Diabetes Overview

Overview

The number of people with diabetes worldwide is 382 million people. Numbers are expected to reach more than 550 million by 2030! (according to the International Diabetes Federation (IDF)).


The top countries with diabetics include China, India, United States, Russia, Germany, and Brazil. Countries with high rates of diabetes occurrence include the United Kingdom, Australia, South Africa, and Japan.


The prevalence of diabetes in the United States is estimated to be 10.3% which is relatively high. By comparison, diabetes rates are 3.6% in the United Kingdom, 9.2% in Canada, and 5.7% in Australia.


Worldwide, it is estimated that 6.4% of adults are living with diabetes and this figure is predicted to increase to 7.7% by 2030.


The number of diabetic patients is expected to double in Africa, the East Mediterranean region, Middle East and South East Asia according to estimates. 


While Europe will have an increase of diabetic patients by 20%, North America will see an increase of 50% diabetics, 85% in South and Central America and 75% in the West Pacific region. India has the dubious distinction of being the diabetic capital of the world.


The disease is one of a number of chronic conditions - along with cancer, cardiovascular and respiratory diseases - that are driving many of the top health issues around the world.


Interestingly, for drug-makers, diabetes offers riches, with global sales of diabetes medicines expected to reach $48-$53 billion by 2016, up from $39.2 billion in 2011, according to the research firm IMS Health.

World Map of Diabetes Epidemic

World Map of Diabetes Epidemic

Types of Diabetes

Overview

There are several forms of diabetes mellitus (DM), but, the 3 major types of diabetes are:

  • Type 1 Diabetes
  • Type 2 Diabetes
  • Gestational Diabetes

Other types of diabetes include: 

  • Type 1.5 LADA (latent autoimmune diabetes in adult)
  • Type 3 Alzheimer's
  • MODY (Maturity onset diabetes of the young)
  • Brittle Diabetes
  • Double Diabetes
  • Steroid-induced diabetes (incl. CFRD, Cystic fibrosis-related diabetes).

Slide: Types of Diabetes

Slide: Types of Diabetes

Doctor Appointments

Overview

You should ensure that you set up the necessary doctor appointments during the calendar year as specified by your doctor (Primary Care Physician). If possible, try to schedule your appointments during the same time period each year. The table (on the right) shows a list of the key doctor visits that you should complete during the year. 


You should visit your primary care physician and/or endocrinologist on a regular basis to review your progress, your blood glucose readings, corrective actions, and other notes – at least until you have your blood glucose level under control. 


Depending on your health needs and your health goals, you should get a complete physical and set of blood work every 6 to 12 months to identify any trends that may be getting overlooked, especially if you’re not making any significant improvements. 


Concerning your feet, you should always clean and inspect them daily. Record any abnormalities to discuss with your physician at your next visit. Keep your feet clean and moist; and wear cotton socks for better absorbency. Concerning your teeth/gums, you should always check them for any bleeding.


image216

Risk Factors

Overview

Here is a list of the major risk factors associated with Type 2 diabetes:

  • Abdominal fat: waistline greater than 40 in. (man), 35 in. (woman)
  • Note: Abdominal fat is biologically more active, causing inflammation
  • Overweight/obesity: Body Mass Index (BMI) greater than 25
  • Note: 5-10% of Type 2s are not overweight or obese
  • Poor nutrition: too many processed foods
  • Sedentary lifestyle: very little physical activity or exercise
  • Age: 45 years or older
  • High blood glucose: 126 or higher
  • High blood pressure: 130/80 or higher
  • High triglycerides: over 150
  • Low HDL cholesterol: under 40 for men, 50 for women
  • High inflammation: high homocysteine, high C-reactive protein
  • A family history: of Type 2 diabetes or cardiovascular disease
  • Non-Caucasian ethnicity: Hispanic-American, African-American, Native-American, Asian- American
  • Poor mental health: e.g. depression, anxiety
  • Gestational diabetes: during multiple pregnancies
  • Drug use: tobacco, alcohol; prescription, OTC, recreational drugs
  • Inflammation markers: C-Reactive Protein (CRP), Tumor Necrosis Factor (TNF-α), Interleukin-6 (IL-6)  

Note: If you have 3 or more of these risk factors, you may be at risk for eventually developing Type 2 diabetes. Contact your doctor and set up an appointment for a complete physical.

Picture: Risk Factors for Type 2 Diabetes

Picture: Risk Factors for Type 2 Diabetes

Symptoms

Overview

The major symptoms associated with diabetes include the following:

  • Excessive thirst
  • Frequent urination
  • Blurred vision
  • Fatigue
  • Unexplained weight loss
  • Frequent infections
  • Slow-healing sores
  • Tingling hands and feet
  • Red, swollen, tender gums

If you have any of these symptoms, make sure that you should schedule an appointment with your doctor as soon as possible.

