Diabetes Mellitus
Diabetes Mellitus
Diagnosis
Approximately 50% of diabetics are undiagnosed. Some patients may have no overt symptoms other than ‘spaciness’, thirst, fatigue, and excess urination. Because the metabolic changes leading to diabetes can often be found 10 years or more before it manifests clinically, information of insulin resistance is of critical importance for prevention of increased cardiac risk, dyslipidemia, hormonal imbalances, and increased mortality rates.
Genetics
If the mother has diabetes mellitus, there is a 2.1% risk the child will have it. If the father has diabetes mellitus, the risk is 6.1% for the child. Monozygotic twins have a 20% to 50% chance if one parent has diabetes. Susceptibility to Type I diabetes is associated with certain proteins coded by the HLA region of the histocompatibility complex.
Oral Glucose Tolerance Test
Oral glucose tolerance test is the confirmatory test for diabetes, in which 75 gm of anhydrous glucose is dissolved in water. However, rarely is this test necessary in clinical practice since the measurement of elevated fasting plasma glucose done on two separate days should suffice in the diagnosis of diabetes.
Selected Clinical Studies and Literature Reviews
For a study of the correlation between mineral levels and abnormal glucose tolerance, see George M. Tamari and Zoltan Rona, “Hair Mineral Levels and Their Correlation with Abnormal Glucose Tolerance,” in Selected Clinical Studies and Literature Reviews, pp. xx-xx.
Fasting Levels
Fasting levels can be obtained after there has been no caloric intake for 8 hours. In a healthy person, the level will be equal or lower than 110 mg/dl. Impaired glucose homeostasis would be above this number, and diabetes is diagnosed at greater or equal to 126 mg/dl (7.0 mmol/l). If a blood sugar test is done at any time of the day, including after a meal, and is higher or equal to 200 mg/dl (11.1 mmol/l), it indicates diabetes.
Hemoglobin A1c and Fructosamine
A comprehensive dysglycemia metabolic profile would also include hemoglobin A1c and fructosamine. Hemoglobin A1c measures long-term blood sugar control over a two to three months period, while fructosamine determines it over a period of 2 to 3 weeks. Imbalances of DHEA, cortisol, and IGF-1 (Insulin Like Growth Factor, Somatodin-C) are contributing factors to the clusters of conditions caused by dysglycemia, due to their influence on blood sugar control. In general, insulin resistance is associated with low DHEA levels especially in men.(6-8) However, in women insulin resistance is usually associated with adrenal hypersecretion and polycystic ovary syndrome. Typically these sub set of patients will have high levels of DHEA and cortisol.(9)
Somatomedin
High levels of Somatomedin-C are associated with hyperglycemia. Most effects of growth hormone are mediated by IG-F. IG-F is made by the liver and various other organs as a response from growth hormone. Somatomedin-C feeds back to the pituitary and suppresses growth hormone levels. Unlike growth hormone, Somatomedin-C has a long half -life and thus is a better diagnostic tool.
Physical Exam
Physical exam can often reveal insulin resistance, paying close attention to truncal obesity and especially patients who look like apples walking on toothpicks.
Contributing Factors for Diabetes
- Greater than 120% desirable body weight
- Imbalances of DHEA, cortisol, and IGF-110
- Sedentary lifestyle, high consumption of refined sugars
- Eating at fast-food restaurants, drinking soft drink
- Nitric oxide deficiency(11)
- Delivered a baby weighing more than 9 pounds, or gestational diabetes
- Low birth weight(12)
Hormonal Conversations
One way to understand the relationship between blood sugar metabolism and the endocrine disorder we call diabetes is to look at the ‘conversation’ between hormones that goes on daily within the body of an ordinary person, John Doe. We can imagine this as a play, with various hormones and organs playing their roles on the stage of John Doe’s endocrine system.
Cast of Characters:
Insulin: the hormone that instigates sugar absorption (decreases blood sugar)
Glucagon: a hormone that increases blood sugar.
Cortisol: a counter-regulatory hormone of insulin (increases blood sugar).
Epinephrine: a counter-regulatory hormone of insulin (increases blood sugar).
Pancreas: the organ that secretes insulin.
Adrenal glands: an organ that secretes stress hormones such as cortisol and epinephrine.
Act 1, Scene 1: It’s early morning and John Doe, a non-diabetic, is still fast asleep. His blood sugar is 70 mg/dl. When his alarm clocks goes off, John’s blood sugar rises as cortisol and epinephrine kick into his system.
Act 1, Scene 2: When John arrives at work, he is blamed for something that wasn’t his fault. He gets angry and frustrated and his blood sugar increases again with a surge of stress hormones from the adrenal glands. Later in the morning, John sits in his car and plays a Ram Dass relaxation tape. The stress hormones stop surging. His blood sugar levels goes down.
Act 2, Scene 1: By lunchtime, Joe’s blood sugar has dropped further to 50 mg/dl. He eats lunch and tops it off with some chocolate ice cream. His blood sugar rises to 100 mg/dl. His pancreas responds by secreting insulin. His blood sugar decreases as the sugar enters his cells. The blood sugar keeps decreasing until the body tries to rebalance levels with glucagon, which again increases the blood sugar.
Act 2, Scene 2: After work, John meets a beautiful woman and his blood sugar goes up as the adrenal glands secrete more stress hormones. As John continues the adventures of daily life, his blood sugar level rises and falls as the hormones continue their counter-regulatory dialog over and over again.
Coda: People with diabetes mellitus are missing something in their hormonal conversation. Their ability to produce or use insulin is diminished. The hormones that tell the body to increase the blood sugar may be working, but the insulin that brings blood sugar down does not respond. Glucagon responds to low insulin levels but it does not respond to low blood sugar levels. This is why the one-way conversation of the counter regulatory hormones can be quite dangerous in a diabetic. Glucagon will keep on increasing blood sugar by responding to low insulin levels, rather than responding to the high blood sugar levels, which can eventually lead to a coma.
Diabetic Therapy: The goal of diabetic therapy is to restore the communication in the body between these systems. This can be achieved by strengthening the pancreas to produce more insulin, by restoring peripheral metabolism of insulin, or by taking exogenous insulin.
