A Safer Oral Drug to Lower Blood Glucose Levels
Note: Because metformin (Glucophage) works from a different prospective in that it does not increase insulin production, it was selected for singular review.

The drug metformin (Glucophage) lowers the amount of sugar in the bloodstream by decreasing sugar production and absorption and by helping the body respond to its own insulin. Many American physicians now prescribe metformin as the first drug of choice. It was safely used in Europe decades before gaining FDA approval.

Metformin lowers fasting blood sugar levels in individuals at risk for Type II diabetes without causing a significant risk of becoming hypoglycemic. However, metformin-induced hypoglycemia is possible in older, weak, and undernourished people as well as those with kidney, liver, adrenal, or pituitary gland problems. If meals are missed, alcohol is consumed, or exercise becomes excessive, hypoglycemia could occur (PDR 1999).

Metformin increases insulin sensitivity, lowers serum insulin levels, and induces moderate weight loss. Metformin causes the number of insulin receptors in muscle and adipocyte cells (fat cells) to increase. Studies have demonstrated that metformin reduces fasting plasma glucose concentrations by 60-70 mg/dL in patients with Type II diabetes as well as HbA1c (Ketz 2001; Life Extension Foundation 2001).

Individuals who need support in maintaining diet-induced weight loss may find additional benefit from metformin therapy. Along with better weight management, some individuals experience a decrease in the incidence of diabetes-associated infections. Some metformin users experience reductions in total and LDL cholesterol, free fatty acids, and two markers reflecting endothelial damage (tissue plasminogen activator antigen and von Willebrand factor) (Charles et al. 1999).

Metformin has better tolerability than many other antidiabetic prescription drugs, but individuals with congestive heart failure or kidney and liver disease are not candidates for metformin therapy. The restriction extends to include those who use alcohol to excess. A benchmark assessment of kidney function followed by an annual renal evaluation is essential (PDR 1999). Vitamin B12 levels should also be regularly checked because chronic use of metformin could cause a deficiency in both folic acid and vitamin B12, resulting in neurological impairment and disruption in homocysteine clearance.

A rare side effect associated with metformin is lactic acidosis, an accumulation of lactic acid in the bloodstream, resulting in a lower pH in muscles and serum (Klow et al. 2001). Almost all reported lactic acidosis cases occurred when metformin and a contrast medium were used in patients with preexisting poor renal function. Metformin should not be used for 2 days before or after having an x-ray procedure with an injectable contrast agent (radioactive iodine).

A number of food and drug interactions could occur with metformin therapy, but from natural medicine, high-dose niacin is the only dietary supplement that appears contraindicated. It is important to note that metformin (or any other antidiabetic drug) is only an aid to better glucose control, not a substitute for a good diet and a health-centered lifestyle with emphasis on exercise and stress reduction.

Many physicians report success when prescribing 500 mg of metformin 2-3 times a day to patients over 40, without extenuating health issues that preclude its usage.

SUMMARY

Diabetes mellitus is a disease characterized by disturbance in the body's use of glucose.

In Type I diabetes mellitus, the body does not make enough of the hormone insulin, which is needed for most tissues to be able to access and use glucose.

In Type II diabetes mellitus, the patient actually over produces insulin and experiences a systemic metabolic disorder that precludes the efficient utilization of glucose. Type II diabetes is the most commonly seen form of the disease. Everyone who is overweight is at risk of developing this disease.

In the later stages of Type II diabetes, the beta cells in the pancreas become dysfunctional and insulin-enhancement therapy becomes necessary. One of the objectives of this protocol is to keep Type II diabetics from progressing to the point where damaging insulin-enhancing therapies become necessary to suppress elevated blood glucose.

For the majority of Type II diabetics, the most important therapy to prevent or reverse the disease is to reduce excess body fat. The reader is asked to refer to the Obesity protocol to learn about novel methods of suppressing excess serum insulin, removing fat from storage and keeping new fat from accumulating in the body. Introducing physical activity into a sedentary lifestyle is also a critical therapeutic component.

The following list summarizes the nutrients profiled in the Therapeutic Section:

Alpha-lipoic acid protects LDL against oxidation and is beneficial in preventing and treating Syndrome X and diabetic complications such as neuropathy. As little as 250-500 mg daily of alpha-lipoic acid may be sufficient in healthy individuals. Diabetics usually take 250-500 mg of alpha-lipoic acid 3 times daily. For the last 30 years, German practitioners have used high doses of lipoic acid to improve insulin sensitivity and diabetic conditions.

