Vitamins that may be helpful
A variety of vitamins, minerals, amino acids, and other supplements may help with symptoms
and deficiencies associated with diabetes. However, many of the studies described below were
done in adults, and the amounts used may not be appropriate for a child with type 1 diabetes.
The proper amount of each nutrient to be used by a child should always be discussed with a
Alpha lipoic acid
Alpha lipoic acid is a powerful natural
antioxidant. Preliminary and double-blind trials have found that supplementing with 600 to
1,200 mg of lipoic acid per day improves the symptoms of diabetic nerve damage
(neuropathy).57 58 59 60 In a preliminary study,
supplementing with 600 mg of alpha-lipoic acid per day for 18 months slowed the progression of
kidney damage in people with type 1 diabetes.61
Chromium, a trace mineral that appears to increase the effectiveness of insulin, has been
shown to improve glucose and related variables in people with many kinds of diabetes,
including type 1 diabetes.62 63 Chromium may also lower levels of total
cholesterol, LDL cholesterol, and triglycerides (risk factors for heart disease).64 65 The typical
amount of chromium used in research trials is 200 mcg per day. Supplementation with chromium
or brewer’s yeast (a source of chromium)
could potentially enhance the effects of drugs for diabetes (e.g., insulin or other blood
sugar-lowering agents) and possibly lead to
hypoglycemia. Therefore, people with diabetes taking these medications should supplement
with chromium or brewer's yeast only under the supervision of a doctor.
People with type 1 diabetes tend to have low magnesium levels, and magnesium given orally
or by injection partially overcomes the reduction in magnesium levels.66 In one
preliminary trial, insulin requirements were
lower in people with type 1 diabetes who were given magnesium.67 Diabetes-induced
damage to the eyes is more likely to occur in magnesium-deficient people with type 1
diabetes.68 In magnesium-deficient
pregnant women with type 1 diabetes, the lack of magnesium may even account for the high
rate of spontaneous abortion and birth defects
associated with type 1 diabetes.69 A double-blind trial found that giving 300 mg
per day of magnesium to magnesium-deficient type 1 diabetics for five years slowed the
development of diabetic nerve damage (neuropathy). The American Diabetes Association
acknowledges strong associations between magnesium deficiency and insulin resistance but has
not said magnesium deficiency is a risk factor.70 Many doctors, however, recommend
that adults with diabetes and normal kidney function supplement with 200 to 600 mg of
magnesium per day (those amounts would be lower for children).
Evening primrose oil
Supplementing with 4 grams of evening primrose oil per day for six months has been found in
double-blind research to improve nerve function and to relieve pain symptoms in people with
diabetic nerve damage (neuropathy).71
In a double-blind study of people with diabetic nerve damage (neuropathy), supplementing
with acetyl-L-carnitine was significantly more effective than a placebo in improving
subjective symptoms of neuropathy and objective measures of nerve function.72
People who received 1,000 mg of acetyl-L-carnitine three times per day tended to fare better
than those who received 500 mg three times per day.
Blood levels of vitamin B1 (thiamine) have
been found to be low in people with type 1 diabetes.73 A controlled trial in Africa
found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant
improvement of symptoms of diabetic nerve damage (neuropathy) after four weeks.74
However, since this was a trial conducted among people in a vitamin B1–deficient
developing country, these improvements might not occur in other people with diabetes. Another
trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12 in high but variable amounts led to
improvement in some aspects of diabetic neuropathy in 12 weeks.75 As a result, some
doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the
optimal level of intake remains unknown.
Taking large amounts of niacin (a form of
vitamin B3), such as 2 to 3 grams per day, may impair glucose tolerance and should be used by
people with diabetes only with medical supervision.76 77
Some clinical trials have shown that
niacinamide (another form of vitamin B3) supplementation might be useful in the very early
stages of type 1 diabetes,78 though not all trials support this claim.79
80 81 Although an analysis of research shows that niacinamide does help
preserve some function of insulin-secreting cells in people recently diagnosed with type 1
diabetes, the amount of insulin required for those given niacinamide has remained essentially
as high as for those given placebo.82 A controlled trial found no beneficial effect
of niacinamide supplementation (700 mg three times per day in addition to intensive insulin
therapy) on pancreatic function and glucose tolerance in people newly diagnosed with type 1
Some,84 but not all,85 reports suggest that healthy children
at high risk for type 1 diabetes (such as the healthy siblings of children with type 1
diabetes) may be protected from the disease by supplementing with niacinamide. Parents of
children with type 1 diabetes should consult their doctor regarding niacinamide
supplementation as a way to prevent diabetes in their other children. Although the optimal
amount of niacinamide is not known, recent evidence suggests that 25 mg per 2.2 pounds of body
weight per day may be as effective as higher amounts.86
Many people with diabetes have low blood levels of vitamin B6.87 88 Levels are even
lower in people with diabetes who also have neuropathy.89 In a trial that included
people with type 1 diabetes, 1,800 mg per day of a special form of vitamin B6—pyridoxine
alpha-ketoglutarate—improved glucose tolerance dramatically.90 Vitamin B6 may
also reduce the amount of glycosylation, so taking adequate amounts of this vitamin may be
beneficial for all people with diabetes.91
Biotin is a B vitamin needed to process
glucose. When people with type 1 diabetes were given 16 mg of biotin per day for one week,
their fasting glucose levels dropped by 50%.92 Biotin may also reduce pain from
diabetic nerve damage (neuropathy).93 Some doctors try 16 mg of biotin for a few
weeks to see if blood sugar levels will fall.
Vitamin B12 is needed for normal
functioning of nerve cells. Vitamin B12 taken orally has reduced symptoms of nerve damage
caused by diabetes in 39% of people studied; when given both intravenously and orally,
two-thirds of people improved.94 In a preliminary trial, people with nerve damage
due to kidney disease or to diabetes plus kidney disease received intravenous injections of
500 mcg of methylcobalamin (the main form of vitamin B12 found in the blood) three times a day
for six months in addition to kidney dialysis. Nerve pain was significantly reduced and nerve
function significantly improved in those who received the injections.95 Oral
vitamin B12 up to 500 mcg three times per day is recommended by some practitioners.
L-carnitine is an amino acid needed to
properly utilize fat for energy. When people with diabetes were given L-carnitine (0.5 mg per
2.2 pounds of body weight), high blood levels of fats—both cholesterol and triglycerides—dropped 25 to 39% in just ten days
in one trial.96
People with type 1 diabetes appear to have low vitamin C levels.97 As with
vitamin E, vitamin C may reduce glycosylation.98 Vitamin C also lowers sorbitol
levels in people with diabetes.99 Sorbitol is a sugar that can accumulate inside
the cells and damage the eyes, nerves, and kidneys of people with diabetes. Vitamin C
supplementation (500 mg twice a day for one year) has significantly reduced urinary protein
loss in people with diabetes. Urinary protein loss (also called proteinuria) is associated
with poor prognosis in diabetes.100 Many doctors suggest that people with diabetes
supplement with 1 to 3 grams per day of vitamin C. Higher amounts could be problematic,
however. In one person, 4.5 grams per day was reported to increase blood sugar
One study examined antioxidant supplement intake, including both vitamins E and C, and the
incidence of diabetic eye damage (retinopathy).102 A surprising finding was
that people with extensive retinopathy had a greater likelihood of having taken vitamin C and
vitamin E supplements. The outcome of this study, however, does not fit with most other
published data and might simply reflect the fact that sicker people are more likely to take
supplements in hopes of getting better. For the present, most doctors remain relatively
unconcerned about the outcome of this isolated report.
Vitamin D is needed to maintain adequate blood levels of insulin.103 Vitamin D receptors have been
found in the pancreas where insulin is made and preliminary evidence suggests that
supplementation might reduce the risk of developing type 1 diabetes.104 Not enough
is known about optimal amounts of vitamin D for people with diabetes, and high amounts of
vitamin D can be toxic. Therefore, people with diabetes considering vitamin D supplementation
should talk with a doctor and have their vitamin D status assessed.
People with low blood levels of vitamin E are more likely to develop type 1
diabetes,105 but no studies have been done using vitamin E supplements to try to
prevent type 1 diabetes. Animal and preliminary human data indicate that vitamin E
supplementation may protect against diabetic eye damage (retinopathy) and nephropathy,106
107 serious complications of diabetes involving the eyes and kidneys, respectively,
though no long-term trials in humans have confirmed this preliminary evidence. Glycosylation
is an important measurement of diabetes; it refers to how much sugar attaches abnormally to
proteins. Excessive glycosylation appears to be one of the causes of the organ damage that
occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in
many,108 109 110 although not all,111
112 studies of people with type 1 diabetes.
People with type 1 diabetes tend to be zinc deficient,113 which may impair immune function.114 Zinc supplements
have lowered blood sugar levels in people with type 1 diabetes.115
Some doctors are concerned about having people with type 1 diabetes supplement with zinc
because of a report that zinc supplementation increased glycosylation,116 generally
a sign of deterioration of the condition. This trial is hard to evaluate because zinc
supplementation increases the life of blood cells and such an effect artificially increases
the lab test results for glycosylation. Until this issue is resolved, those with type 1
diabetes should consult a doctor before considering supplementation with zinc.
Because oxidation damage is believed to play a role in the development of diabetic eye
damage (retinopathy), antioxidant nutrients
might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic
eye damage (retinopathy). During that time, 19
of the 20 people showed either improvement or no progression of their
retinopathy.117 People who wish to supplement with more than 250 mcg of selenium
per day should consult a healthcare practitioner.
Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes
have been reported to be CoQ10 deficient. In one trial, blood sugar levels fell substantially
in 31% of people with diabetes after they supplemented with 120 mg per day of CoQ7, a
substance similar to CoQ10.118 In people with type 1 diabetes, however,
supplementation with 100 mg of CoQ10 per day for three months neither improved glucose control
nor reduced the need for insulin.119 The importance of CoQ10 supplementation for
people with diabetes remains an unresolved issue, though some doctors recommend approximately
50 mg per day as a way to protect against possible effects associated with diabetes-induced
Glucose tolerance improves in healthy people taking omega-3 fatty acid
supplements.120 And in one trial, people with diabetic nerve damage (neuropathy)
and diabetic nephropathy experienced significant improvement when given 600 mg three times per
day of purified eicosapentaenoic acid (EPA)—one of the two major omega-3 fatty acids
found in fish oil supplements—for 48 weeks.121 However, controlled studies
have found that fish oil supplementation increases cholesterol in people with type 1
diabetes.122 123 Until the risk–benefit ratio of using fish oil is
clarified, people with diabetes should feel free to increase their fish intake, but they
should consult a doctor before taking fish oil supplements.
Glucomannan is a water-soluble dietary fiber derived from konjac root (Amorphophallus
konjac). Glucomannan delays stomach emptying, leading to a more gradual absorption of
dietary sugar. This effect can reduce the elevation of blood sugar levels that is typical
after a meal.124 This could lower insulin requirements for type 1 diabetics, but no
research has been done to test this possibility.
Inositol is needed for normal nerve function. Diabetes can cause a type of nerve damage
known as diabetic neuropathy. Certain measures of the severity of this condition have been
reported to improve with inositol supplementation (500 mg taken twice per day);125
however, in other trials, inositol was ineffective.126
People with diabetes may have low blood levels of manganese.127 Animal research
suggests that manganese deficiency can contribute to glucose intolerance and may be reversed
by supplementation.128 A young adult with insulin-dependent diabetes who received
oral manganese (3 to 5 mg per day as manganese chloride) reportedly experienced a significant
fall in blood glucose, sometimes to dangerously low levels. In three other people with type 1
diabetes, manganese supplementation had no effect on blood glucose levels.129
People with type 1 diabetes wishing to supplement with manganese should do so only with a
doctor’s close supervision.
Doctors have suggested that quercetin might help people with diabetes because of its
ability to reduce levels of sorbitol—a
sugar that accumulates in nerve cells, kidney cells, and cells within the eyes of people with
diabetes and has been linked to damage to those organs.130 Clinical trials have yet
to explore whether quercetin actually protects people with diabetes from nerve damage
(neuropathy), nephropathy, or eye damage (retinopathy).
Starch blockers are substances that inhibit amylase, the digestive enzyme required to break
down dietary starches for normal absorption. Controlled research has demonstrated that
concentrated starch blocker extracts, when given with a starchy meal, can reduce the usual
rise in blood sugar levels of both healthy people and diabetics.131 132
133 134 135 While this effect could be helpful in controlling
diabetes, no research has investigated the long-term effects of taking starch blockers for
Taurine is an amino acid found in protein-rich food. People with type 1 diabetes have been
reported to have low blood taurine levels, a condition that increases the risk of heart
disease by altering blood viscosity. Supplementing with taurine (1.5 grams per day) has
restored blood taurine to normal levels and corrected the problem of blood viscosity within
While vanadyl sulfate, a form of vanadium, may improve glucose control in people with type
2 diabetes,137 138 139 it may not help people with type 1
diabetes according to one preliminary report.140 The long-term safety of the large
amounts of vanadium used in diabetes research (typically 100 mg per day) remains unknown. Many
doctors expect that amounts this high may prove to be unsafe in the long term.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
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