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Type 2 diabetes has become an increasing problem in modern America. Because it is chiefly linked to obesity, as more people become overweight, and as the age of gaining weight reaches down into childhood, a largely preventable disease turns into an epidemic. The litany about such lifestyle disorders is now familiar to almost everyone. The changes that prevent Type 2 diabetes all move in the direction of moderation: a balanced diet, exercise, and management of stress.
Yet here we face a paradox – the more information that circulates about lifestyle disorders, the worse the problem grows. A flood of medical warnings hasn’t kept America from eating more, exercising less, turning more sedentary, and working under heavier burdens of daily stress. To escape from this paradoxical trap, we must look deeper. A single disorder like Type 2 diabetes leads us to examine the entire circle of life, which is a massive, tangled feedback loop. Each of us leads a life dictated by how well the circle of life is functioning; no single strand can be isolated to solve the problem, a mistake made by mainstream medicine and its focus on intense specialization.
First, let’s look at the disorder as viewed by a physician. Diabetes begins when cells that normally respond to insulin, such as muscle and liver cells, become insulin resistant. Insulin is a hormone, a chemical “password” that tells a cell to admit glucose (blood sugar). When cells don’t admit glucose into their interiors, sugar builds up in the blood, which has dire consequences for tissues and organs throughout the body. Diabetes is especially pernicious, then, because the damage it causes can crop up almost anywhere.
Insulin resistance usually occurs several years before true diabetes develops. Insulin is secreted by the pancreas and “talks” to cells via insulin receptors on the cell membrane. Once these receptors allow glucose to enter the cell, it is either used immediately as fuel or stored for later use. We now know that our bodies are nothing less than a constant conversation among chemicals that communicate with a trillion cells thousands of times per second.
To really understand what is happening, however, we must move from the molecular level to a person’s lifestyle. In the sixth century BCE, an Indian physician, Susruta, is recorded as the first to diagnose diabetes and to prescribe a treatment. His analysis seems remarkably modern. Susruta wrote that diabetes was either congenital (what we would call type 1 diabetes) or a result of poor diet and a sedentary lifestyle, often resulting in obesity (type 2 diabetes). His prescribed treatment sounds familiar today: eating a healthier diet, taking long walks, engaging in sports such as wrestling, and riding on a horse or elephant.
Your cells grow accustomed to the messages they receive; they have habits that reflect your habits. At present, those habits are trending the wrong way. About 24 million Americans have diabetes—that’s about 8% of the population. About a third of these, 5.7 million people, are undiagnosed. Experts believe that diagnosed diabetes will increase 165% by 2050. That means that one in three people born in 2000 will be affected by the disease. Type 2 diabetes used to be called adult-onset diabetes because it almost never developed in children. Now, however, a disturbing number of cases are appearing in young people.
Ironically, as more people gain access to a comfortable way of living, lifestyle disorders create a backlash. Type 2 diabetes has become a global epidemic, too. The World Health Organization estimates that over 220 million people around the world have type 2 diabetes (90% of people with diabetes worldwide), and it is among the top five causes of death in most developed countries. The economic cost of diabetes is enormous, not just to the individual, but to society as well. In the US, the total costs (direct and indirect) of diabetes in 2007 were estimated to be $174 billion.
Science still doesn’t understand exactly how and why Type 2 diabetes develops, and this problem is the subject of intense research all over the world. It may be that something goes wrong with the insulin receptors or with the glucose transporting process. Whatever the causes, the pancreas responds to the increased levels of glucose in the blood by producing ever-greater amounts of insulin. For a while the increased levels of insulin do work to force the target cells to accept more glucose. This temporarily keeps blood sugar levels within their normal range. But over time the overworked pancreatic beta cells lose their ability to produce extra insulin—they “burn out.” Then blood sugar levels remain elevated, a condition termed hyperglycemia. Blood levels of insulin can also become very high: this is known as hyperinsulemia.
Type 2 diabetes can progress for months or years without symptoms, an insidious reason for the disorder being so dangerous. So it’s important to be tested by a doctor if you have symptoms or risk factors for type 2 diabetes.
· Frequent urination
· Increased thirst
· Slow-healing sores or frequent infections
· Constant hunger
· Unintentional weight loss
· Tingling hands and feet
· Blurred vision
· Fatigue and irritability
· Swollen gums
Risk factors for type 2 diabetes
As we saw, prevention of Type 2 diabetes is simple and straightforward, or should be. What looks simple theoretically can turn out to be quite difficult. About 90% of people with type 2 diabetes are obese or overweight: it’s the number one risk factor for type 2 diabetes. The number two risk factor is having a sedentary lifestyle (exercising fewer than three times a week). Other risk factors are being over the age of 45, belonging to certain races (including African American, Hispanic, American Indian, and Asian American), having a parent or sibling with the disease, and having had gestational diabetes (diabetes developed during pregnancy).
Because diabetes can progress for months or years without symptoms, anyone who is overweight or obese and who has one or more additional risk factors should be tested. With or without risk factors and symptoms, all adults should be tested for prediabetes or diabetes starting at age 45. Children or teens who are overweight or obese and have other risk factors, such as a family history of diabetes, should be tested starting at age 10 or at puberty, whichever comes first.
Since prevention is obviously the main goal, I won’t dwell on the damage caused by diabetes. Most of this damage is through its effects on blood vessels, both large and small. At high levels, glucose acts as a toxin on the cells that line blood vessels.
· Cardiovascular disease (disease of the heart and blood vessels) is the main cause of death in people with diabetes. About three quarters of people with diabetes die of cardiovascular disease. People with diabetes have a 2-4 times higher risk of developing atherosclerosis and of having a stroke than people without diabetes
· Kidney disease. Because the kidneys are densely packed with millions of tiny filtering capillaries, they are especially likely to be damaged by diabetes. Symptoms may not appear until only 10% of the kidney’s filtering function remains.
· Vision damage. The retina, the delicate membrane that lines the back of the eyeball, may be damaged by diabetes. High glucose levels injure the tiny capillaries in the retina, which start to break and bleed. Diabetes also increases the risk of developing cataracts and glaucoma.
Nerve damage, or neuropathy, is also involved. The myelin sheaths that surround nerve cells are very sensitive to changes in glucose concentration. Nerves can also be damaged when damage to the capillaries that feed them cuts off their blood supply.
As standard practice, it’s considered important for diabetics to monitor their glucose levels. Keeping track of your blood sugar allows quick responses to levels that are too low (hypoglycemia) or too high (hyperglycemia). It also helps in planning meals, activities, and medication times. The latest glucose monitors require only a tiny drop of blood, and it doesn’t necessarily have to come from a finger.
But we also need to consider the stress caused by constantly monitoring any condition, whether it is diabetes or high blood pressure. In the body’s feedback loops, all messages are received by the cell membrane, including messages relating to stress, your work environment, relationships, mood, and general sense of well-being. You cannot “feel” your blood sugar levels, and once you begin to change your lifestyle, there is every reason to focus on how your life is going in general, with much less focus on chemical monitoring. Blood sugar follows cycles, like everything else in the body. One day’s high reading may be meaningless, but it can lead to panic and worry. Is it worth ruining a whole day in order to fixate on a number?
The key to getting past any lifestyle disorder, including Type 2 diabetes, is to move in the direction of balance and moderation. This doesn’t mean grim discipline. Instead, you ask yourself on a daily basis:
Am I doing something that makes me happy?
Can I give up a little of what isn’t good for me?
How do I feel about my progress toward well-being?
Can I foresee the weak or tempting moments I need to be most careful about?
In the spirit of making your life better, the preventive steps for Type 2 diabetes fall into place more naturally.
Anyone with prediabetes or diabetes who is overweight has a number of very good reasons to lose weight. For someone with prediabetes, losing just 5-10% of body weight significantly reduces blood sugar levels and reduces insulin resistance. For someone who weighs 200 lbs, that means losing as little as 10 lbs. When losing weight is combined with regular exercise, the risk of developing diabetes is cut by 58%. And there’s another, very significant benefit: losing 5-10% of body weight lowers the chances of having a heart attack or stroke. If you already have diabetes, studies have found that weight loss can significantly reduce symptoms of diabetes and insulin resistance.
The American Diabetes Association recommends a slow-but-steady weight loss goal of .5-1 lb. per week. It’s very useful to consult a registered dietitian for help in changing eating habits, controlling overeating, and designing a diet plan you can live happily with and that provides the right sort of nutrition for diabetes.
Eating right for diabetes
There is no specific “diabetes diet.” A healthy diet for diabetes is the same as a healthy diet for anyone: rich in nutrients and fiber and low in refined carbohydrates, high-glycemic-index foods (like potatoes), and saturated and trans fats. The glycemic index (GI) classifies carbohydrates based on how quickly and how much they boost blood sugar compared to pure glucose. Foods that have a low GI are absorbed slowly in the digestive tract, raising blood sugar evenly over a long period of time.
Exercising regularly is one of the best things you can do for diabetes. Exercise, whether anerobic or aerobic, induces both your muscles and your liver to take up more glucose, lowering your blood sugar levels. Exercise decreases insulin resistance, normalizes blood pressure, improves sleep, and decreases stress.
Talk to your healthcare practitioner before starting a new exercise regimen. Choose something you enjoy and that’s at the right level for your current fitness. It’s best to exercise every day, at the same time.
If you smoke, quit now. Smoking is especially bad for people with prediabetes or diabetes. If you don’t now have diabetes, smoking makes it three times as likely that you will develop it. Smoking further damages already compromised blood vessels, constricting them and injuring them. It causes complications, like kidney disease, retinal disease, and foot problems, to occur sooner, and increases risk of death. What’s more, nicotine has been found to directly increase blood sugar levels.
Being stressed stimulates the production of corticosteroids, the “stress hormones,” which increase blood glucose levels. By the same token, studies show that reducing stress can lower blood sugar levels. Try meditation, biofeedback, or focused breathing techniques. Just doing something you enjoy, like gardening or reading, can be a good way to de-stress. Exercise (aerobic exercise, yoga, tai chi) is an excellent de-stressed. Support groups and therapy may prove very helpful as well.
Supplements and botanicals
These come into play only after you have seriously considered lifestyle changes; they are not a substitute, much less a cure-all. Some people with diabetes have found chromium or alpha-lipoic acid (ALA) to be helpful in controlling their blood sugar. ALA, an antioxidant, may also be useful in treating nerve damage.
Certain botanicals, including cinnamon, fenugreek, ginseng, bitter melon, aloe vera, prickly pear cactus, gurmar (an Indian herb whose name means “sugar destroyer”), and Coccinia indica (ivy gourd) may help to control blood glucose levels. In Chinese and Indian traditional medicine, combinations of botanicals are used to treat diabetes, and there is some evidence that this results in a synergistic effect. Consult with an experienced practitioner of Chinese or Indian medicine if you would like to investigate these treatments.
Some people with peripheral neuropathy—pain in the hands and feet due to nerve damage from diabetes—have found that acupuncture helps to relieve their pain. Acupuncture has few if any dangerous side effects, so it may be worth investigating this form of treatment.
If lifestyle measures don’t sufficiently reduce blood sugar levels, then medications may be prescribed. Medications may lower glucose levels by increasing insulin production by the pancreas, boosting cell sensitivity to insulin, and delaying absorption of glucose from the intestines. Numerous medications are available, and often more than one is prescribed.
Insulin may be prescribed if taking noninsulin glucose-lowering drugs doesn’t get blood sugar levels under control. Insulin must be injected using a syringe, an insulin pen, or with an insulin pump.
In mainstream medicine, diabetes is a circle of chemicals, leading from the insulin produced naturally by the pancreas to the insulin injections prescribed for millions of diabetics. Yet a much larger circle is actually involved. The circle of life embraces who you are and how you want to live. Diabetes, like every other lifestyle disorder, is an indicator that change is required. This doesn’t mean chemical change. It means redefining how you want to achieve well-being in the healthiest possible way.
Deepak Chopra, M.D is the author of more than 65 books, including numerous New York Times bestsellers. His medical training is in internal medicine and endocrinology, and he is a Fellow of the American College of Physicians, a member of the American Association of Clinical Endocrinologists, and an adjunct professor of Executive Programs at the Kellogg School of Management at Northwestern University. He is also a Distinguished Executive Scholar at Columbia Business School, Columbia University, and a Senior Scientist at the Gallup organization.