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Impaired Glucose Metabolism: A Review Philip Maffetone, D.C. June 30, 2001 © 2001 Philip Maffetone.

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Presentation on theme: "Impaired Glucose Metabolism: A Review Philip Maffetone, D.C. June 30, 2001 © 2001 Philip Maffetone."— Presentation transcript:

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2 Impaired Glucose Metabolism: A Review Philip Maffetone, D.C. June 30, 2001 © 2001 Philip Maffetone

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5 Glucose & Memory Sympathetic/Adrenal Stimulation Rapid rise in blood glucose Improved memory of event Intense Event

6 Glucose & Memory Sympathetic/Adrenal Stimulation Rapid rise in blood glucose Improved memory of event Eating (cephalic phase) Intense Event

7 Blood sugar changes from normal effect memory: Change (mg/dL) Result +60-80 Poor memory +15-50 Good memory +0-10 Poor memory

8 Impaired Glucose Metabolism... Carbohydrate intolerance Glucose intolerance Impaired fasting glucose Impaired glucose tolerance Carbohydrate-lipid metabolism disturbance Hypoglycemia Hyperinsulinemia Type IV hyperlipoproteinemia Insulin resistance Type 2 diabetes

9 Impaired Glucose Metabolism          Cardiovascular: - atherosclerosis - circulation Endocrine: - adrenal - pancreas Nervous: - Alzheimer - learning Musculoskeletal: - muscle - joint Gastrointestinal: - absorption - gut hormones

10 Birth Health Disease Death Traditional Model of Health and Disease

11 Optimal Symptoms Onset of Death Health Disease -- Functional Illness -- Full Spectrum of Health & Disease

12 Normal Impaired Glucose Diabetes Death Glucose Full Spectrum of Glucose Metabolism

13 Ruderman NB, Schneider SH, Berchtold P The “metabolically-obese,” normal-weight individual American Journal of Clinical Nutrition (1981;34: 1617-1621)

14 J Diabetes Complications 2001 Jan-Feb;15(1):34-7 Impaired glucose tolerance is a more advanced stage of alteration in the glucose metabolism than impaired fasting glucose. Guerrero-Romero F, Rodriguez-Moran M. This study demonstrates that subjects with IFG show hyperinsulinemia whereas those with IGT have low insulin secretion in response to oral load glucose, suggesting that IFG and IGT correspond to different stages of impaired glucose metabolism.

15 Defining Impaired Glucose Metabolism Impaired Fasting Glucose (IFG) –high insulin secretion Impaired Glucose Tolerance (IGT) –lower insulin secretion

16 Blood Tests for Blood Sugar Baseline Category Cutoff Values, FPG/2hPG, mg/dL (mmol/L) ADA NFG: <110 (6.1) IFG: 110-126 (6.1-7.0) WHO NGT:<126 (7.0)/<140 (7.8) IGT: <126 (7.0)/140-200 (7.8-11.1)

17 Some Risk Factors Associated with Impaired Glucose Metabolism Waist-to-hip ratio BMI Systolic & diastolic BP Fasting insulin 2-hour insulin Fasting triglycerides HDL cholesterol

18 The Waist-to-Hip Ratio Reflects all-cause mortality including that from cardiovascular and non-cardiovascular diseases. Specifically reflects impaired glucose metabolism. Measure: –circumference of the waist at the umbilicus, –divided by the hip circumference. –Android body type = increased risk: Men: > 0.9 inches Women: > 0.8 inches

19 Rising Risk of Impaired Glucose Metabolism

20 Glycated Hemoglobin (HbA 1c ) Parallels Progression of Impaired Glucose Metabolism

21 Ann Intern Med 1998 Apr 1;128(7):524-33 Metabolic risk factors worsen continuously across the spectrum of nondiabetic glucose tolerance The Framingham Offspring Study Meigs JB, Nathan DM, Wilson PW, Cupples LA, Singer DE “...our data reinforce the concept that asymptomatic glucose intolerance is not a benign metabolic condition.”

22 Low Blood Sugar Response Hierarchy Neurogenic (autonomic)/Neuroglycopenic shaky/tremulous heart pounding nervous/anxious sweaty tingling hunger warm weak difficulty thinking tired/drowsy dizziness blurred vision 60 mg/dL - - - - 55 mg/dL - - - - 50 mg/dL

23 Caring for Patients with Impaired Glucose Metabolism Assessment Treatment Lifestyle

24 Assessment Poor concentration or sleepiness after meals Intestinal gas or bloating after meals Polycystic ovary syndrome Frequent hungry Increasing abdominal fat or facial fat (especially cheeks) Chronic fatigue

25 Assessment Insomnia or sleep apnea Waist size increasing with age Low protein intake Personal or family history: diabetes, kidney or gall stones, gout, high blood pressure, high cholesterol/low HDL, high triglycerides, heart disease or stroke, breast cancer.

26 Assessment Blood, saliva and others lab test as needed (including glycated hemoglobin) Physical exam, including neurological AK evaluation

27 Treatment Diet –macronutrient balance –reduce refined carbohydrates –balance fats –eat 5-6 smaller meals or snacks Nutrition –EPA –magnesium –antioxidants –zinc

28 Lifestyle Exercise –increase aerobic, reduce or eliminate anaerobic Stress management

29 Outcome of Patients with Impaired Glucose Metabolism Total Population of 145 subjects with IGT 44% became diabetic 22% remained impaired 34% returned to normal glucose metabolism Weyer et al. (2001)

30 Impaired Glucose Metabolism: A Review Philip Maffetone, D.C. June 30, 2001 © 2001 Philip Maffetone


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