Diabetes Mellitus has become a popular disorder these days all over the globe. No doubt, diabetes mellitus is a non-communicable disease but is on the rise in India and without any hesitation, India would be known as diabetes capital very soon. Now, diabetes is affecting young population especially in the productive age group which is a matter of concern.
Diabetes is a metabolic disorder related to metabolism of carbohydrates. In fact, it is a life style disease without any high mortality condition but a major risk factor for other diseases like cardiovascular manifestations like, kidney diseases, eye ailment, lower limb amputation and many more.
The situation seems to be alarming in India as there are millions of people affected by diabetes and the worst part of it is that plenty of people are ignorant that they are prediabetic and half of them who die are under 60 years of age-, which is quite disturbing. The international Diabetes federation reveals that 425 million people around the globe suffering from diabetes and the figures are expected to rise, rise and rise by 2050, a scary scenario indeed.
Treatment of diabetes mellitus range from so many home remedies, indigenous systems of medicine to allopathy. There are antidiabetic drugs available in allopathic system of medicine which control high blood sugar level without having a permanent cure for diabetes. The patient initially takes oral antidiabetic drugs and followed parenteral therapy in terms of insulin.
Anti-diabetic drugs treat diabetes mellitus by lowering glucose levels in the blood. Traditional Medicines derived from medicinal plants are used by about 60% of the world’s population. This review focuses on Indian Herbal drugs and plants used in the treatment of diabetes, especially in India. Diabetes is an important human ailment afflicting many from various walks of life in different countries. In India it is proving to be a major health problem, especially in the urban areas. Though there are various approaches to reduce the ill effects of diabetes and its secondary complications, herbal formulations are preferred due to lesser side effects, low cost and because of their natural origin.
Though different types of oral hypoglycemic agents are available along with insulin for the treatment of diabetes, there is increased demand by patients to use the natural products with anti-diabetic activity.
In this disease, the animal salts are deficient in the urine, while sugar is secreted in considerable quantity, and these means are calculated to yield the former, and to counteract the later, at the same time that they are capable of correcting the morbid action of the digestive organs.
Diabetes mellitus is one of the common metabolic disorders characterized by hyperglycemia due to absolute or relative deficiency of insulin and results in significant morbidity and mortality. Diabetes, by itself, increases the production of tissue damaging oxidative stress. Therefore, in diabetes the oxidative stress is more referred as a case of double jeopardy for any beta cells that survive the disease.
TYPES OF DIABETES MELLITUS-The two principal types are, Diabetes Mellitus type I and II.
Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin requirement is a must be in Type I, which must be injected or inhaled exogenously. There is massive beta cell necrosis, autoimmune disease process against beta pancreatic cells. Immune cells destroy beta cells in the pancreas and pancreas fails to respond to glucose.
Diabetes mellitus type 2 is a disease of insulin resistance by cells. Treatments include (1) agents which increase the amount of insulin secreted by the pancreas, (2) agents which increase the sensitivity of target organs to insulin and (3) agents which decrease the rate at which glucose is absorbed from the gastrointestinal tract. This type of diabetes mellitus occurs at a late onset past middle age. However, there are other types of diabetes known as Diabetes type 3 and 4.
Type I diabetes (insulin dependent) is caused due to insulin insufficiency because of lack of functional beta cells. Patients suffering from this are therefore totally dependent on exogenous source of insulin while patients suffering from Type II diabetes (insulin independent) are unable to respond to insulin and can be treated with dietary changes, exercise and medication. Type II diabetes is the more common form of diabetes constituting 90% of the diabetic population.
SYMPTOMS OF DIABETES MELLITUS
- Excessive thirst
- Loss of weight
- Blurred vision
- Frequent urination is one of the major symptoms of diabetes
- unusual hunger pain
emptiness stress and irritation
- Nausea and vomiting
- Extreme weakness and tiredness
- lack of wound healing.
