Rethinking Diabetes

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Examples of such interventions include metabolites as diverse as sex hormones like testosterone and oestrogen, neurotransmitters like dopamine and serotonin, hormones like melatonin, ghrelin and growth hormone, and even behaviours like aggression! Both the states are reinforced and stabilized by several mechanisms.

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The emergence of bistability in such a system has far-reaching consequences to our understanding of diabetes. What this means is that an insulin-resistance state of the body — long thought to be the underlying cause of diabetes — is actually not a disease state, but instead an evolutionary adaptation acquired under some environmental circumstances, which have now become obsolete or detrimental. The very fact that diabetes at its core could be an evolutionary adaptation can fundamentally change our outlook towards its treatment and even its prevention. On the other hand, the transition could be achieved easily by targeting the desired levels of dopamine, testosterone, aggressive behaviour and the likes in isolation, or even more effectively, when used in combinations.

When enquired about the possibility that rigorous control of blood glucose levels in diabetics was not significantly improving the lives of these patients, Dr.

Rethinking diabetes care in Canada

If the findings of Prof. The focus could then soon shift from just regulating insulin and glucose levels, towards a more holistic approach of nudging the body from an insulin resistant state to an insulin sensitive state. Not only would this open up more unconventional and better ways to combat diabetes, but also help remove the unnecessary stigma attached with the dietary and lifestyle restrictions that most diabetics face. When asked about how the medical community is going to react to these findings, Prof. Sharada on the other hand felt that it would take a very long time to change our views in India.

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We have our own set of mythologies -- perhaps not more wrong than the "scientific" western ones -- but there is a serious deficit in modern concepts such as the idea of counting calories as opposed to sweetness, irrational beliefs in panaceas and nostrums, severe ignorance of calorific values of foods even among doctors, popularity of unproven Ayurvedic and Unani management, among others.

Watve however remained optimistic about the future: Xu Y et al. Prevalence and Control of Diabetes in Chinese Adults.

Rethinking Diabetes

Diabetes Res Clin Pract, What would such a bottom-up strategy entail? We should ensure that diabetic patients become intimately familiar not only with the traditional tenets of diabetes education e.

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There is no reason that patients cannot be knowledgeable enough to ask their physicians if they should be taking acetylsalicylic acid or an angiotensin-converting enzyme inhibitor or a statin or to ask about — and be engaged in discussions regarding — the implications of abnormal clinical parameters such as impaired g monofilament sensory awareness. That the guidelines are available on-line 3 is helpful, but because they are written for a professional audience, many people with diabetes are unlikely to use them.

So how about an online lay version of the guidelines? Why not encourage pharmacists to distribute CDA-designed information sheets instead of noncontextual and at times alarmist lists of potential adverse drug effects?

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Or even enclose a monofilament and instruction sheet with every new prescription for an oral hypoglycemic agent? I believe that Canada could be at the forefront of a change to bottom-up diabetes management in the same way that we have been and continue to be at the forefront of diabetes research.

And I believe that such a change will create a better informed, more engaged and, ultimately, healthier diabetes patient population. National Center for Biotechnology Information , U.

Author information Copyright and License information Disclaimer. Ian Blumer Internist Ajax, Ont.