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Home > Living Well > Health Library > Type 2 Diabetes (Holistic)
Follow a low-glycemic-index diet by avoiding sweet snacks and processed foods, and emphasizing healthy carbohydrates from whole grains, beans, vegetables, and whole fruit, to help keep blood sugar levels stable.
In addition to eating plenty of high-fiber fruits and vegetables, consider using a fiber supplement such as glucomannan or psyllium with meals.
Lower your blood sugar and improve insulin function with weight loss and regular exercise.
Improve glucose tolerance by taking 200 to 1,000 mcg of this essential trace mineral every day.
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.
An ointment containing 0.025 to 0.075% capsaicin four times a day might help control nerve pain.
Lose excess weight with a program of healthy eating, regular exercise, and group support to maintain healthy insulin sensitivity and prevent type 2 diabetes.
Use regular aerobic and/or strength exercise to maintain healthy insulin sensitivity and prevent type 2 diabetes.
Choose carbohydrate foods with a low glycemic index, such as whole grains, beans (legumes), and other high-fiber, unprocessed foods, to stabilize blood sugar and reduce diabetes risk.
Vegetarians have been shown to have a low risk of type 2 diabetes.
Extra virgin olive oil is a good source of monounsaturated fat. Increasing monounsaturated fats relative to other dietary fats has been shown to improve glucose tolerance.
Diabetes mellitus, usually referred to simply as diabetes, is an inability to metabolize carbohydrates resulting from inadequate insulin production, absence of insulin production, or impaired utilization of insulin. There are several types of diabetes including type 1, type 2, and gestational diabetes, as well as a more recently recognized form of adult-onset diabetes called latent autoimmune diabetes in adults (LADA).1 Diabetes insipidus, a condition characterized by dysregulation of water and electrolyte levels, is not related to these other forms of diabetes.2
This article concerns type 2 diabetes, which is sometimes erroneously called adult-onset diabetes or non-insulin-dependent diabetes. In fact, type 2 diabetes can affect children and sometimes requires treatment with insulin. In people with type 2 diabetes, the pancreas often makes enough insulin, particularly when a person is first diagnosed, but the body's cells grow increasingly unresponsive, or resistant, to its signals. Type 2 diabetes frequently responds well to natural therapies; however, if the condition is not well managed, the pancreas can become unable to make adequate insulin, leading to the need for treatment with insulin. For many people with type 2 diabetes, lifestyle changes and/or oral glucose lowering medications can keep the condition well managed.
In people with diabetes, the cells cannot properly respond to insulin by taking up circulating glucose, the main source for cellular energy. As a result, glucose stays in the blood, causing blood glucose levels to rise, while the cells become starved for glucose.
People with diabetes produce high levels of inflammatory molecules and tissue-damaging free radicals; as a result, they are at increased risk for a wide array of complications including heart disease, atherosclerosis, cataracts, retinopathy, stroke, poor wound healing, infections, Alzheimer's disease, fatty liver, and damage to the kidneys and nerves.3, 4, 5 In addition, those with diabetes have higher rates of certain complications if they also have high homocysteine levels.6, 7, 8 The risk of diabetes-related health complications can be decreased with proper blood glucose management and a healthy lifestyle.
If using supplements to help manage type 2 diabetes, it's important to know that they could potentially enhance the effects of drugs used to treat type 2 diabetes, including insulin or other blood glucose-lowering agents, and increase the risk of hypoglycemia. Therefore, people using medications to treat their type 2 diabetes should only take supplements under the supervision of a doctor.
People with type 2 diabetes are at higher risk of influenza and its complications. It is therefore widely recommended they, as well as their family members and care-givers, be vaccinated against the flu every year.9 In addition to the seasonal flu vaccine, older people with type 2 diabetes should consult with their healthcare provider about the potential benefits of pneumococcal vaccines (PCV13 and PPSV23).10
Overweight and obesity are closely linked to insulin resistance and type 2 diabetes. In fact, excess body fat appears to be key trigger of systemic inflammation leading to insulin resistance.11, 12 Weight loss, while difficult to achieve, can reverse insulin resistance, prevent prediabetes from progressing, and improve insulin sensitivity and glucose metabolism in people with type 2 diabetes.13 Therefore, healthy weight management is an important goal in a type 2 diabetes treatment plan.
Exercise helps decrease body fat and improve insulin sensitivity, promotes metabolic, cardiovascular, and musculoskeletal fitness, and improves mental health and quality of life.14, 15 People who exercise are less likely to develop type 2 diabetes, and physical training, especially when it progresses in intensity and amount, improves glycemic control in people with type 2 diabetes.16 In the short term, however, exercise can induce low blood sugar (hypoglycemia) in people with diabetes taking blood sugar–lowering medications, or even occasionally increased blood sugar.17 Therefore, people with diabetes should consult with a qualified exercise specialist before starting an intensive exercise program. Current research also highlights the harm of prolonged sitting, and a meta-analysis of studies found breaking up prolonged periods of sitting with short bouts of physical activity has a moderate impact on glucose, insulin, and triglyceride levels.18, 19
Drinking light to moderate amounts of alcohol has been associated with lower risk of type 2 diabetes in multiple studies and meta-analyses; however, according to a large meta-analysis that included 38 studies with a combined total of more than 1.9 million subjects, it appears to be more protective for women than men, and may not be protective in people of Asian descent.20, 21 For people with type 2 diabetes, light to moderate intake of alcohol appears to be safe and is not correlated with glycemic control.22 Emerging evidence from a controlled clinical trial, in which 224 people with well-controlled type 2 diabetes were assigned to drink one 150 ml glass (5 ounces, or one serving) of red wine, white wine, or water daily for two years, adds to the evidence that this level of wine consumption is safe in this population; furthermore, red wine in particular appeared to have a positive impact on cardiovascular risk in this study.23, 24 Nevertheless, high alcohol consumption offers no protections and increases the risks of cardiovascular disease and death from all causes in people with and without type 2 diabetes.25 It is also important to note that drinking alcohol may increase the risk of hypoglycemia, especially in those taking blood glucose-lowering medications.26, 27
Smokers are also more likely to develop diabetes, and people with type 2 diabetes who smoke are at higher risk for kidney damage, heart disease, and other diabetes-related problems.28, 29 Because electronic cigarettes also appear to pose cardiovascular and possibly other health hazards, people with type 2 diabetes who don't smoke should not start vaping, and those who do smoke should talk with their healthcare provider to develop an individualized plan for smoking cessation.30
Blood Glucose Monitoring
Although most healthcare professionals agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes, the benefits of SMBG in people with type 2 diabetes who are not being treated with insulin are less clear. Supporters posit the use of SMBG may help people with type 2 diabetes set and achieve their glycemic goals by making it easy for them to see how factors such as food choices and physical activity influence blood glucose levels. Two meta-analyses of clinical trials provide some clarity: they both found people with type 2 diabetes who used SMBG for up to six months were more effective at reducing HbA1c (a marker of long-term blood glucose control) compared to those who didn't use SMBG, but after one year, the difference was gone.31, 32 This suggests SMBG may be especially useful as a short-term educational tool for those newly diagnosed or with poor glycemic control, but may not be useful as a long-term disease management strategy.
While traditional SMBG devices can only detect glucose levels at isolated points in time, new continuous glucose monitoring devices provide information about short-term fluctuations in glucose levels (glycemic variability). Continuous glucose monitoring devices are inserted under the skin and left in place for periods ranging from a few days to a few weeks. This technology is frequently used by insulin-treated type 1 and type 2 diabetes patients and can be integrated with insulin release from automatic insulin pumps to optimize glucose stability. The potential value of monitoring glycemic variability in people with non-insulin-treated type 2 diabetes is still being explored.33, 34
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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.
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Chromium status appears to be an important factor in glucose metabolism: individuals with lower chromium levels are more likely to have type 2 diabetes or pre-diabetes than those with higher levels, and low chromium status is associated with poor glycemic control and insulin resistance in people with type 2 diabetes. Furthermore, chromium supplementation has been shown to improve glucose control, insulin sensitivity, and other metabolic variables in people with insulin resistance and type 2 diabetes.
In one placebo-controlled trial that included 64 participants with type 2 diabetes and heart disease, taking 200 mcg per day of chromium was associated with greater weight loss, lower fasting glucose and insulin levels, improved insulin sensitivity, and reduced blood pressure after four months. In addition, chromium supplementation led to lower levels of inflammatory markers and higher antioxidant capacity. A meta-analysis of 28 other randomized controlled trials concluded that chromium supplementation, particularly chromium chloride or chromium picolinate, reduces fasting blood glucose levels, triglyceride levels, and hemoglobin A1c values, and increases HDL-cholesterol levels. Because of its ability to help regulate dopamine and serotonin activity, some researchers propose chromium may be especially beneficial in people with type 2 diabetes who also suffer from depression or binge eating.
Studies showing beneficial effects from chromium supplementation have generally used 200 mcg per day or more. Many doctors recommend up to 1,000 mcg per day for people with diabetes.
Folic acid, sometimes called vitamin B9, is needed along with vitamins B6 and B12 for healthy homocysteine metabolism. Elevated homocysteine levels have been associated with a range of chronic cardiovascular and neurological diseases. A meta-analysis pooled findings from 18 randomized controlled trials with a combined total of over 21,000 participants with type 2 diabetes. The analysis found folic acid supplementation lowered fasting blood glucose levels and reduced insulin resistance, but had no discernible effect on HbA1c, a marker of long-term blood glucose control.
Meta-analyses of studies have found high homocysteine levels are correlated with increased risk of diabetic retinopathy (damage to the visual center of the eye) and nephropathy (kidney damage). Because folic acid supplementation can lower high homocysteine levels in people with type 2 diabetes, it may be protective. In a preliminary trial, a B vitamin supplement providing 6 mg of methylfolate (the active form of folic acid), along with 70 mg of pyridoxal 5-phosphate (active vitamin B6) and 4 mg of methylcobalamin (active vitamin B12), per day improved retinal function and reduced retinal edema in participants with type 2 diabetes-related retinopathy. Several preliminary and placebo-controlled trials using the same B vitamin supplement indicate this combination may reduce symptoms of neuropathy related to type 2 diabetes.
Numerous studies have shown that poor magnesium status is associated with insulin resistance and type 2 diabetes. Furthermore, diabetes itself causes increased magnesium loss, resulting in a vicious cycle of dropping magnesium levels and worsening insulin resistance. Low magnesium levels have also been correlated with poor blood glucose control and increased risk of complications such as heart disease, kidney disease, and nerve damage in those with type 2 diabetes. Moreover, meta-analyses of randomized controlled trials have concluded that magnesium supplementation can lower blood pressure and decrease the risk of diabetes-related cardiovascular disease in people with type 2 diabetes.
Taking 250 mg of elemental magnesium (from magnesium oxide, gluconate, and lactate) per day for three months improved glycemic control and insulin sensitivity in a randomized controlled trial with 42 participants with type 2 diabetes. In a placebo-controlled trial, patients with diabetes-related kidney failure taking 250 mg of elemental magnesium (from magnesium oxide) per day for 24 weeks had improved vascular health, as well as reduced insulin, total cholesterol, LDL-cholesterol, and C-reactive protein levels, Hgb1c values, and insulin resistance scores, and increased antioxidant capacity. However, another placebo-controlled trial that included people with type 2 diabetes and related kidney disease found the combination of 250 mg magnesium (from magnesium oxide) plus 47 mg calcium (from calcium carbonate) per day improved lipid profiles but had no effect on glucose control and worsened insulin resistance after 12 weeks. Many doctors recommend that people with diabetes supplement with 200 to 600 mg per day of elemental magnesium from a highly bioavailable magnesium salt without added calcium.
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. 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.
Biotin is a B vitamin needed to activate a major enzyme involved in glucose metabolism. In a clinical trial, 43 participants with type 2 diabetes were found to have lower serum biotin levels compared to healthy people without diabetes. Supplementation with 3 mg of biotin three times per day (along with a probiotic) for two months led to normalization of glucose levels. In addition, five participants who continued to take biotin for four years maintained these benefits. In another trial, taking 64.1 micromoles (15 mg) of biotin per day for 28 days led to reductions in high triglyceride levels, but had no effect on glucose or insulin levels in people with type 2 diabetes. Case reports suggest long-term treatment with high-dose biotin may reduce symptoms of diabetes-related nerve pain.
It is thought that biotin may have a synergistic effect with chromium. Placebo-controlled trials investigating the effects of taking 600 micrograms of chromium (as chromium picolinate) plus 2 mg of biotin per day have found this combination improves blood glucose control and triglyceride and other lipid levels; however, it is worth noting these trials were funded by the manufacturer of the chromium/biotin supplement they used.
Preliminary research has suggested that pycnogenol may help lower blood glucose levels in people with type 2 diabetes. In a placebo-controlled trial with 48 subjects with type 2 diabetes, 125 mg of pycnogenol per day for 12 weeks led to reductions in fasting blood glucose and LDL-cholesterol levels, as well as blood pressure and HbA1c. In another 12-week placebo-controlled trial with 77 subjects with type 2 diabetes, 100 mg per day of pycnogenol lowered blood glucose levels, but improvement in HbA1c was not statistically significant.
