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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
Under the supervision of a doctor, take 200 mcg a day of this essential trace mineral to improve glucose tolerance
Protect against diabetic complications, such as nerve and kidney damage, by taking 600 to 1,200 mg of this supplement per day
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
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
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
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.
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.
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.
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.
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.
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.
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.
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.
Animal studies and some very preliminary trials in humans suggest reishi may have some beneficial action in people with diabetes.
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.
Last Review: 06-08-2015
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