Does a Supplement Cocktail a Day Keep the Doctor Away? An Unusual Case of Alcohol Induced Diabetes Mellitus: A Case Report and Review of Literature

Background: Currently there are no evidence-based medical recommendations to support the use of supplements in type 1 diabetes mellitus (DM), although there is some data that supports glucose lowering in type 2 DM with supplements such as cinnamon. Additionally, there is no evidence regarding the use of supplements in insulin-dependent DM secondary to pancreatic dysfunction from alcohol use disorder. Despite lack of clear evidence, it is estimated that more than 65% of Americans with DM use at least one dietary supplement for perceived health benefits. (1)Clinical Case: A 58-year old male presented with insulin-dependent DM secondary to pancreatic dysfunction from alcohol use disorder. Initial labs were significant for a low C-peptide of 0.13 ng/mL (0.80–3.85 ng/mL), A1c -9.4%, and blood glucoses ranging from 160–300 mg/dL. Patient’s DM regimen consisted of glargine 40 units nightly and aspart 12 units three times a day with meals. On a subsequent visit two months later, the patient stated that he had begun taking numerous supplements in hopes that these would improve his overall medical status. Supplements included Blood Boost Formula, Ultra K2 with MK-7, Chromium Picolinate, Male Enhancement, Super C Immune Complex, Nugenix Total-T, Niacinamide, Omega Q Plus Max, Cortisol Hormone Balancer, and Vitamin D3. Simultaneously, the patient self-discontinued all his maintenance medications except for his aforementioned insulin regimen due to the fear of negatively impacting his pancreas. Unexpectedly, his blood glucoses improved to a range of 90–150 mg/dL after being on these supplements without increasing his insulin dose. Upon literature review, three ingredients showed the most evidence for the possible explanation for his improvement in glucose control: L-arginine, nettle extract, and biotin with chromium. Conclusion: Literature review of in vivo and randomized, placebo-controlled studies demonstrated mechanisms of action for L-arginine, nettle extract, and biotin with chromium that indicate their potential role in lowering blood glucoses and increasing C-peptide levels in insulin-dependent DM secondary to pancreatic dysfunction from alcohol use disorder. Further investigations include exploring long-term impact on pancreatic function, glucose control, and insulin resistance. Reference: (1) Garrow, D., Egede, L. Association Between Complementary and Alternative Medicine Use, Preventive Care Practices, and Use of Conventional Medical Services Among Adults with Diabetes. Diabetes Care 2006 Jan; 29(1): 15–19.