PCC | Healthnotes | Type 2 Diabetes

Type 2 Diabetes

Also indexed as: High Blood Sugar

Also known as adult-onset diabetes, type 2 diabetes can often be managed by carefully monitoring your diet. According to research or other evidence, the following self-care steps may be helpful:

Aim for total nutrition with a multivitamin
Help ensure your body is getting the vitamins and minerals it needs to help prevent common infections

Check out chromium
Improve glucose tolerance by taking 200 to 1,000 mcg of this essential trace mineral every day

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 glucomannan or psyllium

Use a topical ointment
An ointment containing 0.025 to 0.075% capsaicin four times a day might help control nerve pain

Improve and protect with ALA
Take 600 to 1,200 mg a day of an alpha lipoic acid supplement to improve insulin sensitivity and help protect against diabetic complications such as nerve damage

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 2 diabetes, which has also been called adult-onset diabetes or non-insulin-dependent diabetes. However, type 2 diabetes may also affect children and may also require treatment with insulin. With type 2 diabetes, the pancreas often makes enough insulin, but the body has trouble using it. Type 2 diabetes frequently responds well to natural therapies.

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. In addition, those with diabetes have a higher mortality rate if they also have high homocysteine levels.¹

Product ratings for diabetes mellitus

Science Ratings	Nutritional Supplements	Herbs
	Alpha lipoic acid Brewer’s yeast (providing approximately 60 mcg of chromium per tablespoon) Chromium Evening primrose oil Fiber Glucomannan Magnesium	Cayenne (topical for neuropathy) Fenugreek (seeds) Psyllium
	Acetyl-L-carnitine (for diabetic neuropathy) Biotin Coenzyme Q10 L-carnitine Multivitamin–mineral supplement (for preventing infections) Vitamin B1 (thiamine; in combination with vitamin B6 or B12 for diabetic neuropathy only) Vitamin B12 (for diabetic neuropathy) Vitamin B6 Vitamin C Vitamin D Vitamin E (for prevention of diabetic retinopathy) Zinc (for deficiency only)	Aloe American ginseng Asian ginseng Bilberry Bitter melon Cinnamon Crepe myrtle (Lagerstroemia speciosa) Gymnema Hairy basil (seed) Holy basil (leaf) Milk thistle Onion
	Fish oil (EPA/DHA) Following are associated with diabetic retinopathy: selenium, vitamin A, vitamin C, and vitamin E (combined) Fructo-oligosaccharides (FOS) Inositol Manganese Medium-chain triglycerides Quercetin Starch blockers Taurine Vanadium Vitamin B3 (niacin) Vitamin E (associated with abetalipoproteinemia)	Açaí Ginkgo Hibiscus Mistletoe Olive leaf Reishi
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Dietary changes that may be helpful

The relationship between eating carbohydrates and type 2 diabetes is complex. While eating carbohydrates increases the need for insulin to keep blood sugar normal, diets high in total carbohydrates do not necessarily increase the risk of type 2 diabetes.² ³ Researchers have found that diets very high in sugar may worsen glucose tolerance in nondiabetic animals and humans.⁴ ⁵ However, the amount of sugar used in these studies in proportion to other foods was much larger than is typically found in human diets.

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.⁶ 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).⁷ People eating large amounts of foods with high glycemic indexes have been reported to be at increased risk of type 2 diabetes. ⁸ ⁹ On the other hand, eating a diet high in carbohydrate-rich foods with low glycemic indexes is associated with a low risk of type 2 diabetes. ¹⁰ ¹¹ ¹² Beans, peas, fruit, and oats have low glycemic indexes, despite their high carbohydrate content, due mostly to the health-promoting effects of soluble fiber.

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.¹³ ¹⁴ ¹⁵ Currently, the American Diabetic Association (ADA) guidelines do not prohibit the use of moderate amounts of sugar,¹⁶ as long as blood levels of glucose, triglycerides, and cholesterol are maintained within normal levels.

Most doctors recommend that people with diabetes to reduce the amount of sugar eaten in 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.¹⁷

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.¹⁸ In this study, the increase in dietary fiber was accomplished exclusively by eating foods naturally high in fiber—such as leafy green vegetables, granola, and fruit—to a level beyond that recommended by the ADA. No fiber supplements were given. All participants received both the ADA diet (providing 24 grams of fiber per day) and the high-fiber diet (providing 50 grams of fiber per day) for a period of six weeks. After six weeks of following each diet, tests were performed to determine blood glucose, insulin, cholesterol, triglyceride, and other values. When glucose levels were monitored over a 24-hour period, participants eating the high-fiber diet had an average glucose level that was 10% lower than participants eating the ADA diet. Insulin levels were 12% lower in the group eating the high-fiber diet compared to the group eating the ADA diet, indicating a beneficial increase in the body’s sensitivity to insulin. Moreover, people eating the high-fiber diet experienced significant reductions in total cholesterol, triglycerides, and LDL (“bad”) cholesterol compared with those eating the ADA diet. They also had slight decreases (improvements) in glycosylated hemoglobin levels, a measure of long-term blood glucose regulation.

High-fiber supplements, such as psyllium,¹⁹ guar gum (found in cluster beans),²⁰ pectin (from fruit),²¹ oat bran,²² and glucomannan,²³ ²⁴ have improved glucose tolerance in some studies. Positive results have also been reported with the consumption of 1 to 3 ounces of powdered fenugreek seeds per day.²⁵ ²⁶ A review of the research revealed that the extent to which moderate amounts of fiber help people with diabetes in the long term is still unknown, and the lack of many long-term studies has led some researchers to question the importance of fiber in improving diabetes.²⁷ Nonetheless, most doctors advise people with diabetes to eat a diet high in fiber. Focus should be placed on fruits, vegetables, seeds, oats, and whole-grain products.

Eating fish also may afford some protection from diabetes.²⁸ Incorporating a fish meal into a weight-loss regimen was more effective than either measure alone at improving glucose and insulin metabolism and high cholesterol.²⁹

Vegetarians have been reported to have a low risk of type 2 diabetes.³⁰ When people with diabetic nerve damage switch to a vegan diet (no meat, dairy, or eggs), improvements have been reported after several days.³¹ In one trial, pain completely disappeared in 17 of 21 people.³² 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.³³ ³⁴ and may also improve glucose tolerance.³⁵ However, in a group of 13 obese males with high blood-insulin levels (as is often seen in diabetes), a high-protein, low-carbohydrate diet resulted in greater weight loss and control of insulin levels, compared with a high-carbohydrate diet.³⁶ Switching to either a high- or low-protein diet should be discussed with a doctor.

Diets high in fat, especially saturated fat, worsen glucose tolerance and increase the risk of type 2 diabetes,³⁷ ³⁸ ³⁹ ⁴⁰ an effect that is not simply the result of weight gain caused by eating high-fat foods. Saturated fat is found primarily in meat, dairy fat, and the dark meat and skins of poultry. In contrast, glucose intolerance has been improved by diets high in monounsaturated oils,⁴¹ ⁴² which may be good for people with diabetes.⁴³ The best way to incorporate monounsaturates into the diet is to use olive oil, especially extra virgin olive oil, which has high antioxidant values.

Lifestyle changes that may be helpful

Most people with type 2 diabetes are overweight.⁴⁴ Excess abdominal weight does not stop insulin formation,⁴⁵ but it does make the body less sensitive to insulin.⁴⁶ Excess weight can even make healthy people prediabetic,⁴⁷ though weight loss can reverse this problem.⁴⁸ In most studies, type 2 diabetes has improved with weight loss.⁴⁹ ⁵⁰ ⁵¹

Exercise helps decrease body fat and improve insulin sensitivity.⁵² ⁵³ People who exercise are less likely to develop type 2 diabetes than those who do not.⁵⁴ However, exercise can induce low blood sugar in diabetics taking blood sugar–lowering medications, or even occasionally increased blood sugar.(⁵⁵ Therefore, people with diabetes should never begin an intensive exercise program without consulting a healthcare professional.

Moderate alcohol drinking in healthy people improves glucose tolerance.⁵⁶ ⁵⁷ ⁵⁸ ⁵⁹ However, alcohol has been reported to worsen glucose tolerance in the elderly and in people with diabetes in some studies.⁶⁰ ⁶¹ People with diabetes who drink have also been reported to have a high risk for eye and nerve damage.⁶² ⁶³

Questions remain about where the line should be drawn regarding alcohol intake. For healthy people, light drinking will not increase the risk of diabetes, and may even reduce the risk of developing type 2 diabetes;⁶⁴ however, heavy drinking does increase the risk of developing diabetes and should be avoided.⁶⁵ People with diabetes should limit alcohol intake to two drinks per day. Total avoidance of alcohol in people with diabetes who are not suffering from alcoholism, liver disease (e.g., cirrhosis), gastritis, ulcers, and other conditions made worse by alcohol might actually be counterproductive. In one report, older people with type 2 diabetes who drank daily, but moderately, had a dramatically lower incidence of deaths from heart disease compared with nondrinkers.⁶⁶ This outcome is not surprising since moderate alcohol intake is associated with protection from heart disease in most other reports. This finding may be of particular importance because heart disease is the leading killer of people with diabetes. In another study, nondrinkers had a higher incidence of type 2 diabetes than did moderate drinkers.⁶⁷

People with diabetes who smoke are at higher risk for kidney damage,⁶⁸ heart disease,⁶⁹ and other diabetes-linked problems. Smokers are also more likely to develop diabetes,⁷⁰ so it's important for diabetic smokers to quit.

Although most healthcare professionals agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes, disagreement exists within the medical community regarding the efficacy and necessity of SMBG by people with type 2 diabetes. A controlled clinical trial found that home glucose monitoring strips did not affect the management of type 2 diabetes.⁷¹ Moreover, a review of available literature concluded that the efficacy of SMBG in people with type 2 diabetes is questionable and should be tested in a rigorous high-quality trial.⁷² 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.⁷³ These observations are well-supported in the medical literature.⁷⁴ Detractors point out that indiscriminate use of self-monitoring is of questionable value and adds enormously to healthcare costs.⁷⁵ 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.⁷⁶ Nevertheless, it is likely that self-monitoring of blood glucose, if used properly, can have a positive effect by increasing a person's involvement in overall diabetes care.⁷⁷ Pharmacists and healthcare practitioners can teach people with diabetes certain skills that will enhance their ability to properly self-manage blood glucose.

Vitamins that may be helpful

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.⁷⁸

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 type 2 diabetes.⁷⁹ ⁸⁰ In recent years, chromium has been shown to improve glucose levels and related variables in people with glucose intolerance and type 2, gestational, and steroid-induced diabetes.⁸¹ ⁸² 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.⁸³ Chromium supplements improve glucose tolerance in people with type 2 diabetes,⁸⁴ apparently by increasing sensitivity to insulin.⁸⁵ Chromium improves the processing of glucose in people with prediabetic glucose intolerance and in women with diabetes associated with pregnancy.⁸⁶ ⁸⁷ Chromium even helps healthy people,⁸⁸ although one such report found chromium useful only when accompanied by 100 mg of niacin per day.⁸⁹ Chromium may also lower levels of total cholesterol, LDL cholesterol, and triglycerides (risk factors in heart disease).⁹⁰ ⁹¹

A few trials have reported no beneficial effects from chromium supplementation.⁹² ⁹³ ⁹⁴ 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.⁹⁵ Many doctors recommend up to 1,000 mcg per day for people with diabetes.⁹⁶

Supplementation with chromium or brewer’s yeast could potentially enhance the effects of drugs used 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 2 diabetes tend to have low magnesium levels.⁹⁷ Double-blind research indicates that supplementing with magnesium overcomes this problem.⁹⁸ Magnesium supplementation has improved insulin production in elderly people with type 2 diabetes.⁹⁹ 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.¹⁰⁰ Elders without diabetes can also produce more insulin as a result of magnesium supplements, according to some,¹⁰¹ but not all, trials.¹⁰² However, in people with type 2 diabetes who nonetheless require insulin, Dutch researchers have reported no improvement in blood sugar levels from magnesium supplementation.¹⁰³ The American Diabetes Association acknowledges strong associations between magnesium deficiency and insulin resistance but has not said magnesium deficiency is a risk factor¹⁰⁴ Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200 to 600 mg of magnesium per day.

Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes.¹⁰⁵ 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.¹⁰⁶ The American Diabetes Association admits “strong associations...between magnesium deficiency and insulin resistance” but will not say magnesium deficiency is a risk factor.¹⁰⁷ 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 to 1,200 mg of lipoic acid per day improves insulin sensitivity and the symptoms of diabetic neuropathy.¹⁰⁸ ¹⁰⁹ ¹¹⁰ ¹¹¹ ¹¹² ¹¹³ ¹¹⁴ ¹¹⁵ In a preliminary study, supplementing with 600 mg of alpha lipoic acid per day for 18 months slowed the progression of kidney damage in patients with type 2 diabetes.¹¹⁶

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.¹¹⁷

Glucomannan
Glucomannan is a water-soluble dietary fiber derived from konjac root (Amorphophallus konjac)that 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. ¹¹⁸ After-meal blood sugar levels are lower in people with diabetes given glucomannan in their food, ¹¹⁹ and overall diabetic control is improved with glucomannan-enriched diets, according to preliminary and controlled clinical trials. ¹²⁰ ¹²¹ ¹²² One preliminary report suggested that glucomannan may also be helpful in pregnancy-related diabetes. ¹²³ For controlling blood sugar, 500 to 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.¹²⁴ ¹²⁵ Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most,¹²⁶ ¹²⁷ ¹²⁸ but not all,¹²⁹ double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes.¹³⁰ ¹³¹ Three months or more of at least 900 IU of vitamin E per day may be required for benefits to become apparent.

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.¹³² Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy,¹³³ ¹³⁴ 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,¹³⁵ ¹³⁶ ¹³⁷ ¹³⁸ ¹³⁹ although not all,¹⁴⁰ ¹⁴¹ ¹⁴² studies.

In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes.¹⁴³ 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) can benefit from small amounts of vitamin E (50 IU per day).¹⁴⁴

Vitamin C
As with vitamin E, vitamin C may reduce glycosylation.¹⁴⁵ Vitamin C also lowers sorbitol levels in people with diabetes.¹⁴⁶ Sorbitol is a sugar that can accumulate inside the cells and damage the eyes, nerves, and kidneys of people with diabetes. Vitamin C may improve glucose tolerance in type 2 diabetes,¹⁴⁷ ¹⁴⁸ although not every study confirms this benefit.¹⁴⁹ 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.¹⁵⁰ 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.¹⁵¹

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).¹⁵² 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 outcome of this isolated report.

B Vitamins
Many people with diabetes have low blood levels of vitamin B6.¹⁵³ ¹⁵⁴ Levels are even lower in people with diabetes who also have nerve damage (neuropathy).¹⁵⁵ Vitamin B6 supplementation has improved glucose tolerance in women with diabetes caused by pregnancy.¹⁵⁶ ¹⁵⁷ Vitamin B6 supplementation is also effective for glucose intolerance induced by birth control pills.¹⁵⁸ In a trial that included people with type 2 diabetes, 1,800 mg per day of a special form of vitamin B6—pyridoxine alpha-ketoglutarate—improved glucose tolerance dramatically.¹⁵⁹ Standard vitamin B6 has helped in some,¹⁶⁰ but not all, trials.¹⁶¹

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 neuropathy after four weeks.¹⁶² 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.¹⁶³ As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.

