Diabetes: Integrative Management
Intro
Diabetes mellitus is a group of conditions when someone has issues with blood sugar, which may happen because of issues with insulin. Insulin is a hormone that is made by the pancreas that is responsible for maintaining healthy blood sugar balance.
Last week, I posted about the symptoms, types, and causes of diabetes. In addition to this, I also spoke about how diabetes is tested for and how the diagnostic criteria for diabetes from American Diabetes Association. This week’s blog post is an extension of that conversation on diabetes, and mainly focuses on management of Type 2 diabetes from the conventional approach and from an evidence-based integrative approach. Remember, this blog post is meant to be educational only, and is not meant to be a resource for diagnosis, treatment, prevention, or cure. So, always speak to your doctor before trying anything new!
Licensed naturopathic doctors (NDs) are trained to provide integrative medical care, which means that licensed NDs are trained in conventional medicine and natural medicine. Additionally, patients seek to treat their patients by identifying the root cause of their symptoms and treating the root cause as integratively as possible.
Overview of the treatment modalities that licensed NDs are trained in:
Conventional medicine that licensed ND’s receive training in are:
Biochemistry, histology, and pathophysiology
Laboratory diagnosis
Imaging diagnosis
Pharmacology & pharmaceuticals
& more
Natural medicine that licensed ND’s receive training in are:
Clinical & therapeutic nutrition
Lifestyle medicine
Nutraceuticals and targeted supplementation of vitamins, minerals, amino acids, and fatty acids
Herbal medicine and herbal plant extracts
Physical medicine and naturopathic manipulation
Bio-identical hormonal replacement therapy
& more
To learn more about Naturopathic medicine, naturopathic medical education, and Naturopathic medical licensure, click here.
Conventional management
Management of diabetes focuses on regulating blood sugar and managing the complications of diabetes. According to the American Academy of Family Physicians’ medical journal, conventional management of Type 2 diabetes is more holistic than before - now involving lifestyle modification and pharmaceuticals. In regards to pharmaceuticals, there are a variety of drugs that can be prescribed by a licensed provider, which different drugs doing different actions in the body to regulate blood sugar levels. Each medication also has its pros and cons and are indicated for co-morbid conditions, such as heart disease and more. So, a provider can pick and choose which to recommend given a person’s personal health history.
Pharmaceuticals that may be prescribed for Type 2 diabetes:
Biguanides (such as Glucophage/Metformin): Metformin is a common pharmaceutical prescribed for diabetes, and it has been recommended by the American Diabetes Association to be the first-line therapy for Type 2 Diabetes if there are no contraindications for the drug. Metformin has been shown to improve rates of all-cause mortality, heart attack, microvascular complications, and more. However, metformin may cause GI effects (such as diarrhea, nausea, and vomiting); and long-term use of metformin may be associated with Vitamin B12 deficiency. Additionally, metformin may not be recommended for those with kidney issues.
Insulin (such as Lantus and Humalog): There are different types of insulin - ones that work immediately and ones that work longer term in the body. As spoken about last week, insulin is the hormone responsible for regulating blood sugar levels. And, people with Type 2 Diabetes may have insulin resistance, and would require more insulin to be added into their system to balance their blood sugar levels. Since there are different types of insulin, there is a possibility of someone experiencing very low blood sugar after injecting insulin.
Sulfonylureas (such as Glucotrol and Amaryl)
Thiazolidinediones (TZDs) (such as Actor and Avandia)
Alpha-glucoside inhibitors (such a Precose)
GLP-1 receptor agonists (such as Victoza and Ozempic)
DPP-4 inhibitors (such as Januvia and Onglyza)
Meglitinides (such as Prandin and Starlix)
Amylin analogues (such as Symlin)
SGLT-2 inhibitors (such as Jardiance and Invokana)
Lifestyle recommendations that may be prescribed for type 2 diabetes:
According to the American Diabetes Association (ADA), lifestyle management is an integral part of conventional management of diabetes. Lifestyle management involves looking at nutrition, physical activity, and more
In regards to nutrition, the ADA mentions the Mediterranean diet and the DASH diet as plant-based diets to consider for those with diabetes.
In regards to physical activity, the ADA recommends 150 minutes of moderate-to-vigorous intensity physical activity per week, spread over at least 3 days with at least no more than 2 consecutive days of inactivity for adults with Type 2 diabetes. The ADA also recommends 2-3 sessions of resistance exercise on non-consecutive days and to decrease amount of time spent doing sedentary behavior for adults with Type 2 diabetes. For older adults, the ADA recommends flexibility training 2-3 days per week, such as yoga or tai chi.
Self-monitoring of blood glucose:
People with Type 2 Diabetes are usually recommended by their providers to check their blood sugar levels at home while undergoing treatment to prevent low blood sugar or high blood sugar. Self-monitoring also helps patient understand how therapeutics and what factors in their personal life are playing a role in high or low levels of blood sugar to help them make educated choices for maintaining optimal blood sugar levels.
Integrative management
As mentioned earlier, licensed NDs are trained to provide integrative medical care and have an understanding on how to treat patients conventionally & naturally. In addition to this, licensed NDs strongly believe in personalized medical care and that cookie-cutter treatment protocols may not work for some people. Given this, licensed NDs are able to tailor treatments that involve various treatment modalities depending on the unique attributes of each patient’s case. With natural options, licensed NDs try to optimize insulin function and blood sugar levels by treating insulin and blood sugar directly and by addressing potential root causes.
Below, you’ll find some evidence-based options that licensed NDs may recommend in addition to conventional treatment. Remember, this post is meant to be educationally ONLY, and is not meant to treat, prevent, diagnose, or cure. Always speak to your trusted medical provider before trying anything new!
Foundations of health: Clinical nutrition, lifestyle medicine, & environmental exposures
Food combining & exercise: To expand on the the ADA’s dietary recommendations for controlling blood sugar levels, there is literature that suggests that specific food combining may aid in balancing blood sugar. More specifically, there is scientific evidence that combining protein with low-glycemic foods significantly increased insulin sensitivity. Additionally, scientific evidence indicates that a combination of exercise (1 hour per day with a maximum heart rate of around 85% for at least 5 days per week for 12 weeks) and the consumption of low-glycemic foods increased insulin sensitivity in prediabetic individuals.
Intermittent fasting: A meta-analysis published in 2021 reviewing literature on Type 2 Diabetes, insulin resistance, and intermittent fasting revealed that “current evidence suggests that intermittent fasting is an effective non-medicinal treatment option for type 2 diabetes”. Authors states that intermittent fasting was “effective at reducing body weight, decreasing fasting glucose, decreasing fasting insulin, reducing insulin resistance, decreasing levels of leptin, and increasing levels of adiponectin”. Authors of the meta-analysis do caution more studies need to be completed to understand how intermittent fasting could be helpful in reducing body weight and that those with diabetes should consult their doctor before starting intermittent fasting.
Environmental exposure: Some licensed ND’s speak about the importance of environmental exposures to the development of disease and focus on reducing exposure to “toxins”. Current scientific findings have found a link between certain environmental exposures and insulin resistance. A review article looking at studies on air pollution and diabetes published in 2012 indicated that “the majority of observations support an association between air pollution, in particular traffic-related sources, and [diabetes]”. A study completed in 2013 revealed that there is a link between phthalate exposure and increased insulin resistance in pediatric subjects from 12-19 years old. This same study indicated that this link could be due to increased consumption of phthalate-containing foods by insulin-resistant subjects. Additionally, a study completed in 2017 revealed that low-to-moderate exposure to arsenic was linked to incidence of diabetes, and the researchers indicated that B vitamin intake and genetics could be playing contributing roles in this connection. And, a meta-analysis reviewing in vitro and in vivo studies on arsenic and diabetes published in 2020 indicated that arsenic metabolites have effects on blood sugar levels, insulin function, pancreatic ß-cell dysfunction, and more. All in all, these studies indicate that is a connection between environmental exposures and insulin resistance and blood sugar dysregulation. However, more studies need to be completed to understand if these environmental exposures are playing roles in the development of disease OR if they just happen to occur alongside disease due to population differences and other factors.
Nutraceuticals & targeted supplementation
Resistant starches: Resistant starches may play a role in balancing blood sugar levels. Resistant starches are defined as “any starch that is not digested in the small intestine but passes to the large bowel.” A small-scale study completed in 2018 revealed that resistant starches reduced post-meal blood sugar levels and reduced insulin response in obese adults compared to those not consuming resistant starches, which suggests that resistant starches may optimize blood sugar levels and insulin response in those with diabetes. And, a meta-analysis published in 2019 revealed that “[resistant starch] supplementation can improve fasting glucose, fasting insulin, insulin resistance and sensitivity, especially for diabetic with overweight or obesity.”
