The Functional Medicine approach to fixing Diabetes

What you need to know about type 2 diabetes, and how Functional Medicine can help...

Type 2 diabetes is a preventable, reversible chronic disease that, while genetics can play a role, is caused by nutrition and lifestyle factors. 

Type 2 diabetes happens when the body is not able to regulate blood sugar (glucose) levels, resulting in a range of serious health complications.

Functional Medicine approach to diabetes blog flyer showing metal fork on green background

Research and practical experience shows that with hard work and dedication, this is a reversible condition

So let’s take a look at the Functional Medicine approach to type 2 diabetes, and how we can help you to feel better, look better, improving the quality and quantity of your life in the process.

Table of Contents

Diabetes is a major global health concern.

Diabetes is so concerning not only because of the human and financial cost of disease management, but also because of the serious complications caused by diabetes, and other conditions that can develop as a result of having it.

The World Health Organisation (WHO), reports that an estimated 422 million people had diabetes in 2014, and that the prevalence had almost quadrupled since 1980 (1).

The disease occurs more commonly in adults, and so used to be called adult-onset diabetes.

But due to modern lifestyles and increasing obesity rates in children, there are now more cases of type 2 diabetes in younger people.

Sadly, children aged as young as 10 are now developing type 2 diabetes and children under the age of 17 account for 1 in 3 new cases in the United States, and 1.3% of all cases in Europe (2).

Fortunately, type 2 diabetes is a well understood disease and with the right interventions, we can make things better both for those who are suffering diabetes, and globally.

What is type 2 diabetes?

Type 2 diabetes is a chronic disease largely driven by nutrition, lifestyle and environmental factors (although genetics can also play a role).

The normal management of blood glucose and insulin in the body should look like this:

And insulin should work like this, activating the insulin receptors on cells, and opening the glucose channel into the cell, so that blood glucose is taken into the cells to be used as energy:

In diabetes, the ability of the body to regulate blood sugar is impaired.

Not enough blood glucose is carried into the cells to provide energy, and this leads to too much glucose being left in the blood (which goes on to cause a host of other problems).

This happens because:

In the early stages of type 2 diabetes, insulin production is high, as the pancreas tries to compensate for high blood sugar by making more insulin.

This helps to drive glucose into the cells, reducing and normalising blood glucose levels.

But eventually the pancreatic beta cells lose their function and are no longer able to produce insulin, so levels of insulin fall – permanently.

This is the stage of diabetes when you may need to inject insulin, as it’s no longer being produced in your body.

All of this is avoidable, and the aim of a Functional Medicine approach to diabetes is to ensure it never reaches this stage.

Signs & symptoms of type 2 diabetes

Three common symptoms of diabetes are polyuria (increased urination, particularly at night), polydipsia (increased thirst) and polyphagia (excess hunger).

Other signs and symptoms include:

Complications of type 2 diabetes

The development of type 2 diabetes is a journey that normally takes years.

On this journey, we go from a state of normal insulin function all the way to a failure of our pancreatic beta cells to produce insulin.

There are lots of degrees of imbalance along the way, and the process of going from normal insulin and blood sugar levels to the failure of pancreatic beta cells is a journey that takes many years.

In fact, insulin resistance can begin up to 10 years prior to a diagnosis of type 2 diabetes (3).

Some of the complications of blood sugar and insulin dysfunction happen because higher blood glucose levels and insulin resistance cause ‘oxidative stress’.

Oxidative stress is a state where there are too many reactive oxygen species, or free radicals, and insufficient antioxidants to deal with them.

And this increased oxidative stress is one mechanism by which common diabetic complications develop.

Many of the complications can be divided into two categories.

They can be microvascular complications or macrovascular complications. 

This means that either our small blood vessels, or our large blood vessels are affected in various different organs / systems in the body.

Common diabetic health complications include:

Again, the aim of a Functional Medicine approach to diabetes is to ensure you stay well away from these complications.

Causes & risk factors of type 2 diabetes

So how do you develop type 2 diabetes?

Excess body fat is observed to be the strongest risk factor for developing type 2 diabetes (4).

And you develop excess body fat by eating (and drinking) too many calories for the amount of exercise you’re doing, and your health status.

Yes, there are conditions, such as hypothyroidism and PCOS, that make it easier to gain excess fat, but the vast majority of people who have type 2 diabetes don’t suffer from these conditions.

When you also add too many simple carbohydrates and sugars to those excess calories, it becomes a metabolic nightmare (as well as raising other risk factors such as high triglycerides and high cholesterol, which are both also not good). 

It’s important to note, though, that ‘excess body fat’ doesn’t only mean people who are clinically obese.

A person with normal (or low) BMI, can also have excess body fat (‘skinny fat’) – just because you’re not overweight or obese, doesn’t mean you’re not at risk of developing type 2 diabetes.

Using other indicators of body composition such as waist circumference, waist to hip ratio, body fat percentage, and ethnicity, are more accurate ways of determining your chances of developing this condition.

But to be clear; excess body fat, or being overweight or obese, along with physical inactivity, significantly increases your risk of developing type 2 diabetes.

However, factors such as ethnicity and family history are also important in diabetes.

For example, research tells us that waist circumference, an important risk factor, should be lower in the Asian population than it is for Caucasians, due to genetic differences.

Environmental and lifestyle factors are also huge influencers on the development management of diabetes.

For instance, stress and poor sleep can significantly disrupt blood sugar management, and can make it easier to gain excess body fat.

Nutrient insufficiencies or deficiencies such as magnesium, coenzyme Q10, alpha lipoic acid, zinc, omega 3 are all risk factors, as they are so vital in supporting proper blood sugar management.

Inflammation or oxidative stress, coming from poor nutrition, high stress, environmental chemicals, or a disrupted microbiome can also contribute to the development of pre-diabetes and diabetes.

Optimal cellular energy metabolism (how we convert calories to energy) helps support blood glucose management and can be reduced by damaging environmental chemicals and chronic viruses.

These are areas not often considered by conventional medicine.

Additionally, low testosterone in men is an important risk factor for, and an associated condition in, type 2 diabetes. 

Men with higher testosterone levels are significantly less likely to develop diabetes, and around half of men with diabetes, have low testosterone levels. (5).

The conventional medicine approach to type 2 diabetes

In conventional medicine, doctors are working to:

The type of medication prescribed, is therefore dependant on the stage of dysfunction – where you are on your journey.

In complex cases, or where one medication type is not effective, then doctors may combine different medications to help gain better blood sugar control.

Metformin is the most prescribed medication for diabetes.

And it has very interesting mechanisms of action. 

Metformin reduces the production of glucose in the liver, helps to increase production of a glucose transporter that carries glucose into cells, and may help the body to make more insulin.

While metformin has also been shown to modulate the microbiome, it can cause a vitamin B12 deficiency (6).

In addition to addressing blood glucose management in type 2 diabetes, any of the commonly associated conditions would also be individually managed through additional medications.

The underlying mechanisms that get out of balance in diabetes, means that there is a higher risk of other conditions developing in addition to type 2 diabetes.

Diabetes can be part of a ‘syndrome’ called metabolic syndrome.

Metabolic syndrome is where, in addition to diabetes, there is also:

Other treatments may therefore be required, for example antihypertensive medications or statins.

The Functional Medicine approach to diabetes

The Functional Medicine approach to diabetes aims to normalise blood sugar levels levels in pre-diabetes, and type 2 diabetes, reduce the need for medication, and help to reduce the risk of many related health issues.

In fact, dietary and lifestyle changes alone have been found to not only improve type 2 diabetes, but completely reverse it.

And this has been demonstrated in a number of research studies (for example the DiRECT trial, Look AHEAD trial and other studies) (7,8,9, 10).

