Diabetes and Inside-Out Healing

Last week during office hours I looked for a moment at my nurse’s comments concerning a new patient I was about to see. "Fatigued, weakness at work."

Walking into the examining room, I said hello to a pleasantly dressed twenty-six year old female. She was a number of things all at the same time; A single mother of two small children, just starting a new job, totally uninsured, about fifty pounds overweight, and fatigued with a slightly increased blood sugar.

Her mother, also a patient of mine, has diabetes. A blood sugar test in the office pretty much confirmed why my new patient felt so lousy. Like her mother, she had developed adult/maturity onset diabetes.

Diabetes is one of the four major cardiovascular risk factors. That is, if you have it, your risk of premature heart disease is greatly increased compared to a same sex, same age person without it. Although a number of the long term complications are the same as juvenile diabetes, the way in which adults become diabetic is very different from the illness that kids get. Understanding the difference leads to understanding the treatment.

The problem in juvenile diabetes (actually now known as Type I or insulin dependent diabetes) is one of destruction of the pancreas, usually by an infectious (viral) source or by some immunologic attack by the patient’s own defense system. Since insulin is made in the pancreas, the destruction of the organ leads to the diabetes. The disease itself involves problems not only associated with elevated blood sugar (glucose) levels, but also metabolic and biochemical problems caused by the absence of insulin.

The diabetes of adulthood, also known as Type II or maturity onset diabetes, is not associated with destruction of the pancreas. In fact, many Type II diabetics have abnormally high insulin levels in their blood. What malfunctions is their ability to use their insulin. Most of these folks are overweight and out of shape before they become diabetic, and the elimination of these problems can lead, in a great majority of patients, to the complete control or virtual elimination of their diabetes. Here’s how:

Most adults who become diabetic have in their genes the tendency to do so. This tendency usually expresses itself as diabetes the longer the adult stays overweight and out of shape. Part of the problem centers around a biochemical structure called an insulin receptor.

The insulin receptor is the name given by scientists to a very real three dimensional structure that exists on the surface of many body cells, particularly muscle cells. Do you remember Tinker Toys? Legos? How about a sphere, shaped internally like a bunch of pretzels, made out of either one? You get the picture.

Now, one of the functions of insulin is to couple up with glucose molecules, forming the famous insulin-glucose team. The duo migrates from the tissue fluids in your body towards the surface of your cells, especially muscle cells, which produce much of our needed energy. At the cell surface sits our friend the insulin receptor. Like a lock and key, the insulin-glucose pair fits into the insulin receptor, and presto! the insulin releases the glucose into the inside of the cell, where it is used for fuel.

So, if you had a situation where the insulin receptors no longer worked, or where they disappeared from the surface of a cell, the glucose would not be able to enter that cell, and would accumulate in the tissues and blood, causing, you guessed it, some of the signs and symptoms associated with diabetes.

The disappearance of insulin receptors is exactly what happens in the overweight, out of shape adult with tendency in their genetics to become diabetic. The treatment should then be directed at reversing the process, that is , re-establishing the insulin receptor population.

It just so happens that two of my favorite passions, namely low fat, low sugar eating coupled with exercise, are the "number one, absolutely no question about it" approach to getting the job done. Diabetic nutritional excellence, not plain dieting, coupled with a combination of cardiovascular and weight training exercise is the treatment for almost all overweight diabetics. Seventy-five percent of obese adult onset diabetes could completely control their illness with this type of lifestyle change. Excellent blood sugar control greatly reduces or may even eliminate some long term cardiovascular risks of the disease.

Sadly, most overweight diabetics are unwilling or unable to effect the lifestyle changes necessary to handle their diabetes. Most will require at least some medication, and many require supplemental insulin. Medications have side-effects, cost lots of money, and in the case of insulin injections can actually make it much more difficult to lose weight.

So here’s my point. The treatment of any adult diabetic whose diabetes is associated with being overweight/out of shape is ideally an inside-out healing process. Most patients, in my experience, initially want the outside-in approach. They want or hope that their doctor can give them something or do something to them/for them. This is understandable, but unfortunately not where healing comes from.

Healing the degenerative diseases of our culture i.e., diabetes, high blood pressure, tobacco addiction, elevated cholesterol, etc. must begin as an inside-out event rather than an outside-in, "doctor do-it-for-me" event. Perhaps we,as physicians, have as much to do with the lack of inside-out healing in our culture as do patients, maybe more. Inside-out healing requires inside-out coaching, which takes time, self-insight, and study.

If you are diabetic, adult, and overweight ask your doctor to talk to you, really talk to you, about how to heal yourself from the inside-out. Not with some unrealistic expectations on your part, but with an attack on the basic body problems that got you into this fix. Get busy with a plan of low-fat, low-sugar eating and exercise. Put on your Nikes, put on some muscle, and put the right fuels into your body. Let’s hear it from those insulin receptors! This is work, but with education and inspiration, anything is possible. To Life!
 

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