Diabetes Mellitus: Current

Understanding and Treatment

Alternatives

Nikolas Arvis, MD and Annette Davis, CN Image: Diabetes © Tupungato/iStock

Diabetes is a group of metabolic diseases charac- Epidemiology and medical statistics

terized by prolonged high blood glucose. Diabetes Prevalence in the US
mellitus is derived from the Greek word diabetes As of 2012, 9.3% of the United States population suf-
meaning “to pass through” and the Latin word mel- fered from diabetes. Diabetes in seniors over the age
litus meaning “honeyed.” It is believed that the term of 65 had a staggering prevalence of 25.9% or 11.2
diabetes was coined by Greek physician Apollonius of million people. In people under the age of 20, only 1
Memphis (circa 250 BC) when he observed excessive in 3 cases of diabetes is type 2 versus 91% encoun-
urination in patients. The term mellitus was added by tered in older ages.
English physician Thomas Willis in 1675 when he no-
ticed that the urine of diabetic patients had a sweet When ethnicity is taken into consideration, 7.6% of
taste. Non-Hispanic Whites, 9% of Asian Americans, 12% of
Hispanics, 13.2% of Non-Hispanic Blacks and 15.9%
Type I diabetes, previously called insulin-dependent of American Indians/Alaskan Natives suffer from
diabetes, occurs when beta cells, the insulin-pro- diabetes.
ducing cells of the pancreas, are destroyed by the
immune system. Type 2 diabetes, previously called Based on death certificate data, diabetes was the 7th
noninsulin-dependent diabetes, occurs when cells leading cause of death in the United States in 2010. In
lose their sensitivity to insulin. 2012, the cost of diabetes including reduced produc-
tivity and medical costs was estimated at $245 billion
If untreated, diabetes can lead to serious conditions (CDC, 2014).
such as blindness, heart disease, kidney disease, nerve
disease and stroke. Pathophysiology
In order to understand diabetes, we first need to
Diagnosed and Undiagnosed Diabetes in the United States, understand carbohydrate metabolism and the action
2012
of insulin. After the consumption of food, carbohy-
All Ages drates are broken down into glucose molecules in
• Total: 29.1 million people or 9.3% of the population have diabetes. the gastrointestinal (GI) tract which then pass into
• Diagnosed: 21.0 million people.
• Undiagnosed: 8.1 million people the bloodstream elevating their concentration in
(27.8% of people with diabetes are undiagnosed.) the blood. This glucose rise stimulates the pancreas
to secrete insulin from its beta cells. Once secret-
By Age
• 20–44: 4.1% ed, insulin activates glucose transporters that allow
• 45–64: 16.2% glucose to enter cells. Much like a key in a lock, the
• 65+: 25.9% activation happens through a receptor in the cell
By Sex membrane that is specific for insulin molecules. Once
• Men: 13.6% glucose has entered the cells, dropping its concentra-
• Women: 11.2% tion in the blood, insulin secretion is inhibited.
(CDC, 2014)

Vol. 4 Issue 2 Fall 2015 IJPHA 13

Hormones such as glucagon, catecholamines, growth Signs and symptoms of diabetes
hormone, thyroid hormones and corticosteroids par- Diabetes type 1 and 2 share the same signs which
ticipate in raising blood glucose. By contrast, insulin is are associated with the inability of glucose to en-
the only hormone known to reduce blood glucose. ter the cells: increased thirst (polydipsia), increased
hunger (polyphagia) that gets worse after eating, and
Diabetes is a metabolic disease that occurs either frequent urination (polyuria). This trio is common to
because the pancreas doesn’t produce enough insulin all types of diabetes. Other signs such as slow wound
or the cells fail to properly respond to insulin. De- healing, fatigue, headaches, and blurry vision are also
pending on the reason, diabetes is divided in type 1 very common, but often ignored or misdiagnosed at
and type 2. first.

