In addition, a strong partnership between the patient and the primary healthcare provider – general practitioner or internist – is an essential tool in the successful management of diabetes. Often the primary care doctor makes the initial diagnosis of diabetes and provides the basic tools to get the patient started on a management program. Regular appointments with the primary care physician and a certified diabetes educator are some of the best things a patient can do in the early weeks after a diagnosis of diabetes. Upon the diagnosis of diabetes, the primary care physician, specialist, or endocrinologist will conduct a full physical and medical examination. A thorough assessment covers topics such as:
The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment.
Levels which are significantly above or below this range are problematic and can in some cases be dangerous. A level of <3.8 mmol/L (<70 mg/dL) is usually described as a hypoglycemic attack (low blood sugar). Most diabetics know when they are going to "go hypo" and usually are able to eat some food or drink something sweet to raise levels. A patient who is hyperglycemic (high glucose) can also become temporarily hypoglycemic, under certain conditions (e.g. not eating regularly, or after strenuous exercise, followed by fatigue). Intensive efforts to achieve blood sugar levels close to normal have been shown to triple the risk of the most severe form of hypoglycemia, in which the patient requires assistance from by-standers in order to treat the episode. In the United States, there were annually 48,500 hospitalizations for diabetic hypoglycemia and 13,100 for diabetic hypoglycemia resulting in coma in the period 1989 to 1991, before intensive blood sugar control was as widely recommended as today. One study found that hospital admissions for diabetic hypoglycemia increased by 50% from 1990–1993 to 1997–2000, as strict blood sugar control efforts became more common. Among intensively controlled type 1 diabetics, 55% of episodes of severe hypoglycemia occur during sleep, and 6% of all deaths in diabetics under the age of 40 are from nocturnal hypoglycemia in the so-called 'dead-in-bed syndrome,' while National Institute of Health statistics show that 2% to 4% of all deaths in diabetics are from hypoglycemia. In children and adolescents following intensive blood sugar control, 21% of hypoglycemic episodes occurred without explanation. In addition to the deaths caused by diabetic hypoglycemia, periods of severe low blood sugar can also cause permanent brain damage. Although diabetic nerve disease is usually associated with hyperglycemia, hypoglycemia as well can initiate or worsen neuropathy in diabetics intensively struggling to reduce their hyperglycemia.
Pramlintide (Symlin) was the first in a class of injectable, anti-hyperglycemic medications for use in addition to insulin for type 1 diabetes or type 2 diabetes. Pramlintide is a synthetic analog of human amylin, a naturally occurring hormone made by the pancreas to help control glucose after meals. Similar to insulin, amylin is absent or deficient in person with diabetes.
According to a review of clinical trials published in December 2014 in JAMA Surgery, people with diabetes who underwent bariatric surgery had greater weight loss than those who received nonsurgical treatment, and the surgery was more effective in helping obese participants get diabetes under control. An article on the notable Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently trial, which was published in February 2017 in the New England Journal of Medicine, suggests that gastric bypass surgery and sleeve gastrectomy helped people with diabetes attain better glycemic control than medication alone. Compared with the medication-only group, people who underwent the surgeries also saw greater reductions in heart disease risk and medication use, as well as an improved quality of life.
Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus. Much evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia (elevated levels of glucose in the blood). Good glycemic control, in the sense of a "target" for treatment, has become an important goal of diabetes care, although recent research suggests that the complications of diabetes may be caused by genetic factors or, in type 1 diabetics, by the continuing effects of the autoimmune disease which first caused the pancreas to lose its insulin-producing ability.
The first approach to managing diabetes usually means practicing healthier lifestyle habits. This is often centered on eating a better diet, getting exercise, and losing weight if necessary. If your doctor says that you need to make these changes, it’s smart to tailor them to your personal preferences so that you'll be more likely to stick with them.
People with T1D work with an endocrinologist to determine proper insulin-to-carb ratio. This ratio is the amount of insulin needed to balance the intake of a certain amount of carbohydrates (typically measured in grams). Measuring the amount of carbohydrates and factoring the insulin to carb (I:C) ratio helps maintain stable blood-sugar levels after eating.
This healthy lifestyle we refer to is being active 150 minutes or more each week and eating a meal plan low in fat and processed sugar with 3-5 vegetables and 2-3 fruits a day most days. It does not require low or no carbohydrate diet like Atkins or counting carbohydrates every meal. Most folks do better when they spread the carbohydrates out evenly over the day.
Diabetes is a costly disease, placing a high financial burden on the patient and the healthcare system. If poorly managed or left untreated, it can cause blindness, loss of kidney function, and conditions that require the amputation of digits or limbs. The CDC reports that it’s also a major cause of heart disease and stroke and the seventh leading cause of death in the United States.
Also called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses. Other factors include how long someone has had diabetes and whether or not the person uses insulin.1
An insulin pump is a small machine that gives you small, steady doses of insulin throughout the day. You wear one type of pump outside your body on a belt or in a pocket or pouch. The insulin pump connects to a small plastic tube and a very small needle. You insert the needle under your skin and it stays in place for several days. Insulin then pumps from the machine through the tube into your body 24 hours a day. You also can give yourself doses of insulin through the pump at mealtimes. Another type of pump has no tubes and attaches directly to your skin, such as a self-adhesive pod.
As a bonus, stress relief may help you sleep better, which is important because studies show that not getting enough sleep can worsen type 2 diabetes. Sleeping less than six hours a night has also been found to contribute to impaired glucose tolerance, a condition that often precedes type 2 diabetes. In fact, a review published in 2015 in Diabetes Care analyzed 10 studies that involved more than 18,000 participants combined and found the lowest risk of type 2 diabetes in the group of participants that slept seven to eight hours per day. That’s the minimum recommended amount of sleep for most adults, according to the National Sleep Foundation.
Since type 2 diabetes is merely excessive glucose in the body, burning it off will reverse the disease. While it may sound severe, fasting has been practiced for at least 2000 years. It is the oldest dietary therapy known. Literally millions of people throughout human history have fasted without problems. If you are taking prescription medications, you should seek the advice of a physician. But the bottom line comes to this.
One of the biggest hits in type 2 diabetes treatment is glucagon-like peptide (GLP)-1 receptor agonists, which induce insulin production in beta-pancreatic cells while suppressing the secretion of glucagon. All big pharma have GLP-1 drugs on the market or their pipelines, including Sanofi, Eli Lilly, Roche, AstraZeneca and Boehringer Ingelheim. But Novo Nordisk is going a step further with the first oral version of a GLP-1 drug, which is now close to the market.
One of the most advanced alternatives comes from the Diabetes Research Institute (DRI) in the US, which is developing a bioengineered mini-organ where insulin-producing cells are encapsulated within a protective barrier. Two years ago, the DRI announced that the first patient treated in an ongoing Phase I/II trial no longer requires insulin therapy.
The earliest predictor of the development of type 2 diabetes is low insulin sensitivity in skeletal muscle, but it is important to recognize that this is not a distinct abnormality but rather part of the wide range expressed in the population. Those people in whom diabetes will develop simply have insulin sensitivity, mainly in the lowest population quartile (29). In prediabetic individuals, raised plasma insulin levels compensate and allow normal plasma glucose control. However, because the process of de novo lipogenesis is stimulated by higher insulin levels (38), the scene is set for hepatic fat accumulation. Excess fat deposition in the liver is present before the onset of classical type 2 diabetes (43,74–76), and in established type 2 diabetes, liver fat is supranormal (20). When ultrasound rather than magnetic resonance imaging is used, only more-severe degrees of steatosis are detected, and the prevalence of fatty liver is underestimated, with estimates of 70% of people with type 2 diabetes as having a fatty liver (76). Nonetheless, the prognostic power of merely the presence of a fatty liver is impressive of predicting the onset of type 2 diabetes. A large study of individuals with normal glucose tolerance at baseline showed a very low 8-year incidence of type 2 diabetes if fatty liver had been excluded at baseline, whereas if present, the hazard ratio for diabetes was 5.5 (range 3.6–8.5) (74). In support of this finding, a temporal progression from weight gain to raised liver enzyme levels and onward to hypertriglyceridemia and then glucose intolerance has been demonstrated (77).
Jambul fruit is an effective anti-diabetes agent considering its effect on the pancreas. The fruit, its seed, and juice, all are helpful in treatment of diabetes. Jambul fruit seeds contain a glucoside compound called "jamboline", which, supposedly, has the power to check the pathological conversion of starch into sugar in cases of increased production of glucose. Regular intake of jambul fruit can trigger pancreas to release insulin. Also, it can bring down blood sugar levels considerably. Therefore, jambul is an excellent anti-diabetes agent. It is one of the best home remedies for diabetes.
Together with evidence of normalization of insulin secretion after bariatric surgery (84), insights into the behavior of the liver and pancreas during hypocaloric dieting lead to a hypothesis of the etiology and pathogenesis of type 2 diabetes (Fig. 6): The accumulation of fat in liver and secondarily in the pancreas will lead to self-reinforcing cycles that interact to bring about type 2 diabetes. Fatty liver leads to impaired fasting glucose metabolism and increases export of VLDL triacylglycerol (85), which increases fat delivery to all tissues, including the islets. The liver and pancreas cycles drive onward after diagnosis with steadily decreasing β-cell function. However, of note, observations of the reversal of type 2 diabetes confirm that if the primary influence of positive calorie balance is removed, then the processes are reversible (21).
Fasting is the simplest and fastest method to force your body to burn sugar for energy. Glucose in the blood is the most easily accessible source of energy for the body. Fasting is merely the flip side of eating — if you are not eating you are fasting. When you eat, your body stores food energy. When you fast, your body burns food energy. If you simply lengthen out your periods of fasting, you can burn off the stored sugar.
Guava is a powerhouse of fiber, and vitamin C. Studies have proved that both nutrients are essential when it comes to maintaining sugar levels in the diabetics. The high content of fiber in the fruit supports metabolism that ultimately leads to better sugar absorption. And the antioxidants will ward off further factors that contribute to type 1diabetes.
The problem, of course, has not been solved — the sugar bowl is still overflowing. You’ve only moved sugar from the blood (where you could see it) into the body (where you couldn’t see it). It’s putting a band-aid over a bullet hole. So, the very next time you eat, the exact same thing happens. Sugar comes in, spills out into the blood and you take medication to cram the sugar back into the body. This works for a while, but eventually, the body fills up with sugar, too. Now, that same dose of medication cannot force any more sugar into the body.
Recent advances and research in management of Diabetes with traditionally used natural therapies have resulted in development of products from that facilitate production and proper utilization of insulin in the body. These preparations (Biogetica) are natural and work in conjugation with conventional therapies as supportive treatment protocols, they are absolutely safe and the patients are never at risk of developing hypoglycemic attacks due to the therapies.
Type 2 diabetes is the most common form of diabetes, and unlike type 1 diabetes, it usually occurs in people over the age of 40, especially those who are overweight. Type 2 diabetes is caused by insulin resistance, which means that the hormone insulin is being released, but a person doesn’t respond to it appropriately. Type 2 diabetes is a metabolic disorder that’s caused by high blood sugar. The body can keep up for a period of time by producing more insulin, but over time the insulin receptor sites burn out. Eventually, diabetes can affect nearly every system in the body, impacting your energy, digestion, weight, sleep, vision and more. (5)
The twin cycle hypothesis of the etiology of type 2 diabetes. During long-term intake of more calories than are expended each day, any excess carbohydrate must undergo de novo lipogenesis, which particularly promotes fat accumulation in the liver. Because insulin stimulates de novo lipogenesis, individuals with a degree of insulin resistance (determined by family or lifestyle factors) will accumulate liver fat more readily than others because of higher plasma insulin levels. In turn, the increased liver fat will cause relative resistance to insulin suppression of hepatic glucose production. Over many years, a modest increase in fasting plasma glucose level will stimulate increased basal insulin secretion rates to maintain euglycemia. The consequent hyperinsulinemia will further increase the conversion of excess calories to liver fat. A cycle of hyperinsulinemia and blunted suppression of hepatic glucose production becomes established. Fatty liver leads to increased export of VLDL triacylglycerol (85), which will increase fat delivery to all tissues, including the islets. This process is further stimulated by elevated plasma glucose levels (85). Excess fatty acid availability in the pancreatic islet would be expected to impair the acute insulin secretion in response to ingested food, and at a certain level of fatty acid exposure, postprandial hyperglycemia will supervene. The hyperglycemia will further increase insulin secretion rates, with consequent enhancement of hepatic lipogenesis, spinning the liver cycle faster and driving the pancreas cycle. Eventually, the fatty acid and glucose inhibitory effects on the islets reach a trigger level that leads to a relatively sudden onset of clinical diabetes. Figure adapted with permission from Taylor (98).
There is no prescribed diet plan for diabetes and no single “diabetes diet”. Eating plans are tailored to fit each individual's needs, schedules, and eating habits. Each diabetes diet plan must be balanced with the intake of insulin and other diabetes medications. In general, the principles of a healthy diabetes diet are the same for everyone. Consumption of various foods in a healthy diet includes whole grains, fruits, non-fat dairy products, beans, lean meats, vegetarian substitutes, poultry, or fish.