan wan, which is used in general to treat diabetes of mild to moderate severity and specifically to treat excessive thirst due to Yin deficiency,12 and ba wei di huang tang (“eight-ingredient pill with rehmannia”), which was originally used to treat people exhibiting weakness, fatigue, and copious urine soon after drinking water.13
Chinese medicine has been using cinnamon for medicinal purposes for hundreds of years. It has been the subject of numerous studies to determine its effect on blood glucose levels. A 2011 study has shown that cinnamon, in whole form or extract, helps lower fasting blood glucose levels. More studies are being done, but cinnamon is showing promise for helping to treat diabetes.
One of the most studied programs in the National Institutes of Health’s Diabetes Prevention Program (DPP). This program helps people who have pre-diabetes or a high risk of developing type 2 diabetes lose weight. Studies of the program have found that those who lost about seven percent of their initial weight, kept some of it off, and maintained an exercise program delayed the onset of type 2 diabetes for three years in 58% of cases.
Evidence linking hepatic insulin sensitivity to intraorgan triglyceride content has been steadily accumulating. In insulin-treated type 2 diabetes, insulin dose correlates with the extent of fatty liver (35), and in turn, this is associated with insulin sensitivity to suppression of hepatic glucose production (36). Decreasing the fat content of liver is associated with improvement in insulin suppression of glucose production and, thereby, with improvement in fasting plasma glucose (20,23).
However, the observation that normalization of glucose in type 2 diabetes occurred within days after bariatric surgery, before substantial weight loss (15), led to the widespread belief that surgery itself brought about specific changes mediated through incretin hormone secretion (16,17). This reasoning overlooked the major change that follows bariatric surgery: an acute, profound decrease in calorie intake. Typically, those undergoing bariatric surgery have a mean body weight of ∼150 kg (15) and would therefore require a daily calorie intake of ∼13.4 MJ/day (3,200 kcal/day) for weight maintenance (18). This intake decreases precipitously at the time of surgery. The sudden reversal of traffic into fat stores brings about a profound change in intracellular concentration of fat metabolites. It is known that under hypocaloric conditions, fat is mobilized first from the liver and other ectopic sites rather than from visceral or subcutaneous fat stores (19). This process has been studied in detail during more moderate calorie restriction in type 2 diabetes over 8 weeks (20). Fasting plasma glucose was shown to be improved because of an 81% decrease in liver fat content and normalization of hepatic insulin sensitivity with no change in the insulin resistance of muscle.
Diabetes is one of the most prevalent chronic diseases in the United States. The morbidity and mortality associated with the disease is significant and derives primarily from complications of persistent hyperglycemia. Longstanding hyperglycemia has been shown to lead to vascular complications involving large and small blood vessels, such as arteriosclerosis, glomerulosclerosis, and retinopathy. Diabetic neuropathy, characterized by pain and paresthesias, is among the most frequent complications of longstanding, poorly controlled diabetes and is often associated with a reduction in physical activity and with sleep disturbances.1,2
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During this 8-week study, β-cell function was tested by a gold standard method that used a stepped glucose infusion with subsequent arginine bolus (21). In type 2 diabetes, the glucose-induced initial rapid peak of insulin secretion (the first phase insulin response) typically is absent. This was confirmed at baseline in the study, but the first phase response increased gradually over 8 weeks of a very-low-calorie diet to become indistinguishable from that of age- and weight-matched nondiabetic control subjects. The maximum insulin response, as elicited by arginine bolus during hyperglycemia, also normalized. Pancreas fat content decreased gradually during the study period to become the same as that in the control group, a time course matching that of the increase in both first phase and total insulin secretion (Fig. 3). Fat content in the islets was not directly measured, although it is known that islets take up fat avidly (24) and that islet fat content closely reflects total pancreatic fat content in animal models (25). Although a cause-and-effect relationship between raised intraorgan fat levels and metabolic effect has not yet been proven, the time course data following the dietary intervention study are highly suggestive of a causal link (21).
I bring this up because sleep apnea increases a person’s risk for developing type 2 diabetes. Also, sleep-disordered breathing is also related to proper nutrition throughout life. And perhaps most importantly, the first line of defense in catching sleep-disordered breathing in patients early, are dentists. This is another area where dentists must get involved if we want to tackle the issue of pervasive type 2 diabetes with any success.