There are several nutritional components beyond vitamins and minerals that either have an affect, or are affected by diabetes. Further, oral hypoglycemics and insulin may deplete some of these essential nutrients, warranting supplementation.

Essential Fatty Acids

Essential fatty acids , including omega-3 (n-3), omega-6 gamma linoleic acid, eicosapentaenoic acid, and do-cocsahexaenoic acid have been studied extensively for their beneficial effects on cholesterol, triglycerides, blood pressure and cardiovascular disease, autoimmune disease, and inflammation. Several compounds have been shown to be particularly relevant to diabetes, beyond their cardiovascular protective effects.

Diabetes, both human and experimental, has been associated with disturbances in Essential fatty acids metabolism; in particular, the conversion of linoleic acid to gamma linoleic acid is inhibited. Linoleic acid shares functional similarities to potent insulin sensitizers, and has been shown to normalize impaired glucose tolerance and improved hyperinsulinemia in animal studies. Gamma linoleic acid, however, is an important component of diabetic complications, particularly neuropathy. In a large multicenter trial, gamma linoleic acid supplementation was provided in the form of evening primrose oil to patients with diabetic neuropathy. Following 1 year of treatment, all symptoms of neuropathy improved. Sources of gamma linoleic acid include evening primrose oil, borage oil, and black currant oil.

Fish oils are an important source of long-chain n-3 fatty acids, eicosapentaenoic acid, and do-cocsahexaenoic acid. The ability of fish oil to enhance the rate of glycogen storage allows skeletal muscle to increase its uptake of glucose, even under conditions where fatty acid oxidation is accelerated. Fish oil enhances insulin secretion by incorporation of n-3 fatty acids into the plasma membrane. This reduces the concentration of amino acids in the plasma membrane, decreasing the production of prostaglandin 2 (PGE2) which, in turn, suppresses the production of cAMP, a well-known enhancer of glucose-induced insulin secretion. Consequently, fish oil enhances insulin secretion from beta cells, regulating blood sugar.

Fish oils have biological properties of potential relevance for the prevention of type 1 diabetes. One large case control study found that cod liver oil, given in the first year of life, was associated with significantly lower risk of type 1 diabetes.

In type 2 diabetes, studies have shown mixed results. One study examined established type 2 diabetics, providing a diabetic diet along with eicosapentaenoic acid and do-cocsahexaenoic acid supplements, or diet alone. Essential fatty acids supplementation resulted in significantly greater improvement in glycemic status, blood pressure, and lipid profiles, as well as reduction in measures of oxidative stress. In other studies, supplementation with fish oils resulted in no change in either fasting serum insulin levels or insulin sensitivity, and one study found an increase in fasting blood glucose following fish oil intervention. However, given the proven vascular benefits of EFAs, with careful monitoring supplementation may be indicated.

Medium chain triglycerides are a component of many foods, with coconut and palm oils being the dietary sources with the highest concentrations. In an inpatient setting, an experimental diet containing 78% of fat calories as Medium chain triglycerides (31% of total energy intake) increased glucose metabolism in patients with type 2 diabetes. In five outpatients with type 2 diabetes, an experimental diet containing 18% of calories from Medium chain triglycerides led to a slight reduction in postprandial blood sugar and no effect on fasting blood sugar. While promising, the role of Medium chain triglycerides in the management of diabetes remains to be decided.

Blood lipid levels should be monitored when supplementing with EFAs. While the results are mixed, and several studies have shown improved lipid levels, but one study found an increase in cholesterol when supplementing people with type 1 diabetes with n-3 fatty acids.

Alpha Lipoic Acid (Thioctic Acid)

Alpha lipoic acid is a naturally occurring thiol, synthesized in the liver. It is a potent antioxidant, a cofactor in many enzymatic complexes, and may play a role in glucose oxidation. Alpha lipoic acid has been shown to improve insulin resistance in a number of animal models, and experimental trials have indicated usefulness in insulin resistance, when delivered both parenterally and orally.

Insulin sensitivity and glucose effectiveness following oral glucose-tolerance test was performed on lean and obese people with type 2 diabetes. Alpha lipoic acid treatment was associated with increased glucose effectiveness in both lean and obese groups, while higher insulin sensitivity and lower fasting glucose were significantly changed in lean subjects only. In another study, blood glucose levels following Alpha lipoic acid supplementation were not changed, however changes in coagulation factors and marked lipid lowering were seen.

A dosage study of Alpha lipoic acid showed a mean increase of 21% in insulin-stimulated glucose disposal in treated subjects, with no significant differences between dosage levels. A relatively low dose, therefore, is sufficient to produce effects.

Coenzyme Qho (Ubiquinone)

Coenzyme Cho (CoQio) is a cofactor in the mitochondrial electron transport chain. Because an adequate supply of energy is essential for the health of virtually all human tissues, CoQio is a vital nutrient. Many recent studies have demonstrated the effectiveness of CoQio in maintaining cardiovascular health.

Several studies have explored the role of CoQio in diabetes. Administration of C0Q7 (a nutritionally equivalent analog of C0Q10) resulted in fasting blood sugar level declines of at least 30% in 31% of the patients. A second study showed improvement in pain and paresthesias in diabetic neuropathy. Several negative studies, however, have indicated that beneficial effects of C0Q10 administration may not be apparent in the short term.

Many of the oral hypoglycemics and all of the lipid-lowering statins deplete C0Q10. Given its known beneficial cardiovascular effects, and emerging effects on glucose control, supplementation in people with diabetes should be considered.

TABLE . Oral Hypoglycemics, Exogenous Insulin, and Nutrient Depletion

Conclusion

This list of nutritional supplements is not meant to be exhaustive. Several other substances, including beta carotene, calcium, manganese, L-carnitine, and glutathione, have shown promise in the treatment of diabetes.

The standard medications for glycemic control can and do influence nutritional status. Table  Oral Hypoglycemics, Exogenous Insulin, and Nutrient Depletion presents the most commonly prescribed diabetes medications, their effect on nutritional substances, and the potential consequences.

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