Diabetes mellitus is an old and complex disease. It can strike anyone in any family at any time, though it is most common among affluent Westerners. The incidence of this autoimmune disease has tripled over the last eight years and, today, over 100 million people around the world have the condition. Nearly a third of these are in Europe. In children, diabetes is one of the fastest growing illnesses, and contracting it can mean a lifetime on medication and the risk of kidney disease later in life.
There are two main types of diabetes. Type I - also known as insulin-dependent diabetes (IDDM) or juvenile-onset diabetes - is less common than type II diabetes - also known as non-insulin-dependent diabetes (NIDDM) or mature-onset diabetes.
There is now strong evidence that environmental factors may play the largest part in the development of diabetes; these include obesity, physical inactivity, dietary fat intake, cigarette smoking and alcohol consumption (BMJ,1995; 310:560-4; BMJ,1995; 310:555-9). NIDDM, in particular, shares a common epidemiology with coronary heart disease, and may be linked to life in the womb, particularly intrauterine growth retardation (Diabetologia, 1993; 36: 62-67).
In both types of diabetes, the underlying problem is that the insulin-producing cells in the pancreas can't produce any or enough of this vital hormone to meet the body's demands. Insulin clears sugar from the bloodstream, vital organs and tissues. It is also necessary to convert food into energy. Individuals with IDDM are unable to produce any insulin, while those with NIDDM can't produce enough, or their bodies can't use it effectively.
Over the years, a number of aggressive medical treatments have emerged in the treatment of both types of diabetes. The basic treatment for IDDM is injections of insulin. The amount needed is often dependent on lifestyle factors, such as how much exercise an individual takes and what foods he or she eats. In extreme cases, the individual's life can end up being centred around the timing of insulin injections.
For NIDDM, treatments are more varied but not always successful. These include sulphonylureas, which stimulate insulin release from the pancreas. These are prescribed when diabetes can't be controlled by diet alone. This type of drug tends to encourage weight gain and has been associated with sensitivity reactions such as rashes, fever, jaundice and photosensitivity. Sulphonylureas can also increase the risk of hypoglycaemia, if blood sugar levels are allowed to get too low.
Other treatments, such as biguanides, lower blood glucose levels, but are associated with nausea and diarrhoea. Alpha-glucosidase inhibitors, which slow down digestion and the absorption of carbohydrates, are sometimes used instead of insulin.
While it is unlikely that any alternative treatment will remove the need for insulin in diabetics, this is one disease which genuinely can be controlled through conscientious self-management and the careful selection of appropriate therapy.
In addition to seeking out therapies which act directly on the pancreas, liver and kidneys, diabetics should also consider the role which their emotional state can play in reducing glucose tolerance. Stress reduction is one area which shows promise. Another is social support.
Trials involving alternatives for diabetes are small. Many are too small to draw definite conclusions. Because of the ethics involved in removing individuals from lifesaving insulin or other medication, studies into alternatives often involve using these therapies in a more complementary way. Nevertheless, there are indications that many of these therapies can have a significant effect in lowering blood glucose levels, reducing 'bad' LDL cholesterol (a risk factor in diabetics) and relieving some of the other symptoms which diabetic patients experience.
More than 500 traditional plant remedies for diabetes have been recorded, but only a handful have received scientific and medical evaluation (Diabet Care, 1989; 12: 553-64).
Holy basil leaves (Ocimum sanctum and Ocimum album) have been shown to dramatically reduce blood glucose levels. In a single-blind trial involving individuals with NIDDM, holy basil was tested against other types of leaves. Those using holy basil experienced a reduction in glucose levels of between 7.3 and 17.6 per cent. Those using other types of leaves did not experience the same effect. Holy basil was also associated with a lowering of total cholesterol levels (Int J Clin Pharm & Ther, 1996; 34:406-9).
In another trial of holy basil, 27 NIDDM patients were monitored for 30 days while taking the remedy. At the end of the trial, they experienced a significant lowering of blood glucose levels (20.8 per cent), a reduction in LDL cholesterol by 14 per cent and a 16.4 per cent lower triglyceride level ( J Nutr Environ Med, 1997; 7: 113-8).
In another study, 36 NIDDM patients were treated for eight weeks with ginseng (either 100 or 200 mg daily) or a placebo. Ginseng was shown to elevate mood, improve psychological and physical functions, and reduce fasting blood glucose and body weight. The 200 mg dose was the most effective. The authors concluded that ginseng may be a useful adjunct to other therapies (Diabet Care, 1995;18: 1373-5).
For those with IDDM, fenugreek seeds (Trigonella foenum-graecum) may prove useful. In one study, Type I individuals were divided into two groups: one given a managed diet and fenugreek seeds, and a control group with a managed diet only. Those in the diet and herb group received defatted seed powder, 100 g daily, divided into two doses at lunch and dinner.
The herb and diet group showed significant improvement in their fasting blood sugar levels and improved in the glucose tolerance test. They also experienced a 54 per cent reduction in 24-hour urinary glucose excretion. In addition, serum total cholesterol, LDL and VLDL (very low-density lipoprotein) were all significantly reduced. HDL remained unchanged. These changes were not noted in the diet-only group (Eur J Clin Nutr,1990; 44: 301-6).
Fenugreek seeds have received a great deal of study and do not appear to be associated with damaging side effects (Phytother Res, 1996; 10: 519-20).
Dandelion root, Jerusalem artichoke and burdock root all contain a substance called inulin, which assists in blood sugar control (Am J Clin Nutr, 1990; 52: 675-81) and in reducing hyperglycaemia and fatigue after starchy meals (Am Intern Med, 1931; 5: 274-84).
Finally, Gingko biloba has been shown to be better than placebo for those experiencing visual impairment due to diabetes (J Francais d'Opthamal, 1988; 11: 671-4).
The use of traditional remedies remains contentious (Afr J Med Sci, 1992; 22: 31-7), yet there is evidence that many of these ethnic remedies are effective.
The stems of prickly pears (of the opuntia cactus or nopal), commonly eaten in Mexico, have a reputation for treating diabetes. In an experimental, double-blind study, a group of NIDDM patients ate 500 g of broiled nopal stems. After three hours, they experienced an average reduction in glucose levels of 17 per cent and, in insulin levels, 50 per cent, compared with those taking a control food (Diabet Care, 1988; 11: 63-6).
Coccinia indica is an Ayurvedic remedy made from a creeper which grows wild in Bangladesh and in many parts of the Indian subcontinent. In a double-blind controlled trial of 32 patients, 16 received Coccinia indica. There was a marked improvement in their glucose tolerance, while the placebo group showed no improvement. (Bang Med Res Council Bull, 1979; 5: 60-6).
The Ayurvedic herbal mixture MA-471 has also shown promising results in treating patients with NIDDM who have been diagnosed for less than five years. Its use can result in a significant fall in serum total cholesterol and postprandial blood glucose levels. In one trial, it helped patients achieve control over symptoms in 68.3 per cent of cases (Alt Ther Clin Pract, 1996; 3: 26-31).
Also from the Indian subcontinent, the bark of sanderswood has a long history in the treatment of diabetes. The bark contains a flavonoid called epicatechin and, when combined with the alcoholic extract of Pterocarpus marsupium, has been proved able to regenerate functional cells of the pancreas (Lancet, 1981; 2: 759-60; Lancet, 1982; 2: 272).
In traditional Chinese medicine a simple remedy, guava juice, has been used for years to prevent and improve the condition of diabetics (Am J Chinese Med, 1983; 11: 74-6). Other TCM remedies include the herbal medicine Goshajinkigan. Given in doses of 7.5 g per day for three months, it was shown to relieve symptoms of numbness in nine out of 13 patients. Numbness returned or worsened when the drug was discontinued (Diabet Res Clin Pract, 1994, 26:121-8).
Bushenhuoxue can help diabetics with vascular disease. When 68 patients took either this TCM remedy or placebo, those taking bushenhuoxue experienced lowered blood sugar levels, while HDL cholesterol levels increased. There were virtually no changes in the placebo group (Chung Kuo Chung Hsi i Chieh Ho Tsa Chih, 1995; 15: 661-3).
Two other TCM remedies are of note. In a small trial involving 40 patients, jin-qi-jiang-tang-pian was tested against another herb for two months. Twenty patients got the active herb, and all experienced major improvement in their symptoms (Chung Kuo Chung Hsi I Chieh Ho Tsa Chih, 1993; 13: 587-90).
When jiang tang san ([TS) was tested in a group of 30 people with NIDDM, results suggested that JTS lowered blood glucose levels by 86 per cent. It also lowered blood lipid and blood pressure levels and promoted the elevation of serum insulin levels one hour after eating. The researchers concluded that JTS may be helpful for those who do not respond well to conventional hypoglycaemic medications (Chung Kuo Chung Hsi I Chieh Ho Tsa Chih,1994; 14:650-2).
Homoeopathic studies are thin on the ground. However, one review article showed that when a small group of diabetics were treated with individually prescribed homoeopathic drugs, blood sugar levels fell significantly, especially in those taking the remedy Tarentula cub (Hahnemann Hom Scand, 1987; 11: 105-13).
In one small study of 78 individuals with NIDDM, half received the conventional antidiabetic treatment glibenclamide (Daonil) in combination with an individually chosen homoeopathic remedy and half received conventional treatment and a placebo. Both groups received dietary instructions as well. All the patients in the study group were matched for age, sex and weight, and required doses of antidiabetic medication.
After nine months of treatment, both groups were assessed, and it was found that individuals in the homoeopathic group had significantly lower blood glucose levels. In addition, the amount of medication used decreased significantly in the homoeopathic group, but not in the allopathic group - 54 per cent compared with 0.5 per cent. There were also fewer infections in the homoeopathic group - 10 per cent compared with 30 per cent (Proceedings of the 43rd Congress of the International Homoeopathic Medical League, Athens, May 22-26, 1988).
Yoga may be useful as an aid to conventional therapy, according to a study from London's Royal Free Hospital. The study group consisted of 21 NIDDM patients, 13 taking medication, eight on diet control alone. Each patient was randomised into either a yoga or control group (control consisted of continuing with whatever treatment they were using).
Those in the yoga group met once or twice a week, in addition to practising one or more times a week at home. After 12 weeks, the fasting blood glucose levels and glycated haemoglobin in the yoga group had improved, and a third of those on medication were able to reduce their medication. Patients also reported feeling better, less anxious and more in control of themselves, and expressed a desire to continue with the yoga after the trial (Comp Med Res, 1992; 6: 66-8).
It is unlikely that acupuncture alone can significantly cure diabetes. Because diabetics can present with mixed symptoms such as thirst, excessive appetite, fever, flushing, cold limbs and oedema, acupuncture can be used to treat these, though its effect on blood glucose levels is mixed (J Trad Chin Med, 1985; 5: 79-84; J Trad Chinese Med, 1987; 7: 95-100; J Chinese Med, 1984; 15: 3-5). Reviews of acupuncture in the treatment of diabetes seem to reinforce its complementary nature U Trad Chin Med 1995; 15: 145-54; Chung His I Chieh Ho Tsa Chich, 1991; 11: 382-4).
Studies are confused as to which group of diabetics may benefit most from relaxation (Diabet Care, 1993; 16: 1087-94). Some say that those with emotional problems who also have diabetes may gain genuine benefit from counselling or relaxation (Diabet Med, 1993; 10: 530-34). Relaxation techniques can also be useful for diabetic children (Patient Ed Counsel, 1990; 16: 247-53).
But, in general, relaxation techniques do seem to have an important role to play in the self-management of both IDDM and NIDDM. In one study, 12 patients with IDDM were tested at baseline with a glucose tolerance test and intravenous insulin tolerance test.
Half were then given five days of progressive relaxation training, after which all patients were re-tested. The treated patients were tested while practising relaxation, and it was found that this group had significantly improved glucose tolerance, without affecting insulin sensitivity or glucose-stimulated insulin secretory activity (Diabet Care, 1983; 6: 176-9).
Using biofeedback as an aid to relaxation may also be helpful. In a study of 20 patients - 10 with poorly controlled IDDM and 10 untreated NIDDM subjects - biofeedback proved to be not so useful in treating IDDM but more useful in cases of NIDDM (Diabet Care, 1987; 10: 72-5). For those with IDDM, this method may be more beneficial as an adjunct to other treatments (Diabet Care, 1991; 14:360-5).
In the same vein, several studies into the level of social support of diabetes sufferers have turned up interesting results. In one, 240 diabetics (types I and II) were randomised into two groups: a training programme on how to manage their condition, or a training programme with eight support group meetings. At seven-month follow-up, both groups improved with regard to understanding their condition and knowledge of how to manage it, but the support group expressed greater satisfaction with what they had learned (Diabet Ed, 1992; 18: 303-9). In another study, older diabetics were followed for two years. Those who took part in intensive support groups, followed by monthly sessions for continuing education and support, experienced better quality of life and felt better able to control diabetes themselves U Am Ger Soc, 1992; 40: 147-50).
Meditation can also have a positive effect on the symptoms of diabetes (Diabet Ed, 1984; 10: 22-5). Transcendental meditation has a proven track record in lessening free radical damage and alleviating stress. In one pilot study, subjects practising TM experienced reduced serum glucose levels, as defined by an oral glucose-tolerance test. (Report from the International Conference on Research on Higher States of Consciousness, Faculty of Science, Mahidol University, Bangkok, Thailand, 4-6 December, 1980).
Massage of all types has been established as a stress beater, though studies relating specifically to diabetes are difficult to find. In one, 32 individuals with NIDDM were randomly divided into a medication group or medication plus foot reflexology.
After 30 days, a number of measurements, including fasting blood glucose levels and serum lipid peroxide, greatly reduced in the reflexology group, but there was no change in the medicine-only group (Chung Kuo Chung His I Chieh Ho Tsa Chih,1993; 13:536-8).
Finally, in one small, double-blind, crossover study of the effect of non-contact therapeutic touch and prayer on IDDM, small reductions in insulin dose levels were found. The study was not large enough to draw sweeping conclusions (J Sci Explor, 1994; 8: 367-77).
Many people with diabetes don't know it until the symptoms of the disease become so acute they need urgent medical attention. This is one reason why finding ways of preventing the disease is so urgent. Another reason for implementing lifestyle changes before problems occur is that some individuals with diabetes find that their quality of life diminishes greatly
in relation to the amount of time they need to spend focusing on food intake and medication. For those who already have diabetes, there is no cure but careful self-management. The
appropriate choice of complementary therapies can mean a reduction in aggressive medications and a boost to your day-to-day quality of life.
Insulin can be a lifesaver, but its use is also associated with debilitating side effects. While you may never be able to come off insulin completely if you are diabetic, lowering the amount you need to rely on can reap many benefits.
Firstly, it is possible that some diabetics are taking too much insulin. For example, 'white coat hyperglycaemia' - in which blood glucose is higher in the clinic than when measured at home - is a well-documented phenomenon (MD Med J, 1990; 39: 555-9; BMJ, 1992; 305: 1194-96), though doctors are quick to ascribe this to patient error. Nevertheless, your doctor could be overprescribing or giving you a just-in-case dose, even though there is no evidence that prophylactic insulin is either safe or effective (Lancet, June 20, 1992, 1504).
What is more, reliance on insulin can cause longer-term problems such as neurological complications, eye problems, nephropathy, neuropathy and cardiovascular disease. These side effects are the most common cause of death in IDDM. The jury is also still out on the safety of human insulin, which is not 'natural' at all but genetically engineered and more likely to cause death and debilitating side effects than the porcine variety. Human insulin can also prevent diabetics from perceiving symptoms of a hypo, thus increasing the likelihood of severe hypoglycaemia (Lancet, 1987; ii; 382-5).
Instead of not producing enough insulin, your body may be insulin-resistant, in which case insulin injections may not be the best way to approach the problem. Certain outside influences can increase your resistance to insulin. These include cigarette smoking (Lancet, May 19,1992;1128), obesity (Diabet Care, 1991; 14: 173-94) and hypertension. Insulin resistance is actually quite common in those who are not diagnosed as diabetic. As many as 25 per cent of the 'normal' population are insulin-resistant, as are those diagnosed as glucose-intolerant or NIDDM (Diabetes, 1988; 37: 1595-607). In these individuals, the pancreas will compensate by increasing insulin production. Others will go on to develop IDDM (Lancet, 1994; 344: 521-3).
To protect yourself
Check levels of vitamins and minerals. If necessary, have a blood test and correct any deficiencies. Chromium deficiency can be related to reduced glucose tolerance, increased glucose levels on an empty stomach and reduced number of insulin receptors. Supplements may help (Erfahrungsheilkunde, 1997; 46: 150-2). Try taking 200 ug daily (Am J Clin Nutri, 1991; 54: 909-16). Magnesium deficiency is also common in NIDDM (Diabet Res Clin Pract, 1990; 10: 203-9; Magnesium, 1984; 3: 315-23). Other common deficiencies in those with glucose intolerance include copper, zinc and manganese. In cases of insulin resistance, common deficiencies include phosphorous and potassium.
