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Health Condition

Type 1 Diabetes

About This Condition

Diabetes mellitus is the reduced ability, or inability, to metabolize carbohydrates resulting from inadequate insulin production or utilization.

Several types of diabetes exist: type 1, type 2, gestational, and several specific types due to “other” causes, such as cystic fibrosis. In types 1 and 2, various genetic and environmental factors result in the loss of pancreatic beta cells, which manifests as hyperglycemia (high blood sugar). This article concerns type 1 diabetes, in which autoimmune destruction of the beta cells of the pancreas result in insulin deficiency.

People with all forms of diabetes face equal risk of the same complications once hyperglycemia occurs. Long-term elevations in blood sugar significantly increase the risk of cardiovascular disease, stroke, kidney and nerve damage, poor wound healing, infections, and eye problems including retinopathy and cataracts.

People with type 1 diabetes should work with the doctor prescribing insulin before using any of the lifestyle or dietary changes mentioned in this article. Any change that makes the body more responsive to insulin could require adjustments in insulin dosage that the treating physician must supervise.1

Reducing Your Risk

Health experts don’t yet know the best ways to reduce type 1 diabetes risk, but they do note that risk can run in families. Your child may be at higher than average risk if you or anyone in your family has type 1 diabetes or an autoimmune condition such as celiac disease or rheumatoid arthritis. Other risk factors include:

  • Genetics. The presence of certain genes can indicate increased type 1 diabetes risk. Having a first-degree relative (parent or sibling) with type 1 diabetes may increase the risk of developing the disease 15-fold.2 Therefore, the presence of type 1 diabetes in one family member may mean other family members should be tested for type 1 diabetes risk factors; however, this testing may not be available at present without participating in a research study.2
  • Low vitamin D levels. Not getting enough vitamin D during infancy and childhood may increase risk.
  • Omega-3 fats. Lack of omega-3 fats in the pregnant mother’s and baby’s diets may increase risk.
  • Timing of adding cereals. Introduction of cereal grains, such as rice—typically a first solid food—into a baby’s diet prior to three months or after seven months may increase risk.
  • Cow’s milk (dairy) products. There is some evidence that early introduction of milk and other dairy into a baby’s diet may increase type 1 diabetes risk, especially in genetically susceptible infants.
  • Geography. Risk appears to increase with distance from the equator. For example, rates of the disease are significantly higher in North America and northern Europe than in countries near the equator.
  • Cold weather. Type 1 diabetes develops more often in winter than summer and is more common in places with cold climates.4
  • Pregnancy and birth factors. Preeclampsia (defined as high blood pressure and excess protein in the mother’s urine), as well as jaundice in the infant at birth, may increase risk.
  • Respiratory infections. Newborns who experience respiratory infections just after birth may have an increased type 1 diabetes risk.
  • Maternal age. Children of younger mothers, especially those under age 25 at the time of birth, may be at increased risk for developing type 1 diabetes.

You can’t change your child’s genetics, and it’s unlikely you’ll be moving specifically to address the potential health risk associated with geography, but if you have or your baby has other risk factors for type 1 diabetes, talk to your pediatrician about steps you can take to potentially minimize the chances that your little one later develops the disease.

Living With It

Our experts recommend the following tips to support your health when managing diabetes symptoms:

