Diabetes - Types, Signs & Symptoms, Diagnosis & Treatment

Diabetes mellitus, commonly known as diabetes is a group of metabolic disorders characterized by a high blood sugar (glucose) level over a prolonged period of time, because the body does not produce enough insulin.

Glucose, or blood sugar, is the main and most important source of energy for most living organisms. All human cells use glucose for their energy needs. The brain uses the most, and during fasting can account for up to 80% of glucose consumption in the whole body. Serum glucose is the quantity of glucose in the blood. Glucose concentrations in the blood (serum glucose) are maintained within a narrow range through the action of various hormones (i.e. insulin and glucagon) and mechanisms (i.e. gluconeogenesis, glycogenolysis, and glycolysis). Glucose can be measured in a laboratory using blood samples or with glucose meters using reactive strips.

Insulin, a hormone released from the pancreas, controls the amount of sugar in the blood. When a person eats or drinks, food is broken down into materials, including sugar, that the body needs to function normally. Sugar is absorbed into the bloodstream and stimulates the pancreas to produce insulin. Insulin allows sugar to move from the blood into the cells, once inside the cells, sugar is converted to energy. Which is either used immediately or stored until it is used.

If the body does not produce enough insulin to move the sugar into the cells, the resulting high levels of sugar in the blood and the inadequate amount of sugar in the cells together produce the symptoms and complications of diabetes.

Symptoms often include frequent urination, increased thirst, and increased appetite. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, damage to the nerves or damage to the eyes and cognitive impairment. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced.

Diabetes mellitus is classified into four broad categories: type 1 diabetes, type 2 diabetes, gestational diabetes, and "other specific types". The "other specific types" are a collection of a few dozen individual causes. Diabetes is a more variable disease than once thought and people may have combinations of forms. The term "diabetes", without qualification, refers to diabetes mellitus.

Prediabetes:

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.

You can have prediabetes for years but have no clear symptoms, so it often goes undetected until serious health problems such as type 2 diabetes show up. It’s important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for prediabetes, which include: Being overweight, being 45 years or older, having a parent, brother, or sister with type 2 diabetes, Being physically active less than 3 times a week, ever having gestational diabetes (diabetes during pregnancy) or giving birth to a baby who weighed more than 9 pounds or having polycystic ovary syndrome.

Race and ethnicity are also a factor: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.

Doctors sometimes refer to prediabetes as Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG), depending on what test was used when it was detected. This condition puts you at a higher risk for developing type 2 diabetes and cardiovascular disease. You can get a simple blood sugar test to find out if you have prediabetes. Ask your doctor if you should be tested.

Type 1 Diabetes (T1D):

Is an autoimmune disease that occurs when T cells attack and decimate the beta cells in the pancreas that are needed to produce insulin. The pancreas makes too little insulin or no insulin. Without the capacity to make adequate amounts of insulin, the body is not able to metabolize blood sugar (glucose), and toxic acids (ketoacidosis) build up in the body. There is a genetic predisposition to type 1 diabetes.

The disease tends to occur in childhood, adolescence or early adulthood, before age 30, but it may have its clinical onset at any age. The symptoms and signs of type 1 diabetes characteristically appear abruptly, although the damage to the beta cells may begin much earlier and progress slowly and silently.

This form was previously referred to as "Insulin-Dependent Diabetes Mellitus" (IDDM) or "Juvenile Diabetes". The cause of this autoimmune response is unknown.

Type 1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes. In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors, such as a viral infection or diet. Several viruses have been implicated, but to date there is no stringent evidence to support this hypothesis in humans. Among dietary factors, data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood.

It can occur at any age, and a significant proportion is diagnosed during adulthood. Latent Autoimmune Diabetes of Adults (LADA) is the diagnostic term applied when type 1 diabetes develops in adults; it has a slower onset than the same condition in children. Given this difference, some use the unofficial term "type 1.5 diabetes" for this condition. Adults with LADA are frequently initially misdiagnosed as having type 2 diabetes, based on age rather than cause.

Type 2 Diabetes (T2D):

Is the type in which the beta cells of the pancreas produce insulin but the body is unable to use it effectively because the cells of the body are resistant to the action of insulin. Although this type of diabetes may not carry the same risk of death from ketoacidosis, it otherwise involves many of the same risks of complications as does type 1 diabetes (in which there is a lack of insulin).

This form was previously referred to as "Non-Insulin Dependent Diabetes" (NIDDM) or "Adult-Onset Diabetes". The most common cause is a combination of excessive body weight and insufficient exercise.

Type 2 diabetes is the most common type of diabetes mellitus. Many people with type 2 diabetes have evidence of pre-diabetes (impaired fasting glucose and/or impaired glucose tolerance) before meeting the criteria for type 2 diabetes. The progression of pre-diabetes to overt type 2 diabetes can be slowed or reversed by lifestyle changes or medications that improve insulin sensitivity or reduce the liver's glucose production.

Type 2 diabetes is primarily due to lifestyle factors and genetics. A number of lifestyle factors are known to be important to the development of type 2 diabetes, including obesity (defined by a body mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization. Excess body fat is associated with 30% of cases in people of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders. Even those who are not obese may have a high waist–hip ratio.

Dietary factors such as sugar-sweetened drinks is associated with an increased risk. The type of fats in the diet is also important, with saturated fat and trans fats increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk. Eating white rice excessively may increase the risk of diabetes, especially in Chinese and Japanese people. Lack of physical activity may increase the risk of diabetes in some people.

Gestational Diabetes (GDM):

Gestational diabetes resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery. It is recommended that all pregnant women get tested starting around 24–28 weeks gestation. It is most often diagnosed in the second or third trimester because of the increase in insulin-antagonist hormone levels that occurs at this time. However, after pregnancy approximately 5–10% of women with gestational diabetes are found to have another form of diabetes, most commonly type 2. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required.

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital heart and central nervous system abnormalities, and skeletal muscle malformations. Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause infant respiratory distress syndrome. A high blood bilirubin level may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.

Other Types of Diabetes:

Maturity Onset Diabetes of the Young (MODY) is a rare autosomal dominant inherited form of diabetes, due to one of several single-gene mutations causing defects in insulin production. It is significantly less common than the three main types, constituting 1-2% of all cases. The name of this disease refers to early hypotheses as to its nature. Being due to a defective gene, this disease varies in age at presentation and in severity according to the specific gene defect; thus there are at least 13 subtypes of MODY. People with MODY often can control it without using insulin.

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes). This form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells, whereas others increase insulin resistance (especially glucocorticoids which can provoke steroid diabetes).

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20) but may be the first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease and about 75% of deaths in people with diabetes are due to coronary artery disease. Other macro vascular diseases include stroke, and peripheral artery disease.The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and eventual blindness. Diabetes also increases the risk of having glaucoma, cataracts, and other eye problems. It is recommended that people with diabetes visit an eye doctor once a year. Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplantation. Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes. The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle atrophy and weakness. Very high and very low blood sugar level or diabetes- related buildup of acid in your blood can cause confusion, lethargy and even coma and death. So if you are experiencing such symptoms it is best that you contact your doctor immediately. Other diabetes complications such as numbness of feet, visual problems should be reported immediately to your doctor.

There is a link between cognitive deficit and diabetes. Compared to those without diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function. Having diabetes, especially when on insulin, increases the risk of falls in older people.

Oral health:

Diabetes can have many adverse effects on your teeth, including:

• Dry mouth
• Gingivitis
• Difficulty tasting
• Higher risk of decay
• Infection susceptibility

Because of these risk factors, it is important that you visit an experienced dentist. Seeing a provider who understands the care you will need is essential to your oral health.

Now that you know what it does to your teeth, you should know why and how it happens. Diabetes itself causes a decrease in the production of saliva in your mouth, which results in dry mouth. Saliva is what keeps your teeth naturally clean in between brushing and without it, you are at a much higher risk of getting cavities. As far as gum disease, or periodontal disease goes, it is not just diabetics who are at risk. Everyone has some amount of bacteria living in their mouth at all times and are at risk for developing gum disease. Since diabetes makes it harder for your body to control blood sugar, it makes it harder to prevent infections. The bacteria in your mouth will take advantage of this lessened defence and put your oral health in danger. Periodontal disease is when bacteria goes in between your teeth and your gums, creating less of a solid foundation for your tooth to sit in. As a result, over time, many periodontal disease sufferers lose teeth that do not have the ability to stay in the gums. Preventing and treating periodontal disease is essential to stopping tooth loss.

While it might look like diabetes is tough on your oral health, it is something that can be treatable when you work side-by-side with your dentist. Working with an experienced dentist, like Dr. Kiavash Hossini, a dentist in Port Coquitlam, you can make a plan of attack against any oral health concerns caused by diabetes. One of the most important things that you can do is make sure that you are keeping up with your routine dental exams and hygiene appointments. Some patients may be recommended to come in more frequently than others in an effort to keep your teeth and gums healthy and strong. Additionally, good home care will help you in between your dental appointments.

Outside of consulting with your dentist, you should also consult with your healthcare provider about any diabetes concerns that you might have and make sure that any medication that you are taking is in fact keeping your blood sugars under control. There are other steps that you can take to help keep you healthy, including:

• Brush twice a day, floss once a day
• Quit smoking
• Keep any removable denture or appliance clean daily
• Control your blood sugar levels, using medication as directed and following the recommended diet plan
• Visit the dentist for regular check-ups

It is still important to keep in contact with your medical and dental providers to keep your oral health as good as possible, but you can help the process by taking care of yourself well, including following a healthy diet and practice good oral hygiene.

Complications of high blood glucose level (hyperglycemia):

Blood vessel damage:

High glucose levels in the body damage the inner lining of blood vessels. This is because high glucose increases damaging (reactive oxidative species, CRP) and inflammatory compounds (cytokines), and makes it harder for the vessels to relax (via reducing NO). The resulting oxidative stress in the blood vessels causes inflammation. Proteins and leukocytes accumulate, harden blood vessels, and eventually lead to the formation of plaques that block blood flow (atherosclerosis). This is the root cause of heart disease in people with diabetes. If left untreated, high blood sugar can lead to stroke, heart disease, and other blood vessel disorders, the most common complication of type 2 diabetes.

Nerve damage (neuropathy):

Diabetic neuropathy happens when high glucose causes nerve damage in people with diabetes. High glucose increases inflammation in the nerves, resulting in mild numbness and pain in the legs and feet or problems with digestion, urination, and heart function. A common complication of diabetic neuropathy is called the diabetic foot, with ulcers, infections, and minimal to no feeling in feet or legs. Loss of feeling in the foot may lead to more injuries and open wounds, while a lower immune response in people with diabetes makes it harder to fight the infections off.

Kidney damage (nephropathy):

Kidney damage (nephropathy) is another common complication of both type 1 and type 2 diabetes. Diabetes can damage the delicate filtering system in the kidneys. Severe damage can cause kidney failure and even end-stage kidney disease, which requires dialysis and a kidney transplant.

Weakened immune system:

High blood glucose impairs white blood cells (neutrophils), reduces antioxidant activity, and reduces immunity (humoral). This increases the risk of skin disorders and infections. This can be seen from studies that looked at HbA1c. In a study of over 1000 healthy people, elevated HbA1c was associated with impaired immune response (T-cell).

Dementia:

Dementia refers to memory loss, impaired brain function, and low cognitive activity.

Impaired vision or hearing (retinopathy):

Diabetic retinopathy (damage to blood vessels in the retina) is a frequent complication of diabetes, and the most common cause of blindness in the working-age population. Fluid build-up in the eyes (diabetic macular edema) also causes loss of vision in those with diabetes. Blindness can be prevented by regularly monitoring and controlling both blood sugar and blood pressure. Hearing impairment is also more common in people with diabetes. This may be due to the effects of high glucose on the blood vessels and nerves in the ear.

Osteoporosis:

Mental illness:

Studies suggest that individuals with type 1 diabetes have a higher risk of depression, anxiety, and eating disorders. If you have diabetes and are suffering from a mental health issue, don’t hesitate to ask for help and support.

Cancer:

Studies suggest that diabetes may increase the risk of liver, pancreas, uterus, colon/rectum, breast, and bladder cancer.

Complications of low blood glucose level (hypoglycemia):

Hypoglycemia, or very low glucose levels, has severe health effects and increases the risk of serious complications in people with diabetes. It is a very dangerous state that can lead to coma and even death, depending on its severity or duration. The brain relies on glucose to function. Long-term, very low glucose levels could damage cognitive function, particularly in young children. Hypoglycemia can usually be prevented by regular glucose monitoring, as well as being consistent with your lifestyle and drug regimen.

Brain damage:

Glucose is fuel for the brain. Inadequate glucose supply over time will result in dementia. Severe episodes may even lead to coma and death.

Heart disease:

Patients with type 2 diabetes have a higher chance of getting heart disease (cardiovascular disease). But the mortality rates from heart disease are even higher in those who experience severe hypoglycemia. Acute hypoglycemia activates the fight-or-flight response (sympathetic nervous system), which releases epinephrine. This increases heart rate and blood pressure, which can be especially risky for patients with a history of complications.

Impaired vision:

Hypoglycemia can cause visual disorder in individuals with diabetes and has been linked with double vision (diplopia), dizziness/blurred vision and loss of contrast sensitivity. Hypoglycemia also makes your eyes more sensitive, reduces eye muscle responses, and generally heavily damages and kills cells in the eye (retinal cell dysfunction, retinal cell death, and cone cell death). All these factors can heavily impair vision, and may even cause blindness.

Mental illness:

Recurrent hypoglycemia episodes generate feelings of powerlessness, anxiety, and depression amongst patients and their families. Acute hypoglycemia can result in mood swings including irritability, stubbornness, and feelings of depression.

There is no known preventive measure for type 1 diabetes. You will not develop type 2 diabetes automatically if you have prediabetes. For some people with prediabetes, early treatment can actually return blood glucose levels to the normal range. Type 2 diabetes, which accounts for 85–90% of all cases worldwide, can often be prevented or delayed by maintaining a normal body weight, engaging in physical activity, and eating a healthy diet.

The relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. There is growing evidence that the underlying determinants of diabetes are a reflection of the major forces driving social, economic and cultural change: globalization, urbanization, population aging, and the general health policy environment.

Diabetes management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with dietary changes, exercise, weight loss, and use of appropriate medications (insulin, oral medications).Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels. Per The American College of Physicians, the goal of treatment is an HbA1c level of 7-8%.

Attention is also paid to other health problems that may accelerate the negative effects of diabetes. These include smoking, high blood pressure, metabolic syndrome obesity, and lack of regular exercise. Specialized footwear is widely used to reduce the risk of ulcers in at-risk diabetic feet although evidence for the efficacy of this remains equivocal.

To control and manage type 1 diabetes, you need to inject insulin regularly, up to eight times per day. You must also test your blood sugar frequently, using a home blood-sugar monitor. You use that information, in consultation with your doctor to regulate your insulin dosage, diet and exercise.

Treatment of type 2 diabetes also starts with home blood-sugar monitor testing. But only a fraction of people with type 2 diabetes need insulin injections. Most can be controlled with blood sugar dietary changes, healthy diet, regular physical exercise and oral medications, a normal body weight, and avoiding use of tobacco. Type 2 diabetes may be treated with medications such as insulin sensitizers with or without insulin. Control of blood pressure and maintaining proper foot and eye care are important for people with the disease. Insulin and some oral medications can cause low blood sugar. Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 diabetes. Gestational diabetes usually resolves after the birth of the baby.

If you are diagnosed with type 1 diabetes or type 2 diabetes, you should definitely must be under doctor’s care and management. And you should never stop using your medications or injections, or alter your dosage, without your doctor’s approval.

Some of the oral medication normally given to type 2 diabetes patients are:

• Glyburide (Micronase), medication that spur the release of more insulin
• Metformin (Glucophage), medication that slows your liver’s release of stored sugar
• Acarbose (Precose), medication that slows the digestion of carbohydrates
• Troglitazone (Rezulin), medication that increases cellular insulin sensitivity

Unfortunately, none of these drugs or medication is very effective over the long term. During the first year of treatment, these drugs may improve blood-sugar control in about 90% of people who take them. But as years pass by, the drugs stop working for about half of those who take them. If that happens, you have to use insulin injection instead.

There are other medical developments that may include a pancreas transplant for type 1 diabetes. You may ask your doctor for added information. To enjoy a healthier lifestyle even if you are afflicted with diabetes, you may follow some simple suggestions using blended medicine. Though the following suggestions are more tailored for type 2 diabetes.

What is Diabetes Management?

A diabetes management plan is a personalized plan that details how you can manage your diabetes. It takes into account your individual health goals, medications, and lifestyle. Following your plan can help you achieve your blood sugar goals, reduce your risk of heart disease and stroke, and other complications, such as kidney disease and nerve damage.

A diabetes management plan includes:

• Regular checking of your blood sugar levels
• A healthy diet plan to keep blood sugars in target range
• A plan for physical activity
• Medications to manage blood glucose levels
• Stress management measures that may include counselling, meditation or other activities.

Decreasing blood sugar:

If you don’t have diabetes but your blood glucose is in the prediabetic range, your health care providerwill likely recommend a few lifestyle changes to bring your levels down to the safe range. This usually takes the form of weight loss, changes to your diet (reducing the size of your portions and avoiding foods high in sugar, simple carbohydrates, and saturated fats), and regular exercise. A plan to lose between 5% and 10% of your body weight within 6 months is a common recommendation. However, this approach doesn’t always work if you have type 2 diabetes and won’t work at all if you have type 1.

• Higher levels of physical activity (more than 90 minutes per day) reduce the risk of diabetes by 28%. Exercising moderately (such as brisk walking) 30 minutes a day, five days a week.
• Adding more movement to your daily life can be as simple as just moving around more while working, stretching regularly, and avoiding sitting as much, in addition to more structured exercise.
• Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish.
• Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help prevent diabetes.
• Weight loss, if you are overweight, losing 5% - 7% of your weight. Losing 7% of your body weight (or 15 pounds if you weigh 200 pounds). Don't worry if you can't get to your ideal body weight. Losing even 10 to 15 pounds can make a huge difference.
• Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well.
• You should work with your health care provider to develop a lifestyle plan, but you may also need medication to control your blood glucose levels throughout the day and prevent dangerous spikes. If you have type 2 diabetes, you may be able to take medications by mouth, such as metformin.
• You might also need calculated doses of insulin released into your bloodstream; the amounts you should take will depend on your blood glucose test results. This can be done with regular injections throughout the day or with a device attached to your body called an insulin pump, which automatically administers it as needed.

Increasing blood sugar:

Hypoglycemia, where your blood glucose is lower than 70 mg/dL, is a common problem for people with type 1 diabetes. It’s important to know how to handle it when it happens. Hypoglycemia can be caused by a number of things, such as taking too much insulin, waiting too long before eating or not eating enough, and exercising a lot more than usual.

• Eating something that can raise your blood glucose. But in severe cases, where your blood glucose dips below 55 mg/dL, this might not be enough.
• If you’re at risk of this, your health care provider might prescribe an injectable medication called glucagon to use in an emergency. You can use it yourself, or someone else can use it on you if you’re not able to.
• You will then need to seek emergency treatment after the injection to make sure that your glucose levels make it back up to a safe level.

The 15-15 Rule:

This is a helpful guideline for raising your blood glucose when it’s in the 55 mg/dL to 69 mg/dL range. It means that you should eat 15 grams of carbohydrates, then wait 15 minutes and check your blood glucose. If your blood glucose level is still too low, repeat the process until you’re back in your target range. After this, you should try to eat something nutritious and low in fat (fat slows the absorption of sugars) to make sure it doesn’t get too low again.

Glucose control:

Controlling blood sugar levels is very necessary at all costs. This can be done by routine monitoring in the morning, one or two hours before and after having a meal, and before going to bed. So, it is important to know the safe levels and adjust the required eating habits and calorie intake accordingly. Low blood sugar is often fatal and appears with the symptoms of sweating, shaking, anxiety and nervousness, hunger, irritability, confusion, or dizziness. To prevent these conditions, the patient should be immediately treated with something sweet to increase the low blood sugar levels. For high blood sugar levels, physical exercise, adherence to medication, and excessive water intake are recommended.

Most medications used to treat diabetes act by lowering blood sugar levels through different mechanisms. There is broad consensus that when people with diabetes maintain tight glucose control – keeping the glucose levels in their blood within normal ranges – they experience fewer complications, such as kidney problems or eye problems. There is however debate as to whether this is appropriate and cost effective for people later in life in whom the risk of hypoglycemia may be more significant.

There are a number of different classes of anti-diabetic medications. Type 1 diabetes requires treatment with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin analogs. Type 2 diabetes may also be treated with insulin at later stages. Some medications for type 2 diabetes are taken by mouth, such as metformin, while others are only administered by injection, such as GLP-1 agonists.

Metformin:

Is generally recommended as a first-line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. It works by decreasing the liver's production of glucose. Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type 2 diabetes. These include agents that increase insulin release (sulfonylureas), agents that decrease absorption of sugar from the intestines (acarbose), agents that inhibit the enzyme dipeptidyl peptidase-4 (DPP-4) that inactivates incretins such as GLP-1 and GIP (sitagliptin), agents that make the body more sensitive to insulin (thiazolidinedione) and agents that increase the excretion of glucose in the urine (SGLT2 inhibitors). When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Doses of insulin are then increased until glucose targets are reached.

Cholesterol and blood pressure lowering:

High cholesterol levels and high sugar levels also interfere with blood pressure by damaging the blood vessels, and ultimately contribute to the onset of cardiovascular diseases. Diabetic patients are also found to have been linked with cardiac problems and therefore, have high chances of having a heart attack and stroke. To prevent these diabetes complications, it is suggested to eat healthily, reduce weight, consume less salt and low levels of fats and properly adhere to the medication prescribed by the physician.

Cardiovascular disease is a serious complication associated with diabetes, and many international guidelines recommend blood pressure treatment targets that are lower than 140/90 mmHg for people with diabetes. However, there is only limited evidence regarding what the lower targets should be.

Lifestyle:

People with diabetes can benefit from education about the disease and treatment, dietary changes, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.

Weight loss:

Can prevent progression from prediabetes to diabetes type 2, decrease the risk of cardiovascular disease, or result in a partial remission in people with diabetes. No single dietary pattern is best for all people with diabetes. Healthy dietary patterns, such as the Mediterranean diet, low-carbohydrate diet, or DASH diet are often recommended, although evidence does not support one over the others.

Weight loss surgery in those with obesity and type 2 diabetes is often an effective measure. Many are able to maintain normal blood sugar levels with little or no medications following surgery and long-term mortality is decreased. There is, however, a short-term mortality risk of less than 1% from the surgery. The body mass index cutoffs for when surgery is appropriate are not yet clear. It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control. A pancreas transplant is occasionally considered for people with type 1 diabetes who have severe complications of their disease, including end stage kidney disease requiring kidney transplantation.

For type 1 diabetes it is important to keep a check of the carb intake and determine the insulin levels you need to take. However, in type 2 diabetes, patients are usually observed to ensure that they’re not overweight. Being obese means the normal functioning of insulin in the body is hard to maintain. Therefore, for patients suffering from type 2 diabetes, the major focus is to take a diet that helps in burning fat and consequently results in controlling body weight.

Exercise routinely:

Studies suggest that physical exercise is a very important factor in disease management if you have type 2 diabetes. However, as the disease develops, patients feel weak and therefore, become physically less active. As we all know, exercise burns calories, and the calories are sufficient primarily from sugar reserves present in the blood. 

Physical exercise is known to improve the control over blood glucose levels and consequently delay or prevent the onset of type 2 diabetes, helping you avoid diabetes complications. It also positively interferes with lipid metabolism and in cardiovascular diseases by controlling blood pressure and thus ensures a healthy lifestyle and an improved quality of life. 

Physical exercise contributes by improving the response of the body to blood sugar levels. This suggests the importance of exercise and if it is incorporated in the daily routine of a diabetic patient, it would greatly help in maintaining the blood sugar levels in a safer range thus, preventing complications.

Numerous studies have underscored these benefits, and some of the results of these studies have been highlighted below:

• Exercise lowers HbA1c values by 0.7% in those who suffer from diabetes. Those studied were also taking a variety of different medications and following a plethora of different diets. Thus, this improvement occurs regardless of whether people lost weight or not after exercising.
• Every form of exercise including resistance and aerobic exercise helps to lower insulin resistance in those adults with abdominal obesity.
• Combining two different forms of exercise has proven to be far more beneficial than performing one form of exercise. 
• Those with diabetes who walked for at least two hours per week were far less likely to die as a result of heart disease when compared to their counterparts. Those who exercised for four hours per week cut their risk more dramatically.
• Women who had diabetes and spent four hours per week exercising had a 40% lower risk of developing heart-related diseases than those who did not exercise at all. These benefits continued even after researchers included other factors including BMI and heart disease risk factors including smoking.

Avoid smoking and alcohol:

You may not realize it, but smoking and drinking alcohol can make your diabetes worse. It is highly advisable to quit smoking if one is suffering from diabetes mellitus, especially type II, and wants to stay safe from diabetes complications. Studies suggest that smoking has been associated with aggravating the risk of developing heart, eye, nerve, and kidney diseases. It can also cause decreased blood flow to the limbs, leading to diabetic ulcers and infections, premature deaths, and also interferes with the normal glucose metabolism in the blood. 

Chemicals present in cigarettes produce inflammatory responses, thus interfering with the cell’s potential of responding to insulin and taking up glucose from the bloodstream. As a result, the excess of glucose is accumulated in the body, mainly increasing the belly fat that further worsens the disease condition. To conclude, smoking may result in serious consequences in diabetic patients if left ignored. Therefore, diabetic patients should consider quitting smoking – an excellent tip to avoid diabetes complications and multiple health conditions.

Guidelines for alcohol intake are similar to those for the general population, which recommend that women and men limit their average daily intakes of alcohol to one drink and two drinks per day, respectively. In addition, individuals using insulin or medications that promote insulin secretion should consume food when they ingest alcoholic beverages to avoid hypoglycemia (alcohol can cause hypoglycemia by interfering with glucose production in the liver). Conversely, an excessive alcohol intake (three or more drinks per day) can worsen hyperglycemia and raise triglyceride levels in some individuals. People who should avoid alcohol include pregnant women and individuals with advanced neuropathy, abnormally high triglyceride levels, or a history of alcohol abuse.

Your doctor will tell you that smoking is a risk factor for heart disease, which is a major cause of death among people with diabetes. Additionally, drinking alcohol can increase the risk of developing high blood sugar levels.

Manage stress:

Stress can affect your blood sugar levels in a couple of ways. If you’re stressed out and have low blood sugar, it’s best to eat something sugary right away (like a candy bar or some fruit). In the case of high blood sugar, if your stress level is at an all-time high, try eating something salty or fatty to bring down those levels. Stress management techniques such as meditation are known to help people with diabetes manage their stress levels better overall. These were a few tips that can help you manage stress. It is recommended that you visit your doctor regularly and get their opinion before trying out anything new.

Pay special attention to infections:

High blood sugar levels result in reduced blood flow, especially in the limbs. This reduced blood flow also results in loss of sensation and flushing of the cellular debris. If left unnoticed, it may result in blisters from where microorganisms can directly enter and cause infections. These infections may take longer than usual in recovery and are often observed to spread in the nearby area inside the body. It mainly occurs in the feet. Therefore, to prevent the problems associated with the diabetic foot and stay safe from diabetes complications, the following preventive measures is highly recommended:

• Wash your feet with lukewarm water routinely, while preventing soaking the feet at the same time as it may lead to dry skin that is more prone to infections
• Wash and moisturize your hands and feet with petroleum jelly or with moisturizer. This not only prevents the dryness of the skin but also prevents the growth of microorganisms in the foot
• Do not over-moisturize your feet as moisture can also support the growth of microorganisms
• Regularly check your feet for blisters, sores, calluses or swelling. Also avoid walking barefoot, even in your home
• If you detect any foot problem, consult a physician as early as possible

Nutrition and diet for diabetes:

For diabetes management and control, it is generally advised that the person should start to make adjustments on his lifestyle. This include maintaining a simple diet, eating foods that are less saturated with fat and cholesterol. By reducing or eliminating animal products and eating more fiber-rich plant foods such as whole grains, beans, fruits, and vegetables.

Eat a lot of foods that are rich in antioxidants. Plant-derived foods are rich in the antioxidant nutrient including beta-carotene and vitamin C and E. Antioxidants neutralize free radicals, preventing this unstable oxygen molecules from damaging healthy cells. Free radicals not only lay the groundwork for the most serious complications of diabetes, they are also the cause of high blood sugar level. Include fiber-rich food to your diet. Foods that is rich in fiber helps in controlling the blood sugar level. It works by holding the nutrient in the digestive tract longer, allowing a slower absorption rate and reducing blood sugar ups and downs. Soy products and Tofu can also help people with diabetes. Soy is a good source of amino acids, glycine and arginine, that help block the body’s synthesis of cholesterol. Low levels of magnesium have been established in certain studies to be a factor in developing diabetes. Beef up your diet with magnesium rich food such as grains, nuts, and leafy green vegetables. According to Tandem Diabetes’ experts, “You should avoid alcohol and sugary drinks because they contain carbohydrates that affect blood glucose levels".

• Use less salt in meals
• Select healthy carbohydrate sources, such as whole grains, fruits, vegetables, dairy items, and pulses
• Avoid consuming red meat and replace them with lentils, vegetables, poultry, and fish
• Select healthy fats such as those obtained from nuts, fish, fruits (Avocado), and vegetables
• You may also take vitamin, mineral supplements and herbs to help you in diabetes management and control.

Macronutrient:

The recommended macronutrient distribution (percent of calories from carbohydrate, fat and protein) depends on food preferences and metabolic factors (for example: insulin sensitivity, blood lipid levels, and kidney function). Intakes suggested for the general population is often used as a guideline. Day-to-day consistency in carbohydrate intake is associated with better glycemic control, unless the patient is undergoing intensive insulin therapy that matches insulin doses to mealtime carbohydrate intakes.

Carbohydrate:

The amount of carbohydrate consumed has the greatest influence on blood glucose levels after meals, the more grams of carbohydrate ingested, the greater the glycemic response. The carbohydrate recommendation is based in part on the person’s metabolic needs, the type of insulin or other medications used to manage the diabetes, and individual preferences. For optimal health, the carbohydrate sources should be whole grains, legumes, vegetables, fruits and milk products, whereas foods made with refined grains and added sugars should be limited.

Glycemic index:

Different carbohydrate-containing foods have different effects on blood glucose levels after they are ingested; for example, consuming a portion of white rice causes blood glucose to increase more than would a similar portion of barley. A food’s glycemic effect is influenced by the type of carbohydrate in a food, the food’s fiber content, the preparation method, the other foods included in a meal, and individual tolerances. For individuals with diabetes, choosing foods with a low glycemic index (GI) over those with a high GI may modestly improve glycemic control. A food’s glycemic effect is not usually a primary consideration when treating diabetes, however, because clinical studies investigating the potential benefits of low-GI diets on glycemic control have had mixed results. Nonetheless, high-fiber, minimally processed foods—which typically have lower glycemic effects than do highly processed, starchy foods—are among the foods frequently recommended for persons with diabetes.

Sugars:

A common misperception is that people with diabetes need to avoid sugar and sugar-containing foods. In reality, table sugar (sucrose), made up of glucose and fructose, has a lower glycemic effect than starch. Because moderate consumption of sugar has not been shown to adversely affect glycemic control, sugar recommendations for people with diabetes are similar to those for the general population, which suggest minimizing foods and beverages that contain added sugars. However, sugars and sugary foods must be counted as part of the daily carbohydrate allowance.

Fructose, a naturally occurring monosaccharide in fruit, has minimal effects on blood glucose levels when compared with similar amounts of sucrose or starch. Although some food products marketed to people with diabetes are sweetened with fructose, intakes of fructose should be limited—to no more than 12 percent of total calories—to avoid excessive energy intakes or adverse effects on blood lipids (high fructose intakes may increase blood triglyceride levels in some individuals). Sugar alcohols (such as sorbitol and maltitol) have lower glycemic effects than glucose or sucrose and may be used as sugar substitutes. Artificial sweeteners (such as aspartame, saccharin and sucralose) contain no digestible carbohydrate and can be safely used in place of sugar.

Whole Grains and Fiber:

Recommendations for whole grain and fiber intakes are similar to those for the general population. People with diabetes are encouraged to include fiber-rich foods such as whole-grain cereals, legumes, fruits, and vegetables in their diet. Although some studies have suggested that very high intakes of fiber (more than 50 grams per day) may improve glycemic control, many individuals have difficulty enjoying or tolerating such large amounts of fiber.

Dietary fat:

In individuals with diabetes, a Mediterranean-style dietary pattern that emphasizes monounsaturated fats may benefit both glycemic control and cardiovascular disease (CVD) risk. In addition, increased intakes of omega-3 fatty acids from fatty fish or plant sources may improve the lipoprotein profile and various other CVD risk factors. Other guidelines related to fat intake are similar to those suggested for the general population: saturated fat should be less than 10 percent of total calories, Trans fats should be minimized and cholesterol intake should be less than 300 milligrams daily.

Protein:

Protein recommendations for people with diabetes are similar to those for the general population. The average protein intake is about 15% of the energy intake. Although several small, short-term studies have suggested that protein intakes above 28% of total calories may improve glycemic control or lipoprotein levels in diabetic individuals, other studies did not show any benefit. In addition, high protein intakes are sometimes discouraged because they may be detrimental to kidney function in patients with nephropathy.

Micronutrients:

Micronutrient recommendations for people with diabetes are the same as for the general population. Vitamin and mineral supplementation is not recommended unless nutrient deficiencies develop; those at risk include the elderly, pregnant or lactating women, strict vegetarians, and individuals on calorie-restricted diets

Vitamin E:

By taking vitamin E, diabetes patients may manage and prevent its complications. Clinical nutritionists normally recommend taking 600 to 800 international units (IU) a day. But be cautioned that taking vitamin E more than 400 IU should be taken under doctor’s supervision.

Chromium:

The mineral chromium plays a key role in the manufacture of insulin and in the maintenance of blood sugar with normal range. Normal recommended dosage is from 400 to 600 micrograms per day. But you must have your doctor’s approval before taking chromium supplement.

Zinc:

Several studies have shown that animals deprived with zinc develop high blood sugar. Other studies have determined that diabetes increases the excretion of zinc in urine, reducing the amount of the mineral in your blood. Normal recommended dose is at 30 to 50 milligrams per day and should be taken under medical supervision.

Magnesium:

As mentioned earlier, magnesium helps in controlling high blood sugar content. If you feel like you are not taking enough magnesium from your diet, you may take in some extra magnesium supplements. Normal suggested dose is at 20 to 30 milligrams a day.

Borage Oil and Primrose Oil:

These oils contain gamma-linoleic acid, which improves blood circulation through your small blood vessels. These small blood vessels are the ones that are normally blocked if you have chronically high blood-sugar level. A good number of patients with high blood sugar levels have shown remarkable improvements after taking borage oil and primrose oil every day. Ask your doctor for a dosage.

Alternate-day fasting (ADF):

Alternate-day fasting can improve endothelial functions in mice with type-2 diabetes. This paper has managed to turn a few heads. More importantly, it has created the idea that alternate-day fasting can be beneficial when battling diabetes. Through alternate day fasting, you can lose weight and reduce the risk factors that cause type-2 diabetes. It also regulates insulin levels, which further serves the purpose of battling diabetes. Besides, alternate-day fasting can also help tackle heart disease.

Alternate-day fasting is a variation of intermittent fasting. Here, you fast one day and eat whatever you would like the next, preferably something healthy. In doing so, you reduce calorie intake, which allows a more efficient regulation of insulin levels.

Increase water intake:

Water is a drink with zero sugar present in it. Therefore, it is considered the best for diabetics. Studies suggest that drinking more water helps in lowering blood sugar levels and thus helps you avoid diabetes complications. The body of diabetics is actively trying to remove excess glucose and for doing this more water is required as sugar is excreted through urine. This increased demand for water by the bodies of diabetics is also linked to dehydration. Therefore, it is very important to keep the body hydrated all the time as it is critical for carrying out daily chores. At the same time, it is helpful in flushing out the excess sugar present in the bloodstream.

Herbal medicine and supplements:

Herbs and supplements work to lower your blood sugar levels. In doing so, they provide numerous health benefits as well as protect you from diabetes. Rosemary is one such herb that helps balance blood sugar levels and also fights cholesterol. This way, the herb promotes weight loss and allows you to maintain a healthy body weight. Like Rosemary, sage has a similar impact. It, too, lowers your blood sugar levels like Rosemary and has a significant impact when you consume it on an empty stomach. Oregano, Aloe Vera and Ginger have similar blood sugar-combating properties. These natural herbs have been used for centuries to deal with many health problems, including diabetes. Even in an age where medical science is at its best, people frequently go back to these herbs when seeking natural means to deal with diabetes.

Supplements mimic the effects of these herbs when dealing with diabetes. They release chemicals that either neutralize high sugar levels or prevent carbs from turning into sugar which might increase blood sugar levels. 

Banaba (Lagerstroemia speciosa)

Banaba is a flowering plant that grows in warm climates like the Philippines and India. Banaba is widely used in the Philippines and other Asian countries in traditional medicine as herbal treatment for diabetes. In India, Banaba is also used in Ayurvedic medicine for the treatment of diabetes.

The following details the preparation and application of Banaba herbal medicine for diabetes:

• Dry Banaba leaves and fruits for about two weeks
• Cut Banaba leaves into peices
• Boil the dried Banaba leaves and fruits in water,
• One cup of dried banaba leaves and fruits to one cup water.
• Let it steep for 30 minutes,
• Strain the leaves and fruits.
• Take the Banaba herbal tea for 4 to 6 times daily.
• Although studies have shown that Banaba does not contain any toxic ingredients. It is recommended that before taking any herbal medicine for your diabetes, consult with your doctor.

Bitter Melon - Ampalaya (Momordica charantia):

Ampalaya (Momordica charantia) also known as Bitter Melon is a tropical and subtropical vine of the family Cucurbitaceae, widely grown in the Amazon, Carribean, South east Asia such as Philippines for its edible fruit.Bitter melon as the name implies has a bitter taste due to the presence of momordicin, and is believed to be among the most bitter of all vegetables. Ampalaya is a widely used herbal remedy to lower the blood sugar levels for diabetic patients.

Cinnamon - Canela (Cinnamomum verum, Cinnamomum zeylanicum):

Cinnamon, originates from Sri Lanka, is actually a one of the earliest and most well-known household herbs utilized in Jamaica today. The herb can be found in its powdered form in just about all kitchens throughout the island. Cassia has been utilized in Chinese medicine for centuries. There are numerous other types of Cinnamon, mainly from Asia and Madagascar. Even though Cinnamon is known and utilized as a spice it provides a variety of health advantages that numerous may be unacquainted with. Cinnamon has the power to increase insulin sensitivity, and this helps in the prevention of type 2 diabetes and metabolic resistance. Cinnamon helps in lowering of blood sugar level in a person, and hence, is known as anti-diabetic food. Cinnamon slows down breaking up of carbohydrates in the digestive system, after entering the blood stream, thereby reducing blood sugar level. Hence, Cinnamon can sometimes act as a boon for diabetic patients.

Cinnamon tea, which is high in anti-diabetic properties, is the safest way to regulate and lower blood sugar levels. Cinnamon contains elements that can help lower blood sugar levels by reducing insulin fighting capability and increasing insulin efficacy levels in the body. The spice-infused tea works in the same way as insulin does, transferring sugar from the bloodstream to the tissues. Cinnamon tea, taken after meals, helps in the digestion of carbohydrates in the stomach and prevents a spike in blood sugar levels. Suggested use: ¼ teaspon of Cinnamon a day added to coffee, fruit juice or cereal. It may also delay the onset of type of diabetes.

Cat's Whiskers - Balbas Pusa (Orthosiphon aristatus):

Cat's Whisker (Orthosiphon aristatus) is a tropical herbaceous perennial plant that is native in Southeast Asia usually found in China, Taiwan, Philippines, Thailand and even in Australia. Balbas pusa, commonly referred to as Java tea is a herb used as medicine for many centuries.

Swamp Cabbage - Kangkong (Ipomoea aquatica):

Kangkong (Ipomoea aquatica) is a semiaquatic, tropical plant that flourishes naturally in water and moist soil. Kangkong is an edible plant harvested as a leaf vegetable. Kangkong thrives in tropical and subtropical regions and is more commonly found in Southeast Asian countries. Kangkong can grow rapidly spreading through waterways forming floating mats that can block water flow and passage of small water crafts. The USDA categorized Kangkong as a “noxius weed” and is included in prohibited aquatic plant list.

Kangkong is considered safe even for pregnant women and breast feeding mothers. Kangkong is actually used to treat diabetes during pregnancy. Kangkong might have a side effect of lowering the blood sugar levels. Caution is advised if you are taking diabetes medicine.

Cayenne Pepper - Siling Labuyo (Capsicum frutescens):

Siling Labuyo (Capsicum frutescens) is a variety of cayenne pepper commonly found in Southeast Asian Region. It is commonly mistaken as Capsicum annum which has many similar physical characteristics but Siling Labuyo has more pungent odor and taste. Siling Labuyo is believed to lower blood cholesterol and can help cure diabetes.

Soursop - Graviola (Anona muricata):

Graviola tree (Anona muricata Linn.) is a small tree, usually about 5 to 7 meters high. Graviola is a fruit bearing tree, broadleaf, flowering, and evergreen that is native to Central America, the Carribean and South America. Graviola can be found in Mexico, Colombia, Brazil, Peru, and Venezuela. Graviola or Soursop are also native in sub-Saharan African countries. Graviola is adaptable to tropical climate and are currently cultivated for its fruit in most Southeast Asian countries such as Malaysia, Indonesia and Philippines.

Indian Guduchi - Gulancha Tinospora - Makabuhay (Tinospora cordifolia):

Makabuhay (Tinospora cordifolia) or Guduchi is a popular Ayurveda medicinal plant, also called Heavenly elixir or divine nectar, widely used to promote overall health. Makabuhay claims health benefits for diabetes, glucose metabolism, inflammation, immune system support, and neurology. Makabuhay plant is a native plant from tropical and subtropical rainforests in the Far East such as in India, Philippines, Sri Lanka and Malaysia.

Makabuhay has a long history of medicinal use in India in Ayurveda medicine. Ayurvedic practitioners in India used Makabuhay to promote longevity, prevent diseases and to treat various illnesses from arthritis to treatment of cancer. In the Philippines, Makabuhay plant extract is traditionally combined with Coconut oil to treat rheumatism and arthritis, abdominal pains (kabag), scabies, skin ulcers and others.

Makabuhay (Tinospora cordifolia) might have a side effect of lowering the blood sugar levels. Caution is advised if you have diabetes. The doses of your diabetes medicine might need to be adjusted.

Black Plum - Java Plum - Duhat (Syzygium cumini):

Black Plum was found throughout the Philippines, planted in many regions spontaneous. Probably of prehistoric introduction from Malaya, also occurs in the Indo-Malayan region generally. Naturally the tree grows in India, Himalayas, Malaysia, Sri Lanka and Australia. It got introduced to Fiji, Cook Islands, Guam, French Polynesia, New Caledonia, Florida, Hawaii, Palau, Niue, China, Tonga, Palau, Malaysia, Indonesia, Australia, Christmas Island, India, Africa, South America and Caribbean.

Black Plum is used for treating various diseases especially diabetes and associated complications. The plant possesses several compounds which are found to be the characteristics of plant. The pharmacological activities on diabetes were carries out with seed. There are not so much works with pharmacological actions of phytochemical constituents of Black plum. On the basis of these facts, the role of Black Plum in variety of treatments and recommended that further clinical and phytochemical research should be carried out on the plant for making safer drugs.

White Mulberry - Moras - Morera (Morus alba):

The plant is native to Central and eastern China. It is now grown in plantations, and for ornamental reasons in gardens and parks throughout the warm temperate world, and is naturalized both in Europe and North America. It is generally a short-lived tree with a lifespan comparable to that of humans, although there are some specimens known to be over 250 years old.

There are more than a few references for Morus alba use in cancer, diabetes, infection, and neurodegenerative disorders. Root juice of white mulberry agglutinates the blood and kills worms in the digestive system. Leaf juice is used to prevent throat infections and inflammation and it is its diaphoretic and emollient properties helps with this action. Having a cooling and laxative property, the fruit juice is also use to treat fevers, colds, diarrhea, malaria, constipation, and intestinal worms. Plant is perhaps best known for its effects on diabetes. The active ingredient in white mulberry, commonly referred to as 1-DNJ, is able to shut down or slow down sugar processing in the body, resulting in more manageable blood sugar levels. This can greatly improve quality of life for diabetic patients.

Madagascar Periwinkle - Amnias - Tsitsirika (Catharanthus roseus):

Madagascar Periwinkle is native of south-eastern and eastern Madagascar, found growing as wild plant species in rain forest. It is established in many parts of the Philippines and is often very abundant along sandy seashores. Tsitsirika contains more than 70 powerful alkaloids, most of which are well-known for their medicinal properties. It contains the anti-cancerous vincristine and vinblastine as well as anti-hypertensive reserpine. It also helps in managing your blood sugar levels. Madagascar Periwinkle is traditionally used to treat diabetes in many Asian folk medicines. In the Philippines and China, the plant is boiled for several minutes and consumed daily to help manage insulin level in the body and minimize high blood pressure.

Devil’s Cotton - Anabo (Abroma augusta):

Anabo was found from the Batan Islands and northern Luzon to Mindanao. It is available in Eastern Africa, South & Tropical Asia and Australia. It is cultivated widely in India from Punjab, Uttar Pradesh, Assam, Arunachal Pradesh, Tripura and Meghalaya, in thickets, waste places, and open secondary forests at low and medium altitudes. Also reported from India to southern China to Malaya. It is cultivated for ornamental purposes. The research shows that the leaf extracts of devil’s cotton helps to treat Type 2 Diabetes Mellitus which assist the glucose absorption. The presence of water soluble fibers helps to lowers the metformin activities. It also prevents the physical and chemical interaction. It also eliminates the drugs absorption which is still need to be investigated.

In India, it is used in Ayurvedic medicine in order to treat the diabetes. Coccinia indica and Abroma augusta helps to cure the diabetes. The extract of dried roots (powdered) and leaves should be provided regularly for about eight weeks. It stimulates the glucose tolerance and lipid profile of serum.

Custard Apple - Sugar Apple - Atis (Annona squamosa):

Custard Apple is said to have originated from West Indies, but the fruit was carried through Central America to southern Mexico. For a long time, the custard apple was grown and naturalized in countries like Peru and Brazil. Proof suggests that these fruits have been grown in the Bahamas, Bermuda and southern Florida. This fruit rapidly spread across tropical Africa around the 17th century and was grown in South Africa as a dooryard fruit tree. In India, the custard apple was prevalent in parts of Kolkata. Eventually, it gained popularity on the east coast of Malaya, south-east Asia and the Philippines. 80 years ago, custard apples were found in abundance in Guam, a region off the western Pacific Ocean.

Custard Apple is one of the nutritious and healthy fruit. There are several advantages of consuming custard apple. The health benefits of custard apple have been proven in various research studies, folklore remedies and Ayurvedic medicine.

Longevity Spinach - Sabuñgai - Kamañgi (Gynura procumbens):

Sabuñgai is a medicinal herb originating in India, Thailand, Indonesia, Malaysia, Vietnam and Africa, its natural range extending from the Himalayan foothills to southern China and the Philippines, in thickets along streams, in old clearings, etc., at low and medium altitudes, ascending to 1,500 meters, from northern Luzon to Mindanao, in most islands and provinces. It also occurs in Thailand and Indo-China to Malaya.

Research concluded that Longevity Spinach can induce a hypoglycemic effect in diabetic animals. It has been verified to considerably reduce fasting blood sugar levels and reduce glucose spike during glucose tolerance test in diabetic rats but not normal rats. You may drink the potion in the stew of Longevity Spinach leaves once every day for better result.

Chinese Salacia - Matang-Ulang (Salacia chinensis):

Chinese Salacia is a threatened medicinal plant, found in thickets and forests at low altitudes, often near the sea, in Zambales, Bataan, Batangas, Quezon, and Camarines Provinces in Luzon; and in Mindoro, Palawan, Biliran, Romblon, Leyte, Panay, Bucas Grande, Mindanao, and the Sulu Archipelago. Also occurs in India, through Malaya to tropical Australia. In traditional South and Southeast Asian herb medicine, Ayurvedic and Unani medicine, Chinese Salacia is used as antidiabetic agent. In India, hot water extraction of the whole plant has been used orally as anti-diabetic.

Bird's Eye - Marrango - Danggo (Azadirachta excelsa):

Bird's Eye is native to the Philippines, Malaysia, Borneo, Indonesia, Vietnam, Papua New Guinea, usually in old clearings or secondary forests; sea level to 350 meters altitude. and exotic in Singapore and Thailand. Malays used the plant to lower blood glucose. Seed oil used in traditional medicine for treatment of diabetes, antibacterial, wound healing and as antifertility medicine.

Curry Leaf - Karipata (Bergera koenigii):

Karipata is native to Assam, Bangladesh, Cambodia, China, Hainan, Himalaya, India, Laos, Malaya, Nepal, Pakistan, Sri Lanka, Thailand, Vietnam, grows primarily the wet tropical biome. This herb is used for diabetes, dysentery, fever, inflammation, and to treat hypertension.

Licorice - Anis (Glycyrrhiza glabra):

Licorice is native to the Mediterranean of southeast Europe and parts of the South-West Asia and particularly to the Indian subcontinent. Licorice root has been used in both Eastern and Western medicine to treat a variety of illnesses ranging from the common cold to liver disease. Some scientific research suggests licorice root to be effective against diabetes but research have been conducted on animals only.

Kudzu - Baai - Tahaunon (Pueraria montana):

The plant is native to East Asian countries (India, Indochina, China, Japan, Korea, Myanmar, Thailand, Laos, Vietnam, Malaysia, Indonesia, Philippines and Papua New Guinea.). Probably it is also native to, or an early introduction to, some western Pacific islands (i.e. Fiji, New Caledonia, the Solomon Islands and Vanuatu). It was introduced to South America and Southern United States, Africa, Central Asia, Ukraine and Caucasus. It is also present in the coastal districts of north-eastern Northern Territory, and is regarded as being native to this area.

Earlier research suggests that taking puerarin, a chemical in kudzu, 750 mg daily by mouth along with the diabetes medication rosiglitazone (Avandia) decreases blood sugar in patients with type 2 diabetes. It also improves kidney function in people with diabetic nephropathy.

Stevia - Sweet Leaf (Stevia rebaudiana):

Stevia, originally native to Paraguay and Brazil, commercially cultivated in Brazil, Paraguay, Uruguay, Central America, Thailand and China, was recently introduced and cultivated in the Benguet region for its sweet leaves. If you ask dietitians about sugar, sugar substitutes, and natural sweeteners, they will all say the same thing: the best sugar is no sugar at all, with Stevia being the second best when it comes to sweeteners of all kinds. Stevia seems to be a new generation sweetener that is all the rage right now, but in fact, it is a well-known natural sweetener. As we would expect, it had its fair share of controversy back in the 80s, when The U.S. Food and Drug Administration FDA deemed it unsafe for consumption. Years later, after careful review and debates including dietitians, nutritionists, and doctors, the FDA lifted the ban in the 2000s, labelling rebaudioside A, the sweetest Stevia extract, as generally safe for consumption. Today, we have a handful of foods and beverages containing Stevia-based sweeteners, but Stevia seems to have more health benefits than just being a no-calorie healthy sugar.

Still focusing on the field of blood sugar control, weight loss, and cholesterol control, as one can easily imagine, Stevia sweeteners are safer for diabetics than artificial sweetenes. Those following a diabetic diet plan know they should give up on sugar and stir away from chemical artificial sweeteners, found to raise blood sugar levels even more than regular sugar. In other words, if you are a diabetic or in high risk of diabetes, do not pick up diet soda, no matter what the label says about “zero sugar” or “zero calories”.

Animal-based studies showed that a daily dose of 250 and 500 milligrams of Stevia sweetener significantly reduces fasting blood sugar levels and stable insulin resistance, triglycerides and alkaline phosphatase (which is usually higher in cancer patients). Human studies showed similar results: consuming Stevia lowers blood glucose and insulin levels, aiding in glucose regulation. If you are in risk of diabetes, talk to your doctor and dietitian about the safe consumption of Stevia sweetener to achieve balanced insulin levels.

Preparation of fresh Stevia:

• Add several leaves to a cup of hot liquid. (About 3 tablespoons of chopped fresh leaves equal one cup of sugar or 1 tsp of processed Stevia extract powder.)
• Fresh whole leaf extract: Steep a tea ball packed with fresh stevia leaves in just-boiled water for 30 minutes. Add the liquid to foods where its green color is compatible.

Preparation of dried Stevia:

• Dry in a warm dark and dry area.
• Grind the dry leaves to a fine powder. Store in an airtight container away from light.
• One tablespoon of dried powder equals a cup of sugar or 1 tsp of processed Stevia extract powder.

Traditional Chinese Medicine (TCM):

Practitioners of Traditional Chinese Medicine attribute diabetes to the depletion of yin. The imbalance of the yin and yang causes Heat to dry up bodily fluids, leading to the thirst and excess urination associated with diabetes. For diabetes treatment, prevention and management, low-fat diet is recommended together with intake of plenty of water and eliminating sugar, salt, spicy foods, coffee and alcohol. Chinese herbs used as medications such as Rehmannia root (Rehmannia glutinosa), Kuzu or Pueraria root (Pueraria montana), Licorice root (Glycyrrhiza glabra), and Schisandra fruit (Schisandra chinensis) can also help in diabetes treatment and management.

Ayurvedic Medicine:

Ayurvedic practitioners consider diabetes, or prahema a disorder or urine caused by an excess of Kapha dosha, which disrupts metabolism. Ayurvedic treatment and management of diabetes depends on your owns dosha, or constitutional type. But generally, practitioners prescribe a combination of dietary restrictions (less fat, fewer sweet). Herbal medications (including fenugreek and turmeric), daily exercise (including yoga), and Ayurvedic massage therapy (panchakarma) for diabetes treatment.

Acupuncture:

Acupuncture is another effective treatment for diabetes. Acupuncture only has one job, to create stimulation in the central nervous system. In doing so, the procedure helps release various chemicals into your brain, muscles and spinal cord. These chemicals, in turn, stimulate your body’s natural healing capabilities, promoting healthy physical and mental well-being. Acupuncture has been used in the past to treat diabetes naturally. To this day, it is still used in many parts of the world as a natural cure for this health problem. Through acupuncture, you can manage your blood sugar levels and lose weight too. Because of that, it becomes easier to manage your diabetes. You can consult your professional acupuncturist for this kind of therapy treatment. For self care approach, try acupressure instead. Simply apply penetrating finger pressure to each of the following points for 3 minutes.

• Kidney, located in the hollow between your Achilles tendon and the inside of your anklebone.
• Stomach, located on your foot in the webbing of your second and third toes.
• Spleen, located four finger-widths above your inner anklebone on the back inner border of your shinbone.

Besides, acupuncture helps protect your pancreas’ islet function. Doing so helps maintain insulin production, which is vital for dealing with blood sugar levels. Acupuncture also helps ensure hormonal balance through which maintaining your blood sugar levels becomes less difficult.

Aromatherapy:

Aromatherapy is used for many purposes. In many cases, it is used as a way to help people relax. That is why aromatherapy is widely used in spas as well as in hospitals. Through aromatherapy, it is possible to provide pain relief, improve mood and create a relaxing environment. However, did you know that aromatherapy can also be used in battling diabetes?

Aromatherapy uses the properties of essential oils to work its magic. The same essential oils can provide temporary relief from diabetes-related issues. For instance, Lemon Balm, Coriander seed and Black Pepper seed are widely used as essential oils in aromatherapy. These extracts can somewhat help maintain blood sugar levels. In doing so, they help you deal with diabetes. However, aromatherapy can never be used as an alternative to medical care. It is merely a way to provide temporary relief.

Essential oils:

Essential oils are extremely popular in modern culture. Some people use them almost exclusively, and others who consider them folklore and push past them on their way to the doctor’s office. The fact is, essential oils are anything but new. They are not a fad. Essential oils have a proven track record that dates back thousands of years. Essential oils are plant extracts that have been pressed or steamed from the various parts of a plant. This leaves you with a highly concentrated form of oils that contain all of the properties of the plant. It can take several pounds of a plant to make one bottle of essential oil.

These oils will have an effect on your blood sugar levels, stress levels, and may increase insulin levels. For this reason, you must keep a close watch on your blood sugar. As stated, essential oils are powerful. If they work better than you expect, do not be caught off-guard. Test your blood sugar with your diabetic blood sugar meter every day before you use the essential oils. After you have used the oils, retest.

Coriander:

This oil is rich in vitamin A, C, K, folic acid, calcium, and magnesium. It helps regulate glucose levels in the blood by activating enzymes whose primary function is to remove sugar from the blood. Coriander helps prevent overeating.

Helichrysum or Grapefruit:

Being overweight does not automatically make you a diabetic, but it is a key factor in controlling diabetes when you have it. It also increases your chances of developing type 2 diabetes over time. Weight management is a key factor in controlling the condition. Usually, losing weight is one of the first instructions a doctor will give a newly diagnosed patient. Essential oils may help.

After a workout, a massage with a base oil that contains Helichrysum or Grapefruit essential oils which may help promote weight control and relaxation.

Black Pepper:

The essential oil from black pepper may help manage or prevent type 2 diabetes and high blood pressure. Black pepper carries a lot of antioxidants that actually block some enzymes that contribute to diabetes and high blood pressure.

Clove:

Clove bud reduces the levels of enzymes in the pancreas. This can play a role in combating diabetes. It is believed to prevent symptoms of diabetes that are the result of oxidative stress. Oxidative stress happens when the diabetic body no longer produces enough antioxidants to fight unstable molecules that damage cells in the body.

Yoga:

Doing yoga for 20-30 minutes each day can improve your nerve condition. It further helps improve your metabolism, balance hormone and glucose levels and boost your strength and balance. Besides, practicing yoga daily can enhance your flexibility, which means you do not have to worry about hurting yourself while doing various physical tasks or exercises.

Yoga also helps battle diabetes. You can increase the number of insulin receptors in your body through yoga. That, in turn, improves insulin kinetics and reduces insulin levels. As these alterations take place, anyone with diabetes will have their blood sugar levels lowered. As long as you continue yoga, you will see significant improvements in your health and blood sugar levels.

Stones and crystals:

Very broadly speaking, diabetes is primarily a metabolic disorder. It is also a result of problems with the pancreatic hormone known as insulin, which causes high levels of blood sugar. If we look at it from a crystal point of view, the major energy pathways associated with diabetes is Solar Plexus. Stones and crystals in relation to diabetes must not only deal with the endocrine system, but also protect the circulatory system and correct chemical imbalances within these systems: There is also a need to be able to protect against the side effects that diabetes is known for; sensory nerve damage, kidney damage, vision problems, poor circulation, weight control and heart disease. Throughout the ages, some stones and crystals have been more recommended than others. Diabetes is connected to the Solar Plexus chakra, and it is therefore recommended to place these stones and crystals on your Solar Plexus for 15-20 minutes a few times a week. These are certain gems that have been used throughout the ages to provide some relief from your diabetes.

Once you have chosen one or more of the above, best results are achieved by carrying them with you or wearing it continuously. A small bag or pouch can be handy to carry them in, and you can place them in bed at night. Or you may prefer to work with your crystals on the Solar Plexus for 15-20 minutes a few times a week. Research in the field is still in the initial stages, so it requires many more studies and experiences before it can be definitively stated that stones and crystals work against diabetes. This means that there is only one way to find out if stones and crystals are for you, by trying them out. It is a brave decision to make and therefore also one that you should not be alone in making. Therefore, it is recomended that you to talk to your doctor before you start using stones and crystals for diabetes.

Citrine:

Citrine is the stone that is specifically known to be very helpful in helping with diabetes. It is an unusually beneficial stone that carries the power of the sun. It helps to give energy to life. It transforms the vibration that helps the pancreas and spleen stay fresh and healthy. It is used to improve endurance and energy levels in the body. It is used to help hormonal imbalances, chemical imbalances in the body and is known to help reverse degenerative diseases, as well as to relieve your fatigue.

Serpentine:

Serpentine is a beneficial, versatile and metaphysically protective stone. It helps you gain more control over your life. It helps to consciously direct healing energy towards problem areas. Is very cleansing and detoxifying for the body and blood. It relieves diabetes and hypoglycemia.

Emerald:

Emerald is a stone that regenerates and restores. It improves the ability to enjoy life to the fullest and ensures physical, mental and emotional balance. It eliminates negativity and encourages positive action. It relieves diabetes. Soothes the eyes and improves vision and has a detoxifying effect on the liver.

Red Jasper:

Red Jasper has a stabilizing effect that allows you to use your energy in a balanced way. It is used to aid healing by maintaining positive progress in all types of ailments and diseases. It is especially useful for diabetes and heart problems. Increases blood circulation and encourages positive blood flow.

Malachite:

Malachite is one of the most effective physical healing tools as it is filled with copper carbonate that gives it its vibrant blend of green healing colors. It gives the pancreas the support it needs for people with diabetes to free themselves from the energy of diabetes in the energy field. It is also good for digestion; and it helps to "digest" the sugar so that you can use the energy from it in a good way. It is best worn at the waist.

Sodalite:

Sodalite is useful in the treatment of disorders of the digestive system and is said to help prevent diabetes. It strengthens the metabolism and the lymphatic system, increases the immune system and can help with weight loss. It also has a calming effect on the thyroid, nervous system and glandular functions. By balancing the endocrine system, it strengthens the metabolism, reduces stress and provides physical endurance. To get the full benefit of Sodalit, it is best worn over a longer period.

Chrysocolla:

Chrysocolla is an amazing crystal on many levels. With a natural and beautiful mix of colors, created due to its high copper content, it has a strong healing energy. It balances the blood and treats blood disorders. It supports the pancreas and helps with the regulation of insulin and blood sugar. It is especially useful for type 2 diabetes.

Blood Stones:

Bloodstone is an excellent powerful healer of the blood and a powerful healer that can help cleanse and detoxify the body. It stimulates the metabolic processes. Helps with fatigue, removes energy blockages and helps to create an even and gentle flow of energy in the body. It benefits all the blood-rich organs and regulates blood flow through the circulatory system. It detoxifies the liver, kidneys, spleen and bladder. Protects the cardiovascular system, the endocrine system and helps with diabetes.

Ruby:

Ruby detoxifies the blood and improves circulation and is extremely beneficial for the heart. Ruby stimulates the adrenal glands, kidneys and spleen and helps where there is insufficient circulation and energy flows in the feet and legs. It also helps with weight problems, which is something very useful for diabetics.

Diabetic socks:

Once you have diabetes, protection should always be a priority. This is because it takes longer for a person to heal when having diabetes. In this case, the legs are the most exposed part of the body. To prevent them from any harm, you may require quality socks that can protect the skin. It would be best if you researched this to make sure that you invest in the best kind of socks for your needs. Quality socks should have thermoregulation, and they should not hinder blood circulation. This way, you will have proper management of diabetes by protecting your nerves. These socks vary in quality and brand.

Diabetes education:

Learning about diabetes and how to manage it is an important part of living with the condition. There are a number of books, websites, and other resources available to help you learn about diabetes. Your doctors and healthcare service providers will also help you in case you have any doubts.

Support:

In countries using a general practitioner system care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care in a team approach. Home telehealth support can be an effective management technique.