TREATMENT OF DIABETES MELLITUS
A) Pharmacological-Therapy---a) Treatment with drugs ---Allopathic and Herbal
b) Non pharmacological Therapy ---Treatment without drugs /Dietary changes
A) Pharmacological therapy involves treatment with oral hypoglycemic drugs which tend to lower blood glucose levels. These drugs are to be taken just before meals either breakfast or lunch or dinner or as directed by the physician accordingly. In later stages when oral hypoglycemics maintain poor blood glucose levels, the treatment is switched over to insulin therapy by parenteral route. In addition to treatment with allopathic drugs there are so many herbs available in Ayurveda which is the indigenous system of medicine to treat diabetes.
There are numerous effective herbs available that can cure diabetes by lowering blood sugar and are lipid friendly. Let me quote a number of examples such as Bilberry (Vaccinium Mytilus) and Blueberry are effective herbs that cure diabetes by lowering blood sugar and are lipid friendly as they tend to lower cholesterol levels cholesterol levels. Secondly, who doesn’t know about bitter gourd. People prepare different veggies out of it. The medicinal benefits of bitter gourd are amazing in diabetes.
Bitter gourd (Momordica Charentais) if taken as decoction fruit decoction in the morning in empty stomach at least for one month is helpful in bringing the blood sugar level back to normal. Indians prepare different vegetarian preparations such as Kaddy/khadi pakora, semolina preparations like upma, flattened rice like poha and many more which necessarily contain Curry leaves.it can act as important home remedy for curing diabetes. Curry leaves if chewed in empty stomach is very beneficial in controlling blood sugar levels.
People are fond of preparing jams or pickles out of amla, a natural herb, can cure diabetes and controls blood sugar levels.
So many people take Gooseberry, amla. It is a natural herb that cures diabetes and brings the blood sugar to normal. These days people are spending so much money on green tea which is considered a status symbol and there are numerous brands available in the market.
Green tea (Camellia sinensis) consumption has been used traditionally and in fact its consumption has increased for the last so many years and is considered as status symbol also. In fact, it has been used traditionally to control blood sugar levels. Green tea has remarkable effect on diabetics as is being reveled by literature survey. It beneficial for type 2 diabetes mellitus and prevents it by controlling fasting blood sugar level, reducing triglycerides and free fatty acids, and enhancing ability of adipocytes to respond to insulin.in fact, adipocytes get sensitive towards insulin and absorb blood sugar.
Last but not the least the triggering factor is blood glucose gets utilized by peripheral tissues and skeletal muscles. Green tea contains a number of active principles especially, polyphenols which prove a boon to in glucose uptake and insulin signaling and these actions are regulated by genes. This very effect is rather enhanced by polyphenols. Consumption also increases the body’s ability to utilize blood sugar. Green tea polyphenols regulate the expression of genes involved in glucose uptake and insulin signaling.
Gurmar cures diabetes by lowering high sugar level in the blood and lead to proper functioning of insulin and also minimize the urge of taking sweets in the diabetes patients.
Another natural cure for diabetes mellitus comes from consumption of dry mango leaves. Mango leaves are collected and dried and powdered. The powder is taken with a glass of water every day.
Surprisingly, this is an important, good and natural cure for diabetes mellitus
There are reports that papaya if boiled and made into a paste with a pinch of common salt and jeera powder can act as an important cure for diabetes mellitus. This treatment is to be continued for six months at least.
Mushrooms are considered a very good delicacy. Research has shown the Maitake mushroom (Grifola frondosa) has a hypoglycemic effect, and may be beneficial for the management of diabetes. The reason Maitake lowers blood sugar is due to the fact the mushroom naturally acts as an alpha glucosidase inhibitor. These agents tend to lower the absorption of glucose via intestines and thereby maintain post prandial blood glucose levels.
Cinnamon is well known house hold herb used by almost all people in India at least.
The study on people published in 2003 conducted in the Department of Human Nutrition, NWFP Agricultural University, Peshawar, Pakistan concluded: The results of this study demonstrate that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes. Here I am impressed to mention a few names of medicinal plants of Indian origin with antidiabetic properties.
The plant extract of seeds of acacia arabica acts as an antidiabetic agent by acting as secretagogue to release insulin. It induces hypoglycemia in control rats but not in alloxanized animals. Powdered seeds of Acacia arabica when administered (2, 3 and 4 g/kg body weight) to normal rabbits induced hypoglycemic effect by initiating release of insulin from pancreatic beta cells.
