Diabetes is a chronic metabolic disease characterized by problems with the body’s production or use of insulin, leading to abnormally high blood sugar levels. Insulin is a hormone produced by the pancreas that helps cells absorb glucose from the blood for energy and normal function.

There are two main types of diabetes:

1. Type 1 Diabetes: This is an autoimmune disease that usually occurs in young people. The immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas, resulting in a significant decrease in insulin production in the body, or even a complete loss of it. Patients must rely on external insulin injections to control blood sugar levels.
2. Type 2 Diabetes: This is a relatively late-onset disease that is usually more common in adults. In type 2 diabetes, the body either cannot use insulin effectively or does not produce enough insulin to respond to the demands of blood sugar. This type of diabetes is often associated with lifestyle factors (mainly a diet high in carbohydrates and sugars).

Some common symptoms of diabetes include:

• Frequent urination: This is caused by high blood sugar levels, which causes the kidneys to excrete more urine.
• Intense thirst: Frequent urination leads to loss of body fluids, which causes thirst.
• Extreme hunger: The body feels hungry because cells cannot effectively use glucose in the blood.
• Unintentional weight loss: Despite an increased appetite, patients may lose weight because body cells are not getting enough energy.
• Fatigue: This is caused by cells not being able to obtain energy normally.

In the long run, uncontrolled high blood sugar levels may lead to a variety of complications, including cardiovascular disease, kidney disease, retinopathy, neuropathy, etc.

Normal blood sugar

Normal blood sugar levels will fluctuate slightly throughout the day, especially in response to eating and drinking. Common units used to measure blood sugar are millimoles per liter (mmol/L) or milligrams per deciliter (mg/dL), and the specific normal range may vary from laboratory to laboratory and country to country. The following are generally accepted blood sugar level ranges:

1. Fasting blood sugar (fasting state):
   • Normal range: 4.0 – 5.6 mmol/L (72 – 100 mg/dL)
2. Traditional blood sugar two hours after a meal:
   • Normal range: less than 7.8 mmol/L (140 mg/dL)
3. Low-carb high-fat/ketogenic diet blood sugar two hours after meal
   • Normal range: less than 6 mmol/L (108 mg/dL)

HBA1C Diabetes Index

HbA1c is a blood test that measures the percentage of hemoglobin A1c in the blood. This measure reflects average blood sugar levels over the past two to three months and is an important tool in diabetes management and diagnosis.

Normal HbA1c levels are usually between 4% and 5.6%. For people with diabetes, your doctor may adjust the target range based on your specific situation. Maintaining an appropriate HbA1c level is important for people with diabetes because it reflects the average level of blood sugar over a long period of time and helps prevent and monitor diabetes-related complications.

Understanding insulin resistance

Insulin resistance occurs when the body’s cells become less responsive to insulin, making it less effective at helping glucose enter the cells. Normally, insulin is a hormone produced by the pancreas that helps maintain blood sugar levels within a normal range. When food is digested, insulin acts to prompt cells to take up glucose from the blood and use it as an energy source, and to store any excess glucose as glycogen.

Insulin resistance means that glucose cannot enter cells effectively, resulting in elevated blood sugar levels. This condition is often associated with Type 2 diabetes, where the body’s cells become less responsive to insulin and can even become resistant to it.

A high-carbohydrate diet causes insulin resistance, and this relationship involves multiple complex physiological processes. First, a high-carbohydrate diet usually leads to increased blood sugar levels because carbohydrates are broken down into glucose in the body. In response to high blood sugar, the pancreas releases more insulin to encourage cells to take up glucose. However, a long-term high-carbohydrate diet may lead to frequent and excessive release of insulin, causing cells to gradually weaken their sensitivity to insulin and form a state of insulin resistance.

Secondly, the development of insulin resistance requires the pancreas to continuously increase insulin production, which may eventually lead to insulin exhaustion. This state not only affects the normal regulation of blood sugar, but is also closely linked to the development of chronic inflammation. Excessive fat accumulation caused by a high-carb diet, especially in the abdomen, may lead to the production of inflammatory factors, further exacerbating insulin resistance.

In addition, a high-carb diet is often associated with obesity. Obesity is one of the main risk factors for insulin resistance, and excess body fat directly interferes with the normal function of insulin. This state of obesity and insulin resistance together contribute to the development of diabetes, forming an unfavorable health cycle.

Understanding Nonalcoholic Fatty Acid Pancreas

Non-alcoholic fatty pancreas (NAFP) is a condition in which fat accumulates in the pancreatic tissue in the absence of alcohol abuse. Similar to non-alcoholic fatty liver disease (NAFLD), NAFP is a metabolic disease caused by abnormal accumulation of fat in the pancreatic tissue. It usually takes 8-10 years for non-alcoholic fatty pancreas to develop.

Normally, the pancreas is responsible for producing digestive enzymes and insulin, which help the body break down food and regulate blood sugar levels. However, in NAFP, the amount of fat in the pancreatic tissue exceeds normal levels, which may cause the pancreas to function poorly. This condition may increase the patient’s risk of developing diseases such as pancreatitis and diabetes.

NAFP is closely associated with metabolic diseases such as obesity, type 2 diabetes, and hyperlipidemia. These diseases are often accompanied by the body’s resistance to insulin, which causes fat to accumulate more easily in non-fat tissues, including the pancreas. Although research on NAFP is relatively new, some studies have shown that NAFP may be associated with the development of pancreatic disease and chronic inflammation, which may have adverse effects on pancreatic function.

With non-alcoholic fatty pancreas (NAFP), the pancreas may face several challenges, one of which is that it may not release enough insulin. Normally, the pancreas releases insulin when blood sugar rises to help cells absorb and use glucose in the blood. However, when too much fat accumulates in the pancreatic tissue, this normal insulin release mechanism may be disrupted.

NAFP may cause inflammation and fibrosis of pancreatic tissue, which may affect normal insulin secretion function. The accumulation of fat in the pancreas may lead to insulin resistance, which is a weakened response of cells to insulin, which makes the pancreas need more insulin to maintain normal blood sugar levels.

Therefore, when NAFP occurs, the pancreas may not be able to effectively respond to the rise in blood sugar, increasing the patient’s risk of developing diabetes. This also emphasizes the importance of understanding NAFP and its potential effects, and focusing on restoring insulin sensitivity and pancreatic function during treatment.

High blood sugar levels can lead to inflammation in the body

High blood sugar levels can lead to inflammation in the body, a process that can be explained by different biological mechanisms. First, when blood sugar concentrations are too high, sugar molecules bind to proteins or lipids to form advanced glycation end products. These products can cause damage to cells and tissues, thereby triggering an inflammatory response.

In addition, under high blood sugar conditions, the degree of oxidative stress increases. The free radicals produced by oxidative stress may damage cells and tissues, thereby initiating an inflammatory response. At the same time, high blood sugar increases the release of inflammatory mediators (such as inflammatory cytokines) in the body, which can activate the immune system and further aggravate the inflammatory process.

In addition, high blood sugar levels may lead to ER stress, which is a disorder of ER function. There is a close relationship between this ER stress state and inflammation because it can also trigger an inflammatory response. In summary, long-term high blood sugar levels may have a negative impact on the initiation of inflammatory responses in the body, especially for diabetic patients, who are more likely to experience inflammation-related problems caused by long-term high blood sugar levels.

The Impact of Diabetes on Wound Healing and Skin Manifestations

Chronic hyperglycemia significantly impairs skin health and tissue repair. Elevated blood glucose leads to microvascular damage and nerve injury, restricting local blood supply. Oxygen and nutrients fail to adequately reach wound sites, and white blood cell function is suppressed, increasing the risk of infection. Consequently, diabetic patients often experience delayed wound healing, particularly in the feet and lower legs, which may progress to chronic ulcers or gangrene. This underscores the need for strict glycemic control and meticulous wound care.

In addition, skin manifestations associated with diabetes are common, with acanthosis nigricans and acrochordons (skin tags) being the most characteristic.

• Acanthosis nigricans is characterized by thickened, hyperpigmented skin with a velvety texture, typically appearing in skin folds such as the neck, axillae, and groin. It is considered a clinical marker of insulin resistance.
• Acrochordons, also known as soft fibromas or skin tags, are small, soft, flesh-colored or slightly darker pedunculated lesions, commonly seen on the neck and axillae. They are also closely linked to insulin resistance and an increased risk of diabetes.

Therefore, for diabetic patients, in addition to maintaining proper blood glucose control and preventing complications, timely recognition of these skin changes, along with appropriate management and education, is an integral part of diabetes care.

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I. The Impact of Diabetes on Wound Healing

Diabetic patients frequently exhibit impaired wound healing, which not only delays wound closure but also increases the risk of infection, chronic ulceration, and even amputation. The main mechanisms include:

1. Vascular Damage

Hyperglycemia causes both microvascular and macrovascular damage, compromising local blood supply. Inadequate capillary perfusion results in tissue hypoxia and nutrient deficiency at the wound site, significantly slowing repair processes.

