Over 30 million people in the United States alone have diabetes. It’s estimated that another 7.2 million already have the disease but aren’t aware of it. Diabetes and its complications are currently the 7th most common cause of death in the U.S. and the numbers continue to grow.
Type 1 Diabetes
Although they share the same primary symptom (high blood sugar), type 1 and type 2 diabetes are very different.
In type 1 diabetes, your body is unable to make enough insulin to meet your needs. There is no medication which can correct this, and it cannot be controlled through diet. People with type 1 diabetes must take insulin shots on a daily basis.
Type 1 diabetes is incurable, though research into various treatments including an artificial pancreas is ongoing. For more information see Type 1 diabetes.
What IS diabetes?
DIABETES MELLITUS– which most of us just know as “diabetes” –is a group of conditions in which your body cannot properly regulate the amount of glucose (sugar) in your blood. These conditions include type 1 diabetes, which is usually diagnosed in childhood; type 2 diabetes, which may occur in any age group; and gestational diabetes, which is unique to pregnant women and resolves after delivery. Type 2 diabetes is by far the most common of these, making up some 90% of cases of diabetes diagnosed.
Glucose is what your body uses for fuel. This simple sugar is what gives all your cells, from your heart to your brain to your skin cells, the power they need to do their jobs. Every single cell in your body uses glucose for energy, and you will have a certain amount of glucose in our blood at any given time.
However, having the right amount of glucose in your blood is important. If your blood sugar is too low, your cells don’t get the fuel they need to work properly. And if it’s too high, it can lead to damage throughout your body. High blood sugar can damage everything from your nerves to your kidneys and even your eyes. People with high blood sugar are also more likely to develop heart disease.
When you eat food, your body breaks much of it down into glucose. It’s then ferried around your body via your blood– which is why we talk about “blood glucose” or “blood sugar.” Your cells then take whatever glucose they need directly from your bloodstream. If your body is working properly, your blood sugar will neither get too high nor too low, but stay safely in between. If it’s not, you may end up with dangerously high or low levels of sugar. Keeping your blood sugar in the normal range is extremely important.
To do this, your body uses a hormone (a sort of chemical messenger) called insulin. When too much sugar builds up in your blood, your body releases insulin. The insulin travels through your body in your blood, making contact with all your cells.
This sends the cells a message to take in more sugar. And the more sugar your cells absorb, the less left in your blood. When your sugar level has come back into the normal range, your body turns off the insulin.
But when you have diabetes, this messaging system doesn’t work correctly. Your body may simply not be able to make enough insulin to send the message in the first place (type 1 diabetes). Or your cells may not be able to receive or respond to the message once it is sent (insulin resistance). In either case, the end result is chronically high blood sugar…which is what we call diabetes.
People with type 1 diabetes usually begin showing symptoms in childhood, which is why it’s sometimes called “juvenile diabetes.” There is no cure for type 1 diabetes. People who have the disease must take insulin for their entire lives.
Type 2 diabetes, which we used to call “adult-onset diabetes,” is more common and can affect people of any age. In the past, type 2 diabetes was most common in those who were middle-aged or older. However, in recent years the disease has become much more prevalent. Today it’s also common among younger adults and even children.
Unlike type 1 diabetics, people with type 2 diabetes may or may not need to take insulin—or any medication at all. Some people may be able to manage the disease simply by changing their diets. Others may need sugar-regulating medication, and still others may need insulin. Some people, especially people who have had the disease for a long time, may need a combination of all three approaches. Type 2 diabetes is typically progressive, becoming more serious and requiring more medication the longer you have it.
What are the main symptoms of type 2 diabetes?
Depending on how high your blood sugar is, and how long you’ve had diabetes, you may experience a variety of symptoms. These symptoms may range from mild to severe or even life-threatening. A handful of people may experience no symptoms at all, even when they’ve had diabetes for years.
The main symptoms of diabetes (the “big three”) are:
- Frequent urination. One of the ways your body tries to remove excess blood glucose is by filtering it out through your kidneys. This causes you to need to urinate more often.
- Excessive thirst. Because your body is losing water through higher urine output, you may become dehydrated. This cause you to be thirsty. The dehydration and accompanying thirst may be mild, or in more severe cases your thirst may be almost unquenchable.
- Increased appetite. In the non-diabetic body, once your blood sugar hits a certain level your body releases insulin. Not only does this tell your cells to absorb more glucose from your blood, it also signals your body to produce the hormone which tells you that you’re full. When your body is unable to produce enough insulin, or your cells are unable to respond to insulin, your brain never gets the message that you’re full. This leaves you feeling hungry even when you shouldn’t be.
Other common symptoms include:
- Daytime fatigue, especially if it occurs after meals
- Itchy skin
- Slow healing of wounds
- Frequent infections
- Sudden weight loss
- Recurring yeast infections
- Blurred vision
If your blood glucose is severely elevated, you may also experience:
- Dizziness or lightheadedness
- Hot, dry skin
- Drowsiness or difficulty waking up
If your blood sugar gets too high, you may become confused or disoriented and even lose consciousness.
All of these may also be symptoms of other conditions. However you experience one or more on a regular basis, or if you experience several, you could have undiagnosed diabetes.
What causes type 2 diabetes?
While we’ve long known that there’s a strong link between excess weight and type 2 diabetes, the exact cause of the disease is still a matter for debate. There is, however, strong evidence that fat deposits in and around internal organs—specifically the pancreas and liver—may lead to type 2 diabetes.
Professor Roy Taylor, one of the world’s leading diabetes researchers, has shown that decreasing fat in and around the pancreas by only a gram can reverse type 2 diabetes in 50-80% of patients. People who have weight-loss surgery also often find their diabetes reverses itself once they lose a significant amount of weight.
Although there’s no consensus as to the cause of type 2 diabetes, there are a variety of factors which make you more likely to develop it. These include:
- Genetics. Type 2 diabetes tends to run in families. If you have a parent or sibling with diabetes, you’re at higher risk than if your family is diabetes-free. If one of your parents is diabetic, your risk for type 2 diabetes increases by 15%, and if both parents have diabetes skyrockets by 75%. You’re also more likely to develop type 2 diabetes if you are:
An Alaskan Native
Or a Pacific Islander
- Excess body weight. Or more accurately, excess body fat– especially fat around your belly. The more body fat you have, the higher your risk of type 2 diabetes.
- Large waist size. Women with a waist size larger than 31.5 inches or men with a waist above 37 inches are more likely to develop type 2 diabetes, even if they appear to be normal-weight. This may be because a large waist size can be the result of fat around the internal organs.
- Sedentary lifestyle. The less physical activity you get, the greater your diabetes risk. Physical activity uses up blood glucose for energy, and increases your insulin sensitivity.
- While type 2 diabetes has become a disease that affects all ages, you’re still more likely to develop the condition in middle age or later. The older you are, the more likely it becomes.
Some risk factors are specific to women:
- Gestational diabetes. If you developed gestational diabetes during a pregnancy, you’re more likely to have type 2 diabetes later in life.
- Very large baby. Likewise, if you delivered a baby weighing nine pounds or more, you’re more likely to be come diabetic at a later date.
- Polycystic ovary syndrome. Although we don’t know why, women who have polycystic ovary syndrome have a higher risk of type 2 diabetes than women who don’t have the condition.
And finally, some medications can contribute to the development of diabetes. These include:
- Some types of diuretics or “water pills”
- Some anti-seizure medications
- Some HIV drugs
- Pentamidine, which is used to treat Pneumocystis pneumonia
- Glucocorticoid medications, used to treat asthma and certain autoimmune diseases such as rheumatoid arthritis
- Some psychiatric drugs
- Anti-rejection medications taken by organ-donation recipients
What kind of treatment is available for type 2 diabetes?
Drug side effects
Although most people with type 2 diabetes are on some type of drug regimen, drug therapy can have its downside. Each class of drugs comes with side effects, and those effects range from mildly annoying (like dry mouth) to severe (some diabetes drugs have been linked to life-threatening problems like heart attack or cancer). The section below lists some of the more severe and more surprising possible side effects of common diabetes drugs. If you are taking diabetes medications, talk to your doctor about all possible side effects.
Metformin: Low blood sugar, vitamin B12 deficiency, flu-like symptoms, weakness, abnormal liver function, hepatitis, chest pain, heart palpitations, skin rash, discolored nails, hives, infections (very common), muscle pain, lightheadedness, taste disturbances, and hay fever. For a complete list of side effects see Metformin’s page at Drugs.com.
Sulfonylureas: Pancreatitis (inflammation of the pancreas), blindness, low production of red blood cells, overproduction of white blood cells, clotting disorders, aplastic anemia, jaundice, hepatitis, abnormal liver function, kidney failure, arthritis, convulsions, deafness, psychosis, heart arrhythmia, high blood pressure, gastrointestinal bleeding, joint pain, muscle pain, migraines, conjunctivitis (“pinkeye”), retinal hemorrhage, insomnia, confusion, depression, hair loss, liver damage, fainting, difficulty breathing, brain damage, anaphylaxis (anaphylactic shock), inflammation of the blood vessels. For a complete list of side effects see the following pages at Drugs.com: DiaBeta, Glynase, Glucotrol, and Amaryl
Meglitinides: Low blood sugar (in over 1/3 of patients), poor circulation (common), high blood pressure, chest pain (common), angina (common), heart attack, heart palpitations, arrhythmia, other serious cardiovascular events, allergies, anaphylaxis, tooth isorders, pins-and-needles sensation, pancreatitis, back pain, upper respiratory infections (in up to 16% of patients), bronchitis, sinusitis, hepatitis, severe liver dysfunction, urinary tract infections (common), hair loss, joint inflammation, swelling of feet or hands. For a complete list of side effects see the following pages at Drugs.com: Prandin and Starlix.
DPP-4 inhibitors: Acute pancreatitis (including fatal and non-fatal hemorrhagic or necrotizing pancreatitis), Interstitial lung disease, anaphylaxis, impaired kidney function, foot pain, osteoarthritis, disabling joint pain, joint inflammation, high blood pressure (common), upper respiratory tract infections (common), low blood sugar (common), high cholesterol, high triglycerides, congestive heart failure, gastroenteritis (common), erectile dysfunction, muscle pain (common), anxiety, depression, death due to pancreatitis, blisters on the skin (some requiring hospitalization), acid reflux, bowel obstruction, severe skin reactions. For a complete list of side effects see the following pages at Drugs.com: Januvia, Onglyza, Tradjenta, and Nesina.
GLP-1 receptor agonists: Acute hemorrhagic or necrotizing pancreatitis, including deaths; intestinal obstruction, toothache, gallbladder disease, dehydration, abnormal sense of taste, elevated heart rate, urinary tract infections, kidney failure, jaundice, hepatitis, thyroid cancer, thryroid tumors, viral gastroenteritis, acid reflux, toothache, high blood pressure (common), hair loss, erectile dysfunction, muscle and joint pain, muscle spasms, diabetic neuropathy, depression, influenza. For a complete list of side effects see the following pages at Drugs.com: Victoza and Byetta.
SGLT2 inhibitors: Yeast infections, urinary tract infections, lower limb amputations (double the rate of those not taking the drug), increased risk of broken bones, decrease in bone mineral density, inflammation or infection of the penis, kidney infection, fainting, low blood pressure, acidosis requiring hospitalization, dangerously high potassium levels, low blood sugar, high cholesterol, ketoacidosis, kidney damage (including deaths), electrolyte imbalance, influenza, bladder cancer (with Fargixa), hepatitis. For a complete list of side effects see the following pages at Drugs.com: Invokana and Farxiga.
Actos and Avandia: [Actos] Congestive heart failure (common), death from congestive heart failure, heart failure, chest pain, low blood sugar, weight gain, upper respiratory infections (common), abcessed teeth, urinary tract infection, bone fractures (50% increase in those taking the drug), muscle cramps, joint or muscle pain, impaired sense of touch, influenza, bladder cancer. [Avandia] Heart failure, angina, heart attack, coronary artery disease, anemia (common), jaundice, liver failure, low blood sugar (common), high blood sugar (common), high cholesterol (common) weight gain, resumption of ovulation in post-menopausal women, diabetic macular edema, pulmonary edema, back pain (common), increased likelihood of fractures. For a complete list of side effects see the following pages at Drugs.com: Actos and Avandia.
Often, side effects don’t become obvious until a drug has been on the market for some time. If you have symptoms that you feel are related to a medication you’re taking, discussing them with your doctor is always a good idea. You can also make a side-effects report to the FDA here.
The established medical view is that type 2 diabetes is a life-long disease which cannot be reversed or cured but only managed. Treatment focuses on reducing blood sugar to within normal range.
Although many people with type 2 diabetes may be able to control their glucose levels through diet and exercise alone, the most common treatment is still drug therapy. Most patients are started on drug therapy at diagnosis whether lifestyle changes are recommended or not.
There are several classes of prescription drugs which reduce blood sugar. Patients generally start out on milder medication and as the disease progresses, more medications may be added or stronger medications substituted. In advanced or long-term type 2 diabetes, insulin therapy is not uncommon.
Some of the most common drugs prescribed for type 2 diabetes include:
- Metformin. This drug is sold under the brand names Glucophage, Glumetza, Fortamet, and Glucophage XR and is one of the oldest diabetes drugs on the market. It’s also an ingredient in come combination medications.
Metformin works by improving your body’s insulin sensitivity. It has fewer and milder side effects than many other diabetes medications and is often the first-line treatment. It is commonly prescribed in combination with diet and lifestyle changes. However, metformin alone may not control blood sugar well enough. In this case, other medications may be added. Most patients begin with metformin and progress through steadily stronger medications as the disease progresses. Common side effects include nausea and diarrhea.
- Sulfonylureas. This class of drugs includes medications such as DiaBeta, Glynase, Glucotrol (glipizide), and Amaryl (glimepiride), which work by telling your pancreas to produce more insulin. Common side effects are weight gain and low blood sugar.
- Meglitinides. Drugs in this class, such as Prandin (repaglinide) and Starlix (nateglinide) also cause your body to make more insulin. However, they’re faster-acting than sulfonylurea drugs and their effect wears off faster. Common side effects also include weight gain and low blood sugar, though the risk is less than with sulfonylureas.
- DPP-4 inhibitors. A fairly new class of drugs, DPP-4 inhibitors or “gliptins” include drugs such as Januvia (sitagliptin), Onglyza (saxagliptin), Tradjenta (lingliptin), and Nesina (alogliptin). They tend to have a more moderate effect than other drug classes and are often mixed with metformin in combination medicines such as Janumet or Kazano. Common side effects include headache, respiratory infections, urinary tract infections, and other infections. Less common but more serious side effects include severe and crippling joint pain.
- GLP-1 receptor agonists. Examples of drugs in this class include Victoza (liraglitude) and Byetta (exenatide). These drugs slow digestion, lowering blood sugar levels, and may even promote mild weight loss. However, they are less effective at lowering blood sugar than other medications and are seldom prescribed alone. Nausea is a common side effect, and they increase the risk of pancreatitis (inflammation of the pancreas.)
- SGLT2 inhibitors such as Invokana (canagliflozin) and Farxiga (dapagliflozin) are the “new kids on the block” in the world of diabetes treatment. Unlike other diabetes drugs, they work by stopping your kidneys from reabsorbing sugar into your blood and allowing it to be removed through your urine instead. Yeast infections and urinary tract infections are common with these medications, as are increased urination and low blood pressure.
- The drugs Actos (pioglitazone) and Avandia (rosiglitazone), although banned in Europe due to the risk of severe or life-threatening side-effects, are sometimes prescribed when other diabetes drugs fail. Like metformin, these two drugs increase your body’s insulin sensitivity. Common side effects include headaches, water retention, cold symptoms, upper respiratory infections, and low blood sugar.
- Insulin. Although insulin used to be a last-resort drug for type 2 diabetics, it’s being prescribed increasingly earlier in recent years. Insulin is marketed under the brand names Apidra, Humalog, Novolog, Lantus, Levemir, and Humulin N or Novolin N.
Insulin is most commonly injected (digestion interferes with insulin taken by mouth, so there is no oral form), but wearable insulin pumps which dispense carefully calculated doses at specific times are also a possibility. The most common side effect of insulin therapy is low blood sugar.
Bariatric surgery (weight-loss surgery) may also treat type 2 diabetes. Many people undergoing weight loss surgery find their type 2 diabetes reverses itself after the procedure, and it is increasingly being promoted as a possible treatment for type 2 diabetes patients who are morbidly obese.
Natural treatment for type 2 diabetes
The internet abounds with claims of natural, non-drug treatments for type 2 diabetes…but do any of them work? Many of the “home remedies” for diabetes are simply old wives’ tales. A small percentage of them, on the other hand, have been shown to have a real effect on your blood sugar.
Approximately 90% of people with type 2 diabetes are overweight or obese, and the evidence is clear: significant weight loss is an effective, drug-free treatment for type 2 diabetes. This is the one factor which the three clinically-proven diabetes-reversal treatments have in common. However, the key word is significant weight loss—that is, weight loss amounting to 15% or more of starting body weight. This is an intimidating goal for many people, and they often look for easier natural treatments such as supplements.
For those who are pre-diabetic or who are able still able to control their diabetes through diet, some supplements may be a beneficial addition to their diabetes management program, though the evidence is mixed. These include:
Cinnamon: (Specificially, cassia cinnamon. Ceylon cinnamon has not been studied in conjunction with diabetes.) Some studies have found that supplementing with 1.5 to 6 grams of cinnamon per day may help lower blood glucose levels. However, the studies have all been small, and while some have found cinnamon to be very effective others have not had the same result. As is so often the case with natural treatments, the evidence is conflicting. While cinnamon might be helpful in conjunction with other diabetes treatment, it’s probably not wise as a stand-alone treatment.
Chromium picolinate: The evidence for this essential mineral is somewhat more consistent. Chromium picolinate supplementation does appear to help lower fasting glucose levels and to have some effect on HbA1c values. However, the effect is not great enough to discontinue diabetes medications and once again this supplement is probably better as an adjunct to conventional treatment.
Bitter melon: This herbal supplement is widely promoted as an anti-diabetic agent and is a traditional natural treatment in some parts of the Eastern world. In animal studies it appears promising, but few human studies have been done. Many of the human studies which have been performed have had design flaws which make them unreliable.
Alpha-lipoic acid (ALA): While there is disagreement over whether this antioxidant compound improves blood glucose levels or not, it has been shown to be beneficial in treating and in preventing diabetic neuropathy and macular degeneration associated with diabetes. Animal studies suggest that it may be helpful for preventing type 2 diabetes in the first place, and that it may have a protective effects on the insulin-producing cells of the pancreas.
While these supplements may be helpful when used in conjunction with other diabetes treatment, none of them appears to be suitable as a standalone treatment. There are, however, two natural treatments which have been clinically proven not just to treat type 2 diabetes but, in many cases, to actually reverse it.
The first of these is significant weight loss through a very low calorie diet (VLCD). This was the approach taken by the three Newcastle studies, which demonstrated that type 2 diabetes can in fact be reversed in 50-80 percent of patients.
In the first two studies, participants followed a VLCD consisting of meal replacement shakes that totaled 600-700 calories per day for 8 weeks. By the end of week 1, participants had normal fasting glucose levels and by the end of the diet 50-80 percent (depending on the length of time they had been diabetic) were diabetes-free. All had lost substantial amounts of weight (30 pounds or more). Follow-up appointments (at 3 months for the first study and 6 months for the second) showed that those who were able to sustain the weight loss remained diabetes-free.
The third study, which is still ongoing but which published its initial 1-year results last year, has shown the same results although the calorie allotment has increased somewhat (to 825 calories per day) over a slightly longer time frame (3 months instead of 2).
A very low-carbohydrate diet (also known as a ketogenic diet) has also been clinically proven to treat and in many cases even reverse type 2 diabetes. The ketogenic diet drastically cuts carbohydrates, replacing them with healthy fat instead. In clinical studies, ketogenic diets reduce blood glucose, improve insulin sensitivity, and reduce both cholesterol and triglyceride levels. Ketogenic diets, like VLCDs, also result in significant weight loss.
Information on the Newcastle studies and Professor Taylor’s work:
http://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/low-calorie-diet-article.pdf http://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/long-versus-short-term-reversal-article.pdf http://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/DiRECT1yearResults.pdf http://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/PersonalFatThreshold_Paper.pdf http://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/long-versus-short-term-reversal-article.pdf http://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/2017%20Diabetes%20reversal%20info.pdf https://campus.recap.ncl.ac.uk/Panopto/Pages/Viewer.aspx?id=c3bef819-e5f4-4a55-876f-0a23436988ed http://care.diabetesjournals.org/content/39/11/2080 http://care.diabetesjournals.org/content/36/4/1047 http://onlinelibrary.wiley.com/doi/10.1111/dme.12039/full https://www.ncbi.nlm.nih.gov/pubmed/21656330 https://link.springer.com/article/10.1007/s00125-011-2204-7
Comprehensive list of current studies on low-carbohydrate diets with regard to type 2 diabetes, weight loss, and to a lesser degree, cardiovascular disease, with synopses of findings: