Overview: Type 2 Diabetes

• Diabetes mellitus (DM) is a condition characterized by the pancreas either failing to produce sufficient insulin or the body's cells becoming resistant to the insulin produced.

• As a result, glucose in the bloodstream cannot be effectively absorbed into the cells.

• Common symptoms include frequent urination, fatigue, excessive thirst, and increased hunger.

• DM is a chronic condition that can lead to severe health complications, such as kidney failure, heart disease, stroke, and blindness. In the United States, approximately 14 million people (roughly 5% of the population) are affected by diabetes.

• Alarmingly, up to half of these individuals may not be aware that they have the disease.

The Mechanism

• The insulin resistance characteristic of type 2 DM is just one aspect of a chronic, systemic inflammatory response.

• Despite this complexity, type 2 DM is primarily diagnosed and treated based on abnormalities in glucose metabolism.

• This intricate process involves various transporters, receptors, enzymes, and messenger molecules, all regulated by hormones, cytokines, and neurotransmitters across multiple tissues.

• The metabolic pathway begins with carbohydrate consumption, whether in the form of simple sugars or starches.

• This intake is driven by signals such as hunger, satiety, cravings, and others originating in the brain. These signals are influenced by hormones like cholecystokinin, leptin, ghrelin, and glucagon-like peptide. 

• Additionally, brain signals are modulated by a range of factors, including stress, mood, hydration, circadian rhythms, physical activity, family eating habits, and even social interactions.

• Overeating and other modern eating habits appear closely linked to the twin epidemics of obesity and type 2 DM, and addressing these issues requires a comprehensive public health strategy that incorporates social, economic, and educational policies.

Carbohydrates

• Carbohydrates are long-chain molecules that are broken down into glucose and other sugars by pancreatic and brush border enzymes in the digestive system.

• The amount of insulin released by the beta cells in the pancreatic islets depends on how much glucose enters the bloodstream. 

• Rapid and sustained increases in blood glucose levels stimulate greater insulin release, which can trigger pro-inflammatory effects throughout the body.

The variations in blood glucose and insulin levels after consuming carbohydrates have been studied for hundreds of foods, forming the foundation of the glycemic index (GI) and glycemic load (GL) systems. These tools help measure the impact of specific foods on blood sugar levels.

Insulin resistance is just one part of the metabolic syndrome. Environmental toxins, glycemic load, obesity, emotional factors, certain infections, and other sources of oxidative stress and chronic inflammation likely play a role in the epidemic of type 2 diabetes mellitus.

Certain foods have been shown to be beneficial for individuals with type 2 diabetes mellitus. These include plant-based proteins, whole grains, coffee, carotenoid-rich fruits and vegetables, green leafy vegetables, chia seeds, onions, and moderate alcohol consumption. Conversely, animal protein, particularly from eggs, has been linked to an increased risk.

Integrative Medicine Therapeutic Review and Prevention Prescription

Consult with physician before starting any supplementation and pharmaceutical drug listed below.

Prevention Prescription

• Manage psychological stress and treat emotional trauma or mood disorders if present. 

• Obtain 6 to 8 hours of restful sleep per night. 

• Eat a low-glycemic Mediterranean diet that includes whole grains, vegetable protein, vegetables and some fruit, coffee, and moderate alcohol. 

• Avoid sugar-sweetened beverages, animal protein, and eggs. 

• Practice short sprints of activity every 30 minutes. This includes 1-2 mins short sprints, air-squats, light jog, resistance bands every half-hour. The aim is to reach a sum total of 60 mins through the day spread out rather than one hour of activity and sitting on a chair the rest of the day.

• Manage weight and treat obesity. 

• Avoid air pollution by maintaining safe distance
  from high-traffic roads at work or home. 

• Maintain proper oral hygiene and treat periodontitis if present

• Treat hypertension with ramipril(2.5to10mg  daily) or another angiotensin-converting enzyme inhibitor. 

• Red Raspberry Leaf

• Treat pre-diabetes with aggressive lifestyle intervention  and consider metformin, 500 to 1000 mg twice daily. 

• Manganese: Some studies show that people with diabetes have low levels of Manganese. It is unclear if having diabetes lowers Mn, or if low levels in blood allow for the development of diabetes. Take Manganese less than 10 mg/day.

• Treat vitamin D deficiency if present

• Take Tocotrienol for a dose up to 200 mg daily for 5 years.

• Take 16 mg/day Niacin (Vitamin B3): A randomized control trial looked at the effect of niacin on lipid profile and glycemic control in individuals with diabetes. Niacin usage showed sig-Niacin usage showed significant improvements in HDL-C and LDL-C. 

• Take omega-3 fatty acids at 1 to 2 g daily

• Take Vitamin B6 (Pyridoxine) 1.3 mg/day for adults. Pyridoxine supplementation has been shown to be effective in lowering blood glucose in those with gestational diabetes

• Take 100–300 mg of CoQ10 twice daily

• Take 3 to 6 g Lysine daily for 1 year

• Acarbose is a pharmaceutical drug 50 mg (if weight < 60 mg) and 100 g (weight > 60 kg) [Consult with physician]

• Take magnesium at 100 to 300 mg daily. 

• Take Vanadium: 50-100 mcg/day (May improve sensitivity to insulin in type1 and 2 diabetes; may also lower cholesterol levels and blood pressure.)

• Take Zinc 15 mg/day

• Avoid selenium supplementation if serum levels are adequate

Therapeutic Review

Lifestyle

• Consider referral to a comprehensive lifestyle program if available.

Exercise

• Encourage daily aerobic, resistance, or mindfulness-based (e.g., tai chi) exercise.

