INTRODUCTION
As the 6th leading cause of death in the United States, we urgently need to address the diabetes crisis, which is largely preventable. “In the forty years between 1958 and 1998, the number of Americans diagnosed with diabetes rose 600 percent!”1 Though some of the increase is due to more people being tested, the surge is still alarming and one that is continuing with children growing in the number of those diagnosed.
What is diabetes
Diabetes is a disease in which your blood sugar levels are highly elevated, due to either the lack of insulin production or insulin resistance and insufficiency. In type I diabetes, cell in the pancreas are unable to produce insulin, the hormone responsible for transporting glucose into your cells to be used for energy. More common is type II diabetes, where not enough insulin is produced or the cells are not responding the the insulin’s presence.
Symptoms
- Extreme hunger
- Extreme thirst
- Frequent urination
- Unexplained weight loss
- Fatigue or drowsiness
- Blurry vision
- Slow-healing wounds, sores or bruises
- Tingling or numbness in the hands or feet
- Frequent or recurring skin, gum, bladder or vaginal yeast infections
Prevalence
According to data from the CDC, there are over 30 million people in the US (9.4% of the population) diagnosed with diabetes. 7.2 million of those are undiagnosed. Of those 65 years of age and older, 25.% are diagnosed.
Estimated age-adjusted prevalence of diagnosed diabetes by race/ethnicity and sex among adults aged ≥18 years, United States, 2013–2015
“An estimated 33.9% of U.S. adults aged 18 years or older (84.1 million people) had prediabetes in 2015, based on their fasting glucose or A1C level. Nearly half (48.3%) of adults aged 65 years or older had prediabetes”2
Based on a recent publication in the National Institutes of Health, the incidence of diabetes is expected to grow by 54% between 2015 and 2030. 3
Risk Factors
- Diet high in saturated fat and refined carbohydrates
- Obesity
- Age (increased risk after 45, though there is increasing incidence in children)
- Race / Ethnicity
- Native American
- Hispanic American
- African American
- Pacific Islander
- Sedentary lifestyle / lack of exercise
- Gestational diabetes (occurs during pregnancy) and goes away afterwards. Around 50% of women with gestational diabetes will go on to develop type II diabetes within 15 years.
Stress
A lesser known but equally important risk factor is stress. Usually associated with a negative effect, stress has historically played a role in keeping us safe from predators and other dangers. Stress activates our sympathetic nervous system via the fight or flight reaction. In order to provide our muscles with the energy needed to react to a potentially dangerous situation, the hormone cortisol is released from the adrenal glands. Cortisol then triggers the release of insulin to transport the needed sugar into the bloodstream.4
Over time, when the body experiences repetitive stress, but the glucose mobilized isn’t used, it stays in the bloodstream. This reaction also happens with chronic lack of sleep.
Complications
Among the most serious of complications from diabetes is heart disease.
“People with diabetes develop heart disease at younger ages and are nearly twice as likely to die of heart attack or stroke as people who do not have diabetes.”5 This is more common in people with type II diabetes than type I, but the causes are not clear.
Because people with diabetes have difficulty controlling the blood sugar level, they are more susceptible to hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) levels, both of which can be life-threatening if unchecked.
Other complications are kidney disease, loss of vision and nerve damage.
Management
Diet
Above all, diet will play the the most significant role in how diabetes is precipitated or managed.
Reduce and or eliminate all refined carbohydrates and sugary drinks, such as pastries, white rice and potatoes, sodas and other sugary flavored beverages. Consume less saturated fats and more fresh vegetables (not canned) and a minimal amount of whole grains.
Juicing has its benefits, but people with diabetes should use caution before starting a juicing diet. Since you are not eating the fiber contained in the fruit, your body will metabolize the sugar in the juice at a much faster rate, spiking your blood sugar levels.
Carefully read the labels on any packaged foods. Avoid foods with high fructose syrup and other artificial sweeteners. A crucial piece of information which will not be on a label is the glycemic index. Glycemic index is the amount, (usually 50 grams) of an ingested carbohydrate, which raises the blood sugar level for a period of time, compared to the same amount of pure glucose.
Recent studies have shown that people that adhere to a low carbohydrate diet over a short-term have reduced their insulin levels; while people on the same diet over the long term did not show a significant difference in insulin levels. Doctors suggest that the discrepancy may be due to the consistency in maintaining the diet.
Here is a partial list of foods by their glycemic index:6
| FOOD | Glycemic index (glucose = 100) | Serving size (grams) | Glycemic load per serving |
| BAKERY PRODUCTS AND BREADS | |||
| Banana cake, made with sugar | 47 | 60 | 14 |
| Sponge cake, plain | 46 | 63 | 17 |
| Baguette, white, plain | 95 | 30 | 14 |
| Coarse barley bread, 80% kernels | 34 | 30 | 7 |
| Hamburger bun | 61 | 30 | 9 |
| Pumpernickel bread | 56 | 30 | 7 |
| White wheat flour bread, average | 75 | 30 | 11 |
| Whole wheat bread, average | 69 | 30 | 9 |
| 100% Whole Grain® bread (Natural Ovens) | 51 | 30 | 7 |
| Pita bread, white | 68 | 30 | 10 |
| Corn tortilla | 52 | 50 | 12 |
| Wheat tortilla | 30 | 50 | 8 |
| BEVERAGES | |||
| Coca Cola® (US formula) | 63 | 250 mL | 16 |
| Fanta®, orange soft drink | 68 | 250 mL | 23 |
| Apple juice, unsweetened | 41 | 250 mL | 12 |
| Cranberry juice cocktail (Ocean Spray®) | 68 | 250 mL | 24 |
| Gatorade, orange flavor (US formula) | 89 | 250 mL | 13 |
| Orange juice, unsweetened, average | 50 | 250 mL | 12 |
| Tomato juice, canned, no sugar added | 38 | 250 mL | 4 |
| BREAKFAST CEREALS AND RELATED PRODUCTS | |||
| All-Bran®, average | 44 | 30 | 9 |
| Coco Pops®, average | 77 | 30 | 20 |
| Cornflakes®, average | 81 | 30 | 20 |
| Cream of Wheat® | 66 | 250 | 17 |
| Grape-Nuts® | 75 | 30 | 16 |
| Oatmeal, average | 55 | 250 | 13 |
| Instant oatmeal, average | 79 | 250 | 21 |
| Special K® (US formula) | 69 | 30 | 14 |
| GRAINS | |||
| Pearled barley, average | 25 | 150 | 11 |
| Sweet corn on the cob | 48 | 60 | 14 |
| Couscous | 65 | 150 | 9 |
| Quinoa | 53 | 150 | 13 |
| White rice, boiled, type non-specified | 72 | 150 | 29 |
| Brown rice, steamed | 50 | 150 | 16 |
| COOKIES AND CRACKERS | |||
| Graham crackers | 74 | 25 | 13 |
| Vanilla wafers | 77 | 25 | 14 |
| Rice cakes, average | 82 | 25 | 17 |
| Soda crackers | 74 | 25 | 12 |
| DAIRY PRODUCTS AND ALTERNATIVES | |||
| Ice cream, regular, average | 62 | 50 | 8 |
| Milk, full-fat, average | 31 | 250 mL | 4 |
| Milk, skim, average | 31 | 250 mL | 4 |
| Reduced-fat yogurt with fruit, average | 33 | 200 | 11 |
| FRUITS | |||
| Apple, average | 36 | 120 | 5 |
| Banana, raw, average | 48 | 120 | 11 |
| Dates, dried, average | 42 | 60 | 18 |
| Grapefruit | 25 | 120 | 3 |
| Grapes, black | 59 | 120 | 11 |
| Oranges, raw, average | 45 | 120 | 5 |
| Peach, average | 42 | 120 | 5 |
| Pear, raw, average | 38 | 120 | 4 |
| Prunes, pitted | 29 | 60 | 10 |
| Raisins | 64 | 60 | 28 |
| Watermelon | 72 | 120 | 4 |
| BEANS AND NUTS | |||
| Baked beans | 40 | 150 | 6 |
| Black-eyed peas | 50 | 150 | 15 |
| Black beans | 30 | 150 | 7 |
| Chickpeas | 10 | 150 | 3 |
| Chickpeas, canned in brine | 42 | 150 | 9 |
| Navy beans, average | 39 | 150 | 12 |
| Kidney beans, average | 34 | 150 | 9 |
| Lentils | 28 | 150 | 5 |
| Soy beans, average | 15 | 150 | 1 |
| Cashews, salted | 22 | 50 | 3 |
| Peanuts | 13 | 50 | 1 |
| PASTA and NOODLES | |||
| Macaroni and Cheese (Kraft®) | 64 | 180 | 33 |
| Spaghetti, white, boiled, average | 46 | 180 | 22 |
| Spaghetti, whole-grain, boiled | 42 | 180 | 17 |
| SNACK FOODS | |||
| Corn chips, plain, salted | 42 | 50 | 11 |
| M & M’s®, peanut | 33 | 30 | 6 |
| Microwave popcorn, plain, average | 65 | 20 | 7 |
| Potato chips, average | 56 | 50 | 12 |
| Snickers Bar®, average | 51 | 60 | 18 |
| VEGETABLES | |||
| Green peas | 54 | 80 | 4 |
| Carrots, average | 39 | 80 | 2 |
| Baked russet potato | 111 | 150 | 33 |
| Boiled white potato, average | 82 | 150 | 21 |
| Instant mashed potato, average | 87 | 150 | 17 |
| Sweet potato, average | 70 | 150 | 22 |
| Yam, average | 54 | 150 | 20 |
| MISCELLANEOUS | |||
| Hummus (chickpea salad dip) | 6 | 30 | 0 |
| Chicken nuggets, frozen, reheated in microwave oven 5 min | 46 | 100 | 7 |
| Pizza, plain baked dough, served with parmesan cheese and tomato sauce | 80 | 100 | 22 |
| Honey, average | 61 | 25 | 12 |
Exercise
“Experts recommend moderate-intensity physical activity for at least 30 minutes on 5 or more days of the week. Some examples of moderate-intensity physical activity are walking briskly, mowing the lawn, dancing, swimming, or bicycling.” 7
In response to vigorous exercise, the pancreas releases a hormone called glucagon, which works as the antagonist to insulin — it helps regulate blood glucose levels and metabolize fat. Even if you are not diabetic or prediabetic, you still benefit from exercise and physical activity, through improved cardiovascular health, weight loss, and muscle strength.
The American Diabetes Association has an official position on the effects of exercise on diabetes; you can read the entire statement here. By in large, the main benefit of exercise for different types of diabetes is a reduction in insulin resistance. They carefully point out the effects of specific exercises based on the type of diabetes. For example, with type 1 diabetes, resistance exercise helps reduce the risk of exercise-induced hypoglycemia as compared to aerobic exercise.8
In a population with a high sedentary lifestyle, there is a greater risk of mortality. Simple activities such as walking 15 minutes after meals and taking 5 minute breaks every 30 minutes, helps to control blood glucose levels.
Acupuncture
The hypothalamus pituitary adrenal (HPA) axis is responsible for the release of hormones during a stress response. By assisting to regulate the HPA and releasing endorphins, acupuncture can help reduce stress9, thereby inhibiting the release of cortisol and reducing insulin levels.
An abstract10 from PubMed references a review analysis of over 234 publications, which support the use of acupuncture for the treatment of insulin resistance. Though the evidence is limited, there is enough significance to show that clinical randomized controlled trials are warranted.
References
1. Steward, H. L. (2003). The new sugar busters!: cut sugar to trim fat. New York: Ballantine Books.
2. National Diabetes Statistics Report, 2017 Estimates of Diabetes and Its Burden in the United States [PDF]. (2017). CDC. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
3. Rowley, William R., et al. “Diabetes 2030: Insights from Yesterday, Today, and Future Trends.” Population Health Management, Mary Ann Liebert, Inc., 1 Feb. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5278808/
4. “A Closer Look at Cortisol.”Intensive Dietary Management (IDM), 30 Oct. 2017,www.idmprogram.com/closer-look-cortisol-hormonal-obesity-xxxx
“Acupuncture in Diabetes Treatment.” Evidence Based Acupuncture, 19 Dec. 2014, www.evidencebasedacupuncture.org/diabetes/
5. How Do People Die From Diabetes? www.nytimes.com/2017/10/13/well/how-do-people-die-from-diabetes.html
6. Publishing, Harvard Health. “Glycemic Index and Glycemic Load for 100+ Foods.” Harvard Health, www.health.harvard.edu/diseases-and-conditions/glycemic-index-and-glycemic-load-for-100-foods
7. staff, familydoctor.org editorial. “Diabetes.” Familydoctor.org, 1 Feb. 2017, www.familydoctor.org/condition/diabetes/
8.Colberg, Sheri R., et al. “Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association.” Diabetes Care, American Diabetes Association, 1 Nov. 2016, care.diabetesjournals.org/content/39/11/2065.
9.Goetz, Teri. “Acupuncture for Stress and Depression? Yes, Please!” Psychology Today, Sussex Publishers, 28 Sept. 2015, www.psychologytoday.com/blog/renaissance-woman/201509/acupuncture-stress-and-depression-yes-please.
10.Liang, F, and D Koya. “Acupuncture: is it effective for treatment of insulin resistance?” Diabetes, obesity & metabolism., U.S. National Library of Medicine, July 2010, www.ncbi.nlm.nih.gov/pubmed/20590731.
