How To Improve Insulin Resistance in Type Two Diabetes by Jeffrey Dach MD

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Mar 3, 2008, 10:26:14 AM3/3/08
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How To Improve Insulin Resistance in Type Two Diabetes by Jeffrey Dach
MD

Original Article can be seen here:

http://jeffreydach.com/2008/02/29/how-to-improve-insulin-resistance-in-type-two-diabetes-by-jeffrey-dach-md.aspx

Mrs. Duvalier is an insulin dependent diabetic on daily insulin
injections. She uses a home glucometer to measure her fasting blood
sugar which ranges from 200 to 300. She explained to me that she is
interested in natural treatments to reduce her need for insulin. She
wants to be able to get off insulin entirely. I replied that I would
do my best, however, the best we could hope to achieve would be a
partial improvement. Getting off insulin altogether with a normal
blood sugar would be a tall order, I told her.

Natural Approach with Diet, Exercise and Nutritional Supplements

A logical and natural approach to treatment for diabetes involves
modifying the diet to a low glycemic diet, exercise program, and
weight loss.

The Atkins Low Glycemic Diet (6)(7)

The Atkins type diet which is low carbohydrates diet, and high in fat
and protein has been known to improve insulin resistance and reduce
fasting blood sugar values. It is also helpful for weight loss.
Eliminate refined sugar and refined carbohydrates for maximal
benefit.

Exercise and Weight Loss

Weight Loss associated with a vigorous exercise program will improve
insuilin sensitivity and reduce fasting blood sugar values.

Nutritional Supplements for Improving Insulin Resistance

Chromium Picolinate (chromium polynicotinate) 500-1000 mcg daily. FDA
approves first qualified health claim for a supplement.

Biotin 9-16 mg daily

R-Alpha-lipoic acid has been shown to improve insulin sensitivity and
resistance in individuals with existing type 2 diabetes. 100-600
milligrams 1-3 times daily of R-Lipoic Acid. (7)

Vitamin D, check vitamin D level and supplement if found to be low.
Recheck every 6 months.

Benfotiamine, a lipid soluble form of vitamin B-1. 300 mg 2-3 times
per day.

Coenzyme Q10 30 to 60 milligrams of coenzyme Q10 daily.

Acetyl L Carnitine shuttles fatty acids across mitochondrial
membrane. Useful for fat metabolism. Works together with Coenzyme Q
10 and D Ribose to increase mitochondrial function.

Cinnamon has been recommended by some, considered ineffetive by
others. It is cheap and available as a spice at the grocery store.

Iodoral Supplements

Iodine Supplementation to Reverse Insulin Resistant Diabetes

It is not widely known that iodine supplementation is beneficial in
reversing diabetes.

The following is a link to a case report of an individual treated by
Dr George Flechas. This patient had thyroid cancer treated with
surgery and radioactive iodine, and was later treated with 75 mg of
Iodine per day with improvement in insulin resistant adult onset
diabetes. Apparently the iodine was beneficial in reversing the
diabetes. (16)(17)

Case Report Mr. Mack - Thyroid Cancer, Hypothyroidism

Mack is a 58 year old social worker living in North Carolina. Mack
went to Dr. Flechas to see if he had Fibromyalgia as he was
experiencing constant pain. Dr. Flechas did a thorough physical on
Mack and discovered a thyroid nodule on the first visit. He also
discovered that Mack had diabetes and high blood pressure. Mack had
already been diagnosed with sleep apnea and restless leg syndrome.

Dr. Flechas' first course of action was to begin a series of tests to
diagnose the thyroid nodule. He was also started on medicines to
control his diabetes and high blood pressure. A ultrasound of his
thyroid was performed in the office and revealed that the nodule was
solid. He then sent him for a thyroid uptake nuclear scan. The test
revealed that the nodule was "cold". A "cold" nodule is an indicator
that the nodule could be malignant. The next was a fine needle biopsy
of the nodule. The biopsy was inconclusive saying that the nodule
could neither be defined as malignant or benign. After much discussion
between three doctors including Dr. Flechas, an endocrinologist, and a
ENT, it was decided that Mack would have surgery to remove the nodule.
During the surgery the nodule was sent directly to pathology and it
was discovered to be Papillary Thyroid Cancer and the decision was
made to go ahead and remove all of Mack's thyroid.

