Diabetes is a disorder of blood sugar (glucose) metabolism, characterized by abnormal elevations of glucose in the blood. There are two types of diabetes. In Type 1 diabetes, also known as insulin-dependent diabetes mellitus (or IDDM), the body does not produce insulin and so cannot break down glucose in the blood. In type 2, also known as non-insulin­dependent diabetes mellitus (or NIDDM), the body produces insulin, but its cells don’t and to it. Type 2 diabetes is the most common (accounting for 90 percent of all cases) and is strongly related to obesity.

If your blood sugar is not well controlled, you can have both rapidly occurring and slowly occurring complications. The rapid problems occur when your blood sugar is too low or too high. When it’s too low, you can develop hypoglycemia; symptoms include sweating, nervousness, tremor, hunger, or fainting. If left untreated, hypoglycemia can use shock and death. Alternatively, when your blood sugar is too high, you can develop coondosis (too much acid in your blood); symptoms include extreme fatigue, nausea, and miting. Ketoacidosis can also lead to coma and death if untreated. Diabetes is the seventh leading cause of death in the U.S.

Long-term complications of diabetes include the following:

• Atherosclerosis, especially of the heart and brain arteries.
• Neuropathy (loss of peripheral nerve function) and Charcot joints (osteoarthritis of the foot bones caused by the neuropathy).
• Retinopathy (serious eye disease and the leading cause of blindness in the country). About half of all people with diabetes will develop this complication within 10 years of diagnosis.
• Nephropathy (damage to the kidneys and the leading cause of death in people with diabetes).
• Foot ulcers, which are the leading cause of amputation.

Symptoms for diabetes

Here are some common symptoms for diabetes 

• Increased thirst
• Increased urination
• Increased appetite
• Weight loss
• Fatigue
• Nausea
• Blurred vision
• Frequent vaginal infections

What You Need to Know

One-third of Americans who have diabetes are not aware that they have it, especially Africian-Americans, Hispanics, and Native Americans. There’s also a strong correlation between diabetes and obesity. It is important to have your blood sugar checked regulaly especially if your ethnic heritage puts you at increased risk or you are overweight.

If you have diabetes, the most important action you can take is to monitor your blood sugar levels and keep those levels as close to normal as possible. This is your best strategy for avoiding the complications. Many physicians use blood glucose level to determine control, but the best and recommended test is called HbA1c. If you aim for an HbA1c (also called glycosalated hemoglobin) value of 6.5 percent or less (5 percent is the best) you’ll significantly reduce your chances of diabetic complications.

Avoid alcohol, which interferes with your body’s use of blood sugar, causing low blood sugar. Although this might seem to be an advantage, it actually creates a craving for more alcohol and high sugar foods, which eventually makes your diabetes worse. You should also stop smoking, because smoking increases the risk of diabetic complications, especially heart attack, stroke, neuropathy, and leg ulcers.

There are several herbs that can lower blood sugar as a side effect-and that can be dangerous if you’re not aware of these effects, and your blood sugar goes too low (hypoglycemia). So if you’re taking broom, buchu, dandelion, or juniper, monitor your blood sugar more closely. Some over-the-counter remedies contain ingredients that can cause additional prolems with blood sugar levels. For example, aspirin can alter blood glucose levels if taken in large amounts. Respiratory products containing phenylephrine, ephedrine, or epinephrin can raise blood sugar levels. Appetite suppressants containing caffeine can do the same.

Finally, a recent study showed that 80 percent of people with diabetes who also have high blood pressure (hypertension) do not have their blood pressure under control, and may not even know they have hypertension. If you have diabetes, make sure you have your blood pressure checked, and, if it’s high, get treatment. Otherwise, the above complications, especially heart disease and stroke, can become much worse.

General Recommendations

Diabetes Diet: Eat a balanced diet that is low in refined sugars, fat, and animal products and high in plant fiber. Trans-fatty acids, found in commercially baked and deep-fried food (processed and fast foods), are especially bad. The American Diabetes Association (ADA) diet is adequate and appropriate. However, I prefer the HCF diet (HCF stands fo “high-complex-carbohydrate”-in other words, high fiber). As you plan your meals follow the HCF daily guidelines: Eat 70 percent to 75 percent complex carbohydrates, 15 percent to 20 percent proteins, and only 5 percent to 10 percent fats. The HCF diet is plentiful in grains (bread, cereal, rice, and pasta), starchy vegetables (potatoes, earn peas), and legumes (dried beans, peas, lentils), and is packed with vitamins, minerals, and fiber. You should consume at least 20 grams to 35 grams of fiber, but I recommend more if possible, because recent studies have shown that daily consumption of 50 grams of fiber leads to a 10 percent decrease in blood sugar.

