Diabetes mellitus (DM) is caused by various abnormalities that lead to increased glucose (sugar, one of the final breakdown products from food) in the blood and urine. There are various types, but most commonly we refer to type 1 and type 2, which are caused by different problems. Type 1 is an autoimmune disease, and Type 2 is caused by insulin resistance combined with increased insulin production and other hormonal problems. Prolonged high blood sugars damage blood vessels and healthy tissues, leading to significant diabetic complications. Diabetes treatment goals are to avoid acute, serious, life threatening problems of very high (or very low) blood sugar, and to reduce the long-term eye, kidney, blood vessel (heart attack, stroke, and limb) complications, and peripheral and autonomic nervous system deficiencies.

Most of those with type 1 diabetes mellitus have an autoimmune disease which completely destroys the pancreas, the gland that produces the hormone (natural body chemical) insulin. The function of insulin is described here. These people produce no insulin at all, and must have insulin administered. Those with type 2 diabetes, suffer from insulin resistance; these people produce their own insulin for many years, although it decreases over time. Other hormones/systems are dysregulated in type 2 diabetes as well. ^[1]

The risks for type 2 diabetes development include age greater than 45; weight more than 120 percent of desirable (90 percent of patients who develop diabetes type 2 are obese); first degree relative with type 2 diabetes; Hispanic, Native American, African American Asian American or Pacific Island descent; impaired glucose tolerance; hypertension; diabetes in pregnancy; polycystic ovarian syndrome; ^[2] and very possibly depression ^[14]. The risk for type 1 diabetes development is largely genetic.

Most people with either type of diabetes can have the following symptoms when blood sugars are high: frequent, large volumes of urine, constant thirst, constant hunger, weight loss, blurred vision, yeast/other infections, and later on, numbness of the lower legs, vision loss, or kidney damage. Severe, life-threatening symptoms of hyperglycemia or hypoglycemia (very high or very low blood glucose levels) will not be covered here.

Both type1 and type 2 diabetes are defined by the American Diabetes Association as:

• Fasting blood glucose of 126mg/dL or greater
• 2 hours after 75g of glucose, blood glucose at or above 200mg/dL
• Random blood glucose of 200mg/dL or higher
• Some consider hemoglobin A1c (HbA1c) 6.5 percent as possibly diagnostic

If type 1 is suspected, extra tests (insulin level, C-peptide, and/or possibly autoantibodies) are needed.

Diabetes contributes to the cholesterol plaques that narrow blood vessels, reduce blood flow, and thus diminish food and oxygen supply to the tissues/organs these blood vessels supply. This can occur in small blood vessels (microvasculature, affecting the eye/blindness, kidney/kidney failure), large blood vessels (macrovasculature, affecting the heart/heart attack, brain/stroke, legs/leg pain), or damage the nerves supplying the organs or limbs. Diabetes carries additional risks for cognitive decline and some cancers. To help prevent these problems, your doctor will follow: HbA1c (measures average blood sugar levels) 2-4 times per year, dilated eye exams and urine microalbumin (kidney status test) yearly, blood pressure (130/80) and foot checks at each visit.

Because so much of diabetes treatment is in the patient’s hands, patient education for proper diabetes care is very extensive and beyond the scope of this review. Please refer to these sources for comprehensive training. The pharmaceutical company producing your medication is likely good resource as well.

American Diabetes Association

National Diabetes Education Program

Merck Pharmaceuticals

Treatments must include medications to maintain proper blood sugar, cholesterol and blood pressure levels; daily aspirin therapy; likely statin therapy; and hypertension medication to protect the kidneys regardless of whether there is hypertension.

In the last several years, likely due to the extension of insulin therapy to more patients with diabetes, the diet and lifestyle recommendations from Western medicine have changed. With “tighter glucose control,” emphasis on the composition of the diet/ glycemic index (vs. calorie intake) has lessened, and alcohol avoidance is less discussed. Both Chinese and traditional Indian (Ayurvedic) medicines maintain low glycemic and alcohol abstinence recommendations independent of medical glycemic control. Diet and exercise cannot be overstressed.^[1]

Traditional Medicines do not supplant conventional medical care for diabetes, and should only be used to complement conventional care.^{[2, 3]}

In Traditional Chinese Medicine, diabetes of either type is one of the most severe or “deep” conditions encountered. It’s formation requires many years of “Organ System imbalance” combined with improper health habits. It is most often known as “Xiao-ke” or “Wasting Thirst” which often accompanies “Bone Steam or Wilting Bones.” The combination of emotional disturbances, excessive consumption of fatty or sweet foods, and “Yin deficiency” leads to this condition. “Yin” represents many concepts in TCM, but in this case, it is the structure/substance of the body and contains our constitutional energetic reserves.

People are viewed as possessing finite “energetic” reserves in this concept, being endowed with specific quantities of “Yin” and “Yang” at birth that roughly correlate to constitutional strength. “Yang” is our active energy, the energetic currency we use for day-to-day and athletic activities, like cash in our pocket. “Yin” is like our energetic “reserve” held in the bank—some have large reserves, some less so. If we overtax the system (improper diet, difficult to digest food, late nights, over-work, excess stimulation with light, sound, sex, athletics, activities, not living in harmony with nature), we deplete our “Yin” stores as the “Yin” is drawn upon and converted to “Yang” energy to sustain the activity level.

When “Yin” is “deficient”, it no longer controls the “Yang”; “Yin” is cool and “Yang” is hot, and “Yin” anchors “Yang”. When “Yin” is low, the “Yang” “escapes and rises,” leading to a “false heat” producing excessive thirst and dryness. Additionally, as an end-stage digestive problem, “Spleen and Kidney Qi and Yin” are markedly deficient. As a late stage illness, it requires aggressive measures to treat, including acupuncture, moxabustion, Chinese Herbal Medicine, diet, and exercise ^[15]. Ayurveda, medicine from India, can prove invaluable in addressing the diet and exercise modifications needed to address diabetes. Ayurvedic diets are very satisfying and naturally low in fat and glycemic index; yoga exercises can help even the very sedentary start using large muscle groups, which improves insulin resistance.

Traditional Chinese Medical treatment of “Xiao-ke” makes specific recommendations concerning meals:

• The body should be kept upright during meals, and for at least an hour after each meal.
• Liquids should be drunk sparingly with meals. Green tea is the preferred drink.
• Foods should be eaten when in season.
• A wide variety of foods should be consumed.
• Three to four light meals should be eaten every day, at regular hours; the largest meal should be eaten at mid-day, and the evening meal should be eaten at least two hours before bedtime.
• Light exercise should be taken in the fresh air after each meal, following the Chinese proverb, “100 paces after each meal will allow one to live a healthy 100 years.”