MoonDragon's Pregnancy Information
GESTATIONAL DIABETES MELLITUS
Clinical Practice Recommendations
American Diabetic Association
Volume 23 Supplement 1
American Diabetes Association:
Clinical Practice Recommendations 2000
DEFINITION, DETECTION, AND DIAGNOSIS
Definition: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy.
Approximately 4 percent of all pregnancies are complicated by GDM, resulting in ~135,000 cases annually. The prevalence may range from 1 to 14 percent of all pregnancies, depending on the population studied and the diagnostic tests employed.
Detection and diagnosis: Risk assessment for GDM should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. If they are found not to have GDM at that initial screening, they should be retested between 24 and 28 weeks of gestation. Women of average risk should have testing undertaken at 24 to 28 weeks of gestation. Low-risk status requires no glucose testing, but this category is limited to those women meeting all of the following characteristics:
A fasting plasma glucose level >126 mg/dl (7.0 mmol/l) or a casual plasma glucose >200 mg/dl (11.1 mmol/l) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge. In the absence of this degree of hyperglycemia, evaluation for GDM in women with average or high-risk characteristics should follow one of two approaches:
- Age 25 years.
- Weight normal before pregnancy.
- Member of an ethnic group with a low prevalence of GDM.
- No known diabetes in first-degree relatives.
- No history of abnormal glucose tolerance.
- No history of poor obstetric outcome.
One-Step approach: Perform a diagnostic oral glucose tolerance test (OGTT) without prior plasma or serum glucose screening. The one-step approach may be cost-effective in high-risk patients or populations (e.g., some Native-American groups).
Two-Step approach: Perform an initial screening by measuring the plasma or serum glucose concentration 1 hour after a 50-g oral glucose load (glucose challenge test [GCT]) and perform a diagnostic OGTT on that subset of women exceeding the glucose threshold value on the GCT. When the two-step approach is employed, a glucose threshold value >140 mg/dl (7.8 mmol/l) identifies approximately 80 percent of women with GDM, and the yield is further increased to 90 percent by using a cutoff of >130 mg/dl (7.2 mmol/l).
With either approach, the diagnosis of GDM is based on an OGTT. Diagnostic criteria for the 100-g OGTT are derived from the original work of O'Sullivan and Mahan, modified by Carpenter and Coustan, and are shown in Table 1. Alternatively, the diagnosis can be made using a 75-g glucose load and the glucose threshold values listed for fasting, 1 h, and 2 h; however, this test is not as well validated as the 100-g OGTT.
OBSTETRIC & PERINATAL CONSIDERATIONS
The presence of fasting hyperglycemia (>105 mg/dl or >5.8 mmol/l) may be associated with an increase in the risk of intrauterine fetal death during the last 4 to 8 weeks of gestation. Although uncomplicated GDM has not been associated with increased perinatal mortality, GDM increases the risk of fetal macrosomia and other neonatal morbidities including hypoglycemia, hypocalcemia, polycythemia, and jaundice. GDM is associated with an increased frequency of maternal hypertensive disorders and the need for cesarean delivery. The latter complication may result from fetal growth disorders and/or alterations in obstetric management due to the knowledge that the mother has GDM.
Long-term considerations: Women with GDM are at increased risk for the development of diabetes, usually type 2, after pregnancy. Obesity and other factors that promote insulin resistance appear to enhance the risk of type 2 diabetes after GDM, while markers of islet cell directed autoimmunity are associated with an increase in the risk of type 1 diabetes. Offspring of women with GDM are at increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood.
THERAPEUTIC STRATEGIES DURING PREGNANCY
Maternal metabolic surveillance should be directed at detecting hyperglycemia severe enough to increase risks to the fetus. Daily self-monitoring of blood glucose (SMBG) appears to be superior to intermittent office monitoring of plasma glucose. For women treated with insulin, evidence indicates that postprandial monitoring is superior to preprandial monitoring.
Urine glucose monitoring is not useful in GDM. Urine ketone monitoring may be useful in detecting insufficient caloric or carbohydrate intake in women treated with calorie restriction.
Maternal surveillance should include blood pressure and urine protein monitoring to detect hypertensive disorders.
Increased surveillance for pregnancies at risk for fetal demise is appropriate, particularly when fasting glucose levels exceed 105 mg/dl (5.8 mmol/l) or pregnancy progresses past term. The initiation, frequency, and specific techniques used to assess fetal well-being will depend on the cumulative risk the fetus bears from GDM and any other medical/obstetric conditions present.
Assessment for asymmetric fetal growth by ultrasonography, particularly in early third trimester, may aid in identifying fetuses that can benefit from maternal insulin therapy (see below).
All women with GDM should receive nutritional counseling, by a registered dietitian when possible, consistent with the recommendations by the American Diabetes Association. Individualization of medical nutrition therapy (MNT) depending on maternal weight and height is recommended. MNT should include the provision of adequate calories and nutrients to meet the needs of pregnancy and should be consistent with the maternal blood glucose goals that have been established. Non-caloric sweeteners may be used in moderation.
For obese women (BMI > a 30 to 33 percent calorie restriction (an intake of ~1,800 kcal/day) has been shown to reduce hyperglycemia and plasma triglycerides with no increase in ketonuria. Obese women may do well with moderate calorie restriction as a goal.
Insulin is the only pharmacologic therapy that has been shown to reduce fetal morbidities when added to MNT. Selection of pregnancies for insulin therapy can be based on measures of maternal glycemia with or without assessment of fetal growth characteristics. When maternal glucose levels are used, insulin therapy is recommended when MNT fails to maintain fasting whole blood glucose levels < 95 mg/dl (5.3 mmol/l) or 2-hour postprandial whole blood glucose levels < 120 mg/dl (6.7 mmol/l). Insulin should be administered to maintain maternal glycemia below these levels.
Measurement of the fetal abdominal circumference early in the third trimester can identify a large subset of infants with no excess risk of macrosomia in the absence of maternal insulin therapy. This approach has been tested primarily in pregnancies with maternal fasting serum glucose levels < 105 mg/dl (5.8 mmol/l).
Human insulin should be used when insulin is prescribed, and SMBG should guide the doses and timing of the insulin regimen. The use of insulin analogs has not been adequately tested in GDM.
Oral glucose-lowering agents are not recommended during pregnancy.
Women with an active lifestyle should be encouraged to start or continue a program of moderate exercise, which has been shown to lower maternal glucose concentrations.
GDM is not of itself an indication for cesarean delivery or for delivery before 38 weeks completed gestation. Prolongation of gestation past 38 weeks increases the risk of fetal macrosomia without reducing cesarean rates, so that delivery during the 38th week is recommended unless obstetric considerations dictate otherwise.
Breast-feeding, as always, should be encouraged in women with GDM.
LONG-TERM THERAPEUTIC CONSIDERATIONS
Reclassification of maternal glycemic status should be performed at least 6 weeks after delivery and according to the guidelines of the "Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus". If glucose levels are normal postpartum, reassessment of glycemia should be undertaken at a minimum of 3-year intervals. Women with IFG or IGT in the postpartum period should be tested at more frequent intervals. Patients should be educated regarding lifestyle modifications that lessen insulin resistance, including maintenance of normal body weight through MNT and physical activity. Medications that worsen insulin resistance (e.g., glucocorticoids, nicotinic acid) should be avoided if possible. Patients should be advised to seek medical attention if they develop symptoms suggestive of hyperglycemia. Education should also include the need for family planning to assure optimal glycemic regulation from the start of any subsequent pregnancy. Low-dose estrogen-progestogen oral contraceptives may be used in women with prior histories of GDM, as long as no medical contraindications exist.
Offspring of women with GDM should be followed closely for the development of obesity and/or abnormalities of glucose tolerance.
1. Metzger BE, Coustan DR (Eds.): Proceedings of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 21 (Suppl. 2):B1- B167, 1998
2. Franz MJ, Horton ES, Bantle JP, Beebe CA, Brunzell JD, Coulston AM, Henry RR, Hoogwerf BJ, Stacpoole PW: Nutrition principles for the management of diabetes and related complications (Technical Review). Diabetes Care 17:490-518, 1994
3. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 23 (Suppl. 1):S4-S19, 2000
The recommendations in this paper are based on the evidence reviewed in the following publications: Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 21 (Suppl. 1):S5 S19, 1998; and the Proceedings of the 4th International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 21 (Suppl. 2):B1 B167, 1998.
Originally approved 1986. Most recent review/revision, 1999.
- GCT, glucose challenge test
- GDM, gestational diabetes mellitus
- IFG, impaired fasting glucose
- IGT, impaired glucose tolerance
- MNT, medical nutrition therapy
- OGTT, oral glucose tolerance test
- SMBG, self-monitoring of blood glucose.
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DIABETIC DIET SUGGESTIONS
Dietary changes are an important aspect of the treatment and specific diet instructions will be provided. Following the prescribed diet will decrease the risks to mother and unborn child. A low fat, high fiber diet including raw vegetables and fresh vegetable juice is recommended. Avoid saturated fats and simple sugars. Avoid or restrict alcohol use.
MoonDragon's Nutritional Information - Gestational Diabetes: Nutrition & Diet
These diet changes will involve increased fiber intake, fat restriction, elimination of concentrated sweets, and possibly the monitoring of caloric intake to prevent excessive weight gain.
Consultation with a dietician is often recommended for educational purposes, to answer your dietary questions and to provide follow-up encouragement.
REDUCING PROBLEMS ASSOCIATED WITH GESTATIONAL DIABETES
In addition to your midwife, there are other health professionals who specialize in the management of diabetes during pregnancy including internists or diabetologists, registered dietitians, qualified nutritionists, and diabetes educators. Your midwife may recommend that you see one or more of these specialists during your pregnancy. In addition, a neonatologist (a health care provider specializes in the care of newborn infants) may also be called in to manage any complications the baby might develop after delivery.
One of the essential components in the care of a woman with gestational diabetes is a diet specifically tailored to provide adequate nutrition to meet the needs of the mother and the growing fetus. At the same time the diet has to be planned in such a way as to keep blood glucose levels in the normal range (60 to 120 mg/dl). The meal plan will control blood sugar as well as provide optimal nutrition for pregnancy.
