There are many articles all over the Web on how to get rid of Diabetes coming from different sources. Our mission is to combine knowledge and experience of the top experts in this area and provide quality content for everyone dealing with this condition or trying to prevent it. Below you can find the list of commonly asked questions with answers from professionals who have spent a large portion of their careers working on related conditions.
Here are brief bios of experts involved in writing of the post:
Dr Christian Thoma is a lecturer at Auckland University of Technology, and founder of the integrated health coaching service Built for Motion. A nutritionist and clinical exercise physiologist, he has worked his way from bench top to bedside doing research into conditions such as type 2 diabetes, non-alcoholic fatty liver disease, metabolic syndrome, and related chronic health conditions. Christian holds a BSc in microbiology and immunology and an MSc in human nutrition from the University of Otago, New Zealand, and a PhD focusing on lifestyle therapies for non-alcoholic fatty liver disease from Newcastle University, United Kingdom. He is also certified by the American College of Sports Medicine as a Clinical Exercise Physiologist. When not teaching, doing research, or seeing clients, he blogs on a broad range of health and wellness related topics.
Website: www.builtformotion.co.nz
Facebook page www.facebook.com/diabetesdoctorNZ
Email: christian@builtformotion.co.nz
Dr Vani Pulijala, doctor by profession,Hyderabad, India
Blogger ID is: DRVANISRINIVAS.blogspot.com
Twitter handle is @VANISRINIVAS
1) What causes diabetes?
CT: It is very important to be clear that there is no single condition known as diabetes. The majority of people, some estimates suggest 90%, with diabetes have what’s commonly referred to as type 2 diabetes. A much smaller number have what is known as type 1 diabetes, but there are also several rarer conditions that feature the name diabetes, e.g. latent autoimmune diabetes of adults, and monogenic diabetes of the young. Making distinctions is important as the causes and treatments of the different types of diabetes differ substantially.
[It’s best to address only one type of diabetes in a given article and be explicit as to which one you are addressing. As type 2 diabetes is by far the most common and the only type that can, in most people, be wholly addressed by lifestyle. I’ll focus on type 2 diabetes and recommend you do too for this article. Just in case, I’ll also cover type 1, but in less detail].
Type 2 diabetes is primarily a combination of two things: 1) a resistance to the effects of the hormone insulin; and 2) a reduced ability of the pancreas to produce insulin. Basically, there is an imbalance between how much insulin the body needs to function normally, and how much insulin it can produce. Insulin helps regulate things like how much glucose or ‘sugar’ is in the blood, and also how much fat. Glucose and fat are our body’s main energy sources, so it’s fair to say that insulin helps regulate how our body uses and stores energy. One hormone never works alone, other hormones like glucagon, in many ways insulin’s opposite, is also affected in type 2 diabetes, and other hormones such as the stress hormone cortisol and the master regulators of metabolism, the thyroid hormones, can also be important in some people. The focus of treatment however is on insulin.
The causes of type 2 diabetes will vary from person to person.For most people it will be a combination of a genetic predisposition along with lifestyle factors. Diet, lack of sufficient physical activity, poor sleep quality and quantity, high body fat, and stress can all contribute to the underlying mechanisms of type 2 diabetes. Just as we are all unique, type 2 diabetes expresses itself uniquely in everyone. For example, some people with type 2 diabetes go on to have problems with their liver, others develop problems with the small blood vessels in their eyes or kidneys, may develop heart problems etc.
Contrary to popular belief, it isn’t necessary to be obese in order to get type 2 diabetes. What appears to matter far more is how and where the fat is stored. People with type 2 diabetes tend to have excess fat around their organs (abdomen), and more importantly within their organs, especially the liver and pancreas. Reversal of type 2 diabetes is associated with reductions in liver and pancreas fat. Also, although what we now call type 2 diabetes used to be called adult onset diabetes and is far more common with advancing age, the number of children with the condition is on the rise.
Type 1 diabetes involves an autoimmune attack on the pancreas, specifically the insulin producing beta-cells of the pancreas. This drastically reduces the ability of our body to produce insulin. Although people with type 2 diabetes may go on to require insulin eventually, people with type 1 diabetes need insulin as the foundation of their treatment. Someone with type 1 diabetes may develop insulin resistance as well, but whereas this is the first step in type 2 diabetes, it is very much secondary in type 1. The causes of type 1 diabetes are not very clear, there is likely a genetic predisposition, as for other autoimmune conditions, and one or more environmental triggers that start off the autoimmune attack. Type 1 diabetes more often starts in children and teenagers, but can occur later in life.
VP: Diabetes occurs due to deranged metabolism of carbohydrates and is mainly due to either lack of insulin (type-1Diabetes) or inefficiency of insulin (type-2 Diabetes) to act on glucose, which eventually results in hyperglycemia-Diabetes mellitus.
2) How is diabetes managed?
