Type 1 Diabetes

Type 1 Diabetes


Alternative Medicine
The following information is specific for alternative and complementary medicine. For additional evidence-based information on diseases, conditions, symptoms, diagnosis, treatment and wellness issues, continue searching the Healthwise Knowledgebase.

Overview

What you need to know

Also known as childhood-onset diabetes, type 1 diabetes requires regular blood sugar tests and medical intervention. According to research or other evidence, the following self-care steps may be helpful:

  • Go for the chromium
  • Under the supervision of a doctor, take 200 mcg a day of this essential trace mineral to improve glucose tolerance
  • Fight back with fiber
  • Under a doctor's supervision, stabilize your blood sugar by eating fiber from whole grains, beans (legumes), vegetables, and fruit, and consider using a fiber supplement such as psyllium or guar gum
  • Protect with alpha lipoic acid
  • Protect against diabetic complications, such as nerve and kidney damage, by taking 600 to 1,200 mg of this supplement per day
  • Discover EPO
  • Help relieve pain from diabetic neuropathy by taking 4 grams of evening primrose oil supplements per day
  • Get to know niacinamide
  • Talk to a knowledgeable healthcare provider to determine if taking large amounts of the supplement niacinamide might prevent or limit the severity of type 1 diabetes in your family

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full diabetes article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About diabetes

Diabetes mellitus is an inability to metabolize carbohydrates resulting from inadequate insulin production or utilization. Other forms of diabetes (such as diabetes insipidus) are not included in this discussion.

There are two types of diabetes mellitus, type 1 and type 2. This article concerns type 1 diabetes, which has also been called childhood-onset diabetes or insulin-dependent diabetes. In type 1 diabetes, the pancreas cannot make the insulin needed to process glucose. Natural therapies cannot cure type 1 diabetes, but they may help by making the body more receptive to insulin supplied by injection. It is particularly critical for people with type 1 diabetes to work carefully with the doctor prescribing insulin before contemplating the use of any herbs, supplements, or dietary changes mentioned in this article. Any change that makes the body more receptive to insulin could require critical changes in insulin dosage that must be determined by the treating physician.

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. People with diabetes are at high risk for heart disease, atherosclerosis, cataracts, retinopathy, stroke, poor wound healing, infections, and damage to the kidneys and nerves.

Check list

Product ratings for diabetes mellitus

RatingNutritional SupplementsHerbs
3Stars

Alpha lipoic acid
Chromium
Evening primrose oil
Fiber
Magnesium

Cayenne (topical, for diabetic neuropathy)

2Stars

Acetyl-L-carnitine (for diabetic neuropathy)
Biotin
L-carnitine
Vitamin B1 (thiamine)
Vitamin B3 (niacinamide only, for prevention of type 1 diabetes)
Vitamin B6
Vitamin C
Vitamin D
Vitamin E (for prevention of diabetic retinopathy and neuropathy)
Zinc

Bilberry
Gymnema
Onion

1Star

Antioxidant combination (selenium, vitamin A, vitamin C, and vitamin E )
Coenzyme Q10
Fish oil (EPA/DHA)
Glucomannan
Inositol
Manganese
Quercetin
Starch blockers
Taurine
Vitamin B12

Açaí
Asian ginseng
Fenugreek (seeds)
Ginkgo
Hibiscus
Mistletoe
Olive leaf
Reishi

3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

Diet

Dietary changes that may be helpful

Eating carbohydrate-containing foods, whether high in sugar or high in starch (such as bread, potatoes, processed breakfast cereals, and rice), temporarily raises blood sugar and insulin levels.1 The blood sugar-raising effect of a food, called its "glycemic index," depends on how rapidly its carbohydrate is absorbed. Many starchy foods have a glycemic index similar to table sugar (sucrose).2 Beans, peas, fruit, and oats have low glycemic indexes, despite their high carbohydrate content, due mostly to the health-promoting effects of soluble fiber. Controlled studies have found that people with type 1 diabetes who follow a low-glycemic-index diet have better long-term control over their blood sugar levels compared with those following a high-glycemic-index diet.3 However, other studies find similar benefits from training patients to adjust their insulin doses according to the total carbohydrate content of each meal or snack ("carbohydrate counting").4 People with type 1 diabetes should always discuss changes in their diet with their treating physician.

Diabetes disrupts the mechanisms by which the body controls blood sugar. Until recently, health professionals have recommended sugar restriction to people with diabetes, even though short-term high-sugar diets have been shown, in some studies, not to cause blood sugar problems in people with diabetes.5, 6, 7 Currently, the American Diabetic Association (ADA) guidelines do not prohibit the use of moderate amounts of sugar,8 as long as blood levels of glucose, triglycerides, and cholesterol are maintained within normal levels.

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.9

Older studies suggested that including 30 grams per day or more of fiber helps control blood sugar in type 1 diabetes.10 However, a more recent controlled study of people with well-controlled type 1 diabetes on intensive insulin regimens found no important benefits from consuming a high-fiber diet.11 In another trial, a low-glycemic-index diet containing 50 grams per day of fiber improved blood sugar control and helped prevent hypoglycemic episodes in a group of people with type 1 diabetes taking two or more insulin injections per day.12 Consuming more fiber may not be as helpful in type 1 diabetes when modern intensive insulin regimens are used, but eating high-fiber foods is recommended for its many other health benefits.13

When taken with meals, high-fiber supplements such as guar gum reduced the rise in blood sugar following meals in people with type 1 diabetes.14, 15 More research is needed to determine if regular use of fiber supplements benefits long-term blood sugar control in type 1 diabetes.

When people with diabetic nerve damage (neuropathy) switch to a vegan diet (no meat, dairy, or eggs), improvements have been reported after several days.16 In one trial, pain completely disappeared in 17 of 21 people.17 Fats from meat and dairy may also contribute to heart disease, the leading killer of people with diabetes. Vegetarians also eat less protein than do meat eaters. Reducing protein in the diet has lowered kidney damage caused by diabetes and may also improve glucose tolerance in type 1 diabetes.18, 19, 20 Switching to either a high- or low-protein diet should be discussed with a doctor.

Changing the overall percentage of calories from fat and carbohydrates in the diets of people with type 1 diabetes is often difficult. However, it is possible to modify the quality of the dietary fat. In adolescents with type 1 diabetes, increasing monounsaturated fats relative to other dietary fats is associated with better control over blood sugar and cholesterol levels.21 The best way to incorporate monounsaturates into the diet is to use olive oil, especially extra virgin olive oil, which has the highest antioxidant values.

