糖尿病，2型

導言
我應該怎麼了解2型糖尿病？

糖尿病，一個術語，意思是"貫穿糖"，是首次發現，在公元1世紀。（1）疾病舊書描述為"熔化肉進入尿液。"糖尿病是一種慢性疾病，在有胰島素不足比身體的需要。這可以是低胰島素，這個問題與釋放胰島素，胰島素不能工作，細胞需要它，或胰島素是滅活之前，能發揮作用。糖尿病是一種疾病，身體中的不生產或不使用胰島素有效。這不僅是高血糖，還是太多了葡萄糖（糖）在血液中。

胰島素是一種激素產生於胰腺的β細胞中的胰島。胰島素釋放這些特殊的細胞是受金額血液葡萄糖。它負責運送葡萄糖（來自碳水化合物）進入細胞的能源生產。吃完飯，當血糖上升，胰島素釋放增加。兩餐之間，當血糖低，胰島素低。胰島素是由胰腺釋放直接進入肝臟，在肝臟的一部分用於一些分解，清除出身體。其餘被釋放到普通的血液循環。通過幫助移動葡萄糖進入細胞，胰島素降低血糖。胰島素也降低了故障的儲存脂肪和甘油三酯的基礎。胰島素是參與蛋白質的生產。正確的成長和發展兒童依賴於胰島素。

糖尿病可以影響任何年齡的人。它增加慢性疾病的風險，如心髒病，視網膜病變（一種疾病的視網膜）和失明，周圍神經病變（1疾病，神經系統），流通問題，可能導致截肢，問題與免疫系統，皮膚潰瘍傷口癒合差。

糖尿病的診斷實驗室的測試，無論是空腹血糖（FPG）或2小時血糖（糖耐量 - 口服糖耐量試驗）。有兩種形式的糖尿病：1型（也稱為胰島素依賴型糖尿病，胰島素依賴型糖尿病，或幼年型）和2型（Ⅱ型糖尿病，非胰島素依賴型糖尿病，或成人發病）。

百分之九十的人都與 2型糖尿病。這些人多數超過 40歲。其中5例是在年齡超過 65歲，百分之八十是超重。（2）許多患者血糖增加7到10年前症狀。

當事情是錯一個人的血糖的調節，即使是正在生產胰島素的胰腺所，個人可能有2型糖尿病。患有2型不需要依靠注射胰島素才能生存。 2型糖尿病沒有得到充分理解。三身體異常通常發生在2型：胰島素抵抗，提高葡萄糖生產，肝臟，和β細胞功能差。這些可能發生單獨或合併。

胰島素抵抗似乎是第一階段的疾病。這意味著，胰島素不能去幫助葡萄糖從血液進入細胞。（3）雖然β細胞能夠釋放正常甚至高於正常數量的胰島素，葡萄糖進入細胞的運動不振，血糖慢慢開始上升。因此，血糖保持甚至增加胰島素是由胰腺產生的。然後，胰腺就會釋放更多的胰島素，胰島素（胰島素過多血液中）開始。

這可能是由於遺傳缺陷，影響如何使用或胰島素的方式輸送到細胞。胰島素抵抗是由於高胰島素水平，血糖水平不高。因此，個人永遠是高血糖。最終，β細胞"燒掉"及胰島素抵抗可能變成糖尿病。

許多人2型糖尿病患者也產生大量的葡萄糖在肝臟中。 Thisincrease肝臟葡萄糖生產，很可能與其脂肪崩潰。當身體不能有效地利用葡萄糖作為能量的來源，儲存脂肪成為一個重要的燃料來源。細目脂肪使肝臟產生葡萄糖。由於患者2型糖尿病不敏感，胰島素的影響，通常停止生產的葡萄糖在肝臟中，這種情況仍在繼續。這種情況似乎也與體重和身體活動。

在2型糖尿病，有能力的β細胞釋放胰島素的第一筆後需要進餐（餐後胰島素釋放）早在惡化的疾病。因此，血糖仍然增加了一到兩個小時後，主餐。隨著病情的惡化，胰島素釋放，繼續奉行吃飯也進一步惡化，導致一種名為胰島β細胞衰竭。

2型糖尿病似乎是由於遺傳缺陷，在第一次讓一個人不能夠回應的行動胰島素和，隨著時間的推移，在β細胞的胰腺會停止釋放胰島素。然而，新的證據表明，飲食和生活習慣的重要因素，可能是負責開發的疾病。一個人的年齡在45和超重是一個可能的候選人 2型糖尿病。約 30-39百分之美國的肥胖者，更多的是超重。研究表明，一個強大的連接之間的上半身肥胖（人與"蘋果形"）和發展的2型糖尿病。（4）

長期的並發症與糖尿病是嚴重的，往往危及生命和診斷的晚期疾病。這些並發症是由於連續高血糖血糖控制欠佳。其中許多慢性並發症可以追溯到改變血管導致血流量減少。這些變化包括冠心病和周圍血管疾病，視網膜病變，腎病和神經病變。

心髒病的主要原因是與糖尿病有關的死亡，與成年人有3時 58倍心髒病死亡率比成年人沒有疾病。中風的風險為 2至4倍的人患有糖尿病。糖尿病患者的動脈粥樣硬化發展（硬化的動脈）比沒有糖尿病的人，有的百分之60-65糖尿病患者有高血壓。

當大量的高血糖存在於組織，如鏡頭的眼睛和神經細胞，該機構發現其他方式來處理額外的葡萄糖在這些細胞。酶（蛋白，刺激的化學反應發生在機構）的工作分解，額外的葡萄糖，造成增加山梨醇和果糖（類型的糖）。這種過剩食糖這些細胞會承擔額外的液體，最終損害這些細胞。

視網膜病變是導致事業的新案件，成年人失明20至74歲。由於葡萄糖增加，血管削弱和微血管瘤（小腫脹的血管）發生在視網膜毛細血管的。視網膜細胞，然後破裂，出血（出血）。這模糊了視野，可導致視網膜脫離的。

腎病（腎病）是全球領先導致腎功能衰竭需要透析。第一個跡象是微量（一種蛋白在尿液），從而導致蛋白尿（蛋白尿），最終終末期腎病。

神經病變（疾病，神經系統），導致麻痺和刺痛的手臂，腿，手，腳，最終導致受傷和糖尿病的發展潰瘍（傷口）在這些領域。糖尿病是導致截肢原因在美國的其他變動中出現的病變，包括胃腸道問題，如胃輕癱（一癱瘓在胃腸道），慢性便秘，或腹瀉;喪失性功能，膀胱功能和心臟問題。
統計
國際糖尿病聯合會，2007。

    *糖尿病目前影響全球2.46億人，預計影響 3.8億，到2025年。
    *糖尿病是第四大死亡原因，全球因疾病。
    * 2007年，5個國家與人數最多的糖尿病人是印度（40.9萬），中國（39.8萬美元），美國（19.2萬），俄羅斯（9.6萬美元）和德國（740萬美元）。
    *每年1 700萬人，進一步發展為糖尿病的。
    *每年380.00萬人死亡的原因是糖尿病。
    *每10秒2人發展成糖尿病。
    *高達 80％的2型糖尿病是可以預防的，通過健康飲食和增加體力活動。
    * 2型糖尿病已經成為最常見的狀況與腎功能衰竭的人，在國家的西方世界。
    *據估計，有250多萬人受到全世界有糖尿病視網膜病變。
    *心血管疾病是主要的死亡原因糖尿病，佔約 50％的糖尿病死亡，和許多殘疾。

