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Diabetes Mellitus (Part One)

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Diabetes Mellitus (Part One) JOURNAL OF CHINESE MEDICINE NUMBER 58 SEPTEMBER 1998 MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE DIABETES MELLITUS (PART ONE) by Clinton J. Choate 1. Background the conventional medical approach of simply using insulin There is nothing new about diabetes; it has been a medical or oral drugs to treat diabetes is incomplete and the person problem since antiquity. The name which was originated relying on them to prevent long-term complications re- by Aretaeus (30-90 CE) came from the Greek words mean- mains at risk. ing ‘siphon’ and ‘to run through’, signifying the chronic excretion of an excessive volume of urine. About Blood Sugar Diabetes mellitus, because of its frequency, is probably Carbohydrate is the active fuel of the body and is ordinarily the single most important metabolic disease and is widely the main source of energy of the tissue cell. In the normal recognized as one of the leading causes of death and disabil- digestive process, food sugars and starches (carbohydrates) ity in the United States. It affects every cell in the body and are changed into sugar glucose. This is stored in the form of the essential biochemical processes that go on there. glycogen (animal starch) in the liver and muscles for later Diabetes has been linked to the western lifestyle, as it is use as a body fuel, at which time it is reconverted into uncommon in cultures consuming a more primitive diet. glucose. Blood sugar rises somewhat after eating, and in As cultures switch from their native diets to more commercial healthy individuals returns to normal levels in about an foods, their rate of diabetes increases, eventually reaching hour or two. The amount of glucose in the blood is control- the same proportions seen in western societies. led mainly by the hormones insulin and glucagon. Too A great deal of research has been conducted into the much or too little of these hormones (or if they are somehow possible aetiology of diabetes. Most of the prevalent ideas ineffective) can cause blood sugar levels to fall too low can be classified under one of the following categories: (hypoglycaemia) or rise too high (hyperglycaemia). Other heredity, endocrine imbalance, dietary indiscretion and hormones that influence blood sugar levels are cortisol, obesity, sequelae of infection, and severe and continued growth hormone and catecholamines (epinephrine and psychic stress. norepinephrine). Although genetic factors appear important in determin- The pancreas, a gland in the upper abdomen is responsi- ing susceptibility to diabetes, environmental and dietary ble for producing insulin and glucagon. The pancreas is factors are also important in its development and many dotted with hormone-producing tissue called the islets of have been identified. A diet high in refined fibre-depleted Langerhans, which contain alpha and beta cells. When carbohydrate is believed to be the causative factor in many blood sugar rises after a meal, the beta cells release insulin. individuals, while a high intake of high-fibre complex The insulin helps glucose enter body cells, lowering blood carbohydrate foods is protective against diabetes. glucose levels to the normal range. When blood sugar drops Obesity appears to be a significant factor, particularly too low however, the alpha cells secrete glucagon. This considering the fact that 90% of Type 2 (see below) sufferers signals the liver to release stored glycogen and change it are obese. Even in normal individuals, significant weight back to glucose, raising blood sugar levels to the normal gain results in carbohydrate intolerance, higher insulin range. The result of the disturbed metabolism of glucose levels and insulin insensitivity in the fat and muscle tissue. causes an abnormal accumulation of sugar in the blood The progressive development of insulin insensitivity is stream and the diabetic condition. believed to be the main underlying factor in Type 2 diabe- tes. Weight loss can correct all of these abnormalities in Blood Sugar Ranges many instances and significantly improves the metabolic The quantity of glucose in the blood seldom exceeds 160 disturbance of diabetes in most cases. milligrams/decilitre (mg/dl) of blood shortly after food What has become apparent through years of research is sugar has been absorbed, nor seldom falls below 60 mg/dl that the diabetic condition is not simply a matter of one or during fasting. This increases about 2 mg/dl per decade two things having gone wrong. It is a complex condition after age 30. Some mild diabetics will have normal fasting with a multitude of metabolic imbalances. Consequently, blood sugar values and values in the diabetic range only JOURNAL OF CHINESE MEDICINE NUMBER 58 SEPTEMBER 1998 after meals. Occasionally very mild cases will have values Symptoms usually develop over a short period, although within normal at both times and the diabetic tendency will beta cell destruction can begin months, even years, earlier. be evident only when these persons are required to handle Over time both Type 1 and Type 2 diabetes are accompa- more than an ordinary amount of carbohydrate. nied by many severe complications, such as blindness, In the fasting state, blood sugar can occasionally fall renal failure, lower- limb amputations, cardiovascular dis- below 60 mg/dl and even to below 50 mg/dl and not ease and stroke. For those with Type 1 diabetes the object indicate a serious abnormality or disease. This can be seen is not to find a way to get off insulin but rather to prevent the in healthy women, particularly after prolonged fasting. long-term complications. It is encouraging to note that Blood sugar levels below 45 mg/dl in a woman or 55 mg/ modern research has demonstrated the amount of insulin dl or less in a man indicate a strong possibility of required could be reduced through appropriate life style hypoglycaemia. modifications and the likelihood of consequent complica- Higher-than-normal blood sugar levels, for example 140 tions significantly lowered. mg/dl or higher after an overnight fast, can indicate diabe- tes mellitus. In moderately severe diabetes, after-meal Type 2 Diabetes (Noninsulin-Dependent Diabetes values of 250-350 mg/dl are not unusual. If a person with Mellitus/NIDDM) diabetes develops hyperglycaemia and it is left untreated, The most common form of diabetes is noninsulin-depend- the result can lead to coma or death. ent diabetes. About 90 to 95 percent of people with diabetes Diabetes is characterised by three well-known syndromes, have Type 2. In the USA more than 16 million people, over polydipsia (excessive thirst), polyphagia (excessive hunger) 7% of the adult population, have Type 2 with 600,000 new and polyuria (excessive urination). Laboratory findings cases diagnosed each year. In many patients, the initial reveal high blood sugar and glucose in the urine and as the diagnosis of Type 2 diabetes is delayed perhaps by as much metabolic derangement worsens, excessive ketone bodies as 10 years because symptoms are often absent or very mild in the blood and urine. The accumulation of these produces during its early stages. acidosis which, if not counteracted, can result in coma and Type 2 diabetes usually develops in adults over the age of death. 40 and is most common among adults over age 55. It is There are three main types of diabetes: particularly common among the elderly and in many mi- • Type 1 or 'Insulin-Dependent Diabetes Mellitus' nority populations, including African Americans, Hispanic (IDDM) also known as 'Juvenile Onset Diabetes'. Americans, American Indians and Asian and Pacific Is- • Type 2 or 'Noninsulin-Dependent Diabetes Mellitus' lander Americans, in whom it may occur in 10–50% of (NIDDM) also known as 'Adult Onset Diabetes'. adults. • Gestational diabetes. Type 2 diabetics typically have elevated levels of insulin, often producing two to three times the normal amount. Type 1 Diabetes (Insulin-Dependent Diabetes Rather than an insulin deficiency condition it is an “insulin Mellitus/IDDM) resistance” condition whereby the body loses its ability to Insulin-dependent diabetes is considered an autoimmune properly respond to the signals given by insulin. We now disease in which the immune system attacks the insulin- know that excess insulin brought on by insulin resistance is producing beta cells in the pancreas and destroys them. The not only associated with elevated blood sugar levels, but pancreas produces little or no insulin and it is then almost also with high blood pressure and increased rates of athero- certain that life-long insulin replacement will be necessary. sclerosis. The exact mechanism for the body’s immune system attack In the treatment of Type 2 diabetes, dietary modification to the beta cells is unknown but the most likely causes are has been found to be of primary importance and should be viral infection, genetic factors and free radicals. diligently followed before using drug intervention since Interest has been generated lately in the strong evidence most cases can be controlled by diet alone. For all Type 2 linking exposure to a protein in cow’s milk (bovine albumin diabetics an effective treatment approach should employ a peptide) in infancy to the autoimmune response and subse- broad-based therapeutic regimen. Such a regimen would quent Type 1 diabetes. In detailed studies1 it was shown incorporate appropriate diet, prescribed exercise, stress that patients with Type 1 diabetes were more likely to have reduction techniques and a substantial amount of specific been breast-fed for less than three months and to have been nutritional supplements. If adequate control of blood sugar exposed to cow’s milk or solid foods before the age of four levels remains problematic, conventional treatment with months. Since the cow’s milk protein can enter the mother’s insulin and oral agents can be initiated. breast milk, in cases of family history of diabetes it is recommended that the mother avoid cow’s milk while Gestational Diabetes breast-feeding.
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