Reversing Diabetes...It Can be Done!

Reversing diabetes is all but impossible, or so most medical practitioners will say. The common thinking is that diabetes is manageable but not curable and to most it isn't.

Why? Because once a diagnosis of diabetes is made, no further thinking is required, either by the patient or the healthcare provider.

Diagnose, prescribe a pill (or maybe five pills), file the insurance claim and that's it until the next complication arrives.

With diabetes, it's all about the pancreas and insulin and the body's sensitivity to insulin.

Any efforts directed at reversing diabetes starts with controlling blood sugar; actually lowering blood sugar. Preferably this will be accomplished naturally through dietary adjustments and not the rush to prescribe drugs. We will explore why later in this article.

If you saw the page in this site on the endocrine system, you will have already gleaned a lot of information about the pancreas and the hormone, insulin.

Out of necessity, we will review much of it below but for reference you can also go to Endocrine System and read up on it in the context of the entire endocrine system.

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Just consider the National statistics on diabetes to grasp how big a problem it really is.

In the U.S., 17.9 million people have been diagnosed with diabetes and it is estimated that another 5.7 million people are walking around with diabetes but not yet diagnosed; that's 8% of the total population.

Add to that, about 57 million pre-diabetics. A pre-diabetic is someone who will develop full-blown diabetes unless they make some changes in their lifestyle and eating habits.

In 2005, deaths from diabetes totaled 75119, up from 74219 in 2003; a 1.2% increase. This was 25.3 deaths per 100,000 making it the sixth largest killer in the top ten causes of deaths in the U.S. Some would say it's the fifth, but it depends on whose data we look at.

Diabetes is possibly the fastest growing disease condition affecting all age groups. Evidence is that the epidemic is being driven by poor nutrition, sedentary lifestyles and chronic overweight and obesity.

The causes and treatment will be examined as well as preventative lifestyle changes we can make to avoid this disease.

Before going forward, here is a recommended must have book from the American Diabetes Association; "Intensive Diabetes Management". Virtually all patients with diabetes—type 1 or type 2—can improve their glycemic control and overall health through intensive diabetes management.

Intensive Diabetes Management (ADA)

With an emphasis on the team approach, this hands-on book offers the information needed to help each patient move toward treatment goals appropriate for their individual skills and medical condition.

For clinicians striving to deliver diabetes therapy for the 21st century, this book is an essential guide. Just click on the link above for more information on how to order the book from Amazon.com.

If someone's blood glucose level is in the normal range of 80–120 mg/dl or 4–6 mmol/l when read at various times during the day, they are considered to be non-diabetic.

Your doctor is not likely to make a diagnosis based on the little glucose meter you pick up at Walgreen's or Wal-Mart.

Photo: Four generations of glucose meters commonly used over the years

The doctor is more likely to send you to a lab for a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT).

That way you will get hit with two copays instead of just one.

Either test can be used to diagnose pre-diabetes or diabetes but the American Diabetes Association favors the FPG because it is easier, faster, and less expensive to perform.

With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes.

A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes. Remember that the top range of normal is 120 mg/dl (milligram per dalton).

In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes.

If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes. What is being measured is how fast the pancreas reacts to clear the bloodstream of the excess glucose.

In the glycemic index, glucose is 100. It is the standard at the top of the scale. Click on The Glycemic Index to brush up on what that is all about. It is mandatory to follow the glycemic index when reversing diabetes.

When it comes to diabetes, apparently men are more clueless than women. About 12 million men over 20 have diabetes although about a third of them don't know it.

About the same number of women over 20 have diabetes (11.5 million) but only about a fourth of them aren't aware of it.

It pays to get tested, especially if one is overweight.

If you have diabetes or just want to monitor your blood sugar, you may want to check out American Diabetes Wholesale by clicking on the button at the top left. Anyone paying for diabetes supplie out of their own pocket will probably save a significant amount of money.

This vital organ sits in the curve of the duodenum and the stomach and is fed by a huge supply of blood from four major arteries. Its head joins the second portion of the duodenum and the tail extends over to the spleen.

Functionally, 99% of the pancreas is made up of clusters of exocrine cells that produce digestive hormones that feed into ducts to the duodenum. Remember that an exocrine gland has ducts and feeds its output into the hollow area of the target organ.

Only 1% is devoted to producing insulin but that 1% consists of several million cells called islets of Langerhans, named after the German scientist who discovered them way back in 1869.

The graphic below shows the location of the pancreas. Surgically, it is hard to get to and hard to diagnose problems early.

Taking Two Steps Back

Before trying to start reversing diabetes, it helps to understand the physiology of how sugar gets in the blood stream in the first place and how the pancreas acts to clear it out.

Let’s keep it simple. Certain foods get converted to blood sugar faster than others or possibly not at all. Glucose is one of the sugar types. You drink a glucose solution and it all shows up in the blood stream very quickly. Eat a white potato and gets converted to blood sugar very quickly also. Eat a helping of broccoli and almost none of it is converted to sugar.

Getting a Little More Complex

Now back to the pancreas; in reversing diabetes, it's good to know a little physiology about how it works. The islets of Langerhans contain a type of cells called beta cells that produce the hormone insulin. Alpha and Beta cells make up almost all of the endocrine system part of the pancreas with two other types, Delta and F cells, making up less than 1% combined.

Scientists seem to like alphabetic letters for everything. It would have been more meaningful to call these cells the glucagon cell instead of Alpha, the insulin cell instead of beta, somatostatin instead of delta and polypeptide instead of F cells.

The glucagon from alpha cells, which make up about 20% of the islet cells, raise blood sugar to maintain normal levels.

Insulin from the beta cells work to lower blood sugar. We have a real balancing act between alpha and beta; glucagon and insulin.

Somatostatin from the delta cells inhibit release of insulin and the polypeptide from the F cells inhibit the release of somatostatin which has the combined effect of increasing the release of insulin.

All the hormones released from these four cell type have one purpose in life; to control blood sugar (glucose). The consequences of failure to control blood sugar are extremely serious and reversing diabetes depends on control.

High blood sugar from too little insulin may be slow to exhibit symptoms but when it does, fatigue, confusion, a smell of acetone on the breath, coma and death can be the outcome. Treatment is the administration of insulin.

Low blood sugar from too much insulin has a faster presentation of symptoms which also include confusion, coma, shock and death. The usual treatment is oral or intravenous glucose. Who would have thought that something like sugar could affect our health so much and take so many hormones to control.

Diabetes Mellitus

You will know the disorders of high glucose levels in the blood as diabetes mellitus characterized by the three "polys".

• Polyuria is very high urine production
• polydipsia is excessive thirst and water intake
• polyphagia is excessive eating

Diabetes mellitus is literally "sweet urine" and in the old days, tasting of the urine was actually a diagnostic procedure for diabetes. No thanks, I pass!

The vast majority of diabetics are either classified as type 1 or type 2 and it makes a huge difference when it comes to reversing diabetes.

Type 1 diabetes is a deficiency of insulin due to the death of insulin-producing beta cells of the islets of Langerhans in the pancreas.

Type 1 is further differentiated as an autoimmune attack or idiopathic. An idiopathic disease is one in which the doctors don't have a clue as to its cause.

About 10% of all diabetes cases are type 1.

Most type 1 diabetics start out healthy with a normal weight when onset occurs. Sensitivity and responsiveness to insulin is usually normal, especially in the early stages.

Type 1 diabetes can affect children or adults but was traditionally termed "juvenile diabetes" because it represents a majority of the diabetes cases in children.

Treatment of type 1 diabetes is via injection of artificial insulin combined with careful monitoring of blood glucose levels using blood testing monitors.

