I. Symptoms
If you have the below symptoms, please check with your family doctor. You might have diabetes:
1. Frequent urination
If you feel that you are needing to urinate more often than usual or a compelling urge to urinate, along with discomfort in your bladder. According to the study by Departamento de Ginecologia, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, in the study of seventy-seven patients (13.3%), researchers found that type 2 diabetes was predominant (96.1%). Stress urinary incontinence was the most frequent urodynamic diagnosis (39%) in diabetic patients, followed by detrusor overactivity (23.4%). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95%CI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8% diabetic patients and in 31.5% non-diabetic patients(1).
2. Excessive thirst, Unexplained weight loss
The urge to drink too much beyond a certain limit may be a symptom of high blood sugar in your bloodstream , and can be an important clue in detecting diabetes. Loss of body weight can occur due to various conditions ranging from eating disorders to severe metabolic conditions including diabetes. Drastic weight loss of more than 5 to 10 pounds when you're not trying to, requires medical attention because it may be a sign of diabetes.According to the research team lead by Khan N, in a data on 168 university students (47 males and 121 females) included in the analysis. Of the participants, 25% were overweight or obese and only 27% exercised regularly. Regarding their knowledge of DM, 70% knew that it is characterised by high blood sugar levels and identified family history as a major risk factor. Surprisingly, only just over half could link obesity and physical inactivity as risk factors for developing DM, or could identify an excessive feeling of thirst, frequent urination, and weight loss as symptoms(2).
3. Gastrointestinal symptoms
Diabetes mellitus (DM), such as stomach pain, heartburn, diarrhea, constipation, nausea and vomiting, has been associated with neuronal changes in the enteric, peripheral and/or central nervous system with abnormal visceral sensation and gastrointestinal (GI) symptoms are seen in up to 75% of patients. According to the study by Department of Gastroenterology & Hepatology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Diabetic patients had higher stimulus intensities to evoke painful sensation (p ≤ 0.001), longer latencies of N2 and P2 components (both p ≤ 0.001), and lower amplitudes of P1-N2 and N2-P2 complexes (p ≤ 0.001; p = 0.02). Inverse modelling of brain sources showed deeper bilateral insular dipolar source localization (p = 0.002). Symptom score index was negatively correlated with the depth of insular activity (p = 0.004) and positively correlated with insular dipole strength (p = 0.03)(3).
4. Depression
Depression is a normal response as part of our daily lives such as the loss of s job, the death of a love one, and illness. Over 30 million Americans suffer from depression and the amount is increasing in an alarming rate. It is common in people with diabetes, and related to higher HbA(1c) levels(4).
5. Sleeping difficulties, appetite problems and suicidal ideation
If you are experiencing the drive to eat excessively due to emotional and physical causes then it is an emotion disorder that compels you to eat even after you are full. Increased appetite can be an early symptom of diabetes. According to the study conducted in three tertiary diabetes clinics in the Netherlands of a total of 288 out of 646 subjects with diabetes (45%) reported one or more depressive symptom(s). Depressed mood (β = 0.11, P = 0.005), sleeping difficulties (β = 0.16, P < 0.001), appetite problems (β = 0.15, P < 0.001) and suicidal ideation (β = 0.14, P = 0.001) were significantly related to higher baseline HbA(1c) values. Furthermore, depressed mood (β = 0.09, P = 0.03) sleeping difficulties (β = 0.12, P = 0.004), appetite problems (β = 0.11, P = 0.01) and psychomotor agitation/retardation (β = 0.09, P = 0.04) were significantly related to higher HbA(1c) values at 1-year follow-up. Associations were more pronounced in Type 1 diabetes than in Type 2 diabetes(4).
6. Emotion stress
Emotion stress in diabetes patient is associsted to significantly poorer glycaemic control.
Diabetes-distress mediated the relation between depression and glycaemic control and not differently for both disease types. Post-hoc analyses revealed that patients depressed and distressed by their diabetes were in significantly poorer glycaemic control relative to those not depressed nor distressed (HbA(1c) 8.7 +/- 1.7 vs. 7.6 +/- 1.2% in those without depressive symptoms, 7.6 +/- 1.1% in depressed only and 7.7 +/- 1.1% in the distressed only, P < 0.001). Depressed patients without elevated diabetes-distress did not show a significantly increased risk of elevated HbA(1c), according to the study EMGO Institute for Health and Care Research, VU University Medical Centre(5).
7. Vulvovaginal symptoms and Candida colonization
Women with type 2 diabetes mellitus (T2DM) are atgreater risk for vaginal Candida colonization, as a result of glucosuria. In a double-blind study, subjects with T2DM and inadequate glycemic control on metformin were randomized to placebo; canagliflozin 50, 100, 200, 300 mg daily or 300 mg twice daily; or sitagliptin 100 mg daily for 12 weeks, researchers found that 23/198 (12%) females had vaginal cultures positive for Candida (C. glabrata: 14; C. albicans: 5; other: 4), with age ≤55 years associated with increased risk (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1-10.7)(6)..
5. Nonrefractive visual impairment
This is a symptom of great concern. If the blood sugar levels are too high, sugar builds up in your eye, This excess sugar also draws in fluid, changing the shape of the lens and making blurry vision. Certain types of blurry vision can be a medical emergency where delay can lead to loss of sight. In the study to estimate prevalence of nonrefractive visual impairment and to describe its relationship with demographic and systemic risk factors including diagnosed diabetes, showed that prevalence of nonrefractive visual impairment was significantly higher in 2005-2008 than in 1999-2002 and may be attributable, in part, to higher prevalence of diabetes, an associated risk factor that increased in prevalence during this time period(7).
6. Fear, Behavior and Worry
Behavior and Worry scores were positively related to psychological symptoms, perceived stress, and previous experiences with hypoglycemia. Fear was significantly higher for patients who had greater variability and lower mean daily blood glucose, according to the study by University of Virginia Health Sciences Center(8).
7. Reduced awareness
Reduced awareness may be associated to patient with diabetes, depending to experienced hypoglycemia(9).
8. Increased fatigue
Unlike the tiredness experienced by a healthy person, sudden increase of fatigue is a bad thing in people with symptoms of diabetes. Most Type II diabetes are caused by uncontrolled diet that are high in saturated fat. In the case of the cells of the pancreas dying off, experts believe it is caused by excessive drinking of alcohol. According to the study by INRA, Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), Fatigue is frequent in patients with diabetes and this symptom appears to be more prominent in type 2 rather than type 1 diabetic subjects. Chronic inflammation represents one characteristic of type 2 diabetes that may contribute to fatigue symptoms(10).
9. Slow wound healing
Slow wound healing is associated with poor wound healing in patient with diabetes as a result of weakened immune function. According to Dr. Prosdocimi M, and Dr. Bevilacqua C, the mechanisms underlying tissue repair are altered in the diabetic patient with respect to a healthy individual, namely for a diminished response of the keratinocytes and a reduced capacity of the endothelial cells to form new vessels (neoangiogenesis)(11).
10. Dry skin
In the study to evaluate the efficacy of a new product (Neuropad repair foam(®)) in promoting skin hydration of the foot in type 2 diabetes, found that there was no difference in skin capacitance between right and left foot (P = 0·186). However, skin capacitance was significantly higher on the right versus left foot, both after 7 days (P < 0·001) and after 14 days of treatment (P < 0·001). In conclusion, results with the new foam appear encouraging in ameliorating skin dryness in the diabetic foot(11).
11. Etc.
II. Causes and Risk factors
A. The Causes
1. Head trauma
Head trauma may be associated to the causes of Head trauma as a possible cause of central diabetes insipidus of central diabetes insipidus. There ia a report of a13-month-old female domestic shorthair cat presented with a 10-month history of polyuria and polydipsia that began after having been hit by a car. Neurological examination revealed visual deficits and an absent bilateral menace response. Hematological and serum biochemical analysis were within reference values, but hyposthenuria was identified. Failure to concentrate urine during the water deprivation test followed by an increase in urine specific gravity after administration of synthetic antidiuretic hormone (ADH) suggested central diabetes insipidus diagnosis(12).
2. Metabolic syndrome
Metabolic syndrome are associated with the increased risk of diabetes. Ghrelin is one of the circulating peptides, which stimulates appetite and regulates energy balance, and thus is one of the candidate genes for obesity and T2DM. During the last years both basic research and genetic association studies have revealed association between the ghrelin gene and obesity, metabolic syndrome or type 2 diabetes(13).
3. Gestational diabetes
Gestational Diabetes is defined as a condition of high blood glucose of a pregnant women who is experience such diseases or symptoms only during pregnancy as a result of hormonal change, but return to normal blood sugar after giving birth. Gestation diabetes is considered as an indication of type II diabetes. It affects approximately 3% of pregnant women.
4. Prediabetes
In prediabetics, either the pancreas can't produce enough insulin on demand or the cells do not actively respond to the insulin in the bloodstream.Prediabetes is caused by unhealthy diets with high in saturated fat, smoking and excessive alcohol drinking. Prediabetes is a high-risk state for diabetes, especially in patients who remain with prediabetes despite intensive lifestyle intervention. Reversion to normal glucose regulation, even if transient, is associated with a significantly reduced risk of future diabetes independent of previous treatment group(14).
5. Damage to the Pancreas
Dr, Guimarães ET and the research tean in the study of "Transplantation of Stem Cells Obtained from Murine Dental Pulp Improves Pancreatic Damage, Renal Function and Painful Diabetic Neuropathy in Diabetic Type 1 Mouse Model" indicated that mouse dental pulp stem cells (mDPSC) therapy may contribute to pancreatic β-cell renewal, prevents renal damage in diabetic animals, and produces a powerful and long-lasting antinociceptive effect on behavioral neuropathic pain. Our results suggest stem cell therapy as an option for the control of diabetes complications such as intractable diabetic neuropathic pain(15).
6. Influenza a viruses
Influenza A viruses commonly cause pancreatitis in naturally and experimentally infected animals. In the study to investigate whether influenza virus infection could cause metabolic disorders linked to pancreatic infection, found that that influenza virus infection may play a role as a causative agent of pancreatitis and diabetes in humans and other mammals(16).
