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Assessing Blood Glucose Regulation Functional Medicine University’s Functional Diagnostic Medicine Training Program Mod 4 * FDMT533B Primary and Advanced Testing: Assessing Blood Glucose Regulation By Wayne L. Sodano, D.C., D.A.B.C.I., & Ron Grisanti, D.C., D.A.B.C.O., M.S. http://www.FunctionalMedicineUniversity.com Limits of Liability & Disclaimer of Warranty We have designed this book to provide information in regard to the subject matter covered. It is made available with the understanding that the authors are not liable for the misconceptions or misuse of information provided. The purpose of this book is to educate. It is not meant to be a comprehensive source for the topic covered, and is not intended as a substitute for medical diagnosis or treatment, or intended as a substitute for medical counseling. Information contained in this book should not be construed as a claim or representation that any treatment, process or interpretation mentioned constitutes a cure, palliative, or ameliorative. The information covered is intended to supplement the practitioner’s knowledge of their patient. It should be considered as adjunctive and support to other diagnostic medical procedures. This material contains elements protected under International and Federal Copyright laws and treaties. Any unauthorized reprint or use of this material is prohibited. Functional Medicine University; Functional Diagnostic Medicine Training Program/Insider’s Guide Module 4: FDMT 533B: Primary and Advanced Testing: Assessing Blood Glucose Regulation Copyright © 2010 Functional Medicine University, All Rights Reserved Functional Medicine University’s Functional Diagnostic Medicine Training Program Module 4: FDMT 533B: Primary and Advanced Testing: Assessing Blood Glucose Regulation By Wayne L. Sodano, D.C., D.A.B.C.I., & Ron Grisanti, D.C., D.A.B.C.O., M.S. http://www.FunctionalMedicineUniversity.com Contents The Four Types of Diabetes 2 Impaired Glucose Tolerance/Impaired Fasting Glucose 3 Drug-induced Disorders of Glucose Tolerance 3 Progression to Type II Diabetes 5 Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C 6 Diagnostic Studies 7 In Summary 12 New on-line library document available on FMU: Procedures/Diagnostic Tests-Oral Glucose Tolerance Test Patient Education Handout: Clinical Center National Institutes of Health Required reading: The Oral Glucose Tolerance Test Revisited. This article may be found with the Insider’s Guide and Handouts for this lesson and in the on-line library at www.FunctionalMedicineUniversity.com 1 Functional Medicine University’s Functional Diagnostic Medicine Training Program Module 4: FDMT 533B: Primary and Advanced Testing: Assessing Blood Glucose Regulation By Wayne L. Sodano, D.C., D.A.B.C.I., & Ron Grisanti, D.C., D.A.B.C.O., M.S. http://www.FunctionalMedicineUniversity.com The Four Types of Diabetes 1. Type 1 Diabetes – 5 to 10 percent of all diagnosed cases of diabetes. Risk factors include autoimmune, genetic, environmental, and viral. 2. Type 2 Diabetes – 90 to 95 percent of all diagnosed cases of diabetes. Risk factors include aging, obesity, family history, sedentary lifestyle, race/ethnicity, history of gestational diabetes, and impaired glucose tolerance. 3. Gestational diabetes – develops in 2 to 5 percent of all pregnancies. Resolves when pregnancy is over. 4. “Other Special Types” – results from specific genetic syndromes, surgery, drugs, malnutrition, infections, mDNA mutations, oxidative stress and other illnesses. Accounts for 1 to 2 percent of all diagnosed cases of diabetes. Certain viruses have been associated with beta-cell destruction. Diabetes can occur in patients with congenital rubella, although most of these patients have HLA and immune markers characteristic of type 1 diabetes. In addition, coxsackievirus B, cytomegalovirus, adenovirus and mumps have been implicated in inducing certain cases of the disease.10 Insulin resistance has been loosely defined as the requirement of 200 or more units of insulin per day to attain glycemic control and to prevent ketosis. Criteria from the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) are used to clinically identify patients with insulin resistance. The diagnosis of insulin resistance (metabolic syndrome) is established when three or more of the following are present: Abdominal Obesity-waist circumference more than 40 inches (102 cm) in men or more than 35 inches (88 cm) in women Fasting triglyceride level of 150 mg/dL or greater Blood pressure of 130/85 or greater HDL-C less than 40 mg/dL in men and less than 50 mg/dL in women Fasting glucose level of 100 mg/dL or higher (Note: Detection, Evaluation, and High Blood Cholesterol in Adults (Adult Treatment Panel IV) expected release date is fall of 2011.) 