Non-Insulin Dependent Diabetes Melitus
In simple terms NIDDM is a condition in which blood sugar levels rise above normal for sustained periods of time. Over the long term it can contribute to heart disease, kidney disease, brain, foot and eye complications, to name but a few of its many complications.
What is Insulin Resistance (IR)?
In many cases IR is thought to precede NIDDM. Insulin is the hormone that regulates blood sugar levels. It basically acts as the key to the lock in the cell membrane that allows sugar to enter the cell.
When IR exists, insulin becomes less effective in regulating blood sugar levels. As a result, the pancreas must secret more insulin to maintain stable blood sugar levels. Hence the cells appear to be increasingly resistant to the effect of insulin, explaining the concept of Insulin resistance.
Are there any early signs of IR?
Abdominal obesity in particular (pear shapes) is an indication of the possibility of IR. Waist measures as follows are considered indicative of IR:
Europeans Male>94cm Female > 80 cm
South Asians(incl. Chinese) Male>90cm Female> 80 cm
How does Insulin Resistance progress to NIDDM?
Eventually the increase in insulin secretion cannot match what is required to maintain normal blood sugar levels. As a result blood sugar levels begin to rise, leading to the diagnosis of NIDDM.
What are the cornerstones of treating IR and NIDDM?
Diet and Exercise should always be the first approach to NIDDM.
What Healthy Eating Plan should I follow?
This depends upon whether you have IR or NIDDM. For IR, an Insulin Resistance Healthy Eating Plan is recommended, in which your intake of high carbohydrate foods is limited. If you have NIDDM, a Diabetes Healthy Eating Plan is recommended, in which all high carbohydrate foods are limited initially. Over time, if your insulin and blood sugar levels stabilise, you may step down to an Insulin Resistance (if starting on a Diabetes Healthy Eating Plan) or Optimal Health Eating Plan.
Of course any improvement in eating is better than no change to a currently poor eating programme.
Are there any Superfoods I should eat more of?
Carrots, Oats, Beans and Lentils. Fibre rich foods, lecithin granules and deep sea oily fish (for Omega 3 content).
Magnesium, Chromium and Zinc rich foods.
How important is breakfast?
Not eating breakfast may lead to blood sugar level changes. Lows may occur, particular if taking Diabetic medication, but some people notice high blood sugar levels instead, possible due to a stress response leading to the secretion of stored sugar from the liver.
What Nutrients/Herbs can assist with IR and NIDDM?
The following nutrients and herbs have been demonstrated to influence IR and hence NIDDM.
Magnesium, Zinc and Chromium Picolinate are important minerals that contribute to assisting insulin gain access for sugar into the cell membrane and to support the pancreas. You should obtain quality supplements from an integrative practitioner as cofactors to these nutrients are important in the effectiveness of their use. Fasting insulin, BSL and HbA1c (average 3 monthly BSLs) should be monitored after a 3 month regime.
The herbs Fenugreek, Gymnema Sylvestre, Panax Ginseng and Cinnamon are also thought to affect IR and sugar regulation.
What about a structured weight loss programme?
If you can join a structured weight loss programme and commit successfully, this may be an alternative. However, you should monitor your fasting insulin, BSL- blood sugar level and HbA1c to ensure the diet you have chosen is effective for your health, regardless of its effect on your weight.
How much exercise do I need to do?
Current guidelines to help overcome IR and NIDDM now range between 30-60 minutes of aerobic exercise per day. Of course, trying to do this at the start of a new programme may be difficult, so you should build towards these levels as rapidly as possible.
Is there a risk with Exercise and NIDDM?
This depends upon your risk of both Hypoglycemia (if you exercise too much) or Hyperglycemia (which may occasionally occur in the first few minutes of exercise if you already have high blood sugar levels).
Discuss your individual exercise guidelines with your Doctor, Diabetes Educator or Exercise Physiologists/Therapist, especially at the beginning of any new exercise programme.
Is managing the Effects of Stress important?
Yes. The physiological stress response, whether due to environmental, psychological or infective factors, leads to additional elevation in blood sugar levels. Chronic stress can therefore be a factor in maintaining ongoing high blood sugar levels and should be managed.
Stress, Life Balance, Emotional Intelligence, Spirituality
Any therapy that deals with your mental health may be an advantage.
Such interventions may include:
Relaxation and Meditation independent or as part of a Yoga programme
Other Effects Based Stress Managements techniques
Cause Based Stress Management Techniques
Achieving Work Life Balance
Learning to effectively manage Emotions
Prioritising Family and other Relationships (including healing old wounds)
Becoming connected with your community, environment and, if you are spiritual, the concept of God/Universe that matters to you.
What if I am prescribed medication?
An integrated approach to care works with prescription medicine when necessary. The key is to combine the use of medication in a coordinated manner where all Doctors and other health practitioners are in communication. The objective once blood sugar stability is achieved, is to wean off prescribed drugs through using Nutrients/Herbs and Lifestyle Medicine approaches. Ideally, if possible, you would then work on weaning your supplements and rely solely on Lifestyle modification.
One factor you must account for is the possible reduction of medication as the nutrient/herbs start to decrease blood sugar levels. If medication is not reduced in parallel with this, there is a significant risk of Hypoglycemic episodes.This is why it is imperative for your doctor to be aware of any supplement regime, exercise, diet and/or weight loss programme you are about to embark upon.
Smoking? The answer's Obvious
This is probably the most significant change you can make in your life if you are a smoker. If you cannot quit without assistance, this being the majority of smokers, it may be sensible to join a multidisciplinary programme. Peer support is often essential to the success of any quit smoking plan.
Remember, although pharmaceutical approaches that replace nicotine via chewing gum, patch or otherwise are often helpful, eventually they must be weaned otherwise you may simply be trading the risk of lung cancer for other diseases.
What other factors are important?
If you have NIDDM, you should educate yourself to the implications of the disease by discussing your condition with a Diabetes Educator.
In particular, you should be aware of how to measure your blood sugar levels, how frequently your Doctor wishes this to be done and how to identify the difference between a Hypoglycemic (symptomatically low blood sugar) and Hyperglycemic (symptomatically high blood sugar) attack.
As with all conditions, you should be fully aware of the risks and side effects of any medication you are taking, including any drug-nutrient-herb reactions that may be possible.
Every 3 months you should have a HbA1c test to establish the effectiveness of your NIDDM control. This may then be extended once good control is established.
Every year you should also have a foot check by a Podiatrist if you have NIDDM and a review of your eyes by an Optometrist to identify if there is any risk of NIDDM complications to the feet and eyes. Your doctor will also keep an eye on your kidney function as is necessary.
What other Medical Conditions must you manage?
You should also have your cardiac risk assessed (see Cardiovascular Disease) as 80% of NIDDM sufferers eventually die of cardiac complications.
Blood Pressure monitoring and treatment is also critical as high blood pressure accelerate the complications of NIDDM.
IR may also manifest in hormonal conditions in women as it encourages Oestrogen Dominance. For instance, Polycystic Ovaries is commonly associated with IR in younger women.