Type 1 diabetes When high glucose is present in the bloodstream, the

Type 1 diabetes is an autoimmune condition with kidneys are forced to work excessively in order to
unknown cause, although a viral infection is usually filter and absorb it. The capacity for such action how-
blamed. The immune system attacks and destroys ever is limited, and excess glucose is secreted in the
the beta cells of the pancreas halting the production urine along with water. Polyuria leads to dehydration
of insulin. The onset is usually before the age of 30. which triggers a thirst response. Fatigue is also the
Patients are generally slim to normal weight. The lack result of dehydration and the inability of the body to
of insulin results in the inability of glucose to enter use sugar to produce energy. Weight loss is the result
the cells, and cellular energy requirements fail to be of constant urination as well and the loss of calo-
met. The starving cells utilize a process called lipolysis ries through urine. This often manifests in the early
to break fats into glycerol which further metabolizes stages of diabetes when patients lose weight rapidly.
into glucose and fatty acids. The fatty acids metabo- The high concentration of glucose circulating in the
lize into ketones which in turn drop the metabolic bloodstream is also important at a cellular level.
pH. This condition called diabetic ketoacidosis (DKA) The increased osmotic pressure in the extracellular
is usually the first symptom of type 1 diabetes. fluids forces water to passively stream from the cells
causing inflammation, damage, or even cellular death.
Type 2 diabetes Conditions such as diabetic retinopathy, nephropathy
Type 2 diabetes is vastly different than type 1 diabe- and neuropathy are the direct result of this process.
tes. Autoimmunity is not responsible, and fortunately
the beta cells are not destroyed allowing the pan- Treating diabetes
creas to still produce insulin. In addition to genetic The management of diabetes concentrates on keep-
factors, type 2 diabetes is caused by obesity, dietary ing blood sugar levels as close to normal as possible.
and lifestyle factors, and advanced age. The pathology Type 1 diabetes is, of course, treated with insulin
behind this type is a result of one or a combination injections and in some cases by pancreatic transplan-
of the following factors: peripheral resistance to in- tation. Type 2 diabetes is treated with anti-diabetic
sulin, altered insulin secretion, and increased produc- medications such as Metformin which decrease
tion of glucose by the liver. The reason cells become production of glucose by the liver. Other medications
resistant to insulin is quite complex. While not yet may be used to increase the release of insulin, make
fully understood, staggering evidence points toward cells more sensitive to insulin, or decrease the ab-
obesity and a diet rich in simple carbohydrates and sorption of sugar from the intestines. Insulin may also
fats. When cells become resistant to insulin, the pan- be used in type 2 diabetes. Fortunately, a number of
creas compensates by increasing insulin production medicinal plants have also shown promising results in
causing hyperinsulinemia. Over time, the secretion the management of diabetes. “More than 400 plants
of insulin drops to subnormal levels. Because our and compounds have shown antidiabetic activities in
body is remarkably able to adapt, diabetes can remain vitro and/or in vivo” (Chang et al, 2013).
undiagnosed for years.

14 IJPHA Vol. 4 Issue 2 Fall 2015

Case study (example) Follow-up
A 55-year-old man presents with fatigue, chronic The client returned for a follow-up at five months.
headache, chronic thirst, and frequent urination. He He had been compliant with his tincture blend only
has gained 50 pounds over the past year in spite having missed an occasional weekend dose. He had
of the fact that he stopped drinking beer when the cut his soda intake to 12 oz per day and snack foods
weight gain started. He admits that he snacks on sug- to one per day. He continued to abstain from beer
ary foods and chips, and drinks one to two liters of except for Friday or Saturday nights when he social-
soda daily. He works a desk job. He lifts weights once izes with friends. He had added a leafy green salad
a week and tries to walk once a week, but is other- and whole fruit smoothie to his daily diet. He had
wise largely inactive. He has a paternal family history switched from white rice to brown rice 50% of the
of type 2 diabetes. His blood sugar measured 145 six time, and from white bread to whole grain bread
months ago and 150 two weeks ago. His Hemoglo- 75% of the time. He was limiting bacon and fried
bin A1c measures high at 6.8. His total cholesterol is foods to one or two servings each per week. He had
within normal range at 198; however, his HDL cho- added a 30-minute treadmill run twice per week and
lesterol is mildly elevated at 39. His body mass index took a walk around the block on his lunch hour most
(BMI) is 29, and his blood pressure is mildly elevated weekdays. He still lifted weights once per week and
at 145/95. He currently takes no medications, herbs agreed to try and increase to twice per week. He had
or supplements. He has refused pharmaceutical treat- lost 10 pounds (reducing his BMI from 29 to 28). His
ment and is seeking alternatives. blood sugar had decreased to 138. His LDL choles-
terol had decreased from 39 to 38 bringing it within
Analysis normal range. His Hemoglobin A1c had decreased
His problem is type 2 diabetes, likely influenced by a from 6.8 to 5.9 (normal range 4–5.6%). His blood
genetic component though largely caused by dietary pressure had decreased to 143/93. He stated that his
and lifestyle factors. His elevated blood sugar, BMI symptoms had all decreased approximately 50%. The
and blood pressure are increasing his risk for heart client was satisfied with his progress. He agreed to
disease, stroke and kidney disease. continue his tincture blend while continuing dietary
and lifestyle improvements. He was advised to sched-
Treatment ule a follow-up visit in two months and follow-up
Treatment includes a life-long low-glycemic or oth- laboratory tests in six months.
er weight-reduction diet and an interval exercise
program to promote weight reduction. Botanical Herbs that may be useful in the treatment of diabetes
support includes anti-diabetic, anti-inflammatory, Cinnamon bark (Cinnamomum Reduces insulin resistance,
zeylanicum) anti-inflammatory (Ranasinghe et
and hypotensive herbs such as Cinnamon (Cinnamo-
al, 2012)
mum zeylanicum) (Ranasinghe et al, 2012), Fenugreek Fenugreek seed (Trigonella foe- Reduces postprandial glucose
(Trigonella foenum-graecum) (Neelakantan et al, 2014), num-graecum) levels (Neelakantan et al, 2014)
Chamomile (Anthemis nobilis) (Zhao et al, 2014), Lem- Chamomile, Roman flower Hypoglycemic, anti-inflammatory,
on Balm (Melissa officinalis) (Weidner et al, 2014), Tar- (Anthemis nobilis) hypotensive (Zhao et al, 2014;
Zeggwagh et al, 2009)
ragon (Artemisia dracunculus) (Kheterpal et al, 2010),
Lemon Balm leaf (Melissa offic- Reduces insulin resistance (Weid-
and Geranium (Pelargonium graveolens) (Bouhkris et inalis) ner et al, 2014)
al, 2012). Licorice (Glycyrrhiza glabra) herb will be Tarragon leaf (Artemisia dracun- Anti-diabetic (Kheterpal et al,
avoided in this case due to his mild hypertension. The culus) 2010)
client has been directed to keep a journal of his ex- Geranium leaf (Pelargonium Anti-diabetic (Boukhris et al,
ercise, food intake, blood sugar and blood pressure. graveolens) 2012)
He will have a follow-up clinic visit Licorice root (Glycyrrhiza glabra) Reduces insulin resistance, anti-
inflammatory (Sil et al, 2013)
every two months and follow-up
labs every three to six months to
measure his progress and adjust his
treatment plan as needed.

