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Conventional Treatment for patients with type 2 diabetes includes diet, exercise, and drug therapy. Diet is considered to be the first treatment to try. Maintaining ideal body weight can help the patient to control the disease. Exercise can help the insulin that is available to work better and help regulate glucose production in the liver. Even with diet and exercise, however, within the first five years after diagnosis, over 60 percent of patients will need oral antidiabetic drugs. It is also estimated that approximately 40 percent of patients will eventually need insulin injections to control their blood sugar.
Oral Antidiabetic Drugs
Oral drug therapy for the management of type 2 diabetes now includes more choices in several drug classes, most of which work differently. Sulfonylureas cause release of insulin from the pancreas and help insulin to work better; biguanides work in the liver; thiazolidenedones work in muscles; glucosidase inhibitors work in the small intestine; and meglitinide causes release of insulin from the pancreas.
Oral Drugs for Treating Diabetes
First Generation
Tolbutamide 250mg, 500mg
Acetohexamide 125mg, 250mg
Tolazamide 100mg, 250mg, 500mg
Chlorpropamide 100mg, 250mg
Second Generation
Glipizide 5mg, 10mg
Glipizide extended release 2.5mg, 5mg, 10mg
Glyburide 1.25mg, 2.5mg, 5mg
Glyburide Micronized 1.5mg, 3mg, 6mg
Glimepiride 1mg, 2mg, 4mg
Alpha-Glucosidase Inhibitors
Acarbose 50mg, 100mg
Miglitol 25mg, 50mg, 100mg
Biguanides
Metformin 500mg, 850mg, 1,000mg
Metformin extended release 500mg
Meglitinides
Repaglinide 0.5mg, 1mg, 2mg
Thiazolidinediones
Rosiglitazone 2mg, 4mg, 8mg
Pioglitazone 15mg, 30mg, 45mg
Combination Products
Glyburide and Metformin 1.25/250mg, 2.5/500mg, 5/500mg
Sulfonylureas
Oral sulfonylureas are related to sulfa antibiotics but do not have antibacterial action. They stimulate insulin release, increase the amount of insulin circulating in the bloodstream, and make the beta cells more sensitive to the actions of glucose.(1) They are used along with diet and exercise. They are only effective in patients that can produce insulin. They don't prevent beta cell loss. Therefore, sulfonylureas can become less effective over time. The newer agents in this group of drugs have less drug interactions than the first drugs that were marketed in this group. About 50 percent of patients will successfully control their diabetes with the use of sulfonylureas. These agents can also be used in combination with injectable insulin.
All of the sulfonylureas can be taken with food except for glipizide. Food slows down glipizide absorption, so it is recommended that this drug be taken 30 minutes before meals.
Biguanides
Metformin is a member of the biguanide group of antidiabetic drugs and not related to the sulfonylureas. It makes the insulin that is available work better – it doesn't increase the amount of insulin that is released. By not increasing insulin release, it does not cause hyperinsulinemia. It also decreases blood glucose without producing hypoglycemia. It can be used with diet or in combination with other drugs. It does not produce weight gain.(2) Metformin is the only antidiabetic drug ever shown to extend the life of patients with type 2 diabetes.
Thiazolidinediones
Troglitazone, a member of the thiazolidinedione drug class became available in January, 1997, and was reported to lower blood glucose by decreasing insulin resistance, not by increasing insulin release. It could be used alone, with insulin, or along with oral sulfonylureas. By December of that year, the FDA announced new guidelines to be followed to monitor patients for signs of liver injury. This was due to 35 reports of liver injury<
Nutritional Supplementation Additional information (Precautions) is available by clicking on the underlined supplement. Chromium
The way that chromium affects blood sugar was first discovered in animal studies in the 1950's. In the 1970's, it was discovered that chromium is important in special intravenous (IV) feeding solutions called total parenteral nutrition (TPN solutions). It was discovered that when chromium was missing from the TPN solution, after several months, blood sugar increased in patients. Chromium was added and blood sugar in TPN patients returned to normal. Various studies support that chromium has a positive effect on blood glucose.(3)
It is thought that chromium helps insulin by moving glucose and other nutrients into the cells of the body.(4) This helps to maintain muscle mass during times when the diet does not provide enough calories. Chromium also stabilizes the body's metabolism. Chromium can lower cholesterol and triglycerides. Chromium may also decrease hunger and limit food cravings. Insulin is involved in the regulation of the center in the brain the makes one feel full and stop eating. Insulin is also important in the development of a brain chemical linked to the craving for carbohydrates.
Most Americans are at risk for low chromium because of a diet rich in refined sugars. Individuals who eat diets high in refined sugars tend to eliminate 300 percent more chromium in their urine than those whose diets are low in refined sugars. Individuals who live in countries with high levels of chromium that comes from diets rich in unrefined grains have a lower rate of diabetes and atherosclerosis (hardening of the arteries). People who exercise regularly eliminate two to six times the normal amount of chromium in their urine on days of exercise.(5) Many athletes make this problem worse by using high-carbohydrate supplements. The elderly also are at risk for low chromium due to not enough chromium in the diet and poor absorption. Women can have a drop in chromium levels during the third trimester (seventh, eighth, and ninth months) of pregnancy.(6)
There is a disagreement among healthcare professionals over what is the best chromium to use. Chromium is only active in certain forms. The most important of these forms is glucose tolerance factor (GTF). Dr. Walter Mertz of the United States Department of Agriculture did research with GTF chromium. He found that chromium was a crucial part of the process where insulin attaches to cells. GTF chromium is safe and usually does not cause side effects.
Chromium picolinate is another popular form of chromium that is used to regulate blood sugar levels.(7, 8) Even though chromium picolinate is considered safe, a recent study in lab animals at Dartmouth College and The George Washington Medical Center reported that certain doses of chromium picolinate caused damage to chromosomes.(9) More information is needed about this supplement because other studies have reported that it is safe and effective.
For diabetics, adding chromium or other blood sugar regulating agents to their diet should be done slowly, especially if they are on other medication to control their diabetes. With lifestyle and dietary changes, only a small dose of chromium may be needed.
Magnesium
Magnesium is involved in the breakdown of glucose in the body and release of insulin.(10) Low magnesium may make diabetes worse in some people.(11) Hypomagnesemia (low magnesium in the blood) happens in about 25 percent of diabetic patients.(12) Many Americans are below the RDA (Recommended Dietary Allowance) for magnesium. Many experts feel that the RDA for magnesium needs to be increased.
Magnesium is eliminated from the body by the kidneys. Individuals with kidney disease should consult a healthcare professional before using a magnesium supplement. Too much magnesium may cause diarrhea. Vanadium
Vanadium is a trace mineral that is very important for plant nutrition, but what it does for human nutrition is not clear. It works with enzymes in the body. High amounts of vanadium are found in the kidneys, liver, and bone. Fat cells temporarily store vanadium for quick release into the body. Supplementing with vanadyl sulfate and other forms of vanadium has been reported to improve diabetes.(13, 14)
Animal studies have reported that when vanadium was given to diabetic rats, their increased blood glucose returned to normal. Other studies have reported that vanadyl sulfate not only lowers blood glucose in diabetic animals, but also decreases cholesterol and triglycerides.(15) In one study in diabetic rats, researchers found that vanadium may protect the pancreatic beta cells.(16)
Human studies are encouraging. Type 2 diabetics given oral vanadyl sulfate had a nearly 20 percent drop in fasting blood glucose in one study.(17) Minor gastrointestinal upset was the only reported side effect. In another study, supplementation with vanadyl sulfate daily for three weeks resulted in improved insulin action.(18)
Vanadium pentoxide and vanadyl sulfate are active forms of vanadium that are easily absorbed by the body. Vanadium appears to be safe even at high doses. Doses should be increased gradually, especially if it is given with GTF chromium. Alpha-Lipoic Acid (ALA)
Alpha-lipoic acid (ALA) is an antioxidant made by the body. ALA is also known as alpha-lipoate or thiotic acid. Lipoates are small water and fat-soluble molecules that are easily absorbed from the gastrointestinal tract. It is also used in heart disease and for AIDS patients.(19) Alpha-lipoic acid affects insulin and blood sugar in type 2 diabetics.(20, 21, 22) ALA may be effective in the treatment of diabetic neuropathy.(23) In a recent study, about 97 percent of diabetic patients treated with ALA daily for three weeks reported an improvement in their neuropathy symptoms.(24) There are no known toxicities with ALA. It is important to monitor blood glucose closely in diabetics supplementing their diet with ALA. Zinc
Zinc deficiency is found in patients with problems in blood glucose control.(25) In clinical studies, diabetic animals and humans with zinc deficiencies improved when supplemented with zinc.(26, 27) Zinc helps to regulate insulin production by the pancreas and glucose use by muscle and fat cells. Very high doses of zinc may cause diarrhea, dizziness, lethargy, vomiting, and loss of muscle coordination. Cyclo (His-Pro)
Cyclo hispro may be a useful agent in improving blood sugar regulation in individuals with hypoglycemia, diabetes, and impaired glucose tolerance (IGT).(26) It has been reported that individuals with diabetes have problems with absorbing zinc from the intestines, causing low zinc levels in the blood. Both animal and human studies report that cyclo hispro may affect the absorption of zinc from the intestines. This extract also contains high levels of zinc. For the diabetic patient, zinc is important for wound healing, proper functioning of the immune system, and for the skin. There are no reported side effects with the use of cyclo hispro.
In a recent clinical study, cyclo hispro was given to 22 male subjects with type 2 diabetes. After three months, the treatment group reportedly decreased fasting blood glucose levels and fasting plasma insulin levels. In addition, the treatment group had slight decreases in cholesterol and LDL and increased plasma zinc concentrations. The results of the study demonstrated the benefit of the use of cyclo hispro extract with zinc in type 2 diabetics.(28)
Herbal Supplementation Additional information (Precautions) is available by clicking on the underlined supplement. Evening Primrose
Evening primrose oil (EPO) contains gamma-linolenic acid, which is an omega-6 fatty acid.(29, 30) Omega-6 fatty acids may decrease inflammation. Using essential fatty acids such as EPO may prevent zinc deficiency, possibly improving the immune system.(31) Fatty acids are an important part of the normal functions of the human body. The human body can produce all of the fatty acids it needs except for omega-3 and omega-6 fatty acids. Both of these must come from the diet or with the use of supplements. A balance of these two fatty acids is very important. Essential fatty acids are needed for building cells and hormones. Modern diets often do not provide enough fatty acids.
Diabetics who cannot make gamma-linolenic acid (GLA) from linoleic acid will need a quality GLA supplement.(32, 33) This is very important for proper nerve function and for the prevention of diabetic neuropathy.(34, 35) Evening primrose oil has been reported to be beneficial for patients with diabetic neuropathy.(36, 37) Gymnema
Gymnema is a rain forest vine found in Central and Southern India, which has a long tradition in the treatment of diabetes. The Indian name is Gurmar, which means, “sugar destroyer.” Its use has been documented in Ayurvedic medical texts for over 2,000 years in the treatment of “sweet urine.” The leaves of gymnema are thought to increase insulin secretion, and several studies report control of hyperglycemia in diabetic laboratory animals.(38, 39) A decrease in body weight has also been reported.
Human studies have reported decreased blood glucose during therapy with gymnema.(40, 41) Improved lab test results and the need for less prescription medications have also been reported. In some studies, patients with diabetes were able to stop taking prescription diabetes medication and control their blood glucose with gymnema alone.(41) Researchers report that beta cells may be repaired in type 2 diabetics taking gymnema supplements.(42) Other studies report that gymnema controls blood glucose by decreasing the absorption of glucose in the intestines.(43)
Because gymnema leaf powder acts like an anesthetic on the taste buds that can last for several hours, some researchers feel that gymnema may be a possible agent to use for weight control and to decrease the craving for sweets.(44) A recent study also reports decreases in cholesterol with the use of gymnema.(45) Gymnema may be useful for athletes who want to develop more lean muscle mass compared to body fat. Another study suggested that gymnema may be safe and effective for weight reduction, BMI and promoting healthy blood lipids.(46)
Bitter Melon
Bitter melon or karela fruit has been used in South America and the Orient as a food and also as a febrifuge (fever reducer), abortifacient (an agent that causes abortion), emmenagogue (increases menstruation), anthelmintic and vermifuge (agents that remove intestinal worms), antiviral, emetic (induces vomiting), and agent for diabetes.(47) Recent studies have looked at the benefits of the fruit in diabetes and hyperinsulinemia, HIV viral infection (AIDS), and certain cancers.(48, 49)
Bitter melon has been reported to improve glucose control in humans.(50, 51) Research reports that molecules with insulin-like activity may be present in bitter melon seeds.(52) A few studies say that bitter melon may increase glucose use in the liver rather than having any effect on insulin release.(53) Bitter melon has also been reported to lower cholesterol and triglycerides in diabetic patients. Some reports have said that bitter melon extracts did not lower blood sugar in laboratory animals.(54, 55) It is recommended that a standardized extract of bitter melon always be used.
Diet & Lifestyle Diet: Diabetes and obesity have increased over the past 50 years in the United States. People don't eat enough fresh foods, and there are fewer micronutrients in the soil (like chromium and vanadium) where food is grown. Fad diets of high protein, low or high fat, and low or no carbohydrates are not the answer. While this type of diet may help take weight off at first, it is not a long-term answer. Carbohydrates alone are not the cause because humans were eating carbohydrates long before these problems arose. It is true, however, that people are eating excessive amounts of carbohydrates, and it would be better to moderate that habit.
There are several ways to support and improve insulin regulation by using natural agents, but the real key is to change the selection of foods in the diet. In general, the American diet is made up of a large amount of carbohydrates, especially refined carbohydrates. People limit their intake of fresh vegetables and fruits, and quality sources of protein and legumes, and they do not take in enough essential fats. As of 1985, the typical American diet was 46 percent carbohydrates, 43 percent fat (poor quality), and only 11 percent protein. With the average American eating approximately 150 pounds of sugar a year, there is a continuous demand for more insulin to be released. The average person drinking two “big gulp” drinks a day is receiving about 54 teaspoons of sugar. Using diet drinks does not work either because they contain sodium. This is particularly a problem for diabetics with hypertension (high blood pressure). While current research shows that dietary fat and cholesterol are definite problems, this situation is only made worse by the continuous, increased amount of carbohydrates along with the fat. Dietary fat is then stored because of excess insulin that is released while eating a high amount of carbohydrates.
Many experts over the years have praised the low-fat, high-carbohydrate diet. The problem with this diet has been that it does not cause weight loss. In fact, a diet with too many carbohydrates has been linked to increased LDL cholesterol and triglycerides.(56) The other thing to be aware of is that many prepared foods may be labeled low fat, but are loaded with refined sugars, which increase insulin release, and therefore, fat storage.
The obvious first step is to eat foods that will cause the least amount of insulin to be released. This will not only benefit the diabetic, but many individuals wanting to lose weight will benefit from this approach as well. The first concept to understand is the glycemic index - the fact that certain foods actually cause a sharper rise in insulin release than others. The glycemic index was first developed to help diabetics control postprandial (after meals) insulin blood sugar regulation, since this is the most difficult part of controlling blood sugar. Foods that do not cause a rapid rise in blood sugar will not cause increased insulin release. For example, in the past, it was thought that all complex carbohydrates were equal. It is now known that grains have different glycemic indexes. It is valuable to look at glycemic index when choosing foods that contain different amounts of carbohydrates. Proteins and fats do not have a glycemic index.
Legumes: Almost all legumes have a moderate glycemic index. They also provide a source of water-soluble fiber that is valuable for lowering cholesterol. They also provide phytoestrogens, which may provide health benefits.
Vegetables: Some vegetables have a high glycemic index and should be used in moderation if one is trying to actively control blood sugar. These include white potatoes (baked), carrots, beets, and turnips. However, if an individual is eliminating other sources of refined sugar in the diet and is decreasing the amount of complex carbohydrates (breads and pastas), he/she should be able to eat these vegetables with moderation.
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