The disorder called diabetes mellitus is actually two very different diseases that share a common feature: high blood sugar. The kind of diabetes that usually develops in childhood (Juvenile Onset Diabetes or Type I Diabetes) occurs because something - a viral infection or chemical toxin - has destroyed the cells in the body that produce insulin.

Without enough insulin, the hormone that controls blood sugar, the body cannot store the calories coming in, and they run right through the body as sugar in the urine. A person with this kind of diabetes will develop weight loss, ravenous appetite and thirst, and constant urination. This kind of diabetes require that the person take injections of insulin and be under the care of a knowledgeable physician.

A person suffering from Type I diabetes can certainly improve with proper nutrition and regular exercise, but without the ability to make insulin, he or she cannot treat the disease by diet alone.

The other kind of diabetes that comes on in adulthood (Adult Onset or Type II Diabetes) develops not from lack of insulin but from overabundance of it. In all of us, when we eat, our blood sugar rises and this signals the gland that makes insulin (the pancreas) to do so.

The insulin acts on sensors in the tissues to allow them to take up the sugar from the blood to use or to store away, and the blood sugar falls to normal. In some people, the pancreas over responds to the call for insulin, providing too much of it.

The high levels of insulin, over time, damage the sensors in the tissues, making them insensitive or unresponsive to that amount of insulin. Then the pancreas must make more, and more, and more to make the sensors respond to bring the blood sugar back to normal. As long as the pancreas can make more insulin, it will, and the body can control blood sugar, however at some point, the sensors become so damaged that the full capacity of insulin available from the pancreas is no longer enough to bring blood sugar back down to normal. Once that point comes, the blood sugar begins to rise, adult onset diabetes mellitus has developed.

The overabundance of insulin can cause other mischief in adult onset diabetics: the production of cholesterol, triglycerides (other blood fats) , heart disease, hardening of the arteries, high blood pressure, salt and fluid retention, and the storage of excess body fat.

This disorder, if caught and treated in time, will respond virtually completely to nutritional rehabilitation and the symptoms will come under control. But diabetes is an unforgiving disorder - keeping it controlled requires constancy and vigilant adherence to your nutritional regimen. You can learn to control it, but the metabolic tendency to produce too much insulin in response to diet always remains. Given access to the wrong kinds of foods, your diabetic state will return, and with it the whole host of medical maladies that were present before.

One final word: If you are an adult onset diabetic, already taking insulin shots or medion by mouth to control your sugar, you must only undertake this kind of nutritional regimen under the care of your personal physician, who can help you adjust the doses of these medions safely as your blood sugar control improves. The control will happen quickly if you adhere strictly to the regimen, and in order to check your sugar and blood pressure (which will also drop quite precipitously) frequently, you may want to invest in (and learn to use) a home blood glucose testing machine and blood pressure cuff. That way, you can monitor your readings, record them, and report them to your physician, who can help you reduce your medion safely.

You could develop insulin shock or severe low blood sugar or blood pressure if you continue to take same doses of medion on this kind of nutritional regimen. I also strongly recommend you find. read, and reread a copy of the book Diabetes Type II (Prentice Hall 1990) by a diabetic physician named Richard Bernstein, which is by far the best book currently available on controlling this disease. But now, let's look at what nutrition can do to help you.

Other sources are: NIDDK and Diabetes KnowledgeBase

What helps it?

The right diet can work miracles in adult onset diabetes. But the diet usually recommended to treat this disorder can make matters worse. Conventional medical wisdom has for years deemed the best diabetic diet to be made of 55 to 60% complex carbohydrate, 30% polyunsaturated fat, and 10 to 15% protein. A quick analysis of that diet, beginning with protein intake, shows the fallacy in the thinking. Look at this with me for a moment.

Let's take as an example an adult man weighing 195 pounds with a lean body mass of 140 pounds. That person will need a minimum of 70 grams of lean protein per day to support his muscles and organs. Each gram of protein accounts for 4 calories; therefore, his minimum protein requirement alone is 280 calories. If that represents 10% of his day's calories, he will eat 2800 calories per day.

That's fine, but now he's supposed to eat 60% of these 2800 calories in complex carbohydrate (starches) , and that comes to 1680 calories of starch. As for protein, every 4 calories of starch is 1 gram, and that means this gentleman will be eating 420 grams of carbohydrate per day. The rest of his calories come from fats, which don't alter insulin response at all.

Now reason with me here. The man is an adult diabetic. His diabetes is the result of many years of a high insulin level. The dietary components that makes insulin rise, unrestrained by opposing hormones, is carbohydrate (starch and sugar). As little as 80 to 100 grams of starch in a day will cause a big outpouring of insulin.

Does it make sense, then, for this person to consume nearly five times that amount of starch every day? Absolutely not! Should we be surprised that the consequences of his diabetes - the blood pressure, the weight gain, the fatigue, the risk for heart disease, the formation of cataracts - don't improve very much on that kind of diet? No!

So what should he have eaten?

- I have outlined the proper composition of macronutrients, protein, carbohydrate and fat, best suited to control of insulin inSection 1, page 28 - Macronutrients, Protein, Carbohydrates, & Fats. Refer to that discussion to construct a diet to maintain control of insulin. In the beginning, to bring insulin into line, you will have to restrict some carbohydrates even more vigorously.

Try to divide your day's intake of protein, starch, and fat into roughly equal portions eaten six times a day. Limit your intake of carbohydrate from all sources to about 5 grams at each sitting (a total of 30 grams per day) until your sugar is normal (consistently under 140).

- Soluble fiber is the component "complex carbohydrates," which slows down the absorption of the digestible starch in the meal and the fat, too. In fruit, the soluble fiber is called pectin, in grains, it is called bran, and in vegetables, it is psyllium. Whatever the name, the function is the same.

As a diabetic, you should ultimately take in at least 50 grams of soluble fiber each day from the foods you eat and from vegetable fiber supplements, but don't go from little fiber to that amount overnight or you will suffer mightily with bloating, gas, and abdominal cramping.

Recommendation: Aim for a steady daily total of at least 50 grams of soluble fiber per day. But do it slowly! Begin by eating a diet that includes fiber - rich vegetables and a little fruit (melon and berries preferred and in small quantities) with each of your six meals. To that base, add a commercial vegetable bulk powder (konsyl, Metamucil, Citrucil) very gingerly. Begin with one quarter teaspoon in a sugar-free citrus beverage with breakfast for one week. Then add a second one - quarter teaspoon dose at diner for one week, and finally take one - quarter teaspoon with each meal, four to six times a day, then three-quarter teaspoon, a full teaspoon, 1 and one - half teaspoon, and finally 2 teaspoons four to six times a day.

That will give you about 30 to 40 grams of soluble fiber in supplemental form to augment what you get from fiber - rich foods in your diet. It is very important that you maintain a constant level of fiber - for example, don't take 60 one day and 10 for three days and then 60 again. Be consistent with your intake, and you'll get the best results in sugar control.

Another.- Vitamin C plays a more critical role in maintaining good health if you are a person with diabetes than with perhaps any other disorder except a major viral illness.

It combats, through potent antioxidant protection, the constant assault on your tissues that high blood sugar causes, strengthens the integrity of small blood vessels (where so much of the damage of diabetes occurs) , improves carbohydrate tolerance, and reduces the "bad" kind of cholesterol and triglycerides (another blood fat).

Recommendation: Take an absolute minimum of 1 gram per day. I would further recommend that over a period of 4 to 6 weeks, you work your way up to a total daily intake of 4 to 8 grams per day using ascorbic acid in crystalline form, or to your bowel tolerance level.

Refer to the discussion of vitamin C in the A to Z Nutrient listing for a schedule of increasing dosage to that level.

Note: People with diabetes suffer a defect in metabolizing ascorbic acid that an lead to breakdown products that can damage the linings of blood vessels. You can prevent this problem by taking the vitamin C along with bioflavinoids.

- Biotin improves the sensitivity of your tissues to insulin and helps to lower blood sugar. It may also help the numbness, pain, and tingling sensations you may experience in your legs, feet, and hands.

Recommendation: Take a dose of about 15mg biotin per day. If you take insulin or oral diabetic medions, you must check your blood sugar frequently each day, because it may fall too low on your current doses of medion.