  • Dial in your diet. Certain foods and nutrients may improve blood sugar control in people with type 1 diabetes. Olive oil and fiber may provide benefits. Select the Eating Right tab for more information. Monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation, remains a key strategy in achieving glycemic control 2 because dietary carbohydrates have a direct effect on glucose levels after eating. Carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products should be prioritized over intake from other carbohydrate sources.6 Provided that one controls carbohydrate intake, however, the evidence suggests that several different macronutrient distributions/eating patterns may lead to improvements in glycemic and/or CVD risk factors.
  • Work with an expert. Nutrition therapy delivered by a registered dietitian (RD) is recommended for all people with type 1 diabetes; it should begin at diagnosis or at first referral for medical nutrition therapy (MNT), should be comprised of three to four encounters lasting 45–90 minutes, and should be completed within three to six months. At least one follow-up encounter is recommended annually to reinforce lifestyle changes and to evaluate and monitor outcomes that indicate the need for changes in MNT or medication(s); an RD should determine whether additional MNT sessions are needed.6
  • Inquire about insulin. Insulin is a mainstay of type 1 diabetes management. The body does not make this vital hormone at all in people with the condition. But there are many types of insulin, which can be combined in different ways to best manage blood sugar levels. Work with your healthcare provider to find the right options for your lifestyle. Select Medications, above, for more information.
  • Get pumped. In general, intensive management using constant glucose monitoring (CGM) should be strongly encouraged, with active patient/family participation enhancing successful outcomes.2 CGM can be accomplished with or without an insulin pump, which is a device that delivers rapid- or short-acting insulin 24 hours a day through a catheter placed under the skin. If an insulin pump is being utilized, CGM typically is integrated into the pump function. If a pump is not being used, CGM can be accomplished with a tiny sensor inserted under the skin to check glucose levels in tissue fluid. The sensor stays in place for several days to a week, and then must be replaced.
  • Focus on the numbers. As part of a comprehensive intervention, self-monitoring of blood glucose (SMBG) generally, of which CGM is one technique, is a crucial component of effective therapy for type 1 diabetes, because SMBG results are useful in preventing hypoglycemia, adjusting medications, and understanding the impact of appropriate nutrition therapies and physical activity. More frequent SMBG is correlated with lower A1C levels.2
  • Track with accuracy. Finding the right tools to track your blood glucose is important. Learn all you can about the features and costs of various glucose monitors. It may be worth spending a little more if you like extra features, such as an option to download your results to a computer. Select Personal Care, above, for more ideas on tools for a healthier life.
  • Visit the vitamin aisle. Certain dietary supplements, such as magnesium, chromium, and alpha-lipoic acid, may improve blood sugar management or lessen frequency and severity of diabetes complications. Select Vitamins, above, for more information.

References

1. American Diabetes Association Standards of Medical Care in Diabetes—2017. Diabetes Care 2017;40.

2. Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association. American Diabetes Association [cited 2015 Feb 16]. Available from URL: http://care.diabetesjournals.org/content/37/7/2034.

3. Genetics of Diabetes. American Diabetes Association [cited 2015 Feb 16]. Available from URL: http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html.

4. Evert AB, Boucher JL, Cypress M, et al., American Diabetes Association. Nutrition Therapy Recommendations for the Management of Adults With Diabetes. Diabetes Care 2013. 36(11):3821-42.

5. Ruhnau KJ, Meissner HP, Finn JR, et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med 1999;16:1040-3.

6. Reljanovic M, Reichel G, Rett K, et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res 1999;31:171-9.

7. Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care 1999;22:1296-301.

8. Morcos M, Borcea V, Isermann B, et al. Effect of alpha-lipoic acid on the progression of endothelial cell damage and albuminuria in patients with diabetes mellitus: an exploratory study. Diabetes Res Clin Pract 2001;52:175-83.

9. Lee NA, Reasner CA. Beneficial effect of chromium supplementation on serum triglyceride levels in NIDDM. Diabetes Care 1994;17:1449-52.

10. Hermann J, Chung H, Arquitt A, et al. Effects of chromium or copper supplementation on plasma lipids, plasma glucose and serum insulin in adults over age fifty. J Nutr Elderly 1998;18:27-45.

11. Vuorinen-Markkola H, Sinisalo M, Koivisto VA. Guar gum in insulin-dependent diabetes: effects on glycemic control and serum lipoproteins. Am J Clin Nutr 1992;56:1056-60.

12. Ebeling P, Yki-Jarvinen H, Aro A, et al. Glucose and lipid metabolism and insulin sensitivity in type 1 diabetes: the effect of guar gum. Am J Clin Nutr 1988;48:98-103.

13. De Leeuw I, Engelen W, Aerts P, Schrans S. Effect of intensive magnesium supplementation on the in vitro oxidizability of LDL and VLDL in Mg-depleted type 1 diabetic patients. Magnes Res 1998;11:179-82.

14. Sjorgren A, Floren CH, Nilsson A. Oral administration of magnesium hydroxide to subjects with insulin dependent diabetes mellitus. Magnesium1988;121:16-20.

15. McNair P, Christiansen C, Madsbad S, et al. Hypomagnesemia, a risk factor in diabetic retinopathy. Diabetes 1978;27:1075-7.

16. Mimouni F, Miodovnik M, Tsang RC, et al. Decreased maternal serum magnesium concentration and adverse fetal outcome in insulin-dependent diabetic women. Obstet Gynecol 1987;70:85-9.

17. American Diabetes Association. Magnesium supplementation in the treatment of diabetes. Diabetes Care 1992;15:1065-7.

18. Scharrer A, Ober M. Anthocyanosides in the treatment of retinopathies. Klin Monatsblatt Augenheilk 1981;178:386-9.

19. Coggeshall JC, Heggers JP, Robson MC, Baker H. Biotin status and plasma glucose in diabetics. Ann NY Acad Sci 1985;447:389-92.

20. Koutsikos D, Agroyannis B, Tzanatos-Exarchou H. Biotin for diabetic peripheral neuropathy. Biomed Pharmacother 1990;44:511-4.

21. [No authors listed]Gymnema sylvestre. Altern Med Rev 1999;4:46-7.

22. Shanmugasundaram ER, Rajeswari G, Baskaran K, et al. Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus. J Ethnopharmacol 1990;30:281-94.

23. Joffe DJ, Freed SH. Effect of extended release gymnema sylvestre leaf extract (Beta Fast GXR) alone or in combination with oral hypoglycemics or insulin regimens for type 1 and type 2 diabetes. Diabetes In Control Newsletter 2001;76:no page number.

24. Abdel-Aziz MT, Abdou MS, Soliman K, et al. Effect of carnitine on blood lipid pattern in diabetic patients. Nutr Rep Int 1984;29:1071-9.

25. Jain RC, Sachdev KN. A note on hypoglycemic action of onion in diabetes. Curr Med Pract 1971;15:901-2.

26. Mathew PT, Augusti KT. Hypoglycaemic effect of onion, Allium cepa Linn, on diabetes mellitus, a preliminary report. Indian J Physiol Pharmacol 1975;19:231-7.

27. Tjokroprawiro A, Pikir BS, Budhiarta AA, et al. Metabolic effects of onion and green beans on diabetic patients. Tohoku J Exp Med 1983;141(suppl):671-6.

28. Sharma KK, Gupta RK, Gupta S, Samuel KC. Antihyperglycemic effect of onion: Effect on fasting blood sugar and induced hyperglycemia in man. Indian J Med Res 1977;65:422-9.

29. Haugen HN. The blood concentration of thiamine in diabetes. Scand J Clin Lab Invest 1964;16:260-6.

30. Abbas ZG, Swai ABM. Evaluation of the efficacy of thiamine and pyridoxine in the treatment of symptomatic diabetic peripheral neuropathy. East African Med J 1997;74:804-8.

31. Stracke H, Lindemann A, Federlin K. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy. Exp Clin Endocrinol Diabetes 1996;104:311-6.

32. Molnar GD, Berge KG, Rosevear JW, et al. The effect of nicotinic acid in diabetes mellitus. Metabolism 1964;13:181-9.

33. Gaut ZN, Pocelinko R, Solomon HM, Thomas GB. Oral glucose tolerance, plasma insulin, and uric acid excretion in man during chronic administration in nicotinic acid. Metabolism 1971;20:1031-5.

