While no supplement can replace prescribed medication or healthy lifestyle changes, several natural compounds have shown significant promise in helping manage type 2 diabetes by supporting blood sugar control and insulin sensitivity. Key supplements often highlighted by research and experts include Berberine, Chromium, and Alpha-Lipoic Acid, each offering unique mechanisms to aid in glucose metabolism and overall diabetic health. This guide will explore these and other beneficial supplements, helping you understand their potential role in your diabetes management plan.
Understanding Supplements and Type 2 Diabetes Management
Managing type 2 diabetes is a multifaceted endeavor that primarily relies on prescribed medications, a carefully balanced diet, and regular physical activity. Supplements, while not a standalone solution, can play a supportive role in this comprehensive strategy. It’s crucial to approach supplementation with an informed perspective, recognizing its place within the broader context of diabetes care.
Supplements should complement, not replace, conventional medical treatments and healthy lifestyle choices.
Supplements are designed to supplement your existing health regimen, not to supplant it. The foundational pillars of type 2 diabetes management—insulin or oral medications, a nutrient-dense eating plan, and consistent exercise—are non-negotiable. Skipping prescribed medications in favor of supplements can have severe and dangerous consequences, potentially leading to uncontrolled blood sugar levels, severe complications like kidney disease, nerve damage, or cardiovascular issues. Think of supplements as an additional layer of support, chosen to address specific deficiencies or enhance particular metabolic pathways that contribute to better glucose control, always working in concert with your medical team’s recommendations. For instance, while Berberine may mimic some effects of metformin, it should never be seen as a direct substitute without explicit medical advice and careful monitoring.
Always consult your doctor or a registered dietitian before starting any new supplement regimen to ensure safety and avoid interactions with medications.
This is arguably the most critical piece of advice when considering supplements for any health condition, especially type 2 diabetes. Your healthcare provider possesses an in-depth understanding of your specific health profile, existing medications, and potential comorbidities. They can assess the appropriateness of a supplement, evaluate potential drug-supplement interactions, and advise on safe dosages. For example, some supplements can potentiate the effects of blood sugar-lowering medications, leading to hypoglycemia ( dangerously low blood sugar). Others might interact with blood thinners, affecting coagulation, or interfere with the absorption of other vital medications. A registered dietitian can also provide personalized guidance on how certain supplements might integrate with your dietary plan and overall nutritional needs, ensuring a holistic and safe approach.
Focus on evidence-based supplements that have demonstrated efficacy in clinical studies.
The supplement market is vast and unfortunately, not all products are created equal. Many claims lack rigorous scientific backing, and some products may contain undisclosed ingredients or varying potencies. To make informed decisions, prioritize supplements that have been thoroughly investigated in high-quality clinical trials and systematic reviews. Look for research published in reputable medical journals that demonstrates a statistically significant benefit for individuals with type 2 diabetes. This emphasis on evidence-based choices helps you avoid wasting money on ineffective products and, more importantly, reduces the risk of consuming something potentially harmful. Organizations like the National Institutes of Health (NIH) or professional medical associations often provide summaries of research on various supplements, offering a reliable starting point for your investigation.
Berberine: A Potent Plant Extract
Berberine is a bioactive compound extracted from several plants, including Berberis (barberry), goldenseal, and Oregon grape. It has a long history of use in traditional Chinese medicine for various ailments, and modern research has highlighted its profound impact on metabolic health, particularly in managing type 2 diabetes.
Mechanism of Action: Berberine can improve insulin sensitivity, reduce glucose production in the liver, and enhance glucose uptake by cells, similar to some diabetes medications.
Berberine’s multifaceted action is what makes it so compelling. One of its primary mechanisms involves activating AMP-activated protein kinase (AMPK), often referred to as a “metabolic master switch.” AMPK activation plays a critical role in cellular energy homeostasis, leading to several beneficial effects:
* Reduced Hepatic Glucose Production: By activating AMPK, berberine suppresses gluconeogenesis (the production of glucose in the liver) and glycolysis (the breakdown of glucose). This directly contributes to lower fasting blood sugar levels, much like the action of metformin.
* Improved Insulin Sensitivity: Berberine helps enhance the sensitivity of cells to insulin, meaning the body’s own insulin can work more effectively to clear glucose from the bloodstream. It does this, in part, by increasing the expression and phosphorylation of insulin receptors.
