GETTING DOWN TO BASICS

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Diabetes is a disease where your blood glucose (sugar) levels are above normal. It results fromthe inability of the glucose to get into your cells. As a result your cells are  starving for their food (glucose). It would be like a starving person surrounded by tables of wonderful food but their mouth has been sewn closed and they can't eat.

About 17 million Americans are believed to have diabetes and one-third of those patients don't even know they have it. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the 6th leading cause of death in the US. And most diabetics develop heart disease. In fact, just having diabetes carries the same risk of having a heart attack as someone who has already had such an event. Therefore it is very important for patients that have diabetes to also have a physician that closely monitors and treats their cholesterol levels as well as their blood pressure. Additionally, any use of tobacco products multiplies the risks and should be stopped.

Are there different kinds of diabetes?

Certainly. But the basic features of the disease are same. In any form of diabetes there is some underlying reason why your body is not able to utilize glucose (sugar) for energy, and that causes the levels of glucose (sugar) in your blood build up above normal. There are three areas that are important for you to understand in diabetes. First, the cells in your body which use the glucose are important as they must be able to remove sugar from the blood and put it inside the cell as a fuel.

Secondly, the insulin which is made by your pancreas (an organ near your stomach) is important to allow the sugar to enter the cell (the key to unlock the door to enter), and lastly, glucose which is broken down from your food or from muscle and liver from a storage form of glucose called glycogen. Now if you think of the disease diabetes as involving a locking gas cap on your car, it will be easier to understand.

If you understand how a locking gas cap works, then you can understand how diabetes works. All of the cells in your body have a locking gas cap on them. Insulin is the key to the locking gas cap, and glucose would be the fuel for the car. In one form of diabetes, the body totally quits making insulin (keys) so you can't get glucose (fuel) into your cells. In other forms of diabetes, your body makes some insulin (keys) but not much as your body needs. Therefore, only a few of the cells can be unlocked and opened to put the glucose (fuel) inside. Another thing that happens is that some of the locks on the cells become rusty and won't work properly.  So even if you have insulin (keys) you can't get the cells to open. This is called insulin resistance. If the cells won't open, you can't get glucose (fuel) inside the cell for energy. The result of all of this is excess glucose in your blood.

Types Of Diabetes.

Type 1 diabetes is usually diagnosed in children and young adults and only accounts for 5-10% of diabetes patients. In type 1 diabetes the pancreas doesn't make any insulin (keys) at all.

Type 2 diabetes is the most common form of the disease. It accounts for 90-95% of all the cases of diabetes. In type 2 diabetes, either your body doesn't make enough insulin (keys), or the cells in your body ignore the insulin (the lock is rusty and doesn't work) so they can't utilize glucose like they are supposed to. When your cells ignore the insulin, as mentioned above, it is often referred to as insulin resistance.

Other types of diabetes which only account for a small number of the cases of diabetes include gestational diabetes, which is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies and usually disappears when the pregnancy is over.

Other types of diabetes resulting from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses may account for 1% to 2% of all cases of diabetes.

How do you get diabetes?

There are risk factors that increase your chance of developing diabetes. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.  Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in developing this type of diabetes.

What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for a diagnosis. They might have SOME or NONE of the following symptoms: frequent urination, excessive thirst, unexplained weight loss, extreme hunger, sudden vision changes, tingling or numbness in hands or feet, feeling very tired much of the time, very dry skin, sores that are slow to heal, more infections than usual.  Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of type 1 diabetes.

Glucose is sugar!  So all I have to do is avoid sweets, right?

It is not that simple. The truth is, most food, and all of the carbohydrates you eat, are broken down into its simplest structure, glucose. As food arrives in your stomach, the acid starts to break the food down immediately. Proteins are broken down for their amino acids, and carbohydrates for their glucose. Once your gastrointestinal system breaks your food down into something your body can utilize, the blood picks it up and carries it to your cells to for energy. In healthy people, the blood picks up the glucose absorbed from the GI tract, and sends a signal to your pancreas (an organ near your stomach) to make and release insulin. Remember, in Type 2 diabetes your body

doesn't make enough insulin (keys), or some of your cells ignoring the insulin that is there. (The locks are rusty and won't work) In both situations, your cells don't get the glucose they need for energy and they are starving while all the extra glucose is just floating around in your blood and can't be used. The worst part is, when all that extra glucose is floating around in your blood, it is causing damage to your blood vessels and organs and that damage increase your risk of heart disease. That is why it is very important to keep your blood glucose levels as close to normal as possible. When the glucose levels get really high, the glucose starts to leak out into your urine.

How do you treat diabetes?

There are several things you need to do to help control your diabetes. For type 1 diabetes, healthy eating, physical activity, and insulin injections are the basic therapies. The amount of insulin taken must be balanced with food intake and daily activities.  For patients with type 1 diabetes, blood glucose levels must be closely monitored through frequent blood glucose testing.

