Type I: Insulin Dependent Diabetes Mellitus (IDDM)

In type I diabetes or insulin dependent diabetes mellitus (IDDM), the beta cells in the pancreas are being destroyed, which results in decreased insulin production. The primary step in the pathogenesis of diabetes mellitus is the activation of host T lymphocytes against specific antigens present on the patient’s beta cells. These activated cells orchestrate a slow destruction of the beta cells. The histology of the pancreas shows an inflammatory infiltrate of mononuclear cells.
     Type I diabetes can occur at any age, though it usually develops before age 30. Type I patients tend to be thin. They are prone to develop diabetic ketoacidosis and hypoglycemic coma from excessive exogenous insulin injections.

Causal Mechanisms

Genetics

Traditionally, Type I diabetes has been considered to be caused by a genetic factor that results in the destruction of the beta cells of Langerhans. However, this does not seem entirely true.

Viral Infections

Infections may be the cause of diabetes mellitus. It was first reported in a Scandinavian study that two children developed diabetes mellitus after the mumps. In a study done in London over a 10-year period, scientists tracked the seasonal incidence of the onset of diabetes Type I. Virtually all reported cases of Type I developed in the fall and winter, the highest level being in October. Onset peaks at age 5 and 11, which epidemiologists attribute to the time children undergo radical environmental changes as they move from home to school and are exposed to a high amount of viruses. Suspected triggers for Type I diabetes include coxsackie b4 virus, mumps, and other unidentified diabetagenic viruses.13

Cow’s Milk

Other than viruses, foods have also been linked to Type I. Cow’s milk ingested in the first 6 to 8 weeks of infancy has been speculated as causing an autoimmune response to the milk by a process called molecular mimicry. The body produces antibodies against an antigen, such as bovine albumin peptide in cow’s milk, which mimics the pancreatic cells of the body. As a result, the white blood cells attack the pancreas. Review of the medical literature indicates that ingestion of cow’s milk increases the risk of Type I diabetes by a factor of 1.5.14

Conventional Pharmaceutical Treatment [SH]

A specialized team consisting of an endocrinologist and a naturopathic physician can give pharmacological advice, counseling on behavioral modifications, and nutritional recommendations.

Type I Intensive Therapy

For intensive care in Type I patients, it is recommended to test the blood 4 to 8 times/day to assess blood sugar control before and after eating. The patient is asked to count the exact amount of carbohydrates ingested or use the diabetic exchange system to make exact estimates on insulin adjustments.
The availability of self-blood monitoring (SMBG), along with multiple-dose insulin regimens, and the evolution of the diabetes treatment has made significant improvement in glycemic control. Improved glycemic control in Type I patients has been shown to reduce the risk of long-term diabetic complications. The Diabetes Control and Complication Trial (DCCT) showed a 34% to 76% reduction in clinically meaningful retinopathy in Type I diabetic patients using intensive diabetes monitoring compared to patients who did not.15

Nocturnal Hyperglycemia in Type I

The risk of secondary complications is caused by high blood sugar at any time, regardless of day or night. One way to stabilize blood sugar during the night is to split the insulin dose into one dose before dinner and one before sleeping. The latter injection will cause insulin levels to peak at 5 or 6 in the morning. The levels will maintain through the night, and nocturnal hyperglycemia can thus be avoided.

Troubleshooting the Insulin Regime

Diabetics may often have difficulty in keeping the blood sugar in range. Certain foods, especially high glycemic foods (foods that easily increase blood sugar), exercise, and physiological or emotional stress can temporarily increase blood sugar.
    If the patient is taking insulin and hyperglycemia is still occurring, it is important to look at these contributing factors:

• Accuracy of the self-monitoring blood glucose test
• Pharmakinetics of insulin (abdomen>arms>thighs)
• Diet
• Stress
• Use of corticosteroids
• Menses

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Naturopathic Medical Treatment and Prevention [SH]

Patients can often decrease insulin requirements with the use of herbal medicine. However, there are only a few reported cases of completely eliminating exogenous insulin with the use of natural medicine. While it is widely believed that all patients will eventually require insulin for glucose control and survival, rare anecdotal reports indicate otherwise with the use of IV hydrogen peroxide, niacinamide, and neuropeptide injections upon diagnosis.

Clinical Nutrition

Niacinamide: Niacinamide (also called nicotinamide) has been shown in animal and human studies to help prevent the development of Type I diabetes. There have been six clinical, double-blind, placebo controlled studies performed on the use of niacinamide on patient’s suffering from Type I within 5 years of diagnosis. Out of these six studies, three have demonstrated a positive effect in terms of remission, lowering insulin requirements, and increasing beta cell function. Some of the recently diagnosed Type I patients were able to go into complete remission with niacinamide. The main difference between the trials that proved to be positive and those that proved to be negative was that in positive trials subjects were older and had higher fasting c peptide levels. The theoretical mode of action of niacinamide acts as an antioxidant and inhibits macrophage and interleukin 1 mediated beta cell damage.16

Selected Clinical Studies and Literature Reviews

For more information on naturopathic treatment and prevention of insulin resistance, see Gregory S. Kelly, “Insulin Resistance: Lifestyle and Nutritional Interventions,” in Selected Clinical Studies and Literature Reviews, pp. xx-xx.

Hemopathic Medicine

Autohemotherapy: Molecular mimicry happens in a variety of autoimmune disorders that are triggered by infections and other antigens, such as chronic prostatitis, adrenal disorders, and thyroiditis. Autohemotherapy is a treatment used commonly in Europe by clinicians as a tool in treating autoimmune disorders. This process involves taking the patient’s serum and homeopathically potentiating it. Then the modified blood is reinjected in the patient, and it is speculated that the patient synthesizes antibodies against the original antibodies. The use of neuropeptide injections has some of the most promising evidence of help with autoimmune diseases.

Lifestyle
People who are under stress have increased cortisol levels, which will increase blood sugar. Many people do not realize when they are stressed, but often their bodies are. Stress of any type, including psychological, will cause higher cortisol and blood sugar levels. An anxious mind will reflect in the physical form. Lifestyle counseling and meditative practices, such as yoga, have shown to decrease stress.