According to facts and figures provided by the American Diabetes Association, there are an estimated 20.8 million people in the United States, approximately 7% of the population, with diabetes. Approximately 6.2 million of these people have not yet been diagnosed. Additionally, there are 54 million Americans that are pre-diabetic with higher than normal blood glucose levels yet not elevated enough for the "diabetes" diagnosis.1 The hyperglycemia resulting from types I and II diabetes mellitus can lead to multiple challenges for the person with diabetes. Patients who are struggling to compensate for a lack of insulin secretion and=or a lack of insulin efficiency face possible complications, such as retinopathy, nephropathy, neuropathy, and atherosclerosis. At the core of preventing and dealing with diabetes mellitus is an understanding of how the body regulates the metabolism of its principal energy source, glucose, and how specific nutrients, diet modifications, and supportive botanical medicines can be utilized to optimize glucose metabolism.
PHYSIOLOGY: AGES, CROSS-LINKING, AND ELEVATED BLOOD SUGAR
Elevated blood sugar has been shown to cause several physiological reactions in the body leading to disease states. One of these reactions involves adding sugars to molecules, a process known as glycosylation. "Advanced glycosylation end products'' (AGEs) are formed by the attachment of reducing sugars onto biological proteins. This reaction is irreversible causing these proteins with sugars attached to accumulate over time. One well-known example of AGEs is hemoglobin A1C, which is frequently measured to evaluate long-term blood sugar control in diabetics. It is proposed that AGE formation is a normal physiological process that functions as a signal for recognition of old molecules to be broken down and excreted by the kidneys. With increasing age, the excretion of these molecules decreases. AGE formation and accumulation is greatly accelerated with high levels of circulating sugars and oxidative stress seen in conditions such as diabetes.2 A study was performed with individuals diagnosed with type 1 diabetes comparing various inflammatory markers and AGE levels with blood sugar control after eating. The investigation demonstrated a significant increase in AGE levels and pro-inflammatory markers with increased blood sugar levels after eating.3 AGEs are also ingested in the diet generally in the form of foods undergoing prolonged heating, particularly fats, meat and meat-substitutes, and broiled foods.4 In individuals with normal kidney function, only about one-third of ingested AGEs are excreted in the urine within 48 hours, and less AGE excretion is found with kidney disease. Also, this study found that serum AGE cross-linking is significantly increased after ingestion of an AGE-containing meal.5 Animal studies also indicate that high-fat diets are correlated with obesity, tissue damage, and increased levels of AGEs.6 AGEs can be inhaled through tobacco smoke as well.7 Physiological reactions involving AGEs have been implicated in the pathology of numerous diseases.
Table 11-1. Common Complications of Diabetes
CompIications of Diabetes
Statistics of Secondary Diseasesa
Heart disease Stroke
Hypertension Retinopathy Nervous system Amputations Dental disease
Renal disease Metabolic syndrome
Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
The risk for stroke is 2 to 4 times higher and the risk of death from stroke is 2.8 times higher among people with diabetes.
About 73% of adults with diabetes have high blood pressure.
Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years of age.
About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.
The rate of amputation for people with diabetes is 10 times higher than for people without diabetes.
Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 mm or more.
Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2002.
About 47 million U.S. residents have metabolic syndromeb aAccording to the American Diabetes Association.68 bSee Chapter 24 on metabolic syndrome.
AGEs react with molecules creating cross-linkages. Proteins and other large molecules, such as lipids, can undergo cross-linking reactions that cause them to become less elastic and less digestible by enzymes for degradation. Conditions such as diabetes show an increase in gly-cosylation of proteins, which may be the causative link with the increase in chronic diseases seen with these diseases.8 AGEs have been implicated in the vascular changes found with diseases of the nerves, kidneys, and eyes in diabetic individuals.9
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