Insulin is a hormone produced by cells in the pancreas called beta cells. Insulin helps the body use blood glucose (a type of sugar) for energy. People with type 2 diabetes do not make enough insulin and/or their bodies do not respond well to it, leading to elevated blood sugar levels. Oral diabetes medications bring blood sugar levels into the normal range through a variety of ways.
The fact these improvements can happen independently of weight loss should also signify a shift in how we conceptualize both obesity and diabetes, according to Peter Billings, the Seattle bariatric surgeon who operated on Benari. Billings, a nearly 20-year veteran in the field, has started to perform surgery on other lower-BMI patients similar to Benari, though they often pay out of pocket.
One of my patients, aged 58, had an initial hemoglobin A1c of 7.2%. She was taking oral hypoglycemic agents, statins, and proton pump inhibitors—the basic treatment for every diabetes diagnosis. The patient was 28 lbs overweight and worked long hours. She didn’t exercise, mostly ate a processed food diet, and was sleep deprived. The patient had a family history of diabetes, and ultimately her lifestyle expressed her genetic tendencies.
The twin cycle hypothesis of the etiology of type 2 diabetes. During long-term intake of more calories than are expended each day, any excess carbohydrate must undergo de novo lipogenesis, which particularly promotes fat accumulation in the liver. Because insulin stimulates de novo lipogenesis, individuals with a degree of insulin resistance (determined by family or lifestyle factors) will accumulate liver fat more readily than others because of higher plasma insulin levels. In turn, the increased liver fat will cause relative resistance to insulin suppression of hepatic glucose production. Over many years, a modest increase in fasting plasma glucose level will stimulate increased basal insulin secretion rates to maintain euglycemia. The consequent hyperinsulinemia will further increase the conversion of excess calories to liver fat. A cycle of hyperinsulinemia and blunted suppression of hepatic glucose production becomes established. Fatty liver leads to increased export of VLDL triacylglycerol (85), which will increase fat delivery to all tissues, including the islets. This process is further stimulated by elevated plasma glucose levels (85). Excess fatty acid availability in the pancreatic islet would be expected to impair the acute insulin secretion in response to ingested food, and at a certain level of fatty acid exposure, postprandial hyperglycemia will supervene. The hyperglycemia will further increase insulin secretion rates, with consequent enhancement of hepatic lipogenesis, spinning the liver cycle faster and driving the pancreas cycle. Eventually, the fatty acid and glucose inhibitory effects on the islets reach a trigger level that leads to a relatively sudden onset of clinical diabetes. Figure adapted with permission from Taylor (98).
TCM does not offer a cure for diabetes, but instead aims to optimize the body’s ability to function normally. There is still a great need for more and better research on the efficacy and safety of both Chinese herbals, which are being used along with or in lieu of Western pharmaceuticals, and acupuncture in the care of diabetic patients. Patients, TCM practitioners, and physicians who choose to integrate the two forms of care must all recognize the importance of careful monitoring of blood glucose levels, as well as monitoring for potential side effects such as drug-herb interactions.
In type 1 diabetes, patients sometimes experience what physicians have come to call a "honeymoon period" shortly after the disease is diagnosed. During the "honeymoon period" diabetes may appear to go away for a period of a few months to a year. The patient's insulin needs are minimal and some patients may actually find they can maintain normal or near normal blood glucose taking little or no insulin.
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.
Treatment plans are designed around the pattern of insulin normally supplied by the pancreas throughout the day in someone without diabetes. In general, this involves providing a fairly steady "background" level of insulin to control blood sugar levels between meals and overnight, along with doses of rapid- or short-acting insulin to handle the fast rises in blood sugar that occur with meals.
Curcumin. The compound curcumin, which is found in the spice tumeric, has been shown to both boost blood sugar control and help prevent the disease. In a nine-month study of 240 adults with pre-diabetes, those who took curcumin capsules (which are available over-the-counter) completely avoided developing diabetes while a sixth of patients in the placebo group did.
Now mineral X shall be 4% of total body fluids and kidneys will be removing the excess more efficiently. So in another 12 hours the kidneys will bring down the mineral X from 300 units to 200 unit which is exactly 4% of the total fluid. But the body tends to remain in the same condition over a small period of time. Over consumption of X will soon cause build up of X in the body.
