Evidence that psychological and behavioural factors significantly affect the course and outcomes of diabetes continues to accumulate. One in every four diabetic patients suffers from recurring problems of depression, anxiety, or eating disorders [Source: Diabetes Care 15:1640-57, 1992].

The incidence of diabetes is rising alarmingly. It is estimated to affect over three million people in the UK today. Furthermore recent statistics suggest that up to five million people in the UK will develop Type 2 Diabetes by 2025. Nutrition – ingredients used for the preparation of many foods (i.e. palm oil) and medications (i.e. statins) are partly to blame for such an increase.

Should you search “What exactly is diabetes” – you probably will not find a straight answer. What in fact we are told is: “Diabetes is a metabolic disorder in which the body’s ability to manufacture or use the hormone insulin is diminished”.  Allow me to explain better, please.

• The food you eat consists of three basic nutrients: carbohydrates, protein and fat.
• During digestion, chemicals in your stomach break down carbohydrates into glucose, which is absorbed into your bloodstream.
• Your body uses glucose for energy.
• Glucose metabolism requires insulin, a hormone produced by your pancreas.
• Your pancreas responds to the glucose by releasing insulin.
• Insulin is responsible for allowing glucose into your body’s cells.
• When the glucose enters your cells, the amount of glucose in your bloodstream falls.
• Without insulin, the glucose can’t get into your cells.
• The pancreas performs the vital duty of producing hormones (insulin, somatostatin, gastrin and glucagon), most notably insulin – to maintain the balance of blood glucose (sugar) and salt in the body.
• Glucagon helps insulin maintain normal blood glucose – is released to stop blood sugar levels dropping too low. To do this, it acts on the liver in several ways:

1. It stimulates the conversion of stored glycogen (stored in the liver) to glucose which can be released into the bloodstream. This process is called glycogenolysis.
2. It promotes the production of glucose from amino acid molecules. This process is called gluconeogenesis.
3. It reduces glucose consumption by the liver so that as much glucose as possible can be secreted into the bloodstream to maintain blood glucose levels.

Glucocorticoids are secreted by the middle region of the adrenal cortex(1). The principal glucocorticoid is cortisol, which increases blood glucose levels. Cortisol is a glucocorticoid or steroid hormone produced by the adrenal gland. Cortisol increases blood sugar through gluconeogenesis, acts as a natural anti-inflammatory to suppress the immune system and aids in fat, protein and carbohydrate metabolism while it decreases bone formation. When insulin is high and glucagon is low, the adrenals are called upon to produce extra cortisol as a back-up response to help raise blood sugar.

If you have type 1 diabetes (Diabetes mellitus – aka DM), then your body doesn’t produce any insulin to handle the glucose in your body. Type 1 DM results from the pancreas’s failure to produce enough insulin. This form was previously referred to as “insulin-dependent diabetes mellitus” (IDDM) or “juvenile diabetes”. The cause is unknown.

If you have type 2 diabetes, your pancreas secretes less insulin than your body requires because your body is resistant to its effect. With both types of diabetes, glucose cannot be used for energy, and it builds up in your bloodstream.

People with diabetes may become hyperglycemic if they don’t keep their blood glucose level under control. Hyperglycemia means high (hyper) glucose (gly) in the blood (emia). Hyperglycemia is a defining characteristic of diabetes— it happenes when the blood glucose level is too high because the body isn’t properly using or doesn’t make the hormone insulin.

If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn’t have enough insulin. Without insulin, your body can’t use glucose for fuel, so your body breaks down fats to use for energy. When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they end up building up in your blood. Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:

• Shortness of breath
• Breath that smells fruity
• Nausea and vomiting
• Very dry mouth

Diabetes screening tests are a good preventative method for catching the development of diabetes at an early stage; these include:

• A C-peptide test is a blood test carried out to find out how much insulin your body is producing.
• A GAD(2) test measures whether the body is producing a type of antibody which destroys its own GAD cells. In type 1 diabetes, a number of autoantibodies are thought to circulate including those which target glutamic acid decarboxylase. Presence of these autoantibodies suggests type 1 diabetes.
• Glucose Tolerance Test (GTT) – also (OGTT), is a method which can help to diagnose instances of diabetes mellitus or insulin resistance.
• HbA1C test is a blood test for people with diabetes. It measures average blood glucose level over a 2 to 3 months period.
• A fasting plasma glucose test (the most common test) also known as a fasting glucose test (FGT), is a test that can be used to help diagnose diabetes or pre-diabetes. The test is a simple blood test taken after several hours of fasting.

There is a significant amount of confusion about what actually causes insulin resistance. There are a number of reasons, and these are heavily influenced by economic forces that profit on lifelong health conditions like diabetes. You may have heard the phrase “there is no money in the cure.” This is a true statement, and this practice is what keeps life-saving information out of the hands of those who need it.

Insulin resistance is a complex metabolic condition mainly caused by lipid overload, resulting from either a high fat diet or insufficient fat “burning” (not enough… movement). Saturated fatty acids(3) are the most potent influencers of insulin resistance.

Saturated fatty acids are derived mainly from animal sources, and have direct negative effects on the muscle and liver. Sucrose (white table sugar), white rice, white flour and processed foods also increase liver insulin resistance. Other causes of insulin resistance may include ethnicity; certain diseases; hormones; steroid use; some medications; older age; sleep problems, especially sleep apnoea; and cigarette smoking.

Therefore diet and exercise can help you avoid producing less insulin in your body – dos and don’ts include:

1)      Do not eat late at night

2)      Do not consume white sugar (don’t drink any carbonated beverages)

3)      Eat more vegetables (home-made soups are great)

4)      Avoid trans-fats (trans fat is made by adding hydrogen to vegetable oil – anything fried or battered)

5)      Eat oily fish a couple of days a week

6)      Add supplements like: Magnesium, Bitter Melon, Fenugreek, Aloe Vera, Gymnema Sylvestre etc.

7)      Get enough sleep

8)      Avoid high-fructose foods

9)      Avoid sitting for long periods

Many diabetes patients find it challenging to make the lifestyle changes necessary to stay healthy, including changing their diet. Making healthy lifestyle choices is important for people with type 2 diabetes. Psychologists can help patients change their behaviours to gradually improve eating habits, activity levels and their overall outlook.

Article by A B M Procaccini © – Counselling Psychologist, Naturopathist

Notes:

(1) – Situated along the perimeter of the adrenal gland, the adrenal cortex mediates the stress response through the production of mineralocorticoids and glucocorticoids, such as aldosterone and cortisol, respectively. It is also a secondary site of androgen synthesis.

(2) – GAD, which stands for glutamic acid decarboxylase, is an enzyme in the brain and the pancreas that plays several roles in the body. As an enzyme, it converts the excitatory amino acid glutamate into the inhibitory neurotransmitter GABA, which nerve cells use to communicate.

(3) – Saturated fatty acids are fats that contain no double bonds between the carbon atoms. Saturated fatty acids are fats that cannot break down in the body and therefore, collect in places in the body and get stored. Some examples of saturated fatty acids are: lauric, myristic, palmitic and stearic acids.