Nitric Oxide and Diabetes

diabetes is an epidemic but its symptoms may be treated with nitric oxide Scientists around the world are working feverishly to increase our understanding of the nitric oxide in the human body.  The results so far have been nothing short of astounding.  Having already identified numerous incredible benefits related to increased blood, oxygen and nutrient flow, scientists are now doing research into the effect of nitric oxide on some of society’s most vexing health issues like diabetes.  Diabetics have a lower level of nitric oxide than normal and that low NO may contribute to the complications that plague diabetics.  Nitric oxide may ameliorate the symptoms of of the associated conditions inherent to diabetes like reduced blood flow, kidney disease, retinopathy and ulcers.

The effect of nitric oxide on diabetes is a very important topic for personal reasons.  My oldest son was diagnosed with Type 1 diabetes at age 7.  As opposed to Type 2 diabetes which is characterized by insulin resistance, in Type 1 Diabetes, the body produces too little or no insulin at all.  Insulin is a critical hormone for causing the cells to take up glucose, their primary fuel.  Without insulin, there is no way for the glucose to get into the cells.  Without glucose, the cells die.  Perhaps out of desperation, when the body notices a lack of insulin, it starts to burn fats.  That may sound great to some people, but it can be devastating.  Your internal organs and brain are mostly made of fats and become a food source in this desperate situation.  Without insulin, no matter what the body breaks apart to use for fuel, it cannot get glucose into the cells. However, the glucose, or sugar doesn’t just go away, it stays in the blood.  The body does try to excrete the excess glucose through the urine, however, it ends up becoming dehydrated because of the reverse osmosis that pulls water out of the cells to deal with all of the excess sugar.  This state of Diabetic Keto-Acidosis or DKA can be very dangerous.  Besides vomiting, dehydration, blurred vision, increased blood pressure, and headaches, a person suffering DKA can experience precipitous drops in potassium levels leading to all kinds of complications, as well as cerebral edema, coma and death.

Even when properly managed, both type 1 and type 2 diabetes have significant long term complications, many of which are related to the vascular system.  Diabetics have a much higher incidence of hypertension and atherosclerosis (heart disease) than the normal population as well as other circulation problems.  In addition to these problems, diabetics also have higher incidences of circulatory related diseases like retinopathy and decreased kidney function.

The Sad Facts About Diabetes

In addition to the approximately 18 million Americans with either type 1 or type 2 diabetes, 57 million Americans are in a pre-diabetic condition where their blood glucose levels are higher than normal but not quite high enough to be diagnosed with type 2 diabetes.

Complications of Diabetes!

According to the Diabetes Association of Greater Cleveland:

  • Diabetes is a leading cause of adult blindness, lower-limb amputation, kidney disease and nerve damage.
  • 40% of diabetics suffer some degree of hearing impairment.
  • 66% of diabetics die from a heart attack or stroke.
  • 28% of diabetics develop kidney disease
  • 23% of diabetics have foot problems including numbness and amputations.


Nitric Oxide

Nitric oxide (NO) is a simple molecule consisting of a single nitrogen atom coupled with a single oxygen atom.  In 1977, as scientists were trying to discover how nitroglycerin, a heart medicine, works, they found that nitrates release nitric oxide, which causes the smooth muscle in the blood vessels to relax.  This vasodilation had such profound impacts in the body, that in 1992, nitric oxide was named “Molecule of the Year” and by 1998, Robert F. Furchgott, PhD, Louis J. Ignarro, PhD, and Ferid Murad, MD, PhD received a Nobel Prize for their work with the chemical.

Nitric oxide is highly reactive.  Even in the human body, it typically only lasts a few seconds before used up in various processes.  We know now that NO is formed an enzyme, Nitric Oxide Synthase (NOS) which breaks down L-arginine.  NOS has three isoforms;  NOS1, NOS2, and NOS3.

NOS1 is the brain isoform.  It can help transmission of information across the synapses of nerves in the brain as well as from peripheral nerves to neurons in the brain.

NOS2 is called “inducible” or iNOS.  This enzyme pumps out huge quantities of NO in response to bacterial infection or injury.  This NOS is responsible for wound healing and moderating the influence of platelets and are produced at a rate of 100 – 1000 times normal.

NOS3 or ecNOS, which stands for endothelial cell nitric oxide synthase is the one that most bodybuilders, athletes and supplement manufacturers are focused on.  ecNOS is always active and forms in the endothelium, or the inner lining of the blood vessels.  The nitric oxide produced by this isoform is what keeps the blood vessels relaxed and supple.  Furthermore, ecNOS can cause the creation of new blood vessels, especially important in certain injuries like ulcers and burns.

It is easy to see how incredibly powerful the nitric oxide is because of it effects on nearly every system in our body.   And there are even more benefits that flow from having the optimal amount of nitric oxide in your body.  NO improves or enhances:

  1. Brain function
  2. Muscle growth
  3. Endurance
  4. Sexual health, including addressing erectile dysfunction
  5. Blood pressure
  6. Organ health
  7. Eye sight
  8. Hair regrowth
  9. Pain tolerance
  10. Wound healing and tissue repair

In short, every system in the body that can benefit from increased blood, oxygen, and nutrient flow as well as waste elimination, benefits from having optimal nitric oxide.

Recent research from Thomas Burke, PhD indicates that nitric oxide is not only responsible for initiating and maintaining vasodilation, but that in allows sufficient oxygen and glucose to flow to the nerve cells and directly reduces pain by increasing cGMP (cyclic guanosine monophosphate) which is the mechanism by which opioids work and indirectly by reducing pressure on nerves.  NO also stimulates cell division and growth.  It also enhances collagen formation, important in wound healing.  L-arginine and nitric oxide are needed for minimal scar tissue formation and increasing the strength of newly formed/healed tissue.  These benefits are especially important in diabetes where wounds take a much longer time to heal.

Mark S. Segal, from the University of Florida’s College of Medicine has found that in diabetics, cells that are normally produced in the bone marrow to deal with wounds, simply don’t show up to the damage site.   His group isolated these “repair” cells from patients with diabetes and kidney disease and found that they were unable to move normally.  After exposing them to nitric oxide, the cells became less rigid and more able to move around.

Diabetics commonly have low levels of NO in their system.  Dr. Burke believes that there are several reasons that people with diabetes have impaired or reduced nitric oxide levels.   NOS is inhibited by asymmetrical dimethyl arginine (ADMA).  Normally, ADMA doesn’t accumulate in the body and is excreted through the kidneys, but impaired kidney function that is associated with diabetes, may contribute to the retention of ADMA which, will limit the production of NO.

Furthermore, NOS, the enzyme which generates nitric oxide, is pH dependent.  The more acidic the environment, the less effective it is.  Ketoacidosis and high blood glucose levels may reduce NO production in this way.

High blood glucose levels, which many diabetics struggle with, may also cause the nitric oxide to be bound so tightly in a form called nitrosothiol, that it cannot be easily released to maintain blood flow through vasodilation.

Dr. Segal thinks that not only could nitric oxide help invigorate the body’s natural repair cells, but that by vasodilation, the body could move them to the wound site more effectively.   And Dr. Burke suggests that many in the scientific community feel that proper NO levels in patients with diabetes would reduce the incidence of ulcers and other wounds as well as address the peripheral neuropathy that diabetics suffer with.  So, clearly it is important for diabetics to have optimal levels of nitric oxide in their bodies.

Where to get More Nitric Oxide

Spinach and Garlic are rich in nitric oxide inducing nutrientsEdothelial cell nitric oxide, the kind the body uses to enhance circulation, is a by-product  of the breakdown of arginine by nitric oxide synthase (NOS).  Arginine is a semi-essential amino acid, meaning that the body can produce it.  However, as we age, our body becomes less efficient at producing arginine and as a result NO production is impaired.   The great news is that we can increase our nitric oxide by consuming foods rich in l-arginine and l-citrulline, another semi-essential amino acid.  These foods include nuts, fish, spinach, kale, beets, watermelon, and dairy.  You can read more about these in my article Foods that Increase Nitric Oxide.

You will also notice that these foods are often found on many health food lists.  Having a good diet and keeping control of blood sugar levels is absolutely critical for diabetics and pre-diabetics, especially if you want to maximize nitric oxide.  Blood glucose that is too high will inhibit NO production and utilization.

Nitric Oxide Supplements

As you’ve searched about information related to nitric oxide, no doubt you’ve seen a plethora of supplements all promising tremendous benefits.  Those that have formulations proven to help the body generate nitric oxide do work.  Some of these include noXplode and Nitrix from BSN, NOW Arginine and Citrulline, Neo40 by Neogenis, and Circ02 products.  I have personally used BSN products.  You can find complete listings at,< and Vitamin Shoppe.  All three offer terrific customer service and can answer any other questions you have about ingredients and daily doses.  Also, consult with your physician before adding these or any supplements to your diet, especially if your are diabetic.


Clearly nitric oxide is an incredibly important chemical in the human body.  It is responsible for benefits including blood vessel dialation, which improves circulation, blood pressure, wound healing and addresses other symptoms of diabetes.  While it will not affect your insulin levels, nitric oxide may reduce neuropathy and the degradation of blood vessels and organs that occurs with diabetes.  That being said, it is important for diabetics and pre-diabetics to keep your diet clean in order to get the most benefit from NO as high glucose levels will impair nitric oxide’s action on the body.  Even if not diabetic, consider enhancing your diet with nitric oxide supplements containing L-Arginine, and L-Citrulline to address the natural decrease that comes with age and to provide the healthful benefits you deserve.




Dan Hammer ,”Nitric Oxide and Diabetes!”

Thomas Burke Ph.D,  “Nitric Oxide and its Role in Health and Diabetes

Nitric Oxide Holds Promise for Diabetes Cell Repair
University of Florida, office of the Senior Vice President for Health Affairs, PO Box 100253, Gainesville, FL 32610-0253; telephone: (352) 273-5810; Web site: