Type 2 Diabetes and the Circle of Life

Type 2 diabetes has become an increasing problem in modern America. Because it is chiefly linked to obesity, as more people become overweight and as the age of gaining weight reaches down into childhood, a largely preventable disease turns into an epidemic. The litany about such lifestyle disorders is now familiar to almost everyone. The changes that prevent Type 2 diabetes all move in the direction of moderation: a balanced diet, exercise and management of stress.

Visualization is courtesy of TheVisualMD.com

Yet here we face a paradox -- the more information that circulates about lifestyle disorders, the worse the problem grows. A flood of medical warnings hasn't kept America from eating more, exercising less, turning more sedentary and working under heavier burdens of daily stress. To escape from this paradoxical trap, we must look deeper. A single disorder like Type 2 diabetes leads us to examine the entire circle of life, which is a massive, tangled feedback loop. Each of us leads a life dictated by how well the circle of life is functioning; no single strand can be isolated to solve the problem, a mistake made by mainstream medicine and its focus on intense specialization.

First, let's look at the disorder as viewed by a physician.  Diabetes begins when cells that normally respond to insulin, such as muscle and liver cells, become insulin resistant. Insulin is a hormone, a chemical "password" that tells a cell to admit glucose (blood sugar). When cells don't admit glucose into their interiors, sugar builds up in the blood, which has dire consequences for tissues and organs throughout the body. Diabetes is especially pernicious, then, because the damage it causes can crop up almost anywhere.

Insulin resistance usually occurs several years before true diabetes develops. Insulin is secreted by the pancreas and "talks" to cells via insulin receptors on the cell membrane. Once these receptors allow glucose to enter the cell, it is either used immediately as fuel or stored for later use.  We now know that our bodies are nothing less than a constant conversation among chemicals that communicate with a trillion cells thousands of times per second.

To really understand what is happening, however, we must move from the molecular level to a person's lifestyle. In the sixth century BCE, an Indian physician, Susruta, is recorded as the first to diagnose diabetes and to prescribe a treatment. His analysis seems remarkably modern. Susruta wrote that diabetes was either congenital (what we would call Type 1 diabetes) or a result of poor diet and a sedentary lifestyle, often resulting in obesity (Type 2 diabetes). His prescribed treatment sounds familiar today: eating a healthier diet, taking long walks, engaging in sports such as wrestling and riding on a horse or elephant.

Your cells grow accustomed to the messages they receive; they have habits that reflect your habits. At present, those habits are trending the wrong way. About 24 million Americans have diabetes -- that's about 8 percent of the population. About a third of these, 5.7 million people, are undiagnosed. Experts believe that diagnosed diabetes will increase 165 percent by 2050. That means that one in three people born in 2050 will be affected by the disease. Type 2 diabetes used to be called adult-onset diabetes because it almost never developed in children. Now, however, a disturbing number of cases are appearing in young people.

Ironically, as more people gain access to a comfortable way of living, lifestyle disorders create a backlash. Type 2 diabetes has become a global epidemic, too. The World Health Organization estimates that over 220 million people around the world have Type 2 diabetes (90 percent of people with diabetes worldwide), and it is among the top five causes of death in most developed countries. The economic cost of diabetes is enormous, not just to the individual, but to society as well. In the U.S., the total costs (direct and indirect) of diabetes in 2007 were estimated to be $174 billion.

Science still doesn't understand exactly how and why Type 2 diabetes develops, and this problem is the subject of intense research all over the world. It may be that something goes wrong with the insulin receptors or with the glucose transporting process. Whatever the causes, the pancreas responds to the increased levels of glucose in the blood by producing ever-greater amounts of insulin. For a while the increased levels of insulin do work to force the target cells to accept more glucose. This temporarily keeps blood sugar levels within their normal range. But over time the overworked pancreatic beta cells lose their ability to produce extra insulin -- they "burn out." Then blood sugar levels remain elevated, a condition termed hyperglycemia. Blood levels of insulin can also become very high: this is known as hyperinsulemia.

Type 2 diabetes can progress for months or years without symptoms, an insidious reason for the disorder being so dangerous. So it's important to be tested by a doctor if you have symptoms or risk factors for Type 2 diabetes.

Symptoms include:

• Frequent urination
• Increased thirst
• Slow-healing sores or frequent infections
• Constant hunger
• Unintentional weight loss
• Tingling hands and feet
• Blurred vision
• Fatigue and irritability
• Swollen gums

Risk factors for Type 2 diabetes

As we saw, prevention of Type 2 diabetes is simple and straightforward, or should be. What looks simple theoretically can turn out to be quite difficult. About 90 percent of people with Type 2 diabetes are obese or overweight: it's the number one risk factor for Type 2 diabetes. The number two risk factor is having a sedentary lifestyle (exercising fewer than three times a week). Other risk factors are being over the age of 45, belonging to certain races (including African American, Hispanic, American Indian, and Asian American), having a parent or sibling with the disease, and having had gestational diabetes (diabetes developed during pregnancy).