* Enhanced Glucose Uptake: Berberine can stimulate glucose uptake by peripheral cells, such as muscle cells, by increasing the translocation of glucose transporter 4 (GLUT4) to the cell surface. This allows more glucose to be shuttled out of the blood and into cells for energy.
* Other Actions: It also influences gut microbiota composition, improves lipid metabolism (reducing cholesterol and triglycerides), and has anti-inflammatory properties, all of which contribute to better metabolic health.
Benefits and Usage: Often praised for its significant impact on lowering fasting and post-meal blood sugar levels, as well as its potential to reduce HbA1c.
Numerous clinical studies have demonstrated berberine’s efficacy in individuals with type 2 diabetes. Research has shown that berberine can significantly reduce fasting blood glucose, postprandial (after-meal) blood glucose, and hemoglobin A1c (HbA1c), a key marker of long-term blood sugar control. In some studies, berberine has shown comparable effects to standard diabetes medications like metformin, with reductions in HbA1c ranging from 0.5% to 1.5%. Beyond glucose control, berberine has also been observed to:
* Improve Lipid Profiles: Lowering LDL (“bad”) cholesterol and triglycerides, which are often elevated in individuals with type 2 diabetes.
* Aid in Weight Management: Some studies suggest a modest reduction in body weight and body mass index (BMI), which is beneficial for diabetes management.
* Support Gut Health: Positive modulation of gut bacteria, which is increasingly recognized as important for metabolic health.
Considerations: May cause gastrointestinal side effects; dosage and timing should be discussed with a healthcare professional.
While generally well-tolerated, berberine can cause gastrointestinal side effects in some individuals, particularly when first starting supplementation or at higher doses. These can include nausea, diarrhea, constipation, and abdominal discomfort. To mitigate these effects, it is often recommended to:
* Start with a lower dose: Gradually increasing the dosage allows the body to adjust.
* Take with meals: Dividing the daily dose and taking it with meals can help reduce digestive upset.
Typical dosages for berberine range from 500 mg two to three times daily. However, due to its potent effects and potential interactions with medications (especially other blood sugar-lowering drugs and certain antibiotics), it is absolutely essential to consult with your doctor or a qualified healthcare professional before starting berberine. They can help determine the appropriate dosage, monitor for side effects, and adjust other medications as needed to prevent hypoglycemia.
Chromium: The Essential Trace Mineral
Chromium is a trace mineral that is vital for normal macronutrient metabolism and plays a specific, critical role in glucose regulation. Although required in small amounts, its deficiency can have significant implications for individuals with impaired glucose tolerance or type 2 diabetes.
Role in Glucose Metabolism: Chromium is crucial for the proper functioning of insulin, helping it transport glucose from the bloodstream into cells more efficiently.
Chromium’s primary function in glucose metabolism revolves around its ability to enhance the action of insulin. It is believed to be a key component of a molecule called “glucose tolerance factor” (GTF), although the exact structure of GTF remains elusive. What is known is that chromium facilitates the binding of insulin to its receptors on cell surfaces and enhances the signal transduction pathways downstream of insulin binding. In essence, chromium helps “unlock” the cells, allowing insulin to effectively escort glucose from the bloodstream into cells (like muscle and fat cells) for energy or storage. Without sufficient chromium, insulin’s efficiency is reduced, leading to higher blood sugar levels because glucose cannot readily enter the cells.
Deficiency and Supplementation: Many individuals with type 2 diabetes show lower chromium levels, suggesting supplementation could be beneficial for improving insulin action.
Research indicates that individuals with type 2 diabetes often have lower chromium levels compared to those without the condition. This observation suggests that a deficiency in this trace mineral might contribute to insulin resistance or exacerbate existing glucose control issues. Factors such as a diet high in refined sugars can deplete chromium stores, as the body uses more chromium to process sugar. Therefore, supplementation becomes a consideration for improving insulin action and potentially stabilizing blood sugar levels, especially in those with documented deficiencies or poor glycemic control despite conventional treatments. Studies have explored the benefits of chromium supplementation, particularly in populations where deficiencies are more prevalent.
Forms and Efficacy: Chromium picolinate is a common and well-absorbed form, often studied for its effects on blood sugar control.
