Diabetes, Diabetes mellitus
Description: Diabetes is becoming a global epidemic of gargantuan proportions. The US Centre for Disease Control predicts 1 child in 3 born after the year 2000 will develop it. It affects people in developed and developing nations and also the third world. The problem is not just the diabetes, but its affects on heart disease, high blood pressure, stroke, kidney disease, blindness and nerves is huge .
There are 2 forms of diabetes - type 1 - where the insulin cells in the pancreas are destroyed and no longer make insulin, and
type 2 - where the insulin is produced but the cells become resistant to its actions. Click here for a video of type 1 and 2 diabetes.
In both the blood sugar rises, but many other changes happen in the body causing all the complications listed above. Sadly just controlling blood sugar does not necessarily stop the complications developing.
Type 1 diabetes -
This used to be the only diabetes that children developed, but with overeating (especially sugars), obesity and lack of exercies - type 2 diabetes also is becoming common in children.
In type 1 diabetes some destructive immune process destroys the insulin-producing cells in the pancreas (islets of Langerhans). This means the body produces no insulin and without this, glucose cannot enter the cells. Very high blood sugar develops and unless treated is fatal.
We are still unsure on why this happens, it has some hereditary and ethnic background, other suspected causes include viral infections, particularly enterovirus infections, immunizations, diet, especially exposure to A1 cow's milk at an early age, obesity and Vitamin D deficiency
Once the diagnosis is made, then the child/adolescent needs careful coaching on how to manage what will become a lifelong illness, or at least until pancreas implants and other future treatments have developed. It is frightening for a child because it involves needles and unpleasant testing and different foods, it can restrict activities with their friends and they must be positive in their outlook, and be able to look after their illness as soon as possible. Frightening them that they will develop heart disease, blindness and kidney failure if they do not control their diabetes perfectly, is not productive.
They need to have a caring diabetic doctor/nurse/dietician team which they relate well with, and it is best if the parents have a deep understanding of diabetes themselves.
- Discuss with the family on a healthy (but fun) daily schedule, recording blood glucose test results, insulin administration, and the timing and carbohydrate content of meals and snacks.
- Blood glucose testing - this must be done regularly and well. Usually this is done 4 times a day - fasting, before means and before bed; more frequently in unstable children. There are a variety of instruments which have made this much easier, but most still require a finger prick. Some instruments use the forearm, this is less painful, but also less accurate. Continuous monitoring with subcutaneous sensors are becoming available, are very expensive and their role is still debated. Long term I am sure these will be the testing of the future, with a pump administering insulin depending on the results).
- Insulin injections - there are many forms of insulin, and your doctor will decide the best for your child. Parents must understand the duration of the various types of insulin their child is receiving, and how to adjust the dose depending on the glucose tests. How to add short-acting insulin if necessary with illness or high blood glucose levels. It is best if the parent gives the first few injections (it is a good idea for parets to inject themselves with water/saline, to see how relatively painless these injections are. Insulin pens make life easier, but are not good for mixtures and are more expensive.
- Injection techniques - areas used are the upper arms and legs, abdomen and buttocks. Pinch the skin and inject vertically into the top area and into the hilt of the syringe (shallow injections are more painful), Studies have shown that cleaning the skin with alcohol swabs makes no difference with infections, is time-consuming and can make the injection more painful.
- Types of insulin - your doctor will prescribe the best type and regimen for your child.
Rapid-acting (eg, lispro, aspart, glulisine) and/or short-acting insulins (eg, regular insulin) are given before meals based on the glucose level and anticipated carbohydrate content of the meal.
Intermediate insulin (NPH, insulin lispro) is given 2-3 times a day
Long-acting insulins (insulin glargine) are given once or twice daily, and can be combined with the more rapid insulins if necessary.
- Hypoglycaemia (low blood sugar) - both parents and child need to recognise the signs of low blood sugar (tremor, pale skin, sweating, rapid heart rate, fatigue, lethargy, headaches, unconsciousness, twitching. In young children behavioural symptoms - irritability, agitation, erratic behaviour, quietness or tantrums are common. Parents should check the blood sugar and if low, give the child a glucose sweet or drink (barley sugar, sweetened fruit juice or cake frosting. Then to sustain blood sugar levels - a peanut butter sandwich, cheese and butter sandwich or other fat and protein. Check blood sugar after 20-30 minutes. If the child has severe hypo attacks with unconsciousness or difficulty in getting food in orally, parents should probably be instructed on the use of glucagon injections to raise the blood sugar.
- Blood or urine ketones - when diabetes is beginning to go out of control, the body produces ketones which can be detected in the blood and urine (and also in the breath). Parents should check the urine for ketones at times of illness, or if 2 or more blood sugar levels are above 14 mmol/L.
- If in doubt, have no hesitation in taking your child to the doctor or emergency department, as diabetic crises caught early, and much easier and safer to treat than waiting until the child is dehydrated and ketotic.
Apart from insulin injections, the management and approach for type 1 diabetics is similar to that for type 2 - see below.
Type 2 diabetes
Prevention - if one in 3 of our kids will develop diabetes and up to 20% of adults will also get it - then prevention is the only obvious solution, especially when one looks at how poorly the results of our treatment are. There are a number of features in our modern world which are fueling this epidemic:
- High glycaemic foods - processed foods, high in sugars which are very rapidly absorbed into the blood stream. Especially high fructose corn syrup which is used extensively as a sweetener for many of today's foods. Because the body deals differently with fructose, it is believed that its extensive use may in part be the cause of the rise in diabetes.
- The sugar in soft drinks is a major cause of obesity and thus type 2 diabetes in children.
- Exercise - the modern generation, with all the labour saving devices and transport does far less exercise than we should. Exercise helps the glucose to enter the cells, thus a couch potato lifestyle, or children playing computer games rather than outdoor sports, increases the likelihood of developing diabetes.
- Obesity - especially abdominal obesity has today almost become the accepted norm, and leads straight to type 2 diabetes. .
- Other factors that are being implicated - grains, high fructose syrups, milk ( A1 vs A2 milk), low vitamin D, changes in the bacteria in the bowel (leaky gut),
So we should all be looking at these, especially in our children. Changes are easy and cheap to implement and could make a huge difference in both their quality and quantity of lives.
What doctors can do once diabetes has developed
- Encourage you to eat a good diet (low sugar and low saturated fat, low glycaemic sugars) and reduce your weight to ideal levels.
- Insulin injections may be necessary to control the blood glucose. Insulin pumps and automated infusions are making the insulin responses more like the normal situation, and it is hoped that these may reduce the complications of diabetes.
- In type 2 diabetes, oral drugs (metformin, sulphanyl ureas) can often control the blood sugar levels. Newer drugs like rosiglitazone can make the cells more sensitive to insulin and can be used when the other oral drugs fail ( but they recently have been implicated in increased heart disease and has been taken off many world markets). However a totally new group of drugs (Empagliflozin) works by increasing urine excretion of glucose has been shown to reduce heart disease deaths by over 30% in those with cardiovascular disease and may well become greatly used, and has been approved by the FDA.
- Treat other risk factors – high blood pressure and cholesterol. NB Many doctors will start diabetic patients on statin drugs ( like Lipitor, Simvistatin). There is now data that statins increase the risk of developing diabetes by 10 - 15%, so really should be used with great caution in people at risk of or with diabetes. Discuss with your doctor and ask if statins are really worth the risks? Especially in women where there is very little evidence of primary prevention benefit.
- Encourage good care of feet and legs to prevent ulceration.
What you can do
- A good healthy lifestyle is essential in people with diabetes to avoid very nasty complications in the future.
- Get your weight as near as possible to the ideal
- Diet - use a sensible approach, especially low glycaemic foods , with plenty of fresh vegetables and whole grains. Eat plenty of fruits and vegetables and limit red meat and fat
- Exercise moderately and regularly most days. exercise is absolutely crucial for diabetics. In some way it enables the muscle and fat cells to respond to insulin
again (reverse the insulin resistance) and bring not only the blood sugar under control, but also may help with the complications.
- Reduce the stresses in life and have plenty of rest at night.
- There is increasing evidence that milk (A1 milk) may be playing a role in the cause and continuation of diabetes. If it is available, I would recommend all diabetics either to use A2 milk or avoid cow's milk altogether.
- There are some good low glycaemic shakes and bars which diabetics can use as snacks and meal replacements, .
- Of course, cigarettes are absolutely verboten!
Because treatment does not just involve controlling the blood sugar but aims to reduce the risk of developing heart disease, kidney disease and stroke, good nutrition can play a huge part in keeping diabetics healthy.
- A good multivitamin/multimineral makes sure that the tissues have all the nutrients and minerals required to function perfectly. Many of the vitamins (especially the B group) help preserve nerve function. The minerals chromium, magnesium and vanadium have been shown to improve the response to insulin, and although doctors don’t yet recommend their use, they should be in a good multimineral preparation. In a Chinese study, diabetic patients given a trace dose of chromium picolonate, improved their diabetic control and needed less insulin.
- Calcium and magnesium, 800-1,000mg/day. Magnesium not only has a very calming effect, it helps with sleep and enables people to cope better. Magnesium also helps dilate the blood vessels, increasing blood flow to the legs and kidneys. These two minerals also reduce the risk of osteoporosis and high blood pressure.
- Vitamin D seems to play an important role in many diseases including diabetes. Taking 4 - 8,000iu daily seems wise advice (Vitamin D seems to have many beneficial actions, including turning the genes on and off when required. Low D levels are present in many diseases and it does seem important to have adequate levels all year round)
- Grape seed extract (proanthocyanidins) is a powerful antioxidant and anti-inflammatory agent. As oxidative damage is more common in diabetes and most of the complications are aggravated by free radicals, a surfeit of antioxidants seems a wise idea. (Also note the comment on * Cellsentials at the bottom of this page.
- Omega 3 fish oils, 1-2 grams daily. These can help lower the triglyceride fats which are often raised in diabetes, and also have major benefits for the heart, skin and blood vessels.
- CoEnzyme Q10 - is an enzyme inside the cells which is essential for making energy. Low levels have many effects and some drugs which your doctor may have put you on ( beta blockers, statins) can lower the CoQ10 levels. There have been some small studies showing improved diabetic control with CoQ10. I personally recommend my patients with diabetes to take 60 - 100mg of CoQ10 daily.
- Low glycaemic and fibre drinks and shakes can help keep the blood sugar under control, as well as washing the toxins out of the bowel.
The Nutritional supplements I use and recommend to my patients
For my diabetic patients I recommend -
USANA - *Cellsentials, Biomega, Active Calcium plus,Vitamin D, Proflavanol C, Probiotics, Coquinone, hepa plus, the USANA low glycaemic shakes, fibre drinks and bars and vitamin D -