CT: Type 2 diabetes is conventionally managed first with lifestyle intervention and then medication, sometimes it is also managed with bariatric surgery. The goal of management is improving blood glucose control, which is another way of saying – keeping blood glucose to as close to the normal range as possible. Common medications include metformin, sulfonylureas, gliptins, and pioglitazone, however other medications also exist. The doses and sequences with which these medications as prescribed vary from country to country and person to person.
Lifestyle intervention can involve changes to diet (addressed in another question), physical activity/exercise, and more holistically by improving sleep quality and/or quantity, and improving stress control. The focus of most medical practitioners is on weight reduction, which has been consistently shown to improve type 2 diabetes even in those not obese to begin with.
Type 1 diabetes is primarily managed through insulin injections. The insulin used varies from short-acting to long-acting with the doses varying from person to person based on personal response and diet. Irrespective of the type of diabetes, any other medical conditions that occur alongside it are also important to manage. It is therefore common for people to also be getting medication for high blood pressure, heart problems, and cholesterol for example.
Because diabetes increases the risk of damage to blood vessels and nerves in our periphery, think hands and feet, it is important for people to check these areas daily. Wounds often heal slowly and can get infected if not kept clean. The nerve damage can mean people are unaware of their injury, and the diabetes makes healing slow and infection risk high. That’s why it is important to look for wounds before they get so bad it requires amputation. Doctors in turn regularly test for long-term blood glucose control as indicated by HbA1c, and also test for nerve damage, kidney function, and some of the other conditions common in people with the relevant type of diabetes, e.g. high blood pressure and high cholesterol. Regular eye checks should also be done. The meaning of ‘regular’ varies by country, age, and how well a person is controlling their blood glucose.
VP: Diabetes can be managed with dietary changes, lifestyle changes, exercise, oral hypoglycemic medications and Insulin (Injectable medication).
3) How can I know if I have diabetes?
CT: Countries vary a little on how diabetes, all kinds of diabetes, diagnosis is done. Common symptoms include frequent urination often combined with excessive thirst, increased hunger, weight loss, tiredness/fatigue, poor concentration, lack of interest, tingling or numbness in the hands or feet, blurred vision, frequent infections, slow healing of wounds, vomiting or stomach pain. These symptoms can come on quite suddenly with type 1 diabetes, but tend to be more gradual with type 2. Many people are diagnosed with type 2 diabetes before they develop obvious symptoms.
Formal diagnosis should be done by a medical doctor and will usually involve a measurement of fasting blood glucose, something called glycatedhaemoglobinA1c or just HbA1c for short, and/or an oral glucose tolerance test. To distinguish between type 1, type 2, and other forms of diabetes, additional tests are likely, e.g. an autoantibody test to check for type 1. The diagnoses are based on drawing a line in the sand; a value above that line is considered to indicate diabetes, whereas a value below it can indicate ‘pre-diabetic’ conditions such as impaired glucose tolerance and/or impaired fasting glucose, or even normal metabolism. Although most doctors do little or nothing until the line for diabetes is crossed, anyone with abnormal results can go a long way toward preventing themselves from ever crossing the line
VP: Diabetes can present with certain symptoms such as sudden loss of muscular weight, dryness of skin texture, early tiredness, increased frequency of urination, increased thirst due to excessive loss of fluid by frequent urinations, increased hunger, blurred vision, delayed wound healing etc.
4) Can you get rid of diabetes with homemade remedies or only with medical treatments?
CT: Talking about a ‘cure’ for type 2 diabetes is to misunderstand the condition. The word cure suggests someone can do or take something at one time to make the problem go away. Type 2 diabetes is a physiological state, and abnormal one, brought on mainly by lifestyle factors (described above). Type 2 diabetes can, in most cases, be reversed by eliminating the causes, e.g. reducing fat stored in the pancreas through dietary changes, reducing insulin resistance with physical activity, stress reduction, improved quality and quantity of sleep, reducing inflammation in the body, and whatever else is fuelling an individual’s diabetes. However, if and when the initial causes/triggers of type 2 diabetes return, so will the condition. Freedom from type 2 diabetes is a lifelong pursuit.
In terms of reversing type 2 diabetes, this is easier to do sooner after first diagnosis than later. We now have several studies showing that very low calorie diets and bariatric surgery, which basically involves very low calorie diets followed by a low calorie diet long-term, are effective in reversing type 2 diabetes. The effects are often rapid, with major improvements within days to a few weeks. Very low carbohydrate diets are also showing promise in the research, and more promise in private practice and self-experimentation, despite this the majority of health practitioners and diabetes charities still recommend low fat high carbohydrate diets.
Medicines can only help to manage, not ‘cure’ or reverse type 2 diabetes. The vast majority of people on medication end up on more medications and higher doses. Bariatric surgery shows more long-term success. However, what matters is that any change, e.g. reduction of fat in the pancreas by maintaining reduced overall body fat, is maintained over the long-term.
