Type 2 Diabetes

Type 2 Diabetes

Type 2 diabetes is one of the most common and impactful conditions I see in practice. Conventionally it is often managed as a lifelong disease with an ever growing amount of medications, yet with the right approach it can be reversed in the majority of patients. Let food be thy medicine.

Using advanced functional medicine strategies, I investigate the true drivers of diabetes, including metabolic dysfunction, nutrient imbalances, inflammation, and mitochondrial stress. In-depth testing helps reveal modifiable risk factors and hidden contributors that standard NHS care can not investigate due to its limitations.

By restoring a balanced biochemistry, optimising micronutrients, and enhancing mitochondrial function glucose control can be re-normalised and medications can be stopped.

Through lifestyle interventions, nutrition and targeted supplementationI help moving beyond disease management toward reversal and regaining metabolic health.

This holistic strategy results in a longer health and life-span, reduced risk of complications, and a marked improvement in quality of life offering patients the best chance of sustained health and independence.

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There are different types of diabetes. Type 1 is not very common, type 1.5 even less and we will focus on type 2. More than 90% of diabetes patients have type 2 diabetes (T2DM), which is also called insulin resistant diabetes. You were not born with it and it is clear that the vast majority of diabetes is lifestyle related and preventable. That is why I place so much emphasis on early screening and lifestyle modification.

However, what many patients and doctors do not realise is, that type 2 diabetes is in principal reversible. This is where YOU need to take control and get to know your symptoms and what to do if you have been diagnosed with type 2 diabetes.

I am here to coach, support and monitor you and help in whatever way I can.

Heart disease is the leading cause of death in diabetic patients, which is especially true for T2DM patients as the insulin resistance has many negative effects on your health.
This just means that you absolutely need to focus on prevention.

However, if you have been diagnosed with pre-diabetes (a terrible term and I will explain why later) or diabetes then you need to understand that this will shorten your life significantly.

For instance, the estimated life expectancy of men at the age of 55 years with type 2 diabetes, 5 years after diagnosis, is 13.2 years for a patient who smokes, has a systolic blood pressure of 180 mmHg, a total:HDL cholesterol ratio of 8, and HbA1c of 10%.

In other words you will enjoy your pension for only 1.2 years after retirement before ‘handing in the towel’ or ‘handing back the spoon’ (Loeffel abgeben) as we say in Germany.

Fortunately, you can improve your life expectancy by doing the right things.

The metabolic imbalance leading to type 2 diabetes is usually not diagnosed for many years. This leads to unnecessary delays and missed opportunities to prevent and reverse when it’s still a lot easier. We all know leaving things to the last minute is rarely a wise strategy.

This delay has to do with the traditional diagnostic approach regarding T2DM. Doctors have and sadly are still being trained to focus exclusively on the blood sugar (glucose) level as key parameter.

Focusing only on the blood sugar levels means that only when your body can no longer compensate and your sugar levels get out of control a diagnosis is made and action taken. In my opinion this means on average patients suffer a diagnostic delay of years or decades.

This also means treatment is so much more difficult as many changes have already happened, but the good news is that most patients still can reverse their diabetes and significantly improve their health and wellbeing.

Type 2 Diabetes in more detail

The incidence of type 2 diabetes is constantly rising globally, and it’s estimated that more than 4.3 million people are living with diabetes in the UK, with potentially another 850,000 adults yet to be diagnosed. It is – in other words – another pandemic and it is getting worse every year.

Insulin resistance is clinically silent. This means you do not notice anything at all.

Many patients can be insulin resistant for years or even decades before a formal diabetes diagnosis is being made. Think of it a bit like a ship with a leak in the hull taking in water. The leak is initially small and only a little bit of water gets in. The water getting in is equivalent to having insulin resistance.

Eventually, however, the ship sinks and that is when conventional medicine calls the condition diabetes. I think of it as early/mid/late stage of insulin resistance and my aim is to raise awareness and screen early. So please share this information widely and help me raising awareness.

The symptoms of IR/T2DM nearly always develop slowly over years or decades. Most people do not notice them at first, but this is usually due to not knowing what to look for. Please check if any of the following symptoms apply to you:

  • Feeling tired/lack of energy despite good sleep.
  • Feeling hungry approximately 60 min after having just eaten.
  • Having a dip (tired) approximately 60min after a meal.
  • Brain fog especially after a meal.
  • Unable to lose weight despite calorie restriction and/or exercising.
  • Being less emotionally balanced i.e. either more aggressive/angry or more anxious than previously. Large swings in blood glucose levels can cause you to be less able to control your emotions.
  • Frequent urination, especially at night
  • Feeling very thirsty
  • Increased hunger
  • Unexplained weight loss
  • Blurred vision
  • Frequent infections or slow-healing sores
  • Tingling or numbness in the hands or feet

As symptoms are hard to spot, it’s essential to be aware of what causes IR/T2DM and to take steps to eliminate this risk.

In one word: lifestyle.

It is usually a combination of factors that all play together to lead to IR/T2DM. However, in our (western) society there are several factors that stand out.

