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Modern Medicine and Traditional Chinese
Medicine - Diabetes Mellitus by
Clinton Choate
Background There is nothing new about diabetes; it has been a medical problem since antiquity. The name which was originated by Aretaeus (30-90 CE) came from the Greek words meaning 'siphon' and 'to run through', signifying the chronic excretion of an excessive volume of urine.
Diabetes mellitus, because of its frequency, is probably the single most important metabolic disease and is widely recognized as one of the leading causes of death and disability in the United States. It affects every cell in the body and the essential biochemical processes that go on there.
Diabetes has been linked to the western lifestyle, as it is uncommon in cultures consuming a more primitive diet. As cultures switch from their native diets to more commercial foods, their rate of diabetes increases, eventually reaching the same proportions seen in western societies.
A great deal of research has been conducted into the possible aetiology of diabetes. Most of the prevalent ideas can be classified under one of the following categories: heredity, endocrine imbalance, dietary indiscretion and obesity, sequelae of infection, and severe and continued psychic stress.
Although genetic factors appear important in determining susceptibility to diabetes, environmental and dietary factors are also important in its development and many have been identified. A diet high in refined fibre-depleted carbohydrate is believed to be the causative factor in many individuals, while a high intake of high-fibre complex carbohydrate foods is protective against diabetes.
Obesity appears to be a significant factor, particularly considering the fact that 90% of Type 2 (see below) sufferers are obese. Even in normal individuals, significant weight gain results in carbohydrate intolerance, higher insulin levels and insulin insensitivity in the fat and muscle tissue. The progressive development of insulin insensitivity is believed to be the main underlying factor in Type 2 diabetes. Weight loss can correct all of these abnormalities in many instances and significantly improves the metabolic disturbance of diabetes in most cases.
What has become apparent through years of research is that the diabetic condition is not simply a matter of one or two things having gone wrong. It is a complex condition with a multitude of metabolic imbalances. Consequently, the conventional medical approach of simply using insulin or oral drugs to treat diabetes is incomplete and the person relying on them to prevent long-term complications remains at risk.
About Blood Sugar
Carbohydrate is the active fuel of the body and is ordinarily the main source of energy of the tissue cell. In the normal digestive process, food sugars and starches (carbohydrates) are changed into sugar glucose. This is stored in the form of glycogen (animal starch) in the liver and muscles for later use as a body fuel, at which time it is reconverted into glucose. Blood sugar rises somewhat after eating, and in healthy individuals returns to normal levels in about an hour or two. The amount of glucose in the blood is controlled mainly by the hormones insulin and glucagon. Too much or too little of these hormones (or if they are somehow ineffective) can cause blood sugar levels to fall too low (hypoglycaemia) or rise too high (hyperglycaemia). Other hormones that influence blood sugar levels are cortisol, growth hormone and catecholamines (epinephrine and norepinephrine).
The pancreas, a gland in the upper abdomen is responsible for producing insulin and glucagon. The pancreas is dotted with hormone-producing tissue called the islets of Langerhans, which contain alpha and beta cells. When blood sugar rises after a meal, the beta cells release insulin. The insulin helps glucose enter body cells, lowering blood glucose levels to the normal range. When blood sugar drops too low however, the alpha cells secrete glucagon. This signals the liver to release stored glycogen and change it back to glucose, raising blood sugar levels to the normal range. The result of the disturbed metabolism of glucose causes an abnormal accumulation of sugar in the blood stream and the diabetic condition.
Blood Sugar Ranges
The quantity of glucose in the blood seldom exceeds 160 milligrams/decilitre (mg/dl) of blood shortly after food sugar has been absorbed, nor seldom falls below 60 mg/dl during fasting. This increases about 2 mg/dl per decade after age 30. Some mild diabetics will have normal fasting blood sugar values and values in the diabetic range only after meals. Occasionally very mild cases will have values within normal at both times and the diabetic tendency will be evident only when these persons are required to handle more than an ordinary amount of carbohydrate.
In the fasting state, blood sugar can occasionally fall below 60 mg/dl and even to below 50 mg/dl and not indicate a serious abnormality or disease. This can be seen in healthy women, particularly after prolonged fasting. Blood sugar levels below 45 mg/dl in a woman or 55 mg/ dl or less in a man indicate a strong possibility of hypoglycaemia.