Different carbohydrates can cause different increases in your blood sugar, and I recommend that you use the glycemic index to help guide you. This index tells you how quiclly your blood sugar will rise when you eat a particular carbohydrate. (For more information about the glycemic index of common foods, go to www.glycemicindex.com.) You should eat those foods that have a low glycemic index. Be aware, however, that some low­ glycemic foods, such as sausage and ice cream, are also high-fat and can make you gain weight.

The best way to obtain fiber is from food. Here are some good sources of fiber:

• Legumes (beans)
• Oat bran
• Psyllium seed husks
• Seeds
• Most vegetables
• Nuts
• Pears
• Apples

You can supplement fiber in your diet if you like. I recommend using 20 grams to 30 grams per day of guar, pectin, or oat bran.

As for protein, I recommend soy for several reasons. First, the protein from soy is the only protein from a plant source that is “complete,” meaning that it contains food proteins that provide all the essential amino acids to maintain good health. Second, soy can help control blood sugar levels. Third, soy can help prevent or reduce complications of diabetes, especially atherosclerosis and nephropathy.

Cornstarch is absorbed slowly and is especially effective for Type I diabetics prone to low blood glucose levels overnight. Adding red wine vinegar (3 teaspoons) to your salad also can lower your blood sugar by up to 30 percent after meals by slowing digestion. Lemon juice works in the same way, so squeeze a fresh lemon into the water you drink. If you eat meat, chicken is better than red meat because chicken has lower saturated fats and a higher percentage of beneficial fatty acids.

If you have a high risk of diabetes or have a prediabetic condition (mildly elevated blood sugars), eating nuts may help keep you from actually getting the disease. I suggest eating one cup of nuts three to four times per week. Finally, onion and garlic lower your blood glucose and compete with insulin for liver sites, thus increasing the release of free insulin. I recommend incorporating them into your diet whenever possible.

Although you can follow these recommendations by yourself, planning well-balanced meals can be hard, especially if you have a busy schedule. No matter which diet you choose to follow, I recommend that you consult with a licensed dietician who can help you develop a good diet plan (for referral to a dietician specializing in diabetes, go to www.eatright.com. the Web site of the American Dietetic Association).

Exercise: My second important recommendation is exercise, which enhances insulin sensitivity, improves glucose tolerance, reduces serum cholesterol and triglycerides, lowers blood pressure, and helps in weight control. In general, aerobic exercise is the most effective. Exercise must be tailored to your individual needs, especially if you are insulin dependent, because exercise can significantly decrease your blood sugar levels. I recomend that you get advice from your doctor and/or a fitness trainer who has expertise working with diabetics.

Before starting an exercise program, and especially if you have not exercised make sure you have a physical examination and exercise tolerance test, so that you can plan appropriate program and avoid additional complications. And always monitor your bloodsugar before and after exercise. Start your exercise slowly and build up gradually.

Caution: If you have complications of diabetes, avoid high-impact activities because they can cause further damage to the eyes and kidneys. Also, even small blisters that form on your feet can lead to chronic wounds or infection. Be sure to check your feet and any cuts, scrapes, or abrasions (use topical antibiotic ointment), and go to your doctor immediately if these do not heal or if they get worse.

Your Herbal Healing Action Plan for Type 1 Diabetes (Insulin-Dependent)

Step 1: Take Niacinamide and Vitamin D for Children at Risk for Developing Diabetes

For children who are at high risk of developing diabetes because of family history, give niacinamide, 25mg per kilogram of body weight (11.4mg per pound). This has been shown to prevent the development of Type 1 diabetes in many of these children. In addition, give your child Vitamin D supplementation in the form of cod liver oil (2,000 IU daily) during the first year of life. Make sure you see your pediatrician for further guidance and to monitor your child.

Step 2: Take Insulin Injections

Type 1 diabetes requires insulin replacement. Insulin can be taken only through injections. There are short-, intermediate-, and long-acting forms of insulin from several different sources (pork, humans, RNA), so consult with your doctor to find out which form is the best for you. A new form of insulin is now available that can be inhaled and helps reduce the number of injections required on a daily basis. However, it cannot be used if you have any problems with your lungs. Make sure you monitor and regulate your glucose regularly and under the guidance of a doctor.

Step 3: Begin Taking Niacinamide as Soon as You Are Diagnosed

If you have just been diagnosed as having Type 1 diabetes, take niacinamide, 25mg per kilogram of your body weight (11.4mg per pound) daily. If taken soon after onset of diabetes, niacinamide may slow the progression of-or possibly even reverse-the disease. You must still take insulin to control your blood sugar while the niacinamide has time work. Monitor your blood sugar carefully and frequently during this time. If your blood sugar does not go down further after several weeks, then the niacinamide won’t work, and you should stop taking it.

Step 4: Take Vitamin C, Vitamin E, Vitamin B!2, Vitamin B6, Niacin, Magnesium, Mixed Flavonoids, Zinc, and Flaxseed Oil

Certain vitamins and minerals have been shown to help control and decrease blood sugar, and reduce complications from diabetes. In general, you should take the following amounts on a daily basis, from a combination of diet and supplementation:

• Vitamin C, 2,000mg
• Vitamin E, 800 IU to 1,200 IU
• Vitamin B12, 1,000mcg
• Vitamin B6, 100mg
• Niacin, 1200mg to 3,000mg
• Magnesium, 700mg
• Mixed flavonoids, 1,000mg to 2,000mg
• Flaxseed oil, 1 tablespoon
• Zinc, 30mg

A registered dietician can help you determine whether your diet provides the proper amounts of these nutrients.

Step 5: Take an Aspirin a Day to Help Prevent Heart Disease

If you have diabetes, you are at increased risk for heart disease, and you should take one aspirin daily to lower your risk. Take no more than 325mg per day for optimum benefit (81mg is sufficient to thin your blood). Take aspirin along with the previous steps.

Cautions: If you take aspirin, you should avoid taking ibuprofen, which blocks the blood-thinning effects of aspirin. If you must take ibuprofen, take the aspirin first, and wait an hour to take the ibuprofen so that the aspirin has time to take effect. Also, aspirin can deplete your body’s stores of vitamin C, so you might need to replace this nutrient through your diet or by taking supplements (600mg per day).

Step 6: Take Gymnema Sylvestre, Bitter Melon, Defatted Fenugreek, Salt Bush, and/or Corosolic Acid (Queen’s Crepe Myrtle)

Several herbs have been noted to decrease and help regulate blood sugar, as well as make the body’s cells more responsive to insulin. The purpose of trying these herbs is to reduce your insulin dosage. In order of effectiveness, they are

• Gymnema sylvestre extract, 400mg daily
• Bitter melon, three to six ounces of fresh juice daily
• Defatted fenugreek powder, 50g daily
• Salt Bush, 3g daily

These herbs should decrease your blood sugar within one to two months, and you can take all of them together. If your blood sugar decreases, you then may be able to lower your insulin requirement, although you won’t be able to discontinue the insulin completely. If your blood sugar hasn’t decreased, there’s no reason to continue taking the herbs. (There is a product that contains all four herbs along with the vitamins/minerals in Step 4.

Your Herbal Healing Action Plan for Type 2 Diabetes (Non-Insulin Dependent)

• You should have your liver enzymes and creatinine levels tested to assess your kidney function. If the levels are abnormal, insulin (Step 11) is usually recommended, and then return to Step 1.

Step 1: Lose Weight

Most people with Type 2 diabetes are overweight. If you are, you may be able to regulate your blood sugar levels with weight loss, diet, and exercise alone. A six-week trial will tell you whether the changes in your blood sugar are significant enough to forego medication, so it’s certainly worth the effort.

Step 2: Take an Aspirin a Day to Help Prevent Heart Disease

If you have diabetes, you are at increased risk for heart disease. Take one aspirin daily to lower your risk. Take no more than 325mg per day for optimum benefit (81mg is sufficient to thin your blood). Take aspirin along with the previous steps.

Cautions: If you take aspirin, you should avoid taking ibuprofen, which blocks the blood-thinning effects of aspirin. If you must take ibuprofen, take the aspirin first, and wait an hour to take the ibuprofen so that the aspirin has time to take effect. Also, aspirin can deplete your body’s stores of vitamin C, so replacement by diet or supplementation may be necessary (600mg per day).

Step 3: Take Vitamin C, Vitamin E, Vitamin B12, Vitamin B6, Niacin, Magnesium, Mixed Flavonoids, Zinc, and Flaxseed Oil

Certain vitamins and minerals have been shown to help control and decrease blood sugar, as well as reduce complications from diabetes. In general, you should take the following amounts on a daily basis, from a combination of diet and supplementation:

• Vitamin C, 2,000mg
• Vitamin E, 800 IU to 1,200 IU
• Vitamin B12, 1,000mcg
• Vitamin B6, 100mg
• Niacin, 1200mg to 3000mg
• Magnesium,700mg
• Mixed flavonoids, 1000mg to 2000mg
• Flaxseed oil, 1 tablespoon
• Zinc, 30mg

A registered dietician can help you determine whether your diet provides the proper amounts of these nutrients. It may take one to two months before there are any glucose­ lowering effects. But even if the nutrients don’t lower your blood sugar, you should still take them, because they can help maintain your general health and prevent complications from your diabetes.

Step 4: Take Gymnema Sylvestre, Bitter Melon, Defatted Fenugreek, and Salt Bush

If your blood sugar is still elevated, I recommend trying several herbs that have been found to decrease and help regulate blood sugar, and make the body’s cells more responsive to insulin. In order of effectiveness, these are

• Gymnema sylvestre extract, 400mg daily
• Bitter melon, 3 ounces to 6 ounces of fresh juice daily
• Defatted fenugreek powder, 50g daily
• Salt Bush, 3g daily

These herbs should decrease your blood sugar within one to two months, and you can take all of them together. But if your blood sugar does not decrease, there is no reason for you to continue taking the herbs. (There is a product that contains all four herbs along with the vitamins/minerals in Step 3)

If these herbs don’t work for you or are only partially effective, you can try Corosolic Acid, also called Queen’s Crepe Myrtle. Take 480 to 550 mcg, 1 to 2 tablets, 3 times a day. This recently discovered supplement has been shown to significantly decrease blood sugar in many Type II diabetics. It takes about two weeks to get the maximum benefit.

Step 5: Take Appropriate Chinese Herbal Remedies to Normalize Blood Sugar

If the previous steps do not bring your blood sugar to a normal level, or if you have fluctuations in blood sugar, I recommend taking Chinese herbs, such as Zuo Gui Wan/You Gui Yin in combination with Zhi Bai Di Huang Wan. These formulas can reduce and regulate blood sugar; they can reduce backache and excessive thirst and urination as well. Consult a practitioner qualified in Chinese herbal medicine to determine which Chinese herbal formulas are the best for your particular syndromes. You should see improvement in your blood sugar within three to six weeks (sometimes sooner), but you may need to take the herbs longer, depending on your condition.

Step 6: Undergo Acupuncture

Acupuncture has been used for centuries to reduce blood sugar, and it can be used in addition to the previous steps. You should use it especially with the Chinese herbs in Step 5. Principal points usually include M- BW-12 on the mid-back (called pancreas hollow, this point controls pancreatic function), with others found elsewhere on the back and on the legs and ankles. Always seek evaluation and treatment from a practitioner certified in acupuncture. You should notice improvement within six treatments, but you might need additional sessions for maximum benefits.

Step 7: Take Chromium to Lower Blood Sugar

If your blood sugar remains elevated, I recommend taking chromium (200mcg per day). Chromium has been shown to increase insulin sensitivity and binding, and it can lower blood sugar, especially if you are deficient in this mineral. You should see a decrease blood sugar within one to two months. If your blood sugar does not decrease, stop tak the chromium.

Step 8: Take a Prescription Oral Medication

If the previous steps still have not controlled your blood sugar, then you should start prescription medications. There are many different types of antidiabetic medications, it is important to obtain guidance from your doctor or a diabetic specialist (endocrino gist). In general, your doctor may make these recommendations:

• If your liver and kidney tests are normal, and you are obese, your doctor may prescribe metformin, an oral antidiabetic medication that does not cause weight gain. Check your B12 level when taking this drug, and, if it’s low, take a supplement.
• If your liver and kidney tests are normal, and you are normal weight, your doctor may prescribe a sulfonylurea medication (Glipizide, Glyburide). The major side effect is hypoglycemia (blood sugar that’s too low). These medications can interact with trimethoprim (a kidney antibiotic), cimetidine (an antiulcer medication sold under the brand name Tagamet), alcohol, and anticoagulants (blood thinners), all of which can increase the chances of hypoglycemia if you take them with sulfonylureas.
• For some patients, the above two types of medication (Glipizide, Glyburide) can be used in combination for better glycemic control. Check with your doctor to see whether that’s appropriate for you.
• If urine testing detects microalbuminuria, you should take an ACE inhibitor (such as captopril or analapril) along with the previous medications.

