Supplements for Diabetes, what products are actually suitable?

Alfredo Valdés 28 April, 2020 Well-being habits Leave a comment

Today, we are going to deal with a topic that raises many questions: “I have diabetes, can I use supplements? Is there any restriction?”

In this post, we will take a look at the particular features of a patient with diabetes in terms of nutrients. Moreover, we will explain the things they have to take into account when it comes to choosing food supplementation depending on their needs and objectives.

Index

1. Diabetes, a general methodology
2. What are the risks of diabetes?
3. Supplements for diabetes, friends or foes?
4. What supplements can be useful for diabetes?
5. Diabetes and Carbohydrate Supplements
6. What are the best carbohydrates for diabetes?
7. Creatine for diabetes
8. Other supplements that improve the performance
9. Bibliography

Diabetes, a general methodology

Before we begin, we need to know that diabetes is a metabolic disease that appears when the organism cannot maintain the glucose homeostasis. Consequently, our glycemia increases uncontrollably when we take carbohydrates.

Figure I. Curve after an oral tolerance test in patients with diabetes (treated and non-treated with insulin) and control (non-diabetic). (Jato et al., 2018).

Above all, there are two “versions” of diabetes:

Type I diabetes: An autoimmune disease that appears when we are born. Basically, the immune system alters the functionality of pancreatic cells in charge of producing insulin. This is the hormone that removes glucose from the blood.
Type II diabetes: A metabolic disease that occurs when the pancreas does produce insulin, but the cells are not sensitive to this hormone.

Imagine you are sending a WhatsApp message to a friend and insulin is the message:

A patient with type I diabetes will never send the message because they do not have internet, so there is never a “signal”.
On the contrary, a patient with type II diabetes will send the message. However, their friend has blocked them, which is why the message will never reach its destination.

In both cases, the message does not arrive, but both situations are still different.

Currently, the diabetes is a metabolic pandemic. In fact, the WHO has already warned us that the number of patients with diabetes has increased almost 4 times in the last 30 years.

Figure II. Infographic from the World Health Organization about diabetes (WHO, 2018).

What are the risks of diabetes?

An uncontrolled diabetes can lead to the onset of potentially deadly conditions. These are usually related to alterations of the cardiovascular system (diabetic nephropathy, peripheral ischemia, ictus and heart attacks).

But, if we control diabetes through behavior therapy (improving the lifestyle) and/or pharmacological treatment, it will be compatible with a normal lifestyle. In fact, there are many high performance athletes who actually have this disease.

Figure III. Sal Fuld in action. Ex-professional player from the MLB with Type I Diabetes mellitus, diagnosed when he was 10 years old.

Supplements for diabetes, friends or foes?

Many athletes who suffer diabetes are afraid of using food supplements because they believe they can make matters worse. Others believe that these products may interact with their pathology in some way.

If you have diabetes, you should consult an endocrinologist about the possibility of using any supplements. Actually, there are no direct contraindications of using a product with a controlled diabetes, specially when we talk about athletes.

What supplements can be useful for diabetes?

Many patients want to improve their body composition:

Lose fat.
Gain muscle mass.

Or their sport performance:

Shorter and better muscle recovery, with more nutrients that will provide energy for the workouts, improving the rest…

Can people with diabetes take Evolate 2.0?

Of course they can!

What about Evowhey 2.0?

Yes!

The protein supplements developed and produced by HSN contain very low amounts of sugar. Therefore, they are not dangerous for this condition, since they do not significantly increase the glycemia (Frid et al., 2005).

In fact, the studies shown metabolic improvements after increasing the protein content from the diet of people with diabetes (Gannon et al., 2003).

Do you want to gain muscle? Do you have diabetes? So what? You have the best supplements within your reach!

Diabetes and Carbohydrate Supplements

Well, once we have cleared that up, let’s take a closer look at the issue at hand… Do you want to take carbohydrates?

Can you take a high glycemic index carbohydrate?

You can, you just have to carry your glucose meter and see how your glycemia reacts.

If you have type I diabetes, follow the insulin administration patterns provided by your endocrinologist. If you suffer type II diabetes, regulate the carbohydrate dose depending on your glycemic response.

For example, dextrose is a high glycemic index carbohydrate. It is particularly useful against hypoglycemia, which is quite frequent in type I diabetes or when doing exercise.

It is quite common to find people with diabetes that suffer blood sugar drops. A controlled and constant intake of a high glycemic index carbohydrates during the workout can definitely improve this condition.

What are the best carbohydrates for diabetes?

There are other preferences when it comes to choosing a “base” carbohydrate:

Palatinose

It is isomaltulose, a disaccharide made up of fructose and glucose (like tabletop sugar). But it has a different bond (1.6- instead of 1.4-), which is harder to “break” by the organism.

This results in a lower blood glucose and insulin response. Therefore, it is a great product for people with diabetes who want a carbohydrate that is easy to digest.

Figure IV. Curve of glucose (a), insulin (b) and glucagon (c) after taking the same amount of tabletop sugar (sucrose) and palatinose (isomaltulose). (Keyhani-Nejad et al., 2016).

Amylopectin

Another choice would be amylopectin, a complex carbohydrate obtained from waxy maize. It is a big and highly branched glucose polymer, which does not cause gastrointestinal discomfort, keeping all the technological properties from starch. For instance, this type of carbohydrate is present in oats. People with diabetes can take this supplement without any big issue as long as they control its intake.

Figure V. Curve of glucose and AUC after taking the same amount of carbohydrates from white bread (control), maltodextrin and amylopectin. (Sands et al., 2009).