Carnosine interferes with the toxic glycation process, thereby preventing the formation of nonfunctioning structures in the body known as AGEs. Diabetics have greatly accelerated rates of glycation compared to nondiabetics. A suggested dosage is 1000 mg daily.
Essential fatty acids protect the plasma membrane insulin receptors and reduce CRP. Type II diabetics should supplement with at least 900 mg of GLA a day from borage oil, along with 500 mg of EPA and 1300 mg of DHA from fish oil. By using highly concentrated borage and fish oil supplements, this quantity of fatty acids (GLA, EPA, and DHA) can be obtained in 8 capsules.
Carnitine improves blood glucose management and increases insulin sensitivity and glucose storage, essential for fat and carbohydrate metabolism. Deficiencies correlate with diabetic neuropathy. A suggested acetyl-L-carnitine dosage is 500-1000 mg twice daily.
Chromium regulates blood glucose levels, fights insulin resistance, lowers HbA1c, aids in weight loss, and inhibits glycation. A suggested dosage is 200-600 mcg daily.
DHEA deficiency is associated with a higher rate of insulin resistance and diabetes. A suggested dosage is 15-75 mg, taken early in the day (50 mg represents a typical daily dose). For a discussion relating to caveats surrounding DHEA supplementation, refer to the Therapeutic Section of this protocol.
CLA aids weight loss and may improve insulin sensitivity. A suggested CLA daily dose is 3000-4000 mg (usually four to five 1000-mg (76%) CLA capsules).
Magnesium lowers blood glucose levels, increases insulin sensitivity, and calms the SNS. Use at least 500 mg of elemental magnesium daily.
Silymarin improves hepatic glucose control and reduces free-radical activity. A suggested dosage for Syndrome X patients (those not yet diagnosed with diabetes) is a supplement that provides 250 mg a day of silibinin and 60 mg of silymarin. Diabetic patients often take 2-3 of these silibinin/silymarin capsules each day.
N-acetyl-L-cysteine (NAC) protects beta cells against free-radical destruction. A suggested dosage is 600 mg daily.
CoQ10 enhances beta cell function and glycemic control and protects against heart disease. A suggested dosage is 100-300 mg a day.
Vitamin C lowers blood glucose levels, inhibits glycation, prevents accumulation of sorbitol, strengthens capillaries, aids wound healing, and protects against free radicals. A suggested dosage is 1-3 grams daily in divided doses.
Vitamin E reduces oxidative stress, enhances insulin sensitivity and glucose transport, and prevents complications arising from inflammation. Antidiabetic value has been observed using from 400-1200 IU of alpha tocopherol vitamin E daily along with a supplement that provides at least 200 mg of gamma tocopherol.
Bilberry reduces blood glucose levels. A suggested dosage is 100-200 mg 3 times daily. (The bilberry extract should be standardized to contain 25% anthocyanidins.)
Biotin aids in metabolism of macronutrients, enhances glucose utilization, and is beneficial in diabetic neuropathy. A suggested antidiabetic dosage is 8000-16,000 mcg daily.
Vitamin K appears to play a role in insulin's response to glucose. Vitamin K is nontoxic at the recommended 10-mg daily dose.
A convenient way to obtain many of the nutrients listed is to take the following formulas:

Life Extension Mix
Life Extension Super Booster
ChronoForte
Super GLA/DHA
Some of the nutrients listed are to be taken individually.

Drug considerations:
In addition to diet modification, increased physical activity, and nutrient supplementation, Type II diabetics should consider low-dose aspirin (81 mg per day) to reduce their risk of heart attack and stroke.

The most effective prescription drug to treat many pathological mechanisms of Type II diabetes is metformin sold under the trade name Glucophage. Metformin is also available in generic form. Typical doses of metformin prescribed are 500 mg 2-3 times a day.

Aminoguanidine assists in controlling AGEs, a process that advances diabetic complications. Since aminoguanidine is not readily available, natural alternatives (alpha-lipoic acid, aspirin, carnosine, chromium, and vitamin C) become particularly attractive options.

Drugs to avoid:
If at all possible, avoid the sulfonylurea class of drugs that work by stimulating pancreatic secretion of insulin. While these drugs can lower elevated blood glucose for the short-term, they increase the risk of severe diabetic complications in the future. Insulin injections also increase the likelihood of diabetic complications. Persons with advanced diabetes may need insulin-enhancement therapy, but the objective is to control the disease state so that the body does not require huge amounts of insulin to maintain glycemic control.

Note: Although fiber improves insulin sensitivity and reduces hyperinsulinemia, fiber should be slowly added to the diet, allowing time for digestive adjustments. Calculate the amount of fiber gained from foodstuffs and supplement to compensate for shortfalls. Successful trials used 50 grams of soluble and insoluble fibers a day. Monitor blood glucose levels closely to assess gains and to adjust either oral or injectable hypoglycemic agents. It is important that prediabetic and diabetic patients be evaluated regarding hemochromatosis, periodontal disease, and CRP levels. These conditions can hasten the onset of diabetes or worsen blood glucose control in confirmed cases; conversely, the correction of these anomalies can culminate in remarkable gains.
Refer to the Obesity protocol for critical information about suppressing excess serum insulin and reducing the percentage of body fat.

For more information

Contact the American Diabetes Association, (800) 232-3472.

Diabetes Protocol Pg (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease