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Medical options for diabetes mellitusPeople diagnosed with type 1 diabetes are treated with insulin. Though most insulin is available over the counter, individuals should obtain an accurate diagnosis, as well as thorough guidance from their healthcare provider, before self-medicating. Insulin preparations are grouped according to onset and duration of action either as rapid-acting, such as regular (Humulin-R®, Novolin-R®); intermediate-acting, such as NPH (Humulin N®, Novolin N®) and lente (Humulin L®, Novolin L®); and long-acting, such as ultralente (Humulin U Ultralente®). Oral glucose tablets (such as B-D Glucose®) and gels (Glutose®, Insta-Glucose®, and Insulin Reaction®) are available to treat low blood sugar resulting from insulin overdose. Prescription-only insulin includes Insulin Analog Injection (Humalog®). Injectable glucagon (Glucagon Emergency Kit®) is used to treat severe hypoglycemia resulting from insulin overdose. Dietary changes that may be helpfulEating carbohydrate-containing foods, whether high in sugar or high in starch (such as bread, potatoes, processed breakfast cereals, and rice), temporarily raises blood sugar and insulin levels.1 The blood sugar–raising effect of a food, called its “glycemic index,” depends on how rapidly its carbohydrate is absorbed. Many starchy foods have a glycemic index similar to table sugar (sucrose).2 Beans, peas, fruit, and oats have low glycemic indexes, despite their high carbohydrate content, due mostly to the health-promoting effects of soluble fiber. Controlled studies have found that people with type 1 diabetes who follow a low-glycemic-index diet have better long-term control over their blood sugar levels compared with those following a high-glycemic-index diet.3 However, other studies find similar benefits from training patients to adjust their insulin doses according to the total carbohydrate content of each meal or snack (“carbohydrate counting”).4 People with type 1 diabetes should always discuss changes in their diet with their treating physician. Diabetes disrupts the mechanisms by which the body controls blood sugar. Until recently, health professionals have recommended sugar restriction to people with diabetes, even though short-term high-sugar diets have been shown, in some studies, not to cause blood sugar problems in people with diabetes.5 6 7 Currently, the American Diabetic Association (ADA) guidelines do not prohibit the use of moderate amounts of sugar,8 as long as blood levels of glucose, triglycerides, and cholesterol are maintained within normal levels. Most doctors recommend that people with diabetes cut intake of sugar from snacks and processed foods, and replace these foods with high-fiber, whole foods. This tends to lower the glycemic index of the overall diet and has the additional benefit of increasing vitamin, mineral, and fiber intake. Other authorities also recommend lowering the glycemic index of the diet to improve the control of diabetes.9 Older studies suggested that including 30 grams per day or more of fiber helps control blood sugar in type 1 diabetes.10 However, a more recent controlled study of people with well-controlled type 1 diabetes on intensive insulin regimens found no important benefits from consuming a high-fiber diet.11 In another trial, a low-glycemic-index diet containing 50 grams per day of fiber improved blood sugar control and helped prevent hypoglycemic episodes in a group of people with type 1 diabetes taking two or more insulin injections per day.12 Consuming more fiber may not be as helpful in type 1 diabetes when modern intensive insulin regimens are used, but eating high-fiber foods is recommended for its many other health benefits.13 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.14 15 More research is needed to determine if regular use of fiber supplements benefits long-term blood sugar control in type 1 diabetes. When people with diabetic nerve damage (neuropathy) switch to a vegan diet (no meat, dairy, or eggs), improvements have been reported after several days.16 In one trial, pain completely disappeared in 17 of 21 people.17 Fats from meat and dairy may also contribute to heart disease, the leading killer of people with diabetes. Vegetarians also eat less protein than do meat eaters. Reducing protein in the diet has lowered kidney damage caused by diabetes and may also improve glucose tolerance in type 1 diabetes.18 19 20 Switching to either a high- or low-protein diet should be discussed with a doctor. Changing the overall percentage of calories from fat and carbohydrates in the diets of people with type 1 diabetes is often difficult. However, it is possible to modify 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 over blood sugar and cholesterol levels.21 The best way to incorporate monounsaturates into the diet is to use olive oil, especially extra virgin olive oil, which has the highest antioxidant values. Should children avoid milk to prevent type 1 diabetes? The relationship between cows' milk and type 1 diabetes remains unclear, although there is some evidence that milk consumption might increase the risk of developing type 1 diabetes. Worldwide, children whose dietary energy comes primarily from dairy or meat products have a significantly higher chance of developing type 1 diabetes than do children whose dietary energy comes primarily from vegetable sources.22 Countries with high milk consumption have a high risk of type 1 diabetes.23 Animal research also indicates that avoiding milk affords protection from type 1 diabetes.24 Milk contains a protein related to a protein in the pancreas, the organ that produces insulin. Some researchers believe that drinking milk may cause children who are allergic to milk to make antibodies that attack the pancreas, causing type 1 diabetes.25 Several studies have linked cows’ milk consumption to the occurrence of type 1 diabetes in children.26 27 28 29 However, other studies have failed to find such a link.30 31 One study even reported a protective effect of higher intake of dairy products on diabetes risk in children.32 One reason for the conflicting results of the research may be that different genetic strains of cows’ milk protein (casein) are associated with different levels of risk.33 Immune-system problems in people with type 1 diabetes have been tied to other allergies as well,34 and the importance of focusing only on the avoidance of dairy products remains unclear.35 Preliminary studies have found that early introduction of cows’ milk formula feeding increases the risk of developing type 1 diabetes, although contradictory results have also been published.36 37 A study of Finnish children (including children with diabetes) showed that early introduction of cows’ milk formula feeding (before three months of age vs. after three months of age) was associated with increased risk of type 1 diabetes.38 This research supports abstaining from dairy products in infancy and possibly in early childhood, particularly for children with a family history of type 1 diabetes. Recent research also suggests a possible link between milk consumption in infancy and an increased risk of type 2 (non-insulin-dependent) diabetes.39 Lifestyle changes that may be helpfulUnusually rapid weight gain in infancy has been associated with a one-and-a-half-fold increase in the risk of developing type 1 diabetes in childhood.40 Being overweight also increases the need for insulin. Therefore, people with type 1 diabetes should achieve and maintain appropriate body weight. People with type 1 diabetes who engage in regular exercise require less insulin.41 However, in the short term, exercise can induce low blood sugar or even occasionally increased blood sugar.42 Moreover, a preliminary study has shown that long-term physical activity was not associated with control of blood glucose in people with type 1 diabetes.43 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.44 Similar to research on healthy people, preliminary studies in adults with diabetes find reduced risk of heart disease with light to moderate drinking.45 Drinking alcohol with type 1 diabetes can result in hypoglycemia or hyperglycemia, depending on the circumstances, but moderate amounts of alcohol ingested with food does not affect blood glucose levels.46 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,47 but another, larger study found no association between alcohol use and eye damage.48 People with diabetes who smoke are at higher risk for kidney damage,49 heart disease,50 and other diabetes-linked problems. Smokers are also more likely to develop diabetes,51 so it's important for diabetic smokers 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 ADA, have observed that SMBG by people with diabetes has revolutionized management of the disease, enabling them to achieve and maintain specific goals.52 These observations are well-supported in the medical literature.53 Detractors point out that indiscriminate use of self-monitoring is of questionable value and adds enormously to healthcare costs.54 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.55 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.56 Pharmacists and healthcare practitioners can teach people with diabetes certain skills that will enhance their ability to properly self-manage blood glucose. Vitamins that may be helpfulA variety of vitamins, minerals, amino acids, and other supplements may help with symptoms and deficiencies associated with diabetes. However, many of the studies described below were done in adults, and the amounts used may not be appropriate for a child with type 1 diabetes. The proper amount of each nutrient to be used by a child should always be discussed with a doctor. 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).57 58 59 60 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.61 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.62 63 Chromium may also lower levels of total cholesterol, LDL cholesterol, and triglycerides (risk factors for heart disease).64 65 The typical amount of chromium used in research trials is 200 mcg per day. Supplementation with chromium or brewer’s yeast (a source of chromium) could potentially enhance the effects of drugs for diabetes (e.g., insulin or other blood sugar-lowering agents) and possibly lead to hypoglycemia. Therefore, people with diabetes taking these medications should supplement with chromium or brewer's yeast only under the supervision of a doctor. 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.66 In one preliminary trial, insulin requirements were lower in people with type 1 diabetes who were given magnesium.67 Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes.68 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.69 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.70 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). 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).71 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.72 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. B Vitamins Blood levels of vitamin B1 (thiamine) have been found to be low in people with type 1 diabetes.73 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.74 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.75 As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown. 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.76 77 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,78 though not all trials support this claim.79 80 81 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.82 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.83 Some,84 but not all,85 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.86 Many people with diabetes have low blood levels of vitamin B6.87 88 Levels are even lower in people with diabetes who also have neuropathy.89 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.90 Vitamin B6 may also reduce the amount of glycosylation, so taking adequate amounts of this vitamin may be beneficial for all people with diabetes.91 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%.92 Biotin may also reduce pain from diabetic nerve damage (neuropathy).93 Some doctors try 16 mg of biotin for a few weeks to see if blood sugar levels will fall. Vitamin B12 is needed for normal functioning of nerve cells. Vitamin B12 taken orally has reduced symptoms of nerve damage caused by diabetes in 39% of people studied; when given both intravenously and orally, two-thirds of people improved.94 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.95 Oral vitamin B12 up to 500 mcg three times per day is recommended by some practitioners. 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.96 People with type 1 diabetes appear to have low vitamin C levels.97 As with vitamin E, vitamin C may reduce glycosylation.98 Vitamin C also lowers sorbitol levels in people with diabetes.99 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.100 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.101 One study examined antioxidant supplement intake, including both vitamins E and C, and the incidence of diabetic eye damage (retinopathy).102 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. Vitamin D is needed to maintain adequate blood levels of insulin.103 Vitamin D receptors have been found in the pancreas where insulin is made and preliminary evidence suggests that supplementation might reduce the risk of developing type 1 diabetes.104 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. People with low blood levels of vitamin E are more likely to develop type 1 diabetes,105 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 (retinopathy) and nephropathy,106 107 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,108 109 110 although not all,111 112 studies of people with type 1 diabetes. People with type 1 diabetes tend to be zinc deficient,113 which may impair immune function.114 Zinc supplements have lowered blood sugar levels in people with type 1 diabetes.115 Some doctors are concerned about having people with type 1 diabetes supplement with zinc because of a report that zinc supplementation increased glycosylation,116 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. 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.117 People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner. 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 CoQ10.118 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.119 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. Glucose tolerance improves in healthy people taking omega-3 fatty acid supplements.120 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.121 However, controlled studies have found that fish oil supplementation increases cholesterol in people with type 1 diabetes.122 123 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. 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.124 This could lower insulin requirements for type 1 diabetics, but no research has been done to test this possibility. 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);125 however, in other trials, inositol was ineffective.126 People with diabetes may have low blood levels of manganese.127 Animal research suggests that manganese deficiency can contribute to glucose intolerance and may be reversed by supplementation.128 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.129 People with type 1 diabetes wishing to supplement with manganese should do so only with a doctor’s close supervision. 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.130 Clinical trials have yet to explore whether quercetin actually protects people with diabetes from nerve damage (neuropathy), nephropathy, or eye damage (retinopathy). 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.131 132 133 134 135 While this effect could be helpful in controlling diabetes, no research has investigated the long-term effects of taking starch blockers for this condition. 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.136 While vanadyl sulfate, a form of vanadium, may improve glucose control in people with type 2 diabetes,137 138 139 it may not help people with type 1 diabetes according to one preliminary report.140 The long-term safety of the large amounts of vanadium used in diabetes research (typically 100 mg per day) remains unknown. Many doctors expect that amounts this high may prove to be unsafe in the long term. Herbs that may be helpfulSeveral herbs may help in managing symptoms associated with diabetes, including the control of blood sugar levels. 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).141 142 Four or more applications per day may be required to relieve severe pain. This should be done only under a doctor’s supervision. 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.143 Test tube and animal studies have found several mechanisms by which gymnema may help normalize blood sugar control in diabetics.144 In a controlled trial with people with type 1 diabetes, 400 mg per day of gymnema extract reduced requirements for insulin.145 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.146 Gymnema is not a substitute for insulin, but insulin amounts may need to be lowered in order to avoid hypoglycemia while taking gymnema. 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.147 148 149 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.150 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.151 152 Animal research has also revealed a direct blood sugar–lowering effect of ginseng.153 However, no human trials have tested Asian ginseng in people with type 1 diabetes. Fenugreek seeds are high in soluble fiber, which helps lower blood sugar by slowing down carbohydrate digestion and absorption.154 Animal research suggests that fenugreek may also contain a substance that stimulates insulin production and improves blood sugar control.155 156 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.157 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.158 Hibiscus is a traditional remedy in India for diabetes; this treatment is supported by preliminary studies from that country and by animal studies.159 160 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. Mistletoe extract has been shown to stimulate insulin release from pancreas cells,161 and animal research found that it reduces symptoms of diabetes.162 No research in humans has yet been published; however, given mistletoe’s worldwide reputation as a traditional remedy for diabetes, clinical trials are warranted to validate these promising preliminary findings. Traditionally, mistletoe is prepared by soaking 2 to 4 teaspoons (5 to 12 grams) of chopped mistletoe in 2 cups (500 ml) of water overnight. The mixture is drunk first thing in the morning and sweetened with honey if desired. Another batch may be left to steep during the day and drunk at bedtime. Olive leaf extracts have been used experimentally to lower elevated blood-sugar levels in diabetic animals.163 These results have not been reproduced in human clinical trials. Animal studies and some very preliminary trials in humans suggest reishi may have some beneficial action in people with diabetes.164 165 Holistic approaches that may be helpfulAcupuncture may be helpful in the treatment of diabetes, or complications associated with diabetes. 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 were also able to reduce pain medications, but no long-term change in blood-sugar control was observed.166 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.167 168 |
 References:1. Wolever TMS, Brand Miller J. Sugars and blood glucose control. Am J Clin Nutr 1995;62:212S–7S [review]. 2. Wolever TMS, Brand Miller J. Sugars and blood glucose control. Am J Clin Nutr 1995;62:212S–7S [review]. 3. Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2003;26:2466–8 [review]. 4. Franz MJ. The glycemic index: not the most effective nutrition therapy intervention. Diabetes Care 2003;26:2466–8 [review]. 5. Colagiuri S, Miller JJ, Edwards RA. Metabolic effects of adding sucrose and aspartame to the diet of subjects with noninsulin-dependent diabetes mellitus. Am J Clin Nutr 1989;50:474–8. 6. Abraira C, Derler J. Large variations of sucrose in constant carbohydrate diets in type II diabetes. Am J Med 1988;84:193–200. 7. Loghmani E, Rickard K, Washburne L, et al. Glycemic response to sucrose-containing mixed meals in diets of children with insulin-dependent diabetes mellitus. J Pediatr 1991;119:531–7. 8. American Diabetes Association. Position Statement: nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 1999;22:S42–5 [review]. 9. Brand-Miller J, Foster-Powell K. Diets with a low glycemic index: from theory to practice. Nutr Today 1999;34:64–72 [review]. 10. 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]. 11. Lafrance L, Rabasa-Lhoret R, Poisson D, et al. Effects of different glycaemic index foods and dietary fibre intake on glycaemic control in type 1 patients with diabetes on intensive insulin therapy. Diabet Med 1998;15:972–8. 12. Giacco R, Parillo M, Rivellese AA, et al. Long-term dietary treatment with increased amounts of fiber-rich low-glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients. Diabetes Care 2000;23:1461–6. 13. U.S. Department of Agriculture, U.S. Department of Health and Human Services: Dietary Guidelines for Americans, 2005. Home and Garden Bulletin No. 232, 2005. Available from URL: www.health.gov/dietaryguidelines/dga2005/document. 14. Vuorinen-Markkola H, Sinisalo M, Koivisto VA. Guar gum in insulin-dependent diabetes: effects on glycemic control and serum lipoproteins. Am J Clin Nutr 1992;56:1056–60. 15. Ebeling P, Yki-Jarvinen H, Aro A, et al. Glucose and lipid metabolism and insulin sensitivity in type 1 diabetes: the effect of guar gum. Am J Clin Nutr 1988;48:98–103. 16. Crane MG, Sample CJ. Regression of diabetic neuropathy with vegan diet. Am J Clin Nutr 1988;48:926 [abstract #P28]. 17. Crane MG, Sample C. Regression of diabetic neuropathy with total vegetarian (vegan) diet. J Nutr Med 1994;4:431–9. 18. Cohen D, Dodds R, Viberti G. Effect of protein restriction in insulin dependent diabetics at risk of nephropathy. BMJ 1987;294:795–8. 19. Evanoff G, Thompson C, Bretown J, Weinman E. Prolonged dietary protein restriction in diabetic nephropathy. Arch Intern Med 1989;149:1129–33. 20. Gin H, Aparicio M, Potauz L, et al. Low-protein, low-phosphorus diet and tissue insulin sensitivity in insulin-dependent diabetic patients with chronic renal failure. Nephron 1991;57:411–5. 21. Donaghue KC, Pena MM, Chan AK, et al. Beneficial effects of increasing monounsaturated fat intake in adolescents with type 1 diabetes. Diabetes Res Clin Pract 2000;48:193–9. 22. Muntoni S, Cocco P, Aru G, Cucca F. Nutritional factors and worldwide incidence of childhood type 1 diabetes. Am J Clin Nutr 2000;71:1525–9. 23. Dahl-Jorgensen K, Joner G, Hanssen KF. 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