Diabetes Book

"Take Charge of Your Diabetes" is an excellent book on diabetes, written by Dr. Zaidi, a leading endocrinologist. In this book on diabetes, Dr. Zaidi showcases his ground breaking, revolutionary approach to the treatment of diabetes. His unique approach to treat diabetes is based on treating insulin resistance, the root cause of diabetes in the vast majority of the diabetics.

The results of this new scientific approach to treat diabetes:

Most people DO NOT  end up on insulin. Those Type 2 diabetics who are insulin can come off insulin.

Only rare occurrence of low blood glucose ( hypoglycemia).

With the passage of time, you decrease the number of antidiabetic medications, instead of increasing them, as is the usual result if you follow the traditional approach to treat diabetes.

You not only achieve an excellent control of diabetes but also prevent complications of diabetes, because complications of diabetes are simply other manifestations of insulin resistance, besides diabetes.

Take Charge of Your Diabetes

Table of Contents

Introduction

PART I Understanding and Diagnosing Diabetes

CHAPTER 1 What Is Diabetes?

CHAPTER 2 What Causes Diabetes?

CHAPTER 3 Diagnosing Diabetes

CHAPTER 4 The Conventional Treatment for Diabetes and Its Flaws

PART II Taking Charge of Your Diabetes

 CHAPTER 5 The Five Pillars of Treatment

CHAPTER 6 Dr. Z’s Diabetic Diet

CHAPTER 7 Exercise and Managing Your Stress

CHAPTER 8 Vitamins and Herbal Medicines

CHAPTER 9 Using Prescription Medications to Help Control Type 2 Diabetes

CHAPTER 10 Treating Type 1 Diabetes

PART III Preventing, Stopping, and Even Reversing Complications of Diabetes

CHAPTER 11 Managing Complications of Diabetes

CHAPTER 12 Monitoring Guidelines

Notes

Acknowledgements

Index

Sample Chapters

Introduction

 George, a Caucasian male, came to see me for his diabetes, after undergoing three angioplasties in two years. Despite following his doctor’s advice—adhering to a conventional antidiabetic regimen of a special diet, more exercise, and insulin injections—he developed severe coronary artery disease. He was obviously quite demoralized. It shouldn’t have to be this way.

In the last fifteen years, there has been a tremendous amount of research in the field of diabetes, and the resulting treatment changes are revolutionary. Unfortunately, most doctors have not embraced these new scientific developments. They continue to treat diabetes with an outdated, conventional approach that merely focuses on lowering blood glucose but does not treat the underlying root cause of diabetes. It’s like trying to halt the growth of a poisonous tree by trimming its branches. Meanwhile, the roots continue to grow stronger. Using new scientific research and developments, I developed a revolutionary approach to treating diabetes. With my new treatment strategy, most diabetic patients can avoid insulin injections and do well with new oral medications. They can truly prevent deadly complications of diabetes! Those who have already developed complications, like George, can prevent further damage.

Most people develop diabetes due to a complex disease process in their body known as insulin resistance. It takes many years of insulin resistance before you become diabetic. During this time, insulin resistance causes many other changes in your body that are quite harmful. For example, insulin resistance increases serum triglycerides (the fat in blood), lowers HDL cholesterol (the good cholesterol), and changes LDL cholesterol (the bad cholesterol) from Type A (less dangerous) to Type B (more dangerous). In addition, insulin resistance increases blood pressure, makes it easier for blood to clot, and impairs our body’s natural ability to break down blood clots. All of these abnormalities set the stage for a heart attack and/or stroke.

When I first saw George, his diabetes was out of control despite insulin shots. He was on the usual, conventional treatment for diabetes. For years, he took glyburide, an oral medication, which initially controlled his blood glucose. Predictably, after a few years, his blood glucose started escalating, and glyburide was of no help. Glyburide is an old drug and belongs to the class of drugs known as sulfonylurea drugs. Other drugs in this class include glipizide, glimepiride, and chlorpropamide. Before 1994, these were the only oral drugs available in the U.S. for the treatment of Type 2 diabetes. These sulfonylurea drugs act by stimulating the pancreas to produce more insulin, but they do not treat insulin resistance. This treatment is like flogging a tired horse. Eventually the horse slows down, stumbles, and drops dead. George’s exhausted pancreas, like a tired horse, could not produce enough insulin despite stimulation from sulfonylurea drugs. Eventually, he had to go on insulin shots to control his diabetes. However, once again, this was an ineffective strategy. The reason? Like sulfonylurea drugs, insulin shots do not treat insulin resistance. Eventually, most diabetic patients using insulin shots, like George, develop coronary heart disease requiring angioplasties or even heart bypass surgery. They are also at a high risk for a stroke and leg amputation.

Ten years ago, I realized that to effectively treat Type 2 diabetics, insulin resistance must be treated first and foremost. I developed a new, revolutionary, and still cutting-edge strategy that focuses on treating insulin resistance instead of merely chasing blood sugar levels. Once insulin resistance is treated, the burden of excessive insulin production on the pancreas is gone. Relieved of the stress of overproducing insulin, the pancreas begins to work efficiently again. As a result, patients achieve long-lasting control of blood sugars without stressing the pancreas. They do not have to resort to insulin injections. Many of those who are already on insulin shots can gradually be weaned off.

My new treatment plan, outlined in this book, not only controls diabetes but also reduces serum triglycerides, increases HDL (good) cholesterol, changes LDL cholesterol from Type B (more dangerous) to Type A (less dangerous), and re-establishes the body’s ability to break clots. It accomplishes these major goals by effectively treating insulin resistance—the root cause of these medical disorders. In this way, my new treatment strategy significantly reduces the risk for heart attack, stroke, leg amputation, dementia, kidney disease, and other complications of diabetes. Those who already have gone through a coronary angioplasty can stop the vicious cycle of repeated angioplasties. Those who have suffered a stroke can prevent future episodes. Those with memory loss and dementia can prevent further deterioration. Those who have developed an early stage of kidney disease can prevent further progression and avoid ending up on kidney dialysis. Patients with diabetes can now prevent leg amputation and blindness. This certainly has been my clinical experience as the director of the Jamila Diabetes & Endocrine Medical Center.

By using this new treatment strategy, the majority of my diabetic patients do not need to resort to insulin shots to control their diabetes. Most of those patients who are already on insulin injections gradually come off insulin. Most of my diabetic patients have not required coronary angioplasties, heart bypass surgery, or kidney dialysis. Patients with previous strokes have not suffered any further episodes. There have been no leg amputations or loss of eyesight in many years.

George has benefited from this new treatment plan. Once I started treating his insulin resistance, his diabetes came under much better control. Gradually, I took him off insulin. I think it’s fair to say that he was quite thrilled that he no longer had to endure insulin injections. More impressively, as of this writing, he hasn’t had a single coronary angioplasty in eight years.