After Mack had recovered from the surgery, he was then sent back into
the hospital for a radioactive iodine treatment to kill any remaining
thyroid tissue that may be in his body.

When the course of treatment for his thyroid cancer was completed, Dr.
Flechas started Mack on Iodoral - 3 tablets in the morning and 3
tablets at night. Since starting the Iodoral, Mack's diabetes had
almost completely disappeared. He is no longer on diabetes' medicines
and his blood sugars have been in the normal range for over a year.

Update April, 2005: Mack is now down to 240 lbs after starting at a
weight of about 320 lbs when first starting treatment with Dr.
Flechas. His overall general health is wonderful. He is sleeping well
for the first time in years and very active. Quoted directly from Dr
Flechas' Web Site.

Iodoral Supplement

Quoted from George Flechas MD:

Iodine Supplements Found to be Beneficial in Diabetics

"It was while treating a large 320-pound woman with insulin dependent
diabetes that we learned a valuable lesson regarding the role of
iodine in hormone receptor function. This woman had come in via the
emergency room with a very high random blood sugar of 1,380 mg/dl. She
was then started on insulin during her hospitalization and was
instructed on the use of a home glucometer. She was to use her
glucometer two times per day. Two weeks later on her return office
visit for a checkup of her insulin dependent diabetes she was informed
that during her hospital physical examination she was noted to have
FBD.

She was recommended to start on 50 mg of iodine (4 tablets) at that
time. One week later she called us requesting to lower the level of
insulin due to having problems with hypoglycemia. She was told to
continue to drop her insulin levels as long as she was experiencing
hypoglycemia and to monitor her blood sugars carefully with her
glucometer. Four weeks later during an office visit her glucometer was
downloaded to my office computer, which showed her to have an average
random blood sugar of 98.

I praised the patient for her diligent efforts to control her diet and
her good work at keeping her sugars under control with the insulin.
She then informed me that she had come off her insulin three weeks
earlier and had not been taking any medications to lower her blood
sugar. When asked what she felt the big change was, she felt that her
diabetes was under better control due to the use of iodine. Two years
later and 70 pounds lighter this patient continues to have excellent
glucose control on iodine 50 mg per day.

We since have done a study of twelve diabetics and in six cases we
were able to wean all of these patients off of medications for their
diabetes and were able to maintain a hemoglobin A1C of less than 5.8
with the average random blood sugar of less than 100.

To this date these patients continue to have excellent control of
their Type II diabetes. The range of daily iodine intake was from 50
mg to 100 mg per day. All diabetic patients were able to lower the
total amount of medications necessary to control their diabetes. Two
of the twelve patients were controlled with the use of iodine plus one
medication. Two patients have control of diabetes with iodine plus two
medications. One patient had control of her diabetes with three
medications plus iodine 50 mg. The one insulin dependent diabetic was
able to reduce the intake of Lantus insulin from 98 units to 44 units
per day within a period of a few weeks." quoted from George Flechas MD

Diabetes Drugs

Increase Insulin Output by Pancreas: Chlorpropamide, Tolbutaminde,
Glyburide, Glipizide, glimepiride.

Decrease glucose from the liver: Metformin (Glucophage). Metformin
does not alter concentrations of insulin in the blood and, therefore,
rarely causes low blood glucose levels.

Increase Insulin Sensitivity: Troglitazone (Rezulin) which was taken
off the market in March 2000 due to liver toxicity, or rosiglitazone
(Avandia) whose long-term safety profile is not known.

Decrease the Absorption of Carbohydrates from the Intestine: Precose.
Precose has significant gastrointestinal side effects. Abdominal pain,
diarrhea, and gas are common and are seen in up to 75% of patients.

Increase the Amount of Insulin: Insulin Injectable Humulin.

A full discussion of Diabetes Drugs will be the subject of a later
report. In the meantime, see (28) and (29) for discussions of
limitations of Diabetes Drugs.

More intensive drug treatment with intensive lowering of blood sugar
and HGB-A1C does not always translate into improvement in health in
high risk diabetes, as the ACCORD study demonstrates. The ACCORD study
was halted early because the more intensive treatment group had a
higher mortality.(30)-(41)

Disclaimer: click here for disclaimer http://www.drdach.com/wst_page20.html

This article is for educational purposes only.

As always, consult with a knowledgeable physician before making any
changes in your diet, exercise or supplement program, including any
decisions regarding Iodine supplements, or any other supplements or
medications.

References

Chromium, Biotin and Cinnamon

(1) http://jn.nutrition.org/cgi/reprint/123/4/626
Chromium in Human Nutrition: A Review WALTER MERTZ U.S. Department of
Agriculture, Agricultural Research Service,Beltsuille Human Nutrition
Research Center, Beltsville, MD 20705, American Institute of
Nutrition. Received 21 July 1992.

(2) http://www.ncbi.nlm.nih.gov/pubmed/15208835?ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Diabetes Educ. 2004;Suppl:2-14.A scientific review: the role of
chromium in insulin resistance.

(3)
http://www.ncbi.nlm.nih.gov/pubmed/17952838?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1
Horm Metab Res. 2007 Oct;39(10):743-51. Chromium in metabolic and
cardiovascular disease.Hummel M, Standl E, Schnell O. Diabetes
Research Institute & Academical Hospital Munich-Schwabing, Munich,
Germany.

(4)
http://www.ncbi.nlm.nih.gov/pubmed/17109595?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1
Diabetes Technol Ther. 2006 Dec;8(6):636-43. Links

The effect of chromium picolinate and biotin supplementation on
glycemic control in poorly controlled patients with type 2 diabetes
mellitus: a placebo-controlled, double-blinded, randomized
trial.Singer GM, Geohas J. Section of Cardiovascular Medicine, Yale
University School of Medicine, New Haven, Connecticut 06520-8017,
USA.

Biotin 2 mg 667% Chromium 6000 mcg 500%

(5)
http://www.ncbi.nlm.nih.gov/pubmed/16117721?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1

Dis Manag. 2005 Aug;8(4):265-75.

Use of chromium picolinate and biotin in the management of type 2
diabetes: an economic analysis. Fuhr JP Jr, He H, Goldfarb N, Nash DB.
Department of Economics, Widener University, Chester, Pennsylvania,
USA.

Average 3-year cost savings for chromium picolinate plus biotin
(Diachrome) use could range from 1,636 dollars for a poorly controlled
patient with diabetes without heart diseases or hypertension, to 5,435
dollars for a poorly controlled patient with diabetes, heart disease,
and hypertension. Average 3-year cost savings was estimated to be
between 3.9 billion dollars and 52.9 billion dollars for the 16.3
million existing patients with diabetes. Chromium picolinate plus
biotin (Diachrome) use among the 1.17 million newly diagnosed patients
with T2DM each year could deliver lifetime cost savings of 42 billion
dollars, or 36,000 dollars per T2DM patient.

Atkins Diet

(6) http://www.atkins.com/products/atkins-diabetes-revolution
Atkins Diet Revolution for Diabetes

(7) http://www.nutritionandmetabolism.com/content/1/1/14
Book review, Review on "Atkins Diabetes Revolution: The Groundbreaking
Approach to Preventing and Controlling Type 2 Diabetes" by Mary C.
Vernon and Jacqueline A. Eberstein
Surender Arora and Samy I McFarlane, Nutrition & Metabolism 2004,
1:14

Alpha Lipoic Acid

(8) http://www.thorne.com/altmedrev/.fulltext/11/3/232.pdf
Alha Lipoic Acid Review Article Thorne

(9) http://www.phlaunt.com/diabetes/20144672.php
Supplements that are thought to work for diabetes in the opinion of
Jenny's Blood Sugar101 (ALA, Benfotine, Vit D etc.)

(10) http://www.phlaunt.com/diabetes/15877514.php
Supplements that are questionale or not thought to be effective in the
opinion of Jenny's Blood Sugar 101 (Cinnamon, Chromium etc.)

Benfotiamine Vitamin B1 Thiamine

(11) http://www.purecaps.com/NewsResearch/newsletter/20050920/index.asp
BenfoMax (Benfotiamine): Novel Support for Nerve, Retina and Kidney
Function
Benfotiamine, S-benzoylthiamine-O-monophosphate, is a fat soluble
vitamin B1 (thiamine) derivative that has enjoyed over a decade of
popular use in Europe.

(12) http://www.benfotiamine.org/index.htm
Benfotiamine.org Lipid soluble form of thiamine B1

(13) http://www.benfotiamine.org/Benfo600Study.pdf
Benfotiamine Inhibits Intracellular Formation of Advanced Glycation
End Products in vivo
JIHONG LIN, ALEX ALT, JUTTA LIERSCH, REINHARD G. BRETZEL, MICHAEL
BROWNLEE*, HANS-PETER HAMMES Third Medical Department, Justus-Liebig-
University Giessen, Germany *Albert-Einstein College, New York, NY,

Chromium and Cinnamon

(14) http://www.ncbi.nlm.nih.gov/pubmed/18234131?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Proc Nutr Soc. 2008 Feb;67(1):48-53. Chromium and polyphenols from
cinnamon improve insulin sensitivity.Anderson RA. Beltsville Human
Nutrition Research Center, USDA, Beltsville, MD 20705, USA.

(15) http://www.purecaps.com/NewsResearch/newsletter/20050920/article_three.asp
FDA Concludes that Chromium Picolinate is Safe;Approves First
Qualified Health Claim.
In August, the FDA recognized chromium picolinate as a safe
nutritional supplement with credible evidence to support the first
qualified health claim with regard to the role of chromium in healthy
glucose metabolism.

Iodine References

(16) http://www.helpmythyroid.com/mack.html
Case Report on Mack - Thyroid Cancer, Hypothyroidism George Flechas MD
HelpMyThyoid.com

(17) http://www.iodine4health.com/disease/diabetes/flechas_diabetes.htm
George FLECHAS MD Orthoiodosupplementation in a Primary Care Practice,
Flechas JD. Role of Iodine in Diabetes

References dealing with Nutritional Supplements for Diabetes:

(18) http://www.phlaunt.com/diabetes/index.php
Blood Sugar 101 by Jenny

(19) http://www.raysahelian.com/diabetes.html
Natural Supplements for Diabetes by Ray Sahelian MD

(20) http://www.encyclopedia.com/doc/1G1-81138246.html
A Natural Approach to Diabetes - Brief Article Townsend Letter for
Doctors and Patients, Jan, 2002 by Farhang Khosh. Excellent Reveiw
with References

(21) http://www.drlam.com/A3R_brief_in_doc_format/Diabetes.cfm#Diabetes
Dr Lam's Diabetes Protocol

(22) http://www.westonaprice.org/moderndiseases/diabetes.html
Treating Diabetes: Practical Advice for Combating a Modern Epidemic By
Tom Cowan, MD
Weston Price Org

(23) http://healthmoz.org/how-to-reverse-type-2-diabetes-and-insulin-resistance-in-5-simple-steps/#comment-2040
How To Reverse Type 2 Diabetes And Insulin Resistance In 5 Simple
Steps Mark Hyman, MD is a pioneer in functional medicine, practicing
physician and best-selling author. A sneak preview of his book "The
UltraSimple Diet" is available.

More on Chromium, First Health Claim Approved by the FDA

(24) http://www.purecaps.com/itemdy00.asp?T1=CRG61
chromium polynicotinate from pure encapsulations, preferred tyoe of
chromium

(25) http://www.cfsan.fda.gov/~dms/qhccr.html
There was one study (Cefalu et al., 1999) that showed a benefit for
chromium picolinate and insulin resistance. FDA finds that there is
very limited credible evidence for a qualified health claim
specifically for chromium picolinate and a reduced risk of insulin
resistance, and therefore possibly a reduced risk of type 2 diabetes.
However, the reported findings of Cefalu et al., 1999 have not been
replicated.

(26) http://www3.interscience.wiley.com/cgi-bin/abstract/61004819/ABSTRACT
Cefalu, W.T., A.D. Bell-farrow, J. Stegner, Z.Q. Wand, T. King, T.
Morgan, J.G. Terry. Effect of chromium picolinate on insulin
sensitivity in vivo. Journal of Trace Elements in Experimental
Medicine. 1999;12:71-83.

(27) http://care.diabetesjournals.org/cgi/content/full/27/11/2741
Diabetes Care 27:2741-2751, 2004 by the American Diabetes Association,
Inc. Review Article Role of Chromium in Human Health and in Diabetes,
William T. Cefalu, MD and Frank B. Hu, MD, PHD

Diabetes Drugs

(28)
http://doctorjames.wordpress.com/2008/02/28/the-truth-about-diabetes-and-why-drugs-dont-work/
The Truth About Diabetes and Why Drugs Don't Work Posted by
doctorjames on February 28, 2008

(29) http://sparkofreason.blogspot.com/2008/02/insulin-insanity.html
insulin Insanity from Spark of Reason

Accord Study Halted Early

(30)
http://www.nytimes.com/2008/02/07/health/07diabetes.html?_r=1&ei=5065&en=a58f37b02db7215d&ex=1203051600&partner=MYWAY&pagewanted=print&oref=slogin
February 7, 2008 Diabetes Study Partially Halted After Deaths By GINA
KOLATA New York Times

(31) http://www.pbs.org/newshour/bb/health/jan-june08/diabetes_02-07.html
Diabetes Study Partially Halted Due to Cardiac Risk. A new study on
Type 2 diabetes was partially halted after research showed lowering
blood sugar levels for some high-risk patients increased their chances
of dying from a heart attack. The head of the American Diabetes
Association details the surprising findings.

(32) http://doctorrw.blogspot.com/2008/02/accord-study-what-does-it-mean.html
The ACCORD study: what does it mean? A safety analysis and early halt
to the intensive glycemic control arm of the ACCORD study was reported
yesterday in an NIH press release. It says intensive glycemic control
(it was really what I'd call ultra-intensive glycemic control, more
stringent than what current guidelines call for) was associated with
increased cardiovascular mortality (essentially macrovascular) in
patients with type 2 diabetes.

(33) http://www.diabetesmine.com/2008/02/accord-study-a.html
ACCORD Study: Wrong and Wronger The media loves a good scare. So
they've jumped all over the failed ACCORD study (Action to Control
Cardiovascular Risk in Diabetes) with headlines making it sound like
tight blood glucose control is now proven to be "bad for you." Ugh.

(34) http://www.cbsnews.com/stories/2008/02/06/health/main3797887.shtml?source=RSSattr=Health_3797887
Diabetes Patients' Deaths Stunt Study. Unexpected Number Of Fatalities
Cuts Short Experimental Treatment For Type 2 Diabetics WASHINGTON,
Feb. 7, 2008

(35) http://hcrenewal.blogspot.com/2008/02/is-more-always-better-accord-study.html
Thursday, February 07, 2008 Is More Always Better? - the ACCORD Study
Results. Health Care Renewal

(36) http://diabetesupdate.blogspot.com/2008/02/how-advance-differs-from-accord.html
How ACCORD differed from Advance by Jenny Ruhl Blood Sugar 101.
Accord added statins and fibrates to the program.

(37) http://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=2551
For Safety, NHLBI Changes Intensive Blood Sugar Treatment Strategy in
Clinical Trial of Diabetes and Cardiovascular Disease. NIH News
Release.