Persatuan糖尿病馬來西亞，2007年。

    *在近120萬馬來西亞人患有糖尿病，超過 98％的2型糖尿病。

Sudaram醫學基金會，2007。

    *這是目前估計有35億糖尿病患者在印度。這個數字預計再增加60％，到2025年。

糖尿病新西蘭，2006年。

          Ø大約 105,000人在新西蘭被確診患有2型糖尿病患者。據估計，一十一點五〇萬頃確診。

在疾病控制中心，全國糖尿病概況介紹，1998年。

    * 60-65％的糖尿病人有高血壓（惠博普）。
    * 15.7萬人患糖尿病，約佔人口的5.9％。
    * 10.3萬人被診斷患有糖尿病。
    * 5.4萬人確診。
    *有七十九萬八千糖尿病的新病例每年診斷。
    * 630.00萬 65歲或以上，或18.4％的人在這一年齡組有糖尿病。

疾病控制中心和預防，2003。

    *超過 1萬成人18歲至79歲年齡被診斷患有糖尿病於 2000年。

體徵和症狀
下面的列表不存在保證本的健康狀況。請參閱您的文本和保健專業人士獲取更多信息。
糖尿病初期症狀包括尿頻，口渴，疲勞，煩躁。頭暈，嗜睡，煩躁，失去協調，在汗水被標記集的低血糖（血糖"60mg/dl）。高血糖（血糖"250mg/dl）在胰島素依賴型糖尿病可導致酮症酸中毒，特點是口渴，噁心，嘔吐，和丙酮或"果香"氣味的呼吸。
一般

    *尿頻
    *渴望
    *疲勞
    *易怒
    *集的低血糖（血糖"60mg/dl）可以顯著的頭暈，嗜睡，煩躁，失去協調，排汗
    *集高血糖（血糖"250毫克

治療方案

常規
病人治療 2型糖尿病，包括飲食，運動和藥物治療。飲食被認為是第一次治療的嘗試。保持理想的體重可以幫助病人控制病情。運動可以幫助胰島素可以更好的工作，有助於調節葡萄糖在肝臟中生產。即使在飲食和運動，但在頭 5年後診斷，百分之六十以上的患者需要口服降糖藥。據估計，大約有百分之四十的患者最終需要注射胰島素來控制血糖。

口服降糖藥

口服藥物治療管理的2型糖尿病現在包括了更多的選擇幾個藥物類，其中大部分是工作方式不同。磺脲類藥物會導致釋放胰島素的胰腺和幫助胰島素更好地發揮作用;雙胍類工作的肝臟; thiazolidenedones工作的肌肉;葡萄糖苷酶抑製劑的工作在小腸和氯茴苯酸原因釋放胰島素的胰腺。

口服藥物治療糖尿病

第一代
甲苯磺丁250毫克，500毫克
Acetohexamide 125mg，250毫克
妥拉磺脲100毫克，250毫克，500毫克
氯磺丙脲100毫克，250毫克

第二代
格列吡嗪5毫克，10毫克
格列吡嗪緩釋每公升2.5毫克，5毫克，10毫克
格列本脲1.25mg，每公升2.5毫克，5毫克
格列本脲微粉1.5毫克，3毫克，為 6mg
格列美脲1毫克，2毫克，4毫克

α-葡萄糖苷酶抑製劑
阿卡波糖50毫克，100毫克
米格列醇25毫克，50毫克，100毫克

雙胍類
二甲雙胍 500毫克，850mg，1000毫克
二甲雙胍緩釋劑 500毫克

Meglitinides
瑞格列奈0.5mg，1毫克，2毫克

噻唑
羅格列酮2毫克，4毫克，8毫克
吡格列酮15毫克，30毫克，45mg使

組合產品
格列本脲和二甲雙胍 1.25/250mg，2.5/500mg，5/500mg

磺脲類
口服磺脲類藥物是與磺胺類抗生素，但沒有抗菌作用。他們刺激胰島素分泌，增加胰島素的數量在血液中循環，使β細胞更為敏感的葡萄糖的行動。（五）使用與飲食和鍛煉。他們是唯一有效的治療，可產生胰島素。他們不阻止β細胞的損失。因此，磺脲類藥物可以變得不那麼有效時間的推移。較新的代理商在這組藥物較少有藥物的相互作用比第一藥物的銷售在這一組。約百分之五十的病人成功地控制他們的糖尿病與磺脲類藥物的使用。這些代理商也可以結合使用注射胰島素。

所有的磺酰脲類可以採取與食物除了格列吡嗪。格列吡嗪減慢食物的吸收，因此建議採取這種藥物前30分鐘吃飯。

雙胍類
二甲雙胍是成員的雙胍類降糖藥組和無關磺脲類。它使胰島素，可更好地工作 - 它不會增加數額胰島素被釋放。通過不增加胰島素的釋放，它不會導致高胰島素血症。它也降低血糖水平不會產生低血糖。它可以用來與飲食或與其他藥物。它不會產生體重增加。（6）二甲雙胍是唯一的抗糖尿病藥物日益顯示出延長病人的生命與 2型糖尿病。

噻唑
曲格列酮，一成員噻唑類藥物可在1月開始，1997年和據報導，降低血糖通過降低胰島素抵抗，而不是通過增加胰島素的釋放。它可以單獨使用，與胰島素，或沿口服磺脲類藥物。到同年12月，美國食品藥品管理局宣布了新的準則，以監測患者的肝損傷的跡象。這是由於 35個報告肝損傷患者的美國和日本，其中包括肝臟移植，1人死亡。製造商消除了藥物從市場在2000年3月。

1999年5月，FDA批准羅格列酮，第二類藥物在抗糖尿病藥物。它似乎並不具有相同的肝臟問題，被認為與曲格列酮。沒有明顯的藥物相互作用的報導。但是，仍然需要謹慎，看病人這種藥物仍然建議。

第三本組藥物獲得 FDA批准吡格列酮。它的優勢比其他兩種藥物在這一組。大多數患者有降低甘油三酯，增加高密度脂蛋白膽固醇，也沒有改變 LDL膽固醇與這種藥物。這可能是重要的病人2型糖尿病是高風險的心髒病。看著病人這種藥物仍然建議。

α-葡萄糖苷酶抑製劑
阿卡波糖和米格列醇的α-葡萄糖苷酶抑製劑。他們降低餐後血糖通過減緩的消化和吸收的碳水化合物。這些代理不影響吸收的單糖，如葡萄糖和乳糖。磺脲類藥物不同，它們不會引起低血糖，高血糖，或體重增加。他們不增加胰島素的釋放。它們可用於單獨或與飲食結合磺脲類或雙胍類藥物。據報導，他們減少甘油三酯和低密度脂蛋白膽固醇。這些藥物是最有用的病人在早期階段疾病誰高血糖在飯後，但空腹血糖正常的實驗室結果。

Meglitinides
瑞格列奈屬於一類藥物被稱為 meglitinides，無關磺脲類藥物。它降低血糖，增加胰島素的釋放胰腺。它需要有β細胞的功能有效地工作。瑞格列奈可以單獨使用或與二甲雙胍。使用時與二甲雙胍，結果好於單獨使用兩種藥物。它必須採取每日多次，通常在15分鐘內各餐。病人誰沒有做好與磺脲類可能不與瑞格列奈。

使用胰島素的2型糖尿病
患者2型糖尿病患者，重要的是確保藥物治療具有特別意義，每一個病人。當幾乎沒有反應不佳或藥物從一個類，一類毒品從另一個可以代替，看看該工程的病人。誰的病人需要它，第二個從另一個類藥物可以增加。然而，控制血糖可能會隨時間而減少，2型糖尿病是一種漸進性疾病 - 也就是說，它隨著時間的推移變得更糟。

即使在使用口服劑，餐後高血糖仍然是一個問題的百分之六十的病人。失敗的口服降糖藥控制血糖是常見的。百分之二十五以上的2型糖尿病患者需要適當控制他們的血糖。血糖監測，並採取一切適當的抗糖尿病藥物是非常重要的。
營養補充
鉻
鉻的方式影響血糖首次在動物實驗中發現，在1950年的。在20世紀 70年代，人們發現，鉻是重要的特殊靜脈（IV）餵養的方法解決全腸外營養（TPN解決方案）。有人發現，當鉻缺少TPN輸液，幾個月後，血糖增加的病人。加入鉻和血糖的腸外營養病人恢復正常。各種研究的支持，鉻有積極影響血糖。（7）

據認為，鉻有助於通過移動葡萄糖胰島素和其他營養物質進入細胞的身體。（8）這有助於保持肌肉的時候，在飲食沒有提供足夠的熱量。鉻也穩定了人體的新陳代謝。鉻能降低膽固醇和甘油三酯。鉻也可以減少飢餓和限制食物的渴求。胰島素是參與調節中心的大腦中令人感到全面停止進食。胰島素也是重要的發展聯繫在一起的大腦化學物質的慾望的碳水化合物。

大多數美國人是在風險低鉻由於飲食富含精製糖。個人誰吃碳水化合物含量高的精製醣類往往以消除鉻的3倍多，他們的尿液比那些飲食低精製醣類。個人生活的國家誰水平高鉻是來自大量攝入不登大雅之堂糧食的比率則較低糖尿病和動脈粥樣硬化（硬化的動脈）。經常鍛煉的人誰消除二至六倍正常鉻量在他們的尿液對天的演習。（9）許多運動員使這一問題變得更加嚴重採用高碳水化合物的補充。老人還處於風險低鉻，由於沒有足夠的鉻的飲食和吸收不良。婦女可以有一個鉻水平下降3個月期間（第七，第八和第九個月）懷孕。（10）

有一種意見分歧的醫護人員對什麼是最佳的鉻使用。鉻只是在某些形式的活動。其中最重要的這些表格是葡萄糖耐量因子（廣交會）。沃爾特博士莫茨美國農業部研究與廣交會沒有鉻。他發現，鉻是一個關鍵的一部分的過程，其中胰島素細胞的重視。廣交會鉻是安全的，通常不會引起副作用。

吡啶羧酸鉻是另一種受歡迎的形式鉻的，用來控制血糖水平。（11），（12）即使吡啶羧酸鉻被認為是安全的，最近的一項研究，在實驗室動物身上的達特茅斯學院和喬治華盛頓醫療中心報告說，某些劑量的吡啶羧酸鉻對染色體造成損害。（13）更多信息，這需要補充，因為其他的研究報告說，它是安全有效的。

對於糖尿病患者來說，加入鉻或其他血糖調節劑，以他們的飲食應該慢慢來，特別是如果他們對其他藥物來控制他們的糖尿病。隨著生活方式和飲食的變化，只有一小劑量的鉻可能需要。
鎂
鎂是參與葡萄糖的故障在身體和釋放胰島素。（14）低鎂可能使糖尿病惡化，在一些人。（15）低鎂血症（低血液中鎂）發生在百分之二十五左右的糖尿病患者。（ 16）許多美國人低於 RDA的（推薦膳食供給量）的鎂。許多專家認為，反種族歧視法鎂需要增加。

鎂是清除出身體的腎臟。個人與腎臟疾病應諮詢醫療專業人士在使用鎂的補充。過多的鎂可能引起腹瀉。
釩
釩是一種微量礦物質，它是非常重要的植物營養，但它為人類營養不明確。它與酶在體內。高量的釩中發現，腎，肝和骨骼。脂肪細胞暫時存放釩快速釋放到人體中。補充與硫酸氧釩和其他形式的釩據報導，以改善糖尿病。（17），（18）

動物研究報告說，釩的時候給予了糖尿病大鼠，其增加的血糖恢復正常。其他一些研究報告說，硫酸氧釩，不僅降低血糖的糖尿病動物，而且還降低膽固醇和甘油三酯。（19）在一項研究中對糖尿病大鼠，研究人員發現，釩可以保護胰腺β細胞。（20）

人類研究是令人鼓舞的。 2型糖尿病患者口服硫酸氧釩給予了將近百分之二十下降，空腹血糖在一項研究。（21）輕微腸胃不適，是唯一的副作用。在另一項研究，補充了硫酸釩每日三個星期內改善胰島素的行動。（22）

五氧化二釩及釩活躍硫酸釩的形式很容易被人體吸收。釩似乎是安全的，即使在高劑量。劑量應逐步增加，特別是當它給予廣交會鉻。
α-硫辛酸（ALA）的
α-硫辛酸（ALA）的一種抗氧化劑，是由身體。阿爾卡特也被稱為α- lipoate或thiotic酸。 Lipoates小水和脂溶性分子，很容易吸收的胃腸道。它還可用於心髒病和為艾滋病患者。（23）α-硫辛酸影響胰島素和血糖在2型糖尿病。（24），（25），（26）阿爾卡特可有效地治療糖尿病神經病變。（27）在最近的研究，大約百分之97的糖尿病患者的治療與阿爾卡特每日三週報告說，改善其神經症狀。（28）沒有任何已知的毒性與 ALA。重要的是要密切監測血糖在糖尿病患者的飲食補充與 ALA。
鋅
缺鋅發現有問題的患者在血糖控制。（29）在臨床研究中，動物和人類糖尿病與缺鋅時輔以改善鋅。（30），（31）鋅有助於調節胰島素分泌的胰葡萄糖利用肌肉和脂肪細胞。非常高劑量的鋅可能會導致腹瀉，頭暈，嗜睡，嘔吐，肌肉協調損失。
環（他的，專業版）
環 hispro可能是有用的代理人在改善血糖的調節，在個人與低血糖，糖尿病和糖耐量低減（IGT）。（32）據報導，個人有問題的糖尿病患者與鋅的吸收腸道，造成低鋅血液中的水平。動物和人體研究報告，環 hispro可能會影響鋅的吸收，從腸道。這種提取物還包含高鋅。對於糖尿病患者，鋅是重要的傷口癒合，正常運作的免疫系統，及皮膚。沒有副作用與使用環 hispro。

