Type 1 Diabetes
Type 1 diabetes is also known as ‘Juvenile Diabetes’ as it is most often diagnosed in childhood or adolescence. Type 1 diabetes is a genetic condition that involves the loss of beta-cells from the pancreas whose function is to produce insulin. This in turn leads to a lack of insulin in the body and therefore a dysfunction of blood sugar regulation which may result in several different complications if not monitored and managed properly. For reasons of complexity, the majority of this article will focus on monitoring, treatments and risks of Type 2 diabetes.
Type 2 Diabetes
Type 2 diabetes differs from Type 1 as it is not independently related to genetic causes and is caused mainly by poor diet and lifestyle. People with Type 2 diabetes are still able to produce insulin, however the receptors that take up the sugar from the blood have become resistant or less sensitive to the insulin and will therefore lead to higher levels of blood sugars. Type 2 diabetes is generally diagnosed later in life, but there has been a great increase in the number of children and adolescents diagnosed with Type 2 diabetes due to the availability of processed foods and refined sugars. The most effective treatments for Type 2 diabetes include diet and lifestyle changes.
Hormones involved in blood sugar regulation
Insulin is made in the pancreas by beta-cells and is secreted in to the body after the consumption of sugars. It functions to remove the sugar from the bloodstream and deliver it to the tissues of the body to be used as energy. Special receptors on the tissues recognize the insulin and this acts as a signal to move sugar out of the blood therefore lowering the amount of sugars in the blood stream. When the body is consistently overloaded with sugar, the receptors become less sensitive to this signal and high blood sugars are seen upon testing and Type 2 diabetes is diagnosed.
Glucagon, which is also made by the pancreas, essentially acts in opposition to insulin and signals the liver to convert stored glycogen to glucose and send it in to the blood stream. This is done in response to low sugar in the blood as it draws from the stored glucose to feed starving tissues in the absence of food sources.
Monitoring and Lab Work
Fasting Blood Glucose
This test is used as a screening test for diabetes and measures the amount of glucose or sugar that remains in the blood after fasting for 8-12 hours. This can be an indicator for how well the insulin signal is working or if the body is lacking insulin. High blood glucose results should be repeated at a later date in order to make a diagnosis.
Oral Glucose Tolerance Test
The OGTT involves a challenge to the system with a standard glucose solution after a fasting blood glucose test. The blood sugar is then measured two hours after ingesting the glucose solution. This test is used for diagnostic purposes and commonly used during pregnancy for screening and diagnosis of gestational diabetes.
HbA1c is used to determine the amount of hemoglobin that has been effected by the elevated levels of glucose in the blood. Normally, hemoglobin carries oxygen to and from the tissues in the body through the blood, however when glucose is high it binds to the hemoglobin and disrupts its normal function. This test does not require fasting and is used mainly to monitor the effectiveness of treatments every three to six months.
Individuals diagnosed with diabetes are at greater risk for developing heart disease. This risk can be calculated using the UKPDS Risk Calculator based on equations from the Framingham Heart Study. The risk varies depending on whether or not the blood glucose levels are being monitored and controlled properly. The dangers typically lie with those who go uncontrolled and have chronically elevated blood glucose levels. It is extremely important for those with Type 1 diabetes to monitor their blood sugar levels multiple times per day for reasons that are beyond this article such as ketoacidosis however, studies have shown that those with well controlled Type 2 diabetes are able to monitor less frequently and constant monitoring may actually cause unwarranted stress and harm.
Approximately 1% of patients diagnosed with Type 2 diabetes will result in kidney failure requiring dialysis. This is caused by uncontrolled, chronically elevated blood sugar levels. Be sure to monitor kidney function appropriately with help of a medical professional.
Diabetics are at greater risk of developing neuropathy in peripheral limbs, most commonly the feet as well as in the eyes. It is important to monitor the hands and feet for any ulcerations and lack of sensation and to have eye exams performed on a yearly basis. Again, proper management of blood sugar levels can greatly reduce the risk of these complications.
Diabetes greatly increases the risk of many different comorbidities that we did not go in to detail here and these can be reduced through proper monitoring, treatment and control of blood sugar levels. If you are diagnosed with diabetes it is recommended that you work with a health care professional to assess and monitor your risks.
This is one of, if not the most effective treatment option for those with Type 2 diabetes. Physical activity leads to the muscle tissue creating more insulin receptors which ultimately increase the effectiveness of the insulin signal and more sugar is moved from the blood in to the muscle tissue. This helps regulate blood sugar levels and a difference may be seen after only a thirty minute walk. It is recommended to measure blood glucose before and after physical activity to see the vast difference that it can make. Caution is urged to those on insulin and/or medication therapy as dosage adjustments may be necessary to avoid hypoglycemia. This can be done with the help of a health care professional. Aside from lowering blood glucose levels, exercise will also lead to other positive changes such as weight loss, elevated mood and increased energy. Start with low intensity physical activity (20-30 minute walk per day) and slowly increase that intensity of the activity based on your own limitations.
Diets low in carbohydrates as advocated by Dr. Richard K. Bernstein, have been shown to lower blood glucose levels and lead to more well controlled blood sugar levels. Consuming foods that do not contain or are lower in carbohydrates limits the amount of sugars available for absorption and ultimately keeps them out of the blood stream where they can cause harm. As the body does require some form of carbohydrate in order to function optimally, it is best if the foods eaten contain mainly complex carbohydrates. These include fresh fruits, vegetables and whole grains. Complex carbohydrates take longer for the body to digest and are absorbed more slowly than simple or refined sugars which cause an immediate spike in blood glucose levels. We advocate a simple whole food diet made up mostly of plants, healthy fats and proteins.
The most common and effective drug for diabetes on the market is called Metformin. This drug helps regulate blood sugars levels without the risk of hypoglycemia or low blood sugar. It helps to increase the body’s response to the insulin released after ingesting foods. Relative to the other drugs on the market, Metformin has been shown to safely control blood sugar levels and reduce risk of cardiovascular events in those with diabetes. The main side effect of Metformin is gastrointestinal upset or abdominal pain, which is rare if prescribed properly. As mentioned previously, the best treatments for Type 2 diabetes include a healthy diet and consistent exercise, but pharmaceutical therapy may be necessary in conjunction with diet and exercise. Drugs are not a substitute for healthy living.
Insulin is used in Type 1 and advanced Type 2 diabetes. If you are currently being treated with insulin it is important to constantly monitor your blood sugar levels and use the appropriate dose as prescribed by your doctor. If starting a new diet or exercise regime that will lower blood sugars then be aware that your dose of insulin may need to be adjusted with the help of a health care practitioner.
There are several other drugs that are used in the treatment and management of Type 2 diabetes but we will not go in to detail about those in this post. Our goal with this blog is to address the most common and effective treatments for diabetes.
Type 2 diabetes has become more and more common in the last decade and is starting to be diagnosed in younger populations in epidemic proportions. This is entirely unacceptable with the advances being made today in modern medicine and the well documented connection to food, activity and diabetes. We believe that with proper medical care at an early age, Type 2 diabetes can be prevented or treated with the use of healthy foods and exercise.