Lifestyle factors play a major part in determining how much insulin a diabetic needs. If you wish to lower your insulin requirements, consider these options:

Watch your diet. The composition of your diet may be very influential. Diabetics should aim for a diet in which 55-60 per cent of the calories come from carbohydrates (J Am Coll Nutr, 1989; 8: S61-7).Adequate amounts of water soluble fibre appears to be an important part of such a diet. In one study, a high fibre/complex carbohydrate, low fat diet plus 4.2 g gel fibre in the form of glucomannan was found to significantly improve glycaemic control, insulin requirement and HDL cholesterol levels in IDDM patients, but not in patients on oral medication (Int Clin Nutr Rev, 1988; 8: 140-6). Similarly, apple pectin has been found to decrease insulin requirements and improve glucose control in IDDM (Diabet Metab, 1982; 8: 187-9; Lancet, 1976; ii: 172-4), though not all studies have been positive (Diabetes Care, 1984; 7: 143-6).

Quit smoking. There is evidence that smokers have a 15-20 per cent higher insulin requirement and serum triglyceride concentration than non smokers. In heavy smokers, insulin requirements may be as much as 30 per cent higher (Diabetes Care, 1980; 3: 41-3).

Choose your exercise carefully. In type I diabetics, exercise can be beneficial, but it can also have the reverse effect. Individuals with IDDM may notice a rise in blood sugar with physical exertion. This is particularly true for those whose blood sugar was above 250 mg/dL at the onset of exercise (Am Faro Phys, 1996; 53: 1611-6). This can result in ketoacidosis. Urine ketone levels should be checked before intense exercise is undertaken by these patients. Another risk of exercise in diabetics, particularly those over 40, is the possibility of unmasking an existing cardiovascular problem. Ocular complications may also be precipitated by vigorous exercise in diabetics.

But exercise can also lower blood glucose levels, increase insulin sensitivity and improve cardiovascular function. In diabetics who maintain tight glucose control, exercise has the effect of lowering blood sugar. Remember: exercise does not have to be vigorous. Tai Chi and yoga as well as more vigorous activities (such as jogging) can improve strength and flexibility.

Investigate other herbs, including Coccinia indica which, in animal models, has demonstrated blood glucose lowering effects similar to bitter melon’s (Biochem J, 1993; 292: 267-70; Plants Med, 1990; 56: 426-9). Tricosanthes dioica has shown a similar effect (Indian J Med Res, 1989; 90: 300-5).

Ginkgo biloba may help prevent the development of retinopathy (Lens Eye Toxic Res, 1992; 9: 521-8).

Finally, an animal study of the effects of 12 plants used traditionally in Europe for the treatment of diabetes found that only three guayusa, mushroom and nettles had any effect on IDDM. In this study, Ilex guayusa (guayusa) and Agaricus bisporus (cultivated mushroom) retarded the development of hyperglycaemia in diabetic mice. In addition, the mushroom improved the hypoglycaemic effects of exogenous insulin (Diabetes Res, 1989; 10: 69-73). Other researchers also found that Urtica dioica (nettles) produced a hyperglycaemic effect in animal models (Arch Med Res, 1992; 23: 59-64).

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