Diabetes is a multifaceted disease. Now seen much more profoundly than previously, it is perceived not so much as a "high blood sugar" disease, but more as a "small vessel" disease. This evolving understanding focuses on more adequate treatments. Excessive sugar, trans-fats, poor diet, stress and Syndrome X (insulin insensitivity due to stress), lack of exercise (obesity with cellular waste buildup), liver and renal dysfunction and hypertension are prevalent in diabetes/blood vessel damage. Shift of focus to compromised material delivery/cardiovascular system also includes damage from homocysteine buildup (lack of B12/folate), insufficient methyl groups and antioxidants, etc. At the cellular level (RBC's and recipient tissue) is noted the inability of needed materials including oxygen to be delivered to and/or transported into the cells because of cell membrane compromise (too many trans-fatty acids and insufficient EFA's, mineral lack, or receptor sites blocked). In the end, suffocating toxic laden cells lose function, turn cancerous or die. An integrated collapse requires an integrated healing approach. Any remedy must first address the person and lifestyle that allows it, and then modalities and nutritional support become significant. Otherwise it is an expensive and unfruitful chasing of shadows with disease names.

"High Costs of Poor Eating Patterns in the United States," Frazao E, Nutrition Week, June 18, 1999;29(23):4-5. Healthier diets might prevent $71 billion a year in medical costs, lost productivity and premature deaths associated with coronary heart disease, cancer, stroke, diabetes, hypertension, overweight and osteoporosis. A 1993 estimate stated that a 1% reduction in intake of fat and saturated fat and a 0.1% reduction in the intake of cholesterol would prevent over 56,000 cases of coronary heart disease and cancer, avoid over 18,000 deaths and save over 117,000 life-years over 20 years. In 1994, coronary heart disease was the cause of over 480,000 deaths in the United States. Cancer claimed over 530,000 lives in the United States in 1994. Hypertension, or high blood pressure, affects as many as 50 million people in the United States. In 1994, 23,943 deaths from hypertensive heart disease, 2,494 deaths from hypertensive heart disease and renal disease, and 11,765 deaths from hypertension with or without renal disease, totaling 38,202 deaths per year when listed together, make this the ninth leading cause of death. Being overweight accounts for an increased risk for coronary heart disease, hypertension, noninsulin-dependent diabetes and some cancers. "Lifestyle and 15-Year Survival Free of Heart Attack, Stroke, and Diabetes in Middle-Aged British Men," Wannamethee SG, et al, Arch Intern Med, December 7/21, 1998;158:2433-2440. In a prospective study of 7,142 men between 40 and 59 years of age during a follow-up of 15 years, there were 1,064 deaths from all causes, 770 major heart attacks, 247 stroke events and 252 cases of diabetes.  Cigarette smoking, overweight and physical inactivity, individually or in combination, were major hazards to survival free of cardiovascular disease and diabetes.  There is strong evidence that the cessation of smoking is associated with a reduced risk of all-cause mortality in middle-aged men.

"Role of Oxidative Stress in Diabetic Complications: A New Perspective on an Old Paradigm," Baynes JW and Thorpe SR, Diabetes, January, 1999;48:1-9.  In diabetes, there are increased glycoxidation and lipoxidation products in plasma and tissue proteins. There are elevated levels of oxidizable substrates of amino acids such as lysine and arginine residues.  Age-adjusted levels of oxidized amino acids are not increased in skin collagen in diabetes.  This suggests that increased chemical modification of proteins by carbohydrates and lipids in diabetes is the result of an overload on metabolic pathways involved in detoxification of reactive carbonyl species, which leads to an increase in steady-state levels of reactive carbonyl compounds formed by oxidative and nonoxidative reactions.  The elevated glycoxidation and lipoxidation of tissue proteins in diabetes may be seen as a result of increased carbonyl stress. 