Biotin is a B vitamin needed to process glucose. When people with type 2 diabetes were given 9 mg of biotin per day for two months, their fasting glucose levels dropped dramatically.¹⁶⁴ Biotin may also reduce pain from diabetic nerve damage.¹⁶⁵ Some doctors try 9 to 16 mg of biotin per day 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.¹⁶⁶ 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.¹⁶⁷ 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 to 3 grams per day, may impair glucose tolerance and should be used by people with diabetes only with medical supervision.¹⁶⁸ ¹⁶⁹ Smaller amounts (500 to 750 mg per day for one month followed by 250 mg per day) may help some people with type 2 diabetes,¹⁷⁰ though this research remains preliminary.

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.¹⁷¹ 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 CoQ10.¹⁷² 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 DL-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.¹⁷³

Acetyl-L-carnitine
In a double-blind study of people with diabetic 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.¹⁷⁴ 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.

Zinc
People with type 2 diabetes tend to be zinc deficient,¹⁷⁵ but some evidence indicates that zinc supplementation does not improve their ability to process sugar.¹⁷⁶ Nonetheless, many doctors recommend that people with type 2 diabetes supplement with moderate amounts of zinc (15 to 25 mg per day) as a way to correct the deficit.

Antioxidants
Because oxidation damage is believed to play a role in the development of diabetic 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 retinopathy. During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy.¹⁷⁷ People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.

Vitamin D
Vitamin D is needed to maintain adequate blood levels of insulin.¹⁷⁸ Vitamin D receptors have been found in the pancreas where insulin is made, and preliminary evidence suggests that supplementation can improve some measures of blood sugar control in people with type 2 diabetes.¹⁷⁹ ¹⁸⁰ 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.

Inositol
Inositol is needed for normal nerve function. Diabetes can cause a type of nerve damage known as diabetic neuropathy. This condition has been reported in some, but not all, trials to improve with inositol supplementation (500 mg taken twice per day).¹⁸¹

Taurine
Animal studies have shown that supplementing with taurine, an amino acid found in protein-rich food, may affect insulin secretion and action, and may have potential in protecting the eyes and nerves from diabetic complications.¹⁸² However, a double-blind trial found no effect on insulin secretion or sensitivity when men with high risk for developing diabetes were given 1.5 grams per day of taurine for eight weeks.¹⁸³ In another double-blind trial, taurine supplementation (2 grams per day for 12 months) failed to improve kidney complications associated with type 2 diabetes.¹⁸⁴

Fish oil
Glucose tolerance improves in healthy people taking omega-3 fatty acid supplements,¹⁸⁵ and some studies have found that fish oil supplementation also improves glucose tolerance,¹⁸⁶ high triglycerides,¹⁸⁷ and cholesterol levels in people with type 2 diabetes.¹⁸⁸ And in one trial, people with diabetic 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.¹⁸⁹ However, other studies have found that type 2 diabetes worsens with fish oil supplementation.¹⁹⁰ ¹⁹¹ ¹⁹² ¹⁹³ Until this issue is resolved, people with diabetes should feel free to eat fish, but they should consult a doctor before taking fish oil supplements.

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.¹⁹⁴ Clinical trials have yet to explore whether quercetin actually protects people with diabetes from neuropathy, nephropathy, or retinopathy.

Vanadium
Vanadyl sulfate, a form of vanadium, may improve glucose control in people with type 2 diabetes.¹⁹⁵ ¹⁹⁶ ¹⁹⁷ Over a six-week period, a small group of people with type 2 diabetes were given 75 to 300 mg of vanadyl sulfate per day.¹⁹⁸ Only in the groups receiving 150 mg or 300 mg was glucose metabolism improved, fasting blood sugar decreased, and another marker for chronic high blood sugar reduced. At the 300 mg level, total cholesterol decreased, although not without an accompanying reduction in the protective HDL cholesterol. None of the amounts improved insulin sensitivity. Although there was no evidence of toxicity after six weeks of vanadyl sulfate supplementation, gastrointestinal side effects were experienced by some of the participants taking 150 mg per day and by all of the participants taking 300 mg per day. The long-term safety of the large amounts of vanadium needed to help people with type 2 diabetes (typically 100 mg per day) remains unknown. Many doctors expect that amounts this high may prove to be unsafe in the long term.

Fructo-oligosaccharides
In a preliminary trial, supplementation with fructo-oligosaccharides (FOS) (8 grams per day for two weeks) significantly lowered fasting blood-sugar levels and serum total-cholesterol levels in people with type 2 diabetes.¹⁹⁹ However, in another trial, supplementing with FOS (15 grams per day) for 20 days had no effect on blood-glucose or lipid levels in people with type 2 diabetes.²⁰⁰ In addition, some double-blind trials showed that supplementing with FOS or galacto-oligosaccharides (GOS) for eight weeks had no effect on blood-sugar levels, insulin secretion, or blood lipids in healthy people.²⁰¹ ²⁰² Because of these conflicting results, more research is needed to determine the effect of FOS on diabetes and lipid levels.

Manganese
People with diabetes may have low blood levels of manganese.²⁰³ Animal research suggests that manganese deficiency can contribute to glucose intolerance and may be reversed by supplementation.²⁰⁴ A young adult with insulin-dependent diabetes who received oral manganese chloride (3 to 5 mg per day as manganese chloride) reportedly experienced a significant fall in blood glucose, sometimes to dangerously low levels. In four other cases, manganese supplementation had no effect on blood glucose levels.²⁰⁵ People with diabetes wishing to supplement with manganese should do so only with a doctor’s supervision.

Medium-chain triglycerides
Based on the results of a short-term clinical trial that found that medium-chain triglycerides (MCT) lower blood glucose levels,²⁰⁶ a group of researchers investigated the use of MCT to treat people with type 2 diabetes mellitus. Supplementation with MCT for an average of 17.5% of their total calorie intake for 30 days failed to improve most measures of diabetic control.²⁰⁷

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.²⁰⁸ ²⁰⁹ ²¹⁰ ²¹¹ ²¹² While this effect could be helpful in controlling diabetes, no research has investigated the long-term effects of taking starch blockers for this condition.

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

Herbs that may be helpful

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

Aloe
Animal research and preliminary controlled human trials have found that Aloe vera, either alone or in combination with the oral hypoglycemic drug glibenclamide, effectively lowers blood sugar in people with type 2 diabetes.²¹³ ²¹⁴ ²¹⁵ ²¹⁶ The typical amount used in this research was 1 tablespoon (15 ml) of aloe gel per day.

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 neuropathy (numbness and tingling in the extremities caused by diabetes).²¹⁷ ²¹⁸ Four or more applications per day may be required to relieve severe pain. This should be done only under a doctor’s supervision.

Fenugreek
Fenugreek seeds are high in soluble fiber, which helps lower blood sugar by slowing down carbohydrate digestion and absorption.²¹⁹ Animal research suggests that fenugreek may also contain a substance that stimulates insulin production and improves blood sugar control.²²⁰ ²²¹ In a controlled trial, incorporating 15 grams of powdered fenugreek seed into a meal eaten by people with type 2 diabetes reduced the rise in blood glucose following the meal.²²² Another controlled trial found that taking 2.5 grams of fenugreek twice a day for three months reduced blood sugar levels in people with mild, but not those with severe, type 2 diabetes.²²³ In a double-blind study, 1 gram per day of an extract of fenugreek seeds for two months improved some measures of blood sugar control and insulin function in people with type 2 diabetes.²²⁴

Psyllium
Supplementing with psyllium has been shown to be a safe and well-tolerated way to improve control of blood glucose and cholesterol. In a double-blind trial, men with type 2 diabetes who took 5.1 grams of psyllium per day for eight weeks lowered their blood glucose levels by 11 to 19.2%, their total cholesterol by 8.9%, and their LDL (bad) cholesterol by 13%, compared with a placebo.²²⁵

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.²²⁶ ²²⁷ Animal research has also revealed a direct blood sugar–lowering effect of ginseng.²²⁸ A double-blind trial found that 200 mg of ginseng extract per day improved blood sugar control, as well as energy levels in people with type 2 diabetes.²²⁹

American ginseng
In a small preliminary trial, 3 grams of American ginseng was found to lower the rise in blood sugar following the consumption of a high-glucose drink by people with type 2 diabetes.²³⁰ The study found no difference in blood sugar–lowering effect if the herb was taken either 40 minutes before the drink or at the same time. A follow-up to this study found that increasing the amount of American ginseng to either 6 or 9 grams did not increase the effect on blood sugar following the high-glucose drink in people with type 2 diabetes.²³¹ This study also found that American ginseng was equally effective in controlling the rise in blood sugar whether it was given together with the drink or up to two hours before.

Basil
Preliminary trials of holy basil (Ocimim sanctum) leaves and hairy basil (Ocimum canum) seeds have shown that these herbs may help people with type 2 diabetes control their blood sugar levels.²³² ²³³ ²³⁴ An uncontrolled study reported that 1,000 mg per day of holy basil lowered blood sugar, LDL (“bad”) cholesterol, and triglycerides,²³⁵ while a controlled trial tested 2,500 mg per day and found similar changes in blood sugar, but only minor effects on total blood cholesterol.²³⁶ The mechanism of action of holy basil leaf is not understood and it is unknown whether common culinary sweet basil (Ocimum basilicum) would have similar effects.

Gymnema
Gymnema may stimulate the pancreas to produce insulin in people with type 2 diabetes. Gymnema also improves the ability of insulin to lower blood sugar in people with both type 1 and type 2 diabetes. So far, no double-blind trials have confirmed the efficacy of gymnema for people with any type of diabetes. However, a preliminary study of type 2 diabetics reported that 400 mg per day of gymnema extract taken for periods of 18 months or longer resulted in improvement, according to diabetes blood tests, and allowed reduction of diabetic medications.²³⁷ In a controlled trial with type 1 (insulin-dependent) diabetics, a similar amount of gymnema extract reduced requirements for insulin.²³⁸ Whether the extract used in these studies was standardized for active constituents is unclear. Recently, a preliminary trial found improved blood sugar levels after three months in a group of type 1 and type 2 diabetics who took 800 mg per day of an extract standardized for 25% gymnemic acids.²³⁹ Gymnema is not a substitute for insulin, but insulin amounts may need to be lowered while taking gymnema to avoid hypoglycemia.

Milk thistle
In a double-blind trial, supplementation with silymarin (a component of milk thistle) in the amount of 200 mg three times per day for four months significantly improved measures of blood sugar control compared with a placebo.²⁴⁰

Bitter melon
Whole, fried slices,²⁴¹ water extracts,²⁴² and juice of bitter melon may improve blood-sugar control in people with type 2 diabetes,²⁴³ according to preliminary trials. However, double-blind trials are needed to confirm this potential benefit.

Cinnamon
Test tube studies have suggested that cinnamon may improve the glucose utilization. In a study of people with type 2 diabetes, supplementing with cinnamon in the amount of 1, 3, or 6 grams per day for 40 days was significantly more effective than a placebo at reducing blood glucose levels.²⁴⁴ The reduction averaged 18 to 29% in the three treatments groups, and 1 gram per day was as effective as 3 and 6 grams per day. However, in a double-blind study, supplementation with 1.5 g of cinnamon per day for six weeks was no more effective than a placebo for reducing blood sugar levels.²⁴⁵

Crepe myrtle
Lagerstroemia speciosa, commonly known as crepe myrtle, grows in various tropical countries and Australia. In folk medicine it has been used to treat diabetes. In a preliminary study of people with type 2 diabetes, supplementing with an extract from the leaves of Lagerstroemia speciosa for two weeks resulted in a fall in blood-glucose levels averaging 20 to 30%.²⁴⁶ The amount used was 32 or 48 mg of a product standardized to contain 1% corosolic acid (a putative active ingredient). The larger amount was somewhat more effect than the smaller amount. Although these results are promising, additional studies are needed to demonstrate the long-term safety and efficacy of this herbal preparation.

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.²⁴⁷ ²⁴⁸ ²⁴⁹ 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.²⁵⁰

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.²⁵¹

Açaí
Açaí is reported to be a traditional remedy for diabetes. Although oxidative stress may contribute to diabetes²⁵² and anthocyanins may improve insulin secretion,²⁵³ there is no published evidence that açaí has any effect on diabetes.

Ginkgo
Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic neuropathy, though research is at best very preliminary in this area.²⁵⁴

Hibiscus
Hibiscus is a traditional remedy in India for diabetes; this treatment is supported by preliminary studies from that country and by animal studies.²⁵⁵ ²⁵⁶ Hibiscus is usually taken as tea, such as 1 to 2 teaspoons (3 to 6 grams) of dried flower infused in to 1 cup (250 ml) three times per day.

Mistletoe
Mistletoe extract has been shown to stimulate insulin release from pancreas cells,²⁵⁷ and animal research found that it reduces symptoms of diabetes.²⁵⁸ 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.²⁵⁹ 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.²⁶⁰ ²⁶¹

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

Holistic approaches that may be helpful

Acupuncture may be helpful in the treatment of diabetes, or complications associated with diabetes. Preliminary trials have suggested that acupuncture can lower blood sugar and improve insulin production in people with type 2 diabetes,²⁶² ²⁶³ ²⁶⁴ ²⁶⁵ but trials on long-term effects have not been concluded. In a preliminary trial, 77% of people suffering from diabetic 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.²⁶⁶ 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.²⁶⁷ ²⁶⁸

References
(To view, roll mouse over the "References" heading; to hide, click on the heading)

1. Hoogeveen EK, Kostense PJ, Jakobs C, et al. Hyperhomocysteinemia increases risk of death, especially in type 2 diabetes: 5-year follow-up of the Hoorn Study. Circulation 2000;101:1506–11.

2. Colditz GA, Manson JE, Stampfer MJ, et al. Diet and risk of clinical diabetes in women. Am J Clin Nutr 1992;55:1018–23.

3. Feskens EJ, Bowles CH, Kromhout D. Carbohydrate intake and body mass index in relation to the risk of glucose intolerance in an elderly population. Am J Clin Nutr 1991;54:136–40.

4. Wright DW, Hansen RI, Mondon CE, Reaven GM. Sucrose-induced insulin resistance in the rat: modulation by exercise and diet. Am J Clin Nutr 1983;38:879–83.

5. Reiser S, Hallfrisch J, Fields M, et al. Effects of sugars on indices of glucose tolerance in humans. Am J Clin Nutr 1986;43:151–9.

6. Wolever TMS, Brand Miller J. Sugars and blood glucose control. Am J Clin Nutr 1995;62:212S–7S [review].

7. Wolever TMS, Brand Miller J. Sugars and blood glucose control. Am J Clin Nutr 1995;62:212S–7S [review].

8. Salmeron J, Manson JE, Stampfer MJ, et al. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 1997;277:472–7.

9. Salmeron J, Ascherio A, Rimm EB, et al. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 1997;20:545–50.

10. Feskens EJ, Virtanen SM, Rasanen L, et al. Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study. Diabetes Care 1995;18:1104–12.

11. Salmeron J, Manson JE, Stampfer MJ, et al. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 1997;277:472–7.

12. Salmeron J, Ascherio A, Rimm EB, et al. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 1997;20:545–50.

13. 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.

14. Abraira C, Derler J. Large variations of sucrose in constant carbohydrate diets in type II diabetes. Am J Med 1988;84:193–200.

15. 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.

16. American Diabetes Association. Position Statement: nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 1999;22:S42–5 [review].

17. Brand-Miller J, Foster-Powell K. Diets with a low glycemic index: from theory to practice. Nutr Today 1999;34:64–72 [review].

18. Chandalia M, Garg A, Lutjohann D, et al. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. New Engl J Med 2000;342:1392–8.

19. Rodríguez-Morán M, Guerrero-Romero F, Lazcano-Burciaga G. Lipid- and glucose-lowering efficacy of plantago psyllium in type II diabetes. Diabetes Its Complications 1998;12:273–8.

20. Landin K, Holm G, Tengborn L, Smith U. Guar gum improves insulin sensitivity, blood lipids, blood pressure, and fibrinolysis in healthy men. Am J Clin Nutr 1992;56:1061–5.

21. Schwartz SE, Levine RA, Weinstock RS, et al. Sustained pectin ingestion: effect on gastric emptying and glucose tolerance in non-insulin-dependent diabetic patients. Am J Clin Nutr 1988;48:1413–7.

22. Hallfrisch J, Scholfield DJ, Behall KM. Diets containing soluble oat extracts improve glucose and insulin responses of moderately hypercholesterolemic men and women. Am J Clin Nutr 1995;61:379–84.

23. Doi K, Matsuura M, Kawara A, Baba S. Treatment of diabetes with glucomannan (konjac mannan). Lancet 1979;1:987–8 [letter].

24. Vuksan V, Sievenpiper JL, Owen R, et al. Beneficial effects of viscous dietary fiber from Konjac-mannan in subjects with the insulin resistance syndrome: results of a controlled metabolic trial. Diabetes Care 2000;23:9–14.

25. Sharma RD, Raghuram TC. Hypoglycaemic effect of fenugreek seeds in non-insulin dependent diabetic subjects. Nutr Res 1990;10:731–9.

26. Raghuram TC, Sharma RD, Sivakumar B, Sahay BK. Effect of fenugreek seeds on intravenous glucose disposition in non-insulin dependent diabetic patients. Phytother Res 1994;8:83–6.

27. Nuttall FW. Dietary fiber in the management of diabetes. Diabetes 1993;42:503–8.

28. Feskens EJM, Bowles CH, Kromhout D. Inverse association between fish intake and risk of glucose intolerance in normoglycemic elderly men and women. Diabetes Care 1991;14:935–41.

29. Mori TA, Bao DQ, Burke V, et al. Dietary fish as a major component of a weight-loss diet: effect on serum lipids, glucose, and insulin metabolism in overweight hypertensive subjects. Am J Clin Nutr 1999;70:817–25.

30. Snowdon DA, Phillips RL. Does a vegetarian diet reduce the occurrence of diabetes? Am J Publ Health 1985;75:507–12.

31. Crane MG, Sample CJ. Regression of diabetic neuropathy with vegan diet. Am J Clin Nutr 1988;48:926 [abstract #P28].

32. Crane MG, Sample C. Regression of diabetic neuropathy with total vegetarian (vegan) diet. J Nutr Med 1994;4:431–9.

33. Cohen D, Dodds R, Viberti G. Effect of protein restriction in insulin dependent diabetics at risk of nephropathy. BMJ 1987;294:795–8.

34. Evanoff G, Thompson C, Bretown J, Weinman E. Prolonged dietary protein restriction in diabetic nephropathy. Arch Intern Med 1989;149:1129–33.

35. 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.

36. Baba NH, Sawaya S, Torbay N, et al. High protein vs high carbohydrate hypoenergetic diet for the treatment of obese hyperinsulinemic subjects. Int J Obes Relat Metab Disord 1999;23:1202–6.

37. Feskens EJ, Virtanen SM, Rasanen L, et al. Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study. Diabetes Care 1995;18:1104–12.

38. Feskens EJ, Kromhout D. Habitual dietary intake and glucose tolerance in euglycaemic men: the Zutphen Study. Int J Epidemiol 1990;19:953–9.

39. Marshall JA, Hoag S, Shetterly S, et al. Dietary fat predicts conversion from impaired glucose tolerance to NIDDM. The San Luis Valley Diabetes Study. Diabetes Care 1994;17:50–6.

40. Marshall JA, Hamman RF, Baxter J. High-fat, low-carbohydrate diet and the etiology of non-insulin-dependent diabetes mellitus: the San Luis Valley Diabetes Study. Am J Epidemiol 1991;134:590–603.

41. Uusitupa M, Schwab U, Makimattila S, et al. Effects of two high-fat diets with different fatty acid compositions on glucose and lipid metabolism in healthy young women. Am J Clin Nutr 1994;59:1310–6.

42. Sarkkinen E, Schwab U, Niskanen L, et al. The effects of monounsaturated-fat enriched diet and polyunsaturated-fat enriched diet on lipid and glucose metabolism in subjects with impaired glucose tolerance. Eur J Clin Nutr 1996;50:592–8.

43. Garg A, Bananome A, Grundy SM, et al. Comparison of a high-carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin dependent diabetes mellitus. N Engl J Med 1988;319:829–34.

44. Isida K, Mizuno A, Murakami T, Shima K. Obesity is necessary but not sufficient for the development of diabetes mellitus. Metabolism 1996;45:1288–95.

45. Casassus P, Fontbonne A, Thibult N, et al. Upper-body fat distribution: a hyperinsulinemia-independent predictor of coronary heart disease mortality. Arterioscler Thromb 1992;1387–92.

46. Karter AJ, Mayer-Davis EJ, Selby JV, et al. Insulin sensitivity and abdominal obesity in African-American, Hispanic, and non-Hispanic white men and women. Diabetes 1996;45:1547–55.

47. Park KS, Hree BD, Lee K-U, et al. Intra-abdominal fat is associated with decreased insulin sensitivity in healthy young men. Metabolism 1991;40:600–3.

48. Long SD, Swanson MS, O’Brien K, et al. Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. Diabetes Care 1994;17:372.

49. Pi-Sunyer FX. Weight and non-insulin-dependent diabetes mellitus. Am J Clin Nutr 1996;63(suppl):426S–9S.

50. Wing RR, Marcuse MD, Blair EH, et al. Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Diabetes Care 1994;17:30.

51. Henry RR, Gumbiner B. Benefits and limitations of very-low-calorie diet therapy in obese NIDDM. Diabetes Care 1991;14:802–23.

52. Hersey WC, Graves JE, Pollock ML, et al. Endurance exercise training improves body composition and plasma insulin responses in 70- to 79-year-old men and women. Metabol 1994;43:847–54.

53. Rasmussen OW, Lauszus FF, Hermansen K. Effects of postprandial exercise on glycemic response in IDDM subjects. Diabetes Care 1994;17:1203.

54. Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991;325:147–52.

55. (REF:Bell DSH. Exercise for patients with diabetes—benefits, risks, precautions. Postgrad Med 1992;92:183–96 [review].

56. Kiechl S, Willeit J, Poewe W, et al. Insulin sensitivity and regular alcohol consumption: large, prospective, cross sectional population study Bruneck study. BMJ 1996;313:1040–4.

