Diabetes results when the effects of insulin in the body are impaired. This causes blood sugar levels to be too high. Micronutrient medicine aims to reduce these blood sugar levels. Diabetics can benefit from taking vitamins, minerals, and dietary fibers. They can also reduce the risk of developing other diseases associated with diabetes by protecting the blood vessels. Find out more about which types of minerals and vitamins are especially important in the treatment of diabetes how you can effectively support the therapy.
Causes and Symptoms
Diabetes mellitus: How does it develop and what types are there?
According to the definition, diabetes is an impairment affecting the release of insulin, the effects of insulin, or a combination of both. This leads to increased blood sugar levels (hyperglycemia). Insulin is a hormone which is produced in the B cells of the pancreas. They normally ensure that blood sugar (glucose) reaches the cells to produce energy which in turn causes the blood sugar levels to fall.
The diagnosis of the disease distinguishes between different types:
Type 1: Type 1 diabetes means that the body has an insulin deficiency because the cells which produce insulin have been destroyed. This happens because of the body's own antibodies (autoimmune disease). Type 1 diabetes can be hereditary. But it can also be caused by viral infectious diseases. The condition can affect children and young people and there is no cure.
Type 2: Type 2 diabetes affects adults. It usually develops as the result of an unhealthy lifestyle and lack of physical activity. With this type of diabetes, the body's cells no longer react to insulin (insulin resistance). This means the cells no longer absorb blood sugar and the levels don't fall. The body counterbalances the insulin resistance by producing more insulin until the pancreas is worn out and stops insulin production. When this happens, the patient develops an insulin deficiency. Some doctors differentiate between type 2a and type 2b: With type 2b diabetes the patients are obese, unlike patients with type 2a.
Previously, type 2 diabetes was known as old age diabetes due to the act that it mainly affected older people. Nowadays, due to changes in our lifestyle, it is affecting an increasing number of children.
Type 3: Type 3 diabetes is caused by genetic defects causing not enough insulin to be produced. This is a rare form of diabetes.
Type 4: Type 4 is diabetes during pregnancy, known as gestational diabetes. The body's insulin requirement increases during pregnancy. If the pancreas is unable to meet the demand, this results in diabetes.
To enable a diagnosis of diabetes, the doctor will test for the fasting and long-term blood sugar levels (HbA1c). A glucose tolerance test is also carried out.
Signs and Symptoms of Diabetes
Elevated blood sugar levels are not visible and can only be determined by blood testing. However, the following symptoms are typical for diabetes, especially when it has not been diagnosed or if it is not managed:
- Increased thirst and urge to go to urinate
- Nausea and weight loss
- Dizziness, weakness, and tiredness
- Impairment of consciousness through to diabetic coma
Effects and Consequences:
Early diagnosis is important to prevent secondary diseases. Over time, increased blood sugar levels will damage the blood vessels and nerves. Common complications:
- Vascular damage (angiopathy), such as arteriosclerosis
- Nerve diseases (polyneuropathy)
- Retinal damage (retinopathy)
- Kidney disease (nephropathy)
Dementia and depression are also associated secondary diseases: Diabetics are more likely to suffer from depression and dementia related to vascular damage.
Aim of the treatment
What is the standard treatment for diabetes?
A change in lifestyle is the foundation of the treatment: Weight loss, physical activity, only moderate alcohol consumption, and a balanced diet often lead to an improvement in the patient's condition. If the patient sticks with these changes, therapy is unnecessary in many cases.
Medications typically used in the treatment or diabetes are:
Antidiabetic Medication: There is a difference made between active pharmaceutical ingredients which promote the release of insulin (sulphonylureas), and other substances which act via different mechanisms (Metformin, Gliflozin, Glitazones):
- Metformin slows the uptake of glucose in the intestinal tract and promotes uptake in the body's cells. These include Siofor®, Diabesin®, and Glucophage®.
- SGLT-2 inhibitors (Gliflozin) prevent glucose in the kidneys from being reintroduced into the bloodstream during the "cleaning" of the blood. This means that the glucose is removed from the body. For example, Farxiga®.
- Glitazones help improve the cells' reaction to insulin. However, this class of medication, like Pioglitazone (e.g., Actos®), are not commonly prescribed due to their side effects.
- Sulphonylureas promote the release of insulin from the pancreas. Examples are glibenclamides, such as Euglucon® or Semi-Euglucon®.
Insulin: If the blood sugar levels cannot be controlled by antidiabetic medication, the doctor will prescribe insulin which must be injected. Since patients with type 1 diabetes can no longer produce insulin, they will always be prescribed insulin therapy. Nowadays, insulin can be administered via an insulin pump.
The aims of micronutrient medicine
Certain types of vitamins, minerals, and plant substances, along with fatty acids can be used as supportive measures for the treatment of diabetes. In the field of diabetology, the aim of micronutrient medicine is to slow down the progression of the disease. Certain types of micronutrients, such as chromium, vitamin D and magnesium help promote and improve the effects of insulin and can help reduce blood sugar levels. A diet rich in dietary fibers enables the blood sugar level to increase gradually. This makes things easier for the pancreas because there is less need for insulin. This can delay the need for medication-based treatment.
The use of micronutrients also helps minimize the risk of secondary diseases: For example, Vitamin-D deficiency increases the risk of nerve and vascular damage. Antioxidants catch free radicals, which may be produced by high blood sugar levels and may cause vascular damage. In turn, this leads to inflammation, which can be reduced by omega-3 fatty acids.
Treatment using micronutrients
Insulin is ineffective without chromium.
How it works
The trace element chromium and diabetes are closely correlated: chromium regulates the metabolism of glucose and strengthens the effects of insulin. The exact mechanism is not, however, known: It is suspected that chromium activates a signal molecule which then binds to the insulin receptor making it easier for blood sugar to enter the cell.
Metastudies have shown that chromium notably reduces the fasting and long-term blood sugar levels (HbA1c) of diabetics. Metastudies are studies where numerous studies are reviewed together to obtain an overview. Many, but not all metastudies confirm this effect.
Reasons for the contradictory study findings: It is possible that some patients had an existing chromium deficiency and others did not. Currently, there is no dependable method to determine chromium intake. In some studies, blood sugar levels improved during placebo treatment. It could be an indication that study participants changed their habits during the study.
Dosage and Recommended Use
For the treatment of type 2 diabetes , micronutritionists recommend a daily intake of at least 200 micrograms of chromium to boost the effects of insulin. Ideally, as the compound chrompicolinat: Compared to other chromium compounds, this one is well-absorbed. It is recommended to spread the intake of chromium throughout the day, for example, 100 mg in the morning and 100 mg in the evening.
It has not been discovered if chromium has a positive effect on the treatment of type 1 diabetes There is an insufficient number of relevant studies available. Pregnant womenshould ensure a chromium intake of 30 micrograms per day.
Chromium: Usage instruction when taking antidiabetic medication, when pregnant, when breastfeeding, and with allergies:
If chromium is combined with antidiabetic medication, then blood should be checked more regularly than normal, especially in the initial phase of supplementation. If you have low blood sugar levels, talk to your doctor about adjusting your dosage.
Chromium is most likely safe for women who are pregnant or breastfeeding. Nevertheless, high-dosage chromium supplements (above 50 micrograms) should only be taken following a critical assessment of the benefits by your doctor.
People with a contact allergy to chrome should not use chromium supplements. They may have a negative reaction to the chrome in the supplement. Those most affected are people who have daily contact with cement or concrete.
Vitamin D for the production of insulin
How it works
Blood sugar testing
The body requires vitamin D to enable its release from the pancreatic beta cells. Compared to the placebo, vitamin D improved the fasting and long-term blood sugar (HbA1c) as well as insulin resistance (HOMA index) levels. This was shown in several metastudies where clinical studies were evaluated.
However, researchers found no or very little effect on blood sugar levels. This can be due to variations in duration and dosage, that the study participants had different vitamin D blood levels at the start of the study, or a higher body-mass index (BMI): Those who are overweight require more vitamin D due to the fact that vitamin D disperses throughout the fatty tissue.
Deficiencies should be compensated for all types of diabetes.
Vitamin D inhibits the production of inflammatory messenger substances in diabetic patients. Diabetes has been linked to chronic inflammation. These "hidden" inflammations are involved in the development of the other diseases which accompany diabetes. In diabetics, vitamin D deficiency increases the risk for developing kidney diseases, as well as retinal and nerve damage.
The extent to which the intake of vitamin D can prevent or improve these diseases, requires further study. In an initial study, vitamin D appeared to be effective against nerve damage: Administering directly into the muscle improves overall quality of life.
Dosage and Recommended Use
For diabetes patients, between 1,000 and 4,000 international units per day of vitamin D. Ideally, the vitamin D levels should be determined via laboratory blood testing. If a vitamin D deficiency is identified, a higher dosage is required to achieve a normal level and for the substance to have the desired effect. Depending on the severity of the deficiency, doctors may recommend up to 10,000 international units per day for several weeks.
If you do not know what your vitamin D status is, you can use up to 2,000 international units per day. Vitamin D supplements should be taken at mealtimes. It is a fat-soluble vitamin and requires fat to be able to be absorbed by the body.
General instruction for increasing vitamin D levels: 1,000 international units (IU) per day permanently, in addition the body's own production of 4,500 international units will increase the vitamin D levels by 10 nanograms per liter (ng/ml).
Laboratory vitamin D level testing
Blood serum is used to determine the vitamin D levels. This is the liquid of the blood without blood cells. The ideal level is between 40 and 60 nanograms per milliliter. A level of 20 nanograms per milliliter or less is considered deficient.
Vitamin D: Instructions if taking diuretic medications or if suffering from kidney disease
Those with kidney disease should avoid taking vitamin D before consulting their doctor first. Kidney patients have problems with the mineral balance in their body. They may have calcium levels that are too high. Because vitamin D promotes the absorption of calcium in the intestinal tract, calcium levels in the blood can increase sharply. Patients with kidney stones (which contain calcium) must also be careful.
Patients with the inflammatory connective tissue disease sarcoidosis (also known as Boeck's disease) should not supplement with vitamin D: Patients with sarcoidosis often have high calcium levels in their blood, which may increase further if taking vitamin D supplements.
Thiazide diuretic medications, containing the active substances hydrochlorothiazide (Esidrix®), xipamide, and indapamide, reduce the levels of calcium removed from the body by the kidneys and this leads to increased levels of calcium in the blood. Because vitamin D also increases the calcium levels in the blood, vitamin D should only be taken in combination with thiazide diuretics when the calcium levels are subject to regular monitoring.
Zinc for diabetes: For insulin storage and wound healing
How it works
Zinc plays an essential role in the production and storage of insulin in the pancreas. Zinc is also important for the correct functioning of the cells and enables them to absorb sugar from the blood. An analysis of 52 observational study findings showed that diabetics have lower zinc levels than the healthy control subjects. A reason for this is: Diabetics often expel more zinc through their kidneys and are therefore at greater risk of developing a deficiency. In turn, a zinc deficiency disrupts the storage and effectiveness of insulin and, as a result, the metabolizing of sugar.
Supplementing with zinc also has a positive effect on fasting blood sugar levels: In contrast to the placebo, zinc was found to reduce blood sugar levels on average by 18.13 milligrams per deciliter. Both the long-term blood sugar levels (HbA1c) and the level directly after eating also improved with the supplementation of zinc. This was shown in an analysis of 25 high-quality studies with type 1 and type 2 diabetics.
Another high-quality study showed that zinc intake (30 milligrams per day) also had a positive effect on pregnant women: Zinc reduced the blood sugar and insulin levels in pregnant women with gestational diabetes when compared to the placebo group.
Zincimproves the wound healing process: The body requires zinc for cell division and repair processes. Diabetics often need longer for wounds to heal. Damage to the blood vessel and nerves as well as reduced immune system function have been identified as the cause. A high-quality study showed that zinc not only improved the control of the blood sugar levels but improved the healing of diabetic foot – a typical secondary disease defined by poorly healing wounds.
Dosage and Recommended Use
For the treatment of type 1 and type 2 diabetes, micronutrient medicine specialists recommend between 15 and 30 milligrams of zinc per day. Pregnant women should consult their doctor before taking high dose zinc supplements (more than 10 milligrams).
As a supportive treatment for diabetes, zinc should always be taken at mealtimes: This makes the substance more easily digestible for the stomach and easier for the intestinal tract to absorb. Amino acids from dietary proteins promote the uptake of zinc in the body.
Zinc: Instructions if taking medications or if suffering from kidney disease
Zinc can reduce the effectiveness of certain types of antibiotics containing the active substance tetracycline (Doxybene®, Doxycyclin®). Medication for osteoporosis (bisphosphonates) will be chemically bound to zinc, which in turn makes the medication ineffective. These include alendronate (such as Fosamax®, Tevanate®) or clodronate (such as Bonefos®). Between taking the medicated dosage and zinc supplement, there should a period of at least two hours.
Those with chronic kidney disease should not use zinc supplements. Weakened kidneys are not able to fully excrete the zinc from the body and this leads to an increase of zinc levels in the blood.
Magnesium deficiency is a common symptom of diabetes
How it works
Magnesium regulates the release of hormones, and therefore insulin. If there is a magnesium deficiency, insulin production in the pancreas drops. Increased intake of magnesium reduces the risk of diabetes (type 2). Many diabetics suffer from magnesium deficiency because insulin also controls the magnesium levels in the body. Magnesium deficiency has been identified as being related to the progression of diabetes.