Aegle mamelons: (Bengal Quince, Bel or Belva)
Administration of aqueous extract of leaves of Belva improves digestion and reduces blood sugar and urea, serum cholesterol in alloxanized rats as compared to control. Along with exhibiting hypoglycemic activity, this extract also prevented peak rise in blood sugar at 1h in oral glucose tolerance test.
Allium cepa: (Onion), which forms the basic necessity of poor man has also antihyperglycemic properties.
Dried onion powder has been shown to have antihyperglycemic activity. Onion, Allium cepa, possesses Sulphur containing compounds mainly s-methyl cysteine was found to lower blood glucose levels in experimental rabbits. Literature survey also reveals that diabetic individual were fed with 50 g of onion juice orally, there was improvement in maintaining post prandial glucose levels significantly .it was also observed that the activities of liver hexokinase, glucose 6-phosphatase and HMG Co A reductase maintained their biochemical function normally.
Allium sativum: (Garlic), how can one ignore garlic
Some people are reluctant to eat garlic on account of its pungent odor. The pungent odor is on account of Allicin, a sulfur-containing compound is responsible for its pungent odor and it has been shown to have significant hypoglycemic activity. It has been observed and confirmed experimentally also.
Aloe vera-Who doesn’t know about aloe vera these days? People are very much fascinated by aloe vera these days on account of its long historical medicinal background and multipurpose folk remedy.
The plant can be separated into two basic products: gel and latex. Aloe vera gel is the leaf pulp or mucilage, aloe latex, commonly referred to as “aloe juice,” is a bitter yellow exudate from the pericyclic tubules just beneath the outer skin of the leaves. People who take extracts of aloe vera gum increase glucose tolerance effectively. This has been observed in normal and diabetic rats. dose of exudates of Aloe. Aloe vera acts basically as insulin releaser, a secretagogue. Oral administration of Aloe vera might be a useful adjunct for lowering blood glucose in diabetic patients.
Coccinia indica: (Ivy gourd)
Research conducted on Coccinea indica reveled that dried extracts of this plant when fed to diabetic patients for a couple of weeks showed significant hypoglycemia in alloxanized diabetic dogs and also increased glucose tolerance in normal and diabetic dogs. Study also showed that enzymatic activities of lipoprotein lipase got reduced while that of lactate dehydrogenase and glucose -6-phosphatase got reduced in untreated diabetics.
Eugenia jambolana: (Indian gooseberry, Jamun) The use of this plant is not new but exists as a major constituent in formulations for diabetics. The study showed that alcoholic and aqueous extracts of this plant caused reduction in blood glucose level, however, it varies with different levels of diabetes.
In India decoction of kernels of Eugenia jambolana is used as household remedy for diabetes. This also forms a major constituent of many herbal formulations for diabetes. Antihyperglycemic effect of aqueous and alcoholic extract as well as lyophilized powder shows reduction in blood glucose level. the seed of the same fruit required 24 h. The oral administration of the extract resulted in increase in serum insulin levels in diabetic rats
Juglans regia: (Walnut) people keep on taking walnuts during winter season and so many preparations-like sweets are made out of it.
It is one of the medicinal plants used in tradition Indian medicine as a treatment for diabetes, but little scientific documentation supports its anti-diabetic action. The scientists at Isfahan University, Isfahan, Iran evaluated the anti-diabetic effect of ethanolic walnut leaf extract.
Leucas lavandulifolia:
The plant Leucas lavandulifolia belongs to family Labiatae. It was evaluated for its Antidiabetic activity in alloxan induced diabetic rats as well as for its in vitro antioxidant property. The leaves were put in methanol and methanolic extract was examined thoroughly and it was observed that Methanolic extract of L. lavandulifolia exhibited significant antidiabetic activity in dose dependent manner, but the antidiabetic activity was not better than glibenclamide.
Mangifera indica: (Mango)
The leaves of this plant are used as an antidiabetic agent in Nigerian folk medicine, although when aqueous extract given orally did not alter blood glucose level in either normoglycemic or streptozotocin induced diabetic rats. However, antidiabetic activity was seen when the extract and glucose were administered simultaneously and also when the extract was given to the rats 60 min before the glucose. The results indicate that aqueous extract of Mangifera indica possess hypoglycemic activity. This may be due to an intestinal reduction of the absorption of glucose. [5]
Momordica charantia: (Bitter gourd)
It is commonly used as an antidiabetic and antihyperglycemic agent in India as well as other Asian countries. Extracts of fruit pulp, seed, leaves and whole plant was shown to have hypoglycemic effect in various animal models. Polypeptide p, isolated from fruit, seeds and tissues of M. charantia showed significant hypoglycemic effect when administered subcutaneously to langurs and humans. Ethanolic extracts of M. charantia (200 mg/kg) showed an antihyperglycemic and also hypoglycemic effect in normal and STZ diabetic rats. [10]
Osmium sanctum: (Holy basil, Tulsi)
Since ancient times, this plant is known for its medicinal properties. The aqueous extract of leaves of Ocimum sanctum showed the significant reduction in blood sugar level in both normal and alloxan induced diabetic rats. The experimental findings revealed that Significant reduction in fasting blood glucose, uranic acid, total amino acid, total cholesterol, triglyceride and total lipid was caused which clearly indicated the hypoglycemic effects of Tulsa in diabetic rats. Extract of this plant when administered orally for 30 days led to reduction in blood glucose levels.it was further found that skeletal muscle and hepatic glycogen levels decreased by 68 and 75% respectively in diabetic rats as compared to control.
Phyllanthus amarus: (Bhuiamala)
Traditionally it is used in diabetes therapeutics. The whole plant extract also reduced the blood sugar in alloxanized diabetic rats.
Pterocarpus marsupium: (Indian kino tree). It contains an active principle, Pterostilbene, a constituent derived from wood of this plant caused hypoglycemia in dogs showed that the hypoglycemic activity of this extract is because of presence of tannates in the extract. Flavonoid fraction from Pterocarpus marsupium has been shown to cause pancreatic beta cell regranulation.
Trigonella frenum graecum: (Fenugreek, Methi). We are quite familiar with fenugreek. Its seed contains
4-hydroxyleucine, a novel amino acid from fenugreek seeds. The research revealed that it increased glucose stimulated insulin release by isolated islet cells in both rats and humans. When this extract was administered orally the results were quite fascinating. It produced dose dependent decrease in the blood glucose levels in both normal as well as diabetic rats. Moreover, glucose metabolism also got improved by administration of fenugreek seeds. Further, creatinine kinase activity in heart, skeletal muscle and liver of diabetic rats was also improved.
Tinospora cordifolia: (Guduchi)
Oral administration of the extract of Tinospora cordifolia roots for 6 weeks resulted in a significant reduction in blood and urine glucose and in lipids in serum and tissues in alloxan diabetic rats. The extract also prevented a decrease in body weight. T. cordifolia is widely used in Indian ayurvedic medicine for treating diabetes mellitus. Oral administration of an aqueous T. cordifolia root extract to alloxan diabetic rats caused a significant reduction in blood glucose.
HERBAL DRUGS WITH ANTI DIABETIC PROPERTIES
Many formulations are in the market and are used regularly by diabetic patients on the advice of the physicians.
Diabecon is well known herbal market preparation manufactured by ‘Himalaya’.This preparation is beneficial in getting peripheral glucose utilized ,increases hepatic and muscle glucagon contents, promote B cells repair and regeneration and increase c peptide level. It exerts an insulin like action by reducing the glycated hemoglobin levels. It minimizes long term diabetic complications.
Epinsulin marketed by Swastik formulations contains epicatechin, a benzopyran, as an active principle. Additionally, it has an insulin-mimetic effect on osmotic fragility of human erythrocytes and it inhibits Na/K ATPase activity from patient’s erythrocytes. It is reported to be a curative for diabetes, Non-Insulin Dependant Diabetes Mellitus (NIDDM) and a good adjuvant for Insulin Dependant Diabetes Mellitus (IDDM), in order to reduce the amount of needed insulin. It is advised along with existing oral hypoglycemic drugs and is known to prevent diabetic complication.
