Diabetes (4 Types) and Thyroid Health
Published January 15 2018
According to the World Health Organization, the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 (1). The disease especially has a high prevalence in the Western countries, and it has been linked extensively with heart attacks, strokes, high blood pressure, kidney failure, and blindness. For this reason, a lot of research has gone into the disease progression and treatment options available for diabetes. In this article I’m going to discuss four different types of diabetes, along with some of the natural treatment options available. Then towards the end of this article I’ll discuss how each type relates to thyroid health.
Before discussing the different types of diabetes, I’d like to answer the question “why is there an increased prevalence of diabetes?” Although genetics is a factor in the development of the different types of diabetes, the main reason why there has been an increased prevalence is due to poor diet, along with other lifestyle factors. This is especially true with type 2 diabetes, but it is also a factor in the other types of diabetes as well.
Let’s go ahead and look at the different types of diabetes:
Type 1 Diabetes
Type 1 diabetes is an autoimmune condition that involves the immune system attacking the pancreas. Beta cells are destroyed in the pancreas, and these beta cells are responsible for the production of insulin. Insulin is involved in the regulation of blood glucose levels. Consequently, there isn’t a way for glucose in the blood to enter the cells without insulin, resulting in high blood sugar. Adolescents typically develop this type, which is why type 1 diabetes once was referred to as “juvenile diabetes.” However, adults can also develop type 1 diabetes, although many times they actually have type 1.5 diabetes, which I’ll discuss later in this article.
Potential Causes of Type 1 Diabetes
Just as is the case with other autoimmune conditions, genetics plays a role in the development of type 1 diabetes. Some children who are born with a particular genotype variation with a family history of the disease have a 1 in 5 chance of developing this condition (2). Interestingly, more than 85 percent of children who have type 1 diabetes don’t have a family history (2). Just as is the case with Hashimoto’s thyroiditis and Graves’ disease, we can ‘t change the genetics of those with type 1 diabetes, but we can modify diet and lifestyle factors, which can have a huge impact.
In the past I wrote a blog post where I discussed the triad of autoimmunity. This is also known as the 3-legged stool of autoimmunity, and according to this triad, the development of any autoimmune condition requires the following three components: 1) a genetic predisposition, 2) an environmental trigger, and 3) a leaky gut. And while the damage to the beta cells supposedly can’t be reversed, in type 1 diabetes the goal still should be to find and remove the environmental triggers and heal the gut. This of course is true will all autoimmune conditions, including Graves’ disease and Hashimoto’s.
Diagnosis of Type 1 Diabetes
The diagnosis of type 1 diabetes is usually based on a person’s symptoms and blood tests. Some of the common symptoms patients with type 1 diabetes experience include excessive thirst, hunger, blurry vision, lethargy, and weight loss. These symptoms occur because since insulin isn’t available to shuttle glucose into cells, they are left without an immediate source of energy.
Laboratory tests involve testing fasting blood sugar, glycosylated hemoglobin (A1C), and an oral glucose tolerance test. It’s also a good idea to test for fasting insulin. These tests will usually be conducted initially. C-peptide is a 31 amino acid peptide that can also provide some valuable information, and it is more reliable than insulin as a measure of endogenous insulin secretion (3). In type 1 diabetes we would expect the C-peptide levels to be low, while someone with type 2 diabetes will usually have normal or high levels of C-peptide.
As is the case with other autoimmune conditions, it is also possible to test for autoantibodies. These include antibodies to insulin (IAA), glutamic acid decarboxylase (GAD) and protein tyrosine phosphatase (IA2). These antibodies can be tested at most labs, including Labcorp and Quest Diagnostics.
Conventional Treatment Options For Type 1 Diabetes
Conventional treatment options usually involve providing dose-dependent amounts of insulin the patient has to take at regular intervals. Even though type 1 diabetes is an autoimmune condition, conventional medical treatment doesn’t do anything to improve the health of the person’s immune system.