57. Facchini F, Chen Y-DI, Reaven GM. Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity. Diabetes Care 1994;17:115.

58. Rimm EB, Chan J, Stampfer MJ, et al. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ 1995;310:555–9.

59. Stampfer MJ, Colditz GA, Willett WC, et al. A prospective study of moderate alcohol drinking and risk of diabetes in women. Am J Epidemiol 1988;128:549–58.

60. Goden G, Chen X, Desantis R, et al. Effects of ethanol on carbohydrate metabolism in the elderly. Diabetes 1993;42:28–34.

61. Ben G, Gnudi L, Maran A, et al. Effects of chronic alcohol intake on carbohydrate and lipid metabolism in subjects with type II (non-insulin-dependent) diabetes. Am J Med 1991;90:70.

62. Young RJ, McCulloch DK, Prescott RJ, Clarke PF. Alcohol: another risk factor for diabetic retinopathy? BMJ 1984;288:1035.

63. Connor H, Marks V. Alcohol and diabetes. A position paper prepared by the Nutrition Subcommittee of the British Diabetic Association’s Medical Advisory Committee and approved by the Executive Council of the British Diabetic Association. Human Nutr Appl Nutr 1985;39A:393–9.

64. Ajani UA, Hennekens CH, Spelsberg A, Manson JE. Alcohol consumption and risk of type 2 diabetes mellitus among US male physicians. Arch Intern Med 2000;160:1025–30.

65. Wei M, Gibbons LW, Mitchell TL, et al. Alcohol intake and incidence of type 2 diabetes in men. Diabetes Care 2000;23:18–22.

66. Valmadrid CT, Klein R, Moss SE, et al. Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus. JAMA 1999;282:239–46.

67. Wei M, Gibbons LW, Mitchell TL, et al. Alcohol intake and incidence of type 2 diabetes in men. Diabetes Care 2000;23:18–22.

68. Stegmayr B, Lithner F. Tobacco and end stage diabetic nephropathy. BMJ 1987;295:581–2.

69. Scala C, LaPorte RE, Dorman JS, et al. Insulin-dependent diabetes mellitus mortality—the risk of cigarette smoking. Circulation1990;82:37–43.

70. 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.

71. Rindone JP, Austin M, Luchesi J. Effect of home blood glucose monitoring on the management of patients with non-insulin dependent diabetes mellitus in the primary care setting. Am J Manag Care 1997;3:1335–8.

72. Faas A, Schellevis FG, Van Eijk JT. The efficacy of self-monitoring of blood glucose in NIDDM subjects. A criteria-based literature review. Diabetes Care 1997;20:1482–6.

73. [No authors listed.] Position statement: Tests of glycemia in diabetes. American Diabetes Association. Diabetes Care 2000;23(Suppl 1):S80–2.

74. Goldstein DE, Little RR, Lorenz RA, et al. Tests of glycemia in diabetes. Diabetes Care 1995;18:896–909 [review].

75. Gallichan M. Self monitoring of glucose by people with diabetes: evidence based practice. BMJ 1997;314:964–7 [review].

76. Steel LG. Identifying technique errors. Self-monitoring of blood glucose in the home setting. J Gerontol Nurs 1994;20:9–12.

77. Foster SA, Goode JV, Small RE. Home blood glucose monitoring. Ann Pharmacother 1999;33:355–63 [review].

78. Barringer TA, Kirk JK, Santaniello AC, et al. Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2003;138:365–71.

79. Herepath WB. Journal Provincial Med Surg Soc 1854:374.

80. Offenbacher EG, Pi-Sunyer FX. Beneficial effect of chromium-rich yeast on glucose tolerance and blood lipids in elderly subjects. Diabetes 1980;29:919–25.

81. Anderson RA. Chromium in the prevention and control of diabetes. Diabetes Metab 2000;26:22–7 [review].

82. Martin J, Wang ZQ, Zhang XH, et al. Chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects with type 2 diabetes. Diabetes Care 2006;29:1826–32.

83. Anderson RA. Chromium, glucose intolerance and diabetes. J Am Coll Nutr 1998;17:548–55 [review].

84. Evans GW. The effect of chromium picolinate on insulin controlled parameters in humans. Int J Biosocial Med Res 1989;11:163–80.

85. Gaby AR, Wright JV. Diabetes. In Nutritional Therapy in Medical Practice: Reference Manual and Study Guide. Kent, WA: 1996, 54–64 [review].

86. Anderson RA, Polansky MM, Bryden NA, Canary JJ. Supplemental-chromium effects on glucose, insulin, glucagon, and urinary chromium losses in subjects consuming controlled low-chromium diets. Am J Clin Nutr 1991;54:909–16.

87. Jovanovic L, Gutierrez M, Peterson CM. Chromium supplementation for women with gestational diabetes. J Trace Elem Exptl Med 1999;12:91–8.

88. Anderson RA, Polansky MM, Bryden NA, et al. Chromium supplementation of human subjects: effects on glucose, insulin, and lipid variables. Metabolism 1983;32:894–9.

89. Urberg M, Zemel MB. Evidence for synergism between chromium and nicotinic acid in the control of glucose tolerance in elderly humans. Metabolism 1987;36:896–9.

90. Lee NA, Reasner CA. Beneficial effect of chromium supplementation on serum triglyceride levels in NIDDM. Diabetes Care 1994;17:1449–52.

91. 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.

92. Sherman L, Glennon JA, Brech WJ, et al. Failure of trivalent chromium to improve hyperglycemia in diabetes mellitus. Metabolism 1968;17:439–42.

93. Rabinowitz MB, Gonick HC, Levin SR, Davidson MB. Effects of chromium and yeast supplements on carbohydrate and lipid metabolism in diabetic men. Diabetes Care 1983;6:319–27.

94. Uusitupa MI, Kumpulainen JT, Voutilainen E, et al. Effect of inorganic chromium supplementation on glucose tolerance, insulin response, and serum lipids in noninsulin-dependent diabetics. Am J Clin Nutr 1983;38:404–10.

95. Anderson RA, Cheng N, Bryden NA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes 1997;46:1786–91.

96. Gaby AR, Wright JV. Nutritional protocols: diabetes mellitus. In Nutritional Therapy in Medical Practice: Protocols and Supporting Information. Kent, WA: 1996, 10.

97. Paolisso G, Scheen A, D’Onofrio FD, Lefebvre P. Magnesium and glucose homeostasis. Diabetologia 1990;33:511–4 [review].

98. Eibl NL, Schnack CJ, Kopp H-P, et al. Hypomagnesemia in type II diabetes: effect of a 3-month replacement therapy. Diabetes Care 1995;18:188.

99. Paolisso G, Sgambato S, Pizza G, et al. Improved insulin response and action by chronic magnesium administration in aged NIDDM subjects. Diabetes Care 1989;12:265–9.

100. Lima M, Cruz T, Carreiro Pousada J, et al: The effect of magnesium supplementation in increasing doses on the control of type 2 diabetes. Diabetes Care 1998;21:682–6.

101. Paolisso G, Sgambato S, Gambardella A, et al. Daily magnesium supplements improve glucose handling in elderly subjects. Am J Clin Nutr 1992;55:1161–7.

102. Smellie WS, O’Reilly DS, Martin BJ, Santamaria J. Magnesium replacement and glucose tolerance in elderly subjects. Am J Clin Nutr 1993;57:594–6 [letter].

103. de Valk HW, Verkaaik R, van Rijn HJM, et al. Oral magnesium supplementation in insulin-requiring type 2 diabetic patients. Diabet Med 1998;15:503–7.

104. American Diabetes Association. Magnesium supplementation in the treatment of diabetes. Diabetes Care 1992;15:1065–7.

105. McNair P, Christiansen C, Madsbad S, et al. Hypomagnesemia, a risk factor in diabetic retinopathy. Diabetes 1978;27:1075–7.

106. 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.

107. American Diabetes Association. Magnesium supplementation in the treatment of diabetes. Diabetes Care 1992;15:1065–7.

108. Konrad T, Vicini P, Kusterer K, et al. alpha lipoic acid treatment decreases serum lactate and pyruvate concentrations and improves glucose effectiveness in lean and obese patients with type 2 diabetes. Diabetes Care 1999;22:280–7.

109. 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.

110. 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.

111. 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.

112. Ziegler D, Schatz H, Conrad F, et al. Effects of treatment with the antioxidant alpha-lipoic acid on cardiac autonomic neuropathy in NIDDM patients. A 4-month randomized controlled multicenter trial (DEKAN Study). Diabetes Care 1997;20:369–73.

113. Jacob S, Ruus P, Hermann R, et al. Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial. Free Radic Biol Med 1999;27:309–14.

114. 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.

115. Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care 2006;29:2365–70.

116. 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.

117. 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.

118. Doi K. Effect of konjac fibre (glucomannan) on glucose and lipids. Eur J Clin Nutr 1995;49(Suppl. 3):S190–7 [review].

119. Melga P, Giusto M, Ciuchi E, et al. Dietary fiber in the dietetic therapy of diabetes mellitus. Experimental data with purified glucomannans. Riv Eur Sci Med Farmacol 1992;14:367–73 [in Italian].

120. Huang CY, Zhang MY, Peng SS, et al. Effect of Konjac food on blood glucose level in patients with diabetes. Biomed Environ Sci 1990;3:123–31.

121. Vuksan V, Jenkins DJ, Spadafora P, et al. Konjac-mannan (glucomannan) improves glycemia and other associated risk factors for coronary heart disease in type 2 diabetes. A randomized controlled metabolic trial. Diabetes Care 1999;22:913–9.

122. Vorster HH, Lotter AP, Odendaal I, et al. Benefits from supplementation of the current recommended diabetic diet with gel fibre. Int Clin Nutr Rev 1988;8:140–6.

123. Cesa F, Mariani S, Fava A, et al. The use of vegetable fibers in the treatment of pregnancy diabetes and/or excessive weight gain during pregnancy. Minerva Ginecol 1990;42:271–4 [in Italian].

124. 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.

125. Salonen JT, Nyssonen K, Tuomainen T-P, et al. Increased risk of non-insulin dependent diabetes mellitus at low plasma vitamin E concentrations: a four year follow up study in men. BMJ 1995;311:1124–7.

126. Bierenbaum ML, Noonan FJ, Machlin LJ, et al. The effect of supplemental vitamin E on serum parameters in diabetics, post coronary and normal subjects. Nutr Rep Int 1985;31:1171–80.

127. Paolisso G, D’Amore A, Giugliano D, et al. Pharmacologic doses of vitamin E improve insulin action in healthy subjects and non-insulin dependent diabetic patients. Am J Clin Nutr 1993;57:650–6.

128. Paolisso G, D’Amore A, Galzerano D, et al. Daily vitamin E supplements improve metabolic control but not insulin secretion in elderly type II diabetic patients. Diabetes Care 1993;16:1433–7.

129. Tütüncü NB, Bayraktar M, Varli K. Reversal of defective nerve condition with vitamin E supplementation in type 2 diabetes. Diabetes Care 1998;21:1915–8.

130. Paolisso G, Di Maro G, Galzerano D, et al. Pharmacological doses of vitamin E and insulin action in elderly subjects. Am J Clin Nutr 1994;59:1291–6.

131. Paolisso G, Gambardella A, Galzerano D, et al. Antioxidants in adipose tissue and risk of myocardial infarction. Lancet 1994;343:596 [letter].

132. Tütüncü NB, Bayraktar M, Varli K. Reversal of defective nerve condition with vitamin E supplementation in type 2 diabetes. Diabetes Care 1998;21:1915–8.

133. 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.

134. 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.

135. Ceriello A, Giugliano D, Quatraro A, et al. Vitamin E reduction of protein glycosylation in diabetes. Diabetes Care 1991;14:68–72.

136. Duntas L, Kemmer TP, Vorberg B, Scherbaum W. Administration of d-alpha-tocopherol in patients with insulin-dependent diabetes mellitus. Curr Ther Res 1996;57:682–90.

137. Paolisso G, D’Amore A, Galzerano D, et al. Daily vitamin E supplements improve metabolic control but not insulin secretion in elderly type II diabetic patients. Diabetes Care 1993;16:1433–7.

138. Jain SK, McVie R, Jaramillo JJ, et al. Effect of modest vitamin E supplementation on blood glycated hemoglobin and triglyceride levels and red cell indices in type I diabetic patients. J Am Coll Nutr 1996;15:458–61.

139. 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.

140. Reaven PD, Barnett J, Herold DA, Edelman S. Effect of vitamin E on susceptibility of low-density lipoprotein and low-density lipoprotein subfractions to oxidation and on protein glycation in NIDDM. Diabetes Care 1995;18:807.

141. 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.

142. 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.

143. Skrha J, Sindelka G, Kvasnicka J, Hilgertova J. Insulin action and fibrinolysis influenced by vitamin E in obese type 2 diabetes mellitus. Diabetes Res Clin Pract 1999;44:27–33.

144. Leppälä JM, Virtamo J, Fogelholm R, et al. Vitamin E and beta carotene supplementation in high risk for stroke: A subgroup analysis of the alpha-tocopherol, beta-carotene cancer prevention study. Arch Neurol 2000;57:1503–9.

145. Davie SJ, Gould BJ, Yudkin JS. Effect of vitamin C on glycosylation of proteins. Diabetes 1992;41:167–73.

146. Will JC, Tyers T. Does diabetes mellitus increase the requirement for vitamin C? Nutr Rev 1996;54:193–202 [review].

147. Eriksson J, Kohvakka A. Magnesium and ascorbic acid supplementation in diabetes mellitus. Ann Nutr Metab 1995;39:217–23.

148. Paolisso G, Balbi V, Volpe C, et al. Metabolic benefits deriving from chronic vitamin C supplementation in aged non-insulin dependent diabetics. J Am Coll Nutr 1995;14:387–92.

149. Will JC, Tyers T. Does diabetes mellitus increase the requirement for vitamin C? Nutr Rev 1996;54:193–202 [review].

150. 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.

151. Branch DR. High-dose vitamin C supplementation increases plasma glucose. Diabetes Care 1999;22:1218 [letter].

152. 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.

153. Wilson RG, Davis RE. Serum pyridoxal concentrations in children with diabetes mellitus. Pathology 1977;9:95–9.

154. Davis RE, Calder JS, Curnow DH. Serum pyridoxal and folate concentrations in diabetics. Pathology 1976;8:151–6.

155. McCann VJ, Davis RE. Serum pyridoxal concentrations in patients with diabetic neuropathy. Aust N Z J Med 1978;8:259–61.

156. Spellacy WN, Buhi WC, Birk SA. Vitamin B6 treatment of gestational diabetes mellitus. Am J Obstet Gynecol 1977;127:599–602.

157. Coelingh HJT, Schreurs WHP. Improvement of oral glucose tolerance in gestational diabetes by pyridoxine. BMJ 1975;3:13–5.

158. Spellacy WN, Buhi WC, Birk SA. The effects of vitamin B6 on carbohydrate metabolism in women taking steroid contraceptives: preliminary report. Contraception 1972;6:265–73.

159. 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.

160. 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.

161. Rao RH, Vigg BL, Rao KSJ. Failure of pyridoxine to improve glucose tolerance in diabetics. J Clin Endocrinol Metab 1980;50:198–200.

162. 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.

163. Stracke H, Lindemann A, Federlin K. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy. Exp Clin Endocrinol Diabetes 1996;104:311–6.

164. Coggeshall JC, Heggers JP, Robson MC, Baker H. Biotin status and plasma glucose in diabetics. Ann NY Acad Sci 1985;447:389–92.

165. Koutsikos D, Agroyannis B, Tzanatos-Exarchou H. Biotin for diabetic peripheral neuropathy. Biomed Pharmacother 1990;44:511–4.

166. 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].

167. 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.

168. Molnar GD, Berge KG, Rosevear JW, et al. The effect of nicotinic acid in diabetes mellitus. Metabolism 1964;13:181–9.

169. 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.

170. Clearly JP. The importance of oxidant injury as a cause of impaired mitochondrial oxidation in diabetes. J Orthomolec Med 1988;3:164–74.

171. Miyake Y, Shouzu A, Nishikawa M, et al. Effect of treatment of 3-hydroxy-3-methylglutaryl coenzyme I reductase inhibitors on serum coenzyme Q10 in diabetic patients. Arzneimittelforschung 1999;49:324–9.

172. 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.

173. 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.

174. 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.

175. Nakamura T, Higashi A, Nishiyama S, et al. Kinetics of zinc status in children with IDDM. Diabetes Care 1991;14:553–7.

176. Niewoehner CB, Allen JI, Boosalis M, et al. Role of zinc supplementation in type II diabetes mellitus. Am J Med 1986;81:63–8.

177. Crary EJ, McCarty MF. Potential clinical applications for high-dose nutritional antioxidants. Med Hypotheses 1984;13:77–98.

178. 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.

179. Boucher BJ. Inadequate vitamin D status: does it contribute to the disorders comprising syndrome ‘X’? Br J Nutr 1998;79:315–27 [review].

180. Borissova AM, Tankova T, Kirilov G, et al. The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients. Int J Clin Pract 2003;57:258–61.

181. Salway JG, Whitehead L, Finnegan JA, et al. Effect of myo-inositol on peripheral-nerve function in diabetes. Lancet 1978;2:1282–4.

182. Franconi F, Di Leo MA, Bennardini F, Ghirlanda G. Is taurine beneficial in reducing risk factors for diabetes mellitus? Neurochem Res 2004;29:143–50 [review].

183. Brons C, Spohr C, Storgaard H, et al. Effect of taurine treatment on insulin secretion and action, and on serum lipid levels in overweight men with a genetic predisposition for type II diabetes mellitus. Eur J Clin Nutr 2004;58:1239-47.

184. Nakamura T, Ushiyama C, Suzuki S, et al. Effects of taurine and vitamin E on microalbuminuria, plasma metalloproteinase-9, and serum type IV collagen concentrations in patients with diabetic nephropathy. Nephron 1999;83:361–2.

185. 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.

186. Popp-Snijders C, Schouten JA, Heine RJ, et al. Dietary supplementation of omega-3 polyunsaturated fatty acids improves insulin sensitivity in non-insulin-dependent diabetes. Diabetes Res 1987;4:141–7.

187. Albrink MJ, Ullrich IH, Blehschmidt NG, et al. The beneficial effect of fish oil supplements on serum lipids and clotting function of patients with type II diabetes mellitus. Diabetes 1986;35 (suppl 1):43A [abstract #172].

188. Wei I, Ulchaker M, Sheehan J. Effect of omega-3 fatty acids (FA) in non-obese non-insulin dependent diabetes (NIDDM). Am Clin Nutr 1988;47:775 [abstract #70].

189. 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.

190. Vandongen R, Mori TA, Codde JP, et al. Hypercholesterolaemic effect of fish oil in insulin-dependent diabetic patients. Med J Aust 1988;148:141–3.

191. Schectman G, Kaul S, Kissebah AH. Effect of fish oil concentrate on lipoprotein composition in NIDDM. Diabetes 1988;37:1567–73.

192. Stackpoole PW, Alig J, Kilgore LL, et al. Lipodystrophic diabetes mellitus. Investigations of lipoprotein metabolism and the effects of omega-3 fatty acid administration in two patients. Metabolism 1988;37:944–51.

193. Glauber H, Wallace P, Griver K, Brechtel G. Adverse metabolic effect of omega-3 fatty acids in non-insulin-dependent diabetes mellitus. Ann Intern Med 1988;108:663–8.

194. Gaby A. Preventing complications of diabetes Townsend Letter 1985;32:307 [editorial].

195. 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.

196. 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.

197. 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.

198. 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.

199. Yamashita K, Kawai K, Itakura M. Effect of fructo-oligosaccharides on blood glucose and serum lipids in diabetic subjects. Nutr Res 1984;4:961–6.

200. Roberfroid M. Dietary fibre, inulin and oligofructose. A review comparing their physiological effects. Crit Rev Food Sci Nutr 1993;33:103–48 [review].

201. van Dokkum W, Wezendonk B, Srikumar TS, van den Heuvel. Effect of nondigestible oligosaccharides on large-bowel functions, blood lipid concentrations and glucose absorption in young healthy male subjects. Eur J Clin Nutr 1999;53:1–7.

202. Luo J, Rizkalla SW, Alamowitch C, et al. Chronic consumption of short-chain fructooligosaccharides by health subjects decreased basal hepatic glucose production but had no effect on insulin-stimulated glucose metabolism. Am J Clin Nutr 1996;63:939–45.

203. Kosenko LG. Concentration of trace elements in the blood of patients with diabetes mellitus. Fed Proc Transl (Suppl) 1965;24:237–8.

204. 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.

205. Rubenstein AH, Levin NW, Elliott GA. Hypoglycaemia induced by manganese. Nature (London) 1962;194:188–9.

206. Eckel RH, Hanson AS, Chen AY, et al. Dietary substitution of medium-chain triglycerides improves insulin-mediated glucose metabolism in non-insulin dependent diabetics. Diabetes 1992;41:641–7.

207. Trudy J, Yost RN, Erskine JM, et al. Dietary substitution of medium-chain triglycerides in subjects with non-insulin dependent diabetes mellitus in an ambulatory setting: impact on glycemic control and insulin-mediated glucose metabolism. J Am Coll Nutr 1994;13:615–22.

208. 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.

209. Boivin M, Flourie B, Rizza RA, et al. Gastrointestinal and metabolic effects of amylase inhibition in diabetics. Gastroenterology 1988;94:387–94.

210. 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.

211. 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.

212. 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.

213. Rajasekaran S, Sivagnanam K, Subramanian S. Hypoglycemic effect of Aloe vera gel on streptozotocin-induced diabetes in experimental rats. J Med Food 2004;7:61–6.

214. Yongchaiyudha S, Rungpitarangs V, Bunyapraphatsara N, Chokechaijaroenporn O. Antidiabetic activity of Aloe vera L. juice. I. Clinical trial in new cases of diabetes mellitus. Phytomedicine 1996;3:241–3.

215. Bunyapraphatsara N, Yongchaiyudha S, Rungpitarangsi V, Chokechaijaroenporn O. Antidiabetic activity of Aloe vera L juice. II. Clinical trial in diabetes mellitus patients in combination with glibenclamide. Phytomedicine 1996;3:245–8.

216. Vogler BK, Ernst E. Aloe vera: a systematic review of its clinical effectiveness. Br J Gen Pract 1999;49:823–8 [review].

217. [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.

218. [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.

219. 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.

220. 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&#

Skip to: