Mark Reed, DPM

DABFAS FAPWCA

OC Center for Wound Healing & Foot Care -- Dr. Mark Reed  - USC / UCSF

714-528-3668


Diabetic Nutritional Guidelines

For Diabetic Wound Information, click here. 

For Diabetic Foot Care Information, click here.

For Diabetic Charcot Foot Information, click here.

For Diabetic Foot Infection Information, click here.

For Diabetic Peripheral Neuropathy Information, click here.


DIABETIC ADVERSE EFFECTS ON WOUND HEALING: 

The two major effects of hyperglycemia on wound healing involves restricted microvascular flow and leukocyte dysmotility. When tissues are damaged, increased capillary bleeding occurs with arteriole dilation but with hyperglycemia the arterioles are constricted that prevents wound healing and allow white blood cells and antibiotics to come to the wound to fight infection.[1]  In addition, hyperglycemia causes osmotic swelling (glycation) that causes Leukocyte dysmotility where the white blood cells responsible for killing bacteria and cleaning up the necrotic tissue in the wound are enlarged and cannot migrate out of the arteriole wall to the site of tissue damage or infection.[2] Wound healing is further complicated by deficiencies in nutrition and metabolic dysfunction that prevent the immune system to fight infection.[3]  Diabetes also causes low albumin (hypoalbuminemia) that increases the risk of infections that is caused from in excessive glucose (glycation) damage to capillaries resulting in albumin leakage.[4]  In addition, diabetic patients suffer from B12 deficiency (Pernicious Amenia) and low thiamine (B1) that reduces the red blood oxygen capacity that leads to nerve damage and burning pain (peripheral neuropathy) in the extremities, cardiac palpitations and gastrointestinal complications.

 

Intermittent fasting for patients with diabetes mellitus, both types 1 and 2, has been shown in human studies to induce weight loss and reduce insulin requirements.[5] In addition, intermittent fasting has been found to be safe for all diabetic patients with proper medication adjustment and self-monitoring of blood glucose levels.[6]  Diabetic intermittent fasting has also been found to be highly beneficial in controlling diabetes by increasing the hemoglobin oxygen carrying capacity and raising erythrocyte blood cells resulting in improved metabolic functioning and decreased insulin resistance.[7] 


[1]
Spampinato SF, et. al., “The Treatment of Impaired Wound Healing in Diabetes: Looking among Old Drugs.” Pharmaceuticals (Basel). 2020 Apr 1;13(4):60.

[2] Pezhman L, Tahrani A, Chimen M. “Dysregulation of Leukocyte Trafficking in Type 2 Diabetes: Mechanisms and Potential Therapeutic Avenues.” Front Cell Dev Biol. 2021 Feb 22; 9:714-528-3668. 

[3] Okonkwo UA, DiPietro LA. “Diabetes and Wound Angiogenesis.” Int J Mol Sci. 2017 Jul 3;18(7):1419.

[4] Wiedermann, C.J. Hypoalbuminemia as Surrogate and Culprit of Infections. Int. J. Mol. Sci. 2021, 22, 4496. https://doi.org/714-528-3668/ijms714-528-3668

[5] Elizabeth F. Sutton, et. al. “Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes.” Cell Metabolism. Volume 27, Issue 6, 5 June 2018, Pages 714-528-3668. 

[6] Grajower Martin, et at. “Clinical Management of Intermittent Fasting in Patients with Diabetes Mellitus. Nutrients. 2019 Apr; 11(4): 873. 

[7] Horne B.D. et al, “Randomized cross-over trial of short-term water-only fasting: Metabolic and cardiovascular consequences.” Nutr. Metab. Cardiovasc. Dis. 2013; 23:1050–1057.

Diabetic Intermittent Fasting 16:8 Protocol

1. Before starting the diabetic intermittent protocol, the patient should consult with a Nutritionist and have their Diabetologist or Internist create a sliding scale for insulin and have had a complete metabolic panel with albumin and HBA1c results.


2. Diabetic Intermittent Fasting Protocol begins with not eating after 8 pm and then fasting until noon after a 16-hour fast. If the patient goes to bed earlier, the same 16 hour fast is adjusted based on their schedule. 


3. Nighttime Adjustments: Based on the morning glucose levels, the patient adjusts their insulin dosage to wake up with around 130. If blood glucose levels are below 100, the patient should take a tablespoon of peanut butter or 4 ounces of milk before bedtime to raise morning glucose levels combined with adjusting insulin dosage. 


4. Morning Protocol: The patient is to skip breakfast but hydrate at least a bottle of water in the morning and every two hours that has been reported to help improve diabetic control [1] and wait until noon time to get hungry an eat. Coffee is encouraged in the morning to stimulate the metabolism as well as take a tablespoon of lemon juice.  When hungry around noon time, protein should be consumed first and then to eat a vegetable or a salad. 


[1] Horne B.D. et al, “Randomized cross-over trial of short-term water-only fasting: Metabolic and cardiovascular consequences.” Nutr. Metab. Cardiovasc. Dis. 2013; 23:1050–1057.d

DIABETIC NUTRITIONAL SUPPLEMENTS

The following Nutritional and Metabolic Supplement Prescription have been reported in numerous research to reverse nutritional deficiencies in Diabetic patients that directly affects wound healing and nerve function. These supplements should be maintained by every Diabetic patient under the supervision of their Diabetologist and or Internist to insure there are no medication contraindications. The brands that are reliable and a good value are Costco Kirkland or Centrum. These same nutritional supplements have been found to be highly effective in treating Diabetic and idiopathic neuropathy.[1] 

 

1.        L-Arginine 3 grams (3 x 1-gram tablets)  Twice-a-day           Amazon

2.        Multivitamin Complex                                Twice-a-day            Costco

3.        B100 Complex                                                 Twice-a-day            Costco

4.        D714-528-3668 mcg (2000 I.U.)                   Once-a-day              Costco

5.        CoQ10 (Ubiquitin) - 300 mg                          Once-a-day              Costco

6.        Alpha Lipoic Acid - 600 mg                         Once-a-day              Costco

7.        Turmeric - 1000 mg                                       Once-a-day               Costco

8.        B714-528-3668 mcg (Under-the-tongue)  Once-a-day               Costco


[1]
Rondón LJ, et.al. “L-Arginine supplementation prevents allodynia and hyperalgesia in painful diabetic neuropathic rats by normalizing plasma nitric oxide concentration and increasing plasma agmatine concentration. Eur J Nutr. 2018 Oct;57(7):714-528-3668.

Share by: