Diabetes

Diabetes has two forms. In the type that develops early in childhood (type 1), the insulin-secreting cells of the pancreas are destroyed (probably by a viral infection), and blood levels of insulin drop nearly to zero. However, in the adult-onset form (type 2), insulin is often plentiful, but the body does not respond normally to it. (This is only an approximate description of the difference between the two types.) In both forms of diabetes, blood sugar reaches toxic levels, causing injury to many organs and tissues.

Conventional treatment for childhood-onset diabetes includes insulin injections and careful dietary monitoring. The adult-onset form may respond to lifestyle changes alone, such as increasing exercise, losing weight, and improving diet. Various oral medications are also often effective for adult-onset diabetes, although insulin injections may be necessary in some cases.

Principal Proposed Treatments for Diabetes:

Several alternative methods may be helpful when used under medical supervision as an addition to standard treatment. They may help stabilize, reduce, or eliminate medication requirements; reduce the symptoms of diabetic complications; or correct nutritional deficiencies associated with diabetes. However, because diabetes is a dangerous disease with many potential complications, alternative treatment for diabetes should not be attempted as a substitute for conventional medical care.

Treatments for Improving Blood Sugar Control

The following treatments may be able to improve blood sugar control in type 1 and/or type 2 diabetes.

Note: Keep in mind that if these treatments work, you will need to reduce your medications to avoid hypoglycemia. For this reason, medical supervision is essential.

Chromium

Chromium is an essential trace mineral that plays a significant role in sugar metabolism. Reasonably good evidence suggests that chromium supplementation may help bring blood sugar levels under control in type 2 diabetes. It may also be helpful for pregnancy-related diabetes.

A 4-month study reported in 1997 followed 180 Chinese men and women with type 2 diabetes, comparing the effects of 1,000 mcg chromium, 200 mcg chromium, and placebo. The results showed that HbA1c values (a measure of long-term blood sugar control) improved significantly after 2 months in the group receiving 1,000 mcg, and in both chromium groups after 4 months. Fasting glucose was also lower in the group taking the higher dose of chromium.

A double-blind trial of 78 individuals with diabetes compared two forms of chromium (brewers yeast and chromium chloride) against placebo. This rather complex crossover study consisted of four 8-week intervals of treatment in random order. The results in the 67 participants who completed the study showed that both forms of chromium significantly improved blood sugar control. Similarly positive results were seen in other small studies. However, there have also been negative results.

One placebo-controlled study of 30 women with pregnancy-related diabetes found that supplementation with chromium (at a dosage of 4 or 8 mcg chromium picolinate for each kilogram of body weight) significantly improved blood sugar control.

Chromium might also be helpful for treating diabetes caused by corticosteroid treatment.

For more information, including dosage and safety issues, see the full chromium article.

Fenugreek

The food spice fenugreek may also help control blood sugar. For millennia, fenugreek has been used both as a medicine and as a spice in Egypt, India, and the Middle East.

In a two-month, double-blind study of 25 individuals with type 2 diabetes, use of fenugreek (1 gm per day of a standardized extract) significantly improved some measures of blood sugar control and insulin response as compared to placebo. Triglyceride levels decreased and HDL (“good”) cholesterol levels increased, presumably due to the enhanced insulin sensitivity. Similar benefits have been seen in animal studies and open human trials, as well.

For more information, including dosage and safety issues, see the full fenugreek article.

Gymnema

A few preliminary studies suggest that the Ayurvedic (Indian) herb gymnema may help improve blood sugar control. It might be helpful for mild cases of adult-onset diabetes, taken alone or in combination with standard treatment (under a doctors supervision in either case).

For more information, including dosage and safety issues, see the full gymnema article.

Ginseng

A double-blind study evaluated the effects of ginseng in 36 people newly diagnosed with adult-onset diabetes over an 8-week period. The results showed a reduction in glucose levels, improved glycosylated hemoglobin (a measure of long-term blood sugar control), and improved physical capacity. The authors believed that it was the increased activity that improved blood sugar.

Improved blood sugar control was also seen in two small double-blind placebo-controlled trials using American ginseng (Panax quinquefolius). One study suggests that ginseng with low ginsenoside content is not effective.

For more information, including dosage and safety issues, see the full ginseng article.

Aloe

The succulent aloe plant has been valued since prehistoric times for the treatment of burns, wound infections, and other skin problems. However, recent evidence suggests that oral aloe might be useful for type 2 diabetes.

Evidence from two human trials suggests that aloe gel can improve blood sugar control.

A single-blind placebo-controlled trial evaluated the potential benefits of aloe in either 72 or 40 individuals with diabetes (the study report appears to contradict itself). The results showed significantly greater improvements in blood sugar levels among those given aloe over the 2-week treatment period.

Another single-blind placebo-controlled trial evaluated the benefits of aloe in individuals who had failed to respond to the oral diabetes drug glibenclamide. Of the 36 individuals who completed the study, those taking glibenclamide and aloe showed definite improvements in blood sugar levels over 42 days as compared to those taking glibenclamide and placebo.

While these are promising results, large studies that are double- rather than single-blind will be needed to establish aloe as an effective treatment for hypoglycemia.

For more information, including dosage and safety issues, see the full aloe article.

Vanadium

Studies in rats with and without diabetes suggest that the mineral vanadium may have an insulin-like effect, reducing blood sugar levels. Based on these findings, preliminary studies involving human subjects have been conducted, with mostly promising results. However, this evidence is too limited to be taken as definitive proof.

For more information, including dosage and safety issues, see the full vanadium article.

Other Treatments That May Help Control Blood Sugar

Preliminary evidence suggests that the herbs bilberry leaf, bitter melon (Momordica charantia), Coccinia indica,garlic, guggul, holy basil (Ocimum sanctum), maitake,nopal cactus (Opuntia streptacantha), onion, pterocarpus, and salt bush and the supplements CLA (conjugated linoleic acid), arginine, and glucomannan might help control blood sugar levels.

Other herbs traditionally used for diabetes that might offer some benefit include Cuminum cyminum (cumin), Azadirachta indica (neem), Musa sapientum L. (banana), Anemarrhena asphodeloides, Catharanthus roseus, Cucumis sativus, Cucurbita ficifolia, Euphorbia prostrata, Guaiacum coulteri, Guazuma ulmifolia, Lepechinia caulescens, Medicago sativa (alfalfa), Phaseolus vulgaris, Psacalium peltatum, Rhizophora mangle, Spinacea oleracea, Tournefortia hirsutissima, and Turnera diffusa.

Preliminary studies indicate that vitamin E may also slightly improve blood sugar control in type 2 diabetes. (For a discussion of the safety issues and the proper dosage amounts, see the article on vitamin E.) The supplements carnitine, coenzyme Q10, and lipoic acid (better known as a treatment for complications of diabetes as described under the heading Treating Complications of Diabetes) might also be helpful.

If your child has just developed diabetes, the supplement niacinamide—a form of niacin, also called vitamin B3—might slightly prolong what is called the honeymoon period. This is the interval during which the pancreas can still make some insulin, and insulin needs are low. However, the benefits (if any) appear to be minor. A cocktail of niacinamide plus antioxidant vitamins and minerals has also been tried, but the results were disappointing.

For more information, including dosage and safety issues, see the full vitamin B3 article.

The supplement biotin is also sometimes said to be helpful in diabetes, for both blood sugar control and reduction of complications, but there is as yet little direct evidence that it works.

Warning: Recent animal studies and case reports have raised concerns that the supplement glucosamine might raise blood sugar levels in individuals with diabetes.

Treating Complications of Diabetes

Several supplements may help prevent or treat some of the common complications of diabetes.

Because atherosclerosis is one of the worst problems associated with diabetes, all the suggestions discussed in the article on atherosclerosis may be useful. In addition, fish oil appears to be safe and effective for reducing levels of triglycerides in diabetics.

Lipoic Acid

Lipoic acid has been widely used in Germany for decades to treat diabetic peripheral neuropathy, a painful nerve condition that often develops after many years of diabetes. However, most of the evidence of its effectiveness for this condition is limited to studies that used the intravenous form of lipoic acid.

This naturally occurring antioxidant may also help prevent and treat cardiac autonomic neuropathy (injury to the nerves controlling the heart).

Lipoic acid is a vitamin-like substance that plays a role in the bodys utilization of energy. Because lipoic acid can be synthesized from other substances, it is not considered an essential nutrient. However, in people with diabetes, levels of lipoic acid are reduced, which suggests (but definitely does not prove) that supplementation would be helpful.

According to some preliminary evidence, lipoic acid may be more effective if it is combined with GLA (gamma-linolenic acid), another supplement used for diabetic neuropathy.

What Is the Scientific Evidence for Lipoic Acid? There is some evidence that intravenous lipoic acid can reduce symptoms of diabetic peripheral neuropathy, at least in the short term. Oral lipoic acid has not been well evaluated, and the best study of oral lipoic acid did not find it effective in long-term use.

A randomized double-blind placebo-controlled study that enrolled 503 individuals with diabetic neuropathy found that intravenous lipoic acid helped reduce symptoms over a 3-week period, but long-term oral supplementation was not effective.

A previous double-blind placebo-controlled trial also found short-term benefit with intravenous lipoic acid.

Warning: Do not inject lipoic acid products intended for oral use.

The positive evidence for oral lipoic acid in diabetic peripheral neuropathy is limited to open studies or trials that were too small upon which to base conclusions.

The DEKAN (Deutsche Kardiale Autonome Neuropathie) study followed 73 people with diabetes, who had symptoms of cardiac autonomic neuropathy, for 4 months. Treatment with 800 mg of oral lipoic acid daily showed significant improvement compared to placebo and no important side effects.

For more information, including dosage and safety issues, see the full lipoic acid article.

GLA (from Evening Primrose)

The evening primrose is a native American wildflower, named for the late-afternoon opening of its delicate flowers. Perhaps it should be described as a food supplement rather than an herb, for evening primrose oil has been popularized mainly as a source of GLA (gamma-linolenic acid), an essential fatty acid also found in black currant and borage oil.

Although many other kinds of fat are unhealthy, essential fatty acids (EFAs) are as necessary as vitamins. The two main kinds of EFAs are called omega-3 and omega-6 fatty acids. The GLA in evening primrose oil is an omega-6 fatty acid. A growing body of scientific evidence suggests that supplementation with GLA may help relieve symptoms of diabetic neuropathy. Fish oil may be helpful as well.

What Is the Scientific Evidence for GLA? Many studies in animals have shown that evening primrose oil can protect nerves from diabetes-induced injury. Good results were also seen in a double-blind study that followed 111 people with diabetes from seven medical centers for a period of 1 year .The results showed an improvement in subjective symptoms such as pain and numbness as well as objective signs of nerve injury. Individuals with good blood sugar control improved the most. Another double-blind study also reported positive results.

For more information, including dosage and safety issues, see the full GLA article.

Other Treatments to Help Treat Complications of Diabetes

According to a 52-week double-blind trial of 19 individuals with diabetes, acetyl-L-carnitine may help prevent or slow down cardiac autonomic neuropathy (injury to the nerves of the heart caused by diabetes).

A 4-month double-blind placebo-controlled trial found that vitamin E at a dose of 600 mg daily might improve symptoms of cardiac autonomic neuropathy. In addition, intriguing evidence suggests that vitamin E may help protect people with diabetes from developing damage to their eyes and kidneys. There is also some evidence that vitamin E as well as selenium might be beneficial for diabetic peripheral neuropathy. The supplement inositol has also been tried as a treatment for complications of diabetes, but the results have been mixed.

Weak evidence suggests that the herb bilberry may help prevent eye damage caused by diabetes.

OPCs and ginkgo are said to provide similar benefits, although the evidence for these is weaker than that for bilberry.

Vitamin C is believed to help prevent cataracts in general. It is not known for sure whether vitamin C produces the same benefit in people with diabetes. However, it has been suggested that vitamin C may actually be especially useful because of its relationship to sorbitol, a sugar-like substance that tends to accumulate in the cells of people with diabetes. Sorbitol is believed to play a role in the development of diabetic cataracts, and vitamin C appears to help reduce sorbitol buildup.However, the evidence that vitamin C provides significant benefits by this route is at present indirect and far from conclusive. For more information, including dosage and safety issues, see the full vitamin C article.

Preliminary evidence suggests that oxerutins might also be helpful for reducing foot and ankle swelling in people with diabetes.In these trials, oxerutin therapy did not affect blood sugar control.

Warning: There is some evidence that the substance glucosamine, used for arthritis, may increase the risk of diabetic cataracts.

Treating Nutritional Deficiencies in Diabetes

Both diabetes and the medications used to treat it can cause people to fall short of various nutrients. Making up for these deficiencies (either through diet or the use of supplements) may not help your diabetes, but it should make you a healthier person overall.

Magnesium appears to be the most common mineral deficiency in type 1 diabetes.People with either type 1 or type 2 diabetes may also be deficient in the mineral zinc.Vitamin C levels have been found to be low in many diabetics on insulin, even though they were consuming seemingly adequate amounts in their diets.Some people with type 1 diabetes appear to be deficient in the amino acid taurine.Finally, manganese deficiency reportedly can occur.

The drug metformin can cause vitamin B12deficiency. Interestingly, taking extra calcium may prevent this.

Preventing Diabetes

Niacinamide

Evidence from a large study conducted in New Zealand suggests that the supplement niacinamide—a form of niacin, also known as vitamin B3—might be able to reduce the risk of diabetes in children at high risk. In this study, more than 20,000 children were screened for diabetes risk by measuring certain antibodies in the blood (ICA antibodies, believed to indicate risk of developing diabetes). It turned out that 185 of these children had detectable levels. About 170 of these children were then given niacinamide for 7 years (not all parents agreed to give their children niacinamide or stay in the study for that long). About 10,000 other children were not screened, but they were followed to see whether they developed diabetes.

The results were positive. In the group in which children were screened and given niacinamide if they were positive for ICA antibodies, the incidence of diabetes was reduced by almost 60%.

These findings suggest that niacinamide is an effective treatment for preventing diabetes. (The study also indicates that tests for ICA antibodies can very accurately identify children at risk for diabetes.)

At present, an enormous-scale, long-term trial called the European Nicotinamide Diabetes Intervention Trial is being conducted to definitively determine whether regular use of niacinamide can prevent diabetes. Results from the German portion of the study have been released, and they were not positive; however, until the entire study is complete, it is not possible to draw conclusions.

A small trial evaluated the effects of niacinamide plus antioxidant vitamins and minerals for children who had just started to show signs of diabetes. Unfortunately, no benefits were seen in terms of moderating the course of the disease.

Warning: Medical supervision is essential before giving your child long-term niacinamide treatment.

For more information, including dosage and safety issues, see the full vitamin B3 article.

Vitamin D

Several observational studies suggest that vitamin D may also help prevent diabetes.

For important information on dosage and safety, see the full vitamin D article.

Supplements to Use with Caution

There is some evidence that the supplement glucosamine, used for osteoarthritis, may increase the risk of diabetic cataracts and possibly worsen blood sugar control.

There are some indications that the herb ginkgo might alter insulin release in individuals with diabetes. The effect appears to be rather complex; the herb may cause some increase in insulin output, and yet might actually lower insulin levels overall through its effects on the liver and perhaps on oral medications used for diabetes. Until this situation is clarified, individuals with diabetes should use ginkgo only under the supervision of a physician.