Type 1 Diabetes (Holistic)

About This Condition

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

Fight back with fiber
Under a doctor's supervision, stabilize your blood sugar by eating fiber from whole grains, beans (legumes), vegetables, and fruit, and consider using a fiber supplement such as psyllium or guar gum
Go for the chromium
Under the supervision of a doctor, take 200 mcg a day of this essential trace mineral to improve glucose tolerance
Protect with alpha lipoic acid
Protect against diabetic complications, such as nerve and kidney damage, by taking 600 to 1,200 mg of this supplement per day

About

About This Condition

Diabetes mellitus is the reduced ability, or inability, to metabolize carbohydrates resulting from inadequate insulin production or utilization.

Several types of diabetes exist: type 1, type 2, gestational, and several specific types due to "other" causes, such as cystic fibrosis. In types 1 and 2, various genetic and environmental factors result in the loss of pancreatic beta cells, which manifests as hyperglycemia (high blood sugar). This article concerns type 1 diabetes, in which autoimmune destruction of the beta cells of the pancreas result in insulin deficiency.

People with all forms of diabetes face equal risk of the same complications once hyperglycemia occurs. Long-term elevations in blood sugar significantly increase the risk of cardiovascular disease, stroke, kidney and nerve damage, poor wound healing, infections, and eye problems including retinopathy and cataracts.

People with type 1 diabetes should work with the doctor prescribing insulin before using any of the lifestyle or dietary changes mentioned in this article. Any change that makes the body more responsive to insulin could require adjustments in insulin dosage that the treating physician must supervise.¹

Healthy Lifestyle Tips

Everyone with diabetes aged 6 months and older should get a seasonal flu shot. Close household contacts and out-of-home caregivers of people with diabetes also should be vaccinated against the flu each year.

People with type 1 diabetes who engage in regular exercise require less insulin.² However, in the short term, exercise can induce low blood sugar or even occasionally increase blood sugar.³ Therefore, people with type 1 diabetes should never begin an intensive exercise program without consulting a healthcare professional.

The American Diabetes Association (ADA) recommends that people with diabetes limit their daily alcohol consumption to one drink for women and two drinks for men.⁴ The Centers for Disease Control defines one drink as equivalent to a 12 ounce can of beer, 8 ounces of malt liquor, 5 ounces of wine, and 1.5 ounces of hard liquor. Similar to research on healthy people, preliminary studies in adults with diabetes find reduced risk of heart disease with light to moderate drinking.⁵ Beyond moderate drinking, alcohol will be more harmful than beneficial. Drinking alcohol with type 1 diabetes can result in hypoglycemia or hyperglycemia, depending on the circumstances, but moderate amounts of alcohol ingested with food are less likely to affect blood glucose levels.⁶ People with diabetes who drink two or more drinks per day were reported to have a high risk for eye damage in one preliminary study,⁷ but another, larger study found no association between alcohol use and eye damage.⁸ However, alcohol consumption does have numerous downsides, including risk of addiction and increased risk of several types of cancer. For this reason, it is not advised that people who do not drink begin doing so simply for its possible heart-protective benefits. Ask your doctor what is best for you, taking into account your personal medical history.

People with diabetes who smoke are at higher risk for kidney damage,⁹heart disease,¹⁰ and other diabetes-related health problems. Smokers also are more likely to develop diabetes,¹¹ so it's important for people with diabetes who smoke to quit.

Most healthcare providers agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes. Advocates of SMBG, such as the American Diabetes Association (ADA), have observed that SMBG by people with diabetes has revolutionized management of the disease, enabling them to achieve and maintain specific blood glucose and laboratory value goals.¹² These observations are well-supported in the medical literature.¹³ Children should be taught proper techniques for SMBG as well. A study of children and adolescents with type 1 diabetes showed that, after adjusting for several factors, increased SMBG frequency was associated with lower A1C—the more intensive the SMBG, the better the child's A1C, suggesting SMBG significantly improves glucose control. In the range of 0–5 tests per day, A1C decreased by 0.46% per additional test per day.¹⁴

Detractors point out that indiscriminate use of self-monitoring is of questionable value and adds enormously to healthcare costs.¹⁵ 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.¹⁶ Nevertheless, it is likely that self-monitoring of blood glucose, if used properly, can have a positive effect by increasing patient involvement in overall diabetes care.¹⁷ Pharmacists and healthcare practitioners can teach people with diabetes important skills that will enhance their ability to properly self-manage blood glucose. Regular follow-up visits with a diabetes healthcare practitioner, including downloading and reviewing SMBG results, is important.¹⁸

Holistic Options

Acupuncture may be helpful in the management of diabetes, or complications associated with the disease. In a preliminary trial, 77% of people suffering from diabetic nerve damage (neuropathy) experienced significant reduction in pain following up to six acupuncture treatments over a ten-week period. Many also were able to reduce pain medications, but no long-term change in blood-sugar control was observed.¹⁹ 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.²⁰^{, 21}

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation	Why
Add some olive oil	Extra virgin olive oil is a good source of monounsaturated fat. Increasing monounsaturated fats relative to other dietary fats is associated with better blood sugar control and cholesterol levels. Changing the overall percentage of calories from fat and carbohydrates in the diets of people with type 1 diabetes can be challenging. However, it is possible to improve the quality of the dietary fat. In adolescents with type 1 diabetes, increasing monounsaturated fats relative to other dietary fats is associated with better control of blood sugar and blood fat and cholesterol levels. The best way to incorporate monounsaturated fats into the diet is to use olive oil, especially extra virgin olive oil, which has the highest antioxidant values in addition to monounsaturated fat.
Be GL savvy	Whole grains, beans, vegetables, and fruit are loaded with nutrients and fiber, providing valuable fuel that will keep blood sugar levels stable. Substituting low–glycemic load foods for higher–glycemic load foods may modestly improve glycemic control, though studies on this question provide a complicated picture. Low-glycemic load foods also tend to be high in fiber, and many studies have not controlled for the independent effects of fiber on blood glucose levels. Further, studies have used inconsistent definitions of "low" and "high" when defining the glycemic load of foods, and have not controlled for how mixtures of different foods affect the overall glycemic load of the diet and blood glucose control. However, most foods that rank low on glycemic load are healthy for other reasons; they provide valuable nutrients to the diet, and help people minimize eating less-healthy, processed foods. People with type 1 diabetes should always discuss changes in their diet with their treating physician. For people who are using intensive insulin therapy, it's important to be as accurate as possible when counting carbohydrates to determine a pre-meal insulin dose. For example, if the dose of insulin is calculated based on a planned meal containing 60 grams of carbohydrates, eating only 40 grams of carbohydrates will result in hypoglycemia, while eating 80 grams will lead to hyperglycemia. For this reason, experts recommend that carbohydrates be counted very accurately, and that the calculated carbohydrate grams be within 10 grams of the actual meal carbohydrate content.
Factor in fat and protein	As much as possible, balance your snacks and meals with carbohydrates, protein, and healthy sources of fat. Including all three macronutrients may help minimize the risk of hypoglycemic events in people who are focused on very tight blood sugar control through intensive insulin therapy. When eaten together, fat and protein have an additive effect in delaying postprandial (post-meal) glycemic rise, and protein may help protect against the development of hypoglycemia. Hypoglycemic events are a very real concern for people with type 1 diabetes, especially those who are opting for the tightest possible blood glucose control (called intensive insulin therapy), and dietary protein can be an important part of minimizing the risk of hypoglycemia.
Feature fiber	Research is mixed regarding the benefits of fiber for lowering or managing blood glucose levels; however, eating more fiber is associated with lower risk of all-cause mortality. People with diabetes should consume at least the amount of fiber and whole grains recommended for the general public. Research is mixed regarding the benefits of fiber for lowering or managing blood glucose levels; however, eating more fiber is associated with lower risk of death due to any cause (all-cause mortality). Further, fiber comes from foods such as vegetables, fruit, legumes, nuts, seeds, and whole grains, which are associated with good health for other reasons. For example, these foods also provide important vitamins, minerals, and phytonutrients.