Because diabetes can progress for months or years without symptoms, anyone who is overweight or obese and who has one or more additional risk factors should be tested. With or without risk factors and symptoms, all adults should be tested for prediabetes or diabetes starting at age 45. Children or teens who are overweight or obese and have other risk factors, such as a family history of diabetes, should be tested starting at age 10 or at puberty, whichever comes first.

Widespread harm

Since prevention is obviously the main goal, I won't dwell on the damage caused by diabetes. Most of this damage is through its effects on blood vessels, both large and small. At high levels, glucose acts as a toxin on the cells that line blood vessels.

• Cardiovascular disease (disease of the heart and blood vessels) is the main cause of death in people with diabetes. About three-quarters of people with diabetes die of cardiovascular disease. People with diabetes have a two to four times higher risk of developing atherosclerosis and of having a stroke than people without diabetes


• Kidney disease. Because the kidneys are densely packed with millions of tiny filtering capillaries, they are especially likely to be damaged by diabetes. Symptoms may not appear until only 10 percent of the kidney's filtering function remains.


• Vision damage. The retina, the delicate membrane that lines the back of the eyeball, may be damaged by diabetes. High glucose levels injure the tiny capillaries in the retina, which start to break and bleed. Diabetes also increases the risk of developing cataracts and glaucoma.

Nerve damage, or neuropathy, is also involved. The myelin sheaths that surround nerve cells are very sensitive to changes in glucose concentration. Nerves can also be damaged when damage to the capillaries that feed them cuts off their blood supply.

Monitoring glucose levels

As standard practice, it's considered important for diabetics to monitor their glucose levels. Keeping track of your blood sugar allows quick responses to levels that are too low (hypoglycemia) or too high (hyperglycemia). It also helps in planning meals, activities, and medication times. The latest glucose monitors require only a tiny drop of blood, and it doesn't necessarily have to come from a finger.

But we also need to consider the stress caused by constantly monitoring any condition, whether it is diabetes or high blood pressure. In the body's feedback loops, all messages are received by the cell membrane, including messages relating to stress, your work environment, relationships, mood and general sense of well-being.  You cannot "feel" your blood sugar levels, and once you begin to change your lifestyle, there is every reason to focus on how your life is going in general, with much less focus on chemical monitoring. Blood sugar follows cycles, like everything else in the body. One day's high reading may be meaningless, but it can lead to panic and worry. Is it worth ruining a whole day in order to fixate on a number?

The key to getting past any lifestyle disorder, including Type 2 diabetes, is to move in the direction of balance and moderation. This doesn't mean grim discipline. Instead, you ask yourself on a daily basis:

• Am I doing something that makes me happy?
• Can I give up a little of what isn't good for me?
• How do I feel about my progress toward well-being?
• Can I foresee the weak or tempting moments I need to be most careful about?

In the spirit of making your life better, the preventive steps for Type 2 diabetes fall into place more naturally.

Weight loss

Anyone with prediabetes or diabetes who is overweight has a number of very good reasons to lose weight. For someone with prediabetes, losing just 5 to 10 percent of body weight significantly reduces blood sugar levels and reduces insulin resistance. For someone who weighs 200 lbs, that means losing as little as 10 lbs. When losing weight is combined with regular exercise, the risk of developing diabetes is cut by 58 percent. And there's another, very significant benefit: losing 5 to 10 percent of body weight lowers the chances of having a heart attack or stroke. If you already have diabetes, studies have found that weight loss can significantly reduce symptoms of diabetes and insulin resistance.

The American Diabetes Association recommends a slow-but-steady weight loss goal of .5 to one pound per week. It's very useful to consult a registered dietitian for help in changing eating habits, controlling overeating, and designing a diet plan you can live happily with and that provides the right sort of nutrition for diabetes.

Eating right for diabetes

There is no specific "diabetes diet."  A healthy diet for diabetes is the same as a healthy diet for anyone: rich in nutrients and fiber and low in refined carbohydrates, high-glycemic-index foods (like potatoes), and saturated and trans fats. The glycemic index (GI) classifies carbohydrates based on how quickly and how much they boost blood sugar compared to pure glucose. Foods that have a low GI are absorbed slowly in the digestive tract, raising blood sugar evenly over a long period of time.

Exercise

Exercising regularly is one of the best things you can do for diabetes. Exercise, whether anerobic or aerobic, induces both your muscles and your liver to take up more glucose, lowering your blood sugar levels. Exercise decreases insulin resistance, normalizes blood pressure, improves sleep and decreases stress.

Talk to your healthcare practitioner before starting a new exercise regimen. Choose something you enjoy and that's at the right level for your current fitness. It's best to exercise every day, at the same time.

Quit smoking

If you smoke, quit now. Smoking is especially bad for people with prediabetes or diabetes. If you don't now have diabetes, smoking makes it three times as likely that you will develop it. Smoking further damages already compromised blood vessels, constricting them and injuring them. It causes complications, like kidney disease, retinal disease and foot problems, to occur sooner, and increases risk of death. What's more, nicotine has been found to directly increase blood sugar levels.

De-stress

Being stressed stimulates the production of corticosteroids, the "stress hormones," which increase blood glucose levels. By the same token, studies show that reducing stress can lower blood sugar levels. Try meditation, biofeedback, or focused breathing techniques. Just doing something you enjoy, like gardening or reading, can be a good way to de-stress. Exercise (aerobic exercise, yoga, tai chi) is an excellent de-stressor. Support groups and therapy may prove very helpful as well.

Supplements and botanicals

These come into play only after you have seriously considered lifestyle changes; they are not a substitute, much less a cure-all. Some people with diabetes have found chromium or alpha-lipoic acid (ALA) to be helpful in controlling their blood sugar. ALA, an antioxidant, may also be useful in treating nerve damage.

Certain botanicals, including cinnamon, fenugreek, ginseng, bitter melon, aloe vera, prickly pear cactus, gurmar (an Indian herb whose name means "sugar destroyer") and Coccinia indica (ivy gourd) may help to control blood glucose levels. In Chinese and Indian traditional medicine, combinations of botanicals are used to treat diabetes, and there is some evidence that this results in a synergistic effect. Consult with an experienced practitioner of Chinese or Indian medicine if you would like to investigate these treatments.

Acupuncture

Some people with peripheral neuropathy -- pain in the hands and feet due to nerve damage from diabetes -- have found that acupuncture helps to relieve their pain. Acupuncture has few if any dangerous side effects, so it may be worth investigating this form of treatment.

Medications

If lifestyle measures don't sufficiently reduce blood sugar levels, then medications may be prescribed. Medications may lower glucose levels by increasing insulin production by the pancreas, boosting cell sensitivity to insulin, and delaying absorption of glucose from the intestines. Numerous medications are available, and often more than one is prescribed.

Insulin may be prescribed if taking noninsulin glucose-lowering drugs doesn't get blood sugar levels under control. Insulin must be injected using a syringe, an insulin pen, or with an insulin pump.

In mainstream medicine, diabetes is a circle of chemicals, leading from the insulin produced naturally by the pancreas to the insulin injections prescribed for millions of diabetics. Yet a much larger circle is actually involved. The circle of life embraces who you are and how you want to live. Diabetes, like every other lifestyle disorder, is an indicator that change is required. This doesn't mean chemical change. It means redefining how you want to achieve well-being in the healthiest possible way.

For more information go to: deepakchopra com

 

 

 

Follow Deepak Chopra on Twitter: www.twitter.com/DeepakChopra

Comments

[Gregory Ashby]

11:12 AM on 01/03/2012

In the beginning was the word and some how we got the word that we are not worth it. Therefore we
lose our sweetness in Life. In search for the sweet of life we reach for sweet foods to fill this void.
This starts a whole biochemical cascade of reactions including the altering of hormones. Cortisol is elevated, Insulin goes on a roller coaster, and Leptin becomes resistant. This is really easy to fix.
All it involves is a change in lifestyle, diet, exercise and stress management. Herbal and Nutrient supplements can help a great deal. But for some reason we go for the big guns first, medication. When in reality, if alter the way we think. We probably would not have the problem in the first place.

[Gringostan]

02:44 AM on 12/26/2011

I’m 5:11 and 170 lbs. My average weekly BP is 168/111 and that’s with meds, any good ideas?

[marcflorida]

11:19 AM on 12/25/2011

Managing diabetes shouldn't be a mystery. There are many good diabetes educators who can get you started. Getting control is basically a balance between diet and medication, and as the diet improves the need for medication goes down. Cutting the consumption of daily carbs to 30-50 grams will make a huge improvement in blood sugar control. Atkins or LCHF diets can make a big difference.

With the help of the Cleveland Clinic, in two months my A1C dropped to 6.1 from 7.3, and my daily insulin use has gone from 140 units to 45 units (Lantus-only). Weight has dropped 12 lbs. I've had type 1 diabetes for 20 years (since I was 39). Without the guidance of my new Endocrinologist and Diabetic Educator, this improvement wouldn't have happened.

If you've recently been diagnosed, get the best medical help you can get. If it's been a while, go find out what's new. Much may have changed. The knowledge is out there, and most of the complications can be avoided with proper care. Best of luck!

[farmilyman]

05:30 AM on 12/22/2011

Diabetes became epidemic because we put corn and/or corn byproducts (like maltodextran, msg, and high fructose corn syrup) in everything. It's even put into pet food which explains the rise in diabetes in pets.

[emaho]

09:28 PM on 12/21/2011

Thank you for pointing out that diabetics should eat a diet “low in refined carbohydrates and high-glycemic-index foods (like potatoes)”. As a Type 1, who uses his blood glucose meter about 8 times per day, I can attest to the need for that. I want to also point out that WHOLE wheat bread has a glycemic index of 75 and that makes it a high glycemic food. In fact, table sugar has a lower index. Its glycemic index is 65. And, even though many don’t think sugar is a high glycemic food, I certainly do and I think you do too. Thus, I believe we both can agree that WHOLE wheat bread is a high glycemic food.

IMHO, there is “diabetic diet”. It is the low carb diet.

[georged193]

11:49 AM on 12/21/2011

RE: Monitoring Glucose Levels: Home glucose meters are very inaccurate: the range is about plus or minus 20% variation from the indicated test result. So if you measure 110, which is considered high and prediabetic, the actual value may be as low as 90, considered normal, or as high as 130, which is consistent with clinical diabetes. I am giving up this home testing lunacy-another health care racket. Your physician should follow up any fasting glucose test from the lab that is above 100 (and I would even say above 90) with a Hemoglobin A1C test, along with a repeat fasting glucose test. As for dietary recommendations, low carb may be the most effective way to lower blood glucose levels, but it has not worked for me and is unproven. Diets have become religions and most studies on dietary regimens for Diabetes will not pass statistical muster (See the Cochrane Reviews for a lot more on that). One thing is sure: if you are diabetic and fat, weight loss will help, but at least 10% of diabetics are thin, not fat (I am one) and their disease may be due to autoimmunity, not diet or lifestyle. Holistic medicine and Indian herbal remedies probably won't cure diabetes , but again there are few good studies that support these alternative approaches.

[R2D2-51]

04:18 PM on 12/21/2011

Page 1

KISS Keep it simple Stupid.

I found that social media spends too much time bombarding the public through it's social media with a lot of dense text & more diet programs than Carter has pills that becomes more of a problem than a solution, and for many an increase in anxiety & stress.

7 years ago I was a grossly 300 lb.grossly obese 50's something as a borderline Type II diabetic with barely the energy to take out the trash & was visiting my doctor every month for symptoms ranging from chest pains to insomnia being prescribed more meds than the law allows for everything from pain pills for a back injury & surgery gone bad to anxiety attacks & diet pills & BP medicine with & GERD leading to an umbilical patch hernia operation.

I am now down to 1 prescription, have been in doctors office once in 4 years except to pickup 1 refill prescription.No longer Type II borderline diabetic & at 6" 165 lbs, have more energy now & feel like 30 something, having hiked 1/2 the Pacific Crest Trail this last summer.

Plan was simple.

1.) I walk 6 miles every day and hike a local mountain trail every Sunday.

2. Eat only whole foods that come from the earth in its natural soil borne form.

3.Developed proven strategies to respond to stressors in my life preventing me from getting stressed out over things I have control & no control over. Its based on

[R2D2-51]

04:19 PM on 12/21/2011

PAGE 2

Most of us like Shakespeare want to be the Director and control the outcomes of life's events. Life doesn't work that way. I found that my level of harmony with the world is contingent upon my acceptance of circumstances when some person, some place or some fact of my life does not fall into place as I would of directed.

Its my experience that once you have changed your lifestyle into one i which your always cognizant of the decisions you make that influence your health the easier it is over time it will be set on default & positive results in time will be achieved to become your normalcy.

[Chas53]

06:38 AM on 12/21/2011

Actually the most effective diet for reversing diabetes is a high carbohydrate, low fat vegan diet. This seminal research was done bt Neal Barnard MD. Read Dr. Neal Barnard's Program For Reversing Diabetes.
Www.pcrm.org

[ambrecel]

09:06 PM on 12/20/2011

I think my PCOS, and insulin resistance is getting under control. And don't order number 3's at McDonald's like I did, it helps pack on the pounds. I also failed at being a veggie person, but moderation and exercise is the trick, so far lost over 50 pounds this year.

[DrP]

08:21 PM on 12/20/2011

The simple answer to the question of how "type II diabetes" became epidemic is: the high carbohydrate content of the modern diet. We simply are not evolved to eat such a high carbohydrate load. Most of us are insulin resistant to some extent and can't metabolize so much glucose. It is the high insulin levels that result from eating excess carbohydrates that cause the complication of diabetes - obesity (obesity is a symptom, not a cause of insulin resistance so it does not cause diabetes;it is association, not cause and effect) and the inflammation that leads to heart disease.
The solution: don't eat the foods that raise blood sugar and insulin levels, that is, carbohydrates. Eat plenty of fat which does not require insulin to metabolism.
12 years of low-carb, high-fat and I have avoided the "diabetes" that plagued three generations of my family. Thankfully, my children started low-carbing even earlier than I did and there is great hope that the family disease has come to an end.

[Chas53]

06:40 AM on 12/21/2011

All successful populations that have thrived existed mainly on a starch based diet.
Www.drmcdougall.com

[DrP]

11:20 PM on 12/26/2011

I don't even want to respond to anyone who cites mcdougall, but I'm talking about my family and we are all insulin-resistant and can't eat starch without horrendous consequences. Many, many other people are of the same gentic type and we simply can't handle starches, sugars, or grains.

[hrhbess]

03:39 PM on 12/20/2011

Articles like this one are so pernicious -- I have type 2 diabetes - I am not overweight - I had elevated blood sugars when i was pregnant 30 years ago and was painfully thin. I endure subtle prejudice from so many people who assume that this disease is somehow MY fault, and articles with this kind of slant perpetuate that unfair judgement. It's a disease, often not preventable, and not a result of some lascivious past or undisciplined life -- I get so tired of reading articles that condemn everyone with diabetes for being fat and lazy. I am neither and never have been.

[kaya8]

08:59 PM on 01/13/2012

I also get annoyed with articles that seem to blame diabetes on lifestyle-I am from a family of thin type 2 diabetics. This is a complicated disease. Obviously, it is unhealthy to be obese but saying that diabetes can be cured by losing weight and playing the blame game is wrong.

[ispeakpaleo]

12:48 PM on 12/20/2011

Eat a #paleo diet and you'll go a long way towards reversing type-2 #diabetes. The refined carbs, gluten and sugar are the culprits here. Its not a big mystery. Remove them for 30 days and see.

[traceymarie]

04:33 PM on 12/20/2011

You don't need to go to the extremes such as the palio diet, try healthy

[DrP]

08:24 PM on 12/20/2011

Sorry, but yes you do need to eliminate carbs (sugar) to prevent abnormal blood sugar. And paleo isn't extreme, it is the diet that we are evolved to consume and full of delicious, healthy, satisfying food.

[Becca Chopra]

12:22 PM on 12/20/2011

The incidence of diabetes and other chronic health problems among Native Hawaiians is one of the highest in the world, and I've seen how returning to a traditional lifestyle ~ eating whole foods, exercising and working hard physically, doing cultural group activities to feed the spirit ~ work to dramatically change the problems caused by the typical modern lifestyle. A good guide to a holistic approach to treating diabetes can be found in The HawaiiDiet by Dr. Terry Shintani.
Aloha,
Becca Chopra, author of The Chakra Diaries
www.thechakras.org

[mandyseay]

11:45 AM on 12/20/2011

Carbohydrate counting is a great tool for people with diabetes, this type of eating helps balance out the blood sugar and allows for all types of carbohydrates - there is room for both simple and complex in a balanced diet.
-Mandy Seay, RD, LD
http://nutritionistics.com/

[DrP]

08:25 PM on 12/20/2011

Not if you are insulin-resistant enough to have high blood sugar readings. Then, there is no room for any carbohydrates in the diet, with the exception of non-starchy vegetables in moderation.

[Rixar13]

10:39 AM on 12/20/2011

I am diabetic, Type 1.. All the more reason to support Health Care Reform.... smile :-)

[Emm Snn]

10:35 AM on 12/20/2011

This article blames the diabetic which is wrong. 30 years ago the Government allowed dirty food chemicals in the Beef, Milk, and Poultry. This breaks the gut insulin and creates diabetes and obesity. This is why you cannot lose weight and the real cause of the diabetes crisis. 4 million died this year from diabetes this is not about "a circle of life" but about FDA approved food chemicals 4 million dead in only 12 months here http://spirithappy.org/wp/2011/09/14/diabetes-now-kills-4-6-million-every-year-diabetic-overweight-or-thin-the-illness-is-taking-lives/