Diabetes in the Overall Metabolic Context
Diabetes mellitus is a collective term for metabolic disorders in which the regulation of blood glucose is permanently impaired. What all forms have in common is that the body can no longer utilize glucose appropriately — with far-reaching consequences for blood vessels, nerves, and organs.
We present these interrelationships and measures for dealing with diabetes in an understandable way — without sugar-coating anything, but also not more bitter than necessary.
What is Diabetes?
The term “diabetes” originates from the Greek “diabaínein” (διαβαίνειν) and means “to pass through” or “to flow through.” This expression was used in antiquity because those affected excreted conspicuously large amounts of urine – the fluid flowed through them. The addition “mellitus” comes from Latin and means “honey-sweet.” It refers to the fact that the urine in diabetes smells and tastes slightly sweet … whatever one may think of that, these were historical diagnostic features (Oxford English Dictionary).
The assessment of a diabetes condition is based on clearly defined and internationally standardized blood glucose thresholds. A fasting value of ≥ 126 mg/dl (≥ 7.0 mmol/l) is, by definition, indicative of diabetes mellitus (DeFronzo et al., 2015; American Diabetes Association, 2023; Word Health Organization Fact Sheet „Diabetes“).
Another important marker is the HbA1c level, which reflects average blood glucose over the past 8–12 weeks:
below 5.7% ~ normal
5.7–6.4% ~ prediabetes
≥ 6.5% ~ diabetes.
Normally, insulin ensures that glucose moves from the bloodstream into the cells, where it is used as energy. However, in a diabetes condition, insulin production is severely impaired, causing the concentration of glucose in the blood — that is, the blood sugar level — to rise. Among the first noticeable signs of diabetes for those affected may be strong thirst, frequent urination, fatigue, blurred vision, and an increased susceptibility to infections. These symptoms arise because elevated blood glucose levels draw water out of the body through osmotic processes, place a greater workload on the kidneys, and prevent cells from being adequately supplied with energy despite high glucose levels (sources above).
In type 1 diabetes, insulin must be replaced for life. It is an autoimmune disease in which insulin-producing cells of the pancreas are destroyed. This process develops over months to years and often only becomes apparent when a large proportion of the cells has already been damaged.
Type 2 diabetes, on the other hand, usually develops gradually. This form accounts for the majority of diabetes cases and is closely linked to obesity, lack of physical activity, and genetic predisposition. At the center is insulin resistance, in which body cells no longer respond adequately to insulin. Other hormones also play a role: glucagon as the counterpart to insulin, cortisol as a stress hormone, and incretins (e.g., GLP-1), which regulate satiety, gastric emptying, and insulin release. That is why these hormones are also specifically targeted pharmacologically (DeFronzo et al., 2015; American Diabetes Association, 2023).
The pancreas is also more than just an “insulin organ.” It additionally produces glucagon and important digestive enzymes. If it is stressed for years by insulin resistance, its overall function can suffer, which further aggravates the course of the disease (DeFronzo et al., 2015).
Diabetes does not arise overnight. In the stage of prediabetes, studies show that metabolic values can improve significantly through weight reduction and physical activity. In this phase, the course is often highly modifiable (Knowler et al., 2002).
Therefore, diabetes is not an isolated blood glucose disorder, but a complex metabolic disease in which hormones, blood vessels, inflammation, and lifestyle are closely interwoven.
Diabetes – What Falls Out of Balance in the Metabolism
Chronically elevated blood glucose levels promote oxidative stress and low-grade inflammation, which in the long term favor vascular and nerve damage (DeFronzo et al., 2015).
Also affected in diabetes are:
· fat metabolism
· vascular function
· inflammatory processes
· cellular energy utilization.
This explains why diabetes is now understood as a multifactorial metabolic disease.
Diabetes and Obesity – The Connection
Obesity is considered one of the most important risk factors for type 2 diabetes. Because adipose tissue is metabolically active and influences hormonal signaling pathways as well as inflammatory processes, increasing fat mass raises insulin resistance, while the pancreas becomes overburdened in the long term (World Health Organization Fact Sheet “Diabetes”).
For these reasons, diabetes and obesity are sometimes considered together in therapy and prevention concepts.
Alternative Medicine Focus: Regulation Instead of Symptom Treatment
From an alternative medicine perspective, diabetes is not defined solely by blood glucose levels, but as an expression of disturbed metabolic regulation. Natural substances receive particular attention.
Berberine, for example, is an alkaloid, a yellow plant compound found in plants such as barberry, goldthread, and Oregon grape, and has traditionally been used in herbal medicine. Berberine intervenes in central processes of blood glucose regulation: it activates AMPK, whereby glucose uptake into the cells increases, hepatic glucose production decreases, and insulin sensitivity improves. In addition, berberine increases the number of insulin receptors and favorably influences the gut flora. Its mechanism of action is very similar to that of common diabetes medications, which is why berberine preparations can be used as supportive measures, for example in capsule or tablet form — but not to replace other medications (Liang et al., 2019).
A similar observation applies, albeit with somewhat less evidence, to fenugreek. Seeds of the plant species Trigonella foenum-graecum, traditionally used as a spice and herbal remedy, showed in studies that they can lower blood glucose levels and HbA1c in people with type 2 diabetes and improve insulin sensitivity. This is likely due to a combination of high soluble fiber content, a slowing of carbohydrate absorption, and stimulation of insulin action (Neelakantan et al., 2014). Fenugreek preparations are also primarily available as capsules and tablets. However, it should not be overlooked that their supportive effect is, as mentioned, less pronounced than that of berberine.
Further focus is placed on:
- insulin sensitivity
- inflammatory status
- gut and liver function
- lifestyle.
The Influence of Lifestyle on Diabetes
Lifestyle factors have a decisive positive influence on the course of type 2 diabetes, as large reviews show (American Diabetes Association, 2023).
These factors include in particular:
o regular physical activity
o weight reduction in obesity (but also overweight)
o a balanced, nutrient-rich diet.
Foods That Should Be Viewed Critically in Diabetes
In diabetes, the issue is not strict prohibitions, but the effects of certain foods on the organism. Scientific guidelines and reviews show that certain dietary patterns are associated with unfavorable metabolic effects:
· Highly sugary foods and beverages: Sugar-rich drinks, sweets, and heavily sweetened products lead to rapid increases in blood glucose and raise the insulin load. Liquid sources of sugar are particularly problematic because they provide little satiety and are quickly absorbed. Studies show a clear association between the consumption of sugar-sweetened beverages and an increased risk of type 2 diabetes (Malik et al., 2010).
· Highly processed carbohydrates: Highly processed carbohydrates: White flour products and refined carbohydrates cause blood glucose to rise more quickly than fiber-rich alternatives. At the same time, fiber is lacking, which supports slower glucose absorption. A high intake of refined carbohydrates is associated with poorer glycemic control (Reynolds et al., 2019).
· Ultra-processed foods: Ultra-processed foods often contain additives, strongly altered fat profiles, and easily available carbohydrates. Observational studies show that a high proportion of such products in the diet is associated with an increased risk of metabolic diseases, including diabetes (Monteiro et al., 2019).
· Unfavorable fat compositions: Foods with a high proportion of trans fats or strongly heated fats can impair insulin sensitivity and promote inflammatory processes.
Individual foods do not cause diabetes. What is decisive is the long-term dietary pattern. Therefore, strict restrictions are not necessary; rather, a more easily regulatable metabolism is desirable.
And that is entirely possible ...
Foods Recommended in Diabetes
o Vegetables and legumes: Non-starchy vegetables such as leafy greens, broccoli, or beans provide fiber and micronutrients that dampen the blood glucose response and contribute to satiety (Reynolds et al., 2019).
o Whole grains and fiber-rich carbohydrates: Whole grains, oats, quinoa, and similar whole-grain forms are digested more slowly and reduce postprandial blood glucose spikes compared to refined carbohydrates (Aune et al., 2013; Reynolds et al., 2019).
o Fruits with a low glycemic index: Berries or other fiber-rich fruits can be a good option despite their natural sweetness, as they provide vitamins and antioxidants (Muraki et al., 2013).
o Healthy protein sources: Fish, lean poultry, legumes, nuts, and seeds support blood glucose stability and promote satiety (Schwingshackl et al., 2017).
o Healthy fats: Plant oils such as olive oil and sources of omega-3 fats (e.g., salmon, walnuts) can favorably influence fat metabolism (Schwingshackl et al., 2017).
Diabetes: Complex and Chronic, but Manageable!
In diabetes, it is not only about being correctly adjusted with medication, let alone constantly thinking about blood glucose measurement. It is about practical lifestyle changes that help ensure that the condition remains manageable.
FAQ – Frequently Asked Questions About Diabetes
1. Can prediabetes completely reverse?
Yes, remission or a return to normoglycemia is possible at an early stage. The underlying susceptibility remains, but measurable blood glucose levels can return completely to normal.
2. Why does type 2 diabetes often remain unnoticed for a long time?
Type 2 diabetes usually develops gradually. The body can compensate for elevated blood glucose levels for a long time without causing obvious symptoms. Initial changes often affect metabolic processes and blood vessels before typical complaints occur.
3. Why are regular blood glucose measurements important even without pronounced symptoms?
Because type 2 diabetes can remain symptom-poor for a long time, only regular checks can provide early indications of metabolic disturbances. This enables timely countermeasures before secondary conditions develop.
4. Why does diabetes often affect blood vessels, nerves, eyes, and kidneys?
The reason lies in the long term consequences of elevated blood glucose-levels. Oxidative stress and inflammatory processes primarily damage small blood vessels – where sensitive structures are supplied.
5. Are there differences between diabetes in younger and older people?
When type 2 diabetes occurs in younger individuals (approx. 35–45 years of age), there is often a stronger genetic predisposition. In addition, diabetes often progresses more aggressively in younger individuals, meaning that insulin therapy may become necessary sooner and secondary conditions may occur earlier. The pancreas is also overloaded more quickly.
Additional information on diabetes and many other topics can be found in the articles on our blog, the volumes of our “Codex Humanus”, and the “Medizinskandale” series. You are welcome to visit our online shop.
Sources:
· Oxford English Dictionary (OED): “Diabetes, mellitus – Etymology,” Oxford University Press.
· DeFronzo, R. A. et al. (2015): “Type 2 diabetes mellitus,” Nature Reviews Disease Primers.
· American Diabetes Association (2023): „Introduction and Methodology: Standards of Care in Diabetes—2023“, Diabetes Ameri
· World Health Organization (WHO): „Diabetes“ (Fact sheet). https://www.who.int/news-room/fact-sheets/detail/diabetes
· Knowler, W. C. et al. (2002): “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin,” New England Journal of Medicine.
· Liang, Y. et al. (2019): “Effects of berberine on blood glucose in patients with type 2 diabetes mellitus: a systematic literature review and a meta-analysis,” Endocrine Journal.
· Neelakantan, N. et al. (2014): “Effect of fenugreek (Trigonella foenum-graecum L.) intake on glycemia: a systematic review and meta-analysis of clinical trials,” Nutrition Journal.
· Malik, V. S. et al. (2010): “Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes: A Meta-analysis,” Diabetes Care.
· Reynolds, A. et al. (2019): “Carbohydrate quality and human health: a series of systematic reviews and meta-analyses,” The Lancet.
· Monteiro, C. A. et al. (2019): “Ultra-processed foods: what they are and how to identify them,” Public Health Nutrition.
· Aune, D. et al. (2013): “Whole grain and refined grain consumption and the risk of type 2 diabetes: A systematic review and dose-response meta-analysis of cohort studies,” European Journal of Epidemiology.
· Muraki, I. et al. (2013): “Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies,” BMJ.
· Schwingshackl, L. et al. (2017): “Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies,” European Journal of Epidemiology.
· Schwingshackl, L. et al. (2017): “Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials,” Nutrition & Diabetes.