Diabetes 2011, Spring Seminar

Diabetes

What is diabetes?What is diabetes? Diabetes is a metabolic abnormality

affecting all nutrients, especially the way your body uses blood sugar (glucose), your main source of energy.

Insulin and glucagon, two hormones produced by your pancreas, regulate the amount of glucose in your bloodstream. When a person has diabetes, this process does not function properly.

“Medical essay: Diabetes.” Supplement to Mayo Clinic Health Letter. Mayo Clinic. February 2004.

Once, there wereOnce, there were two types of diabetes; two types of diabetes; children mainly got one type and adults mostly children mainly got one type and adults mostly got the other. Today, we know that younger got the other. Today, we know that younger people can get people can get type 2type 2 and that and that type 1type 1 often often appears in adulthood. During pregnancy, appears in adulthood. During pregnancy, women can get women can get gestational diabetesgestational diabetes, which , which resembles type 2 and usually disappears after resembles type 2 and usually disappears after childbirth.childbirth.

Diabetes

http://forecast.diabetes.org/diabetes-101/type-2-diabetes

http://forecast.diabetes.org/diabetes-101/type-1-diabetes

http://forecast.diabetes.org/diabetes-101/gestational-diabetes

GestationalGestational

During pregnancy, women can get gestational diabetes, which resembles type 2 and usually disappears after childbirth.

And scientists have identified several other diabetes subtypes beyond types 1 and 2.

http://forecast.diabetes.org/diabetes-101/gestational-diabetes

Latent autoimmune diabetesLatent autoimmune diabetes

The National Institutes of Health (NIDDK) defines LADA as “a condition in which Type 1 diabetes develops in adults.”

LADA is a genetically-linked, hereditary autoimmune disorder that results in the body mistaking the pancreas as foreign and responding by attacking and destroying the insulin-producing beta islet cells of the pancreas. Simply stated, autoimmune disorders, including LADA, are an "allergy to self.”

http://en.wikipedia.org/wiki/Hereditary

http://en.wikipedia.org/wiki/Autoimmune_disorder

http://en.wikipedia.org/wiki/Pancreas

http://en.wikipedia.org/wiki/Beta_cell

http://en.wikipedia.org/wiki/Islet_cell

LADA (Latent AutoimmuneLADA (Latent Autoimmune Diabetes in Adults) Diabetes in Adults)

The most common of these is called latent autoimmune diabetes in adults (LADA), and it accounts for roughly 10 percent of people with diabetes, making it probably more widespread than type 1.

U.S. statisticsU.S. statistics In 2000, 17,702,000 people in the U.S.

had diabetes In 2030, it is projected that

30,312,000 people in the U.S. will have diabetes

More than 20% of Americans 65 and older have diabetes

An estimated 6 million Americans with diabetes do not even know they have it

“Medical essay: Diabetes.” Supplement to Mayo Clinic Health Letter. Mayo Clinic. February 2004. Diabetes: Country and regional data. World Health Organization. http://www.who.int/diabetes/facts/world_figures/en/index3.html Accessed 9/5/2006

Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)

BRFSS, 1990,1995 and 20011990 1995

2001

Source: Mokdad, et al. Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286:10.

No Data <4% 4%-6% 6%-8% 8%-10% >10%No Data <4% 4%-6% 6%-8% 8%-10% >10%

Does diabetes affect Does diabetes affect youyou??

Or does it affect someone you know?Do you want to know more about it?

Can it be prevented - or treated?Let’s take a look!

ComplicationsComplications

Type I diabetes can affect almost every major organ of your body, including:◦ Heart ◦ Blood vessels◦ Nerves ◦ Eyes◦ Kidneys

Type I diabetes. Mayo Clinic. http://www.mayoclinic.com/health/type-1-diabetes/DS00329/DSECTION=4 Accessed 9/5/2006

Health problems: CardiovascularHealth problems: Cardiovascular

Type II diabetes can cause:◦ Heart attacks 2-4 times the risk of dying

from heart disease◦ Strokes 2-4 times the risk of stroke

◦ High blood pressure Increase risk several fold

Health problems that diabetes can cause. Harvard Medical School’s Consumer Health Information. http://www.intelihealth.com/IH/ihtIH/WSIHW000/35072/35073/360341.html?d=dmtContent Accessed 10/3/2006“Medical essay: Diabetes.” Supplement to Mayo Clinic Health Letter. Mayo Clinic. February 2004.

