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     Journal of Herbal Medicine and Toxicology 2 (1) 45-50 (2008)
     ISSN : 0973-4643                                                                                   Review Article


                         K.A. Wadkar*, C.S Magdum, S.S.Patil and N.S.Naikwade
                    Appasaheb Birnale College of pharmacy, South shivaji nagar, Sangli, Maharashtra
                          Received : 08 November, 2007;            Accepted : 20 December, 2007
              Abstract : The present article gives a general idea of diabetic mellitus, its treatment by
              using insulin, oral hypoglycaemic drugs and herbal drugs. Despite considerable
              progress in the treatment of diabetes by oral hypoglycaemic agents, search for newer
              drugs continues because the existing synthetic drugs have several limitations .The
              herbal drugs with antidiabetic activity are yet to be commercially formulated as modern
              medicines, even though they have been acclaimed for their therapeutic properties in
              the traditional systems of medicine.
               Keywords: Anti-diabetic activity, Herbal Drugs, Oral hypoglycaemic agents,
                         Active chemical constituents.

     Diabetes mellitus is a clinical syndrome characterized        Diabetes is a chronic disease affecting around 2-3 %
     by inappropriate hyperglycemia caused by a relative           of the population worldwide. Unfortunately, after the
     or absolute deficiency of insulin or by a resistance to       introduction of sulfonylurea and metformin about 50
     the action of insulin at the cellular level. It is the most   years back no major lead has been obtained in this
     common endocrine disorder, affecting 16 million               direction of finding a proper drug for diabetes. Plant
     individuals in the United States and as many as 200           materials which are being used as traditional medicine
     million worldwide. Diabetes has been a clinical model         for the treatment of diabetes are considered one of
     for general medicine. The primary defect in fuel              the good sources for a new drug or a lead to make a
     metabolism results in widespread, multi-organ                 new drug. Plant extract or different folk plant
     complications that ultimately encompass virtually every       preparations are being prescribed by the traditional
     system of the body and every specialty of medicine.           practioners and also accepted by the users for
     It has been said that to know diabetes is to know             diabetes like for any other diseases in many countries
     medicine and health care. Although from a clinical            especially in third world countries. Now-a days more
     standpoint this may be true, our increasing knowledge         than 400 plants are being used in different forms for
     of the pathophysiology of the syndrome, together with         hypoglycaemic effects all the claims practitioners or
     the mechanisms of long- term complications, has               users are neither baseless nor absolutely. Therefore,
     placed diabetes research at the frontier of immunology        a proper scientific evaluation a screening of plant by
     and molecular biology. 1                                      pharmacological tests followed by chemical
     Diabetes mellitus has been known since ages and the           investigations is necessary.
     sweetness of diabetic urine has been mentioned in             Some plants having hypoglycemic activity as
     Ayurveda by Sushruta. Its pharmacotherapy however             studied by Nahar3 (Table no-1)
     is over 80 years old. The word diabetes was coined by
     the Greek physician Aeretaeus in the first centuryA.D.        Diabetes mellitus is wide spread disorder, which has
     In the 17th century, Willis observed that the urine of        long been in the history of medicine .Before the advent
     diabetics as wonderfully sweet as if imbued with honey        of insulin and oral hypoglycaemic drugs the major form
     or sugar. The presence of sugar in the urine of diabetics     of treatment involved the use of the plants. But now
     was demonstrated by Dobson in 1755.2                          from the last two decades there has been a new trend

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     Journal of Herbal Medicine & Toxicology

