About diabetes

Diabetes is an inability to metabolize carbohydrates resulting from inadequate production or utilization of insulin.

People with diabetes cannot properly process glucose, a sugar the body uses for energy. As a result, glucose stays in the blood, causing blood glucose to rise. At the same time, however, the cells of the body can be starved for glucose. Diabetes can lead to poor wound healing, higher risk of infection , and many other problems involving the eyes, kidneys, nerves, and heart.

Most doctors recommend that people with diabetes cut intake of sugar from snacks and processed foods, and replace these foods with high-fiber, whole foods. This tends to lower the glycemic index of the overall diet and has the additional benefit of increasing vitamin, mineral, and fiber intake. Other authorities also recommend lowering the glycemic index of the diet to improve the control of diabetes.

A high-fiber diet has been shown to work better in controlling diabetes than the diet recommended by the ADA, and may control blood sugar levels as well as oral diabetes drugs. 21 In this study, the increase in dietary fiber was accomplished exclusively through the consumption of foods naturally high in fiber such as leafy green vegetables, granola, and fruit to a level beyond that recommended by the ADA.

A variety of vitamins, minerals, amino acids, and other supplements may help with symptoms and deficiencies associated with diabetes. The Boise Co-op Vitamin and Supplement Department carry several of the recommended types including| Nutritional supplements that may be helpful

Chromium Magnesium Alpha lipoic acid Evening primrose oil Glucomannan Vitamin E Vitamin C B Vitamins Coenzynme Q10 L-carnitine Zinc Vitamin D Inositol Taurine Fish oil Vanadium Fructo-oligosaccharides Manganese Medium chain triglycerides Starch blockers Herbs that may be helpful

Cayenne Psyllium Asian ginseng American ginseng Basil Gymnema Bitter melon Cinnamon Crepe myrtle Onion Bilberry Ginkgo biloba Mistletoe Olive leaf Reishl

For a complete guide of foods that would be useful in keeping with a high-fiber low sugar diet you can go to www.healthnotes.com or to www.diabetes.org.

The information contained in this article was referenced from A Healthnotes, Inc. (HNI), the premier provider of credible, easy-to-use health and lifestyle information. Incorporating research gathered from scientific studies.

A variety of vitamins, minerals, amino acids, and other supplements may help with symptoms and deficiencies associated with diabetes.

Multiple Vitamin Mineral Supplement
In a double-blind study, supplementation of middle-aged and elderly diabetics with a multiple vitamin and mineral preparation for one year reduced the risk of infection by more than 80%, compared with a placebo. 104

Chromium
Medical reports dating back to 1853, as well as modern research, indicate that chromium-rich brewer's yeast (9 grams per day) can be useful in treating diabetes. In recent years, chromium has been shown to improve glucose and related variables in people with glucose intolerance and type 1, type 2, gestational, and steroid-induced diabetes. Improved glucose tolerance with lower or similar levels of insulin have been reported in more than ten trials of chromium supplementation in people with varying degrees of glucose intolerance. Chromium supplements improve glucose tolerance in people with both type 2 and type 1 diabetes, apparently by increasing sensitivity to insulin. Chromium improves the processing of glucose in people with prediabetic glucose intolerance and in women with diabetes associated with pregnancy. Chromium even helps healthy people, 1although one such report found chromium useful only when accompanied by 100 mg of niacin. Chromium may also lower total cholesterol, LDL cholesterol, and triglycerides (risk factors in heart disease).

A few trials have reported no beneficial effects from chromium supplementation. 117 118 119 All of these trials used 200 mcg or less of supplemental chromium, which is often not adequate for people with diabetes, especially if it is in a form that is poorly absorbed. The typical amount of chromium used in research trials is 200 mcg per day, although as much as 1,000 mcg per day has been used. 120 Many doctors recommend up to 1,000 mcg per day for people with diabetes. 121

Supplementation with chromium or brewer's yeast could potentially enhance the effects of drugs for diabetes (e.g., insulin or other blood sugar-lowering agents) and possibly lead to hypoglycemia. Therefore, people with diabetes taking these medications should supplement chromium or brewer's yeast only under the supervision of a doctor.

Magnesium
People with diabetes tend to have low magnesium levels. Double-blind research indicates that supplementing with magnesium overcomes this problem. Magnesium supplementation has improved insulin production in elderly people with type 2 diabetes. However, one double-blind trial found no effect from 500 mg magnesium per day in people with type 2 diabetes, although twice that amount led to some improvement. Elders without diabetes can also produce more insulin as a result of magnesium supplements, according to some, but not all, trials. In some trials, insulin requirements are lower in people with type 1 diabetes who supplement with magnesium. However, in people with type 2 diabetes who nonetheless require insulin, Dutch researchers have reported no improvement in blood sugar levels.

Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes. In magnesium-deficient pregnant women with type 1 diabetes, the lack of magnesium may even account for the high rate of spontaneous abortion and birth defects associated with type 1 diabetes. The American Diabetes Association admits strong associations...between magnesium deficiency and insulin resistance but will not say magnesium deficiency is a risk factor. 132 Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200-600 mg of magnesium per day.

Alpha lipoic acid
Alpha lipoic acid is a powerful natural antioxidant. Preliminary and double-blind trials have found that supplementing 600-1,200 mg of lipoic acid per day improves insulin sensitivity and the symptoms of diabetic neuropathy. In a preliminary study, supplementation with 600 mg of alpha-lipoic acid per day for 18 months slowed the progression of kidney damage in patients with type 1 and type 2 diabetes.

Evening primrose oil
Supplementing with 4 grams of evening primrose oil per day for six months has been found in double-blind research to improve nerve function and to relieve pain symptoms of diabetic neuropathy.

Glucomannan
Glucomannan is a water-soluble dietary fiber that is derived from konjac root (Amorphophallus konjac). Glucomannan delays stomach emptying, leading to a more gradual absorption of dietary sugar. This effect can reduce the elevation of blood sugar levels that is typical after a meal. After-meal blood sugar levels are lower in people with diabetes given glucomannan in their food, and overall diabetic control is improved with glucomannan-enriched diets, according to preliminary and controlled clinical trials. One preliminary report suggested that glucomannan may also be helpful in pregnancy-related diabetes. For controlling blood sugar, 500-700 mg of glucomannan per 100 calories in the diet has been used successfully in controlled research.

Vitamin E
People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes. Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most, but not all, 153 double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes. Three months or more of supplementation may be required for benefits to become apparent. The amount used is at least 900 IU of vitamin E per day.

In one of the few trials to find vitamin E supplementation ineffective for glucose intolerance in people with type 2 diabetes, damage to nerves caused by the diabetes was nonetheless partially reversed by supplementing with vitamin E for six months. 156 Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence.

Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Vitamin E supplementation reduces this problem in many, although not all, studies.

In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes. The reason for the discrepancy between reports is not known.

Vitamin E appears to lower the risk of cerebral infarction, a type of stroke, in people with diabetes who smoke. A review of a large Finnish study of smokers concluded that smokers with diabetes (or hypertension) represent a subset population that can benefit from small amounts of vitamin E (50 IU per day) without experiencing an increased risk of bleeding. 168

Vitamin C
People with type 1 diabetes appear to have low vitamin C levels. As with vitamin E, vitamin C may reduce glycosylation. Vitamin C also lowers sorbitol in people with diabetes. Sorbitol is a sugar that can accumulate and damage the eyes, nerves, and kidneys of people with diabetes. Vitamin C may improve glucose tolerance in type 2 diabetes, although not every study confirms this benefit. Vitamin C supplementation (500 mg twice daily for one year) has significantly reduced urinary protein loss in people with diabetes. Urinary protein loss (also called proteinuria) is associated with poor prognosis in diabetes. Many doctors suggest that people with diabetes supplement with 1-3 grams per day of vitamin C. Higher amounts could be problematic, however. In one person, 4.5 grams per day was reported to increase blood sugar levels.

One study examined antioxidant supplement intake, including both vitamins E and C, and the incidence of diabetic retinopathy (damage to the eyes caused by diabetes). Surprisingly, people with extensive retinopathy had a greater likelihood of having taken vitamin C and vitamin E supplements. The outcome of this trial, however, does not fit with most other published data and might simply reflect the fact that sicker people are more likely to take supplements in hopes of getting better. For the present, most doctors remain relatively unconcerned about the unexpected outcome of this isolated report.

B Vitamins
Many people with diabetes have low blood levels of vitamin B6. Levels are even lower in people with diabetes who also have nerve damage (neuropathy). 180 Vitamin B6 supplementation has improved glucose tolerance in women with diabetes caused by pregnancy. Vitamin B6 supplementation is also effective for glucose intolerance induced by birth control pills. For other people with diabetes, 1,800 mg per day of a special form of vitamin B6 pyridoxine alpha-ketoglutarate has improved glucose tolerance dramatically in some research. Standard vitamin B6 has helped in some, 185 but not all, trials.

Biotin is a B vitamin needed to process glucose. When people with type 1 diabetes were given 16 mg of biotin per day for one week, their fasting glucose levels dropped by 50%. Similar results have been reported using 9 mg per day for two months in people with type 2 diabetes. Biotin may also reduce pain from diabetic nerve damage. Some doctors try 16 mg of biotin for a few weeks to see if blood sugar levels will fall.

Blood levels of vitamin B1 (thiamine) have been found to be low in people with type 1 diabetes. In the 1930s, a trial using 10 mg of vitamin B1 per day for four weeks reported reduced blood sugar levels in six of eleven people with diabetes. More recently, administration of both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic neuropathy after four weeks. However, this was a trial conducted among people in a vitamin B1-deficient developing country. Therefore, these improvements might not occur in other people with diabetes. Another trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12 in high but variable amounts led to improvement in some aspects of diabetic neuropathy in 12 weeks. As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.

Coenzyme Q10
Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. People with type 2 diabetes have been found to have significantly lower blood levels of CoQ10 compared with healthy people. In one trial, blood sugar levels fell substantially in 31% of people with diabetes after they supplemented with 120 mg per day of CoQ7, a substance similar to CoQ10. In people with type 1 diabetes, however, supplementation with 100 mg of CoQ10 per day for three months neither improved glucose control nor reduced the need for insulin. The importance of CoQ10 supplementation for people with diabetes remains an unresolved issue, though some doctors recommend approximately 50 mg per day as a way to protect against possible effects associated with diabetes-induced depletion.

L-carnitine
L-carnitine is an amino acid needed to properly utilize fat for energy. When people with diabetes were given L-carnitine (1 mg per 2.2 pounds of body weight), high blood levels of fats both cholesterol and triglycerides dropped 25-39% in just ten days in one trial. In higher amounts (1 gram per day by injection), L-carnitine has been reported to reduce pain from diabetic nerve damage as well.

Vitamin B12 is needed for normal functioning of nerve cells. Vitamin B12 taken orally, intravenously, or by injection has reduced nerve damage caused by diabetes in most people studied. 199 In a preliminary trial, people with nerve damage due to kidney disease or to diabetes plus kidney disease received intravenous injections of 500 mcg of methylcobalamin (the main form of vitamin B12 found in the blood) three times a day for six months in addition to kidney dialysis. Nerve pain was significantly reduced and nerve function significantly improved in those who received the injections. 200 Oral vitamin B12 up to 500 mcg three times per day is recommended by some practitioners.

The intake of large amounts of niacin (a form of vitamin B3), such as 2-3 grams per day, may impair glucose tolerance and should be used by people with diabetes only with medical supervision. 201 202 Smaller amounts (500-750 mg per day for one month followed by 250 mg per day) may help some people with type 2 diabetes, though this research remains preliminary.

Preliminary trials have shown that niacinamide (another form of vitamin B3) supplementation might be useful in the very early stages of type 1 diabetes, though not all trials support this claim. Although an analysis of research shows that niacinamide does help preserve some function of insulin-secreting cells in people recently diagnosed with type 1 diabetes, the amount of insulin required for those given niacinamide has remained essentially as high as for those given placebo. 208 A controlled trial found no beneficial effect of niacinamide supplementation (700 mg three times per day in addition to intensive insulin therapy) on pancreatic function and glucose tolerance in people newly diagnosed with type 1 diabetes.

Some, but not all, reports suggest that healthy children at high risk for type 1 diabetes (such as the healthy siblings of children with type 1 diabetes) may be protected from the disease by supplementing with niacinamide. Parents of children with type 1 diabetes should consult their doctor regarding niacinamide supplementation as a way to prevent diabetes in their other children. Although the optimal amount of niacinamide is not known, recent evidence suggests that 25 mg per 2.2 pounds of body weight per day may be as effective as higher amounts.

Zinc
People with type 1 diabetes tend to be zinc-deficient, which may impair immune function. Zinc supplements have lowered blood sugar levels in people with type 1 diabetes, though some evidence indicates that zinc supplementation in people with type 2 diabetes does not improve their ability to process sugar. Nonetheless, people with type 2 diabetes also have low zinc levels, caused by excess loss of zinc in their urine. Many doctors recommend that people with type 2 diabetes supplement with moderate amounts of zinc (15-25 mg per day) as a way to correct for the deficit.

Some doctors are concerned about having people with type 1 diabetes supplement with zinc because of a report that zinc supplementation increased glycosylation, 218 generally a sign of deterioration of the condition. This trial is hard to evaluate because zinc supplementation increases the life of blood cells and such an effect artificially increases the lab test results for glycosylation. Until this issue is resolved, those with type 1 diabetes should consult a doctor before considering supplementation with zinc.