Blood Glucose Management
Diabetes Mellitus is an abnormal physiologic response to blood sugar and insulin. The complications of Diabetes are numerous and often devastating, including heart disease and stroke, high blood pressure, nerve damage (neuropathy), kidney damage, eye damage (diabetic retinopathy), foot damage (sometimes leading to toe, foot or leg amputation), hearing impairment, skin conditions (including bacterial and fungal infections), Alzheimer’s disease, and the list goes on and on.
With 1 out of 11 people suffering complications from Diabetes, this is an epidemic that needs more effective preventative measures and more outreach. Type 2 diabetes is looming as the biggest epidemic and public health issue in human history. Close to 300 million people are affected worldwide and another 150 million forecast to be diagnosed by 2030
Conventional Medicine’s Approach to Type 2 Diabetes
In conventional medicine we are trained to name, blame, and tame diseases. In other words, we focus on recognizing a specified set of symptoms and lab values that qualify for a particular diagnosis, blaming the diagnosis for the current condition, and prescribing the medication recommended as “first line” for that diagnosis. There is often very little discussion about what got the person to the point of being diagnosed with their condition, particularly with chronic conditions.
This is the process often followed for Type 2 Diabetes. Once your doctor sees a hemoglobin A1C of 6.5 or greater on your routine labs, you are told you now have the disease called Diabetes
Functional Medicine’s Approach: Getting at the Root Cause of Diabetes
There is a problem with blood sugar in Type 2 Diabetes, but Type 2 Diabetes is not a blood sugar problem. The elevated blood sugar is a symptom, it’s not the cause. If we only treat symptoms we’ll never get rid of the disease. In the years and years leading up to the diagnosis of Type 2 Diabetes, your body is growing increasingly intolerant of certain foods until you get to the point where your body will not tolerate refined or processed carbohydrates or sugars at all. Consuming those foods puts fuel on the already raging fire.
The next question that needs to be asked is “What started the fire in the first place?” In most cases it is something called insulin resistance. Insulin is a very important hormone released by beta cells in the pancreas, and one of its key functions is to keep the blood sugar tightly controlled in your body. In order to control the blood sugar, insulin must go through a process that allows the glucose floating around in your blood to efficiently get absorbed into individual cells throughout your body (muscle, fat, liver, etc).
However, your cells are all surrounded by a protective barrier called the cell membrane. Cell membranes have things on them called receptors which are like key holes. In order for substances that are floating around in the blood to get inside the cells they need to have the right fitting key. Insulin is a key that fits into one of these cell receptors, conveniently named the Insulin Receptor. Once the key is in place (insulin bound within the receptor), then the lock is turned, and blood sugar (glucose) is allowed to enter into the cell and provide the energy the cell needs to perform its functions.
Insulin resistance is kind of like a key in a faulty lock. When there is a change in the structure of the key hole, the key doesn’t fit well anymore, making it more difficult to turn the key and unlock the door. As this progresses, the cell needs a lot more of the keys (insulin) going into the key holes (Insulin Receptors) simultaneously to unlock the gate (cell membrane) and allow glucose in. That requires an increasing amount of insulin to be released into the body by the pancreas with each meal that you eat. As long as the beta cells are able to produce enough insulin to overcome the insulin resistance, your blood sugar levels stay in the healthy range. However, if your blood sugar levels are consistently elevated because your diet, then eventually those poor beta cells in your pancreas just can’t keep up with the insulin need and you begin to build up excess glucose in the blood. The excess sticky sweet glucose then begins sticking to and damaging cells throughout the body, with the first symptoms often seen in your eyes and kidneys.
Another known cause of insulin resistance that results in Type 2 Diabetes is chronic stress. Stress increases cortisol levels in your body, which increases blood sugar. This isn’t a problem if it the stress is temporary. Elevated blood sugar is exactly what you need to go into fight or flight mode to protect your family from an intruder or escape a life threatening situation. However, if the stress persists because you work in a high-stress environment or remain in a stressful relationship then the persistently elevated cortisol then causes persistently elevated blood sugar, and your poor beta cells are once again bound to fail.