Limit sugar	Most doctors recommend that people with diabetes eat less sugary foods like snacks and processed foods and replace these foods with high-fiber, whole foods. Currently, the American Diabetes Association (ADA) guidelines do not set specific limits for sucrose—white table sugar—in the diet, because substituting sucrose-containing foods for equal caloric amounts of other carbohydrates may have similar blood glucose effects. However, consumption of sucrose, which is found mostly in less healthy, processed food items, should be minimized to avoid displacing nutrient-dense food choices, such as vegetables, legumes, fruit, and whole grains. All people, including those with diabetes, should follow the American Heart Association guidelines that men eat no more than 150 calories, or approximately nine teaspoons, of added sugar per day, and that women eat no more than 100 calories, or approximately 6 teaspoons, of added sugar per day.
Pick a pattern	Work with a knowledgeable healthcare practitioner to identify which healthy diet pattern works best for you. The American Diabetes Association (ADA) defines an eating pattern as combinations of different foods or food groups that characterize relationships between nutrition and health promotion and disease prevention. Because current research evidence does not show that there is one ideal eating pattern for all people with diabetes, the ADA recommends that the percentage of calories from carbohydrate, protein, and fat be based on an individualized assessment of current eating patterns, preferences, and metabolic goals. Other factors, including food access and the availability of healthful foods, tradition, cultural food systems, health beliefs, knowledge of foods that promote health and prevent disease, and resources to buy health-promoting foods, should be considered as well when determining the best eating pattern to foster good glycemic control and promote health for each person with diabetes. A Mediterranean diet eating pattern, vegetarian or vegan diets, low-fat diets, low-carbohydrate diets, and the Dietary Approaches to Stop Hypertension (DASH) diet, have all been shown to be healthful choices for some people with diabetes, under some circumstances. The most important thing is to work with a knowledgeable healthcare practitioner to identify which healthy diet pattern works best for each person, and to consult with this person before making any major changes to your diet.
Stay tuned about dairy	The relationship between dairy foods (made from cow's milk) and type 1 diabetes remains unclear, although there is some evidence that these foods may increase the risk of developing type 1 diabetes. Should children avoid dairy foods, especially early in life, to prevent type 1 diabetes? The relationship between dairy foods and type 1 diabetes risk remains unclear, although there is some evidence that milk consumption might increase the risk of developing type 1 diabetes in children who are genetically susceptible to developing the disease. Researchers noted early on that worldwide, in places with higher dairy consumption, children have a significantly higher chance of developing type 1 diabetes compared with areas where less dairy is consumed. Some researchers believe that drinking milk may cause susceptible children to make antibodies that attack the pancreas (autoantibodies), causing type 1 diabetes to develop. One long-running double-blind, randomized controlled study has been following infants with a higher than average risk of developing type 1 diabetes due to the presence of genetic factors for the disease. Infants who were unable to consume breast milk for the first six to eight months of life were assigned to receive either regular cow's milk infant formula or a casein hydrolysate formula. While casein is found in milk, this second formula is considered more digestible and may be less likely to elicit an immune response, because the casein proteins are hydrolyzed or broken down in this product. The first research paper published from this group of children found that those who received the hydrolyzed infant formula had a 50% lower risk of developing type 1 diabetes autoantibodies (antibodies that attack the pancreas) compared with children given cow's milk formula. However, a newer research paper published on this group of children found that the hydrolyzed infant formula did not reduce the risk of type 1 diabetes autoantibodies after an additional 7 years of follow up. Because the evidence is conflicting, there are no official guidelines recommending the avoidance of dairy foods (made from cow's milk) for children at higher than average risk of developing type 1 diabetes. However, if you have concerns about type 1 diabetes, or have a family history of the disease or other autoimmune conditions, such as rheumatoid arthritis or celiac disease, ask your pediatrician about the pros and cons of keeping dairy foods out of your child's diet for the first few years of life. Dairy can provide valuable nutrients to a child's diet, including protein, calcium, and vitamin D, so if you decide to avoid it, work with a registered dietitian who can guide you on how best to replace important nutrients with non-dairy options.

Supplements

What Are Star Ratings?

Our proprietary "Star-Rating" system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.

2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement	Why
3 Stars Alpha Lipoic Acid 600 to 1,200 mg a day	Supplementing with alpha lipoic acid may protect against diabetic complications, such as nerve and kidney damage. Alpha lipoic acid is a powerful natural antioxidant. Preliminary and double-blind trials have found that supplementing with 600 to 1,200 mg of lipoic acid per day improves the symptoms of diabetic nerve damage (neuropathy). In a preliminary study, supplementing with 600 mg of alpha-lipoic acid per day for 18 months slowed the progression of kidney damage in people with type 1 diabetes.
3 Stars Cayenne Topical (Diabetic Neuropathy) Apply an ointment containing 0.025 to 0.075% capsaicin four times per day to areas of nerve pain	Topically applied capsaicin (from cayenne) has been shown to relieve symptoms of diabetic neuropathy. Double-blind trials have shown that topical application of creams containing 0.025 to 0.075% capsaicin (from cayenne [Capsicum frutescens]) can relieve symptoms of diabetic nerve damage (neuropathy). Four or more applications per day may be required to relieve severe pain. This should be done only under a doctor's supervision.
3 Stars Chromium 200 mcg daily	Chromium has been shown to help improve glucose tolerance in people with type 1 diabetes. Chromium, a trace mineral that appears to increase the effectiveness of insulin, has been shown to improve glucose and related variables in people with many kinds of diabetes, including type 1 diabetes. Chromium may also lower levels of total , LDL cholesterol, and (risk factors for heart disease). The typical amount of chromium used in research trials is 200 mcg per day. Supplementation with chromium or (a source of chromium) could potentially enhance the effects of drugs for diabetes (for example, 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.
3 Stars Fiber 30 grams daily	Taking fiber supplements may help to stabilize your blood sugar. When taken with meals, high-fiber supplements such as guar gum reduced the rise in blood sugar following meals in people with type 1 diabetes. More research is needed to determine if regular use of fiber supplements benefits long-term blood sugar control in type 1 diabetes.
3 Stars Magnesium 200 to 600 mg daily	People with type 1 diabetes tend to have low magnesium levels, supplementing with the mineral may reduce the risk of deficiency-related problems, such as eye damage and neuropathy. People with type 1 diabetes tend to have low magnesium levels, and magnesium given orally or by injection partially overcomes the reduction in magnesium levels. In one preliminary trial, insulin requirements were lower in people with type 1 diabetes who were given magnesium. Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes. In magnesium-deficient pregnant women with type 1 diabetes, the lack of magnesium may even account for the high rate of spontaneous abortion and birth defects associated with type 1 diabetes. A double-blind trial found that giving 300 mg per day of magnesium to magnesium-deficient type 1 diabetics for five years slowed the development of diabetic nerve damage (neuropathy). The American Diabetes Association acknowledges strong associations between magnesium deficiency and insulin resistance but has not said magnesium deficiency is a risk factor. Many doctors, however, recommend that adults with diabetes and normal kidney function supplement with 200 to 600 mg of magnesium per day (those amounts would be lower for children).
2 Stars Acetyl-L-Carnitine (Diabetic Neuropathy) 500 to 1,000 mg three times per day	Taking acetyl-L-carnitine may improve symptoms of diabetic neuropathy. In a double-blind study of people with diabetic nerve damage (neuropathy), supplementing with acetyl-L-carnitine was significantly more effective than a placebo in improving subjective symptoms of neuropathy and objective measures of nerve function. 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.
2 Stars Bilberry 160 mg twice per day of an herbal extract containing 25% anthocyanosides	Bilberry may lower the risk of some diabetic complications, such as diabetic cataracts and retinopathy. 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.
2 Stars Biotin 16 mg daily	Biotin may improve glucose levels and reduce pain from diabetic nerve damage. Biotin is a B vitamin needed to process glucose. When people with type 1 diabetes were given 16 mg of biotin per day for one week, their fasting glucose levels dropped by 50%. Biotin may also reduce pain from diabetic nerve damage (neuropathy). Some doctors try 16 mg of biotin for a few weeks to see if blood sugar levels will fall.
2 Stars Gymnema 800 mg per day of an herbal extract standardized for 25% gymnemic acids	Gymnema may help normalize blood sugar control in people with type 1 diabetes. Test tube and animal studies have found several mechanisms by which gymnema may help normalize blood sugar control in diabetics. In a controlled trial with people with type 1 diabetes, 400 mg per day of gymnema extract reduced requirements for insulin. Whether the extract used in this study was standardized for active constituents is unclear. Recently, a preliminary trial found improved blood sugar levels after three months in a group of people with type 1 and type 2 diabetes who took 800 mg per day of an extract standardized for 25% gymnemic acids. Gymnema is not a substitute for insulin, but insulin amounts may need to be lowered in order to avoid hypoglycemia while taking gymnema.
2 Stars L-Carnitine 0.25 mg per 2.2 lbs (1 kg) of body weight	Supplementing with L-carnitine may reduce cholesterol and triglyceride levels in people with diabetes. L-carnitine is an amino acid needed to properly utilize fat for energy. When people with diabetes were given L-carnitine (0.5 mg per 2.2 pounds of body weight), high blood levels of fats—both cholesterol and triglycerides—dropped 25 to 39% in just ten days in one trial.
