Nationwide, there are more than 26 million diagnosed type II diabetics, and that number is expected to rise to 33 million by 2030. Dr. Garry Tobin, Director of Washington University’s Diabetes Center, is concerned that we won’t have enough clinicians to handle that many diabetics. He says the clinician can diagnose and make recommendations, but the patient has to act on them and be honest with his doctor on how well he is following a diet and getting exercise. Both can have a big impact on blood sugar control. If the doctor knows the patient is doing all he can, then he can more accurately choose drugs to get blood sugar, blood pressure and cholesterol under control.
Tobin says although diabetes is associated with obesity, it’s not necessarily caused by being overweight. “However,” he says, “according to a recent study, if I take a group of people predisposed to diabetes and they follow a diet and get 150 minutes of exercise a week to lose 5 percent of their body weight, I will have prevented diabetes in 50 percent of them.”
Because diet and exercise are preventive, overweight people who truly follow a lifestyle modification program maximize their chances that medication will keep their disease from progressing. “Metformin is a good drug, but if patients are complying with their treatment plan and they don’t hit their target numbers, we need to try other therapies,” Tobin warns. “Conversely, if they really change their lifestyle for the better, it is possible to reduce therapy.”
A new approach in clinical trials is a drug that prevents sugar absorption and causes excretion of excess sugar in the urine, decreasing the glucose load on the body. Another hot research topic is ‘regenerative’ medicine: Can we turn other cells into insulin cells to reverse diabetes? That’s the ‘Holy Grail,’ Tobin says.
Dr. Neelavathi Senkottaiyan is an endocrinologist with Mercy Diabetes and Endocrinology Management at St. John’s Mercy Medical Center. She says Type II diabetics have insulin resistance from obesity, and metformin works to decrease insulin resistance. The Avandi drugs also help with insulin resistance. When oral medications don’t control blood sugar, injectables may be needed. Byetta stimulates insulin in the pancreas, decreases glucagon production after meals, and helps people lose weight by decreasing appetite. Different types and combinations of insulin can be used, depending on when blood sugar spikes occur, she adds.
Sean Branham of Premier Health Care is a chiropractor and nutritionist who specializes in treating Type II diabetes. He says the reason treatment often is not successful is because all patients tend to be treated alike. They go into the doctor with diabetic symptoms, have blood work and if diagnosed with diabetes they are given medication, a diet plan, and told to exercise. “They are lost. They don’t feel like exercising and don’t understand the diet, so they just take the pills and get worse,” he says.
Branham says he uses more comprehensive blood testing that looks at all the organs involved in diabetes: the liver, kidneys, thyroid, gastrointestinal tract and the adrenals.
Branham says a large percentage of diabetic patients have infections that cause general inflammation. As inflammation rises in the body, so does blood sugar. After the test results are back, Branham customizes a dietary plan with supplements to target the desired changes. “Most Type II diabetics make enough insulin; they are just insulin resistant. I use supplements to increase receptor site sensitivity: plant enzymes, vitamins, minerals, omega-3 fish oils; increase their fluid and fiber intake to eliminate gastrointestinal toxins.”
Branham’s patients follow the plan for six weeks before retesting. He says big changes can occur in that timeframe. Patients can take the results to their primary doctor and talk about cutting back on some medications. “Patients lose an average of 30 to 60 pounds on their custom diets,” he says, “and the majority are able to wean off diabetic and blood pressure medication.”