The meal plan controls blood sugar by controlling how much carbohydrate food is eaten. Carbohydrates, both sugars and starches, are converted into blood sugar in our bodies. Eating less carbohydrate prevents high blood sugar. Some carbohydrates are digested more slowly and therefore raise blood sugar less than others. In general, your GDM nutritional plan will follow these principles:
A very small breakfast with little carbohydrate, such as 8 oz milk with one slice of toast and an egg or peanut butter for protein. 3 small meals and 2 to 3 small snacks (smaller meals cause lower blood sugars). Avoidance of concentrated sweets and sugars, including fruit juice. Plenty of non-starchy vegetables. Low-fat protein foods such as chicken, tuna, or lean meat. Lower-fat food choices in general, to keep weight gain at a healthy level. Low-fat or non-fat milk, yogurt or cheese for adequate calcium.
Your midwife or health care provider will determine the correct amounts of the different foods and design a menu based on your schedule, the foods you like, your blood sugar levels, and your nutritional needs in pregnancy. The breakfast is generally very small because the pregnancy hormones, which raise blood sugar, are at highest levels in the morning.
Note: Not all of these recommended supplements and herbs are recommended during pregnancy and lactation. These are general suggestions for people with diabetes health issues. Always consult with your midwife or health care provider before taking any medication, dietary supplement, or herbal therapy while you are pregnant and breastfeeding your baby.
Beanpod tea, made up of kidney, white, navy, lima, and northern beans, detoxifies the pancreas.
Most legumes are a good meal choice for diabetics. even though Beans contain starch, they are also rich in protein, fiber and saponins, all of which can help to balance blood sugar. Eat bean burritos, make chili with beans, put kidney beans in salads and prepare bean dips. Homemade bean soup is always nice, especially during the winter months when it is cold and miserable outdoors.
Bitter Melon (Momordica Charantia), Gudmar (Gymnema sylvestre), and Gulvel/Guduchi (Tinospora Cordifo) are herbal remedies used in Ayurvedic medicine to regulate blood sugar levels.
Cedar berries are excellent nourishment for the pancreas.
Dandelion root protects the liver, which converts nutrients into glucose and improves liver function and the metabolism of fats. Note: If you suffer from gallbladder problems, avoid large quantities of dandelion.
Fenugreek seeds have been shown to reduce cholesterol and blood sugar levels.
Fenugreek seeds, Blackberry and Blueberry leaves have a beneficial effect on pancreatic function. Mix in equal parts to make a tea blend. Use 1 teaspoon of the mixture for each cup of water. Steep for 30 minutes and then strain. Drink as much as 2 quarts daily.
Take Garlic capsules and/or eat fresh Garlic in salad dressings or prepare a Garlic tincture. For the tincture, peel 8 to 10 whole bulbs of garlic and place in a blender with enough vodka or brandy to cover. Puree and transfer to a glass jar. Ensure that the garlic is fully covered by adding additional vodka, as needed. Let stand in a dark, warm place for about 2 weeks, shaking it daily. Filter out the garlic pieces and take 1 teaspoon of the tincture 3 to 4 times daily.
Ginseng tea is believed to lower the blood sugar level. Caution: Do not use this herb if you have high blood pressure.
Huckleberry helps to promote insulin production. Huckleberry leaf is used by naturopathic physicians to treat sugar diabetes and ailments of the kidneys and gallbladder.
Stimulate the metabolism. Because the excessive sugars and fats in the blood stream can cause damage to the blood vessels, it is especially important for diabetics to maintain healthy circulation. Ensuring that all organs get enough oxygen is the only way to prevent complications, such as blindness, loss of kidney function and circulatory disease in the extremities. Blueberries and Hawthorn berries can help protect blood vessels from damage, too, just as keeping blood-sugar and cholesterol levels in check and stave off many complications. Regular use of saunas and hot baths can help stimulate the elimination of toxins from the body.
Juniper berries have been found to lower blood glucose levels.
Other herbs that may be beneficial for diabetes include Bilberry, Buchu, Goldenseal, and Uva Ursi. Bilberry leaf isused in connection with vascular and blood disorders and shows positive effects when treating varicose veins, thrombosis, and angina. Bilberry extract is high in bioflavonoid complex anthocyanosides and supports healthy vision. Bilberry is useful for maintaining a healthy digestive system, is an anti-inflammatory and an antioxidant. Buchu herb has traditionally been claimed to treat a wide variety of disorders, some of which include stomach complaints and urinary tract infections. Buchu leaves act as a diuretic and antisepic, and today is used in treating inflammation of the urethra, blood in the urine, bladder infections, and other chronic urinary trat infections. Goldenseal is an antibacterial and antiseptic. Use especially when mucus turns thick and discolored. Use short term only with other herbs. Uva Ursi, also known as bearberry, has a specific affinity for the genito-urinary organs, especially for urinary tract infections, cystitis, nephritis, urethritis, pyelitis, hematuria (bloody urine), yeast infections, vulvitis. Uva Ursi leaves were officially a drug for urinary antiseptic in the United State Pharmacopoeia (U.S.P.) and the National Formulary N.F. from 1820 until 1950. Caution Do not take Goldenseal on a daily basis for more than one week at a time, and do not use it during pregnancy. If you have a history of cardiovascular disease, diabetes, or glaucoma, use it only under a health care provider's supervision.
Beanpod Herbal Products Bilberry Herbal Products Bitter Melon Herbal Products Blackberry Herbal Products Blueberry Herbal Products Buchu Herbal Products Dandelion Herbal Products Fenugreek Herbal Products Garlic Herbal Products Ginseng Herbal Products Goldenseal Herbal Products Gudmar (Gymnema) Herbal Products Guduchi (Gulvel) Herbal Products Hawthorn Herbal Products Huckleberry Herbal Products Juniper Cedar Herbal Products Uva Ursi Herbal Products
Opinions may differ as to the optimal ratio of dietary carbohydrates, proteins and fats for prevention and treatment of diabetes. However, it is safe to say that carbohydrates trigger the release of insulin. As more carbohydrates are consumed, more insulin is produced. The current epidemic of obesity and diabetes in the United States indicates that we are asking our bodies to burn the wrong fuel - refined carbohydrates in this case. It has been suggested by Dr. Gerald Reaven of Stanford University that a diet consisting of 45 percent complex carbohydrates, 40 percent "good" (polyunsaturated) fats, and 15 percent protein will benefit individuals with insulin resistance, the precursor to diabetes. It is estimated that as many as 70 to 80 million Americans may be affected by insulin resistance syndrome. Medications such as metformin (Glucophage) and rosiglitazone (Avandia) are prescribed to combat insulin resistance.
Eat a low-fat, high-fiber diet including plenty of raw fruits and vegetables as well as fresh vegetable juices. This reduces the need for insulin and also lowers the level of fats in the blood. Fiber helps to reduce blood sugar surges. For snacks, eat Oat or Rice Bran crackers with nut butter or cheese. Legumes, root vegetables, and whole grains are also good. Remember to regulate your carbohydrate intake. See Hypoglycemic Diet for helpful dietary suggestions to prevent hypoglycemic episodes.
The types of carbohydrates consumed are at least as important as the total carbohydrate loading. High-glycemic foods such as white rice, white flour products, pasta, starchy vegetables, and many processed foods are quickly converted into blood sugar during digestion, causing insulin to go up. Carbohydrates found in lower glycemic foods such as asparagus, broccoli, cabbage, green beans, and low-starch vegetables and fruits are converted into blood sugar more slowly, which only gradually raises insulin levels. Avoiding "white foods" might be best.
Supplement your diet with Spirulina. Spirulina helps stabilize blood sugar levels. Other foods that help normalize blood sugar include berries, Brewers Yeast, dairy products (especially cheese), egg yolks, fish, Garlic, Kelp, sauerkraut, soybeans, and vegetables.
Get your Protein from vegetable sources, such as grains and legumes. Fish and low-fat dairy products are also acceptable sources of protein. Kidney function in people with type 2 diabetes seems to benefit from dietary Soy Protein. This protein also raises the level of "good" cholesterol.
Avoid saturated fats, trans-fats, hydrogenated or partially hydrogenated oils, and simple sugars (except when necessary to balance an insulin reaction). While total fat intake does not seem to change the risk of getting diabetes, the trans-saturated fats and hydrogenated oils found in most fast foods can greatly increase the risk. Beneficial fats and oils include extra virgin Olive Oil, Salmon Fish Oil, Almond Oil, Avocado Oil, nuts and seed oils such as Sesame Seed Oil, Flaxseed Oil, Sunflower Oil, and Pumpkin Seed Oil.
Eat more complex carbohydrates or reduce your insulin dosage before exercise. Exercise produces as an insulin-like effect in the body. Talk to your health care provider about the right approach for you.
Type 2 diabetes can be controlled by diet and exercise alone, but oral medications or injections of insulin can be added if regulating the diet does not work. Obesity is a major factor in type 2 diabetes, and a weight reduction program is often all that is required to control it.
It was once thought that people with diabetes should avoid sweetened foods. For weight control, this is still the case. However, research has shown that sugar - a simple carbohydrate - does not cause the greatest increase in blood glucose. Eating baked potatoes or some breakfast cereals causes a greater rise in blood sugar. Indeed carrots raise blood sugar more than ice cream does. It is on this principle that many high-protein, low-carbohydrate diets are based. It is essential, therefore, that people with diabetes measure their intake of both simple and complex carbohydrates - not simply those coming from sugar.
MoonDragon's Womens Health Information: Obesity - Description Overview
MoonDragon's Womens Health Information: Obesity - Herbal Suggestions For Weight Loss
MoonDragon's Womens Health Information: Obesity - Holistic & Dietary Information
MoonDragon's Nutrition Information: Diets - Weight Control Diet
MoonDragon's Nutrition Information: Diets - Weight Loss Diet
Do not take fish oil capsules or supplements containing large amounts of para-aminobenzoic acid (PABA), and avoid salt and white flour products. Consumption of these products results in an elevation of blood sugar.
Eat more carbohydrates or reduce your insulin dosage before exercise. Exercise produces an insulin-like effect in the body. Discuss with your health care provider about the right approach for you.
A higher Magnesium intake lowers the risk of getting type 2 diabetes. The journal Diabetes Care published a study in which overweight women who consumed large amount of magnesium were 22 percent less likely to develop type 2 diabetes than women who consumed lower amounts. A diet rich in nuts, whole grains, and vegetables that are high in magnesium may be beneficial.
Do not take supplements containing amino acid cysteine. It has the ability to break down the bonds of the hormone insulin and interferes with absorption of insulin by the cells.
Do not take extremely large doses of Vitamins B-1 (thiamine) and Vitamin C. Excessive amounts may inactivate insulin. These vitamins may, however, be taken in normal amounts. See Nutrient Table for recommendations.