In this book you will learn about my revolutionary treatment strategy for diabetic patients. I will explain insulin resistance and how it leads to diabetes and its complications. You will understand how to cut the poisonous tree of diabetes at its roots rather than merely trimming its branches. Insulin resistance is caused by five factors. Therefore, my treatment plan consists of five corresponding pillars: an easy-to-follow diet, a sensible exercise program, a unique stress management strategy, an unbiased review of vitamins and herbs, and a detailed discussion about drugs. Throughout the explanation of this five-pillar treatment plan, you’ll find real-life case studies from my practice to emphasize and explain my points.

It’s my hope that you’ll start to understand the reality of what is happening in your body and how you can turn things around. My treatment starts to work right away. In a couple of months, you will have made a U-turn and be on a completely different road. Indeed, by the end of this book, you will know how to take charge of your diabetes!

 

 

CHAPTER 1

What Is Diabetes?

To truly understand my new treatment strategy, you first need to understand what is going on in your body. Those of you who think you already know what diabetes is, think again. In fact, forget everything you’ve already learned! Much of what you’ve learned is likely filled with misinformation and errors. Many magazine articles are full of incorrect information. Even some doctors may confuse their patients with poor explanations. When you build a house, you start with a strong foundation. Similarly, if you want to take charge of your diabetes, you need to start with a strong foundation in your knowledge of diabetes and how it develops and affects your body. So wipe out what you think you know about diabetes and let’s start over and get the facts straight.

Most people mistakenly think that diabetes is simply a matter of elevated blood glucose. Take care of high blood glucose and you will be fine. Not true! In the majority of patients, diabetes is one of the manifestations of a seriously harmful disease process in the body called insulin resistance. Simply put, insulin resistance means your own insulin—a hormone naturally produced by the pancreas—becomes less effective in doing its job. In response to this insulin resistance, the pancreas produces more and more insulin so that blood glucose levels remain normal. Eventually the pancreas is unable to continue churning out these huge amounts of insulin, and blood glucose levels start to rise. Usually, it takes several years before your blood glucose rises to a level that is diagnostic for diabetes.

But during this time, the process of insulin resistance is taking a toll on your body by narrowing your blood vessels, depositing fat into your liver, and contributing to the growth of cancer in your body. That is why these patients often experience a heart attack or stroke before they are diagnosed with diabetes. Diabetes is only one of the manifestations of insulin resistance in the majority of diabetic patients. Other manifestations include high blood pressure, cholesterol disorder, heart disease, stroke, dementia, fatty liver, and a high risk for cancer. Understanding this distinction is the first step toward taking charge of your condition.

Before moving ahead to treatment options, however, it’s important to understand the different kinds of diabetes. Types of Diabetes Basically, there are three types of diabetes mellitus: Type 1, Type 2, and gestational.

Type 1 Diabetes Only a minority (about 5%) of diabetic patients are Type 1. In this disease, there is a complete destruction of insulin producing cells (called beta cells) in the pancreas by the person’s own immune system. Consequently, insulin, an essential chemical produced by the pancreas, stops being produced. One of the main functions of insulin is to drive glucose from the blood into the cells, especially muscle cells, where it is used as a fuel to produce energy. Think of the cell as a small room and the blood vessel as a hallway outside of the room. Glucose is a delivery person, running through the hallway trying to enter the room, but the door is closed. Insulin works as the doorman, opening the door for glucose to enter. When there is a complete lack of insulin (the doorman is gone), as happens with Type 1 diabetes, the door to the cell remains closed, which causes a rapid buildup of glucose in the blood. A markedly high level of glucose in the blood leads to the sudden onset of excessive thirst, frequent urination, weight loss, and fatigue. Patients with Type 1 diabetes have to take insulin on a regular basis. If they stop taking insulin, they can rapidly lapse into a coma and die if treatment is not instituted in time.

Type 2 Diabetes

The majority (about 95%) of diabetic patients are Type 2. In contrast to Type 1 diabetics, most Type 2 diabetics do not need insulin shots to manage their diabetes. In Type 2 diabetes, the body is able to produce insulin, but there is resistance to its action. This is known as insulin resistance. Remember, insulin works as a doorman. It must open the door for glucose to enter a cell. In individuals prone to develop Type 2 diabetes, the door hinges of the cell are rusty. Consequently, insulin cannot easily open the door. Now, instead of one doorman, you need three or four doormen to pry the door open. This is called insulin resistance. In response to insulin resistance, the pancreas produces more and more insulin. This keeps your blood sugar in the normal  range for a long time. But if insulin resistance is not treated, the pancreas eventually becomes exhausted and insulin production starts to drop. At this stage, your blood glucose levels start to rise, and you gradually develop prediabetes and then diabetes.

The ability of the pancreas to produce insulin varies from person to person. Some people have a limited ability to produce insulin and they develop diabetes only after a few years of insulin resistance. Others have a tremendous reserve for insulin production and do not develop diabetes for many years despite ongoing insulin resistance.

Gestational Diabetes

Gestational diabetes refers to the development of diabetes during pregnancy. After a pregnancy ends, most women with gestational diabetes return to “normal” blood glucose ranges. However, within ten years, more than 50% of women with gestational diabetes will develop Type 2 diabetes and, therefore, should be closely monitored for the development of diabetes.

Symptoms of Diabetes

You’ve been putting it off, but finally you go to your doctor’s office for your annual checkup. Two days later the doctor calls you with results from your lab test and, unfortunately, it’s bad news. You have diabetes! “But, but, I feel fine!” you stammer. “It must be a mistake. I don’t have frequent urination. No one in my family had diabetes.” But you are actually one of the lucky ones. Many people don’t realize they have diabetes until they’re in the hospital having a heart attack or stroke.

Only a few people have classic symptoms like frequent urination and excessive thirst. Many have nonspecific symptoms such as fatigue or tingling in the toes. Sometimes, people just assume that they’re just getting old and tired. Not knowing you have diabetes is like having mold in your house without knowing it’s what is causing all your awful allergies. Once you discover that mold is the root of your problem, you can do something about it. In the same way, it’s better to know you have diabetes. Then you can take control and do something about it!

Diabetes patients may ultimately develop any of the following symptoms:

•Tingling, numbness, a burning sensation or pain in toes, fingers, or both

• Chest pain/heart attack

• Stroke

• Memory loss

• Impotence

• Blurry vision

• Excessive thirst

•Frequent urination

•Drowsiness, coma

• Susceptibility to and difficulty in clearing up infections Excessive thirst and urination, blurry vision, and drowsiness are usually symptoms of severe diabetes. Type 1 diabetics usually have more dramatic symptoms such as:

•Weight loss

• Excessive thirst

•Frequent urination, especially waking up several times a night to urinate

•A life-threatening condition known as diabetic ketoacidosis (DKA). In this condition, a patient may experience nausea, vomiting, abdominal pain, mental confusion, drowsiness, and can even lapse into a coma. These patients usually have a fruity smell on their breath. Patients with DKA are usually Type 1 diabetics, although it rarely can occur in Type 2 diabetics, as well.

