World Diabetes Day is recognised in November. This year, paying attention to this disease is more important than ever, as diabetes has become a major risk factor in COVID-19 fatalities. As with everything, knowledge is power, so we have asked our doctors to help us understand the disease and its treatment.

What are the different types of diabetes?

WHAT IS TYPE 1 DIABETES?

Type 1 diabetes occurs when our own body cells attack our pancreas. This results in our pancreas not being able to produce insulin. Insulin is a hormone that is usually secreted by the pancreas the moment we start eating food to instruct our glucose receptors (found on the cell membrane) that they need to expect the smallest units of energy (glucose/sugar) to be arriving soon with the swallowing of the chewed food. The glucose receptors need to use the energy coming in, as only a little bit can be stored as glycogen in the liver. As humans, we cannot store sugar, and we need to get rid of it. If no insulin can be produced by the pancreas due to the auto-immune attack on it, then no message is sent to the glucose receptors, and the glucose levels start to climb in the body.

Signs and Symptoms of Type 1 Diabetes Mellitus

• Increased hunger
• Unexplained weight loss
• Increased thirst and urination
• Elevated heart rate (palpitations) and increased perspiration
• Blurred vision
• Unexplained headache
• Extreme fatigue/weakness
• Irritability
• Nausea

WHAT IS INSULIN RESISTANCE?

Insulin resistance is a term that is used when the following situation occurs: the pancreas releases insulin as soon as we start to eat food to:

• instruct the glucose receptors to use that food as a source of energy for now
• to store a little in the liver as glycogen for later
• to get rid of the rest (as humans cannot store sugar). 

But the glucose receptors (found on the cell membrane) are like naughty children with their fingers in their ears, and they do not listen to the message that the pancreas is sending them via the insulin. Since the glucose receptors did not respond to the initial message sent by the pancreas (the insulin secretion), the pancreas again ‘shouts’ out the message by secreting more insulin. This is known as insulin resistance. When the glucose receptors continue to ignore the message from the pancreas via the insulin secretion, eventually the pancreas will become ‘hoarse’ and no longer secrete any insulin. When this occurs, the glucose levels will start to rise in the blood and may result in Type 2 diabetes if the insulin resistance is not attended to.

Signs and Symptoms of Insulin Resistance

• Central abdominal weight gain
• Menstruation irregularities in females
• Skin tags
• Changes to facial hair growth
• Waist circumference over 80cm

WHAT IS TYPE 2 DIABETES?

Type 2 diabetes occurs as a result of insulin resistance that is not treated. Eventually, the pancreas burns itself out by constantly releasing insulin to alert the glucose receptors to take up the glucose in the blood. When this happens and the pancreas can longer secrete insulin, the glucose levels start to rise, and you land up with type 2 diabetes. Type 2 diabetes can be prevented by addressing the insulin resistance via lifestyle changes as well as specific medications that assist the glucose receptors in being more ‘sensitive’ to the insulin’s message. Lifestyle changes include avoiding carbohydrates (especially medium and high glycaemic index carbohydrates) and increasing exercise significantly.

Signs and Symptoms of Type 2 Diabetes Mellitus

• Unexplained weight loss or weight gain
• Increased hunger
• Increased thirst and urination
• Blurred vision
• Unexplained headache
• Fatigue
• Irritability
• Poor wound healing
• Recurrent infections

An Interview with Dr Ayal Peretz

An interview with Dr Ayal Peretz by Dr Hannah Norton

HN: Population statistics indicate that 463 million adults and 1.1 million adolescents worldwide are currently living with diabetes today. In honour of World Diabetes Awareness Day, we have Dr Ayal Peretz with us here today to take us through some important aspects of the condition.

Dr Peretz, would you be able to take us through the difference between type 1 and type 2 diabetes?

AP: Type 1 diabetes is actually an autoimmune disease where your body attacks the cells within the pancreas that produce insulin. So what happens is your body can no longer produce enough insulin for the amount of glucose that you consume. So the glucose and the sugar is unable to enter the cells, particularly the liver and the muscle cells, because of the lack of insulin. With type 2 diabetes, the muscle cells and the liver cells actually become insulin resistant. So they’re not as sensitive to insulin any more, which means you need more insulin for the same amount of glucose to enter the cell. 

HN: What sort of symptoms might a patient with type 2 diabetes present?

AP:  Some of the symptoms that they would start to present with is weight loss, or sometimes weight gain well. Hunger, fatigue, extreme thirst and increased urination. 

HN: Because it’s the predominant condition in South Africa, could you take us through how a homeopathic doctor would go about diagnosing the condition of type 2 diabetes? 

AP: if a homeopathic doctor suspects that a patient may be suffering from type 2 diabetes, in the room, we may do a glucose test with the glucometer, which is just a prick on the finger. We can also do a urine dipstick test to measure the glucose in the urine. When you have diabetes, you urinate more glucose because there’s more glucose in the blood. Then, if we want to take the test further, we can send the patient to the lab and we can get them to do a fasting glucose and fasting insulin test. And then if we want to, we can also send them for a glucose tolerance test.

HN: And from the homeopathic viewpoint, what nutritional and lifestyle factors can an individual living with the condition address to assist their state of health?

AP: That’s a good question. When you look at diabetes, the biggest risk factor for diabetes is actually obesity. And the reason for this is that insulin resistance is actually caused by fat infiltration into muscle cells. We also call it intramyocellular lipids. So we want to do is we want to decrease the fat in our diets and increase the whole, healthy foods. The reason why fat is bad is that when fat gets into the cells, it ‘gums up’ the mechanism that insulin uses to allow glucose into the cell, and then that makes the cell insulin resistant. So the less fat we take in, the better, particularly saturated fats. 

To add on to the issues with saturated fat is that saturated fat and cholesterol have actually been found to destroy the cells in the pancreas that produce insulin. So not only is it causing insulin resistance, but it’s also causing us to produce less insulin to be able to open up that lock in the cell, to let glucose in.

What we can also do to decrease fats and increase insulin sensitivity is exercise. Exercise has been shown to not only decrease the fat, but increase the sensitivity of the cell to insulin. 

So what is recommended is actually to go onto a whole foods diet – get rid of all the processed food, the high sugary food, the high-fat food, particularly the foods high in saturated fat and cholesterol. Get on an exercise program and decrease stress as well, because stress definitely does play a role in insulin resistance and diabetes. 

HN: And from the homoeopathic viewpoint, we understand that treatment is individualised, but are there any predominant remedies which show an application in the treatment of diabetes?

AP: Like you said, homoeopathy is extremely individualised. Two people with diabetes will most likely get two different remedies depending on their symptoms because everyone seems to experience diabetes symptoms very differently. Some people may suffer from thirst more than hunger; other people experience hunger and fatigue more than anything else. So to go into specific remedies is difficult. But what homeopaths often do is to use homeopathic tinctures in conjunction with homeopathic remedies, two of these being Syzygium and Gymnema which have been shown to increase insulin sensitivity, decrease blood glucose levels and actually decrease cholesterol as well.

HN: Thank you so much, Doctor Peretz, for your valuable input and your time here today. To those viewers out there who may be considering a homoeopathic approach to the management of the condition, I’m going to encourage you to navigate to the practitioner search engine at the Homeopathic Association of South Africa’s website today to locate a practitioner near you: https://homeopathy.org.za/search. 

We wish you very well on your health journey with homeopathy, the wellness profession.

[WATCH] The full interview on our YouTube channel.

Visit our website to find a homeopath near you: https://homeopathy.org.za/search.