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Diabetes

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Managing Diabetes Through Functional Medicine: A Case Study

Diabetes is a chronic condition that affects millions of people around the world, and its prevalence continues to rise. The traditional approach to diabetes management involves the use of medications such as metformin, insulin and sulfonylureas. While these medications can be effective in controlling blood glucose levels, they do not address the underlying causes of the condition. Functional medicine takes a different approach to diabetes management. It focuses on identifying the underlying causes of the condition and using a personalized approach to address those root causes.
How does this work in practice? We are sharing the story of JD who is one of the several patients who benefitted from a functional medicine approach to diabetes.

Patient Background

JD, a 47 year old female, came to me with a history of uncontrolled type 2 diabetes despite being on multiple medications.

Upon initial evaluation, the patient’s fasting blood sugar was 200 mg/dL, her HbA1c was 9.5%, and she reported symptoms of fatigue, frequent urination, and weight gain. She reported a diet high in carbohydrates and processed foods, and low in fiber and healthy fats. She also had a sedentary lifestyle and reported high levels of stress due to her job. Her Medical Symptom Questionnaire score (an evaluation of the frequency and severity of symptoms located on our homepage) was 90, a score of less than 10 is optimal.

First Steps in Our Functional Medicine Approach

Given her complex medical history and the severity of her diabetes, I knew that a multidimensional approach would be necessary to achieve optimal health outcomes. As with any new patient, I began by conducting a thorough assessment of her medical history,, symptoms, examination, laboratory tests, and lifestyle factors including stress and family circumstances that play a role in overall health and well-being. It’s like putting together a puzzle, every piece is valuable. This is why I look closely at each individual’s story.

Root Cause

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In functional medicine, the identification of the root cause is an essential step in understanding the underlying causes of a patient’s health problems. In JD’s case, we used a comprehensive approach to identify several core clinical imbalances that were contributing to her condition. To identify the core clinical imbalances that were contributing to the patient’s diabetes, I recommended a dutch hormonal test, Nutritional test  and comprehensive blood panel,

The first core clinical imbalance that was discovered was insulin resistance (under Communication in the functional medicine matrix). This was identified by conducting a fasting blood glucose test and an oral glucose tolerance test (OGTT). Both tests revealed elevated blood glucose levels, indicating impaired glucose metabolism and insulin resistance. In addition, we also measured the patient’s fasting insulin levels, which were high, further confirming the presence of insulin resistance.

Here are a few reasons how her lifestyle was affecting insulin resistance.

  • The patient reported a diet high in processed foods and refined carbohydrates, which contributed to insulin resistance, inflammation, and oxidative stress. These factors can impair insulin signaling and glucose uptake in the body, leading to high blood sugar levels and the development of diabetes.
  • She also had a sedentary lifestyle. Lack of physical activity can also contribute to insulin resistance and impaired glucose metabolism, leading to higher blood sugar levels and the development of diabetes.
  • Finally, patient’s obesity is a major risk factor for developing type 2 diabetes, as it can lead to chronic inflammation, insulin resistance, and impaired glucose metabolism.

The second core clinical imbalance was adrenal dysfunction (under Communication in the functional medicine matrix). This was identified by conducting a urinary cortisol test, which revealed elevated cortisol levels in afternoon and night time, indicating chronic stress and adrenal dysfunction. Patient’s high-stress job was a contributing factor for this adrenal stress. We now know that Chronic stress can raise cortisol levels and trigger inflammation, which can impair insulin signaling and glucose uptake in the body, leading to higher blood sugar levels and the development of diabetes.

The third core clinical imbalance was micronutrient deficiencies and macronutrient excesses (under Energy in Functional medicine matirx). This was identified by a specialized Nutritional urine test which revealed cellular deficiencies in alpha lipoic acid, magnesium, coq10 and various aminoacids.

Finally, the forth core chronic inflammation (under Defence & Repair in the functional medicine matrix). This was identified by conducting a comprehensive blood test that measured various markers of inflammation, including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha). These tests revealed elevated levels of these markers, indicating chronic inflammation.

Based on these core clinical imbalances, we developed a personalized plan that addressed each of these factors. We used dietary and lifestyle interventions, targeted supplements, and stress hormone management to improve insulin sensitivity, support adrenal function, reduce inflammation and improve nutrient deficiencies and macronutrient excesses.

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Functional Medicine Plan

Our first priority for JD’s personalized plan was to focus on her adrenal stress, insulin resistance and micronutrient deficiencies.

Given the patient’s high-stress job, we worked on nourishing her adrenal glands with the right functional medicine protocol with therapeutic dosages of vitamins, minerals and herbs for improving her cortisol levels which were tested to be high. I started her on an adrenal supportive nutrient rich foods and proper meal timings along with the above supplement plan. We also got her the support of our Mindfulness coach who taught her stress management techniques such as deep breathing, meditation to help her manage her cortisol levels and improve her overall well-being.

I prescribed specific supplements in therapeutic dosages as per her deficiencies in nutritional test such as alpha-lipoic acid, magnesium, and vitamins These supplements have also been shown to improve insulin sensitivity, reduce inflammation, and promote healthy blood sugar levels.

I advised JD to adopt a whole foods-based diet that was low in carbohydrates and high in healthy fats and fiber. I also recommended specific foods that were beneficial for her diabetes, such as leafy green vegetables, berries, nuts, and seeds. I provided her with a customized meal plan and recipes (based on her body composition and calorie requirement) that she could follow to make the dietary changes easier to implement. I also got her the support of our Functional medicine health coach to help her to make these behavioral changes and improve her food habits.

Given her elevated cortisol levels. I recommended her to incorporate moderate-intensity exercise into her daily routine, such as walking, cycling, or swimming along with weight training. I emphasized the importance of regular physical activity for improving insulin sensitivity and blood sugar control.

Medication adjustments: I worked closely with the patient’s endocrinologist to adjust her diabetes medications as needed. We were able to reduce the doses of her medications over time as her blood sugar levels improved.

Results

Over the course of 4 months, the patient followed the treatment plan diligently and began to see significant improvements in her health outcomes. Her fasting blood sugar levels decreased to 130 mg/dL, her HbA1c improved to 5.3%, and she reported feeling more energetic and less fatigued. She also lost 15kgs and reported improved sleep quality and stress levels.

The patient’s success was due to the personalized and holistic approach we took to her care. By addressing her nutrition, exercise, stress, nutrient deficiencies, and supplement needs, we were able to improve her underlying biochemistry and support her body’s natural healing processes. We also worked closely with her patient’s endocrinologist to ensure that her medication regimen was appropriate and effective.

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Summary

In summary, functional medicine approaches diabetes by identifying core clinical imbalances through detailed medical history, examination, comprehensive functional testing, and then developing personalized plans that address these imbalances. WIth this therapeutic partnership between me (practitioner) and the patient, we were able to improve her underlying biochemistry and support her body’s natural healing processes, leading to improved health outcomes and a better quality of life.

This case study highlights the importance of understanding core imbalances and a multidimensional personalized approach to diabetes management and the benefits of functional medicine for optimizing health outcomes.

Dr Menka Gupta

IFMCP, MSc, MBBS

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