Natural Treatment Options For Type 1 Diabetes
Although there is no cure for type 1 diabetes, the overall goal should be to improve the health of the person’s immune system. This involves removing any environmental triggers and healing the gut. Even though the person with type 1 diabetes might need to take insulin, it’s important to keep in mind that someone with one autoimmune condition is more likely to develop other autoimmune conditions in the future. Improving the health of the person’s immune system will decrease the chances of other autoimmune conditions developing in the future. In addition, it might slow down or prevent further damage to the beta cells of the pancreas, which means that the person won’t need to take as high of a dosage of insulin.
Curcumin. This is a potent natural treatment option for type 1 diabetes. This is the compound that gives turmeric its orange-yellow color. One study showed that curcumin helps to reduce the release of proinflammatory cytokines and suppresses T cell activity (T cells aid in the destruction of insulin-producing beta cells) (4). Some patients with type 1 diabetes have also used curcumin supplements help control high blood sugar. Another study I came across showed that both curcumin and resveratrol can enhance the function of the pancreatic beta cells (5).
Gymnema sylvestre. This herb has been shown to cause insulin secretion from the beta cells, and might even help with beta cell regeneration (6) (7). This isn’t to suggest that taking gymnema will reverse type 1 diabetes, but taking 500 to 1,000 mg/day might help with insulin secretion.
Type 2 Diabetes
Type 2 diabetes doesn’t involve an autoimmune component, although it does alter the way glucose is used in the body. This condition is characterized by either a lack of insulin, or the body’s inability to use insulin efficiently, the latter which causes a state known as insulin resistance. Either way, the person with type 2 diabetes will have high blood glucose levels. About 90 % of people who have diabetes have type 2 diabetes (8).
Although genetics can play a role in the development of type 2 diabetes, lifestyle and environment seem to be much greater factors. Obesity, weight gain, smoking, and physical inactivity are all risk factors (9).
It’s also worth mentioning that pregnant women can develop gestational diabetes, which is the most common medical complication of pregnancy (10). Dietary changes and exercise usually are recommended initially, although oral hypoglycemic agents or insulin may be given if the blood sugar levels remain high. Gestational diabetes is similar to type 2 diabetes, but usually resolves itself after the woman gives birth. However, women who develop gestational diabetes are often at greater risk for developing diabetes later on.
Just as is the case with the other types of diabetes, the diagnosis of type 2 diabetes involves analyzing the patient’s symptoms and ordering specific tests. In the beginning stages the person might not experience any obvious symptoms, and so it’s commonly found during routine testing. For example, someone might obtain a fasting glucose as part of a routine physical, and upon seeing this value elevated the doctor orders additional tests, such as the hemoglobin A1C and the oral glucose tolerance tests. If the blood sugar levels remain continuously high then the person may experience symptoms such as excessive thirst, frequent urination, fatigue, nausea, and dizziness.
Conventional Treatment Options For Type 2 Diabetes
Depending on the severity of the patient’s condition, some medical doctors will initially recommend diet and lifestyle changes without giving medication. Speaking of medication, metformin is an anti-hyperglycemic drug, and it usually is the first line of therapy recommended to those who have type 2 diabetes. The main way it helps those with type 2 diabetes is by greatly decreasing glucose production in the liver (11). There is also evidence that metformin can help to restore ovarian function in PCOS, reduce fatty liver, and to lower microvascular and macrovascular complications associated with type 2 diabetes (11). However, there is evidence that long-term use of metformin can cause a vitamin B12 deficiency and anemia (12).
In some severe cases of type 2 diabetes the person may need to take insulin. But usually this is a last resort, and many people do fine taking metformin. Of course the overall goal should be to improve the health of the individual so that they hopefully won’t need to take metformin or insulin, at least not for a prolonged period of time.
Natural Treatment Options For Type 2 Diabetes
Eating well and exercising regularly can help with many different health conditions, and without question this includes type 2 diabetes. With regards to diet, eating a standard Paleo or autoimmune Paleo diet can help, although some healthcare professionals recommend a ketogenic diet for type 2 diabetes. This involves a diet that is high in fat and low in carbohydrates, and the body converts the fat into energy instead of the carbohydrates.
