Diabetes Part 1

DIabetes - a most preventable problem

Diabetes is one of the most well understood diseases by medical authorities and the public alike. Most people understand that it means too much sugar in the blood, that children who get it have it for life and that adults who get it need to watch their diet, take tables and may eventually need to take insulin.

Despite excellent public education about diabetes, there is an epidemic rise of both Type 1 and Type 2 diabetes globally. The cause for the increased incidence in Type one diabetes remains a mystery, but in developed countries, Type 2 diabetes is attributed to errors in diet and lifestyle being a major contributing cause.

Whether a person chooses orthodox medicine or natural therapies, there are proven ways of managing symptoms of Type 2 diabetes, achieving good blood sugar control and in some cases curing the condition.

Firstly though, let’s have a look at the condition and what it does in the body. Quite literally, ‘Diabetes Mellitis’ means sweet urine. ‘Diabetes’ is a Greek work meaning that which passes through. ‘Mellitis’ comes from the Latin word Mellis which means honey.

The hormone responsible for controlling sugar in the blood is insulin, which is produced by the pancreas. When we feel hunger, it is a sign that the blood sugar is low.  Eating carbohydrates raise blood sugar which relieves hunger. The resulting sugar in the blood stimulates the production of insulin. Insulin works to remove the sugar from the blood and converts this sugar into energy for the body. When excess insulin is stimulated by eating too much carbohydrate and sugar, the excess energy is stored in the body, in the form of fat, making insulin is a ‘lipogenic’ or ‘fat forming’ hormone. In healthy people, diet, insulin production and energy levels are balanced, resulting in a person of normal weight with good energy levels.

Type 1 Diabetes

Type 1 (Juvenile Onset) diabetes usually occurs in people under the age of 30 years, caused by an auto -  immune process that destroys the insulin-producing or islet-beta cells in the pancreas. It is called ‘Insulin dependent diabetes mellitis’ (IDDM) because it requires treatment with insulin injections. IDDM affects approximately 15 per cent of people with diabetes. (1) Studies show a high, and rising incidence of IDDM in the past two decades in Europe and Australia. (2) and it now ranks as the most common chronic childhood disease in developed countries. (3) In New South Wales the incidence doubled in children under 5 years of age  between 1985 and 2002, leading researchers to conclude this rise of Type 1 diabetes is “due to a major environmental effect.” (4) The reason for this rise is as yet unkown, but one must ask the question of why an auto immune disease like this is so rapidly rising.  In one study, an association between diabetes and a viral trigger causing an auto immune response has been made. (5)

Gestational Diabetes Mellitis (GDM)

GDM occurs when an intolerance to glucose and carbohydrate develops during pregnancy. GDM is increasing in prevalence and many researchers believe that this increase parallels the international rise in Type 2 Diabetes. Women with GDM are managed with dietary measures, with some cases requiring insulin therapy.

“The incidence of diabetes worldwide is expected to double in the next ten years affecting over 200 million people world wide………..dietary modifications can help considerably in improving blood-glucose control and reduce the many complication caused by this condition.”

American Journal of Clinical Nutrition Vol 45, 1987

Type 2 Diabetes

Type II diabetes used to be a disease suffered by overweight men and women over the age of 60 years old. People with Type 2 diabetes have an impaired ability to convert the sugar in their blood into energy in their muscles. This is partly because they don't produce enough insulin, and partly because their fat and muscle cells don't use insulin effectively, a phenomenon known as 'insulin resistance'.

In the past ten years, this middle aged disease has begun to affect children as young as ten years old. Health authorities are predicting that childhood (Type II) diabetes is set to reach epidemic levels by increasing 20-fold over the next ten years.

In 2001 a UK study of 38 general practices, covering a population of 326,000 indicates that the prevalence of Type II diabetes has increased by more than 50% in a decade. (6)

Professor Martin Silink, head of the Institute of Endocrinology at Sydney’s Royal Alexandra Hospital, says that childhood diabetes was almost unheard of as little as five years ago. “Now it is almost like a new disease.” Professor Paul Zimmet, head of the International Diabetes Institute in Melbourne, believes that soon the number of Type II childhood diabetics will outnumber the Type I childhood diabetics. He estimates that in Australia 5000 children under the age of 18 now have Type II diabetes, where ten or more years ago it was unheard of in children.

Diabesity

This new childhood diabetes is, caused by high blood sugar levels from a diet high in sugar, fat and lack of exercise. Since 1985 the number of overweight and obese children in Australia has doubled, which is part of a worldwide trend. One in four Australian children are overweight and one in 20 children are obese. In their adult life, children who now have Type II diabetes will suffer from health problems, like a hugely increased risk of heart disease, blindness, kidney disease and poor limb circulation.  These diseases of the developed world are entirely preventable.

The cause of this trend is quite clear to medical personnel – an excess of sugary, fatty foods and a lack of exercise. Long working hours, fast food, TV and computer games are huge contributing factors. Unless this trend changes with an improved diet and increased physical activity, the course of Type II diabetes in children is set to continue.

FACTS ON DIABETES

Risk Factors for developing Type 2 diabetes are:

  • Chinese, Indian Pacific Islander, Australian Aboriginal race, over 35 years

  • High blood pressure

  • Heart disease

  • Family history of diabetes, or diabetes in pregnancy. 


  • Overweight or obesity

  • Are over 55 years of age

Key signs and symptoms of diabetes

  • Increased thirst

  • Slow healing of cuts

  • Frequent urination

  • Itching, skin infections

  • Feeling tired and lethargic

  • Blurred vision

  • Constant hunger

  • Unexplained weight loss

How is diabetes managed?

  • Education - individual responsibility

  • Healthy eating

  • Regular physical activity

  • Medication - tablets and/or insulin injections

  • Regular health checks with various members of the diabetes team

  • Maintaining a positive mental attitude

  • Monitoring  blood glucose levels & maintain between 3.5-8 mmol/L

Aims of treatment

Keep blood glucose levels close to normal (see GI Factor)

Prevent short term effects of high and low blood glucose levels

Prevent long term complications (blindness, kidney disease, numbness & poor circulation, ischaemic heart disease)

Source: Diabetes Australia – Victoria http://www.dav.org.au/content.asp?rid=500

Treatment

Treatment  for Type 1 diabetes is insulin therapy and a low carbohydrate, sugar free diet. Gaining good blood sugar control is the aim of treatment, and is important to avoid the long term complications of diabetes, like diabetic retinopathy and cataracts that cause blindness, kidney disease, poor circulation that can lead to diabetic ulcers amputations, and chronic heart disease.

Treatment for Type 2 diabetes is very, very simple and well proven. Better diet, more exercise and weight loss leads to improved blood sugar control. A simple example of this, is an elderly and rather overweight man who had been diabetic for 20 years or so, sadly had a stroke and was hospitalised until his death. However, during his prolonged stay in hospital, he lost a large amount of weight – and his diabetes. His elevated blood sugar levels became completely normal, and the long-standing medication he needed was no longer necessary.

Diet

Many patients are able to achieve good blood sugar control and avoid medications and insulin by improving their diet. Dubbed as ‘a glucose revolution’ is the glycaemic index (GI), in a diet. The glycaemic index is the study of the effect of food on blood glucose levels. Some carbohydrates break down quickly during digestion, leading to a rapid rise in blood sugar. These foods have a high glycaemic index. Other carbohydrates break down slowly, releasing glucose slowly into the bloodstream. Using low GI foods is explained clearly for patients in a revolutionary book written by researchers from the University of Sydney (7), where they outline how to normalise  blood glucose levels by making the right food choices. A low GI diet can help to avoid chronic diseases like diabetes and heart disease, help to control and lose weight. This book contains all the dietary information a person suffering from diabetes, or is at risk of developing it, needs, and is highly recommended. It is revealing about which foods raise blood sugar levels. For example, eating potatoes raises blood sugar more quickly than eating sugar itself.

GI (GLYCAEMIC INDEX) FACTOR FACTS

  • High GI diets can increase the risk of developing heart disease and diabetes

  • Many diets are too high in fat and low in carbohydrate

  • Carbohydrates in many diets have a high GI and are absorbed too quickly, leading to higher blood sugar levels

  • Middle aged people who eat a low GI diet are less likely to develop diabetes and heart disease

  • Low GI diets can help to control established Type 2 diabetes

  • Low GI diets can help people to lose weight

  • Low GI diets can help to lower blood lipids (and therefore heart disease risk)

  • Low GI diets improve the body’s sensitivity to insulin

  • Low GI foods include cereals based on wheat bran, oats, psyllium, grainy breads, pasta and acidic foods like vinegar and lemon juice.

  • Acids in food, like red wine vinegar, or lemon juice slows digestion of carbohydrates and lowers blood glucose levels by up to 30 per cent.

  • Sourdough breads contain acids which also reduce blood sugar and insulin levels.

Source: The GI Factor – The Glucose Revolution by Miller, Powell Colagiuri, & Leeds. Published 1996 by Hodder Headline Australia Pty Ltd ISBN 0 7336 1239 3

Exercise

Physical activity improves glucose tolerance, even in the absence of weight loss. Regular exercise also improves levels of High Density Lipids (fats) or ‘HDL’s. HDL’s are the beneficial blood fats that prevent the clogging of arteries, which is an ongoing risk for diabetics. It ‘s the artery

clogging which causes heart disease and poor limb circulation in diabetic (and non-diabetic) patients.

“In a pilot study supported by local Vetinerary Affairs funds, one week of aerobic exercise training improved insulin sensitivity as expected, but also improved (pancreatic) beta-cell function in sedentary older people with Impaired Glucose Tolerance………….” (8)

Exercise activates a chemical in muscle, which helps in the uptake of glucose from the circulation into tissues in the body - the major reason that exercise is an essential part of treatment.

The issue of exercise

International guidelines for physical activity for children should be increased to 90 minutes per day, according to the results of a cross-sectional study reported in the July 22 issue of The Lancet. (9)

Children

The new childhood diabetes is Type II, caused by high blood sugar levels from a diet high in sugar, fat and lack of exercise. Since 1985 the number of overweight and obese children in Australia has doubled, which is part of a worldwide trend. One in four Australian children are overweight and one in 20 children are obese. It is these overweight and obese children who are suffering from Type II diabetes.  In their adult life, children who now have Type II diabetes will suffer from health problems like a hugely increased risk of heart disease, blindness, kidney disease and poor limb circulation.

The cause of this trend is quite clear to medical personnel – an excess of sugary, fatty foods and a lack of exercise. Long working hours, fast food, TV and computer games are huge contributing factors. Unless this trend changes with an improved diet and increased physical activity, the course of Type II diabetes in children is set to continue.

Inevitably, this means less TV, computer games and fast food. Given the choice, children almost always choose chocolate, potato chips, ice cream and hamburgers, so parents are faced with a crucial challenge.

Children are not always able to make healthy choices for themselves until they reach their mid-late teens. They need to be taught what is healthy. It is a rare child who refuses to watch television or eat takeaway, given the chance. They will always say they prefer pizza, chips, ice cream and fizzy drinks in place of vegetables or fruit.

An interesting study was conducted in a UK school, where during lunchtimes children were given the choice to either use school computers, or play in the playground. Given the choice, most children became involved in computer games. However, when they were actually instructed to play in the playground and questioned afterwards, most said that although they would have chosen to use the computer, they enjoyed playing in the playground much more, and felt better afterwards. There is a huge trend in UK schools to help children make healthy food choices and keep active.

Medication

When a patient is diagnosed with Type 2 diabetes, they are often informed that in order to control their blood sugar, eventually they will need medication and that insulin therapy is inevitable.

The Search for a Cure

Researchers continue to search for a way to cure and prevent diabetes from developing. This would be particularly helpful for those who suffer from Type 1 diabete and insulin therapy is their only option. Treatment trials are being conducted using stem cell therapy, medications to alter metabolism via enzymes and immunotherapy.

WAKE UP AUSTRALIA

A report by the Institute of Health and Welfare has found the number of diagnosed cases of diabetes in Australia has more than doubled since 1990. (10) And experts believe for every confirmed case, there is an undiagnosed one. Costs to the health care system are $907 million in per year.

Source: News in Science

http://www.abc.net.au/news/stories/2008/03/28/2201510.htm?site=science&topic=latest