Step 9: Take an Alpha-Glucosidase Inhibitor

If the above prescription medications fail to lower your blood sugar or have intolerable side effects, then your doctor may prescribe an alpha-glucosidase inhibitor. These drugs can be used alone or in combination with a sulfonylurea. They frequently cause side effects such as flatulence, diarrhea, and abdominal cramps, which tend to go away with continued use (or if the medication is started in a low dose).

Step 10: Take an Insulin Sensitizer

The newest antidiabetic medications are thiazolidinediones (called glitazones for short). This class of drugs is designed as “insulin sensitizers”-they improve glucose control while lowering insulin levels. They may also reduce high blood pressure and cholesterol problems associated with insulin resistance. These drugs can be used alone, in place of Step 9, or in combination with metformin or a sulfonylurea (Step 8). However, glitazones may be associated with an increased risk of heart failure, so they need to be closely monitored by your doctor.

Step 11: Take Insulin Injections

If the previous steps don’t control your blood sugar levels, you may need to take insulin. Some doctors prescribe insulin in combination with the oral medications, but this is more expensive and has no distinct advantage over insulin alone. There are short, intermediate, and long-acting forms of insulin and several different sources (pork, humans, RNA), so consult your doctor. A new form of insulin is now available that can be inhaled and helps reduce the number of injections required on a daily basis. However, it cannot be used if you have problems with your lungs. Be sure to monitor and regulate your glucose regularly and under the guidance of a doctor.

Your Herbal Healing Action Plan for Complications of Diabetes

• Prevention-by strictly maintaining healthy blood glucose levels-is the best way to avoid complications of diabetes. When complications do occur, the following treatments can help.

Treatments for Neuropathy (Nerve Problems)

Step 1: Undergo Acupuncture

Acupuncture can be very effective for reducing the symptoms of diabetic neuropathy. Principal acupuncture points usually are found on the legs. Ear point refers to the leg region.

Always seek evaluation and treatment from a practitioner certified in acupuncture.You should improve within six treatments, but you might need additional sessions for maximum benefits.

Step 2: Take a Low-Dose Prescription Tricyclic Antidepressant, Neurontin, or Pregabalin

If Step 1 is partially effective or not effective at all, your doctor can prescribe low-dose anti­depressants such as amitriptyline, 25mg to 50mg per day, which can sometimes reduce pain. An alternative is Neurontin (gabapentin), 300mg to 2,400mg per day. Amitriptyline may cause dryness of the mouth, and both drugs may cause drowsiness. A newer drug, pregabalin, has recently been shown to be effective in 40 percent of people with diabetic neuropathy. It may take several weeks to notice improvement with any of these medications.

Step 3: Take Alpha-Lipoic Acid, Thiamine (Vitamin B1), and/or Gamma-Linoleic Acid

Alpha-lipoic acid (ALA), considered a “super-antioxidant,” has been used for 25 years in Germany to treat diabetic neuropathy. It has been demonstrated to decrease numbness and pain in neuropathy after three weeks of treatment, but this is with intravenous use. Unfortunately, I’m not aware of anywhere in the U.S. where you can receive this supplement intravenously, so you would have to go to Germany for this treatment. Oral alpha-lipoic acid (1,200mg to 1,800mg per day) can improve nerve conduction and decrease serum glucose, but it has not been shown to improve symptoms of neuropathy. I do think it is worth trying the oral form because it does have benefits for the nerves and for your diabetes, and it may slow the progression of your neuropathy. You should notice improvement in two to three months.

Supplements containing gamma-linoleic acid (GLA) can also improve neuropathy, although it may take several months for you to get any benefits from them. Evening primrose oil (480mg daily) is the most commonly used, but I recommend borage oil (1g daily) because it’s less expensive and contains a greater percentage of GLA. Thiamine (vitamin B1. 10mg to 30mg daily) has recently been found to improve neuropathy symptoms, and I recommend it, too. You can take all these supplements together.

Step 4: Use Transcutaneous Electrostimulation

Transcutaneous electrostimulation is sometimes successful in relieving some of the pain associated with neuropathy. This involves the use of a TENS unit, which is carried on a belt and connects electrodes to the leg areas. The unit is available through a doctot’s prescription.

Treatments for Retinopathy (Eye Disease)

Step 1 : Take Bilberry and Mixed Carotenoids

If your retinopathy is mild, supplements containing bilberry (160mg extract twice daily) may be very helpful. There are several products that combine bilberry with mixed carotenoids, which may be more effective than bilberry alone. These supplements protect the eye through their antioxidant effects. You should notice improved vision within one to two months.

Step 2: Undergo Photocoagulation

If your retinopathy is severe, photocoagulation will be necessary. This procedure uses high energy laser to seal leaky blood vessels. If you are losing vision in your eyes despite Step I, consult with an ophthalmologist (eye physician) regarding this procedure.

Treatments for Nephropathy (Kidney Disease)

• Have your urine checked for microalbuminuria every 3 to 6 months. This is the most sensitive test to detect early kidney problems. If the lab results are abnormal, you should have your creatinine, 24-hour protein, and creatine clearance checked every year.

Step 1: Make Dietary Changes to Support Kidney Health

In the early stages, nephropathy can be managed primarily by diet and nutrient balance. Although the Balanced Healing Diet is appropriate for this purpose, I highly recommend consultation with a registered dietician first to help you understand and plan what you need to eat for optimum kidney health. I also recommend adding soy products to your diet; they can provide needed protein, and they can improve kidney function.

Step 2: Take Prescription ACE Inhibitors

If your urine tests show that you have proteinuria (excessive protein in your urine), your doctor may prescribe an ACE inhibitor (such as captopril or analapril) because these drugs reduce the risk of kidney failure. Some people may have coughing as a side effect. If you start coughing, take low-dose ibuprofen (200mg to 600mg per day), which, for many people, can block the cough. (Remember to take the ibuprofen several hours after taking aspirin.)

Step 3: Take Flaxseed Oil

I recommend taking flaxseed oil (1 tablespoon per day) with the previous steps. Flaxseed oil promotes kidney function, due to its effects in preventing artery disease and correcting defects in fatty acid metabolism seen in people with diabetes. Because of these effects, it also helps prevent heart disease.

Step 4: Undergo Dialysis

Severe nephropathy requires dialysis to take over the filtering functions of the damaged kidneys. Dialysis requires the creation of an arteriovenous fistula (surgical attachment of a vein to an artery, usually in the forearm), and then weekly or more frequent sessions in which your blood is cleaned of toxins through a dialysis machine. Because this process leaches many important nutrients from your system along with the toxins, your doctor will have these nutrients replaced in the dialysis solution.

Treatments for Foot Ulcers

Step 1: Good Foot Care for Prevention

Good foot care and avoiding injury are the best approach to foot ulcers. If you do injure your feet, see your regular doctor or diabetes specialist immediately. Don’t wear shoes or boots that squeeze or constrict your feet or that are otherwise uncomfortable.

Step 2: Undergo Conventional Wound Care

Appropriate conventional wound care is necessary if an ulcer starts forming. You need wound debridement (removal of any dead tissue), appropriate antibiotics, ar hyperbaric oxygen treatment. You will likely need surgery if the ulcer progresses into gangrene, in which the tissue dies and turns black. You can use the following steps along conventional care to accelerate the healing process.

Step 3: Undergo Low-Energy Laser Treatment

I recommend the use of low-level energy lasers along with Step 2 because in my studies the laser is very effective for healing ulcers by stimulating the damaged cells to heal and by increasing blood flow to the foot. These lasers are called “cold” lasers because they, not produce heat like the hot lasers used in surgical procedures do. Their primary side effect (in about 25 percent of patients) is that they cause a temporary increase in soreness, which may last from one to three days. You should observe results within two to three weeks. Because low-energy lasers are currently a research device and unavailable to most doctors, see Index C for reference information.

Step 4: Undergo Acupuncture

If your foot ulcers are still not healing or are slow to heal, I recommend acupuncture to stimulate blood flow and tissue healing. The acupuncture needles should be placed around the ulcer, but placement will also depend on your underlying Chinese diagnosis. Always seek evaluation and treatment from a practitioner certified in acupuncture. You should see improvement within six treatments, but you might need additional sessions for maximum benefits. Acupuncture can be used with the laser in Step 3 for faster results.

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