Introduction

Whole person care is a person-centered approach to medicine. It goes beyond treating symptoms or isolated conditions, focusing on the interconnectedness of bodily systems and addressing a wide range of factors. These include biological makeup, behavioral habits, environmental factors, and a patient’s personal beliefs, values, and goals. By tailoring care to align with these unique aspects, healthcare providers can create highly personalized treatment plans that address not only physical health but also emotional and mental well-being.

This template aims to provide healthcare providers with practical suggestions for supplements and lifestyle strategies, helping them design personalized, whole person care plans for patients looking to support healthy blood sugar levels.

Evidence-based supplements included in this protocol are selected for their ability to target multiple mechanisms involved in blood sugar regulation, including improving insulin sensitivity, modulating glucose uptake, and influencing gut microbiota composition. Together, these actions can complement dietary and lifestyle modifications to enhance metabolic outcomes. (NCCIH 2023)

Lifestyle modifications form the cornerstone of long-term healthy blood sugar management. Addressing factors like nutrition, physical activity, stress management, and sleep optimization within a whole-person framework empowers patients to make sustainable changes that foster healthy blood sugar levels to prevent (and possibly even reverse) type 2 diabetes. (DPP Research Group 2002)(Yeh 2023)

Ingredients

Berberine

Dosing: 500 mg, three times per day, minimum 12 weeks (Liang 2019)

Supporting evidence:

• Berberine’s antidiabetic effects can be explained primarily by its activation of the adenosine monophosphate-activated protein kinase (AMPK) pathway, which enhances glucose uptake, stimulates glycolysis, and inhibits gluconeogenesis. Berberine also supports insulin secretion via glucagon-like peptide-1 (GLP-1) and may reduce intestinal glucose absorption. (Och 2022)
• A meta-analysis of 37 randomized controlled trials (RCTs) with 3,048 patients with type 2 diabetes mellitus (T2DM) concluded that berberine was effective in reducing fasting plasma glucose (FPG) (weighted mean difference (WMD) −0.82 mmol/L), two-hour postprandial plasma glucose (PPG) (WMD −1.16 mmol/L), and hemoglobin A1c (HbA1c) (WMD −0.63%). Subgroup analyses demonstrated that berberine therapy was associated with greater absolute reductions in FPG and HbA1c in patients with higher baselines in these parameters. (Xie 2022)
• In a small randomized, double-blind, placebo-controlled pilot trial in 34 adults with prediabetes, participants were assigned to receive berberine or a placebo three times daily for 12 weeks. At the end of the trial, clinically significant reductions were measured in all markers of glycemic control (FPG, fasting insulin, two-hour oral glucose tolerance test (OGTT), HbA1c, and homeostatic model assessment-insulin resistance (HOMA-IR)), with mean reductions in FPG and two-hour OGTT to below prediabetic thresholds. (Panigrahi 2023)

Chromium Picolinate

Dosing: 50–1,000 mcg total per day taken in divided doses with carbohydrate-rich meals 

Take for a minimum of two months; greater benefits are observed with longer intervention periods. (Frauchiger 2004)(Georgaki 2024)

Supporting evidence:

• Chromium deficiency has been identified as a risk factor for hyperglycemia and insulin resistance. (Ngala 2018)
• Based on data collected in the National Health and Nutrition Examination Survey (NAHNES) between 1999 and 2010, the odds of having T2DM were lower in American adults who had taken supplemental chromium in the last 30 days. (McIver 2015)
• Chromium potentiates the actions of insulin and facilitates the translocation of glucose transporter type 4 (GLUT-4) to cell membranes, increasing glucose uptake into cells. (Hua 2012)
• Pooled research shows that supplemental chromium helped effectively lower FPG (WMD −19 mg/dL), insulin (WMD −12.35 pmol/L), HbA1c (WMD −0.71%), and HOMA-IR (WMD −1.53) in patients with T2DM. (Asbaghi 2020) These blood sugar-lowering effects have even been observed in patients with poorly controlled diabetes on hypoglycemic medications. (Paiva 2015)

Probiotics

Dosing: Variable based on formulation

Supporting evidence:

• Systematic reviews and meta-analyses of RCTs have found probiotics effective in supporting glycemic control, as evidenced by reductions in FPG, HbA1c, and HOMA-IR with supplementation. (Kasińska 2015)(Akbari 2016)
• Akkermansia muciniphila is increasingly recognized for its role in metabolism, with lower levels associated with T2DM and higher abundance associated with better metabolic health. (Aja 2025)(Zhang 2025) Emerging research suggests that an A. muciniphila-derived protein (P9) stimulates GLP-1 release, which may underlie the reductions in blood sugar and improvements in insulin sensitivity seen with supplemental pasteurized A. muciniphila. (Cani 2021)(Li 2023)

• A 12-week multicenter, double-blind, randomized placebo-controlled trial including 76 patients with T2DM found that twice-daily supplementation with a probiotic containing A. muciniphila, Clostridium beijerinckii, C. butyricum, Bifidobacterium infantis, and Anaerobutyricum hallii helped improve glucose control, as measured by improvements in glucose total area under the curve (AUC) (−36.1 mg/dL/180 minutes), HbA1c (−0.6%), and glucose incremental-AUC (−28.6 mg/dL/180 minutes). (Perraudeau 2020)
• When given a mixed probiotic of seven strains of Lactobacillus, Bifidobacterium, and Streptococcus for five weeks, patients with T2DM experienced statistically significant reductions in FPG. (Razmpoosh 2019)
• A multi-strain probiotic (containing Bifidobacterium, Lactobacillus, Lactococcus, and Propionibacterium species) was associated with a significant reduction in insulin resistance after eight weeks in a double-blind RCT in 53 patients with T2DM. HOMA-IR decreased from 6.85 ± 0.76 to 5.13 ± 0.49 in the probiotic group, while it remained unchanged in the placebo group. In the overall cohort, HbA1c changes were modest and not statistically significant (−0.24% in probiotics, −0.09% in placebo). However, in the subgroup of “responders” (n = 22)—patients whose HOMA-IR decreased during the intervention—HbA1c fell significantly by 0.39% compared to non-responders. (Kobyliak 2018)

Psyllium Husk

Dosing: 5–20 g total per day, divided into two or three doses and taken before meals; minimum six weeks (Gibb 2015)(Jovanovski 2019)

Supporting evidence:

• A meta-analysis of 35 RCTs evaluating the efficacy of psyllium husk on glycemic control concluded that psyllium dosed before meals led to improvements in FPG (−37.0 mg/dL) and HbA1c (−0.97%) in patients at risk or being treated for T2DM. The greatest improvement was observed in patients with T2DM (vs. patients with euglycemia and prediabetes). (Gibb 2015)
• In an RCT involving 40 adults over the age of 35 with T2DM, participants were assigned to receive either 10.5 g of psyllium daily or to continue their usual diet without supplementation for eight weeks. Psyllium supplementation was associated with notable improvements in markers of glycemic control and insulin sensitivity. In the psyllium group, fasting plasma glucose decreased from 163 mg/dL to 119 mg/dL, HbA1c declined from 8.5% to 7.5%, fasting insulin levels fell from 27.9 μIU/mL to 19.7 μIU/mL, C-peptide concentrations decreased from 5.8 ng/mL to 3.8 ng/mL, HOMA-IR improved from 11.3 to 5.8, and homeostasis model assessment of β-cell function (HOMA-β) increased from 103% to 141%. (Abutair 2016)
• The authors of another meta-analysis of 28 RCTs, including 1,394 individuals with T2DM, concluded that viscous fiber supplements helped improve glycemic control beyond standard-of-care interventions. Fiber supplements, including psyllium, led to significant reductions in HbA1c (−0.58%), FPG (−0.82 mmol/L), and HOMA-IR (−1.89) at a median dose of 13.1 g per day with moderate certainty of evidence. (Jovanovski 2019)

Lifestyle Recommendations

Nutrition

The following dietary patterns have demonstrated efficacy for glycemic control and cardiovascular risk reduction:

• Mediterranean diet: Emphasizes vegetables, whole fruits, legumes, whole grains, nuts, seeds, olive oil, and fatty fish; limits red/processed meats, refined grains, and added sugars (Martín-Peláez 2020) 
• Dietary Approaches to Stop Hypertension (DASH) diet: Focuses on vegetables, fruits, whole grains, low-fat dairy, lean proteins, and sodium restriction (less than 2,300 mg perday); limits sweets, sugar-sweetened beverages, and red meats (Campbell 2017) 
• Low-carbohydrate diet: Limits daily carbohydrate intake to less than 130 g (or less than 26% of total energy) (Wheatley 2021) 
• Vegetarian/vegan diets: Plant-based dietary patterns are associated with improved glycemic control and reduced cardiovascular risk. (McMacken 2017) 

Regardless of dietary pattern, emphasize dietary quality and balance by recommending: 

• A high intake of nonstarchy vegetables
• Complex over simple carbohydrates
• Whole over refined grains
• Poly/monounsaturated fats over saturated fats
• Eliminating of trans fats
• Minimizing processed foods, sugar-sweetened beverages, and desserts (Blonde 2022) 

For patients who are overweight or obese, recommend dietary caloric restriction as part of a structured weight management program conducive to modest (less than 10%) weight loss. (Wing 2011) 

Educate on strategies to reduce postprandial blood sugar spikes:

• Lowering dietary glycemic index/load (Vlachos 2020) 
• Increasing dietary fiber, aiming for a goal of 35 grams per day (Nitzke 2024) 
• Sequencing meals by eating vegetables, protein, and fats before carbohydrates (Imai 2013)
• Drinking 1–2 tsp of apple cider vinegar at mealtimes (Gheflati 2019) 
• Adding cinnamon to food, aiming for a daily intake of 1–6 g (Khan 2003) 

Suggest eating prebiotic and polyphenol-rich foods to support a healthy and balanced gut microbiome. Examples include:

• Grapes
• Cranberries
• Black tea
• Onion
• Asparagus
• Artichoke
• Oats
• Beans (Ballini 2023)(Tian 2024)(Van Buiten 2024) 

Refer patients struggling to achieve stable blood sugar levels to a registered dietitian or nutritionist with expertise in blood sugar management for individualized medical nutrition therapy. (Evert 2019)

Physical Activity

Prescribe an exercise routine that incorporates:

• Aerobic exercise: Recommend beginning at a low level and increasing intensity and duration over time based on physical fitness level, working up to at least 150 minutes of moderate-intensity exercise—such as jogging, cycling, swimming, or dancing—accomplished in 3–5 sessions per week. For physically fit adults, shorter durations (at least 75 minutes per week) of vigorous-intensity or interval training are appropriate.
• Resistance exercise: Incorporate 2–3 sessions per week on nonconsecutive days that target all major muscle groups. This may include free weights, machines, resistance bands, or body weight exercises. 
• Customize exercise recommendations based on an individual’s health-related and physical limitations. (Blonde 2022)

Less intense physical activity also reduces the risk of diabetes mellitus. 

• Reduction of sedentary behaviors: Counsel patients to interrupt sedentary time with at least three minutes of light activity (e.g., standing, walking, stretching) every 30 minutes. (Keadle 2017)
• Postprandial walking: Advocate for walking 10–30 minutes at a comfortable or brisk pace, initiated within 15–30 minutes after meals. (DiPietro 2013)(Bellini 2022)

Stress

Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevations in cortisol that increase blood sugar. (Vedantam 2022)

• Routinely ask patients about stress and anxiety; monitor for changes in stress levels over time to adjust interventions as needed.
• Counsel on the role of stress reduction techniques as a first-line intervention in supporting stress resilience and healthy coping mechanisms to stressful triggers. Examples include mindfulness meditation, deep breathing, and progressive muscle relaxation. Individualize stress management strategies to patient preferences and available resources. (Hamasaki 2023)
• Refer patients to behavioral health professionals for structured behavioral interventions, such as cognitive behavioral therapy (CBT), as needed. (Dong 2023)

Sleep

Disruptions in sleep quality and duration will exacerbate dysglycemia. (DePietro 2016)

• Routinely assess sleep health in all patients. Ask about sleep duration, quality, timing, and symptoms of sleep disorders.
• Recommend that adults sleep 7–9 hours per night to minimize the risk of T2DM. (Darraj 2023)

To support patients in getting good quality sleep, provide them with sleep hygiene tips, such as: 

• Establishing a regular bedtime and wake-up time
• Creating a dark, quiet, and cool sleep environment
• Turning off electronic devices at least 30 minutes before bedtime
• Avoiding caffeine, nicotine, and alcohol in the evenings (AASM 2012)

Obstructive sleep apnea (OSA) is highly prevalent in T2DM, and its severity correlates with glycemic control. (Malik 2017)

• Routinely screen for OSA using validated screening tools (e.g., STOP-Bang questionnaire). (Pivetta 2021)
• As indicated, refer patients for sleep studies or sleep medicine consultation for additional evaluation and treatment.