Categorizing Your Diabetes

An endocrinologist, the diabetes expert, can diagnose whether you have Type 1 or Type 2 diabetes based upon clinical information. Unfortunately, a physician who is not a diabetes specialist may incorrectly categorize the kind of diabetes you have.

You Are Probably a Type 2 Diabetic If:

•You are not on insulin

•You are on insulin but in the past you were successfully treated with diabetic pills for several years before you were placed on insulin

•You are on relatively large doses of insulin (usually more than 40 units/day)

•You are obese

•You have high triglycerides (more than 150 mg/dl)

•You have low HDL cholesterol (less than 50mg/dl in females and less than 40 mg/dl in males)

•You have high blood pressure (more than 130/85 mm Hg)

•You have a family history of diabetes, high blood pressure, heart disease, stroke, or high cholesterol

You Are Probably a Type 1 Diabetic If:

•You have been on insulin ever since the diagnosis of your diabetes or shortly thereafter (although sometimes your physician may erroneously place you on insulin even though you are a Type 2 diabetic)

•You are on relatively small doses of insulin (usually less than 40 units/day)

•You are thin •You do not have a family history of diabetes

•You do not have high triglycerides and low HDL cholesterol

•You do not have high blood pressure

Age Has No Bearing on Your Type of Diabetes

In the past, we erroneously used to classify Type 1 diabetes as “Juvenile Onset Diabetes” and Type 2 diabetes as “Adult Onset” or “Maturity Onset.” But then we realized that many young people were actually not Type 1 but Type 2. As a matter of fact, Type 2 diabetes among teenagers is increasing at an alarming rate, thanks to our culture of fast food and a sedentary lifestyle. Type 1 diabetes can rarely develop in adults. Therefore, now we use the terms Type 1 or Type 2 and don’t use the previous, age-related cat- egories. Sadly, I see some physicians still using the old terms. Presuming someone has Type 1 diabetes based upon their young age can be very misleading.

Blood Testing to Categorize the Type of Diabetes

There is a special blood test that can help categorize whether a person is Type 1 or Type 2. This blood test is known as C-peptide, which is a hormone produced by the pancreas in conjunction with insulin. The blood test for C-peptide should be done one hour after a meal. Almost all Type 2 diabetic patients have some production of insulin and C-peptide. Actually, many Type 2 diabetics have excessive production of insulin and an elevated level of C-peptide. In contrast, most Type 1 diabetics have no insulin production and, therefore, no C-peptide in their blood.

Rarely, and only in small quantities, is C-peptide detectable in the early stages of Type 1 diabetes. In these difficult cases, further blood testing, such as anti-islet cell antibodies or anti-GAD antibodies, can be carried out. These antibodies are present in most patients with Type 1 diabetes.

Case Study:

Let me share a real case from my medical practice to demonstrate how I use clinical information and blood tests to categorize a patient’s diabetes type. At the young age of thirty, David, a Caucasian male, was diagnosed with Type 1 diabetes and placed on insulin. Demoralized and frustrated, he took several injections of insulin a day, but his blood glucose remained high, in the 200 mg/dl range most of the time. Each visit to his doctor produced the same response: “Increase your insulin dose, David.”

David didn’t understand why his diabetes was so out of control despite all that insulin he was injecting. Over six years, he saw four different physicians, attended several diabetes education sessions, and thought he knew everything about diabetes. Finally, he came to see me.

When I first saw David, I had a strong clinical impression that he was not a Type 1, but in fact, a Type 2 diabetic. Why? Because David was obese, especially around his waistline. He had a family history of Type 2 diabetes, and he was on large doses of insulin, about 140 units/day. When I first told him that he was probably a Type 2 diabetic, he was shocked. Later, he confessed that he did not initially believe me. “How could all the other doctors treating me in the last six years be wrong?” So, I ordered a C-peptide for David. It turned out to be high at 6.0 ng/ml (normal range is 0.8–3.1).

It confirmed my clinical impression that David indeed was a Type 2 diabetic. I took him off insulin and started him on my new approach to treating Type 2 diabetes. Within a month, his blood glucose values dropped from the 200–300 mg/dl range to about the 100–130 mg/dl range. Four months later, his hemoglobin A1c (a measure of overall blood glucose control in a three-month period) dropped from 7.8% to 6.6%. David was thrilled—not only was he able to stop insulin shots, but his diabetes was under control for the first time since he had been diagnosed.

You Can Be Either Type 1 or Type 2, but Never Both

Some people mistakenly think they have Type 1 as well as Type 2 diabetes. Others think that they were originally Type 2 and later progressed to Type 1. To my surprise, even some physicians have these misconceptions.

Type 1 and Type 2 diabetes are two different disease processes. You have one or the other. You do not progress from one to the other. There is no crossover. In Type 1 diabetes, there is complete destruction of insulin producing cells in the pancreas and, consequently, your body no longer produces insulin. You must take insulin on a regular basis to survive. In Type 2 diabetes, the body is able to produce insulin, but there is resistance to the action of insulin. It is a completely different disease from Type 1 diabetes. Unfortunately, many Type 2 diabetics are treated according to the “usual, conventional” treatment strategy with drugs that stimulate the pancreas to produce more and more insulin while nothing is done to reduce insulin resistance. The pancreas eventually exhausts and dries out—unable to produce enough insulin to meet the huge demands due to insulin resistance. At that point, patients are placed on insulin injections to control their blood glucose. Some patients (and surprisingly some physicians) erroneously think that their diabetes converted from Type 2 to Type 1 and they will have to stay on insulin for the rest of their life.

In fact, if Type 2 diabetics are treated with my new approach, they do not develop pancreatic exhaustion, and they do not have to go on insulin. Even those Type 2 diabetics who are already on insulin injections can gradually come off insulin by using my new approach that rejuvenates the pancreas. My recommended protocol is discussed in detail in Part II. If you are Type 2, then your physician, in consultation with an endocrinologist, can attempt to gradually take you off insulin. But take note: you must never stop insulin on your own! If you are a Type 1 diabetic, you still may develop insulin resistance as you grow older and gain excessive weight. You will require larger doses of insulin to control your blood glucose and have other manifestations of insulin resistance as discussed in detail in chapter 2.

 

 

CHAPTER 2

What Causes Diabetes?

Before we discuss the treatment of diabetes, you must fully understand what caused your diabetes. Only then can you truly understand the distinctions and advantages of my approach to treatment. More than 95% of diabetics are Type 2. The root cause for Type 2 diabetes is a disease process in your body known as insulin resistance. Therefore, insulin resistance is the underlying problem for the great majority of diabetic patients. Fewer than 5% of diabetics are Type 1. The total destruction of insulin-producing cells in the pancreas is the underlying cause for Type 1 diabetes. However, as they age, many Type 1 diabetics also suffer from insulin resistance. Therefore, all Type 1 diabetics should pay close attention to this discussion of insulin resistance. Toward the end of this chapter, I will also discuss what causes Type 1 diabetes in more detail.

Insulin Resistance Syndrome

Insulin Resistance Syndrome is the most common medical condition affecting the world today. It is estimated that well over 100 million Americans have it and don’t know it. Worldwide, there is an epidemic of this devastating disease. And most people have never heard of it. For a long time we have known that obesity, high blood pressure, and cholesterol disorder tend to cluster in a person who subsequently develops Type 2 diabetes or has a heart attack or stroke. What we didn’t know was the link between these medical conditions. In the last twenty years, there has been tremendous research in this field. Now we know the missing link is insulin resistance, hence the name Insulin Resistance Syndrome. Insulin Resistance Syndrome (IRS) is also known as metabolic syndrome or syndrome X.

I prefer Insulin Resistance Syndrome because it clearly defines the underlying disease process. Syndrome X sounds to me like the title of a Hollywood movie: catchy, but ultimately a bit confusing. Metabolic syndrome does not fully convey the serious nature of this condition, either.

The Major Components of Insulin Resistance Syndrome (IRS)

The major components of Insulin Resistance Syndrome include:

• Being overweight, especially around the waistline; this is also called abdominal obesity (a waistline of more than 35 inches in females and more than 40 inches in males; in Asians, these numbers are 32 and 35 inches respectively)

• Low HDL cholesterol (less than 50 mg/dl in females; less than 40 mg/dl in males) • High triglycerides (more than 150 mg/dl)

• High blood pressure (more than 130/85 mm Hg, even in a physician’s office)

• Impaired glucose tolerance (blood glucose between 140 mg/dl and 200 mg/dl at two hours after 75 grams of a glucose drink in an oral glucose tolerance test*)

• Impaired fasting glucose (a fasting blood glucose level between 100 mg/dl and 125 mg/dl). Many people with impaired fasting glucose or impaired glucose tolerance eventually develop diabetes. Therefore, these conditions are also known as prediabetes.

• Diabetes (a fasting blood glucose level of more than 125 mg/dl or a two-hour blood glucose level of more than 200 mg/dl in an oral glucose tolerance test)

• Increased tendency for clot formation, which can cause an acute heart attack or stroke • High insulin level in the blood

• Increased uric acid level in the blood (which can cause gout)

• Fatty liver (an abnormal deposition of fat in the liver that can cause liver dysfunction)

 •Women with Polycystic Ovary Syndrome (PCO syndrome); symptoms include irregular menses, excessive facial hair growth, and acne

You don’t have to have all of these conditions to fit the diagnosis of Insulin Resistance Syndrome. Most individuals with IRS have abdominal obesity, low HDL cholesterol, and high triglycerides. In more advanced stages of insulin resistance, patients also develop high blood pressure and prediabetes or diabetes. What combination of these metabolic disorders you have depends upon the severity and duration of insulin resistance in your body and your body’s ability to produce large amounts of insulin to meet the challenge of insulin resistance. Some people have a limited ability to produce large amounts of insulin. These patients usually develop diabetes at a younger age—in their thirties and forties or even in their teens. Others have an extraordinary ability to produce large amounts of insulin. These patients do not develop diabetes until late in life. They may die of a heart attack or stroke before they develop diabetes.

These metabolic disorders also cluster in family members. For example, a mother may have high blood pressure while her son may have diabetes and suffered a heart attack. An aunt may have diabetes and her niece may have high blood pressure and low HDL cholesterol. Initially, people with IRS don’t have any symptoms and therefore are under the impression that there is nothing wrong with them. Then one day, they show up in the emergency room of a hospital with an acute heart attack. Family and friends wonder how it could have happened to such a (seemingly) healthy person.

The Causes of Insulin Resistance Syndrome:

The main reasons people develop Insulin Resistance Syndrome are:

• Genetic predisposition

• Obesity

• Aging

• Lack of exercise

• Stress Genetics play an important role in determining the degree of insulin resistance.

 While no one is immune to this syndrome, certain ethnic groups, such as Native American Indians, African Americans, Latinos, and Asians, have a higher prevalence of insulin resistance than Caucasians. Make no mistake though numbers of Caucasians also suffer from this disease. Asians often develop this syndrome even at a relatively normal weight. One in four Latinos is diagnosed with diabetes by the age of forty-five. Abdominal obesity is a key player in most patients with Insulin Resistance Syndrome, especially in younger individuals.

Obesity and diabetes have increased at an alarming rate in the last decade. According to recent statistics from the Centers for Disease Control (CDC), the prevalence of obesity in the U.S. increased by 61% from 1991 to 2000. During the same period, diabetes increased by 49% with a 76% increase in people aged thirty to thirty-nine, according to a study published in 2001 in the Journal of the American Medical Association (1).

Obesity in children and adolescents is also rapidly increasing. Children as young as five have exhibited signs of insulin resistance. As we age, insulin resistance worsens. That is why diabetes, high blood pressure, heart disease, and stroke are so prevalent in people over the age of fifty. In the U.S., seniors are the most rapidly expanding segment of society, which is contributing to the fast rate at which insulin resistance is increasing. Forty percent of adult Americans suffer from Insulin Resistance Syndrome, according to estimates published in 2003 in the Endocrine Practice, the official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (2).

This number increases to 50% by age seventy. In other words, every other American over the age of seventy has Insulin Resistance Syndrome. These estimates are rather conservative due to the methodology used. In real life, this disease is even more prevalent. Lack of exercise is another major factor that causes worsening of insulin resistance. Too many of us have become couch potatoes glued to the ever-present television or computer. The only workout we get is from pressing the remote control for the television or maneuvering the mouse on our computer. Our lifestyles have become too sedentary.

An interesting study was published in the Archives of Internal Medicine in 2001 (3). The investigators studied 37,918 men between the ages of forty and seventy-five over a period of ten years and found that the risk for development of diabetes was directly related to time spent watching television. Stress plays a major role in the worsening of insulin resistance.

Stress directly causes an increase in two hormones in the body, cortisol and catecholamines. Both of these hormones worsen insulin resistance. People who are stressed (as most of us are to some extent) often overeat despite knowing the health hazards of obesity. Increase in weight further worsens insulin resistance. This is how stress indirectly affects insulin resistance.

Think of insulin resistance as five guys controlling a speeding train. All five of them must halt to stop the deadly train called Insulin Resistance Syndrome. Unfortunately, two out of the five (genetics and aging) are out of your control. That is the reason why diet, exercise, and stress management alone are generally inadequate to prevent diabetes and the other complications of Insulin Resistance Syndrome. You need to add vitamins and drugs to effectively treat this deadly disease.

Insulin Resistance and How It Damages Your Body:

 There is a tremendous amount of clinical evidence to show that insulin resistance is the root cause for coronary artery disease, stroke, diabetes, and high blood pressure. Insulin resistance causes narrowing of the blood vessels throughout your body. In the heart, it leads to heart attacks; in the brain, it causes stroke and dementia; and in the legs, it causes poor circulation and, ultimately, amputation.

Insulin has several actions in the body, one of which is to drive glucose from the blood into the muscle cells, where it is used as a fuel for energy. Recall the image from chapter 1 of the cell as a small room and a blood vessel as a hallway outside of the room. Glucose, the delivery person, moves through the hallway but is unable to enter the room because the door is closed. Insulin works as the doorman, opening the door for glucose to enter the cell. In individuals with insulin resistance, the door hinges of the cell are rusty, making it difficult for insulin to open the door easily. Now, instead of one doorman, you need three or four. This is insulin resistance. Your body produces excessive insulin to compensate for the door’s resistance.

A high level of insulin may keep your blood glucose normal, but is not good for the rest of your body. A high level of insulin causes high blood pressure. This association between high insulin levels and the development of high blood pressure has been confirmed by several researchers (4).

 A high level of insulin is also associated with a high risk for heart disease. This association has been documented by several excellent clinical studies—The Helenski Policeman Study (5), the Paris Prospective Study (6), and the Danish Study (7).

How does insulin cause heart disease?

Insulin stimulates smooth muscle cell growth in the walls of arteries and causes thickening and stiffness of arterial walls, which, in turn, contributes to narrowing of blood vessels (8).

Hypertension (high blood pressure) itself causes further narrowing of the blood vessels. Narrowed blood vessels lead to heart attacks and strokes.

A high level of insulin also leads to the growth of tumors in the body.

Several clinical studies have shown a high prevalence of cancer in people with Insulin Resistance Syndrome. Certain cancers, especially breast cancer, colon cancer, and prostate cancer have been linked to insulin resistance. An excellent, large clinical study, known as the American Nurses Health Study was published in Diabetes Care in 2003 (9). In this study, 111,488 American female nurses who were thirty to fifty-five years old and free of cancer in 1976 were followed through 1996 for the occurrence of Type 2 diabetes and through 1998 for breast cancer. Women with Type 2 diabetes (a component of Insulin Resistance Syndrome) were found to have a higher incidence of breast cancer than those who did not have diabetes.

Development of Prediabetes and Diabetes:

As long as your pancreas can churn out lots of extra insulin, your blood glucose will remain in the normal range. This “overworked pancreas” scenario can go on for years in apparently healthy individuals. This phenomenon was brilliantly studied in nondiabetic children of diabetic parents and published in 1990 in the Annals of Internal Medicine (10). Eventually, your pancreas can’t continue to produce large amounts of insulin to compensate for rising insulin resistance.

What causes this decline in insulin production by the pancreas is undergoing intense research at this time. We know that genetics play a significant role. Free fatty acids (a product from the breakdown of fat) have also been shown to cause damage to the insulin producing cells (beta cells) of the pancreas1(11).

Once insulin production by the pancreas starts to decline, your blood glucose levels start rising, initially only after meals. This stage is known as impaired glucose tolerance (IGT). At this stage, your fasting blood glucose is usually normal. Impaired glucose tolerance can only be diagnosed if you have an oral glucose tolerance test.

Several years later, your blood glucose starts rising even in the fasting state. This occurs due to insulin resistance in the liver. Normally your liver produces glucose during a fasting state, such as at night time. Insulin keeps this glucose production in check. However, when there is resistance to the action of insulin, this glucose production by the liver gets into high gear and your fasting blood glucose starts to rise. If your fasting blood glucose rises into the range of 100–125 mg/dl, it is known as impaired fasting glucose (IFG).

Impaired glucose tolerance and impaired fasting glucose are early stages in the development of diabetes and, therefore, are also known as prediabetes.

Ultimately, a diagnosis of diabetes is made when your fasting blood glucose is more than 125 mg/dl or when your blood glucose is more than 200 mg/dl two hours after a glucose drink in an oral glucose tolerance test.

Low HDL Cholesterol, High Triglycerides and Type B LDL Cholesterol:

Another role that insulin plays is to keep fat where it belongs: inside fat cells. In individuals with abdominal obesity, there is resistance to the action of insulin at the level of the fat cells. Consequently, an increased amount of fat escapes from the fat cells and enters the blood stream. A breakdown product of this fat is free fatty acids. Thus, in individuals with insulin resistance, there is a high level of free fatty acids in the blood. The liver takes up these free fatty acids and converts them into VLDL cholesterol (very low density lipoproteins). These cholesterol particles are rich in triglycerides, which is why individuals with insulin resistance have a high level of triglycerides. When VLDL particles interact with HDL (good cholesterol) particles, VLDL exchanges its triglycerides for the cholesterol of HDL particles. This results in a decrease in HDL cholesterol. These triglycerides-enriched HDL particles also break down easily, which further lowers HDL levels. That is why individuals with insulin resistance end up with low HDL cholesterol.

HDL cholesterol is popularly known as the good cholesterol as it sweeps out the built-up gunk (technically known as plaque) inside the blood vessels. If your HDL is low, you have a decreased number of “sweepers,” which means less cleansing and, therefore, more gunk buildup inside your blood vessels. This leads to narrowing of the blood vessels.

VLDL particles also give rise to the formation of another cholesterol particle, known as IDL (intermediate density lipoprotein), which then converts to LDL (low density lipoproteins). LDL particles in individuals with insulin resistance are of Type B, which means that they are small, dense, and get deposited in the walls of blood vessels more easily and are, therefore, more harmful. LDL, VLDL, and IDL particles deposit in the arterial wall and cause narrowing of the vessel wall.

A Delay in the Diagnosis of Diabetes:

On average, many years of insulin resistance go by before a diagnosis of diabetes is made. During this time, narrowing of the blood vessels takes place due to low HDL cholesterol, Type B LDL cholesterol, elevated IDL and VLDL cholesterol, high insulin levels, and high blood pressure. Narrowing of the blood vessels leads to heart attacks and strokes.

Many people die of a heart attack before they are diagnosed with diabetes. Most people have developed advanced narrowing of the blood vessels by the time they are diagnosed with diabetes. The Stages of Insulin Resistance Syndrome Insulin resistance is a continuous disease process that worsens over time. In order for you to understand this disease process, I have divided this syndrome into four stages. This staging system is very practical and physicians can easily use it in their day-to-day practice.

 Zaidi Staging System of Insulin Resistance Syndrome (IRS)

Stage 1 of IRS

• HDL cholesterol is low

•Triglyceride level is high

• Insulin level is high

• Blood glucose is normal in the fasting state as well as after the glucose intake in the oral glucose tolerance test

• Blood pressure is normal

Stage 2 of IRS

• HDL cholesterol is low

•Triglyceride level is high

• Insulin level is high

•Fasting blood glucose is normal, but blood glucose is elevated in the range of 140–200 mg/dl at two hours in an oral glucose tolerance test; this is known as impaired glucose tolerance (IGT)

• Blood pressure is usually high

 Stage 3 of IRS

• HDL cholesterol is low

 •Triglyceride level is high

• Insulin level is high

•Fasting blood glucose is elevated in the range of 100–125 mg/dl, which is known as impaired fasting glucose (IFG)

• Blood pressure is usually high

 Stage 4 of IRS

• HDL cholesterol is low

•Triglyceride level is high

• Insulin level is normal to high

•Fasting blood glucose is more than 125 mg/dl, which is diagnostic for diabetes

• Blood pressure is usually high

People in all stages are at risk for heart attack, stroke, dementia, cancer, fatty liver, and leg amputation. With the progression in the stage, the risk for these diseases gets worse.

Please note that people in stage 1 have normal blood pressure. It is in stage 2, 3, and 4 that blood pressure is high. Therefore, by the time you’re found to have high blood pressure, the process of insulin resistance and, consequently, narrowing of the blood vessels, has already been going on for a few years.

Also note that diabetes can be diagnosed at an earlier stage (stage 3) by an oral glucose tolerance test (see chapter 3), as compared to the routine fasting blood glucose test, which diagnoses diabetes at a later, more advanced stage (stage 4).

Unfortunately, it is in stage 4 that diabetes is usually diagnosed, because many physicians do not order an oral glucose tolerance test. Therefore, by the time a person is diagnosed with diabetes, the process of insulin resistance and, consequently, narrowing of the blood vessels, has been going on for a very long period of time, usually ten to fifteen years. That is the reason why diabetics are at such a high risk for heart attack, stroke, dementia, kidney failure, blindness, cancer, fatty liver, and amputation of the legs.

Stage 1 of Insulin Resistance Syndrome:

In this stage of Insulin Resistance Syndrome, you are a healthy person on the surface. You will pass an annual physical checkup. Your blood pressure, blood glucose, total cholesterol, and LDL (bad) cholesterol are in the normal range. The only abnormality is low HDL (good) cholesterol and high triglycerides. Many laboratories have set their normal ranges too low for HDL cholesterol and too high for triglycerides. Therefore, mild abnormalities of HDL cholesterol and triglycerides are often erroneously placed in the normal column on your blood report. A typical blood cholesterol profile may look like this: Total cholesterol = 195 mg/dl LDL cholesterol = 117 mg/dl

Case Study:

 At the age of forty-four, Jeff, an Asian male, started taking Lipitor to control his cholesterol disorder. Over several years, his triglycerides had been in the 200–250 mg/dl range, his HDL cholesterol had been in the 35–45 mg/dl range, and his LDL cholesterol had been in the 130–160 mg/dl range.

Otherwise, he was in excellent health. He was about 10 lbs over- weight around his waistline. His blood pressure was normal. His mother had hypertension. She suffered a debilitating stroke at the age of fifty-five and spent the last twenty-four years of her life wheelchair bound. His father had hypertension and diabetes. One of his brothers developed diabetes at the age of forty-five. Jeff underwent a two-hour oral glucose tolerance test along with a measurement of his C-peptide level.

His blood glucose was normal, but his C-peptide was markedly elevated. With proper treatment, his C-peptide came down. Seven years later, his blood glucose and blood pressure continue to be normal. With early diagnosis and proper treatment, we halted the progression of his insulin resistance.

At this stge of IRS, typically, you will be told that you are in good shape, but in truth, you have Insulin Resistance Syndrome. Narrowing of the blood vessels is developing insidiously. Then one day, out of the blue, you have a heart attack! I have seen these cases too often, and it’s one of the reasons I decided to write this book. Do not ignore your low HDL cholesterol and high triglycerides. These are early markers for IRS. If you have the kind of cholesterol profile mentioned above, you should undergo a two-hour oral glucose tolerance test with a measurement of insulin level (or C-peptide). If you are in the early stages of Insulin Resistance Syndrome, your blood glucose levels may be in the normal range, but your insulin levels (or C- peptide) will likely be high, indicating that glucose levels are being kept normal because you are able to produce large amounts of insulin. This large amount of insulin, along with low HDL cholesterol, cause narrowing of the blood vessels. Even at this early stage, you are at high risk for developing diabetes.

Stage 2 of Insulin Resistance Syndrome:

Your cholesterol profile is the same as in stage 1, but now you have high blood pressure. Unfortunately, this is often ignored and blamed on being in the doctor’s office. (“If you hadn’t made me wait forty-five minutes and weren’t wearing that scary looking white coat, my blood pressure would be just fine, doc!”) If the stress of being in a doctor’s office causes your blood pressure to rise, just think what happens in your everyday life when you get stuck in a traffic jam or misplace your wallet. Life is full of stresses everyday. Any blood pressure higher than 130/85 mm Hg/, even in a doctor’s office, is too high. A good blood pressure is less than 115/75 mm Hg. In this stage, you also have impaired glucose tolerance (IGT) that is diagnosed only if you have an oral glucose tolerance test. IGT is also known as prediabetes.

Your risk for progression to diabetes is very high. Remember, your fasting blood glucose is normal at this stage. You are generally given a clean bill of health. But in fact, the process of narrowing your blood vessels is getting worse. Your impending date in the hospital emergency room is looming.

At this stage, many people develop tingling and numbness of toes (and sometimes fingers) as a manifestation of peripheral neuropathy. Unfortunately, you are told you don’t have diabetes because your fasting blood glucose is normal. Extensive diagnostic worhk-up for peripheral neuropathy is done and often no reason is found. You and your physician get totally confused and frustrated. One simple test, the oral glucose tolerance test, would easily diagnose your condition. Unfortunately, this important test is rarely done.

Case Study:

At the age of seventy-one, Zack, a Caucasian male, developed tingling in his fingertips. For many years, his HDL cholesterol was low and his blood pressure was high. During a two-hour oral glucose tolerance test (OGTT), Zack’s fasting blood glucose was normal at 90 mg/dl, but at one hour, it climbed to 232 mg/dl, and at two hours, it was still high at 154 mg/dl. This indicated that he had impaired glucose tolerance (IGT). He was in stage 2 of IRS.

Even at stage 2, Zack had developed peripheral neuropathy manifesting as tingling in his fingertips. In addition, he had also developed severe narrowing of his coronary arteries, which had required heart bypass surgery three years before.

 Stage 3 of Insulin Resistance Syndrome:

In stage 3, you will have the same cholesterol profile as in stage 1, and you will have high blood pressure. In addition, now your fasting blood glucose has escalated into the range of 100–125 mg/dl. You now have impaired fasting glucose (IFG).

Many patients in this stage could be diagnosed with diabetes if they have an oral glucose tolerance test. Narrowing of the blood vessels has advanced even further. You are at an even higher risk for heart attack, stroke, dementia, and peripheral neuropathy.

Case Study:

Miley, a seventy-eight-year-old Asian female, consulted me for her ele- vated serum triglycerides level. Her medical records showed that two years prior, her serum triglyceride level was elevated at 520 mg/dl and her fasting blood glucose was elevated at 112 mg/dl. Her physician placed her on Lipitor, but she continued to have elevated triglycerides. She was amazed when I told her that her blood glucose was in the range of prediabetes. She complained of tingling and numbness in her toes that had been gradually worsening over the past several years. Her mother had Type 2 diabetes. Mylie was overweight around her waistline. Her blood pressure was high at 130/90 mm Hg.

I ordered a two-hour oral glucose tolerance test (OGTT) with the following results of her Blood Glucose.

Baseline=112 mg/dl

 One hour=243 mg/dl

 Two hours=234 mg/dl

Her fasting blood glucose was elevated into the range of IFG, putting her into stage 3 of IRS. With the help of the OGTT, we were able to diagnose her diabetes.

At this stage, IRS had already caused peripheral neuropathy in the form of tingling and numbness of her toes.

Case Study:

Lester, a forty-two-year-old Caucasian male, came to see me out of desperation. At the age of thirty-six, he had heart bypass surgery. Six years later, he started having chest pain again. His cardiologist discovered that even his bypass grafts had shut down. There was near com- plete blockage of all three major coronary arteries. Angioplasty was at- tempted but unsuccessful. He was told that the prognosis was grim. He had about six months to live. At that point, his wife (who happened to be my patient) brought him to see me.

A review of his recent laboratory tests showed that Lester’s fasting blood glucose was elevated at 122 mg/dl, which was consistent with the diagnosis of impaired fasting glucose. His HDL cholesterol was low at 33 mg/dl and his triglyceride level was elevated at 224 mg/dl. His LDL cholesterol was appropriately low at 61 mg/dl due to his drug therapy with Lipitor. His total cholesterol was 139 mg/dl.

Lester’s brother died of a heart attack at the age of forty-two. His mother, who had Type 2 diabetes, died of a heart attack at the age of seventy. His father died of a stroke at the age of seventy. I diagnosed Lester with IRS stage 3 and started him on the appropriate treatment seven years ago. Not only is he still alive, but he’s enjoying a good quality of life.

Stage 4 of Insulin Resistance Syndrome:

With stage 4 IRS, you have the same cholesterol profile as in stage 1 and you have high blood pressure. In addition, now your fasting blood glucose is above 125 mg/dl. You are now officially diabetic. Unfortunately, you may be told that “you have borderline high blood sugar” or “you have a touch of diabetes.” You might even be told to “cut sugar out of your diet and everything will be all right.” The fact is that the narrowing of your blood vessels is very advanced and your risk for heart attack, stroke, dementia, and peripheral neuropathy is extremely high.

Case Study:

 Danny, a forty-five-year-old Caucasian male, came to see me because his sister read about Insulin Resistance Syndrome and insisted that he be evaluated for it. He thought he was in good health. For a long time, he had low HDL cholesterol and high triglycerides. He also had high blood pressure, but it was written off as caused by the stress of being in a doctor’s office.

On my evaluation, he was obese, especially around his stomach. His blood pressure was high at 150/100 mm Hg. His HDL cholesterol was low at 34 mg/dl and his triglycerides level was high at 646 mg/dl.

I ordered an oral glucose tolerance test, which showed that he had developed diabetes. His insulin level was also high. Results of his blood glucose on two-hour oral glucose tolerance test:

Baseline=129 mg/dl

One hour=283 mg/dl

Two Hours Blood Glucose=238 mg/dl

OGTT results clearly showed that he was a diabetic. He was a ticking time bomb. Amazingly, he believed nothing was wrong with him. I diagnosed him with Insulin Resistance Syndrome, stage 4, and started the appropriate treatment. He is enjoying “true” good health now.

The Risk Profile for Insulin Resistance Syndrome:

 Chances are that you have Insulin Resistance Syndrome if you are/have any three of the following:

• Older than forty years old

• Family history of diabetes, high blood pressure, cholesterol disorder, heart attack, stroke, or dementia

• Overweight, especially in the abdominal area, with a waistline of more than 35 inches if you are a woman or more than 40 inches if you are man (for Asians, these numbers are 32 inches and 35 inches respectively)

•A sedentary lifestyle

• HDL cholesterol of less than 50 mg/dl for females; less than 40 mg/dl for males

•Triglyceride level greater than 150 mg/dl

• High blood pressure (higher than 130/85 mm Hg, even in a physician’s office)

• Fasting blood glucose of more than 100 mg/dl but less than 125 mg/dl (this is known as impaired fasting glucose)

• Impaired glucose tolerance (IGT) diagnosed on a two-hour oral glucose tolerance test

•Diabetes

• Heart attack, angioplasty, or heart bypass surgery • Stroke or ministroke

• Dementia

• History of gestational diabetes or delivery of a baby that weighs more than 9 lbs

•Women with polycystic ovary syndrome (most common cause for irregular menses, acne, and excessive facial hair)

• Abnormal liver function due to fatty liver in the absence of alcoholism and hepatitis

Laboratory Testing for Insulin Resistance Syndrome:

 The following three blood tests can appropriately diagnose Insulin Resistance Syndrome in most people:

Blood Test for Low HDL Cholesterol and High Triglyceride Level.

Low HDL Cholesterol Less than 50 mg/dl in women Less than 40 mg/dl in men,regardless of lab reference range.

High Triglyceride level Greater than 150 mg/dl Regardless of lab reference range.

 Low HDL cholesterol and/or high triglycerides strongly indicate that you are at risk of having Insulin Resistance Syndrome, in spite of what the lab may say is a safe range.

Oral Glucose Tolerance Test (OGTT).

This test can appropriately diagnose impaired glucose tolerance (IGT), impaired fasting glucose (IFG), as well as diabetes, which are various stages in the progression of Insulin Resistance Syndrome. See chapter 3 for details on the oral glucose tolerance test.

Blood Insulin Level or C-peptide Level.

An elevated blood insulin level (or C-peptide level) strongly indicates that you have Insulin Resistance Syndrome.