People with diabetes always need to try to maintain their glucose concentrations between 200-220mg/dL after a meal, unless the endocrinologist has said otherwise.

Carbohydrates can be used to improve the recovery of athletes, increasing the energy availability. In addition, it improves the performance by increasing the blood glucose concentrations.

These supplements for diabetes are ideal when it comes to gaining muscle mass and improving the recovery.

Creatine for diabetes

Many patients with diabetes are afraid of using creatine because it increases the urinary output of creatinine. This has been traditionally related to renal damage.

The truth is that this association is completely wrong. Those who have a higher protein intake, who use creatine supplementation and do physical exercise, etc. have higher blood creatinine levels. But this does not mean that their kidneys is not functioning properly. Rather, it means that their phosphagen metabolism is more active.

Figure VI. Effects of different variables on the creatinine concentrations that describe the phenotype of active vs sedentary individuals (Hull, 2019).

Alterations in the hematological and biochemical parameters and intense physical exercise have already been discarded as the “cause” of the disease. Athletes have higher concentrations of these markers but that it not something they should worry about. Our colleague Borja Bandera talks more about this issue here.

Then, is creatine safe for people with diabetes?

Of course it is!

Creatine is one of the supplements that are regarded as safe for people with diabetes. It does not alter the functionality or structure of the kidneys, which are the target organ that could be damaged and be prone to nephropathy (Gualano et al., 2011).

Did you know that creatine also helps to control the glucose?

It does! It is an incredibly versatile nutrient. Even if we do not fully understand the way it works, the truth is that creatine helps to control the glucose in “stable” patients with diabetes (Gualano, 2011).

Some say that creatine is literally “a conditionally essential nutrient in chronic renal disease”! (Post et al., 2019).

Like we said, you should consult an endocrinologist since they know your case and they can give you individual advice. Still, creatine has proven to be effective and safe for people with diabetes.

Taking creatine has been related to consistent increase in muscle mass, anaerobic performance and muscle strength (Mielgo-Ayuso et al., 2019, Chilibeck et al., 2017). What are you waiting for to start taking creatine after the workout?

Other supplements that improve the performance

The supplements that we have previously mentioned are those that are more controversial.

There is no solid evidence that proves that these supplements can have adverse effects that can damage a person with diabetes.

In fact, there are many food supplements that are being used to improve the metabolic parameters in people with diabetes which are being used by endocrinologists as adjuvant therapy.

The main effects are…

Supplement	Effects on diabetes
Alpha Lipoic Acid	1. Improves insulin sensitivity. 2. Reduces the lipid peroxidation and protecting the cell membranes. 3. Supports the functioning of the kidneys.
Chromium	1. Lowers the glucose on an empty stomach. 2. Reduces glycosylated hemoglobin and fructosamine, glycation markers. 3. Lowers insulin on an empty stomach, which improves its sensitivity. 4. Improves the functioning of the heart. 5. Decreases glucose and insulin after the meals. 6. Buffers the oxidation and protecting the cells. 7. Improves the lipid profile (lowering the triglycerides)
Folic acid (vitamin B9)	1. Improves the functionality of the vascular walls (improving the circulation)
Isoflavones	1. Reduces glycosylated hemoglobin. 2. Lowers insulin on an empty stomach. 3. Improves the insulin sensitivity. 4. Lowers the total cholesterol and LDL cholesterol. 5. Improves the Cholesterol/HDL-c ratio. 6. Reduces the triglycerides.
Magnesium	1. Decreases the fructosamine concentrations. 2. Handles glucose. 3. Reduces glycosylated hemoglobin. 4. Lowers the cholesterol. 5. Lowers the triglycerides
Pycnogenol	1. Lowers glucose on an empty stomach. 2. Reduces glycosylated hemoglobin. 3. Increases the expression of Endothelin-1, which improves the circulation. 4. Improves the blood flow in the eye capillaries. 5. Improves the visual acuity.
Selenium	1. Reduces the NF-κB expression, an inflammation factor. 2. Buffers the lipid oxidation and protects the cells. 3. Improves the functioning of the kidneys.
Vitamin C	1. Lowers the total and LDL cholesterol. 2. Improves the arterial flexibility, lowering the systolic and diastolic blood pressure. 3. Reduces the production of free radicals. 4. Decreases the insulin concentrations. 5. Lowers the triglycerides.
Vitamin E	1. Reduces the inflammatory markers. 2. Lowers the heart rate and the blood pressure. 3. Improves the antioxidant status. 4. Lowers the LDL. 5. Improves the functioning of the kidneys. 6. Reducing glycosylated hemoglobin.
Zinc	1. Buffers oxidative stress and lipid peroxidation.
Ginseng	1. Lowers the glucose concentrations on an empty stomach. Precaution for people with diabetes who take anticoagulants like Warfarin
Nicotinamide (vitamin B3)	1. Reduces the incretin production, improving the functioning of the pancreas when it comes to producing insulin.
Fenugreek	1. Lowers the insulin on an empty stomach. 2. Reducing glycosylated hemoglobin. 3. Decreases glucose on an empty stomach and after the meals.
Vitamin D	1. Decreases glucose on an empty stomach. 2. Improves the insulin sensitivity.
Cinnamon	1. Decreases glucose on an empty stomach.

Figure VII. Chart that gathers the most studied supplements for diabetes and the current evidence of their utility on controlling parameters associated with diabetes. (Chart adapted from the meta-analysis by Berlett et al., 2008; Ylmaz et al., 2017).

After reading this article, I hope that you understood that, even if you have diabetes, you can practically use any supplement.

Not only you can, but it can actually help to control glucose better. That is why using supplements is a completely valid option for people with diabetes who want to improve their sport performance.