Type 2 Diabetes

Question 1

Type 2 diabetes (T2DM)

Answer 1

Insulin resistance / relative deficiency.

Question 2

Blood sugar levels in diagnosing diabetes

Answer 2

Question 3

HbA1c test:

Answer 3

• 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)

Question 4

Signs and symptoms:

Answer 4

• 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).

Question 5

Complications:

Answer 5

• Acute: Hyperosmolar hyperglycaemia.
• Macrovascular: Cardiovascular disease, hypertension, stroke. Elevated homocysteine.
• Microvascular: Retinopathy, neuropathy (peripheral, autonomic), nephropathy.
• Depression, periodontal disease. Alzheimer’s disease.

Question 6

Causes and risk factors

Answer 6

• 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.

Question 7

Diabetes and Microbiome

Answer 7

Good
* Bifidobacterium, bacteroides, faecalibacterium, akkermansia and roseburia

Bad
* Ruminococcus , fusobacterium and blautia are associated with a higher risk of T2DM.

Question 8

Naturopathic goals T2DM

Answer 8

1. Stabilise blood sugar levels (and monitor):
2. Reduce inflammation and boost antioxidants:
3. Correct macronutrient and micronutrient status:
4. Optimise insulin sensitivity and mitochondrial function

Question 9

Nutritional support

Answer 9

• 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.

Question 10

T2DM: Supplements

Answer 10

Chromium
Alpha Lipoic Acid
Cinnamon
Magnesium
Vitamin D
Myoinositol
Biotin
EPA and DHA
Zinc
CoQ10
Berberine

Question 11

Chromium

Answer 11

• 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

Question 12

Alpha
lipoic acid

Answer 12

• 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

Question 13

Cinnamon

Answer 13

Cinnamon enhances insulin sensitivity and promotes insulin release

In the diet (1-6 g/day)

Question 14

Magnesium

Answer 14

• 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

Question 15

Vitamin D

Answer 15

Vitamin D has a direct role in beta cell function, also has a role in insulin
sensitivity and systemic inflammation.

Question 16

Myoinositol

Answer 16

Reduces blood glucose and insulin levels by improving insulin cell signalling, including in PCOS.

Dosage:
up to 4g

Question 17

Biotin

Answer 17

• Increases activity of glucokinase enzyme glucokinase acts as a
  ‘glucose sensor’ for the pancreas.
• May increase expression of the glucose transporter.

Dosage: 1-2mg

Question 18

EPA and DHA

Answer 18

Improves insulin sensitivity, GLUT4 glucose transporter translocation into cell membranes and reduces systemic inflammation.

Dosage: 3g daily

Question 19

Zinc

Answer 19

• 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.

Question 20

CoQ10

Answer 20

• Coenzyme Q10 deficiency can lead to reduced glucose metabolism and insulin resistance.
• Critical for cell respiration (electron transport chain).

Dosage: 100-200 mg

Question 21

Berberine:

Answer 21

• 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.

Question 22

Other natural approaches

Answer 22

• 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.