2 Stars Onion 20 grams fresh onion three times per day	Large amounts of onion have been shown to lower blood sugar levels in people with diabetes, possibly by blocking the breakdown of insulin in the liver. 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. 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.
2 Stars Vitamin B1 25 mg daily, with 50 mg of vitamin B6 daily	People with type 1 diabetes may be deficient in vitamin B1. Supplementing with vitamin B1 may restore levels and improve symptoms of diabetic neuropathy. Blood levels of vitamin B1 (thiamine) have been found to be low in people with type 1 diabetes. A controlled trial in Africa found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic nerve damage (neuropathy) after four weeks. 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. As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.
2 Stars Vitamin B3 (Niacin) Consult a qualified healthcare practitioner	Taking vitamin B3 (as niacin or niacinamide) might prevent or limit the severity of type 1 diabetes in your family. Taking large amounts of niacin (a form of vitamin B3), such as 2 to 3 grams per day, may impair glucose tolerance and should be used by people with diabetes only with medical supervision. Some clinical trials have shown that niacinamide (another form of vitamin B3) supplementation might be useful in the very early stages of type 1 diabetes, though not all trials support this claim. Although an analysis of research shows that niacinamide does help preserve some function of insulin-secreting cells in people recently diagnosed with type 1 diabetes, the amount of insulin required for those given niacinamide has remained essentially as high as for those given placebo. A controlled trial found no beneficial effect of niacinamide supplementation (700 mg three times per day in addition to intensive insulin therapy) on pancreatic function and glucose tolerance in people newly diagnosed with type 1 diabetes. Some, but not all, reports suggest that healthy children at high risk for type 1 diabetes (such as the healthy siblings of children with type 1 diabetes) may be protected from the disease by supplementing with niacinamide. Parents of children with type 1 diabetes should consult their doctor regarding niacinamide supplementation as a way to prevent diabetes in their other children. Although the optimal amount of niacinamide is not known, recent evidence suggests that 25 mg per 2.2 pounds of body weight per day may be as effective as higher amounts.
2 Stars Vitamin B6 1,800 mg daily of of pyridoxine alpha-ketoglutarate or 50 mg daily pyridoxine	People with diabetes often have low vitamin B6 levels. Supplementing with the vitamin may restore levels and improve glucose tolerance. Blood levels of vitamin B1 (thiamine) have been found to be low in people with type 1 diabetes. A controlled trial in Africa found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic nerve damage (neuropathy) after four weeks. 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. As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown. Many people with diabetes have low blood levels of vitamin B6. Levels are even lower in people with diabetes who also have neuropathy. In a trial that included people with type 1 diabetes, 1,800 mg per day of a special form of vitamin B6—pyridoxine alpha-ketoglutarate—improved glucose tolerance dramatically. Vitamin B6 may also reduce the amount of glycosylation, so taking adequate amounts of this vitamin may be beneficial for all people with diabetes.
2 Stars Vitamin C 500 mg twice per day	Supplementing with vitamin C may benefit people with type 1 diabetes in several ways, including by reducing sorbitol levels, urinary protein loss, glycosylation, and eye damage. People with type 1 diabetes appear to have low vitamin C levels. As with vitamin E, vitamin C may reduce glycosylation. Vitamin C also lowers sorbitol levels in people with diabetes. Sorbitol is a sugar that can accumulate inside the cells and damage the eyes, nerves, and kidneys of people with diabetes. Vitamin C supplementation (500 mg twice a day for one year) has significantly reduced urinary protein loss in people with diabetes. Urinary protein loss (also called proteinuria) is associated with poor prognosis in diabetes. 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. One study examined antioxidant supplement intake, including both vitamins E and C, and the incidence of diabetic eye damage (retinopathy). A surprising finding was that people with extensive retinopathy had a greater likelihood of having taken vitamin C and vitamin E supplements. The outcome of this study, however, does not fit with most other published data and might simply reflect the fact that sicker people are more likely to take supplements in hopes of getting better. For the present, most doctors remain relatively unconcerned about the outcome of this isolated report.
2 Stars Vitamin D Consult a qualified healthcare practitioner	Vitamin D is needed to maintain adequate insulin levels, and supplementing with it may reduce the risk of developing type 1 diabetes. Vitamin D is needed to maintain adequate blood levels of insulin. Vitamin D receptors have been found in the pancreas where insulin is made and some, but not all preliminary evidence suggests that supplementation might reduce the risk of developing type 1 diabetes. Vitamin D supplementation may also slow the decline of pancreatic function in people with newly diagnosed type 1 diabetes who have not yet suffered an extensive loss of pancreatic function. 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.
2 Stars Vitamin E (Diabetic Retinopathy) 1800 IU daily	Supplementing with vitamin E may combat free radicals associated with diabetic retinopathy. People with low blood levels of vitamin E are more likely to develop type 1 diabetes, but no studies have been done using vitamin E supplements to try to prevent type 1 diabetes. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic eye damage and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence. Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. 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,although not all, studies of people with type 1 diabetes.