Should children avoid milk to prevent type 1 diabetes? The relationship between cows' milk and type 1 diabetes remains unclear, although there is some evidence that milk consumption might increase the risk of developing type 1 diabetes. Worldwide, children whose dietary energy comes primarily from dairy or meat products have a significantly higher chance of developing type 1 diabetes than do children whose dietary energy comes primarily from vegetable sources.22 Countries with high milk consumption have a high risk of type 1 diabetes.23 Animal research also indicates that avoiding milk affords protection from type 1 diabetes.24 Milk contains a protein related to a protein in the pancreas, the organ that produces insulin. Some researchers believe that drinking milk may cause children who are allergic to milk to make antibodies that attack the pancreas, causing type 1 diabetes.25, 26 Several studies have linked cows' milk consumption to the occurrence of type 1 diabetes in children.27, 28, 29, 30 However, other studies have failed to find such a link.31, 32 One study even reported a protective effect of higher intake of dairy products on diabetes risk in children.33 One reason for the conflicting results of the research may be that different genetic strains of cows' milk protein (casein) are associated with different levels of risk.34

Immune-system problems in people with type 1 diabetes have been tied to other allergies as well,35 and the importance of focusing only on the avoidance of dairy products remains unclear.36 Preliminary studies have found that early introduction of cows' milk formula feeding increases the risk of developing type 1 diabetes, although contradictory results have also been published.37, 38 A study of Finnish children (including children with diabetes) showed that early introduction of cows' milk formula feeding (before three months of age vs. after three months of age) was associated with increased risk of type 1 diabetes.39 This research supports abstaining from dairy products in infancy and possibly in early childhood, particularly for children with a family history of type 1 diabetes. Recent research also suggests a possible link between milk consumption in infancy and an increased risk of type 2 (non-insulin-dependent) diabetes.40

Lifestyle

Lifestyle changes that may be helpful

Unusually rapid weight gain in infancy has been associated with a one-and-a-half-fold increase in the risk of developing type 1 diabetes in childhood.41 Being overweight also increases the need for insulin. Therefore, people with type 1 diabetes should achieve and maintain appropriate body weight.

People with type 1 diabetes who engage in regular exercise require less insulin.42 However, in the short term, exercise can induce low blood sugar or even occasionally increased blood sugar.43 Moreover, a preliminary study has shown that long-term physical activity was not associated with control of blood glucose in people with type 1 diabetes.44 Therefore, people with type 1 diabetes should never begin an intensive exercise program without consulting a healthcare professional.

The American Diabetes Association (ADA) recommends that people with diabetes limit their daily alcohol consumption to one drink for women and two drinks for men.45 Similar to research on healthy people, preliminary studies in adults with diabetes find reduced risk of heart disease with light to moderate drinking.46 Drinking alcohol with type 1 diabetes can result in hypoglycemia or hyperglycemia, depending on the circumstances, but moderate amounts of alcohol ingested with food does not affect blood glucose levels.47 People with diabetes who drink two or more drinks per day were reported to have a high risk for eye damage in one preliminary study,48 but another, larger study found no association between alcohol use and eye damage.49

People with diabetes who smoke are at higher risk for kidney damage,50heart disease,51 and other diabetes-linked problems. Smokers are also more likely to develop diabetes,52 so it's important for diabetic smokers to quit.

Most healthcare providers agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes. Advocates of SMBG, such as the ADA, have observed that SMBG by people with diabetes has revolutionized management of the disease, enabling them to achieve and maintain specific goals.53 These observations are well-supported in the medical literature.54 Detractors point out that indiscriminate use of self-monitoring is of questionable value and adds enormously to healthcare costs.55 The ADA acknowledges that accuracy of SMBG is instrument- and technique-dependent. Errors in technique and inadequate use of control procedures have been shown to lead to inaccurate test results.56 Nevertheless, it is likely that self-monitoring of blood glucose, if used properly, can have a positive effect by increasing patient involvement in overall diabetes care.57 Pharmacists and healthcare practitioners can teach people with diabetes certain skills that will enhance their ability to properly self-manage blood glucose.

Supplements

Vitamins that may be helpful

A variety of vitamins, minerals, amino acids, and other supplements may help with symptoms and deficiencies associated with diabetes. However, many of the studies described below were done in adults, and the amounts used may not be appropriate for a child with type 1 diabetes. The proper amount of each nutrient to be used by a child should always be discussed with a doctor.

Alpha lipoic acid

Alpha lipoic acid is a powerful natural antioxidant. Preliminary and double-blind trials have found that supplementing with 600 to 1,200 mg of lipoic acid per day improves the symptoms of diabetic nerve damage (neuropathy).58, 59, 60, 61 In a preliminary study, supplementing with 600 mg of alpha-lipoic acid per day for 18 months slowed the progression of kidney damage in people with type 1 diabetes.62

Chromium

Chromium, a trace mineral that appears to increase the effectiveness of insulin, has been shown to improve glucose and related variables in people with many kinds of diabetes, including type 1 diabetes.63, 64 Chromium may also lower levels of total cholesterol, LDL cholesterol, and triglycerides (risk factors for heart disease ).65, 66 The typical amount of chromium used in research trials is 200 mcg per day. Supplementation with chromium or brewer's yeast (a source of chromium) 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 with chromium or brewer's yeast only under the supervision of a doctor.

Magnesium

People with type 1 diabetes tend to have low magnesium levels, and magnesium given orally or by injection partially overcomes the reduction in magnesium levels.67 In one preliminary trial, insulin requirements were lower in people with type 1 diabetes who were given magnesium.68 Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes.69 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.70 A double-blind trial found that giving 300 mg per day of magnesium to magnesium-deficient type 1 diabetics for five years slowed the development of diabetic nerve damage (neuropathy). The American Diabetes Association acknowledges strong associations between magnesium deficiency and insulin resistance but has not said magnesium deficiency is a risk factor.71 Many doctors, however, recommend that adults with diabetes and normal kidney function supplement with 200 to 600 mg of magnesium per day (those amounts would be lower for children).

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 in people with diabetic nerve damage (neuropathy).72

Acetyl-L-carnitine

In a double-blind study of people with diabetic nerve damage (neuropathy), supplementing with acetyl-L-carnitine was significantly more effective than a placebo in improving subjective symptoms of neuropathy and objective measures of nerve function.73 People who received 1,000 mg of acetyl-L-carnitine three times per day tended to fare better than those who received 500 mg three times per day.

B Vitamins

Blood levels of vitamin B1 (thiamine) have been found to be low in people with type 1 diabetes.74 A controlled trial in Africa found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic nerve damage (neuropathy) after four weeks.75 However, since this was a trial conducted among people in a vitamin B1-deficient developing country, 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.76 As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.

Taking large amounts of niacin (a form of vitamin B3), such as 2 to 3 grams per day, may impair glucose tolerance and should be used by people with diabetes only with medical supervision.77, 78

Some clinical trials have shown that niacinamide (another form of vitamin B3) supplementation might be useful in the very early stages of type 1 diabetes,79 though not all trials support this claim.80, 81, 82 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.83 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.84

Some,85 but not all,86 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.87

Many people with diabetes have low blood levels of vitamin B6.88, 89 Levels are even lower in people with diabetes who also have neuropathy.90 In a trial that included people with type 1 diabetes, 1,800 mg per day of a special form of vitamin B6-pyridoxine alpha-ketoglutarate-improved glucose tolerance dramatically.91 Vitamin B6 may also reduce the amount of glycosylation, so taking adequate amounts of this vitamin may be beneficial for all people with diabetes.92

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%.93 Biotin may also reduce pain from diabetic nerve damage (neuropathy).94 Some doctors try 16 mg of biotin for a few weeks to see if blood sugar levels will fall.