Bitter gourd powder marketed by Garry and Sun. The It lowers blood and urine sugar levels. The Bitter gourd is specifically used as a folk medicine for diabetes. It contains compounds like bitter glycosides, saponins, alkaloids, reducing sugars, phenolics, oils, free acids, polypeptides, sterols, 17-amino acids including methionine and a crystalline product named p-insulin. It is reported to have hypoglycemic activity.
Dia-Care manufactured by Admark Herbals Ltd. is claimed to be effective for both Type 1, Type 2 diabetes within 90 days of treatment and cures within 18 months. Persons taking insulin will eventually be liberated from the dependence on it. The whole treatment completes in 6 phases, each phase being of 90 days. Approx. 5 grams (1 tea spoon) powder is mixed with 1/2 glass of water, stirred properly and kept overnight. Only the water and not the sediment must be taken in the morning on empty stomach. To the remaining medicine fresh water is added and kept for the whole day and is consumed half an hour before dinner. The taste of the drug is very bitter. It is a pure herbal formula without any side effects.
Gurmar powder manufactured by Garry and Sun has manufactured a fascinating product, Gurmar powder.It acts as an anti-diabetic drug.it suppresses the intestinal absorption of saccharides, which prevents blood sugar fluctuations. Gurmar stimulates insulin secretion and acts as a insulin secretagogue and shows blood sugar reducing properties. It has one more fascinating property that blocks sweet taste receptors when applied to tongue in diabetes to remove glycosuria. It deadens taste of sweets and bitter things like quinine (effects lasts for 1 to 2 hours).
DIABETA,is an Ayurvedic formulation. The antidiabetic effect of this formulation has been proved through continuous research . Diabeta acts on different sites in differing ways to effectively control factors and pathways leading to diabetes mellitus. It attacks the various factors, which precipitate the diabetic condition, and corrects the degenerative complications, which result because of diabetes. It is reported that Diabeta is quite safe in controlling diabetes as a single supplement as compared to synthetic anti diabetic agents. Diabeta helps overcome resistance to oral hypoglycemic drugs when used as adjuvant to cases of uncontrolled diabetes.
Plethico Laboratory has manufactured a product called Syndrex.It contains extracts of germinated fenugreek seeds. Fenugreek is used as an ingredient of traditional formulations over 1000 years. The mechanism of this antidiabetic drug is under investigation.
Thus, many different plants have been used individually or in formulations for treatment of diabetes and its complications. One of the major problems with this herbal formulation is that the active ingredients are not well defined. It is important to know the active component and their molecular interaction, which will help to analyze therapeutic efficacy of the product and also to standardize the product. Efforts are now being made to investigate mechanism of action of some of these plants using model systems.
Antidiabetic Activity of an Herbal Formulation from Tinospora cordifolia stem and Plumbago rosea root has also been investigated.
PRTC contains the medicinal herbs, P. rosea and T. cordifolia is widely used in Ayurveda to treat diabetes. A starchy water, Guduchi satwa,extract prepared from it is recommended as an anti-diabetic tonic. Antioxidant properties of T. cordifolia have also been reported. Therefore, the significant antioxidant effects exhibited by PRTC herein may partly be due to the presence of the T. cordifolia component. It is also reported to decrease levels of plasma lipid per oxidation in alloxan diabetic rats. In consonance with the results, T. cordifolia ameliorated cyclophosphamide induced toxicity, due to its free radical scavenging activity.
Every diabetic individual needs to follow the following guidelines in order to lead life comfortably with diabetes. Any individual suffering from diabetes mellitus is advised to follow dietary requirements in terms of low-calorie diet.
A regular monitoring of blood sugar level and other parameters like urea, uric acid, creatinine, lipid profile needs to be carried out on regular basis.
The diabetic individual needs to avoid overeating habits’ and don’t let obesity to dominate.
Lastly, regular consultation with doctor should be followed.
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In the present discussion an attempt has been made to exploit the antidiabetic effect of herbal active principles and some herbal formulations as an alternative to allopathic medicines.
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