The SWEET killer - Diabetes

Diabetes Mellitus is a Greek word that means 'discharge of "honey sweet" water'. It is one of the most commonly encountered diseases by healthcare professionals worldwide. In Singapore, the current incidence rate is an alarming 1:10 as compared to 1:50 way back in 1975. With such an exponential rise in numbers, is there an effective cure for this disease?

Causes

Diabetes Mellitus is a syndrome characterised by metabolism disorder (body is unable to use carbohydrates, protein and fat in a normal way) and high blood sugar resulting from either low levels of the hormone insulin or a failure of the body cells to respond to insulin.

Normally, food carbohydrates are converted into the form of sugar called glucose to supply heat or energy, or store as glycogen in the muscle and liver cells for future use. This important task of regulating the uptake of glucose from the blood into the cells is carried out by insulin, the principal hormone secreted by the beta cells of the islets found in the pancreas.

 

Under normal condition, our urine does not contain any sugar. In uncontrolled diabetic condition, glucose accumulates in the blood. Eventually, it has to be expelled from the body by way of the urine with sugar loaded.

Two classifications of diabetes are:

Type 1 - Usually called juvenile diabetes, it affects 5-10% of diabetic patients who need to undergo daily injection of insulin. It is an auto-immune disease in which the body’s immune system attacks and destroys the insulin-producing cells in the pancreas, resulting in insufficient insulin for optimal use. The onset is usually intense and takes only few days to develop, often arising from an infection. Some babies fed on cow milk are found to end up having this condition.

Type 2 - Usually called adult onset diabetes or non-insulin dependent diabetes, insulin resistance occurs in 95% of diabetic patients, a condition in which cells fail to use insulin properly or insulin produced in small quantities not sufficient to fuel the cells.

Other causes -

+ Pancreatitis where the pancreas is inflamed or diseased, and may be surgically removed. Also possible is viruses produce antibodies that destroy the islet cells resulting in diabetes.

+ An increase in the rate at which insulin is used up or destroyed in the body may lead to diabetes. The efficacy of insulin is compromised due to liver disease or prolonged used of drugs (eg. steroids) that impede insulin activity.

+ In the case of pregnancy, a rare type Gestational Diabetes can develop during the late stages of pregnancy. Normally it goes away after birth delivery or slips into Type 2 Diabetes later in life (high chance if baby weighed more than 9 lbs). Hormonal changes are responsible for the shortage of insulin. It does not cause birth defects sometimes seen in babies whose mothers had diabetes before pregnancy.

Irrespective of the type, diabetes leads to a rise in the blood sugar level, which can ultimately affect the various organs of the body and their functions, leading to severe complications. (see below)

What is the safe level?

Guideline for blood sugar levels (mg) after fasting 12 hours -

* 70 to 110 - normal

* 110-126 – impaired glucose tolerance/borderline

* 126 and over for a 2-3 days period – diabetes

* Below 50 and above 250 – red flag rang

A more accurate reading is HbAIc test where the amount reflects blood sugar control for the past 120 days, which is the usual lifespan of a red blood cell. Well-controlled range should be in the region of 6.5 to 7.


You should also test your urine or blood for ketones when any of the following occurs:

• blood sugar is higher than 240 mg/dL
• symptoms of diabetic ketoacidosis (ketones buildup especially for type 1)
• feel sick or nauseated, regardless of blood sugar reading

Running low on glucose, or due to diabetes, the body does not have enough insulin to help the cells to absorb the glucose, and starts breaking down fats for energy. Ketones are byproducts of the breakdown of fatty acids. Results for ketone testing are labeled in the following way:

• normal/negative: less than 0.6 millimoles per liter (mmol/L)
• low to moderate: between 0.6 to 1.5 mmol/L
• high: 1.6 to 3.0 mmol/L
• very high: greater than 3.0 mmol/L

At dangerous high levels, the kidneys can be at risk of being severely damaged by such large molecules. Other serious effects include: 

• swelling in the brain
• a loss of consciousness
• diabetic coma
• death

Symptoms

Diabetes often goes undiagnosed because many of its symptoms seem so harmless. Studies indicate that early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.

In diabetic patients, glucose build-up in the mainstream instead of being taken into the cells to be used as energy, leading to hyperglycemia (abnormally high levels of glucose in the blood). A quarter of diabetic patients are not able to perceive sweet tastes and tend to over-consume unknowingly. Other symptoms include:

1. Frequent urination

2. Excessive thirst

3. Extreme hunger

4. Increased fatigue

Above symptoms are usually ignored especially in hot humid weather where drinking and visiting the toilet is a routine.

5. Unusual weight loss

6. Constant infection

7. Blurred vision (cataract)

8. Cut or wound difficult to heal

9. Numbness of the limbs and lost of sensation

10. Recurrent skin, gum and bladder infection.

The reversal frequently occurs is symptoms of hypoglycemia (less than normal amount of glucose in the blood) which strikes suddenly with a missed meal, too much exercise or a reaction to excess insulin. In functional hypoglycemia, the liver releases stored sugar to compensate for low sugar level and thus takes care of all the symptoms naturally.

 Initial signs are -

1. Hunger

2. Dizziness

3. Sweating

4. Confusion

5. Palpitations

6. Numbness or tingling of the lips

If not treated, can experience double vision, trembling, disorientation or may lapse into a coma. The quickest way to fix up this problem is to take some sweets, fruit juice or soda pop. Repeat 20 mins later if it does not work in the first instance. If second treatment still fails, or still cannot ingest food, seek immediate medical attention and/or administer a glucagon injection.

Complications

In the long run, high level of blood sugar can lead to damaged vessels, which in turn can cause eye disease, heart disease and kidney disease.

+ When the tiny blood vessels of the kidney are damaged, they fail to filter waste materials from the blood, a condition termed diabetic nephropathy. The persistent presence in urine of protein is usually the first sign. Eventually, the accumulated fluids and waste products cause kidney failure, where dialysis or kidney transplantation is required.

+ In diabetic retinopathy, high inflow of blood sugar can cause expansion of the blood vessels of the eye to the extent of collapsing. New blood vessels usually develop but most are defective and unable to contain the blood. As a result, the blood vessels burst causing blurred vision, glaucoma, cataracts or blindness when a large hemorrhage formed.

+ Diabetic patients can experience narrowing or hardening of the arteries, heart attack, stroke and high blood pressure, giving rise to increasing risk for coronary artery disease, heart disease and cardiovascular disease.

+ Presence of excess sugar in the blood can damage the wall of the blood vessels, and the covering of the nerves, especially around the legs and feet, termed diabetic neuropathy. This can manifest in symptoms like tingling and numbness of legs, hands and feet, nausea, vomiting, diarrhea, urinary problems and constipation. For some, is a loss of sensation in the feet. For others, it can be minor injuries to the feet like blisters, sores and highly infectious cuts as there is a lack of oxygen and blood to heal promptly. In advanced stage, it is often accompanied by excruciating leg pains. A severe infection or gangrene when developed, may necessitate foot or leg amputation to prevent further spread to other part of the body. By then, the foul smell emitting can be unbearable.
+ Impotence occurs frequently amongst men with diabetes because of interference with the nerves or blood supply to the male organ. Difficulties with erections may be a man's first sign of diabetes.

+ People with diabetes are more likely to suffer from skin conditions such as fungal and bacterial infections along with bone and joint problems (eg. osteoporosis).

+ Diabetic acidosis is the condition where ketones accumulate in the body. This happens when cells fail to absorb and utilise glucose, thereby turning to fats to derive energy. Breakdown of fats generates ketones as byproducts, which if accumulate in a large amount can increase acidity of blood and the tissues, leading to serious complications, if not treated promptly. One grave consequence is permanent kidney damage or failure.

+ Pregnancy puts a diabetic woman at special risk due to hormonal changes and the demands of the foetus can lead to wild fluctuation in blood sugar. There is a high chance of retaining excessive amount of water, develop high blood pressure and miscarriage. Conceiving mums with poorly controlled diabetic condition is likely to give birth to infants with birth defects eg. heart and nerve disorders, cleft lip and palate.

Diabetes Medications

Most diabetic patients chose to use medications to control their glucose levels without even realising the side effects of the medication. One popular drug Avandia is found to increase heart attack rate by 43%, and thus prohibited for use by patients with heart problems such as acute coronary syndrome, ischaemic heart disease and heart failure.

Other side effects include hypoglycemia, diarrhoea or abdominal discomfort. Long-term consumption might even cause weight gain, kidney and liver damage. That is why the medication dosage must be under the surveillance of a personal physician who can constantly monitor the body condition.

What can a diabetic patient do?

Diet and exercise alone, without insulin, can control some 30-40% of cases, especially overweight people and those with mild condition. The strong link between type 2 diabetes and obesity shows reducing caloric intake does help.

Hence, no special diet, as long as is nutritionally sound, taken in moderation, suits the patient’s lifestyle and incorporates dietary recommendations to prevent other common diseases like heart disease.

(1) Dieting - well-balanced, high in fibre and lower in fat

For diabetic patients, is important to watch out for the glycemic index (measures how fast food is being absorbed into the blood) of the food. Food which has a high GI (insulin is unable to pick up on fast-moving glucose on time) causes a sharp rise in blood glucose, whilst food with a low GI induces a smaller but more prolonged increase, which is ideal for diabetics. This index also changes depending on how a food is cooked, processed and, in the case of fruit, how ripe it is. Skipping meals can also cause a spike in blood glucose.

Also to follow the Healthy Guidelines - the carbohydrate intake should limit to half of total calories (most have poor carbohydrate utilisation), protein 20% (lesser for renal failure) and 30% good fats, distributed evenly throughout the day.

+ Carbohydrate foods like rice, noodle, vermicelli, bread and salt, white flour product increase the sugar level and should not be eaten excessively, preferably break up into small servings. Note rice turns into porridge yields a higher GI value and when cooked with fat reduces GI index but is unhealthy.