       Table 1 : Some plants having hypoglycemic activity as studied by Nahar 3

        Plant                                         Plant Part                    Type of Test Sample
                                                      seed                          Alcohol ,water extract
        Trigonella foenum-gracecum
                                                      bulb                          juice
        Nephoelepsis tuberose
                                                      rhizome                       juice
        Costus specious
                                                      husk                          Powder
        Plantago ovata
                                                      bulb                          juice
        Allium sativum
                                                      root                          alcoholic extract
        Hemidesmus indicus
                                                      bulb                          juice
        Allium cepa

     in the preparation and marketing of herbal drugs.            cytoma, Cushing’s syndrome, glucagonoma).
     Further it has been estimated that in the U.S. 25% of
                                                                  Drugs or chemical induced reactions (eg:
     all prescription dispensed from community pharmacies
                                                                  glucocorticoids, anticancer agents, streptozotocin or
     contain plant extracts4.
                                                                  diazoxide, thiazide, some psychoactive agents).
     On the basis of etiology two main categories of
                                                                  Insulin receptor abnormalities.
     diabetes are recognized, viz.
                                                                  Certain genetic syndromes (Hyperlipidemea and
     Primary diabetes
                                                                  muscular dystrophy).
     Secondary diabetes
     (1) Primary diabetes                                         Diagnosis of early Diabetes Mellitus
     It is divided into two types.
                                                                  In moderately severe early diabetes, following
     Juvenile onset diabetes which is also referred as Type       features are present.
     1 or Insulin dependent diabetes mellitus(IDDM)
     In Juvenile onset diabetes there is a profound
     decrease in the number of b cells in the islet of
     Langerhans and thus there is absolute deficiency of          Loss of weight due to increased breakdown of fat
     insulin. The main treatment for this type is insulin.        and tissue protein.
     Maturity onset diabetes which is also referred as Type       Increased production of ketone bodies by liver and
     II / Non-insulin dependent diabetes mellitus (NIDDM)         their incomplete utilization by the tissue leading to their
                                                                  accumulation in blood (Ketosis) and elimination in
     The patients are usually obese and the treatment is
                                                                  urine (Ketonuria).
     usually dietary, though supplementary oral
     hypoglycaemic drugs. It is diagnosed by blood or             Lowering of PH of blood due to circulating keto acids
     urinary glucose measurement. Insulin resistances as          (acidosis).
     well as loss of insulin secretion contribute to the onset
                                                                  Dehydration due to elimination of large amounts of
     of disease.
                                                                  water with glucose in urine.
     2) Secondary Diabetes                                        Increased levels of lipid, fatty acids and cholesterol
     The symptoms result from the following                       in blood (lipemia).
                                                      Increased tendency to develop cataract in the eye
     Pancreatic dysfunction (pancreatitis, pancreatectomy).
                                                      and atheromatous and artherosclerotic lesions of blood
     Hormonal imbalance (eg : Acromegaly, pheochroma-
                                                      vessels 5.

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                                                                                                        Wadkar et. al.
     Glucose- tolerance test                                    in a person due to the functional disorder of the
     Currently the presence of abnormally high glucose          pancreas.
     levels in the blood is the only criterion on which
     diagnosis of diabetes mellitus is based.                   Oral Hypoglycaemic Drugs
                                                                         These drugs lower blood glucose level and
     A sensitive diagnostic criterion is provided by glucose-
                                                                are effective orally. The chief drawback of insulin is
     tolerance test. After a night without food, the patient
                                                                it must be given by injection. Hence, the search for
     drinks a test dose of 100g of glucose dissolved in a
                                                                orally active drugs was demanded.
     glass of water. The blood glucose concentration is
     measured before the test dose and at 30 min. intervals     Classification:
     for several hours thereafter. A normal individual
     assimilates glucose readily, the blood glucose rising      (1) Sulfonylureas:
     to no more than about 9 or 10mM; little or no glucose        First generation              Second generation
     appears in urine. Diabetic individuals assimilate the
     test dose of glucose poorly; their glucose level far       Tolbutamide                     Glibenclamide
     exceeds the kidney threshold (about 10 mM) causing         Chlorpropamide                  Glipizide
     glucose to appear in their urine.6
                                                                Acetohexamide                   Gliclazide
     The results of glucose analysis are plotted as a graph
     against time7. (Table no. 2)                               Tolazamide
                                                                (2) Biguanides
     Treatment of Diabetes Mellitus
     Insulin                                                         Phenformin

     Oral hypoglycaemic Drugs                                        Metformin

     Herbal Drugs.                                              (3) Miscellaneous

     Insulin                                                         (I) Acarbose

     Insulin is hormone secreted by the â cells of the islets        (II) Guar gum
     of langerhans in the pancreas. The diabetic mellitus       (I) Sulfonylureas : ( Mode of Action)
     has been well known as a wasting disease due to
     insulin deficiency in human beings. The pancrease                   Sulphonylureas activate receptors on the â
     secrete insulin. Carbohydrate metabolism is primarily      islet cells of the pancrease to release more stored
     under the control of insulin. Insulin deficiency occurs    insulin in response to glucose. They do not increase

       Table 2 : The main features of GIT curve in normal persons, prediabetic persons, mild diabetic,
       severe diabetes are as follows:
                                                                      Prediabetic        Mild                Severe
                                               Normal person
                                                                       persons          Diabetes            Diabetes
                                                                       105-110          115-125              150-160
        1. Fasting blood sugar                80-120 mg/100ml
                                                                       mg/100ml        mg/100ml             mg/100ml

        2. Blood sugar reaches its peak                                150-160          190-200              320-350
           to in 1 hr.                                                 mg/100ml        mg/100ml             mg/100ml.

                                               At the end of 2-       At the end of                         At the end
        3. Returns to the fasting level                                                     -
                                                   21/2 hr.               3 hrs.                             of 4hrs
                                                                                        1- 2 %              More than
        4. Urine                                  No glucose           No glucose
                                                                                        glucose               2%

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     Journal of Herbal Medicine & Toxicology

     insulin formation. They are ineffective in totally insulin    viscous gel on contact with water. Administered just
     deficient patients and for successful therapy probably        before or mixed with food, it slows gastric emptying,
     requires about 30% of normal â cells function subjects        intestinal transit and carbohydrate absorption.
     as well as diabetes.
                                                                   Guar gum can be used to supplement diet and to lower
     (II) Biguanides: (Mode of Action)                             sulfonylurea dose and as a hypocholesterolemic.
            They do not cause insulin release but                  Precautions with oral hypoglycaemic agent:
     presence of some insulin is essential for their action.
                                                                   Hypoglycemia occurs with sulphonylurea compounds
     Suppress hepatic gluconeogenesis and glucose output           but occurrences are much fewer than with insulin
     from liver, probably the major action                         therapy.
     Enhance binding of insulin to its receptors and               A biguanide should not be used in patient with renal
     stimulate insulin mediated glucose disposal.                  diseases.
     Interfere with mitochondrial respiratory chain- The associated disadvantages with insulin and oral
     promote peripheral glucose utilization by enhancing hypoglycemic agents have lead to stimulation in the
     anaerobic glycolysis.                                   research for locating natural resources showing anti
                                                             diabetic activity. Many studies have been carried out
     Inhibit intestinal absorption of glucose, other hexose,
                                                             in search of a suitable plant drug that would be
     amino acids and vit.B12.
                                                             effective in Diabetes mellitus. Herbal remedies for
     III) Miscellaneous                                      diabetes have been recorded in ancient medical
                                                             literature. Plants hold definite promises in the
     (i) Acarbose: It is complex oligosaccharide which management of diabetes mellitus8.
     reversibly inhibits á- glucosidases, the final enzymes
     in the digestion of carbohydrates in the brush border Despite considerable progress in the treatment of
     of small intestinal mucosa. It is mild hypoglycaemic; diabetes by oral hypoglycemic agents, search for
     may be used as an adjuvant to diet in obese diabetics. newer drugs continues because the existing synthetic
     Their main side effect is flatulence.                   drugs have several limitations. In recent times there
                                                             has been renewed interest in the plant remedies.9 In
     (ii) Guar gum: It is dietary fibre (polysaccharide), the Ayurvedic treatment, medicines consists of plant
     from Indian cluster beans (Guar) which forms a products, either single drug or in combination with