• Provide behavioral support tailored to patients’ stage of readiness to change

• Strive to inspire patients with your own lifestyle choices.

Diet

• Low-glycemic diet and moderate carbohydrate

• Avoidance of sugar-sweetened beverages and juices, reduction animal protein, and eggs

• Consumption of more lentils, beans, pulses and soy, chia and other whole grains, onions and leafy green vegetables, and walnuts and other nuts

• Moderate coffee and wine consumption

Mind-Body Therapy

• Ask about and treat disordered sleep, stress, anxiety, and depression.

• Discuss stress reduction options and facilitate the chosen modality.

• Refer patients to a psychologist you are comfortable with as needed.

Acupuncture

• Spleen channel (SP 6, SP 9)

• Kidney meridian (KI 3)

• Stomach meridian (ST 36)

Supplements

• Vitamin B3 (Niacin): 16 mg/day

• Vitamin B6 (Pyridoxine): 1.3mg/day for adults

• Vitamin D: 1000 to 4000 units daily unless deficient

• Alpha-lipoic acid: 50 to 100 mg daily

• Chromium: 200 to 1000 mcg daily

• CoQ10: 100-300mg twice daily

• Benfotiamine: 350 mg with meals

• Omega-3 fatty acids: 1 to 4 g daily

• L-Carnitine: 500 to 1000 mg three times daily

• Lysine: 3 to 6 g daily for 1 year

• Magnesium: 200 to 500 mg daily (Magnesium can act as a cofactor on the metabolism of insulin and glucose)

• Manganese 10 mg/day.

• Vanadium: 50-100 mcg/day

• Vitamin K: 100 mcg daily (caution with warfarin)

• Zinc 15 mg/day

Botanicals

• Berberine (Berberis vulgaris): 200 to 500 mg three times daily

• Ivy gourd (Coccinia indica): 15 g powdered dried leaves or equivalent extract)

• Fenugreek (Trigonella foenum-graecum): 30 g seed powder or equivalent extract with meals 

• Red Raspberry Leaf 5–10 mg (1–2 tsp) crushed leaf per 240 mL of water up to six times per day, or up to 12 g dry leaf

• Liverwort: Dosing of liverwort is about 200 mL of boiled water with 1 g of dried liverwort. This should be consumed twice a day for about 1 month. 

• Cinnamon: 1 to 5 g ground bark with meals or equivalent extract

• Panax ginseng: 1 to 2 g ground root or 100 to 400 mg extract

• Prickly pear cactus (Opuntia streptocantha): 85 g broiled or liquefied stems with a meal

• Pycnogenol (Pinus maritima): 100 to 200 mg daily

• Willow Bark (Salix)

TCM

• Xiao Ke Wan (Emaciation and Thirst Pill) for diabetics with increased levels of sugar in blood and urine.

• Yu Quan Wan (Jade Spring Pill) for diabetics with a deficiency of Yin.

• Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia) for stabilized diabetics with a deficiency of Kidney Yin.

• Jin Gui Shen Wan (Kidney Qi Pill) for stabilized dia- betics with a deficiency of Kidney Yang.

Pharmaceuticals

•⁠  ⁠Metformin: 500 to 1000 mg twice daily

•⁠  ⁠Ramipril: 5 to 10 mg daily (or another angiotensin-converting enzyme inhibitor)

•⁠  Acarbose 50 mg (if weight < 60 mg) and 100 g (weight > 60 kg)

•⁠  ⁠Pravastatin: 20 to 80 mg daily (or other statin or red yeast rice)

•⁠  ⁠Other drug classes as needed to achieve a glycosylated hemoglobin level lower than 7.0%, including thiazolidinediones, sulfonylureas, incretins, and insulin

Surgery

•⁠  ⁠Bariatric surgery for morbidly obese patients

A Note on Improving Metabolism

Walking as Medicine

Walking regularly is incredibly beneficial for health. If walking were a pill, it would be one of the most effective “medications” in modern medicine.

Studies show:

• Walking 7,000 steps daily reduces all-cause mortality by up to 70%.

• Walking 8,000–12,000 steps daily lowers the risk of mortality by 50–65%.

• Regular movement reduces the risk of chronic conditions such as Alzheimer’s, diabetes, depression, cancer, and obesity.

Muscle Contraction and Glucose Metabolism:

• Muscle contractions, even low-grade ones like walking or squats, activate cellular processes that lower blood glucose levels.

• Moving throughout the day helps glucose channels reach the cell membrane, allowing cells to use glucose more efficiently.

• Prolonged sitting causes glucose channels to remain inactive, even if a person exercises intensely once a day.

Short Walks vs. Continuous Exercise:

• Regular short movement (e.g., 2–3 minutes every 30 minutes) is more beneficial for glucose and insulin regulation than one continuous workout session.

• Studies show that spreading movement throughout the day results in better metabolic health than exercising for an hour and remaining sedentary afterward.

Rethinking “Exercise”:

• Western culture views exercise as a dedicated activity, while societies with higher longevity (e.g., Blue Zones) integrate movement into daily life.

• The industrialized lifestyle has removed natural movement from daily routines, leading to a mismatch between gym-based exercise and poor health outcomes (e.g., rising obesity despite increased gym memberships).

Practical Advice:

• Take short movement breaks every 30 minutes, such as walking, air squats, or push-ups.

• Build movement into daily activities (e.g., standing while working, taking the stairs).

• Regular movement complements structured exercise but does not replace the need for continuous daily activity.

Conclusion:

• Health is optimized not by one intense workout but through consistent, light movement throughout the day. Reintegrating frequent activity into modern life is key to reversing chronic diseases and improving metabolic health.