In this era, diabetes mellitus (DM) is one of the major public health problems in many developing countries. DM is a common chronic systemic syndrome characterized by hyperglycemia, which can lead to serious complications and premature death. DM is a disease caused by either inadequate insulin production or unresponsive of body cells to insulin. Hence, it results in hyperglycemia or elevated blood glucose levels. Insulin is a vital hormone in our body to regulate carbohydrate and fat metabolism in order to maintain our blood glucose level. There are two type of DM. Type 1 diabetes (T1D), also known as insulin-dependent DM; it is characterized as an autoimmune-mediated destruction of pancreatic β-cell which leads to deficiency in insulin production and requires daily administration of insulin. Next, Type 2 diabetes (T2D) is more common form of DM. It is previously known as non-insulin-dependent DM results from the body's ineffective use of insulin. Type 2 diabetes comprises 90% of people with DM around the world. This is primarily the result of excess body weight and physical inactivity.
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In T1D, without sufficient insulin produced, the amount of glucose in the blood becomes abnormally high (hyperglycemia). When glucose levels exceed renal threshold, the glucose will passes into the urine (glycosuria). Consecutively, the amount of urine produced will increase (polyuria) (Sadie L. Hebert, 2010). Despite increase in energy intake, negative energy balance will still occur due to insulin deficiency. Besides, lacking of glucose as an energy substrate at the cellular level, fat and muscle tissue has to be use by our body as an alternative energy source. All these will express the symptoms of DM such as excessive urine production, thirst and significant weight loss. If insulin deficiency is severe, usage of fat as metabolic fuel may result in diabetic ketoacidosis which is characterized by excessive production of ketones and electrolyte disturbances.
In T2D, the insulin levels may be normal, elevated or depressed. However, they are inadequate to overcome insulin resistance. As a result, hyperglycemia occurs. Before the individual develop DM, there is a compensatory increase in insulin secretion, which maintains normal glucose concentrations; but as the disease progresses, insulin production decreases gradually. As insulin secretion decreases, hepatic glucose production increases, causing the increase in fasting blood glucose level. Insulin resistance also affects the adipocyte level by stimulating lipolysis and increase free fatty acid (FFA) in blood circulation. When FFA increases, insulin sensitivity will be further decrease at the cellular level. Besides, pancreatic insulin secretion will be impaired and lipotoxicity will occur (Bergman and Adler, 2000).
There are many ways to prevent and treat DM. One of the interventions is by stabilizing blood sugar levels through consumption of low glycemic index (GI) diet. According to Jay Udani, 2007, this may lower the risk of diabetes by 25-30%. There are studies shown that by consuming a low GI diet, the risk of becoming diabetic can be reduced by 37%. Besides, low GI diets have also been found to increase insulin sensitivity by 50%.
Next, we can also prevent becoming diabetic by decreasing inflammation. Chronic low-level inï¬‚ammation plays a role in insulin resistance, glucose intolerance and T2D. In humans, the glucose tolerance seems to improved with the uses of statin or thiazolidinedione due to their anti-inï¬‚ammatory properties (Bastard JP, et al. 2006). There are many anti inï¬‚ammatory nutraceuticals. The popular and commonly used is ï¬sh oil. Besides, evening primrose oil and borage oil are also used to control inï¬‚ammation. In addition, anti-inï¬‚ammatory herbs/supplements such as boswellia, bromelain, ginger, prickly pear cactus, quercetin and turmeric can be use to decrease inflammation in our body too (Jay Udani, 2007). Moreover, peroxisome proliferator-activated receptors (PPARs) are found to have the ability to help in controlling lipid and glucose metabolism and inï¬‚ammation. PPAR-gamma agonists are commonly used in the treatment of T2D, as it increase the sensitivity of insulin receptors and have anti-inï¬‚ammatory effects on the liver, adipose and vascular tissues. Furthermore, they also raise adiponectin levels by three times. Natural substances like punica grantum ï¬‚ower, banaba water leaf extract, Korean red ginseng, mulberry leaf extract, bitter melon seed oil, turmeric and conjugated linoleic acid act as PPAR-gamma agonists (Jay Udani, 2007)
Besides, to prevent T2D, oxidative stress in our body must be reduced as it can lead to production of free radicals which then increase oxidative damage of various tissues and organs due to the accumulation of lipid peroxides and advanced glycosylation end-products, chronic inï¬‚ammation, insulin resistance and abnormal changes in intracellular signaling in DM. On the other hand, supplementation with antioxidants has been shown to give some beneï¬ts in diabetes. Hence, antioxidants such as vitamin E, alpha-lipoic acid and N-acetylcysteine should be consume more to improve insulin sensitivity, protect pancreas from oxidative stress and preserve the ability of the islet cells to secrete insulin.
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In addition, dietary fat plays an important role in DM. The risk of developing DM can be lowered by consuming some foods includes nuts peanut butter and whole grains. Besides, polyunsaturated fats and vegetable fats also reduced DM risk, while saturated fats and processed meats increased it. A study of 910 people followed for 8 years found that drinking caffeinated coffee decreased the risk of T2D by an amazing 60% in people with or without impaired glucose tolerance (Smith B, et al, 2006). Moreover, reducing alcoholic drinks per day seems to reduce DM by 40% meanwhile if a person takes more than 2 drinks per day may triple the risk (Wei M, et al, 2000). Besides, physical activities are vital in preventing and treating DM. In T1D, weight gain is undesirable because increase in weight has the potential to adversely affect lipids and blood pressure in T1D patient. Hence, T1D patient have to maintain their energy intake with the output of energy by doing some physical activities. Meanwhile, weight loss is beneficial in person with T2D. Physical activities can improves insulin sensitivity, lower blood glucose in persons with T2D and also improve cardiovascular health.
On the market, there are many types of drugs and supplements that can be used to help prevent and treat diabetes, but there is still a need to consider the safety of using the drugs. Recently, there are many studies that found out some of the natural substances that have anti-diabetes action. Many nutraceuticals have demonstrated significant potential in preventing DM and should be considered as first option for the prevention or treatment of DM.
In addition, there are also many research works on the use of nutraceuticals for prevention of DM that have been done. One of the research works is on the effects of low levels (1-6 g per day) of cinnamon on the reduction of glucose, triglyceride, LDL cholesterol and total cholesterol levels in subjects with T2D done by Khan, A. and his colleagues (2003). In this research, they found that the extracts of cinnamon activate glycogen synthase, increase glucose uptake, inhibited glycogen synthase kinase-3, activate insulin receptor kinase and inhibit dephosphorylation of the insulin receptor which then leads to rise in insulin sensitivity. From this research also, they have shown that extracts of cinnamon also function as potent antioxidants, which would lead to additional health benefits of this substance. As conclusion, cinnamon reduced serum glucose, triglyceride, total cholesterol, and LDL cholesterol levels in people with T2D. Furthermore, cinnamon may be useful to prevent and control elevated glucose and blood lipid levels in normal population.
The next research work was done by Lopez-Ridaura R, Willett WC, Rimm EB, et al (2004) on magnesium intake and the risk of T2D in men and women. This study has shown that by consuming adequate of magnesium which is essential to glucose metabolism may help to prevent the onset of DM and complications. In an 18-year follow-up study of 128,000 people with no DM, cardiovascular diseases, or cancer at baseline, they found that those with the highest intakes of dietary magnesium were about 30% less likely to develop DM than those with lower intakes. The major food sources of magnesium like whole grains, nuts, and green leafy vegetables should be consumed more to increase one's magnesium intake. The mineral may also beneï¬t pre-diabetic patients, with studies showing that those with higher blood levels of magnesium are less likely to go on to develop of DM.
In a conclusion, there are many types of medications and interventions that can prevent and treat DM. However, prevention is better than cure. Hence, we must maintain balance diet and live a healthy lifestyle to lower the risk of getting T2D and other diseases.