For type 2 diabetes, healthy eating, physical activity, and blood glucose testing are the basic therapies. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.  Some of the oral medications work by stimulating your pancreas to make more insulin (keys). Other oral medicines work to make the rusty locks start working again. In a sense they are kind of like WD-40 for the rusty locks on the cells. It fixes the lock on the cells so the insulin (keys) can open the cell to allow the glucose (fuel) inside. Once the glucose (fuel) is allowed inside the cells, your blood sugar levels will drop back down to normal.

What medicine am I going to have to take for my diabetes?

There are many different types of medications that your doctor may prescribe for diabetes; however these prescriptions can cause certain nutritional deficiencies that may increase your risk for chronic degenerative diseases. NutraMD Diabetes Essential Nutrients® supplement was designed to work with your diabetic medications by replacing lost nutrients reducing the risk of dangerous side effects, and promote better health

The main classes of diabetic medications include sulfonylureas, biguanides, and thiazolidinediones.

Sulfonylureas include the following medications: Orinase ,Tolinase, Diabinese, Glipizide, Glyburide, Amaryl, Prandin, Strarlix

The main function of sulfonylureas is to increase insulin production in the beta cells of the pancreas. Sulfonylureas can interfere with the body's normal metabolism of Coenzyme Q10.

Because CoQ10 is necessary to make energy in all tissues of the body, this effect may decrease your body's natural ability to utilize or "burn up" sugars, and may even reduce the ability of the pancreas to produce insulin over time.

Biguanides include the following medications: Glucophage (Metformin) Glucovance (metformin + glyburide)

The main functions of biguanides are to lower the production of glucose by the liver thereby reducing blood glucose levels.  Your doctor may prescribe this type of medicine in combination with sulfonylureas insulin, or a class of drugs known as thiazolidinediones. Unfortunately, biguanides have been shown to deplete vitamin B-12, folic acid and Coenzyme Q10 (CoQ10). A few of the problems which may arise from deficiencies of folate and vitamin B-12 include the following: Heart disease, stroke, anemia, arthritis, joint pain, muscle pain, and neuropathies (nerve damage).

Because diabetes increases your risk for heart disease, stroke, and neuropathy, it is especially important to prevent nutritional deficiencies which may add to these risk factors. Therefore to reduce potential side effects of nutrient deficiencies you should take NutraMD Diabetes Essential Nutrients® supplement as long as you are on your diabetic medication.

Because both medication types listed above can deplete CoQ10, it is important to understand some of the symptoms of a deficiency. CoQ10 deficiency has been linked to the following diseases and symptoms: Congestive heart failure, high blood pressure, rhabdomyolysis (muscle break down), muscle and joint pain, and fatigue. Therefore to achieve maximum benefit from the diabetes medications and minimize potential side effects of nutrient deficiencies, you should compliment your prescription medication by taking NutraMD Diabetes Essential Nutrients® supplement. By doing this, you will balance the risk/benefit ratio further in your favor.

In summary, diabetic medications prescribed by your doctor are necessary to treat your condition; however, you should also be aware that the long term potential nutritional side effects may be just as big a risk factor for your health as the disease you set out to treat in the first place. Put the odds in your favor and maintain your health with NutraMD Diabetes Essential Nutrients® supplement

How do I know I am keeping my blood sugar under control?

Frequent blood tests are used to monitor your blood sugar. Most patients with diabetes should have a home blood monitoring kit. Some doctors ask their patients to check their blood sugar as frequently at 6 times a day, though this is an extreme. The more information you have about your blood sugar levels, the easier it will be for you to control it. People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high.

When your blood sugar is too high, your doctor refers to it as hyperglycemia. When your blood sugar is too high, you may not experience any symptoms, but the high levels of glucose in your blood is causing damage to your blood vessels and organs. That is why it is important to have your body utilize the sugar properly and get it out of your bloodstream.

When your blood sugar is too low, your doctor refers to it as hypoglycemia. Having low blood sugar can be very dangerous and patients taking medication for diabetes should watch for symptoms of low blood sugar. It is also important that your monitor your blood sugar regularly to avoid both low as well as high blood sugar. It is important that you keep your blood sugar as close to normal as possible at all times.

How does my doctor know if I am keeping my blood sugar under control?

Some patients are may not follow the proper diet and exercise except for the days leading up to a blood test in the doctor's office. They want to look like they are doing a good job controlling their blood sugar. This way their fasting blood glucose test results will be good for the doctor. But, there is a test that will show your doctor the real picture over the past 3 months or so. It is called the hemoglobin A1C (HbA1C) test. Hemoglobin is the part of your blood, or red cells, that carries oxygen to your cells. Glucose sticks to the hemoglobin in your red cells of the blood as they emerge from the bone marrow where they are made.

The amount of sugar on the red cell is proportionate to the blood sugar level at the moment the red cell goes into circulation, and remains at that level for the life of the red cell. So if there has been a lot of extra glucose in your blood, there will be a lot of glucose stuck all over your hemoglobin. Since the average lifespan of the hemoglobin in your blood is 90-100 days, a HbA1C test shows a doctor how well you have been controlling your blood sugar over the last 3 months.

This test is a check on the overall sugar control, not just the fasting blood sugar. So it is important to control your blood sugar at all times, and not just before visiting the doctor. The most important reason to control your blood sugar is so that you can live a longer, healthier life without complications that can be caused by not controlling your diabetes.