34. Clearly JP. Vitamin B3 in the treatment of diabetes mellitus: case reports and review of the literature. J Nutr Med 1990;1:217-25.

35. Lewis CM, Canafax DM, Sprafka JM, Bazrbosa JJ. Double-blind randomized trail of nicotinamide on early-onset diabetes. Diabetes Care 1992;15:121-3.

36. Chase HP, Butler-Simon N, Garg S, et al. A trial of nicotinamide in newly diagnosed patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia1990;33:444-6.

37. Mendola G, Casamitjana R, Gomis R. Effect of nicotinamide therapy upon B-cell function in newly diagnosed type 1 (insulin-dependent) diabetic patients. Diabetologia1989;32:160-2.

38. Pozzilli P, Browne PD, Kolb H. Meta-analysis of nicotinamide treatment in patients with recent-onset type 1. The nicotinamide trialists. Diabetes Care 1996;19:1357-63.

39. Vidal J, Fernandez-Balsells M, Sesmilo G, Aguilera E. Effects of nicotinamide and intravenous insulin therapy in newly diagnosed type 1 diabetes. Diabetes Care 2000;23:360-4.

40. Elliott RB, Picher CC, Fergusson DM, Stewart AW. A population based strategy to prevent insulin-dependent diabetes using nicotinamide. J Pediatr Endocrinol Metab 1996;9:501-9.

41. Lampeter EF, Klinghammer A, Scherbaum WA, et al. The Deutsche Nicotinamide Intervention Study. An attempt to prevent type 1 diabetes. Diabetes1998;47:980-4.

42. Visalli N, Cavallo MG, Signore A, et al. A multi-centre randomized trial of two different doses of nicotinamide in patients with recent-onset type 1 diabetes (The IMDIAB VI). Diabetes Metab Res Rev 1999;15:181-5.

43. Haugen HN. The blood concentration of thiamine in diabetes. Scand J Clin Lab Invest 1964;16:260-6.

44. Abbas ZG, Swai ABM. Evaluation of the efficacy of thiamine and pyridoxine in the treatment of symptomatic diabetic peripheral neuropathy. East African Med J 1997;74:804-8.

45. Stracke H, Lindemann A, Federlin K. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy. Exp Clin Endocrinol Diabetes 1996;104:311-6.

46. Visalli N, Cavallo MG, Signore A, et al. A multi-centre randomized trial of two different doses of nicotinamide in patients with recent-onset type 1 diabetes (The IMDIAB VI). Diabetes Metab Res Rev 1999;15:181-5.

47. Wilson RG, Davis RE. Serum pyridoxal concentrations in children with diabetes mellitus. Pathology 1977;9:95-9.

48. Davis RE, Calder JS, Curnow DH. Serum pyridoxal and folate concentrations in diabetics. Pathology 1976;8:151-6.

49. McCann VJ, Davis RE. Serum pyridoxal concentrations in patients with diabetic neuropathy. Aust N Z J Med 1978;8:259-61.

50. Passariello N, Fici F, Giugliano D, et al. Effects of pyridoxine alpha-ketoglutarate on blood glucose and lactate in type I and II diabetics. Int J Clin Pharmacol Ther Toxicol 1983;21:252-6.

51. Solomon LR, Cohen K. Erythrocyte O2 transport and metabolism and effects of vitamin B6 therapy in type II diabetes mellitus. Diabetes 1989;38:881-6.

52. Cunningham JJ, Ellis SL, McVeigh KL, et al. Reduced mononuclear leukocyte ascorbic acid content in adults with insulin-dependent diabetes mellitus consuming adequate dietary vitamin C. Metabolism1991;40:146-9.

53. Davie SJ, Gould BJ, Yudkin JS. Effect of vitamin C on glycosylation of proteins. Diabetes 1992;41:167-73.

54. Will JC, Byers T. Does diabetes mellitus increase the requirement for vitamin C? Nutr Rev 1996;54:193-202 [review].

55. McAuliffe AV, Brooks BA, Fisher EJ, et al. Administration of ascorbic acid and an aldose reductase inhibitor (tolrestat) in diabetes: effect on urinary albumin excretion. Nephron 1998;80:277-84.

56. Branch DR. High-dose vitamin C supplementation increases plasma glucose. Diabetes Care1999;22:1218 [letter].

57. Mayer-Davis E, Bell RA, Reboussin BA, et al. Antioxidant nutrient intake and diabetic retinopathy. The San Luis Valley Diabetes Study. Ophthalmology 1998;105:2264-70.

58. Labriji-Mestaghanmi H, Billaudel B, Garnier PE, Sutter BCJ. Vitamin D and pancreatic islet function. I. Time course for changes in insulin secretion and content during vitamin deprivation and repletion. J Endocrine Invest 1988;11:577-84.

59. Hypponen E, Laara E, Reunanen A, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet2001;358:1500-3.

60. Simpson M, Brady H, Yin X, et al. No association of vitamin D intake or 25-hydroxyvitamin D levels in childhood with risk of islet autoimmunity and type 1 diabetes: the Diabetes Autoimmunity Study in the Young (DAISY). Diabetologia 2011;54:2779-88.

61. Gabbay MAL, Sato MN, Finazzo C, et al. Effect of cholecalciferol as adjunctive therapy with insulin on protective immunologic profile and decline of residual beta-cell function in new-onset type 1 diabetes mellitus. Arch Pediatr Adolesc Med 2012;166:601-7.

62. Nakamura T, Higashi A, Nishiyama S, et al. Kinetics of zinc status in children with IDDM. Diabetes Care 1991;14:553-7.

63. Mocchegiani E, Boemi M, Fumelli P, Fabris N. Zinc-dependent low thymic hormone level in type I diabetes. Diabetes1989;12:932-7.

64. Rao KVR, Seshiah V, Kumar TV. Effect of zinc sulfate therapy on control and lipids in type I diabetes. J Assoc Physicians India 1987;35:52 [abstract].

65. Cunningham JJ, Fu A, Mearkle PL, Brown RG. Hyperzincuria in individuals with insulin-dependent diabetes mellitus: concurrent zinc status and the effect of high-dose zinc supplementation. Metabolism1994;43:1558-62.

66. Maxwell SR, et al. Poor glycaemic control is associated with reduced serum free radical scavenging (antioxidant) activity in non-insulin-dependent diabetes mellitus. Ann Clin Biochem 1997;34( Pt 6):638-44.

67. Jayaprakasam B, Vareed SK, Olson LK, Nair MG. Insulin secretion by anthocyanins and anthocyanidins. J Agric Food Chem 2005;53:28-31.

68. Boivin M, Zinsmeister AR, Go VL, DiMagno EP. Effect of a purified amylase inhibitor on carbohydrate metabolism after a mixed meal in healthy humans. Mayo Clin Proc 1987;62:249-55.

69. Boivin M, Flourie B, Rizza RA, et al. Gastrointestinal and metabolic effects of amylase inhibition in diabetics. Gastroenterology 1988;94:387-94.

70. Lankisch M, Layer P, Rizza RA, DiMagno EP. Acute postprandial gastrointestinal and metabolic effects of wheat amylase inhibitor (WAI) in normal, obese, and diabetic humans. Pancreas 1998;17:176-81.

71. Holt PR, Thea D, Yang MY, Kotler DP. Intestinal and metabolic responses to an alpha-glucosidase inhibitor in normal volunteers. Metabolism 1988;37:1163-70.

72. Layer P, Rizza RA, Zinsmeister AR, et al. Effect of a purified amylase inhibitor on carbohydrate tolerance in normal subjects and patients with diabetes mellitus. Mayo Clin Proc 1986;61:442-7.

73. Zhang T, Hoshino M, Iguchi K, et al. Ginseng root: Evidence for numerous regulatory peptides and insulinotropic activity. Biomed Res 1990;11:49-54.