在最近的臨床研究，環 hispro是給男性受試者 22日與 2型糖尿病。 3個月後，治療組降低據說空腹血糖水平，空腹胰島素水平。此外，治療組有輕微下跌的膽固醇和低密度脂蛋白，增加血漿鋅濃度。結果研究表明，造福使用循環 hispro提取鋅的2型糖尿病。（33）
草藥補充劑
月見草
月見草油（EPO）的含有γ-亞麻酸，這是ω- 6脂肪酸。（34），（35）的Omega - 6脂肪酸可以減少炎症。使用必需脂肪酸，如促紅細胞生成素可以防止缺鋅，可能提高免疫系統。（36）脂肪酸的重要組成部分的正常功能人體。人體能夠產生所有需要脂肪酸除了ω- 3和ω- 6脂肪酸。這兩項必須來自飲食或與使用的補充。阿平衡這兩種脂肪酸是非常重要的。必需脂肪酸，需要建立細胞和荷爾蒙。現代飲食往往不能提供足夠的脂肪酸。

糖尿病誰不能γ-亞麻酸（GLA）由亞油酸將需要補充亞麻酸的質量。（37），（38），這是很重要的正常神經功能和預防糖尿病神經病變。（39），（40 ）月見草油據報導是有益的病人，糖尿病周圍神經病變。（41），（42）
藤
藤是熱帶雨林中發現葡萄中部和南部的印度，有著悠久的傳統，在治療糖尿病。印度名字是Gurmar，這意味著，"糖的破壞者。"它的使用已經被記錄在阿育吠陀醫學課本為 2000年的治療"甜尿。"藤的葉子被認為是胰島素分泌增加，一些研究報告，在控制高血糖的糖尿病實驗動物。（43），（44）阿減少體重還報告。

人類研究報告減少治療過程中血糖與藤。（45），（46）改進實驗室測試結果和需要較少處方藥也有報導。一些研究表明，糖尿病患者能夠停止服用處方藥物和糖尿病血糖控制與藤單。（47）的研究人員報告說，β細胞可能修復的2型糖尿病患者服用藤補充。（48）其他研究報告藤控制血糖通過減少吸收的葡萄糖在腸道。（49）

由於藤葉粉的行為就像麻醉劑的味蕾，可以持續幾個小時，一些研究人員認為，藤可能成為一種可行劑用於控制體重，並減少對甜食的渴望。（50）最近的一項研究也報告降低膽固醇與使用藤。（51）藤可能是有用的運動員，誰想要發展更多的肌肉量相比，身體脂肪。另一項研究則表明，藤，可安全有效的減肥，體重指數和血脂，促進健康。（52）
苦瓜
苦瓜或karela水果已用於在南美洲和東方作為食物，又是退熱藥（發燒減速），引產（代理人導致流產），emmenagogue（增加月經），驅蟲藥和驅蟲藥（劑，能夠將腸道蠕蟲），抗病毒，嘔吐（誘導嘔吐），糖尿病和代理。（53）最近的研究著眼於利益的水果糖尿病和高胰島素血症，艾滋病毒感染（艾滋病），和某些癌症。（54），（ 55）

苦瓜據報導，以改善人類的血糖控制。（56），（57）分子的研究報告說，與胰島素樣活性可能存在於苦瓜種子。（58）一些研究指出，苦瓜可能增加葡萄糖的利用在肝臟中，而不是任何影響胰島素的釋放。（59）苦瓜另據報導，以降低膽固醇和甘油三酯糖尿病患者。有報導說，苦瓜提取物並沒有降低血糖的實驗動物。（60），（61）這是一個標準化的建議，苦瓜提取物始終使用。
飲食和生活方式
飲食：糖尿病和肥胖的增加，在過去 50年來在美國。人們不要吃足夠的新鮮食品，並有減少土壤中的微量元素（如鉻，釩）在糧食種植。時尚飲食的高蛋白，低或高脂肪，低或無碳水化合物並不是答案。雖然這種類型的飲食可能有助於採取起飛重量首先，它不是一個長期的答案。碳水化合物本身不是原因，因為人類是食用碳水化合物很久，這些出現的問題。這是真的，但是，人們過量食用碳水化合物，而且最好是溫和的習慣。

有幾種方法來支持和改善胰島素調節劑使用自然，但真正的關鍵是要改變選擇食品的飲食習慣。一般來說，美國的飲食是由一個大量的碳水化合物，尤其是精製碳水化合物。人限制他們攝入的新鮮蔬菜和水果，和質量的來源和豆類蛋白質，他們不參加足夠的基本脂肪酸。截至1985年，典型的美國飲食百分之四十六碳水化合物，脂肪百分之四十三（質量差），只有百分之十一的蛋白質。隨著美國人平均大約 150磅的食用糖的一年，有一個不斷增長的需求更多的胰島素被釋放。一般人喝了兩個"大口"喝一天收到有關 54茶匙的糖。使用減肥飲料也不行，因為它們含有鈉。這更是一個問題，為糖尿病患者高血壓（高血壓）。雖然目前的研究表明，膳食脂肪和膽固醇是明確的問題，這種情況只能惡化了連續的，增加的量的碳水化合物以及脂肪。膳食脂肪被存儲，因為過剩的胰島素釋放，而吃高碳水化合物量。

許多專家多年來都讚揚了低脂肪，高碳水化合物的飲食。這個問題與此飲食習慣是，它不會導致體重減輕。事實上，飲食過多的碳水化合物一直與增加低密度脂蛋白膽固醇和甘油三酯。（62）的另一件事要注意的是，許多準備的食物可能被標記為低脂肪，但富含精製糖，增加胰島素釋放，因此，脂肪儲存。

