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Glycemic Issues and Autoimmunity

Is hypoglycemia and/or hyperglycemia an autoimmune condition?

One of the fascinating features of your immune system is its capacity to recognize and neutralize the millions of foreign antigens that cross your path each day.  If it didn’t have this ability, your immune system couldn’t insulate you from your hostile environment.  Unfortunately, when this process malfunctions, your own tissues—and their metabolic products—become “the enemy.”  This is the situation that exists in type 1 diabetes, which is characterized by autoimmune destruction of the insulin-producing cells in your pancreas, and in insulin autoimmune syndrome (IAS), where it is insulin itself that is destroyed by circulating autoantibodies.  While type 1 diabetes manifests as hyperglycemia, IAS often leads to bouts of severe hypoglycemia.  Thus, while autoimmunity isn’t the only cause of glycemic imbalance, it can be the driving force behind hypoglycemia, or hyperglycemia in specific situations.

Are there studies that show how often glycemic issues lead to type 1 diabetes?

There are plenty of anecdotal reports of individuals who experienced hypoglycemic episodes before they were diagnosed with type 1 diabetes.  However, no epidemiologic studies have been conducted to show how often this occurs, so it is not clear if there’s a consistent link between pre-existing hypoglycemia and type 1 diabetes.  And, since type 1 diabetes typically develops abruptly in previously healthy people, it’s unlikely the disease is preceded by extended periods of asymptomatic hyperglycemia.  Interestingly, though, a study published in the September 2010 issue of Diabetes Care revealed that approximately 10% of adolescents with type 2 diabetes (a disorder that typically is heralded by a period of hyperglycemia) produce antibodies against their own pancreatic islet cells.  Similarly, a small number of adults with a syndrome that behaves like type 2 diabetes—latent autoimmune diabetes in adults, or LADA—possess autoantibodies that are usually only detected in type 1 diabetics.  So, just as type 1 diabetes is an autoimmune disease, some type 2 diabetics exhibit autoimmune features, as well.

Is hyper/hypoglycemia considered pre-diabetes?

There’s no question that hyperglycemia (more specifically, glucose intolerance) presages type 2 diabetes, so in this situation it could be called “pre-diabetes.”  However, type 1 diabetics typically don’t become hyperglycemic until the disease strikes.  Hypoglycemia can’t always be considered pre-diabetes, either, since it doesn’t consistently precede the onset of either type 2 diabetes or autoimmune diabetes (type 1 or LADA), and it occurs in people who never develop diabetes.

What are the treatment options for glycemic issues aside from diet?

Primary hypoglycemia – low blood sugars that aren’t caused by an underlying medical disorder (insulinoma, pheochromocytoma, etc.) or by taking insulin or other diabetes medications – is typically managed through dietary measures: frequent, small meals; avoidance of sugars and simple carbohydrates (except during hypoglycemic episodes); and limiting alcohol consumption.

Hyperglycemia due to glucose intolerance is best managed with weight loss, avoidance of simple carbohydrates, and regular exercise (muscular activity increases insulin sensitivity and lowers blood glucose levels).  When hyperglycemia exceeds the diagnostic threshold for diabetes, medications are added to lifestyle measures.

The most straightforward way to improve carbohydrate digestion is with a digestive enzyme supplement.  Although a number of enzymes are involved in digesting carbohydrates in the human intestine (amylase, lactase, sucrase [invertase], maltase, and isomaltase), most OTC digestive enzymes contain only amylase.   Once sugars are absorbed into the bloodstream, cinnamon, chromium picolinate, zinc, and vanadium may improve its metabolism by enhancing the effects of insulin.

In order to prevent sugars from being absorbed into your bloodstream in the first place, there are a number of products that ostensibly perform this miracle; most are based on glucomannan, a water-soluble plant-based polysaccharide (konjac is a popular source) that binds to sugars and carries them through the gut.  Glucomannan may also increase satiety and therefore reduce sugar cravings.

Questions for your doctor:

  • Do I have any risk factors for diabetes?
  • If I’m at risk for diabetes, when (and how) should I get screened?
  • Does my autoimmune condition or the medications I’m taking increase my risk for glucose intolerance and/or diabetes?

References
GJ Klingensmith, et al. The presence of GAD and IA-2 antibodies in youth with a type 2 diabetes phenotype: results from the TODAY study. Diabetes Care. 2010;33(9):1970-1975
P Patel, A Macerollo. Diabetes mellitus: diagnosis and screening. Am Fam Phys. 2010;81(7):863-870
BC Lupsa, et al. Autoimmune forms of hypoglycemia.  Medicine. 2009;88(3):141-153

 

About the Author
Steve Christensen, MD – “Doom” to his close friends – was trained at the University of Utah School of Medicine. Since his premature retirement from medicine in 2003, Dr. Christensen has expanded his knowledge of alternative medicine: he is a certified herbalist; he has dabbled at the edges of Ayurvedism, shared ideas with Chinese physicians, rubbed shoulders with Native American healers and contemplated the healing powers of channeled energy.

 

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