Diabetes / Metabolic Syndrome

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

The United States National Diabetes Surveillance System shows that annual new cases of diabetes have increased from about 440,000 in 1980 to to more than 1,600,000 by 2008, and this number was still increasing until 2011, when efforts to educate the public in dietary and lifestyle changes finally showed results with a drop in new cases of diabetes. These numbers reflect new cases diagnosed each year, and also reflects a failure to prevent diabetes from occurring in the United States for decades, as an emphasis on medication rather than a more holistic approach obviously failed. By 2012, the U.S. Centers for Disease Control and Prevention (CDC) reported that almost 30 million adults were diagnosed with diabetes, representing 12.3 percent of the adult population, with diabetes diagnosed in nearly 26 percent of adults age 65 and older! The increasing numbers of children diagnosed is even more alarming, largely reflecting epigenetic inherited propensity and environmental concerns, especially dietary habits, both of which can be corrected over time with a more holistic approach to this greatest of health concerns in the U.S. In 2016, the World Health Organization (WHO) reported that similar numbers are now seen worldwide, with a four-fold increase in diagnosis since 1980 and about 9 percent of the total world population estimated to have a diabetic or metabolic disease. The fast spread of poor dietary habits, fast food, processed foods, sedentary lifestyle and other causative factors long associated only with developed countries is blamed. By educating the public to the complex subject of diabetes, and the ways that we can prevent this devastating metabolic, and sometimes autoimmune, disorder, we could not only dramatically improve the quality of life for millions of people, but drastically reduce the cost of health care and the national deficit for us all. The idea that such complex problems can just be solved by blindly taking a number of medications to block the metabolism, instead of adopting healthy restorative medicine, is a concept that is outdated in the 21st century. The key to reversing this devastating health problem is to clearly differentiate the types of diabetic and metabolic disorders and promote specific holistic protocols for each type of the disease, not a one-size-fits-all pharmaceutical approach. Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) has long provided an array of therapeutic protocols that individualizes each case and provides sound advice on dietary and lifestyle changes that enhance the effects of short courses of acupuncture with more prolonged step-by-step herbal and nutrient medicine protocols. Understanding the disease and the goals in therapy is all important. CIM/TCM provides adjunct care and a holistic approach to this systemic disease and is not an 'alternative' to standard medicine - an informed proactive approach is absolutely necessary to success with complex metabolic disease.

Diabetes and Metabolic Syndrome also need to be prevented. Since these diseases are usually developing slowly, signs and symptoms of metabolic imbalance, and underlying causes of diabetes, need to be recognized early, with integration of Complementary Medicine and holistic protocols encouraged to prevent the progression. Once diabetes is diagnosed each patient must understand how to manage the disorder with an individualized and comprehensive proactive protocol, which needs to incorporate sensible dietary principles, daily exercise and activity, and Complementary and Integrative Medicine (CIM). There are many problems with just depending on pharmaceuticals alone to manage diabetes, and there are many types and varieties of severity under the broad designation of diabetes. More than any other disease category, diabetes requires a strong proactive approach on the part of the patient. The Complementary Medicine physician, in the form of a Licensed Acupuncturist and herbalist, or a Naturopathic Doctor, can help each patient create a path to understanding and managing their diabetic disorder professionally, integrated with standard care. This medical service can be individualized to accommodate any budget, insurance plan, and time constraint, and is a sensible way to reduce medication side effects, and insure much better long-term outcomes with restorative medicine. With scientific study and evidence increasing dramatically each year in support of Complementary Medicine in the treatment of diabetes and Metabolic Syndromes, as you can see at the end of this article with links to some of the many studies, and websites of standard medical institutions that now support and tout integration of Complementary Medicine, we now only need a more proactive effort on the part of patients to achieve healthy success, and perhaps a cure for many some day. Today, the difficult task is in understanding of the type of diabetes or Metabolic Syndrome that you have, and then to understand the equations of risk versus benefit of the many types of diabetic medications now in use. A knowledgeable Complementary Medicine physician can help greatly with this understanding and individualized design of a treatment protocol.

While most patients still think that diabetes is a term for just one type of medical disorder, scientific study in the last few decades has clearly shown that this is a broad classification with disease dysfunction in multiple systems in the body, and even the classification as Type 1, Type 2 and now Type 3 Diabetes, as well as the prior classifications as Diabetes Mellitus, Insipidus and Gestational, as well as secondary and drug-induced diabetes, do not adequately reflect the variety of factors that may result in high circulating blood sugars, insulin resistance, pancreatic beta cell degeneration, and poor regulation of the liver metabolism that is seen in individual cases.

The longstanding treatment protocol with synthesized insulin obviously did not address the full needs of the patients in this class of disease, and newer types of medications have been fraught with serious adverse effects, and obviously have not achieved a reduction in incidence of diabetes, or a fully effective control of metabolism. Treatment of supposedly "pre-diabetic" states has not achieved success, either, but has served to alarm and confuse patients. Oversimplifying the "pre-diabetic" state to a matter of weight gain and implying that weight loss is the key to reversing Metabolic Syndrome has been misleading as well. In fact, if weight gain is involved, first reversing the metabolic disorder is essential to weight loss, not the other way around. Diabetes has always demanded a strong therapeutic role on the part of a proactive patient, but with this level of incidence in the population due to a variety of causes, including modern processed diets, environmental stressors and toxins, increased use of steroidal drugs, increased use of pharmaceutical drugs in tandem (polypharmacy) that negatively impact metabolic function, increased autoimmune disorder, and even low-grade deep viral infections that are poorly controlled, a more thorough and holistic approach with a strong patient involvement is needed if we are to finally reduce incidence and provide a better quality of life for diabetic patients. In recent years, the longstanding belief that pancreatic beta cells once damaged or destroyed by true diabetes could not be repaired or regrown has been found to be untrue, and only Complementary and Integrative Medicine (CIM/TCM) provides patients with protocols that may help the body to achieve such repair and regrowth currently. You may go to Additional Information at the end of this long article to access such scientific studies with links to the studies or summaries themselves. The first step in this process is, of course, better patient understanding of the broad category of diabetic disease.

Diabetes Type 1, or type 1 Diabetes Mellitus, usually involves autoimmune destruction of the pancreatic insulin-producing beta cells, and accounts for only about 5 percent of all diagnosed cases, with most disease onsets occurring during childhood. Type 2 Diabetes accounts for about 95 percent of all diabetes diagnoses, and is still poorly understood by both patients and the medical community. This type of diabetes is almost always a Metabolic Syndrome, with the insulin producing pancreatic beta cells stimulated to produce too much insulin, not too little. Chronic excess insulin production leads to insulin resistance at the fat cells and other cells with insulin hormone receptors, especially liver cells. This results in over-expression of insulin hormone receptors and an imbalance in related hormones, such as glucagon, leptin, adiponectin and ghrelin. While pharmacological treatment provides drugs to manage either deficient insulin production in Type 1 Diabetes due to pancreatic dysfunction, or excess production with insulin resistance and a relative deficiency in insulin in Type 2 Diabetes (Metabolic Syndrome), to truly cure or even manage this widely varied set of diseases, the underlying health problems and systemic effects on the whole system of metabolism, immune response, and neurohormonal health need to be addressed. It is obviously important to distinguish Metabolic Syndrome from actual diabetes to design the right treatment protocol to prevent progression, but standard medicine has failed us in this regard, instead stubbornly insisting the Metabolic Syndrome be called a 'pre-diabetes' or diabetes itself. While standard medicine does now stress the need for a healthier diet and a routine of daily exercise to control the disease and its many health complications, there is no disease that demands integration of holistic Complementary Medicine more than diabetes. There is much that can be accomplished with truly utilizing Complementary and Integrative Medicine (CIM), with no adverse effects, and only a businesslike sense of competition has prevented this necessary integration. Restorative Medicine with CIM can be very beneficial. We now know that pancreatic beta cells are able to regrow and regain function in Type 1 Diabetes, and that a persistent protocol may reverse the systemic effects involving peripheral insulin receptors on fat cells and other cells in the body, including neurons and neural glial cells, but that these treatment protocols will take time, and so need to be encouraged by the M.D., not discouraged. If Metabolic Syndrome is the problem, a focus on fatty liver and high triglycerides, chronic low-grade inflammatory dysfunction at the fat cells, and improved neurohormonal balance and function is essential. These are big tasks and should not be taken lightly. Prevention, better disease management, and restoration of healthy function can all be achieved with CIM/TCM.

In the last decade, a diagnosis of diabetes occurred in about 13 percent of the population in nearly all states in the U.S. and across all ethnic groups, but the U.S. Centers for Disease Control and Prevention (CDC) stresses that also about 33 percent of all U.S. adults have a potentially prediabetic state called Metabolic Syndrome, and that as of 2010, fewer than 8 percent of this one-third of U.S. adults were aware that they should deal with this potentially prediabetic state of Metabolic Syndrome. In addition, the rates of diabetes and Metabolic Syndrome in children have increased dramatically in the United States, as has the rate of gestational diabetes, occurring during pregnancy, and affecting the child. Utilization of Complementary and Integrative Medicine (CIM) to provide early identification and treatment of prediabetic states would save millions of Americans from the devastating effects of diabetes and lower health care spending dramatically.

Research findings released in early 2014 by the U.S. Centers for Disease Control and Prevention showed that between 2001 and 2009, the prevalence of Type 2 Diabetes in children rose over 30 percent, and the prevalence of Type 1 Diabetes, formerly called Childhood Diabetes, increased 21 percent, affecting both boys and girls, and nearly all racial groups. Most experts agree that the reasons for this dramatic rise in childhood Type 2 Diabetes and Metabolic Syndrome include the type of food we feed our children, a decrease in daily aerobic activity, and an amazing rise in environmental chemicals and food additives that affect the child's hormonal system. Further studies have identified use of statin drugs and potentially antidepressants during pregnancy as contributors, as well as the overuse of antibiotics in the first years of life for infants. The dramatic rise in childhood Type 1 Diabetes confounds experts, though, primarily because the causes of Type 1 Diabetes are still not clear, despite over a century of intense scientific research, according to Dr. Dana Dabelea M.D. Ph.D., associate dean of faculty at the Colorado School of Public Health in Aurora, and lead author of this 2014 study of over 3 million children and adolescents across the United States. This dramatic rise in prevalence of Type 1 Diabetes occurred in children 5 years and older, and the only ethnic group not affected were the Native American children, a segment of the population that has suffered the highest rates of Diabetes Type 1 in the past. Diabetes Type 2 had been called Adult Onset Diabetes in the past, and this dramatic rise in incidence across all ethnic lines for U.S. children, a sign that a much greater percentage of our children are affected by undiagnosed Metabolic Syndrome, is greatly alarming. The U.S. CDC estimates that annual medical expenses for a person with diabetes is more than twice that of a person without diabetes, and that a conservative estimate in 2007 of the total cost of diabetes in the United States was $174 billion per year. This cost, driving both our federal deficit higher with increased federal healthcare expenditures, and the cost of insurance for both businesses and individuals, is increasing dramatically, and thus makes this set of diseases a cause of concern for all Americans.

Diabetes is a term that has been misused and poorly understood in recent decades. The term diabetes has been used since the second century, and derives from the Greek word meaning siphon, referring to the symptom of frequent urination that accompanies true diabetic states. The origin of the problem was traced back to the hormone secreting pancreas, with deficient secretion of insulin hormone pushing protein and fat breakdown over carbohydrate use in the body, which caused excess dumping of protein metabolites, as well as sugars, in the urine, causing excess urination and thirst, as well as wasting. The eventual threat to health in chronic cases came from kidney dysfunction, electrolyte imbalance, acidosis, and blood vessel degeneration. It was diagnosed primarily with excess circulating blood values of glucose, or sugar, which is called hyperglycemia. Unfortunately, in the last century, less than 10 percent of these patients with hyperglycemia had a true diabetes, and a second form of metabolic disorder was then called Diabetes type II, which is now properly called Metabolic Syndrome for most patients. By paying attention to what is actually going on in the body, and progressing past misconceptions of the past, both the patient and the physician can better address this health problem with the most comprehensive and specific course of therapy. Addressing the problem of Metabolic Syndrome in the population effectively would involve alerting the patient to the need to take a holistic approach to reversing this metabolic dysfunction before chronic hyperglycemia occurred. Unfortunately, this has not occurred, and standard treatment of the "prediabetic" state instead relied on statin drugs that are now proven to actually increase the risk of progression to a diabetic state.

Developing New Attitudes and Approaches to Diabetes and Metabolic Disease

When the term "diabetes" comes up in your health profile or diagnosis today, this term could signify a wide variety of scenarios and problems. The intelligent patient will not ignore the complexities of diabetes, but will try to gain a full understanding of this health imbalance, understand the specific type of diabetes that he or she has, and thus form a protocol that addresses the disease in the individualized way that will best restore healthy function and prevent serious consequences. With diabetes afflicting up to an estimated 13 percent of the U.S. population, and another third of the population affected by a potentially prediabetic state of Metabolic Syndrome, reclassification of the disease, perhaps utilizing the terms Diabetes Mellitus, Insulin Resistant Diabetes, Metabolic Diabetes and Metabolic Syndrome could help the patient understand their particular problem, and help guide therapy with less of a one-size-fits-all protocol, avoiding problematic drugs when possible, and finally integrating Complementary Medicine to achieve better and safer results in the long term. Findings of large studies in recent years that confirm that cholesterol-lowering statin drugs increase the risk of developing true diabetes in Metabolic Syndrome and may contribute to higher insulin and insulin resistance, and findings that some diabetic drugs may contribute to increased cardiovascular risk, obesity and metabolic disorder have created a more complex consideration of the risk-benefit equation, and stimulated a wider acceptance of the integration of Complementary Medicine to treat diabetic states. Clearly, polypharmacy is not the answer.

Kevin Patterson is a medical doctor and writer that has worked around the world treating patients, most recently as an internist and intensive care specialist in Afghanistan for the Canadian Combat Surgical Hospital. In 2010, he noted in an essay in Maisonneuve Journal that "Type 2 diabetes historically did not exist only 70 to 80 years ago, and what has driven it, of course, is the rise in obesity, especially the accumulation of abdominal fat. That fat induces changes in our receptors that cells have for insulin. Basically, it makes them numb to the effect of insulin." Obesity itself is a complex disease process and cannot be simply equated with simple weight gain. The tactic of resolving the systemic dysfunction of obesity by simply dieting has not worked, nor has the tactic of gastric banding or pharmaceutical weight loss. In fact, to achieve weight loss in obesity, this systemic neurohormonal metabolic dysfunction has to first be reversed. This is not a simple task, and progress cannot be judged purely by the amount of weight loss in Metabolic Syndrome, obesity, and Type 2 Diabetes.

Dr. Patterson described how surgical patients in Afghanistan, and in many parts of Africa, had little or no visible fat beneath the typical fatty layer under the skin, but that patients from the United States, Canada and Europe typically had most of the organs encased in fat. He stated that "it had a visceral potency to it when you could see it directly there." Dr. Patterson noted high rates of Type 2 diabetes, or Metabolic Syndrome, in every culture that adopted a modern Western diet, and stated that "no country in the world has the resources to continue to treat diabetics the way that they are being treated now, if the prevalence rates increase at the rates that they are increasing for much longer." Changes in our modern diet and adoption of holistic protocols to treat Metabolic Syndrome and Type 2 diabetes are becoming a matter of survival, not only concerning our health, but concerning our economy. Complementary and Integrative Medicine (CIM/TCM) presents a significant part of the solution to this problem, and patient and public understanding is vital to the proactive partnership between the Complementary Medicine physician and the patient to both treat and prevent this now common and devastating health problem. Once insulin resistance and accumulation of fatty tissues in and around our organs occurs, though, this problem is no longer easy to reverse.

The hormone insulin is part of an elaborate feedback network of relatively simple molecules called steroid hormones that trigger responses at a variety of hormonal cell receptors in our bodies. The various receptors perform the variety of functions triggered by the same simple insulin molecule. The physiological responsibilities of this hormone insulin includes primary regulation of the metabolism of fats and sugars, but to assume that this cellular energy regulation is the sole function of insulin, or that insulin alone regulates energy usage is a misconception. A variety of hormones and hormonal balance maintains our complex regulation of the energy metabolism. A relative excess of insulin inhibits the ability to utilize stored fats as a source of energy by conversion to glucose, while a relative absence of insulin, as in true diabetes, results in glucose not being taken up by body cells, and the excess use of stored fat as an energy source. When true diabetes occurs, the patient thus becomes thin, suffers dangerous metabolic deficiency, and depends upon exogenous insulin injections to survive. This is obviously different from what we now call Type 2 diabetes.

In the most prevalent form of what we call diabetes, type 2, or Metabolic Syndrome, the patient is not able to use stored fats due to insulin resistance, and becomes obese. This insulin resistance at the target cells usually, but not always, precedes obesity and the development of hyperglycemia, or high circulating blood sugar. A very few of these patients develop a relative insulin deficiency, and require exogenous insulin to control blood sugars. On the other hand, almost all of these patients instead experience fluctuating excess insulin effects due to insulin resistance stimulating excess need for insulin, and slow uptake of insulin at fat and muscle cell receptors.To reverse this disease, the factors underlying the insulin resistance need to be addressed, and slowly reversed.

The negative health effects of this fluctuating excess insulin and insulin resistance at cell receptors are much broader than just poor usage and storage of sugars and fats. Insulin also has a variety of effects besides regulation of sugar and fat metabolism, acting with other hormones to regulate amino acid uptake by cells, various anabolic processes, and important regulatory processes in the brain. Anabolic processes are the cellular processes that create important molecules from simpler components. We see that in metabolic syndrome, insulin resistance at the cells is extremely important, and must be addressed to restore health, not only to regulate circulating blood sugar and decrease stored fats, but also to restore overall health and function. More and more scientific studies show the potential for acupuncture and herbal/nutrient medicine to reverse insulin resistance, as well as the underlying causes of insulin resistance, such as fatty liver and chronic low-grade inflammation. Some of these numerous studies are cited below in Additional Information. For instance, in 2014, a study at Guangdong Pharmaceutical University, in Guangzhou, China, published in the Journal of Translational Medicine (Vol. 12), utilized polymerase chain reaction and metabolic measures to insure that actual insulin resistance in liver cells was accurately assessed in a study of a typical Chinese Herbal Medicine formula, called FTZ (Ligustrum lucidum / Nu zhen zi, Salvia miltiorhiza / Dan shen, Coptis chinensis / Huang lian, Panax notoginseng / San qi, Eucommia ulmoides / Du zhong, Cirsium japonicum / Da ji, and Citrus medica / Zhi shi). The results in laboratory animals with Metabolic Syndrome, or Diabetes Type 2, were that insulin resistance in liver cells was reversed, with upregulated PI3K expression in adipose cells, and reactivation of latent IRS1/PI3K pathways in liver cells. Also, decreased serum triglycerides, total cholesterol, fasting blood glucose, and increased serum HDL-C was noted. If such study findings were published for a new pharmaceutical treatment it would result in widespread prescription, but with this study there was absolutely no advice from an M.D. to perhaps integrate such as formula into care. Such a cynical response should be recognized for what it is by the public and patients with Metabolic Syndrome. These herbs are found in a great number of common TCM herbal formulas and pills, showing that utilization of TCM herbal treatment can be both preventive and helpful in treating Metabolic Syndrome.

Gaining a better understanding of the hormone insulin in our bodies, and how to restore the insulin metabolism to prevent diabetes, cancer and other comorbid disease

Insulin is not only produced in the pancreas, but also in the brain, and influences brain function, such as learning, memory and cognition, as well as vascular compliance (the elastic ability to respond to needed changes in blood pressure), rates of breakdown of proteins (the main messengers or regulating molecules in our cells), DNA replication, modification of enzyme activities, and even the rate of degradation of damaged cell components called organelles (linking metabolic syndrome to neurodegeneration and what is now called Diabetes Type 3). In fact, insulin may be considered a peptide neurohormone. Insulin is widely stored in fat cells as well, and so there is more to our insulin metabolism than just the hormone that is released from the pancreas, and more to the effects of insulin than just regulation of blood sugars. Most of the insulin released by the pancreas produces this effect of blood sugar regulation and is destroyed in less than 10 minutes, and almost all of it within an hour, mostly within the liver. Liver function is thus very important to insulin metabolism and balance, but as we see, insulin in the brain, hormonal balance, and overall metabolic function is also very important to the healthy insulin metabolism in your body. By merely controlling the circulating blood sugar and insulin levels, the patient achieves the basic need in staying alive, but the needs of the body to restore full health and relieve a wide variety of health problems related to insulin metabolism and insulin resistance are not addressed. Complementary and Integrative Medicine (CIM) is making great leaps forward in research to help the patient achieve these goals, especially in decreasing insulin resistance and the causes for insulin resistance and obesity, such as deficient leptin and excess adiponectin, as well as improved liver function and a better kisspeptin metabolism. In type 2 diabetes, the problem involves control of lipid metabolism and obesity as well, or fatty liver disease, and often does not use synthetic or bioidentical insulin, and so does not actually restore healthy insulin levels, just the circulating levels of blood glucose. Traditional Chinese Medicine (CIM/TCM) has discovered in research a number of therapeutic protocols to effectively achieve a number of the goals in treatment, including regrowth of pancreatic beta cells and restoration of beta cell function when needed, with integrated complement therapies that can be safely used as adjunct protocols with standard care.

In true diabetes, where the blood sugar levels are not managed, and hyperglycemia results, the long-term injury is mostly seen in the cardiovascular system and kidney dysfunction. In 1993, the results of a 10-year multicenter study found that by rigorously managing blood sugar levels, diabetics could substantially reduce the long-term complications of the disease, especially peripheral neuropathies, kidney dysfunction, degeneration of the eye, and other cardiovascular problems. Heart attacks are one of the most common causes of death in the United States, and patients with diabetes and metabolic syndromes comprise over one third of these heart attack victims. Managing blood sugar levels is best handled on an individualized basis, and there are many ways to achieve the best and healthiest regimen depending on the individual parameters of the disease. The focus needs to be on the particular reasons for the improper regulation of blood sugar, not just the level of blood sugar alone. The metabolic and neurohormonal regulation of blood sugar metabolism involves a number of factors, and all of these need to be addressed in a holistic individualized manner. It is not recommended that the patient depend on insulin injections alone, but rather adopt a holistic proactive approach to improving overall health and managing energy usage via stricter dietary and exercise control. Complementary and Integrative Medicine (CIM) could play a big role in this healthier proactive approach for insulin-dependent, as well as non-insulin dependent, Diabetes type 1 patients. Since cardiovascular risk is the main concern with chronic diabetic states, the alarming findings of increased cardiovascular risk from newer diabetic drugs has been a chief concern in recent years, even prompting the removal or restriction of some diabetic medications from the market. This irony appears to be largely lost on the medical doctors and patients, but is prompting interest in healthier and safer approaches. Consequently, integrating Complementary Medicine to improve cardiovascular health has had a renewed interest in the medical community, as well as utilizing better dietary and lifestyle advice, and Complementary Medicine to treat diabetes with a more comprehensive and holistic approach.

In 2012, Dr. Pankah Shah, chief endocrinologist at the Mayo Clinic, noted that the rise in incidence of both Metabolic Syndrome and Cancers in recent years was dramatic, with about 1.6 million new cases of diabetes and 1.4 new cases of cancer diagnosed each year in the United States, and many patients diagnosed with both a Metabolic Syndrome or diabetes, and cancer. Dr. Shah stated: "Evidence suggests that these two common conditions coexist much more often than would be expected to occur by chance." One potential link between Metabolic Syndrome and progression to diabetes type 2 and cancer onset concerns findings of a peptide neurohormone called kisspeptin, with various type of kisspeptin found to be associated with both reaction to cancer metastasis and progression of Metabolic Syndrome to actual diabetes. Of course, a combination of factors, both genetic and metabolic, as well as environmental and epigenetic, are involved. All of these scientific findings implies that a more holistic approach to care and prevention is needed.

Studies are now being conducted to determine why patients diagnosed with Metabolic Syndrome would acquire various cancers, and why patients treated for cancer would be more likely to develop Metabolic Syndrome. Dr. Shah postulates that insulin induces cell growth and proliferation, and excess insulin is associated with higher estrogen levels, which may be linked to breast, ovarian and uterine cancers. Along with increased insulin in Metabolic Syndrome, higher levels of insulin-like growth factor is noted in obesity as well, due to cell resistance that accompanies insulin resistance, and this has been linked to cancer growth. In addition, cancer cells may proliferate due to increased glucose as well as increased angiogenesis and epithelial growth that is linked to Metabolic Syndrome. Attention is even being paid to the possibility that common drug regimens may increase the possibility of these comorbid diseases, and in 2012, FDA drug warnings were issued linking the diabetic drug Actos (pioglitazone, a thiazolidinedione, like Avandia) to increased risk of bladder cancer, prompting the withdrawal of the drug in a number of countries, including France and Germany. A number of studies have also linked the popular dipeptidyl peptidase-4 inhibitors (DDP-4 inhibitors), such as Januvia (sitagliptin), to increased cancer risk, especially with colon and pancreatic cancers (see research links below in additional information). The newer yet IGP-1 receptor agonists, such as Victoza, introduced in 2012, already have a black box warning of increased risk of thyroid cancer and pancreatitis. Restoration of a healthy homeostasis, and decreased dependence on drug regimens if possible, is thus vital to future health. The smart proactive patient will work to improve the underlying health, and not just focus on the control of the circulating blood sugars with drugs.

The search for causes of the vast rise in new cases of diabetes and Metabolic Syndrome has led researchers to mine databases to discover if combinations of pharmaceuticals could be contributing. In 2013, researchers at Stanford University School of Medicine, Vanderbilt University, and Harvard Medical School jointly conducted such a study, and found that the combination of the antidepressant Paxil with the cholesterol lowering drug Pravachol (pravastatin) could cause an unexpected rise in blood glucose levels that could lead to the diagnosis of diabetes. Neither of these drugs alone was shown in their clinical trials to raise blood glucose. Dr. Russ Altman MD, PhD, chair of the bioengineering department at Stanford, headed this research, and found four such pairs of drugs that could cause a sustained rise in blood glucose levels, although the other three were not commonly prescribed. By replicating the findings in the laboratory, where levels of blood glucose rose dramatically in study animals, from about 128 mg/dL to 193 mg/dL, these scientists proved that their data-mining research was accurate. Such study will be ongoing to point out the problems with diagnosis, and with overprescription of pharmaceuticals. A huge number of patients have been prescribed both a statin drug for cholesterol lowering and an anti-depressant SSRI, and many of these patients developed a Metabolic Syndrome and Diabetes due to these drugs. Hopefully, new guidelines will alter the way that doctors look at individuals diagnosis and treatment.