What happens if I do not control my diabetes?

The complications of diabetes can be devastating. Both forms of diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. The damage that hyperglycemia causes to your body is extensive and includes: Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.

Diabetes predisposes people to high blood pressure and high cholesterol and triglyceride levels.

These independently and together with hyperglycemia increase the risk of heart disease, kidney disease, and other blood vessel complications.

Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure with posture changes.

Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.

Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of lack of normalsensation in the foot, which can lead to wounds and ulcers, and all too frequently to foot and leg amputations.

Diabetes accelerates atherosclerosis or "hardening of the arteries", and the formation of fatty plaques inside the arteries, which can lead to blockages or a clot (thrombus), which can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).

Hypoglycemia, or low blood sugar, occurs from time to time in most people with diabetes. It results from taking too much diabetes medication or insulin, missing a meal, doing more exercise than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremors of hands, and sweating are common symptoms of hypoglycemia. You can faint or have a seizure if blood sugar level gets too low.

Diabetic ketoacidosis is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup in the blood of acidic waste products called ketones. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like insulin, or medical emergencies like stroke and heart attack.

Hyperosmolar hyperglycemic nonketotic syndrome is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly and often leads to dehydration so severe that it can cause seizures, coma, even death. This syndrome typically occurs in people with type 2 diabetes who are not controlling their blood sugar levels or have become dehydrated or have stress, injury, stroke, or medications like steroids.

My doctor says I have pre-diabetes? What is that?

Pre-diabetes is a common condition related to diabetes. In people with pre-diabetes, the blood sugar level is higher than normal but not high enough to be considered diabetes. Pre-diabetes increases your risk of getting type 2 diabetes and of having heart disease or a stroke. Pre-diabetes can be reversed without insulin or medication by losing a modest amount of weight and increasing your physical activity. This can prevent, or at least delay, onset of type 2 diabetes. When associated with certain other abnormalities, it is also called the metabolic syndrome.

What are normal blood glucose levels? The amount of glucose (sugar) in your blood changes throughout the day and night. Your levels will vary depending upon when, what and how much you have eaten, and whether or not you have exercised. The American Diabetes Association categories for normal blood sugar levels are the following, based on how your glucose levels are tested:

A fasting blood glucose test: This test is performed after you have fasted (no food or liquids other than water) for eight hours. A normal fasting blood glucose level is less than 100 mg/dl. A diagnosis of diabetes is made if your blood glucose reading is 126 mg/dl or higher. (In 1997, the American Diabetes Association lowered the level at which diabetes is diagnosed to 126 mg/dl from 140 mg/dl.)

A "random" blood glucose test can be taken at any time. A normal blood glucose range is in the low to mid 100s. A diagnosis of diabetes is made if your blood glucose reading is 200 mg/dl or higher and you have symptoms of disease such as fatigue, excessive urination, excessive thirst or unplanned weight loss.

Another test called the oral glucose tolerance test may be performed instead. For this test, you will be asked, after fasting overnight, to drink a sugar-water solution. Your blood glucose levels will then be tested over several hours. In a person without diabetes, glucose levels rise and then fall quickly after drinking the solution.  In a person with diabetes, blood glucose levels rise higher than normal and do not fall as quickly.

A normal blood glucose reading two hours after drinking the solution is less than 140 mg/dl, and all readings between the start of the test until two hours after the start are less than 200 mg/dl.

Diabetes is diagnosed if your blood glucose levels are 200 mg/dl or higher.

What else do I need to do if I have diabetes?

People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.

Diabetes, and its precursor, the metabolic syndrome, can lead to a multitude of problems if not adequately controlled. These include vascular diseases that result in heart attack and stroke, kidney damage leading to kidney failure, damage to nerves (neuropathy), retinal damage leading to blindness, high blood pressure, and various metabolic defects such as high triglycerides or high cholesterol. It is therefore crucial to control the diabetes as well as all the other risk factors for artery diseases that cause heart attack and stroke.

To do this, your doctor will insist on a good diet and regular exercise. Medications are added to lower the blood sugar, and if these are inadequate, insulin or other injectable medication will be required. The medications that treat diabetes may cause depletion of folic acid, which in turn can cause a high homocysteine, which is a risk factor for artery disease that underlies heart attack and stroke. You can shift the risks in your favor by taking NutraMD Diabetes Essential Nutrients along with your doctor prescribed medications.

Donald Ford, MD, Diplomate of the American Board Internal Medicine. Dr. Ford has practiced general internal medicine for the past 22 years. He is a native Texan and trained at Baylor University, the University of Texas Medical School at Houston, and Scott and White in Temple. He is a Clinical Assistant professor at Baylor College of Medicine. In addition to general Internal Medicine, his practice includes travel medicine, vascular disease prevention, and Integrative Medicine with nutrients. He has been interested in the body’s ability to heal itself since medical school, and has used nutrients throughout his career to help patients use less prescription medication, or avoid it altogether.While he sees the tremendous value prescription medications can provide, he is also aware of the value and place for nutrients.

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