Treatment of type 2 diabetes is best approached in a holistic manner.
Diabetes pathophysiology was explained earlier to prepare you to understand how important each of the components of therapy is. What has to be achieved by the treatment plan is that blood sugars stay in the normal range, even after meals. The most important aspect of the therapy therefore is to adopt a diabetic diet plan, where sugar and starch (rice, pasta, potatoes) are limited. This needs to be supervised for several months by a registered dietitian. Changing eating habits is a challenge, that’s why a registered dietitian’s input is important. As we cut down on the sugar/starch load the insulin producing cells in the pancreas are preserved and the glucose-6-phosphatase enzyme in the liver will function normally again, which leads to the retaining of glycogen at meal times with a slow release of sugar from a controlled breakdown of glycogen between meals.
The second aspect, which often is overlooked by the diabetic patient is to change the life style to include a home exercise program, if it has not already been done. By changing to a more active life style where every day there is some speed walking, swimming, square-dancing, ballroom dancing or similar regular physical activity, the metabolism is being changed. Why is this important? Because we know that the insulin resistance and sugar toxicity is being controlled this way. To stubbornly attempt to treat diabetes with only pills or only insulin without paying attention to the patient’s life style and without paying attention to the direction, in which the hemoglobin A1C is moving, would be a big mistake. Unfortunately the patient would be paying the price with avoidable complications and premature death.
In the mid 1980’s the hemoglobin A1C level became available on a large scale, which is still one of the most valuable diagnostic tools in this century. In the past it was said that this should be less than 7%. However, in the meantime we know that people still got complications from diabetes at this level and the recommendation now is that a normal hemoglobin A1C level is 5.7% to 6.4%, while a patient with a Hgb A1C of 6.5% and larger is considered to have diabetes. When patients are in the normal range of Hgb A1C their blood sugar is also below 140 mg/dL 1 hour after a meal, most likely even at 100 mg/dL or below. The best way for the diabetic to monitor their disease is to measure blood sugar 1 hour following a meal using the glucometer at home.
Fast forward to 2014/2015: At the 22nd Annual World Congress on Anti-Aging Medicine in Las Vegas Dec. 10-14, 2014 Dr. Theodore Piliszek gave a lecture entitled: “Personalized Genetics: Applying Genomics to General Health, Nutrition, and Lifestyle Modification”. In it he revealed that the previous recommendation of a hemoglobin A1C of 6.5% or less was a biased recommendation. He said that the new normal range for hemoglobin A1C is now 3.8 to 4.9%! A patient whose hemoglobin A1C is 5.5 has diabetes and needs to be treated aggressively to prevent complications associated with diabetes (blindness, heart attacks, amputation of limbs etc.)
There were large trials showing in type 2 diabetes patients that pills were not as good as insulin injections in controlling hemoglobin A1C levels or controlling after meal blood sugars optimally. We also knew from studies with type 1 diabetics that there was less mortality in patients who were treated with 3 or 4 insulin injections per day.
However, the “dogma”(or the prevailing teaching) in the 1980’s was that type 1 diabetes should be treated with insulin and type 2 diabetes should be treated with pills. On the positive note diabetologists (diabetes specialists) have been able to study the metabolic syndrome (=syndrome of insulin resistance) in more detail and how this can lead to insulin resistance and diabetes type 2.
They have found that type 2 diabetics may need both oral hypoglycemic tablets to control the insulin resistance as well as insulin injections to control the hyperglycemia. Now it is common knowledge that patients with type 2 diabetes often need both hypoglycemic medication and insulin needles for optimal control and long-term survival without complications. The physician is guided by how well the blood sugar is controlled using a one touch glucometer by the patient. The physician will also order hemoglobin A1C measurements every 3 months to see whether normal blood sugars are present most of the time over the long-term.
Newer therapeutic interventions for diabetes
Based on newer insights regarding diabetes the following points can be made:
1. Dietary changes are an absolute must. A Mediterranean diet or a DASH type diet is the beginning. Essentially sugar intake should be limited and pasta/potatoes/rice and other high glycemic foods need to be avoided as much as possible. This is easy when you replace these with low glycemic foods and you prepare low calorie snacks and keep them in the fridge for the times when you are hungry. A low calorie diet is what we are after as this has been proven to both control diabetes and also lead to longevity.
2. Green coffee bean extract (380 to 400 mg three times per day) has been proven to slow sugar absorption from the gut and leads to lower after-meal sugar concentrations in the blood.
3. Do frequent glucometer readings 1 hour after a meal to determine how well the blood sugar is controlled (normal is less than 100 mg/dL). Keep the hemoglobin A1C level in the 3.8 to 4.9% range.
4. Metformin: This medication is useful for those who have a high fasting insulin level as it works on insulin resistance, is an anti-inflammatory and has several other benefits. It slows absorption of sugar from the gut, inhibits the breakdown of glycogen in the liver and suppresses appetite. The result is a lowering of blood sugar, of insulin, of LDL cholesterol, triglycerides and C-reactive protein.
5. Nitric oxide (N-O): It has been known for some time that people who have diabetes age faster. Uncontrolled high blood sugar levels cause free radicals to be released into the blood stream due to oxidative stress. This damages the lining of all blood vessels and reduces the production of nitric oxide that is normally produced there. With normal nitric oxide production the blood vessels will be wide open, but deficient nitric oxide leads to high blood pressure, heart and brain vessel damage, kidney damage and damage to the retina of the eyes. In short it is the associated lack of nitric oxide production that is responsible for the complications of diabetes (Ref.36 and 37). A product, called NEO 40 is able to rebuild the lining of the arteries naturally with only two lozenges per day. This supplement contains red beet and hawthorn.
6. Exercise: As already indicated above, exercise is important for diabetics. Newer studies have shown that exercise stimulates the lining of the arteries to produce nitric oxide, which counteracts the metabolic derangements associated with diabetes (Ref. 38).
7. A newer finding based on a small study from June 2014 found that 200 mg of resveratrol per day significantly improved long-term glucose control with a reduction of hemoglobin A1C (see this link with more information).
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