Understanding the physiology in Diabetes and Metabolic syndromes

To understand diabetes, let's first try to understand the pancreatic hormone insulin. Insulin, a regulatory protein, normally binds with fat cells, muscle fiber, and cells of the liver, causing not only increased transport of glucose into these cells, but also stimulating a cascade of enzyme activity that regulates storage and release of glucose. Insulin also plays a major role in fat metabolism, inhibiting the breakdown of triglycerides into fatty acids (causing a stubborn obesity in metabolic syndromes when insulin levels are high, and insulin resistance is seen in the fat cell receptors). When insulin is not available, as in Type 1 diabetes, these fatty acids are released, and are abundant in the blood, attached to lipoproteins, and storage of these fats are blocked, leading to high cholesterol and athersclerosis. In addition, the excess fatty acids are converted to large quantities of acetoacetic acid, which leads to acidosis, or ketoacidosis (DKA), a pH imbalance that causes coma and often results in death. Patients with DKA usually seek medical care within 2 days due to the severity of symptoms such as abdominal pain with nausea and vomiting, and difficult rapid breathing (dyspnea). Signs of DKA are a sweet, fruity breath and impaired consciousness. Lastly, insulin promotes protein formation and inhibits protein breakdown, and the absence of insulin leads to lack of protein storage and availability, causing neurological problems and a hyperuremic state (excess protein in the blood and urine), as well as a host of other problems.

In contrast, what we usually see in diabetes type 2 / metabolic syndrome involves a high availability of insulin but poor insulin function. When the insulin doesn't function well, the types of symptoms are varied and your health suffers in many ways that can be indirectly linked to insulin dysfunction. The key to insulin dysfunction is a metabolic problem called insulin resistance, where the insulin hormone is not affecting the fat cells properly. When this occurs, the fat cells are not able to efficiently release fat for conversion to glucose in the liver. The fat cells become enlarged, and the patient is unable to lose weight, and often has an unusual craving for simple carbohydrates. Inflammatory dysfunction in the fat cells has been found to be a key component in this process. Dysfunction of hormone receptors also plays a key role. Since all steroid hormones are very similar molecules, the receptors for hormones may respond in part to various hormones. Imbalances of other steroid hormones may play a significant role in this receptor dysfunction, as well as an imbalance of inflammatory cytokines.

Both hormone imbalances and inflammatory dysfunction are tied to adrenal stress. Physiologically, stress is more than just the feeling of being stressed emotionally. It is the process of increased metabolic demands that are greater than your systems can handle. One key cause of this metabolic adrenal stress occurs when normal quantities of carbohydrates are not available in the body. When a person eats simple carbohydrates, such as sugar and bread, these convert quickly to glucose to fuel the body, but in a short time, there is a lack of new carbohydrates to form glucose. When this occurs, the pituitary gland secretes more corticotropin, which signals production of large quantities of the adrenal hormone cortisol, and other glucocorticoid hormones. Cortisol stimulates the extraction of proteins from all cells to provide amino acids to the liver to make more glucose. Cortisol levels are also regulated on a diurnal basis, and poor adrenal function often creates a diurnal dysfunction that results in excess cortisol stimulation at night, with insomnia, and deficient cortisol secretion during the day, with easy fatigue. Since only about 60 percent of amino acids can be turned into glucose in the liver, this process of cortisol stimulated protein metabolism is important to sugar metabolism, and cortisol imbalance can create enormous liver stress, as the liver copes with other pathways to provide the necessary glucose as fuel for the body. Cortisol imbalance, cellular protein depletion, and liver stress also combine to create inflammatory dysfunction that contributes to insulin resistance. When the patient consumes complex carbohydrates, with a high glycemic index, the breakdown of the carbohydrates is slow and steady, and this episodic adrenal and liver stress may be alleviated somewhat.

Cortin is a term referring to the active principle of the adrenal cortex, related to several hormones. The adrenal cortex produces a hormone that is essential to health, regulating appetite, metabolism and muscle function, and a host of other essential processes related to thyroid hormone conversion. A bioidentical adrenal cortex has long been used in Complementary Medicine, providing some relief for syndromes of adrenal stress where cortin is deficient, and a number of herbs and nutrients act to improve this adrenal metabolism, including PKA and wild mountain yam. Prednisolone is a corticosteroid drug that mimics Cortin, and some versions of this problematic drug are now called Pri-Cortin 50, but numerous adverse side effects occur in a high number of patients taking synthesized cortin. On the other hand, bioidentical adrenal cortex presents no side effects in clinical studies. Recent studies also show that specific acupuncture stimulations increase and modulate cortin (see links to these studies in Additional Information). Cortin is also found in the brain, and proopiomelano-cortin (POMC) is secreted by specialized neurons and affected by the hormone leptin, a symbiotic companion to insuline, glucagon, and adiponectin. This neurohormonal metabolism appears to be integral to central regulation of metabolism, and studies show how specific acupuncture stimulations beneficially modulate this central metabolsm as well.

While there may be a number of factors contributing to adrenal stress, we see from the above explanation the importance of changing your diet and integrating Complementary Medicine when you have insulin resistance and Type II non-insulin dependent diabetes, or Metabolic Syndrome. When the body's metabolic systems struggle, we need to help them by adopting proactive strategies to compensate for poor autonomic function. Avoiding or decreasing sugary foods and baked goods, or flours, and increasing whole grains and honey may have a dramatic result. Excess intake of fruit also is a source of simple carbohydrates and should be avoided, such as consuming large doses of fruit juice in one setting. The way that we see that that the body is having a problem with steady glucose supply and subsequent liver stress, is that your blood tests show high triglycerides. Triglycerides are the intermediate molecule in the conversion of proteins to glucose, and also carry the fats and proteins in the cholesterol carrier, lipoproteins. A deficiency of high density lipoproteins, which carry these fuels for glucose back to the liver, inhibits this process further. When the liver is very stressed, the liver enzymes, or transanimases, GOT, SGOT, are also high on your blood tests. The pharmaceutical answer to these metabolic problems is to block genetic expression, or production, of these lipoproteins and triglycerides. Common sense tells us that this is not a healthy approach in the long run, and a more comprehensive strategy to restore healthy metabolic and hormonal function is a sensible approach with the best lasting results and optimal health. Hormonal balance, and alleviation of adrenal stress and cortisol imbalance is another subject that can be explored on this website.

To summarize, insulin activity regulates sugar, fat, and protein metabolism in the body, all of which may be converted to glucose to meet the body's energy needs. In the absence of insulin great care must be taken to 1) regulate these metabolic balances by controlling the intake of carbohydrates, fats, and proteins, and 2) to regulate the utilization of these substances by increasing exercise when glucose levels are too high. If this is not done in an intelligent way, blood glucose levels are not maintained and cholesterol levels and subsequent cardiovascular disease becomes a real threat. In NIDDM, or type 2, or Metabolic Syndrome, glucose binding must be enhanced, and if the patient is overweight, weight reduction is often the key to improvement of insulin sensitivity, (as well as the 2 steps described above), as insulin binding to fat cells is more difficult in the obese person. Obesity has been firmly linked to insulin resistance and chronic inflammatory states in the white fat cells. Dieting has not been successful in many cases, and when dieting is unsuccessful, hormonal correction and regulation of the inflammatory process is necessary to lose weight. Since insulin is a steroid hormone of the endocrine system, your hormonal and endocrine balance must be improved to achieve proper insulin function, endocrine balance and weight loss.

Insulin binding and utilization is also a problem in diseases with abnormal fat distribution and cholesterol buildup. In AIDS patients taking protease inhibitors, fatty deposits will accumulate on the shoulders and neck, and trunk, and onset of diabetic symptoms often will follow. In hypothyroidism, Cushing's syndrome, and other endocrine disorders, fatty deposits will accumulate on the trunk and face and this will lead to a higher risk of diabetes onset. Study of these problems has led us to conclude that obesity in diabetes type 2 / Metabolic Syndrome is linked to protein dysfunction and endocrine disorder. The interrelations of these various disorders confirms the need to adopt a more holistic strategy to bring patients with this complex syndrome back to a healthy state. A patient-centered, step-by-step, persistent, and thorough approach, with patient education and a proactive participation in therapy, may be the only way that we can reduce the extreme rise in metabolic disorder that threatens the population in the United States.