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Diabetes is More Than Just Controlling Blood Sugar

Diabetes is More Than Just Controlling Blood Sugar
February 4, 2019 Patrick Nemechek, D.O.

The growth in our understanding about why people develop Diabetes Mellitus Type 2 (DMT2) is greatly out-pacing our present treatment strategy.

In the early 1900’s, the primary fear about getting DMT2 was from the very elevated levels of blood sugar (glucose in the 400-700 mg/dl range) that would trigger a deadly condition called diabetic ketoacidosis.  Diabetic ketoacidosis is very different than the mild ketoacidosis that occurs from restricting carbohydrates in the diet.

In 1921 insulin was discovered and the fatal complication of diabetic ketoacidosis was now, in many cases, avoided.

Now instead of dying from a diabetic coma, patients were living longer and their more common cause of death from DMT2 was the consequence of chronically elevated blood sugar within the blood stream. 

Atherosclerosis in DMT2 occurs when the blood sugar (glucose greatly than 137 or a HgbA1c level greater than 6.4%) is not enough to trigger the deadly ketoacidosis but it is enough to act as a toxic irritant to the surface of the blood vessels.  The chronic toxic nature of this concentration in diabetes of blood sugar damages the inner lining of the blood vessels and leads to blindness, kidney failure, amputations, and premature death.

In the more modern era, the development of additional blood sugar-lowering medications has given diabetics the ability to maintain their blood sugar HgbA1C levels less than 6.4%.  Keeping one’s blood sugar in this range greatly reduces the toxic complications of blindness, numbness in the feet, kidney failure and amputations, and greatly increases survival.

Today our understanding about DMT2 has grown even further.  There is overwhelming evidence that DMT2 is fueled by a chronic elevation of inflammation chemicals released by white blood cells.  Known as pro-inflammatory cytokines, these chemicals circulate throughout the blood stream and are capable of triggering a wide array of genetic disorders including DMT2.

These proinflammatory cytokines not only turn on the gene(s) that trigger DMT2, they also influence the level of abnormal blood sugar elevation.  The higher the levels of inflammatory cytokines in someone with a gene for DMT2, the higher their blood sugar level.  And conversely, the lower the cytokine levels, the lower their blood sugar.

These inflammatory cytokines also activate other genes leading to the development of cancer, hypertension, Alzheimer’s dementia, and can cause direct damage to the tissues throughout the body which leads to sensory neuropathy (numbness in the feet), osteoarthritis, heart disease, osteoporosis and most dangerously, damage to the autonomic nervous system. 

Unfortunately, the present goal of diabetes management of reducing blood sugars without also focusing on the elevated cytokine levels has led to continued high rates of sudden death, cancer, and Alzheimer’s in patients whose blood sugar levels are “under control”.

Insulin, metformin, and the ever-growing number of prescription medications that lower blood sugar do little to nothing to lower inflammation.  The toxic effects of inflammatory cytokines continue to damage the body and activate other dangerous genes continues unabated.

The persistent elevation of inflammation is why patients with controlled diabetes have a much higher incidence of cancer, strokes, and heart attacks than people without a diagnosis of DMT2.

Furthermore, the single most common cause of death in individuals with DMT2 is due to direct inflammatory damage of the autonomic nervous system; a condition known as diabetic autonomic neuropathy or cardiac autonomic neuropathy (CAN). 

Cardiac autonomic neuropathy is a profound weakened state of the parasympathetic branch of the autonomic nervous system and results in the instability of heart rate control.  Diabetics have other autonomic issues from parasympathetic dysfunction such as bloating, heartburn, constipation, widely fluctuating blood pressure, and gastroparesis.

In fact, the autonomic nervous system of a diabetic prematurely ages because of inflammation and often has a functional capacity of someone approximately 20 years older than a person the same age without diabetes.  Autonomic function is critical to maintaining good health and a prolonged lifespan because a healthy autonomic nervous system is required for your brain to properly control your heart.

Patients die from sudden cardiac death due to cardiac autonomic neuropathy because their heart rates will suddenly jump to 300 beats per minute, so they cannot maintain any blood pressure at this point, and then they die of cardiovascular system collapse.  In 2016, the SAVOR-TIMI 53 Trial determined that approximately 1/3 of deaths in persons with DMT2 were caused by sudden cardiac death.

There are no symptoms or warning signs as cardiac autonomic neuropathy silently develops.  It can be easily detected with a physician’s common electrocardiogram (ECG or EKG) through a measurement known as heart rate variability (HRV).  If it is detected death can easily be prevented by reversing the underlying inflammation or blocking the arrhythmia with medication but unfortunately most modern ECG machines do not provide physicians with that simple information.

The Nemechek Protocol® was developed with this condition in mind, and CAN was the reason why I became interested in testing and treating the autonomic nervous system.  Cardiac autonomic neuropathy can easily be detected by assessing the autonomic nervous system with a simple 17-minute test known as spectral analysis. 

Once detected, my patients are started on The Nemechek Protocol® and their cardiac autonomic neuropathy (CAN) is often reversed in 3 to 5 months.  During that time, patients are temporarily placed on a medication that greatly reduces the risk of sudden cardiac death from occurring while the protocol allows the autonomic nervous system to recover.

Over the last few decades we have witnessed DMT2 is occurring in younger and younger individuals.  This is because the abnormal elevation of chronic inflammatory cytokines is beginning at younger and younger ages as well.

If you have diabetes, there are several things you can do to prevent yourself from dying from CAN and sudden cardiac death.

First, ask your physician to refer you to a cardiologist capable of determine whether cardiac autonomic neuropathy exists.  Second, study and learn everything you can about chronic metabolic inflammation and how it affects your health.

And finally, start developing a program to lower your inflammatory cytokines. The Nemechek Protocol® is a great place to start.  Supplementing your diet with omega 3’s (fish oil), omega 9’s (extra virgin olive oil) and reducing your intake of calories, carbohydrates, and advanced glycation end products (AGE’s are abnormal molecules formed when food is cooked quickly and at high temperatures) all have an additive effect on lower inflammation and helping your autonomic nervous system to recover.

With time you will be able to detect the reduction of inflammation in your blood work.  Look for reductions in your fasting blood sugar, HgbA1c level, and your triglycerides.  Reductions in those numbers are all indications that your inflammation is declining.  Additional tests such as the highly sensitive C-reactive protein (hsCRP) will also decline once your inflammation is lowered.

The Nemechek Protocol® also encompasses the use of transcutaneous Vagus nerve stimulation to provide a significant reduction in pro-inflammatory cytokines and is often required to get substantial recovery of autonomic function.  This is a type of electric neuromodulation to the Vagus nerve which completely controls inflammation throughout the body.

Diabetes management is no longer just about taking pills to keep blood sugar levels low, because diabetes is never under control in a high inflammation environment.  Diabetes management must include a focus on inflammation control by the combined benefit of calorie reduction, carbohydrate reduction, AGE reduction, and improvement of autonomic nervous system health to prevent death from sudden cardia death. 


  1. N. Panayotova 4 days ago

    Hello dr Nemechek! Should I avoid walnut oil in your protocol? It contains polyunsaturated fatty acids (72% of total fats), particularly alpha-linolenic acid (14%) + linoleic acid (58%), oleic acid (13%) and saturated fats (9%). Also I have not found information about avoiding or not gamma linolenic acid GLA, which is an omega-6 fatty acid but also can reduce inflammation in brain cells. Thank you in advance!

    • Author
      Patrick Nemechek, D.O. 4 days ago

      I would generally limit its use

  2. Serene 6 days ago

    Hi Dr Nemechek,
    My son is only 8 months old. He is currently constipated. PD has prescribed him with lactulose. Is it okie to use it to treat constipation during protocol? If not is magnesium citrate safe for a 8 month old kid and what is the dose to give? Thanks

    • Author
      Patrick Nemechek, D.O. 6 days ago

      Yes, it is OK to treat constipation during the protocol.

  3. Rohma 2 weeks ago

    Hello. My 4 year old daughter is on protocol for 5 months now. Alot of gains but one thing bothers me alot. Wheneevr she sits to study or write she would yawn constantly. If this period is extended for more than 20 mins she would have water coming out of eyes due to yawning. I dont understand why. What do i need to do to fix this? Please help. I understand gaining more concentration would take longer time. Thanks alot!!

    • Author
      Patrick Nemechek, D.O. 1 week ago

      This symptoms is low blood pressure to the brain due to autonomic dysfunction. This will resolve with more time.

  4. Bill 2 weeks ago

    Hi Doc,
    For the adult protocol, can I take the fish oil pills maybe 2 at a time spread throughout the day? Getting close to starting and worry taking 6 at the same time might be sort of a gut bomb. Thanks.

    • Author
      Patrick Nemechek, D.O. 2 weeks ago

      Yes, its fine to spread them out. I personally take 3 in the Am and another 3 before I go to bed.

  5. Katie McCollum 2 weeks ago

    We are scheduled to come see you in August. (SO excited) We just got my son’s genetic test back and his results showed a huge mitochondrial dysfunction. His mitochondrial are functioning so low that his current dr. thinks he may have mitochondrial disease (cirtrate synthase 25%, RC-IV 336%, RC-I 34%). Now, I know your views are that mitochondrial dysfunction is a downstream effect of the ANS dysfunction, however, in my son’s case, I think his low functioning mitochondrial may be causing the majority of his issues. My son has been on the protocol for 1.5 years and I would think if it were an ANS issue, then his mito functioning test results would have been better after a year and a half of healing the ANS. So, I’m wondering if this issue is outside the scope of the protocol. Thank you!

    • Author
      Patrick Nemechek, D.O. 2 weeks ago

      Other than severe genetic mutations, almost all mitochondrial issues are related not to autonomic dysfunction but to systemic inflammation

  6. Rosita 2 weeks ago

    Thank you Dr. I believe we need to visit you for the VNS machine. Can one VNS machine be used for the entire family? Thanks.

    • Author
      Patrick Nemechek, D.O. 2 weeks ago

      While the device we use is adaptable more you and old and a wide variety of medical conditions we treat, I can only prescribe its use for the individuals that are formally under my care.

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