Vitamin B12 is needed for normal functioning of nerve cells. Vitamin B12 taken orally has reduced symptoms of nerve damage caused by diabetes in 39% of people studied; when given both intravenously and orally, two-thirds of people improved.95 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.96 Oral vitamin B12 up to 500 mcg three times per day is recommended by some practitioners.

L-carnitine

L-carnitine is an amino acid needed to properly utilize fat for energy. When people with diabetes were given L-carnitine (0.5 mg per 2.2 pounds of body weight), high blood levels of fats-both cholesterol and triglycerides -dropped 25 to 39% in just ten days in one trial.97

Vitamin C

People with type 1 diabetes appear to have low vitamin C levels.98 As with vitamin E, vitamin C may reduce glycosylation.99 Vitamin C also lowers sorbitol levels in people with diabetes.100 Sorbitol is a sugar that can accumulate inside the cells and damage the eyes, nerves, and kidneys of people with diabetes. Vitamin C supplementation (500 mg twice a day 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.101 Many doctors suggest that people with diabetes supplement with 1 to 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.102

One study examined antioxidant supplement intake, including both vitamins E and C, and the incidence of diabetic eye damage (retinopathy ).103 A surprising finding was that people with extensive retinopathy had a greater likelihood of having taken vitamin C and vitamin E supplements. The outcome of this study, 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 outcome of this isolated report.

Vitamin D

Vitamin D is needed to maintain adequate blood levels of insulin.104 Vitamin D receptors have been found in the pancreas where insulin is made and preliminary evidence suggests that supplementation might reduce the risk of developing type 1 diabetes.105 Not enough is known about optimal amounts of vitamin D for people with diabetes, and high amounts of vitamin D can be toxic. Therefore, people with diabetes considering vitamin D supplementation should talk with a doctor and have their vitamin D status assessed.

Vitamin E

People with low blood levels of vitamin E are more likely to develop type 1 diabetes,106 but no studies have been done using vitamin E supplements to try to prevent type 1 diabetes. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic eye damage (retinopathy ) and nephropathy,107, 108 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. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many,109, 110, 111 although not all,112, 113 studies of people with type 1 diabetes.

Zinc

People with type 1 diabetes tend to be zinc deficient,114 which may impair immune function.115 Zinc supplements have lowered blood sugar levels in people with type 1 diabetes.116

Some doctors are concerned about having people with type 1 diabetes supplement with zinc because of a report that zinc supplementation increased glycosylation,117 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.

Antioxidants

Because oxidation damage is believed to play a role in the development of diabetic eye damage (retinopathy ), antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic eye damage (retinopathy ). During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy.118 People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.

Coenzyme Q10

Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. 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 CoQ10.119 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.120 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.

Fish oil

Glucose tolerance improves in healthy people taking omega-3 fatty acid supplements.121 And in one trial, people with diabetic nerve damage (neuropathy) and diabetic nephropathy experienced significant improvement when given 600 mg three times per day of purified eicosapentaenoic acid (EPA)-one of the two major omega-3 fatty acids found in fish oil supplements-for 48 weeks.122 However, controlled studies have found that fish oil supplementation increases cholesterol in people with type 1 diabetes.123, 124 Until the risk-benefit ratio of using fish oil is clarified, people with diabetes should feel free to increase their fish intake, but they should consult a doctor before taking fish oil supplements.

Glucomannan

Glucomannan is a water-soluble dietary fiber 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.125 This could lower insulin requirements for type 1 diabetics, but no research has been done to test this possibility.

Inositol

Inositol is needed for normal nerve function. Diabetes can cause a type of nerve damage known as diabetic neuropathy. Certain measures of the severity of this condition have been reported to improve with inositol supplementation (500 mg taken twice per day);126 however, in other trials, inositol was ineffective.127

Manganese

People with diabetes may have low blood levels of manganese.128 Animal research suggests that manganese deficiency can contribute to glucose intolerance and may be reversed by supplementation.129 A young adult with insulin-dependent diabetes who received oral manganese (3 to 5 mg per day as manganese chloride) reportedly experienced a significant fall in blood glucose, sometimes to dangerously low levels. In three other people with type 1 diabetes, manganese supplementation had no effect on blood glucose levels.130 People with type 1 diabetes wishing to supplement with manganese should do so only with a doctor's close supervision.

Quercetin

Doctors have suggested that quercetin might help people with diabetes because of its ability to reduce levels of sorbitol-a sugar that accumulates in nerve cells, kidney cells, and cells within the eyes of people with diabetes and has been linked to damage to those organs.131 Clinical trials have yet to explore whether quercetin actually protects people with diabetes from nerve damage (neuropathy), nephropathy, or eye damage (retinopathy ).

Starch blockers

Starch blockers are substances that inhibit amylase, the digestive enzyme required to break down dietary starches for normal absorption. Controlled research has demonstrated that concentrated starch blocker extracts, when given with a starchy meal, can reduce the usual rise in blood sugar levels of both healthy people and diabetics.132, 133, 134, 135, 136 While this effect could be helpful in controlling diabetes, no research has investigated the long-term effects of taking starch blockers for this condition.

Taurine

Taurine is an amino acid found in protein-rich food. People with type 1 diabetes have been reported to have low blood taurine levels, a condition that increases the risk of heart disease by altering blood viscosity. Supplementing with taurine (1.5 grams per day) has restored blood taurine to normal levels and corrected the problem of blood viscosity within three months.137

Vanadium

While vanadyl sulfate, a form of vanadium, may improve glucose control in people with type 2 diabetes,138, 139, 140 it may not help people with type 1 diabetes according to one preliminary report.141 The long-term safety of the large amounts of vanadium used in diabetes research (typically 100 mg per day) remains unknown. Many doctors expect that amounts this high may prove to be unsafe in the long term.

Are there any side effects or interactions?

Refer to the individual supplement for information about any side effects or interactions.

Herbs

Herbs that may be helpful

Several herbs may help in managing symptoms associated with diabetes, including the control of blood sugar levels.

Cayenne

Double-blind trials have shown that topical application of creams containing 0.025 to 0.075% capsaicin (from cayenne [Capsicum frutescens]) can relieve symptoms of diabetic nerve damage (neuropathy).142, 143 Four or more applications per day may be required to relieve severe pain. This should be done only under a doctor's supervision.

Bilberry

Bilberry may lower the risk of some diabetic complications, such as diabetic cataracts and retinopathy. One preliminary trial found that supplementation with a standardized extract of bilberry improved signs of retinal damage in some people with diabetic retinopathy.144

Gymnema

Test tube and animal studies have found several mechanisms by which gymnema may help normalize blood sugar control in diabetics.145 In a controlled trial with people with type 1 diabetes, 400 mg per day of gymnema extract reduced requirements for insulin.146 Whether the extract used in this study was standardized for active constituents is unclear. Recently, a preliminary trial found improved blood sugar levels after three months in a group of people with type 1 and type 2 diabetes who took 800 mg per day of an extract standardized for 25% gymnemic acids.147 Gymnema is not a substitute for insulin, but insulin amounts may need to be lowered in order to avoid hypoglycemia while taking gymnema.

Onion

Preliminary trials and at least one double-blind trial have shown that large amounts of onion can lower blood sugar levels in people with diabetes.148, 149, 150 The mechanism of onion's blood sugar-lowering action is not precisely known, though there is evidence that constituents in onions block the breakdown of insulin in the liver. This would lead to higher levels of insulin in the body.151

Açaí

Açaí is reported to be a traditional remedy for diabetes. Although oxidative stress may contribute to diabetes152 and anthocyanins may improve insulin secretion,153 there is no published evidence that açaí has any effect on diabetes.

Asian ginseng

Asian ginseng is commonly used in Traditional Chinese Medicine to treat diabetes. It has been shown in test tube and animal studies to enhance the release of insulin from the pancreas and to increase the number of insulin receptors.154, 155 Animal research has also revealed a direct blood sugar-lowering effect of ginseng.156 However, no human trials have tested Asian ginseng in people with type 1 diabetes.

Fenugreek

Fenugreek seeds are high in soluble fiber, which helps lower blood sugar by slowing down carbohydrate digestion and absorption.157 Animal research suggests that fenugreek may also contain a substance that stimulates insulin production and improves blood sugar control.158, 159 In a controlled study in people with type 1 diabetes, incorporating powdered fenugreek seed into lunch and dinner meals (50 grams per meal) for ten days improved several measures of blood sugar control compared to a similar ten-day diet without added fenugreek.160

Ginkgo

Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic nerve damage (neuropathy), though research is at best very preliminary in this area.161

Hibiscus

Hibiscus is a traditional remedy in India for diabetes; this treatment is supported by preliminary studies from that country and by animal studies.162, 163 Hibiscus is usually taken as tea, 1 to 2 teaspoons (3 to 6 grams) of dried flower infused in to 1 cup (250 ml) of water three times per day.

Mistletoe

Mistletoe extract has been shown to stimulate insulin release from pancreas cells,164 and animal research found that it reduces symptoms of diabetes.165 No research in humans has yet been published; however, given mistletoe's worldwide reputation as a traditional remedy for diabetes, clinical trials are warranted to validate these promising preliminary findings. Traditionally, mistletoe is prepared by soaking 2 to 4 teaspoons (5 to 12 grams) of chopped mistletoe in 2 cups (500 ml) of water overnight. The mixture is drunk first thing in the morning and sweetened with honey if desired. Another batch may be left to steep during the day and drunk at bedtime.

Olive leaf

Olive leaf extracts have been used experimentally to lower elevated blood-sugar levels in diabetic animals.166 These results have not been reproduced in human clinical trials.

Reishi

Animal studies and some very preliminary trials in humans suggest reishi may have some beneficial action in people with diabetes.167, 168

Are there any side effects or interactions?

Refer to the individual herb for information about any side effects or interactions.

Other Alternatives

Holistic approaches that may be helpful

Acupuncture may be helpful in the treatment of diabetes, or complications associated with diabetes. In a preliminary trial, 77% of people suffering from diabetic nerve damage (neuropathy) experienced significant reduction in pain following up to six acupuncture treatments over a ten-week period. Many were also able to reduce pain medications, but no long-term change in blood-sugar control was observed.169 Bladder control problems, a complication of long-term diabetes, responded to acupuncture treatment with a significant reduction in symptoms in both controlled and uncontrolled trials.170, 171