If you take insulin shots, you should enlist the aid of your personal physician in monitoring your blood sugar when you begin vitamin supplements that may alter it. With the help of your physician, adjust your medions according to the lower need for them.

• The B vitamin group

are important, especially in preventing or relieving the neuropathy (nerve damage) that often comes as a consequence of diabetes. The members of the B group work best when taken all together. Even when you supplement additional amounts of certain members, you should take at least a minimal daily dose of the others. Recommendation: Take 100 mg B - complex daily, along with specific doses of individual B vitamins:

• Niacin (vitamin B3)

is a part of a substance called glucose tolerance factor (GTF) , important in insulin and blood sugar regulation. In studies conducted on insulin - dependent diabetics, the use of niacin supplements enabled 66% of the people to discontinue insulin shots.

Let me hasten to add that these people were adult onset diabetics whose need for insulin had outstripped their own ability to make it and who had to take shots of yet more insulin to control their blood sugar, not juvenile diabetics who can make little or no insulin of their own.

Recommendation: If you are an adult onset diabetic currently taking insulin, take a dose of niacin (as nicotinamide) 500mg three to six times daily (a total of 1.5 to 3 grams per day) while carefully watching blood sugar and slowly tapering insulin dose with the help of your personal physician.

If you do not currently take insulin, you may improve your tolerance of carbohydrate (glucose) by taking 500mg once or twice a day.

Warning: Niacin causes flushing in some people.

Please refer to the full discussion of this vitamin and familiarize yourself with its side effects and interactions.

• Thiamine (vitamin B1)

must be present for your body to use glucose normally. Deficiency of this vitamin can not only worsen blood sugar control, but may contribute to numbness, pain, and tingling in the feet, legs, fingers, and hands that many diabetics experience.

Recommendation: Take 100mg to 200mg thiamine daily for at least 2 weeks to assess your response. If you notice improved sensation and sugar control, continue at this level until your symptoms clear. Maintain on a dose of 50mg daily.

• Levels of Vitamin B6

pyridoxine may fall especially low in people with diabetes who suffer from numbness and tingling sensations.

Supplementation improves the symptoms of nerve damage that cause these feelings some, but not all, people. Deficiency of pyridoxine also seems to worsen the problem of "insulin resistance," which is at the root of the problem of adult onset diabetes.

Recommendation: Take 50mg vitamin B6 (pyridoxine) three times daily for 4 to 6 weeks to assess your response. If your symptoms improve, continue to take the vitamin at a dose of 50mg daily.

Warning: Do not exceed the recommended dosage for this vitamin. Doses of as little as 200mg per day over a several year period have caused irreversible nerve damage in some people.

• Vitamin B12 deficiency

may also contribute to the problems with numbness, tingling, and pain in your feet and hands is diabetes. In this instance, supplementation works best whengiven a shot, although oral doses may also help.

Recommendation: You will need to enlist the aid of your personal physician to administer or prescribe injectable cyanocobalamin (vitamin B12) in a dose of 500 micrograms weekly until the symptoms begin to respond, then dropping to a monthly dose of 500 micrograms indefinitely.

In oral form, take 500 to 1000 micrograms in sublingual (dissolves under the tongue) form weekly for 4 to 6 weeks to assess your response.

The oral route may not work as well, but it's worth a try.

• Vitamin E

the potent antioxidant, may prevent diabetic problems of the small blood vessels, the heart, and the eyes. Supplementation with this vitamin, while beneficial, should be undertaken with care if you take insulin shots, because the vitamin can reduce your need for insulin. It can also increase blood pressure in some people, and for both reasons, you should cautiously increase your dose.

Recommendation: Begin with a 100 IU dose of vitamin E (as alpha-tocopherol succinate). Check blood sugar and blood pressure on this dose. With the help of your personal physician, you may need to drop your insulin dose with each change in vitamin E. Once your blood sugar regulation and insulin dose are stable - and if your blood pressure has not risen above 140/90 - increase your vitamin E dose to 200 IU.

