Diabetes Mellitus and its Herbal Treatment Research Article

Transcription

Diabetes Mellitus and its Herbal Treatment Research Article
International Journal of Research in Pharmaceutical and Biomedical Sciences
ISSN: 2229-3701
____________________________________________Research Article
Diabetes Mellitus and its Herbal Treatment
Pallab Das Gupta and Amartya De*
BCDA College of Pharmacy and Technology, 78 Jessore road (south), Hridaypur, Barasat,
Kolkata, west Bengal, India.
__________________________________________________________________________________
ABSTRACT
Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, that
result from defects in insulin secretion, or action, or both. Herbal medicines have been highly esteemed source
of medicine throughout the human history. They are widely used today indicating that herbs are a growing
part of modern high-tech medicine. Some of the herbal plants and active chemical constituents which have a
role in the management of Diabetes mellitus are compiled here are discussed in this review.
Key Words: Diabetes Mellitus, Blood Sugar, Insulin, Oral Hypoglycemic agent, Herbal treatment.
INTRODUCTION
Diabetes mellitus is a group of metabolic diseases
characterized by high blood sugar (glucose) levels,
that result from defects in insulin secretion, or
action, or both. Diabetes mellitus, commonly
referred to as diabetes (as it will be in this article)
was first identified as a disease associated with
"sweet urine," and excessive muscle loss in the
ancient world. Elevated levels of blood glucose
(hyperglycemia) lead to spillage of glucose into the
urine, hence the term sweet urine.
Normally, blood
glucose levels
are
tightly
controlled by insulin, a hormone produced by the
pancreas. Insulin lowers the blood glucose level.
When the blood glucose elevates (for example,
after eating food), insulin is released from the
pancreas to normalize the glucose level. In patients
with diabetes, the absence or insufficient
production of insulin causes hyperglycemia.
Diabetes is a chronic medical condition, meaning
that although it can be controlled, it lasts a
lifetime.1
Blood sugar level in normal & diabetic patients
Fasting Value
Category of a person
Post Prandial
Minimum Value
Maximum Value
Value 2 hours after consuming glucose
70
100
Less than 140
Early Diabetes
101
126
140 to 200
Established Diabetes
More than 126
-
More than 200
Normal
* All values are in mg/100ml
The two types of diabetes are referred to as type 1
(insulin dependent) and type 2 (non-insulin
dependent).
The major complications of diabetes are both acute
and chronic.

Acutely
Dangerously elevated blood sugar, abnormally low
blood sugar due to diabetes medications may
occur.

Chronically
Disease of the blood vessels (both small and large)
which can damage the eye, kidneys, nerves, and
heart may occur
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Diabetes treatment depends on the type and
severity of the diabetes. Type 1 diabetes is treated
with insulin, exercise, and a diabetic diet. Type 2
diabetes is first treated with weight reduction, a
diabetic diet, and exercise. When these measures
fail to control the elevated blood sugars, oral
medications are used. If oral medications are still
insufficient, insulin medications are considered.2
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Regulation of blood glucose in normal &
diabetic patients3,4
( in normal case)
(in diabetic patients)
Causes of Diabetes
Insufficient production of insulin (either absolutely
or relative to the body's needs), production of
defective insulin (which is uncommon), or the
inability of cells to use insulin properly and
efficiently leads to hyperglycemia and diabetes.
This latter condition affects mostly the cells of
muscle and fat tissues, and results in a condition
known as "insulin resistance." This is the primary
problem in type 2 diabetes. The absolute lack of
insulin, usually secondary to a destructive process
affecting the insulin producing beta cells in the
pancreas, is the main disorder in type 1 diabetes. In
type 2 diabetes, there also is a steady decline of
beta cells that adds to the process of elevated blood
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sugars. Essentially, if someone is resistant to
insulin, the body can, to some degree, increase
production of insulin and overcome the level of
resistance. After time, if production decreases and
insulin cannot be released as vigorously,
hyperglycemia develops.
Glucose is a simple sugar found in food. Glucose
is an essential nutrient that provides energy for the
proper
functioning
of
the
body
cells. Carbohydrates are broken down in the small
intestine and the glucose in digested food is then
absorbed by the intestinal cells into the
bloodstream, and is carried by the bloodstream to
all the cells in the body where it is utilized.
However, glucose cannot enter the cells alone and
needs insulin to aid in its transport into the cells.
Without insulin, the cells become starved of
glucose energy despite the presence of abundant
glucose in the bloodstream. In certain types of
diabetes, the cells' inability to utilize glucose gives
rise to the ironic situation of "starvation in the
midst of plenty". The abundant, unutilized glucose
is wastefully excreted in the urine.
Insulin is a hormone that is produced by
specialized cells (beta cells) of the pancreas. (The
pancreas is a deep-seated organ in the abdomen
located behind the stomach.) In addition to helping
glucose enter the cells, insulin is also important in
tightly regulating the level of glucose in the blood.
After a meal, the blood glucose level rises. In
response to the increased glucose level, the
pancreas normally releases more insulin into the
bloodstream to help glucose enter the cells and
lower blood glucose levels after a meal. When the
blood glucose levels are lowered, the insulin
release from the pancreas is turned down. It is
important to note that even in the fasting state there
is a low steady release of insulin than fluctuates a
bit and helps to maintain a steady blood sugar level
during fasting. In normal individuals, such a
regulatory system helps to keep blood glucose
levels in a tightly controlled range. As outlined
above, in patients with diabetes, the insulin is either
absent, relatively insufficient for the body's needs,
or not used properly by the body. All of these
factors cause elevated levels of blood glucose
(hyperglycemia).5
Pathophysiology of Diabetes
Type 1 Diabetes Mellitus (DM) is a catabolic
disorder in which circulating insulin is very low or
absent, plasma glucagon is elevated, and the
pancreatic beta cells fail to respond to all insulinsecretory stimuli. The pancreas shows lymphocytic
infiltration and destruction of insulin-secreting cells
of the islets of Langerhans, causing insulin
deficiency. Patients need exogenous insulin to
reverse this catabolic condition, prevent ketosis,
decrease hyperglucagonemia, and normalize lipid
and protein metabolism.
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One theory regarding the etiology of type 1 DM is
that it results from damage to pancreatic beta cells
from infectious or environmental agents. In a
genetically susceptible individual, the immune
system is thereby triggered to develop an
autoimmune response against altered pancreatic
beta cell antigens or molecules in beta cells that
resemble a viral protein. Approximately 85% of
type 1 DM patients have circulating islet cell
antibodies, and the majority also have detectable
anti-insulin antibodies before receiving insulin
therapy. Most islet cell antibodies are directed
against glutamic acid decarboxylase (GAD) within
pancreatic beta cells.
Currently, autoimmunity is considered the major
factor in the pathophysiology of type 1 DM.
Prevalence is increased in patients with other
autoimmune diseases, such as Graves disease,
Hashimoto thyroiditis, and Addison disease.
Approximately 95% of patients with type 1 DM
have either human leukocyte antigen (HLA)-DR3
or HLA-DR4. HLA-DQs are considered specific
markers of type 1 DM susceptibility.
Amino acid metabolism also plays a key role in the
pathogenesis of diabetes. Amino acid profiles could
help assess risk of developing diabetes.[6] It might
help elucidate further how diabetes evolves.
Recent evidence suggests a role for vitamin D in
the pathogenesis and prevention of diabetes
mellitus. Vitamin D deficiency is also an important
independent predictor of development of coronary
artery calcification in individuals with type 1
DM.[7] Joergensen et al determined that vitamin D
deficiency in type 1 diabetes may predict all causes
of mortality but not development of microvascular
complications.[8] The contribution of vitamin D
deficiency to mortality must be mediated by
nonvascular mechanisms.
Type 2 diabetes is characterized by the
combination of peripheral insulin resistance and
inadequate insulin secretion by pancreatic beta
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cells. Insulin resistance, which has been attributed
to elevated levels of free fatty acids in plasma,[9]
leads to decreased glucose transport into muscle
cells, elevated hepatic glucose production, and
increased breakdown of fat.
For type 2 Diabetes Mellitus to occur, both defects
must exist. For example, all overweight individuals
have insulin resistance, but diabetes develops only
in those who cannot increase insulin secretion
sufficiently to compensate for their insulin
resistance. Their insulin concentrations may be
high, yet inappropriately low for the level of
glycemia.
Beta cell dysfunction is a major factor across the
spectrum of pre-diabetes to diabetes. A study of
obese adolescents by Bacha et al confirms what is
increasingly being stressed in adults as well: Beta
cell function happens early in the pathological
process and does not necessarily follow stage of
insulin resistance.[10] Singular focus on insulin
resistance as the "be all and end all" is gradually
shifting, and hopefully better treatment options that
focus on the beta cell pathology will emerge to
treat the disorder early.
In the progression from normal glucose tolerance
to abnormal glucose tolerance, postprandial blood
glucose levels increase first; eventually, fasting
hyperglycemia develops as suppression of hepatic
gluconeogenesis fails.
During the induction of insulin resistance, such as
is seen after high-calorie diet, steroid
administration, or physical inactivity, increased
glucagon levels and increased glucose-dependent
insulinotropic polypeptide (GIP) levels accompany
glucose intolerance; however, postprandial
glucagonlike peptide-1 (GLP-1) response is
unaltered.[11]This has physiologic implications; for
example, if the GLP-1 level is unaltered, GLP-1
may be a target of therapy in the states mentioned
above.
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The high mobility group A1 (HMGA1) protein is a
key regulator of the insulin receptor gene (INSR).12
Functional variants of the HMGA1 gene are
associated with an increased risk of diabetes. These
variants were shown to lead to reduction in protein
content of both HMGA1 and INSR.
Although the pathophysiology of the disease differs
between the types of diabetes, most of the
complications,
including
microvascular,
macrovascular, and neuropathic, are similar
regardless of the type of diabetes.
Hyperglycemia appears to be the determinant of
microvascular and metabolic complications.
Macrovascular disease, however, is much less
related to glycemia. Insulin resistance with
concomitant lipid abnormalities (ie, elevated levels
of small dense low-density lipoprotein cholesterol
[LDL-C] particles, low levels of high-density
lipoprotein cholesterol [HDL-C], elevated levels of
triglyceride-rich remnant lipoproteins) and
thrombotic abnormalities (ie, elevated type-1
plasminogen activator inhibitor [PAI-1], elevated
fibrinogen as well as conventional atherosclerotic
risk factors (eg, family history, smoking,
hypertension, elevated LDL-C, low HDL-C),
determine cardiovascular risk. Unlike liver and
smooth muscle, insulin resistance is not associated
with increased myocardial lipid accumulation13
Increased cardiovascular risk appears to begin prior
to the development of frank hyperglycemia,
presumably because of the effects of insulin
resistance. Stern in 1996[14]and Haffner and
D'Agostino in 1999[15]developed the "ticking
clock" hypothesis of complications, asserting that
the clock starts ticking for microvascular risk at the
onset of hyperglycemia, while the clock starts
ticking for macrovascular risk at some antecedent
point, presumably with the onset of insulin
resistance.
Symptoms

The early symptoms of untreated diabetes
are related to elevated blood sugar levels, and loss
of glucose in the urine. High amounts of glucose in
the urine can cause increased urine output and lead
to dehydration. Dehydration causes increased thirst
and water consumption.

The inability of insulin to perform
normally has effects on protein, fat and
carbohydrate metabolism. Insulin is an anabolic
hormone, that is, one that encourages storage of fat
and protein.

A relative or absolute insulin deficiency
eventually leads to weight loss despite an increase
in appetite.

Some untreated diabetes patients also
complain of fatigue, nausea and vomiting.

Patients with diabetes are prone to
developing infections of the bladder, skin, and
vaginal areas.
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
Fluctuations in blood glucose levels can
lead to blurred vision. Extremely elevated glucose
levels can lead to lethargy and coma16.
Herbal Treatment of Diabetes Mellitus
BITTER MELON
Biological source
It is obtained from edible fruit of Momordica
charantia, belonging to the family Cucurbitaceae.
Chemical constituents
The plant contains several biologically active
compoundsa) Chiefly momordicin I & momordicin II,
cucurbitacin B
b) Glycosides
(
momordin,
charantin,
charantosides, goyaglycosides)
c) Terpenoid
compoundsmomordicinin,
momordicilin, momordol
d) Cytotoxic ( ribosome inactivating) proteins
such as momorcharin & momordin.[17]
Uses
Bitter melon is used as anti-diabetic. It contains
lectin that has insulin like activity due to its nonprotein specific linking toghther to insulin
receptors. This lectin lowers blood glucose level by
acting on peripheral tissues. Lectin is a major
contributor to hypoglycemic effect.[18]
Scientific work doneTriterpenoids Isolated
from Bitter Melon has showed antidiabetic
activity.19
Dosage form
It is used as fresh juice, tincture, juice extract &
powered leaf.
Dose
Fresh juice- 57-113 gm daily, Tincture- 1.3 ml/
twice/ daily, Juice extract- 300-600 mg, Powered
leaf- 1-2 gm
FIERY COSTUS
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Biological Source
It is obtained from the leaves of the plant Costus
igneus, belonging to the family Costaceae.
Chemical Constituents- The main chemical
constituents are Beta-carotene, deoxyribose,
phenol, flavonoids, insulin precursors.
Uses- The leaves of insulin plant reduced the
fasting and postprandial blood sugar levels,
bringing them down towards normal. Reduction in
the fasting and the postprandial blood sugar levels
with leaves of insulin plant was comparable with
that obtained with Glibenclamide 500 µg/kg at 250
mg/kg/day and 500 mg/kg/day of powdered leaves
of the insulin plant.
The hypoglycemic action can be due to release of
insulin, insulin-sensitizing action or a combination
of both. Hence further studies need to be
undertaken to determine the mechanism of action
by measurement of either insulin or 'C' peptide
level.20
Scientific work done Costus igneus has showed
effect on hyperglycemia.21
Dosage Forms- It is used as oral hypoglycemic
agent, or as i.v. injection
Dose- Tablet- 1 tablet/ day
Dandelion
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Uses
It is a good antidiabetic drug. It can lower the blood
glucose level .Tests on diabetic mice show that
dandelion extract may help regulate blood sugar
and keep cholesterol in check.[23]
Scientific work done
Dandelion has showed antihyperglycemic effect.[24]
Dosage forms
Capsules, tinctures, and teas containing dandelion
leaves, roots, flowers, or the entire plant is used.
Doses
Capsules- taken after each meal
Adult doses: There is disagreement on the optimal
form and dose of dandelion. Reputable
physicians and herbalists recommend a range of
doses
Fresh leaves: 4-10 grams daily
Dried leaves: 4-10 grams daily
Fresh leaf juice: 1 tsp (4-8 ml) twice daily
Fluid extract: 1-2 teaspoons daily
Fresh roots: 2-8 grams daily
Dried powdered extract: 250-1000 mg three to four
times daily
Tea: Pour 2 cups boiling water over one ounce of
fresh leaves and steep for 10 minutes.
Or, boil 1 cup of water with 2-3 tsp of dried, cut
root for 15 minutes. Cool.
Pediatric dosages: Unknown
French Lilac
Biological Source
It is obtained from the leaves of Taraxacum
officinale, belonging to the family Asteraceae.
Chemical Constituents
1. Sesquiterpene lactones (bitters): taraxinic acid
(taraxacin), tetrahydroridentin B
2. Triterpenoids and sterols: taraxasterol, taraxerol,
cycloartenol, beta-sitosterol
3.Other: Vitamin A, Vitamin C, tannins, alkaloids,
pectin, inulin, starch, potassium, beta
carotene, caffeic acid, flavonoids (apigenin)[22]
Biological Source
It consists of the aerial parts of the plant, flowers,
leaf, stem, seeds of the plant Galega officinalis,
belonging to the family Fabaceae.
Chemical Constituents
Oleanane & ursane type triterpinoids like
sophoradiol, soyasapogenol b, & 9-sitosterol,
Sophorediol,galactogil,galegine,peganine,
hydroxygalegine,vasicinone,
alkaloids
like
lutein,pentahydroxyflavone 5 glucoside, luteoline,
galuteoline, luteoline 5 glucosides,flavonoids,
saponines etc.25
Uses
It has been known since the Middle Ages for
relieving the symptoms of diabetes mellitus. Upon
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analysis, it turned out to contain compounds related
to guanidine, a substance that decreases blood
sugar by mechanisms including a decrease in
insulin resistance, but were too toxic for human
use. Georges Tanret identified an alkaloid from this
plant (galegine) that was less toxic, and this was
evaluated in clinical trials in patients with diabetes
in the 1920s and 1930s.
Other related compounds were being investigated
clinically at this time, including biguanide
derivatives. This work led ultimately to the
discovery of metformin (Glucophage), currently
recommended in international guidelines for
diabetes management as the first choice for
antidiabetic pharmacotherapy alongside diet and
exercise[26] and the older agent phenformin, which
has been withdrawn in most countries due to an
unacceptable risk of lactic acidosis (the risk of
lactic acidosis with metformin is no higher than
with other antidiabetic therapies when it is
prescribed according to its label)27 The study of
galegine and related molecules in the first half of
the 20th century is regarded as an important
milestone in the development of oral antidiabetic
pharmacotherapy.28
Dosage form
It is used as herbal infusion, tincture & leaves.
Doses- Herbal infusion- twice daily, Tincturethrice daily
GULVEL
Biological source
It is obtained from the stems and roots of
Tinospora cordifolia, belonging to the family
Menispermaceae.
Chemical Constituents
The
active adaptogenic constituents
are
diterpene compounds
including
tinosporone,
tinosporic acid, cordifolisides A to E, syringen, the
yellow
alkaloid, berberine,
Giloin,
crude
Giloininand, a glucosidal bitter principle as well as
polysaccharides,
including arabinogalactan polysaccharide (TSP).
Picrotene and bergenin were also found in the
plant. The active principles of Tinospora cordifolia,
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a traditional Indian medicinal plant were found to
possess
anticomplementary
and
immunomodulatory activities.29
Use
It is used as antidiabetic30.
Scientific work done
Tinospora cordifolia has showed Anti-diabetic
activity.31
Dosage form
Aqueous extract of roots is used.
Dose
Aqueous extract of root- 2.5g, 5 g/ kg body weight
TURMERIC
Biological Source
It consists of dried fresh rhizomes of the plant
Curcuma longa belonging to the family
Zingiberaceae.
Chemical Constituents
Turmeric contains 5% of volatile oil, resin,
zingiberaceous starch grains & yellow coloured
curcuminoids. The chief components of
curcuminoids is known as curcumin. Volatile oil is
composed of mono and sesquiterpens such as alpha
& beta pinene, alpha- phellandrene, camphor,
camphene, zingiberene, alpha & beta curcumenes.32
Use- It is used as anti- diabetic drug.33
Scientific works done
1. Turmeric has showed
hypoglycemic,
hypolipidemic & antioxidant activity34
2. Turmeric has shown effect in diabetes.[35]
Dosage form
Powdered form of turmeric is used.
Dose
Powdered turmeric- 500-8000 mg/ day .
GURMAR
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Biological source
It is obtained from leaves & roots of Gymnema
sylvestre, belonging to the family Asclepiadaceae.
Chemical constituents
The principal active ingredient is gymnemic acid.
The other compounds found are calcium oxalate,
anthraquinone compound, tartaric acid, cellulose
but no tannin is present36.
Uses
1)
This is one of the main herbs used for
healing diabetes mellitus.
2)
Gymnema removes sugar from pancreas,
restores pancreatic function.
3)
Gymnema stimulates circulatory system,
increases urine secretion.37
Scientific works done
1. Gymnema sylvestre has shown Enzyme changes
and glucose utilization.38
2. Gymnema sylvestre has showed effect in
controlling blood glucose level.39
Dosage forms
It is used as water soluble acidic solution & as
powered leaf.
Doses
Power leaf- 2-4 mg/daily, Water soluble acidic
solution- 400 mg/day
BAEL
Biological source
It consists of unripe or half ripe fruits of the plant
known as Aegle marmelos, belonging to the family
Rutaceae.
Chemical constituents
The chief constituent of the drug is marmelosinn
( 0.5%) which is a furocoumarin. Other coumarins
are marmesin, psoralin, umbelliferone. The drug
also contains carbohydrate, protein, volatile oil &
tannins. The pulp also contains good amount of
vitamin A & C. Two alkaloids, Omethylhalfordinol & isopentylhalfordinol has been
isolated from fruits.[40]
Use
It is used as anti-diabetic drug.41
Scientific work done
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Leaf & callus extract of Aegle marmelos has
shown antidiabetic activity. [42]
Dosage forms
It is used as aqueous decoction & aqueous leaf
extract.
Doses
Aqueous decoction- 1 ml/ 100 mg, Aqueous leaf
extract- 1 gm/ kg/
AMLA
Biological Source
It is obtained from the dried as well as fresh fruits
of Emblica officinalis, belonging to the family
Euphorbiaceae.
Chemical Constituents
Amla is a rich natural source of vitamin C. It
contains 0.5% fat, phyllemblin, 5% tannin. It also
contains phosphorus, iron & calcium. It contains
pectin & 75% moisture43.
Use- It is used as anti-diabetic44.
Scientific work done
Emblica officinalis has shown Anti-diabetic
activity in animal models. 45
Dosage form
It is used as amalaki capsules.
Dose
Capsule- 1 capsule/ twice a day before meal
FENUGREEK
Biological source
It is obtained from the leaves and seeds of
Trigonella foenum- graecum, belonging to the
family Fabaceae.
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Chemical constituents
The nicotinic acid, alkaloid trogonelline, and
coumarin contained by defatted section of the seed
of fenugreek proves to be the responsible active
ingredient for its anti-diabetic properties.[46]
Uses- It is used as anti-diabetic. The fiber-rich
fraction of fenugreek seeds can lower blood sugar
levels in people with type II diabetes.46
Scientific works doneMetabolic and molecular action of Trigonella
foenum-graecum
(fenugreek) and trace metals has been shown in
experimental diabetic tissues.47
2. Fenugreek Seed has shown the postprandial
hypoglycemic activity48.
Dosage forms
The leaves & seeds of fenugreek are used in
therapeutic purpose.
Doses
Leaves- 5-30 gm/ thrice daily with meal, Seeds- 3
½ ounces/ daily.
GINSENG
Biological Source
It is obtained from the dried roots of Panax
ginseng, belonging to the family Araliaceae.
Chemical Constituents
Ginseng contains a mixture of several saponin
glycosides, belonging to triterpenoid group. They
are grouped as follows1)
Ginsenosides
2)
Panaxosides
3)
Chikusetsusaponin
Ginsenosides contain aglycone dammarol while
panaxosides have oleanolic acid as aglycone.
About 13 ginsenosides have been identified.
Panaxosides give oleanolic acid, panaxadiol &
panaxatriol on decomposition.49
Use
It is used as hypoglycemic agent.50
Scientific works done
1. Use of Ginseng in diabetes.51
2. Ginseng has shown hypoglycemic effect.52
Dosage forms
dried root and tincture are used.
Doses
Dried root- 0.5- 9 gm/ daily, Tincture- 0.2- 3/ one
to three times daily
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INDIAN KINO TREE
Biological source
It is obtained from the dried juice of the plant
Pterocarpus marsupium & obtained by making
vertical incisions to the stem bark & it belongs to
the family Leguminaceae.
Chemical constituents
It contains about 70%- 80% of kinotannic acid,
kino- red, k- pyrocatechin ( catechol) , resin &
gallic acid. Kinotannic acid is glucosidal tannin,
while kino- red is anhydride of kinoin. Kinoin is an
insoluble phlobaphene & is produced by action of
oxydase enzyme. It is more dark in colour than
kinotannic acid.
If the juice is boiled during drying, enzyme gets
destroyed & thus insolubilisation & darkening is
prevented.53
Uses
The heartwood of the plant is used in treatment of
diabetes. The gum resin is the only herbal product
ever found to regenerate B cells that make insulin
in the pancreas.54
Scientific works done
1.Phenolics from Pterocarpus marsupium has
shown antihyperglycemic activity.55
2.Hypoglycaemic
activity
of Pterocarpus
marsupium has been seen.56
Dosage forms
The wood extract & bark decoction is used.
Doses
Wood extract ( pterostilbene ) – 10 mg/ kg, Bark
decoction- 1 gm/ 100 mg body weight for 10 days.
NAYANTARA
Biological source
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It is obtained from the dried whole plant of
Catharanthus roseus, belonging to the family
Apocynaceae.
Chemical constituents
The main active compounds here are alkaloids &
tannins. The major alkaloid is vincamine. Aclosely
related semi-synthetic derivative of vincamine is
vinpocetin. There are over 130 constituents with an
indole or dihydroindole structure, including the
principal component vindoline, vinblastine,
vincristine, learocristine, vinine, ajmalicine,
leurocine, vinomine etc.57
Use- It is used as antihyperglycemic agent.58
Scientific works done
1.
Effect of an antidiabetic extract of
Catharanthus roseus has been seen.59
2. The juice of fresh leaves of Catharanthus
roseus has shown reduction blood glucose.60
Dosage forms
It is used as tincture & infusion.
Doses
Tincture- 1-2 ml/ 3 times daily, Infusion- 2-3 cups
daily.
NEEM
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CINNAMON
Biological source
It consists of dried inner bark of shoots of coppiced
trees of Cinnamomum zeylanicum, belonging to
the family Lauraceae.
Chemical constituents- Cinnamon bark contains
volatile oil, tannins, mucilage, calcium oxalate,
starch & mannitol. Cinnamon oil contains
cinnamaldehyde, other terpenes like phellandrene,
pinene, cymene, caryophyllene.64
Uses- Cinnamon is used in the treatment of type II
diabetes mellitus & insulin resistance.65
Scientific works done
1. Alcoholic Extract of Cinnamomum zeylanicum
Leaves has shown antidiabetic Activity.66
2.
Cinnamon improves glucose and lipid of
people67
Dosage form
It is mostly used as powdered form.
Dose
Powder- ½ teaspoon daily
SAPTRANGI
Biological source
It is obtained from the leaves of Azadirachta
indica, belonging to the family Meliaceae.
Chemical constituents
It contains glycerides of saturated & unsaturated
fatty acids. The main fatty acids are oleic (50%) &
stearic (20%) acids. The oil contains 2.0% of
bitters, which are sulpher containing compounds,
nimbidin, nimbin, nimbinin, nimbidol. The
unsaponifiable part contains nimbosterol ( 0.03% )
The main limonoid that it contains is azadirachtin
but it also contains azadiradione, fraxinellone,
nimbin, salannin, salannol, vepinin, vilasinin.61
Use- It is used in diabetes.62
Scientific work done
Azadirachta indica leaf extract has shown antihyperglycemic and
antidyslipidemic activity.63
Dosage form
Capsules are used.
Dose
Capsule- 1-2 capsules/ twice daily.
Vol. 3 (2) Apr – Jun2012
Biological source
It is obtained from the stem, root & leaves of
Salacia oblonga, belonging to the family
Hippocrateaceae.
Chemical constituents
It contains 2 potent alpha- glycosidase inhibitorssalicinol, kotalanol, sesquiterpene (salasol A & B) ,
triterpenes ( salasones A-E, salaquinones A & B
)[68]
Uses- It is used as anti-diabetic. It binds to
intestinal enzymes alpha- glucosidases that break
down carbohydrate into glucose in body68.
Scientific work done
Salacia oblonga has shown antidiabetic potential69.
Dosage form
Aqueous extract of the root bark is used.
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714
International Journal of Research in Pharmaceutical and Biomedical Sciences
Dose
Aqueous extract of root bark- 250 ml/ kg
ONION
Biological source- It is obtained from the bulb of
the plant Allium cepa, belonging to the family
Liliaceae.
Chemical constituents- It contains essential amino
acid composition of arginine, histidine, lysine,
tryptophan, phenylalanine, methionine, threonine,
leucine & isoleucine. The bulb on steam distillation
yields an essential oil known as onion oil. The bulb
contains several phenolic acid, such as
protocatechuic acid, p-hydroxybenzoic acid,
vanillic acid, caffeic acid, & o & p- coumaric acids.
Citric, abietic, oxalic and mialic acids are also
present. It also contains several oligosaccharides.70
Uses- Onion consists of an active ingredient called
APDS (allyl propyl disulphide). APDS has been
shown to block the breakdown of insulin by the
liver and possibly to stimulate insulin production
by the pancreas, thus increasing the amount of
insulin and reducing sugar levels in the blood. It is
found to lower lipid levels, inhibit platelet
aggregation and are antihypertensive. So, liberal
use of onion is recommended for diabetes
patients.71
Scientific work done
Clinical Hypoglycemic effect of Allium cepa (Red
onion) has been seen.72
Dosage forms
Raw & boiled onion extracts are used. APDS can
also be administered orally.
Dose
APDS- 125 mg/ kg to fasting humans.
GARLIC
Vol. 3 (2) Apr – Jun2012
ISSN: 2229-3701
Biological source
It consists of bulbs of the plant known as Allium
sativum, belonging to the Liliaceae.
Chemical constituents
Garlic bulbs contain 29% of carbohydrate, about
56% of proteins
(albumin), 0.1% of fat,
mucilage, and 0.06- 0.1% of volatile oil. It also
contains phosphorus, iron & copper. Volatile oil of
the drug is the chief active constituent, and contains
allyl propyl disulphide, diallyl disulphide, alliin
and allicin. Alliin by action of enzyme allinlyase is
converted into allicin. Garlic oil is yellow in
colour.[73]
Uses- Garlic cloves lower blood sugar
significantly. Subsequently, scientific studies have
proven that the presence of disulfides in garlic such
as allyl propyl and diallyl sulfide have played a role
in the decrease of blood glucose levels. They have
been seen to have actions similar to Tolubutamide,
a sulfonylurea drug of the first generation. They act
on the pancreas and stimulate the production
of insulin so as to control the sugar levels in the
blood. It is those patients with type 2 diabetes who
benefit the most out of this.74
Scientific work done
Anti-diabetic and hypolipidaemic properties of
garlic has been seen.[75]
Dosage form
Juice extract of it is used.
Dose
Juice extract- 50 ml / daily
OPUNTIA
Biological source
It is obtained from the stems of Opuntia ficusindica, belonging to the family Cactaceae.
Chemical constituents
The main chemical constitutes are 3methoxytyramine76, candicine77, hordinine78, Nmethyltyramine79, tyramine79 etc.
Use- It is used in the treatment of type II diabetes.
Scientific work done
Polysaccharides from Opuntia has shown antidiabetic effects. [80]
Dosage form
Boiled stems are used.
Doseoiled stem- 100-500/ daily
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International Journal of Research in Pharmaceutical and Biomedical Sciences
BLUEBERRY
Biological source
It is obtained from the leaves of Vaccinium
myrtillus, belonging to the family Ericaceae.
Chemical constituents
The main chemical constituents are· flavonoids
(hyperoside,
isoquercitrin,
quercitrin,
astragaline),·anthocyanosides (myrtillin, malvidin,
cyanidin, delphinidin and others), catechin tannins
(2-10%), others (carbohydrates including invertose,
organic acids, pectins, alkaloids)81
Uses- Blueberry is a natural herb of controlling or
lowering blood sugar levels when they are slightly
elevated. It contains an active agent known as
myrtillin which is an anthocyanoside. It is weaker
and less toxic than insulin.81
Scientific works done
1. Vaccinium myrtillus has shown antidiabetic
activity.82
2. Vaccinium myrtillus has shown hypoglycemic
effect.83
Dosage form- Leaf extracts are used.
Dose- Leaf extract- 3 cups/ day
Blackberry
Biological Source
It is obtained from the edible fruits of the plant
Rubus fruticosus belonging to the family
Rosaceae.
Chemical Constituents
The principal compounds isolated from red
blackberry leaves are hydrolyzable tannins. Simple
compounds such as 1,2,6-tri-O -galloyl-glucose[84]
and penta- O -galloyl glucose are oxidatively
coupled through galloyl groups to form more
complex compounds such as casuarictin,
pendunculagin, sanguin H-685 and lambertianin
Vol. 3 (2) Apr – Jun2012
ISSN: 2229-3701
A[86], with as many as 15 galloyl groups coupled to
3 glucose units87.
Common flavonoids have also been isolated from
the leaves . Rutin was isolated88,,as were
kaempferol, quercitin, quijaverin, and kaempferol3- O -β-D-glucuronopyranoside89. Major leaf
volatiles studied by GC-MS include the
monoterpenes geraniol and linalool as well as 1octane-3-ol and decanal90. Phenolic acids common
to the Rosaceae family have also been identified.91
Use- It is used as anti-diabetic.
Dosage form- It is used as fruit powder.
Dose- Dried fruit powder- 20 mg/day.
Herbal Home Remedies for Diabetes92
Diabetes has been referred to as 'Madhumeh' by
Ayurveda. This desease is caused by imbalance of
the hormone insulin (which controls the sugar level
of blood) that has to be taken externally by a
diabetes patient regularly. Ayurvedic therapies
recommend many Indian herbs and general
practices to improve the secretion of insulin
through
natural
ways.
Some of the home and herbal remedies prescribed
by Ayurveda are described below.

Include turmeric and cinnamon in your
diets. You can even take one teaspoon of cinnamon
powder daily.

Soak one teaspoon of fenugreek seeds in 1
cup of water overnight. Drink this water in the
morning on an empty stomach and eat the seeds.

Take a bitter gourd, remove the seeds and
saturate in a cup of water. Drain this preparation
and drink every morning.

Boil around fifteen mango leaves in one
cup of water. Keep it over night and filter in the
morning. Drink every morning on an empty
stomach.

Avoid oily, fried and starchy foodstuffs.

Avoid coffee, sugar, refined flour and
alcohol.

Eat smaller meals (low fat diet) five to six
times a day instead of having three large meals.

Increase intake of vegetables like spinach,
cucumber, tomatoes, onion, sprouts, beans, garlic
etc.

Refrain from taking stress.

Do regular exercise. Walk for at least 40
minutes a day.

Avoid red meat and excessive salt in your
meals. Fish and soy can be taken due to their good
protein value.

Bitter herbs like Azadirachta Indica
(Neem), bitter gourd and fenugreek are like miracle
drugs for diabetics. Take them in any form you can.

Avoid white bread, rice, potatoes, sweet
and sugary foods.

Chew 8-10 curry leaves (Meetha Neem)
on an empty stomach. It is very effective for
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International Journal of Research in Pharmaceutical and Biomedical Sciences
bringing the urine and blood sugar to their normal
levels, even in hereditary diabetic patients.

Emblica officinalis or Indian gooseberry
(Amla) is very beneficial for diabetic patients.
Prepare a fine powder of dry amala and put this
powder in water. Allow it to stand for some time.
Then filter the solution and mix some lemon juice
in it. Take this early in the morning. You can even
use extract of amla easily available in the market.

Syzygium cumini or Indian plum (Jamun),
is considered a panacea for diabetes. Eating this
fruit is very beneficial for patients of diabetes. In
fact, more than fruit, the seeds of jamun fruit is
beneficial when taken in powdered form mixed
with some water.
ISSN: 2229-3701
herbal extract of its leaves should be taken
preferably with a pinch of black pepper.

Garlic contains allicin that helps in
reducing sugar level in blood.

The leaves of Butea monosperma (Palas)
tree are very useful in diabetes. They reduce
blood sugar and are useful in glycosuria- the
presence of large amount of glucose inurine.

Tenner’s cassia (Tarwar) is an effective
remedy for diabetes. A decoction of the whole
plant or bubs is used to treat diabetes. The powder
of the herb, mixed with honey, is very effective.
Seeds can also be used in the similar manner as
flowers.

The holy fruit of India- the bel fruit or the
Aegle marmelos has anti-diabetic properties. The
Some marketed Antidiabetic Polyherbal Formulations93
Name
Company
Ingredients
Diabecon
Himalaya
Gymnema sylvestre, Pterocarpus marsupium, Glycyrrhiza glabra, Casearia esculenta, Syzygium
cumini, Asparagus racemosus, Boerhavia diffusa, Sphaeranthus indicus, Tinospora cordifolia,
Swertia chirata, Tribulus terrestris, Phyllanthus amarus, Gmelina arborea, Gossypium
herbaceum, Berberis aristata, Aloe vera, Triphala, Commiphora wightii, shilajeet, Momordica
charantia, Piper nigrum, Ocimum sanctum, Abutilon indicum, Curcuma longa, Rumex
maritimus.
Diasulin
Tobbest
Busindo
Cassia auriculata, Coccinia indica, Curcuma longa, Emblica officinalis, Gymnema sylvestre,
Momordica charantia, Scoparia dulcis, Syzygium cumini, Tinospora cordifolia, Trigonella
foenum graecum.
Bitter
gourd
Powder
Garry and Sun
natural remedies
Dia-care
Admark Herbals
Limited
Sanjeevan Mool; Himej, Jambu beej, Kadu, Namejav, Neem chal.
DiabetesDaily Care
Nature’s Health
Supply
Alpha Lipoic Acid, Cinnamon 4% Extract, Chromax, Vanadium, Fenugreek 50%
extract, Gymnema sylvestre 25% extract Momordica charantia 7% extract, Licorice Root
20% extract
Gurmar
powder
Garry and Sun
natural Remedies
Gymnema sylvestre
Epinsulin
Swastik
Formulations
Pterocarpus marsupium
Diabecure
Nature beaute
sante
Juglans regia, Berberis vulgaris, Erytherea centaurium, Millefolium, Taraxacum
Diabeta
Ayurvedic cure
Ayurvedic Herbal
Health Products
Gymnema sylvestre, Vinca rosea , Curcuma longa , Azadirachta indica , Pterocarpus
marsupium , Momordica charantia, Syzygium cumini , Acacia arabica , Tinospora cordifolia ,
Zingiber officinale
Syndrex
Plethico
Laboretaries
Germinated Fenugreek seed extract
Momordica charantia
CONCLUSION
Diabetes mellitus is the most common endocrine
disorder, affecting more than 300 million people
worldwide. For this, therapies developed along the
principles of western medicine (allopathic) are
Vol. 3 (2) Apr – Jun2012
often limited in efficacy, carry the risk of adverse
effects & are often too costly, especially for the
developing world. Therefore, treating diabetes
mellitus with plant derived compounds which are
accessible & do not require laborious
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717
International Journal of Research in Pharmaceutical and Biomedical Sciences
pharmaceutical synthesis seems highly attractive.
All the herbal drugs discussed in the review exhibit
significant clinical & pharmacological activity. The
potency of herbal drugs is significant & they have
negligible side effects than the synthetic anti
diabetic drugs. In this review article an attempt has
been made to focus on hypoglycemic plants &
maybe useful to the health professionals, scientists
and scholars working in the field of pharmacology
& therapeutics to develop evidence based
alternative medicine to cure different kinds of
diabetes in man & animals.
Isolation & identification of active constituents
from these plants,
preparation of standardized
dose & dosage regimen can play a significant role
in improving the hypoglycemic action.
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Halim Eshrat M., Hussain AliHYPOGLYCEMIC, HYPOLIPIDEMIC
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Vol. 3 (2) Apr – Jun2012
ISSN: 2229-3701
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