Type 1 diabetes is still considered incurable, however progress is being made in the area of cell transplants. This involves implanting insulin producing cells in the hopes that these escape autoimmune attack and restore the body’s ability to produce insulin. For now, the condition is managed with insulin injections, for which there is no substitute. The specific do however vary with some people relying on manual blood glucose checks and insulin injections, while others wear continuous glucose monitoring devices and glucose pumps. This combination doesn’t work for everyone and isn’t available to everyone, but in those for whom it works, it’s the closest thing to ‘normal’ currently achievable.
VP: Diabetes can be cured with homemade remedies and life style changes if it is type-2 Diabetes and also if you are recently diagnosed, simple dietary changes are enough to treat Diabetes, without any medical treatment. But chronically diabetic patients who are on Insulin therapy have to continue Insulin along with dietary changes.
5) What are the best and the worst meals for diabetes?
CT: Diabetes, irrespective of the cause, results in an intolerance to glucose. Doctors and researchers even label people as having ‘impaired glucose tolerance’. Insulin is required to regulate blood glucose, so when there isn’t enough insulin or the body isn’t responding properly to insulin, blood glucose, which is the main form of carbohydrate in our blood, goes up. Despite keeping blood glucose as close to normal ranges as possible being the goal of diabetes treatment, many doctors, dieticians, and diabetes charities still recommend high carbohydrate low fat meals. Research and logic suggests the opposite – blood glucose is best controlled by reducing carbohydrate (sugars and starches). In type 2 diabetes, reducing carbohydrates improves blood glucose control. In people with type 1 diabetes, reducing carbohydrates reduces insulin dose; the lower the carbohydrate content of the diet, the more accurately insulin doses can be calculated. Of course when experimenting with a change in diet, regular blood glucose testing is essential to ensure the insulin dose is correct and to avoid hypoglycaemia (low blood glucose), which is life threatening if not treated early enough with glucose.
Research is beginning to show us what astute self-observers have known for a long time – blood glucose response to different meals and different foods can vary a lot from one person to another. So, whether or not you choose to follow the majority view or opt for an alternative approach, it is very important to test your own blood glucose response to meals using a blood glucose meter. Doing that lets you know how your body responds, and puts you in control.
VP: Foods with high glycemic index like white bread, potato chips, cereals, cakes, watermelon, popcorn, pineapple, canned fruits, packaged fruit juices, soft drinks, cakes, pastries etc., can result in sudden hyperglycemic episodes in Diabetics, so should be avoided. Foods with low glycemic index like whole wheat bread, oats, sweet potatoes, grape fruits, lentils, beans, vegetables, apples, milk etc., works best for diabetics to maintain their blood sugar levels optimal even after food.
6) How can I monitor the development and progression of diabetic complications?
CT: This was addressed a little above. Regular checkups with your doctor and ophthalmologist will be needed to check on the progression of diabetes related complications. You can keep track of your blood glucose using a glucose meter, and check your feet daily for injuries.
Hopefully, assuming you have type 2 diabetes, you will be inspired to better than monitor complications and instead begin to reverse the condition by taking steps to improve the health of your pancreas by reducing you body fat, and reduce insulin resistance with exercise, more/better sleep habits, and better stress management, as well as addressing any other health issues you have with appropriate lifestyle changes.
If you have type 1 diabetes, you may also want to consider dietary changes that allow you to lower your insulin dose while reducing the risk of both hypo and hyperglycaemia. In the past, virtually all of the problems associated with diabetes have been blamed on chronically high blood glucose, but slowly we are beginning to see that chronically high insulin may also bring its own problems.
VP: HbA1c – Glycosylated hemoglobin levels can be monitored to assess the risk of complications of Diabetes. Urinary albumin excretion(UAE)- micro albumin levels in urine also can be monitored to assess the risk of developing diabetic nephropathy in long standing Diabetic patients.
7) Can I take both pills and insulin to control my blood sugar?
CT: Many people do take both insulin and medication, but the details are something to discuss with your healthcare team as the best combination will be unique to you. Of course, if we are talking about type 2 diabetes, insulin will hopefully not be necessary.
You can find more thorough and detailed explanations here: http://www.builtformotion.co.nz/reversing-type-2-diabetes-blog
VP: Yes, both oral pills and Insulin can be used to manage Diabetes.
8) What does the treatment usually involve?
VP: Treatment of Diabetic patients involves oral hypoglycemic agents, Insulin – in the form of sub-cutaneous injections, exercise and dietary changes.
9) What should my blood sugar level be?
VP: The normal fasting plasma glucose levels should be more than 126mg/dL, which can confirm the diagnosis of Diabetes.
10) What are symptoms of low blood sugar?
VP: The symptoms of hypoglycemia(low blood sugar) shall present as sudden nervousness, sudden anxiety, sudden anger, blurred vision, light headedness, tremors, confusion, cold extremities, pale skin, increased heartbeat, extreme weakness, sweating, chills, coma etc.
Diabetes can present with certain symptoms such as sudden loss of muscular weight
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