Diabetes is one condition where medical doctors, naturopathic physicians, and certified diabetes educators should play a significant role in education, coaching,
and prescribing of care. Unless it is properly managed and supervised, diabetes can be viewed as a state of biochemical anarchy that will lead to organ injury and accelerated aging. Diabetes damages many of the complex control systems that faithfully govern and protect the body. Diabetics who develop a keen awareness of the risk factors through regular testing and properly supervised self-monitoring program are much more likely to benefit from changes in lifestyle,
diet, supplements, and medications. If the blood sugar gets too high, the kidneys are unable to conserve all of the sugar in the blood that it is filtering and glucose will then begin appearing in the urine. Most diabetics can do away with urine glucose measurements as long as they are willing and able to follow a proper program of blood glucose monitoring.
In a diabetic, ketones will appear in the urine when there is a severe deficiency in the availability or the activity of insulin. This can occur if an insulin-dependent diabetic accidentally or purposefully forgets to take his or her insulin. It can also occur when a diabetic becomes ill, is injured, or is given high doses of cortisone-related drugs.
Severe dehydration also rapidly occurs because the kidneys are unable to conserve water in the presence of such extraordinary levels of blood sugar. This dangerous state, called diabetic ketoacidosis, must be treated as a medical emergency, usually necessitating intravenous insulin, high amounts of IV fluids, and careful monitoring, usually in an intensive-care unit. Ignoring ketoacidosis can rapidly lead to death. The presence of urine ketones may indicate impending or even established ketoacidosis, thus requiring immediate medical attention.
Diabetics who do not maintain vigilant awareness of their blood sugar and who do not make every effort to keep their blood sugar under tight control can expect a significant increase in their risk of serious health problems such as eye, kidney, and heart disease as well as a host of other problems such as depression, fatigue, impotence, and chronic infections. In order to achieve blood sugar levels that are consistently as close to normal as possible, type 1 diabetics must replicate this natural situation as closely as possible. They need to monitor their blood sugar frequently, and they must learn to use this information to make ongoing adjustments to their insulin injections, diet, and exercise.
Intensive insulin therapy allows a diabetic to achieve near-normal levels of blood glucose along with enjoying improved lifestyle flexibility. With conventional, infrequent insulin injections, diabetics must structure their meals and other lifestyle aspects around their injections or face serious abnormalities of blood sugar.
Every type 2 diabetic should own a blood glucose monitor and should become intimately familiar with its use. Type 2 diabetics who are not on insulin and whose blood sugar is well controlled according to regularly scheduled laboratory testing would still be wise to designate an intensive blood sugar measuring day every 1 to 3 weeks. Numerous dietary factors, supplements, exercise, stress, and illness can all have a significant impact on blood sugar control.
Diabetics who have more advanced diabetes and who have diminished pancreatic insulin production may also benefit from efforts to establish consistently near-normal blood sugar control using intensive insulin therapy similar to that of type 1 diabetics. A blood test of C-peptide levels can provide an estimate of how much insulin the type 2 diabetic is producing and is one way to help determine the appropriateness of using insulin.
The greatest breakthrough in blood glucose monitoring is found in the device known as the GlucoWatch. The GlucoWatch is worn much like a wristwatch. A small electrical current from the device works to extract a tiny amount of fluid through the skin. Clinical studies conducted by the manufacturer indicated that GlucoWatch measurements generally were consistent with results from traditional finger-prick blood tests.
The GlucoWatch was less effective at detecting very low glucose levels than it was at detecting very high levels.
More than half of diabetics (both type 1 and type 2) have high blood pressure (hypertension). Effective blood pressure control has also been shown to help maintain insulin sensitivity in the diabetic. Ideal treatment will maintain a diabetic’s blood pressure consistently at less than 130/85. Diabetics with a history of hypertension periodically undergo ambulatory blood pressure
monitoring. Ambulatory blood pressure monitoring enables the physician to determine whether blood pressure is under ideal control around the clock and in a variety of circumstances.
Diabetes is the primary cause of kidney failure, dialysis, and kidney transplant. All diabetics should undergo regular monitoring for early kidney disease through measuring the level of small amounts of the protein albumin in the urine every 3 months when visiting the doctor for A1C determination. Diabetics should also be carefully followed by an eye specialist who should perform a dilated retinal eye exam at least once per year. It is also important for all diabetics to have a foot exam every 3 months to look for breaks or ulcers in the skin, damage to or abnormalities of the nails, and quality of circulation, and also sensory tests to rule out nerve damage. Treadmill testing is useful as a screen for coronary artery blockages as well as a general measure of aerobic fitness.
Part 7: Diet Therapy in Managing Diabetes
Recommended reading: How to Prevent and Treat Diabetes with Natural Medicine (Michael Murray, N.D., Michael Lyon, M.D.)