Diabetes mellitus has been known since antiquity. It has recently become a major health problem and is affecting millions of people worldwide. The global prevalence is set to double by the end of 2010 with most of the increase occurring in the developing countries. Diabetes still continues to pose major public and personal health problems, despite exciting advances that have been made over recent years.

Diabetes is a result of problems with the pancreatic hormone insulin. It is characterised by a persistently increased concentration of glucose in the blood. The disorder occurs when the pancreas fails to produce enough insulin or when the body cannot utilise the insulin produced.

Insulin is a hormone that regulates blood sugar levels. The pancreas secretes it immediately after eating. Carbohydrates are broken down into glucose in the intestines and transported to the liver where some of it is stored as glycogen and released when energy is needed. Some of the glucose is released into the bloodstream
for immediate use by the organs, red blood cells and the muscles. It binds to the cell receptors and enables the glucose to enter the cell membranes of fat and muscle cells, providing energy for all the biochemical activities that are taking place. If the pancreas produces too little insulin the glucose (sugar) from the food we eat cannot enter cells and glucose builds up in the blood. Other cells that do not need insulin for glucose absorption, such as brain cells, have an oversupply of sugar, the sugar starts to ferment and can cause damage to cells and organs.

So how common is diabetes?

Diabetes is a serious illness and medical advise and care is imperative. It is the sixth leading cause of death in the United States of America.  It is estimated that some 200 million people worldwide have diabetes.  In Europe around 5% of the adult population (over 22 million people) have type 2 (non-insulin dependant) diabetes.  In Britain alone approximately 1.5 million people have diabetes, and in Australia 1. 2 million. The African continent is experiencing a diabetes epidemic and South Africa, with a population of approximately 40 million people, shows a devastating 5.6 million people diagnosed with this disease.

The deaths due to diabetes in different South African populations show that the Indian population is most affected at 8.2%, followed by the Coloured population at 3.9%, the black population at 2.8% and the white population at 2.5%.

Different types of diabetes

There are two major types of diabetes, type 1 (insulin-dependant-diabetes mellitus) and type 2 (non-insulin-dependant diabetes mellitus).

Type 1 diabetes starts at a fairly early age and affects between 5 to 10 percent of people with diabetes. It is an auto-immune disease in which the body's immune system attacks and destroys the insulin producing cells in the pancreas. The cause of this is yet unknown but some experts believe that it may result from an immune response after a viral infection.  Symptoms often include fatigue, extreme thirst, loss of weight, constantly feeling hungry, dizziness, sweating, constant need to urinate, palpitations, problems with eyesight, repeated infections, and confusion.

Type 2 diabetes, also known as adult-onset diabetes, is a condition in which the body cannot use its own insulin very well.  It is by far the most common form of diabetes. This type of diabetes normally begins in later years, but is now affecting more and more younger people. In type 2 diabetes, the pancreas only produces insulin in small quantities, but not enough to regulate glucose levels effectively. Another reason is that the cells may become resistant to the effects of what little insulin there is in the blood stream. Insulin controls the amount of glucose in the blood and the rate at which glucose is absorbed into the cells. Symptoms are basically the same as for type 1 diabetes, although the onset is more gradual and milder in nature. People with type 2 diabetes often can not perceive sweet tastes.

Diagnosis

Once the diagnoses is suspected, it must be confirmed bio-chemically by means of certain tests. They include a blood test that will show fasting blood sugar levels (FBS - taken in the morning before breakfast) above 100 milligrams per decilitre (mg/dL) or it will show random blood sugar (RBS) above 126 mg/dL, a glucose tolerance test which is these days seldom required, except for difficult cases or in pregnancy, and a urine test that will show the presence of glucose, plus ketones.

Other acute and long-term complications

Ketoacidosis - Diabetics are often subject to episodes of both high and low blood sugar and can thus experience symptoms for both hypoglycemia (low blood sugar) and  hyperglycemia (high blood sugar). Untreated diabetes can lead to ketoacidosis. This situation occurs when the body is so low in insulin that it starts using stored fat as fuel. When the fat breaks down, substances known as ketones are produced, large quantities can cause excessive acidity in the body.

Coronary Artery Disease is the predominant cause of death in type 2 diabetes.

Peripheral Vascular Disease affects mainly the lower limbs

Renal Artery Disease results from partial obstruction of the renal arteries supplied by atheromatous deposits,

Cerebro-vascular Disease may manifest as a transient neurological episode or as a complete stroke.

Gestational Diabetes is another type of diabetes which can develop in pregnant women when hormonal changes affect the body's resistance to insulin.

Metabolic Syndrome or Syndrome X was researched by Dr. Gerald Reaven at Stanford University during 1988, and affecting one out of five people, is another disorder that can become a forerunner for diabetes. Primarily, Syndrome X is insulin resistance, whereby the body becomes resistant to its own insulin and suffers from an overload of glucose.

Management of type 2 diabetes

Although there is no known cure for diabetes, changes in lifestyle can help to control it.   A change in lifestyle and an adjustment to food intake is a must for diabetics.  To enable the diabetic to cope with this disorder more successfully, it is essential to begin a programme which includes the following:

1) Learn how achieve near-normal glycaemia and maintain near-normal blood glucose levels.

2) Learn how to handle special situations such inadequate food intake or skipped meals.

3) Learn how to recognise the symptoms of hypoglycaemia and hyperglycaemia, what corrective actions need to be taken, and when to seek help from a doctor or other healthcare professional specialising in diabetes.

4) Follow a diet of healthy food choices and manage body weight. Many diabetics are overweight. Obesity develops over time and this may be one of several causes of type 2 diabetes. Exercise and an adjustment in the diet can bring weight down and may help in controlling blood sugar levels.

5) Begin a programme of increased physical activity.  Exercise boosts physical health. Physical exercise increases a muscle cell's  mitochondria.  These are the organelles which exchange oxygen and sugar for energy. Exercise also reduces cholesterol in the blood, a well-known problem in most diabetics. Exercise can also reduce high blood pressure another disorders associated with diabetes.

6) Learn how to manage stress and hypertension.  Stress can be a contributory factor in diabetes or diabetics could find it difficult to handle stress. It may also be that diabetics do not take active steps to cope with the demands of the disease. Ways to cope and manage stress should be considered.

7) Have regular medical check-ups of diabetic nephropathy, cystic fibrosis and celiac.

8) Monitor blood pressure.  Hypertension is common in diabetics.  A marked change in blood sugar level may cause high blood pressure, aggressive behaviour, dizziness, loss of self-control, loss of consciousness, temporary visual impairment and other life threatening disorders may develop.  It is therefore important to try and maintain a blood sugar level that is as close to normal as possible. Once again diet and exercise is of cardinal importance to keep high blood pressure in check.

Nutritional in the Management of Diabetes

Nutritional guidelines for diabetics should include:

1) Eat a variety of natural foods.

2) Choose low-fat or fat-free foods whenever possible

3) Substitute ingredients in recipes when necessary.

4) Eat smaller meals more frequently and at regular intervals during the day.

5) Eat slowly, putting fork or spoon down between bites.

6) Resist the temptation to take second helpings.

7) Read food labels and pay attention to fat, sugar and salt contents and calories.

8) Drink alcohol in moderation.  Red wine and dry cider are are safest choices.

9) DO NOT SMOKE !!!

The foundation of good nutrition is the complex carbohydrates. They supply the fuel for our bodies and diabetics should have at least six servings per day.

Vegetables and fruit are the suppliers of vitamins, minerals and fibre to our diet. Vegetables are low in calories and should be eaten liberally. Three to five vegetable servings and two to four fruit servings per day are essential for diabetics. Fruit and fruit juices should be fresh and the diabetic should rather choose those that fall under 55 in the glycaemic index. Raw vegetables are best.  Only eat canned food which is guaranteed to contain no added sugar, salt or fat.

A high-fibre diet, including whole-wheat bread, bran cereals, jacket potatoes, spinach, almonds and baked beans (not canned), reduces the body's need for insulin and may further lower fat levels, thereby lessening the risk of heart disease in diabetics.

Foods that are necessary for the protein, calcium, iron and zinc they provide, come mainly from animals and diabetics are advised to choose the low-fat or non-fat dairy products and pay attention to the size of the meat
portions. The number of servings of these food groups is determined by the calories that are needed by individuals to maintain their weight.

Nothing can be truer than this statement and some diabetics might find that it will take them a long time to research their personal nutritional needs.

Weight control and Diabetes.

Being overweight is a contributing cause in many illnesses. It increases the body's resistance to insulin and susceptibility to infection and increases the risk for other serious illnesses such as coronary heart disease, kidney failure, high blood pressure, stroke and many more that can result in premature death. It is therefore most important for diabetics to keep their weight down. They should pay attention to the fat in their diet, cut down on refined foods, should not consume sweets, pastries, pies, cakes, doughnuts, or any other forms of sugar. Diabetics should also avoid eating at bed time and during the night.

A change in eating habits is essential for reducing weight. The diabetic person should not skip meals. Smaller more regular meals during the day will keep metabolism stable and avoid wild blood sugar swings. Breakfast is probably the most important meal of the day. Taking protein at breakfast will help to maintain a fairly even blood sugar level during the day.

Exercise is a very important factor in keeping weight down.  What is more, it also helps in keeping sugar levels down, increasing the metabolic rate and burning off calories. The answer to a leaner body is to adopt a healthier, more active life style.

Useful supplements and herbs for diabetics.

Chromium is probably one of the most important minerals for maintaining constant blood sugar levels. It improves the function of insulin and is used to treat both low and high blood sugar levels. It improves the absorption of glucose by the cells so that it can be used for generating energy. Together with niacin and three amino acids, glycine, cysteine and glutamic acid it binds to the insulin molecules and the cell receptors to improve the absorption of glucose, thereby reducing blood sugar levels. Good Food Sources of chromium are: asparagus, mushrooms, whole grains, nuts, pulses, and seeds.

Magnesium can stimulate insulin activity. Taken with Calcium ensures a good sleeping pattern. Magnesium is present in all green vegetables, seeds and nuts.

Zinc is also known to help control blood glucose levels. Zinc is found in seafood, especially oysters, pumpkin seeds, egg yolks, lamb, whole grains and almonds.

Manganese is part of the antioxidant enzyme dismutase and may help to improve the metabolism of glucose. It is involved in various enzyme systems, which control the metabolism of glucose and proteins, bone formation, cholesterol and many more. Food sources include: whole grains, seeds, nuts and some tropical fruits.

Vitamin E is known for reducing insulin requirements in diabetics. It also reduces cell damage and helps in the healing of diabetic wounds. Highest food sources of vitamin E are cold pressed vegetable oils, dark green leafy vegetables, legumes, nuts, seeds and whole grains.

Vitamin B6 (Pyridoxine) can be useful in improving the damage to the extremities of limbs in diabetics, caused by poor blood circulation. It can also improve the oxygen supply to tissue and helps to prevent atherosclerosis.  Highest food sources of vitamin B6 are Brewer's yeast, carrots, eggs, chicken, fish, meat, peas, spinach, sunflower seeds, walnuts and wheat germ.

Vitamin B12 can also reduce the effects of diabetics. It helps in the metabolism of carbohydrates and fats. It prevents nerve damage common in diabetics. Best food sources are: liver, kidney, mackerel, herring, eggs, seafood, milk and dairy products and brewer's yeast.

Flavonoids (a class of water-soluble plant pigments) such as quercetin, proanthocyanidin, MHCP (methylhydroxy chalcone polymer)  and Ginko biloba are strongly recommended for diabetics. They prevent damage from free radicals caused by the abnormal glucose metabolism; they help to prevent loss of sight, protect all the organs from increased blood sugar levels and reduce the damage to peripheral blood vessels. Sources of flavonoids are: citrus fruits, apricots, cherries, plums, prunes, blackberries, raspberries, rose hips and red wine.

Antioxidants. Because of abnormal glucose metabolism in diabetics, lots of free radicals are produced. It would, thus, be useful for diabetics to use antioxidants. Vitamin E and selenium, for instance, play an important role in the treatment of diabetes. They restrict the damage of the free radicals produced and prevent damage to the small blood vessels, a side effect that is very common in long-term diabetes.

Bilberry (Vaccium myrtillus), also known as blueberry is widely used in America, England and Europe as a safe and mild remedy for reducing high blood levels of blood sugar in type 2 diabetes. It is also available as an extract or a tincture.

Milk thistle (Silybum marianum) is an amazing herb used to treat diabetes, liver disease.  It can be purchased in powder, capsule, and liquid extract form.  Milk thistle is a flowering plant in the Aster family. A native of Europe, it has been used since the time of the Roman emperors as a liver tonic. Milk thistle is one of the traditionally used herbs that has been widely accepted by conventional science to have significant medicinal value.  Its the active ingredient is flavonoid compound called “silymarin.” Most milk thistle extracts available contain about 80 percent silymarin.

Fenugreek (trigonella foenum-graecum) is a food and a spice commonly eaten in many parts of the world and has been used for centuries by practitioners of Ayurvedic Herbal Medicine and Traditional Chinese Medicine. It  is an annual that grows 12-18" high with branched, trifoliate leaves. Fenugreek belongs to the legume family. Research has shown that fenugreek seeds help balance blood sugar in diabetics. Fenugreek may also have beneficial effects on triglycerides. Due to its rather bitter taste, debitterised seeds or encapsulated products are often preferred. The typical range of intake for diabetes or cholesterol-lowering is 5–30 grams with each meal or 15–90 grams all at once with one meal. As a tincture, 3–4 ml of fenugreek can be taken up to TID.  Hoever use of more than 100 grams of fenugreek seeds daily can cause intestinal upset and nausea. Individuals with peanut allergies use with caution or avoid. Otherwise, fenugreek is extremely safe.

Garlic (Allium sativum) is a bulbous perennial food plant of the family Alliaceae. The word comes to us from Old English gārlēac, meaning "spear leek".  The bulb has a strong and characteristic odour and an acrid taste, and when pure yields a strongly smelling oil, essence of garlic, composed of diallyl sulphide (C3H5)2S. Fresh garlic is thought to help regulate blood sugar levels, and so can be helpful in late-onset diabetes.

In conclusion

Type 2 diabetes can be prevented or at least managed by making lifestyle changes. It is certainly not the end of the world when one has diabetes, it can be controlled by the correct diet, exercise and vitamin and mineral supplementation, but it should be done under supervision and guidance of a doctor or health professional, specializing in the treatment of this life threatening disease.

Bibliography

Patrick Holford, Optimum Nutrition, 1992, ION Press, London.

Bernard Jensen, Nutrition Handbook, 1993

Barry I. Joffe, Know Your Blood Sugar, 1999, Anglo Pocket-book Publishers, South Africa.

Richard Bernstein,  Dr. Bernstein's Diabetes Solution:
Complete Guide to Achieving Normal Blood Sugars

Mary-Ann Shearer, The Natural Way, a Family's Guide to Vibrant Health,
2000, Ibis Books and Editorial Services