Adverse Effects of Insulin
The most serious and feared adverse effect of insulin therapy is hypoglycemia. Intensive insulin therapy is an aggressive treatment approach requiring close monitoring of blood glucose levels and frequent doses of insulin. In the United Kingdom Prospective Diabetes Study (UKPDS) published in 1998, major hypoglycemia occurred in 2.3 percent of type 2 diabetic patients who wee treated with insulin compared to 0.1 to 0.4 percent in those on a diet or sulfonylurea therapy. When the A1C level is below 7.4 percent, the risk of hypoglycemia has been shown to increase significantly.
A 6.5-year follow-up of the Diabetes Control and complications Trial (DCCT) published in 1997 found at least one episode of severe hypoglycemia in 35 percent of patients in the conventional treatment group and 65 percent in the intensive group. Likewise, during a 10-year follow-up of the Stockholm Diabetes Intervention Study published in 1996, the corresponding figures were 73 percent and 86 percent. In a meta-analysis published in 1997, the respective median incidence of severe hypoglycemia was 4.6 and 7.9 episodes per 100 patient years in conventionally and intensively treated patients. Recurrent severe hypoglycemia may lead to cumulative cognitive impairment, and can be associated with significant morbidity, including death.
Weight gain also is a common side effect of insulin therapy. In the UKPDS, type 2 diabetic patients taking insulin gained 4 kg (nearly 9 pounds) more than those treated with diet therapy over 10 years. Asking patients to increase their exercise time and restrict calories and the concurrent use of certain medications can help them control their weight gain.
Adverse Effects of Diabetic Drugs
Hypoglycemic agents are often first choice drugs, along with lifestyle modifications, for patients with type 2 diabetes, these include the sulfonylureas, which work by stimulating beta cells in the pancreas to produce more insulin. Data shows that in patients receiving second generation sulfonylureas (especially glyburide), major and minor hypoglycemic episodes were frequent. This was also true in those receiving metformin or thiazolidinediones, but less so than with sulfonylureas.
In published studies, hypoglycemic risk was up to 36 percent for second-generation sulfonylureas, up to 21 percent for metformin, and up to 24 percent for thiazoldinediones. There was a two percent higher risk for hypoglycemia with glyburide and glibenclamide compared to other second generation sulfonylureas.
Gastrointestinal Problems. The gastrointestinal symptoms occur more frequently with metformin than most other oral diabetes medication:
• Metformin up to 63 percent
• Thiazolidinediones up to 36 percent
• Second-generation sulfonylurea up to 32 percent
• Repaglinide up to 11 percent
The percentages of gastrointestinal symptoms seen with acarbose ( a medication that works by decreasing the absorption of carbohydrates in the gut) were similar to that with metformin.
Congestive Heart Failure. In clinical trials, there was an absolute risk of congestive heart failure ranging from 0.8 percent to 3.6 percent for thiazolidinediones and 0 percent to 2.6 percent for nonthiazolidinediones. In most cases, neither metformin nor second-generation sulfonylureas were associated with congestive heart failure risk.
Peripheral Edema. Edema was more frequent in patients receiving thiazolidinediones as monotherapy (0 to 26 percent) than in patients receiving second generation sulfonylureas (0 to eight percent) or metformin (0 to four percent). The absolute risk differences ranged from two percent to 21 percent in head-to-head randomized trials.
Cholecystitis. Pioglitazone, an insulin sensitizer medication, was found to be associated with an increased risk for hospitalization for acute cholecystitis in a pooled analysis of 1,526 patients.
Triglycerides. Rosiglitazone, an insulin sensitizer medication, generally increases triglyceride levels.
Dietary Modification
Dietary modification is universally considered the primary means of controlling blood glucose levels. In study after study, nutrition therapy in patients with type 2 diabetes has been shown to reduce A1C levels, reflecting long-term blood glucose control. Perhaps most effective is the use of a low glycemic index (GI) diet.
In a review published in 2009 assessing the effects of low-GI diets on glucose control in people with diabetes, researchers examined 11 clinical studies involving 402 type 1 or 2 diabetics whose diabetes was not already optimally controlled. When these diabetics followed the low-GI/low-GL diets, there was a statistically significant decrease in A1C levels.
In addition, there were significantly fewer episodes of hypoglycemia (low blood glucose) in diabetics with a low-GI diet compared to those with a high-GI diet. Furthermore, the proportion of participants reporting more than 15 episodes of hyperglycemia (high blood sugar) per month was significantly lower for those following a low-GI diet. The researchers in this review concluded that a low-GI diet can improve glucose control in diabetes without causing additional hypoglycemic episodes.
Exercise
Data from 20 studies in a review published in 2008 present a consistent picture indicating that regular physical activity substantially reduces risk of type 2 diabetes. In fact, a high level of physical activity is associated with a 20 to 30 percent reduction in diabetes risk.
Lifestyle intervention programs that include exercise and healthy diets have long been known to exert beneficial effects on whole-body metabolism, in particular leading to enhanced insulin-sensitivity in type-2 diabetics. In a review of 20 studies published in 2009, researchers found that resistance training (e.g., weight-lifting) helped improve blood glucose control and insulin sensitivity in adults with type 2 diabetes. Specifically, the reviews found that supervised resistance training provided these benefits. When supervision was removed, however, the diabetes did not tend to be as regular with their exercise, and blood glucose control decreased.
Relaxation Techniques
In studies using biofeedback-assisted relaxation training, type 1 diabetic patients had a significant reduction in blood glucose levels. However, type 1 diabetics have the potential to develop low blood glucose levels following the relaxation, and therefore need to be prepared to compensate if necessary.
A review of the scientific literature published in 2008 indicates yoga-based therapy for the management of type 2 diabetes has positive short-term effects on multiple diabetes-related outcomes. Furthermore, Hatha yoga (physical movement and postures) and meditation provide benefits in stabilizing blood glucose. A group of researchers studied the response of people with type 2 diabetes to yoga therapy. In their study, published in 1993, 70 percent of participants had a fair to good response. After 40 days, there was a significant reduction in high blood glucose levels.
Nutritional Support
A variety of dietary supplements may provide benefit as part of a comprehensive program for diabetes. Following are a few of those:
Bitter melon: Found to significantly improve the glucose tolerance of 73 percent of people with suboptimal glucose metabolism. Significantly balanced blood glucose levels during a glucose tolerance test in people with suboptimal glucose metabolism.
Goat’s rue: Animal research has demonstrated the effectiveness of goat’s rue at supporting healthy blood glucose levels.
Cinnamon: Supported healthy blood glucose levels in people with less than optimal glucose metabolism. Resulted in significant improvement in fasting blood sugar balance, decreased body fat by 0.7 percent and increased muscle mass by 1.1 percent.
Vitamin B6: Can reduce the oxidative stress-induced structural and functional protein damage associated with glycation and advanced glycation end-products (AGEs)
Vanadium: Can support healthy hepatic and peripheral insulin efficiency and maintain healthy blood glucose levels in people in need of support.
Chromium: Helps optimize insulin efficiency and keeps fasting glucose levels healthy.
Vitamin D: Also helps optimize insulin efficiency and balance glycosylated hemoglobin levels.
Conclusion
While the use of medications for the treatment of diabetes can be useful and, in some cases, necessary, physicians need to closely monitor patients for adverse effects associated with these drugs. Instead, physicians should place heavy emphasis on natural treatments to keep blood sugar levels in the healthy range.