74. Suzuki Y, Hikino H. Mechanisms of hypoglycemic activity of panaxans A and B, glycans of Panax ginseng roots: Effects on plasma levels, secretion, sensitivity and binding of insulin in mice. Phytother Res 1989;3:20-4.

75. Waki I, Kyo H, Yasuda M, Kimura M. Effects of a hypoglycemic component of ginseng radix on insulin biosynthesis in normal and diabetic animals. J Pharm Dyn 1982;5:547-54.125.

76. Shigeta Y, Izumi K, Abe H. Effect of coenzyme Q7 treatment on blood sugar and ketone bodies of diabetics. J Vitaminol (Kyoto) 1966;12:293-8.

77. Henriksen JE, Bruun Andersen C, Hother-Nielsen O, et al. Impact of ubiquinone (coenzyme Q10) treatment on glycaemic control, insulin requirement and well-being in patients with Type 1 diabetes mellitus. Diabet Med 1999;16:312-8.

78. Jamal GA, Carmichael H. The effect of gamma-linolenic acid on human diabetic peripheral neuropathy: a double-blind placebo-controlled trial. Diabet Med 1990;7:319-23.

79. Dyer O. GMC reprimands doctor for research fraud. BMJ 2003;326:730.

80. Hannan JM, Rokeya B, Faruque O, et al. Effect of soluble dietary fibre fraction of Trigonella foenum graecum on glycemic, insulinemic, lipidemic and platelet aggregation status of Type 2 diabetic model rats. J Ethnopharmacol 2003;88:73-7.

81. Broca C, Manteghetti M, Gross R, et al. 4-Hydroxyisoleucine: effects of synthetic and natural analogues on insulin secretion. Eur J Pharmacol 2000;390:339-45.

82. Puri D, Prabhu KM, Murthy PS. Mechanism of action of a hypoglycemic principle isolated from fenugreek seeds. Indian J Physiol Pharmacol 2002;46:457-62.

83. Sharma RD, Raghuram TC, Rao NS. Effect of fenugreek seeds on blood glucose and serum lipids in type I diabetes. Eur J Clin Nutr 1990;44:301-6.

84. Zak A, Zeman M, Hrabak P, et al. Changes in the glucose tolerance and insulin secretion in hypertriglyceridemia: effects of dietary n-3 fatty acids. Nutr Rep Int 1989;39:235-42.

85. Okuda Y, Mizutani M, Ogawa M, et al. Long-term effects of eicosapentaenoic acid on diabetic peripheral neuropathy and serum lipids in patients with type II diabetes mellitus. J Diabetes Complications 1996;10:280-7.

86. Mori TA, Vandongen R, Masarei JR, et al. Comparison of diets supplemented with fish oil or olive oil on plasma lipoproteins in insulin-dependent diabetics. Metabolism1991;40:241-6.

87. Mori TA, Vandongen R, Masarei JR. Fish oil-induced changes in apolipoproteins in IDDM subjects. Diabetes Care 1990;13:725-32.

88. Koltringer P, Langsteger W, Lind P, et al. [Ginkgo biloba extract and folic acid in the therapy of changes caused by autonomic neuropathy]. Acta Med Austriaca 1989;16:35-7 [in German].

89. Doi K. Effect of konjac fibre (glucomannan) on glucose and lipids. Eur J Clin Nutr 1995;49(Suppl. 3):S190-7 [review].

90. Alam MM, Siddiqui MB, Hussain W. Treatment of diabetes through herbal drugs in rural India. Fitoterapia 1990;61:240-2.

91. Sachdewa A, Khemani LD. Effect of Hibiscus rosa sinensis Linn ethanol flower extract on blood glucose and lipid profile in streptozotocin induced diabetes in rats. J Ethnopharmacol2003;89:61-6.

92. Salway JG, Whitehead L, Finnegan JA, et al. Effect of myo-inositol on peripheral-nerve function in diabetes. Lancet1978;2:1282-4.

93. Gregersen G, Borsting H, Theil P, Servo C. Myoinositol and function of peripheral nerves in human diabetics. Acta Neurol Scand 1978;58:241-8.

94. Kosenko LG. Concentration of trace elements in the blood of patients with diabetes mellitus. Fed Proc Transl (Suppl) 1965;24:237-8.

95. Baly DL, Schneiderman JS, Garcia-Welsh AL. Effect of manganese deficiency on insulin binding, glucose transport and metabolism in rat adipocytes. J Nutr 1990;120:1075-9.

96. Rubenstein AH, Levin NW, Elliott GA. Hypoglycaemia induced by manganese. Nature (London) 1962;194:188-9.

97. Gray AM, Flatt PR. Insulin-secreting activity of the traditional antidiabetic plant Viscum album (mistletoe). J Endocrinol 1999;160:409-14.

98. Swanson-Flatt SK, Day C, Bailey CJ, Flatt PR. Evaluation of traditional plant treatments for diabetes: Studies in streptozotocin-diabetic mice. Acta Diabetologica Latina 1989;26:51-5.

99. Peirce A. Practical Guide to Natural Medicines. New York: William Morrow and Co., 1999, 469-71.

100. Gaby A. Preventing complications of diabetes Townsend Letter 1985;32:307 [editorial].

101. Van der Hem LG, van der Vliet JA, Bocken CF, et al. Ling Zhi-8: studies of a new immunomodulating agent. Transplantation1995;60:438-43.

102. Jones K. Reishi mushroom: Ancient medicine in modern times. Alt Compl Ther 1998;4:256-66 [review].

103. Cao Q, Qu W, Deng Y, et al. Effect of flavonoids from the seed and fruit residue of Hippophaerhamnoides L. on glycometabolism in mice. Zhong Yao Cai2003;26:735-7 [In Chinese].

104. Wang J, Zhang W, Zhu D, et al. Hypolipidaemic and hypoglycaemic effects of total flavonoids from seed residues of Hippophaerhamnoides L. in mice fed a high-fat diet J Sci Food Agric 2011;91:1446-51.

105. Nemes-Nagy E, Szocs-Molnár T, Dunca I, et al. Effect of a dietary supplement containing blueberry and sea buckthorn concentrate on antioxidant capacity in type 1 diabetic children. ActaPhysiologicaHungarica 2008; 95: 383-393.

106. Crary EJ, McCarty MF. Potential clinical applications for high-dose nutritional antioxidants. Med Hypotheses 1984;13:77-98.

107. Franconi F, Bennardini F, Mattana A, et al. Plasma and platelet taurine are reduced in subjects with insulin-dependent diabetes mellitus: effects of taurine supplementation. Am J Clin Nutr 1995;61:1115-9.

108. Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes Res Clin Pract 1998;39:115-21.

109. Zheg HT, Huang XM, Sun JH. Treatment of diabetic cystopathy by acupuncture and moxibustion. J Tradit Chin Med 1986;6:243-8.

110. Zhang W. Acupuncture for treatment of diabetic urinary bladder neural dysfunction—a report of 36 cases. J Tradit Chin Med 1997;17:211-3.

111. Evert AB, Boucher JL, Cypress M, et al., American Diabetes Association. Nutrition Therapy Recommendations for the Management of Adults With Diabetes. Diabetes Care 2013. 36(11):3821-42.

112. Smart CE, King BR, McElduff P, Collins CE. In children using intensive insulin therapy, a 20-g variation in carbohydrate amount significantly impacts on postprandial glycaemia. Diabet Med. 2012;29(7):e21-4.

113. Smart CE, Evans M, O'Connell SM, et al. Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive. Diabetes Care 2013;36:3897-902. Available from URL: http://care.diabetesjournals.org/content/36/12/3897.long.

114. Evert AB, Boucher JL, Cypress M, et al., American Diabetes Association. Nutrition Therapy Recommendations for the Management of Adults With Diabetes. Diabetes Care 2013. 36(11):3821-42.