When type 2 diabetics used magnesium supplements, the fasting blood sugar levels dropped on average by 4.6 milligrams per deciliter. This is a confirmed effect which was found in all the analyzed studies (meta-analysis). The control of blood sugar levels (such as fasting blood sugar levels, insulin values, HOMA index) in patients with type 1 and gestational diabetes also showed improvement during magnesium supplementation.
Magnesium has a relaxing effect on the blood vessels and therefore reduces high blood pressure in diabetics. Additionally, an improved intake of magnesium is associated with fewer diabetes-related complications, such as coronary heart disease, or vascular illnesses and arteriosclerosis.
Magnesium deficiency produces symptoms such as concentration problems and muscle cramps. Sleeping problems can also develop.
Dosage and Recommended Use
Micronutritionists recommend a daily dosage of at least 250 milligrams magnesium for diabetics. For the treatment of preexisting secondary diseases, higher dosages are recommended, for example 700 milligrams for increased blood pressure.
The correct dosage to treat a deficiency can be determined using the texture of the stool. Make sure to increase the magnesium dosage until you see that the texture of the stool has changed. Soft stool is a sign that the intestine is unable to absorb any more magnesium and that the body has sufficient levels. In this case, reduce the dosage by one capsule.
To make the magnesium more easily digestible it should be taken during mealtimes.
Alkaline magnesium compounds such as citrate, taurate, or gluconate are ideal. These compounds are able to counteract high levels of acidity (acidosis) which can occur in patients with diabetes.
If you are regularly taking high dosage magnesium (more than 250 milligrams), your magnesium level should be tested.
Because magnesium is mainly present in the red blood cells, the most effective way to test is in whole blood. Whole blood contains all the red blood cells. The normal range is between 1.38 and 1.50 millimoles per liter of whole blood.
Magnesium: Instructions if taking medications or if suffering from kidney disease
Magnesium can affect certain medications by binding with them and making them ineffective. There should be an interval of at least two hours between taking medication and taking magnesium supplements. These include antibiotics, especially gyrase inhibitors and tetracycline, as well as osteoporosis medication (bisphosphonates):
- Gyrase inhibitors Ciprofloxacin (e.g., Ciloxan®, Ciprobay®), Enoxacin (e.g., Enoxor®), Levofloxacin (e.g., Tavanic®), Moxifloxacin (e.g., Avalox®), Norfloxacin (e.g., Bactracid®, Norfluxx®) and Ofloxacin (e.g., Floxal®, Tarivid®)
- Tetrazycline: Tetracycline (e.g., Sumycin®), Doxycycline (e.g., Vibramycin®), Minocycline (e.g., Dynacin ®)
- Bisphosphonates: Alendronate (e.g.,Fosamax®), Clodronate (e.g., Bonefos®), Etidronate (e.g., Didronel®), Ibandronate (Bondronat®), Pamidronate (Aredia®), Risedronate (Actonel®) and Tiludronate (Skelid®)
Impaired kidneys are unable to sufficiently remove excess magnesium. Therefore, those with chronic kidney disease should not use additional magnesium supplements without consulting their physician beforehand.
Dietary fibers slow the increase in blood sugar levels
How it works
Dietary fibers cause the carbohydrates in the foods we eat to be digested more slowly, meaning that the blood sugar levels also increase at a slower rate. This is why complex carbohydrates are recommended for diabetics in place of simple sugar and household sugar.
Galactose is recommended as an alternative sugar. Galactose is absorbed by the cells without the need for insulin. You can use galactose to sweeten your tea and coffee.
Beta-Glucans from oats
Dietary fibers from oats (beta-glucans) are an excellent option because they have excellent absorption qualities. This means that they bind water in the digestive tract which in turn slows the stomach-emptying process and the conversion of carbohydrates into sugar. Beta-glucans also appear to inhibit the absorption of sugar in the intestinal tract. An assessment of various overview studies found that type 2 diabetics who supplemented their diet with beta-glucans from oats improved their long-term and fasting blood sugar.
Beta-glucan also reduces cholesterol levels, which are often found to be too high in diabetic patients and pose a risk of secondary diseases.
Dosage and Recommended Use
A diabetic should consume at least 40 grams of fiber per day, preferably more. Pulses and cereal products are excellent sources of dietary fiber.
The majority of studies showed that supplementing a meal with between 2.5 and 6 grams of beta-glucans enable better blood sugar control. 3 grams of beta-glucan is contained in approximately 80 grams of oatmeal or in 40 grams of oat bran. If you don't want to eat oats every day, you can purchase specialbeta-glucan compound products. These products can be mixed with yogurt or with liquid.
Dietary Fibers: Instructions if taking medications or if gluten intolerant
Soluble dietary fibers, such as beta-glucans from oats, can reduce the absorption of medications by forming a gel-like substance in the intestinal tract. This gel slows the absorption rate of the medication, enabling less of the active pharmaceutical ingredient to enter the bloodstream. At this point, it is recommended to leave at least two hours between taking each substance.
Patients with celiac disease must be careful with oat beta-glucan. Oats contain low levels of gluten. Some are able to tolerate oats without any problems, while others develop symptoms. If you suffer from celiac disease but would like to take oat beta-glucan, consult your doctor beforehand.
Alpha-lipoic acid reduces blood sugar levels and protects against nerve diseases
How it works
Alpha lipoic acid can reduce blood sugar levels: It was found to improve several of the characteristic signs of diabetes after eight weeks, including fasting blood sugar, high blood sugar levels directly after meals, and reduced insulin response. The effect corresponds to the dosage: 1,200 milligrams reduces blood sugar levels by more than 300 milligrams.
Alpha-lipoic acid is also an antioxidant: It neutralizes free radicals which prevents the development of oxidative stress. Oxidative stress is responsible for secondary diseases related to diabetes.
Especially the symptoms of nerve damage (polyneuropathy) can be reduced by alpha-lipoic acid: in several studies where questionnaires were used to record symptoms, researchers found there was an improvement of the patient, for example, with pain levels and tingling on the skin. The quality of life also improved: Half of the patients felt better after taking alpha-lipoic acid and participated more in daily life.
The use of alpha-lipoic acid was tested in studies for up to four years and it was found to be well-tolerated by patients. Scientists in a metastudy, with eight clinical studies, showed that when administered directly into the vein (intravenous), it was also effective.
Alpha-lipoic acid can be used as a supportive supplement during a diet. In diabetics, the alpha-lipoic acid group lost notably more weight than the control group not given alpha-lipoic acid.
Dosage and Recommended Use
At least 300 milligrams of alpha-lipoic acid is recommended per day to reduce blood sugar levels. For the treatment of nerve disorders related to diabetes types 1 and 2, micronutritionists recommend between 600 and 1,200 milligrams per day.
Alpha-lipoic acid should be taken on an empty stomach, for example, one hour before a meal. Minerals contained in food inhibit the absorption in the intestinal tract.
Supplementing biotin. If alpha-lipoic acid is being used over the course of several weeks, it should be supplemented with a day dosage of biotin between 100 and 500 micrograms. Alpha-lipoic acid reduces the effects of biotin.