Pycnogenol has been shown to be helpful for improving small vessel health and restoring healthy blood flow in people with type 2 diabetes and related vascular symptoms. Clinical trials have also reported its benefits in treating microvascular complications of type 2 diabetes, such as diabetic retinopathy, skin ulcers, and neuropathy. The doses of pycnogenol used in these studies are 100 to 200 mg per day.
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. 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.
Vitamin C, at a dose of 500 mg twice per day, was found to reduce fasting blood glucose levels, although not HbA1c, after four months in a placebo-controlled trial. A meta-analysis of other controlled trials found vitamin C supplementation can reduce blood glucose levels (but not HbA1c) in people with type 2 diabetes, and is especially effective in those who are older and those who have taken vitamin C for 30 days or more.
Through its anti-inflammatory and antioxidant effects, vitamin C has been shown to lower blood pressure and improve cardiovascular health in people with type 2 diabetes. In addition, like other antioxidants, vitamin C reduces formation of advanced glycation end-products (AGEs), which cause widespread damage to proteins and DNA. Antioxidants like vitamins C and E protect against damage to micro-vessels and therefore have the potential to help prevent type 2 diabetes complications such as retinopathy, nephropathy, and neuropathy. Furthermore, low vitamin C levels in blood and in the eye have been correlated with increased risk of retinopathy. In a pilot study, a combination supplement with vitamin C and other antioxidant vitamins, minerals, and plant extracts improved vision in subjects with type 2 diabetes and early stage retinopathy.
High-dose vitamin C supplementation has been reported to interfere with some devices for self-monitoring of blood glucose levels. This can raise the risk of overtreatment leading to hypoglycemia. Therefore it is important that people with type 2 diabetes who rely on self-monitoring glucose devices talk with their healthcare provider before starting a vitamin C supplement.
Vitamin D is now recognized as necessary for healthy immune function, regulation of inflammatory processes, insulin production, and cellular responsiveness to insulin. Vitamin D deficiency has been linked to high blood glucose levels, insulin resistance, type 2 diabetes, and diabetes complications. Numerous studies have examined the effect of vitamin D supplementation on blood glucose control in people with type 2 diabetes, and meta-analyses of randomized controlled trials have found evidence of benefits, particularly in those with vitamin D deficiency. One meta-analysis found a minimum dose of 4,000 IU of vitamin D per day is needed to improve blood glucose management and insulin sensitivity in people with type 2 diabetes.
Vitamin D is vital for both large and small blood vessel health, and deficiency has been associated with cardiovascular and microvascular diabetes complications. More research is needed to clearly establish a role for vitamin D supplementation in prevention and treatment of diabetes complications.
People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes. Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most, but not all, double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes. 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. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy 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.
In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes. 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).
Zinc is important for normal pancreatic insulin production and release. Zinc deficiency is very common in people with type 2 diabetes and may be related to genetic susceptibility. In one study, zinc deficiency was present in 77% of subjects being treated with metformin (a widely used anti-diabetes drug) and 90% of subjects being treated with both metformin and glimepiride (another anti-diabetes drug). A growing body of evidence shows zinc supplementation may be helpful in preventing and treating type 2 diabetes, but only those with poor zinc status appear to benefit.
In a placebo-controlled trial that included 200 participants with prediabetes, average zinc levels were noted to be lower than normal and taking 20 mg of zinc per day for one year resulted in reduced blood glucose, cholesterol, and LDL-cholesterol levels, and improved the fasting response to glucose ingestion (glucose tolerance), measures of insulin resistance, and pancreatic cell function. Moreover, 25% of those in given placebo progressed to type 2 diabetes, while only 11% of those given zinc developed diabetes. Nevertheless, the relationship between zinc status and type 2 diabetes risk remains unclear, as some research has noted a correlation between higher blood zinc levels and increased diabetes risk.
A controlled trial in people with type 2 diabetes with urinary protein loss (a sign of diabetes-related kidney damage) found that adding 50 mg of zinc (as zinc sulphate) to their diabetes treatment for 12 weeks improved blood glucose and triglyceride levels and reduced urinary protein loss. Studies have also shown that supplementing with a combination of melatonin (10 mg per day) plus zinc (50 mg per day [as zinc acetate]), can improve blood glucose and lipid levels and reduce urinary protein loss in people with type 2 diabetes.
Many doctors recommend that people with type 2 diabetes and low zinc levels supplement with 15 to 25 mg of zinc per day to normalize zinc levels. Taking high doses of supplemental zinc long term increases the risk of copper deficiency. Most multivitamin-mineral supplements provide adequate copper to prevent deficiency.
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Last Review: 06-08-2015
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