Health problems: KidneysHealth problems: Kidneys Type II diabetes can cause:

◦ Kidney damage (nephropathy) Signs and symptoms include fatigue, high

blood pressure, swollen ankles, feet or hands, shortness of breath, low levels of red blood cells (anemia), and leakage of albumin (a blood protein) into the urine

◦ Kidney failure 40% of people needing dialysis have kidney

failure from diabetes

“Medical essay: Diabetes.” Supplement to Mayo Clinic Health Letter. Mayo Clinic. February 2004. Health problems that diabetes can cause. Harvard Medical School’s Consumer Health Information.

http://www.intelihealth.com/IH/ihtIH/WSIHW000/35072/35073/360341.html?d=dmtContent Accessed 10/3/2006

Health problems: EyesHealth problems: Eyes Type II diabetes can cause:

◦ Eye Damage More than 60% of people with Type II

diabetes develop deterioration in the blood vessels of the retina

Diabetes increases the risk of developing cataracts and glaucoma

◦ Blindness Diabetes is the most common cause

of blindness that starts between ages 20 and 74

“Medical essay: Diabetes.” Supplement to Mayo Clinic Health Letter. Mayo Clinic. February 2004.Health problems that diabetes can cause. Harvard Medical School’s Consumer Health Information. http://www.intelihealth.com/IH/ihtIH/WSIHW000/35072/35073/360341.html?d=dmtContent Accessed 10/3/2006

Health problems: NervesHealth problems: Nerves Type II diabetes can cause:

◦ Peripheral neuropathy Feet and legs can develop tingling,

pain, or a loss of feeling◦ Amputations Nearly 86,000 amputations are

performed every year in the U.S. on diabetics, which accounts for 50% of all amputations in the U.S.

Health problems that diabetes can cause. Harvard Medical School’s Consumer Health Information. http://www.intelihealth.com/IH/ihtIH/WSIHW000/35072/35073/360341.html?d=dmtContent Accessed 10/3/2006

Health problemsHealth problems Type II diabetes can cause:

◦ Sexual-function problems Impotence

◦ Localized nerve failures Single muscle can lose its function Problems that may result:Eye movement problems with double visionDrooping of the cheek or one side of the head (Bell’s palsy)


Health problemsHealth problems

Type II diabetes can cause:◦ Stomach and bowel problems Nausea, constipation, or

diarrhea◦ Dizziness when standing Poor circulation causing low

blood pressure and dizziness when standing


Controllable risks: LDLControllable risks: LDL

Reduce low-density lipoprotein (LDL) cholesterol in the blood◦ LDL promotes accumulation of

fats in the arteries◦ Diet should not include any animal

products of any kind◦ Avoid free fats (mayonnaise, oils,

margarine, etc.)

Thrash, Agatha and Calvin, M.D. Diabetes & the hypoglycemic syndrome: facts, findings and natural treatments. Seale, AL: NewLifestyle Books, 1993. p. 42

Controllable risks: HDLControllable risks: HDL

Increase high-density lipoprotein (HDL) cholesterol in the blood◦ HDL removes fats from blood

and tissues◦ Increased by: Exercise Weight reduction Stopping smoking


Controllable risks:Controllable risks:Stress & HypertensionStress & Hypertension

Religious experience◦ Develop a daily program of Bible

study and prayer◦ Learn to control thoughts and to

dwell on heavenly themes

Thrash, Agatha and Calvin, M.D. Diabetes & the hypoglycemic syndrome: facts, findings and natural treatments. Seale, AL: NewLifestyle Books, 1993. p. 42, 160-163


◦ Control talkingNot too much, not too littleTalk only about cheerful subjectsDo not talk about yourselfDo not talk about a single subject



◦ Exercise Start with a graduated exercise program Take a brisk walkHold your head upBreathe deeplyMaintain good posture

Walk in nature an hour or more each day◦ Do deep breathing exercises



◦ Observe strict regularity for meals◦ Omit all evening food◦ Guard against overeating or undereating Stress increases after too much food

◦ Eliminate sugar, honey, coconut, dried or very sweet fruits and vegetables during periods when you are feeling stressed



◦ Avoid nerve stimulating or irritating foods Examples: hot pepper, ginger,

cinnamon, cloves, nutmeg, vinegar, anything made with vinegar (pickles, mayonnaise, catsup, mustard, etc.)



