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Although one study has locked at fasting glucose levels in those treated with glucosmine and found no effect, insulin levels have not been studied in diabetics taking glucosamine.

Two studies tested short term glucosamine infusion in nondiabetics.

One ,in 18 participants, found no effect on insulin sensitivity; the other , in 10 participants,found no effect on glucose-stimulated insulin secretion but did find an increase in fasting glucose levels and glucose threshold of glucose-stimulated insulin secretion.

glucosamine increases insulin resistance in both normal and diabetic animals,through mechanisms that are not clear.

intravenous doses as low as 0.1mg/kg significantly reduce glucose uptake in skeletal muscle.

in rats, glucosamine induced significant insulin resistance both at the level of the whole body an in rectus abdomens muscle and blunted the increase in muscle glycogen normally induced by insulin.

time dependent inhibition in postreceptor insulin signalling (necessary for glucose transport and glycogen storage)was also seen.

in rats, severe impairment in insulin secretion induced by glucose or arginine were seen after intravenous infusion of 3.5mg/kg/minute, which may indicate an adverse effect on beta cells. there is enough disturbing animal evidence to make it imperative to study the effect of glucosamine on insulin levels in diabetes.

references

1.Effect of glucosamine infusion on insulin secretion and insulin action in humans.

2.short term glucosamine infusion does no affect insulin sensitivity in humans.

3.glucosamine induces insulin resistance in vivo by affecting GLUT4 translocation in skeletal muscle.

4.activation of hexosamine pathway by glucosamine in vivo induces insulin resistance of early postreceptor insulin signaling events in skeletal muscle.

5.glucosamine infusion in rat mimics the beta cell dysfunction of non-insulin-dependant DM.

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Warning:

Concurrent use of GLUCOSAMINE and ANTIDIABETIC AGENTS may result in reduced antidiabetic agent effectiveness.

Clinical Management:

Glucosamine is likely safe in patients with well-controlled diabetes (HbA1c less than 6.5%) taking one or two oral antidiabetic medications or controlled by diet only. In patients with higher HbA1c levels or those taking insulin, monitor blood glucose levels closely.

Onset:

Rapid

Severity:

Minor

Documentation:

Fair

Probable Mechanism:

glucosamine may impair insulin secretion through competitive inhibition of glucokinase in pancreatic beta cells and/or alteration of peripheral glucose uptake

Summary:

Glucosamine did not affect hemoglobin A1c in a randomized, double-blind, placebo-controlled trial of 34 patients with well-controlled type 2 diabetes mellitus (Scroggie et al, 2003). The results of this trial may not apply to patients with uncontrolled diabetes. The Arthritis Foundation has recommended that patients with diabetes monitor their blood glucose more frequently when taking glucosamine (Anon, 2002). Clinical studies are inconclusive regarding the effect of glucosamine on glucose and insulin sensitivity (Pavelka et al, 2002; Pouwels et al, 2001; Reginster et al, 2001; Almada et al, 2000; Monauni et al, 2000).

Literature:

Glucosamine did not significantly affect hemoglobin A1c (HbA1c) in a randomized, double-blind, placebo-controlled trial of 34 patients with well-controlled type 2 diabetes mellitus. Patients received glucosamine (Cosamin DS) 1500 milligrams (mg) (n=22) or placebo (n=12) daily for 90 days. The Cosamin DS also contained chondroitin sulfate 400 mg, manganese 5 mg, and ascorbic acid 66 mg. HbA1c increased from a mean baseline of 6.45% to 6.5% in the glucosamine group, and decreased from a mean baseline of 6.25% to 6.09% in the placebo group (not significant). The study had 80% power to detect a difference of greater than 0.3% between groups, and 80% power to detect a difference of 0.15% from before to after treatment in the glucosamine group (Scroggie et al, 2003).

In a trial of 212 non-diabetic patients taking glucosamine for knee osteoarthritis, blood glucose levels were slightly decreased after 3 years versus placebo (Reginster et al, 2001). In a second three-year study of 202 non-diabetic patients, 3 patients taking placebo and one patient taking glucosamine were diagnosed with diabetes (Pavelka et al, 2002). In 15 nondiabetic patients, 12 weeks of glucosamine treatment did not affect fasting glucose, but did increase fasting insulin versus placebo (p = 0.01) (Almada et al, 2000). In 5 healthy subjects, intravenous glucosamine sulfate reduced glucose tolerance and insulin sensitivity under hyperglycemic conditions (Monauni et al, 2000), whereas glucosamine infusion did not affect insulin-induced glucose uptake in 18 healthy subjects (Pouwels et al, 2001).

Reference(s):

Almada A, Harvey P & Platt K: Effects of chronic oral glucosamine sulfate on fasting insulin resistance index (FIRI) in non-diabetic individuals. FASEB J 2000; 14(4):A750.

Monauni T, Zenti MG, Cretti A et al: Effects of glucosamine infusion on insulin secretion and insulin action in humans. Diabetes 2000; 49(6):926-935.

Pavelka K, Gatterova J, Olejarova M et al: Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002; 162(18):2113-2123.

Pouwels MJ, Jacobs JR, Span PN et al: Short-term glucosamine infusion does not affect insulin sensitivity in humans. J Clin Endocrinol Metab 2001; 86(5):2099-2103.

Reginster JY, Deroisy R, Rovati LC et al: Long-term effects of glucosamine sulfate on osteoarthritis progression: a randomized, placebo-controlled clinical trial. Lancet 2001; 357(9252):251-256.

Scroggie DA, Albright A & Harris MD: The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Arch Intern Med 2003; 163(13):1587-1590.

Scroggie DA, Albright A & Harris MD: The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled,double-blinded, randomized clinical trial. Arch Intern Med 2003; 163(13):1587-1590.

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