7. HSP70-2 gene
According to the study by Service de Nutrition expérimentale, Institut de Nutrition, in aAnalysis of the -308 TNFalpha polymorphism in patients with type 2 diabetes and in control subjects revealed that the heterozygous TNF1/TNF2 genotype was significantly less frequent in the patient group (p=0.003), suggesting that TNF1/TNF2 may be considered as a protective marker against type 2 diabetes (OR=0.58), showing a high frequency of P2-HSP70-2 genotype in obese Tunisians, suggest that HSP70-2 polymorphism has susceptibility implications in both obesity and diabetes(16a).
8. NF-kappaB p65 activation
Lipid induced NF-kappaB activation is associated with insulin resistance and type2 diabetes. Excess of NF-kappaB p65 pool thus created in the cells made them insulin resistant. According to the study by Indian Institute of Chemical Biology(16b).
9. Etc.
B. Eisk factor
1. MG-AGEs
Prolonged period exposure to MG-AGEs can deplete host-defenses AGER1 and SIRT1, raise basal OS/Infl, and increase susceptibility to dysmetabolic IR, of that can lead to type II diabetes(17).
2. Postmenopausal breast cancer
Risk of diabetes moderated increase with women with postmenopausal breast cancer. According to the study by Women's College Hospital, Women's College Research Institute, among postmenopausal breast cancer survivors, the risk began to increase 2 years after cancer diagnosis but the highest risk was in the first 2 years in those who received adjuvant therapy(18).
3. Alcoholism
Chronic use of alcohol is considered to be a potential risk factor for the incidence of type 2 diabetes mellitus (T2DM), which causes insulin resistance and pancreatic β-cell dysfunction that is a prerequisite for the development of diabetes(19).
4. Non-alcoholic fatty liver disease
According to the study by Sungkyunkwan University, School of medicine, non-alcoholic fatty liver disease (NAFLD) was an independent risk factor of future development of type 2 DM. These results suggest the potential availability of NAFLD as an early predictor of type 2 DM(20).
5. Aging
The risdk of diabetes increased sunstantially after the ages of 45.
6. Obesity
Obesity is associated with a state of chronic systemic inflammation that is a primary etiologic factor in the development of insulin resistance and diabetes(21).
7. High blood pressure
Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. High blood pressure means raising pressure in your heart and staying high over time, damaging the body in many ways. Certain study indicated that there are some evidences for improved blood pressure outcomes with nurse-led interventions for hypertension in people with diabetes compared with doctor-led care. Nurse-based interventions require an algorithm to structure care and there is some preliminary evidence for better outcomes with nurse prescribing(22).
8. High levels of LDL cholesterol
Hig levels of LDL cholesterol is associated with the increased of diabetes. In a study of two thousand nine hundred and eight (2908) subjects including 1957 men and 951 women, aged 20 year and older, free of prediabetes and diabetes at baseline were enrolled in 2008 and followed for 3 years. The hazard ratio (HR) for developing diabetes were 4.46 (95% CI = 1.88-10.60) in men and 4.64 (95% CI = 1.20-17.97) in women for people who were HTGW phenotype at baseline, after adjusting for age, body mass index, systolic blood pressure, total cholesterol and low density lipoprotein-cholesterol(23).
9. Testosterone deficiency
In the study to evaluate the relationships between testosterone, metabolic syndrome (MetS), T2D, and IR and discuss the relationships among androgen deficiency and these factors, especially as it ultimately relates to the development of cardiovascular disease and erectile dysfunction (ED)., showed that androgen deficiency is associated with IR, T2D, MetS, and with increased deposition of visceral fat, which serves as an endocrine organ, producing inflammatory cytokines and thus promoting endothelial dysfunction and vascular disease(25).
10. Other risk factors
NICE advises using a validated risk assessment tool to identify patients at risk of diabetes. Risk factors used by such tools include: age; ethnicity; weight; first-degree relative with type 2 diabetes; low birthweight and sedentary lifestyle. Certain comorbidities increase the risk of type 2 diabetes, these include: cardiovascular and cerebrovascular disease; polycystic ovary syndrome; a history of gestational diabetes; and mental health problems. According to the GP Watercress Medical, Medstead GPwSI Cardioogy(24).
11. Etc.
III. Complications and diseases associated with diabetes
A. Complications
1. Gangrene
Gangrene is defined as a condition of the death of tissue in part of the body. There is a report of aA 78-year-old diabetic woman experienced multiple sites of gangrene not only in fingers that were directly bitten by a dog but also in fingers and toes that had not been bitten. Her glycemic control was fair and microvascular complications were mild. There were no clinical findings related to angitis, collagenosis or severe infection(26).
2. Loss of sensation in limbs
Accoring to Dr. Boulton AJ. at theUniversities of Manchester, as neuropathy is silent in up to 50% of patients, all diabetic patients should receive an annual screening by careful examination of the lower limbs for evidence of any sensory loss or peripheral vascular disease(27).
3. Amputation
Ampution is a result of nerve damage and poor blood circulation to the foot of that can lead poor healing of foot-ulceration. According to the study by Department of Biostatistics and Epidemiology, University of Pennsylvania, Lower extremity amputation (LEA) is a life-altering complication of diabetes, in a study of 1,490 individuals who were African Americans and 1,550 were whites.,LEA occurred in 162 (5.3%) subjects, 93 (6.2%) of African Americans and 69 (4.4%) of whites(28).
4. Diabetic retinopathy
Diabetic retinopathy is a condition of diabetic cause of the damage to the blood vessels of the light-sensitive tissue at the back of the eye. According to the study by Isfahan University of Medical Sciences and Health Services, of the 549 patients free of retinopathy at initial registration with at least one follow-up visit between 1992 and 2001, the incidence of any retinopathy was 89.4 (95% confidence interval (CI): 79.0, 101.0) [96.1 (95% CI: 76.7, 118.0) in males and 86.6 (95% CI: 74.5, 99.9) in females] per 1000 person-years based on 2786 person-years of follow-up. The incidence rate of retinopathy was 60% greater among insulin-treated than non-insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) clinic attenders(29).
5. Diabetic gastropathy
Diabetic gastropathy is defined as a condition of a number of neuromuscular dysfunctions of the stomach, including abnormalities of gastric contractility, tone, and myoelectrical activity in patients with diabetes(30).
6. Oral and dental complications
According to the study by Department of Medicine, MLN Medical College, Allahabad, oral manifestations in DM of which included periodontal disease in 34%, oral candidiasis in 24%, tooth loss in 24%, oral mucosal ulcers in 22%, taste impairment in 20%, xerostomia and salivary gland hypofunction in 14%, dental caries in 24%, and burning mouth sensation in 10% cases. Fasting [(FBG) (P = 0.003)] and postprandial blood glucose [(PPBG) (P = 0.0003)] levels were significantly higher among cases(31).
7. Recurrent infections
Women with diabetes have an increased risk of urinary tract infections (UTIs), especially recurrences. Relapses and reinfections were reported in 7.1% and 15.9% of women with diabetes versus 2.0% and 4.1% of women without diabetes, According to the study by University Medical Center Utrecht(32).
8. Rheumatic conditions
Diabetes mellitus (DM) is a chronic systemic disease with a wide range of complications, including complications in the musculoskeletal system. Diabetic patients suffer from diverse rheumatic conditions that affect their life quality, according to the study by Imam Muhammad Ibn Saud Islamic University(33).
9. Risk of fracture-related hospitalization
In the study to examine the association between diabetes, glycemic control, and risk of fracture-related hospitalization in the Atherosclerosis Risk in Communities (ARIC), showed that the study supports recommendations from the American Diabetes Association for assessment of fracture risk and implementation of prevention strategies in persons with type 2 diabetes, particularly those persons with poor glucose control(34).
10. Other complications
Diabetes Mellitus is a metabolic cum vascular syndrome with resultant abnormalities in both micro- and macrovasculature, including abnormalities of the retina, kidneys, and fetus, impaired wound healing, increased risk of rejection of transplanted organs, and impaired formation of coronary collaterals(35).
B. Diseases associated with diabetes
1. Acute myocardial infarction
Diabetes is considered as a risk factor for acute myocardial infarction (AMI). The relative risk (RR) in diabetic men was 2.9; 95% confidence interval (CI) 2.6-3.4, and in diabetic women, RR 5.0; CI 3.9-6.3. The risk for re-infarction was about twice as large in patients with diabetes as in patients without diabetes. In both sexes the overall 28 day case fatality (CF) was significantly higher in diabetic compared to non-diabetic subjects, according to the study by Department of Medicine, Kalix Hospital(36).
2. Risk of esophagus cancer
A study of 549 patients with esophageal cancer newly diagnosed in 2000-2009 and randomly selected 2196 controls without any cancer, frequency matched by sex, age and diagnosis year of cases. found that patients with DM are not at higher risk for esophagus cancer. However, esophageal disorders and anti-diabetic drugs are associated with the risk of the disease, according to the Taiwan's insurance data(37).
3. Cardiovascular disease
Type 2 diabetes is associated with a increased risk of cardiovascular disease. In the study of 2838 patients aged 40-75 years in 132 centres in the UK and Ireland were randomised to placebo (n=1410) or atorvastatin 10 mg daily (n=1428), showed that Atorvastatin 10 mg daily is safe and efficacious in reducing the risk of first cardiovascular disease events, including stroke, in patients with type 2 diabetes without high LDL-cholesterol(38).
4. Mortility
In the study to examine mortality in ICU patients with type 2 diabetes with and without pre-existing heart and kidney diseases compared with nondiabetic patients, reseachers at the Department of Anesthesiology and Intensive Care, Aarhus University Hospital, showed that among 45 018 ICU patients, 7219 (16·0%) had type 2 diabetes. Overall, 1-year mortality was 36·0% in ICU patients with type 2 diabetes, rising to 54·6% in patients with pre-existing heart and kidney diseases, compared with 29·1% in nondiabetic patients. Comparing diabetic with nondiabetic patients, the adjusted 0- to 30-day HR was 1·20 (95% confidence interval (CI): 1·13-1·26) and 1·19 (95% CI: 1·10-1·28) during the 31- to 365-day follow-up period(39).
