Diabetes Awareness Week

Diabetes Mellitus is an abnormal physiologic response to blood sugar and insulin. It is important to understand NORMAL physiology before we can understand how diabetes is abnormal.
Our blood sugar is controlled to a very narrow range. The normal range of blood glucose is 4.0-7.88mmol/L - these are important numbers to looks at. 
We start to have symptoms of true hypoglycemia. Hypoglycemia can be mild, moderate, or severe.

• Mild Hypoglycemia: nausea, jittery/trembling, cold/clammy/wet skin, rapid heart beat (tachycardia)
  
• Moderate Hypoglycemia: irritability/anxiety,
• Severe Hypoglycemia:

Understanding Diabetes Type I & Type II
We have a fairly good understanding of Diabetes these days. Every cell in your body needs sugar for energy, and sugar enters the cells through the action of insulin. When sugar can’t enter cells, it accumulates in the blood. 

• Type 1 diabetes usually appears in childhood, and is caused by the body’s inability to produce insulin. Type 1 diabetes is the discovery (and production) of insulin transformed type 1 diabetes from a death sentence to a chronic illness. I’m also going to ignore the other forms of diabetes (e.g., gestational diabetes).
• Type 2 diabetes is different. Either the cells are insensitive to insulin, or the body does not make enough to lower blood sugar – or it may be a combination of both effects. Type 2 diabetes is predominantly a disease of older adults. Type 2 diabetes is a chronic illness that is managed with a specific goal – reducing the complications of the disease. Diabetes can lead to cardiovascular disease (e.g., heart attacks), cerebrovascular disease (e.g., strokes), eye disease causing blindness, kidney disease leading to kidney failure and dialysis, and nerve disease leading to problems like foot ulcers that can eventually lead to amputations. The risks of these outcomes are reduced by managing blood sugar levels. Evidence shows that those with diabetes can have fewer complications if they can control blood sugars effectively. (How intensely blood sugar must be managed is a continued source of debate.)
  

There are three main lifestyle components to managing diabetes before turning to medication, and they are the cornerstones of treatment:

• dietary changes
• regular exercise
• weight control
  
  
  

Diabetes: The facts

The brain is a ‘Glucose BEASTLY HOG!
It consumes roughly 1/2 of the circulating blood sugar. It requires glucose (almost exclusively) and this is why most of the symptoms associated with true hypoglycemia are neurologic in nature. However, those who are appropriately adapted do very well with ketones as a fuel source for the brain.Since we don’t know (at least our bodies don’t know) when we are going to be able to eat again, we have to have a mechanism that increases blood sugar to keep it above 70.

Glucagon is released from the Alpha cells in the pancreas. It is the hormone responsible for making new glucose (gluconeogenesis) in the liver and mobilizing fatty acids for energy utilization.

Cortisol is released from the adrenal glands which works to break down muscle and stimulate gluconeogenesis in the liver. Blood sugar dysregulation is a major contributor to adrenal fatigue and hypercortisolism.

Blood Sugar >10
This issue is also very important because, at levels above 100, glucose begins to be toxic. These elevated levels increase the formation of Advanced Glycation End-Products (AGE) which are very pro-inflammatory and are responsible for the multiple medical problems that patients with uncontrolled diabetes often end up getting.

Insulin is the hormone responsible for keeping blood sugar below 10. It protects us from the toxic effects of hyperglycemia.
There are 4 primary tissues that utilize and/or store most of the glucose we consume or create:

1. Brain – as stated above, it utilizes a lot of glucose. It does not need insulin to get glucose into its cells
2. Liver – stores about 100 grams of glucose in the form of glycogen. That isn’t very much. Its about 3 cans of Coca-Cola. The liver requires insulin to get glucose into the hepatocyte (liver cell).
3. Muscle – stores a limited amount of glycogen. Muscle needs insulin to get glucose into the myocyte (muscle cell) except during exercise.
4. Adipose (fat) – Adipocytes (fat cells) also require insulin to get glucose into them. This is the ultimate repository for continual elevated blood glucose, once liver and muscle sources are full. The excess glucose has to go somewhere and the adipocyte is the storage location.

HOW IS DIABETES DIAGNOSED?

A blood test is taken from a vein and sent to a pathology lab. The tests done can include:

• a fasting sugar (glucose) test - fasting is required for at least eight hours, such as eating or drinking overnight
  
• a random glucose test taken anytime during the day
• an oral glucose tolerance test (OGTT) - where a patient who has fasted drinks a sugary drink and then has a blood test done 1 and then 2 hours later

Treatment
Regardless of the type of diabetes, Naturopathic & Nutritional Medicine treatment strategies aim to get a patient’s blood sugar levels back within a healthy range. For example, even though type 2 diabetes is caused by a number of factors, most of them are controllable, including diet, physical activity, stress, eating habits and behaviors, and obesity.
Nutritional deficiencies, environmental toxins and hormonal imbalances can also contribute to insulin resistance, and require special training to evaluate.
A Naturopathic Doctor/Nutritional Medicine Doctor explores all of these factors to determine which ones should be prioritized and how they can be modified.
A visit with a Naturopathic Doctor to address diabetes will include a comprehensive intake and physical exam, along with review of health history, diet, and lifestyle factors. Any recent lab work will be reviewed, and new labs will be ordered if needed.

Generally, a Naturopathic treatment approach for diabetes includes a combination of:

• Review of diet diary and/or blood sugar log
• Dietary guidance to strive for more balanced blood sugar throughout the day
• A thorough review of other systems impacted by diabetes, including the heart, kidney, liver, and brain
• Lifestyle counseling strategies to engage patients in their own disease management and encourage lifestyle improvement
• Preventative strategies to avoid disease worsening
• Herbs and/or nutritional supplements to correct nutritional deficiencies and/or support blood sugar management
• Consultation on medication management (including insulin)
  
  

Following an initial appointment, a Naturopathic Doctor will determine which areas are the highest priority to address and which approaches are likely to be most effective. These will be used to create a personalized treatment plan.

The thing that is IMPERATIVE is to seek assistance in the management of Diabetes.

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