+ It has been observed that most diabetic patients do not consume much sugary foods and yet are obese. So what is the culprit? Genetics as some claimed. Our forefathers were mostly agriculturists and lived on their harvests like rice, wheat flour and corn. These traditional staple diets are high in carbohydrates and contribute to weight gain if is not burnt off and left to linger in the bloodstream or stored as fat.

+ Fruits should be taken in whole and not fruit juice as the sugar element (call fructose) can contribute to a sharp rise in blood sugar level. To avoid sweet fruits eg. grapes, mangoes, bananas, melons. Guava is a great fruit that provides lots of fiber, low GI and enzymes that can reduce glucose effectively.

+ Fresh vegetable juices help to reduce the need for insulin and lower fats level in the blood. To avoid starchy vegetables eg. carrots, potatoes, beets.

+ Iron loading from foods like meat can worsen diabetic condition. Avoid iron cast cooking pan.

+ Slowly digested foods like brown rice, whole grain bread, oats, apple, spirulina, egg yolks, fish, garlic and vegetables help to moderate the rate of transfer of glucose to the blood. This can further improve by chewing as much as possible.

+ A recent study showed that certain cinnamon compounds may help obese people in the fight against fat, inflammation and oxidative stress. In the study, obese people with pre-diabetes took a cinnamon extract called cinnulin twice daily. At the end of the 12-week study, participants' bodies were experiencing less oxidative stress and their antioxidant defenses against inflammation were heightened. They even lost some fat mass while gaining a bit of lean muscle. Researchers think that cinnulin helps cells take in sugar and use insulin better -- otherwise difficult for people who are obese and have pre-diabetes.

+ Stevia leaf has been used for centuries in South America and Japan to substitute for sugar and treat diabetes mellitus type 2. Some studies showed it has a possible trophic effect on β-cells of pancreas, improving insulin sensitivity in rats, and possibly even to promote additional insulin production, helping to reverse diabetes and metabolic syndrome.

+ For vegetarians, to include beans, tofu, seeds and nuts in every meal. Thiamine (Vitamin B) deficiency has been linked to increase in glucose levels. Hence, increased intake helps to speed up metabolism and flush out excess glucose in the bloodstream.

+ Researchers think that cinnulin had such a favorable effect in the study because compounds in the extract may somehow help cells take in sugar and use insulin better. Substitute for sugar to your favorite hot drinks.

(2) Sleep duration can also affect risk factor. A recent study found that those who were not getting enough sleep or getting too much had an increased risk of developing Type 2. A joint effort between researchers from the New England Research Institutes and the Yale School of Medicine over 15 years gained some stunning findings:

* those who slept 6-8 hrs per nite are the healthiest

* those who slept 5-6 hrs per nite have twice the risk of developing type 2 diabetes

* those who slept more than 8 hrs per nite have triple the risk

(3) Regular exercise can regulate insulin sensitivity by achieving better glucose control and improving glucose tolerance to reduce insulin resistance and assist in decreasing risk associated factors like hypertension, obesity and atherosclerosis.

Physical activity helps the body's cells absorb and utilise more glucose for energy, thus effectively reducing elevated glucose cells in the bloodstream. Though all exercises promote healthy blood glucose levels, aerobic exercise is a good choice for most people in its utilisation. The intensity of resistance exercise in utilising more glucose to build more muscle means the body has to increase the storage capacity of glucose.


(4) Close monitoring of blood sugar level and keeping a normal body weight prevent and delay the onset of obesity and diabetes mellitus.

When all precautionary steps are taken and still fail to yield satisfactory result, oral medications or injections of insulin can be added to prevent deterioration.

Conclusion

Having a parent or sibling with the chronic metabolic disease, being overweight with a body mass index above 23.5, and being inactive and older are factors which can increase the risk of developing diabetes.


Maintaining a healthy lifestyle is of prime important. Most people would become diabetic in their old age if this rule is not properly observed.


VIVA corner

VIVA Glucoguard contains chromium yeast that acts as Glucose Tolerance Factor (GTF) which aids in the digestion and absorption of glucose, enhances the effects of insulin and thus improves diabetic condition.

VIVA Green Barley provides fibre that helps to stabilise blood glucose level. It also contains chromium and amylase to promote the metabolism and utilisation of carbohydrate, thus helping to regulate blood sugar levels.


VIVA Vivashield is rich in antioxidant and is able to neutralise free radicals that cause blood lipid oxidation. A good example is flavonoids present here which help to inhibit the accumulation of polyols (elevated glucose levels in the lens of the eyes)

VIVA Floraguard promotes absorption of vitamins and minerals and helps to inhibit bacterial or fungal overgrowth, which is common in diabetes.

VIVA Gingko Biloba improves blood circulation thus beneficial for retinopathy and other diabetic complications.

Sources:

Singapore Med J 2002 Vol 43/3 1`28-134,  Diabetes Lifestyle, NaturalNews, Am J Clinical Nutrition 1995