Diabetes is widely recognized as one of the leading causes of death in the United States. According to death certificate data, diabetes contributed to the deaths of more than 193,140 people in the U.S in 1996 alone.¹ Diabetes is associated with long-term complications that affect almost every major part of the body. It contributes to blindness, heart disease, strokes, kidney failure, liver damage, nerve damage, and amputations. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.¹

Type I diabetes
Type I, or insulin dependent diabetes mellitus (IDDM) accounts for about 5 to 10 percent of diagnosed diabetes in the United States.¹ It is considered to be an autoimmune disease, i.e., a disease in which the immune system turns against a part of the body. In IDDM, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Because of this, people with type I diabetes must have their glucose levels monitored closely by frequent blood sugar testing. They also need daily insulin injections, balanced with their meals and activities. IDDM develops most often in children and young adults, but the disorder can appear at any age. Symptoms of IDDM usually develop over a short period of time, although beta cell destruction can begin years before symptoms appear. Symptoms of IDDM include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme tiredness. If not diagnosed and treated with insulin, a person with IDDM can lapse into a life-threatening coma.

Type II diabetes
The most common form of diabetes is Type II, or noninsulin-dependent diabetes mellitus (NIDDM). About 90 percent of people with diabetes have this form of the disease.¹ NIDDM usually develops in adults over the age of 40 and is most common among adults over age 55. About 80 percent of people with NIDDM are overweight. Usually, in NIDDM the pancreas produces insulin but, for some reason, the body is unable to use the insulin efficiently. This results in elevated blood sugar levels. Diet, exercise, and blood testing for glucose are the basis for management of NIDDM. In addition, some people with NIDDM take oral drugs or insulin to lower their blood glucose levels. The symptoms of NIDDM develop gradually and are not as pronounced as in IDDM. They include tiredness, frequent urination (especially at night), unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds and sores.

Other forms of diabetes
While IDDM and NIDDM account for over 95 percent of diabetes cases, there are other forms of diabetes, such as gestational and secondary diabetes, that affect a significant number of people. Gestational diabetes mellitus (GDM) is a term for impaired glucose tolerance that appears during pregnancy. It is estimated to affect anywhere from 1 to 14 percent of pregnancies in the United States.² Although gestational diabetes usually disappears when the pregnancy is over, women who have had the disorder have a greater risk of developing NIDDM later in life. Secondary diabetes refers to glucose intolerance that develops in association with other disorders such as pancreatic disease, endocrine disease, or drug side-effects. It accounts for about 1 to 2 percent of all diabetes.³ With all forms of diabetes, the goal of treatment is to keep blood glucose levels as close to the normal (nondiabetic) range as possible.

Nutritional/lifestyle considerations
Diet plays a crucial role in the management of diabetes. The primary goals of nutritional therapy are to optimize blood sugar control and blood lipid levels and to prevent and treat hypoglycemic (low blood sugar) events and chronic diabetic complications such as cardiovascular, kidey, liver, eye, and neurological diseases. For individuals with IDDM, an additional goal is to match diet to insulin requirements to ensure normal growth and development for adolescents and children. For overweight NIDDM individuals, nutritional therapies are designed to reduce weight and maximize the success of oral hypoglycemic therapy. Regular exercise can also contribute to weight reduction and glycemic control in NIDDM individuals.

A number of nutrients and herbs may play roles in controlling diabetes and diabetic complications. Chromium is needed to make glucose tolerance factor (GTF), which helps improve insulin activity, and several studies report that chromium supplementation may improve diabetes control.^4-6 Adequate magnesium intake also appears to be important, as magnesium deficiency has been associated with poor blood sugar control in NIDDM and has also been implicated in certain diabetic complications.^7-15 Studies suggest vanadium may help improve insulin sensitivity and reduce insulin requirements in some diabetic subjects.^16-19 Dietary fiber also contributes to blood sugar control; studies have shown that supplementing the diet with psyllium can help reduce blood sugar and lipid levels in NIDDM patients.^20-22 Other studies suggest that nutrients such as vitamins A, C, E, and B-6, selenium, and alpha lipoic acid may help protect against diabetic eye diseases.^23-31 Herbs with demonstrated hypoglycemic activity include aloe vera,³² gymnema,^33,34 ginseng,^35,36 momordica,^37-39 fenugreek,^40,41 and nopal cactus.⁴² Diabetics who take supplements should monitor their blood sugar carefully to guard against hypoglycemia and to adjust their insulin intake as needed.