References

1. Wolever TMS, Brand Miller J. Sugars and blood glucose control. Am J Clin Nutr 1995;62:212S-7S [review].
2. Wolever TMS, Brand Miller J. Sugars and blood glucose control. Am J Clin Nutr 1995;62:212S-7S [review].
3. Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2003;26:2466-8 [review].
4. Franz MJ. The glycemic index: not the most effective nutrition therapy intervention. Diabetes Care 2003;26:2466-8 [review].
5. Colagiuri S, Miller JJ, Edwards RA. Metabolic effects of adding sucrose and aspartame to the diet of subjects with noninsulin-dependent diabetes mellitus. Am J Clin Nutr 1989;50:474-8.
6. Abraira C, Derler J. Large variations of sucrose in constant carbohydrate diets in type II diabetes. Am J Med 1988;84:193-200.
7. Loghmani E, Rickard K, Washburne L, et al. Glycemic response to sucrose-containing mixed meals in diets of children with insulin-dependent diabetes mellitus. J Pediatr 1991;119:531-7.
8. American Diabetes Association. Position Statement: nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 1999;22:S42-5 [review].
9. Brand-Miller J, Foster-Powell K. Diets with a low glycemic index: from theory to practice. Nutr Today 1999;34:64-72 [review].
10. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002;25:148-98 [review].
11. Lafrance L, Rabasa-Lhoret R, Poisson D, et al. Effects of different glycaemic index foods and dietary fibre intake on glycaemic control in type 1 patients with diabetes on intensive insulin therapy. Diabet Med 1998;15:972-8.
12. Giacco R, Parillo M, Rivellese AA, et al. Long-term dietary treatment with increased amounts of fiber-rich low-glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients. Diabetes Care 2000;23:1461-6.
13. U.S. Department of Agriculture, U.S. Department of Health and Human Services: Dietary Guidelines for Americans, 2005. Home and Garden Bulletin No. 232, 2005. Available from URL: www.health.gov/dietaryguidelines/dga2005/document.
14. Vuorinen-Markkola H, Sinisalo M, Koivisto VA. Guar gum in insulin-dependent diabetes: effects on glycemic control and serum lipoproteins. Am J Clin Nutr 1992;56:1056-60.
15. Ebeling P, Yki-Jarvinen H, Aro A, et al. Glucose and lipid metabolism and insulin sensitivity in type 1 diabetes: the effect of guar gum. Am J Clin Nutr 1988;48:98-103.
16. Crane MG, Sample CJ. Regression of diabetic neuropathy with vegan diet. Am J Clin Nutr 1988;48:926 [abstract #P28].
17. Crane MG, Sample C. Regression of diabetic neuropathy with total vegetarian (vegan) diet. J Nutr Med 1994;4:431-9.
18. Cohen D, Dodds R, Viberti G. Effect of protein restriction in insulin dependent diabetics at risk of nephropathy. BMJ 1987;294:795-8.
19. Evanoff G, Thompson C, Bretown J, Weinman E. Prolonged dietary protein restriction in diabetic nephropathy. Arch Intern Med 1989;149:1129-33.
20. Gin H, Aparicio M, Potauz L, et al. Low-protein, low-phosphorus diet and tissue insulin sensitivity in insulin-dependent diabetic patients with chronic renal failure. Nephron 1991;57:411-5.
21. Donaghue KC, Pena MM, Chan AK, et al. Beneficial effects of increasing monounsaturated fat intake in adolescents with type 1 diabetes. Diabetes Res Clin Pract 2000;48:193-9.
22. Muntoni S, Cocco P, Aru G, Cucca F. Nutritional factors and worldwide incidence of childhood type 1 diabetes. Am J Clin Nutr 2000;71:1525-9.
23. Dahl-Jorgensen K, Joner G, Hanssen KF. Relationship between cows' milk consumption and incidence of IDDM in childhood. Diabetes Care 1991;14:1081-3.
24. Coleman DL, Kuzava JE, Leiter EH. Effect of diet on incidence of diabetes in nonobese diabetic mice. Diabetes 1990;39:432-6.
25. Karajalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. N Engl J Med 1992;327:302-7.
26. Luopajärvi K, Savilahti E, Virtanen SM, et al. Enhanced levels of cow's milk antibodies in infancy in children who develop type 1 diabetes later in childhood. Pediatr Diabetes 2008;9:434-41.
27. Gerstein H. Cow's milk exposure and type I diabetes mellitus. Diabetes Care 1994;17:13-9.
28. Virtanen SM, Laara E, Hypponen E, et al. Cow's milk consumption, HLA-DQB1 genotype, and type I diabetes. Diabetes 2000;49:912-7.
29. Hypponen E, Kenward MG, Virtanen SM, et al. Infant feeding, early weight gain, and risk of type I diabetes. Diabetes Care 1999;22:1961-5.
30. Verge CF, Howard NJ, Irwig L, et al. Environmental factors in childhood IDDM. A population-based, case-control study. Diabetes Care 1994;17:1381-9.
31. Bodington MJ, McNallyPG, Burden AC. Cow's milk and type I childhood diabetes: no increase in risk. Diabetes Med 1994;11:663-5.
32. Wadsworth EJ, Shield JP, Hunt LP, Baum JD. A case-control study of environmental factors associated with diabetes in the under 5's. Diabetes Med 1997;14:390-6.
33. Dahlquist G, Blom L, Lonnberg G. The Swedish Childhood Diabetes Study-a multivariate analysis of risk determinants for diabetes in different age groups. Diabetologia 1991;34:757-62.
34. Elliott RB, Harris DP, Hill JP, et al. Type I (insulin-dependent) diabetes mellitus and cow milk: casein variant consumption. Diabetologia 1999;42:292-6.
35. Scott FWE, Norris JM, Kolb H. Milk and type I diabetes. Diabetes Care 1996;19:379-83 [review].
36. Atkinson MA, Bowman MA, Kao K-J, et al. Lack of immune responsiveness to bovine serum albumin in insulin-dependent diabetes. N Engl J Med 1993;329:1853-8.
37. Gerstein H. Cow's milk exposure and type I diabetes mellitus. Diabetes Care 1994;17:13-9.
38. Akerblom HK, Knip M. Putative environmental factors in Type 1 diabetes. Diabetes Metab Rev 1998;14:31-67 [review].
39. Hyppönen E, Kenward MG, Virtanen SM, et al. Infant feeding, early weight gain, and risk of type 1 diabetes. Diabetes Care 1999;22:1961-5.
40. Pettit DJ, Forman MR, Hanson RL, et al. Breast feeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet 1997;350:166-8.
41. Hyppönen E, Kenward MG, Virtanen SM, et al. Infant feeding, early weight gain, and risk of type 1 diabetes. Diabetes Care 1999;22:1961-5.
42. Grimm J-J, Muchnick S. Type I diabetes and marathon running. Diabetes Care 1993;16:1624 [letter].
43. Bell DSH. Exercise for patients with diabetes-benefits, risks, precautions. Postgrad Med 1992;92:183-96 [review].
44. Ligtenberg PC, Blans M, Hoekstra JB, et al. No effect of long-term physical activity on the glycemic control in type 1 diabetes patients: a cross-sectional study. Neth J Med 1999;55:59-63.
45. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2003;26:S51-S61 [review].
46. Ajani UA, Gaziano JM, Lotufo PA, et al. Alcohol consumption and risk of coronary heart disease by diabetes status. Circulation 2000;102:500-5.
47. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002;25:148-98 [review].