Alpha-lipoic acid: Instructions when taking antidiabetic medication, when pregnant, and when breastfeeding
High-dosage alpha-lipoic acid (1,200 milligrams) can, in individual cases, cause low blood sugar levels (hypoglycemia) when taken in combination with antidiabetic medication and insulin. Therefore, regular blood testing is essential, especially in the initial phase of treatment. Consult your doctor about a dosage adjustment.
Pregnant women and those who are breastfeeding should begin a course of treatment with alpha-lipoic acid when only prescribed by their doctor. There are currently no available relevant studies.
Omega-3 fatty acid inhibits inflammation and reduces blood sugar levels.
How it works
The body uses omega-3 fatty acids to produce messenger substances which inhibit inflammation. Micronutritionists recommend omega-3 fatty acids in the treatment of chronic diseases which are linked to inflammatory processes, such as diabetes. Omega-3 fatty acids have been confirmed to reduce the inflammatory values in the blood in diabetics.
Cell membranes contain high levels of omega-3. This helps with the protection of the nerve cells: Type 1 diabetics who used omega-3 supplements (with a high DHA percentage) for a period of one year showed improvement in their neuropathy-related symptoms.
Omega-3 also appears to have a direct influence on blood sugar levels: When compared to the placebo, the use of omega-3 EPA led to an improvement of fasting and long-term blood sugar levels.
Dosage and Recommended Use
For the treatment of diabetes, a dosage of between 700 and 2,000 milligrams of omega-3 extracted from krill, fish, from algae, ideally with a high level of EPA, as EPA has anti-inflammatory properties, is recommended.
For nerve diseases, micronutritionists often recommend the omega-3 fatty acid DHA. This is also referred to as the "nerve's fatty acid" due to the fact that the membrane which surrounds the cells has high levels of DHA. There are special compounds which contain high levels of DHA. Up to 1,000 milligrams of DHA per day are recommended.
Omega-3 fatty acids should always be taken at meals as the body is better able to absorb them.
Make sure fish oil products are high quality. Make sure you buy products with high purity and which are free of unwanted residual pollutants and other impurities.
The omega-3 index shows the levels of omega-3 in the blood
The omega-3 index is the ideal way to determine omega-3 blood levels. It shows exactly the level of omega-3 fatty acid (EPA and DHA) is contained in the red blood cells. Ideally, the omega-3 index should show a level of over eight percent.
Omega-3 Fatty Acids: Instructions when taking blood-thinning medication, during illness, and before surgeries.
Dosages above 1,000 milligrams of omega-3 fatty acids can increase the effects of blood-thinning medications. Talk to your doctor before taking omega-3 supplements. If necessary, the doctor will be able to adjust your dosage.
These medications include Cumarin derivatives, (like Marcumar®), Warfarin (Coumadin®), acetylsalicylic acid (ASA, Aspirin®), Heparin (Clexane®) and new anticoagulants: Apixaban (Eliquis®), Dabigatran (Pradaxa®), Edoxaban (Lixiana®) and Rivaroxaban (Xarelto®).
In the event that liver disease, acute pancreatic, or gallbladder inflammation develops, stop taking omega-3 supplements. If you have a blood coagulation disorder, please discuss the use of omega-3 supplements with your doctor beforehand. The same applies if you are due to undergo an operative procedure.
Antioxidants reduce the risk of secondary diseases
How it works
Due to their high blood sugar levels, the majority of diabetics have an imbalance between free radicals and substances which neutralize the harmful effects of free radicals (antioxidants). This is known as oxidative stress. This can cause cell damage and inflammation and is linked to other diseases.
This is why micronutrient medicine recommends the use of antioxidants to slow the progression of the disease. These include vitamins C and E, zinc, selenium, and coenzyme Q10 - but also plant substances such as flavonoids and catechins from green tea.
Certain types of antioxidants have a positive effect on the control of blood sugar levels: Various studies have shown that vitamin C, zinc, and coenzyme Q10 improved fasting blood sugar levels or insulin resistance.
Dosage and Recommended Use
Micronutritionists usually recommend a combination of different low-dosage antioxidants in the form of multivitamin products with the substances supporting each other in their effectiveness and regeneration. For example, vitamin C is necessary to allow vitamin E to regenerate itself after it has finished neutralizing free radicals.
Soluble antioxidants, such as coenzyme Q10 or vitamin E, should be taken together at mealtimes to enable the body to absorb them.
For an additional blood sugar-reducing effect, 1,000 milligrams of vitamin C and between 100 and 200 milligrams of coenzyme Q10 are recommended.
Antioxidants: Instructions if taking medications or during illness
Vitamin C should not be taken in high dosages if you are suffering from kidney insufficiency (no more then 500 milligrams per day). The impaired kidney is unable to deal with it. For those with kidney stones, the vitamin C dosage should remain under 1,000 milligrams per day. The body converts some of the vitamin C into oxalic acid. The oxalic acid binds with calcium and creates calcium oxalate stones.
Because vitamin C improves the body's iron absorption, those suffering from hemochromatosis (chronic iron overload) should only use vitamin C supplements with regular monitoring by their doctor.
Vitamin C was shown in animal testing to reduce the effectiveness of the leukemia medication Bortezomib (Velcade®). High dosage vitamin C (more the 1,000 milligrams per day) can also influence the effectiveness of the blood-thinning medication Warfarin (Coumadin®). Therefore, if taking these types of medications, vitamin C supplements should only be used after consulting your doctor.
Coenzyme Q10 can reduce the effectiveness of certain types of blood-thinning medication. These include Cumarine, containing the active substance phenprocoumon (e.g., Marcumar®, Falithrom® and Marcuphen®) and Warfarin (Coumadin®). These effects have been reported when taking coenzyme Q10 dosages as low as between 30 and 100 milligrams. Consult your doctor before taking coenzyme Q10 supplements. The doctor uses the PT quick blood test (PT: prothrombin time).
B vitamins for blood sugar metabolism and to combat high homocysteine levels
How it works
B vitamins are essential for blood sugar metabolism to enable the body to extract energy from sugar. The sufficient intake of B vitamins is especially important for diabetics. Those suffering from diabetes types 1 and 2 usually have lower levels of vitamin B1 in their blood than healthy people. They also excrete higher levels of vitamin B1 through the kidneys. In a further study, researchers identified a vitamin B6 deficiency in those with type 2 diabetes.
In a study with 75 type 2 diabetics, the targeted intake of B vitamins reduced the symptoms of neuropathy. This study applied the following dosages: 10 milligrams vitamin B1, 20 milligrams vitamin B2, 10 milligrams vitamin B6, 10 micrograms vitamin B12, 1,000 micrograms folic acid and 200 micrograms biotin.
The body also requires vitamins B6 and B12 as well as folic acid for the breakdown of homocysteine. If there is a deficiency of these vitamins in the body, this substance cannot be broken down and this in turn leads to vascular damage. Diabetics can have elevated levels of homocysteine.
Dosage and Recommended Use
Micronutritionists recommend that all diabetics take a B vitamin product - especially type 1 and 2 diabetics, containing at least 10 milligrams of vitamin B1 and 200 micrograms of biotin Talk to your doctor about taking daily biotin dosages above 180 micrograms.
The following daily dosage is recommended to reduce elevated homocysteine levels: Between 5 and 15 micrograms of vitamin B6, up to 500 micrograms of vitamin B12 (in the form of methylcobalamin), and between 200 and 500 micrograms of folic acid (fast metabolizing 5-methyltetrahydrofolate).
Approximately 50% of people are unable to fully metabolize folic acid. They produce an insufficient amount of active form 5-methyltetrahydrofolate because the enzyme necessary for production is not functioning correctly.
Testing homocysteine levels
Diabetics should have their homocysteine levels tested to ensure that the blood vessels are not being further damaged by homocysteine.
The blood plasma is tested to determine the homocysteine levels. Blood serum is the liquid part of the blood without blood cells. Normal levels are below 10 micromoles per liter.
B vitamins: Instructions for during pregnancy, when breastfeeding, when suffering from an illness, or taking medication
Vitamin B2, B6, and B12 should only be used in high dosages when pregnant or when breastfeeding if a deficiency has been confirmed and after consultation with your gynaecologist.
Diabetics with kidney damage must take special care: Taking high dosage B vitamin supplement to reduce homocysteine levels can further reduce the function of the kidneys. Scientists suspect that this is linked to vitamin B12: High dosages of the cyanocobalamin form of the vitamin are most likely to be damaging to patients with kidney problems. The cyanocobalamin form of vitamin B12 should not be used, but rather methylcobalamin.
The effects of taking B vitamin supplements after the placement of a stent and following a heart attack have not been subject to a sufficient amount of study. B vitamins have a possible negative effect in these cases. High dosage vitamin B12 (60 to 400 micograms per day) should be avoided.
At higher dosages (above 5 milligrams per day), vitamin B6 can reduce the effect of antiepileptic medications (such as Carbamazepine or Gabapentin) and medication for the treatment of Parkinson's disease (Levodopa (L-Dopa)). These active pharmaceutical ingredients should not be taken in combination with high dosage vitamin B6 supplements.
Medications with the following active substances are used for the treatment of infectious diseases: trimethoprim (Infectotrimet®), proguanil (Paludrine®) and pyrimethamine (Daraprim®) Folic acid reduces the effectiveness of these medications.
Daily micronutrient recommendations for diabetes
Diabetes Type 1 and 2
1,000 to 4,000 International Units (IU)
1,000 to 4,000 International Units
up to 1,000 milligrams (mg)
at least 110 milligrams
at least 200 micrograms (µg)
30 to 60 micrograms
at least 10 milligrams
at least 1.2 milligrams
5 to 15 milligrams
up to 500 micrograms (Methylcobalamin)
at least 3 micrograms ( Methylcobalamin)
200 to 500 micrograms ( 5-Methyltetrahydrofolate)
400 to 800 micrograms ( 5-Methyltetrahydrofolate)
at least 200 micrograms
30 to 100 micrograms
at least 250 milligrams
at least 250 milligrams
up to 30 milligrams
600 to 1,200 milligrams
at least 40 grams (g)
2.5 to 6 Grams
at least 40 Grams
2.5 to 6 Grams
Omega-3 fatty acids
700 to 2,000 milligrams omega-3 fatty acids with a high EPA level for nerve diseases: to 1,000 milligrams DHA
700 to 2,000 milligrams omega-3 fatty acids with a high EPA level
100 to 200 milligrams
Overview of recommended laboratory tests
Recommended blood tests for Diabetes
Vitamin D (Serum)
40 to 60 nanograms per milliliter (ng/ml)
Magnesium (Whole blood)
1.38 to 1.50 Millimoles per Liter (mmol/l)
over 8 percent
above 10 Micromoles per Liter (µmol/l)
Supporting the effects of medication with micronutrients
Metformin causes vitamin B12 deficiency
The active pharmaceutical ingredient Metformin (e.g., Biocos®, Siofor®, Mediabet® and Glucophage®) slows the absorption of sugar in the intestinal tract and improves the regulation of blood sugar levels. However, metformin inhibits the absorption of vitamin B12:
Many diabetics who are taking metformin have lower levels of vitamin B12 in their blood when compared to diabetics who are not taking metformin. A study showed that those diabetics who had been taking metformin for more than four years were particularly affected. It cannot be ruled out that vitamin B12 may promote the development of diabetes-related nerve diseases.
Micronutritionists recommend regular vitamin B12 blood testing and, if necessary, compensate for any deficiencies with a daily dosage of between 500 and 1,000 micrograms. To prevent a deficiency when taking metformin, 250 micrograms of vitamin B12 are recommended.
Studies have shown that metformin also increased levels of cell-damaging homocysteine - especially when no B vitamin supplements were used. Because of this, the supplementation with folic acid (at least 200 micrograms) and vitamin B6 ( at least 5 milligrams) is recommended. The body also requires vitamins B6, B12 and folic acid to be able to break down homocysteine.
Combining glitazone with bone nutrients
Like the active substance pioglitazone (Actos®), glitazone helps improve the insulin responsiveness of the cells and the absorption of sugar from the blood. Nowadays, however, they are rarely prescribed to diabetics due to their side-effects. Glitazone also increases the risk of bone fracture - especially for women. This why micronutritionists recommend supplement bone nutrients:
- The vitamin D levels should be tested when taking the medications and any subsequent deficiencies compensated for. Depending on the levels, a daily dose of between 1,000 and 4,000 international units of vitamin D are recommended.
- Additionally, calcium is also important: A daily dose of 1,000 milligrams are necessary for healthy bones. Studies have shown that glitazones increase the amount of calcium being removed from the body by the kidneys.
- Vitamin K, especially the subtype K2, is required to store calcium in the bones. At least 80 micrograms of vitamin K2 per day are recommended to prevent osteoporosis.
Daily micronutrient recommendations when taking
5 to 15 milligrams (mg)
250 micrograms (µg) (Methylcobalamin)
200 to 500 micrograms (as 5-methyltetrahydrofolate)
1,000 and 4,000 International Units (IU)
at least 80 micrograms
In diabetes, the body's cells either no longer respond to the blood sugar hormone insulin or the pancreas produces too little insulin.
This causes blood sugar levels to be too high. Chromium, vitamin D, and magnesium ensure that insulin works correctly in the body and dietary fibers slow down the breakdown of carbohydrates to sugar. This means that the blood sugar level does not spike.
Omega-3 fatty acids, antioxidants such as vitamin C, zinc, and coenzyme Q10 but also alpha-lipoic acid and B vitamins all protect the blood vessel and therefore can prevent the development of diabetes-related secondary diseases. Secondary complications, such as nerve damage, are caused by blood sugar levels being too high, oxidative stress, and chronic inflammation.