5. Cognitive decline in elder patient
According to the study by Centre Mémoire de Ressources et de Recherche, Neurology Unit, University Hospital of Saint-Etienne, in a sample of elderly non-demented community dwellers, diabetes mellitus (but not IFG) is associated with a higher decline in selective attention and executive functioning. These results emphasize the importance of detecting and man- aging diabetes and impaired fasting glucose, in order to prevent cognitive impairment and dementia(40).
6. Dementia
Dementia is the loss of mental ability that is severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people. In the study to determine the risk of developing dementia in subjects with type 2 diabetes mellitus of a 749 participants (13.8%) with diabetes mellitus in the Mexican elder population, showed that diabetes mellitus have an increased risk of developing dementia. Sociodemographic factors and other co-morbidities highly prevalent in the Mexican population contribute to the diabetes-dementia association(41).
7. Etc.
III. Diagnosis and management
A. Diagnosis
If you are experience certain symptoms above, you may be diabetic. After recording your physical exam and family history of the diseases, the tests which your doctor ordered include
1. Glycated hemoglobin (A1C) test
it is the yest to measure and identify the average plasma glucose concentration over a periods of 2-3 months. Abnormal amount of glycated haemoglobin such as A1c ≥ 48 mmol/mol (≥6.5%) may be an indication of diabetes. A1C ≥6.5%: The test should be performed in a laboratory using a method that is National Glycohemoglobin Standardization Program (NGSP) certified and standardized to the Diabetes Control and Complications Trial (DCCT) assay, according to American diabetes association(42).
2. Fasting blood sugar test
It is a test to measures blood glucose after you have not eaten for at least 8 hours, but no more than 16 hours. A fasting blood sugar level between 6.0 and 6.9 mmol/L is considered prediabetes. If it's 7 mmol/L or over on two separate tests, you'll be diagnosed with diabetes.
3. Etc.
B. Management
B.1. How Diabetes Effects Men's Sex Lives
Diabetes can have an effect on sexual activity affecting both men and women, since diabetes effects the vessels and nerve systems involving normal function of the penis leading to various forms of sexual dysfunction.
Understanding Erection
With either mental or physical stimulation, your brain signals the nerve ending in the penis to release nitric oxide. Nitric oxide relaxes or dilates blood vessels, enabling them to open up and bringing more blood to the penis and helping to create an erection.
Sexual dysfunction occurs when a complication of diabetics resulting from poor blood sugar control, damages the nerves of the penis or there is plague building up in the arteries that feed blood into the penis causing vessels in the penis to be partially blocked preventing enough blood from getting into the penis.
To avoid sexual dysfunction, diabetics should actively work with their dietitian or nutritionist to create a healthy meal plan that is designed only for them. Delaying this step might cause high levels of glucose in the blood stream, resulting in high blood pressure and high cholesterol levels as well as
clogging up arteries and causing heart disease.This leads to blood vessels in the penis to be partially blocked causing sexual dysfunction.
Here are some natural remedies that will help to increase circulation of blood in your body:
1. Mistletoe extract or tea stimulates circulation and lower pressure of blood.
2.Ginkgo biloba aids small blood vessel circulation.
3. Arjuna is an Ayurvedic herb for improving circulation of blood and high blood pressure
You can buy these natural remedies at your local health food store. Be sure to read the recommended dosage.
B.2. How to Get High Carbohydrate Quality
Understanding Carbohydrates is a very important issue for diabetics because glycemic potency varies based on the glycemic index(GI), different carbohydrate foods that you eat will have dramatically different effects on your blood glucose levels.
What is Glycemic Index(GI)?
The GI index is a system for ranking carbohydrates according to how quickly they are converted to glucose. Foods with a low GI (less than 55) are absorbed into the blood stream slowly.
There are 2 types of carbohydrates:
1. Simple carbohydrates
Carbohydrates broken down quickly in the digestive system, therefore glucose are released quickly into bloodstream, such as chocolate, glucose,...etc.
2. Complex carbohydrates
After entering the digestive system, complex carbohydrates are broken down slowly such as whole grain, grapefruit, and apples. Therefore glucose is released gradually into the bloodstream.
Understanding simple and complex carbohydrates and the GI index will help you to choose the right type of carbohydrates in creating a specific meal plan tailoring to your own needs.
Please do not think that all complex carbohydrates have a low GI. Some complex carbohydrates contain a lot of simple carbohydrates, such as Baked Potatoes, Corn Flakes, Watermelons, and white bread have GIs higher than 72, while others have very low GIs such as grapefruits, lentils, and apples.
We know that combinations of high GI and low GI in one meal is the better choice to keep both your glucose and insulin levels lower over the course of a whole day.
B.3. Smoking danger
Nicotine is a stimulant, speeding up the heart by about 20 beats per minute with every cigarette and reduces the body's ability to use insulin by 15 percent. It also raises blood pressure. Nicotine makes arteries all over the body become smaller making it harder for the heart to pump through the constricted arteries, causing the body to release it's stores of fat and cholesterol into the blood, therefore smoking decreases the circulation of blood throughout our body causing less oxygen to be delivered to our vital organs and tissues. This makes diabetics harder to manage heart disease at the same time causing it.
Because of poor circulation of blood in the body, the immune system slowly reacts to allergens, bacteria and virus attacks, smoking diabetics are easier to get colds, the flu and sick more often. This poor circulation also increases the risk of impotence, that is a significant problem for men with diabetes even if they don't smoke.
Also, smoking blunts the ability to taste. Smokers choose foods with strong flavors, therefore smokers tend to eat less fruits and vegetables and more in fat and salt.
Since smoking causes fluctuation of insulin in the blood stream this increases blood pressure, and cholesterol and decreases the circulation of blood in our body. Smoking diabetics are at least 3 times at risk of developing heart disease than diabetics who don't smoke and they are much likely to die if they suffer a heart attack. Managing meal plans become very difficult for diabetics smokers. Therefore stop smoking is the benefit for a diabetic smoker's own good.
B.4. Tips For Managing Diabetes
1. Get your team together. Although your primary-care physician may have been the one to order blood-glucose testing, you need a team of professionals to guide you through all of diabetes' medical details. Ideally your team will include your primary-care physician, an endocrinologist (a hormone specialist who understands the intricacies of insulin), a registered dietitian to help you fine-tune your eating plan, an ophthalmologist (an eye specialist who can look for diabetes-related signs of damage to the retina), a podiatrist (a foot-care specialist who can help prevent complications from diabetes-related nerve damage and skin sores), and a dentist to keep periodontal disease and other infections under control.
2. Monitor your blood-glucose levels every daySome people resist checking their blood-sugar levels, but daily monitoring really is the only way to know if they are under control. Foods, activity level, medications, illness, and even stress can affect blood glucose. Unless you check, you might not know whether your levels are holding steady or spiraling out of control. Ask your doctor how often you need to check — and what to do if your blood glucose readings are abnormal.
3. Take diabetes medication as directed.
Diabetes symptoms are silent, so you may not notice an immediate repercussion when you neglect to take your medicine — and that means far too many people decide against taking prescribed medications (or "forget" to take them). Don't be one of them! Untreated diabetes carries the grave risks of heart disease, nerve damage, and other complications. Take medications or insulin as directed by your physician. If you have uncomfortable side effects or questions about your medication or treatment plan, talk with your doctor.
4. Exercise
Next to weight control and medical treatment, exercise is the most important thing you can do to take control over diabetes. Exercise decreases body fat and promotes weight loss — but even if you don't lose weight as a result, exercise will improve blood-sugar control and your body's response to insulin and even help prevent heart disease. Aim for 30 minutes of activity, five days per week. Studies show that all levels of exercise are beneficial, from moderate-intensity walking to high-intensity resistance training with weights. The key is to find something you enjoy doing and will stick with — whether it's walking, swimming, cycling, or dancing — and then get moving!
6. Drink alcohol only in moderation…if at all.
Drinking between one-half and two alcoholic drinks per day has been shown to reduce the risk of developing type 2 diabetes by an average of 30 percent, compared with nondrinkers or heavy drinkers. However, among people who already have diabetes, there is some question about the benefits of alcohol. Talk to your doctor to make sure that alcohol is safe for you and that you understand how it might affect your blood-glucose levels. And if you don't already drink alcohol, don't start.
7. Brush and floss regularly.
Just as unregulated diabetes leads to high levels of glucose in your blood, it also leads to higher-than-usual levels of glucose in your saliva, which raises the risk for dental decay. Plus, diabetes makes fighting infection harder, so that if gum disease develops, you'll have a more difficult time getting rid of it than someone without diabetes. However, research suggests that people with diabetes who gain control over their periodontal problems have better glycemic control after gum treatment than before. For healthy teeth and gums, dentists and nutritionists alike recommend that you see your dentist regularly, brush with a fluoride toothpaste at least twice a day, and remember to floss.
8. Seek treatment for sleep apnea or daytime sleepiness.
Excessive daytime sleepiness is often a sign of sleep apnea, a disorder that causes interruptions in breathing during sleep up to several times per night. It may be caused by faulty signals from the brain or because the soft tissue at the back of the throat relaxes and blocks the airway (called obstructive sleep apnea, or OSA). Most people with sleep apnea don't know what is happening or why they feel so tired after what seems like a full night's rest. People with diabetes are more likely to have sleep apnea than people without diabetes — and OSA itself increases the risk of insulin resistance and may be a roadblock to diabetes control. If you have sleep apnea, or if you experience unusual sleepiness during the daytime, talk with your doctor. A full night's sleep is not just a luxury, it's a health necessity.
B.5. Managing Diabetes When Dining Out
We eat out because it's easy, it's quick, and it's fun. But is it healthy? For type II diabetics, if you only eating out once a month, there is no need to worry about what you eat, but if it is 2 or 3 times a week, making good choices of foods is critical to your nutrition as well as blood sugar. Food in the restaurants contain more salt, saturated fat and I tend to eat more than we would at home.
Here are some tips on avoiding the traps when dining out:
1. Do not go out with an empty stomach
Eat a light healthy breakfast and lunch before you go. This will take the edge off your appetite and you will be less likely to over-eat.
2 Start with bread:
Ask the server if they have whole grain bread, because it will be digested slowly and gradually turned into glucose in your bloodstream. Also bread makes you feel full and you will be less likely to over-eat.
3. Drinks:
Water is the best choice in dining out. Most restaurants today offer free cool water for all customers, if not you can still ask for it. If you really want to drink, limiting yourself to 1-2 glasses of alcohol.
4. Remember that your meals should contain carbohydrates, proteins and vegetables:
Pick foods from menus that give you all three of the above components.
5. Eat slowly:
Take time to enjoy your foods and talk to your friends, eating slowly will help you stomach digest foods more slowly, resulting in glucose entering the bloodstream more slowly giving time for insulin to do it's job.
6. Order your food slowly:
Do not order all your foods at once. Otherwise, you will be likely to over-eat.
B.6. Nutrition and Meal Planning
All of us benefit and improve our health by eating healthy foods and exercising. Studies support the benefits of eating fruits, vegetables, whole grains, low fat dairy foods, lean meats and healthy fat. If you are diabetics, you need to manage your meal plan by keeping your blood sugar well in target range, while at the same time allowing you to enjoy your favorite foods.
Generally, all foods fall into one of the following groups:
*Carbohydrates: liver and muscle convert carbohydrates to energy.
* Proteins: made up of amino acid. It is vital in the growth and repair of tissues.
* Fat or fatty acids: are important for maintaining the membranes of all cells and regulates many body processes which include inflammation and blood clotting.
1. Carbohydrates:
Carbohydrates are the best source for body energy. In oder to determine the best meal plan for diabetics, monitoring the glucose in the bloodstream after each meal becomes very important. If the blood sugar reading is high, you must decrease a portion of the carbohydrates in your meal. Since adding fiber can slow down the release of glucose to the bloodstream, changing carbohydrate intake with more fiber such as whole grain will help. On the other hand, if the blood sugar is too low you must add more carbohydrates. After many tests, you will find the best balanced diet plan that puts your blood sugar well in the healthy range.
2. Protein:Poultry, meat, and dairy are protein containing saturated fats that are the major contributors of cholesterol building up in your arteries. Therefore, it is for a diabetic's benefit to reach out to other better protein sources such as fish, egg white, soy product and white chicken meat. Limit your daily protein between 15-20% of your total energy intake is the best for diabetics. Protein does not directly effect blood sugar levels after a meal, but does stimulate secretion of significant amounts of insulin and half of the protein eventually convert to glucose.
3. Fat:Monounsaturated fats such as olive oil, canola oil and polyunsaturated fats such as oils made from nuts, seeds and sunflowers are the best choice for a diabetic's diet because it not only gives the same nutrition profile as in saturated fat, but also helps to lower triglyceride levels and increase your HDL cholesterol.
By understanding and choosing a correct percentage of carbohydrates, proteins and fats for your meal planning, you might already have a healthy, nutritional meal plan that helps to keep your sugar level in a normal range.
B.7. Food Guide
In order to control glucose in the bloodstream, diabetics should meet with a dietitian to have an individualized meal plan designed for you, based on your eating habits, activity, lifestyle and diabetes treatment goals. The aim of any food guide or plan is to maximize your nutritional intake, at the same time minimize the risk of progression to diabetes and development of heart disease.
Your daily food guide: Total 100%
1. Carbohydrates: 50-55% such as whole grain, cereals, fruits, vegetables, recommended those with high fiber.
2. Protein: 25-30% such as red meat, milk products, eggs, white chicken meat, soy and soy products, recommended those with less saturated fat. Since meat contains high levels of iron, eating more white meatshould add iron supplement into a diabetic's diet.
3.Fat: 20%-25%. Avoid using Saturated fat
a)Monounsaterate fat: such as olive oil, canola oil
b) Polyunsaterated fat: such as sunflower oil, flax seed oil.
B.8. What is the Healthy Weight
Since Type II diabetes are caused by unhealthy diet that are high in saturated fat, most diabetics are overweight and obese, therefore weight loss becomes an important factor with even a few pounds being significant. Losing 20- 30 pounds in 3-4 months will improve health of diabetics remarkably, because the glucose in the bloodstream will drop and the cholesterol and triglycerides will go down.
The improvement of all the above will give diabetics more energy and better health.
But what is the ideal weight for diabetics?
Here is an easy way for diabetics to guess a good target weight by using this simple formula:
weight when you were age 20 X 1.2= target weight.
In order to achieve the target diabetics usually follow some kind of diet program that we have discussed in many articles. In this article, we will try to approach this subject differently.
1. Eat less food
* Use a small plate instead of the large dinner plate. This makes it look like you are getting more
foods.
*Eat small servings.
*Eat low calorie soup before meal.
* Eat small portions of fruits or vegetables before you have a meal or snack.
2. Eat less fat
* trim the fat of meat.
*do not eat fried foods.
*Use little oil when you cook.
*Take off the skin of chicken.
3. Eat regular meals
Eat your meals at the same time everyday, do not skip any meals. Skipping meals will only make you hungrier and eat more at the next meal.
4. Try to eat different colors of fruits and vegetables for your meal, because different colors of fruits and vegetables contain many different kinds of vitamins and minerals.
5. Eat fewer sweets and desserts.
6. Exercise:
Exercise everyday will help to increase your physical activity as well as reducing body weight.
B.9. How to Lose Weight and Reduce Glucose
If you are diabetic and over weight, there is a good chance that you have tried many kinds of diet programs. I hope by the time you read this article, you have already got your weight and glucose under control. If not, you might try some of the suggestions below.
1. Before you start, cleanse your body system of toxins and get rid of all parasites and plaguesBowel detoxification with liquid clay and ground fax seeds are particularly helpful for improving body conditions, because the clay absorb toxins while the seeds expands in water and brush the intestine clean. Also bowel detoxification with ground dandelion leaves and apple juice help the liver to cleanse toxinsrapidly.The next approach now is how to eliminate the parasites and plagues.
Harmful parasites: if left to live and breed inside your stomach, small and large intestines and your colon will then use your body as a food store house so they can live and breed by the millions. They will eventually cause you to get sick.
Plague: If let alone, it will cause you to get sick more often.
Vermifuge, taenifuges, anti fungals are natural remedies helpful to get rid of these harmful parasites and plagues.
2. Put extra protein in your diet, but reduce daily intake of red meats.By substituting your daily intake of red meat by cold water fish that has plenty of proteins and omega 3 fatty acid. Omega 3 fatty acid helps to lower triglycerides without causing the rise of glucose in your bloodstream.3. Increase intake of food with high fiber. Fiber helps to reduce the amount of insulin released by the pancreas by slowing down the breakdown of carbohydrates into glucose entering the bloodstream. Fiber also absorb water, causing it to swell. This gives a nice feeling of fullness that many weight loss programs do not provide. Food with high fiber such as broccoli, berries, peanut, spinach, whole grain, etc. lower cholesterol, triglycerides and improve diabetes.
4. Add some foods that reduce cholesterol and high blood pressure.Most foods that reduce cholesterol and high blood pressure have a profit of lower glucose in your bloodstream. Omega-3 fatty acids have the uncanny ability to break down cholesterol in the lining of blood vessels and also serve as a solvent for saturated fats and eventually lower your blood pressure.
5. Foods help to reduce glucose in your blood stream.1/2 table spoon of cinnamon and cactus tea everyday could be enough to help control your blood sugar. Cinnamon can help your fat cell recognize and response to insulin better. Other natural remedies such as garlic, ginger, bitter melon and etc. also have the same ability to lower blood sugars as well.
6. Quit smoking and reduce alcohol intake
7. Exercise.Physical activity improves insulin sensitivity, allowing your body to make better use of its own insulin.
8. Water and green leaf vegetables.Drink at least 8 ounces of water everyday to avoid brain dehydration and help the kidney to cleanse through the urine produced.
Green leaf vegetable has vitamins A, C, E and other minerals that help to replace vitamins and minerals of juices. You can enjoy leafy green vegetables every day without having to worry about them raising your glucose levels.
B.10. Tips to Protect Your Heart
If you are insulin insensitive type II diabetic that means your body produces sufficient insulin, but the cell at the receptor sites does not respond to it because the receptor sites were clogged up by fat and cholesterol, becoming insensitive to insulin. The damage of receptor sites cause the fluctuations in blood sugar, that leads to inner arterial wall damage. The major cause of insulin insensitive type II diabetic is uncontrolled diet with high in saturate fat. If you don't change your diet, the continuing build up of high levels of cholesterol in arteries and receptor sites make them even more difficult for blood to pass through, causing the serve case of diabetes, leading to higher blood pressure and ardiovascular disease. These are the risk factors and you must take steps to protect your heart.
Here are some tips:
1. How to control your cholesterol:Even if your cholesterol falls within the healthy range, as a diabetic you still can not relax. Exercise and healthy diet featuring plenty of vegetables, fruit, and whole grain. Cut back on meat and saturated fat would help you to get those cholesterol in line.
2. Reduce the Pressure:If you are diabetic, your risk for high blood pressure doubles and high blood pressure causes up to 75% of all heart disease in diabetics. But to get your blood pressure in the range of 135/85, you must have a proper diet---low in red meat, saturated fat and high in fruits, vegetables, and whole grains.
3. Give up smoking and alcohol:
The easy way to lower your risk of cardiovascular disease is to quit smoking and cut down on drinking.
4.Taking an aspirin a day:The ADA already recommend aspirin for all diabetics because it keeps your blood from clotting. It also has anti-inflammatory power and guard you from diabetic blindness.
B.11. Etc.