Another cause of insulin resistance is sleep deprivation. According to research presented, for some individuals one night of sleep deprivation can give you as much insulin resistance as 6 months on a junk food diet!
Additionally, the state of your microbiome plays a role in insulin resistance. The balance of the trillions of bugs living in your gut is critical for your overall health. A disruption of that balance can cause overgrowth of “bad” bacteria that carry lipopolysaccharide (LPS). LPS release is a known cause of insulin resistance.
WHAT IS “PRE-DIABETES”?
Pre-Diabetes is a condition of increasing blood sugar levels and/or intolerance to glucose (inability to appropriately handle glucose in the diet after meals). This is most often due to insulin resistance issues.
Basically, if you have pre-diabetes then you have severe metabolic derangement which absolutely must be addressed. Pre-diabetes should serve as a warning that there are serious problems ahead. I think it is similar to have a sign saying “Bridge Out Ahead”. If you continue down that road you will see the true severity of the problem. If you don’t pay attention to the signs then you’ll end up in a bad spot.
Pre-Diabetes is, by itself, a risk factor for cardiovascular disease and future diabetes. Again, there is already metabolic derangement which is causing problems.
THESE PATIENTS ARE AT MUCH HIGHER RISK OF BECOMING DIABETIC!
Preventing Type 2 Diabetes
As functional medicine doctors, we are also very proactive in preventing Type 2 Diabetes. Because we do increased lab testing and have more sensitive parameters than most doctors, we are able to recognize and begin to reverse problematic changes (like insulin resistance) that lead to diabetes much sooner than is considered the “Standard of Care” in conventional medicine. In other words, we are setting completely new standards, which allow for early detection of diabetes. For starters, conventional lab ranges for blood glucose and hemoglobin A1C, which are the labs doctors look at when screening for diabetes, allow for quite high levels of blood sugars before diabetes is diagnosed. Currently, the following lab values that qualify you for Type 2 Diabetes include:
- Hemoglobin A1C of 6.5% or greater
- A random (non-fasting) blood glucose level of 200 or greater
- A fasting blood glucose of > 125 on 2 separate occasions
However, in functional medicine we look for early warning signs, such as mild elevations of glucose or of insulin. Early markers for Type 2 Diabetes and related conditions include fasting glucose > 100, an elevated triglyceride level, elevated uric acid level, low HDL (good cholesterol), elevated LDL, hemoglobin A1C > 5.6%, increased insulin or c-peptide levels (for long term average insulin production), certain antibodies (GAD 65, Pancreatic Islet Cells), increased waist size (>40 inches in men, > 35 inches in women), elevated blood pressure, and others. By heeding the early warning signals, you can not only halt the dangerous progression leading towards diabetes, but you can actually reverse them and regain health!
Managing Type 2 Diabetes
Then next big question then is “what can be done?” In conventional medicine the primary treatment continues to be to prescribe Metformin or another pharmacological agent, or even to give insulin if the A1C is really high, further increasing the individual’s risk of obesity and inflammation. However, science (and common sense) really support diet and lifestyle changes as the primary treatment for Type 2 Diabetes and for lab changes that suggest any insulin resistance. This is where Functional Medicine shines. Not only do we take more than the typical 10-15 minutes with you in our office visits, but we educate you at length about food and nutrition. Visits typically range from 30-90 minutes. We provide a personal health coach to walk you through the sometimes difficult dietary changes that have to be made. Your labs are monitored carefully to ensure we are moving in the right direction. We can use physician grade, scientifically proven nutraceuticals as needed to boost the body’s ability to respond to the dietary and lifestyle changes you are making. This is all done in a personalized way, in which you are actively participating in all decisions and plans. This is how we can manage conditions like Type 2 Diabetes.