Ketosis vs. Ketoacidosis
When talking about a ketogenic diet, some people get concerned about diabetic ketoacidosis. This is a serious complication of diabetes, and it occurs when there are very high levels of ketones in the body. This is more common in those people with type 1 diabetes, although it can also affect those with type 2 diabetes who don’t properly manage their health. Ketoacidosis happens when your body is unable to produce enough insulin, and some of the symptoms include frequent urination, excessive thirst, nausea and vomiting, abdominal pain, weakness or fatigue, and/or shortness of breath (13). In addition, the person will usually have high blood sugar levels and high ketone levels in the urine.
How does this differ from ketosis? Ketosis is considered to be a mild form of ketoacidosis. When someone is eating a lower amount of carbohydrates and is eating a good amount of healthy fats (i.e. avocados, coconut oil, fatty fish) their body will create ketones. With the ketogenic diet the body is essentially using fat for energy instead of glucose.
Berberine. I mentioned how metformin is the most common conventional medical treatment for type 2 diabetes. For those who are looking for a natural option, berberine is something to consider taking. Berberine is an isoquinoline derivative alkaloid isolated from the herb Rhizoma Coptidis, and it has anti-hyperglycemic properties (14). Not only is berberine a potent oral hypoglycemic agent, but it also has beneficial effects on lipid metabolism (15). In other words, berberine not only can help to lower fasting glucose and hemoglobin A1C levels, but can also help lower total cholesterol and LDL.
Chromium. A few studies have shown that chromium can benefit those with type 2 diabetes by helping with glycemic control and increasing insulin sensitivity (16) (17) (18).
Magnesium. Intracellular magnesium plays a key role in regulating insulin action, and oral magnesium supplementation can have beneficial effects on blood glucose levels (19) (20).
Fish oils. Fish oil supplementation is a natural treatment option for patients with type 2 diabetes. One study has shown that the omega-3 fatty acids in fish oil can help improve insulin sensitivity (21).
Cinnamon. Research has demonstrated that patients taking oral cinnamon daily reduced their blood glucose and triglyceride levels (22). As for conventional treatment, patients are often started off with metformin, which increases insulin sensitivity.
Exercise. While eating well and taking nutritional supplements can decrease insulin resistance associated with type 2 diabetes, studies also show that exercise can help to increase insulin sensitivity (23) (24).
Type 1.5 Diabetes
Type 1.5 diabetes, also known as latent autoimmune diabetes of adulthood (LADA), has characteristics of both type 1 and type 2 diabetes. It is similar to type 2 diabetes in that 1) it is diagnosed during adulthood, and 2) has a slow onset. However, it is similar to type 1 diabetes in that the person has autoantibodies that damage the beta cells of the pancreas, and as a result, insulin therapy will eventually be required. Type 1.5 diabetes accounts for 2%-12% of all cases of diabetes (25).
What frequently happens is that someone is mistakenly diagnosed as having type 2 diabetes, and as a result may be put on an oral hypoglycemic agent such as metformin. But while this can greatly help someone with type 2 diabetes, type 1.5 involves destruction to the beta cells of the pancreas, and so eventually the person will become insulin dependent.
Type 1.5 diabetes is often a result of genetic, environmental, and lifestyle factors.
In addition to screening the person for blood sugar imbalances (i.e. fasting glucose, hemoglobin A1C), autoantibody tests can be ordered. This includes antibodies to insulin, glutamic acid decarboxylase (GAD) and protein tyrosine phosphatase . The most common autoantibody present is GAD, and this usually results in a slower destruction of the beta cells than other types of antibodies.
LADA has also been sub-classified as type I and II. Patients with higher GAD antibody (GADA) levels are classified as LADA 1, and are more similar to type 1 diabetics, while patients with lower levels of GADA are classified as LAD2, and are more similar to type 2 diabetics (26).
C-peptide might also play a role in the early detection of those with type 1.5 diabetes. I mentioned C-peptide earlier, and discussed how it is usually low in type 1 diabetics, while in those with type 2 diabetes it is usually high or normal. It seems that those with type 1.5 diabetes have normal or decreased C-peptide levels, and so if someone has elevated levels of C-peptide this would rule out type 1.5 diabetes (27).
Conventional Treatment Options For Type 1.5 Diabetes
The treatment of patients with type 1.5 diabetes can be complex. Insulin therapy is typically used to help delay the onset of islet cell failure. Sometimes oral hypoglycemic agents (i.e. metformin) will also be administered. Just as is the case with type 1 diabetes, nothing is done to improve the health of the immune system from a conventional medical standpoint.
Natural Treatment Options For Type 1.5 Diabetes
As for natural treatment options, agents that can lower blood glucose levels and increase insulin sensitivity can be taken. I mentioned some of these earlier, including berberine, chromium, magnesium, and alpha lipoic acid. However, just as is the case with type 1 diabetes, with type 1.5 diabetes the autoimmune component also needs to be addressed. In other words, the environmental triggers need to be detected and removed, and the leaky gut needs to be healed.
Type 3 Diabetes
Some researchers label Alzheimer’s disease as being a neuroendocrine disease, and the reason for this is because of the shared molecular and cellular features among type 1 and type 2 diabetes associated with memory deficits and cognitive decline in the elderly (28). As a result, many refer to Alzheimer’s as being “type 3 diabetes”.
Because glucose is the primary fuel for the brain, if someone has problems with the uptake and utilization of glucose, then this can essentially cause the brain to starve. This in turn can cause oxidative stress, impairments in homeostasis, and increased cell death (29). The inhibition of insulin/ insulin-like growth factor (IGF) signaling mediates Alzheimer’s disease neurodegeneration (29). In other words, chronic deficits in insulin can lead to the development of Alzheimer’s disease, which has characteristics of insulin deficiency that is associated with type 1 diabetes, as well as insulin resistance that is more characteristic of type 2 diabetes. It’s also worth mentioning that amyloid beta protein deposits on the pancreas in patients with type 2 diabetes are similar to the protein deposits that occur in the brain in type 3 diabetes (30).
As mentioned previously, issues with insulin and IGF are contributors to type 3 diabetes progression. Although Alzheimer’s disease has characteristics of both type 1 and type 2 diabetes, the research shows that people who have type 2 diabetes are at increased risk for developing Alzheimer’s disease (30). In fact, those with type 2 diabetes have almost twice the risk of developing Alzheimer’s when compared to those who only have insulin resistance.
Conventional Treatment Options For Type 3 Diabetes
Although most medical doctors don’t recognize Alzheimer’s disease itself as being a type of diabetes, keep in mind that many of these people will be diagnosed with type 2 diabetes. As a result, some people with Alzheimer’s will be given dietary and lifestyle advice, along with medications to lower blood glucose such as metformin. However, drugs are also commonly given to treat the cognitive symptoms, such as memory loss. These drugs include cholinesterase inhibitors (Aricept, Exelon, Razadyne) and memantine (Namenda).
Natural Treatment Options For Type 3 Diabetes
If Alzheimer’s disease is indeed a form of diabetes, then it makes sense to do what is necessary to lower and stabilize blood sugar levels. As I mentioned earlier in this article, this should be addressed through dietary and lifestyle factors, although nutritional supplements can also be of benefit. Here are a few nutrients/herbs that have been shown in the research to benefit those with Alzheimer’s disease:
Gingko. A few different studies show that Ginkgo biloba has neuroprotective properties, and might play a role in the treatment and prevention of Alzheimer’s disease (31) (32).
Bacopa. A few studies show that Bacopa monnieri can enhance cognition and has neuroprotective effects against Alzheimer’s disease (33) (34).
Curcumin. Curcumin has many different health benefits, and this includes helping people with Alzheimer’s by inhibiting the formation and promoting the disaggregation of amyloid-B plaques (35) (36).
Resveratrol. Like turmeric, resveratrol has many different health benefits, and it also seems to have neuroprotective benefits in animal models of Alzheimer’s disease (37) (38).
Green tea. Epigallocatechin-3-Gallate (EGCG), is the main and most significantly bioactive polyphenol found in solid green tea extract, and there are a few studies demonstrating the beneficial effects of EGCG in the treatment of Alzheimer’s disease (39) (40).
Vitamin D. Human studies strongly support a correlation between low levels of vitamin D and cognitive impairment or dementia, and it might play a role in preventing and even stopping neurogeneration in those with Alzheimer’s disease (41) (42).
