Nothing trumps a balanced meal plan, an active lifestyle, and diabetes medications as needed to keep your blood glucose levels in check. You might have considered other diabetes remedies to try to lower blood sugar. Find out what works and what you should avoid.

Jill Weisenberger, M.S., R.D., CDE

Skipping Meals

Skipping meals could potentially push your blood glucose higher. When you don't eat for several hours because of sleep or other reasons, your body fuels itself on glucose released from the liver. For many people with type 2 diabetes (PWDs type 2), the liver doesn't properly sense that the blood has ample glucose already, so it continues to pour out more. Eating something with a little carbohydrate signals the liver to stop sending glucose into the bloodstream and can tamp down high numbers.

Skipping meals can also lead to overeating, which can cause an increase in weight. And if you take certain diabetes medications that stimulate the body's own insulin such as common sulfonylureas, or you take insulin with injections or a pump, you risk having your blood glucose drop too low when you skip or delay meals.

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Going Low-Carb

Low-carb diets "are not balanced and deprive the body of needed fiber, vitamins, and minerals," says Constance Brown-Riggs, M.S.Ed, R.D., CDE, CDN, author of The African American Guide to Living Well with Diabetes (Career Press, 2010). Recently, Brown-Riggs counseled a PWD type 2 who ate very little carbohydrate. The result: poor energy and severe headaches. Brown-Riggs helped the person balance out his meal plan by suggesting fruits, grains, and other carb-containing foods. "His headaches subsided, his energy level was restored, and he was happy to learn that he could eat healthy sources of carbohydrate and manage his blood glucose levels successfully," Brown-Riggs says. The keys to success are to manage portions of all foods, spread your food out over your day, and work with your health care team to devise an individualized meal, activity, and medication plan.

Eating Pasta Al Dente

It is best to eat your spaghetti al dente, says David J. A. Jenkins, M.D., Ph.D., D.Sc., Canada research chair in nutrition and metabolism at the University of Toronto and St. Michael's Hospital. Overcooked pasta and other starches become soft, lose their form, and give up their glucose more readily, likely giving you a bigger rise in blood glucose, he says.

"The real problem with pasta is that it's so palatable," and you may eat more than you intend, says Jenkins. A cupful of pasta provides as many calories and carb grams as three slices of bread, and the pasta goes down faster. Jenkins' advice: Cook starchy foods adequately, but avoid overcooking. Most important, control portions and count the calories and carb grams.

Adding Diabetes Shakes and Bars to Meals

Shakes or bars made specifically for people with diabetes can help you control blood glucose levels when you're on the go, says Brown-Riggs. "When used as a meal replacement or snack, they take the guesswork out of carb counting," she says. Toss them in your purse, suitcase, or desk drawer so you'll always have a suitable choice when you're stuck in traffic or can't break for lunch. But if you fall into the trap of eating them in addition to your usual meals or snacks, both your weight and your blood glucose could climb. You have to swap them for other foods, or your calorie and carbohydrate intake will likely be too high.

Sprinkling Cinnamon

A study reported in Diabetes Care in 2003 suggested that cinnamon might lower blood glucose, triglyceride, and cholesterol levels for people with type 2 diabetes. Other studies were not so positive, however. When researchers combined the results of five studies with a total of 282 subjects with type 1 or type 2 diabetes, they found no benefit from cinnamon; their results were reported in a 2008 issue of Diabetes Care.

Enjoy this sweet, fragrant spice anyway to delight your taste buds without adding calories or sodium. Cinnamon brings out the natural sweetness of tomatoes in a sauce and adds an interesting complexity to beef and poultry. Sprinkle it on oatmeal, yogurt, and fruit to add sweetness without adding sugar.

Drinking Alcohol

Alcohol may lower blood glucose, but it can do so erratically and therefore isn't considered a safe or effective method of glucose control. Alcohol interferes with the liver's ability to raise blood glucose and can cause low blood glucose (hypoglycemia). In fact, it's hard to predict just when alcohol might cause hypoglycemia. Sometimes the effects even occur the following day. And when alcohol is mixed with high-sugar drinks such as sodas and juices or eaten with carbohydrate-containing foods, your blood glucose may initially rise but drop later. This is especially important to note if a person takes a blood glucose-lowering medication that can cause hypoglycemia, such as a sulfonylurea or insulin.

Drinking Green Tea

Replacing sugary drinks with green tea is a great way to cut calories, save carbohydrate, and get a good dose of disease-fighting polyphenols, but don't bank on it to lower your blood glucose. Some studies suggest that green tea may help prevent type 2 diabetes and improve insulin sensitivity, but the evidence isn't strong enough to make firm recommendations.

Green tea extracts -- but not the beverage -- in high doses have been associated with several cases of liver toxicity, according to Laura Shane-McWhorter, Pharm.D., BCPS, BC-ADM, CDE, a professor at the University of Utah College of Pharmacy and author of The American Diabetes Association Guide to Herbs and Nutritional Supplements (2009). Shane-McWhorter recommends people with diabetes use supplements with caution.

Drinking Excessive Water

It's a smart idea to drink plenty of calorie-free beverages, especially water, when your blood glucose is elevated. Because high blood glucose can cause excessive urination, drinking plenty of water helps prevent dehydration, says Constance Brown-Riggs, M.S.Ed., R.D., CDE, CDN. It won't, however, lower high blood glucose levels, she says.

Splashing a Little Vinegar

Can a spoonful of vinegar help the blood sugar go down? Yes, says Carol S. Johnston, Ph.D., R.D., professor and director of the nutrition program at Arizona State University's College of Nursing & Health Innovation. Consuming 1-2 tablespoons of vinegar before a meal may slow the rise of "the postmeal surge in blood glucose by as much as 40 percent," she says. But that"s still not a license to go carb crazy.

Vinegar may inhibit starch digestion and hold food in the stomach a little longer, Johnston says. By delaying emptying of the stomach, vinegar may help to blunt the rise of blood glucose in response to eating. The problem is the vinegar itself. It just isn't fun to drink a couple tablespoons before a meal. Take advantage of vinegar's benefits by splashing some on a salad and adding it to cooked vegetables.

Use caution if you adjust insulin based on your carbohydrate intake; reports have shown a higher frequency of hypoglycemic episodes in individuals with type 1 diabetes ingesting vinegar, says Johnston.

Doubling Up on Diabetes Medicines

Is twice as much medicine twice as good at lowering your blood sugar? This is dangerous because you risk your blood glucose dropping critically low when taking blood glucose lowering medication. If your blood glucose consistently runs high, work with your health care provider to adjust your medications and develop an individualized meal plan. If it's high because of simply eating too much, learn from your mistake and move on. You should not adjust your medications without first discussing it with a member of your health care team.

Exercising Instead of Sleeping

Too little sleep or poor sleep can disrupt your hormones, leading to increased appetite, higher blood glucose, and a thicker waistline. In fact, researchers from the Netherlands found that a single night of sleep deprivation can decrease insulin sensitivity by almost 25 percent.

Sleeping Instead of Exercising

"If you're giving up exercise for sleep, on the other hand," says Jennifer Hyman M.S., R.D., CDE, registered dietitian and diabetes educator in Rockville Centre, New York, "chances are you are not active enough during the day." It becomes a vicious cycle, because inactivity can reduce the quality of sleep, and poor sleep leaves you too lethargic to exercise.

Sneak in at least a few minutes of daily exercise by walking on your lunch break and taking the stairs instead of the elevator, says Hyman.

Taking Supplements

Research results for several popular diabetes supplements have been mixed. Claims abound that bitter gourd or bitter melon, which is eaten as a vegetable in India and other parts of Asia, lowers blood glucose. Some studies suggest that the fruit, juice, or extract improve glucose tolerance. Unfortunately, "most of the studies have not had good study design, and the results have been variable," says Laura Shane-McWhorter, Pharm.D., BCPS, BC-ADM, CDE.

Chromium picolinate may work as an insulin sensitizer and improve blood glucose levels in people with type 1 or type 2 diabetes, Shane-McWhorter says. Again, studies are mixed, with "some showing benefit and some showing no benefit," she says.

According to the Natural Medicines Comprehensive Database, taking guar gum with meals might lower blood glucose after the meal. Its high fiber content may help reduce cholesterol levels as well, but also may cause stomach upset. Guar gum might also reduce the absorption of penicillin and other medications.

"The biggest controversy with supplements is the issue of a reliable manufacturer and whether the product contains what it actually states on the label," Shane-McWhorter says. So how can you know? She suggests checking both the United States Pharmacopoeia website, and the ConsumerLab website, before considering supplements.

This article was reviewed by Hope S. Warshaw, R.D., CDE, BC-ADM, 2010.

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