While several forms of chromium supplements are available, chromium picolinate is the most extensively studied and widely used for its effects on blood sugar. This form combines chromium with picolinic acid, which is believed to enhance its absorption and bioavailability within the body. Other forms include chromium chloride and chromium polynicotinate.
* Efficacy: Clinical trials on chromium picolinate for type 2 diabetes have yielded mixed but generally promising results. Some studies have reported improvements in fasting blood glucose, HbA1c, and insulin sensitivity, particularly in individuals who are chromium deficient or have poorly controlled diabetes. For example, a meta-analysis on chromium supplementation found a significant reduction in HbA1c for people with diabetes.
* Dosage: Typical dosages for chromium picolinate in diabetes management range from 200 mcg to 1000 mcg per day, divided into one or two doses.
* Safety: Chromium supplementation is generally considered safe at recommended dosages. However, as with all supplements, consultation with a healthcare professional is advised, especially if you have kidney disease or are taking other medications, to avoid potential interactions or adverse effects.
Alpha-Lipoic Acid (ALA): Antioxidant Support
Alpha-Lipoic Acid (ALA) is a powerful antioxidant naturally produced in the human body, playing a crucial role in cellular energy metabolism. Its unique ability to function in both water-soluble and fat-soluble environments allows it to provide antioxidant protection throughout the body, including the brain. For individuals with type 2 diabetes, ALA offers several specific benefits, particularly related to insulin sensitivity and nerve health.
Improving Insulin Sensitivity: ALA acts as a powerful antioxidant that may help reduce oxidative stress, a factor contributing to insulin resistance and nerve damage.
Oxidative stress, characterized by an imbalance between the production of free radicals and the body’s ability to counteract their harmful effects, is a significant contributor to the development and progression of insulin resistance in type 2 diabetes. High blood sugar levels themselves can generate excessive free radicals, creating a vicious cycle. ALA counteracts this by:
* Scavenging Free Radicals: Directly neutralizing harmful free radicals throughout the body.
* Regenerating Other Antioxidants: ALA has the remarkable ability to regenerate other vital antioxidants, such as Vitamin C, Vitamin E, and glutathione, thereby amplifying the body’s overall antioxidant defense system.
* Enhancing Glucose Utilization: Research suggests ALA can improve glucose uptake into cells by promoting the translocation of GLUT4 transporters to the cell membrane, similar to insulin’s action. It also influences key enzymes involved in glucose metabolism. By reducing oxidative stress and enhancing cellular glucose metabolism, ALA contributes to improved insulin signaling and sensitivity, making cells more responsive to insulin.
Neuropathy Relief: It has been particularly studied for its potential to alleviate symptoms of diabetic neuropathy, such as tingling, numbness, and pain in the extremities.
One of the most debilitating complications of long-standing diabetes is diabetic neuropathy, a form of nerve damage caused by chronic high blood sugar and associated oxidative stress. Symptoms can range from mild tingling and numbness to severe burning pain, especially in the feet and hands. ALA has been extensively studied for its neuroprotective properties and its potential to alleviate these symptoms. Its mechanisms for neuropathy relief include:
* Reducing Oxidative Damage to Nerves: By neutralizing free radicals, ALA helps protect nerve cells from the damaging effects of oxidative stress, which is a major factor in neuropathy development.
* Improving Nerve Blood Flow: ALA can enhance microcirculation to nerve tissues, ensuring adequate oxygen and nutrient supply, which is often compromised in diabetic neuropathy.
* Enhancing Nerve Conduction Velocity: Some studies suggest ALA can improve the speed at which nerve impulses are transmitted, leading to better nerve function.
* Anti-inflammatory Effects: Reducing inflammation, which can contribute to nerve damage and pain.
Clinical trials, particularly in Europe, have shown that intravenous and oral ALA supplementation can significantly reduce symptoms like pain, burning, numbness, and tingling in patients with diabetic peripheral neuropathy.
Dosage and Types: Available in R-ALA and S-ALA forms, with R-ALA being the biologically active form, often taken in doses ranging from 300-600mg daily.
ALA exists in two distinct forms:
* R-Alpha-Lipoic Acid (R-ALA): This is the naturally occurring, biologically active form of ALA that is produced in the body and found in food. It is generally considered more bioavailable and potent.