But rather than ‘reversing type 2 diabetes’, many organisation prefer to call it – ‘putting diabetes into remission’ (as there is no guarantee that your diabetes is gone forever).

We achieve this by identifying the degree of dysfunction at play – where you are on the journey – and the root causes or risk factors for diabetes for you personally.

Our understanding of what is contributing to diabetes is pretty robust (particularly when we compare this to some other chronic conditions).

Diabetes subtypes

With the considerable body of research that exists we now understand that there are five subtypes to diabetes.

Each subtype is determined by clinical parameters and are briefly described below:

SAID = Severe Autoimmune Diabetes. Defined by:

SIDD = Severe Insulin Deficient Diabetes. Defined by:

This population benefits from an early, intensive Functional Medicine approach to diabetes.

SIRD = Severe Insulin Resistant Diabetes. Defined by:

MOD = Mild Obesity-Related Diabetes. Defined by:

MARD = Mild Age-Related Diabetes. Defined by:

These subtypes are associated with different risks relating to diabetes complications, related health issues (comorbidities), genetics, and how well one would respond to treatment (11).

Diabetes sub-types help us to understand how the disease has occurred in each individual.

This means that ‘how’ diabetes presents is not the same in everyone with the condition, and therefore each person requires a different Functional Medicine approach to their diabetes.

As with any Functional Medicine approach, our team work closely with you to identify any underlying causes and risk factors.

These underlying causes and risk factors can then be avoided or minimised where possible, while ensuring that your body has the optimal levels of nutrients and antioxidants to support better blood sugar regulation.

Read about Coho client PJ's results...

I went for the GP blood tests today and it happened to be my diabetic nurse that took them…. was expecting her to be a bit peeved that I hadn’t taken them (prescribed medication for diabetes) and gone elsewhere for advice….

She weighed me and said “oh gosh well something’s working you’ve really lost some weight”. 

She said she thought my Nutritionist sounded amazing to keep trying what I was doing, it made total sense to her. 

That probably 10 years ago my thyroid would have been classified as a problem by the GP but that the boundaries have decreased. 

She asked me who you were as her sister has low level thyroid issues that are not classified as an issue by the NHS but that are having a negative affect…

7 days later…

My HbA1c in December (after I’d been calorie counting and generally doing the ‘eat right plate’) was 57, this is when the diabetic nurse first suggested I go on the tablets that have a side effect of thrush. 

She said the target for me was 48, this seemed impossible as I felt I was trying so hard already. 

My result today, after roughly just 6 or 7 weeks doing what you’ve said (and not 100% perfectly) is 46!!

I am absolutely delighted!! And surprised!! I just obviously need to keep doing what I’m doing.I seriously cannot thank you enough. 

I know I am still on a journey but I know feel like I’m on the right path. So glad I didn’t take those extra tablets and contacted you instead.

Nutrition

Nutrition is a fundamental factor in improving blood sugar regulation and reducing risk factors for type 2 diabetes.

While conventional medicine has tried to provide dietary support for diabetics (with some success), the approach is not tailored to the individual because there is no ONE diet for everyone with diabetes.  

For instance, even meal timing is a consideration in the Functional Medicine approach to diabetes, but this is rarely addressed in conventional medicine.

Diet and lifestyle interventions are therefore fundamental.

Lower carbohydrate diets have consistently shown to help reduce body fat, normalise blood glucose levels, and help to reduce medication requirements.

Diets such as the ketogenic diet and the Mediterranean diet have been studied, and show multiple benefits in people with diabetes (12, 13).

Importantly, we also need to understand the unique dietary requirements for each person, what foods may be causing a blood sugar spike, what foods may be contributing to inflammatory processes, or which foods are associated with symptoms.

This is unique from one person to the next. 

Understanding these factors then helps us to design a tailored nutritional protocol.

For example, where one food may result in a normal to low glucose response in an individual, if the same food was consumed by someone else, then it could cause a sharp rise in blood glucose levels. 

We all digest, absorb and utilise foods differently, and this is where the Functional medicine approach to diabetes can be life changing, as we look to understand what works best specifically for you.

Useful supplements

As well as thinking about blood glucose responses to foods / meals, at Coho Health, we would also assess your nutrient requirements.

Having optimal levels of nutrients helps to:

Interestingly, studies have reported comparable benefits of using supplemental berberine and alpha lipoic acid, to metformin (14).

NAC has been shown to improve fasting blood glucose and insulin levels, as well as metformin.

Supporting cellular energy metabolism and insulin sensitivity is also an important factor in our Functional Medicine approach to type 2 diabetes.

We can do this through nutrients such as chromium, vitamin D, magnesium, and coenzyme Q10

Nutrient requirements and supplementation are therefore important considerations in a Functional Medicine approach to diabetes (remembering that some medications, such as statins, cause a coenzyme Q10 depletion (15)).

Lifestyle

Exercise can make a huge difference by influencing many of the risk factors for type 2 diabetes, for example it can help to:

Amazingly, the number of glucose transporters in cell membranes (the GLUT4 glucose transporters), which are ready and waiting to carry more glucose into cells, is increased with exercise.

Exercise also improves the cells capacity to produce energy, by improving the function of the mitochondria (energy producing factories inside cells).

Exercise of various types have been researched in diabetes.

A minimum of 150 minutes (2.5 hours) of exercise per week is recommended, split into 3 to 5 sessions per week. 

While a mix of strength and cardio based exercises are effective, even just walking has been shown to improve blood glucose levels, body composition, HbA1c, and insulin sensitivity (16).

Stress is a major disrupter of normal blood sugar levels. 

As a response to increased stress hormones, stored glucose is released into the blood, and the liver produces more ‘new’ glucose to be released into the blood, causing high blood glucose levels. 

Chronic stress can also raise inflammatory immune molecules (cytokines), thus chronic stress causes inflammation, that can contribute to diabetes and its complications (17)

Sleep issues such as insufficient sleep duration, waking up frequently overnight and irregular sleep patterns can all increase diabetes risk, or make diabetes worse.

Studies observing population trends have noted that those with insufficient sleep have an increased risk of obesity.  

People who sleep too little (5-6 hours per day) are twice as likely to be diagnosed with prediabetes or type 2 diabetes, whilst those who sleep for too long are almost 60% more likely to develop type 2 diabetes, compared to what is considered ‘normal sleep duration’ (7-8 hours per day) (18).

Functional testing in diabetes

Conventional blood tests include:

A high HbA1c level is indicative of pre-diabetes or diabetes, and is also a marker used in the management of diabetes.

Functional testing can help alert us to a problem much earlier, for instance if you are looking to minimise your risk before a diagnosis, and there is a family history of type 2 diabetes. 

Early indicators of developing type 2 diabetes include a fasting insulin test, or a c-peptide test.

C-peptide can be an indicator of type 2 diabetes in some people, and c-peptide can be high even when HcA1c (the main way of identifying type 2 diabetes) is normal.

Ensuring a full panel of the risk factors is checked is important as it helps to highlight which systems / functions need to be supported, for instance:

Then after these baseline checks are done, we’d look at functional testing in areas where there are suspected imbalances, for instance:

Which tests are recommended is highly dependent on current and past signs and symptoms, previous blood test results, medical and family history, prior exposures and infections, for example.

The wrap...

While increasingly common, and a condition that many people live with for many years, type 2 diabetes is a serious condition that has the potential to cause life changing complications.

But it doesn’t have to be that way.

Type 2 diabetes is a preventable, reversible condition.

And through the Coho Functional Medicine approach to diabetes, we want to help you live your healthiest and best life, free of the risk of health complications and ill health.

If we can help you, use the contact form below, or book a free 15 minute discovery call now.

To your optimised, healthy future,

Dee & the Coho Health team

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