Diabetes Mellitus

By Dr. Fred Hui, MD

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or action, or both. Insulin is secreted by the pancreas, and it is responsible for making glucose available as fuel for the cells.

The two types of diabetes are referred to as Type 1 DM and Type 2 DM.

TYPE 1 DM

• Type 1 DM can occur at any age – most commonly in juveniles but can also occur in adults.
• In this type, there is no insulin secretion because of autoimmune destruction of the insulin secreting cells of the pancreas.

TYPE 2 DM 

• Type 2 DM is most common in adults over 30 yrs.
• Obesity, ↓exercise,↑ calorie& alcohol intake and family history are important causative factors.
• In this type, insulin secretion is present, but  there might be  insufficient insulin receptors to utilise the glucose. This is called insulin resistance.

You can think of it as insulin “knocking” on the doors of muscle and fat cells. The ‘doorman’ (insulin receptors) hears the knock, open the doors, and let glucose in to be used by the cell. With insulin resistance (in Type 2 DM), the ’doorman is deaf’. He doesn’t hear the knock to open the door to let glucose in. Now, when the muscle cells don’t get enough glucose, the pancreas is notified to make more insulin, which further increases the level of insulin and unutilised glucose in the blood.

What happens to the unused, excess glucose?

When the blood glucose level reaches a maximum limit, most of the excess glucose gets excreted in the urine (therefore excessive urination and excessive thirst).

The excess glucose also gets converted into fat, and this is deposited in the abdominal area, around the waist and in the arteries.

Some symptoms of DM

• ↑ Hunger (because food is not being used properly)
• ↑ Urination (because more glucose has to be excreted out)
• ↑ Thirst (because of increased urination)
• Weakness (because body is low on fuel)
• Frequent infections (because the high sugar levels is acting as a good growth medium for the bacteria)

Some complications of DM

The excess levels of glucose in the blood, over time, can cause damage to the different organs in the body, like kidneys, nerves, blood vessels, heart, eyes etc.

• Nerve damage
  Tingling, numbness or burning in fingers and feet.
• Heart & Blood vessels
  High blood pressure, chest pain, heart attack, stroke, poor blood flow to all organs, impotence.
• Kidney damage
  Kidney failure, the filtering system gets affected and the body starts excreting essential proteins and accumulates waste instead.
• Foot damage
  Tingling, numbness and burning pain.  Cuts and blisters on feet can be infected easily and heals slowly. Severe damage may require amputation.
• Eye damage
  Cataracts, glaucoma, blindness.

Blood sugar level – how important is this number?

A blood sugar reading is only a number. It doesn’t hurt and you don’t feel it. For this reason, it is not uncommon for many patients to take it lightly and leave it unmonitored for many years.

You can think of this scenario of ‘washing a car with salty water’. The car would come out squeaky clean and glossy each time. Yet, unseen to the eye, it damages the car and over time, it would rust.

If you leave high levels of sugar floating in your body for years, it would ‘rust’ your body – and it would spare no organ. For this reason, it is necessary for you to monitor your blood sugar levels several times a day and control your sugar intake and have your medication adjusted accordingly.

We will deal with exact numbers and how to monitor and regulate blood sugar soon.

Approach to Controlling Diabetes

The CD on Diabetes (available at the front desk) will explain my approach to DM in detail.

The book Diabetic Solutions by Richard Bernstein will explain a highly effective dietary approach  that I recommend.

1) Diet

A low carb diet is advised for optimal control of blood sugar levels.
A detailed list of allowed foods and foods to be avoided is available at the front desk. Here is a brief summary below:

You should avoid:

X  SUGARS – Fruits/juices/sugar/artificial sugar/milk etc.

X  STARCH – Bread/Pasta/Cereal/Rice/Corn/Root vegetables like carrots, beets, potatoes etc. Starches convert to sugars in the body and hence must be avoided.

Starches convert to sugars in the body and hence must be avoided.

You may have:

            ↑↑Leafy vegetables    ↑↑Meat

↑↑↑Seafood  ↑↑Cheese

            ↑↑↑Nuts    ↑↑Eggs

↑↑Oils (esp olive oil) / butter

            ↑↑Avocado

Diet Diary

• Record your blood sugar level first thing in the morning, at every mealtime and 2 hours after each meal.
• Timing and dosage of your medication.
• The foods you have eaten throughout the day and the time. Portions are not important.

This will give me a clear understanding of your blood sugar levels and if your medications need any adjustment. It also helps to correct any mistakes you might be making in your diet.

You are advised to fill your dietary diary as follows:

DAY 1: Your regular diet (the one that you usally follow)

DAY 2: Diabetic diet (the one that your doctor suggested- with ↓ fat, ↓cholesterol, ↓oil, ↓meat, ↑fruits/↑vegetables/ ↑fibres/cereals/ ↑whole wheat.

DAY 3 and onwards: Dr. Hui’s way (the low carb diet mentioned above)

2) Blood Sugar Monitoring

• Fasting level (before breakfast) – < 6 (Ideal)
• 2 hours after meals –
• <7 (Ideal)
• 8-9 (not satisfactory, yet acceptable)
• >10 (out of control)

— This is the more important reading because it shows the actual effect of food on your blood sugar levels.

— It also shows how effective your diet is and how well your medications are working in order to keep the blood sugar under control at all times.

— This reading determines if you need to alter the dosage of your medications, switch to a drug more suitable for you or follow your diet more strictly.

3) Medication

How do some DM medications work to control sugar levels?

(i) INSULIN

Insulin is very effective in controlling blood glucose levels. It is used only in Type 1 DM and in    patients with Type 2 DM not controlled by other medication.

However, I prefer to take patients off insulin because of the side effects – some are:

• ↑Appetite (uncontrollable cravings)
• ↑↑weight gain (abdominal obesity)
• Deposition of fat around the waist and in the artery walls.
• Danger of overshooting if the dosage is not adjusted and timed with food intake.

(Taking a dose too early before a meal, or taking too much/a double dose accidentally, or not eating enough sugars in relation to the dose taken, can cause hypoglycemia – presents with sweating, shakiness, dizziness, ↓coordination, blurred vision, trouble performing routine tasks etc. Similarly, taking a low dose/ forgetting a dose and then having a meal can cause blood sugar levels to shoot up – hyperglycemia.

(ii) METFORMIN

It acts on the insulin receptors (the ‘doorman’) and hence allows glucose to enter the cells to be used as fuel. Thereby, it does not induce the body to produce more insulin, but instead utilises the sugar with the insulin already available. It also prevents the melting of glucose from liver into the circulation.

• Cons – With Metformin, you may experience gas, diarrhea, nausea, metallic taste in the mouth, but the body will adapt to these within a few days.

(iii) JANUVIA (Sitagliptin) or ONGLYZA (Saxagliptin)

When sugar-rich food (carbohydrates) enters the stomach, a message is sent out to the pancreas to secrete more insulin to act on these sugars.

Januvia and Onglyza allows this messenger to remain in the body for a longer time (slows breakdown of messenger) and thereby, allows sustained release of insulin in exact amounts to match the amount of glucose that newly entered.

(iv) OZEMPIC/RYBELSUS (Semaglutide)

These stimulate the secretion of insulin in the body corresponding to the intake of carbohydrates.

• The advantages of injectable Ozempic is that it needs to be taken only once weekly because it is long acting. In the case of oral Rybelsus it needs to be taken once daily. No matter if it is taken orally or injected subcutaneously, it causes satiety (feeling of fullness) after a meal, thereby may help greatly in weight loss unlike insulin which causes increased cravings and subsequent weight gain.
• The side effects are gastrointestinal disturbances (which the body will adapt to after gradual dose increase) and decreased appetite, the latter of which usually proves to be an advantage.

4) Exercise

When you exercise, the muscle cells require fuel – the glycogen in the cells act as the primary fuel (by converting into glucose).

Once the glycogen stores are depleted, glucose transporters (insulin receptors) come into play. They are floating molecules which float from within the cell to the cell surface, and become receptors to which insulin attaches, and ushers the glucose from the blood stream into the cells.

In an inactive person, these floating molecules will have receded to the inside of the cell. On the other hand, in an active person, insulin receptors at the cell surface would be greater, and hence more glucose can be moved into the cells to be burnt for energy. This leaves lesser glucose in the blood stream. So the diabetic patient will notice that on the days that they have any activity, their blood sugar will be much lower.

For those people who find it difficult to motivate themselves to exercise, they will find that activity such as cleaning the house, going to the supermarket, will still produce much better blood sugar control than doing nothing at all. Even walking 20-30 minutes twice a day or jogging on the spot for 10-20 minutes three times daily will increase sensitivity to insulin. If weather conditions are not favourable, then jogging on the spot or shadow boxing can also help immensely

5) Diabetes and Chelation

Several years of uncontrolled blood sugar levels can lead to circulatory damage (which can be compared to RUSTING of pipes) and this causes subsequent damage to various organs, as was discussed earlier under “Complications”.

In order to clean out these rusted pipes (arteries) and prevent damage to organs, you may be prescribed chelation treatments with EDTA and/or PLAQUEX to clear your circulation, depending on my assessment of your condition.