Avoid foods having a fermenting, putrefying or rotting phase of processing◦ Examples: sauerkraut, cheese, soy

sauce and similar products Eliminate all concentrated foods

such as wheat germ, margarine, dried skim milk and all animal products



Abstain from baking soda and baking powder products, caffeine and other methyl xanthines such as theophylline and theobromine which are found in coffee, tea, colas, chocolate and nicotine

Eat freely of foods high in B-vitamins such as greens, legumes and whole grains



Take a sunbath daily, weather permitting◦ Early in the morning

(<10:00 a.m.)◦ Late in the afternoon

(>3:00 p.m.) Take a neutral bath daily



Herbal teas◦ Diuretics Watermelon seed Buchu Burdock Dandelion Cornsilk

◦ Hawthorn berry and Dandelion together


Diabetes management: Diabetes management: Controllable risksControllable risks

Stop the smoking habit◦ Smoking intensifies all risks in diabetes and must not be a part of the diabetic’s lifestyle

Avoid being overweight


In almost all cases of Type II diabetes, In almost all cases of Type II diabetes, control of the disease is completely control of the disease is completely determined by control of appetite, weight determined by control of appetite, weight and exercise. and exercise.


Control of appetiteControl of appetite

General guidelines:◦ Eat at set times Do not snack!

◦ Chew thoroughly◦ Eat slowly◦ Fasting Along with other benefits, fasting helps

people learn how to manage their appetites and lose weight

Thrash, Agatha and Calvin, M.D. Diabetes & the hypoglycemic syndrome: facts, findings and natural treatments. Seale, AL: NewLifestyle Books, 1993. p. 156, 50

Weight controlWeight control

Weight controlWeight control

Rule of thumb for average weight:◦ Give yourself 100 pounds for your first

five feet in height.◦ Women: add 5 pounds per inch

thereafter◦ Men: add 6-7 pounds per inch thereafter

(depending on how muscular you are)


Weight control: ObesityWeight control: Obesity

Definition: having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher

BMI = a measure of an adult’s weight in relation to his or her height

Obesity trends among U.S. adults between 1985 an d 2004. CDC http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/obesity_trends_2004.pdf

Weight Control: Weight Control: Body Mass IndexBody Mass Index

ExamplesHeight:Normal (19-24):Overweight (25-29): Obese (30-39): Extreme obesity (>40):

72” (6’)

136-172 lbs

184-213 lbs

221-287 lbs

>294 lbs

64” (5’4”)

110-140 lbs

145-169 lbs

174-227 lbs

> 232 lbs

National Institutes of Health. http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.pdf Accessed 8/29/2006

19961991

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2004

(*BMI ≥30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

2004

Source: Behavioral Risk Factor Surveillance System, CDC.

Weight control: Weight control: Factors that affect weightFactors that affect weight

Positive effect:◦ Regular, moderate exercise◦ Green, leafy vegetables and salads

Negative effect:◦ The amount and type of dietary fats◦ Sedentary lifestyle


Weight control: Weight control: Factors that affect weightFactors that affect weight

Negative effect:◦ Irregular meal times◦ Eating sweets◦ Loss of sleep◦ Late and heavy suppers◦ Eating many varieties at one meal◦ Protein of animal origin


Weight control: GuidelinesWeight control: Guidelines Cut out all free fats

◦ Includes: butter, margarine, mayonnaise, fried foods, cooking fats, salad oils, peanut butter and all other nut or seed butters

Consider becoming a total vegetarian◦ Animal products predispose us to

many ailments, and are not needed to get essential nutrients


Weight control: GuidelinesWeight control: Guidelines

Eat nothing after 3:00 p.m.◦ Metabolism changes about that

time, so eating increases your likelihood of gaining weight

Do not eat between meals Eat more raw foods

◦ Could include juices or purees Home-made is best

Thrash, Agatha and Calvin, M.D. Diabetes & the hypoglycemic syndrome: facts, findings and natural treatments. Seale, AL: NewLifestyle Books, 1993. p. 154-6

Weight control: GuidelinesWeight control: Guidelines

Eat a small variety of food at one meal◦ Lower weight gain◦ Beneficial for digestion and health of

insulin receptors Exercise immediately after meals

◦ About 25 minutes◦ Non-strenuous, but brisk◦ Walking or bicycling will suffice


ExerciseExercise

Exercise: DPP studyExercise: DPP study

The Diabetes Prevention Program (DPP) performed a 3-year, federally funded, study of 3,234 people at high risk for diabetes.

The goal of the study was to find out if moderate diet changes and exercise will delay and prevent Type II diabetes.

The answer was yes: diet and exercise sharply reduced the chances that a person with impaired glucose tolerance would develop diabetes

Am I at risk for Type II diabetes? Taking steps to lower your risk of getting diabetes. National Diabetes Information Clearinghouse, NIH.Diabetes Prevention Program. NIH NDIC. http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/index.htm Accessed 10/23/2006

Exercise: DPP studyExercise: DPP study

The participants were divided into two groups: the lifestyle change group, and the group that took the diabetes drug metforim.

Those in the lifestyle change group exercised ~30 minutes a day 5 days a week, usually by walking, and lowered their intake of fat and calories.

The lifestyle change group reduced their risk of getting diabetes by 58% (71% for those over 60.) The metforim group only reduced their risk by 31%

Am I at risk for Type II diabetes? Taking steps to lower your risk of getting diabetes. National Diabetes Information Clearinghouse, NIH.

Exercise: multiple benefitsExercise: multiple benefits

The National Institutes of Health recommend that you should “be physically active every day.”

Regular exercise benefits in several ways◦ Helps you lose weight◦ Keep your cholesterol and blood pressure

under control◦ Helps your body use insulin


Exercise: How?Exercise: How?

If you are not very active, start slowly Work up to 30 minutes a day most days of

the week Choose activities you enjoy Incorporate it into your daily life

◦ Examples: take the stairs instead of the elevator; park at the far end of the parking lot and walk; get off the bus a few stops early and walk the rest of the way


Case history 1: 58 year-old femaleCase history 1: 58 year-old female

History:◦ Gained ~30 pounds over the past

year◦ Sugar level = 350 mg/dl

Diagnostics before starting program◦ Weight = 160 lbs, Height = 5’5’’◦ Blood pressure = 160/90◦ Fasting blood sugar = 368◦ Serum cholesterol = 348



Treatment◦ Diet Predominately vegetarian Very low in fats High in unrefined carbohydrates Plenty of raw foods

◦ Exercise◦ Weight control



Result◦ 2 weeks Lost 6 pounds Fasting blood sugar was down to 190

◦ 4 weeks Fasting blood sugar dropped to 124 Cholesterol dropped to 220



Result◦ 4 months Lost 30 pounds Blood sugar was normal

◦ Ongoing Blood pressure continued to drop slowly Cholesterol reached 190 Dropped to 118 pounds


Case history 2: 68 year-old maleCase history 2: 68 year-old male

History:◦ Taking 65 units of NPH insulin daily◦ On medication for hypertension◦ Had a heart attack several years before◦ Continued to have severe angina◦ Had osteoarthritis in many joints◦ Had chronic phlebitis in both lower legs◦ Weight: 215 pounds◦ Blood sugar: 265; serum cholesterol: 258◦ Blood pressure: 176/100


Case history 2: 68 year-old maleCase history 2: 68 year-old male

Treatment, part 1:◦ Stopped the insulin immediately◦ Went on a two day fast

Result◦ Blood pressure dropped to 150/90◦ Blood sugar dropped to 200


Case history 2: 68 year-old maleCase history 2: 68 year-old male Treatment, part 2:

◦ Mildly heated whirlpool to lower extremities

◦ Massage◦ Mild exercise◦ Diet: total vegetarian, oil-free, high in

unrefined carbohydrates Results

◦ Within 3 days, his blood sugar had dropped within the normal range

◦ In 3 weeks, his serum cholesterol camedown to 186


Documents

Diabetes 2011, Spring Seminar