Optimal Diabetes Living
The average life expectancy for people living in the United States is 78.6 years [1]. The average life expectancy of someone with diabetes is less. The quality of that life expectancy is much less depending on how well controlled the diabetes [2].
Optimal diabetes living is having well controlled blood sugars, HgA1c safely stable close to 6.0 while relying on the least amounts of medication possible. It includes healthy eating, healthy body condition, preventions and screenings for the most common follow on diseases to diabetes, especially cardiovascular disease.
On the treatment side medications are insufficient for the best results. Biochemical/nutritional interventions compliment and enhance blood sugar regulation. Herbal medicines have been long available that stimulate the same pathways now being discovered with the latest, greatest, and most expensive medications — with a much lower risk profile for major side effects.
Lifestyle, dietary habits and choices, essential nutrients, herbal medicines, pharmacological agents, with preventions and screenings along with regular followup medical care is the big picture strategy Dr. Clark pursues with those who seek his help to individually manage their diabetes.
Short Review of the Diabetes Medications Dr. Clark Favors
Metformin. This is the universally recognized first line diabetes medication that is now generic, covered by every plan, and inexpensive enough for most to purchase out of pocket. Its method of action (MOA) is to reduce the amount of blood sugar created by the liver during fasting periods. It doesn’t lead to weight gain, but for a subset of people can have sufficient negative effects to not be well tolerated [3].
SGLT-2 inhibitors. Sodium glucose linked transporter inhibitors reduce serum glucose by causing more glucose to exit the body through urination. This MOA also reduces blood pressure in the same way as a diuretic and supports weight loss through calorie excretion through the urine. The drugs in this class are still on fresh patents, so very expensive, and often require a pre-approval from insurance plans. The most important negative to consider about using this drug is the risk of urinary tract infections. Worse for women, but a concern for both genders. The glucose coming out in the urine rapidly ferments bacteria, yeast and fungus. Meticulous hygiene after each and every urination is essential to avoid this always present risk for complication [4].
GLP-1 receptor agonists. These drugs stimulate blood sugar regulation in the same way as the self-made hormone class known as“incretins” [5]. These hormones and the drugs that simulate them have a broad impact on insulin secretion, inhibiting glucagon, feeling hunger satisfied with a meal and a slower emptying of the stomach after a meal. Reducing insulin resistance is also proposed for this medication class, making it a near wonder drug. Unfortunately the medications offered in this class to date are weekly injections and come with significantly increased risks for pancreatitis and thyroid disease [6] [7]. There is a millennias old tradition in European herbal medicine called “digestive bitters.” These herbal remedies act as digestive and incretin “secretagogues” when taken right before a meal. Upon further inspection the MOA of these many herbs follows the very same biochemical strategy as GLP-1 agonists in that they produce and enhance incretin effect. These are short acting herbal agents that must be taken before each meal to produce the glycemic results that lower HgA1c. Most of us have at least one of these herbal formulas available in our pantry in the form of apple cider vinegar.
Basal insulin. Type I and the progression of type II diabetes both lead to insulin dependence. Once the body cannot produce enough of its own insulin to control blood sugar, no medication, vitamin or herb is going to change the need for insulin. Basal insulins are taken by self-injection one time per day to lower blood sugar throughout the day. It pairs very well with all of the medication classes listed above. The primary problem with using insulin alone to manage blood sugar is that it is a blunt tool that bypasses a lot of intricate hormonal control over blood sugar and energy needs between meals. An extremely common side effect of basal and short term insulin injections is weight gain.
Short acting insulin. Insulin dependence can become more severe with the progression of type II diabetes and suddenly and completely at the onset of type I diabetes. Short acting insulin dosing at each meal is an attempt to simulate normal glucose management by the pancreas. There are insulin pumps available for implantation that simplifies these regular doses of short acting insulin. There is significant effort to develop an artificial pancreas that automatically injects both insulin and glucagon as needed to manage blood sugar.
The risks of short acting insulin center on how disciplined the patient is about managing blood sugar meal to meal. Not taking the insulin in a timely manner or taking too much can both lead to a diabetic coma, a major medical emergency. Hyperglycemia, too much blood sugar can cause this emergency. Hypoglycemia, too little blood sugar from taking too much short acting insulin can also produce this emergency, and runs a high risk of triggering a cardiovascular event aka a “heart attack.” Before the discovery of short acting insulin people died from diabetes as they lost their own pancreatic insulin production.