Detailed information, testimonials and PROS AND CONS of these treatments are further discussed in detail in the CD, DVD, and hand-outs that will be provided to you at the front desk.

A few points on these treatments are given below:

1)   EDTA – Ethylene-diamine-tetra-acetic acid

• By removing hard plaques (cholesterol deposits + hard mineral deposits), EDTA may help to improve circulation to all organs including the brain, heart, kidneys etc. As a result of this, you may greatly reduce incidence of diabetic complications, strokes, heart attacks, angina, peripheral vascular diseases etc.
• EDTA may also decrease free radical damage, deposition of calcium in blood vessels, and improve flexibility of arteriesin older patients.
• EDTA also binds and removes certain toxic heavy metals like lead, aluminum, cadmium etc.
• The treatment is a 90-120 mins intravenous infusion of EDTA in a bag of sterile water containing a mixture of vitamins and minerals.
• You will typically require 30–40 sessions (EDTA alone) or (EDTA + Plaquex), depending on the severity of your condition – you may start seeing differences by 10 sessions. You will be reviewed every 10-20 treatments through a follow-upappointment with me, and your progress will be assessed.
• The frequency of treatments is usually 1-2 times/ week. After your prescribed number of treatments and satisfactory progress is achieved, you may taper to a maintenance dose of once/month, to keep the circulation clear from deposits.
• Every 5 treatments with EDTA, you will be given a Vitamin treatment- this is a 90-minute intravenous infusion of several vitamins and minerals. Along with this vitamin treatment, a blood work to assess your kidney function will also be done.
• RUSTPROOFING – While you are on EDTA treatments, you will also be put on a vitamin, mineral and antioxidant supplementation called Ultra Balance III – 3 pills twice a day.

A few cons of EDTA treatment:

1)  May not be suitable for patients with already-weak kidneys.

• This is because EDTA binds and removes hard mineral deposits and toxic metals that have accumulated in the body for several years. These have to be excreted, but weak kidneys cannot excrete this load of toxic metals that gets washed out with each treatment.

What can be done about this?

• EDTA will hence be prescribed only after an initial blood workup is done and your kidneys are found to be in good function. Also, after every 5 treatments with EDTA, another blood work to assess your kidney function will be repeated.
• If your kidney function is being affected, you may either be given a smaller dose, or switched entirely to Plaquex (which is absorbed through the intestines), depending on my assessment of your condition.

2) May deplete the vitamins and minerals in your body.

• Along with removing the hard mineral deposits and heavy metals, EDTA may also strip your body of vitamins and minerals.
• You will hence be put on a vitamin, mineral and antioxidant supplementation called Ultra Balance III – 3 pills twice a day.
• Every 5 treatments with EDTA, you will be given a Vitamin treatment– this is a 90-min intravenous infusion of several vitamins and minerals.

2)  PLAQUEX – Phosphatidyl choline

• Plaquex treatment is used to remove cholesterol deposition (soft plaques) in the arteries. It also decreases the damage to the walls of the arteries caused by aging (lipid peroxidation), diabetes and certain other conditions.
• It may also improve the flexibility of aging blood vessels by improving elasticity, shape and function of the cells in the arterial walls.
• By removing soft plaques and increasing flexibility of arteries, Plaquex improves the circulation to all organs of the body and thus, may prevent diabetic complications, heart attacks, angina, strokes etc.
• Plaquex treatment is a 90-minute intravenous infusion of Phosphatidyl choline in a bag of 5% Dextrose solution.
• You will typically require 20-30 sessions, depending on the severity of your condition. You may start seeing differences by about 10 sessions.
• The frequency of treatments is usually 1-2 times/week. After satisfactory progress is achieved, you may taper to a maintenance dose of once/month, to keep the circulation clear.
• Further information on Plaquex can be available to you at www.plaquex.net.

3)  ALPHA LIPOIC ACID (ALA) (IV FORM)

• Neuropathy is one of the complications of diabetes that causes much concern (especially in long standing cases). This presents as numbness, tingling, burning, itching, pain in hands and feet.
• Alpha Lipoic Acid is a powerful antioxidant. It deactivates “free radicals”, which are the waste products created when the body turns food into energy. Free radicals damage cells and organs over time- it is even known to cause damaging effects on DNA, thus accelerating the aging process.
• ALA also improves nerve conduction and this function helps to relieve symptoms of neuropathy.
• This treatment is a 30-min intravenous infusion of ALA in 100ml 0.9% NaCl solution, recommended at least once/week.
• In addition to the intravenous form, an oral dose of 300mg ALA thrice/day may be advised to receive maximum benefits form the healing properties of Alpha Lipoic Acid.