Higher-than-normal blood sugar levels, for example 140 mg/dl or higher after an overnight fast, can indicate diabetes mellitus. In moderately severe diabetes, after-meal values of 250-350 mg/dl are not unusual. If a person with diabetes develops hyperglycaemia and it is left untreated, the result can lead to coma or death.
Diabetes is characterised by three well-known syndromes, polydipsia (excessive thirst), polyphagia (excessive hunger) and polyuria (excessive urination). Laboratory findings reveal high blood sugar and glucose in the urine and as the metabolic derangement worsens, excessive ketone bodies in the blood and urine. The accumulation of these produces acidosis which, if not counteracted, can result in coma and death.
There are three main types of diabetes:
o Type 1 or 'Insulin-Dependent Diabetes Mellitus' (IDDM) also known as 'Juvenile Onset Diabetes'.
o Type 2 or 'Noninsulin-Dependent Diabetes Mellitus' (NIDDM) also known as 'Adult Onset Diabetes'.
o Gestational diabetes.
Type 1 Diabetes (Insulin-Dependent Diabetes Mellitus/IDDM)
Insulin-dependent diabetes is considered an autoimmune disease in which the immune system attacks the insulinproducing beta cells in the pancreas and destroys them. The pancreas produces little or no insulin and it is then almost certain that life-long insulin replacement will be necessary. The exact mechanism for the body's immune system attack to the beta cells is unknown but the most likely causes are viral infection, genetic factors and free radicals.
Interest has been generated lately in the strong evidence linking exposure to a protein in cow's milk (bovine albumin peptide) in infancy to the autoimmune response and subsequent Type 1 diabetes. In detailed studies1 it was shown that patients with Type 1 diabetes were more likely to have been breast-fed for less than three months and to have been exposed to cow's milk or solid foods before the age of four months. Since the cow's milk protein can enter the mother's breast milk, in cases of family history of diabetes it is recommended that the mother avoid cow's milk while breast-feeding.
IDDM accounts for about 5 to 10 percent of diagnosed diabetes in the USA and develops most often in children and young adults, but the disorder can appear at any age. Symptoms usually develop over a short period, although beta cell destruction can begin months, even years, earlier.
Over time both Type 1 and Type 2 diabetes are accompanied by many severe complications, such as blindness, renal failure, lower- limb amputations, cardiovascular disease and stroke. For those with Type 1 diabetes the object is not to find a way to get off insulin but rather to prevent the long-term complications. It is encouraging to note that modern research has demonstrated the amount of insulin required could be reduced through appropriate life style modifications and the likelihood of consequent complications significantly lowered.
Type 2 Diabetes (Noninsulin-Dependent Diabetes Mellitus/NIDDM)
The most common form of diabetes is noninsulin-dependent diabetes. About 90 to 95 percent of people with diabetes have Type 2. In the USA more than 16 million people, over 7% of the adult population, have Type 2 with 600,000 new cases diagnosed each year. In many patients, the initial diagnosis of Type 2 diabetes is delayed perhaps by as much as 10 years because symptoms are often absent or very mild during its early stages.
Type 2 diabetes usually develops in adults over the age of 40 and is most common among adults over age 55. It is particularly common among the elderly and in many minority populations, including African Americans, Hispanic Americans, American Indians and Asian and Pacific Islander Americans, in whom it may occur in 10-50% of adults.
Type 2 diabetics typically have elevated levels of insulin, often producing two to three times the normal amount. Rather than an insulin deficiency condition it is an "insulin resistance" condition whereby the body loses its ability to properly respond to the signals given by insulin. We now know that excess insulin brought on by insulin resistance is not only associated with elevated blood sugar levels, but also with high blood pressure and increased rates of atherosclerosis.
In the treatment of Type 2 diabetes, dietary modification has been found to be of primary importance and should be diligently followed before using drug intervention since most cases can be controlled by diet alone. For all Type 2 diabetics an effective treatment approach should employ a broad-based therapeutic regimen. Such a regimen would incorporate appropriate diet, prescribed exercise, stress reduction techniques and a substantial amount of specific nutritional supplements. If adequate control of blood sugar levels remains problematic, conventional treatment with insulin and oral agents can be initiated.
Gestational Diabetes
Gestational diabetes develops or is discovered during pregnancy. This type usually disappears when the pregnancy is over, but women who have had gestational diabetes have a greater risk of developing NIDDM later in their lives.
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