Chromium: According to a scientific review, chromium is a mineral that has been shown to “have a beneficial role in the regulation of insulin action and its effects on carbohydrate, protein and lipid metabolism”, and it has been show to be an “important factor for enhancing insulin activity”. And more specifically, “chromium picolinate… has been shown to reduce insulin resistance and to help reduce the risk of cardiovascular disease and type 2 diabetes”.
Amino acids: A study completed in 2020 revealed that combined amino acids (L-Leucine, L-Threonine, L-Lysine Monohydrochloride, L-Isoleucine, L-Valine) with chromium was able to improve blood sugar levels in overweight adults, but the study was completed on those who did not have diabetes.
Inositol: Inositol has been utilized by many naturopathic providers to support insulin sensitivity, specifically in those with polycystic ovarian syndrome (PCOS). Literature indicates that inositol improved fasting blood sugar levels, fasting insulin levels, and insulin resistance index scores in females with PCOS. A study completed in 2020 revealed that inositol has been shown to improve blood sugar levels and glucose metabolism in diabetic animal models, possibly by increasing insulin sensitivity and sugar transport mechanisms.
Herbal medicine & Plant extracts
Cinnamon: A 2013 meta-analysis reviewing RCTs on cinnamon supplementation and hemoglobin A1c, fasting blood sugar, and more in Type 2 Diabetes revealed that cinnamon doses of 120 mg/day to 6 g/day for 4 to 18 weeks significantly reduced fasting blood sugar, but did not significantly reduce hemoglobin A1c levels. In addition to these findings, researchers also found that cinnamon supplementation reduced markers for heart disease, with significantly higher levels of HDL cholesterol and lower levels of total cholesterol, LDL cholesterol, and triglycerides. And, a 2020 double-blind, placebo-controlled, clinical trial in prediabetic subjects showed that 12 weeks of cinnamon supplementation at 500 mg three times daily led to improved fasting blood sugar levels compared to those taking placebo. With the varying dosages in cinnamon supplementation in these studies, people need to speak to their trusted medical providers first before starting supplementation.
Berberine: Berberine is a compound that is found in various herbs, such as Coptis chinenesis, Phellodendron, Oregon Grape, and more. A 2019 study completed on subjects 60-80 years old with Type 2 Diabetes, high cholesterol, and high blood pressure showed that combined use of pharmaceutical treatment with berberine alleviated insulin resistance, reduced inflammation, and regulated blood sugar and cholesterol levels compared to those only taking pharmaceutical treatment.
Gynostemma pentaphyllum: In a 2013 study, daily use of Gynostemma tea for 4 weeks has been shown to reduce fasting blood sugar levels in subjects with Type 2 Diabetes compared to diabetic subjects taking placebo. And, researchers of this study attributed this improvement in fasting blood sugar with Gynostemma with improved insulin sensitivity.
There are many more evidence-based natural treatments that a licensed ND may recommend beyond the ones mentioned above. And, if natural treatment does not make a difference in labs, a licensed naturopathic provider will start to lean more towards pharmaceutical management of diabetes to help patients reach lab targets. Licensed ND’s will refer out to an endocrinologist who specializes in diabetes if patents do no respond to baseline pharmaceutic management for further management with insulin and more.
Summary & Takeaways
Integrative medical treatment with a licensed ND entails the use of conventional and natural treatments. Licensed naturopathic providers can help guide patients through integrative treatment and explain to them if more-natural treatment, more-integrative treatment, or if more-pharmaceutical treatment would be best for their personal health.
The overall goals with diabetes management are to:
Achieve blood sugar targets with therapeutics.
Prevent or manage complications of diabetes.
In this blog post you learned:
The various conventional and natural diagnostics and treatments that licensed NDs are trained in to provide holistic treatment options
Conventional management of diabetes as per the American Diabetes Association involves the use of conventional therapies/pharmaceuticals with lifestyle recommendations
Evidence-based natural options for optimizing blood sugar can involve lifestyle recommendations, targeted nutraceutical supplementation, herbal medicine/plant extracts, and more
Diabetic patients are recommended to complete at-home blood sugar self-monitoring
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