Sunday, May 23, 2010

A Simple Exercise for Diabetics (and anyone wanting to lose weight!)

There is no doubt that exercise improves glucose levels, increases insulin sensitivity, improves glucose utilization by the muscles, reduces the vascular and neurological damage caused by high glucose, and improves weight control. However, time and energy are at a premium for many people with diabetes. Although any exercise is better than no exercise, I recommend the following exercise regimen for my patients:

Individualized Interval Training


1. Do a vigorous aerobic activity as fast and as hard as you are able in your current state of health. This may be running, going up and down stairs, doing jumping jacks, dancing vigorously, bicycling, or any aerobic gym machine.

2. When you are breathing hard and your heart is pounding, STOP! This may be after ten seconds or five minutes, depending on your state of health and your exercise capacity.

3. Rest until your breathing and your heartbeat normalize.

4. Do the aerobic activity vigorously again.

5. When you are breathing hard and your heart is pounding, STOP!

6. Rest until your breathing and your heartbeat normalize.

7. Repeat this until 12 to 15 minutes is up.

This type of exercise breaks down fat over the next twenty-four to forty-eight hours, improves the strength of the heart muscle, lowers blood sugar and cholesterol, builds muscle, reduces vascular inflammation and increases the feel-good chemicals in the brain.

This exercise is tailored to fit your individual needs. You do not go beyond your limit because your breathing and heartbeat tell you when to stop. Over time the amount of time you can exercise increases, and the amount of time you rest decreases. Your body improves at its own individual rate and ability. Be patient with it. It knows what it’s doing!

Conclusion to these blogs on Diabetes (yes, we're finally coming to an end!!)
This information was designed to inform the person diagnosed with diabetes or pre-diabetes about the nature of the disease process, the effect of medications, and ways to improve and at times even stop the disease process.

When each person takes individual responsibility for their own health, rather than depending completely on the health system to tell them what to do, they will find the ability to change their life and change their health.

In my experience, many who follow the Sugar Stabilization Program, along with supplementation and exercise, can reduce, and in many cases for Type 2 Diabetes, come off of their diabetic medications under the supervision of a physician. The less medication needed, whether insulin or oral medications, the less long term side effects of those medications. And the more balanced the glucose and insulin levels become, the less long-term complications from the disease process occur.

The earlier a person starts a program like this the more effective it is. Someone who has been dealing with diabetes for many years has more damage to clean up, so it takes longer to balance the blood sugars. But be patient, because the more you do for yourself, the better you will be in the long run. If it took you a long time to come to this state of health, it may take one or two years to improve. But it will be worth it!!

Best wishes to you all in your pursuit of health!

My next few blogs will be on the effects of hypoglycemia, or low blood sugar. Did you know that people who have low blood sugar have less self control? Stay tuned!

Until we meet again,
Dr. Judi

Wednesday, May 19, 2010

Supplements for Diabetes

The following supplements have been shown through scientific studies to have a positive effect on blood glucose and/or insulin levels, and some are protective for the body and blood vessels when the blood sugar goes to high:

1. Glucose tolerating factors—chromium and biotin have been shown in studies to help optimize glycemic control by increasing insulin sensitivity, and are needed to burn protein, carbs and fat.

2. Vanadium—mimics the effect of insulin in the body.

3. Alpha Lipoic Acid—recirculates anti-oxidants to reduce free radical damage, is necessary for converting glucose to energy, and can protect brain and nerve tissue from elevated glucose levels.

4. Gymnema Sylvestre—slows the transport of sugar into the blood stream.

5. MHCP from Cinnamon bark—acts as a natural insulin, increases insulin receptivity of the cells, and helps maintain good triglyceride and LDL levels.

6. Benfotiamine—a form of Thiamine (Vitamin B-1) that protects the vessels from the complications of diabetes, reducing retinopathy, nephropathy and neuropathy.

7. N-acetyl-L-cysteine—prevents or delays beta cell dysfunction in the pancreas and improves glutathione production for better detoxification of the body.

8. Acetyl-L-carnitine—prevents and reduces pain associated with neuropathy, and may improve glucose balance.

9. Banaba leaf—has been shown to lower blood sugar with insulin-like properties.

10. Nopal (Prickly Pear Cactus)—normalizes blood sugar, whether too low or too high, increases insulin sensitivity and reduces inflammation.

11. Karela (Bitter Melon)—lowers blood sugar, increases insulin sensitivity, and stimulates digestion.

12. Agaricus Blazei—mushroom that increases adiponectin levels, a protein hormone that is produced by adipocytes (fat cells), which regulates the body’s metabolism of lipids and glucose, influences the body’s response to insulin, and reduces inflammation in the vessel walls.

I developed a supplement, Glucose Balance by SpringTree Nutrition (, which contains all of these ingredients listed above. Used in combination with SuperMulti Plus, which contains all the vitamins, minerals, bioflavinoids and anti-oxidants necessary to provide for what becomes depleted in the diabetic body, blood sugar levels frequently improve, energy and health improve, and often medication can be reduced under a physician’s supervision.

Other supplements that I would recommend for people with diabetes:

• A good soluble fiber supplement to reduce glucose absorption and assist digestion.

• Betaine HCL, taken at the beginning of a meal, to improve stomach acid, which is often low in those with diabetes. Low stomach acid reduces stomach emptying, reduces digestion and absorption of calcium and other minerals, B-vitamins, and proteins. It also increases acid reflux.

• Digestive enzymes, taken at the end of a meal, to assist digestion.

• An adrenal support supplement, such as Adrenal Stress Relief by SpringTree Nutrition, as stress increases blood sugar and makes the disease process worse. Diabetes itself is also very stressful to the body and a good adrenal support will assist the body in better dealing with that stress.

• If overweight, a healthy supplement to assist with weight loss such as Appetite and Carb Control, which will be soon released by SpringTree Nutrition.

GI Health, coming soon from SpringTree Nutrition, is an excellent support for digestive health, containing soluble fiber, pre-biotics and pro-biotics, and other excellent ingredients to support the digestive health of a patient with diabetes who struggles with gastro-intestinal problems.

Next blog will be on a simple exercise that does wonders for weight loss and blood sugar control for people with diabetes.

Until we meet again,
Dr. Judi

Saturday, May 8, 2010

What Can I Eat When I Have Diabetes?

I'm going to discuss two diets here: the diet proposed by the American Diabetes Association (ADA) and the diet I have found works best for the diabetic patients that come to my office.

The ADA recommends the following:

•Grains and starches 6-11 servings a day
•Vegetables 3-5 servings a day
•Fruit 2-4 servings a day
•Milk and dairy 2-3 servings a day
•Meat and meat substitutes 4-6 oz. divided between meals
•Fats, sweets and alcohol keep small servings for a special treat

A serving of grains or starches includes 1 slice of bread, ¼ bagel, 1/3 cup rice, ½ cup potatoes, yams, peas, corn, beans.

A serving of vegetables is 1 cup raw or ½ cup cooked.

A serving of fruit is ½ cup canned fruit, 1 small fresh fruit, or 1 cup melon or berries.

A serving of mild and dairy is 1 cup non-fat or low-fat milk or 1 cup of yogurt.

Four ounces of meat is a quarter pound. 1 oz. of meat is equal to ¼ cup cottage cheese, 1 egg, 1 tablespoon peanut butter, and ½ cup tofu.

A typical serving of sweets includes ½ cup ice cream, 1 small cupcake or muffin, or 2 small cookies.

The problem I see in my patients on this diet, even though basically healthy, is that their blood glucose and insulin levels are still not controlled. And I believe the greatest source of that problem is in the grains and the starches, which are given the highest priority in this diet.

Sugar Stabilization Program

The following is the program I put my patients on which has very positive effects in balancing their blood glucose and insulin levels. This can be used for both type 1 and type 2 diabetics, and often both the amount of insulin and/or oral medication can be reduced (under the direction of a physician) when the diet is used in combination with the supplements.

1. Avoid refined sugar: sucrose, fructose, maltodextrose, etc. No honey, syrup, turbinado sugar, etc. Avoid artificial sweeteners: aspartame (Nutrasweet, Equal), saccharin (Sweet'N Low, SugarTwin), acesulfame K (Sunett, Sweet One), Sucralose (Splenda). Limited amounts of xylitol, stevia and agave nectar are acceptable.

2. Eat a palm size piece of protein (meat, fish, egg, tofu) at each of the three major meals a day.

3. Eat as many vegetables as possible—preferable five servings a day, especially green leafy and non-starchy vegetables. Eat potatoes sparingly.

4. Eat three fruits a day, preferably as a dessert after a normal meal. Eat bananas sparingly. Avoid fruit juice.

5. Eat a healthy (protein, vegetable, nuts or seeds, cheese) snack between meals.

6. Avoid products made with flour: bread, crackers, tortillas; use pasta sparingly. Whole grains: whole wheat berries, brown rice, whole barley, oatmeal are acceptable in limited amounts, unless you are gluten sensitive. Bread made from sprouted grains rather than flour are acceptable in limited amounts. DO NOT USE GRAINS IF YOUR BLOOD GLUCOSE REMAINS HIGH ON THIS DIET.

7. Legumes, nuts and seeds are acceptable.

8. Dairy is acceptable if there is no allergy to it.

9. Use healthy fats and oils: olive, sunflower, safflower, grape seed, walnut, etc.

10. Drink 6-8 cups of water a day.

11. Glucose Balance supplement daily.

12. Interval exercising 12 minutes a day.

This way of eating combined with the supplements and exercise program described in a future blog often reduces blood sugar enough to reduce or even come off of medication (under a doctor’s supervision) for Type 2 Diabetes, and often reduce the level of insulin necessary in Type 1 Diabetes, which reduces long-term complications.

Before you start this program, it is important to take your blood sugars four times a day: before each meal and at bedtime, to get a baseline of where your blood sugars are normally, and then continue for the first couple of weeks on the program to see how you are responding to it. Once a month it is useful to take your blood sugars four times a day, if you are not already doing it, to be sure that your regimen is working for you. If your blood sugars start going too low, talk to your doctor about reducing your medication.

After you get used to the basics of this program, having been on it for more than a month, if your glucose readings are still too high, you can modify it in the following steps as needed, one at a time, step by step, until your readings, along with supplements and/or medication, are between 80 and 110 (the majority of diabetics will not have to go beyond the first one to two steps):

1. Using an online carbohydrate counter and reading labels, count the number of grams of carbohydrates you are eating and reduce to 75 grams a day.

2. Use an online glycemic index table, and only eat foods that are given the value of 50 or below.

3. Cut out all gluten (wheat, oatmeal, rye and barley). Some people are sensitive to gluten and it causes an unusual rise in insulin levels.

4. Reduce the number of grams of carbohydrates you eat to 50 grams a day.
5. Reduce the number of grams of carbohydrates to 25 grams a day.

Studies have shown that people who don’t eat gluten (in wheat, oatmeal, rye and barley), lose weight, lower glucose levels, and increase their HDL and ApoA1 levels.

The low number of carbohydrates seems restrictive, but blindness and kidney dialysis and amputations are much more restrictive. Often, when the blood sugars are under control for a year, the body can handle more carbohydrates without a rise in blood sugar.

The next blog will be about supplements that have been shown to assist in lowering and stabilizing glucose and insulin levels.

Until we meet again,
Dr. Judi

Wednesday, May 5, 2010

About the Medicines Used for Diabetes

The information in this blog is rather technical and probably boring for someone who doesn't have diabetes. However, if you are on any type of medication for diabetes I recommend that you at least read about the medicines you are taking. It is important to be knowledgable about what you are taking into your body, so that you can be aware of what is helping and what may be causing a problem.

Type 1 diabetes is always treated with insulin. Without insulin, a person with type 1 will develop hyperglycemia that progresses to ketoacidosis, and eventually death. They are usually given a long acting insulin that is given in shots once or twice a day, depending on the type, and then supplement it with short acting insulin at mealtime to cover the amount of carbohydrates they eat. There are various brands and types of long-acting and short-acting insulin, and sometimes they are put together in one shot. The combination shot may work for some people with type 2 diabetes, but I don't recommend it for type 1.

Type 1 diabetics now have the option of using an insulin pump, which keeps a more steady flow of insulin. However, they often still may need to give extra short acting insulin to cover their meals.

Often I have heard doctors tell type 1 diabetics that they can eat what they want; just cover the amount of carbohydrates with adequate insulin. However, if type 1 diabetics eat high carbohydrate meals or eat too much so that they need large amounts of insulin, eventually their cells become resistant to insulin and they also develop type 2 diabetes. High levels of insulin also increase fat deposition and increase inflammation in the body, which increases hardening of the arteries, heart disease and stroke risk. I believe that it is very important for all diabetics to watch what they eat, and recommend the Sugar Stabilization Program given later in this book.

Type 2 diabetes is usually treated with oral medications, unless it advances to a level where they no longer work, and then insulin is given.

Please read the following carefully if you are taking oral medications for diabetes. Make sure the medication you are taking is not causing you serious side effects.

The various types of oral medications can be catagorized as follows:

Sulfonylureas. Sulfonylureas used to be the first medication to be prescribed for type 2 diabetes. However, with the newer drugs, they are usually now added after the other drugs are not giving enough control. Sulfonylureas lower blood sugar by stimulating the pancreas to release more insulin. The first drugs of this type that were developed -- Dymelor, Diabinese, Orinase and Tolinase -- are not as widely used since they tend to be less potent, have more side effects, and are shorter-acting drugs than the newer sulfonylureas. They include Glucotrol, Glucotrol XL, DiaBeta, Micronase, Glynase PresTab, and Amaryl. These drugs can cause a decrease in the hemoglobin A1c (HbA1c) of up to 1%-2%.

