Nutraceutical Approaches to Diabetes Management

By Meagan Purdy, ND

Recently, I’ve noticed a trend in my clinical practice. I’m seeing far more instances of blood sugar dysregulation on screening labs, even in patients I wouldn’t otherwise suspect of metabolic issues. Many patients have joked that it’s due to quarantine weight or lifestyle changes that they know are less than ideal. Cultural changes that have taken place over the past two years have no doubt brought about changes to our overall health. Many people have opted for less nutritious foods and decreased their activity levels during times of quarantine, which can disrupt metabolic health.


Chromium is a trace mineral that’s often overlooked but of utmost importance for proper blood sugar regulation. Low chromium levels are associated with impaired glucose and insulin function, and subsequently, type II diabetes.3 Physicians first noticed the importance of chromium for glucose tolerance with patients receiving long-term total parenteral nutrition (TPN). TPN patients developed symptoms of diabetes, yet their symptoms would not respond to insulin administration. However, they improved when supplemented with chromium, suggesting that the chromium deficiency may be a source for symptoms of glucose dysregulation, which spurred a much-needed area of study for diabetic patients.2

More recent research has shed light on chromium’s mechanisms as an integral piece of blood sugar regulation. Chromium increases insulin receptor numbers and affinity, allowing for increased insulin binding to cells.4 Chromium also activates intracellular signaling pathways involved in glucose transporter 4 (GLUT4) translocation, increasing glucose transport and enhancing insulin sensitivity.5 Long-term chromium supplementation leads to improved glucose tolerance because it potentiates insulin in the cell.

Chromium has also been shown to have acute effects clinically, with multiple studies documenting improved postprandial glucose levels when supplemental chromium was ingested with the meal.3 In clinical trials, it appears that levels above 200 mcg daily have been shown effective for improving glucose profiles and that chromium picolinate or polynicotinate are the most efficacious forms.2


Biotin can act as an important adjunct vitamin to chromium in blood sugar regulation. It has been shown to increase the efficacy of chromium when used to address blood glucose levels.3 Pairing biotin with chromium in clinical trials has resulted in improved HbA1c, fasting glucose levels, and decreases in current prescription medications for diabetic patients.3 These results may be due to biotin’s essential role in carbohydrate metabolism.3

Biotin functions as a gene modulator, as it alters gene expression. Proposed mechanisms for biotin’s hypoglycemic qualities include upregulation of hepatic and pancreatic glucokinase expression.6 Glucokinase is a critical enzyme that regulates glucose uptake by the liver and regulates insulin secretion in response to changes in blood glucose concentration. Biotin upregulates insulin production through these mechanisms in the presence of elevated glucose.7

Biotin deficiencies have been linked to impaired glucose tolerance tests and decreased glucose utilization, while supplemental biotin, particularly when paired with chromium, is linked to better glucose regulation. One RCT involving 447 subjects with poorly controlled type 2 diabetes were given 600 mcg of chromium picolinate paired with 2 mg of biotin or a placebo. Changes in HbA1c and fasting glucose levels were significantly different in the treatment group vs. placebo.7 Multiple studies have revealed similar results, suggesting that biotin and chromium can be used in concert to enhance their properties of glucose regulation.8

Fraxinus excelsior L. (European Ash, Ash)

Many American physicians might not readily recognize this botanical. Still, it has a long history of traditional use as a hypoglycemic agent, particularly in North Africa, where the tree that bears the seed is native. Locals know of the seeds as a health-promoting food and consume them regularly in the diet.9 While the exact mechanisms of European Ash remain unknown, some researchers suggest that the glycoside flavonoids present in it partially inhibit intestinal glucose uptake.10

In clinical studies, it has performed quite remarkably. One study looked at the effects of a liquid extract of F. excelsior L. seed on glucose-induced postprandial hyperglycemia in healthy, non-diabetic volunteers. The glycemic curve for the treatment group showed a gradual improvement over the first two hours following glucose ingestion compared to the placebo group.9 Another randomized, crossover, double-blind, placebo-controlled study utilized Glucevia®, a branded standardized extract of Fraxinus excelsior, to observe its effects on insulin sensitivity and glycemic homeostasis for a group of overweight individuals aged 50-80 years old, a cohort with a high risk of diabetes development. Researchers observed that Glucevia® administration resulted in a remarkable reduction (28%) in glucose area under the curve (AUC) values compared to the placebo group.11 There were no changes to insulin levels in each of the studies mentioned above, suggesting that Ash inhibits glucose uptake without impacting insulin sensitivity. Likely due to this mechanism of action, Ash has a very high safety profile while effectively moderating postprandial glucose levels, positioning it as both a preventative and an effective interventional agent.


Berberine is well-known as a metabolic gem in integrative medicine. Its mechanism for lowering blood glucose rests in its ability to increase insulin receptor expression.12 Research also suggests that berberine increases AMP-activated protein kinase activity, stimulating glucose uptake in the muscles and reducing glucose reproduction in the liver.13 There is also some evidence that berberine increases glucagon-like-peptide-1 secretion in animal models.14

Berberine’s multiple mechanisms of glycemic control are consistent with its results in clinical trials. One clinical trial found berberine to be comparable to metformin in individuals with newly diagnosed type 2 diabetes mellitus. The measured parameters included HbA1c, fasting blood glucose, postprandial blood glucose, and plasma triglycerides, each significantly improved in the berberine group as well as the metformin group.15 Multiple clinical studies have repeated these results, with berberine consistently showing a reduction in both blood glucose and lipid profiles.16 Berberine is well-worth considering as a supplemental agent for patients struggling with impaired blood glucose regulation.


Insulin resistance and blood sugar dysregulation can each be a dangerous and deadly process. Unfortunately, we often see this process progress rather than regress once it has begun unless interventions are made. It is well-documented that diet and lifestyle  play a significant part in the onset and also the progression of diabetes and metabolic syndrome. Those interventions should always be discussed and implemented, as they are of utmost importance, particularly for the truly integrative approach. However, some patients might find these challenging and need supportive options while they are incorporating new lifestyle changes that may take time to become second nature. This is where natural interventions can really shine. When working with a patient who desires a natural approach to diabetes or blood sugar dysregulation but could use some speedy results, consider integrating one or all of these options. In doing so, you could support healthy insulin levels, postprandial glucose levels, fasting glucose levels, and a healthier HbA1c.


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  16. Han Y, et al. Pharmacokinetics and Pharmacological Activities of Berberine in Diabetes Mellitus Treatment. Evid Based Complement Alternat Med. 2021;2021:9987097. Published 2021 Aug 21.
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