The National Heart, Lung, and Blood Institute (NHLBI) of the National
Institutes of Health has stopped one treatment within a large, ongoing
North American clinical trial of diabetes and cardiovascular disease
18 months early due to safety concerns after review of available data,
although the study will continue.

In this trial of adults with type 2 diabetes at especially high risk
for heart attack and stroke, the medical strategy to intensively lower
blood glucose (sugar) below current recommendations increased the risk
of death compared with a less-intensive standard treatment strategy.
Study participants receiving intensive blood glucose lowering
treatment will now receive the less-intensive standard treatment.

The ACCORD (Action to Control Cardiovascular Risk in Diabetes) study
enrolled 10,251 participants. Of these, 257 in the intensive treatment
group have died, compared with 203 within the standard treatment
group. This is a difference of 54 deaths, or 3 per 1,000 participants
each year, over an average of almost four years of treatment. The
death rates in both groups were lower than seen in similar populations
in other studies.

"A thorough review of the data shows that the medical treatment
strategy of intensively reducing blood sugar below current clinical
guidelines causes harm in these especially high-risk patients with
type 2 diabetes," said Elizabeth G. Nabel, M.D., director, NHLBI.

Those participants in the intensive treatment group will now be
treated to the same A1C goals as those already in the standard
treatment group.

The intensive treatment group had a target blood sugar goal, measured
by hemoglobin A1C, of less than 6 percent. This is similar to blood
sugar levels in adults without diabetes. The standard treatment group
aimed for a target similar to what is achieved, on average, by those
with diabetes in the United States (A1C of 7 to 7.9 percent) and lower
than at study entry.

In ACCORD, half of the participants in the intensive treatment group
achieved an A1C of less than 6.4 percent, and half of the participants
in the standard treatment group achieved an A1C of less than 7.5
percent.

(38) http://www.medscape.com/viewarticle/480545_print
Expert Interview. The Incretin Hormones in the Treatment of Type 2
Diabetes: An Expert Interview With John Buse, MD, PhD Medscape
Diabetes & Endocrinology 6(1), 2004. (c) 2004 Medscape
Posted 06/14/2004

(39) http://www.sourcewatch.org/index.php?title=GlaxoSmithKline,_the_Diabetes_Drug_Avandia_and_The_Intimidation_of_Dr._John_Buse
GlaxoSmithKline, the Diabetes Drug Avandia and The Intimidation of Dr.
John Buse

Statin Drugs for Diabetics

(40) http://clinical.diabetesjournals.org/cgi/content/full/21/4/168
Clinical Diabetes 21:168-172, 2003(c) American Diabetes Association (R),
Inc., 2003
Practical Pointer Statin Treatment in Diabetes Mellitus John Buse, MD,
PhD, CDE
Athough cardiac events are reduced in diabetics, where is the HPS all-
cause mortality data?

(41) http://www.vitamincfoundation.org/statinalert/hps.html
Comments by Statistician Eddie Vos (Health-heart.org)
The full HPS mortality data have never been properly published and one
of the HPS authors just asked me WHY I wanted to know, instead of
coming up with the data. One of the letter authors in Lancet Aug. 30
figures they won't ever provide these data --and that should be
denounced in the Journals. I sent letters into Lancet Aug. 30,
unsuccessfully asking for complete mortality data.

Only 2 of the last 4 big trials give cumulative mortality data but
PROSPER claims no mortality benefit, yet HPS DOES. HPS may well have
been stopped at a coincidentally particularly advantageous moment in
the statistical ups and downs [as ASCOT was stopped with a small NS
benefit showing, while 3 months before the curves touched].

(c) 2008 Jeffrey Dach MD All Rights Reserved http://www.drdach.com/wst_page20.html

Jeffrey Dach MD
4700 Sheridan
Suite T
Hollywood Fl 33021
954-983-1443
http://www.drdach.com
disclaimer http://www.drdach.com/wst_page20.html
My Blog http://www.jeffreydach.com

Original Article can be seen here:

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