**8. Micronutrients: Vitamins and minerals**

By complying with a proper and balanced diet, people with diabetes daily take adequate amount of vitamins and minerals, so there is usually no need for pharmacological supple‐ ments. The exceptions are some trace elements-copper, selenium and magnesium.

Individuals on weight –reducing diet, strict vegetarians patients with poor metabolic control and patients in critical care environments require special attention and assessment. A sup‐ plementation therapy containing vitamins and minerals is most often needed in these cases. In animal models it was shown that chromium deficiency was often associated with elevat‐ ed blood glucose, cholesterol and triglyceride levels (Schrroeder HA, 1966;Wolscroft J et al, 1977). While serum zinc levels are generally lower in people with diabetes, zinc replacement is only suggested to be of benefit in helping to heal venous leg ulcer (Hoolbook T., et al 1979). There may be a need for magnesium replacement in patients with poor glycemic con‐ trol or who are on diuretics. Magnesium depletion has been associated with decreased insu‐ lin sensitivity, which may improve with oral supplementation (Beaugerie L et al, 1990).

Some studies indicated that magnesium is a novel factor implicated to the pathogenesis of the diabetic complications. Magnesium plays a fundamental role as a cofactor in various en‐ zymatic reactions of energy metabolism. Magnesium is a cofactor in cell membrane glucose – transporting mechanisms, as well as in various enzymes in carbohydrate oxidation. It is also involved, at multiple levels, in insulin secretion, binding and activity. Magnesium defi‐ cit has been described in patients with type I diabetes. Hypomagnesemia can also be the cause or a result of diabetes complications. If it is followed by diabetes, osmotic dieresis may play a role in the mechanisms responsible for magnesium deficiency. Magnesium loss may be linked to the development of diabetes complications via a reduction in the rate of inositol transport and its subsequent intracellular depletion that might enhance the development of complications. Magnesium is also taking part as a cofactor in many enzymes which are in‐ volved in lipid metabolism. Magnesium administration could decrease triglyceride, choles‐ terol and LDL cholesterol levels and also increase HDL cholesterol (Soltani N., 2011).
