Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization (WHO) when the current taxonomy was introduced in 1999.
Diabetes experts feel that these blood glucose monitoring devices give patients a significant amount of independence to manage their disease process; and they are a great tool for education as well. It is also important to remember that these devices can be used intermittently with fingerstick measurements. For example, a well-controlled patient with diabetes can rely on fingerstick glucose checks a few times a day and do well. If they become ill, if they decide to embark on a new exercise regimen, if they change their diet and so on, they can use the sensor to supplement their fingerstick regimen, providing more information on how they are responding to new lifestyle changes or stressors. This kind of system takes us one step closer to closing the loop, and to the development of an artificial pancreas that senses insulin requirements based on glucose levels and the body's needs and releases insulin accordingly - the ultimate goal.
Certain drugs that affect the brain can help to control chronic pain. Antidepressants in the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), which include duloxetine (Cymbalta), are often prescribed for pain. So are tricyclic antidepressants (TCAs) such as amitriptyline (Elavil). SSRIs often boost energy, while TCAs can make you sleepy. According to the Harvard Medical School website, “Some physicians prescribe an SSRI during the day and amitriptyline at bedtime for pain patients.”
Electrical stimulation can sometimes block pain signals from traveling up the nerves. The most commonly used system is called TENS, which stands for transcutaneous electrical nerve stimulation. TENS works by sending electrical pulses across the surface of the skin into the nerves. The stimulating pulses help prevent pain signals from reaching the brain. They also help stimulate your body to produce higher levels of its own natural painkillers, called endorphins.
“A significant cost is the association of wellness with money—thinking you need something external, tinctures and potions and balms. Its, you know, it’s the stuff that’s here,” said the Zen priest Angel Kyodo Williams, the second of only four black women recognized as teachers in the Japanese Zen lineage, during a talk in the latter wing as she gestured in the direction of the expo. “And there’s nothing wrong with those things, but we have a psychic connection that wellness equals something I can purchase, something I’m in competition for, something that I have to acquire because it’s not intrinsic to me.”
Diabetes is an illness related to elevated blood sugar levels. When you stop releasing and responding to normal amounts of insulin after eating foods with carbohydrates, sugar and fats, you have diabetes. Insulin, a hormone that’s broken down and transported to cells to be used as energy, is released by the pancreas to help with the storage of sugar and fats. But people with diabetes don’t respond to insulin properly, which causes high blood sugar levels and diabetes symptoms.
Some research, however, suggests a more drastic dietary change. A 2017 literature review concluded that “whole-foods, plant-based diet—legumes, whole grains, fruits, vegetables, and nuts, with limited or no intake of refined foods and animal products—are highly beneficial for preventing and treating type 2 diabetes.” A 2018 study found that overweight people who switched to a vegan diet for 16 weeks showed improvements in insulin sensitivity compared to a control group.
A 2017 article in the journal Diabetes Care explains that the goals for dietary change should be “healthful eating patterns emphasizing a variety of nutrient-dense foods in appropriate portion sizes.” Additional goals include achieving a healthy weight; attaining healthy blood sugar, blood pressure, and lipid levels; and reducing complications. The authors emphasize developing an individualized plan based on “personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness and ability to make behavioral changes, and barriers to change.”
Type 2 DM is primarily due to lifestyle factors and genetics. A number of lifestyle factors are known to be important to the development of type 2 DM, including obesity (defined by a body mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization. Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders. Even those who are not obese often have a high waist–hip ratio.
Joyce Lashof, then the dean of Berkeley’s School of Public Health, remembers that wellness was initially a tough sell at the school. Not much was known on campus about the earlier work of Travis and his fellow wellness advocates, but Lashof’s colleagues associated the term wellness with the “flakiness” of Mill Valley and surrounding Marin County. The NBC newsman Edwin Newman had televised an exposé of Marin County’s hedonistic lifestyle, which notoriously opened with a woman getting a peacock-feather massage from two nude men. The Berkeley Wellness Letter, however, managed to avoid such unseemly associations by publishing serious, evidence-based articles on health promotion, while debunking many of the holistic health fads of the day.
For now, I manage my diabetes through a combination of technologies. I use a blood test meter to measure my glucose levels at least five times a day. I use a pump that is attached to my abdomen to deliver frequent doses of insulin throughout the day. And now I also use a continuous monitoring device that measures my subcutaneous blood sugar levels to help the insulin pump work more effectively.
Body blasting was just one of the hundreds of classes, sessions, panels, talks, and silent dance parties at the inaugural Wellspring wellness festival. Last month some 2,000 mannequin-shaped people floated into Palm Springs, California, for what advertisements promised to be “a first-of-its-kind wellness festival, that will feature over 200 transformational workshops, treatments, and fitness across multiple categories.” The goal was to “provide seekers the tools to learn and take action in real time for a healthier mind in a relational platform.” (Relational platform was a new term to me, but people seemed less than pleased when I used the word conference.)