Improve Insulin Resistance in Type Two Diabetes

by Jeffrey Dach MD

Mrs. Duvalier is an insulin dependent diabetic on daily insulin injections. She uses a home glucometer to measure her fasting blood sugar which ranges from 200 to 300.  She is interested in natural treatments to reduce her need for insulin.  She wants to get off insulin entirely.  I explained to her that getting off insulin altogether with a normal blood sugar would be difficult.

This article discusses our approach to improving insulin sensitivity, and how to decrease the insulin requirement in Type 2 Diabetes with diet, exercise, and nutritional supplements.

This article is part one of a series.
For Part Two Click Here.
For Part Three Click Here.

Natural Approach with Diet, Exercise and Nutritional Supplements

A logical and natural approach to treatment for diabetes involves modifying the diet to a low glycemic diet, exercise program, and weight loss.

The Atkins Diabetes Revolution, The Low Glycemic Diet (6)(7) Left Image courtesy of Dr. Atkins.

The Atkins type diet which is low carbohydrates diet, and high in fat and protein has been known to improve insulin resistance and reduce fasting blood sugar values. It is also helpful for weight loss. Eliminate refined sugar and refined carbohydrates for maximal benefit.  Also recomennded is Protein Power by Drs. Michael and Mary Dan Eades.(46)

Jenny Ruhl’s New Book, Blood Sugar 101
Image courtesy of Jenny Ruhl

An excellent resource is Jenny Ruhl’s new book, Blood Sugar 101.

Jenny Ruhl explains how to improve insulin sensitivity by using a glucometer to measure blood sugar after a meal.  Knowing how high your blood sugar goes after a carbohydrate load provides information about types of carbohydrates to avoid, and empowers one to control blood sugar with diet.  By keeping blood sugar under control, the insulin resistance improves automatically.(45)

Exercise and Weight Loss

Weight loss associated with a vigorous exercise program will improve insulin sensitivity and reduce fasting blood sugar values.  We have a number of weight loss programs in the office.

1) Wheat Elimination will serve as a basic weight loss program.
2) A nutritional supplement based program called Isagenix .
3) the ALCAT food sensitivity program serves as a weight loss program.

Nutritional Supplements

1) Berberine  

The recommended Berberine product is Dr. Jonathan V. Wright’s InsuLife-BThis is a combination supplement containing Berberine which is a botanical with profile similar to the diabetic drug Metformin.  This also contains: Cinnamon (Cinnamomum cassia) bark extract, Oregon grape (Mahonia aquifolium) root extract (80% Berberine),Resveratrol,Alpha-lipoic acid,Quercetin,

2) Thiamine Vitamin B-1.  Use Benfotiamine 300 mg 3 times per day.See my previous article: on Thiamine Deficiency and Diabetes

3) Alpha-lipoic acid has been shown to improve insulin sensitivity and resistance in individuals with existing type 2 diabetes.  100-600 milligrams 1-3 times daily of R-Lipoic Acid. (7)

4) Vitamin D, check vitamin D level and supplement if found to be low.  Recheck every 6 months.

5) Chromium Picolinate – (chromium polynicotinate) 500-1000 mcg daily. FDA approved first qualified health claim for a supplement.

6) Biotin 9-16 mg daily

7) Coenzyme Q10 30 to 60 milligrams of coenzyme Q10 daily.

8) Acetyl L Carnitine shuttles fatty acids across mitochondrial membrane.  Useful for fat metabolism. Works together with Coenzyme Q 10 and D Ribose to increase mitochondrial function.

Cinnamon has been recommended by some, considered ineffective by others.  It is cheap and available as a spice at the grocery store.

 

Iodine Supplementation to Reverse Insulin Resistant Diabetes

It is not widely known that iodine supplementation is beneficial in reversing diabetes.

Iodine Supplements found to be beneficial in Diabetics.

Quoted from George Flechas MD:

“It was while treating a large 320-pound woman with insulin dependent diabetes that we learned a valuable lesson regarding the role of iodine in hormone receptor function. This woman had come in via the emergency room with a very high random blood sugar of 1,380 mg/dl. She was then started on insulin during her hospitalization and was instructed on the use of a home glucometer. She was to use her glucometer two times per day. Two weeks later on her return office visit for a checkup of her insulin dependent diabetes she was informed that during her hospital physical examination she was noted to have FBD.

She was recommended to start on 50 mg of iodine (4 tablets) at that time. One week later she called us requesting to lower the level of insulin due to having problems with hypoglycemia. She was told to continue to drop her insulin levels as long as she was experiencing hypoglycemia and to monitor her blood sugars carefully with her glucometer. Four weeks later during an office visit her glucometer was downloaded to my office computer, which showed her to have an average random blood sugar of 98.

I praised the patient for her diligent efforts to control her diet and her good work at keeping her sugars under control with the insulin. She then informed me that she had come off her insulin three weeks earlier and had not been taking any medications to lower her blood sugar. When asked what she felt the big change was, she felt that her diabetes was under better control due to the use of iodine. Two years later and 70 pounds lighter this patient continues to have excellent glucose control on iodine 50 mg per day.

We since have done a study of twelve diabetics and in six cases we were able to wean all of these patients off of medications for their diabetes and were able to maintain a hemoglobin A1C of less than 5.8 with the average random blood sugar of less than 100.

To this date these patients continue to have excellent control of their Type II diabetes. The range of daily iodine intake was from 50 mg to 100 mg per day. All diabetic patients were able to lower the total amount of medications necessary to control their diabetes. Two of the twelve patients were controlled with the use of iodine plus one medication. Two patients have control of diabetes with iodine plus two medications. One patient had control of her diabetes with three medications plus iodine 50 mg. The one insulin dependent diabetic was able to reduce the intake of Lantus insulin from 98 units to 44 units per day within a period of a few weeks.“

Above Quoted from George Flechas MD.(17)

Diabetes Drugs: More is not always better.

The large NIH Diabetes study (ACCORD) was halted because of higher mortality in the intensive treatment group according to a February 7 New York TImes article by Gina Kolata. (30)  The patients with the tighter control of blood sugar had the higher mortality. This shocked and stunned the medical community because it has always been believed that the closely or “tightly controlled” blood sugar had the best results for diabetes.  A few comments which explain this paradoxical results are found here  and here .(32)(33)  One explanation is that, in order to control blood sugar, the intensive group was given insulin and other medications which created high insulin levels.  High insulin levels are harmful to the heart as discussed in this Mercola article  by Ron Rosedale MD.(42)

Anti-Diabetes Drugs

Metformin (Glucophage).

This is the best and most commonly used anti-diabetic drug.  This drug is very beneficial. It decreases glucose output from the liver.  Metformin does not alter concentrations of insulin in the blood and, therefore, rarely causes low blood glucose levels.

Increase Insulin Output by Pancreas:

Chlorpropamide, Tolbutaminde, Glyburide, Glipizide, glimepiride.

Increase Insulin Sensitivity:

Troglitazone (Rezulin) which was taken off the market in March 2000 due to liver toxicity, or rosiglitazone (Avandia) whose long-term safety profile is not known.

Decrease the Absorption of Carbohydrates from the Intestine:

Precose. Precose has significant gastrointestinal side effects. Abdominal pain, diarrhea, and gas are common and are seen in up to 75% of patients.

Increase the Amount of Insulin:

Insulin Injectable Humulin.

A full discussion of Diabetes Drugs will be the subject of a later report. In the meantime, see (28) and (29) for discussions of limitations of Diabetes Drugs.

More intensive drug treatment with intensive lowering of  blood sugar and HGB-A1C does not always translate into improvement in health in high risk diabetes, as the ACCORD study demonstrates. The ACCORD study was halted early because the more intensive treatment group had a higher mortality.(30)-(41)

Read material from Ron Rosedale MD click here (42)(43)(44)

This article is part one of a series.
For Part Two Click Here.
For Part Three Click Here.

Articles with Related Interest: 

Metformin the Miracle Drug

Thiamine Deficiency and Diabetes

Disclaimer: http://www.drdach.com/wst_page20.html

This article is for educational purposes only.

As always, consult with a knowledgeable physician before making any changes in your diet, exercise or supplement program, including any decisions regarding Iodine supplements, or any other supplements or medications.

Jeffrey Dach MD
7450 Griffin Road Suite 190
Davie, Florida 33314
954-792-4663
http://www.jeffreydach.com/
http://www.drdach.com/
http://www.naturalmedicine101.com/
http://www.truemedmd.com/
http://www.bioidenticalhormones101.com/

References

Chromium, Biotin and Cinnamon

(1) http://jn.nutrition.org/cgi/reprint/123/4/626
Chromium in Human Nutrition: A Review WALTER MERTZ U.S. Department of Agriculture, Agricultural Research Service,Beltsuille Human Nutrition Research Center, Beltsville, MD 20705, American Institute of Nutrition. Received 21 July 1992.

(2) http://www.ncbi.nlm.nih.gov/pubmed/15208835
Diabetes Educ. 2004;Suppl:2-14.A scientific review: the role of chromium in insulin resistance.

(3) http://www.ncbi.nlm.nih.gov/pubmed/17952838?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1
Horm Metab Res. 2007 Oct;39(10):743-51. Chromium in metabolic and cardiovascular disease.Hummel M, Standl E, Schnell O. Diabetes Research Institute & Academical Hospital Munich-Schwabing, Munich, Germany.

(4) http://www.ncbi.nlm.nih.gov/pubmed/17109595?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1
Diabetes Technol Ther. 2006 Dec;8(6):636-43. The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized trial.Singer GM, Geohas J. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8017, USA.

Biotin 2 mg 667%  Chromium 6000 mcg 500%

(5) http://www.ncbi.nlm.nih.gov/pubmed/16117721
Dis Manag. 2005 Aug;8(4):265-75.

Use of chromium picolinate and biotin in the management of type 2 diabetes: an economic analysis. Fuhr JP Jr, He H, Goldfarb N, Nash DB. Department of Economics, Widener University, Chester, Pennsylvania, USA.

Average 3-year cost savings for chromium picolinate plus biotin (Diachrome) use could range from 1,636 dollars for a poorly controlled patient with diabetes without heart diseases or hypertension, to 5,435 dollars for a poorly controlled patient with diabetes, heart disease, and hypertension. Average 3-year cost savings was estimated to be between 3.9 billion dollars and 52.9 billion dollars for the 16.3 million existing patients with diabetes. Chromium picolinate plus biotin (Diachrome) use among the 1.17 million newly diagnosed patients with T2DM each year could deliver lifetime cost savings of 42 billion dollars, or 36,000 dollars per T2DM patient.

Atkins Diet

(6) http://www.atkins.com/products/atkins-diabetes-revolution
Atkins Diet Revolution for Diabetes

(7) http://www.nutritionandmetabolism.com/content/1/1/14
Book review, Review on “Atkins Diabetes Revolution: The Groundbreaking Approach to Preventing and Controlling Type 2 Diabetes” by Mary C. Vernon and Jacqueline A. Eberstein
Surender Arora  and Samy I McFarlane, Nutrition & Metabolism 2004, 1:14

Alpha Lipoic Acid

(8) http://www.thorne.com/altmedrev/.fulltext/11/3/232.pdf
Alha Lipoic Acid Review Article Thorne

(9) http://www.phlaunt.com/diabetes/20144672.php
Supplements that are thought to work for diabetes in the opinion of Jenny’s Blood Sugar101 (ALA,  Vit D etc.)

(10) http://www.phlaunt.com/diabetes/15877514.php
Supplements that are questionale or not thought to be effective in the opinion of Jenny’s Blood Sugar 101 (Cinnamon, Chromium etc.)

Vitamin B1 Thiamine

(11) http://www.purecaps.com/NewsResearch/newsletter/20050920/index.asp
BenfoMax (Benfotiamine): Novel Support for Nerve, Retina and Kidney Function
Benfotiamine, S-benzoylthiamine-O-monophosphate, is a fat soluble vitamin B1 (thiamine) derivative that has enjoyed over a decade of popular use in Europe.

(12) http://www.benfotiamine.org/index.htm
Benfotiamine.org Lipid soluble form of thiamine B1

(13) http://www.benfotiamine.org/Benfo600Study.pdf
Benfotiamine Inhibits Intracellular Formation of Advanced Glycation End Products in vivo
JIHONG LIN, ALEX ALT, JUTTA LIERSCH, REINHARD G. BRETZEL, MICHAEL BROWNLEE*, HANS-PETER HAMMES Third Medical Department, Justus-Liebig-University Giessen, Germany *Albert-Einstein College, New York, NY,

Chromium and Cinnamon

(14) http://www.ncbi.nlm.nih.gov/pubmed/18234131
Proc Nutr Soc. 2008 Feb;67(1):48-53. Chromium and polyphenols from cinnamon improve insulin sensitivity.Anderson RA. Beltsville Human Nutrition Research Center, USDA, Beltsville, MD 20705, USA.

(15) http://www.purecaps.com/NewsResearch/newsletter/20050920/article_three.asp
FDA Concludes that Chromium Picolinate is Safe;Approves First Qualified Health Claim.
In August, the FDA recognized chromium picolinate as a safe nutritional supplement with credible evidence to support the first qualified health claim with regard to the role of chromium in healthy glucose metabolism.

Iodine References

(16) http://www.helpmythyroid.com/mack.html
Case Report on Mack – Thyroid Cancer, Hypothyroidism George Flechas MD HelpMyThyoid.com

(17) http://www.iodine4health.com/disease/diabetes/flechas_diabetes.htm
George FLECHAS MD Orthoiodosupplementation in a Primary Care Practice, Flechas JD. Role of Iodine in Diabetes

References dealing with Nutritional Supplements for Diabetes:

(18) http://www.phlaunt.com/diabetes/index.php
Blood Sugar 101 by Jenny

(19) http://www.raysahelian.com/diabetes.html
Natural Supplements for Diabetes by Ray Sahelian MD

(20) http://www.encyclopedia.com/doc/1G1-81138246.html
A Natural Approach to Diabetes – Brief Article Townsend Letter for Doctors and Patients,  Jan, 2002  by Farhang Khosh. Excellent Reveiw with References

(21) http://www.drlam.com/A3R_brief_in_doc_format/Diabetes.cfm#Diabetes
Dr Lam’s Diabetes Protocol

(22) http://www.westonaprice.org/moderndiseases/diabetes.html
Treating Diabetes: Practical Advice for Combating a Modern Epidemic By Tom Cowan, MD
Weston Price Org

(23) http://healthmoz.org/how-to-reverse-type-2-diabetes-and-insulin-resistance-in-5-simple-steps/#comment-2040
How To Reverse Type 2 Diabetes And Insulin Resistance In 5 Simple Steps Mark Hyman, MD is a pioneer in functional medicine, practicing physician and best-selling author. A sneak preview of his book “The UltraSimple Diet” is available.

More on Chromium, First Health Claim Approved by the FDA

(24) http://www.purecaps.com/itemdy00.asp?T1=CRG61
chromium polynicotinate from pure encapsulations, preferred tyoe of chromium

(25) http://www.cfsan.fda.gov/~dms/qhccr.html
There was one study (Cefalu et al., 1999) that showed a benefit for chromium picolinate and insulin resistance.  FDA finds that there is very limited credible evidence for a qualified health claim specifically for chromium picolinate and a reduced risk of insulin resistance, and therefore possibly a reduced risk of type 2 diabetes.  However, the reported findings of Cefalu et al., 1999 have not been replicated.

(26) http://www3.interscience.wiley.com/cgi-bin/abstract/61004819/ABSTRACT
Cefalu, W.T., A.D. Bell-farrow, J. Stegner, Z.Q. Wand, T. King, T. Morgan, J.G. Terry. Effect of chromium picolinate on insulin sensitivity in vivo. Journal of Trace Elements in Experimental Medicine. 1999;12:71-83.

(27) http://care.diabetesjournals.org/cgi/content/full/27/11/2741
Diabetes Care 27:2741-2751, 2004 by the American Diabetes Association, Inc. Review Article Role of Chromium in Human Health and in Diabetes, William T. Cefalu, MD and Frank B. Hu, MD, PHD

Diabetes Drugs

(28)
http://doctorjames.wordpress.com/2008/02/28/the-truth-about-diabetes-and-why-drugs-dont-work/
The Truth About Diabetes and Why Drugs Don’t Work Posted by doctorjames on February 28, 2008

(29) http://sparkofreason.blogspot.com/2008/02/insulin-insanity.html
insulin Insanity  from Spark of Reason

Accord Study Halted Early

(30) http://www.nytimes.com/2008/02/07/health/07diabetes.html?_r=2&ei=5065&en=a58f37b02db7215d&ex=1203051600

February 7, 2008 Diabetes Study Partially Halted After Deaths  By GINA KOLATA New York Times

(31) http://www.pbs.org/newshour/bb/health/jan-june08/diabetes_02-07.html
Diabetes Study Partially Halted Due to Cardiac Risk. A new study on Type 2 diabetes was partially halted after research showed lowering blood sugar levels for some high-risk patients increased their chances of dying from a heart attack. The head of the American Diabetes Association details the surprising findings.

(32) http://doctorrw.blogspot.com/2008/02/accord-study-what-does-it-mean.html
The ACCORD study: what does it mean? A safety analysis and early halt to the intensive glycemic control arm of the ACCORD study was reported yesterday in an NIH press release. It says intensive glycemic control (it was really what I’d call ultra-intensive glycemic control, more stringent than what current guidelines call for) was associated with increased cardiovascular mortality (essentially macrovascular) in patients with type 2 diabetes.

(33) http://www.diabetesmine.com/2008/02/accord-study-a.html
ACCORD Study: Wrong and Wronger The media loves a good scare.  So they’ve jumped all over the failed ACCORD study (Action to Control Cardiovascular Risk in Diabetes) with headlines making it sound like tight blood glucose control is now proven to be “bad for you.”  Ugh.

(34) http://www.cbsnews.com/stories/2008/02/06/health/main3797887.shtml?source=RSSattr=Health_3797887
Diabetes Patients’ Deaths Stunt Study. Unexpected Number Of Fatalities Cuts Short Experimental Treatment For Type 2 Diabetics WASHINGTON, Feb. 7, 2008

(35) http://hcrenewal.blogspot.com/2008/02/is-more-always-better-accord-study.html
Thursday, February 07, 2008 Is More Always Better? – the ACCORD Study Results. Health Care Renewal

(36) http://diabetesupdate.blogspot.com/2008/02/how-advance-differs-from-accord.html
How ACCORD differed from Advance by Jenny Ruhl Blood Sugar 101.  Accord added statins and fibrates to the program.

(37) http://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=2551
For Safety, NHLBI Changes Intensive Blood Sugar Treatment Strategy in Clinical Trial of Diabetes and Cardiovascular Disease. NIH News Release.

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has stopped one treatment within a large, ongoing North American clinical trial of diabetes and cardiovascular disease 18 months early due to safety concerns after review of available data, although the study will continue.

In this trial of adults with type 2 diabetes at especially high risk for heart attack and stroke, the medical strategy to intensively lower blood glucose (sugar) below current recommendations increased the risk of death compared with a less-intensive standard treatment strategy.  Study participants receiving intensive blood glucose lowering treatment will now receive the less-intensive standard treatment.

The ACCORD (Action to Control Cardiovascular Risk in Diabetes) study enrolled 10,251 participants. Of these, 257 in the intensive treatment group have died, compared with 203 within the standard treatment group. This is a difference of 54 deaths, or 3 per 1,000 participants each year, over an average of almost four years of treatment. The death rates in both groups were lower than seen in similar populations in other studies.

“A thorough review of the data shows that the medical treatment strategy of intensively reducing blood sugar below current clinical guidelines causes harm in these especially high-risk patients with type 2 diabetes,” said Elizabeth G. Nabel, M.D., director, NHLBI.

Those participants in the intensive treatment group will now be treated to the same A1C goals as those already in the standard treatment group.

The intensive treatment group had a target blood sugar goal, measured by hemoglobin A1C, of less than 6 percent. This is similar to blood sugar levels in adults without diabetes.  The standard treatment group aimed for a target similar to what is achieved, on average, by those with diabetes in the United States (A1C of 7 to 7.9 percent) and lower than at study entry.

In ACCORD, half of the participants in the intensive treatment group achieved an A1C of less than 6.4 percent, and half of the participants in the standard treatment group achieved an A1C of less than 7.5 percent.

(38) http://www.medscape.com/viewarticle/480545_print
Expert Interview. The Incretin Hormones in the Treatment of Type 2 Diabetes: An Expert Interview With John Buse, MD, PhD Medscape Diabetes & Endocrinology 6(1), 2004. © 2004 Medscape
Posted 06/14/2004

(39) http://www.sourcewatch.org/index.php?title=GlaxoSmithKline,_the_Diabetes_Drug_Avandia_and_The_Intimidation_of_Dr._John_Buse
GlaxoSmithKline, the Diabetes Drug Avandia and The Intimidation of Dr. John Buse

Statin Drugs for Diabetics

(40) http://clinical.diabetesjournals.org/cgi/content/full/21/4/168
Clinical Diabetes 21:168-172, 2003
Practical Pointer Statin Treatment in Diabetes Mellitus John Buse, MD, PhD, CDE  Athough cardiac events are reduced in diabetics, where is the HPS all-cause mortality data?

(41) http://www.vitamincfoundation.org/statinalert/hps.html
Comments by Statistician Eddie Vos (Health-heart.org)
The full HPS mortality data have never been properly published and one of the HPS authors just asked me WHY I wanted to know, instead of coming up with the data. One of the letter authors in Lancet Aug. 30 figures they won’t ever provide these data –and that should be denounced in the Journals. I sent letters into Lancet Aug. 30, unsuccessfully asking for complete mortality data.  Only 2 of the last 4 big trials give cumulative mortality data but PROSPER claims no mortality benefit, yet HPS DOES. HPS may well have been stopped at a coincidentally particularly advantageous moment in the statistical ups and downs [as ASCOT was stopped with a small NS benefit showing, while 3 months before the curves touched].

Harmful Effects of High Insulin Levels

(42) http://www.mercola.com/2001/jul/14/insulin.htm
Insulin and Its Metabolic Effects By Ron Rosedale, M.D. Presented at Designs for Health Institute’s BoulderFest August 1999 Seminar, mercola.com

(43) http://nourishedmagazine.com.au/blog/articles/insulin-resistance-the-real-culprit
Insulin Resistance: The Real Culprit By Ron Rosedale Ron Rosedale, M.D., is an internationally renowned expert in nutritional and metabolic medicine and is a specialist in the biology of aging.

(44) http://www.amldiet.com/
Advanced Metabolic Laboratories (AML) offers a truly effective way to treat diabetes, heart disease and obesity, and improve longevity. Led by Dr. Ron Rosedale, internationally known for reversing type II diabetes, obesity and heart disease, and author of THE ROSEDALE DIET, we provide an affordable, yet highly reliable alternative. Although a diet low in carbohydrates is an essential part, our approach is very different from the low-carb diets available today.

(45) http://www.phlaunt.com/technionbooks/20645175.php
Jenny Ruhl Blood Sugar 101

(46) http://www.proteinpower.com/
The Official Web Site of Drs. Michael and Mary Dan Eades. Protein Power Book.

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Jeffrey Dach MD
7450 Griffin Road Suite 190
Davie, Florida 33314
954-792-4663
http://www.jeffreydach.com/
http://www.drdach.com/
http://www.naturalmedicine101.com/
http://www.truemedmd.com/
http://www.bioidenticalhormones101.com/

Disclaimer click here: http://www.drdach.com/wst_page20.html
The reader is advised to discuss the comments on these pages with  his/her personal physicians and to only act upon the advice of his/her personal physician. Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician — patient relationship.

Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur.

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