If symptoms of hyperglycemia develop, go to the emergency room of the nearest hospital or medical center. This is a potentially dangerous situation. Intravenous administration of proper fluids, electrolytes, and insulin may be required.
Avoid taking large amounts of Vitamin B-3 (Niacin). However, small amounts (50 to 100 milligrams daily), taken by mouth, may be beneficial. In one study, large amounts of niacin raised blood sugar levels in people with non-insulin-dependent diabetes by as much as 16 percent. Over time, this could cause dependence on insulin or medication. Niacin can also cause the level of uric acid in the blood to rise, indicating probable kidney dysfunction and an increased risk of gout. However, niacinamide, a form of niacin, shows down the destruction and enhances the regeneration of the insulin-producing beta cells in the pancreas, and therefore may be helpful for those with type I diabetes.
Chromium deficiency may be a key player in the type 2 diabetes problem. In addition, Chromium may help improve body composition - that is, the ratio of fat to muscle. Chromium is not generally available in plant foods as plants have no requirement for it and thus do not concentrate it. Brewers Yeast, beer, whole grains, cheese, broccoli, and meat are good dietary sources, but not all are good choices for people with diabetes. Inorganic forms of chromium are poorly absorbed. Chromium Picolinate is an effective organic form that is readily available as a supplement. See Nutrient Table for dosage and details.
Many nutrients recommended for people with diabetes are available in combination supplements. See Diabetic Supplements for a list of products.
If you have a child with diabetes, be sure his or her teacher knows how to respond to the warning signs of hypoglycemia and hyperglycemia.
If symptoms of hypoglycemia develop, immediately consume fruit juice, soda pop, or anything else that contains sugar. If that fails to help within 20 minutes, repeat this regimen. If the second treatment fails, or if you cannot ingest food, seek immediate medical attention and/or administer a glucagon injection. Anyone who has insulin-dependent diabetes should always carry a glucagon kit and know how to use it.
MoonDragon's Nutrition Information: Diets - Hypoglycemic Diet
Avoid tobacco in any form. It constricts the blood vessels and inhibits circulation. Keep your feet clean, dry, and warm, and wear only white cotton socks and well-fitting shoes. Lack of oxygen (because of poor circulation) and peripheral nerve damage (with loss of pain sensation) are major factors in the development of diabetic foot ulcers. Try to avoid injury, and take measures to improve the circulation in the feet and legs. See Circulatory Problems.
Alcohol now and then may help. A growing body of evidence links moderate alcohol consumption with reduced risks of heart disease. The same may be true for type 2 diabetes. Moderate amounts of alcohol - a drink a day for men, a drink every other day for women - increases the efficiency of insulin at getting glucose inside cells. And some studies indicate that moderate alcohol consumption decreases the risk of type 2 diabetes. If you already drink alcohol, the key is to keep your consumption in the moderate range. If you do not drink alcohol, there is no need to start - you can get the same benefits by losing weight, exercising more, and changing your eating patterns.
CHROMIUM PICOLINATE: A COMPLEMENTARY NUTRITIONAL THERAPY FOR DIABETES
Chromium Picolinate is a nutritional supplement that can help control diabetes. As the name implies, it is a combination of two different substances: chromium and picolinate. Chromium is a mineral that helps to increase the efficiency of insulin, the hormone that controls blood glucose (blood sugar) levels; picolinate is an amino acid derivative that allows the body to use chromium much more readily.
The shape of individual insulin molecules is important to the hormone's effectiveness. If the molecules maintain their proper shape, the insulin can effectively transport glucose into the cells, where it is needed. Without chromium, insulin molecules become misshapen, and can no longer serve as an effective transportation system, glucose builds up in the bloodstream, starting a chain reaction that eventually leads to diabetes.
Scientists have long known that chromium is a vital nutrient, but not until chromium was combined with picolinate was a truly effective means of providing supplemental chromium developed. In the body, chromium takes the form of an ion, a particle with an electrical charge. This charge is repelled by the body's cells, making it difficult for chromium to enter the cells. Picolinate is a chelator, a substance that can bind with an ion and neutralize its charge. Once chromium and picolinate join together, the chromium's repellant charge is done away with. The body's cells then are able to accept the chromium.
The effectiveness of chromium picolinate has been tested on individuals with a number of different health problems, including diabetes. Research shows that most people with diabetes experience a decline in blood glucose levels after they start taking daily chromium picolinate supplements. As a result, it is believed that chromium picolinate may be able to help many people with diabetes (especially type II diabetes) to control their blood sugar levels. This in turn would allow them to cut back on their intake of insulin and other drugs, likely resulting in fewer side effects. Furthermore, since improving the action of insulin also helps the body to use fat as a fuel, chromium picolinate can help reduce obesity. This means that it may enable some people with type II diabetes to lose enough weight to stop taking drugs entirely.
However, it is not recommended that people with diabetes simply go out and buy chromium picolinate supplements and start taking them. Anyone who has diabetes, especially type I diabetes, must exercise caution with this supplement. Its effects on insulin requirements are very real. Blood sugar levels must be monitored carefully and the appropriate dosages of insulin and/or other drugs adjusted as needed in response. Otherwise, a potentially dangerous insulin reaction may occur as a result of too little glucose in the blood.
Anyone interested in using chromium picolinate for the treatment of diabetes should first seek the advice of a qualified health-care provider, preferably a nutritionally oriented practitioner who has experience in this area.
Almond (Sweet) Herbal Oil Products Avocado Oil Herbal Products Brewers Yeast Herbal Products Chromium Supplement Products Diabetic Supplement Products Flaxseed Oil Herbal Products Garlic Herbal Products Kelp Herbal Products Magnesium Supplement Products Oat Herbal Products Olive Oil Herbal Products Pumpkin Seed Oil Herbal Products Rice Herbal Products Salmon Fish Oil Supplement Products Sesame Seed Oil Herbal Products Soy Protein Supplement Products Spirulina Herbal Products Sunflower Oil Herbal Products Vitamins B-1 Supplement Products Vitamin B-3 Supplement Products Vitamin C Supplement Products
Unless otherwise specified, the following recommended doses are for adults over the age of 18. For a child between 12 and 17 years, reduce the dose to 3/4 the recommended dose. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended dose.
NUTRIENTS Supplement Suggested Dosage Comments
Alpha-Lipoic Acid As directed on label. For treatment of peripheral nerve damage in diabetic patients. Helps control blood sugar levels. Chromium Picolinate 400 to 600 mcg daily. Improves insulin's efficiency, which lowers blood sugar levels. Caution: If you have diabetes, consult with your health care provider before taking any supplement containing chromium. Or
Diabetic Nutrition Rx
As directed on label. Add to your regular foods and drinks as a nutritional supplement.
Mix the desired amount into your favorite foods to taste. Dissolves easily and brings added nutritional value to all foods. Sprinkle over salads, cottage cheese, and yogurt. Excellent as a vitamin supplement. Add a tablespoon in your favorite morning juice. A combination of chromium picolinate, vanadyl sulfate, and other vitamins and minerals that work synergistically to regulate blood sugar levels and correct deficiencies. Caution: If you have diabetes, consult with your health care provider before taking any supplement containing chromium.
Diabetic Nutrition RX Supplement Products Or
(With Added Chromium)
As directed on label. An excellent source of protein and several B-vitamins. Take with chromium supplement. Garlic (Kyolic) As directed on label. Decreases and stabilizes blood sugar levels. Enhances immunity and improves circulation. L-Carnitine 500 mg twice daily, on an empty stomach. Take with water. Do not take with milk. Take with 50 mg Vitamin B-6 and 100 mg Vitamin C for better absorption. Mobilizes fat. Plus
500 mg twice daily, on an empty stomach. Take with water. Do not take with milk. Reduces the craving for sugars. Plus
500 mg twice daily, on an empty stomach. Take with water. Do not take with milk. Aids in the release of insulin. Quercetin
100 mg 3 times daily. Helps protect the membranes of the lens of the eye from accumulations of polyols as a result of high glucose levels. Raw Adrenal Glandular
Raw Pancreas Glandular
As directed on labels. Aids in rebuilding and nourishing these organs. See Glandular Therapy. Vanadium As directed on label. Vanadium aids insulin's ability to move glucose into the cells. Use Vanadyl Sulfate form. Vanadyl Sulfate is a trace mineral that is believed to help support normal glucose and lipid metabolism. Vanadyl Sulfate is a supplement derived from the trace mineral vanadium. Vitamin B Complex 50 mg of each B vitamin daily, with meals 3 times daily (amounts of individual vitamins in a complex will vary). Do not exceed 300 mg daily from all supplements. B vitamins work best when taken together. Plus Extra
5 to 50 mg (5,000 to 50,000 mcg) daily. Improves the metabolism of glucose.
Biotin does not appear to have any toxic levels when taken at high doses. Studies have been done with doses between 5 mg (5,000 mcg) to 15 mg (15,000 mcg) daily. Biotin is not known to be toxic. Oral biotin supplementation has been well-tolerated in doses up to 200 mg/day in people with hereditary disorders of biotin metabolism. In people without disorders of biotin metabolism, doses of up to 5 mg/day for two years were not associated with adverse effects.
Biotin Supplement Products And
50 mg daily. Important for circulation and for prevention of atherosclerosis. Vitamin B-12 As prescribed by health care provider or directed on label. Needed to prevent diabetic neuropathy. Injections (under a health care provider's supervision) are best. If injections are not available, use a lozenge or sublingual form. Zinc 50 to 80 mg daily. Do not exceed a total of 100 mg daily from all supplements. Deficiency has been associated with diabetes. Use zinc gluconate lozenges or OptiZinc for best absorption. Coenzyme Q-10 80 mg daily. Improves circulation and stabilizes blood sugar. Coenzyme A As directed on label. Facilitates the repair of RNA and DNA. Supports the immune system's detoxification of many dangerous substances. Can streamline metabolism, ease depression and fatigue, and increase energy. Works well with CoQ10. Magnesium 750 mg daily. Important for enzyme systems and pH balance. Protects against coronary artery spasm in arteriosclerosis. Manganese 5 to 10 mg daily. Take separately from calcium. Needed for repair of the pancreas. Also a cofactor in key enzymes of glucose metabolism. Deficiency is common in people with diabetes. Psyllium Husks
As directed on label. Take with a large glass of water. Take separately from other supplements and medications. Psyllium husks are good fiber sources and fat mobilizers. Flax seed is a good fiber source as well as a source of essential fatty acids.
Vitamin A 15,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily. An important antioxidant needed to maintain the health of the eyes. Use emulsion form for the best absorption. Plus
25,000 IU daily.
As directed on label.
An antioxidant and precursor of vitamin A. Needed by all cells for repair and rebuilding. Important antioxidant needed to maintain the health of the eyes. Vitamin C
3,000 to 6,000 mg daily, in divided doses. Essential in immune function and tissue repair. Deficiency may lead to vascular problems in people with diabetes. Vitamin E 200 to 400 IU daily. Improves circulation and prevents complications through its antioxidant properties. Use d-alpha-tocopherol emulsion form for easier assimilation and greater safety at higher doses.
Calcium 1,500 mg daily. Important for pH balance. Copper Complex As directed on label. Aids in protein metabolism and in many enzyme systems. Maitake 1 to 4 grams (1,000 to 4,000 mg) daily. Maitake mushroom extract may help to normalize blood sugar levels. Multi-Enzyme Complex
As directed on label. Take with meals. To aid digestion. Proper digestion is essential in management of diabetes. Pantethine
As directed on label. A form of pantothenic acid that reduces LDL cholesterol and helps prevent buildup in the arteries. Pycnogenol
Grape Seed Extract
As directed on label.
As directed on label.
Contains powerful antioxidants that also enhance the activity of vitamin C and strengthens connective tissue, including that of the cardiovascular system. Spirulina
As directed on label. Take between meals. To supply protein, needed to build and repair tissue. Also acts as an appetite stimulant.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER
If You are 24 to 28 weeks pregnant and have not had a screening test for gestational diabetes mellitus. If Following diagnosis of gestational diabetes, you develop any new signs or symptoms that cause you concern. If You have difficulty in following a recommended diet or exercise program.
MoonDragon's Pregnancy Information: Gestational Diabetes (GD) Index
MoonDragon's Pregnancy Information: Gestational Diabetes (GD)
MoonDragon's Pregnancy Information: Gestational Diabetes Introduction & Overview
MoonDragon's Pregnancy Information: Gestational Diabetes Introduction & Overview (Page 2)
MoonDragon's Pregnancy Information: ADA Clinical Practice Recommendations
MoonDragon's Nutrition Information: Gestational Diabetes: Nutrition & Diet
MoonDragon's Nutrition Information: Hypoglycemic Diet
MoonDragon's Health & Wellness: Diabetes, Types & Descriptions
MoonDragon's Variations of Pregnancy Birthing Guidelines
MoonDragon's Variations of Pregnancy: Glycosuria / Glucosuria In Pregnancy
What is Gestational Diabetes?
Understanding Gestational Diabetes
Gestational Diabetes: Self-Care Tips
BabyZone: Understanding Gestational Diabetes
What is Different About Gestational Diabetes?
Diabetes & Pregnancy - Pregnancy/Childbirth
Jelly Bean Alternatives for Glucose Testing
Diabetes Resource Website
NIH Index - Government Publications About Gestational Diabetes
Plus Size Pregnancy Website by Kmom - Kmom has some excellent information & resources about Gestational Diabetes and the larger woman.
MoonDragon's Pregnancy Information: Pregnancy Information & Survival Tips
MoonDragon's Pregnancy Index
MoonDragon's Womens Pregnancy Health Information Index
MoonDragon's Pediatric Information Index
MoonDragon's Parenting Information Index
MoonDragon's Nutrition Information Index
DIABETES NUTRITIONAL SUPPLEMENTAL PRODUCTS
Information, products and supplements to support treatment and management of blood sugar and diabetes, a disease of the pancreas related to the release of insulin into the blood stream. Consult with your health care provider or midwife before taking any nutritional supplement or changing your dietary/medicational plan. Please note that some of these products may not be recommended for use during pregnancy. Be sure to read product descriptions carefully before using.
DIABETES NUTRITIONAL SUPPLEMENT PRODUCTS
Adrenal Glandular Products Alfalfa Herbal Products Almond (Sweet) Herbal Oil Products Aloe Vera Herbal Products Alpha Lipoic Acid Products Appetite Suppressant Products Astragalus Herbal Products Avocado Oil Herbal Products Basil Essential Oil Products Beanpod Herbal Products Beta Carotene Products Bhumy Amalaki Herbal Products Bilberry Herbal Products Bioflavonoids Supplement Products Biotin Supplement Products Bitter Melon Herbal Products Blackberry Herbal Products Blackseed Herbal Products Blood Sugar Management Products Blueberry Herbal Products Books - Diabetic & Blood Sugar Brewers Yeast Herbal Products Buchu Herbal Products Calcium Supplement Products Carnitine Supplement Products Carotene Complex Products Cedar Berry Herbal Products Cinnamon Herbal Products Chlorella Herbal Products Chromium Supplement Products Coenzyme A Supplement Products Completia Diabetic Products Coenzyme Q-10 Supplement Products Dandelion Herbal Products DHEA Supplement Products Diabetic FootCare Products Diabetic Nutrition RX Products Diabetic Supplement Products Eleuthero Herbal Products Fenugreek Herbal Products Fiber Supplement Products Flaxseed Herbal Products Flaxseed Oil Herbal Products Garlic Herbal Products Ginkgo Biloba Herbal Product Ginseng Herbal Products Glucomannan Supplement Products Glutamine Supplement Products Goldenseal Herbal Products Grape Seed Herbal Products Gudmar (Gymnema) Herbal Products
Guduchi (Gulvel) Herbal Products Hawthorn Herbal Products Huckleberry Herbal Products Inositol Supplement Products Juniper Herbal Products Kelp Herbal Products Magnesium Supplement Products Maitake Mushroom Herbal Products Manganese Supplement Products Multi-Enzyme Supplement Products Mushroom Complex Herbal Products Natural Calm Supplement Products Oat Herbal Products Olive Oil Herbal Products Pancreas Glandular Products Pancreatic Support Products Psyllium Herbal Products Pumpkin Seed Herbal Products Pycnogenol Supplement Products Quercetin Supplement Products Reishi Mushroom Herbal Products Rhodiola Herbal Products Samento Herbal Products Rice Herbal Products Salmon Fish Oil Supplement Products Seabuckthorn Herbal Products Sesame Seed Herbal Products Soy Protein Supplement Products Spirulina Herbal Products Spirutein Protein Supplement Products Stevia Herbal Products Sugar Balancer TCM Products Sunflower Herbal Products Sutherlandia Herbal Products Taurine Supplement Products Thyroid Glandular Products Uva Ursi Herbal Products Vanadium Supplement Products Vitamin A Supplement Products Vitamins B-1 Supplement Products Vitamin B-3 Supplement Products Vitamin B-5 Supplement Products Vitamin B-6 Supplement Products Vitamin B-12 Supplement Products Vitamin B-Complex Products Vitamin C Supplement Products Vitamin E Supplement Products Wolfberry (Goji) Herbal Products Yarrow Herbal Products Yohimbe Herbal Products Zinc Supplement Products
QUALITY SUPPLIES & PRODUCTS
BOOKS - DIABETIC, BLOOD SUGAR, & SUGAR ADDICTION HABIT
AMAZON PRODUCTS- SUGAR ADDICTION
Nancy Appleton, Ph.D., shows you how sugar upsets the body chemistry and devastates the endocrine and immune systems, leading to a host of diseases and conditions including hypoglycemia, diabetes, osteoporosis, arthritis, cancer, heart disease, headaches, allergies, asthma, obesity, periodontal disease, tooth decay, and more.
Amazon: Lick the Sugar Habit, By Nancy Appleton, Ph.D.
Amazon: Suicide By Sugar: A Startling Look at Our #1 National Addiction, By Nancy Appleton, Ph.D.
Amazon: Lick the Sugar Habit Sugar Counter: Discover the Hidden Sugar in Your Food, By Nancy Appleton, Ph.D.
AMAZON PRODUCTS - DIABETES
Amazon: Natural Treatments for Diabetes (Woodland Health), By R.N. Ellsworth
Diabetes is a growing epidemic, but you can protect yourself - naturally! This revised and updated booklet provides a comprehensive overview of diabetes (including its symptoms and complications) and covers natural approaches, dietary guidelines and supplements that can help with both prevention and treatment of diabetes.
Amazon: Reversing Diabetes, By Julian Whitaker
Reversing Diabetes guide will arm you with safer and equally effective ways of treating diabetes through a sensible diet, exercise, and specific nutritional supplement suggestions. You can improve blood sugar control, reduce if not eliminate reliance on medication, decrease risk of complications and diseases associated with diabetes.
Amazon: Reversing Diabetes Cookbook: More Than 200 Delicious, Healthy Recipes, By Julian Whitaker
Amazon: The Metabolic Syndrome Program: How to Lose Weight, Beat Heart Disease, Stop Insulin Resistance and More
Big Belly? High Body Mass Index? High Blood Pressure? If this sounds like you, you may be one of the millions of North Americans with Metabolic Syndrome. Predicted by medical experts as the likely number one risk factor for heart disease-Metabolic Syndrome, or MSX, describes a constellation of conditions, including those mentioned above, of which the body' resistance to insulin is a primary feature. A byproduct of obesity, 25 percent of the adult U.S. population is now estimated to have MSX. The Metabolic Syndrome Program offers readers a sensible lifestyle-based approach to treating MSX. One of the first books to name and address this condition, The Metabolic Syndrome Program outlines a realistic plan of treatment-without magic pills or quick-fixes to a growing and little-known threat to public health. The Metabolic Syndrome Program includes: Facts about MSX, the risk factors associated with it and its impact on your overall health. The role of nutrition in combating MSX. The truth about fats, carbs and proteins and the balance needed to maintain optimal health. All the latest research on insulin resistance, Type 2 Diabetes, hypertension and Cardiovascular disease-the worst outcomes of metabolic syndrome. Detailed information on natural supplements that can be used to combat the risk factors of MSX. Recipes and meal plans that will help you make the immediate lifestyle changes required if you are one of the millions at risk for MSX. "Karlene Karst has done an excellent job outlining the seriousness of obesity and insulin resistance, and their ensuing complications,while providing a nutrition and lifestyle action plan to help you get back to the basics of good health." --Sam Graci, author of the Path to Phenomenal Health and The Food Connection. "The Metabolic Syndrome Program provides an effective comprehensive solution by detailing a clear, rational approach to a complex topic." --Michael T. Murray, N.D., co-author of the Encyclopedia of Natural Medicine.
Nutrition Basics: Blood Sugar Supplement Information
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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MOONDRAGON'S REALM - WEBSITE DIRECTORY
A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.