48. Young RJ, McCulloch DK, Prescott RJ, Clarke PF. Alcohol: another risk factor for diabetic retinopathy? BMJ 1984;288:1035.
49. Moss SE, Klein R, Klein BE. The association of alcohol consumption with the incidence and progression of diabetic retinopathy. Ophthalmology 1994;101:196-8.
50. Stegmayr B, Lithner F. Tobacco and end stage diabetic nephropathy. BMJ 1987;295:581-2.
51. Scala C, LaPorte RE, Dorman JS, et al. Insulin-dependent diabetes mellitus mortality-the risk of cigarette smoking. Circulation 1990;82:37-43.
52. Rimm EB, Manson JE, Stampfer MJ, et al. Cigarette smoking and the risk of diabetes in women. Am J Public Health 1993;83:211-4.
53. [No authors listed.] Position statement: Tests of glycemia in diabetes. American Diabetes Association. Diabetes Care 2000;23(Suppl 1):S80-2.
54. Goldstein DE, Little RR, Lorenz RA, et al. Tests of glycemia in diabetes. Diabetes Care 1995;18:896-909 [review].
55. Gallichan M. Self monitoring of glucose by people with diabetes: evidence based practice. BMJ 1997;314:964-7 [review].
56. Steel LG. Identifying technique errors. Self-monitoring of blood glucose in the home setting. J Gerontol Nurs 1994;20:9-12.
57. Foster SA, Goode JV, Small RE. Home blood glucose monitoring. Ann Pharmacother 1999;33:355-63 [review].
58. Ruhnau KJ, Meissner HP, Finn JR, et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med 1999;16:1040-3.
59. Ruhnau KJ, Meissner HP, Finn JR, et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med 1999;16:1040-3.
60. Reljanovic M, Reichel G, Rett K, et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res 1999;31:171-9.
61. Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care 1999;22:1296-301.
62. Morcos M, Borcea V, Isermann B, et al. Effect of alpha-lipoic acid on the progression of endothelial cell damage and albuminuria in patients with diabetes mellitus: an exploratory study. Diabetes Res Clin Pract 2001;52:175-83.
63. Anderson RA. Chromium in the prevention and control of diabetes. Diabetes Metab 2000;26:22-7 [review].
64. Gaby AR, Wright JV. Diabetes. In: Nutritional Therapy in Medical Practice: Reference Manual and Study Guide. Kent, WA: 1996, 54-64 [review].
65. Lee NA, Reasner CA. Beneficial effect of chromium supplementation on serum triglyceride levels in NIDDM. Diabetes Care 1994;17:1449-52.
66. Hermann J, Chung H, Arquitt A, et al. Effects of chromium or copper supplementation on plasma lipids, plasma glucose and serum insulin in adults over age fifty. J Nutr Elderly 1998;18:27-45.
67. De Leeuw I, Engelen W, Aerts P, Schrans S. Effect of intensive magnesium supplementation on the in vitro oxidizability of LDL and VLDL in Mg-depleted type 1 diabetic patients. Magnes Res 1998;11:179-82.
68. Sjorgren A, Floren CH, Nilsson A. Oral administration of magnesium hydroxide to subjects with insulin dependent diabetes mellitus. Magnesium 1988;121:16-20.
69. McNair P, Christiansen C, Madsbad S, et al. Hypomagnesemia, a risk factor in diabetic retinopathy. Diabetes 1978;27:1075-7.
70. Mimouni F, Miodovnik M, Tsang RC, et al. Decreased maternal serum magnesium concentration and adverse fetal outcome in insulin-dependent diabetic women. Obstet Gynecol 1987;70:85-9.
71. American Diabetes Association. Magnesium supplementation in the treatment of diabetes. Diabetes Care 1992;15:1065-7.
72. Jamal GA, Carmichael H. The effect of gamma-linolenic acid on human diabetic peripheral neuropathy: a double-blind placebo-controlled trial. Diabet Med 1990;7:319-23.
73. Sima AA, Calvani M, Mehra M, Amato A. Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: an analysis of two randomized placebo-controlled trials. Diabetes Care 2005;28:89-94.
74. Haugen HN. The blood concentration of thiamine in diabetes. Scand J Clin Lab Invest 1964;16:260-6.
75. Abbas ZG, Swai ABM. Evaluation of the efficacy of thiamine and pyridoxine in the treatment of symptomatic diabetic peripheral neuropathy. East African Med J 1997;74:804-8.
76. Stracke H, Lindemann A, Federlin K. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy. Exp Clin Endocrinol Diabetes 1996;104:311-6.
77. Molnar GD, Berge KG, Rosevear JW, et al. The effect of nicotinic acid in diabetes mellitus. Metabolism 1964;13:181-9.
78. Gaut ZN, Pocelinko R, Solomon HM, Thomas GB. Oral glucose tolerance, plasma insulin, and uric acid excretion in man during chronic administration in nicotinic acid. Metabolism 1971;20:1031-5.
79. Clearly JP. Vitamin B3 in the treatment of diabetes mellitus: case reports and review of the literature. J Nutr Med 1990;1:217-25.
80. Lewis CM, Canafax DM, Sprafka JM, Bazrbosa JJ. Double-blind randomized trail of nicotinamide on early-onset diabetes. Diabetes Care 1992;15:121-3.
81. Chase HP, Butler-Simon N, Garg S, et al. A trial of nicotinamide in newly diagnosed patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1990;33:444-6.
82. Mendola G, Casamitjana R, Gomis R. Effect of nicotinamide therapy upon B-cell function in newly diagnosed type 1 (insulin-dependent) diabetic patients. Diabetologia 1989;32:160-2.
83. Pozzilli P, Browne PD, Kolb H. Meta-analysis of nicotinamide treatment in patients with recent-onset type 1. The nicotinamide trialists. Diabetes Care 1996;19:1357-63.
84. Vidal J, Fernandez-Balsells M, Sesmilo G, Aguilera E. Effects of nicotinamide and intravenous insulin therapy in newly diagnosed type 1 diabetes. Diabetes Care 2000;23:360-4.
85. Elliott RB, Picher CC, Fergusson DM, Stewart AW. A population based strategy to prevent insulin-dependent diabetes using nicotinamide. J Pediatr Endocrinol Metab 1996;9:501-9.
86. Lampeter EF, Klinghammer A, Scherbaum WA, et al. The Deutsche Nicotinamide Intervention Study. An attempt to prevent type 1 diabetes. Diabetes 1998;47:980-4.
87. Visalli N, Cavallo MG, Signore A, et al. A multi-centre randomized trial of two different doses of nicotinamide in patients with recent-onset type 1 diabetes (The IMDIAB VI). Diabetes Metab Res Rev 1999;15:181-5.
88. Wilson RG, Davis RE. Serum pyridoxal concentrations in children with diabetes mellitus. Pathology 1977;9:95-9.
89. Davis RE, Calder JS, Curnow DH. Serum pyridoxal and folate concentrations in diabetics. Pathology 1976;8:151-6.
90. McCann VJ, Davis RE. Serum pyridoxal concentrations in patients with diabetic neuropathy. Aust N Z J Med 1978;8:259-61.
91. Passariello N, Fici F, Giugliano D, et al. Effects of pyridoxine alpha-ketoglutarate on blood glucose and lactate in type I and II diabetics. Int J Clin Pharmacol Ther Toxicol 1983;21:252-6.
92. Solomon LR, Cohen K. Erythrocyte O2 transport and metabolism and effects of vitamin B6 therapy in type II diabetes mellitus. Diabetes 1989;38:881-6.
93. Coggeshall JC, Heggers JP, Robson MC, Baker H. Biotin status and plasma glucose in diabetics. Ann NY Acad Sci 1985;447:389-92.
94. Koutsikos D, Agroyannis B, Tzanatos-Exarchou H. Biotin for diabetic peripheral neuropathy. Biomed Pharmacother 1990;44:511-4.
95. Yamane K, Usui T, Yamamoto T, et al. Clinical efficacy of intravenous plus oral mecobalamin in patients with peripheral neuropathy using vibration perception thresholds as an indicator of improvement. Curr Ther Res 1995;56:656-70 [review].
96. Kuwabara S, Nakazawa R, Azuma N, et al. Intravenous methylcobalamin treatment for uremic and diabetic neuropathy in chronic hemodialysis patients. Intern Med 1999;38:472-5.
97. Abdel-Aziz MT, Abdou MS, Soliman K, et al. Effect of carnitine on blood lipid pattern in diabetic patients. Nutr Rep Int 1984;29:1071-9.
98. Cunningham JJ, Ellis SL, McVeigh KL, et al. Reduced mononuclear leukocyte ascorbic acid content in adults with insulin-dependent diabetes mellitus consuming adequate dietary vitamin C. Metabolism 1991;40:146-9.
99. Davie SJ, Gould BJ, Yudkin JS. Effect of vitamin C on glycosylation of proteins. Diabetes 1992;41:167-73.
100. Will JC, Tyers T. Does diabetes mellitus increase the requirement for vitamin C? Nutr Rev 1996;54:193-202 [review].
101. McAuliffe AV, Brooks BA, Fisher EJ, et al. Administration of ascorbic acid and an aldose reductase inhibitor (tolrestat) in diabetes: effect on urinary albumin excretion. Nephron 1998;80:277-84.
102. Branch DR. High-dose vitamin C supplementation increases plasma glucose. Diabetes Care 1999;22:1218 [letter].
103. Mayer-Davis E, Bell RA, Reboussin BA, et al. Antioxidant nutrient intake and diabetic retinopathy. The San Luis Valley Diabetes Study. Ophthalmology 1998;105:2264-70.
104. Labriji-Mestaghanmi H, Billaudel B, Garnier PE, Sutter BCJ. Vitamin D and pancreatic islet function. I. Time course for changes in insulin secretion and content during vitamin deprivation and repletion. J Endocrine Invest 1988;11:577-84.
105. Hypponen E, Laara E, Reunanen A, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 2001;358:1500-3.
106. Knekt P, Reunanen A, Marniumi J, et al. Low vitamin E status is a potential risk factor for insulin-dependent diabetes mellitus. J Intern Med 1999;245:99-102.
107. Ross WM, Creighton MO, Stewart-DeHaan PJ, et al. Modelling cortical cataractogenesis: 3. In vivo effects of vitamin E on cataractogenesis in diabetic rats. Can J Ophthalmol 1982;17:61.
108. Bursell SE, Schlossman DK, Clermont AC, et al. High-dose vitamin E supplementation normalizes retinal blood flow and creatinine clearance in patients with type I diabetes. Diabetes Care 1999;22:1245-51.
109. Ceriello A, Giugliano D, Quatraro A, et al. Vitamin E reduction of protein glycosylation in diabetes. Diabetes Care 1991;14:68-72.
110. Duntas L, Kemmer TP, Vorberg B, Scherbaum W. Administration of d-alpha-tocopherol in patients with insulin-dependent diabetes mellitus. Curr Ther R es 1996;57:682-90.
111. Jain SK, McVie R, Smith T. Vitamin E supplementation restores glutathione and malondialdehyde to normal concentrations in erythrocytes of type 1 diabetic children. Diabetes Care 2000;23:1389-94.
112. Bursell S-E, Schlossman DK, Clermont AC, et al. High-dose vitamin E supplementation normalizes retinal blood flow and creatineine clearance in patients with type I diabetes. Diabetes Care 1999;22:1245-51.
113. Fuller CJ, Chandalia M, Garg A, et al. RRR-alpha-tocopheryl acetate supplementation at pharmacologic doses decreases low-density-lipoprotein oxidative susceptibility but not protein glycation in patients with diabetes mellitus. Am J Clin Nutr 1996;63:753-9.
114. Nakamura T, Higashi A, Nishiyama S, et al. Kinetics of zinc status in children with IDDM. Diabetes Care 1991;14:553-7.
115. Mocchegiani E, Boemi M, Fumelli P, Fabris N. Zinc-dependent low thymic hormone level in type I diabetes. Diabetes 1989;12:932-7.
116. Rao KVR, Seshiah V, Kumar TV. Effect of zinc sulfate therapy on control and lipids in type I diabetes. J Assoc Physicians India 1987;35:52 [abstract].
117. Cunningham JJ, Fu A, Mearkle PL, Brown RG. Hyperzincuria in individuals with insulin-dependent diabetes mellitus: concurrent zinc status and the effect of high-dose zinc supplementation. Metabolism 1994;43:1558-62.
118. Crary EJ, McCarty MF. Potential clinical applications for high-dose nutritional antioxidants. Med Hypotheses 1984;13:77-98.
119. Shigeta Y, Izumi K, Abe H. Effect of coenzyme Q7 treatment on blood sugar and ketone bodies of diabetics. J Vitaminol (Kyoto) 1966;12:293-8.
120. Henriksen JE, Bruun Andersen C, Hother-Nielsen O, et al. Impact of ubiquinone (coenzyme Q10) treatment on glycaemic control, insulin requirement and well-being in patients with Type 1 diabetes mellitus. Diabet Med 1999;16:312-8.
121. Zak A, Zeman M, Hrabak P, et al. Changes in the glucose tolerance and insulin secretion in hypertriglyceridemia: effects of dietary n-3 fatty acids. Nutr Rep Int 1989;39:235-42.
122. Okuda Y, Mizutani M, Ogawa M, et al. Long-term effects of eicosapentaenoic acid on diabetic peripheral neuropathy and serum lipids in patients with type II diabetes mellitus. J Diabetes Complications 1996;10:280-7.
123. Mori TA, Vandongen R, Masarei JR, et al. Comparison of diets supplemented with fish oil or olive oil on plasma lipoproteins in insulin-dependent diabetics. Metabolism 1991;40:241-6.
124. Mori TA, Vandongen R, Masarei JR. Fish oil-induced changes in apolipoproteins in IDDM subjects. Diabetes Care 1990;13:725-32.
125. Doi K. Effect of konjac fibre (glucomannan) on glucose and lipids. Eur J Clin Nutr 1995;49(3 Suppl):190S-197S [review].
126. Salway JG, Whitehead L, Finnegan JA, et al. Effect of myo-inositol on peripheral-nerve function in diabetes. Lancet 1978;2:1282-4.
127. Gregersen G, Borsting H, Theil P, Servo C. Myoinositol and function of peripheral nerves in human diabetics. Acta Neurol Scand 1978;58:241-8.
128. Kosenko LG. Concentration of trace elements in the blood of patients with diabetes mellitus. Fed Proc Transl (Suppl) 1965;24:237-8.
129. Baly DL, Schneiderman JS, Garcia-Welsh AL. Effect of manganese deficiency on insulin binding, glucose transport and metabolism in rat adipocytes. J Nutr 1990;120:1075-9.
130. Rubenstein AH, Levin NW, Elliott GA. Hypoglycaemia induced by manganese. Nature (London) 1962;194:188-9.
131. Gaby A. Preventing complications of diabetes Townsend Letter 1985;32:307 [editorial].
132. Boivin M, Zinsmeister AR, Go VL, DiMagno EP. Effect of a purified amylase inhibitor on carbohydrate metabolism after a mixed meal in healthy humans. Mayo Clin Proc 1987;62:249-55.
133. Boivin M, Flourie B, Rizza RA, et al. Gastrointestinal and metabolic effects of amylase inhibition in diabetics. Gastroenterology 1988;94:387-94.
134. Lankisch M, Layer P, Rizza RA, DiMagno EP. Acute postprandial gastrointestinal and metabolic effects of wheat amylase inhibitor (WAI) in normal, obese, and diabetic humans. Pancreas 1998;17:176-81.
135. Holt PR, Thea D, Yang MY, Kotler DP. Intestinal and metabolic responses to an alpha-glucosidase inhibitor in normal volunteers. Metabolism 1988;37:1163-70.
136. Layer P, Rizza RA, Zinsmeister AR, et al. Effect of a purified amylase inhibitor on carbohydrate tolerance in normal subjects and patients with diabetes mellitus. Mayo Clin Proc 1986;61:442-7.
137. Franconi F, Bennardini F, Mattana A, et al. Plasma and platelet taurine are reduced in subjects with insulin-dependent diabetes mellitus: effects of taurine supplementation. Am J Clin Nutr 1995;61:1115-9.
138. Halberstam M, Cohen N, Schlimovich P, et al. Oral vanadyl sulfate improves insulin sensitivity in NIDDM but not in obese nondiabetic subjects. Diabetes 1996;45:659-66.
139. Boden G, Chen X, Ruiz J, et al. Effects of vanadyl sulfate on carbohydrate and lipid metabolism in patients with non-insulin dependent diabetes mellitus. Metabolism 1996;45:1130-5.
140. Goldfine AB, Patti ME, Zuberi L, et al. Metabolic effects of vanadyl sulfate in humans with non-insulin-dependent diabetes mellitus: in vivo and in vitro studies. Metabolism 2000;49:400-10.
141. Aharon Y, Mevorach M, Shamoon H. Vanadyl sulfate does not enhance insulin action in patients with type 1 diabetes. Diabetes Care 1998;21:2194 [letter].
142. [No authors listed.] Treatment of painful diabetic neuropathy with topical capsaicin. A multicenter, double-blind, vehicle-controlled study. The Capsaicin Study Group. Arch Intern Med 1991;151:2225-9.
143. [No authors listed.] Effect of treatment with capsaicin on daily activities of patients with painful diabetic neuropathy. Capsaicin Study Group. Diabetes Care 1992;15:159-65.
144. Scharrer A, Ober M. Anthocyanoside in der Behandlung von Retinopathien. Klin Monatsblatt Augenheilk 1981;178:386-9.
145. [No authors listed]Gymnema sylvestre. Altern Med Rev 1999;4:46-7.
146. Shanmugasundaram ERB, Rajeswari G, Baskaran K, et al. Use of Gymnema sylvestre leaf extract in the control of blood glucose insulin-dependent diabetes mellitus. J Ethnopharmacol 1990;30:281-94.
147. Joffe DJ, Freed SH. Effect of extended release gymnema sylvestre leaf extract (Beta Fast GXR) alone or in combination with oral hypoglycemics or insulin regimens for type 1 and type 2 diabetes. Diabetes In: Control Newsletter 2001;76:no page number.
148. Jain RC, Sachdev KN. A note on hypoglycemic action of onion in diabetes. Curr Med Pract 1971;15:901-2.
149. Mathew PT, Augusti KT. Hypoglycaemic effect of onion, Allium cepa Linn, on diabetes mellitus, a preliminary report. Ind J Physiol Pharmacol 1975;19:231-7.
150. Tjokroprawiro A, Pikir BS, Budhiarta AA, et al. Metabolic effects of onion and green beans on diabetic patients. Tohoku J Exp Med 1983;141(suppl):671-6.
151. Sharma KK, Gupta RK, Gupta S, Samuel KC. Antihyperglycemic effect of onion: Effect on fasting blood sugar and induced hyperglycemia in man. Ind J Med Res 1977;65:422-9.
152. Maxwell SR, et al. Poor glycaemic control is associated with reduced serum free radical scavenging (antioxidant) activity in non-insulin-dependent diabetes mellitus. Ann Clin Biochem 1997;34( Pt 6):638-44.
153. Jayaprakasam B, Vareed SK, Olson LK, Nair MG. Insulin secretion by anthocyanins and anthocyanidins. J Agric Food Chem 2005;53:28-31.
154. Zhang T, Hoshino M, Iguchi K, et al. Ginseng root: Evidence for numerous regulatory peptides and insulinotropic activity. Biomed Res 1990;11:49-54.
155. Suzuki Y, Hikino H. Mechanisms of hypoglycemic activity of panaxans A and B, glycans of Panax ginseng roots: Effects on plasma levels, secretion, sensitivity and binding of insulin in mice. Phytother Res 1989;3:20-4.
156. Waki I, Kyo H, Yasuda M, Kimura M. Effects of a hypoglycemic component of ginseng radix on insulin biosynthesis in normal and diabetic animals. J Pharm Dyn 1982;5:547-54.125.
157. Hannan JM, Rokeya B, Faruque O, et al. Effect of soluble dietary fibre fraction of Trigonella foenum graecum on glycemic, insulinemic, lipidemic and platelet aggregation status of Type 2 diabetic model rats. J Ethnopharmacol 2003;88:73-7.
158. Broca C, Manteghetti M, Gross R, et al. 4-Hydroxyisoleucine: effects of synthetic and natural analogues on insulin secretion. Eur J Pharmacol 2000;390:339-45.
159. Puri D, Prabhu KM, Murthy PS. Mechanism of action of a hypoglycemic principle isolated from fenugreek seeds. Indian J Physiol Pharmacol 2002;46:457-62.
160. Sharma RD, Raghuram TC, Rao NS. Effect of fenugreek seeds on blood glucose and serum lipids in type I diabetes. Eur J Clin Nutr 1990;44:301-6.
161. Koltringer P, Langsteger W, Lind P, et al. [Ginkgo biloba extract and folic acid in the therapy of changes caused by autonomic neuropathy]. Acta Med Austriaca 1989;16:35-7 [in German].
162. Alam MM, Siddiqui MB, Hussain W. Treatment of diabetes through herbal drugs in rural India. Fitoterapia 1990;61:240-2.
163. Sachdewa A, Khemani LD. Effect of Hibiscus rosa sinensis Linn ethanol flower extract on blood glucose and lipid profile in streptozotocin induced diabetes in rats. J Ethnopharmacol 2003;89:61-6.
164. Gray AM, Flatt PR. Insulin-secreting activity of the traditional antidiabetic plant Viscum album (mistletoe). J Endocrinol 1999;160:409-14.
165. Swanson-Flatt SK, Day C, Bailey CJ, Flatt PR. Evaluation of traditional plant treatments for diabetes: Studies in streptozotocin-diabetic mice. Acta Diabetologica Latina 1989;26:51-5.
166. Peirce A. Practical Guide to Natural Medicines. New York: William Morrow and Co., 1999, 469-71.
167. Van der Hem LG, van der Vliet JA, Bocken CF, et al. Ling Zhi-8: studies of a new immunomodulating agent. Transplantation 1995;60:438-43.
168. Jones K. Reishi mushroom: Ancient medicine in modern times. Alt Compl Ther 1998;4:256-66 [review].
169. Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes Res Clin Pract 1998;39:115-21.
170. Zheg HT, Huang XM, Sun JH. Treatment of diabetic cystopathy by acupuncture and moxibustion. J Tradit Chin Med 1986;6:243-8.
171. Zhang W. Acupuncture for treatment of diabetic urinary bladder neural dysfunction-a report of 36 cases. J Tradit Chin Med 1997;17:211-3.

This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Privacy Policy. How this information was developed to help you make better health decisions.