Metformin: The DPP study found that metformin, the safest first-line therapy for type 2 diabetes, may help delay the onset of type 2 diabetes in people with prediabetes. Participants who took the low-cost generic drug had a 31% reduced risk of developing type 2 diabetes compared to the control group (those not on metformin or intensive lifestyle intervention). Again, 15-year follow up data showed that 17% of those on metformin continued to have a significant reduction in type 2 progression. At this time, metformin (or any other medication, for that matter) is not currently FDA approved for prediabetes, and it is sometimes prescribed “off-label” by a healthcare provider. Your healthcare provider can give you more information and determine whether metformin is a good option for you.
Practitioners agree that nutrition is the cornerstone of diabetes management, and that a range of nutrition intervention strategies can be used to meet the metabolic goals and individual preferences of the person with diabetes. However, there are significant differences in the approach and methodologies used by alternative and conventional practitioners to manage the disease. One difference is in terminology. When is remission really remission?
The theory of Five Phases, Wu Xing, is a means of classifying phenomena in terms of five basic processes represented by the elements wood, fire, earth, metal, and water. There exists a dynamic balance and relationship among the elements such that if the balance is interrupted or destroyed, pathological changes may occur. The clockwise movement of one element into the next (wood, fire, earth, and so forth) whereby one element generates, acts on, or promotes the following element, is referred to as the Sheng cycle. The Ke cycle represents an element acting on or controlling another element in a different order (Figure 2).3
In type 1 diabetes, the body produces none of the insulin that regulates our blood sugar levels. Very high glucose levels can damage the body's organs. Patients with type 2 diabetes, however, do produce insulin - just not enough to keep their glucose levels normal. Because I was fit and not overweight (obesity is a major risk factor in type 2 diabetes; however, a number of non-obese people, particularly members of south Asian communities, are also prone to it), my doctor told me I could control my condition with diet alone.
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The NIH National Institute of Diabetes and Digestive Diseases and Kidney Diseases says it, “currently supports studies that are working toward obtaining FDA licensure to reclassify islet allo-transplantation as therapeutic. In other countries, such as Canada and Scandinavia, islet allo-transplantation is no longer considered experimental and is an accepted therapy in certain patients.” It adds that “Some patient advocates and islet researchers feel that islet allo-transplantation is close to having a therapeutic label.”
Type 2 diabetes is by far the most common form (around 90% of all cases) and the one which is increasing the most. It primarily affects overweight people in middle age or later. It’s not uncommon for the affected person to also have a high blood pressure and an abnormal lipid profile. Gestational diabetes is a temporary special case of type 2 diabetes.
2. Biguanides Metformin is the only form of biguanide currently available. While it may promote modest weight loss and a slight decline in LDL, or "bad," cholesterol, side effects may include nausea, diarrhea, and (when other risk factors are present) the harmful buildup of lactic acid. Glucophage, Glumteza, and Riomet are some brand-name types of metformin available for use.
Pancreatic islet allo-transplantation is a procedure in which islets from the pancreas of a deceased oran donor are purified, processed, and transferred into another person. Immunosuppressive medications are needed to prevent rejection which is a typical challenge with any transplant. These medications carry a number of serious side effects such as decreased kidney function, high blood pressure, anemia and lowered white blood cells counts.
These findings present a hopeful option not just for improved management of the condition, but a potential cure. One that doesn’t rely on expensive medications or invasive surgery, but instead, on improved diet and lifestyle — which could also be beneficial in managing and preventing a number of other chronic conditions which are affected by weight. As Taylor told The Guardian, “The weight loss goals provided by this programme [sic] are achievable for many people. The big challenge is long-term avoidance of weight re-gain.”
Some of the above drugs are available in compound form, and there are many patients taking three to four of them to control their blood sugar. But again, "the most common duo is metformin and a sulfonylurea,” says Arti Bhan, MD, division head of endocrinology at Henry Ford Health System in Detroit. “Metformin makes the body utilize insulin more effectively, and the sulfonylurea works on the pancreas to make more insulin in response to food consumption. Another common combination is metformin and insulin.”
Sage can have metformin-like effects, according to a study published in the British Journal of Nutrition. So you may want to consider cooking with this herb often. It has been used on traditional medicine for centuries, as one of the important herbs to reduce blood sugar. A word of warning – taking high doses of sage along with diabetes medications might cause your blood sugar to go too low, a condition called hypoglycemia. Monitor your blood sugar closely.
One can't, in spite of the initial reported success of following a 600 kcal vegetarian diet for 8 weeks cured all 11 participants of their diabetes, resulting in an enormous very beneficial weight loss of 15 kg and reversal of pancreatic fat infiltration that many think is the underlying defect causing type 2 diabetes, see this 2011 paper Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol only just 3 months afterwards diabetes had recurred in 5 out of the 11 see Diet reverses Type 2 Diabetes
Conventional cow’s milk: Conventional cow’s milk and dairy products should be eliminated, especially for people with type 1 diabetes. Dairy can be a fantastic food for balancing blood sugar if it comes from goat’s, sheep or A2 cows. But stay away from all other forms of dairy because the A1 casein produced by conventional cows will harm the body and trigger an immune response similar to gluten. When buying dairy, only purchase raw and organic products from pasture-raised animals.
A major feature of the disease is a condition known as insulin resistance. Insulin is a hormone that moves glucose (sugar), from the bloodstream into the body’s cells where it is used for energy. For a variety of reasons that are not fully understood, the body’s tissues don’t respond adequately to insulin and glucose then becomes elevated in the bloodstream.
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.
In 1991, the National Institutes of Health issued a consensus statement, cautiously recommending surgery as a treatment for people living with morbid obesity, meaning they have a body mass index, or BMI, over 40. For people who have health complications connected to obesity, such as type 2 diabetes, the limit goes down to a BMI of 35. Relying on these guidelines, insurance companies and public payers like Medicaid and Medicare typically only cover surgery for people living with diabetes who fall into that category.
Eating meals at regular times generally makes this easier. Although eating on schedule may work well for younger kids, sticking to a routine can be a challenge for older kids and teens, whose school, sleep, and social schedules often vary. The diabetes health care team can help you work through any problems your child might have with scheduling meals and insulin injections.
The only reason to continue to give this bad advice is the lingering fear of natural fat. If you’re going to avoid fat you need to eat more carbohydrates in order to get satiated. But in recent years the old theory about fat being dangerous has been proven incorrect and is today on its way out. Low-fat products are simply unnecessary. So this reason doesn’t hold up either.
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“BCG has been known for more than 30 years to boost production of a cytokine called tumor necrosis factor (TNF), which may be beneficial in autoimmune diseases both by eliminating the autoreactive T cells that attack an individual’s tissues – in the case of type 1 diabetes, pancreatic islets – and by inducing production of regulatory T cells (Tregs) that could prevent an autoimmune reaction. Faustman’s team first reported in 2001 that inducing TNF production could cure type 1 diabetes in mice, but since TNF dosing is toxic in humans, clinical trials have utilized BCG for its ability to elevate TNF levels safely.
Because TCM defines diabetes as a disease characterized by Yin deficiency and excess internal heat, an example of a dietary prescription would be to consume spinach, which is cooling, “strengthens all the organs, lubricates the intestines, and promotes urination.”7 A recommendation might be to boil tea from spinach and drink 1 cup three times/day. Other foods considered to be cooling and beneficial for diabetes include vegetables and grains, such as celery, pumpkin, soybeans (i.e., tofu, soymilk), string beans, sweet potato/yam, turnips, tomato, wheat bran, and millet. Fruit remedies, which act in specific therapeutic ways, include crab apple, guava, plum, strawberry, and mulberry.7 It is generally recommended that patients eat a wide variety of seasonal foods and avoid or minimize consumption of sweets and fruits. Meals should be smaller, eaten more frequently, and eaten at regular times each day.
The overall goal of treatment with insulin (and other diabetes medicines) is to achieve the best match possible between the amounts of insulin given and the person's individual needs for insulin throughout the day and night. In this way, blood sugar levels can be kept as close to normal as possible to help avoid both short- and long-term problems from diabetes.
In addition to giving you some ideas about what to eat, the plan also might recommend limiting foods that contain lots of fat or calories and that don't contain vitamins and minerals. Everyone who eats a healthy diet should limit these foods anyway, because eating too much of them can lead to too much weight gain or long-term health problems like heart disease.
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