IV. Preventions
A. Diet to prevent diabetes
1. Effect of a low-carbohydrate diet
According to the study by Temple University School of Medicine, Philadelphia, Pennsylvania, and University of Medicine and Dentistry of New Jersey School of Osteopathic Medicinen, a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous reduction in energy intake to a level appropriate to their height; weight loss that was completely accounted for by reduced caloric intake; much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A1c; and decreased plasma triglyceride and cholesterol levels. The long-term effects of this diet, however, remain uncertain(43). Unfortunately, according to the study by CSIRO Health Sciences and Nutrition, without active ongoing dietary advice, adherence to dietary intervention is poor(44).
2. High-cocoa polyphenol-rich chocolate
High polyphenol chocolate is effective in improving the atherosclerotic cholesterol profile in patients with diabetes by increasing HDL cholesterol and improving the cholesterol:HDL ratio without affecting weight, inflammatory markers, insulin resistance or glycaemic control(45). Other study indicated that Cocoa polyphenols may increase the concentration of HDL cholesterol, whereas chocolate fatty acids may modify the fatty acid composition of LDL and make it more resistant to oxidative damage(46).
3. Probiotics
Probiotics particularly lactobacilli and bifidobacteria have recently emerged as the prospective biotherapeutics with proven efficacy demonstrated in various in vitro and in vivo animal models adequately supported with their established multifunctional roles and mechanism of action for the prevention and disease treatment, according to the study of "Probiotics as the potential biotherapeutics in the management of Type 2 Diabetes -Prospects and Perspectives" by Dairy Microbiology Division, National Dairy Research Institute(47). Others suggested that probiotics could have beneficial effects beyond gastrointestinal health, as they were found to improve certain metabolic disorders such as hypertension. Hypertension is caused by various factors and the predominant causes include an increase in cholesterol levels, incidence of diabetes, inconsistent modulation of renin and imbalanced sexual hormones(48).
4. Cinnamon
in the elucidation of the mechanisms by which p-Methoxycinnamic acid (p-MCA), a cinnamic acid increases [Ca2+]i and insulin secretion in INS-1 cells. p-MCA (100 μM) increased [Ca2+]i in INS-1 cells, found that p-MCA enhanced glucose-, glibenclamide-induced insulin secretion whereas it also potentiated the increase in insulin secretion induced by arginine, and Bay K 8644, an L-type Ca2+ channel agonist. Taken together, our results suggest that p-MCA stimulated insulin secretion from pancreatic β-cells by increasing Ca2+ influx via the L-type Ca2+ channels, but not through the closure of ATP-sensitive K+ channels, according to "Mechanisms of p-methoxycinnamic acid-induced increase in insulin secretion" by Adisakwattana S, Hsu WH, Yibchok-anun S.(49)
5. Bitter melon
In the study of Sialic acid changes in NIDDM patients, following bitter melon (55 ml/24h) and rosiglitazone (4 mg/24h) treatment in a total of 25 patients of both sexes, found that bitter melon and rosiglitazone treatment revealed no significant difference but the study showed that bitter melon could be more effective in the management of diabetes and its related complications as compared to rosiglitazone(50).
6. Garlic
In the study to evaluate the potential hypoglycemic effects of garlic in type 2 diabetic patients, showed that combination of garlic with typical antidiabetic remedy has shown to improve glycemic control in addition to antihyperlipidemic activity. Garlic may be a good addition in the management of patients with diabetes and hyperlipidemia(51).
7. Onion
In the study of the effect of feeding 15 mg% capsaicin diet or 3% freeze dried onion powder containing diet were examined in albino rats rendered diabetic with streptozotocin injection, found that Significant decrease in blood phospholipids and triglycerides also brought about by dietary onion. Hepatic cholesterol, triglycerides, phospholipids which were elevated under diabetic condition were countered significantly by dietary onion. Dietary capsaicin did not have any significant influence on any of the parameters tested in diabetic rats. Thus, the study reveals that onion feeding improves the metabolic status in diabetic condition, probably because of its hypoglycemic as well as hypocholesterolemic effect(52).
8. Turmeric
In the evaluation of the effect of feeding 0.5% curcumin diet or 1% cholesterol diet in albino rats rendered diabetic with streptozotocin injection, indicated that curcumin feeding improves the metabolic status in diabetic conditions, despite no effect on hyperglycemic status or the body weights. The mechanism by which curcumin improves this situation is probably by virtue of its hypocholesterolemic influence, antioxidant nature and free radical scavenging property(53).
9. Green tea and coffee
Drinking green tea and coffee are associated to reduced risk of diabetes. People who drink at least 4 cups of tea per day may have a 16% lower risk of developing type 2 diabetes than non-tea drinkers, according to InterAct Consortium(53a). coffee consumption decreased the risk of developing diabetes. The protective effect may exist aside from the influence of caffeine intake, according to the study by Gifu University Graduate School of Medicine(53b).
10. Reduced Satured and Tran fat comsuption
As fatty acids influence glucose metabolism by altering cell membrane function, enzyme activity, insulin signaling, and gene expression. By Dietary fat is of particular interest because fatty acids influence glucose metabolism by altering cell membrane function, enzyme activity, insulin signaling, and gene expression(53c).
B. Phytochemicals to prevent diabetes
1. Curcumin
Curcumin is a phytochemical found abundant in the plant. In acidic solutions (pH <7.4) it turns yellow, whereas in basic (pH > 8.6) solutions it turns bright red. Diabetic nephropathy is a debilitating disease that leads to end-stage renal failure in the Western world. According to the study by University of Western Ontario, diabetes-induced upregulation of vasoactive factors (endothelial nitric oxide synthase and endothelin-1), transforming growth factor-beta1 and extracellular matrix proteins (fibronectin and extradomain-B-containing fibronectin) in the kidneys. These changes were associated with increased oxidative stress, mesangial expansion, and p300 and nuclear factor-kappaB activity that were prevented with curcumin treatment(54). Other suggested that dietary curcumin admixture ameliorated diabetes in high-fat diet-induced obese and leptin-deficient ob/ob male C57BL/6J mice as determined by glucose and insulin tolerance testing and hemoglobin A1c percentages. Curcumin treatment also significantly reduced macrophage infiltration of white adipose tissue, increased adipose tissue adiponectin production, and decreased hepatic nuclear factor-kappaB activity, hepatomegaly, and markers of hepatic inflammation(55).
2. Gallocatechin,
Gallocatechin, containing catechin is phytochemicals of Flavan-3-ols, in the group of Flavonoids (polyphenols), found abundantly in green tea, almonds, black diamond plums, black tea, cocoa beans, Fuji apples, golden delicious apple, etc,. In the observation of Terminalia sericea stem bark extract and theirs effect against alpha-glucosidase and alpha-amylase enzymes, found that four known compounds namely beta-sitosterol (1), beta-sitosterol-3-acetate (2), lupeol (3), and stigma-4-ene-3-one (4), in addition to two inseparable sets of mixtures of isomers [epicatechin-catechin (M1), and gallocatechin-epigallocatechin (M2). 1 and 3 showed the best inhibitory activity on alpha-glucosidase (IC50:54.5 and 66.5 microM). Bio-evaluation of the inhibitory activity of the purified compounds on alpha-amylase showed that 3 and 1 exhibited IC50 values of 140.7 and 216.02 microM, respectively against alpha-amylase, according to "Antidiabetic activity of Terminalia sericea constituents" by Nkobole N, Houghton PJ, Hussein A, Lall N.(56).
Others, suggested that green tea (400 and 800 mg EGCG as PPE; ~5-10 cups) supplementation for 2 months had suggestive beneficial effects on LDL cholesterol concentrations and glucose-related markers, according to "Effect of 2-month controlled green tea intervention on lipoprotein cholesterol, glucose, and hormonal levels in healthy postmenopausal women" by Wu AH, Spicer D, Stanczyk FZ, Tseng C, Yang CS, Pike MC.(57)
3. Resveratrol
Resveratrol is a phytochemical in the class of Stilbenoids, found abundantly in skins and seed of grape wine, nuts, peanuts, etc. In the evaluation of resveratrol, a polyphenolic SIRT1 activator and its SIRT1 activation in an in vitro fluorescent based assay (EC(50) : 7 μM) and the efficacy of resveratrol was also evaluated in ob/ob mice for its antidiabetic and associated metabolic effects, found that a significant improvement observed in the glucose excursion in the oral glucose tolerance test performed for 120 min; although an insignificant improvement in the triglycerides, total cholesterol, adiponectin and free fatty acid levels was observed at different doses of resveratrol tested. The present findings suggest that resveratrol is an antihyperglycemic agent and drugs similar to resveratrol can be considered as an effective therapeutic adjuvant for the current treatment of diabetes mellitus, according to "Antidiabetic activity of resveratrol, a known SIRT1 activator in a genetic model for type-2 diabetes" by Sharma S, Misra CS, Arumugam S, Roy S, Shah V, Davis JA, Shirumalla RK, Ray A.(58).
4. Genistein
Genistein is a phytochemical in the Isoflavones, belonging to the group of Flavonoids (polyphenols), found abundantly in food of the family of legumes, soy, alfalfa sprouts, red clover, chickpeas, peanuts, etc,. In the investigation of the effect of genistein on beta-cell proliferation and cellular signaling related to this effect and further determined its antidiabetic potential in insulin-deficient diabetic mice, found that genistein induced protein expression of cyclin D1, a major cell-cycle regulator essential for beta-cell growth. Dietary intake of genistein significantly improved hyperglycemia, glucose tolerance, and blood insulin levels in streptozotocin-induced diabetic mice, concomitant with improved islet beta-cell proliferation, survival, and mass. These results demonstrate that genistein may be a natural antidiabetic agent by directly modulating pancreatic beta-cell function via activation of the cAMP/PKA-dependent ERK1/2 signaling pathway, according to "Genistein induces pancreatic beta-cell proliferation through activation of multiple signaling pathways and prevents insulin-deficient diabetes in mice" by Fu Z, Zhang W, Zhen W, Lum H, Nadler J, Bassaganya-Riera J, Jia Z, Wang Y, Misra H, Liu D.(59).
