Blood Sugar Support Protocol: A Resource for Practitioners


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by Fullscript’s Integrative Medical Advisory Team

In 2017, the National Diabetes Statistics Report reported that the total number of individuals with diabetes was over 30 million in the United States, accounting for 9.4% of the population. Nearly one-quarter of these cases were undiagnosed. (3) The most prevalent form of diabetes, type 2 diabetes, accounted for 90-95% of all cases. (4) Similar statistics were reported in Canada, with 7.3% of the population being diagnosed with diabetes in 2017. (22) Diabetes prevention and management may involve both lifestyle modification and medication to reduce complications of the disease and risk of mortality. (6)

What is diabetes?

Diabetes is a metabolic disorder characterized by elevated blood glucose (sugar). Diabetes can occur as a result of insulin resistance, insufficient insulin secretion, or both. Insulin resistance, a state in which the body’s cells resist the action of insulin, or insulin deficiency resulting from insufficient secretion, results in hyperglycemia, mineral and electrolyte imbalances, and irregular metabolism of lipids and protein. (21) Insulin is a hormone that regulates glucose, lipid, and protein metabolism in several ways, including by stimulating the uptake of glucose in muscle for energy. (10)

Outlined below are three primary types of diabetes, which include gestational, type 1, and type 2 diabetes. (6) Certain forms of diabetes may also occur as a result of genetic defects in beta cells or insulin function, endocrine diseases, and/or exposure to certain medications or chemicals. (21)

Gestational diabetes

Characterized by glucose intolerance that is recognized and diagnosed during pregnancy. In most women, the onset of gestational diabetes occurs during the third trimester. (21)

Type 1 diabetes (T1D)

Also known as juvenile diabetes, it is an autoimmune condition in which the immune system destroys beta cells of the pancreas. The beta cells are responsible for producing, storing, and releasing insulin, so their destruction typically leads to insulin deficiency. It is primarily diagnosed in children or adolescents but can occur at any age. (15)

Type 2 diabetes mellitus (T2DM)

Characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion. In individuals with T2DM, the body attempts to release more insulin to help regulate elevated blood sugar levels. However, insulin resistance prevents glucose from entering cells and blood glucose levels may remain elevated. This leads to beta cell failure over time and insulin deficiency progresses. In T2DM, metabolic syndrome is often present. Metabolic syndrome is a group of symptoms including hypertension, vascular endothelial dysfunction, high triglycerides, and low high-density lipoprotein (HDL) cholesterol levels. (21)

Type 2 diabetes is the most prevalent form of diabetes, accounting for 90-95% of all cases. (4) Unlike T1D and gestational diabetes, T2DM can be prevented or delayed through lifestyle modifications, which can help prevent complications of the disease. (13)

Fingerprick using a lancet outdoors on a sunny day.

Hyperglycemia and abnormal insulin regulation occur in all types of diabetes.

Causes and risk factors for TD2M

There are a number of causes and risk factors for type 2 diabetes, including:

  • Overweight or obesity
  • Family history of diabetes
  • Age 45 or older
  • African American, Alaska Native, American Indian, Asian American, Hispanic/Latino,
  • Native Hawaiian, or Pacific Islander descent
  • Low levels of high-density lipoprotein (HDL) cholesterol
  • High levels of triglycerides
  • High blood pressure
  • History of gestational diabetes, heart disease, or stroke
  • Sedentary lifestyle
  • Depression
  • Polycystic ovary syndrome (PCOS) (14)
Older couple measuring blood pressure in a sunlit room.

Individuals with high blood pressure, as well as those who are overweight or obese and greater than 45 years old have a greater risk of developing type 2 diabetes.

Signs, symptoms, and complications associated with TD2M

The signs and symptoms of T2DM include:

  • Increased thirst and hunger
  • Increased urination
  • Unexplained weight loss
  • Fatigue
  • Blurred vision
  • Tingling or numbness in hands or feet (16)
  • Very dry skin
  • Healing more slowly
  • Being more prone to infections (5)

If left unmanaged, type 2 diabetes may also lead to certain complications, including:

  • Neuropathy
  • Nephropathy
  • Retinopathy
  • Cardiovascular disease
  • Stroke
  • Peripheral artery disease (PAD)
  • Dental diseases
  • Birth complications with gestational diabetes (18)

Integrative protocol for blood sugar support

In order to address and manage type 2 diabetes, it is essential to support balanced blood glucose levels. Target blood glucose levels typically range from 80 to 130 mg/dL before a meal and less than 180 mg/dL two hours after the start of a meal. (12) Research has shown that the nutrients and botanicals included below may help improve blood glucose levels.