2. Neuropathy

Diabetic neuropathy reduces pain sensation and sensitivity to injury and infection. As a result, minor trauma may go unnoticed and untreated, exacerbating the wound and delaying recovery.

3. Impaired Immune Function

High blood glucose suppresses white blood cell chemotaxis, phagocytosis, and bactericidal activity, lowering local immune defense and increasing susceptibility to infection. Once infected, wounds heal even more slowly and may become chronic, purulent ulcers.

4. Suppressed Collagen Synthesis

Diabetes impairs fibroblast function and collagen production, delaying granulation tissue formation and hindering wound contraction and epithelialization.

Clinical Presentation: Diabetic wounds often appear slow to heal, with irregular edges, high susceptibility to infection, and may progress to hard-to-heal diabetic foot ulcers. Thus, strict glycemic control, early intervention, and good wound management are key to preventing serious complications.

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II. Acanthosis Nigricans

1. Definition and Features

Acanthosis nigricans is a common hyperpigmented skin condition, presenting as thickened, darkened, velvety skin in body folds such as the posterior neck, axillae, and groin. The affected skin is rough, mildly hypertrophic, and may sometimes be accompanied by mild itching or discomfort.

2. Pathogenesis

Acanthosis nigricans is a clinical marker of insulin resistance. Elevated insulin levels stimulate the growth of epidermal keratinocytes and dermal fibroblasts, resulting in epidermal hyperplasia and hyperpigmentation. It is commonly observed in patients with type 2 diabetes, obesity, and metabolic syndrome, serving as an important warning sign of metabolic derangement.

3. Clinical Significance

Acanthosis nigricans is considered a high-risk indicator of insulin resistance and type 2 diabetes. Patients with this condition should undergo screening for blood glucose, insulin levels, and other metabolic markers, and should be advised on lifestyle interventions and, when necessary, medical treatment.

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III. Acrochordons (Skin Tags)

1. Definition and Features

Acrochordons, also known as skin tags or soft fibromas, are benign skin growths that appear as soft, slightly darker or flesh-colored, pedunculated papules. They are commonly found on the neck, axillae, and inframammary folds. Although they are asymptomatic in most cases, they may occasionally become painful or inflamed due to friction.

2. Pathogenesis

Acrochordons are strongly associated with insulin resistance and obesity. High insulin levels may stimulate growth factor pathways, promoting local fibroblast and adipocyte proliferation, leading to skin tag formation. Therefore, patients with recurrent or multiple skin tags should be evaluated for potential metabolic disease.

3. Clinical Significance

Although acrochordons themselves are benign and do not pose a direct health threat, their presence indicates a higher likelihood of insulin resistance, obesity, or increased diabetes risk. Such patients should be encouraged to undergo metabolic screening and appropriate intervention.

Low-carb, high-fat diet can reverse diabetes

A low-carb, high-fat diet has a positive impact on improving insulin resistance by reducing carbohydrate intake and increasing fat and protein intake. Here are some possible mechanisms that explain how a low-carb, high-fat diet can help reverse diabetes:

1. Reduce insulin fluctuations: Restricting carbohydrate intake can reduce blood sugar fluctuations, thereby reducing insulin release. Excessive insulin release may cause cells to gradually become insensitive to it, thereby aggravating insulin resistance. By reducing fluctuations in blood sugar and insulin levels, a low-carb, high-fat diet helps reduce the degree of insulin resistance.
2. Improve insulin sensitivity: Fat intake can increase insulin sensitivity to cells. Fat is an important regulator of insulin, and appropriate fat intake can help promote the normal function of insulin and reduce cell resistance to insulin.
3. Improve body fat distribution: A low-carb, high-fat diet can help reduce the accumulation of body fat, especially abdominal fat. Abdominal fat is closely related to insulin resistance, so reducing the distribution of fat in the abdomen may help improve insulin sensitivity.
4. Regulate lipid metabolism: A low-carb, high-fat diet increases fat intake, making the body more inclined to use lipids as energy and reduce its dependence on carbohydrates. This change in lipid metabolism helps reduce the need for insulin and helps improve insulin resistance.
5. Controlling chronic inflammation: A low-carb, high-fat diet may help reduce levels of chronic inflammation, which is associated with the development of insulin resistance and diabetes. The anti-inflammatory effects of fatty acids may help improve insulin sensitivity.

Blood sugar record

Recording fasting blood sugar, pre-meal blood sugar, and two-hour post-meal blood sugar is an effective way to follow a low-carb, high-fat diet and keep an eye on blood sugar control. This record can help you understand the impact of your diet on your blood sugar, making it easier for you to adjust your diet and lifestyle to achieve better blood sugar control.

Fasting blood sugar:

Fasting blood sugar refers to blood sugar levels measured in the morning before eating. It is an important benchmark because it reflects your body’s ability to maintain blood sugar without food intake.

Recording method: After waking up every morning, use a blood glucose meter to test your blood glucose level and record it.

Blood sugar before meal:

A pre-meal blood sugar level is a blood sugar level measured before you eat. This can help you understand the immediate effects of your food choices on your blood sugar.

Recording method: Before each meal, such as breakfast, lunch and dinner, use a blood glucose meter to test your blood glucose level and record it.

Blood sugar two hours after meal:

Two-hour postprandial blood sugar refers to the blood sugar level measured two hours after eating. This time point is to observe the peak and fall speed of blood sugar after eating.

Recording method: After each meal, that is, two hours after eating, use a blood glucose meter to test blood glucose levels and record them.

Notes for recording:

1. Be consistent: Try to test your blood sugar at the same times and under the same conditions to get a more accurate picture of how your blood sugar is changing.
2. Keep a diet log: In addition to your blood sugar levels, it’s important to keep a log of your food choices and intake to help you identify dietary factors associated with blood sugar fluctuations.
3. Share with your healthcare team: Share your recorded results with your doctor or diabetes professional so they can provide you with more accurate advice and guidance.

By keeping track of your blood sugar, you can gain better insight into your diabetes management.

Blood sugar dawn phenomenon

The blood sugar dawn phenomenon refers to the physiological phenomenon that the blood sugar level in the body rises when waking up in the early morning. The main reasons for this phenomenon involve the secretion of hormones and the role of the biological clock. In the early hours of the morning, the human body releases some hormones, including glucagon, cortisol and growth hormone. The release of these hormones prompts the liver to release more glucose into the blood, causing the blood sugar level to rise.

Here are some of the main causes of the blood sugar dawn phenomenon:

1. Hormone release: Glucagon in the body decreases, while other hormones (such as cortisol and growth hormone) increase, causing the liver to release more glucose to provide the body with energy needs in the morning.
2. Biological clock regulation: The body’s biological clock regulates various physiological processes, including hormone secretion and energy metabolism. In the early morning, the biological clock signal will prompt a series of hormonal changes in the body, thereby affecting blood sugar levels.
3. Energy requirements during sleep: During sleep, the body still needs energy to maintain basal metabolism and life activities, so the glucose released by the liver helps meet these energy needs.
4. Stress : Stress pushes the body into “fight or flight” mode, triggering the production of stress hormones, which break down glycogen, a form of storage sugar, into glucose. Continued stress keeps stress hormone levels high, stimulating the breakdown of nutrients and raising blood sugar levels.

Although patients may observe a rise in blood sugar in the morning, this is not a cause for concern because once patients get up and begin their daily activities, the body produces more insulin and other hormones that help cells take up glucose. This physiological response allows the glucose in the body to be used efficiently, causing blood sugar levels to gradually drop to normal levels.

Foods that increase insulin sensitivity

Green tea, apple cider vinegar, and guava leaf tea are thought to have some positive effects on increasing insulin sensitivity, although scientific research in this area is relatively limited.

1. Green tea: Green tea is rich in antioxidants, one of the main components of which is tea polyphenols. Some studies have shown that tea polyphenols may help improve insulin sensitivity and have a certain positive effect on blood sugar regulation.
2. Apple cider vinegar: Some small studies suggest that apple cider vinegar may have a positive effect on improving insulin sensitivity. It is thought that apple cider vinegar may help lower blood sugar and increase the cellular response to insulin.
3. Guava leaf tea: Guava leaf tea is also believed to contain some natural antioxidants that may have some effects on insulin sensitivity.

It is important to note that despite these potential positive effects, improvements in blood sugar control and insulin sensitivity should primarily be achieved through an integrated healthy living and dietary approach.

The importance of salt

The importance of salt to insulin is mainly reflected in maintaining the balance of electrolytes inside and outside cells, which enables insulin to function normally. Salt contains sodium ions, a key electrolyte that works with other ions to regulate the permeability of cell membranes and help cells absorb glucose. Insulin is a key hormone that regulates blood sugar levels, and a normal balance of electrolytes helps ensure the smooth secretion of insulin and the sensitivity of cells to it. Therefore, the right amount of salt is essential to maintaining the body’s metabolic balance and the function of insulin.

High blood sugar can drink sugar-free alcohol

After drinking, the liver will quickly process the alcohol and convert it into energy. This is because the liver contains enzymes such as alcohol dehydrogenase, which can catalyze the metabolism of alcohol. Alcohol is metabolized in the body mainly through two pathways: one is in the gastrointestinal tract by alcohol dehydrogenase on the gastric mucosa, and the other is further metabolized in the liver.

In the liver, alcohol is first converted into acetaldehyde, which is then further converted into acetic acid by the enzyme acetaldehyde dehydrogenase. This process releases energy that can be used for the body’s energy needs. Therefore, while the liver is processing alcohol, it is actually providing the body with a certain degree of energy.

In addition, the liver adjusts some biochemical reactions when processing alcohol, one of which is to stop gluconeogenesis (gluconeogenesis refers to the liver’s conversion of non-sugar substances into glucose through a series of reactions). Because the metabolism of alcohol needs to be carried out first, the liver temporarily stops the gluconeogenesis process, causing the blood sugar level in the body to drop.

In this case, the glucose in the body mainly comes from the metabolism of alcohol and the previously ingested carbohydrates. Therefore, after drinking, these physiological changes in the liver will lead to a drop in blood sugar levels in the body. When drinking, you should pay attention to the amount, preferably within the level of personal comfort, and avoid excessive drinking to avoid adverse effects on the body.

Sugar-free alcoholic beverages such as red wine, grape liquor, colored wine, and pure rice wine are suitable for diabetics because they usually contain illegal low carbohydrates and are more beneficial for blood sugar control.

Additional blood tests

1. hs-CRP (High Sensitivity C-Reactive Protein):
   • Function:  It is an inflammatory marker that reflects the level of inflammation in the body.
   • Importance: The reason why people with diabetes get high-sensitivity C-reactive protein (hsCRP) tested is that hsCRP is an inflammatory marker that can help assess the level of inflammation in the body. Inflammation may play a role in the development of diabetes, especially as it relates to the risk of complications. By monitoring hsCRP levels, doctors can get a more complete picture of the inflammatory status of their patients with diabetes and potentially be used to assess the risk of complications such as cardiovascular disease.
2. Vitamin D:
   • Benefits:  Essential for bone health, mood and immune system function.
   • importance:
     • There is a certain correlation between vitamin D levels and mental health, and low vitamin D levels may be associated with mood disorders such as anxiety and depression. By maintaining adequate vitamin D levels, good mental health can be supported to a certain extent.
     • Vitamin D has anti-inflammatory properties, and inflammation is associated with poor mood and stress responses. By maintaining good vitamin D levels, you can help reduce inflammation levels, which can have a positive impact on mood and psychological stress.
3. Insulin
   • What it’s used for: Testing insulin levels can help doctors understand how well a patient’s body is producing insulin.
   • Importance: People with type 2 diabetes may develop insulin resistance, which means that the body’s cells become less responsive to the hormone insulin. Measuring insulin levels can help assess this resistance and help develop a more effective treatment plan.
4. Cortisol
   • What it does: Cortisol is a stress hormone whose release usually increases in response to stress and stress. Cortisol is also closely linked to the immune system. In people with diabetes, the balance of the immune system may be disturbed, and changes in cortisol levels may be related to this condition.
   • Importance: Cortisol is involved in regulating metabolic processes, including blood sugar regulation. In some cases, high levels of cortisol may have an impact on blood sugar control. Knowing cortisol levels can help assess a patient’s metabolic status.

Summarize

The low-carb, high-fat diet is supported by scientific research as a potential way to reverse diabetes. By reducing carbohydrate intake and increasing the proportion of fat and protein, this diet helps stabilize blood sugar levels and improve insulin sensitivity. Individuals can adjust their diet more flexibly according to their needs, record fasting blood sugar, pre-meal blood sugar, and two-hour post-meal blood sugar to gain a deeper understanding of the impact of diet on blood sugar, and make adjustments under the guidance of medical professionals. This scientific, personalized approach is expected to improve quality of life and provide a feasible path to the goal of reversing diabetes. Under professional supervision, everyone can try a low-carb, high-fat diet with more peace of mind and look forward to positive health results.