Herbs for diabetes © Avosb/iStock

Vol. 4 Issue 2 Fall 2015 IJPHA 15

 Sample phytotherapeutic diabetes treatment Kheterpal I, Coleman L, Ku G, Wang Z Q, Ribnicky D, Cefalu W T.
(2010). Regulation of insulin action by an extract of Artemisia dracuncu-
Fenugreek (Trigonella foenum-graecum) tincture 80 cc lus L. in primary human skeletal muscle culture: a proteomics approach.
Chamomile (Anthemis nobilis) tincture 80 cc Phytother Res. 24 (9), p1278–1284.
Lemon Balm (Melissa officinalis) tincture 80 cc
Neelakantan N, Narayanan M, de Souza R J, van Dam R M. (2014).
Cinnamon bark (Cinnamomum zeylanicum) essential oil *3 cc Effect of fenugreek (Trigonella foenum-graecum L.) intake on glycemia: a
Tarragon (Artemisia dracunculus) essential oil *3 cc meta-analysis of clinical trials. Nutr J. 18;13:7. Available: http://www.ncbi.
Geranium (Pelargonium graveolens) essential oil *3 cc nlm.nih.gov/pubmed/24438170. Last accessed 1May 2015.
Blend all of the above together in an 8 oz glass bottle. Shake well Ranasinghe P, Jayawardana R, Galappaththy P, Constantine G R, de Vas
before use. Take 2 cc with each three meals diluted in a small glass Gunawardana N, Katulanda P. (2012). Efficacy and safety of ‘true’ cinna-
of water. (*Essential oils for oral use should be highly diluted in an mon (Cinnamomum zeylanicum) as a pharmaceutical agent in diabetes: a
appropriate carrier. The amount of essential oil contained in this systematic review and meta-analysis. Diabet Med. 29 (12), p1480–1492.
tincture blend is approximately 0.375 drops of each oil—1.125
drops total per 2 cc dose.) Sil R, Ray D, Chakraborti A S. (2013). Glycyrrhizin ameliorates insulin
Stress a low glycemic, weight-reduction diet and exercise plan. resistance, hyperglycemia, dyslipidemia and oxidative stress in fruc-
Note: This sample phytotherapeutic treatment is intended to be tose-induced metabolic syndrome-X in rat model. Indian J Exp Biol. 51
used under the supervision of a qualified healthcare professional. (2), p129–138.
Optimal results are achieved when treatment plans are customized
to each patient. Weidner C, Wowro S J, Freiwald A, Kodelja V, Abdel-Aziz H, Kelber O,
Sauer S. (2014). Lemon balm extract causes potent antihyperglycemic
and antihyperlipidemic effects in insulin-resistant obese mice. Mol Nutr
Diabetes is an extremely common, disabling, and Food Res. 58 (4), p903–907.
potentially deadly disease. Increasing public aware-
ness of the signs and symptoms of the disease will Zeggwagh N A, Moufid A, Michel J B, Eddouks M. (2009). Hypotensive
effect of Chamaemelum nobile aqueous extract in spontaneously hyper-
greatly increase early diagnosis and treatment result- tensive rats. Clin Exp Hypertens. 31 (5), p440–450.
ing in a reduction of premature death and disability.
For example, reducing Hemoglobin A1c (a labora- Zhao J, Khan S I, Wang M,Vasquez Y,Yang M H, Avula B, Wang Y H,
Avonto C, Smillie T J, Khan I A. (2014). Octulosonic acid derivatives
tory measure of blood glucose control) by just one from Roman chamomile (Chamaemelum nobile) with activities against
percentage point can reduce the risk of eye, kidney inflammation and metabolic disorder. J Nat Prod. 77 (3), p509–515.
and nerve diseases by an impressive 40%. Keeping
blood pressure under control can reduce the risk of Nikolas Arvis, MD is a European Union licensed Medical
Doctor. He attended the University of Belgrade School
heart disease and stroke by up to 50%. Reducing LDL of Medicine where he earned his medical degree in 2007.
(“bad”) cholesterol, while increasing HDL (“good”) Upon graduation he completed his internship at the
cholesterol, can reduce the risk of cardiovascular Cardiovascular Insititute of Belgrade and then entered the
forensics residency program. He moved from Greece to the United
events by up to 50% (CDC, 2014). While anti-diabetic States in 2011. He is currently studying Endobiogeny and working
medications are sometimes unavoidable, anti-diabetic toward his medical licensing in Idaho. info@endobiogenic.com
herbs and essential oils in combination with dietary Annette Davis, CN, is a Clinical Nutritionist with over 20
and lifestyle modifications can be valuable tools in years of clinical Phyto-Aromatherapy and Endobiogeny
reducing the need for prescription medicines while experience. She has studied Endobiogeny under Dr. Jean
Claude Lapraz since 1989. She was introduced to holistic
greatly improving the quality of life for diabetic pa- healing by her grandmother and American Aromatherapy
tients. d pioneer, Annemarie Buhler. She currently serves as the President of
the National Association of Holistic Aromatherapy and as the Mem-
bership Chair for American Society of Endobiogenic Medicine and
References Intregative Physiology. info@endobiogenic.com
Boukhris M, Bouaziz M, Feki I, Jemai H, El Feki A, Sayadi S. (2012).
Hypoglycemic and antioxidant effects of leaf essential oil of Pelargonium
graveolens L’Hér. in alloxan induced diabetic rats. Lipids in Health and Dis- Editor’s note
ease. Available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3439344/. French Lilac (Galega officinalis) has been
Last accessed 1 May 2015.
used since the Middle Ages as an herbal
Centers for Disease Control and Prevention. (2014). National Diabetes remedy for the symptoms of diabetes.
Statistics Report: Estimates of Diabetes and Its Burden in the United States, The plant contains guanadine com-
2014. Atlanta, GA: US Department of Health and Human Services.
Galega officinalis pounds that lower blood sugar levels.
Chang C L T, Lin Y, Bartolome A P, Chen Y-C, Chiu S-C,Yang W-C. H. Zell Guanadine itself is too toxic to be used
(2013). Herbal Therapies for Type 2 Diabetes mellitus: Chemistry, as a drug, but it inspired chemists to make very
Biology, and Potential Application of Selected Plants and Compounds.
Evidence-Based Complementary and Alternative Medicine. Available: http://
similar compounds. One of these is now sold as the
dx.doi.org/10.1155/2013/378657. Last accessed 1 May 2015. diabetes drug Metformin. - Royal Botanic Gardens, Kew
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