Sulfonylureas often induce hypoglycemia (low blood sugar) which often prevents a diabetic from achieving good glucose control; people usually keep their blood glucose elevated above optimal in order to reduce the frequency and severity of hypoglycemia, which can cause coma.

Like insulin, sulfonylureas can induce weight gain, which increases problems associated with diabetes. Other side-effects can be abdominal upset, headache and hypersensitivity reactions.

Sulfonylureas are potentially harmful to the fetus and should not be used in pregnancy or in patients who may become pregnant. Impairment of liver or kidney function increase the risk of hypoglycemia, and are contraindications.

The use of sulfonylurea agents has been reported, but not proven in all studies, to increase the risk of death from heart and blood vessel disease, probably because they cause an increase in insulin levels. Patients with diabetes are already more likely to have these problems, but they should be aware that many of these drugs make heart disease worse. However, glyburide (Micronase, Diabeta and Glynase) and gliclazide (Glipizide) have been shown in studies to have a positive effect on heart and blood vessel disease.

Biguanides. Metformin (Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza) is the most commonly used oral diabetic agent, and actually originates from the French lilac (Galega officinalis), a plant known for several centuries to reduce the symptoms of elevated blood sugar.
Metformin works by reducing glucose production by the liver (gluconeogenesis). The "average" person with type 2 diabetes has three times the normal rate of gluconeogenesis; metformin treatment reduces this by over one third. Metformin also causes the cells to become more sensitive to insulin, increasing glucose uptake by the cells and therefore lowering blood sugar. Meformin can decrease the HbA1c 1%-2%. It also increases fatty acid oxidation, which reduced triglyceride and LDL cholesterol levels.

Unlike other diabetic medications, metformin does not cause low blood sugar, one of the most dangerous side effects of most medications. It has a lower side effect profile than the other drugs.

The most common side effect is gastrointestinal upset, including diarrhea, cramps, nausea, vomiting, and increased flatulence. GI upset happens most often at the beginning of use, or when the dose is increased. It is better to start low and slowly increase.

Metformin should not be used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients, which can cause death.

Thiazolidinediones. These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of sugar released by the liver and make fat cells more sensitive to the effects of insulin. Rosiglitazone (Avandia) and Pioglitazone (Actos) are the two drugs of this class. A decrease in the HbA1c of 1%-2% can be seen with this class of oral diabetes medications.

These drugs may take a few weeks before they have an effect in lowering blood sugar.
The main side effect of all thiazolidinediones is water retention, leading to edema, generally a problem in less than 5% of individuals, but a big problem for some and potentially, with significant water retention, leading to congestive heart failure. Therefore, thiazolidinediones should be prescribed with both caution and patient warnings about the potential for water retention/weight gain, especially in patients with decreased ventricular function (NYHA grade III or IV heart failure).

Recent studies have shown there may be an increased risk of coronary heart disease and heart attacks with rosiglitazone.

Pioglitazone treatment, in contrast, has shown significant protection from both micro- and macro-vascular cardiovascular events and plaque progression.

Alpha-glucosidase inhibitors, including Precose and Glyset. These drugs block enzymes that help digest starches, slowing the rise in blood sugar. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.

Meglitinides, including Prandin and Starlix. These diabetes medicines lower blood sugar by stimulating the pancreas to release more insulin. The effects of these diabetes pills depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia.

However, these medications can still cause hypoglycemia to some degree. They can also cause weight gain because of the increased levels of insulin.

Dipeptidyl peptidase IV (DPP-IV) inhibitors, including sitagliptin (Januvia). Januvia works to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control sugar without causing weight gain, and often reduces appetite. The medication may be taken alone or with other medications such as metformin.

Side effects include headache, nausea, diarrhea or constipation, sore throat and respiratory tract infections. More rare but serious side effects include fever and a headache with a severe blistering, peeling red rash. Many report an increase in joint pain. The FDA has warned of serious pancreatitis that can lead to death.

Incretin mimetics. Exanitide (Byetta) is a new class of medication approved in 2005. Byetta is administered as a subcutaneous injection (under the skin) of the abdomen, thigh, or arm, 30 to 60 minutes before the first and last meal of the day. It is a synthetic version of exendin-4, a hormone found in the saliva of the Gila monster. It enhances the glucose-dependent secretion of insulin, suppresses glucagon secretion, and slows gastric emptying. It supposedly reduces appetite and assists with weight loss.
The main side effects of Byetta use are gastrointestinal in nature, including acid or sour stomach, belching, diarrhea, heartburn, indigestion, nausea, and vomiting. Other side effects include dizziness, headache, and feeling jittery. The FDA has issued a warning about severe pancreatitis that can lead to death associated with Byetta.

Combination therapy. There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet which utilizes both metformin and rosiglitazone (Avandia) in one pill.

When blood sugars are not able to be controlled with oral medication, a person with type 2 diabetes may also be placed on insulin.

The next blog will be about diets used for diabetes, including my Sugar Stabilization Program.

Until we meet again,
Dr. Judi

Monday, May 3, 2010

How is Diabetes Diagnosed?

The medical guidelines for diagnosing diabetes is as follows:

Fasting plasma glucose (a blood test after at least 8 hours of fasting):
•80-99 normal
•100-125 pre-diabetes (impaired glucose tolerance)
•126 or over diabetes

2-hour glucose tolerance test (blood test 2 hours after fasting and then drinking 75 grams of glucose):
•under 149 normal
•140-199 pre-diabetes (impaired glucose tolerance)
•over 200 diabetes

Hemoglobin A1C levels:
•under 6.0 normal
•6.0 to 6.4 pre-diabetes
•over 6.5 diabetes

The American Diabetic Association recommends that people aged 45 or older should consider getting tested for pre-diabetes or diabetes. People younger than 45 should consider testing if they are overweight, obese, or extremely obese and have one or more of the following risk factors:
•being physically inactive
•having a parent, brother, or sister with diabetes
•having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander
•giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes
•having high blood pressure—140/90 mmHg or above—or being treated for high blood pressure
•having an HDL, or “good,” cholesterol level below 35 mg/dL or a triglyceride level above 200 mg/dL
•having polycystic ovary syndrome, also called PCOS
•having IFG or IGT on previous testing
•having a condition called acanthosis nigricans, characterized by a dark, velvety rash around the neck or armpits
•having a history of cardiovascular disease—disease affecting the heart and blood vessels

If results of testing are normal, testing should be repeated at least every 3 years. Doctors may recommend more frequent testing depending on initial results and risk status. The ADA states that people whose test results indicate they have pre-diabetes should have their blood glucose checked again in 1 to 2 years and take steps to prevent type 2 diabetes.

I find that many people have a normal fasting blood glucose but still have pre-diabetes. My test of choice for testing for insulin resistence, glucose intolerance and diabetes, which used to be done commonly but is rare now, is a 4-hour Glucose Tolerance Test. The blood glucose level AND the insulin level is taken fasting, and then after a glucose drink it is taken at ½ hour, 1 hour, 2 hours, 3 hours and 4 hours, testing both glucose and insulin levels at each draw. This shows if the glucose and/or insulin goes too high, and often it will then drop too low at 3 or 4 hours, which increases stress on the body. THIS TEST SHOULD NOT BE USED TO DIAGNOSE TYPE 1 DIABETES.

Rather than advocating simply being re-tested in 1 to 2 years if there are any signs of pre-diabetes, we immediately change the diet and other risk factors, and start the patient on supplements that will reduce their risk of getting diabetes.

Type 1 diabetes is diagnosed through the same glucose level parameters. Most children diagnosed with diabetes have type 1, though that is changing. Most diagnoses of type 1 are made when the child presents to the emergency room extremely ill in ketoacidosis.

Most adults diagnosed with diabetes have type 2, but rarely it is type 1. Most of those with type 1 lose weight when their blood sugar rises. Most of those with type 2 fight obesity because of the elevated levels of insulin, which hold onto fat, though this isn't 100% true.

The differences between type 1 and type 2 in testing are:
•People with type 1 have ketones in their urine when their blood sugar is high. People with type 2 don't have ketones, unless they have been fasting or eating only protein.
•Extra testing to determine if diabetes is type 1 include a c-peptide test (which measures levels of this protein associated with insulin production) or tests for islet cell antibodies (ICA), insulin auto-antibodies (IAA), and/or glutamic acid decarboxylase (a beta cell protein known as GAD).

If you suspect the possibility that you may have diabetes or pre-diabetes, please ask your doctor to test you. Early treatment with diet and supplements before medication is needed may keep you from ever needing medication.

The next blog will be on the medications that are used to treat diabetes.

Until we meet again,
Dr. Judi