Berberine

Berberine is a constituent of Rhizoma Coptidis (Huang Lian), which comes from the dried rhizome of plants in the Ranunculaceae family. (7)(23) It is an alkaloid that makes up approximately 5.2% to 7.7% of Rhizoma Coptidis. (7) Examples of plants that contain berberine include Oregon grape, goldenseal, and European barberry. (11)

Berberine demonstrates anti-inflammatory effects and antidiabetic actions that include improving insulin resistance, increasing insulin secretion, and improving dyslipidemia. (7) Berberine has also been shown to significantly improve levels of triglycerides, total cholesterol, and low-density lipoprotein (LDL) cholesterol in patients with T2DM and dyslipidemia compared to placebo. Research has found berberine treatment to be safe and effective in patients with type 2 diabetes. (7)(25)

Research findings:

  • In diabetic patients, demonstrated a reduction in blood glucose levels comparable in effect to hypoglycemic pharmaceutical interventions (25)
  • Overall effectiveness measured by reduction of T2DM biomarkers (25)

US: Search for Berberine in the Fullscript catalog.
CAN: Search for Berberine in the Fullscript catalog.

European barberry branches, leaves, and fruit.

Berberine is an alkaloid found in plants such as European barberry.

Chromium picolinate

Chromium is a trace mineral used in the body to metabolize carbohydrates and lipids. People with glucose intolerance and diabetes may have a higher requirement for chromium. (1) While chromium can be found in certain foods, such as brewer’s yeast, beef, turkey breast, and broccoli, levels of chromium will vary based on agricultural and manufacturing conditions. (17)

A form of the mineral known as trivalent chromium or glucose tolerance factor was first discovered in brewer’s yeast. One type of trivalent chromium, chromium picolinate, is commonly available as a supplement. A systematic review of randomized controlled trials found that chromium picolinate supplementation in individuals with T2DM lowered fasting glucose levels and hemoglobin A1C. Hemoglobin A1C is hemoglobin bound to glucose and is used as a measure of glycemic control in diabetic patients. (2)

Research findings:

  • Current literature confirms a minor reduction in blood glucose when supplemented consistently for four weeks or longer (1)
  • Chromium supplements should be taken with a carbohydrate-containing meal (8)

US: Search for Chromium Picolinate in the Fullscript catalog.
CAN: Search for Chromium Picolinate in the Fullscript catalog.

Psyllium husk

Psyllium husk comes from the seeds of the Plantago ovata plant. The active component of the husk is called arabinoxylan, a highly branched carbohydrate. (24) Psyllium husk is a water-soluble fiber commonly used to treat constipation. (20) When psyllium is consumed, it forms a gel and slows the rate at which digestive enzymes mix with chyme (partially digested food) in the digestive tract. This slows the absorption of glucose, which may result in lower blood glucose following meals. Other beneficial effects of psyllium husk include lowering cholesterol levels and reducing symptoms of diarrhea and IBS. (9) Psyllium husk was found to be well-tolerated in type 2 diabetes patients. (19)

Research findings:

  • In diabetic patients, demonstrated minor to moderate reduction in blood glucose levels (20)
  • 15 g daily is the minimum recommended dose and can be titrated up gradually to patient tolerance (19)
  • However, no current literature points to an increased benefit using more than 15 g daily (19)

US: Search for Psyllium Husk in the Fullscript catalog.
CAN: Search for Psyllium Husk in the Fullscript catalog.

Psyllium seeds in a small bowl on a wooden table

Psyllium husk is a soluble fiber derived from Plantago ovata seeds.

Key takeaways

Dietary and lifestyle modifications are key to the management and treatment of hyperglycemia and type 2 diabetes. Dietary supplements, such as berberine, chromium picolinate, and psyllium husk, may help regulate blood glucose. A protocol using natural supplements can be used therapeutically on its own or as an adjunct to existing treatment. If you are not an integrative healthcare provider, we recommend speaking with one to learn whether these supplements are right for your wellness plan.

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript!