Check and stabilize again for a week or two after each dose increase. If you sugar control and blood pressure remain normal, aim in a stepwise fashion for a daily dose of 600 to 800 IU per day.

• Depletion or loss of Inositol

from the muscle fibers of the blood vessels and in the nerve tissues may contribute to the development of small blood vessel damage (which contributes to high blood pressure and hardening of the arteries) and the numbness tingling in the feet, legs, and hands common in diabetes. Again, some people respond to supplementation with inositol, and others don't seem to.

Recommendation: Take a dose of 500mg of myo-inositol twice a day to 2 weeks to assess your response. If your symptoms respond, continue a dose of 500 to 750mg per day.

• Chromium

is a critical component of glucose tolerance factor (GTF), which is a substance that improves the response of your tissues to insulin and promotes blood sugar control. Deficiency of chromium not only worsens sugar metabolism, pain, and tingling in your feet, legs, and hands that diabetes causes.

Recommendation: Take chromium ( as chromium picolinate, see also ChromeMate) in a dose of 200 micrograms per day, or chromium rich brewer's yeast 9 grams per day. Within 4 to 6 weeks, you should see improvement in blood sugar control, as well as lessening of the tingling sensations.

• Magnesium

deficiency occurs quite commonly in adult diabetics, especially those that must take insulin. Magnesium plays a key role in regulation of blood sugar, energy production, the release of insulin from the pancreas, and as protector and preserver of the fragile, insulin - producing cells (the beta cells) in the pancreas. When your levels of magnesium fall too low, you increase your risk for the complions of diabetes: heart disease, eye disease, kidney disease, and hypertension.

Recommendation: Take 100mg of magnesium twice a day for 4 weeks to assess response. (Also take 1500mg Calcium a day during this period.) You should see at least some improvement of your sugar control, blood pressure, and feel less fatigue.

After that period of 4 weeks, reduce your intake to 500mg per day, taken along with 1000mg of calcium. Refer to the discussions of magnesium and calcium, which interact with one another, for more information about why these two minerals should be taken together.

• Manganese

levels may fall in people with diabetes to as low as one - half the level found in non - diabetic people. Manganese is important in the breakdown and use of blood sugar, and therefore, deficiency of it can cause intolerance to sugar.

Recommendation: If you take insulin or oral medions to lower blood sugar, you must enlist the aid of your personal physicia to carefully watch your blood sugar and help you adjust your medion doses accordingly. Begin with a daily dose of 5 to 10mg. (If you take blood sugar lowering medions or insulin, adjust the doses as your blood sugar level falls.)

After 2 to 3 weeks, increase your dose to 20mg per day (and adjust medicines again if needed) and remain there.

• Phosphorus

deficiency, also common in diabetes, may worsen blood sugar control and contribute to fatigue.

Recommendation: Take phosphorus as calcium phosphate, 1 gram, three times a day. (If you take this kind of calcium - phosphorus supplement, you should discontinue supplementation of other forms of calcium.)

• Potassium

deficiency can worsen the effects of magnesium deficiency on the heart and kidneys and can interfere with the use of glucose (blood sugar) by the tissues.

Recommendation: Begin by eating foods rich in potassium: broccoli, tomatoes, bananas, and citrus fruits. You can purchase a potassium containing salt substitute, called "NO SALT," at most grocery stores. Use one - quarter to one - half teaspoon of this product in cooking each day to add potassium to your diet.

Warning: If you take insulin, do not supplement with extra potassium unless your physician has instructed you to do so after verifying you to be deficient. Dangerously high levels of potassium can result from taking supplemental potassium in this instance.

• Zinc

deficiency can occur in tissues of people with diabetes, even when blood levels test normal. Deficiency of zinc worsens blood sugar control and changes the way your body metabolizes fats.

Recommendation: Take 10 to 20mg chelated zinc (zinc aspartate, picolinate, or gluconate) each day.

Warning: Supplementation of zinc in its ionic form can create deficiencies of other minerals, such as copper, by competing with them for absorption from the intestine.

Chelation of the minerals (see discussion, Section 1, page 34 on Chelation) prevents this competition to get into your body allowing you to fully absorb each of them.

