Positive Health Online

Being over-weight means there is a high risk of diabetes.  Did you know that most limb amputations occur as a result of diabetes not accidents[1]?

There are estimated to be more than 21/2 million diabetics in the UK and that number is expected to double by 2010[2].

So, as we indulge our eating fancies over holidays such as Christmas we really ought to spare a thought for our blood sugar levels, and the hormone insulin that is required to deal with them.

Insulin resistance (pre-diabetes) is a major undiagnosed problem in the UK, and it often goes hand-in-hand with weight gain around the middle that really won't budge.

What is Insulin Resistance?

Glucose comes from the food that we eat (and from liver stores), and in order to get this body fuel into our cells the pancreas secretes insulin.  However, the general diet and lifestyle of today is creating a problem with this process.

Insulin resistance is when our cells will not respond to insulin normally.  When this happens our cells are starved of their energy.  The individual continues to eat high carbohydrate fuels to gain energy, but it is like the fuel line in a car being blocked; it's not getting through.  The pancreas continues to secrete more and more insulin to respond to the high glucose levels that aren't going anywhere, unsuccessfully attempting to regulate the problem.  If the resistance is not resolved, the pancreas will become exhausted.  When we no longer produce insulin we are in an insulin-dependent diabetic state.

However, for those who are still in an evolving state of insulin resistance there is much that can be done to reverse things back to insulin sensitivity once more.

Let us examine the factors that can be involved in creating insulin resistance in the first place.

The first one to consider is stress.  High levels of the stress hormone cortisol will promote insulin resistance through down-regulating (turning down) insulin receptors on cells.  

Here are some pointers for considering your stress levels:

• Are you getting enough good quality sleep? 
• Do not skip meals.  Meal skipping will cause your body to start 'eating' itself through breaking down important body tissue to make blood sugar.  This will increase cortisol levels;
• Set realistic goals for achievement each day and allow yourself 'down-time' in a relaxing bath, take up yoga, read a novel....whatever you feel will give you space and a feeling of peace;
• Do you self-medicate with caffeine to keep you going and alcohol to slow you down?  If you recognize this you should evaluate what is behind it so that you can make some positive changes. 

Stress and cortisol levels are important markers to consider in an evolving problem with insulin resistance.

Hormone imbalance can be another factor that will have a negative impact on weight management, and an evolving problem with insulin resistance.

• Are you on HRT or the Pill?  High oestrogen levels (often caused by these drugs) will stimulate the secretion of insulin.  If you don't have enough blood sugar to meet this insulin, you will get blood sugar lows that will make you reach for sugary snacks to fill them.

Drugs can also affect us:

• Steroid drugs often prescribed for asthma, inflammatory bowel diseases, arthritis and skin problems, can raise blood glucose levels, which can lead to insulin resistance;
• Beta-blockers, a type of drug for high blood pressure can decrease insulin sensitivity[3];
• Anti-depressants (SSRIs) such as Prozac and Citalopram have been known to interfere with blood glucose regulation as per manufacturer information.

A natural approach to appropriate diet and exercise, which includes assessment of related hormone levels, will make a big difference to:

• Weight management problems;
• Energy levels;
• Cosmetic advantages such as improved hair, skin and nails;
• Lowering of blood fats (cholesterol and triglycerides);
• Lowering of blood pressure;
• Achieving improved thyroid function.  (Your thyroid controls your metabolism.)

The best basic way to assess your client is to do an insulin and HbA1c test.  Testing fasting glucose levels only gives you a spot check, whereas HbA1c looks at the average glucose level over the last couple of months, and you can see exactly how insulin is responding.  This can all be done by the client in the privacy of their own home using a blood spot test.  It could otherwise take months, and a number of visits to their GP, to get to the point of this type of testing.

If insulin levels are up, supplements can be very helpful with improving glucose regulation and insulin sensitivity.  This will also help in any dietary or weight management advice being taken.

• Biotin is a B-complex vitamin, and high doses have been found to decrease glucose levels after a meal, assist glucose tolerance and insulin resistance in animal studies[4];
• Chromium is an essential trace mineral necessary for sugar metabolism[5];
• Vanadium is another mineral involved with improving insulin sensitivity[6];
• Alpha-Lipoic Acid has been found to activate insulin signalling and enhance glucose uptake[7];
• Banaba Leaf Extract has been shown to enhance transport of glucose into cells.  As appetite and certain food cravings are related to fluctuations in blood sugar and insulin, this may help with weight management programmes[8];
• Gymnema Sylvestre Extract can be very helpful with effective glucose metabolism[9].

There are many benefits to having good physical condition without the use of drugs, not least because they help you to lead a full and vital life that makes you and others happy.

References

1.    Centres for Disease Control and Prevention.  National diabetes fact sheet: general information and national estimates on diabetes in the USA. 2000.
2.    Dyson P.  Nutrition and diabetes control: advice for non-dieticians.  British J Commun Nursing; 7: 414-419. 2002.
3.    Gress TW, Nieto FJ, Shahar E, Wofford MR and Brancati FL.  Hypertension and anti-hypertensive therapy as risk factors for type 2 diabetes mellitus.  Atheroschlerosis Risk in Communities Study. N Engl. J Med; 342:905-12. 2000. 
4.    Zhang H, Osada K, Maebashi M, Ito M, Komai M and Furukawa Y.  A high biotin diet improves the impaired glucose tolerance of long-term spontaneously hyperglycaemic rats with non-insulin-dependent diabetes mellitus. J Nutr Science and Vitaminology (Japan); 42/6; 517 – 526. 1996.
5.    Wang Z, Zhang X, Russell J, Hulver M and Cefalu W. Chromium Picolinate Enhances Skeletal Muscle Cellular Insulin Signalling In Vivo in Obese, Insulin-Resistant Rats. American Society for Nutrition. J Nutr; 136: 415-420. 2006.
6.    Cohen N, Halberstam M, Shlimovich P, Chang CJ, Shamoon H and Rosseti L. Oral vanadyl sulfate improves hepatic and peripheral insulin sensitivity in patients with non-insulin-dependent diabetes mellitus. J Clin Invest; 95(6):2501-2509. 1995. 
7.    Jacob S, Streeper RS, Fogt DL, Hokama JY, Tritschler HJ, Dietze GJ and Henriksen EJ. The antioxidant alpha-lipoic acid enhances insulin-stimulated glucose metabolism in insulin-resistant rat skeletal muscle. Diabetes; 45(8): 1024-9. 1996.
8.    Judy WV, Hari SP, Stogsdill WW, Judy JS, Naguib YM and Passwater RJ. Anti-diabetic activity of a standardized extract (Glucosol) from Lagerstroemia speciosa leaves in Type II diabetics. A dose-dependence study. Journal of Ethnopharmacology; 87, 115-117. 2003.
9.    Baskaran K, Kizar Ahamath B, Radha Shanmugasundaram K and Shanmugasundaram ER. Anti-diabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients. J Ethnopharmacol; 30(3):295-300. 1990.