Micronutrients taken at the same time as medication are important. The active pharmaceutical ingredient Metformin can cause vitamin B12 deficiency because it inhibits the body’s absorption of the vitamin. To avoid an increase of homocysteine levels, doctors often recommend vitamin B12, B6, and folic acid supplements.
Study and Source Index
Abbasi, N.N. et al. (2016): Oat β-glucan depresses SGLT1- and GLUT2-mediated glucose transport in intestinal epithelial cells (IEC-6). Nutr Res. 2016 Jun;36(6):541-52. https://www.ncbi.nlm.nih.gov/pubmed/27188900, retrieved on: 2018-04-18.
Abdali, D. et al. (2015): How effective are antioxidant supplements in obesity and diabetes? Med Princ Pract. 2015;24(3):201-15. https://www.ncbi.nlm.nih.gov/pubmed/25791371, retrieved on: 2018-04-19.
Agathos, E. et al. (2018): Effect of α-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy. J Int Med Res. 2018 Jan 1:300060518756540. https://www.ncbi.nlm.nih.gov/pubmed/29517942, retrieved on: 2018-04-17.
Agrawal, P. et al. (2011): Association of macrovascular complications of type 2 diabetes mellitus with serum magnesium levels. Diabetes Metab Syndr. 2011 Jan-Mar;5(1):41-4. https://www.ncbi.nlm.nih.gov/pubmed/22814841, retrieved on: 2018-04-18.
Ahmed, M. A. et al. (2017): Perspectives on Peripheral Neuropathy as a Consequence of Metformin-Induced Vitamin B12 Deficiency in T2DM. Int J Endocrinol. 2017; 2017: 2452853. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591993, retrieved on: 2018-04-19.
Akbari, M. et al. (2017): The Effects of Vitamin D Supplementation on Glucose Metabolism and Lipid Profiles in Patients with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Horm Metab Res. 2017 Sep;49(9):647-653. https://www.ncbi.nlm.nih.gov/pubmed/28759943, retrieved on: 2018-04-17.
Alam, U. et al. (2017): Improvement in Neuropathy Specific Quality of Life in Patients with Diabetes after Vitamin D Supplementation. J Diabetes Res. J Diabetes Res. 2017;2017:7928083. https://www.ncbi.nlm.nih.gov/pubmed/29445752, retrieved on: 2018-04-17.
Al-Attas, O.S. et al. (2012): Blood thiamine and its phosphate esters as measured by high-performance liquid chromatography: levels and associations in diabetes mellitus patients with varying degrees of microalbuminuria J Endocrinol Invest. 2012 Dec;35(11):951-6. https://www.ncbi.nlm.nih.gov/pubmed/22107884, retrieved on: 2018-04-19.
Ansar, H. et al. (2011): Effect of alpha-lipoic acid on blood glucose, insulin resistance and glutathione peroxidase of type 2 diabetic patients. Saudi Med J. 2011 Jun;32(6):584-8. https://www.ncbi.nlm.nih.gov/pubmed/21666939, retrieved on: 2018-04-16.
Aroda, V.R. et al. (2016): Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016 Apr; 101(4): 1754–1761. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880159/, retrieved on: 2018-04-19.
Asemi, Z. et al. (2015): Magnesium supplementation affects metabolic status and pregnancy outcomes in gestational diabetes: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2015 Jul;102(1):222-9. https://www.ncbi.nlm.nih.gov/pubmed/26016859, retrieved on: 2018-04-18.
Bodmer, M. et al. (2009): Risk of fractures with glitazones: a critical review of the evidence to date. Drug Saf. 2009;32(7):539-47. https://www.ncbi.nlm.nih.gov/pubmed/19530741, retrieved on: 2018-04-19.
Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2013): Nationale VersorgungsLeitlinie Therapie des Typ-2-Diabetes – Langfassung, 1. Auflage. Version 4, zuletzt geändert: November 2014. http://www.awmf.org/uploads/tx_szleitlinien/nvl-001gl_S3_Typ-2-Diabetes-Therapie_2014-11.pdf, retrieved on: 2018-04-16.
Costello, R.B. et al. (2016): Chromium supplements for glycemic control in type 2 diabetes: limited evidence of effectiveness. Nutr Rev. 2016 Jul;74(7):455-68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009459/, retrieved on: 2018-04-16.
Dibaba, D.T. et al. (2017): The effect of magnesium supplementation on blood pressure in individuals with insulin resistance, prediabetes, or noncommunicable chronic diseases: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2017 Sep;106(3):921-929. https://www.ncbi.nlm.nih.gov/pubmed/28724644, retrieved on: 2018-04-18.
EFSA Panel on Food Additives and Nutrient Sources added to Food (2010): Scientific Opinion on the safety of chromium picolinate as a source of chromium added for nutritional purposes to foodstuff for particular nutritional uses and to foods intended for the general population. EFSA Journal 2010;8(12):1883. https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2010.1883, retrieved on: 2018-04-16.
Elfaleh, E. et al. (2017): Analysis of zinc status in type 2 diabetic patients and its correlation with glycemic control. Endocrine Abstracts (2017) 49 EP482 https://www.endocrine-abstracts.org/ea/0049/ea0049ep482, retrieved on: 13.07.2018.
Ellulu, M.S. et al. (2015): Effect of vitamin C on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial. Drug Des Devel Ther. 2015 Jul 1;9:3405-12. https://www.ncbi.nlm.nih.gov/pubmed/26170625, retrieved on: 2018-04-19.
Fang, X. et al. (2016): Dose-Response Relationship between Dietary Magnesium Intake and Risk of Type 2 Diabetes Mellitus: A Systematic Review and Meta-Regression Analysis of Prospective Cohort Studies. Nutrients. 2016 Nov 19;8(11). pii: E739. https://www.ncbi.nlm.nih.gov/pubmed/27869762, retrieved on: 2018-04-18.
Farvid, M.S. et al. (2011): Improving neuropathy scores in type 2 diabetic patients using micronutrients supplementation. Diabetes Res Clin Pract. 2011 Jul;93(1):86-94. https://www.ncbi.nlm.nih.gov/pubmed/21496936, retrieved on: 2018-04-19.
Felício, J.S. et al. (2016): Vitamin D on Early Stages of Diabetic Kidney Disease: A Cross-sectional Study in Patients with Type 1 Diabetes Mellitus. Front Endocrinol (Lausanne). 2016 Dec 12;7:149. https://www.ncbi.nlm.nih.gov/pubmed/28018288, retrieved on: 2018-04-17.
Francelino Andrade, E.et al. (2014): Effect of beta-glucans in the control of blood glucose levels of diabetic patients: a systematic review. Nutr Hosp. 2014 Jan 1;31(1):170-7. https://www.ncbi.nlm.nih.gov/pubmed/25561108, retrieved on: 2018-04-18.
Gant, C.M.et al. (2018): Higher Dietary Magnesium Intake and Higher Magnesium Status Are Associated with Lower Prevalence of Coronary Heart Disease in Patients with Type 2 Diabetes. Nutrients. 2018 Mar 5;10(3). pii: E307. https://www.ncbi.nlm.nih.gov/pubmed/29510564, retrieved on: 2018-04-18.
Garcia-Alcala, H. et al. (2015): Treatment with α-lipoic acid over 16 weeks in type 2 diabetic patients with symptomatic polyneuropathy who responded to Initial 4-week high-dose loading. J Diabetes Res. 2015;2015:189857. https://www.ncbi.nlm.nih.gov/pubmed/26345602, retrieved on: 2018-04-17.
Gommers, L.M. et al. (2016): Hypomagnesemia in Type 2 Diabetes: A Vicious Circle? Diabetes. 2016 Jan;65(1):3-13. https://www.ncbi.nlm.nih.gov/pubmed/26696633, retrieved on: 2018-04-18.
Gröber, U. (2011): Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Aufl. Wissenschaftliche Verlagsgesellschaft mbH Stuttgart.
Gröber, U. (2018): Arzneimittel und Mikronährstoffe – Medikationsorientierte Supplementierung. 8. Aufl. Wissenschaftliche Verlagsgesellschaft mbH Stuttgart.
Herold, G. et al. (2017): Innere Medizin 2017. 1. Aufl. Gerd Herold, Köln.
Hou, Q. et al. (2015): The Metabolic Effects of Oats Intake in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Nutrients. 2015 Dec 10;7(12):10369-87. https://www.ncbi.nlm.nih.gov/pubmed/26690472, retrieved on: 2018-04-18.
House, A.A. et al. (2010): Effect of B-vitamin therapy on progression of diabetic nephropathy: a randomized controlled trial. JAMA. 2010 Apr 28;303(16):1603-9. https://www.ncbi.nlm.nih.gov/pubmed/20424250, retrieved on: 2018-04-19.
Hua, Y. et al. (2012): Molecular mechanisms of chromium in alleviating insulin resistance. J Nutr Biochem. 2012 Apr;23(4):313-9. https://www.ncbi.nlm.nih.gov/pubmed/22423897, retrieved on: 13.02.2018.
Huang, H. et al. (2018): Chromium supplementation for adjuvant treatment of type 2 diabetes mellitus: Results from a pooled analysis. Mol Nutr Food Res. 2018 Jan;62(1). https://www.ncbi.nlm.nih.gov/pubmed/28677892, retrieved on: 2018-04-16.
Islam, M.R. et al. (2016): Zinc supplementation for improving glucose handling in pre-diabetes: A double blind randomized placebo controlled pilot study. Diabetes Res Clin Pract. 2016 May;115:39-46. https://www.ncbi.nlm.nih.gov/pubmed/27242121, retrieved on: 2018-04-19.
Jayawardena, R. et al. (2012): Effects of zinc supplementation on diabetes mellitus: a systematic review and meta-analysis. Diabetol Metab Syndr. 2012; 4: 13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407731/, retrieved on: 13.07.2018.
Karamali, M. et al. (2015): Zinc supplementation and the effects on metabolic status in gestational diabetes: A randomized, double-blind, placebo-controlled trial. J Diabetes Complications. 2015 Nov-Dec;29(8):1314-9. https://www.ncbi.nlm.nih.gov/pubmed/26233572, retrieved on: 2018-04-19.
Ko, S.H.et al. (2014): Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes J Korean Med Sci. 2014 Jul;29(7):965-72. https://www.ncbi.nlm.nih.gov/pubmed/25045229 retrieved on: 2018-04-19.
Krausová, Z. et al. (1990): Serum levels and urinary excretion of zinc in patients with insulin-dependent diabetes. Cas Lek Cesk. 1990 Jul 27;129(30):945-9. https://www.ncbi.nlm.nih.gov/pubmed/2208224, retrieved on: 13.07.2018.
Lewis, E. J. H. et al. (2017): Effect of omega-3 supplementation on neuropathy in type 1 diabetes: A 12-month pilot trial. Neurology. 2017 Jun 13;88(24):2294-2301. https://www.ncbi.nlm.nih.gov/pubmed/28515269, retrieved on: 2018-04-18.
Li, X. et al. (2018): The Effect of Vitamin D Supplementation on Glycemic Control in Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis. Nutrients. 2018 Mar 19;10(3). pii: E375. https://www.ncbi.nlm.nih.gov/pubmed/29562681, retrieved on: 2018-04-17.
McRae, M.P. (2018): Dietary Fiber Intake and Type 2 Diabetes Mellitus: An Umbrella Review of Meta-analyses. J Chiropr Med. 2018 Mar;17(1):44-53. https://www.ncbi.nlm.nih.gov/pubmed/29628808, retrieved on: 2018-04-18.
Mehrdadi, P. et al. (2017): The Effect of Coenzyme Q10 Supplementation on Circulating Levels of Novel Adipokine Adipolin/CTRP12 in Overweight and Obese Patients with Type 2 Diabetes. Exp Clin Endocrinol Diabetes. 2017 Mar;125(3):156-162. https://www.ncbi.nlm.nih.gov/pubmed/27657997, retrieved on: 2018-04-19.
Mijnhout, G.S. et al. (2012): Alpha lipoic acid for symptomatic peripheral neuropathy in patients with diabetes: a meta-analysis of randomized controlled trials. Int J Endocrinol. 2012;2012:456279. https://www.ncbi.nlm.nih.gov/pubmed/22331979/, retrieved on: 2018-04-17.
Mirhosseini, N. et al. (2017): The Effect of Improved Serum 25-Hydroxyvitamin D Status on Glycemic Control in Diabetic Patients: A Meta-Analysis. J Clin Endocrinol Metab. 2017 Sep 1;102(9):3097-3110. https://www.ncbi.nlm.nih.gov/pubmed/28957454, retrieved on: 2018-04-17.
Momen-Heravi, M. et al. (2017): The effects of zinc supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Wound Repair Regen. 2017 May;25(3):512-520. https://www.ncbi.nlm.nih.gov/pubmed/28395131, retrieved on: 13.07.2018.
Moradi, M. et al. (2016): Effect of Coenzyme Q10 Supplementation on Diabetes Biomarkers: a Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials. Arch Iran Med. 2016 Aug;19(8):588-96. https://www.ncbi.nlm.nih.gov/pubmed/27544369, retrieved on: 2018-04-19.
Mousa, A. et al. (2018): Vitamin D supplementation for improvement of chronic low-grade inflammation in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. 2018 May 1;76(5):380-394. https://www.ncbi.nlm.nih.gov/pubmed/29490085, retrieved on: 2018-04-17.
Namazi, N. et al. (2018): Alpha-lipoic acid supplement in obesity treatment: A systematic review and meta-analysis of clinical trials. Clin Nutr. 2018 Apr;37(2):419-428. https://www.ncbi.nlm.nih.gov/pubmed/28629898, retrieved on: 2018-04-17.