• Diabetes affects the metabolism

of the essential fatty acids linoleic acid (GLA) and marine (fish) oils (EPA) , by altering the body's conversion of these fats into less of the "good" and more of the "bad" kind of eicosinoid messengers. (Eicosinoids, Section 1, page 27 fully explains the action of these hormone - like body chemicals.)

Suffice it to say here, that when you have diabetes, many of the problems that trouble you - high blood pressure, poor circulation, heart disease, nerve damage, cholesterol and blood fat elevation, and hardening of the arteries - occur at least in part because of an overabundance of members of the "bad" eicosinoid group. Regaining a better balance in these chemical messengers will improve your overall health.

Recommendation: Remember to begin with a basic dietary framework as outlined above and in Macronutrients, Section 1, page 26. To that sound base, add gamma-linoleic acid (GLA) and fish oil (EPA) in a ratio of 1:4 (GLA:EPA) one to three times daily.

The EicoPro essential fatty acid product manufactured by Eicotec Inc. of Marblehead, MA contains ultrapure sources of linoleic acid and fish oils already combined in this ratio. If you cannot get that product, you can purchase linoleic acid in a product called evening primrose oil at most health and nutrition stores, and EPA fish oil as well.

Because it is not as pure a form, the milligram dosing will be different. You can make a reasonable substitute by combining evening primrose oil capsules with fish oil capsules plus vitamin E. Take 500mg of evening primrose oil (a source of linoleic acid in capsule form), plus 1000mg EPA fish oil, plus vitamin E 200IU one to three times a day.

(Warning: EPA fish oil can cause blood sugar fluctuations in some diabetics. Carefully monitor your blood sugar if you use this supplemental oil and discontinue its use if your blood sugar becomes difficult to control.)

• The Bioflavinoids

prevent the abnormal metabolism of vitamin C that often occurs in diabetes. If you supplement with vitamin C (and I strongly urge you to do so), you should also supplement with bioflavinoids. Many vitamin C products available at health and nutrition stores already contain bioflavinoids in their formulation. If you supplement at higher doses using the crystalline or powered form of vitamin C, you will want to add these substances to your regimen.

Recommendation: Take the bioflavinoid rutin in a dose of 250 to 500mg with each dose of vitamin C. A mixture of multiple bioflavinoids is available at health and nutrition stores as bioflavinoid complex (1000mg). Take one bioflavinoid complex tablet (1 gram) for each 4 - gram dose of vitamin C you take.

What makes it worse?

Alcohol may further impair your sensitivity to insulin, and it is insensitivity to insulin that is at the very root of the problem. If you are a diabetic in very good control (blood sugars less than 140mg/dl, no numbness or tingling sensations, normal blood pressure, cholesterol and triglycerides in the (normal range) then a modest amount of alcohol - on the order of one once of distilled spirits or a glass of wine or a single "lite" beer per day - probably won't worsen your problem. Heavier drinking certainly could.

Recommendation: Until you have brought your diabetes under very good control, I would advise you to avoid alcohol.

Some diabetic people develop elevations inferritin, the protein that bind and carries iron in the blood. Treatment of these people with a chemical (called desferrioxamine) that chelates the iron (binds it up and allows it to be removed from the body) improved diabetic control, allowed the people to reduce or discontinue insulin and oral blood sugar lowering medions, even reduced their cholesterol and triglycerides. I am not able to say, from the research available to me at this point, whether or not your taking iron in multi-vitamins would lead to worse diabetic symptoms or, on the other hand, whether your reducing iron intake would make a difference in control of your diabetes. Still, the response of this particular group of people with high ferritin levels is quite impressive.

Recommendation: I would certainly recommend that you ask your personal physician to check your ferritin level, and if it is elevated, to consider this treatment for you. I would further not recommend your taking any kind of supplemental iron unless you specifically suffer from iron deficiency and are anemic.

Some recent research (1990) suggests that a protein in cow's milk may promote the development of juvenile onset diabetes.

Recommendation: Although the connection here is a tenuous one so far, I would recommend erring on the side of caution. If your family includes people who developed the childhood form of diabetes (Insulin Dependent or Type 1 diabetes), I would advise not feeding cow's milk to your infant or toddler.