2 Functional Medicine University’s Functional Diagnostic Medicine Training Program Module 4: FDMT 533B: Primary and Advanced Testing: Assessing Blood Glucose Regulation By Wayne L. Sodano, D.C., D.A.B.C.I., & Ron Grisanti, D.C., D.A.B.C.O., M.S. http://www.FunctionalMedicineUniversity.com Impaired Glucose Tolerance/Impaired Fasting Glucose Impaired glucose tolerance and impaired fasting glucose form an intermediate stage in the natural history of diabetes mellitus. From 10 to 15 percent of adults in the United States have one of these conditions. Impaired glucose tolerance is defined as two-hour glucose levels of 140 to 199 mg/dL (7.8 to 11.0 mmol) on the 75 gram oral glucose tolerance test, and impaired fasting glucose is defined as glucose levels of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) in fasting patients. These glucose levels are above normal but below the level that is diagnostic in fasting patients. Patients with impaired glucose tolerance or impaired fasting glucose have a significant risk of developing diabetes and are thus a target group for primary intervention. Risk factor for diabetes include family history of diabetes, body mass index greater than 25 kg/m2 , sedentary lifestyle, hypertension, dyslipidemia, history of gestational diabetes or large-for gestational-age-infant, and polycystic ovary syndrome.1 The Atherosclerosis Risk in Communities Study concluded that two-thirds of subjects classified at the lower end of impaired fasting glucose (100-109mg/dL) had either diabetes or impaired glucose tolerance.7 These studies appear to support the need for utilizing the functional medicine optimal range for serum glucose as the cut point. Drug-induced Disorders of Glucose Tolerance An investigative article written in the Annals of Internal Medicine concluded that many common therapeutic agents influence glucose metabolism and may cause hyperglycemia, hypoglycemia or both based on the circumstances at the time of use.8 It was recommend that patients avoid such medication or, when not possible, to closely monitor plasma glucose. Medications associated with hyperglycemia include, but not limited to: Thiazide diuretics Central acting alpha-blockers Beta-blockers Calcium-channel blockers Minoxidil Diazoxide Corticosteroids Cyclosporine Phenytion Oral contraceptives and sex hormones Nicotinic acid and niacin Phenothiazines Lithium Thyroid hormone Beta-adrenergic agonists 3 Functional Medicine University’s Functional Diagnostic Medicine Training Program Module 4: FDMT 533B: Primary and Advanced Testing: Assessing Blood Glucose Regulation By Wayne L. Sodano, D.C., D.A.B.C.I., & Ron Grisanti, D.C., D.A.B.C.O., M.S. http://www.FunctionalMedicineUniversity.com Medications associated with hypoglycemia include but not limited to: Salicylates and acetaminophen Sulfamethoxazole Beta-blockers Quinine Pentamidine Beta-2 agonists Disopyramide Ethanol Monoamine oxidase inhibitors and tricyclic antidepressants Angiotensin-converting enzyme inhibitors Alpha-blockers Fibric acid derivatives (gemfibrozil may increase plasma glucose levels) Stretozotocin Statins Cause Diabetes17 A recently published meta-analysis of 13 randomized controlled trials that included a total of 91, 140 participants found that treatment with a cholesterol-lowering statin drug significantly increased the risk of developing diabetes. This new finding adds to the long list of adverse effects of statin drugs, which include myopathy (7%-15%), rhabdomyolysis, hepatotoxicity, cognitive dysfunction, memory loss, gastrointestinal symptoms, headaches, and skin rashes. The article went on the say that pushing the cholesterol level below its usual set point decreases the body’s capacity to synthesis beneficial steroids, such as vitamin D and DHEA.( I have heard discussions on whether or not cholesterol lowering drugs affect steroid synthesis. At present it seems to depend on the type of statin prescribed) DHEA and vitamin D have been shown to increase insulin sensitivity. The article also addressed the cardioprotective effect of statins. Statins drugs are known to lower CRP, however the risk to benefit ratio was questioned. Dr. Gaby suggested alternatives to statins, which include dietary modifications and nutritional supplementation. He also recommending eating foods that have low-AGE (advanced glycated end products). The use of red yeast rice was suggested as an alternative to statin drugs. Red yeast rice contains statin-like compounds and has significantly less side effects than statin drugs, but there is still a long term risk of developing diabetes. 4 Functional Medicine University’s Functional Diagnostic Medicine Training Program Module 4: FDMT 533B: Primary and Advanced Testing: Assessing Blood Glucose Regulation By
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