* S-Alpha-Lipoic Acid (S-ALA): This is the synthetic form of ALA, which is less biologically active and often found as part of a racemic mixture in many standard ALA supplements.
Most commercial ALA supplements contain a 50/50 mixture of R-ALA and S-ALA. While this mixture is effective, supplements containing pure R-ALA are often preferred due to its superior bioavailability and efficacy, though they tend to be more expensive.
* Dosage: For general antioxidant support and improvement in insulin sensitivity, typical oral dosages range from 300 mg to 600 mg per day. For the treatment of diabetic neuropathy symptoms, higher doses of 600 mg to 1800 mg per day are often used, typically divided into multiple doses. It is usually recommended to take ALA on an empty stomach to enhance absorption. As always, discuss the appropriate form and dosage with your healthcare provider.
Other Promising Supplements for Diabetes Support
Beyond the extensively researched Berberine, Chromium, and Alpha-Lipoic Acid, several other supplements show promise in supporting blood sugar control and overall metabolic health for individuals with type 2 diabetes. While some require further large-scale research, their potential benefits warrant consideration under medical guidance.
Magnesium: Often deficient in individuals with type 2 diabetes; adequate levels are important for over 300 enzymatic reactions, including glucose metabolism and insulin secretion.
Magnesium is an essential mineral involved in over 300 enzymatic reactions in the body, many of which are crucial for glucose metabolism and insulin function. These reactions include:
* Glucose Phosphorylation: Magnesium is necessary for the enzymes that convert glucose into energy.
* Insulin Secretion: It plays a role in the function of pancreatic beta cells, which produce insulin.
* Insulin Sensitivity: Magnesium is involved in insulin receptor signaling, helping cells respond more effectively to insulin.
Studies consistently show that a significant proportion of individuals with type 2 diabetes have hypomagnesemia (low magnesium levels), which is believed to contribute to insulin resistance and worsen glycemic control. Factors like increased urinary excretion of magnesium due to high blood sugar and certain medications can exacerbate this deficiency.
* Supplementation: Supplementing with magnesium can help correct deficiencies and potentially improve insulin sensitivity and blood sugar control.
* Forms: Bioavailable forms include magnesium citrate, glycinate, and taurate. Magnesium oxide is less well-absorbed.
* Food Sources: Rich dietary sources include leafy green vegetables, nuts, seeds, whole grains, legumes, and dark chocolate.
* Considerations: Always consult a doctor before supplementing, especially if you have kidney issues, as excessive magnesium can be problematic.
Cinnamon: Research suggests cinnamon may improve insulin sensitivity and lower blood sugar levels, though more large-scale studies are needed to confirm consistent benefits.
Cinnamon, a common spice, has long been investigated for its potential antidiabetic properties. The active compounds, particularly cinnamaldehyde and various polyphenols, are thought to exert several beneficial effects:
* Insulin Mimicry: Some components of cinnamon may mimic insulin, promoting glucose uptake by cells.
* Improved Insulin Sensitivity: Cinnamon may enhance insulin receptor function, making cells more responsive to insulin.
* Slowing Carbohydrate Digestion: It can inhibit digestive enzymes, thereby slowing the breakdown of carbohydrates and reducing the post-meal rise in blood sugar.
While many smaller studies have shown promising results, including reductions in fasting blood glucose and HbA1c in individuals with type 2 diabetes or prediabetes, larger, well-designed clinical trials are still needed to establish consistent and definitive benefits across diverse populations.
* Types: It’s important to distinguish between Ceylon cinnamon (true cinnamon) and Cassia cinnamon (the most common type sold in stores). Cassia cinnamon contains significant amounts of coumarin, a compound that can be toxic to the liver in large doses. For regular use or higher doses, Ceylon cinnamon is generally preferred due to its much lower coumarin content.
* Dosage: Typical research dosages range from 1 to 6 grams per day, often consumed as a powder or extract.
Vitamin D: Linked to insulin production and sensitivity; many people with diabetes have low Vitamin D levels, making supplementation potentially beneficial for metabolic health.
Vitamin D, often called the “sunshine vitamin,” is a prohormone crucial for bone health, immune function, and increasingly, metabolic health. A strong association has been observed between low Vitamin D levels and an increased risk of type 2 diabetes and poor glycemic control.
* Mechanisms: Vitamin D receptors are found on pancreatic beta cells, suggesting a direct role in insulin secretion. It may also enhance insulin sensitivity in peripheral tissues and exert anti-inflammatory effects that can improve metabolic function. Furthermore, Vitamin D deficiency has been linked to increased systemic inflammation and oxidative stress, both of which contribute to insulin resistance.
* Prevalence of Deficiency: Many individuals, especially those with diabetes, are deficient in Vitamin D, due to limited sun exposure, dietary factors, and metabolic differences.
* Supplementation: Correcting a Vitamin D deficiency through supplementation can potentially improve insulin production, enhance insulin sensitivity, and contribute to better overall metabolic health.
* Monitoring: It is highly recommended to have your Vitamin D levels (25-hydroxyvitamin D) checked by your doctor. Optimal levels are generally considered to be between 30-60 ng/mL (or 75-150 nmol/L).
* Dosage: Dosage depends on your current levels and needs, but typically ranges from 1000-5000 IU (international units) per day, often requiring higher doses initially to replete stores.
Key Considerations Before Supplementing
Embarking on a supplement regimen for type 2 diabetes requires thoughtful consideration beyond just choosing the right compounds. Ensuring safety, efficacy, and integration with your existing health plan are paramount.
Purity and Quality: Choose high-quality supplements from reputable brands that undergo third-party testing to ensure potency and absence of contaminants.
The supplement industry is not regulated with the same rigor as pharmaceutical drugs. This means that product quality can vary significantly. To protect your health and ensure you’re getting what you pay for:
* Look for Third-Party Certifications: Seek out supplements verified by independent organizations like USP (U.S. Pharmacopeia), NSF International, or ConsumerLab.com. These certifications indicate that the product has been tested for purity, potency, and absence of harmful contaminants (heavy metals, pesticides, undeclared ingredients).
* Research Brands: Opt for established brands with transparent manufacturing practices and positive reputations. Avoid products with vague ingredient lists, proprietary blends that don’t disclose individual component amounts, or exaggerated claims.
* Check Expiration Dates: Potency can degrade over time, so always check the expiration date.
Investing in high-quality supplements minimizes the risk of adverse effects from contaminants and ensures you’re consuming the intended active ingredients at the labeled dosages.
Drug Interactions: Be aware that some supplements can interact with diabetes medications, blood thinners, or other prescriptions, potentially leading to adverse effects.
This is a critical area of concern. Supplements, despite being “natural,” can have potent pharmacological effects and interact with your prescribed medications, leading to dangerous consequences:
* Increased Hypoglycemia Risk: Supplements like berberine, chromium, and cinnamon can lower blood sugar. When taken with prescribed diabetes medications (e.g., insulin, sulfonylureas, metformin), this additive effect can lead to dangerously low blood sugar (hypoglycemia).
* Bleeding Risk: Alpha-lipoic acid, garlic, and high doses of vitamin E can have mild blood-thinning properties and may increase the risk of bleeding if taken concurrently with anticoagulant medications like warfarin or antiplatelet drugs.
* Altered Medication Efficacy: Some supplements can interfere with the absorption, metabolism, or excretion of medications, either reducing their effectiveness or increasing their side effects. For example, high doses of calcium or magnesium can interfere with the absorption of certain antibiotics or thyroid hormones.
Always disclose all supplements you are taking, or considering taking, to your doctor or pharmacist. They can review your complete medication list and advise on potential interactions.
Monitoring and Adjustment: Regularly monitor your blood sugar levels and communicate any changes or new supplements to your healthcare provider for appropriate dosage adjustments to your medications.
Incorporating supplements into your diabetes management plan is not a set-it-and-forget-it process. Continuous monitoring and open communication with your healthcare team are essential for safety and effectiveness:
* Frequent Blood Sugar Monitoring: If you start a new supplement, increase the frequency of your blood glucose monitoring. This will help you and your doctor observe any immediate effects on your blood sugar levels, preventing episodes of hypoglycemia or hyperglycemia.
* Communicate Changes: Inform your doctor about any new supplements you begin, stop, or change the dosage of. Based on your blood sugar readings and overall health status, your healthcare provider may need to adjust the dosages of your prescribed diabetes medications to maintain optimal glycemic control and prevent complications.
* Listen to Your Body: Pay attention to how you feel. Report any new or unusual symptoms to your doctor, as they could be related to the supplement itself, an interaction, or an adjustment in your medication needs.
This proactive approach ensures that your diabetes management plan remains dynamic, safe, and tailored to your evolving needs, maximizing the benefits of both conventional treatments and targeted supplements.
Incorporating targeted supplements, such as Berberine, Chromium, and Alpha-Lipoic Acid, can offer valuable support in managing type 2 diabetes when used responsibly and under medical guidance. Remember, these are tools to complement, not replace, the foundational elements of diabetes management: a balanced diet, regular physical activity, and prescribed medications. Always prioritize an open dialogue with your healthcare team to create a personalized, safe, and effective diabetes management plan that includes any potential supplements.
Frequently Asked Questions
Which supplements are most effective for managing Type 2 Diabetes and blood sugar levels?
Several supplements show promise in supporting Type 2 Diabetes management and helping to regulate blood sugar levels. Key examples include Berberine, known for its ability to improve insulin sensitivity and lower glucose; Cinnamon, which may help reduce blood sugar and improve insulin function; and Alpha-Lipoic Acid, an antioxidant that can enhance glucose uptake and improve nerve function. Other beneficial options often include Chromium, essential for carbohydrate and fat metabolism, and Magnesium, crucial for over 300 enzymatic reactions, including glucose regulation. Always consult your healthcare provider before adding new supplements to your regimen to ensure safety and effectiveness for your specific condition.
How do supplements like Berberine or Alpha-Lipoic Acid help improve insulin sensitivity for Type 2 Diabetes?
Berberine acts by influencing cellular pathways, such as activating AMP-activated protein kinase (AMPK), which helps regulate glucose and lipid metabolism, ultimately leading to improved insulin sensitivity and lower blood glucose. Alpha-Lipoic Acid (ALA), a potent antioxidant, works by reducing oxidative stress, which is often elevated in Type 2 Diabetes and can impair insulin signaling. ALA can also enhance glucose uptake by cells and improve the function of pancreatic beta cells, further contributing to better insulin sensitivity and glycemic control.
What are the essential vitamins and minerals often recommended for people with Type 2 Diabetes?
Individuals with Type 2 Diabetes frequently benefit from specific vitamin and mineral supplementation due to potential deficiencies or increased metabolic demands. Vitamin D is crucial for insulin production and sensitivity, and many diabetics are deficient. Magnesium plays a vital role in glucose metabolism and insulin signaling, with deficiency linked to poorer blood sugar control. Chromium supports insulin function and carbohydrate metabolism, while B vitamins, especially B12, are important, particularly for those taking metformin, which can deplete B12 levels. Discussing these with your doctor can help identify personalized needs.
Why is it crucial to consult a doctor before starting any new supplements for Type 2 Diabetes?
Consulting a doctor before starting any new supplements for Type 2 Diabetes is paramount for several reasons. Supplements can interact negatively with prescribed medications, potentially causing dangerous side effects or altering the effectiveness of your diabetes treatment. Additionally, some supplements might lower blood sugar too drastically when combined with medication, leading to hypoglycemia. A healthcare professional can provide personalized advice, assess potential risks, and ensure that any chosen supplements complement your existing treatment plan safely and effectively without compromising your overall diabetes management.
Can natural supplements replace prescribed medications for Type 2 Diabetes management?
No, natural supplements should not replace prescribed medications for managing Type 2 Diabetes. While some supplements can complement your treatment plan by helping to improve blood sugar control or address nutrient deficiencies, they are not a substitute for medication, healthy lifestyle changes, or regular medical supervision. Stopping prescribed medication without your doctor’s guidance can lead to uncontrolled blood sugar levels and serious health complications. Supplements are best used as an adjunctive therapy, under the careful supervision of your healthcare provider, to support your comprehensive diabetes management strategy.
References
- https://www.niddk.nih.gov/health-information/diabetes/overview/complementary-alternative-medicine-diabetes
- https://www.diabetes.org/health-wellness/weight-loss/dietary-supplements-and-diabetes
- Page Not Found – Site Help – Mayo Clinic
- https://www.health.harvard.edu/diseases-and-conditions/natural-treatments-for-diabetes
- Diabetes and Dietary Supplements: What You Need To Know | NCCIH
- https://en.wikipedia.org/wiki/Diabetes_mellitus_type_2#Alternative_medicine
