In Diabetes Part 1:  Beyond Blood Sugar I introduced the concept that diabetes mellitus or “sugar” diabetes is a complex disease. I discussed the importance of a low-glycemic diet, regular physical activity, and mineral supplementation in a diabetic management program. I suggested that diabetes cannot be defined simply as having too much sugar in the blood. Elevated blood sugar levels are a clue as to what is happening, but they are not the total answer.

One of the major consequences of diabetes is atherosclerosis (hardening of the arteries). Atherosclerosis is often more serious in diabetics than in others for two reasons. The first is that it develops at an accelerated rate. The second is that, in contrast to the typical progression in non-diabetics, it commonly affects the small blood vessels of the body. This often precludes the use of rescue treatments such as bypass surgery.

Diabetes may also be thought of as a disease of accelerated aging. Glycosylation or glycation is the name given to the reaction that occurs between sugars and proteins. The products of these reactions are referred to as AGEs (advanced glycation end-products). The acronym is appropriate, for these substances are closely linked with the aging process.

One of the tests used to monitor diabetes is called a glycosylated hemoglobin or hemoglobin A1C test. The higher the average level of sugar in the bloodstream the faster links will form between proteins in the hemoglobin molecule, resulting in a greater amount of “glycosylated” hemoglobin. This reaction is not limited to the hemoglobin molecules in red blood cells, however. It is occurring in other body tissues and substances including LDL cholesterol. When the reaction takes place unbalanced molecules called “free radicals” are produced which cause further damage to the cells of the body.

Antioxidant vitamins slow the rate of glycation and neutralize free radicals. It is therefore logical that diabetics require higher levels of these important nutrients. The first vitamin that should be supplemented in diabetes is vitamin A. Vitamin A is critical to protect vision and is essential to the body’s antioxidant defense mechanisms. Vitamin A is usually derived from beta-carotene in the diet. Beta-carotene supplements are also available. Insulin dependent diabetics are unable to convert beta-carotene to vitamin A efficiently, however, and should therefore take supplements of actual vitamin A, not of beta-carotene. 25,000 IU of vitamin A twice daily appears to be reasonable. This is significantly more than is required by non-diabetics. Pregnant women should not exceed 10,000 IU of actual vitamin A daily, although they may take additional beta-carotene.

Additional vitamin E is also required. Non-diabetics need not take more than 400 IU daily, but diabetics are well advised to take 800 to 1000 IU daily. It is important to include all sources of supplementation since many combination vitamin supplements contain significant amounts of vitamin E.

I recommend that 1000 mg. of vitamin C be taken twice daily. Vitamin C is water soluble as are B vitamins. This means that it is passed through the body and eliminated very quickly. If it is taken only once a day it will not provide a full 24 hours of protection. Time released forms of vitamin C are available, but their additional cost is unjustifiable. Simply take the vitamin C in the morning and in the evening, with breakfast and with supper.

Several B vitamins have been shown to slow glycosylation and prevent oxidative (free radical) damage. Since they remain in the body for short periods of time they should be taken at least twice daily. The amount of each B vitamin required varies. Since B vitamins compete with each other for absorption a complete B complex should be taken, not single supplements. Look for levels of B1 and B6 50 mg. or higher, B12 50 mcg. or higher and folic acid (folate) 400 mcg. or higher.

Vitamin D should be taken in usual amounts, 400 to 600 IU daily. It is essential for bone health, but does not appear to be needed in higher levels than those used by non-diabetics.

Plant based supplements, called phytochemicals, are very helpful in complementing the vitamins and minerals and in helping the body utilize them optimally. Many blends are available. Some are fruit and vegetable extracts and others use green plant combinations such as green tea, Siberian ginseng, ginkgo biloba, and barley. One or two tablets or capsules twice daily should be taken depending upon the product. In general follow the recommendations of the product supplier.

Proanthocyanidins are particularly important plant based supplements in diabetes. They are derived from two major sources, pine bark and grape seed. The pine bark products are referred to as “pycnogenol” and the grape seed products as “grape seed extract”.

Proanthocyanidins strengthen blood vessels and are used in Europe to treat diabetic retinopathy (eye disease). Taking 1 mg. per pound daily for 10 to 14 days as a loading dose and 1/2 mg. per pound per day as a maintenance dose should be very helpful in preventing retinopathy and the associated loss of vision. In addition, proanthocyanidins enhance the antioxidant activity of vitamins C and E and improve flexibility by supporting the production of a substance called elastin.

Last month I spoke of viewing diabetes management like legs on a stool. The first 3 legs - diet, activity, and supplements - will be all that many people need to control their diabetic condition. One additional leg, herbals or pharmaceuticals may be necessary, however. Two herbs have been shown to improve blood sugar levels when taken regularly. The first is gimnema sylvestre in an amount of 400 mg. per day. The second is momordica charantia which is also known as Karela or Bitter Gourd. This is usually sold as a powder. Fifty milligrams per kilogram of body weight twice daily is a typical dosage. (A kilogram is equal to 2.2 pounds.)

Diabetes Mellitus is a serious condition which can produce devastating complications and even result in death. There is much room for optimism, however, when an individual makes certain that all of the legs of the management stool are firmly in place. Susan McCullough, whom I introduced to you last month, and the thousands of others who have followed in her footsteps are living examples of the effectiveness of approaching the challenges comprehensively - of going beyond blood sugar!