diabete

Diabetes Mellitus, Type 2

Introduction

What should I know about Type 2 Diabetes Mellitus? Diabetes mellitus, a term that means "the running through of sugar," was first identified in the 1st century AD.(1) The disease was described in old books as "the melting down of flesh into urine." Diabetes mellitus is a chronic condition where there is less insulin than what the body needs. This can be low insulin, a problem with the release of insulin, insulin that cannot work in the cells that need it, or insulin that is inactivated before it is able to function. Diabetes mellitus is a disease in which the body does not produce or does not use insulin effectively. It is not simply hyperglycemia, or too much glucose (sugar) in the blood. Insulin is a hormone produced in the pancreas by the beta cells in the Islets of Langerhans. The release of insulin by these special cells is regulated by the amount of glucose in the blood. It is responsible for transporting glucose (from carbohydrates) into the cells for energy production. After a meal, when blood sugar increases, insulin release increases. Between meals, when blood sugar is low, insulin release is low. Insulin is released from the pancreas directly into the liver where some is used and some is broken down and eliminated from the body. The rest is released into the general blood circulation. By helping to move glucose into the cells, insulin decreases blood sugar. Insulin also decreases the breakdown of stored fat and builds triglycerides. Insulin is involved in the production of protein. The proper growth and development of children is dependent on insulin. Diabetes can affect people of any age. It increases the risk of chronic conditions like heart disease, retinopathy (a disease of the retina) and blindness, peripheral neuropathies (a disease of the nervous system), circulation problems that can lead to amputation, problems with the immune system, and skin ulcers and poor wound healing. Diabetes is diagnosed by lab tests, either a fasting plasma glucose (FPG) or a two-hour plasma glucose (OGTT – oral glucose tolerance test). There are two forms of diabetes mellitus: type 1(also called IDDM, insulin dependent diabetes mellitus, or juvenile onset) and type 2 (NIDDM, non-insulin dependent diabetes, or adult onset). Ninety percent of individuals with diabetes have type 2. Most of these individuals are over 40 years old. One in five patients is over the age of 65, and 80 percent are overweight.(2) Many patients have increased blood sugar seven to ten years before symptoms occur. When something is wrong with a person's blood sugar regulation even if insulin is being produced by their pancreas, the individual probably has type 2 diabetes. People with type 2 do not need to depend on insulin injections to survive. Type 2 diabetes is not fully understood. Three physical abnormalities usually occur in type 2: insulin resistance, increased glucose production in the liver, and poor beta cell function. These can occur individually or in combination. Insulin resistance appears to be the first stage of the disease. It means that insulin cannot help glucose go from the blood into the cells.(3) While the beta cells are able to release normal or even higher than normal amounts of insulin, glucose movement into the cells is sluggish and blood glucose slowly begins to rise. Therefore, blood sugar remains increased even with insulin being produced by the pancreas. Then the pancreas releases even more insulin, and hyperinsulinemia (too much insulin in the blood) begins. This is likely due to a genetic defect that affects how insulin is used or the way it is transported to the cells. Insulin resistance is due to high insulin levels, not high glucose levels. Therefore, the individual is always hyperglycemic. Eventually, the beta cells "burn out" and insulin resistance may turn into diabetes. Many people with type 2 diabetes also produce a large amount of glucose in the liver. Thisincrease in liver glucose production is likely related to fat breakdown. When the body is not efficiently using glucose as an energy source, stored fat becomes an important source of fuel. The breakdown of fat makes the liver produce glucose. Because patients with type 2 diabetes are insensitive to the effects of insulin, which normally stops the production of glucose in the liver, this condition continues. This situation also appears to be related to weight and physical activity. In type 2 diabetes, the ability of the beta cells to release the first amount of insulin needed after eating a meal (postprandial insulin release) deteriorates early on in the disease. Therefore, blood glucose remains increased for one to two hours after a large meal. As the disease gets worse, the insulin release that continues following a meal also worsens, resulting in something called pancreatic beta cell exhaustion. Type 2 diabetes appears to be caused by genetic defects that at first make a person not able to respond to the actions of insulin and, over time, the beta cells in the pancreas will stop releasing insulin. However, new evidence points to diet and lifestyle as important factors that may be responsible for the development of the disease. A person over the age of 45 and overweight is a likely candidate for developing type 2 diabetes. About 30-39 percent of Americans are obese, and many more are overweight. Research has shown a strong connection between upper body obesity (people with "apple shapes") and the development of type 2 diabetes mellitus.(4) The long-term complications associated with diabetes are serious, often life-threatening, and diagnosed in the late stages of the disease. These complications are due to continuous hyperglycemia from poor glucose control. Many of these chronic complications can be traced to changes in blood vessels that cause a decreased blood flow. These changes include coronary heart disease and peripheral vascular disease, retinopathy, nephropathy, and neuropathy. Heart disease is the leading cause of diabetes-related deaths, with adults having two to four times higher heart disease death rates than adults without the disease. The risk of stroke is two to four times higher in people with diabetes. Patient with diabetes develop more atherosclerosis (hardening of the arteries) than people without diabetes, and some 60-65 percent of patients with diabetes have high blood pressure. When high amounts of blood glucose are present in tissues such as the lens of the eye and nerve cells, the body finds other ways to handle the extra glucose in these cells. Enzymes (proteins that stimulate chemical reactions to occur in the body) work to breakdown the extra glucose, causing an increase in sorbitol and fructose (types of sugars). This excess sugar in these cells will then take on extra fluid, eventually damaging these cells. Retinopathy is the leading cause of new cases of blindness among adults 20 to 74 years of age. Because of increased glucose, blood vessels weaken and microaneurysms (small swellings in the blood vessel) occur in the capillaries of the retina. The retinal cells can then burst and hemorrhage (bleed). This blurs vision and can lead to detachment of the retina. Nephropathy (kidney disease) is the leading cause of kidney failure requiring dialysis. The first sign is microalbuminuria (a type of protein in the urine), which leads to proteinuria (protein in the urine), and eventually end stage kidney disease. Neuropathy (disease of the nervous system) causes numbness and tingling in the arms, legs, hands, and feet, eventually leading to injury and the development of diabetic ulcers (wounds) in these areas. Diabetes is the leading cause of amputations in the U.S. Other changes that occur with neuropathies include GI problems, such as gastroparesis (a paralysis in the gastrointestinal tract), chronic constipation, or diarrhea; loss of sexual function, bladder function, and heart problems.

Statistics

International Diabetes Federation, 2007. Diabetes currently affects 246 million people worldwide and is expected to affect 380 million by 2025. Diabetes is the fourth leading cause of global death by disease. In 2007, the five countries with the largest numbers of people with diabetes are India (40.9 million), China (39.8 million), the United States (19.2 million), Russia (9.6 million) and Germany (7.4 million). Each year a further 7 million people develop diabetes. Each year 3.8 million deaths are attributable to diabetes. Every 10 seconds two people develop diabetes. Up to 80% of type 2 diabetes is preventable by adopting a healthy diet and increasing physical activity. Type 2 diabetes has become the most frequent condition in people with kidney failure in countries of the Western world. It is estimated that more than 2.5 million people worldwide are affected by diabetic retinopathy. Cardiovascular disease is the major cause of death in diabetes, accounting for some 50% of all diabetes fatalities, and much disability. Persatuan Diabetes Malaysia, 2007. Of the nearly 1.2 million Malaysians with diabetes, more than 98% have type 2 diabetes. Sudaram Medical Foundation, 2007. It is currently estimated that there are 35 million diabetics in India. The number is expected to increase by another 60% by the year 2025. Diabetes New Zealand, 2006. Approximately 105,000 people in New Zealand have been diagnosed with Type 2 diabetes. It is estimated that 115,000 are undiagnosed. The Center of Disease Control, National Diabetes Fact Sheet, 1998. 60-65% of people with diabetes have High Blood Pressure (HBP). 15.7 million people have diabetes or about 5.9% of population. 10.3 million have been diagnosed with diabetes. 5.4 million people are undiagnosed. There are 798,000 new cases of diabetes diagnosed each year. 6.3 million age 65 or over or 18.4% of all people in this age group have diabetes. Center for Disease Control and Prevention, 2003. Over a million adults between 18 and 79 years of age were diagnosed with diabetes in 2000.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information. Initial symptoms of diabetes include frequent urination, thirst, fatigue, and irritability. Dizziness, lethargy, irritability, loss of coordination, and perspiration are marked during episodes of low blood sugar (blood glucose <60mg/dl). High blood sugar (blood glucose >250mg/dl) among insulin-dependent diabetics can lead to ketoacidosis, characterized by increased thirst, nausea, vomiting, and an acetone or "fruity" odor to the breath. General Frequent urination Thirst Fatigue Irritability Episodes of low blood sugar (blood glucose <60mg/dl) can be marked by dizziness, lethargy, irritability, loss of coordination, and perspiration Episodes of high blood sugar (blood glucose >250mg