Why the Diagnosis of IRS Is Important?

 Insulin Resistance Syndrome in its early stages usually does not cause any symptoms. However, it gradually causes narrowing of the blood vessels, which is known as atherosclerosis. Patients with atherosclerosis are at high risk for heart attacks, strokes, dementia, and leg amputation. These patients are also at a very high risk for development of prediabetes and diabetes, which predisposes them to additional complications, including kidney disease, blindness, and peripheral neuropathy of the feet and hands. In addition, these patients are at a high risk for cancer and liver dysfunction.

Early diagnosis and proper treatment of Insulin Resistance Syndrome can prevent these hideous complications. If diagnosed at the stage of prediabetes, these patients can prevent the development of diabetes. Patients who undergo coronary angioplasty or heart bypass surgery usually have Insulin Resistance Syndrome as the underlying cause. If insulin resistance is not diagnosed and treated appropriately (which unfortunately happens a lot), these patients end up requiring repeated angioplasties. Many end up having bypass surgery. It is only when Insulin Resistance Syndrome is properly diagnosed and treated that patients are safe from further complications. Then they don’t need repeated angioplasties. They don’t suffer from stroke, dementia, and diabetes. They can prevent kidney failure, blindness, and leg amputation.

Why Insulin Resistance Syndrome Isn’t Diagnosed?

Over the years, I have seen several thousand patients with Insulin Resistance Syndrome. To my surprise, few have heard of Insulin Resistance Syndrome. It’s not that they haven’t seen physicians before. Often they have seen several physicians, including cardiologists, as many have undergone coronary angioplasties. Upon reviewing their old medical records, I find that they have had low HDL cholesterol, high triglycerides, high blood pressure, and elevated fasting blood glucose values for years. Insulin Resistance Syndrome was obvious, but no physician had diagnosed it. To me, it’s a very frustrating and sad situation.

I have given serious consideration to the question of why many physicians fail to diagnose Insulin Resistance Syndrome. Let me share my thoughts and observations with you. The discovery of Insulin Resistance Syndrome is relatively new. Many physicians don’t fully understand this syndrome, although these days you can’t pick up a medical journal without reading about it. Physicians are stuck in the past and simply continue to practice the way they always have. Like most of us, they are creatures of habit. Unfortunately, in this case, they are creatures of bad habits. They continue to think of obesity, high blood pressure, cholesterol disorder, glucose abnormalities, heart disease, and stroke as separate entities. They don’t understand that these medical conditions are linked together with the common thread of one disease process: insulin resistance.

When most physicians look at their obese patients, they don’t think of Insulin Resistance Syndrome. To them, obesity is just a weight issue and that is it. They advise their patients to go on a diet and that is the end of the story. The focus on obesity often stresses cosmetic issues, rather than focusing on health issues. Plastic surgeons will be happy to do liposuction so you can look better but won’t tell you anything about insulin resistance. Most insurance companies don’t even recognize obesity as a disease state and therefore don’t pay for weight management strategies.

The media has done a horrible job in educating the public about Insulin Resistance Syndrome. Everybody keeps hammering on the rise of obesity in this country without ever mentioning Insulin Resistance Syndrome. When it comes to cholesterol, the general emphasis is on total cholesterol and LDL cholesterol. Physicians often ignore abnormal values of HDL cholesterol and triglycerides. They don’t realize that a low HDL cholesterol and/or high triglycerides level indicates Insulin Resistance Syndrome and needs more thorough evaluation.

High blood pressure, in the early stages, often goes untreated because patients generally feel fine and don’t want to accept that something is wrong with their health—they are in denial. “Why fix it if it ain’t broke” is their mind-set, and many physicians go along with this strategy. Physicians don’t realize that high blood pressure indicates the more sinister underlying disease process of insulin resistance. Deadly complications can be prevented if these conditions are treated aggressively in the beginning. The strategy should be to “nip the evil in the bud.”

Glucose abnormalities often go unnoticed, and appropriate testing for these abnormalities is often not done. Impaired glucose tolerance is diagnosed on an oral glucose tolerance test, but most physicians don’t order this test, relying, instead, on the routine testing of fasting blood glucose. That is why this important diagnosis is often missed. Even an elevation in fasting blood glucose remains under the radar of many physicians and doesn’t get their attention. In my clinical experience, often a patient has fasting blood glucose in a normal range but is found to have impaired glucose tolerance or even full-blown diabetes when the oral glucose tolerance test is given. In other words, impaired glucose tolerance or even diabetes will be missed if the oral glucose tolerance test is not done.

The Cause of Type 1 Diabetes:

 Type 1 diabetes occurs as a result of the total destruction of beta cells (the insulin producing cells) in the pancreas. This destruction of beta cells in the pancreas takes place because your own immune system has gone wild. Normally your immune system recognizes anything foreign in your body, such as a virus, and gets rid of it. In patients who ultimately develop Type 1 diabetes, the immune system mistakenly thinks that the beta cells of your pancreas don’t belong to you and, therefore, must be destroyed. So it starts attacking the beta cells of your own pancreas. Basically, your own immune system turns against you. That is why we call it an autoimmune disorder. Gradually beta cells start dying out and insulin production starts declining. Ultimately, there is very little or no insulin production. At that point, you must have the administration of insulin to survive.

If Type 1 diabetic patients don’t receive insulin, they can rapidly lapse into a coma. They can die if proper treatment is not initiated in time.

Why does the immune system turn against itself and start attacking the beta cells of the pancreas?

The exact answer is not entirely clear but here are some explanations. Some individuals are genetically predisposed to this immune destruction of the beta cells, but this process has to be triggered by some factor in the environment. The possible triggering factors include a viral illness, childhood immunizations, baby formula, preservatives in food, pesticides, and other unrecognized environmental factors. Stress also plays an important role in weakening the immune system.

Patients with Type 1 diabetes are also at high risk for other autoimmune disorders that include:

• Autoimmune thyroid disease, which can result in an underactive thyroid (also known as Hashimoto’s thyroiditis) or an overactive thyroid (also known as Grave’s disease)

• Impairment of vitamin B12 absorption from the intestines, resulting in vitamin B12 deficiency that may manifest as pernicious anemia; weakness, tingling, and numbness of toes and fingers; unbalanced gait; and dementia

• Autoimmune adrenalitis resulting in adrenal failure (also known as Addison’s disease), manifesting as severe fatigue and low blood pressure

• Autoimmune oophoritis resulting in premature menopause

• Lupus, Rheumatoid arthritis, Asthma, Multiple Sclerosis, Ulcerative colitis and Crohn's disease.

 

To Take Charge of Your Diabetes, please order a copy of "Take Charge of Your Diabetes."

photo New Release, February 2013 as an Audiobook from Audible.com , Amazon.com and iTunes 

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This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.

Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.

 

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