"Hyperhomocysteinemia Increases Risk of Death, Especially in Type 2 Diabetes: 5-Year Follow-Up of the Hoorn Study," Hoogeveen EK, Kostense PJ, Jakobs C, et al, Circulation, April 4, 2000;101:1506-1511.  In evaluating 2,484 men and women who were between 50 and 75 years of age, fasting serum total homocysteine levels were measured in 171 subjects who died, compared with 640 survivors. Hyperhomocysteinemia appears to be a stronger risk factor for mortality in Type 2 diabetics than in nondiabetic subjects. Consider at least Bio- B 100 or Bio-B Complex if not on a good multiple. 

"Physical Activity and the Prevention of Type 2 Diabetes Mellitus: How Much for How Long?" Kriska A, Sports Med, March, 2000;29(3):147-151. Physical activity can reduce the risk of diabetes. Moderate levels of physical activity in sedentary individuals have beneficial effects on insulin sensitivity and glucose tolerance. From a public health perspective, long-term commitments to increase physical activity are required. "Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men With Type 2 Diabetes," Wei M, Gibbons LW, et al, Ann Intern Med, April 18, 2000;132(8):605-611. In 1,263 type 2 diabetic men who were an average of 50 years of age, those who were physically inactive had an increased mortality risk that was 1.7-fold higher than those who were physically active. "Exercise and Insulin Sensitivity: A Review," Borghouts LB, Keizer HA, Int J Sports Med, 2000;21:1-12.  Exercise has a beneficial effect on insulin sensitivity in normal as well as insulin-resistant subjects. Up to 2 hours after exercise, glucose uptake is elevated partially due to insulin-independent mechanisms. A single bout of exercise can increase insulin sensitivity for at least 16 hours post-exercise in healthy as well as non-insulin-dependent diabetes mellitus subjects. Exercise training can improve lipid metabolism and the regulation of hepatic glucose output. To optimize insulin sensitivity, it is advised to perform exercise on a regular basis. Large muscle groups should be used, since skeletal muscle is responsible for a major portion of glucose uptake after exercise. These findings reaffirm the common experiences of why exercise releases the system from the stress of fight-or-flight (and Syndrome X).

"Reversal of Corticosteroid-Induced Diabetes Mellitus With Supplemental Chromium," Ravina A, et al, Diabet Med, 1999;16:164- 167. In 13 patients, urinary chromium losses following corticosteroid treatment increased from 155 ng/day before corticosteroid treatment to 244 ng/day in the first 3 days following treatment. In 3 case reports of corticosteroid-induced diabetes, chromium supplementation as chromium picolinate at 200 ug, 3 times daily, resulted in clinical improvement in these cases, as well as improvement in diabetic and blood sugar control.  The key message is that corticosteroids can increase chromium excretion. A hyperadrenal state due to chronic stress might also aggravate chromium status. "Effect of Chromium Picolinate on Insulin Sensitivity In Vivo," Cefalu WT, et al, J Trace Elem Exp Med, 1999;12:71-83.In 29 male and female subjects at high risk for Type 2 diabetes who received, in a double-blind fashion, 1,000 ug/day of chromium picolinate or placebo for 8 months, results showed chromium picolinate significantly improved insulin sensitivity in these obese subjects with a family history of Type 2 diabetes, suggesting a direct effect of chromium picolinate on muscle insulin action.  One thing that becomes evident regarding chromium picolinate supplementation and blood sugar abnormalities is that to have some type of therapeutic response, the dose needs to be close to 1 mg per day and not 100 or 200 ug. The latter doses may be excellent dietary goals for chromium, but if one has a specific condition, it appears that the dose needs to be increased. "Chromium in the Prevention and Control of Diabetes," Anderson R, Diabetes and Metabolism (Paris), 2000;26(1):22-27. In a variety of studies on insulin-dependent and -independent diabetes, chromium between 200 and 1,000 ug/day lowered blood glucose levels, improved insulin sensitivity and reduced glycosylated hemoglobin levels. Exogenous insulin requirements dropped from 200 units per day to 0 following chromium supplementation. Good sources of chromium include meat, cheese, whole grains, brown sugar, Brewer's yeast, liver, wheat germ, spinach, apples, potatoes and carrots. Consider also Cr-Zyme, Chromium Picolinate, Aqueous Chromium, etc.  

"a-Lipoic Acid Treatment Decreases Serum Lactate and Pyruvate Concentrations and Improves Glucose Effectiveness in Lean and Obese Patients With Type 2 Diabetes," Konrad T, et al, Diabetes Care, February, 1999;22(2):280- 287.  Alpha-lipoic acid (LA), also known as thioctic acid, is a potent free radical scavenger. With regard to glucose metabolism, LA enhances glucose uptake in muscle cells and prevents glucose-induced protein modifications.  LA has reduced serum lactate and pyruvate concentrations by stimulating pyruvate-dehydrogenase (PDH) activity directly in diabetic rats.  LA is a cofactor in the multi-enzyme complexes of PDH, alpha-ketoglutarate and branched chain alpha-ketoacid dehydrogenases, which are impaired in patients with Type 2 diabetes.  In this study, before the LA treatment, the modified frequently sampled intravenous glucose tolerance tests before and after showed fasting lactate and pyruvate levels were significantly increased in patients with Type 2 diabetes.  A 2-fold increase in lactate and pyruvate levels was seen in obese diabetic subjects. After LA treatment of 600 mg, twice daily, of LA oral treatment was associated with an increase in glucose effectiveness in both lean and obese Type 2 diabetics. Lactate and pyruvate before and after glucose loading were approximately 45% lower in lean and obese diabetic patients. "a-Lipoic Acid in the Treatment of Diabetic Polyneuropathy in Germany: Current Evidence From Clinical Trials," Ziegler D, Reljanovic M, Mehnert H, Gries FA, Exp Clin Endocrinol Diabetes, 1999;107:421-430. Fifteen trials have been done with different study designs, durations of treatment, doses, sample sizes and patient populations utilizing at least 600 mg per day of alpha-lipoic acid which have had beneficial results. Short-term treatment for 3 weeks using 600 mg of alpha-lipoic acid intravenous per day can reduce the chief symptoms of diabetic polyneuropathy. A 3-week pilot study of 1,800 mg/day orally suggested therapeutic benefit may be independent of the route of administration. Oral treatment for 4-7 months tends to reduce neuropathic deficits and improves cardiac autonomic neuropathy. Preliminary data over 2 years suggest that long-term improvement in motor and sensory nerve conduction occurs in the lower limbs. What is even more remarkable about alpha-lipoic acid is that not only is it beneficial in this very difficult condition of diabetic neuropathy, but it is also very important in hepatic failure due to any type of toxic insult, with good clinical data from the work of Dr. Burt Berkson, MD, PhD, who used alpha-lipoic acid intravenously in the 1970s in the treatment of hepatic failure due to Amanita (mushroom) poisoning in a hospital setting. This is one of those situations in medicine in which it is hard to believe that a nutrient, which could prevent the need for liver transplant, has been ignored. Alpha-lipoic acid's unique feature is that it is both a water-soluble and lipid-soluble antioxidant. 