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Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

  1. Anderson, R.A., Cheng, N., Bryden, N.A., Polansky, M.M., Cheng, N., Chi, J., & Feng, J. (1997). Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes, 46(11), 1786-91.
  2. Balk, E. M., Tatsioni, A., Lichtenstein, A. H., Lau, J., & Pittas, A. G. (2007). Effect of chromium supplementation on glucose metabolism and lipids: A systematic review of randomized controlled trials. Diabetes Care, 30(8), 2154-2163.
  3. Centers for Disease Control and Prevention. (2018). National diabetes statistics report. Retrieved from https://www.cdc.gov/diabetes/data/statistics/statistics-report.html
  4. Centers for Disease Control and Prevention. (2018). National diabetes statistics report, 2017. Retrieved from https://www.cdc.gov/diabetes/data/statistics-report/index.html
  5. Centers for Disease Control and Prevention. (2019). Symptoms. Retrieved from https://www.cdc.gov/diabetes/basics/symptoms.html
  6. Diabetes Prevention Program Research Group. (2015). Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: The Diabetes Prevention Program Outcomes Study. The Lancet. Diabetes & Endocrinology, 3(11), 866–875.
  7. Dong, H., Wang, N., Zhao, L., & Lu, F. (2012). Berberine in the treatment of type 2 diabetes mellitus: A systemic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2012, 591654.
  8. Frauchiger, M. T., Wenk, C., & Colombani, P. C. (2004). Effects of acute chromium supplementation on postprandial metabolism in healthy young men. Journal of the American College of Nutrition, 23(4), 351-7.
  9. Lambeau, K. V., & McRorie, J. W., Jr. (2017). Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy. Journal of the American Association of Nurse Practitioners, 29(4), 216–223.
  10. Magkos, F., Wang, X., & Mittendorfer, B. (2010). Metabolic actions of insulin in men and women. Nutrition, 26(7-8), 686–693.
  11. McKennon, S.A. (2018). Non-pharmaceutical intervention options for type 2 diabetes: Diets and dietary supplements (botanicals, antioxidants, and minerals). In K.R. Feingold, B. Anawalt, A. Boyce, G. Chrousos, K. Dungan, A. Grossman, et al. (Eds.), Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.
  12. National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Managing diabetes. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes
  13. National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Prevention type 2 diabetes. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-type-2-diabetes
  14. National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Risk factors for type 2 diabetes. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes
  15. National Institute of Diabetes and Digestive and Kidney Diseases. (2016). What is diabetes? Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
  16. National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Type 2 diabetes. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes
  17. National Institutes of Health. (2019). Chromium: Dietary supplement fact sheet. Retrieved from https://ods.od.nih.gov/factsheets/Chromium-HealthProfessional/
  18. Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of diabetes 2017. Journal of Diabetes Research, 2018, 3086167.
  19. Rodríguez-Morán, M., Guerrero-Romero, F., & Lazcano-Burciaga. G. (1998). Lipid- and glucose-lowering efficacy of Plantago Psyllium in type II diabetes. Journal of Diabetes and its Complications, 12(5), 273-8.
  20. Sierra, M., García, J. J., Fernández, N., Diez, M. J., & Calle, A. P. (2002). Therapeutic effects of psyllium in type 2 diabetic patients. European Journal of Clinical Nutrition, 56(9), 830-42.
  21. Solis-Herrera, C., Triplitt, C., Reasner, C., DeFronzo, R.A., & Cersosimo, E. (2018). Classification of diabetes mellitus. In K.R. Feingold, B. Anawalt, A. Boyce, G. Chrousos, K. Dungan, A. Grossman, et al. (Eds.), Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.
  22. Statistics Canada. (2018). Health Fact Sheets: Diabetes, 2017. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54982-eng.htm
  23. Tan, H. L., Chan, K. G., Pusparajah, P., Duangjai, A., Saokaew, S., Mehmood Khan, T., … Goh, B. H. (2016). Rhizoma coptidis: A potential cardiovascular protective agent. Frontiers in Pharmacology, 7, 362.
  24. Wärnberg, J., Marcos, A., Bueno, G., & Moreno, L. A. (2009). Functional benefits of psyllium fiber supplementation. Current Topics in Nutraceutical Research, 7(2).
  25. Zhang, Y., Li, X., Zou, D., Liu, W., Yang, J., Zhu, N., … Ning, G. (2008). Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. The Journal of Clinical Endocrinology and Metabolism, 93(7), 2559-65.