Diabetes mellitus, usually referred to simply as diabetes, is an inability to metabolize carbohydrates resulting from inadequate insulin production, absence of insulin production, or impaired utilization of insulin. There are several types of diabetes including type 1, type 2, and gestational diabetes, as well as a more recently recognized form of adult-onset diabetes called latent autoimmune diabetes in adults (LADA).6 Diabetes insipidus, a condition characterized by dysregulation of water and electrolyte levels, is not related to these other forms of diabetes.7
This article concerns type 2 diabetes, which is sometimes erroneously called adult-onset diabetes or non-insulin-dependent diabetes. In fact, type 2 diabetes can affect children and sometimes requires treatment with insulin. In people with type 2 diabetes, the pancreas often makes enough insulin, particularly when a person is first diagnosed, but the body’s cells grow increasingly unresponsive, or resistant, to its signals. Type 2 diabetes frequently responds well to natural therapies; however, if the condition is not well managed, the pancreas can become unable to make adequate insulin, leading to the need for treatment with insulin. For many people with type 2 diabetes, lifestyle changes and/or oral glucose lowering medications can keep the condition well managed.
In people with diabetes, the cells cannot properly respond to insulin by taking up circulating glucose, the main source for cellular energy. As a result, glucose stays in the blood, causing blood glucose levels to rise, while the cells become starved for glucose.
People with diabetes produce high levels of inflammatory molecules and tissue-damaging free radicals; as a result, they are at increased risk for a wide array of complications including heart disease, atherosclerosis, cataracts, retinopathy, stroke, poor wound healing, infections, Alzheimer’s disease, fatty liver, and damage to the kidneys and nerves.8, 9, 10 In addition, those with diabetes have higher rates of certain complications if they also have high homocysteine levels.11, 12, 13 The risk of diabetes-related health complications can be decreased with proper blood glucose management and a healthy lifestyle.
If using supplements to help manage type 2 diabetes, it's important to know that they could potentially enhance the effects of drugs used to treat type 2 diabetes, including insulin or other blood glucose-lowering agents, and increase the risk of hypoglycemia. Therefore, people using medications to treat their type 2 diabetes should only take supplements under the supervision of a doctor.
People with type 2 diabetes are at higher risk of influenza and its complications. It is therefore widely recommended they, as well as their family members and care-givers, be vaccinated against the flu every year.14 In addition to the seasonal flu vaccine, older people with type 2 diabetes should consult with their healthcare provider about the potential benefits of pneumococcal vaccines (PCV13 and PPSV23).15
Overweight and obesity are closely linked to insulin resistance and type 2 diabetes. In fact, excess body fat appears to be key trigger of systemic inflammation leading to insulin resistance.16, 17 Weight loss, while difficult to achieve, can reverse insulin resistance, prevent prediabetes from progressing, and improve insulin sensitivity and glucose metabolism in people with type 2 diabetes.18 Therefore, healthy weight management is an important goal in a type 2 diabetes treatment plan.
Exercise helps decrease body fat and improve insulin sensitivity, promotes metabolic, cardiovascular, and musculoskeletal fitness, and improves mental health and quality of life.19, 20 People who exercise are less likely to develop type 2 diabetes, and physical training, especially when it progresses in intensity and amount, improves glycemic control in people with type 2 diabetes.21 In the short term, however, exercise can induce low blood sugar (hypoglycemia) in people with diabetes taking blood sugar–lowering medications, or even occasionally increased blood sugar.22 Therefore, people with diabetes should consult with a qualified exercise specialist before starting an intensive exercise program. Current research also highlights the harm of prolonged sitting, and a meta-analysis of studies found breaking up prolonged periods of sitting with short bouts of physical activity has a moderate impact on glucose, insulin, and triglyceride levels.23, 24
Drinking light to moderate amounts of alcohol has been associated with lower risk of type 2 diabetes in multiple studies and meta-analyses; however, according to a large meta-analysis that included 38 studies with a combined total of more than 1.9 million subjects, it appears to be more protective for women than men, and may not be protective in people of Asian descent.25, 26 For people with type 2 diabetes, light to moderate intake of alcohol appears to be safe and is not correlated with glycemic control.27 Emerging evidence from a controlled clinical trial, in which 224 people with well-controlled type 2 diabetes were assigned to drink one 150 ml glass (5 ounces, or one serving) of red wine, white wine, or water daily for two years, adds to the evidence that this level of wine consumption is safe in this population; furthermore, red wine in particular appeared to have a positive impact on cardiovascular risk in this study.28, 29 Nevertheless, high alcohol consumption offers no protections and increases the risks of cardiovascular disease and death from all causes in people with and without type 2 diabetes.30 It is also important to note that drinking alcohol may increase the risk of hypoglycemia, especially in those taking blood glucose-lowering medications.31, 32
Smokers are also more likely to develop diabetes, and people with type 2 diabetes who smoke are at higher risk for kidney damage, heart disease, and other diabetes-related problems.33, 34 Because electronic cigarettes also appear to pose cardiovascular and possibly other health hazards, people with type 2 diabetes who don’t smoke should not start vaping, and those who do smoke should talk with their healthcare provider to develop an individualized plan for smoking cessation.35
Blood Glucose Monitoring
Although most healthcare professionals agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes, the benefits of SMBG in people with type 2 diabetes who are not being treated with insulin are less clear. Supporters posit the use of SMBG may help people with type 2 diabetes set and achieve their glycemic goals by making it easy for them to see how factors such as food choices and physical activity influence blood glucose levels. Two meta-analyses of clinical trials provide some clarity: they both found people with type 2 diabetes who used SMBG for up to six months were more effective at reducing HbA1c (a marker of long-term blood glucose control) compared to those who didn’t use SMBG, but after one year, the difference was gone.36, 37 This suggests SMBG may be especially useful as a short-term educational tool for those newly diagnosed or with poor glycemic control, but may not be useful as a long-term disease management strategy.
While traditional SMBG devices can only detect glucose levels at isolated points in time, new continuous glucose monitoring devices provide information about short-term fluctuations in glucose levels (glycemic variability). Continuous glucose monitoring devices are inserted under the skin and left in place for periods ranging from a few days to a few weeks. This technology is frequently used by insulin-treated type 1 and type 2 diabetes patients and can be integrated with insulin release from automatic insulin pumps to optimize glucose stability. The potential value of monitoring glycemic variability in people with non-insulin-treated type 2 diabetes is still being explored.38, 39
Copyright © 2020 TraceGains, Inc. All rights reserved.
The information presented by TraceGains is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2020.
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