115. Muntoni S, Cocco P, Aru G, Cucca F. Nutritional factors and worldwide incidence of childhood type 1 diabetes. Am J Clin Nutr 2000;71:1525-9.

116. Luopajärvi K, Savilahti E, Virtanen SM, et al. Enhanced levels of cow's milk antibodies in infancy in children who develop type 1 diabetes later in childhood. Pediatr Diabetes 2008;9:434-41.

117. Knip M, Virtanen SM, Seppä K, Ilonen J, Savilahti E, Vaarala O, Reunanen A, Teramo K, Hämäläinen AM, Paronen J, Dosch HM, Hakulinen T, Akerblom HK; Finnish TRIGR Study Group. Dietary intervention in infancy and later signs of beta-cell autoimmunity. N Engl J Med. 2010;363(20):1900-8.

118. Due A, Larsen TM, Hermansen K, et al. Comparison of the effects on insulin resistance and glucose tolerance of 6-mo high-monounsaturated-fat, low-fat, and control diets. Am J Clin Nutr. 2008;87(4):855-62.

119. Strychar I, Ishac A, Rivard M, et al. Impact of a high-monounsaturated-fat diet on lipid profile in subjects with type 1 diabetes. J Am Diet Assoc. 2003;103(4):467-74.

120. Evert AB, Boucher JL, Cypress M, et al., American Diabetes Association. Nutrition Therapy Recommendations for the Management of Adults With Diabetes. Diabetes Care 2013. 36(11):3821-42.

121. Added Sugars. American Heart Association [updated 2014 Nov 19]. Available from URL: http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Added-Sugars_UCM_305858_Article.jsp.

122. Grimm J-J, Muchnick S. Type I diabetes and marathon running. Diabetes Care 1993;16:1624 [letter].

123. Bell DSH. Exercise for patients with diabetes—benefits, risks, precautions. Postgrad Med 1992;92:183-96 [review].

124. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2003;26:S51-S61 [review].

125. Ajani UA, Gaziano JM, Lotufo PA, et al. Alcohol consumption and risk of coronary heart disease by diabetes status. Circulation2000;102:500-5.

126. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002;25:148-98 [review].

127. Young RJ, McCulloch DK, Prescott RJ, Clarke PF. Alcohol: another risk factor for diabetic retinopathy? BMJ 1984;288:1035.

128. Moss SE, Klein R, Klein BE. The association of alcohol consumption with the incidence and progression of diabetic retinopathy. Ophthalmology1994;101:196-8.

129. Stegmayr B, Lithner F. Tobacco and end stage diabetic nephropathy. BMJ 1987;295:581-2.

130. Scala C, LaPorte RE, Dorman JS, et al. Insulin-dependent diabetes mellitus mortality—the risk of cigarette smoking. Circulation1990;82:37-43.

131. Rimm EB, Manson JE, Stampfer MJ, et al. Cigarette smoking and the risk of diabetes in women. Am J Public Health 1993;83:211-4.

132. [No authors listed.] Position statement: Tests of glycemia in diabetes. American Diabetes Association. Diabetes Care 2000;23(Suppl 1):S80-2.

133. Goldstein DE, Little RR, Lorenz RA, et al. Tests of glycemia in diabetes. Diabetes Care 1995;18:896-909 [review].

134. Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association. American Diabetes Association [cited 2015 Feb 16]. Available from URL: http://care.diabetesjournals.org/content/37/7/2034.

135. Gallichan M. Self monitoring of glucose by people with diabetes: evidence based practice. BMJ 1997;314:964-7 [review].

136. Steel LG. Identifying technique errors. Self-monitoring of blood glucose in the home setting. J Gerontol Nurs 1994;20:9-12.

137. Foster SA, Goode JV, Small RE. Home blood glucose monitoring. Ann Pharmacother 1999;33:355-63 [review].

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