These two markers can help you predict your risk at the earliest phase
The prevalence of type 2 diabetes mellitus (T2DM) has increased by sevenfold from 35 millions to 240 millions from 1983 to 2008. In just three years, from 2008 to 2011, another 100 millions people diagnosed as diabetic in our global population. The significant morbidity and mortality associated with the vascular complications of the disease like blindness, heart attack, stroke and kidney failure make T2DM as a serious public health threat and a heavy economic burden on health care system.
With all those fact, in my opinion, we should shift our thinking to “why and how did that happened?” and away from the old paradigm of medicine that would have asked, “should there be a new medicine to manage T2DM invented?" The answer to the first lies within the functional medicine approach in finding the root causes of one’s T2DM, because everyone is unique. You can be diabetic because you are loaded with junk foods, OR you can be diabetic because you are not sleeping well even though you already eat a nutrient dense diet, OR you can be diabetic because you are aging prematurely and your anabolic hormones – your heal and repair hormones – are depleted. This is why one pill not fits all! Diabetes is a lifestyle disease. Your lifestyle choices are the key to either feeding the disease or fighting it.
One of my best friends in medical school blamed her gene for suffering from T2DM. She said she were destined to have it because her mother had it and died at younger age as the consequences. So she relies on pills and getting obese on the way while she entertains her appetite. She is a friend, but she is now avoiding me because at one point I was telling her that IT IS A MYTH, Diabetic is NOT a genetic disease, it is a lifestyle disease.
Our gene does not change, in fact, genetic transformation happened 0.2% in every 20.000 years. But we are in the know now – and I wish that my friend wants to open up with this new medicine – that our gene responds to our environment, and the expression of a certain gene responding to the can always be either diseases or wellness. So, yes diabetic is in her gene, as cancer is in mine, however, I chose to nurture this bad gene in a good way – like how we nurture our bad garden bed in a most caring way – so at the end, I will be able to turn off the cancer gene and be cancer free as well as she can turn off her diabetic gene and be diabetic free. A simple Nutrigenomic Testing is now available to give a more accurate guidance on how to nurture your gene.
As a Functional Medicine practitioner, I know that T2DM is a disease of a continuum where blood glucose metabolism is disturbed, for whatever the root cause is. I also know that as T2DM is a lifestyle disease, improving your lifestyle (what you eat, what you think, how you sleep, what your exercise is, what your social network is and who are your loved ones) to the better will help you get better. There is this one study I encountered that a full-blown type 2 is fully reversible with extreme changes of lifestyle. But as member of community, especially as I come from a family with a long list history of chronic diseases, I know first hand how difficult it is to make an extreme lifestyle changes (and even harder when you ask your loved ones to change theirs) even though you know you badly need it. This is where I would introduce an integrative approach to the patient – to focus on (as Dr David L Katz says) – fork (what you eat), feet (be active), fingers (avoid toxins such as cigarettes and alcohol), strong social network (surround yourself with loved ones), sleep and stress management. Your pills for your ills won’t work without you change your lifestyle.
Now, back to the fact, that there were 100 millions people diagnosed with Type 2 Diabetes within 3 years between 2008-2011, and it is estimated that in 2030, the number of diabetic population will be doubled that in 2015. What did we miss? How do we spot those in the general population who is on elevated risk of developing Type 2 Diabetes and where are they on the Insulin Resistance Continuum so that we can help them reverse it.
Our blood sugar is controlled by the work of our insulin that is produced by our pancreas. The sensitivity of the insulin in sensing our blood glucose level is crucial to make sure the level is always just right. When the level is elevated, the pancreas will work harder, releasing more insulin to make it back to normal. If the glucose level elevated continuously, then the insulin level will too. At this point, your triglycerides – a fatty substance in your blood (that you probably more familiar as part of your cholesterol profile) which is also regulated by insulin, might be elevated too. This will keep going until the pancreas gets tired, in that case the insulin level will be elevated but it is not sensitive anymore in sensing the blood sugar level and thus it no longer can keep the blood glucose level in the normal range so it is now elevated too. So remember this, the elevated blood glucose is the result of the insulin being resistant of which is the sign of the pancreas getting tired – at this point, you might or might not have symptoms.
Full-blown diabetes is diagnosed when the fasting blood glucose level is 125mg/dl or more. This is when the pancreas is tired and the insulin is everywhere in the blood but fail to help lower the glucose. And this is when you will be prescribed with anti diabetic medication. But without saving your pancreas, this medication will never bring your glucose back to normal. In fact, diabetes is not that you don’t have enough insulin, it is when you have too much insulin but they don’t function they way it should.
So, an attempt in fighting diabetes is an early detection. Determining risk when it is still in the earliest phase on the continuum so that we can intervene early is crucial. And in my approach, this starts when your insulin (fasting and 2 hour after meal and I also look at triglycerides) are elevated even when your blood glucose is still in the perfect range. I was so happy when I came across to a study reported in Diabetes Care in 2001. The study by McAuley KA, Williams SM, Mann JI, Walker RJ, Lewis-Barned NJ, Temple LA, Duncan AW concluded, “A weighted combination of two routine laboratory measurements, i.e., fasting insulin and triglycerides, provides a simple means of screening for insulin resistance in the general population”
And if you want to be more thorough, you can also check your adiponectin, the level of adiponectin will change even before the insulin level changes, but let’s just be simple at this time, make sure you include fasting and 2 hour after meal insulin on your next check up. (I assume triglycerides as part of your cholesterol is always included already)
Fight Diabetes. Start now, make lifestyle your medicine!
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