Diabetes: Clinical Approaches

With Allan E. Sosin, M.D.
Author of The Doctor's Guide to Diabetes and your Child

What is the most common mistake that you believe is made in treating diabetic patients?

Starting them on medication without first making lifestyle changes. If the medication is initially effective in controlling the blood sugar, the patient may not implement essential lifestyle changes to prevent future problems. Elevated blood sugar is only a single factor in a combination of problems that have come to be known as Metabolic Syndrome. Patients are subject not only to developing diabetes mellitus, but serious cardiovascular complications such as heart attacks and strokes. Management must not involve simply trying to lower the blood sugar, but also improving the many lifestyle factors that contribute to disease. Major changes are necessary in eating habits, exercise, stress reduction, and especially in understanding of the effect of food on health. Nutritional supplements also have great value in support of the diabetic patient, both by improving blood sugar control and by reducing end organ damage and preserving function of the kidneys, eyes, nervous and cardiovascular systems.

People should be aware of the fact that the benefit of medication on blood sugar control is often temporary. Over time, the medication becomes less effective as the individual sinks deeper into insulin resistance and overweight. Additional medications become necessary with their myriad side effects and ultimate ineffectiveness. Some of the diabetes medications actually result in weight gain, serving to worsen the overall problem. I rarely start a diabetic patient on medication during the first visit. I believe it is important for patients to appreciate the changes that can occur with lifestyle change and the initiation of nutritional supplements to enhance insulin effect.

The American Diabetic Association considers glycemic index as relatively unimportant in the selection of food for diabetics. Do you agree?

The glycemic index has great importance in choosing the proper diet. It does not however provide the only valuable guideline. High glycemic index foods should usually be avoided because they make blood sugar control more difficult, raise cholesterol and triglycerides, and increase weight. Not all high glycemic foods are forbidden. I think, for instance, that carrots provide great nutritional benefits and may be included in the diabetic diet if they are combined with other foods having a lower glycemic index. The nutrient content of foods is also an important factor, as is fiber content.

Do you wean type 2 diabetics off medication? If so, how and when?

Yes. In taking a type 2 diabetic off medication, the blood sugar should be closely followed. Medication may gradually be reduced, provided the blood sugar does not rise excessively. I have seen many individuals reduce medications or eliminate them entirely while keeping the blood sugar in the normal range. When lifestyle changes in diet, exercise and nutritional supplementation are rapidly made, it is important to reduce the dosage of medication early. Otherwise the patient may be at risk of hypoglycemia, particularly if sulfonylurea drugs are used.

Dr. Sosin is the Director of The Institute for Progressive Medicine in Irvine, California. He was previously the Medical Director of the Whitaker Wellness Institute in Newport Beach.

Reprinted with permission from THE STANDARD