"Role of Oxygen Derived Radicals for Vascular Dysfunction in the Diabetic Heart:  Prevention by a- Tocopherol?" Rosen P, et al, Mol Cell Biochem, 1998;188:103-111. Antioxidative treatment may help reduce the cardiovascular risk in diabetics.  Vitamin E has been shown to inhibit LDL oxidation, reduce lipid peroxidation, reduce the generation of thromboxane A2, inhibit platelet aggregation and adhesion, reduce the expression of adhesion proteins, reduce the adhesion of monocytes, protect the endothelium, inhibit smooth muscle cell proliferation, inhibit PKC activation in smooth muscle cells and inhibit the activation of NF-kB. "Low Vitamin E Status Is a Potential Risk Factor for Insulin-Dependent Diabetes Mellitus," Knekt P, et al, J Intern Med, 1999;245:99-102. In a 21-year follow-up study, 19 cases of insulin dependent diabetes mellitus (IDDM), average age of 28 years, were compared with 3 individually matched controls per patient.  Serum vitamin E concentrations at baseline were inversely associated with IDDM occurring 4-14 years later.  These findings support the hypothesis of a protective effect of vitamin E against the development of IDDM. 
"Inhibition of Aldose Reductase in Human Erythrocytes by Vitamin C," Vincent TE, et al, Diabetes Res Clin Pract, 1999;43:1-8. High physiologic concentrations of vitamin C can directly inhibit erythrocyte aldose reductase, thereby inhibiting sorbitol production and accumulation which is linked to cellular dysfunction in the diabetic lens and nerve and reduce this damage. 

"Is Lycopene Beneficial to Human Health?" Bramley PM, Phytochemistry, 2000;54:233-236. Humans cannot synthesize carotenoids de novo and are dependent on dietary uptake of these micronutrients. Lycopene is a red-colored carotenoid, of which 85% of our dietary uptake comes from tomato fruit and tomato- based products. Increased serum lycopene levels are associated with a reduced risk of bladder cancer. A decrease in skin lycopene on exposure to light may increase the risk of skin cancer. Increased serum lycopene levels are associated with a reduced risk of breast cancer. Lycopene levels are associated with an inversed risk of cervical cancer. Adipose tissue lycopene levels are associated with a lower risk of cardiovascular disease. Lower serum lycopene levels result in increased mortality from cardiovascular disease. The "Effect of Supplementation With Tomato Juice, Vitamin E, and Vitamin C on LDL Oxidation and Products of Inflammatory Activity in Type 2 Diabetes," Upritchard JE, Sutherland WHF, Mann JI, Diabetes Care, June 2000;23(6):733-738; two cups of tomato juice daily increases plasma lycopene levels and increases the resistance of isolated LDL to oxidation almost as effectively as a high dose of vitamin E in Type 2 diabetes mellitus patients. 

"Diet for Young Diabetics: Standard and Mediterranean," Pinelli L, et al, Ann Pediatr (Paris), 1998;45(8):571-577. The Mediterranean diet in combination with appropriate insulin therapy is optimal for young diabetics, due to the fact it consists mainly of fiber-rich complex carbohydrates, vegetables, fruit, yogurt, fish and olive oil.  Rigid diets have proved ineffective in adequately controlling blood sugar. "Carbohydrates, Dietary Fiber, and Incident Type 2 Diabetes in Older Women," Meyer KA, Kushi LH, Jacobs DR Jr, et al, Am J Clin Nutr, 2000;71:921-930. In studying 35,988 older Iowa women initially free of diabetes, during 6 years of follow-up, there were 1,141 incident cases of diabetes noted. Total grain, whole-grain, total dietary fiber, cereal fiber and dietary magnesium intakes showed strong inverse associations with the incidence of diabetes. . Elevated homocysteine levels of more than 14 umol/l in diabetics increased their risk of mortality 2.51-fold. In diabetics with poor metabolic control, there is convincing evidence of magnesium deficiency, with higher magnesium excretion in the urine and lower serum magnesium levels. 

"Magnesium in Drinking Water and the Risk of Death From Diabetes Mellitus," Yang C-Y, et al, Magnes Res, 1999;12(2):131-137.In evaluating 6,781 deaths from diabetes mellitus in Taiwan residents from 1990 to 1994 compared with 6,781 deaths from other causes, there was a significant protective effect of magnesium intake from drinking water on the risk of dying from diabetes mellitus. "Serum and Urinary Magnesium in Young Diabetic Subjects in Bangladesh," Khan LA, et al, Am J Clin Nutr, 1999;69:70-73. In 40 newly diagnosed patients with diabetes mellitus, malnutrition was not related to serum glucose or serum or urinary magnesium.  Individuals with fibrocalculus pancreatic diabetes (FCPD) and protein-deficient diabetes (PDDM) had significantly lower serum magnesium concentrations compared with the control groups.  Zero percent of healthy subjects, 7.7% of malnourished control subjects, 42.85% of Type II diabetic subjects, 61.54% of PDDM subjects, and 69.23% of FCPD subjects were hypomagnesemic.  Those in the latter two groups had significantly higher urinary excretion of magnesium than the healthy and malnourished control subjects and Type II diabetic subjects. Hypermagnesuria paralleled hypomagnesemia.  

"The Effect of Flavonoid Treatment on the Glycation and Antioxidant Status in Type 1 Diabetic Patients," y Keenoy BM, Vertommen J, De Leeuw I, Diab Nutr Metab, 1999;12(4):256-263. Flavonoids can scavenge reactive oxygen radicals, and they can chelate transition metals, thereby protecting vitamin C from oxidation, thus protecting vitamin E. Both vitamins C and E may protect thiol groups in protein such as glutathione peroxidase, which helps prevent oxidative damage and glycation. Conducting studies with one antioxidant is really not appropriate, especially when it is given in pharmacologic doses. 

"Vitamin D Supplement in Early Childhood and Risk for Type I (Insulin-Dependent) Diabetes Mellitus," Dahlquist G, et al, Diabetologia, 1999;42:51-54. It was found that vitamin D supplementation was associated with a reduced risk of Type I diabetes without indication of heterogeneity.  These data suggest that activated vitamin D may contribute to immune modulation and protect or arrest an ongoing immune process initiated in susceptible individuals by early environmental exposures.  

Vanadium ranks high on several clinicians' list as absolutely necessary. Nutrients such as vanadium and chromium appear to have insulinomimetic effects and might be excellent complementary nutrients, along with a low glycemic diet with lean protein and unrefined carbohydrate, exercise and weight reduction if appropriate. Vanadium compounds may normalize blood sugar (as well as regulate the body lipid and protein metabolism) in diabetic subjects due to their perceived role as insulin mimicking compounds, which may operate through insulin-dependent and/or independent biochemical pathway(s). In the insulin receptor-independent mode of action, vanadium compounds may activate the tyrosine kinase located in the cytoplasm - the form of kinase that is not accessible to insulin. This broad mechanism of action of vanadium presents a promising complementary approach to the management of diabetes in cases of insulin resistance (including defects in the insulin receptor itself) and insulin deficiency. It has often been clinically noted how blood sugar control was regained when vanadium was given along with the many nutrients touched upon. Note vanadium is included in our products such as Glucobalance, Bio-Glycozyme Forte, Bio-Cardiozyme Forte, Biocardio-Paks and other multiples along with the other clinically proven to similarly needed synergistic nutrients.

With all this data, but for few exceptions of those on balanced organic diets, every patient should at least be on a balanced multiple such as Bio-Multi Plus, a broad spectrum antioxidant (BioProtect) and essential fatty acids (Biomega-3 or Flax seed Oil or Mixed EFA's) at 1 each per meal. The Balancing Body Chemistry doctors offer excellent clinical insights for many conditions. In agreement with the above information, they first indicate possible predisposing conditions, then the lifestyle and dietary changes and finally the primary and secondary nutritional support to give the best clinical response supporting their modality specialties. For instance: primary supplemental support for Hyperglycemia/Diabetes includes: Glucobalance at 3, 3 times a day with meals for 30 days then 2 per  meal with note to monitor with glucometer, Flax Seed Oil at 2, 3 times a day, Hydrozyme at 2-3 per meal, Cytozyme-Pan at 2, 3 times a day with meals (insulin and enzyme production support), and ADHS at 1, 2 times a day with breakfast and lunch (shown to be effective support for anyone stressed). Include Lipoic Acid, especially where neuropathy is present. Usually Glucobalance is considered with hypertension and BioGlycozyme Forte with hypotension.