Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar (hypoglycemia). Your blood sugar level can drop for many reasons, including skipping a meal, inadvertently taking more medication than usual or getting more physical activity than normal. Low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you're taking insulin.
What is prediabetes? Prediabetes is a condition where blood sugar levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes. This occurs when the body has problems in processing glucose properly, and sugar starts to build up in the bloodstream instead of fueling cells in muscles and tissues. Insulin is the hormone that tells cells to take up glucose, and in prediabetes, people typically initially develop insulin resistance (where the body’s cells can’t respond to insulin as well), and over time (if no actions are taken to reverse the situation) the ability to produce sufficient insulin is reduced. People with prediabetes also commonly have high blood pressure as well as abnormal blood lipids (e.g. cholesterol). These often occur prior to the rise of blood glucose levels.
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).
The role of physical activity must be considered. Increased levels of daily activity bring about decreases in liver fat stores (43), and a single bout of exercise substantially decreases both de novo lipogenesis (39) and plasma VLDL (92). Several studies demonstrated that calorie control combined with exercise is much more successful than calorie restriction alone (93). However, exercise programs alone produce no weight loss for overweight middle-aged people (94). The necessary initial major loss of body weight demands a substantial reduction in energy intake. After weight loss, steady weight is most effectively achieved by a combination of dietary restriction and physical activity. Both aerobic and resistance exercise are effective (95). The critical factor is sustainability.
There are major barriers for widespread use of islet also-transplantation that can help people with type 1 diabetes. The shortage of islets from donors is a huge obstacle. The other obstacle is that this is still considered an experimental procedure and until the procedure is considered successful enough to be labeled therapeutic by the FDA instead of experimental, the costs of these transplants come from limited research funds.

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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.
Q. I have Type 2 diabetes, and I currently take 1,000 milligrams (mg) of metformin twice a day, 5 mg of Onglyza (saxagliptin) once a day, and 5 mg of glipizide once a day. Does it matter when I take the Onglyza and the glipizide? I used to take them both at breakfast, but I thought I might get better blood-glucose-lowering coverage if I took one of them with lunch and one with dinner.
• The vegetable/fruit called bitter melon, bitter gourd, or karela seems to stop insulin resistance. It gets glucose into cells. You can cook with it (many Chinese recipes incorporate this ingredient), eat it raw, or juice it. You can get it at Asian markets or farmers’ markets, or sometimes in supermarkets. It can also be taken as capsules or a tea.
Exercise naturally supports your metabolism by burning fat and building lean muscle. To prevent and reverse diabetes, make exercise a part of your daily routine. This doesn’t necessary mean that you have to spend time at the gym. Simple forms of physical activity, like getting outside and walking for 20 to 30 minute every day, can be extremely beneficial, especially after meals. Practicing yoga or stretching at home or in a studio is another great option.
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Although a close relationship exists among raised liver fat levels, insulin resistance, and raised liver enzyme levels (52), high levels of liver fat are not inevitably associated with hepatic insulin resistance. This is analogous to the discordance observed in the muscle of trained athletes in whom raised intramyocellular triacylglycerol is associated with high insulin sensitivity (53). This relationship is also seen in muscle of mice overexpressing the enzyme DGAT-1, which rapidly esterifies diacylglycerol to metabolically inert triacylglycerol (54). In both circumstances, raised intracellular triacylglycerol stores coexist with normal insulin sensitivity. When a variant of PNPLA3 was described as determining increased hepatic fat levels, it appeared that a major factor underlying nonalcoholic fatty liver disease and insulin resistance was identified (55). However, this relatively rare genetic variant is not associated with hepatic insulin resistance (56). Because the responsible G allele of PNPLA3 is believed to code for a lipase that is ineffective in triacylglycerol hydrolysis, it appears that diacylglycerol and fatty acids are sequestered as inert triacylglycerol, preventing any inhibitory effect on insulin signaling.
Online diabetes prevention programs: The CDC has now given pending recognition status to three digital prevention programs: DPS Health, Noom Health, and Omada Health. These offer the same one year long educational curriculum as the DPP study, but in an online format. Some insurance companies and employers cover these programs, and you can find more information at the links above. These digital versions are excellent options for those who live far away from NDPP locations or who prefer the anonymity and convenience of doing the program online.
Chromium plays a vital role in binding to and activating the insulin receptor on body cells, reducing insulin resistance. Supplemental chromium has been shown to lower blood sugar levels, lipids, A1C, and insulin in diabetic patients. It can also help decrease one’s appetite, particularly for sweets. A dosage from 200 mcg to 2,000 mcg a day is safe. Higher doses are unnecessary and can cause acute kidney failure.
A good multiple vitamin and mineral product (or “multiple,” for short) is a great way to start supporting nutrient intake in all diabetic patients. This ensures every day that the body receives all the key nutrients it needs so that all its biochemical, hormonal, nutritional, detoxifying, healing, rebuilding, protecting, and strengthening processes can be performed easily and smoothly. The body runs on enzymes, as enzymes speed up reactions to make the body function more efficiently; all enzymes require nutrient cofactors to enable them to effectively engage the action they are designed to do. A good multiple vitamin supplement for diabetes ensures all those cofactors are available every minute, every day.
Dr. Mona Morstein is a naturopathic physician with a medical practice focused in integrative diabetes treatment. Her clinic, Arizona Integrative Medical Solutions, is located in Tempe, Arizona, where she sees patients of all ages and genders for acute and chronic conditions. An expert on prediabetes and diabetes, she is a frequent lecturer at conferences and webinars, and is the founder and executive director of The Low Carb Diabetes Association. Dr. Morstein is also a member of the Arizona Diabetes Coalition. Visit her website lowcarbdiabetes.org
Diabetes is the major cause of blindness, kidney failure, heart attack and stroke. The number of people affected by all types of diabetic disorders is now over four times higher than just 40 years ago. This has led the World Health Organization (WHO) to consider diabetes an epidemic, predicting it will soon be the seventh biggest cause of death worldwide.
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