If a type 1 doesn't get their insulin injection, a condition known as diabetic ketoacidosis often develops which can lead to coma or death. This is an excess of the acidic ketones in the blood. Reversing diabetes in Type 1 cases is almost unheard of.

Dietary adjustments and exercise programs are increasingly becoming a part of the type 1's treatment although diet and exercise alone can't do much for reversing diabetes of type 1.

In addition to injections under the skin, doctors are now infusing insulin with a pump, which allows the delivery of insulin 24 hours a day at preset levels, and provides the ability to program doses of insulin as needed at meal times.

Non-insulin treatments, such as monoclonal antibodies and stem-cell based therapies, are effective in animal models but have not yet completed clinical trials in humans.

Type 1 treatment must be continued indefinitely in essentially all cases.

Type 2 diabetes, the most common type, is due to insulin resistance or reduced insulin sensitivity, combined with reduced insulin secretion which sometimes ceases altogether.

The impaired responsiveness to insulin almost certainly involves the insulin receptor in cell membranes however, the specific causes are not known.

In the early stage of type 2 diabetes, reduced insulin sensitivity is the prominent characteristic as seen by elevated levels of insulin in the blood.

At this stage, reversing diabetes is still possible by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses, the decline of insulin secretion worsens and insulin injections often become necessary.

Theories abound as to the cause and mechanism of type 2 diabetes. Abdominal fat concentrated around the internal organs are known to set individuals up for insulin resistance. Abdominal fat secrets a group of hormones called adipokines that may impair glucose tolerance.

Obesity is found in approximately 55% of patients while aging accounts for about 20% and family history seems to be a factor as well. Over the last 10 years, more and more children and adolescents have been diagnosed with type 2 diabetes, most likely due the increases in childhood obesity.

In addition, environmental exposures may contribute to increases in the disease. A positive correlation has been found between the concentration of bisphenol A in the urine, a constituent of polycarbonate plastic, and the incidence of type 2 diabetes.

In the early years, symptoms are typically mild, possibly non-existent or sporadic, and usually there are no ketoacidotic episodes (acid build-up in the blood).

Severe long-term complications can result from undiagnosed diabetes, including renal failure due to diabetic nephropathy, vascular disease (including coronary artery disease), vision damage due to diabetic retinopathy, loss of sensation or pain due to diabetic neuropathy, liver damage from non-alcoholic steatohepatitis and heart failure from diabetic cardiomyopathy.

Considering all of this, reversing diabetes seems to be an exercise in futility but read on.

Initial treatments in reversing diabetes usually involve increased physical activity, lowering carbohydrate intake, and losing weight. These can restore insulin sensitivity even when the weight loss is modest, for example around 10 to 15 lb, especially when the loss is in abdominal fat deposits.

It is sometimes possible to achieve long-term, satisfactory glucose control with these measures alone. However, the underlying tendency to insulin resistance is always present, thus a program of diet, exercise, and weight loss must become a lifestyle.

The usual next step in reversing diabetes is treatment with oral antidiabetic drugs.

Insulin production is initially only moderately impaired in type 2 diabetes, so oral medication (often used in various combinations) can be used to improve insulin production (e.g., sulfonylureas), to regulate inappropriate release of glucose by the liver and attenuate insulin resistance to some extent (e.g., metformin), and to substantially attenuate insulin resistance (e.g., thiazolidinediones).

Unfortunately, in reversing diabetes, the temptation to go straight to the drugs is just too much for most caregivers to resist; bypassing the diet, exercise and weight management. Nevertheless, the statistics for combining certain diabetes medications with exercise and diet are compelling.

According to one study, overweight patients treated with metformin compared with diet alone, had relative risk reductions of 32% for any diabetes outcome.

The bad news is that oral medications may eventually fail due to further impairment of insulin secretion by the pancreatic beta cells, at which point, insulin therapy will be necessary to maintain normal or near normal glucose levels.

What are the diabetic meds?