2 Stars Vitamin E (Diabetic Nephropathy) 900 to 1,800 IU daily	Vitamin E supplementation may protect against diabetic neuropathy. People with low blood levels of vitamin E are more likely to develop type 1 diabetes, but no studies have been done using vitamin E supplements to try to prevent type 1 diabetes. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic eye damage and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence. Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. 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,although not all, studies of people with type 1 diabetes.
2 Stars Zinc Consult a qualified healthcare practitioner	Supplementing with zinc may lower blood sugar levels and improve immune function in people with type 1 diabetes. People with type 1 diabetes tend to be zinc deficient, which may impair immune function. Zinc supplements have lowered blood sugar levels in people with type 1 diabetes. Some doctors are concerned about having people with type 1 diabetes supplement with zinc because of a report that zinc supplementation increased glycosylation, generally a sign of deterioration of the condition. This trial is hard to evaluate because zinc supplementation increases the life of blood cells and such an effect artificially increases the lab test results for glycosylation. Until this issue is resolved, those with type 1 diabetes should consult a doctor before considering supplementation with zinc.
1 Star Açaí Refer to label instructions	Açaí is reported to be a traditional remedy for diabetes. Açaí is reported to be a traditional remedy for diabetes. Although oxidative stress may contribute to diabetes and anthocyanins may improve insulin secretion, there is no published evidence that açaí has any effect on diabetes.
1 Star Amylase Inhibitors Refer to label instructions	Amylase inhibitors, when given with a starchy meal, can reduce the usual rise in blood sugar levels of people with diabetes. 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. While this effect could be helpful in controlling diabetes, no research has investigated the long-term effects of taking starch blockers for this condition.
1 Star Asian Ginseng Refer to label instructions	Asian ginseng is commonly used in traditional Chinese medicine to treat diabetes. 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. Animal research has also revealed a direct blood sugar–lowering effect of ginseng. However, no human trials have tested Asian ginseng in people with type 1 diabetes.
1 Star Coenzyme Q10 Refer to label instructions	Supplementing with CoQ10 may improve blood sugar metabolism. Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. In one trial, blood sugar levels fell substantially in 31% of people with diabetes after they supplemented with 120 mg per day of CoQ7, a substance similar to CoQ10. In people with type 1 diabetes, however, supplementation with 100 mg of CoQ10 per day for three months neither improved glucose control nor reduced the need for insulin. The importance of CoQ10 supplementation for people with diabetes remains an unresolved issue, though some doctors recommend approximately 50 mg per day as a way to protect against possible effects associated with diabetes-induced depletion.
1 Star Evening Primrose Oil See Learn More for details	Evening primrose oil has been associated with improved diabetic neuropathy. However, the principal investigator who conducted these clinical trials was found to have falsified research results, so whether EPO or GLA is of any value for neuropathy is still unknown. Supplementing with 4 grams of evening primrose oil per day for six months has been found in double-blind research to improve nerve function and to relieve pain symptoms in people with diabetic nerve damage (neuropathy). However, the principal investigator who conducted these clinical trials was subsequently found by the professional conduct committee of the General Medical Council (United Kingdom) to have falsified the results of the research. Therefore, it is not clear whether evening primrose oil or GLA is of any value for patients with diabetic neuropathy.
1 Star Fenugreek Refer to label instructions	Fenugreek seeds are high in soluble fiber, which helps lower blood sugar by slowing down carbohydrate digestion and absorption. Fenugreek seeds are high in soluble fiber, which helps lower blood sugar by slowing down carbohydrate digestion and absorption. Animal research suggests that fenugreek may also contain a substance that stimulates insulin production and improves blood sugar control. In a controlled study in people with type 1 diabetes, incorporating powdered fenugreek seed into lunch and dinner meals (50 grams per meal) for ten days improved several measures of blood sugar control compared to a similar ten-day diet without added fenugreek.
1 Star Fish Oil Refer to label instructions	Supplementing with fish oil may improve glucose tolerance and symptoms of diabetic neuropathy and nephropathy. Glucose tolerance improves in healthy people taking omega-3 fatty acid supplements. And in one trial, people with diabetic nerve damage (neuropathy) and diabetic nephropathy experienced significant improvement when given 600 mg three times per day of purified eicosapentaenoic acid (EPA)—one of the two major omega-3 fatty acids found in fish oil supplements—for 48 weeks. However, controlled studies have found that fish oil supplementation increases cholesterol in people with type 1 diabetes. Until the risk–benefit ratio of using fish oil is clarified, people with diabetes should feel free to increase their fish intake, but they should consult a doctor before taking fish oil supplements.
1 Star Ginkgo Refer to label instructions	The herb ginkgo may help prevent and treat early-stage diabetic nerve damage. Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic nerve damage (neuropathy), though research is at best very preliminary in this area.
1 Star Glucomannan Refer to label instructions	Glucomannan delays stomach emptying, leading to more gradual sugar absorption and possibly lowering insulin requirements for people with type 1 diabetes. Glucomannan is a water-soluble dietary fiber derived from konjac root (Amorphophallus konjac). Glucomannan delays stomach emptying, leading to a more gradual absorption of dietary sugar. This effect can reduce the elevation of blood sugar levels that is typical after a meal. This could lower insulin requirements for type 1 diabetics, but no research has been done to test this possibility.
1 Star Hibiscus Refer to label instructions	Hibiscus is a traditional remedy in India for diabetes, and is supported by preliminary research. Hibiscus is a traditional remedy in India for diabetes; this treatment is supported by preliminary studies from that country and by animal studies. Hibiscus is usually taken as tea, 1 to 2 teaspoons (3 to 6 grams) of dried flower infused in to 1 cup (250 ml) of water three times per day.
1 Star Inositol Refer to label instructions	Supplementing with inositol may improve diabetic neuropathy. Inositol is needed for normal nerve function. Diabetes can cause a type of nerve damage known as diabetic neuropathy. Certain measures of the severity of this condition have been reported to improve with inositol supplementation (500 mg taken twice per day); however, in other trials, inositol was ineffective.
1 Star Manganese Refer to label instructions	People with diabetes may have low manganese levels, which can contribute to glucose intolerance. Supplementing with the mineral may help. People with diabetes may have low blood levels of manganese. Animal research suggests that manganese deficiency can contribute to glucose intolerance and may be reversed by supplementation. A young adult with insulin-dependent diabetes who received oral manganese (3 to 5 mg per day as manganese chloride) reportedly experienced a significant fall in blood glucose, sometimes to dangerously low levels. In three other people with type 1 diabetes, manganese supplementation had no effect on blood glucose levels. People with type 1 diabetes wishing to supplement with manganese should do so only with a doctor's close supervision.
1 Star Mistletoe Refer to label instructions	Mistletoe extract has been shown to stimulate insulin release from pancreas cells, and it may reduce diabetes symptoms. Mistletoe extract has been shown to stimulate insulin release from pancreas cells, and animal research found that it reduces symptoms of diabetes. 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.
1 Star Olive Leaf Refer to label instructions	Olive leaf extracts have been used experimentally to lower high blood sugar in diabetic animals Olive leaf extracts have been used experimentally to lower elevated blood-sugar levels in diabetic animals. These results have not been reproduced in human clinical trials.
1 Star Quercetin Refer to label instructions	Quercetin may be helpful for its ability to reduce levels of sorbitol—a sugar that accumulates in cells and damages the nerves, kidneys, and eyes of people with diabetes. 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. Clinical trials have yet to explore whether quercetin actually protects people with diabetes from nerve damage (neuropathy), nephropathy, or eye damage (retinopathy).
1 Star Reishi Refer to label instructions	Reishi may have some beneficial action in people with diabetes. Animal studies and some very preliminary trials in humans suggest reishi may have some beneficial action in people with diabetes.
1 Star Sea Buckthorn Refer to label instructions	Animal and preliminary research suggests a connection between sea buckthorn and improved measures of blood sugar control. Animal research reports that sea buckthorn flavonoids lower blood glucose. In a preliminary trial, children with type 1 diabetes who consumed a concentrated mixture of sea buckthorn berries and blueberries (concentration and relative proportions not stated) for two months had improved blood measures of glucose control. Double-blind research using sea buckthorn alone is needed to confirm these findings and to determine an effective daily amount of sea buckthorn.
1 Star Selenium, Vitamin A, Vitamin C, and Vitamin E (Diabetic Retinopathy) Refer to label instructions	Antioxidant nutrients including selenium, vitamin A, vitamin C, and vitamin E may combat free radicals associated with diabetic retinopathy. Because oxidation damage is believed to play a role in the development of diabetic eye damage (retinopathy), antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic eye damage (retinopathy). During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy. People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.
1 Star Selenium, Vitamin A, Vitamin C, and Vitamin E Refer to label instructions	A combination of the antioxidants selenium, vitamin A, vitamin C, and vitamin E has been shown to improve diabetic retinopathy. Because oxidation damage is believed to play a role in the development of diabetic eye damage (retinopathy), antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic eye damage (retinopathy). During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy. People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.
1 Star Taurine Refer to label instructions	People with type 1 diabetes tend to have low taurine levels, a condition that increases the risk of heart disease. Supplementing with taurine may restore levels. Taurine is an amino acid found in protein-rich food. People with type 1 diabetes have been reported to have low blood taurine levels, a condition that increases the risk of heart disease by altering blood viscosity. Supplementing with taurine (1.5 grams per day) has restored blood taurine to normal levels and corrected the problem of blood viscosity within three months.
1 Star Vitamin B12 Refer to label instructions	Supplementing with vitamin B12 may improve symptoms of diabetic neuropathy. 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. 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. Oral vitamin B12 up to 500 mcg three times per day is recommended by some practitioners.