       Table 3 : Certain plants having active antidiabetic principles isolated are

         Plant                                    Part Used                      Active Principles
         Acontium carmichaeii                     Root                           Aconitan A, B, C and D
         Anemarans                                Rhizomes                       Anemarans A, B, C and D
         Atractylodes japonica                    Rhizome                        Glycans A, B, C and D
         Coptis chinensis                         Aerial part                    Bernerine
         Capsicum annum                           Fruit                          Capsaicin
         Dioscorea japonica                       Rhizome                        Glycans A, B, C, D, E, F
         Galega officinalis                       Seed                           Galegin
         Gandoderma lucidium                      Fruit                          GlycansA,B
         Lathyrus japonica                        Seed                           Lathyrines
         Oriza sativum                            Root                           Glycans A, B, C, D
         Tinospora cardifolia                     Plant                          1,2 Substituted Pyrolidines

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                                                                                                         Wadkar et. al.

     others which are considered to be less toxic and free     b) Pterocarpus marsupium:
     from side effects compared to synthetic drugs.10
                                                               Rajasekharan and Tuli carried out clinical trials and
                                                               found that Pterocarpus marsupium bark is effective
     In traditional systems, a number of plant extracts have   in Type 1 diabetes mellitus. Later Charkravarthy et.al.
     been used for their hypoglycaemic activity like Karela    reported epicatechin to be the active hypoglycaemic
     (Momordica charantia), Jambul (Syzigium cumini),          constituent.
     fenugreek (Trigonella foenum-gracecum), Gudmar
     (Gymnema sylvestre). Gymnemic acids 1 – 4,
     guarmarin in Gymnema sylvestre shows antidiabetic         Ghannam et al. carried out their study on 5 patients
     activity11.                                               with NIDDM and also on alloxan treated diabetic
                                                               mice.They reported that oral administration of aloes
     Herbal drugs                                              lowers the fasting serum glucose levels in normal and
     Since ancient times a number of herbal medicines          diabetic subjects.
     have been used in the treatment of this disease. There
     is increasing demand by patients to use the natural       III)Plant drugs acting by modifying glucose
     products with antidiabetic activity.                      utilisation:
                                                               Zingiber officinale (ginger), Cyamospsis
     Herbal medicines for diabetes can be classified into
                                                               tetragonolobus (Gowar plant) and Grewia asiatica
     four categories according to their mode of action:
                                                               ( phalsa) are reported to produce hypoglycaemia by
     Drugs acting like insulin.                                modifying glucose utilisation.
     Drugs acting on insulin secreting beta cells.             Sharma and Shukla reported that ginger juice has
                                                               glucose lowering effect in normal fasting animals and
     Drugs acting by modifying glucose utilization.
                                                               in alloxan diabetic animals.
     Drugs acting by miscellaneous mechanisms.
                                                               Jenkins et al. reported that the hypoglycaemic effect
     I ) Herbal drugs acting like insulin:                     of Cyamospsis tetragonolobus in diabetic and normal
     a) Momordica charantia:
                                                               Gowar plant and the seeds at a dose of 40g/kg showed
     Fruits of Momordica charantia have been successfully
                                                               hypoglycaemic activity similar to that of tolbutamide.
     used by diabetic patients and their crude extract has
                                                               The mechanism of action of gowar is probably related
     been shown to possess hypoglycaemic activity.
                                                               to its ability to increase the viscosity of gastrointestinal
     Khanna and jain isolated a hypoglycaemic peptide
                                                               contents, slow gastric empting and also act as a barrier
     (polypeptide-P) from seeds and other tissues of
                                                               to diffusion. The workers concluded that gowar
     Momordica charantia. They reported that polypeptide-
                                                               produces its hypoglycaemic action by acting at an
     p is a very effective hypoglycaemic agent when
                                                               extrapancreatic site.
     administered subcutaneously to langurs and humans.
     Singh et al. have reported hypoglycaemic effect of        The aqueous extract of Grewia asitica was tested in
     acetone extract of whole fruit powder of Momordica        diabetic cats and rabbits of both sexes by Pakrashi
     charantia.                                                and Mukherjee. These workers reported that the
                                                               fasting blood sugar levels come down to normal after
     II) Drugs acting on insulin secreting betacells           the treatment and remain as such after discontinuation
     a) Allium cepa:                                           of treatment for another 15 days.

