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 and diabetic patients

Category of a person	Fasting Value		Post Prandial
	Minimum Value	Maximum Value	Value 2 hours after consuming glucose
Normal	70	100	Less than 140
Early Diabetes	101	126	140 to 200
Established Diabetes	More than 126	-	More than 200

* All values are in mg/100ml

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 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 blood stream. 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).²

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 compounds-

a) Chiefly momordicin I and momordicin II, cucurbitacin B

b) Glycosides (momordin, charantin, charantosides, goyaglycosides)

c) Terpenoid compounds- momordicinin, momordicilin, momordol

d) Cytotoxic (ribosome inactivating) proteins such as momorcharin and momordin.³

Uses

Bitter melon is used as anti-diabetic. It contains lectin that has insulin like activity due to its non- protein specific linking together to insulin receptors. This lectin lowers blood glucose level by acting on peripheral tissues. Lectin is a major contributor to hypoglycemic effect.⁴

Scientific work done- Triterpenoids Isolated from Bitter Melon has showed antidiabetic

activity.⁵

Dosage form

It is used as fresh juice, tincture, juice extract and 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

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, and 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.⁶

Scientific work done Costus igneus has showed effect on hyperglycemia.⁷

Dosage Forms- It is used as oral hypoglycemic agent, or as i.v. injection

Dose- Tablet- 1 tablet/ day

Dandelion

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)⁸

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.⁹

Scientific work done

Dandelion has showed antihyperglycemic effect.¹⁰

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 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 and ursane type triterpinoids like sophoradiol, soyasapogenol b, and 9-sitosterol, Sophorediol, galactogil, galegine, peganine, hydroxygalegine, vasicinone, alkaloids like lutein, pentahydroxy flavone 5 glucoside, luteoline, galuteoline, luteoline 5 glucosides, flavonoids, saponines etc.¹¹

Uses

It has been known since the Middle Ages for relieving the symptoms of diabetes mellitus. Upon 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 was 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 ¹² 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)¹³ 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.¹⁴

Dosage form

It is used as herbal infusion, tincture and leaves.

Doses- Herbal infusion- twice daily, Tincture- thrice 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, a traditional Indian medicinal plant were found to possess anticomplementary and immunomodulatory activities.¹⁵

Use

It is used as antidiabetic¹⁶.

Scientific work done

Tinospora cordifolia has showed Anti-diabetic activity.¹⁷

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 and yellow coloured curcuminoids. The chief component of curcuminoids is known as curcumin. Volatile oil is composed of mono and sesquiterpens such as alpha and beta pinene, alpha- phellandrene, camphor, camphene, zingiberene, alpha and beta curcumenes.¹⁸

Use- It is used as anti- diabetic drug.¹⁹

Scientific works done

1. Turmeric has showed hypoglycemic, hypolipidemic and antioxidant activity²⁰

2. Turmeric has shown effect in diabetes.²¹

Dosage form

Powdered form of turmeric is used.

Dose

Powdered turmeric- 500-8000 mg/ day.

GURMAR

Biological source

It is obtained from leaves and 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 present²².

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.²³

Scientific works done

1. Gymnema sylvestre has shown Enzyme changes and glucose utilization.²⁴

2. Gymnema sylvestre has showed effect in controlling blood glucose level.²⁵

Dosage forms

It is used as water soluble acidic solution and 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 and tannins. The pulp also contains good amount of vitamin A and C. Two alkaloids, Omethylhalfordinol and isopentylhalfordinol has been isolated from fruits.²⁶

Use

It is used as anti-diabetic drug.²⁷

Scientific work done

Leaf and callus extract of Aegle marmelos has shown antidiabetic activity. ²⁸

Dosage forms

It is used as aqueous decoction and 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 and calcium. It contains pectin and 75% moisture²⁹.

Use- It is used as anti-diabetic³⁰.

Scientific work done

Emblica officinalis has shown Anti-diabetic activity in animal models. ³¹

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.

Chemical constituents

The nicotinic acid, alkaloid trogonelline, and coumarin contained by defatted section of the seed of fenugreek prove to be the responsible active ingredient for its anti-diabetic properties. ³²

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.³³

Scientific works done-

Metabolic and molecular action of Trigonella foenum-graecum (fenugreek) and trace metals has been shown in experimental diabetic tissues.³⁴

2. Fenugreek Seed has shown the postprandial hypoglycemic activity³⁵

Dosage forms

The leaves and 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 follows-

1) 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 and

panaxatriol on decomposition.³⁶

Use

It is used as hypoglycemic agent.³⁷

Scientific works done

1. Use of Ginseng in diabetes.³⁸

2. Ginseng has shown hypoglycemic effect.³⁹

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

INDIAN KINO TREE

Biological source

It is obtained from the dried juice of the plant Pterocarpus marsupium and obtained by making vertical incisions to the stem bark and it belongs to the family Leguminaceae.

Chemical constituents

It contains about 70%- 80% of kinotannic acid, kino- red, k- pyrocatechin (catechol), resin and gallic acid. Kinotannic acid is glucosidal tannin, while kino- red is anhydride of kinoin. Kinoin is an insoluble phlobaphene and is produced by action of oxydase enzyme. It is darker in colour than kinotannic acid.

If the juice is boiled during drying, enzyme gets destroyed and thus insolubilisation and darkening is

prevented.⁴⁰

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.⁴¹

Scientific works done

1. Phenolics from Pterocarpus marsupium has shown antihyperglycemic activity.⁴²

2. Hypoglycaemic activity of Pterocarpus marsupium has been seen.⁴³

Dosage forms

The wood extracts and 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

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 and 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.⁴⁴

Use

t is used as antihyperglycemic agent.⁴⁵

Scientific works done

1. Effect of an antidiabetic extract of Catharanthus roseus has been seen.⁴⁶

2. The juice of fresh leaves of Catharanthus roseus has shown reduction blood glucose.⁴⁷

Dosage forms

It is used as tincture and infusion.

Doses

Tincture- 1-2 ml/ 3 times daily, Infusion- 2-3 cups daily.

NEEM

Biological source

It is obtained from the leaves of Azadirachta indica, belonging to the family Meliaceae.

Chemical constituents

It contains glycerides of saturated and unsaturated fatty acids. The main fatty acids are oleic (50%) and 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.⁴⁸

Use

It is used in diabetes.⁴⁹

Scientific work done

Azadirachta indica leaf extract has shown antihyperglycemic and antidyslipidemic activity.⁵⁰

Dosage form

Capsules are used.

Dose

Capsule- 1-2 capsules/ twice daily.

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 and mannitol. Cinnamon oil contains cinnamaldehyde, other terpenes like phellandrene, pinene, cymene, caryophyllene.⁵¹

Uses

Cinnamon is used in the treatment of type II diabetes mellitus and insulin resistance.⁵²

Scientific works done

1. Alcoholic Extract of Cinnamomum zeylanicum Leaves has shown antidiabetic Activity.⁵³

2. Cinnamon improves glucose and lipid of people⁵⁴

Dosage form

It is mostly used as powdered form.

Dose

Powder- ½ teaspoon daily

SAPTRANGI

Biological source

It is obtained from the stem, root and leaves of Salacia oblonga, belonging to the family Hippocrateaceae.

Chemical constituents

It contains 2 potent alpha- glycosidase inhibitors- salicinol, kotalanol, sesquiterpene (salasol A and B), triterpenes (salasones A-E, salaquinones A and B) ⁵⁵

Uses

It is used as anti-diabetic. It binds to intestinal enzymes alpha- glucosidases that break down carbohydrate into glucose in body⁵⁶

Scientific work done

Salacia oblonga has shown antidiabetic potential⁵⁷

Dosage form

Aqueous extract of the root bark is used.

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 and 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, and o and p- coumaric acids. Citric, abietic, oxalic and mialic acids are also present. It also contains several oligo- saccharides.⁵⁸

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.⁵⁹

Scientific work done

Clinical Hypoglycemic effect of Allium cepa (Red onion) has been seen.⁶⁰

Dosage forms

Raw and boiled onion extracts are used. APDS can also be administered orally.

Dose

APDS- 125 mg/ kg to fasting humans.

GARLIC

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 and 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.⁶¹

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.⁶²

Scientific work done

Anti-diabetic and hypolipidaemic properties of garlic has been seen.⁶³

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 3- methoxytyramine⁶⁴, candicine⁶⁵, hordinine⁶⁶, N- methyltyramine⁶⁷, tyramine⁶⁸ etc.

Use

It is used in the treatment of type II diabetes.

Scientific work done

Polysaccharides from Opuntia has shown antidiabetic effects. ⁶⁹

Dosage form

Boiled stems are used.

Dose-

Oiled stem- 100-500/ daily

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) ⁷⁰

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.⁷¹

Scientific works done

1. Vaccinium myrtillus has shown antidiabetic activity.⁷²

2. Vaccinium myrtillus has shown hypoglycaemic effect.⁷³

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-glucose⁷⁴ and penta- O -galloyl glucose are oxidatively coupled through galloyl groups to form more complex compounds such as casuarictin, pendunculagin, sanguin H-6⁷⁵ and lambertianin A⁷⁶, with as many as 15 galloyl groups coupled to 3 glucose units⁷⁷.

Common flavonoids have also been isolated from the leaves. Rutin was isolated⁷⁸, as were kaempferol, quercitin, quijaverin, and kaempferol- 3- O -â-D-glucuronopyranoside⁷⁹. Major leaf volatiles studied by GC-MS include the monoterpenes geraniol and linalool as well as 1- octane-3-ol and decanal⁸⁰. Phenolic acids common to the Rosaceae family have also been identified.⁸¹

Use

It is used as anti-diabetic.

Dosage form-

It is used as fruit powder.

Dose

Dried fruit powder- 20 mg/day.

Blond Psyllium (Blond Plantago)

Blond psyllium seed husk orally seems to significantly reduce postprandial serum glucose, insulin levels, serum total cholesterol, and low-density lipoprotein (LDL) cholesterol levels in patients with Type II diabetes and hypercholesterolemia. Blond psyllium seems to reduce postprandial blood glucose levels by about 14% to 20%, total cholesterol by about 9%, and LDL cholesterol by 13%. Blonde psyllium also seems to lower postprandial glucose levels in patients with Type I diabetes. Blond psyllium's maximum effect on the glucose levels occurs when psyllium is mixed and consumed with foods. Blond psyllium does not lower postprandial glucose in people who do not have diabetes.

Devil’s Claw

Devil's Claw is native to south and central Africa. Its medicinal value lies in its fleshy roots, which are sliced, chopped, or pulverized while fresh.

Some evidence shows that this herb might decrease blood glucose and have additive effects with medication used in diabetes.

Ginger (Zingiber officinale)

Preliminary research suggests ginger might increase insulin levels. Theoretically, it could have an additive effect with medication used to treat diabetes and cause hypoglycemia.

Glucomannan (Konnyaku root):

A member of the yam family, this herb is high in fiber and can help normalize blood sugar, relieve stress on the pancreas.

Holy Basil (Hot Basil)

Preliminary evidence suggests that holy leaf extract may decrease fasting (17.6%) and postprandial blood glucose in patients with Type II diabetes.

Jambolan (Syzygium cumini)

A close relative of the clove tree Syzygium aromaticum, Jambolan is native to east India and the Malay Peninsula, but has spread as far as China and Australia and is grown in the Caribbean.

Only the bark of the Jambolan has proven medicinal value, although the seeds are often used as well. In Asian medicine, it is used for diabetes, diarrhea, sore throat, and diseases of the spleen.

Kudzu

Kudzu is native to Japan and China, however it grows extremely well in the Southern United states. This vine, when left uncontrolled, will eventually grow over almost any fixed object or other vegetation.

Kudzu or its constituents might have hypoglycemic, hypocholesterolemic, and antioxidant activity.

Prickly Pear Cactus (Nopal)

There is some preliminary clinical evidence that prickly pear cactus used orally can decrease blood glucose levels in patients with Type II diabetes. Single doses can decrease blood glucose levels by 17% to 46% in some patients. However, it is not known if extended daily use can consistently lower blood glucose levels and decrease HbA1c levels. Only the broiled stems of the specific species Opuntia streptacantha seem to be beneficial and raw or crude stems do not seem to decrease glucose levels. Other prickly pear cactus species do not seem to significantly lower blood glucose levels.

Red Sandalwood (Pterocarpus marsupium)

Like Gymnema Sylvestre, this is a traditional herb used in India to help rejuvenate the insulin-producing pancreatic beta cells. One group of researchers investigating diabetic rats compared Pterocarpus' observed effects on blood glucose levels to those of metformin, a drug familiar to many diabetics.

Stevia (Sweet Herb)

Stevia is a non-caloric herb, native to Paraguay, which has been used as a sweetener and flavor enhancer for centuries. Clinical research suggests that stevioside, a constituent of Stevia, might reduce postprandial glucose levels by 18% in people with Type II diabetes.

Herbal Home Remedies for Diabetes⁸²

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 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.

· The holy fruit of India- the bel fruit or the Aegle marmelos has anti-diabetic properties. The 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.

Medicinal plants with antidiabetic and their reported effect on experimental models

Botanical Name	Family	Antidiabetic and other beneficial effects	References
Achiliea santolina L.	Asteraceae	Hypoglycemic, antioxidant	109
Artemisia patterns	Asteraceae	Hypoglycemic, increases peripheral glucose utilization	110
Areca catechu L.	Arecaceae	Hypoglycemic	111
Beta vulgaris L.	Chenopodiaceae	Increases glucose tolerance in OGTT	112
Boerhaavia diffusa L.	Nyctaginaceae	Decreases blood glucose level and increases plasma insulin levels, antioxidant	113
Bombax ceiba L.	Malvaceae	Hypoglycemic	114
Butea manosperma (Lam)	Caesalpinaceae	Anti-hyperglycemic	115
Carum carvi L.	Apiaceae	Potent anti-hyperglycemic	116
Cogniauxia podoleana Baillon	Cucurbitaceae	Hypoglycemic and anti-hyperglycemic	117
Commelina communis L.	Conimelinaceae	Anti-hyperglycemic, management of non-insulin-dependent diabetes.	118
Croton cajucara Benth	Euphorbiaceae	Anti-hyperglycemic	119,120
Curcuma longa L.	Zingiberaceae	Hypoglycemic, plays a role in PPAR-gamma activation	121
Cynodon dactylon Pers	Poaceae	Anti-hyperglycemic	122
Enicostemma littorale Blume	Gentianaceae	Decreases plasma glucose level, glycosylated haemoglobin and glucose-6-phosphatase activity in liver	123
Eriobotrya japonica Lindl.	Rosaceae	Hypoglycemic	124
Gentiana olivieri L.	Gentianaceae	Hypoglycemic, anti-hyperlipidemic	125
Ginkgo biloba L.	Ginkgoaceae	Hypoglycemic, increases pancreatic beta-cell in NIDDM	126,127
Globularia alypum L.	Globulariaceae	Hypoglycemic, increases plasma insulin levels	128
Glycyrrhiza uralensis Fish.	Papilionaceae	PPAR-gamma ligand-binding activity, decreases the blood glucose levels	129
Gymnema nwntanum Hook	Asclepiadaceae	Anti-peroxidative, antioxidant, may prevent the cholinergic neural and retinal complications of hyperglycemia in diabetes	130
Gymnema sylvestre R. Br.	Asclepiadaceae	Hypoglycemic. Hypolipidemic	131
Hintonia standleyana	Rubiaceae	Anti-hyperglycemic	132
Ibervillea sonorae S.	Cucurbitaceae	Acute and chronic hypoglycemic	133
Ipomoea aquatic Forsk.	Convolvulaceae	Decreases serum glucose concentration by 29.4% in Type II diabetic patients. hypoglycemic	134
Kalopanax pictus Thumb.	Araliaceae	Anti-diabetic activity, hypocholesterolmic and hypolipidemic	135
Lagerstroemia speciosa L.	Lythraceae	Insulin-like actions, glucose uptake, anti-adipogenesis	136,137
Medicago saliva L.	Fabaceae	Anti-hyperglycemic, insulin-releasing and insulin-like activity	138
Morus alba L.	Moraceae	Protects pancreatic beta cells from degeneration anddiminishes lipid peroxidation	139
Morus indica. L.	Moraceae	Hypoglycemic	140,141
Morus inignis L.	Moraceae	Hypoglycemic	142
Murraya koenigii L.	Rutaceae	Hypoglycemic, increases glycogenesis,decreases gluconeogenesis and glycogenolysis	143
Nelumbo nucifera L.	Neluntbonaceae	Improves glucose tolerance and potentiates the action of exogenouslyinjected insulin	144
Nigella saliva Gaertn.	Ranunculaceae	Decreases oxidative stress and preserves pancreatic beta-cell integrity.	145
Ocimum gratissinuim L. Var.	Lamiaceae	Hypoglycemic	146
Pandanus odorus Ridl.	Pandanaceae	Hypoglycemic, increases serum insulin levels and liver glycogen	147
Parmentieru edulis A.DC	Bignoniaceae	Hypoglycemic	148
Phyllanthus sellowianus Mull.Arg.	Euphorbiaceae	Hypoglycemic	149
Psacalium decompositum (Gray) H.	Asteraceae	Hypoglycemic	150
Psacalium peltatum (Kunth)	Asteraceae	Anti-hyperglycemic	151
Punica granatum L.	Punicaceae	Improves postprandial hyperglycemia in type 2 diabetes and obesity by inhibiting intestinal alpha-glucosidase activity	152
Solaria oblonga	Celastraceae	Hypoglycemic and possess anti-oxidant activity	153
Sambucus nigra L.	Adoxaceae	Insulin-releasing and insulin-like activity	154
Sanguis draxonis	Apocynaceae	Increase insulin sensitivity and improve the development of insulin resistance in rats	155
Sclerocarya birea (A.Rich)	Anacardiaceae	Hypoglycemic	156
Scoparia dulcis L.	Scrophariaceae	Hypoglycemic, antihyperlipidemic, antidiabetic	157,158
Swertia chirayita (Roxb)	Gentianaceae	Stimulates insulin release from islets	159
Syzygium alternifolium (Wt) Walp.	Myrtaceae	Hypoglycemic, antihyperglycemic and antihyperlipidemic	160,161
Terminalia bellirica (Gaertn)	Combretaceae	Stimulates insulin secretion. Enhances insulin action andinhibits both protein glycation and starch digestion	162
Terminalia chebula Retz.	Combretaceae	Dose-dependent glucose lowering effect, antidiabetic and renoprotective, decreases hepatic and skeletal muscle glycogen content, increases insulin release from the pancreatic islets	163,164
Teucriumpolium	Lamiaceae	Increases insulin release, antioxidant and hypoglycemic	165
Tinospora cordifolia Miers..	Menispermaceae	Hypoglycemic	166
Tinospora crispa (L) Hook.	Menispermaceae	Anti-hyperglycemic, stimulates insulin release from islets	167
Urtica dioica L.	Urticaceae	Anti-hyperglycemic	168
Urtica pilulifera L.	Urticaceae	Hypoglycemic	169
Vinca rosea L.	Apocynaceae	Anti-hyperglycemic	170
Withania soimifera (L) Dunal	Solanaceae	Hypoglycemic, antioxidant, diuretic and hypocholesterolemic	171,172
Withania coagulans Dunal	Solanaceae	Anti-hyperglycemic, anti-hyperlipidemic and hypoglycemic	173,174
Zizyphus sativa Gaertn	Rhamnaceae	Hypoglycemic	175
Zizyphus spina-christi L.	Rhamnaceae	Insulinotropic, hypoglycemic anddepressant effect on the central nervous system	176
Zygophyllum gaetulum Emb	Zygophyllaceae	Hypoglycemic, increases plasma insulin levels	177

Traditional phytotherapies

1. Antidiabetic Extracts

a. Adhatoda vasica Nees:

Extract obtained from the fresh leaves of plant mixed with water. About 10 ml of extract is used thrice a day to treat sugar.

b. Aloe vera Nill + Fagonia indica L. + Tylophora hirsuta L.:

Equal quantity of extract obtained from the fresh aerial parts of Fagonia indica, fresh leaves and stem of Aloe vera and fresh branches of Tylophora hirsuta L. Then these three extracts are mixed and used small teaspoon thrice a day. According to the rural inhabitants of the area this formula is very old and 100% effective to lower the blood glucose level of diabetics.

c. Ficus bengalensis L.:

The latex obtained from the aerial parts of the plant (leaves and young branches) and mixed with honey and used orally to control high blood glucose level.

d. Psidium guajava L.:

Hot water extract made from the dried leaves of plant is used to reduce blood glucose level of diabetics. This hot tea was very common among the local people of the area.

e. Momordica charantia L.:

The juice of fresh fruits, used, one small cup daily. This juice exhibits an antidiabetic property.

f. Cajanus cajan and Vigna mungo (Burm. f.) Walp:

The pulse obtained from the seeds of these plants is cooked and is recommended to diabetics.

g. Allium cepa L.:

The juice obtained from the underground bulb is used, one tea spoon thrice a day. This is given for the control of blood sugar and high blood pressure amongst the diabetics.

h. Caralluma edulis (L.) Benth ex Hook. f.:

The aerial parts are cooked as vegetables by the local people for diabetes mellitus.

2. Antidiabetic leaves

a. Zizyphus jujuba Mill:

4-5 fresh leaves are chewed daily to lower blood glucose level.

b. Dodonaea viscosa (L.) Jacq:

2-3 Fresh leaves of the plant are masticated twice a day with glass of water.

3. Antidiabetic powder (Safoof)

a. Ocimum sanctum L. + Ocimum album L.:

Leaves of these plant species are dried under shade, then ground to make powder (Safoof). One gm power is given with water twice a day for prophylactic and the treatment of diabetes.

b. Momordica charantia L.:

The fruits of the plant are dried under shade, then ground to obtain powder. One table spoon is administered twice a day to lower blood glucose level.

c. Syzygium cumini Skeels:

Seeds of the plant are dried under shade, then ground to make powder About 25 gm powder is used thrice a day with water. This decreases blood glucose level very significantly.

d. Kickxia ramosissima (Wall) Janchen:

The whole plant is dried under shade and is ground to make powder. This powder is prescribed for treatment of diabetes by the inhabitants of the study area.

e. Cichorium intybus L.:

The roots are dried under shade and then ground to obtain powder. About 15 gm of this powder is taken with glass of water twice a day before meal to lower blood glucose level.

f. Melia azedarach L.: The dried fruits of the plant are ground to make powder. About half small teaspoon is given with glass of water before breakfast daily for a month. It is claimed by the inhabitants that it is an effective therapy for the treatment of diabetes.

g. Hordeum vulgare L. + Cicer arietinum L. + Elettaria cardamomum Maton:

Seeds of Hordeum vulgare 125 gram are roasted and mixed with each of 50 gm of Cicer arietinum and Elettaria cardamomum and used @ half teaspoon with water thrice a day to control blood glucose level.

4. Antidiabetic bread:

Equal quantity of Cicer arietinum (Seeds), Daucus carrota ((Dried form), Hordeum vulgare (Seeds), Oryza sativa (Seeds), Triticum aestivum (Seeds) and Zea mays (yellow variety) are ground and made into powder. The bread is cooked from this mixed flour and taken as breakfast with fresh butter of cow for 2-month. This remedy is used as dietary supplement to control diabetes.

5. Antidiabetic seeds

a. Trigonella foenum-graecum L.:

Twenty five gm seeds are given daily for 21 days with water. The inhabtants claimed that it is one of the effective treatments to reduce blood glucose in diabetic patients.

b. Withania coagulens (L.) Dunal.

Fifteen gm seeds of the plant are soaked in water for the whole night. This is given early morning before breakfast to diabetic patients.

6. Antidiabetic Potherbs/Vegetables

a. Solanum nigrum L.:

Fresh aerial parts of the plant are cooked as vegetable and are recommended to control diabetes.

b. Taraxicum officinale Weber:

Fresh leaves are cooked as vegetable (locally-called Saag).

c. Cajanus cajan and Vigna mungo (Burm. F.) Walp.:

The pulses obtained from the seeds of these plants are cooked and is recommended to diabetic patients.

d. Allium sativum L.:

The under ground bulb is cooked or uncooked is used for diabetes and hypertension amongst diabetics.

e. Caralluma edulis (L.) Bth. ex Hk. F.:

The aerial parts are cooked as vegetables by local people for diabetes mellitus.

7. Antidiabetic fruits

a. Vigna sinensis (L.) Savi ex Hassk: The immature pods of the plant are used to reduce blood glucose level.

b. Syzygium cuminii Skeels: The fresh fruits are used for diabetes.

c. Olea ferruginea Royle: Fruit fresh in summer season are collected, dried and recommended to diabetics in winter season for reducing blood glucose level.

8. Antidiabetic herbal mixtures

a. The seeds in 25 gm of Syzygium cumini, Momordica charantia, 12 gm of Cyperus rotundus and Rosa alba are made into powder. This compound is given successfully for lowering blood glucose by the inhabitants of an area.

b. The equal quantity of Tylophlra hirsuta (leaves), Trigonella foenum-graecum (seeds) and aerial parts of Fumaria indica is ground and made into powder. This mixture is claimed a significant therapy to reduce blood sugar of diabetic patients.

Clinical research of CAM supplements in diabetes

Currently, there is not yet sufficient evaluation of herbs, vitamins, and mineral supplements for glucose control in diabetes. Aside from relatively poor study methodological quality, this area of supplement research has been fraught with several complications. First, the multiple constituent nature of botanical products has made standardization a challenging task. Proponents of herbal remedies caution that in standardizing to one constituent, resulting extracts may have lost a proportion of benefit as compared with the whole plant ¹⁷⁸. Precise considerations of purity, chemical composition, and potency of derivatives may be grossly influenced by the age of the plant (especially of roots), the source location, the season of harvest, the method of drying and crude preparation, etc. In the literature we examined, several herb studies used “homemade” or otherwise unspecified preparations. Although individual companies have begun to standardize supplements, there is a general lack of consistency across the market. With vitamin and mineral supplements, these issues are less relevant. In addition, the development of proper supplement regulation and safety codes has been slow. Currently, all dietary supplements (including herbal products) are regulated under the Dietary Supplement Health and Education Act of 1994 (DSHEA), which specifically differentiates supplements from drugs. Consequently, DSHEA does not require the extensive premarket approval that the Food and Drug Adminstration requires for a prescription drug, and although it calls for “good manufacturing practices [GMP],” the burden of proof that a supplement is unsafe lies with the government, leaving manufacturers to operate unchecked. This has contributed to scepticism among clinicians, and makes it especially difficult for physicians to responsibly recommend supplements to patients. In the absence of external regulation, the industry has taken steps to police itself. For example, the National Nutritional Foods Association (NNFA), representing about one-third to one-half of retailers and manufacturers of natural products in the U.S., has encouraged the adoption of strict, self-imposed GMP standards, as well as initiatives such as the TruLabel program (in which products are subjected to random laboratory testing by independent third-party auditors to verify contents) ¹⁷⁹. Research of vitamin and mineral supplements has also been hindered by a lack of accurate and meaningful assays that detect functional micronutrient deficiencies. In the case of chromium, for example, it is postulated that supplementation of targeted individuals might be more beneficial. Some speculate that positive results seen in large studies in diabetic patients in China may be due to the population’s relative chromium deficiency. However, without reliable assays, these theories have remained difficult to test ¹⁸⁰. Finally, the existing literature in this area includes a considerable amount of study population heterogeneity. Future research may need to more precisely define targeted diabetic populations with regard to disease classification, severity, optimal adjunctive interventions, and perhaps nutrient deficiencies. It will also be important to further elucidate mechanisms of action so that applicability to type 1 or type 2 diabetes can be clarified.

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 often limited in efficacy, carry the risk of adverse effects and are often too costly, especially for the developing world. Therefore, treating diabetes mellitus with plant derived compounds which are accessible and do not require laborious pharmaceutical synthesis seems highly attractive. All the herbal drugs discussed in the review exhibit significant clinical and pharmacological activity. The potency of herbal drugs is significant and 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 and maybe useful to the health professionals, scientists and scholars working in the field of pharmacology and therapeutics to develop evidence based alternative medicine to cure different kinds of diabetes in man and animals.

Isolation and identification of active constituents from these plants, preparation of standardized dose and dosage regimen can play a significant role in improving the hypoglycemic action.

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Received on 17.06.2014 Accepted on 30.07.2014

Asian J. Pharm. Res. 4(3): July-Sept. 2014; Page 135-154

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	Momordica charantia
Dia-care	Admark Herbals Limited	Sanjeevan Mool; Himej, Jambu beej, Kadu, Namejav, Neem chal.
Diabetes- Daily 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 santé	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

*Corresponding Author E-mail: venkipharma75@gmail.com