Fish oils. Patients with Alzheimer’s have been shown to have lower docosahexaenoic acid (DHA) levels, and supplementation with DHA might help to prevent or delay the onset of cognitive decline associated with Alzheimer’s disease (43) (44).
How Do These Diabetic Conditions Relate To Thyroid Health?
Type 1 Diabetes. Those with one autoimmune condition have a greater risk of developing another autoimmune condition in the future. And there seems to be a higher prevalence of thyroid autoimmunity in those with type 1 diabetes. One cross-sectional study confirmed that there is an association between thyroid autoimmunity and type 1 diabetes (45). Out of 58 patients, 18 had hypothyroidism, with only one patient experiencing transient hyperthyroidism. Another study involving 1,304 patients showed that the incidence of autoimmune thyroid disease is high (46). Another study involving children and adolescents showed a high prevalence of subclinical hypothyroidism (47).
Type 1.5 Diabetes. Since type 1.5 diabetes also has an autoimmune component, it shouldn’t be surprising that the research shows an increase prevalence of thyroid autoimmunity with this condition. One study investigated the relationship between type 1.5 diabetes and thyroid autoimmunity, and it found that there is a higher risk of thyroid autoimmunity, especially for those with higher levels of GAD antibodies (48). Another study revealed higher levels of both thyroid peroxidase and thyroglobulin antibodies in those with type 1.5 diabetes (49). I wasn’t able to find any evidence that showed an increase in Graves’ disease antibodies in those with type 1.5 diabetes.
Type 2 Diabetes. Although type 2 diabetes isn’t an autoimmune condition, there still seems to be a relationship between this type of diabetes and thyroid conditions. Some suggest that having a hypothyroid or hyperthyroid condition can lead to type 2 diabetes due to impaired glucose utilization and disposal in muscles, the overproduction of glucose output in the liver cells, and enhanced absorption of splanchnic glucose, which in turn contribute to insulin resistance (50). Another study looked at the association of thyroid function with the risk of type 2 diabetes, and the study showed that higher TSH levels were associated with a higher diabetes risk, even when it was within the lab reference range (51). In other words, if the TSH is within the lab reference range, but outside of the optimal range, then this might lead to an increased risk of developing type 2 diabetes.
This doesn’t mean that most people with a thyroid hormone imbalance will develop type 2 diabetes, but only that they will be more susceptible to developing this condition. The good news is that improving diet and lifestyle factors, along with correcting the thyroid hormone imbalance will greatly improve your chances of NOT developing type 2 diabetes.
Type 3 Diabetes. Both hypothyroidism and hyperthyroidism can cause reversible dementia (52), but this doesn’t mean that these conditions can cause Alzheimer’s disease. One study involving 1,864 people looked at the relationship of TSH levels to the risk of developing Alzheimer’s disease (52). Over a follow-up period of 12.7 years, women with the lowest and highest TSH levels demonstrated an increased risk of developing Alzheimer’s disease, but the same study showed that TSH levels were not related to Alzheimer’s disease in men (52).
Another study I came across looked at the relationship between thyroid hormone replacement and the development of Alzheimer’s disease (53). Beta amyloid plaque accumulation is a factor with Alzheimer’s disease, and T3 can increase the production of these plaques (53). The results suggested that taking thyroid hormone medication may be associated with a faster rate of the diagnosis of dementia related to Alzheimer’s disease. However, there were a few limitations to this study, and more research is needed. In addition, the same study discussed how thyroid hormones play a significant role in the production and survival of microglial cells, which help to remove beta amyloid plaque from the brain.
I realize this was a lot of information, but hopefully you have a better understanding of the different types of diabetes. Type 2 diabetes is the most common type, and unlike type 1 and 1.5 diabetes, it does not involve an autoimmune component. Many refer to Alzheimer’s as “type 3” diabetes. The conventional approach for all of these types of diabetes is to lower blood glucose levels through diet and medication, and sometimes insulin therapy is administered, especially in type 1 and 1.5 diabetes. Natural treatment options also incorporate dietary changes, but nutritional supplements and herbs are also utilized. Plus you also need to remember to address the autoimmune component in type 1 and type 1.5 diabetes.