  1. High stress levels
  2. Lack of proper meal planning – often we eat suboptimal food and/or on the run because we don’t have a proper lunch break due to job circumstances
  3. The food choices provided by most places are overwhelmingly substandard from a nutritional point of view and high quality options are usually very expensive
  4. We have never been systematically taught how to manage stress
  5. We suffer the disadvantages of having to use the car or train rather than walking or cycling to work
  6. Most of my patients sleep routinely less than 6 hours. Lack of sufficient sleep as well as poor sleep quality is a major contributor to poor metabolic health
  7. Humans love to snack and have a tendency to over-eat or comfort eat
  8. Many of us do not get enough exercise

All of this and many more things contribute to a chronic inflammatory state and lead to insulin resistance which, when unrecognised and untreated will lead to diabetes. Obesity is often associated with T2DM, but you can be of ideal body weight and still be diabetic and the reverse is true as well. There is a condition called ‘metabolically healthy obese’. I don’t tend to focus on your bodyweight as the real deal is the insulin resistance and that is what I focus on.

The traditional method is to check your fasting blood glucose. There are also continuous glucose monitors available to purchase, which can be of great educational value and I strongly recommend using them if you have been diagnosed with IR/T2DM. The way I assess your metabolic health is checking your fasting insulin and if needed another insulin level after a test meal. This way I make sure we do not miss the early stages of IR and do not fail to initiate appropriate strategies to rebalance your metabolism.

The most important priority is lifestyle.

It is much more powerful than all medications together. Medications only ever treat symptoms (elevated blood glucose), but the lifestyle modifications we will develop will help you to treat the root cause and reverse your metabolic imbalance. My aim is to empower you to get your health back. It’s not going to be a sprint and you need to be committed, but the benefits are significant and especially long term.

It is sometimes necessary to escalate medications in the short term, but overall we should be able to find a strategy allowing you to de-escalate your T2DM medications with the ultimate aim to come off them all together.

Once you have reversed your diabetes you must absolutely not go back to the bad old habits as otherwise, you guessed, it will come back.

It is usually very helpful to work with a nutritionalist and I am very happy to facilitate contact and refer.

Diabetes and your heart

High blood sugar levels can damage your blood vessels and the nerves that control your heart, making it less able to pump efficiently. You are also more likely to develop a build-up of fatty material called atheroma that narrows the coronary arteries, which supply blood to the heart muscle.

This is due to it affecting the inner lining of the blood vessels. The inner lining is called endothelium and is the non-stick layer preventing blood clots etc. When your endothelium is not working properly (endothelial dysfunction) your blood vessel can no longer repair itself, regenerate and is much more vulnerable to cholesterol causing problems of furring up (atheroma formation).

This then can cause angina or, if a coronary artery becomes completely blocked, it can result in a heart attack. Did you know that the most common presentation of coronary artery disease is not angina but death? Yes, it is true, 52% of first presentations of coronary disease present as sudden death.

This means two things:

  1. You can and must not rely on symptoms to forewarn you and,
  2. screening is an absolute necessity

Diabetes and your health

Did you know that there is a growing recognition that dementia is due to poor metabolic health and especially diabetes?

Some actually call dementia ‘type 3 diabetes’ highlighting the close relation between the two conditions. I avoid calling it this way to avoid confusion, but is is clearly a long term complication of type 2 diabetes.

The key question however is why do you have type 2 diabetes? You were not born with it hence something happened to cause it.

The key to understanding the condition is to understand insulin resistance and how it develops silently over time.

Apart from dementia insulin resistance or IR can also cause blindness, cataracts, kidney disease, peripheral vascular disease, hypertension, strokes, atrial fibrillation and of course heart attacks.

Why I screen for diabetes?

In my practice I routinely screen asymptomatic patients for that reason. I even screen young patients in their 20s as we know from autopsy data (e.g. accidental deaths) that 10-20% of patients in their 20s already have early coronary disease. I need to know as early as possible so I can help you reversing it and prevent you to be one of the 52%.

Diabetes is linked to an increased risk of having high blood pressure. People living with type 2 diabetes also often have higher levels of bad cholesterol and lower levels of good cholesterol, which increase the risk of atheroma developing. You can see it is a loop and a vicious one indeed.

Prediabetes as discussed above is a term many doctors use. I do not think it is a useful way of thinking about this as it is the insulin and not the glucose we need to focus on.

For that reason, it is essential to check your fasting insulin levels as a screening investigation. It is not covered by the NHS and you may have to pay privately for it. Is it worth it? Well, you decide – testing for it does not cost much.

If your fasting insulin is suboptimal we can be fairly sure you are at risk of developing full blown diabetes unless you do something about it. If your fasting insulin is normal then it is still possible that you are (early) insulin resistant and I would then recommend a repeat insulin check, but with a test meal to assess your response to a glucose drink. This is something called a glucose/insulin tolerance test. It shows me if you are producing too much insulin to a standard test meal/drink.

The earlier you know the better.

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