Treatment Options

Conventional

Treatment for patients with type 2 diabetes includes diet, exercise, and drug therapy. Diet is considered to be the first treatment to try. Maintaining ideal body weight can help the patient to control the disease. Exercise can help the insulin that is available to work better and help regulate glucose production in the liver. Even with diet and exercise, however, within the first five years after diagnosis, over 60 percent of patients will need oral antidiabetic drugs. It is also estimated that approximately 40 percent of patients will eventually need insulin injections to control their blood sugar. Oral Antidiabetic Drugs Oral drug therapy for the management of type 2 diabetes now includes more choices in several drug classes, most of which work differently. Sulfonylureas cause release of insulin from the pancreas and help insulin to work better; biguanides work in the liver; thiazolidenedones work in muscles; glucosidase inhibitors work in the small intestine; and meglitinide causes release of insulin from the pancreas. Oral Drugs for Treating Diabetes First Generation Tolbutamide 250mg, 500mg Acetohexamide 125mg, 250mg Tolazamide 100mg, 250mg, 500mg Chlorpropamide 100mg, 250mg Second Generation Glipizide 5mg, 10mg Glipizide extended release 2.5mg, 5mg, 10mg Glyburide 1.25mg, 2.5mg, 5mg  Glyburide Micronized 1.5mg, 3mg, 6mg Glimepiride 1mg, 2mg, 4mg Alpha-Glucosidase Inhibitors Acarbose 50mg, 100mg Miglitol 25mg, 50mg, 100mg Biguanides Metformin 500mg, 850mg, 1,000mg Metformin extended release 500mg Meglitinides Repaglinide 0.5mg, 1mg, 2mg Thiazolidinediones Rosiglitazone 2mg, 4mg, 8mg Pioglitazone 15mg, 30mg, 45mg Combination Products Glyburide and Metformin 1.25/250mg, 2.5/500mg, 5/500mg Sulfonylureas  Oral sulfonylureas are related to sulfa antibiotics but do not have antibacterial action. They stimulate insulin release, increase the amount of insulin circulating in the bloodstream, and make the beta cells more sensitive to the actions of glucose.(5) They are used along with diet and exercise. They are only effective in patients that can produce insulin. They don't prevent beta cell loss. Therefore, sulfonylureas can become less effective over time. The newer agents in this group of drugs have less drug interactions than the first drugs that were marketed in this group. About 50 percent of patients will successfully control their diabetes with the use of sulfonylureas. These agents can also be used in combination with injectable insulin. All of the sulfonylureas can be taken with food except for glipizide. Food slows down glipizide absorption, so it is recommended that this drug be taken 30 minutes before meals. Biguanides  Metformin is a member of the biguanide group of antidiabetic drugs and not related to the sulfonylureas. It makes the insulin that is available work better – it doesn't increase the amount of insulin that is released. By not increasing insulin release, it does not cause hyperinsulinemia. It also decreases blood glucose without producing hypoglycemia. It can be used with diet or in combination with other drugs. It does not produce weight gain.(6) Metformin is the only antidiabetic drug ever shown to extend the life of patients with type 2 diabetes. Thiazolidinediones  Troglitazone, a member of the thiazolidinedione drug class became available in January, 1997, and was reported to lower blood glucose by decreasing insulin resistance, not by increasing insulin release. It could be used alone, with insulin, or along with oral sulfonylureas. By December of that year, the FDA announced new guidelines to be followed to monitor patients for signs of liver injury. This was due to 35 reports of liver injury in U.S. and Japanese patients, including one liver transplant and one death. The manufacturer removed the drug from the market in March, 2000. In May, 1999, the FDA approved rosiglitazone, the second drug in this class of antidiabetic drugs. It does not seem to have the same liver problems that were seen with troglitazone. No significant drug-drug interactions have been reported. However, caution is still needed and watching patients on this drug is still recommended. The third drug in this group to receive FDA approval is pioglitazone. It has advantages over the other two drugs in this group. Most patients will have lower triglycerides, increased HDL cholesterol, and no changes in LDL cholesterol with this drug. This may be important for those patients with type 2 diabetes that are at high risk for heart disease. Watching patients on this drug is still recommended. Alpha-Glucosidase Inhibitors  Acarbose and miglitol are alpha-glucosidase inhibitors. They lower postprandial blood glucose by slowing down the digestion and absorption of carbohydrates. These agents do not affect the absorption of simple sugars, such as glucose and lactose. Unlike sulfonylureas, they do not cause hypoglycemia, hyperglycemia, or weight gain. They do not increase insulin release. They can be used with diet alone or combined with sulfonylurea or biguanide agents. They have been reported to decrease triglycerides and LDL cholesterol. These drugs are most useful for patients in the early stages of the disease who have high blood glucose after meals, but have normal fasting blood glucose lab results. Meglitinides  Repaglinide belongs to a drug class known as the meglitinides, not related to the sulfonylureas. It decreases blood glucose by increasing the release of insulin from the pancreas. It needs to have functioning beta cells to work effectively. Repaglinide can be used alone or in combination with metformin. When it is used along with metformin, the results are better than with using either drug alone. It must be taken multiple times daily, usually within 15 minutes of each meal. Patients who have not done well with a sulfonylurea will probably not do well with repaglinide. Use of Insulin in Type 2 Diabetes  In patients with type 2 diabetes, it is important to make sure that the drug therapy is special for each patient. When there is little or poor response to a drug from one class, a drug from another class can be substituted to see how that works in the patient. For those patients who need it, a second drug from another class can be added. However, control of blood glucose is likely to decrease over time, as type 2 diabetes is a progressive disease – that is, it does get worse with time. Even with the use of oral agents, postprandial hyperglycemia still is a problem for 60 percent of patients. The failure of oral agents to control blood sugar is common. More than 25 percent of type 2 patients will require insulin to adequately control their blood sugar. Blood sugar monitoring and taking all antidiabetic drugs properly are extremely important.

Nutritional Supplementation

Chromium The way that chromium affects blood sugar was first discovered in animal studies in the 1950's. In the 1970's, it was discovered that chromium is important in special intravenous (IV) feeding solutions called total parenteral nutrition (TPN solutions). It was discovered that when chromium was missing from the TPN solution, after several months, blood sugar increased in patients. Chromium was added and blood sugar in TPN patients returned to normal. Various studies support that chromium has a positive effect on blood glucose.(7) It is thought that chromium helps insulin by moving glucose and other nutrients into the cells of the body.(8) This helps to maintain muscle mass during times when the diet does not provide enough calories. Chromium also stabilizes the body's metabolism. Chromium can lower cholesterol and triglycerides. Chromium may also decrease hunger and limit food cravings. Insulin is involved in the regulation of the center in the brain the makes one feel full and stop eating. Insulin is also important in the development of a brain chemical linked to the craving for carbohydrates. Most Americans are at risk for low chromium because of a diet rich in refined sugars. Individuals who eat diets high in refined sugars tend to eliminate 300 percent more chromium in their urine than those whose diets are low in refined sugars. Individuals who live in countries with high levels of chromium that comes from diets rich in unrefined grains have a lower rate of diabetes and atherosclerosis (hardening of the arteries). People who exercise regularly eliminate two to six times the normal amount of chromium in their urine on days of exercise.(9) Many athletes make this problem worse by using high-carbohydrate supplements. The elderly also are at risk for low chromium due to not enough chromium in the diet and poor absorption. Women can have a drop in chromium levels during the third trimester (seventh, eighth, and ninth months) of pregnancy.(10) There is a disagreement among healthcare professionals over what is the best chromium to use. Chromium is only active in certain forms. The most important of these forms is glucose tolerance factor (GTF). Dr. Walter Mertz of the United States Department of Agriculture did research with GTF chromium. He found that chromium was a crucial part of the process where insulin attaches to cells. GTF chromium is safe and usually does not cause side effects. Chromium picolinate is another popular form of chromium that is used to regulate blood sugar levels.(11),(12) Even though chromium picolinate is considered safe, a recent study in lab animals at Dartmouth College and The George Washington Medical Center reported that certain doses of chromium picolinate caused damage to chromosomes.(13) More information is needed about this supplement because other studies have reported that it is safe and effective. For diabetics, adding chromium or other blood sugar regulating agents to their diet should be done slowly, especially if they are on other medication to control their diabetes. With lifestyle and dietary changes, only a small dose of chromium may be needed. Magnesium Magnesium is involved in the breakdown of glucose in the body and release of insulin.(14) Low magnesium may make diabetes worse in some people.(15) Hypomagnesemia (low magnesium in the blood) happens in about 25 percent of diabetic patients.(16) Many Americans are below the RDA (Recommended Dietary Allowance) for magnesium. Many experts feel that the RDA for magnesium needs to be increased. Magnesium is eliminated from the body by the kidneys. Individuals with kidney disease should consult a healthcare professional before using a magnesium supplement. Too much magnesium may cause diarrhea. Vanadium Vanadium is a trace mineral that is very important for plant nutrition, but what it does for human nutrition is not clear. It works with enzymes in the body. High amounts of vanadium are found in the kidneys, liver, and bone. Fat cells temporarily store vanadium for quick release into the body. Supplementing with vanadyl sulfate and other forms of vanadium has been reported to improve diabetes.(17),(18) Animal studies have reported that when vanadium was given to diabetic rats, their increased blood glucose returned to normal. Other studies have reported that vanadyl sulfate not only lowers blood glucose in diabetic animals, but also decreases cholesterol and triglycerides.(19) In one study in diabetic rats, researchers found that vanadium may protect the pancreatic beta cells.(20) Human studies are encouraging. Type 2 diabetics given oral vanadyl sulfate had a nearly 20 percent drop in fasting blood glucose in one study.(21) Minor gastrointestinal upset was the only reported side effect. In another study, supplementation with vanadyl sulfate daily for three weeks resulted in improved insulin action.(22) Vanadium pentoxide and vanadyl sulfate are active forms of vanadium that are easily absorbed by the body. Vanadium appears to be safe even at high doses. Doses should be increased gradually, especially if it is given with GTF chromium. Alpha-Lipoic Acid (ALA) Alpha-lipoic acid (ALA) is an antioxidant made by the body. ALA is also known as alpha-lipoate or thiotic acid. Lipoates are small water and fat-soluble molecules that are easily absorbed from the gastrointestinal tract. It is also used in heart disease and for AIDS patients.(23) Alpha-lipoic acid affects insulin and blood sugar in type 2 diabetics.(24),(25),(26) ALA may be effective in the treatment of diabetic neuropathy.(27) In a recent study, about 97 percent of diabetic patients treated with ALA daily for three weeks reported an improvement in their neuropathy symptoms.(28) There are no known toxicities with ALA. It is important to monitor blood glucose closely in diabetics supplementing their diet with ALA. Zinc Zinc deficiency is found in patients with problems in blood glucose control.(29) In clinical studies, diabetic animals and humans with zinc deficiencies improved when supplemented with zinc.(30),(31) Zinc helps to regulate insulin production by the pancreas and glucose use by muscle and fat cells. Very high doses of zinc may cause diarrhea, dizziness, lethargy, vomiting, and loss of muscle coordination. Cyclo (His-Pro) Cyclo hispro may be a useful agent in improving blood sugar regulation in individuals with hypoglycemia, diabetes, and impaired glucose tolerance (IGT).(32) It has been reported that individuals with diabetes have problems with absorbing zinc from the intestines, causing low zinc levels in the blood. Both animal and human studies report that cyclo hispro may affect the absorption of zinc from the intestines. This extract also contains high levels of zinc. For the diabetic patient, zinc is important for wound healing, proper functioning of the immune system, and for the skin. There are no reported side effects with the use of cyclo hispro. In a recent clinical study, cyclo hispro was given to 22 male subjects with type 2 diabetes. After three months, the treatment group reportedly decreased fasting blood glucose levels and fasting plasma insulin levels. In addition, the treatment group had slight decreases in cholesterol and LDL and increased plasma zinc concentrations. The results of the study demonstrated the benefit of the use of cyclo hispro extract with zinc in type 2 diabetics.(33)

Herbal Supplementation

Evening Primrose Evening primrose oil (EPO) contains gamma-linolenic acid, which is an omega-6 fatty acid.(34),(35) Omega-6 fatty acids may decrease inflammation. Using essential fatty acids such as EPO may prevent zinc deficiency, possibly improving the immune system.(36) Fatty acids are an important part of the normal functions of the human body. The human body can produce all of the fatty acids it needs except for omega-3 and omega-6 fatty acids. Both of these must come from the diet or with the use of supplements. A balance of these two fatty acids is very important. Essential fatty acids are needed for building cells and hormones. Modern diets often do not provide enough fatty acids. Diabetics who cannot make gamma-linolenic acid (GLA) from linoleic acid will need a quality GLA supplement.(37),(38) This is very important for proper nerve function and for the prevention of diabetic neuropathy.(39),(40) Evening primrose oil has been reported to be beneficial for patients with diabetic neuropathy.(41),(42) Gymnema Gymnema is a rain forest vine found in Central and Southern India, which has a long tradition in the treatment of diabetes. The Indian name is Gurmar, which means, "sugar destroyer." Its use has been documented in Ayurvedic medical texts for over 2,000 years in the treatment of "sweet urine." The leaves of gymnema are thought to increase insulin secretion, and several studies report control of hyperglycemia in diabetic laboratory animals.(43),(44) A decrease in body weight has also been reported. Human studies have reported decreased blood glucose during therapy with gymnema.(45),(46) Improved lab test results and the need for less prescription medications have also been reported. In some studies, patients with diabetes were able to stop taking prescription diabetes medication and control their blood glucose with gymnema alone.(47) Researchers report that beta cells may be repaired in type 2 diabetics taking gymnema supplements.(48) Other studies report that gymnema controls blood glucose by decreasing the absorption of glucose in the intestines.(49) Because gymnema leaf powder acts like an anesthetic on the taste buds that can last for several hours, some researchers feel that gymnema may be a possible agent to use for weight control and to decrease the craving for sweets.(50) A recent study also reports decreases in cholesterol with the use of gymnema.(51) Gymnema may be useful for athletes who want to develop more lean muscle mass compared to body fat. Another study suggested that gymnema may be safe and effective for weight reduction, BMI and promoting healthy blood lipids.(52) Bitter Melon Bitter melon or karela fruit has been used in South America and the Orient as a food and also as a febrifuge (fever reducer), abortifacient (an agent that causes abortion), emmenagogue (increases menstruation), anthelmintic and vermifuge (agents that remove intestinal worms), antiviral, emetic (induces vomiting), and agent for diabetes.(53) Recent studies have looked at the benefits of the fruit in diabetes and hyperinsulinemia, HIV viral infection (AIDS), and certain cancers.(54),(55) Bitter melon has been reported to improve glucose control in humans.(56),(57) Research reports that molecules with insulin-like activity may be present in bitter melon seeds.(58) A few studies say that bitter melon may increase glucose use in the liver rather than having any effect on insulin release.(59) Bitter melon has also been reported to lower cholesterol and triglycerides in diabetic patients. Some reports have said that bitter melon extracts did not lower blood sugar in laboratory animals.(60),(61) It is recommended that a standardized extract of bitter melon always be used.

Diet and Lifestyle

Diet: Diabetes and obesity have increased over the past 50 years in the United States. People don't eat enough fresh foods, and there are fewer micronutrients in the soil (like chromium and vanadium) where food is grown. Fad diets of high protein, low or high fat, and low or no carbohydrates are not the answer. While this type of diet may help take weight off at first, it is not a long-term answer. Carbohydrates alone are not the cause because humans were eating carbohydrates long before these problems arose. It is true, however, that people are eating excessive amounts of carbohydrates, and it would be better to moderate that habit. There are several ways to support and improve insulin regulation by using natural agents, but the real key is to change the selection of foods in the diet. In general, the American diet is made up of a large amount of carbohydrates, especially refined carbohydrates. People limit their intake of fresh vegetables and fruits, and quality sources of protein and legumes, and they do not take in enough essential fats. As of 1985, the typical American diet was 46 percent carbohydrates, 43 percent fat (poor quality), and only 11 percent protein. With the average American eating approximately 150 pounds of sugar a year, there is a continuous demand for more insulin to be released. The average person drinking two "big gulp" drinks a day is receiving about 54 teaspoons of sugar. Using diet drinks does not work either because they contain sodium. This is particularly a problem for diabetics with hypertension (high blood pressure). While current research shows that dietary fat and cholesterol are definite problems, this situation is only made worse by the continuous, increased amount of carbohydrates along with the fat. Dietary fat is then stored because of excess insulin that is released while eating a high amount of carbohydrates. Many experts over the years have praised the low-fat, high-carbohydrate diet. The problem with this diet has been that it does not cause weight loss. In fact, a diet with too many carbohydrates has been linked to increased LDL cholesterol and triglycerides.(62) The other thing to be aware of is that many prepared foods may be labeled low fat, but are loaded with refined sugars, which increase insulin release, and therefore, fat storage. The obvious first step is to eat foods that will cause the least amount of insulin to be released. This will not only benefit the diabetic, but many individuals wanting to lose weight will benefit from this approach as well. The first concept to understand is the glycemic index - the fact that certain foods actually cause a sharper rise in insulin release than others. The glycemic index was first developed to help diabetics control postprandial (after meals) insulin blood sugar regulation, since this is the most difficult part of controlling blood sugar. Foods that do not cause a rapid rise in blood sugar will not cause increased insulin release. For example, in the past, it was thought that all complex carbohydrates were equal. It is now known that grains have different glycemic indexes. It is valuable to look at glycemic index when choosing foods that contain different amounts of carbohydrates. Proteins and fats do not have a glycemic index. Legumes: Almost all legumes have a moderate glycemic index. They also provide a source of water-soluble fiber that is valuable for lowering cholesterol. They also provide phytoestrogens, which may provide health benefits. Vegetables: Some vegetables have a high glycemic index and should be used in moderation if one is trying to actively control blood sugar. These include white potatoes (baked), carrots, beets, and turnips. However, if an individual is eliminating other sources of refined sugar in the diet and is decreasing the amount of complex carbohydrates (breads and pastas), he/she should be able to eat these vegetables with moderation. Dairy products: Most dairy products have a low glycemic index. However, some people do not tolerate dairy very well. Fruits: Fruits are generally in the middle of the road in terms of glycemic index; but dried fruits, which are concentrated, have a higher index. Drinking fruit juices will definitely increase blood sugar release. Therefore, fruit juices should be limited or diluted with three-fourths water. Most sweeteners such as honey, molasses, sugar, and white grape juice concentrate tend to have a high glycemic index. Rice syrup and granulated rice sweeteners may be used instead. The artificial sweetener aspartame may increase insulin resistance over time. Grains: Grains such as rice, wheat, and corn tend to have a high glycemic index, but grains such as buckwheat, millet, barley, rye, and bulgur are actually quite low. For successful weight loss and blood sugar control, this group of foods should be used in moderation. Also, the addition of fats such as olive oil or butter (in moderation) can lower the glycemic index. Fiber: Fiber is an important part of the diet for a number of reasons. It is well known that fiber helps prevent constipation. However, fiber also controls sugar and cholesterol and helps in the prevention of colon cancer and diverticulitis. Most individuals with diabetes or insulin resistance do not realize that they run a 75 percent risk for developing atherosclerosis. Decreasing cholesterol levels with the use of fiber is one way to combat this problem. Fiber is the indigestible part of plant food that acts as roughage for the body. There are two types of fiber. Water-soluble fiber is found in fruits, vegetables, and legumes in the form of guar, pectin, and gums. These products form a gel in the gastrointestinal tract that allows for a food to be held there longer, causing in a slow rise in blood sugar. This type of fiber also helps to lower cholesterol. Insoluble fiber is made of cellulose, hemicellulose, and lignins, and can be found in grains and bran. This food also takes longer to be broken down and used for energy, but its main value is in adding bulk and preventing constipation. Food Nutrient Groups and Their Importance in Insulin Regulation Proteins: Protein is important in every individual's diet. It is needed for growth and for building tissues. Proteins are made of amino acids. These amino acids are absorbed through the small intestine and used by the body as needed. The body can manufacture most amino acids, but there are eight essential amino acids that must come from the diet. These eight can best be found in eggs, poultry, fish, and meat. Nuts, seeds, legumes, and grains can provide some of these essential amino acids as well. Protein intake is needed for tissue healing and body functions. Carbohydrates: Carbohydrates is the class of foods that are likely to be eaten in excess. They are easy to get, are filling, and tend to be satisfying (like desserts). They are an energy source that eventually gets broken down into sugar. There are complex and simple sugars. Simple sugars are found in fruit and fruit products, white and brown sugar, maple syrup, and honey. These simple sugars increase insulin release. Carbohydrates are the main reason for the late night craving for sweets that occurs for so many individuals. Because of its fiber content, fruit, however, does have the advantage of being broken down in the stomach, with the sugar released over time. However, fruit should not be overeaten, since it does contain, in some cases, a large amount of fructose, a type of sugar. Complex carbohydrates provide the advantage of fiber, but too many complex carbohydrates are not good for the metabolism. Carbohydrates should come from vegetables. Fats: Fats are an important part of the diet. Americans eat poor sources of dietary fat for the most part. Most of the fats come from margarine, partially hydrogenated oils, or oils that have been commercially heated. Monounsaturated fats, such as olive oil, benefit by helping to control cholesterol. The use of omega-3 fatty acids, especially from vegetable sources (flax seed), can provide benefits. Because of the shortage of quality oils in the diet, most people actually need more essential fatty acids, in particular, the omega-3 fatty acids. These fatty acids are important as anti-inflammatories, for the health of nerve tissue, as well as being key nutrients for the health of every cell in the body. Exercise: Along with diet, exercise is the most important step diabetics can take toward blood sugar control. Today, there is more stress and less physical activity than even a generation ago. Exercise can decrease the risk for heart problems in diabetic patients. Regular exercise can improve heart and lung health, make insulin work better, and increase HDL cholesterol while decreasing LDL cholesterol.(63) Exercise also helps to regulate blood sugar. At a minimum, diabetics should get 30 minutes of some form of exercise at least four days a week, but more would be beneficial. Anyone who is over 40, or a brittle diabetic, and has not been exercising, should check with their health care professional before starting any exercise program.

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