Diabetes

Diabetes is a medical epidemic

Diabetics die 10-15 years earlier. Read on to help you prevent this

Diabetes is the commonest of endocrine disorders. Diabetes Mellitus is a clinical syndrome characterised by hyperglycaemia (High blood sugar levels) due to lack of insulin, whether it is an absolute or relative deficiency. There are two types of primary diabetes mellitus:

1. Insulin Dependent Diabetes Mellitus (IDDM) or type 1 due to absolute insulin deficiency.
2. Non-Insulin Dependent Diabetes Mellitus (NIDDM) or type 2 due to relative insulin deficiency.

The ratio of NIDDM : IDDM in Europe and North America is about 7:3 ⁴⁰.

Every year thousands of Australians die as a result of type II diabetes. Many thousands more suffer from heart and kidney problems. Many develop stroke or lose a limb or their vision because of diabetes ⁶.

Diabetes affects more than 430, 000 Australians. Estimates suggest a further 350, 000 are affected but are unaware of their condition ⁶. Two hundred and fifty new cases of type 2 diabetes are diagnosed each day ⁷. Diabetes Prevalence increased from 1.8% in 1989-90 to 2.4% in 1995 ⁷.

Diabetes is increasing in industrialised countries at an incredible rate. According to Dr. Ray Strand the author of ""Bionutrition"", in USA diabetes has increased more than 5 times in the past 35 years. There are 8 million diabetics in America and there are 8 million who have not been diagnosed yet. It is because of late diagnosis of diabetes that 60% of patients have major CVD at the time of diagnosis. There are 24 million Americans with abnormal GTT or preclinical diabetes. Cost to the US economy is estimated to be in excess of 150 billion US dollars.

In UK there are 500,000 cases of diabetes diagnosed and according to surveys, in addition there are half a million cases undiagnosed. This is about 2% of the population ⁴⁵.

What causes diabetes?

One wonders why. Is it life style? Is it diet? Is it stress? Is it pollution? Is it genetic?

In the case of IDDM it seems to be polygenic associated with some environmental influences such as viruses, diet and immunological factors.

IDDM is due to inadequate insulin production by the pancreas. It is believed to be an autoimmune disease whereby the body has developed antibodies against the insulin producing cells with in the pancreas. Therefore, these cells are defective and unable to secret insulin.

Nutritional theory as a cause

The nutritional theory is based on free radical damage to the proteins on the cell. The immune system should clear these abnormal proteins from the body. As a result the antibodies will attack the cells with abnormal proteins. Understandably, these abnormal cells are unable to produce enough insulin resulting in high sugar level ⁷.

On the other hand, NIDDM is not genetically influenced but rather caused by environmental factors such as:

• Lifestyle - such as over-eating, obesity and lack of exercise. Obese people seem to become insulin resistant hence their blood sugar will go up.
• Age - aging plays a major role in developing NIDDM. Most of the cases are over the age of 50.
• Pregnancy - During normal pregnancy placental hormones place a burden on the pancreas to produce more insulin. In women with a tendency to develop diabetes, the pancreas cannot cope with this demand hence the development of gestational diabetes. About 80% of them develop frank diabetes later in life ⁴⁵.

Dr. Ray Strand's theory of developing diabetes

He believes that Americans have a high carbohydrate, low fat diet. There are two types of carbohydrates according to their glycaemic index. Glycaemic index is the rate that sugars from carbohydrates are released into the blood stream.

High glycaemic index carbohydrates, whereby sugar is released into the blood stream fast. Foods like sugar, some chocolates, some cakes, white bread, wholemeal wheat bread, white flour, brown and white rice, baked potatoes, new potatoes and pasta are in this category.

Low glycaemic index carbohydrates, whereby sugar is released into the blood stream slowly. Foods like green beans, soy beans, wholemeal rye bread, whole apples and cauliflower are in this category.

This following table is the glycaemic index of certain foods based on white bread GI of 100 as a reference ⁴⁸.

Figure 6: Courtesy of ACNEM, by Dr. Paul Holman.

After having a high glycaemic meal there is a rapid rise in blood sugar level for which the pancreas has to produce insulin. This happens day after day, year after year. Dr Strand calls it "crying wolf" all of the time. The end result is insulin resistance.

Insulin resistance is the beginning of a series of events like abnormal GTT, high cholesterol and triglycerides, hypertension and eventually full-blown diabetes.

In a 6-year Nurses Health Study of 65,000 women taking high glycaemic carbohydrates it was shown that the incidence of NIDDM diabetes increased by 1.5 times ⁵.

Another nutritional theory

There is another nutritional theory as to the development of type 2 diabetes or NIDDM. As you may know in type 2 diabetes there is insulin but it cannot be effectively utilised by the cell. It is postulated that every cell must have special receptors to recognise insulin to allow an influx of sugar into the cell. In diabetics these receptors are damaged by free radicals over the years. As these receptors are abnormal they cannot recognise insulin, hence sugar cannot enter the cell resulting in high blood sugar levels ⁷.

What are the symptoms of diabetes?

1. Polydipsia or feeling thirsty and drinking large quantities of water.
2. Polyuria or passing a large amount of urine more often.
3. Polyphagia or eating a lot and feeling hungry constantly.
4. There are many more such as recurrent thrush, boils, chest pain, recurrent chest infection, numb legs and so on which should alert one to the possibility of diabetes.

How is the diagnosis made?

Diagnosis is made via GTT (Glucose Tolerance Test) whereby fasting blood glucose is measured and then 75 grams of glucose is orally given.

Figure 7: The measurements are in mmol/l.

What are the side effects?

Vascular

This accounts for 75% of deaths. This is primarily due to atherosclerosis, development of atheroma and blockage of the arteries in the heart and the brain. The main culprit of atherosclerosis is oxidised LDL which is even worse in diabetics. Oxidised LDL becomes glycosalated which means packed with sugar hence more damaging to the arteries.

Eye

Eye complications affect 20% of diabetics. These include retinopathy (retinal damage), macular degeneration, cataract, refractory problems, retinal detachment, retinal haemorrhage, thrombotic glaucoma and sudden blindness due to haemorrhage into the vitreous.

Neuromuscular

This accounts for 30% of cases.

• Peripheral neuropathy. This is the most common neurological disorder associated with tingling, numbness and cramps of the feet and lower legs.
• Autonomic neuropathy. This can cause impotence in 25% of male patients.

There are more neuromuscular side effects but are beyond the scope of this website.

Kidney

This can cause uraemia, hypertension, glomerular damage and ultimately renal failure. Over 30% of deaths in diabetics under the age of 40 are due to kidney complications.

Skin

Insulin sensitivity may cause tender lumps at the injection sites. There could also be atrophy and hypertrophy at the injection sites.

Necrobiosis lipoidica diabeticorum

This is a characteristic rash on the shins showing atrophy and scaring at the centre, violet rings with yellow masses at the periphery ⁴⁵.

What is the problem?

The problem is by the time someone has been diagnosed with diabetes it is already too late because 60% of them would have advanced cardiovascular disease.

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