Type 2 Diabetes Flashcards
Type 2 diabetes (T2DM)
Insulin resistance / relative deficiency.
Blood sugar levels in diagnosing diabetes
HbA1c test:
- Normal: Below 42 mmol / mol (6%)
- Prediabetes: 42 to 47 mmol / mol (6.0 to 6.4%).
- Diabetes: 48 mmol / mol (6.5% or over)
Signs and symptoms:
- Polyuria (increased urination)
- Polydipsia (excess thirst)
- Polyphagia (excess hunger)
- Extreme fatigue. Blurry vision.
- Poor wound healing.
- Recurrent infections.
- Acanthosis nigricans.
- Obesity. Note: Non-obese T2DM rising (60-80% in Asian countries).
Complications:
- Acute: Hyperosmolar hyperglycaemia.
- Macrovascular: Cardiovascular disease, hypertension, stroke. Elevated homocysteine.
- Microvascular: Retinopathy, neuropathy (peripheral, autonomic), nephropathy.
- Depression, periodontal disease. Alzheimer’s disease.
Causes and risk factors
- Strong family history.
- Ethnicity Asian, African, and Afro Caribbean.
- Advancing age > 45 years. Children < 17 ass. with obesity, inactivity, poor nutrition etc.).
- Diet high GL diet
- Nutrient deficiencies
- Obesity (increased waist:hip ratio).
- Reduced physical activity
- High oxidative stress
- Chronic stress
- Mitochondria dysfunction
- Poor methylation
- Pre diabetes, metabolic syndrome, gestational diabetes.
Diabetes and Microbiome
Good
* Bifidobacterium, bacteroides, faecalibacterium, akkermansia and roseburia
Bad
* Ruminococcus , fusobacterium and blautia are associated with a higher risk of T2DM.
Naturopathic goals T2DM
- Stabilise blood sugar levels (and monitor):
- Reduce inflammation and boost antioxidants:
- Correct macronutrient and micronutrient status:
- Optimise insulin sensitivity and mitochondrial function
Nutritional support
- Calorie restriction —↑ skeletal muscle and liver insulin sensitivity.
- A low carbohydrate diet (LCD ) with more nuts shown to reduce weight, improve blood glucose, and regulate blood lipids.
- Reduced carbohydrates increased protein, MUFAs, and fibre (slows down
gastric emptying, slower release of glucose and, therefore, insulin response is lowered, reduces GL of meal). - Low glycaemic index (GI) more effective in controlling HbA1c and fasting blood glucose than a high GI diet, also shown to lower IL 6. Reduced post prandial glucose = reduced insulin.
T2DM: Supplements
Chromium
Alpha Lipoic Acid
Cinnamon
Magnesium
Vitamin D
Myoinositol
Biotin
EPA and DHA
Zinc
CoQ10
Berberine
Chromium
- Cr is a vital component of chromodulin a protein that increases the sensitivity of the enzyme ‘tyrosine kinase’, so that when insulin binds to its receptor, its action is enhanced.
- Cr may reduce carbohydrate cravings.
Dosage: 200 - 1,000
mcg chromium
picolinate
Alpha
lipoic acid
- An antioxidant reduces oxidative stress and inflammation. Has a direct
insulin sensitising action by increasing GLUT4 translocation to cell membranes increasing glucose uptake into cells. - Improves peripheral neuropathy (600mg)
Dosage: 200-600 mg
Cinnamon
Cinnamon enhances insulin sensitivity and promotes insulin release
In the diet (1-6 g/day)
Magnesium
- Intracellular magnesium plays key role in regulating insulin action. Deficiency
can worsen insulin resistance. - Is a co factor for glucose oxidation enzymes and modulates cell membrane glucose transport.
Dosage: 200 - 400 mg/day
Vitamin D
Vitamin D has a direct role in beta cell function, also has a role in insulin
sensitivity and systemic inflammation.
Myoinositol
Reduces blood glucose and insulin levels by improving insulin cell signalling, including in PCOS.
Dosage:
up to 4g
Biotin
- Increases activity of glucokinase enzyme glucokinase acts as a
‘glucose sensor’ for the pancreas. - May increase expression of the glucose transporter.
Dosage: 1-2mg
EPA and DHA
Improves insulin sensitivity, GLUT4 glucose transporter translocation into cell membranes and reduces systemic inflammation.
Dosage: 3g daily
Zinc
- Increased urinary loss in DM due to hyperglycaemia
- Regulates insulin receptor intracellular events that determine glucose tolerance and supports normal insulin response.
- Essential factor for antioxidant enzymes (e.g., SOD).
- Deficiency can ↑ ROS diabetic complications.
Dosage:
15-20 mg daily.
CoQ10
- Coenzyme Q10 deficiency can lead to reduced glucose metabolism and insulin resistance.
- Critical for cell respiration (electron transport chain).
Dosage: 100-200 mg
Berberine:
- Decreases gluconeogenesis and facilitates GLUT4 translocation.
- ↓ expression of proinflammatory genes
- AMPK activity of islet cells = insulin secretion.
- Modulates the microbiome a likely anti-diabetic mechanism. Thought to reduce circulating LPS load (a factor associated with insulin resistance).
- These mechanisms are similar to metformin.
Although metformin = vitamin B12 and folate malabsorption and can hence increase homocysteine.
Other natural approaches
- Support gut microbiome 5R programme’, comprehensive stool testing). Lactobacullus acidphillus for 4 weeks has been shown to preserve insulin sensitivity.
- Reishi mushroom - ganoderic acids increase insulin secretion and decrease cellular resistance to insulin.
- Milk thistle 600 mg for 6 months shown to significantly reduce fasting glucose. Improves liver function; protective role against NAFLD (associated with metabolic syndrome).
- Exercise increase physical activity; mix of aerobic, strength / resistance and flexibility. Aiming for at least 30 minutes daily.
