Supplements for type 2 diabetes

Executive Summary
Here are the supplements that are advisable to prevent or manage type 2 diabetes.

Necessary
A good multivitamin, multimineral, derived from natural sources (take 2 times RDA, preferably);
Vitamin D (2000 IU/day or more);
Water-soluble fiber (10 g/day); and
Omega-3 fish oil (3000 mg/day).

Optional
Herbs & antioxidants mentioned in the article, as available in your country;
Protein (20 g/day extra); and
B-vitamins complex.

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Principles of Diabetes Supplementation

Supplementation strategies in type 2 diabetes rely on three aspects:

1. Reducing insulin resistance:
   This is the prime cause of diabetes and takes root far before one develops diabetes. It is also present in all stages of diabetes.
   It makes your body resistant to the actions of insulin needing more and more insulin for blood glucose to enter cells and generate energy. The excess demand for insulin puts pressure on the pancreas causing it to fail slowly.
   
2. Reducing blood glucose levels:
   As the pancreas starts failing, blood glucose levels end up going higher due to a lack of insulin.
   
3. Reducing blood glucose-related damage:
   High blood glucose for an extended time period leads to the glycation of proteins and other compounds in all body organs. This process wherein a glucose molecule attaches to another organic molecule in the body changes the nature of the molecule and is irreversible. So even if you prevent further damage, whatever is already damaged stays like that forever.

Stages of Diabetes

For the selection of supplements, you can consider three stages of type 2 diabetes:

1. Prevention or prediabetes stage:
   This is when diabetes is not established. The blood glucose levels are marginally higher, without medication. During this, the body is becoming resistant to the actions of the insulin hormone.
   Under these conditions, reducing insulin resistance is the priority. A little assistance in bringing blood glucose levels down also helps.
   
2. Early stages of diabetes:
   These are the first few 5 years of diabetes. The blood glucose is higher than normal or stays normal only with medications. The body is highly resistant to insulin.
   Herein, blood glucose should either be brought down or prevented from going up. Also, the insulin resistance of the body needs to be lowered.
   
3. Late stages of diabetes:
   Once diabetes is present in the body for a few years, high blood glucose starts taking a toll on internal organs. Various diabetes-related complications start setting in. For example, retinopathy (eyesight damage), neuropathy (nervous system damage), nephropathy (kidney damage), heart disease, brain degeneration (memory loss, Alzheimer’s), and sexual problems (erectile dysfunction).
   In this phase, protecting against blood glucose-related damage also becomes important, along with reducing blood glucose and insulin resistance.

Supplementation

Caution

Many excellent supplements help with diabetes control without any major side effects. However, if a supplement helps lower blood glucose levels, and the dosages of prescribed diabetes medicines are not reduced, the blood glucose may dip below safer levels. This becomes a case of too much of a good thing.

Since very low blood glucose levels can be life-threatening, reducing diabetes medications simultaneously is necessary. However, that can only be done by your doctor. So before starting any supplement that can reduce insulin resistance or blood glucose levels, discuss it with your doctor.

Even the supplements that help with diabetes complications may have issues if one is suffering from some condition such as kidney disease or depression. Discuss with your doctor.

Dosage Titration

Typically, a knowledgeable doctor will titrate your medication doses when you start any supplement. They may ask you to add the supplement at half the desired dosage and reduce the medication by 25% or so. The blood glucose levels are monitored over the next few days. Based on the results, more quantity of the supplement is added and medications are reduced further, and so on.

Supplements for Reducing Insulin Resistance

1. Chromium:
   Decreases insulin resistance. Reduces blood glucose levels. Typically, 200 to 1000 µg/day of chromium picolinate helps in controlling blood glucose levels.
   Remember that adequate intake (AI) of chromium is supposed to be 35 µg/day. However, 1000 µg of chromium picolinate contains 124 µg of chromium. Plus, if you take 1000 µg of chromium picolinate, your body absorbs only 12 µg of chromium. So it is easy to get thrown off by seeing 35 µg/day need and 1000 µg/day suggested intake. One should not overanalyse the numbers since what you consume and what your body gets could be vastly different. Instead, take the help of a trusted supplementation expert.
   Take chromium through a good plant-based multimineral supplement. The bioavailability of chromium from a plant-based source is much higher than from chemical-based chromium salt. Also, high doses of chromium may interact with thyroid medicines. So it is better to take chromium through a multimineral tablet rather than a separate chromium tablet.
   
2. Magnesium:
   Type 2 diabetes is strongly associated with low blood magnesium levels. But we do not know if diabetes causes magnesium deficiency or vice versa. Adequate magnesium levels help with controlled blood glucose levels.
   Best to take magnesium in a multimineral rather than a separate magnesium tablet. High-dose magnesium can cause diarrhea and may cause low blood pressure.
   
3. Vanadium:
   Reduces insulin resistance. Mimics insulin action. It can also help lower blood glucose.
   Best to take vanadium through a multimineral supplement.
   
4. Vitamin D:
   It helps in reducing insulin resistance. Some researchers believe it also helps in regulating insulin production. It is found that many diabetes medications turn less effective when one is deficient in vitamin D.
   Ideal levels of vitamin D in the blood are 60 ng/mL. Aim for at least 2000 IU/day of vitamin D. A supplement also containing vitamin K2 is ideal, to protect against calcium deposition in soft tissues of the body such as heart arteries (heart attacks) and kidneys (kidney stones). But talk to your doctor if you are on blood thinners since vitamin K₂ increases blood clotting, unless in a low dose.

Supplements for Reducing Blood Glucose

1. Fiber:
   Fiber does not give any calories and helps in bulking up food in the intestines. It reduces the absorption of nutrients in the intestines. As a result, even the less desirable nutrients such as digested carbohydrates and cholesterol are less absorbed in the intestines and eventually eliminated through the stools.
   Fibers help prevent the development of type 2 diabetes, lower the average blood glucose and insulin levels if one has diabetes, and reduce cholesterol and triglyceride levels.
   Fibers are foods for intestinal bacteria, which help in immunity and nervous system function.
   Amongst the fibers, water-soluble fibers are more helpful in diabetes.
   
2. Protein:
   Most people are deficient in protein. One benefit of protein in diabetes is it substitutes for some foods high in carbohydrates. After all, you can eat only so much. It also helps you stay full longer by slowing down stomach emptying as well as increasing satiety.
   People with kidney damage should discuss it with their doctors before increasing their protein intake.
   
3. Melatonin:
   Melatonin is a natural hormone secreted by the pineal gland in the brain. It regulates circadian and seasonal rhythms. Its levels rise during the night and reduce during the day. It inhibits insulin release, regulating its levels. It also acts as an antioxidant protecting against pancreas degeneration. Studies show melatonin improves blood glucose control.

Supplements for Reducing Diabetes-Induced Damage

1. Omega-3 oils:
   Fish oils contain omega-3 oils called DHA & EPA. Some vegetarian sources contain another omega-3 oil called ALA.
   Omega-3 oils do not help in reducing diabetes or increasing blood glucose control. However, they are found to be extremely beneficial in preventing or slowing down many diabetes complications, such as:
   • Diabetic nephropathy;
   • Diabetic retinopathy;
   • Diabetic nephropathy; and
   • Heart disease and stroke.
   For comprehensive coverage of this nutrient, read on this website: Omega–3 oils: A complete guide
   
2. Antioxidants:
   The cells in the pancreas that produce insulin have low antioxidant capacity. So they are very susceptible to oxidative stress caused by reactive oxygen species (free radicals). People with diabetes have higher levels of free radicals and lower levels of antioxidants in their bodies. Various antioxidants help in protecting against diabetes-induced degenerative damage. They are:
   • Vitamin E (800 IU/day)
   • Vitamin C (1500 mg/day)
   • Coenzyme Q10 (100 mg/day): Read about this vital nutrient: Coenzyme Q10: A complete guide.
   • Selenium
   • Zinc
   • Quercetin
   
3. B-vitamins:
   Many of the B-vitamins mentioned below help in different aspects of diabetes. It is better to take a B-complex supplement that is from natural sources (as against chemically formulated):
   • Niacin or vitamin B₃;
   • Pyrixodine or vitamin B₆;
   • Biotin or vitamin B₇;
   • Folate or Vitamin B₉; and
   • Cobalamin or vitamin B₁₂
   
4. Manganese:
   Helps in the prevention of LDL oxidation, which can lead to plaque formation in the arteries.
   
5. Herbs:
   Many herbs are found to help in diabetes, partly because they have some of the vitamins, minerals, and antioxidants nutrients mentioned above. A few herbs also have some specialised compounds that may be specifically useful in diabetes. As always, check with your doctor before starting to consume them. For many herbs, the daily dosage is not established due to various reasons: no comprehensive trials, too much variation across the samples, etc. You may also wish to take advice from a doctor specialising in the preventive health field:
   
   • Gymnema:
   In the Indian medicinal stream Ayurveda, this herb is known as Meshshringi or Madhunashini (destroyer of sweetness). Gymnema sylvestre temporarily affects your taste buds so that you cannot taste the sweet taste. The effect is similar to using toothpaste or mouthwash. This reduces sugar and carbohydrate cravings for a few hours. It also reduces insulin resistance, increases insulin secretion, and reduces carbohydrate absorption in the intestines.
   
   • Ginger:
   Ginger blocks the enzymes that metabolise carbohydrates in the intestines. It increases insulin secretion, reduces insulin resistance, and mimics insulin action. Interestingly, ginger also helps reduce diabetes-induced medical complications in organs such as the liver, kidneys, eyes, and nervous system as well as in heart problems.
   
   • Cinnamon:
   Cinnamon reduces carbohydrate digestion in the intestines. It reduces the stomach emptying rate, without affecting the feeling of satiety. It has chromium as well as some compounds called polyphenols, which help reduce insulin resistance. It also mimics insulin action.
   
   • Aloe Vera:
   It has cell regenerative properties. So some researchers say that it helps improve pancreatic function.
   It is very difficult to quantify the dosage needed because many aloe vera sources contain different potencies. My experience is one should take as much 100% aloe vera juice in mL as one’s weight is in kg. So an 80 kg person should take 80 mL a day. One should not exceed 50 mL at a time, as that can lead to loose motions. Divide it over more doses in a day.
   Also, aloe vera reduces blood glucose significantly. So be careful about taking it with the regular dosage of diabetes medications.
   
   • Fenugreek seeds:
   They help increase insulin secretion. The seeds also contain fiber that slows down the absorption of carbohydrates in the intestines. Eat it as a part of food but not as a supplement.
   
   • Bitter melon or bitter gourd:
   Bitter gourd helps reduce average blood glucose levels over a 3 week period (lowers fructosamine levels). Eat it as a food item but it is difficult to take it as a supplement.

Long-Term Complications

Prevention or delay in diabetic complications is possible with tight control over blood glucose levels. Long-term complications of diabetes are:

• Heart disease, leading to silent heart attacks
• Brain disorders, leading to stroke, memory loss, Alzheimer’s, Parkinson’s, and depression
• Retinal damage, leading to vision loss and blindness
• Kidney damage, leading to a need for dialysis, end-stage kidney disease, and kidney transplant
• Nerve damage, leading to a loss of sensation
• Foot infections, leading to foot ulcers, gangrene, and amputation
• Sexual problems, leading to erectile dysfunction
• Skin problems, leading to dryness, hair loss, and skin ulcers

My Views

1. Many experts claim that they can cure diabetes. I feel ‘cure’ is a big word. It means there are no traces of the disease left once the problem is over. However, as they say, if you hit nails in the wood, you can remove them later but the holes will still remain. Something similar happens in diabetes. While you may be able to get blood glucose to normal levels using those approaches, the degeneration caused by high blood glucose levels is irreversible. It may also set in motion some illnesses, which don’t need higher blood glucose levels to advance. So a better phrase to use would be ‘remission’, which means a temporary reduction in the severity of the disease.
2. Blood glucose control with medications is not the same as that without medications. While the degeneration is kept in check in either case, the former needs medicines which have their own side effects, especially over long-term.
3. As per some experts in the field, even if the body recovers from diabetes, it is always vulnerable to developing it again if the diet and lifestyle control are eliminated. In that sense, the body is not fully back to its original self.
4. All these point to a reduction in some kind of redundancy or spare capacity in the body. So it may be a good idea to not just stop at rectifying the problem but overcompensating a bit. While it will make no difference to the outcome under normal conditions, the body will have more resilience toward diabetes if things go wrong, such as an illness, dietary changes (travel), working conditions (different time shifts), and life situations (increased stress), etc.
5. My personal belief is the way one saves money for old age, a diabetic should save health for old age when things are bound to get worse as a part of nature. Many of the preventive strategies may look like overkill at the current stage but one would be glad ten or twenty years later that one adopted them now.
6. In case you wish to discuss any of these supplements or their brands, write to me at madhur.kotharay@gmail.com and I will be happy to guide you.

To Read More

• National Institutes of Health: Chromium, for Health Professionals
• Diabetes.co.uk: Protein and Diabetes
• NCCIH: Diabetes and Dietary Supplements
• Verywellhealth: How Much Protein Should a Person With Diabetes Eat?

First published on: 26th December 2021
Image credit: Sora Shimazaki on Pexels
Last updated on: 6th June 2022