Diabetes mellitus: Managing blood sugar and improving metabolic health

Susan’s story

Susan, a 60-year-old woman, came to the clinic with Type 2 Diabetes Mellitus, weight gain, and chronic sleep issues. Her blood glucose levels fluctuated between 7-8 mmol/L, spiking to 17 mmol/L after meals. Her HbA1c was 9.2%, indicating poor blood glucose control over the previous three months. Despite a moderate exercise routine, her weight remained unchanged. Her diet was characterised by frequent meal skipping, a high intake of coffee, and a lack of fruits, vegetables, and fibre.

Understanding the problem

At the initial consultation Susan’s recent pathology was reviewed:

• Her liver function test showed low serum globulin, indicating suboptimal liver function, likely attributable to a poor diet, though not suggestive of serious pathology.
• Her fasting blood glucose was high at 17.7 mmol/L, a significant rise from her previous result of 7.8 mmol/L, confirming the diagnosis of T2DM. This high level indicated that her blood glucose regulation had been poor for several months, requiring oral medications and insulin injections.
• Her serum insulin levels were normal, suggesting that the pancreas could still produce insulin, but it wasn’t sufficient to manage her blood glucose due to insulin resistance.
• Cortisol levels, a marker of stress and inflammation, were elevated, along with high serum triglycerides associated with cholesterol imbalances.

During the consultation it was also found that Susan suffered from bloating and constipation, and her sleep was frequently interrupted by leg cramps and needing to urinate. She also had several amalgam fillings in her teeth, and had begun to suffer from neurological symptoms in her hands and feet, which is commonly associated with poorly controlled T2DM.

Susan had a number of stressors in her life relating to caring for her family and working night shift.

Following the initial consultation some functional pathology tests were ordered. A food reactivity profile was undertaken and showed Susan to be reactive to white potato, sweet potato, garlic and coffee, all of which frequently featured in her diet. These food reactions will contribute to a systemic inflammatory response, further disrupt her diabetic control, and will be an underlying driver for disease progression.

An organic acids test was also completed and showed elevated markers for yeast and bacterial overgrowth, in particular for clostridium difficile. The elevated oxalates also suggested that the yeast overgrowth was likely to be caused by Candida which is often found to be problematic in people with poorly controlled T2DM. A number of other metabolites showed increased lactic acid, poor energy production and increased ketones, all of which are consistent with her diabetic state.

The organic acids report also showed elevated metabolites for her detoxification pathways which is suggestive of potential toxic exposure. Susan undertook a toxic metals blood screen which showed high levels of antimony which has been shown to leech from PET plastic bottles and containers. Mercury levels were also elevated and are likely to be related to her amalgam fillings.

At the end of the consultation, the priorities for managing Susan’s health were determined to be:

• Improve blood glucose regulation and insulin sensitivity through diet and lifestyle interventions, as well as address the underlying food reactions and dysbiosis which were acting as primary drivers for systemic inflammation, further compromising her diabetic control. The end objective was to reduce her reliance on insulin injections to control her blood glucose levels
• Implement strategies for managing her stress and improving sleep by facilitating a shift from sympathetic dominance associated with the fight, flight, freeze stress response, to the parasympathetic state associated with rest, digest, repair and reproduce
• Reduce her weight which would further improve her blood glucose management
• Prevent the progression of her chronic disease state which is indicative of being at risk for the development of a more serious cardiometabolic state

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Implementing the solution

The approach to addressing Susan’s uncontrolled blood sugar regulation involved both effective lifestyle interventions to address diet, exercise, weight control and stress management as well as specific clinical interventions.

Over several months, Susan worked with her health coach to progressively plan and implement the key strategies recommended by her practitioner that sought to improve all four pillars of health. The four pillars are the foundation for establishing health and in Susan’s case, will form the lifelong strategies she will need to follow to continue to manage her diabetes.

EAT: Functional testing detected a number of reactive foods in Susan’s diet. These were removed to reduce the immune priming and inflammatory response that dysregulates blood sugar regulation. Other dietary changes were implemented to reduce the high amount of processed foods and high glycaemic load foods, and to increase fibre and complex carbohydrates. These approaches stabilise blood glucose levels, preventing spikes which can reduce insulin’s ability to bind to cell membrane receptors and allow glucose to enter the cell.

MOVE: There is a significant body of evidence to support the role of regular moderate exercise in managing people with diabetes. For Susan, this included brisk walking outdoors or on the treadmill for 1hr/day 4-5 times per week.

SLEEP: Specific sleep-promoting strategies were implemented to help regulate cortisol and melatonin levels necessary to promote quality sleep. Improving the body’s diurnal cortisol regulation also reduces cortisol’s effect of driving systemic inflammation which is a primary concern in the progression of diabetes.

DE-STRESS: One of the physiological effects of stress is elevated cortisol which becomes a primary driver of systemic inflammation. Regular practice of stress management techniques such as breathing exercises were used to help reduce the physiological impact of stress on Susan, and to improve her cortisol regulation over the course of the day.

Several supplements were also prescribed:

• Alpha-Lipoic Acid, which has been shown to improve insulin resistance, one of the key endocrine disorders that precedes the development of T2DM. ALA also improves symptoms associated with peripheral neuropathy which is commonly experienced in people with diabetes
• Low magnesium has been shown to be associated with insulin resistance. Magnesium citrate was prescribed to correct the low magnesium levels and also to assist with the physiological effects of stress
• Activated B-Complex vitamins are important cofactors involved in a large number of metabolic processes in the body
• Probiotics were prescribed to help restore the healthy gut bacteria and reduce the opportunistic overgrowth of candida. With reduction of the candida, vitamins B6 and B12 will support the oxalate metabolism pathway, reduce the excess oxalates that had been found, and reduce the pro-inflammatory effects of oxalates

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Achieving an incredible result

After three months of consistent effort with the help of her health coach, Susan experienced remarkable improvements:

• Fasting blood glucose dropped from 17 mmol/L to 8 mmol/L
• Her HbA1c levels decreased from 9.2% to 7.9%
• Susan lost 5.5 kg, which further contributed to better blood glucose control

These significant changes demonstrated a substantial reduction in her risk factors for diabetes complications, including peripheral vascular disease, cardiovascular disease, and blindness. Susan’s GP acknowledged her progress and agreed to re-evaluate her insulin regimen. If Susan continued to improve, there would be a possibility of transitioning her to oral medication only to control her blood glucose levels.

This comprehensive, multi-pronged approach – empowered by lifestyle changes, clinical interventions, and the ongoing support of her health coach – has put Susan on the path to better health and long-term management of her diabetes.