Sunday, October 25, 2015

Diabetes Awareness

Dear Readers,

Todd Humphrey, Practice Manager of Vaughan Integrative Medicine, compiled the information in this article. When his hemoglobin A1c resulted at 5.4 he started evaluating the lifestyle choices he was making. Combined with high blood pressure and a few other high risk factors, he decided it was necessary to pay attention to the possibility of prediabetes. Join him in pursuing a life free of insulin injections.

- Dr. Vaughan


According to the American Diabetes Association (ADA) more than 8 million Americans have undiagnosed diabetes. Diabetes is a number of diseases that involve problems with insulin in the body. Insulin is the hormone used to regulate blood sugar (glucose); it is the key that opens the door for glucose to enter cells to be used as fuel to support metabolic processes in the body. People with diabetes either don't make insulin or their body's cells are resistant to insulin, leading to high levels of sugar circulating in the blood. Diabetes is classified as Type 1, Type 2, or Gestational. The classification of diabetes helps determine the best course of treatment each individual.

If the insulin-producing cells of the pancreas are destroyed by the body’s immune system and the body ceases insulin production, type 1 diabetes is the result. Type 1 diabetes typically occurs in individuals less than 20 years of age. Symptoms, which can occur suddenly and become severe, include:
  • Increased thirst 
  • Increased hunger (especially after eating) 
  • Dry mouth 
  • Frequent urination 
  • Unexplained weight loss (even though you are eating and feel hungry) 
  • Fatigue (weak, tired feeling) 
  • Blurred vision 
  • Labored, heavy breathing 

Type 2 diabetes, the most common type of diabetes, occurs in individuals who either do not produce enough insulin or whose bodies are insulin resistant. While type 2 diabetes is historically most common in overweight individuals age 40 or older, it is found in those who are not overweight. More recent studies show an increase in the number of youth with type 2 diabetes – in direct correlation with the rising epidemic of obesity in young people. Symptoms of type 2 diabetes may mimic those of type 1. Most often, there are no symptoms or a very gradual development of symptoms. Other symptoms of type 2 diabetes may include:
  • Slow-healing sores or cuts 
  • Itching of the skin (usually in the vaginal or groin area) 
  • Yeast infections 
  • Recent weight gain 
  • Numbness or tingling of the hands and feet 
  • Impotence or erectile dysfunction 

Hormonal changes during a pregnancy can affect the body’s ability to produce and effectively use insulin. When this occurs, the result is gestational diabetes; this affects approximately 4% of all pregnancies. A woman is at higher risk of gestational diabetes if she is overweight before the pregnancy begins, is over 25 years of age, or is Hispanic, black, Native American, or Asian. Left untreated, gestational diabetes increases the risk of complications to both the mother and her unborn child. Within six weeks of delivery blood sugar levels typically return to normal. Having gestational diabetes increases a woman’s chance of developing type 2 diabetes later in life.

While all classifications of diabetes are treatable, the disease is the primary cause of death for more than 69,000 Americans annually. The downside to treating diabetes is the cost associated with treatment. People with diabetes have a health care cost that is 2.3 times higher than what expenditures would be in the absence of diabetes. The ADA reports that $245 billion is spent annually in the direct costs (treatment) and indirect costs (disability, work loss, premature mortality) associated with diabetes.

The complications that can result from diabetes are significant: Adults with diabetes are more likely to be admitted to a hospital after a heart attack or a stroke than are adults without diabetes. Diabetes is the leading cause of new cases of kidney failure. 60 – 70% of people with diabetes have mild to severe neuropathy. Hearing loss is is twice as common in individuals with diabetes. More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.

If current trends continue, as many as 1 in 3 American adults will have diabetes by 2050. Statistics indicate that in addition to the 8 million diabetics, there are 86 million Americans who have prediabetes – most of whom are undiagnosed. Prediabetics are individuals who are at a significant risk of developing Type 2 diabetes based on elevated blood sugar levels. The most reliable test in determining if an individual is prediabetic is called a Hemoglobin A1c (HA1c), or the glycated hemoglobin test. This test provides an average of an individual’s blood sugar levels over a 2-to-3 month period. Lab results for HA1c are considered normal by most medical providers if they are between 4 and 5.6. Most integrative providers would advise patients that any HA1c result that it above 5.2 indicates that glucose levels are elevated and that a patient has significant inflammation in the body and the body is aging faster. These are factors that contribute to someone becoming prediabetic, and eventually experiencing type 2 diabetes.

Avoiding Prediabetes and Type 2 Diabetes

Of the three classifications of diabetes, type 2 diabetes and its precursor, prediabetes, are the only two that have significant risk factors that can be eliminated through healthy lifestyle choices and with supplementation. According to WedMD.com, risk factors for type 2 diabetes include:
  • Obesity or being overweight. Research shows this is a top reason for type 2 diabetes. Because of the rise in obesity among U.S. children, this type is affecting more teenagers. 
  • Impaired glucose tolerance. Prediabetes is a milder form of this condition. It can be diagnosed with a simple blood test. If you have it, there’s a strong chance you’ll get type 2 diabetes. 
  • Insulin resistance. Type 2 diabetes often starts with cells that are resistant to insulin. That means your pancreas has to work extra hard to make enough insulin to meet your body's needs. 
  • Ethnic background. Diabetes happens more often in Hispanic/Latino Americans, African-Americans, Native Americans, Asian-Americans, Pacific Islanders, and Alaska natives. 
  • High blood pressure. That means blood pressure over 140/90. 
  • Low levels of HDL ("good") cholesterol and high levels of triglycerides. 
  • Gestational diabetes. If you had diabetes while you were pregnant, you had gestational diabetes. This raises your chances of getting type 2 diabetes later in life. 
  • Sedentary lifestyle. You exercise less than three times a week. 
  • Family history. You have a parent or sibling who has diabetes. 
  • Polycystic ovary syndrome. Women with polycystic ovary syndrome (PCOS) have a higher risk. 
  • Age. If you're over 45 and overweight or if you have symptoms of diabetes, talk to your doctor about a simple screening test. As sex hormones drop during menopause and andropause, the risk for diabetes increases. 

Of these 11 risk factors, only a few cannot be influenced by dietary, exercise, and supplementation choices. Reducing the risk factors that lead to prediabetes and eventually to type 2 diabetes not only slows the body’s aging process, but also reduces the risk of other serious health conditions and can promote lower health care costs over a lifetime. To lower the risk factors of prediabetes, the following lab values should be checked annually (or more often if you or your physician have concerns):
  • Hemoglobin A1c. As discussed earlier, a score of greater than 5.2 indicates elevated glucose levels. 
  • Fasting Comprehensive Metabolic Panel. This lab includes a blood glucose level; a value of higher than 99 is indicative of insulin resistance. 
  • Fasting Morning Insulin. This value should be between 2 and 10. 

In addition to these labs, integrative physicians also evaluate thyroid function and the levels of certain vitamins to eliminate other metabolic reasons that may be contributing to prediabetes. These labs help create a clearer picture of a patient’s health and direct the customization of a treatment plan:
  • Thyroid hormone values. An imbalance of thyroid hormones can interrupt proper metabolism and affect insulin’s ability to regulate blood glucose. Integrative physicians look for the values of these hormone labs the be in these ranges and evaluate based on patient feedback: 
    • T3, or triiodothyronine. Range: 3.0 – 4.5 
    • T4, or thyroxine. Range: 1.0 – 1.5 
    • Reverse T3, or reverse triiodothyronine. Range: 10 – 20 
  • Vitamin D. Low levels of Vitamin D can cause a host of symptoms including hypothyroidism, which can affect blood glucose regulation. Range: 65 – 85. 
  • Vitamin A. Low levels of Vitamin A can cause a host of symptoms including hypothyroidism, hypercholesterolemia, or poor glucose control. Range: 65 – 85. 
  • Chromium. Chromium supports the transfer of blood glucose from the blood into cells. Low level s of chromium can also push someone towards prediabetes. This is often measured via a taste test. 

Evaluation of these lab values may dictate a treatment plan that includes pharmaceuticals and nutritional supplementation. Working with a physician to monitor thyroid function and blood glucose levels is necessary if any of the lab values are significantly out of balance. In addition to pharmaceuticals that a physican may prescribe, the following supplements help with blood glucose regulation: Alpha-lipoic acid, American ginsing, Gymnema Leaf Extract, Green Tea Polyphenols, and Chromium. Most integrative providers and supplement specialists can provide dosing instructions for these products.

Providing the right support for organ function, either with nutrition or pharmaceuticals, is secondary to eliminating the top risk factor: obesity or being overweight. Individuals who carry excess weight can significantly reduce the risk of prediabetes and type 2 diabetes by modifying the foods they eat. A meal plan that includes the following is beneficial:
  • High-fiber foods – Fiber helps slow down glucose absorption. Aim for at least 30g of high fiber foods per day from vegetables, berries, nuts, and seeds. 
  • Chromium-rich foods – Foods such as raw cheese, Brewer’s yeast, broccoli and other foods are high in chromium. Chromium deficiency can lead to poor blood sugar control. 
  • Coconut – MCFA’s found in coconut can help balance blood sugar levels and be a preferred fuel source for your body rather than sugar. Including coconut oil, coconut milk, coconut butter in your diet is a great way to intake MCFA’s. 
  • Wild-caught fish – Omega-3 fats reduce inflammation and can help counteract some of the negative effects of elevated blood glucose. 
  • Low-glycemic load foods – Foods with a low glycemic value tend to not spike blood sugar as much as high glycemic foods. 

Special care to AVOID the following foods should be included in efforts to reduce weight:
  • Sugar and grains – Refined sugar rapidly spikes blood glucose and a high grain diet also negatively affects blood sugar levels. 
  • High-fructose corn syrup – This is a sweetener made from corn starch that has been processed by glucose isomerase to convert some of its glucose into fructose. Some studies indicate the rise in obesity in the US is directly proportionate the the use of HCFS in processed foods. 
  • Soda, juice, or other sweet beverages – These forms of sugar enter the bloodstream rapidly and can cause extreme elevations in blood glucose. 
  • Refined and processed foods – Any foods that are refined, processed, and contain no fiber generally will raise blood glucose. 
  • Alcohol – Can dangerously lower blood sugar. Beer and sweet liquors are high in carbohydrates and should be avoided. 

Finally, scheduling time to exercise at least three times a week for thirty minutes or more can help reduce excess weight and lower blood pressure – two significant risk factors in becoming prediabetic. While type 2 diabetes is a disease that can be managed, it is expensive to do and it can tremendously reduce the enjoyment of life. Taking charge of personal health by making lifestyle choices that support healthy aging reduce the risk of diabetes. Get started today!