Picture: Symptoms of Diabetes

Picture: Symptoms of Diabetes

Root Causes

Overview

The major root causes and co-factors associated with diabetes include the following:

  • Biochemical/Hormonal Imbalances
  • Chronic Inflammation
  • Hyperglycemia/Hyperinsulinemia
  • Insulin Resistance
  • Nutrient Deficiencies (Cell Starvation/Dehydration)
  • Oxidative Stress
  • Protein Glycation
  • Toxicity (Excess Cellular Toxic Load)
  • Immune System Impairment/Dysfunction
  • Healing & Cell Repair Dysfunction

The key message to get from this list is that diabetes is a complex disease with multiple root causes.

Diagram: Root Causes of Diabetes

Diagram: Root Causes of Diabetes

Medical Diagnosis

Overview

In most cases, your doctor will use one or more of the following tests to diagnose if you have diabetes:


Random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.


Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.


Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.
A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.


Another test that your doctor may perform is the glycated hemoglobin (A1C) test. This blood test, which doesn't require fasting, indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.


The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal.The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal.

Photo: Doctor & Patient

Photo: Doctor & Patient

Diabetic Medications

Overview

There are several major categories of diabetes medications:

  • Metformin (Glucophage, Glumetza, etc). Generally, metformin is the first medication prescribed for type 2 diabetes. It works by lowering glucose production in the liver. Nausea and diarrhea are possible side effects of metformin. If the side effects do not subside, your doctor may prescribe a different medication, i.e. glipizide.
  • Sulfonylureas. These medications help your body secrete more insulin. Examples of medications in this category include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain.
  • Meglitinides. These medications work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they're faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar, but this risk is lower than with sulfonylureas. Examples include repaglinide (Prandin) and nateglinide (Starlix). Possible side effects include low blood sugar and weight gain.
  • Thiazolidinediones. Like metformin, these medications make the body's tissues more sensitive to insulin. This class of medications has been linked to weight gain and other more serious side effects, such as an increased risk of heart failure and fractures. Because of these risks, these medications generally aren't a first-choice treatment. Examples include pioglitazone (Actos) and rosiglitazone (Avandia) which was pulled off the market by the FDA because of the harm it caused.
  • DPP-4 inhibitors. These medications help reduce blood sugar levels, but tend to have a modest effect. They don't cause weight gain. Examples of these medications are sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta).
  • GLP-1 receptor agonists. These medications slow digestion and help lower blood sugar levels, though not as much as sulfonylureas. Their use is often associated with some weight loss. This class of medications isn't recommended for use by itself. Examples include xenatide (Byetta) and liraglutide (Victoza). Possible side effects include nausea and an increased risk of pancreatitis.
  • SGLT2 inhibitors. These are the newest diabetes drugs on the market. They work by preventing the kidneys from reabsorbing glucose into the blood. Instead, the glucose is excreted in the urine.
    Examples include canagliflozin (Invokana) and dapagliflozin (Farxiga). Side effects may include yeast infections and urinary tract infections, increased urination and hypotension.
  • Insulin. Once the pills lose their effective or if your diabetes is far out of control (like the author), then, your doctor may prescribe insulin therapy. Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Often, people with type 2 diabetes start insulin use with one long-acting shot at night. For others (like the author), your doctor may prescribe a short-acting insulin before meals (e.g. Humalog) and a long-acting insulin at night (e.g. Lantus).
    Insulin injections involve using a fine needle and syringe or an insulin pen injector — a device that looks similar to an ink pen, except the cartridge is filled with insulin.
    There are many types of insulin, and they each work in a different way. Options include:
    • Insulin glulisine (Apidra)
    • Insulin lispro (Humalog)
    • Insulin aspart (Novolog)
    • Insulin glargine (Lantus)
    • Insulin detemir (Levemir)
    • Insulin isophane (Humulin N, Novolin N)

Author's Perspective:

If it weren't for insulin, I would not be alive today. So, diabetic medications serve a critical purpose, especially in acute, life-threatening situations.


However, although the insulin and other drugs that I had to take (Coumadin, Lipitor) were necessary, I knew that long-term use of these drugs (or any drug for that matter) may lead to complications with the liver, kidneys or heart.


So, I did the research and developed a meal plan to gradually reduce my insulin intake. At the time, I was hoping to reduce my insulin from 4 shots a day down to 3 and maybe reduce my dosage from 60 units a day down to 40 or 50.


Fortunately for me, I stuck with the meal plan and exercise regimen; and, within 3.5 months I had weaned myself off the insulin completely! But, my endocrinologist told me that I was going through the "honeymoon period" and would have to go back on insulin within 3 to 6 months.


Needles to say, my endocrinologist was surprised when I was able to continue to maintain normal blood glucose levels without the insulin for 6 months, a year, 18 months, 2 years ...


By this time, people in the community and at work wanted to know how I was able to do this. The next thing I knew I was invited by the American Diabetes Association (ADA) to speak to a local diabetic support group. Then, the American Heart Association and Kidney Foundation invited me to their health fair and free screening events.


So many people told me that they were amazed by my story. But, I kept telling them that what I did would probably not work for them. Needless to say, I was surprised when I started to receive phone calls and emails from diabetics who told me that they were able to reduce their diabetic medications once they started to eat some of the same foods that I was eating, e.g. broccoli, Brussels sprouts, wild salmon, green smoothies, etc.


Because I was getting so many questions, I ended up creating a 1-page pamphlet with my meal plan and exercise regimen. 


But, I warned people that this meal plan and exercise regimen was unique to me and probably would not work for them. Also, I told them that since I was just an engineer and not a doctor, that they should always consult with their own doctor concerning what they should do about managing their diabetes.


But, surprisingly, more and more people started to improve their diabetes! Even some local doctors invited me to come speak to their diabetic patients! 


The 1-page pamphlet grew into a 10-page document which grew to 75 pages. At this point, my mother and my daughter encouraged me to write a book. Many diabetics and some of my engineering co-workers also encouraged me to write a book.


Eventually, I relented; and, like they say, the rest is history. :-)


Key Point About Diabetic Medications

The biggest mistake that some diabetics make is that they continue to follow a poor diet and compensate by taking higher dosages of their diabetic medications to lower their blood sugar.


Unfortunately, what most diabetics don't realize is that the diabetic medication does not slow the progression of the diabetes!  Studies have confirmed that people who rely strictly on diabetic medication eventually end up on insulin and suffer one or more major diabetic complications, such as blindness, kidney failure, amputation, heart attack or stroke.


So, whether you take diabetic medication or not, it is very important that you change your diet and lifestyle and work with your doctor to limit the number of drugs that you have to take.

Photo: Doctor Talking to Patient

Photo: Doctor Talking to Patient

Type 2 Diabetes Pathology

Overview

Type 2 diabetes is a complex metabolic disease characterized by hyperglycemia, insulin resistance, cell inflammation, oxidation, and glycation.


These biological processes gradually cause serious damage to major tissues and organs including the arteries, eyes, kidneys, feet, heart and brain. 


The key stages of Type 2 diabetes pathology and pathogenesis include:

-- Hyperglycemia (High blood sugar)

-- Insulin Resistance

-- Oral Glucose Tolerance

-- Chronic Inflammation/Oxidation

-- Prediabetes

-- Full-blown Type 2 Diabetes

-- Diabetic Complications


Key Point! If you look closely at the stages (listed above), you should notice that diabetic drugs only address hyperglycemia, which is the first stage of Type 2 diabetes pathology! So, the drugs lower your blood sugar; but, they do absolutely nothing to stop the other stages of the diabetes from progressing and causing cell and tissue damage throughout your body!

Diagram: Type 2 Diabetes Pathogenesis

Diagram: Type 2 Diabetes Pathogenesis

Type 2 Diabetes at the Cell Level

Overview

As depicted in the cell diagram, the insulin receptors on the surface of each cell are damaged (inflamed).


These damaged receptors ignore the presence of insulin in your blood and prevent glucose from entering your cells via the glucose transporters  [1a].


Consequently, the glucose stays in the blood, causing your blood glucose level to rise [1b]. As a result, the cells can't produce energy or burn fat [2]


In addition, the cells are unable to remove toxins and waste [3]; and, over time, the cells may become further damaged and lose the ability to communicate with each other [4].

Diagram: Type 2 Diabetes at the Cell Level

Diagram: Type 2 Diabetes at the Cell Level

Type 2 Diabetes Complications

Overview

The major short-term complications associated with Type 2 diabetes include the following:

  • Hyperglycemia
  • Hypoglycemia
  • Ketoacidosis
  • Hyperosmolar Syndrome

As Type 2 diabetes progresses over the years, it rots outs the inside of your body, which eventually leads to one or more of the following long-term complications:

  • Kidney Disease (Dialysis)
  • Eye Disease (Blindness)
  • Nerve Disease (Amputation)
  • Heart Disease (Heart Attack, Stroke)

Other complications associated with Type 2 diabetes include the following:

  • High Blood Pressure
  • High Cholesterol
  • Obesity/Weight Gain
  • Periodontal Disease 
  • Frequent Infections
  • Bruises That Don’t Heal 
  • Sexual Dysfunction, e.g. erectile dysfunction
  • Depression
  • Chronic Fatigue & Adrenal Fatigue
  • Alzheimer's
  • Gout
  • Macular Degeneration


Diagram: Type 2 Diabetes at the Cell Level

Diagram: Type 2 Diabetes at the Cell Level