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How Sweet It Is: Helping Patients Manage Blood Sugar

Healthy Blood Sugar Healthy Blood Sugar

High blood sugar is years in the making, but you can help your patients take control with dietary supplements and lifestyle changes.

Before type 2 diabetes sets in, you can help your patients potentially stave it off. But it appears that there may be several baked-in misunderstandings about the cause of erratic blood sugar and diabetes mellitus (DM).

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), DM results when cells in muscles, fat and liver begin to fail at effectively responding to insulin and glucose uptake from blood—this state is called insulin resistance, which some believe is not a credible theory.

“This mistaken science regarding type 2 diabetes is believed not only by patients but also by medical practitioners, including diabetologists. I suggest it is illogical from a scientific perspective,” asserted practitioner John Poothullil, MD. “Patients with type 2 diabetes have normal levels of insulin in their blood while also having high levels of glucose. The insulin resistance theory states that in adults, cells become the equivalent of deaf and blind to insulin, though the mechanism for this has never been identified. The insulin resistance theory also states that only three types of cells—fat, liver and muscle cells—out of more than 200 cell types in the body become resistant to insulin. How could this be?”

Dr. Poothullil believes there is a more logical explanation for high blood sugar that he said has been verified by scientific research. It is known that muscles use fatty acids instead of glucose to produce energy for metabolic purposes. In 1982, researchers trying to establish the mechanism that leads to glucose elevation in adults explained that even when insulin is available, high fatty acid levels effectively compete with glucose for uptake by cells. This observation was validated years later in research showing that even a normal post-meal elevation in blood fatty acid level inhibited insulin-stimulated glucose uptake.

This means that muscles, the biggest user of glucose in the body, do not need glucose since they already have an abundance of fatty acids available to them, despite receiving signals from insulin. “I suggest that this is precisely the mechanism that leaves glucose in the blood, causing high blood sugar and eventually type 2 diabetes,” he stated. In short, he underscored, blood sugar elevation in type 2 diabetes results from an oversupply of glucose relative to the energy needs of the body.

The concept that getting type 2 diabetes is solely under one’s control of lifestyle is also not quite right, according to Remy Reinstein, vice president of sales, CuraLife, Texas. Most people believe that it is purely their fault that they have high blood sugar. High fasting blood sugar levels rise gradually with no symptoms. Often, patients told for the first time that their blood sugar is high and needs monitoring are understandably upset and bewildered as to how that happened.

But, said Reinstein, “it isn’t always due to poor lifestyle choices, eating sugary foods, or being overweight. It can be caused by genetics. Many also believe that diabetes is easily reversible. Diabetes is hard, and while you can get yourself back into a healthy normal range, it takes time and dedication.”

Dietitian Theresa DeLorenzo, DCN, RD, owner and founder of New York-based Nutrition for Optimal Performance and program director for Logan University’s Master of Science in Nutrition and Human Performance and Master of Science in Applied Nutrition and Dietetics, agreed, noting that people tend to see things in black and white, so she sees many who “tend to go overboard” when they believe they are at risk of developing type 2 diabetes by eliminating more carbohydrates than they really need to. Unfortunately, she noted, excessive carb cutting can also cut out essential nutrients like fiber, which are helpful for managing blood sugar, and can increase the intake of harmful saturated fats. “This can ultimately create inflammation and can worsen the body’s ability to manage blood sugar levels,” she said.

According to Cheryl Myers, chief of scientific affairs and education, EuroMedica, Inc., Wisconsin, there are many myths about high blood sugar and diabetes that “just aren’t borne out.” For example, just because one or both of the parents had type 2 diabetes doesn’t automatically mean that the patient is destined to develop it as well, although it can be a risk factor as observational studies have found.

Celine Torres-Moon, science writer, Protocol For Life Balance, Illinois, sees the most significant underestimation, at least in adults, is that once one’s blood sugar becomes marginally elevated, symptoms will suddenly appear. For a long time, she explained, type 2 diabetes has been called the “silent killer” because chronic high blood sugar damages tissues long before classic type 2 diabetes symptoms appear; it is therefore important to screen your patients for high blood sugar on a regular basis especially in cases of obesity, family history of type 2 diabetes, sedentary lifestyles, and as they get older. “Other big myths are probably that you should not eat carbs when you have diabetes and that drinking ‘diet’ or ‘zero sugar’ sodas and other artificially sweetened sweets and beverages will not affect your blood sugar levels negatively,” she added.

Another misconception is that a diagnosis of type 2 diabetes is a death sentence and bleak days are ahead. According to Joe Brunner, president, Endurance Products Company (EPC), Oregon, many patients continue to believe that type 2 diabetes is an irreversible lifelong condition, and one that inevitably becomes progressively worse. However, he clarified, “a growing body of evidence tells us this is a myth.”

Findings from the recent Diabetes Remission Clinical Trial (DiRECT), a controlled trial designed to assess the effect of a clinic-based, reduced-calorie weight loss program in patients with type 2 diabetes, yielded great hope. After only one year, almost half of the intervention participants (46 percent; 68/149) achieved remission to a non-diabetic state and were off antidiabetic drugs, and more than a third had sustained remission after two years. Successful remission was achieved with a weight loss of approximately 33 pounds.

“For an overweight patient with type 2 diabetes, this is refreshing news,” he commented. “Now, they have a quantifiable target that many would consider quite doable and, more importantly, one that may inspire them to take action. To date, the DiRECT study has resulted in dozens of published articles in Lancet, BMJ and other peer-reviewed journals, helping to bust an old myth and usher in a new mindset on how to advise patients with type 2 diabetes,” he stressed.

The DiRECT study findings were so compelling, they helped inform establishing clinical criteria for the remission of type 2 diabetes. In 2021, the American Diabetes Association, in collaboration with international experts, published a consensus definition. Specifically, a patient who can achieve an HbA1c of less than 6.5 percent for at least three months without antidiabetic drugs is considered to have reversed their diabetes into remission. This, commented Brunner, “is a simple, practical target, one that’s easy to communicate, and hopefully, one that can inspire more doctor-patient conversations about the potential of reversing diabetes and the key role of sustained weight loss. I can’t think of anyone better suited to get the word out than naturopathic doctors.”

This new mindset comes at a time when both cases and awareness of type 2 diabetes is at an all-time high, especially with pharmaceutical commercials abundant on the airwaves. Myers commented, “Unfortunately, prevalence of diagnosed diabetes continues to climb, and even though there are numerous commercials for type 2 diabetes medications on TV and online virtually everywhere, I’m not sure if the message of prevention and integrative treatment have made an impact.”

She added that it can be easy to overlook the potential for type 2 diabetes much in the same way as it is easy to ignore pre-hypertension or even cognitive issues until they manifest with problematic symptoms. Many people tend to wait and see if something becomes a problem rather than taking preventative action. And then treatment gets complicated.

The Carb Complex

To carb or not to carb is now more of a question than ever when helping patients to understand how to manage the trend of inclining blood sugar. The first place to start, is to review with patients how to read labels. “The general population lacks an understanding of ingredients, labels on foods, and the order in which to eat to avoid sugar spikes,” observed Reinstein.

According to Dr. Poothullil, it’s not just solely a matter of sugary food intake. He pointed to a 2022 published review of randomized control trials comparing the efficacy of different eating patterns in the management of type 2 diabetes, finding that inconsistencies in eating patterns could be responsible for the progression of type 2 diabetes.

“This suggests that the modern dietary patterns where most food items are made with grains and grain-flour, such as rice, pasta, bread, cakes, cupcakes, pizza, noodles and prepackaged foods are responsible for the continued incidence as well as progression of type 2 diabetes around the world,” he commented.

Upon digestion, these foods release a vast amount of glucose into the blood, forcing the liver to convert excess glucose into fatty acids for storage in fat cells. When fat cells are full, he explained, fatty acids remain in the blood, prompting muscles to switch to burning fatty acids while ignoring glucose in the blood, leading to blood sugar elevation and type 2 diabetes.

Dr. DeLorenzo noted that while there are indeed many alternatives to white carbs and sugar, gluten-free products, which many people turn to for good health even if they don’t have gluten sensitivities, contain more omega-6 fatty acids that can increase inflammation. “This leads to cells becoming encapsulated in fat and less able to allow insulin and carbs to enter them. Additionally, some artificial sweeteners are molecularly very similar to sugar. They cause the body to think it consumed sugar and then secrete insulin, which in turn makes you crave carbs and sugar later.”

Obesity is known to be consistently associated with the regular consumption of ultra-processed, convenience foods, and we’re eating more of these foods than ever, not only in the U.S. but around the world, Brunner pointed out. “So, avoiding type 2 diabetes is firmly rooted in healthy habits, such as eating a diet based on whole foods, maintaining a healthy body weight and getting regular activity.”

Myers observed that a culture of processed foods is so prevalent that it will take time to change this direction. “Even though many manufactured and processed foods are including ingredients that aren’t as refined as they used to be, they are still manufactured and processed foods, and many people might still be going to their habitual favorites despite healthier options being available.” She also believes that patients concerned about type 2 diabetes do not need to suddenly spend money on specialized, “low-sugar” foods as much as they need to incorporate wholesome real foods into their daily routines.

Blood Sugar Support Supplements

There are several products you may want to recommend to your patients. Curalin, from CuraLife, is a glucose support supplement for patients looking to maintain healthy blood sugar levels. According to Reinstein, Curalin works by blending ayurveda practices with modern science and technology into a synergistic formula. Each ingredient works on different parts of the body. Some support a healthy pancreas and liver, while others support healthy insulin sensitivity. The formula, he said, maintains healthy blood sugar levels (short and long-term), promotes healthy hbA1c levels, and supports healthy pancreas, liver and spleen function. It may also help promote a little weight loss and boost energy, he added.

Protocol For Life Balance has two supplements aimed at maintaining healthy blood sugar that are already within normal range: Glucose Balance and Glucose Management with Berberine HCl. According to Moon, berberine has been extensively studied for its ability to regulate glucose metabolism, notably by inducing glycolysis, as well as affecting insulin secretion and sensitivity.

Another berberine product comes from Endurance Products Company, which recently added Dihydroberberine SR to its line of controlled-release dietary supplements, utilizing the company’s proprietary vegetable wax matrix technology, described Brunner. “Compelling clinical research shows berberine helps improve glycemic control in people with type 2 diabetes,” he said.

As an example, one meta-analysis of controlled clinical trials found that combining berberine with lifestyle intervention or with a typical oral hypoglycemic drug (e.g., metformin, phenformin, glipizide) significantly improves blood glucose levels compared to either intervention alone. “Impressively, berberine’s blood glucose-lowering effect was found to be on par with that of the drugs tested,” Brunner remarked.

However, he stated, the challenge is that berberine is poorly absorbed, therefore effective dosing is typically in the range of 500-600 mg taken three times daily. Some consumers say this dosing regimen is too inconvenient or too much of a commitment, while others say it causes digestive upset. To resolve this issue, Endurance Products Company formulators combined dihydroberberine (a highly bioavailable form of berberine) with the convenience of a vegetable wax matrix controlled-release tablet technology that allows for a slow, steady release over several hours. Once absorbed in intestinal tissues, the dihydroberberine oxidizes to berberine and enters the blood. Dihydroberberine SR tablets feature 150 mg of dihydroberberine embedded in our proprietary vegetable wax matrix tablet core for a metered release over five to seven hours. It’s a more convenient and comfortable way to leverage the benefits of traditional berberine for blood sugar balance.

EuroMedica’s Sucontral D features what Myers described as a clinically studied extract from the bark of Hintonia latiflora. For the past 70 years in Europe, it’s been used to treat high blood sugar levels, insulin resistance, and other aspects of type 2 diabetes.

She explained, “Hintonia has a multitude of effects, the mechanics of which we partially understand. We know hintonia inhibits glucosidases and slows the breakdown and absorption of sugar in the gut. This delays the release of sugar into the bloodstream and keeps glucose levels stable, rather than allowing them to spike, a main cause of excessive insulin release.”

The extract also contains a polyphenol, coutareagenin, which she said appears to be responsible for blood-sugar controlling benefits, reducing insulin resistance along with inflammation that can complicate the condition.

One clinical study of 177 individuals with either type 2 diabetes or pre-diabetes tested a Sucontral D, which contains hintonia extract combined with synergistic nutrients, including vitamins B1, B6, B12, C and E, as well as folic acid, chromium and zinc, for eight months. The results showed that participants’ A1C levels improved by an average of 10.4 percent, and fasting and postprandial glucose readings improved by an average of 23.3 percent and 24.9 percent, respectively.

Sucontral D works with conventional pharmaceuticals, too, Myers added. Throughout the duration of the study, individuals taking anti-diabetic prescription drugs stayed on their medication, adding the hintonia and nutrient combination to their existing regimen. After eight months, of the 114 patients using anti-diabetic drugs at the beginning of the study, 35 reduced their medication and 10 participants ceased using medication entirely because it was no longer necessary. “But what I also think is interesting is that none of the patients taking Sucontral D saw their blood sugar levels drop too low, either,” she reported. “Sucontral D provides practitioners and patients alike with an option that is effective and safe and may be a first line of defense against increasingly high blood sugar numbers.”

It’s not too early to get your younger patients to consider engaging in healthy lifestyle habits and supplements to protect their blood sugar health. For older clients whose numbers are creeping up, they too can arrest and reverse that trend with dedicated efforts and your trustworthy guidance.

Healthy Take Aways

• Blood sugar elevation in type 2 diabetes results from oversupply of glucose relative to the energy needs of the body.
• A 2022 published review of randomized control trials comparing the efficacy of different eating patterns in the management of type 2 diabetes, found that inconsistencies in eating patterns could be responsible for the progression of type 2 diabetes.
• Berberine has been extensively studied for its ability to regulate glucose metabolism, notably by inducing glycolysis. Compelling clinical research shows berberine helps improve glycemic control in people with type 2 diabetes.

For More Information:

CuraLife, www.curalife.com
Endurance Products Company, www.endur.com
EuroMedica, Inc., www.euromedicausa.com
Protocol For Life Balance, www.protocolforlife.com