Essential fatty acids (EFAs) are important and even a modest intake, obtainable by consuming fish regularly, is enough to lower plasma triglyceride levels (Diabetologia, 1997; 40: 45-52). If you do take supplements, try linseed oil (1-2 tablespoons per day), fish oil capsules (200-500 mg of EPA) or combination preparations like Efamol Marine (which contain omega 3 and omega 6 EFAs-four to eight capsules a day).
In a double-blind, placebo-controlled trial of patients with diabetic nerve damage, 12 received 360 mg gamma-linolenic acid (GLA) daily, and 10 placebo, over a six-month period. Those taking GLA experienced improvement in neuropathic symptom scores, muscle use, and heat and cold thresholds (Diabet Med, 1990; 7: 319-23).
Free radical damage has a major role in diabetes. Raised blood glucose levels produce more free radicals. Also, diabetics are often low in vitamin E, which helps to minimise free radical damage (Diabet Care, 1991; 14: 68-72). Taking at least 900 mg daily will improve symptoms (Am J Clin Nutr,1993; 57: 650-56; Am J Clin Nutri, 1993; 58: 412-16). Vitamin E also improves circulation (Diabetes, 1982; 31: 947-51; Metabolism, 1992; 41: 613-21).
Also try 500 mg twice daily of vitamin C. In a placebo-controlled trial of 40 elderly patients with NIDDM, those taking vitamin C improved whole-body glucose disposal, lowered cholesterol and decreased free radical damage. The authors concluded that vitamin C has an important role to play in management of NIDDM (J AM Coll Nutr, 1995; 14: 387-92).
Try antioxidant treatment to prevent nerve dysfunction. In a trial of alpha-lipoic acid ALA in 328 NIDDM patients, intravenous treatment of 600 mg daily over three weeks proved superior to placebo in reducing symptoms without causing serious side effects (Diabetologia 1995; 38: 1425-33).
Try a different diet. In a study of eight patients with IDDM, a largely vegetarian diet produced marked improvement in symptoms (Diabet Med,1991; 8:949-53).
A diet high in complex carbohydrates and plant fibres may be the most effective one. This diet would include lots of cereal grains, legumes and root vegetables, while restricting simple sugars and fat. In one report, it led to the discontinuation of insulin therapy in 60 per cent of IDDM patients and significantly reduced insulin use in the other 40 per cent (Am J Nutr, 1979; 32: 2312-21).
Fresh food is always best. Special diabetic foods such as jams, cereal bars and chocolate probably have no special nutritional advantages and they are expensive.
In addition, you should:
* Cut out caffeine. Finnish scientists believe excessive coffee consumption can be an early trigger for IDDM (BMJ, 1990; 300: 642-3).
* Lose weight. According to a study by the Harvard School of Public Health, there is a strong link between NIDDM and obesity (BMJ, 1995; 310: 555-9; 560-4).
* Eat lots of onions and garlic. They have a significant ability to lower blood sugar (Ind J Med Res,1977, 65: 422-29; Quart J Crude Drug Res, 1979; 17: 139-96).
* Cut out sugar. A high-sugar diet raises your risk of developing NIDDM by one and a half times. When combined with a low intake of fibre, your risk doubles (JAMA, 1997; 277: 472-7).
For your pancreas, try papaya (in capsule form with meals), which contains papain, to help digest protein. Digestion begins in the mouth, so chew your food care-fully. Try also having several small meals instead of a few big ones each day, to take the pressure off the pancreas.
To protect your children:
* Get them moving. Exercise can prevent NIDDM (Lancet, 1991; 338: 774-8), and it can minimise the risk in the insulin-resistant children of diabetic parents who usually have a 40 per cent risk of developing diabetes themselves (N Eng J Med, 1996; 335: 1357-62).
* Breastfeed them. This can also help protect children of diabetics. Early exposure to cow's milk can trigger an immune response, which in turn can cause an allergy. The risk for a baby exposed to cow's milk in the first three months of life is one and a half times greater (Lancet, 1996; 348: 926-8; BMJ, 1994; 308: 534-5). Exclusive breastfeeding for the first two months of life can protect against NIDDM (Lancet, 1997; 350:166-8).
* Early nutrition is important (BMJ, 1993; 306: 283-4). Childhood diabetes doubled in the 12 years to 1994, suggesting that childhood diabetes is a lifestyle condition, not just a genetic one. In one study of childhood NIDDM, 92 per cent were obese. The same researchers also say that watching your child's exposure to harmful chemicals via plant and animal substances should also be a vital part of preventing diabetes in children (Lancet, May 25, 1996).