Diabetes Is Not a Life Sentence -
Medical Associate Newsletter
by Dr. Luis Valencia
Medical Associate, Aegle Wellness Center
Type II Diabetes Mellitus (T2DM), is one of the biggest health problems in the world with an estimated incidence of 40 million in Southeast Asia in 2010. If trends continue, this number could double to 80 million people by 2030. T2DM is the leading cause of adult blindness, peripheral vascular disease, and kidney disease worldwide, thereby making it a health burden to many countries. While it is a disease that usually affects middle-aged adults, there is growing evidence that newly diagnosed T2DM is affecting younger individuals in their late twenties or early thirties. Although T2DM has a genetic expression component, its manifestation is very much influenced by an individual's lifestyle.
The Root of the Problem:
Individuals with T2DM have blood sugar elevation due to the presence of a condition called insulin resistance, and not due to the absence of insulin which is the pathological condition seen in T1DM.
Insulin is a hormone produced in the pancreas. In normal individuals, as one is about to eat, insulin is released by the pancreas into the circulation. Like a lock-and-key mechanism, insulin attaches itself to the insulin receptor, signaling the cell to open up the glucose channels to allow glucose to enter the cell and serve as the fuel for all its metabolic processes. (See figure below)
Insulin enables the liver and the muscle cells to store excess glucose as glycogen, a reserve source of fuel during fasting or increased physical activity. Insulin also enables the fat cells to store triglycerides as an additional source of energy during prolonged fasting.
When a person has T2DM, however, the receptors do not recognize their own insulin. The lock-and-key mechanism does not work, and as a form of compensation, the pancreas produces more than enough insulin to "unlock" more receptors — this is called impaired glucose tolerance (IGT) characterized by mild elevations of blood sugar.
In the later stages, the receptors become less responsive. As such, glucose remains in the blood, and not inside the cells where it is supposed to be used for fuel. In Figure 2, you can see that there is more of the glucose (the small white spheres) remaining in the blood vessels rather than going to the liver and muscle tissues.
Excess glucose in the blood literally creates a very sticky circulation. If it persists over prolonged periods of time, the glucose damages the proteins within the vessel walls, narrowing the opening, and eventually depriving the tissues it supplies of good circulation. In effect, tissues choke on sweet blood.
How Can I Prevent It?
If you have at least one immediate family member who is already diabetic, have your fasting blood sugar checked at least annually. If your level is <100 mg/dl (<5.51 mmol/L), this is normal. But you are encouraged to make lifestyle alterations already just so T2DM doesn’t even have a chance to hit you. Have your body composition analyzed and target to keep your BMI within normal, percentage body fat at 18%, and visceral fat score of <10.
A fasting blood sugar level persistently beyond 140 mg/dl (or above 7.75 mmol/L) is usually diagnostic, especially if this is associated with T2DM’s classic 3 P's: polyuria (increased frequency of urination), polydypsia (increased thirst), and polyphagia (persistent hunger). If your fasting blood sugar is above 100mg/dl but less than 140 mg/dl, you may still be having what is called Impaired Glucose Tolerance (IGT) or pre-diabetes. If managed properly through stringent lifestyle modifications, IGT will not necessarily lead to overt T2DM.
You may opt to have more frequent blood sugar testing if you have an immediate family member who is already diabetic. Early diagnosis, especially if you are still in the IGT stage, is crucial in mitigating, if not totally preventing, the disease and its dreaded complications.
I Am Already Diabetic, What Can I Do?
If you are already diabetic, simply popping pills will not be enough for you to control your blood sugar. Although there are many new drugs that act in many different ways to lower blood sugar, these are not sufficient if they are not accompanied by proper lifestyle modifications:
Your diet definitely has to change. It does not have to be boring. It just needs to be nutritious. Avoid simple sugars, simple carbohydrates, preserved foods, and fast food as much as possible. You need to consider these as "poison" for you. Instead, focus your carbohydrate intake on root crops, whole grains, and vegetables. Choose lean sources of protein, and be judicious in the types of oils that you use for cooking and for dressings.
According to a study published in 2013 in the American Journal of Clinical Nutrition, following a diet similar to the Mediterranean diet seems to be most favorable for maintaining a healthier blood sugar level, thus delaying the onset of the different complications of diabetes.
It is highly advisable that you consult with a nutritionist who will guide you in more concrete ways on how to prepare your food from the market to the table.
Be Active and Exercise:
Cardio exercises thrice a week coupled with some resistance and balance training twice to thrice a week is very favorable. Why? Aside from improving your circulation, doing some resistance training will improve your muscle mass, which usually declines with prolonged blood sugar elevation. Balance training is important since the peripheral nerves, especially in the lower extremities, which sense proper posture and body sense are the most vulnerable to degeneration if exposed to uncontrolled blood sugar levels.
Most doctors will not recommend supplementation. I would, for one simple reason: being diabetic makes your cells age faster than those of a normal individual due to the cells’ exposure to high oxidative stress. Aside from keeping your blood sugar level as normal as possible, it is equally important to protect your cells by giving them an adequate amount of antioxidants through supplementation.
What to Aim For?
If you’re diabetic, it would be ideal to keep your fasting blood sugar below 100 mg/dl plus your hemoglobin A1C below 6.5%, with one medication or even none, and control it mainly through proper nutrition, exercise, and antioxidant supplementation. If you are on a multiple-drug regimen, aim for getting rid of one or two of your medications through proper lifestyle modification. If you’re a diabetic committed to your health, consider this: the regimen you will have is no different from an individual committed to being well and healthy anyway. Changing your perspective about being diabetic will free you from the sugar bind.
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