Type 2 Diabetes

Type 2 diabetes is a condition where the body does not make enough insulin or is not sensitive to the insulin that is produced. Because insulin is needed to drive glucose into the many of the body’s cells, this leads to a state of chronic hyperglycemia (elevated sugar) in the blood. Early signs of hyperglycemia include polydipsia (increased thirst), polyuria (increased urination) and polyphagia (increased appetite). As diabetes progresses, complications can include peripheral neuropathy, nephropathy (kidney diseases), retinopathy (eye diseases), increase susceptibility to infections, cardiovascular diseases (such as stroke and heart attacks) ^[1]. Risk factors for diabetes includes older age, certain ethnicities, lack of physical activity, poor lifestyle and dietary habits, a history of gestational diabetes, previous or other cardiovascular disease, polycystic ovarian syndrome, psychiatric disorders (including depression) and obesity .

In Canada, the number of people diagnosed with diabetes is projected to increase to 3.7 million by 2019 ^[1]. Poorly managed diabetes can lead to complications such as blindness, limb amputation and end stage renal disease. Many of these complications lead to increased health care services and need for assistance both from society and from their caregivers.

Diagnosis

To diagnose diabetes requires blood tests. Several can be used to make this diagnoses: fasting plasma glucose (≥ 7.0mmol/L), glycated hemoglobin or HbA1c (≥ 6.5%) or 2 hour plasma glucose after a 75g glucose challenge or 2hour OGTT (≥ 11.1mmol/L). Even a random plasma glucose (≥ 11.1mmol/L) can be used but another test will be used to confirm the diagnosis.

Treatments

An essential part of managing diabetes is glycemic control. Establishing control means treating to lower HbA1c to ≤ 7% for most patients with diabetes, although a target of ≤ 6.5% may be considered for a specific population trying to lower their risk of kidney or eye diseases. However, in those with limited life expectancy, a high level of functional dependency, extensive heart disease, multiple chronic health conditions or are unable to manage hypoglycemia, a target of 7.1% - 8.5% may be considered ^[2]. Any comprehensive management plan for diabetes should include: comprehensive diet and lifestyle interventions; disease monitoring and medication adjustment; prevention of disease progression and complications; and patient education and empowerment through interprofessional healthcare ^[2].

Diet

An essential part of regulating diabetes is diet and exercise. One of the most studied diets for diabetes and cardiovascular health is the Mediterranean Diet. This diet promotes high quantities of vegetables and fruits, protein sources mainly from fish, some complex carbohydrates (legumes, seeds, nuts, cereals or whole grain), low red meat consumption, use of monounsaturated fats (such as extra virgin olive oil) and moderate consumption of red wine. Patients consuming the Mediterranean Diet not only reduce their risk of developing diabetes, but it can also lower the HbA1c, lower cholesterol, decrease blood pressure, reduce risk of death and can help those diagnosed with diabetes to use less medication ^[3,4]. By reducing the carbohydrate content of the Mediterranean Diet so that less than 35% of the diet is from carbohydrates (and using low-glycemic index ones only), the HbA1c can be even further lowered and can promote further weight loss.

Exercise

Physical activity does not have to be intense. Any type of activity (even leisurely walking) can have health benefits ^[5,6]. The key is to stay active almost every day of the week. Walking two to four hours per week, even without an increase in heart rate can reduce mortality . However, the reduction can be improved by raising your heart rate to 50-85% of your maximum heart rate (calculated by 50-80% of 220 minus your age). Mixing in resistance exercise into an exercise regimen has added benefits. Resistance exercise can help lower HbA1c, lower cholesterol, lower blood pressure and help build lean muscle mass (which is more effective at burning fat).

Supplements

Some supplements have been demonstrated to help lower HbA1c and/or cholesterol. Cinnamon at 360mg per day, when added to anti-hyperglycemic medication, can lower HbA1c by almost 1% ^[7].

It can also lower total cholesterol by 0.87mmol/L and lower triglycerides by 1.6mmol/L. Chromium at 200μg per day can lower HbA1c by 0.55% ^[8]. Gymnema sylvestre at 250mg twice per day can lower HbA1c by 1% ^[9]. Increasing dietary intake of magnesium or supplementing with 365mg per day can significantly decrease HbA1c by up to 3.5% and fasting glucose as much as 4.8mmol/L (this result is likely from those deficient in magnesium) ^[10]. The proposed mechanism of action for magnesium is that it increases your body’s sensitivity to insulin. Curcuma longa at doses of 150mg twice per day up to 1.5g per day may lower fasting glucose by up to 1.3mmol/L and HbA1c by up to 0.75% ^[11]

Conclusion

Diabetes is a common condition present worldwide. Appropriate management can reduce need for frequent medical visits, reduce hospitalizations, reduce various medical complications and also reduce the risk for many other diseases, including heart attacks and strokes. Key to the management of diabetes is ensuring incorporation of a healthy diet like the Mediterranean Diet and adding exercise to your daily routine. A naturopathic doctor can help you implement these changes. Some supplements can also help lower important markers of health such as HbA1c and cholesterol. It is important to speak with your naturopathic doctor to discuss what is the right dose for you and ensure that your glucose levels are appropriately monitored.