     Allium cepa (onion) was investigated for its              IV) Drugs acting by miscellaneous
     hypoglycaemic activity by Collip and Janet, Laurin        mechanisms:
     Brahmachari and Augusti reported that the petroleum
                                                               Leguminous plants:
     ether extract of dried onion has hypoglycaemic activity
     and suggested that it can be a useful substitute for      Hypoglycemic activity of some leguminous plants was
     tolbutamide in controlling alloxan diabetes in rats.      studied by Singh et al. and reported that legumes in

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     Journal of Herbal Medicine & Toxicology

     diet could reduce glucose levels in normal rats than          REFERENCE
                                                                   1.    Debra-Haire-Joshu, Management of Diabetes
     could a normal diet. Chopra (1955) reported that
                                                                         Mellitus, Edn.2, Perspective of care across the life
     leguminous plants in diet could reduce blood sugar                  span, 3. (1991)
     levels and cholesterol levels because of their dietary        2.    Satoskar R.S., Bhandarkar S.D., Ainapure S.S.,
     fibre content.                                                      Pharmacology and Pharmacotheraputics, Edn.16,
                                                                         Popular Prakashan, Mumbai, 874.(1999)
     Euphorbia prostrata & Fumaria parvia                          3.    Nahar N., Traditional medicine, Edn.18, Oxford and
     parviflora:                                                         OBH Publishing Co. Pvt. Ltd., New Delhi, 205-209,
     Aktar et.al. reported extracts from these plants reduce             (1993).
                                                                   4.    Smith and Reynard, Essentials of Pharmacology,
     blood sugar levels in normal rabbits but not in diabetic
                                                                         W.B. Saunders Company, 588. (1995)
                                                                   5.    Davidson’s, Principles and Practice of Medicine,
     A few other plants with hypoglycaemic activity:                     Edn.15, Edited by Macleod, Edwards, Bouchier,
     Panax ginseng, Dioscorea dumatorum, Cuminum 6.                      David Nelson L, Michael Cox M., Lehninger,
     nigrum,Ocimum sanctum, Curcuma longa, Phyllanthus                   Principals of Biochemistry, Edn.3, Worth Publisher,
     embelica.12                                                         New York, U.S.A., 883-884 (2000).
                                                                   7.    Deb A.C., Fundamentals of Biochemistry, Edn.7, New
                                                                         central Book Agency (P) Ltd., Calcutta, 243 (1998).
                                                                   8.    Chatterjee T.K., Herbal options, Eastern Traders,
     All the drugs discussed in this review have exhibited               Calcutta, 9-16 (1997).
     significant clinical & pharmacological activity. The          9.    Davidson Mayer B., Diabetes Mellitus: Diagnosis
     potency of herbal drugs is significant & they have                  and treatment, Edn.2, A Wiley Medical Publication,
     negligible side effects than the synthetic antidiabetic             John Wiley & Sons, 1.(1986)
     drugs. There is increasing demand by patients to use          10.   Resmi C.R., Antidiabetic effects of herbal drug in
                                                                         Alloxan-Diabetic Rats, Indian Drugs, 38 (6), 319.
     the natural products with antidiabetic activity. In recent
     times there has been renewed interest in the plant            11.   Kokate C.K., Purohit A.P. and Gokhale S.B.,
     remedies. Plants hold definite promises in the                      Pharmacognosy, Edn.27, Nirali Prakashan, Pune,
     management of Diabetes mellitus.                                    124. (2001)
                                                                   12.   Z.S.Hakim, Potential Antidiabetic Agents from Plant
     Isolation & identification of active constituents from
                                                                         Sources; Pharmacological Aspects, Indian J.
     these plants, preparation of standardized dose &                    Natural Product. 11(1), 3 .(1995)
     dosage regimen can play a significant role in improving
     the hypoglycaemic action.

     Authors wish to acknowledge Prof. D. D. Chougule,
     Principal, Appasaheb Birnale College of Pharmacy,
     Sangli for their support. We also thank all the teaching
     and non-teaching staff of our college for their help.


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