5. Gallic acid
Gallic acid is a phytochemical in the class of Phenolic acids, found abundantly in tea, mango, strawberries, rhubarb, soy, etc,. In the review of 1, 2, 3, 4, 6-penta-O-galloyl-beta-D-glucose (PGG) is a polyphenolic compound highly enriched in a number of medicinal herbals, indicated that Chemically and functionally, PGG appears to be distinct from its constituent gallic acid or tea polyphenols. For anti-cancer activity, three published in vivo preclinical cancer model studies with PGG support promising efficacy to selectively inhibit malignancy without host toxicity. Potential mechanisms include anti-angiogenesis; anti-proliferative actions through inhibition of DNA replicative synthesis, S-phase arrest, and G(1) arrest; induction of apoptosis; anti-inflammation; and anti-oxidation. Putative molecular targets include p53, Stat3, Cox-2, VEGFR1, AP-1, SP-1, Nrf-2, and MMP-9. For anti-diabetic activity, PGG and analogues appear to improve glucose uptake, according to "Anti-cancer, anti-diabetic and other pharmacologic and biological activities of penta-galloyl-glucose" by Zhang J, Li L, Kim SH, Hagerman AE, Lü J(60).
6. Cinnamic acid
Cinnamic acid is a phytochemical in the class of Hydroxycinnamic acids, found abundantly in cinnamon, aloe. etc,. in the elucidation of the mechanisms by which p-Methoxycinnamic acid (p-MCA), a cinnamic acid increases [Ca2+]i and insulin secretion in INS-1 cells. p-MCA (100 μM) increased [Ca2+]i in INS-1 cells, found that p-MCA enhanced glucose-, glibenclamide-induced insulin secretion whereas it also potentiated the increase in insulin secretion induced by arginine, and Bay K 8644, an L-type Ca2+ channel agonist. Taken together, our results suggest that p-MCA stimulated insulin secretion from pancreatic β-cells by increasing Ca2+ influx via the L-type Ca2+ channels, but not through the closure of ATP-sensitive K+ channels, according to "Mechanisms of p-methoxycinnamic acid-induced increase in insulin secretion" by Adisakwattana S, Hsu WH, Yibchok-anun S.(61).
7. Alliin
Alliin (S-allyl-L-cysteine-S-oxide) is a phytochemical compound sulfoxide,. a derivative of the amino acid cysteine, belonging to the class of sulfur compounds, found abundantly in fresh garlic and onion.
In comparison of the production and therapeutic efficiency of alliin extracted from garlic leaves of plants grown under ex situ and in situ conditions, found that Alliin production noted ~50% enhancement in leaves from plants grown under in situ conditions. Serum glucose, triglycerides, total lipids, total cholesterol, low-density lipoprotein (LDL)-, and very low-density lipoprotein (VLDL)-cholesterol in diabetic rats treated with alliin produced from in situ grown plants noted significant reduction of ~54%, 15%, 14%, 20%, 24%, and 15%, while 35%, 14%, 10%, 12%, 17% and 11% reduction was noted in diabetic rats treated with alliin produced from ex situ grown plants in comparison with those administered with distilled water. High-density lipoprotein (HDL)-cholesterol did not show any significant change. Leaf extract of plants lowered serum enzyme levels (alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase) toward the norm better than glibenclamide, according to "Alliin obtained from leaf extract of garlic grown under in situ conditions possess higher therapeutic potency as analyzed in alloxan-induced diabetic rats" by Nasim SA, Dhir B, Kapoor R, Fatima S, Mahmooduzzafar, Mujib A.(62).
8. Etc.
C. Antioxidants to prevent diabetes
Free radicals are formed disproportionately in diabetes by glucose oxidation, nonenzymatic glycation of proteins, and the subsequent oxidative degradation of glycated proteins. Abnormally high levels of free radicals and the simultaneous decline of antioxidant defense mechanisms can lead to damage of cellular organelles and enzymes, increased lipid peroxidation, and development of insulin resistance. These consequences of oxidative stress can promote the development of complications of diabetes mellitus(63).
1. Vitamin E (Free radical scavenger)
According to the study of Vitamin E: function and metabolism, Vitamin E is the term for a group of tocopherols and tocotrienols, of which α-tocopherol has the highest biological activity(a), and is the most common in the North American diet.
In the study of twenty-eight rats rendered diabetic by streptozotocin injection and fed either with a diet with low (10 mg/kg of chow), medium (75 mg/kg of chow) or high amounts of vitamin E (1300 mg/kg of chow). Nine age-matched nondiabetic rats receiving 75 mg of vitamin E/kg chow served as controls, the results showed that 1) vitamin E has a potential to prevent partially hyperglycemia-induced endothelial dysfunction, 2) under in vivo conditions vitamin E deficiency enhanced diabetic endothelial dysfunction dramatically, and 3) positive effects of vitamin E may be attenuated with a longer disease duration(64).
2. Vitamin C (Free radical scavenger)
Vitamin C or L-ascorbic acid is a water-soluble vitamin needed for the growth and repair of tissues of the body. Epidemiological studies showed that diets high in fruits and vegetables are associated with lower risk of cardiovascular disease, stroke and cancer, and with increased longevity(65).
In the study of 84 patients with type 2 diabetes referred to Yazd Diabetes Research Center, Iran, were included in the study. They received randomly either 500 mg or 1000 mg daily of vitamin C for six weeks, found that daily consumption of 1000 mg supplementary vitamin C may be beneficial in decreasing blood glucose and lipids in patients with type 2 diabetes and thus reducing the risk of complications(66).
3. Vitamin D
Vitamin D is a membrane antioxidant: thus Vitamin D3 (cholecalciferol) and its active metabolite 1,25-dihydroxycholecalciferol and also Vitamin D2 (ergocalciferol) and 7-dehydrocholesterol (pro-Vitamin D3) all inhibited iron-dependent liposomal lipid peroxidation(66a). There is evidence supporting that vitamin D status is important to regulate some pathways related to type 2 diabetes development. Based on available clinical and epidemiological data, the positive effects of vitamin D seem to be primarily related to its action on insulin secretion and sensitivity and secondary to its action on inflammation, according to the study by São Paulo State University(66b). Other study linked vitamin D deficiency as a culprit to the development of Type I and II diabetes. According yo the study by Laboratory of Experimental Medicine and Endocrinology (LEGENDO), Catholic University of Leuven, vitamin D deficiency has been shown to impair insulin synthesis and secretion in humans and in animal models of diabetes, suggesting a role in the development of type 2 diabetes. Furthermore, epidemiological studies suggest a link between vitamin D deficiency in early life and the later onset of type 1 diabetes(66c).
4. Coenzyme Q10
Coenzyme Q10 (CoQ10) found naturally in the body is necessary for the basic functioning of cells. In the study to investigate the effects of coenzyme Q10 (CoQ10) treatment on insulin secretory response, hearing capacity and clinical symptoms of maternally inherited diabetes mellitus and deafness (MIDD), found that the insulin secretory response assessed by glucagon-induced C-peptide secretion and 24 h urinary C-peptide excretion after 3 years in the CoQ10-DM group was significantly higher than that in the control-DM group. CoQ10 therapy prevented progressive hearing loss and improved blood lactate after exercise in the MIDD patients. CoQ10 treatment did not affect the diabetic complications or other clinical symptoms of MIDD patients(67). Other study suggested that CoQ supplementation may improve blood pressure and long-term glycaemic control in subjects with type 2 diabetes, but these improvements were not associated with reduced oxidative stress, as assessed by F2-isoprostanes(68).
5. Alpha-lipoic acid
Alpha-lipoic acid, an antioxidant made by the body and is is necessary for the basic functioning of cells
to turn glucose into energy. According to the study of Bühl and City Hospital, Baden-Baden, Germany, alpha-lipoic acid (ALA), a naturally occuring compound and a radical scavenger was shown to enhance glucose transport and utilization in different experimental and animal models. Oral administration of alpha-lipoic acid can improve insulin sensitivity in patients with type-2 diabetes. The encouraging findings of this pilot trial need to be substantiated by further(69).
6. L-carnitine
L carnitines, is an antioxidant protected our body against lipid peroxidation and oxidative stress. Supplementation of L-carnitine and antioxidants improve lipid profiles and exercise ability in exercise-trained rats. Also, both exercise training and supplementation of carnitine and antioxidants improved lipid profiles and carnitine metabolism in humans, suggesting that carnitine and antioxidant supplementation may improve exercise performance, according to the study by Faculty of Medicine, University of British Columbia(70).
6. Etc.
V. Treatments
A. In conventional medicine perspective
The aim of the treatment is to prolonged life, relieve symptoms and prevent complication as well as enhancing the life quality
A. 1. Life style management
According to the study by Diakonissen-Krankenhaus Salzburg, Salzburg, Österreich, aiabetes education, nutritional advice, exercise recommendations and training for smoking cessation comprise the mainstay of diabetes treatment before starting drug therapy. Prevention as well as treatment of diabetes mellitus is positively influenced by life-style modification(71). Other in the study of The sample aged 53.5±6.6 years, 72.7% aged 50 to 59 years; 45.3% were women; an average of 8±2.08 years in the disease's evolution. suggested that it is necessary to improve life styles on physical activity, self-esteem, diet and attachment to the treatment(72). And in a cross-sectional correlational study indicate that poor metabolic control of diabetic patients has a detrimental effect on quality of life, and when diabetic patients use more self-control skills, they may achieve better quality of life(73).
A.2. Non medication therapy
1. Exercise
Along with diet and medication, exercise is the third cornerstone of type 2 diabetes treatment. Persons with type 2 diabetes should perform at least 90 min per week of vigorous (> 65% of VO (2)max) aerobic exercise or 150 min per week of moderate-intensity (40-65% of VO (2)max) aerobic physical activity. Performing at least 240 min of physical activity per week is associated with greater cardiovascular disease risk reductions as well as with less cardioÂ-vascular events compared with lower volumes of activity, according to the study by Abteilung Bewegung und Gesundheit, Erlangen(74).
2. Diet therapy
Low-carbohydrate and low-fat calorie-restricted diets are recommended for weight loss in overweight and obese people with type 2 diabetes. In the study of 215 overweight people with newly diagnosed type 2 diabetes who were never treated with antihyperglycemic drugs and had hemoglobin A(1c) (HbA(1c)) levels less than 11%, found that after 4 years, 44% of patients in the Mediterranean-style diet group and 70% in the low-fat diet group required treatment (absolute difference, -26.0 percentage points [95% CI, -31.1 to -20.1 percentage points]; hazard ratio, 0.63 [CI, 0.51 to 0.86]; hazard ratio adjusted for weight change, 0.70 [CI, 0.59 to 0.90]; P < 0.001). Participants assigned to the Mediterranean-style diet lost more weight and experienced greater improvements in some glycemic control and coronary risk measures than did those assigned to the low-fat diet and concluded that compared with a low-fat diet, a low-carbohydrate, Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes(75).
A.3. Medication
A.3.1. Oral administration
1. Beta-blocker therapy
In the study to determine the use and association with one-year mortality of beta-blocker therapy for the treatment of acute myocardial infarction (AMI) in elderly diabetic patients and to examine whether beta-blocker therapy was associated with increased rates of hospital readmission for diabetic complications traditionally associated with beta-blockers, researchers showed that Beta-blockers are associated with a lower one-year mortality rate for elderly diabetic patients to a similar extent as for nondiabetics, without increased risk of readmission for diabetic complications. Increasing the use of beta-blockers in elderly diabetic patients represents an opportunity to improve the care and outcomes of these patients after AMI(76). Major side effects include the precipitation or worsening of congestive heart failure, and significant negative(77).
2. Metformin
The oral antidiabetic medicine is the first for patient of type II diabetes, in particular, in overweight and obese people and those with normal kidney function by improving your body responds to insulin to reduce high blood sugar levels with side effect ot limit to nausea, diarrhea, and gas. Over doses can cause vomiting, diarrhea, abdominal pain, tachycardia, drowsiness, and, rarely, hypoglycemia or hyperglycemia, according to the study by Jeffrey R. Suchard, MD and Thomas A. Grotsky, MD(78)
3. Sulfonylurea
The medaction helps to increase the amount of insulin made by your body makes, and lower blood sugar levels. Unfortunately, Patients with type 2 diabetes exposed to sulfonylureas and exogenous insulin had a significantly increased risk of cancer-related mortality compared with patients exposed to metformin(79). Other study indicated that they did not identify an increased mortality risk among the different combinations of sulfonylureas and metformin, suggesting that overall mortality is not substantially influenced by the choice of sulfonylurea(80).
Side effects are not limit to Sweating, Shaking, Feeling hungry and anxious, etc.
4. Thiazolidinediones
The medicine lower blood sugar levels by increasing the body's sensitivity to insulin. Unfortunately, it can causes liver cancer and colorectal cancer in type 2 diabetes mellitus, according to the study of a total of 606,583 type 2 diabetic patients, age 30 years and above, without a history of cancer were identified from the Taiwan National Health Insurance claims database during the period between January 1 2000 and December 31 2000, by Department of Internal Medicine, National Taiwan University Hospital(81). Other suggested that it may cause bone loss(82) and bladder cancer(83). Side effects of Thiazolidinediones are not limit to
heart failure, weight gain, fluid tetention and risk of bone fracture, etc.
5. Insulin
The aim of insulin therapy is to treat diabetes by controlling the amount of sugar (glucose) in the blood. BIAsp 30, a biphasic insulin, has been shown to be more effective in terms of glycaemic control than standard biphasic human insulin 30 (BHI 30). In the study by Institute of Biomedical Research, University of Birmingham, a strong evidence was provided for better glycaemic control with BIAsp 30 without increases in the incidence of major hypoglycaemia or nocturnal hypoglycaemic episodes. Overall, weight gain with BIAsp 30 was minimal and not significantly greater than with basal insulin or BHI 30. The reported efficacy and tolerability of BIAsp 30 in the treatment of diabetes based on a variety of clinical endpoints is supported by a good body of evidence relating to its use in different dosage regimens and in comparison with other insulin treatment regimens(84). Side effects are rare, but allergic reactions can be severe and pose a significant risk to health(85).
6. DPP-IV Inhibitors
The medicine helps to lower glycated hemoglobin, fasting and postprandial glucose levels, with a low incidence of hypoglycemia and no weight gain and only given to patient can not tolerate first line medicine. There is a trend towards increasing use of DPP-IV inhibitors, which are no less efficacious and safe in Asians than Caucasians and may have some advantages over existing oral antidiabetic agents, particularly for certain high-risk groups(86). Clinical trials have shown that vildagliptin is effective in significantly lowering glycosylated hemoglobin (HbA1c), fasting plasma glucose, and prandial glucose levels. beta-cell function may also be improved. The drug has placebo like tolerability and rate of hypoglycemia events. Vildagliptin expands non-injectable treatment options available for management of T2DM patients, who are poorly controlled with monotherapy(87). Other study suggeested that Vildagliptin represents a safe and effective new approach to targeting GLP-1 deficiencies in patients with type 2 diabetes by inhibiting DPP IV(88). Side effects are not limit to incidences of hypoglycemia increased with longer duration and optimal results with minimal adverse effects were achieved with 25 mg twice daily and 50 mg once daily doses(89).
7. Etc.
A.3.2. Insulin or insulin and oral medication therapy
The conbination of GLP-1 analogues and isulin may be effective in the treatment of type 2 diabetes mellitus, as GLP-1 stimulate insulin production and secretion, and suppress glucagon secretion, depending on the blood glucose level and have an effect on the brain, enhancing satiety, and on the gut, where they delay gastric emptying(90).
Unfortunately, In a 136 insulin-naïve respondents (57% female, 69% Latino, mean age 51.1±10.3 years; $200-$1000 median monthly household income; grade 8-12 median education) revealed a 48% prevalence of complete unwillingness to begin insulin, researchers found that Latino respondents were younger, lived fewer years in the U.S., had less education, were more likely unwilling to use insulin (53% vs. 30%, p=0.03), and reported a more negative attitude to 8 of 9 PIR domains (p≤0.01 for each). Fewer years in the U.S. predicted greater unwillingness and a more negative attitude on 8 of 9 PIR domains (p≤0.03 for each); and less education predicted greater feelings of unfairness (p=0.01)(91).
A.4. Surgery
Although surgery is rare and only in nonmorbidly obese patients with uncontrolled type 2 diabetes
1. In this randomized, nonblinded, single-center trial, we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes, showed that in obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone(92). Other indicated that clinical and laboratory manifestations of type 2 diabetes are resolved or improved in the greater majority of patients after bariatric surgery; these responses are more pronounced in procedures associated with a greater percentage of excess body weight loss and is maintained for 2 years or more(93).
Laparosopic gastric sleeve gastrectomy resulted in remission of poorly controlled nonmorbidly obese T2DM patients up to 50% at 1 year after operation. The effect is related more to the decreasing of insulin resistance because of calorie restriction and weight loss rather than to the increasing of insulin secretion. C-peptide >3 ng/mL is the most important predictor for a successful treatment(94). But other indicated that Laparoscopic ileal interposition associated with a sleeve gastrectomy (LII-SG) is a safe and effective operation for the treatment of type 2 diabetic (T2DM) patients with BMI below 35. As the clamp technique, II-SG significantly improved IS and β-cell function as early as 30 days postoperatively in a T2DM population with a BMI of 21.9-33.8.(95).
B. In herbal medicine perspective
The below herbs may have a potential to treat and cure diabetes, according to studies.
1. Cinnamon
Cinnamon is a spice derived from the inner bark of tree, native to South East Asia, of over 300 species of the genus Cinnamomum, belonging to the family Lauraceae.. The herb has been use in herbal and traditional medicine as anti-fungal and bacteria level to improve reproductive organ, prevent flatulence and intestinal cramping, treat indigestion, diarrhea, bad breath, headache, migraine, etc. Cinnamon contains chemicals that tell the cells in your pancreas to release more insulin into the bloodstream. In the investigation of the clinical potential of aqueous extract of cinnamon and it potential effects in diabetes found that high in type A polyphenols, have also demonstrated improvements in fasting glucose, glucose tolerance and insulin sensitivity in women with insulin resistance associated with the polycystic ovary syndrome, according to"Chromium and polyphenols from cinnamon improve insulin sensitivity" by Anderson RA(96). In other study of investigation of Myristicin (1-allyl-5-methoxy-3,4-methylenedioxybenzene) is an active aromatic compound found in nutmeg (the seed of Myristica fragrans), carrot, basil,cinnamon, and parsley and it anti-inflammatory effects found that Myristicin significantly inhibited the production of calcium, nitric oxide (NO),interleukin (IL)-6, IL-10, interferon inducible protein-10, monocyte chemotactic protein(MCP)-1, MCP-3, granulocyte-macrophage colony-stimulating factor, macrophage inflammatory protein (MIP)-1α, MIP-1β, and leukemia inhibitory factor in dsRNA[polyinosinic-polycytidylic acid]-induced RAW 264.7 cells (P < 0.05), according to the study of "Anti-inflammatory effect of myristicin on RAW 264.7 macrophages stimulated with polyinosinic-polycytidylic acid" by Lee JY, Park W. (97).
2. Milk thistle
Milk Thistle is a flowering plant, in the genus Silybum Adans, belonging to the family Asteraceae, native to the Mediterranean. The herb has been used in traditional medicine in treating liver, kidney, gall bladder problems, etc. Milk thistle contains sylimarin that can inhibit kidney damage related to diabetes. In the demonstration of Silybum marianum seed extract (silymarin) and its antioxidant properties on the glycemic profile in diabetic patients found that a significant decrease in HbA(1)c, FBS, total cholesterol, LDL, triglyceride SGOT and SGPT levels in silymarin treated patients compared with placebo as well as with values at the beginning of the study in each group. In conclusion, silymarin treatment in type II diabetic patients for 4 months has a beneficial effect on improving the glycemic profile, according to "The efficacy of Silybum marianum (L.) Gaertn. (silymarin) in the treatment of type II diabetes: a randomized, double-blind, placebo-controlled, clinical trial" by Huseini HF, Larijani B, Heshmat R, Fakhrzadeh H, Radjabipour B, Toliat T, Raza M(98).
3. Bilberry
Bilberry is a species of low-growing shrubs in the genus Vaccinium, belonging to the family Ericaceae, native to Northern Europe. it has been used as foods and herbs in traditional medicine in treating acute and chronic diarrhea, gastritis, gastric ulcer and duodenal ulcer, enterocolitis, ulcerative colitis, anemia, cystitis, kidney disease and psoriasis, diabetes, etc. Bilberry contains biotin that can reduce blood glucose levels. Bilberry leaves (Vaccinium myrtillus L.) has been used in traditional medicine in treating diabetes over thousand of year. The experiment of effect of dietary bilberry extract (BBE) on hyperglycemia and insulin sensitivity in type 2 diabetic mice, see significant activity of the extract in improving hyperglycemia and insulin sensitivity in type 2 diabetes in the study of "Dietary anthocyanin-rich bilberry extract ameliorates hyperglycemia and insulin sensitivity via activation of AMP-activated protein kinase in diabetic mice" by Takikawa M, Inoue S, Horio F, Tsuda T.(99).
In other study of 110 female volunteers were recruited, and they followed four different berry diets (BB, SB, SB phenolic extract (SBe) and SB oil (SBo)) in a randomized order for 33-35 days, conducted by University of Turku, researchers found that Based on the results, it can be stated that different berries and berry fractions have various but slightly positive effects on the associated variables of metabolic diseases(100).
4. Dandelion
Dandelion is a herbaceous perennial plant, genus Taraxacum, beloning to the family Asteraceae, native to temperate regions of the world. It has been used in traditional and herbal medicine to treat gout, eczema, acne, gall bladder, kidney, liver and urinary disorders, hypoglycemia, dyspepsia with constipation, edema, blood pressure and heart weakness, chronic joint, skin diseases, etc,.
In the research of aqueous extracts and their effect on alpha-glucosidase inhibitory activity found that Urtica dioica, Taraxacum officinale, Viscum album, and Myrtus communis with alpha-glucosidase inhibitor activity was conducted to identify a prophylactic effect for diabetes in vitro. All plants showed differing potent alpha-glucosidase inhibitory activity, according to the study of "Inhibition of alpha-glucosidase by aqueous extracts of some potent antidiabetic medicinal herbs' by Onal S, Timur S, Okutucu B, Zihnioğlu F(101).
Other study in the analyzing luteolin and chicoric acid, two abundant constituents of the common dandelion and their anti-inflammatory effects found that luteolin plays a central role in ameliorating LPS-induced inflammatory cascades via inactivation of the NF-κB and Akt pathways, and that chicoric acid strengthens the anti-inflammatory activity of luteolin through NF-κB attenuation, according to the study of "Luteolin and chicoric acid synergistically inhibited inflammatory responses via inactivation of PI3K-Akt pathway and impairment of NF-κB translocation in LPS stimulated RAW 264.7 cells" by Park CM, Jin KS, Lee YW, Song YS(102).
5. Cayenne
Cayenne is also known as Cayenne Pepper, a red, hot chili pepper, belonging to Capsicum annuum, the family Solanaceae, native to sub-tropical and tropical regions. It has been used in traditional medicine to increases metabolism, enhance circulatory system and stomach and the intestinal tract, adjust blood pressure, lower LDL cholesterol and triglycerides, treat frostbite, muscles, arthritis, rheumatism, low back pain, strains, sprains, bruises and neuralgia, etc,. Dietary capsaicin has markedly decreased fasting glucose/insulin and triglyceride levels in the plasma and/or liver, as well as expression of inflammatory adipocytokine genes and increased in adipose tissue and/or plasma, accompanied by increased activation of hepatic AMP-activated protein kinase, a marker of fatty acid oxidation., according to the study of "Dietary capsaicin attenuates metabolic dysregulation in genetically obese diabetic mice" by Kang JH, Tsuyoshi G, Le Ngoc H, Kim HM, Tu TH, Noh HJ, Kim CS, Choe SY, Kawada T, Yoo H, Yu R(103).
6. Ginkgo biloba
Ginkgo biloba is oldest living tree species, genus Ginkgo, belonging to the family Gink-
goaceae, native to China, from temperate zone to subtropical zone and some parts of north America. It Has been used in traditional herbal medicine in treating impotence, memory loss,respiratory diseases, circulatory disorders and deafness as well as preventing drunkenness, and bedwetting.
Ginkgo biloba extract by an NIDDM subject may increase the hepatic metabolic clearance rate of not only insulin but also the hypoglycemic agents. The result is reduced insulin-mediated glucose metabolism and elevated blood glucose, according to the study by The Department of Clinical Laboratory Sciences, School of Allied Health Sciences-MSC 6246(104).
7. Etc.
C. In traditional Chinese medicine perspective
C.1. Causes
In traditional Chinese medicine, Diabetes mellitus is defined as a condition of the depletion-thirst disease, characterized by polydipsia, polyphagia, polyuria, and emaciation as a result of
1. Overeating causes of damage of spleen and stomach
2. Emotion effects anxiety, anger, mental depression, etc. such as causes of the liver qi stagnation
3. Intemperance in sexual life or congenital essence defect causes of the kidney qi deficiency.
C.2. Differentiation
In differentiation, diabetes is classified into 3 types
1. Upper-warmer depletion-thirst diseases
As a result of excessive heat of the lungs that deplete the lung’s yin with symptoms of thick nasal discharge, severe thirst accompanied by dryness of the mouth and tongue, reddened tip and margin of the tongue with thin, yellow coating, full and rapid pulse.
2. Middle-warmer depletion-thirst disease
As a result of excessive heat in the stomach deplete stomach yin with symptoms of constant hunger (Polyphagia), emaciation, painful, swollen, and/or bleeding gums, regurgitation, and/or vomiting after eating, burning sensation in the epigastrium, constipation, reddened tongue with dry, yellow coating, and slippery and strong pulse.
3. Lower-warmer depletion-thirst disease
As a result of excessive heat of the kidney consumes the kidney yin or yin & yang with symptoms of dizziness, vertigo, tinnitus, poor memory, deafness, night sweating, sore back, ache in bone, turbid urine, dry mouth, reddened tongue with little coating, and weak and rapid pulse.
C.3. TCM formulas in treating diabetes
According to the article of TREATMENT OF DIABETES WITH CHINESE HERBS
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon. The below formulas are recommended for diabetics depending to the differentiation(105).1. Reducing Sugar Tablet A (Jiang Tang Jia Pian)
The formula includes the following herbs
astragalus, polygonatum, trichosanthes root, pseudostellaria, and rehmannia, and was recommended for people with low levels of insulin, but are still capable of producing insulin.
The herbs were administered as extracts in tablet form, with 2.3 grams raw material per tablet, 6 tablets each time, three times daily, for a total dose of over 40 grams per day (raw materials equivalent). The effects were said to be enhancing sugar tolerance and elevating the level of serum insulin. In the treatment of 405 cases of diabetes with this preparation at the Guanganmen Hospital, 76.5% of the patients had improved sugar tolerance. Among those patients who most closely fit the therapeutic pattern of the herbs-those with qi and yin deficiency-the effective rate was slightly higher, 81%.
2. Rehmannia Eight Formula was recommended for those patients who produced little or no insulin. This is for patients with advanced disease, representing a deficiency of yin and yang (the cinnamon bark and aconite added to Rehmannia Six Formula to produce Rehmannia Eight Formula are said to restore yang). In laboratory animal studies, use of this formula resulted in reduction of water demand (thirst), blood sugar, and sugar spill into the urine. As a result of positive reports resulting from use of this formula for diabetes in Japan, the current author recommended it for those with early-onset diabetes beginning in 1981, using mainly the patent medicine from China, variously called "Sexoton Pills" or "Golden Book Tea" which is the Rehmannia Eight Formula (Ba Wei Di Huang Wan). When consumed in the amount of 12 pills each time, three times daily, it could help reduce the fluctuations in blood sugar that were experienced by insulin-dependent patients who had difficulties gaining control of blood sugar levels. As a result, there was a slight reduction in total insulin usage, but the main benefit was more reliable effects of insulin.
3. Jade Spring Pill (Yu Quan Wan), a patent formula from China, is recommended for diabetes treatment in the dosage of 50 grams per day (the original form was large honey pills of about 6 grams each), for at least one month. In laboratory animal studies, this formula was shown to increase glycogen in liver cells (the single herb rehmannia also has this effect in laboratory animals). When the current author visited the Sichuan Province United Pharmaceutical Manufactory, a new product was presented: the second generation of "Yuechung Pills" (Jade Spring Pills), comprised of pueraria, trichosanthes root, rehmannia, licorice, schizandra, and other herbs not mentioned on the label. These pills are indicated in the package labeling for the "ill function of the islets of Langerhans." The relatively small pills are packed into small bottles with a total of 6 grams each, and 20 bottles are packed in one box, accompanied by instructions to take one bottle each time, four times daily (the box is a five day supply at 24 grams/day). Compared to the first generation, it is said on the package insert, the new product had been clinically proved to have an improved rate of cure and that the dose had been reduced. Jade Spring Pill is useful for the early stage of diabetes, when yin deficiency and dryness dominate. In a recent clinical evaluation of a Chinese herb formula for diabetes, Jade Spring Pills, used for the control group, was reported to be effective in reducing blood sugar for 79% of cases treated (33).
If you need more information of above formulas, please visit the link (105).
Recommended reading
The Diabetes-reversing Breakthrough by Matt Traverso
Natural Remedy For Arthritis, Gout, And Rheumatism
Discover An Amazing, All-natural System That
Literally Stops Arthritis, Gout, And Rheumatism In As Little As 7 Days.
For common types of diseases of Ages of 50+, please visit http://medicaladvisorjournals.blogspot.ca/p/better-of-living-health-50-over.html
For other health article, visit http://medicaladvisorjournals.blogspot.ca
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