Oral diabetes medications fall into one of five different classes, all of which help in lowering blood glucose levels but each one tackles the job a little differently. These different classes of diabetes medications can be used in combination or with insulin to achieve control the blood sugar.

The classes and actions of the medications are:

Sulfonylureas stimulate the pancreas to make more insulin. The second- and third-generation ones are the best.

Biguanides shut off the liver's excess glucose production

Alpha-Glucosidase Inhibitors slow absorption of carbs in the intestine

Thiazolidinediones increase the body's sensitivity to insulin

Meglitinides stimulate the pancreas to make more insulin

The Mayo clinic has a very good web site on Type 2 diabetes medications where they list the most common ones along with their advantages, disadvantages and costs at Mayoclinic.com. You will see some old friends there such as Januvia, Metformin, Avandia, Actos, Glipizide and more.

From M.D.s Mark Hyman and Mark Liponis in their landmark book, ULTRA-Prevention, we read the following on how they are treating diabetes patients.

Here's where we get to the real scoop on reversing diabetes, at least for Type 2.

Sticking with type 2 diabetes, Glipizide and Gliclazide (trade name Diamicron) are two of the sulfonylurea drugs, designed to lower blood sugar by increasing the production of insulin.

The problem is that over time, these drugs will stop working because the body gets acclimated to the higher levels of insulin.

Once this occurs, insulin resistance will increase over time.

Diabetes medications and anti-inflammatories will seem to be working for awhile but in reality they are making the condition worse.

Eventually the doctor will resort to insulin shots in ever increasing doses just to keep blood sugar under control. The end result is worsening cycle of weight gain, high blood pressure and high cholesterol. The sulfonylurea drugs have actually been shown to increase heart disease, the main cause of death in diabetics.

Reversing diabetes just gets harder and harder the more drugs we take.

It is a rare doctor that has time to delve into WHY someone has diabetes. The conventional thinking is that diabetes is caused by too little insulin when in fact it is a result of too much insulin, causing the ever increasing resistance to insulin.

The usual medical approach is to get the pancreas to pump out more insulin when the focus should be on getting the body to respond normally to the insulin.

Instead the objective should be to lower the output of insulin and restore the body's sensitivity to the insulin that is produced normally.

The key is to avoid the drugs, change the diet to eliminate all sugar and anything the body converts to sugar quickly such as refined grains, processed carbohydrates and starches; in other words, all the high glycemic foods.

Since we are considering nutrition, here's another book recommendation. The medical aspects of reversing diabetes based on "Medical Nutrition Therapy" are detailed in the Handbook for professionals available from Amazon.com and published by Jones and Bartlett. Click on the link below for more details.

Handbook of Diabetes Medical Nutrition Therapy

The pattern of daily food intake must be changed from two or three large meals a day to smaller, more frequent meals. Certain targeted supplements are also important.

In conjunction with the dietary changes, reversing diabetes depends on a program of regular exercise and weight control.

Two studies published in the New England Journal of Medicine validate that lifestyle changes are critical to reversing diabetes.

The May 30, 2001 issue showed that the chances of developing diabetes in high-risk people could be reduced by 58% through the lifestyle changes covered above. The risk factors of the test subjects were being over-weight, middle aged, exhibiting signs of impaired glucose tolerance or having trouble processing sugar.

In the September 21st issue the same year, a study was presented that involved 80,000 women over a sixteen year period in which the lifestyles of high and low risk people were tracked.

The low risk group were those that exercised regularly, ate less saturated fat, trans fat, sugar and higher glycemic foods and consumed more fiber.

The results of the study were dramatic. Full blown diabetes was averted in approximately 90% of the group that followed the healthy lifestyle.

The side benefit of avoiding diabetes is that the effects of aging on all the organs normally affected diabetes is avoided.

So there is hope for reversing diabetes but the ideal situation is to adopt a healthy lifestyle early on, make it a habit, and don't get diabetes in the first place. Remember diet, exercise, weight control and one more; stress management. All these taken together will be a better therapy than all the pills in the world.

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