References

1. American Diabetes Association Standards of Medical Care in Diabetes—2017. Diabetes Care 2017;40.

2. Grimm J-J, Muchnick S. Type I diabetes and marathon running. Diabetes Care 1993;16:1624 [letter].

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

4. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2003;26:S51-S61 [review].

5. Ajani UA, Gaziano JM, Lotufo PA, et al. Alcohol consumption and risk of coronary heart disease by diabetes status. Circulation2000;102:500-5.

6. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002;25:148-98 [review].

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

8. Moss SE, Klein R, Klein BE. The association of alcohol consumption with the incidence and progression of diabetic retinopathy. Ophthalmology1994;101:196-8.

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

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

11. 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.

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

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

14. Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association. American Diabetes Association[cited 2015 Feb 16]. Available from URL: http://care.diabetesjournals.org/content/37/7/2034.

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

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

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

18. Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association. American Diabetes Association[cited 2015 Feb 16]. Available from URL: http://care.diabetesjournals.org/content/37/7/2034.

19. Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes Res Clin Pract 1998;39:115-21.

20. Zheg HT, Huang XM, Sun JH. Treatment of diabetic cystopathy by acupuncture and moxibustion. J Tradit Chin Med 1986;6:243-8.

21. Zhang W. Acupuncture for treatment of diabetic urinary bladder neural dysfunction—a report of 36 cases. J Tradit Chin Med 1997;17:211-3.

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.

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