Diabetes

General information

Diabetes is a group of conditions in which sugar levels in the blood are abnormally high. During digestion the body converts sugars, starches and other carbohydrates into glucose which is carried in the bloodstream to cells throughout the body. Glucose is then used for energy release or stored for later use. The hormone insulin, which is manufactured in the beta cells of the pancreas, is necessary for this process and therefore for the control of blood sugar levels. Diabetes can occur when the body attacks and destroys the cells in the pancreas that produce insulin or when the body is unable to use the insulin the pancreas produces. Sugar then collects in the blood and in the urine. Fat metabolism is also disturbed in diabetes, with high blood levels of cholesterol and triglycerides. As many as 120 million people worldwide have diabetes and the World Health Organization estimates that by the year 2025 this number will rise to 250 million.

Types of diabetes

Type I (insulin-dependent diabetes)

Type I diabetes accounts for around 5 to 10 per cent of cases and is most often seen in children and young adults. It occurs when the body attacks and destroys the cells in the pancreas that make insulin. Insulin production either stops altogether or only a tiny amount is made. Type I diabetes begins suddenly and symptoms quickly become severe. It is treated with insulin injections, regular exercise and a diet low in sugar and fat. Control of Type I diabetes requires a person to balance the intake of food and the entry of insulin into the blood.

Type II (non-insulin-dependent diabetes)

This type of diabetes, which accounts for around 90 per cent of cases, is also known as maturity onset diabetes and occurs most often in adults aged over 40, especially in those who are obese. In Type II diabetes the pancreas produces some insulin but it is not used effectively. The progression of the disease is slow and symptoms are mild in the beginning. Type II diabetes can often be controlled by diet and exercise, which can improve a person's blood glucose response. Overweight people may need to slim down and some people may need medication or insulin injections to control blood sugar.

Other types of diabetes

There are other kinds of diabetes, such as gestational diabetes, which occurs in around 2 to 3 per cent of pregnant women and usually disappears after the birth of the baby. Such women are at increased risk of developing Type II diabetes later in life. Secondary diabetes is caused by damage to the pancreas from chemicals, certain medicines, or diseases such as cancer.

Symptoms of diabetes

Symptoms of Type I diabetes, which usually occur suddenly, include frequent urination, excessive thirst, extreme hunger, dramatic weight loss, weakness, fatigue, blurred vision, nausea and vomiting. The symptoms of Type II diabetes usually occur less suddenly and include any of the above Type I symptoms and others such as recurring skin, gum or bladder infections; drowsiness; blurred vision; itching and tingling; or numbness in the hands and feet.

Causes of diabetes

The exact causes of both types of diabetes are still unknown and there may be several factors that play a part, although how important each factor is remains unclear. In Type I diabetes, the body's immune system attacks the beta cells of the pancreas and it is likely that genetic factors play a role in this. It is also possible that a viral infection that causes the immune system to destroy pancreatic cells instead of the virus may be involved. Cow milk in the first few months of life may increase the risk of developing Type I diabetes, possibly due to the immune system recognizing the similarity between a protein in milk and a protein on the surface of the bod beta cells.

Those who are overweight, do not exercise, eat a poor diet, suffer from hypertension, have high cholesterol and triglyceride levels, are aged over 40, and who have a family history of diabetes, are at particular risk of Type II diabetes. In this disorder the pancreas may produce enough insulin, but excess fat may prevent the insulin from working properly. This is known as insulin resistance and is often reversible with weight loss. Women with unexplained miscarriages, stillbirths, or who have had babies weighing nine pounds or more at birth also seem to be at increased risk of Type II diabetes.

Diet also influences the development of diabetes. Recent research suggests that those who eat an Asian diet have less risk of developing Type II diabetes. In a 1996 study, Japanese American men in Hawaii who had a more Japanese lifestyle with a higher carbohydrate, lower fat, less animal protein-based diet had a lower risk of diabetes than Japanese American men who had a Western lifestyle. A 1997 study published in the Journal of the American Medical Association showed that women who ate diets low in cereal fiber and high in foods which cause sharp rises in blood sugar are at increased risk of Type II diabetes. Similar results have been seen in men. Exercise also appears to decrease the risk of Type II diabetes.

Managing diabetes

Diabetes is a manageable condition, and with proper care, most people can live as they did before developing the disease. Successful management involves following a daily routine, which may include monitoring blood sugar levels, taking insulin or other medications, following a healthy diet and exercising regularly. Diabetics must avoid hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) as both can lead to coma if left untreated. Many experts now believe that keeping blood sugar levels tightly controlled can help prevent complications. Monitoring metabolic parameters including blood glucose, glycated hemoglobin, lipids, blood pressure and body weight is crucial to ensuring good control of the disease.

Diabetic complications

Diabetics are at increased risk of developing certain disorders such as heart, eye and kidney diseases; foot infections; and stroke. Increasing evidence suggests that many of these disorders arise as a result of oxidative damage to tissues. In diabetes, there may be an overproduction of free radicals and decreased efficiency of antioxidant defenses. Studies have shown lower levels of antioxidant vitamins and minerals in diabetic patients, especially those with complications.

Diabetics are at increased risk of cardiovascular disease as they have higher levels of harmful LDL cholesterol, which is more easily oxidized than other forms. The rate of this oxidation also appears to be higher in diabetics. This combination increases the risk of damage to arteries.

There are other compounds and processes that lead to diabetic complications. When glucose is metabolized, one of the compounds formed is sorbitol, which in nondiabetics is then converted to fructose and excreted. However, in diabetics, who often have high blood sugar, sorbitol accumulates and may lead to complications. Prolonged periods of high blood sugar cause glucose molecules to become attached to proteins, causing changes in structure and function. This is known as glycation. Proteins commonly affected include those in red blood cells, the lens of the eye and the myelin sheath that surrounds nerve cells. Vitamins and minerals play an important part in protecting against these alterations in metabolism.

Dr. Li Lei M.D. M.Sc.

Rationale and background:

Diabetes mellitus is a chronic disease and a world wide public health problem. There were approximately 110 millions diabetic patients worldwide in 1994, and this number is expected to double to 221 million by 2010 (1). WHO's diabetes programme of the Division of Noncommunicable Diseases (NCD/DIA) recent estimates predict that if the current trend continues, the number of people with diabetes will more than double from 140 million to 300 millions in the next 25 years. Diabetes type 2 constitutes 97% of all diabetic cases.

Diabetic complications:
Long term high blood sugar level causes 90% of the patient 's vascular damage, which leads to multiple disorders in the body.
1. Macrovascular:
Heart: Coronary artery disease, coronary vascular disease, and heart failure.
Brain: Cerebral vascular disease, stroke.
Peripheral vascular disease:
2. Microvascular:
Eye: Retinopathy, vitreous hemorrhage, and blindness
Kidney: Nephropathy (more than 40%of all patients will develop : Microalbuminuria, overt proteinuria and renal failure)
Neuropathy (peripheral and autonomic)
Liver: lipocatabolic disease (lipoidemia).
Others: hypertension , inflammation( ulcer, dermatitis. etc.) depression and degenerative disease.

Treatment :

In the Current treatment of diabetes, drugs are administered to reduce sugar levels and treat diabetic complications. However, long-term consumption multiple drugs taken will disturb the body's system. Pancreatic function declines year by year, more drugs need to be taken to combat this, and finally the patient becomes dependent on insulin injections for survival. In addition, toxins from the body's metabolism and side effects from the multiple drugs will accumulate in the body, which decreases all the organ's functions, especially those of the kidneys.

Alternative or complementary treatment:
How can we improve pancreatic function in order to produce enough insulin? How can we make blood flow easily to the organs, tissues, and cells? If oxygen and nutrition can be sent to each cell, and at the same time waste and toxins can be removed from cells, this will strengthen the organ's function. How can we deal with multiple disorders using minimal drugs? Using of multiple drugs itself can contribute to further organ (such as kidney) damage. There is a need to find an improved method for managing diabetes, a way to stimulate pancreatic function and assist in managing diabetic complications with minimized drugs. We need to improve the blood circulation, then we have a chance to protect organs, tissues and cells, especially the important organs such as the kidney, liver, heart and brain. We need a way that can combine with minimal routine medication to improve the drugs' response and reduce the toxins: we need a way that can help those patients who can not tolerate drug side effects or who cannot afford expensive drugs.

AIT offers a possible option, a way that is safe, effective, and has few side effects, an easy way to utilize a combined method for taking care of diabetes.Traditional Chinese Medicine(TCM) theory differentiates three stages for diabetes. According to the patient's situation, we can choose the suitable points to treat patients.
1. Certain points to stimulate pancreatic function: U.B-17 (Geshu), etc.
2. Certain points to deal with complications: such as hypertension (LI-11, ST-36,etc.), nephropathy (UB-23, CV-4, SP-6, KID-3), Cardiac disease (CV-17, P-6, BL-15)etc.
3. Stimulating points (on the back, front of body, arms, legs) to improve blood circulation of the whole body ,strengthen and balance whole system function.
4. Improve immune system, clean out toxins of the body.
5. Acupuncture can be effective as the only treatment used, or as the support or adjunct to other medical treatment forms in many medical disorders.
The mechanism of acupuncture: Acupuncture works by stimulating specific points on the body that are related to specific organs and specific problems through meridians. By stimulating those points, blood circulation to the organs is improved. This helps the organs receive proper nutrition, release waste and toxins. Improved nourishment leads to the increased health and strength of the organs' functions. (9)(10)(11)
(A). Each point located on a particular site is able to treat the disorder of this area and of nearby tissues and organs. For example, stimulating UB-17 can improve pancreas function.
(B). The points of the fourteen channels located below the elbow and knee joints are effective not only for local disorders but also for disorders of tissues and organs. For example,stimulating Kid-3 can improve kidney function.
(C). Clinical practice has proved that certain points may bring forth biphasic beneficial regulation on a variety of functional abnormalities of the body. It may induce an increase in low initial values, a decrease of high initial values but does not change intermediate values; for example, the same point( LI-11) can treat either hypertension or hypotension.
(D). Some points show relative specificity, some points have certain effects on defensive and immune reactions of the body. For example, stimulating ST-36 can rise WBC and IgG level.

Antioxidant vitamins

Diabetes is associated with higher levels of oxidized blood fats, which can increase the risk of diabetic complications such as cardiovascular disease. Oxidative stress may be increased because of glucose attachment to proteins. Levels of antioxidants are also lower in diabetics, and this lower level of antioxidant protection is likely to contribute to the development of diabetic complications(5).

Regular consumption of adequate amounts of antioxidant-rich foods, such as fruits and vegetables, is important in the prevention of diabetic complications. Antioxidant supplements may also be beneficial, as the amounts needed to give protection may be higher than those that can easily be obtained from the diet. Multivitamin mixtures with trace elements have been shown to protect diabetic patients against free radical damage(6).

Vitamin C

Vitamin C metabolism is altered in diabetics. The cellular uptake of vitamin C is promoted by insulin and inhibited by high blood sugar; and as diabetics have low insulin levels, they are at greater risk of vitamin C deficiency. Most studies have found people with diabetes to have at least 30 per cent lower vitamin C concentrations than people without the disease. Levels seem to be lower in diabetic people as a result of the disease rather than as a result of poor dietary intake(7). This deficiency can lead to increased capillary permeability, poor wound-healing, increased cholesterol levels, and immunity suppression; which all contribute to diabetic complications.

Several studies suggest that chronic vitamin C administration has beneficial effects on glucose and lipid metabolism in Type II diabetic patients. In a 1995 study, the effect of magnesium and vitamin C supplements on metabolic control was assessed in 56 diabetics. The study involved a 90-day run-in period followed by two 90-day treatment periods, during which the patients each received 600 mg of magnesium and 2 g of vitamin C per day. The results showed that vitamin C supplementation improved glycemic control, fasting blood glucose, cholesterol and triglycerides(8).

Vitamin C supplementation is effective in reducing sorbitol accumulation in the red blood cells of diabetics. In a 58-day study carried out in 1994, researchers investigated the effect of two different doses of vitamin C supplements (100 or 600 mg) on young adults with Type I diabetes. The results showed that within 30 days, vitamin C supplementation at either dose normalized sorbitol levels in those with diabetes(9). Vitamin C may also help to reduce capillary fragility, which also contributes to complications. The ability of the arteries to dilate is impaired in diabetics; Vitamin C supplements improve the response(10). Drugs which are used to reduce sorbitol have many toxic side effects, and vitamin C therapy is beneficial in reducing sorbitol accumulation without the toxicity. Vitamin C has also been shown to reduce the attachment of glucose to proteins, and the damage this causes.

Vitamin E

Vitamin E supplements have been shown to have beneficial effects in diabetics. As an antioxidant, vitamin E reduces damage to cell membranes, improving glucose metabolism and enabling insulin to act more efficiently. It also reduces the attachment of glucose to proteins(11). Vitamin E has also been shown to have beneficial effects on cholesterol levels in diabetics by reducing the susceptibility of LDL to oxidative damage, thus limiting damage to arteries. Vitamin E also reduces blood clotting, another contributory factor to heart disease.

In a study published in 1996, Louisiana researchers examined whether 67 mg (100 IU) per day had any effect on blood lipid oxidation products and blood lipid profiles of 35 diabetic patients over a three-month period. The results showed that vitamin E supplementation significantly lowered lipid peroxidation products and lipid levels in diabetic patients(12).

Vitamin B6 deficiency causes symptoms such as low blood sugar, low insulin levels, degeneration of beta cells and an altered insulin response to sugar. Insulin sensitivity increases when vitamin B6 intake increases in people who are deficient.

Vitamin B12

The vitamin B12 deficiency disease, pernicious anemia, is not uncommon in Type I diabetics. Researchers have studied the effects of vitamin B12 on patients with diabetic nerve disease. Treatment has been shown to improve some of the symptoms.

Chinese herbs :

There are some herbs that can be used to tonify the kidneys, such as celery, Dangui, and Shen Mai
Celery can also strengthen the strenghen spleen and stomach, clear heat, promote diuresis, lower blood pressure. Some herbs can be use to tonify the heart (Dan Shen, Shen Mai), strengthen heart function and improve blood circulation. Some herbs ( Yi Xin Cao, Ba Lan Gan )can be used to tonify the liver by detoxification and a lower lipid level.

As we know, Vitamins play an important role in diabetes. (20)(21)(22)(23)(24)
Can acupuncture be combined with Chinese herbs( Shen Mai, Dan Shen, Da Huang Tan, Dang Gui,etc. )and vitamins to deal with diabetes and its complications?
Acupoint injection with Chinese herbs and vitamin is based on acupuncture, Chinese herbs and vitamins . It means that we use a small dosage of Chinese herbs and vitamins injected into certain meridian acupuncture points to make the stimulation longer and more effective compared with using needles or only taking the herbs and vitamins orally, so the patients will get the both benefit of Acupuncture and drugs ( Chinese herbs and Vitamins ).
In shorts, we choose certain Chinese herbs and vitamins to be directly injected (in small amounts) at those specific acupuncture points which are known to be benefit to the patient suffering from diabetes and its complication. In addition , the acupoint stimulaton by the herbs and vitamims can improve blood circulation which promotes better nutrition to the organs and cleans toxins from the body. We can also select other points to improve pancreatic function, adjust the blood pressure and any other complications whenever it is necessary.

Diabetic nephropathy treated by AIT:

Increasing worldwide rates of diabetes mellitus, combined with the significant micro- and macrovascular complications that accompany the disease, point to a heightened need to develop simple rational strategies to protect end-organ damage, particularly diabetic nephropathy.
Although ACE-inhibitors have played an important role in treating diabetic nephropathy for more than 20 years, renal failure cases continue to increase almost 10 % each year. Furthermore, we also have to consider the side effects and high cost of long term (at least 6 months) treatment . ACE inhibitors can cause hypotension, long term and severe cough, taste disturbance, rash, interruption of the renin-angiotensin system, white blood cell depletion, the elevation of serum creatinine level ( 50% of the patients experienced a 100% increase on creatinine levels ), renal hemodynamic dysfunction and angioedema(12). This is the reason that though use of ACE-inhibitors has been almost the standard treatment for this stage of diabetes for so many years, even so numbers of patients still refuse it because of side effects and high cost. As doctors, what can we do for those patients who have microalbuminuria, but ACE-inhibitors can not help them after suffering diabetes so many years? They are facing a kidney function which declines every year and eventual renal failure . How can we save their kidneys and improve their condition?
Many studies show that the risk factors in diabetes will increase the risk of developing nephropathy (13)(14):
1. Increased urinary albumin excretion rate.
2. Long term poor glycemic control.
3. Long term poor hypertension control.
4. Long term multiple drug use.
5. Hypercholesterolaemia,
Medical therapy available for this condition is very limited. In many cases, patients also suffer from diabetic complications, which increases the need to take multiple drugs. But treatment using drugs can itself cause complications such as kidney damage. When the kidney is impaired or renal function is insufficient, the biological half life of drug will be of longer than the normal duration, therefore drugs used to treat a diabetic nephropathy patient can cause more side effects than usual.
However, Traditional Chinese Medicine (TCM) can provide some other ways dealing with the problem. Instead of total dependence on drugs, TCM is an approach which is more protective of all organs including kidneys, liver, heart, brain, and stomach. Since both TCM and Western medicine have their own advantages and shortcomings, they can possibly be used in a number of combinations to complement the other method's weakness(16) (17).
Acupuncture therapy has a history that spans more than thousands years. It is a very important part of TCM and has been developing continuously from generation to generation. Today it is drawing more attention worldwide. More people study acupuncture and more and more scientific researches showing its cost effectiveness, safety, and ease of use. It is good for long -term diseases or chronic diseases because it has few side effects. Since 1949 , Chinese medical researchers have done a lot of scientific research ( or a number of scientific studies) on Acupuncture and Chinese herbs. Now there are more than 120 countries using this treatment. In 1980, China claimed there were more than100 diseases that could be treated by acupuncture. The 1992book < Handbook on International Acupuncture Moxibustion > which has been approved by the Chinese Acupuncture Association (17), lists 320 kinds of diseases that can be treated by Acupuncture, In 1979, WHO confirmed 43 diseases which can be treated by acupuncture. In 1991 WHO claimed again an index of 57 diseases treatable by acupuncture(18). Moreover, the International Acupuncture Association was set up in 1987 with the full of support WHO, and since that time acupuncture research has moved to international standards.
For NIDDM, the combination with supporting therapy is becoming more and more important to solve the problems of diabetes and its complications, Traditional Chinese Medicine provides a safe and effective method to combine with western medicine to deal with these problems.
Acupoint is the site though which the Qi of the Zang-Fu organ and meridian are transported to the body surface. According to traditional Chinese theory,acupuncture enhances the homeostatic mechanisms of the bodies.
Many studies have been made on the effectiveness of acupuncture alone or oral taking certain Chinese herbs to treat hypertension, diabetes and its complications has been consistently demonstrated.
However, there have been no reports on the use of acupoint injections of herbs and vitamins to treat these kinds of disorder.
Acupuncture has been used successfully to treat common chronic problems such as cerebral palsy, coronary heart disease, hypertension, hyperlipidemia, diabetes, glomerulonephritis, and neuropathy without drug treatment(19)(20)(21)(22)(23). However most of these studies were performed without a strict control, so further clinical study is necessary. Up to now, there are a lot of reports on diabetes and some of the complications, even glomerulonephritis, but still there are no reports on diabetic nephropathy. Whether acupoint injection with Chinese herb-Shen Mai and vitamin C&B can reduce microalbuminuria in type II diabetes for these patients who could not tolerant the side effects of ACE-inhibitors?
Based on the scientific pathophysiological interpretation of diabetic nephropathy being the consequence of insufficiently controlled blood sugar, blood pressure, and blood lipid levels, the intensive taking of drugs and the use of an ACE -inhibitor should cure the disease and accordingly reduce renal failure rate. However the renal failure rate in the world is increasing by 10% every year, so when the intensive method and ACE-inhibitors fail to meet this aim, one may ask whether this scientific interpretation represents the full picture of diabetic nephropathy. In addition, patients are getting bored of taking more and more medications, while the disease is getting more and more severe (or complicated). ACE-inhibitor, as a standard treatment, still can not be accepted by a lot of patients because of the high cost of the drug and side effects, such as consistent cough or others. How can we help the patients? With this in mind, two major questions may be important in evaluating the effects of Acupoint injections with Chinese herb-Shen Mai and vitamin C&B on diabetic nephropathy:
1. A scientific question:
Does Acupoint injections with Chinese herb-Shen Mai and vitamin C&B have a biological effect to reduce microalbuminuria and improve diabetes management (reduce HbA1c level) by stimulating the certain special Acupoints?
2. A clinical question:
Does Acupoint injections with Chinese herb-Shen Mai and vitamin C&B help patients in their daily life?
In terms of clinical improvement, drug taking reduction, quality of life, the annual number of in-hospital days, cost-effective analysis and even the incidence of renal failure rate in both groups should be assessed. However, many years follow up will be needed to answer this question completely.
In this study, the first and second questions will be focused on for 3-6 months, and further study will be done in the future.
I would like to address the challenges that may occur when studying the effect of Acupoint injections with Chinese herb-Shen Mai and vitamin C&B on the diabetic microalbuminuria both from a scientific point of view and from the patient's point of view.

For more detail about this topic, please read: Diabetes

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