Management of Diabetes and Complication: Herbal Therapies  

Triveni Kanwar, Amit Roy, Pushpa Prasad*

Columbia Institute of Pharmacy, Tekari, Raipur, Chhattisgarh – 493111, India

Received: 10-Apr-2017 , Accepted: 25-Oct-2017

Keywords: Diabetes Mellitus, Etiology, Insulin, Symptoms


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Diabetes mellitus is a universal metabolic disease characterized by means of hyperglycemia, hyperlipidemia, hyper aminoacidemia and hypoinsulinaemia. It leads to diminish in insulin, secretion and insulin action. Insulin is natural hormone secreted commencing the βâ€Â cells of pancreas which help out the cells to uptake glucose molecules from the blood flow. Diabetes mellitus is a chronic autoimmune disease related by selective damage of insulin-producing pancreatic β-cells. There are lots of multiple agents obtainable to control and to care for diabetic patients, although total recovery from diabetes has not been reported up to this time. Alternative in the direction of these synthetic agents, plants and nutrients supply a potential source of hypoglycemic drugs and are extensively used in some traditional systems of medicine toward prevent diabetes. Conventional systems of medicines with the perspectives of protection, efficiency, and quality will controls.

1 Introduction 

Diabetes mellitus is a systemic metabolic disease characterize by hyperglycemia (increase glucose level), hyperlipidemia (increase lipid level), hyper aminoacidemia, and hypoinsulinaemia (decrease insulin level) it leads to reduce in insulin, release and insulin action1. human  body do not produce or accurately us insulin, a hormone toward is required to exchange sugar, starches, and supplementary food interested in energy. Diabetes mellitus is characterized in continuous high levels of blood glucose (sugar). Human bodies have to maintain the blood glucose levels lying on a extremely narrow range which is done with insulin and glucagon. The purpose of glucagon is causing the liver to discharge glucose seeing as its cells into the blood for the making of energy2.Chronic hyperglycemia is associated through long-standing damage, dysfunction, and failure of dissimilar organs, especially eyes, kidneys, nerves, heart, and blood vessels3. It is estimated to facilitate in the year 2010 more than 200 million public worldwide will consist of DM and 300 million people will after have the disease in 20254,5.

2 Etiology/Contributing factors

Type 1 Diabetes

  1. Cause during the immune destruction of the beta cells of the pancreas.
  2. Antibodies to islets cells and insulin are present on diagnosis.
  3. Insulin secretion infrequently diminishes.
  4. May nearby every age, but most common in early days and adolescence.
  5. Insulin by injection is compulsory meant for survival

Contributing factors

  1. Genetic predisposition
  2. Environmental triggers (infection or else additional stress)

Type 2 Diabetes

  1. Caused during insulin resistance in the liver and skeletal muscle, greater earlier than glucose production in the liver, over production of free fatty acids by fatty cells and relative insulin paucity.
  2. Insulin secretion decrease through gradual beta cell failure.
  3. Reductions in blood glucose levels frequently care for achieved through changes in food eating and physical activity patterns. Oral medication and/or insulin injections are ultimately required.

 Contributing factors

  1. Fatness
  2. Age (onset of puberty is allied through increased insulin resistance).
  3. Not comprise of physical activity.
  4. Genetic predisposition.
  5. National/ethnic background (African American, Native American, Hispanic and Asian/Pacific Islander).
  6. Conditions associated through insulin resistance, (e.g., polycystic ovary syndrome6,7.

3 Types of mellitus (DM)

  1. TYPES 1 DIABETES:(insulinâ€Âdependent diabetes mellitus, IDDM or immuneâ€Âmediated or juvenileâ€Âonset diabetes): It is because by an autoâ€Âimmune reaction universally the body’s defense system destroys the insulinâ€Âproducing βâ€Âcells.Community with type 1 diabetes turn out very little or no insulin. The disease repeatedly occurs in children or young adults. Patients totally depend on the exogenous insulin to control the levels of glucose in their blood. Genetic factors be thought to go on the main reason of it7.
  2. TYPE 2 DIABETES: (nonâ€Âinsulin dependent diabetes mellitus, NIDDM or adultâ€Âonset diabetes): It accounts designed for at least 90% of all cases of diabetes. It is characterized by insulin resistance and relative insulin deficit. This occurs mainly appropriate to loss of functional βâ€Âcells. Type 2 diabetes is associated by means of very serious life cease complications8.
  3. GESTATIONAL DIABETES (GDM): An appearance of diabetes consisting of high blood glucose levels throughout pregnancy. It develops in 2â€Â4% of pregnancies generally in 2nd or 3rd trimester9.
  4. PREDIABETS: This is body`s declaration of warning sign to make some health change. Preâ€Âdiabetes is diagnosed following the level of glucose in the blood is higher than the normal limits but not quite high enough to diagnose as Typeâ€Â2 diabetes10  (Table:1).

4 Insulin  

Insulin plays an important role for the storage of excess energy in the body, Insulin is a natural hormone buried as of the βâ€Â cells of pancreas which helps the cells to uptake glucose molecules commencing the blood flow. Hence deficiency of insulin results in the breakdown of glucose utilization by the cells and leading to its increased concentration in blood12.

Mechanisms of insulin

Coupled to several additional protein kinase signal

1. Pathways signaling all the draw near during PI 3-kinase and phosphatidylinositol (3,4,5)P3 (PI-3 kinase and protein kinase B/Akt).

2. Mitogen-activated protein kinases (MAPKinases).

NB: Both group 1and 2 signals furthermore activate protein kinase Cγ and Protein kinase Cζ.

3. Possible interaction by kinases not coupled to IRS proteins13.

It have been suggested that the  majority dominant is the first group (PI 3-kinase) which converts phosphatidylinositol 3,4 bisphosphate (PIP2) or [PI(3,4)P2] to phosphatidylinositol 3,4,5 triphosphate PIP3 or (PI 3,4,5)P3. These nucleotides act on the same time as anchors, binding down-line protein kinases to the plasma membrane and activating them. Insulin binds the first alpha subunits and lead to auto phos­phorilation of beta subunits which extending cyto­plasm by have bonds of two subunits, and induces converting active protein kinase14, 15.

Symptom of diabetes

  1.      being especially thirsty
  2.      urinating often
  3.      feeling extremely hungry
  4.      feeling very tired
  5.      losing weight underprovided trying
  6.      sores that heal slowly
  7.      dry, itchy skin
  8.      Approach of pins and needles in your feet
  9.      losing feeling in your feet
  10.    blurry eyesight16, 17.


Diabetes as the two major causes of diabetes seem to be diet and exercise.

  1. Obesity/overweight (especially overload visceral adiposity)
  2. Excess glucorticoids (Cushing’s disorder or steroid treatment)
  3. Excess augmentation hormone (acromegaly)
  4. Lipodystrophy (acquired or genetic, associated with lipid accumulation in liver)
  5. Auto antibodies to the insulin receptor
  6. Mutations of insulin receptor
  7. Mutations that cause genetic obesity (e.g., melanocortin receptor mutations)
  8. Hemochromatosis (a hereditary disease that cause tissue iron accumulation)18, 19.

5 Pathogenesis of type 1 Diabetes

Type 1 diabetes mellitus is a chronic autoimmune disease linked through selective destruction of insulin-producing pancreatic β-cells. The onset of clinical infection represents the end stage of β-cell destruction primary to type 1 diabetes mellitus20 (Fig 1).

1. Presence of immuno-competent and accessory cells in infiltrated pancreatic islet;

2. Association of susceptibility to disease with the class II (immune response) genes of the most important histocompatibility complex (MHC; human leucocyte antigens HLA);

3. Presence of atoll cell specific auto antibodies;

4. Alterations of T cell mediated immune regulation, in exacting in CD4+ T cell compartment;

5. The attachment of monokines and TH1 cells producing interleukins in the illness process;

6. Response to immunotherapy

7. Frequent occurrence of other organ specific auto- immune diseases in affected individuals or in their relatives members21, 22.

6 Pathogenesis  of  type 2 diabetes

In type 2 diabetes these mechanisms break down, among the consequence that the two most important pathological defects in type 2 diabetes are impaired insulin secretion throughout a dysfunction of the pancreatic β-cell, and impaired insulin action during insulin resistance23.

 i) Folks through normal glucose tolerance.

ii) Chemical diabetes (called impaired glucose tolerance).

iii) Diabetes through minimal fasting hyperglycemia (fasting plasma glucose a smaller amount than 140 mg/dl).

iv) Diabetes mellitus in association through overt fasting hyperglycemia (fasting plasma glucose greater than 140 mg/dl)24.

7 Complications in diabetes

The most important reason for this is because diabetes causes problems with the nerves as well as problems with the flow of blood during the blood vessels that supply energy for each organ. These two problems affect each organ in the human body25.So, when the blood glucose levels are not maintain because of unsuccessful or poor selfâ€Âcare, this can trigger the problems with blood vessels and nerves.

Diabetes is related with many complications similar to micro vascular (retinopathy, neuropathy and nephropathy), macro vascular (stokes, peripheral vascular diseases and coronary heart disease)and supplementary large blood vessel diseases similar to atherosclerosis26.

8 Diagnosis of disease

The blood glucose levels of a strong man are 80mg/dl on fastingand uptown 160mg/dl in the post prandial state. Diabetes mellitus ischaracterized by recurrent or persistent hyperglycemia and able to bediagnosed by any one of the subsequent tests:

  1. A fasting plasma glucose (FPG) test:  events blood glucose in a person who has not eat everything for at least 8 hours. (>162 mg/dL).
  2. An oral glucose tolerance test (OGTT): measures blood glucose subsequent to a person fasts at smallest amount 8 hours and 2 hours after the person takes 75g oral glucose load(>200mg/dL).
  3. A casual plasma glucose test: also called the person individual tested last (200>mg/dL).
  4. Impaired Glucose Tolerance (IGT): To replace this grouping of intermediate hyperglycemia by an generally risk assessment for diabetes, cardiovascular disease, or both, which include a measure of glucose as a uninterrupted variable27-28.

9 Diabetes care and medication

Diabetes is not completely curable it wants a being timecommitment to do what is necessary to manage diabetes. Throughproper management it can be controlled to a greater amount. This entire factor is organized. And in the casing of Typeâ€Â2 diabetes29,It can be totally controlled in various cases with diet and exercise. Daily monitoring of blood glucose level through a glucometer.

  1. Insulin injections and additional medications to be taken as directed.
  2. Organization of diet and weight control.
  3. Managing a everyday exercise plan.
  4. Daily monitoring and organization of skin and foot think about.
  5. Every day oral hygiene.
  6. Regular visit to the eye doctor as glowing as the dentist.
  7. Regular remedial for blood pressure etc.

10 Diabetes know how to be managed with different types of medications

  1. Exogenous insulin.
  2. Oral hypoglycaemic mediator.
  3. Alternative medicines resembling herbal treatment, Yoga, Unani medicines etc30, 31.

11 Mechanism of Action of Herbal Antidiabetic

  1. The ant-diabetic activity of herbs depends upon diversity of mechanisms. The mechanism of action of herbal anti-diabetic may be.
  2. α –amylase inhibition.
  3. Inhibition in renal glucose reabsorption.
  4. Stimulation of insulin secretion beginning beta cells of islets or/with
  5. inhibition of insulin derivative process.
  6. Cortisol lowering actions.
  7. Insulin resistance reduction. Providing assured necessary fundamentals like calcium, zinc, magnesium, manganese and copper intended for the β -cells.
  8. Regenerating and/before repairing pancreatic β cells.
  9. Increasing the amount and numeral of cells in the atoll of Langerhans.
  10. Stimulation of insulin emission.
  11. Stimulation of glycogenesis amid hepatic glycolysis.
  12. Inhibition of β -galactocidase among α–glucocidase.
  13. Protective consequence on the destruction of the β cells.
  14. Improvement in digestion alongside with reduction in blood sugar and urea.
  15. Prevention of pathological alteration of starch to glucose31, 33 (Table 2 and Table 3).


12 Conclusion

Herbal therapies used for diabetes have been followed allover the World effectively. Herbs are used to manage Type I and Type II diabetes and their complications. The potency of herbal drugs is considerable & they include negligible side effects than the synthetic ant-diabetic drugs. So it was concluded to facilitate these herbal formulation is supportive to lower glucose level during treatment of diabetes patients. Thus lots of different plants contain be used individually or in formulations used for treatment of diabetes.

13 Conflict of interests

The author declared none

14 Author’s contributions

TK and PP carried out literature review and draft the manuscript. AR participated in collection of data. All authors read and approved the final manuscript.

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