Nix, W.A. et al. (2015): Vitamin B status in patients with type 2 diabetes mellitus with and without incipient nephropathy. Diabetes Res Clin Pract. 2015 Jan;107(1):157-65. https://www.ncbi.nlm.nih.gov/pubmed/25458341, retrieved on: 2018-04-19.
Okanović, A. et al. (2015): Alpha-lipoic acid reduces body weight and regulates triglycerides in obese patients with diabetes mellitus. Med Glas (Zenica). 2015 Aug;12(2):122-7. https://www.ncbi.nlm.nih.gov/pubmed/26276648, retrieved on: 2018-04-17.
Palomba, S. et al. (2010): Effects of metformin with or without supplementation with folate on homocysteine levels and vascular endothelium of women with polycystic ovary syndrome. Diabetes Care. 2010 Feb;33(2):246-51. https://www.ncbi.nlm.nih.gov/pubmed/19933994, retrieved on: 2018-04-19.
Porasuphatana, S. et al. (2012): Glycemic and oxidative status of patients with type 2 diabetes mellitus following oral administration of alpha-lipoic acid: a randomized double-blinded placebo-controlled study. Asia Pac J Clin Nutr. 2012;21(1):12-21. https://www.ncbi.nlm.nih.gov/pubmed/22374556, retrieved on: 2018-04-16.
Qu, G.B. et al. (2017): The association between vitamin D level and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus: An update systematic review and meta-analysis. J Clin Transl Endocrinol. 2017 Jun 3;9:25-31. https://www.ncbi.nlm.nih.gov/pubmed/29067266, retrieved on: 2018-04-17.
Roy, R.P. et al. (2016): Study of Vitamin B12 deficiency and peripheral neuropathy in metformin-treated early Type 2 diabetes mellitus. Indian J Endocrinol Metab. 2016 Sep-Oct;20(5):631-637. https://www.ncbi.nlm.nih.gov/pubmed/27730072, retrieved on: 2018-04-19.
Sanjeevi, N. et al. (2018): Trace element status in type 2 diabetes: A meta-analysis. J Clin Diagn Res. 2018 May;12(5):OE01-OE08. https://www.ncbi.nlm.nih.gov/pubmed/29911075, retrieved on: 13.07.2018.
San Mauro-Martin, I. et al. (2016): Chromium supplementation in patients with type 2 diabetes and high risk of type 2 diabetes: a meta-analysis of randomized controlled trials. Nutr Hosp. 2016 Feb 16;33(1):27. https://www.ncbi.nlm.nih.gov/pubmed/27019254, retrieved on: 2018-04-16.
Sarbolouki, S. et al. (2013): Eicosapentaenoic acid improves insulin sensitivity and blood sugar in overweight type 2 diabetes mellitus patients: a double-blind randomised clinical trial. Singapore Med J. 2013 Jul;54(7):387-90. https://www.ncbi.nlm.nih.gov/pubmed/23900468, retrieved on: 2018-04-18.
Savastio, S. et al. (2016): Vitamin D Deficiency and Glycemic Status in Children and Adolescents with Type 1 Diabetes Mellitus. PLoS One. 2016 Sep 8;11(9):e0162554. https://www.ncbi.nlm.nih.gov/pubmed/27607348, retrieved on: 2018-04-17.
Shahbah, D. et al. (2017): Oral magnesium supplementation improves glycemic control and lipid profile in children with type 1 diabetes and hypomagnesaemia. Medicine (Baltimore). 2017 Mar;96(11):e6352. https://www.ncbi.nlm.nih.gov/pubmed/28296769, retrieved on: 2018-04-18.
Shen, X.L. et al. (2016): Effect of Oat β-Glucan Intake on Glycaemic Control and Insulin Sensitivity of Diabetic Patients: A Meta-Analysis of Randomized Controlled Trials. Nutrients. 2016 Jan 13;8(1). pii: E39. https://www.ncbi.nlm.nih.gov/pubmed/26771637, retrieved on: 2018-04-18.
Soleimani, Z. et al. (2017): Clinical and metabolic response to flaxseed oil omega-3 fatty acids supplementation in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. J Diabetes Complications. 2017 Sep;31(9):1394-1400. https://www.ncbi.nlm.nih.gov/pubmed/28716357, retrieved on: 2018-04-18.
Spence, J.D. (2013): B vitamin therapy for homocysteine: renal function and vitamin B12 determine cardiovascular outcomes. Clin Chem Lab Med. 2013 Mar 1;51(3):633-7. https://www.ncbi.nlm.nih.gov/pubmed/23449527, retrieved on: 2018-04-19.
Suksomboon, N. et al. (2014): Systematic review and meta-analysis of the efficacy and safety of chromium supplementation in diabetes. J Clin Pharm Ther. 2014 Jun;39(3):292-306. https://www.ncbi.nlm.nih.gov/pubmed/24635480, retrieved on: 2018-04-16.
Verma, H. & Garg, R. (2017): Effect of magnesium supplementation on type 2 diabetes associated cardiovascular risk factors: a systematic review and meta-analysis. J Hum Nutr Diet. 2017 Oct;30(5):621-633. https://www.ncbi.nlm.nih.gov/pubmed/28150351, retrieved on: 2018-04-18.
Wu, C. et al. (2017): Vitamin D supplementation and glycemic control in type 2 diabetes patients: A systematic review and meta-analysis. Metabolism. 2017 Aug;73:67-76. https://www.ncbi.nlm.nih.gov/pubmed/28732572, retrieved on: 2018-04-17.
Zanchi, A. et al. (2011): Effects of pioglitazone on renal calcium excretion. J Clin Endocrinol Metab. 2011 Sep;96(9):E1482-5. https://www.ncbi.nlm.nih.gov/pubmed/21752899, retrieved on: 2018-04-19.
Zatalia, S.R. & Sanusi, H. (2013): The role of antioxidants in the pathophysiology, complications, and management of diabetes mellitus. Acta Med Indones. 2013 Apr;45(2):141-7. https://www.ncbi.nlm.nih.gov/pubmed/23770795, retrieved on: 2018-04-19.
Zhang, J. et al. (2017): Relationship between vitamin D deficiency and diabetic retinopathy: a meta-analysis. Can J Ophthalmol. 2017 Nov;52 Suppl 1:S39-S44. https://www.ncbi.nlm.nih.gov/pubmed/29074012, retrieved on: 2018-04-17.
Zhang, Q. et al. (2016): Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2016 Dec 9;8(12). pii: E798. https://www.ncbi.nlm.nih.gov/pubmed/27941660, retrieved on: 2018-04-19.
Ziegler, D. et al. (2011): Efficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes Care. 2011 Sep;34(9):2054-60. https://www.ncbi.nlm.nih.gov/pubmed/21775755, retrieved on: 2018-04-17.