1.

INTRODUCTION

Health and disease are coeval with life. From time immemorial man
has been interestedin trying to control diseases. The medicine man and
herbalist undertook in various ways to cure man's disease and bring relief
to the sick. One of the chronic, worldwide heterogeneous, life threatening
disease is diabeteyrhe prevalence of it will be 5.4% by the year 2025, with
the global diabetic population reaching to 300 million. Among all the WHO
regions, South East Asian region are highest affected with maximum global
burden of the disease and by year 2025 there will be nearly 80 million
diabetic in the region.
Diabetes is a lifelong disease marked by high levels of sugar in the
blood. It develops due to body's inability to make appropriate use of food as
a result of insufficient insulin [a hormone produced by the pancreas to
regulate blood sugar level], resistance to insulin or both. To understand
diabetes, it is important to understand the normal process of food
metabolism. Normally the food eaten is converted within the body into a
form of sugar called glucose, which cells use as a source of energy or fuel.
Glucose cannot enter the cell alone and needs insulin to aid in its transport
into the cells. Glucose causes an increase in blood glucose level which in
turn signals the release of hormone insulin. The role of insulin is to move
glucose from the blood stream into muscle, fat and liver cells where it can
be used as a fuel. Without insulin, cell becomes starved of glucose energy
despite the presence of abundant glucose in the blood.
People with diabetes have high blood glucose level, as their muscle,
fat, and liver cells do not respond to insulin normally, or both. So the cells
in ability to utilize glucose give rise to ironic situation of starvation in the
midst of plenty. The abundant unutilized glucose is waste fully executed in

the urine .Insulin is produce in pancreas. Pancreas has islets of langerhans,

which produce four different types of hormones.

2. PANCREATIC HORMONE

2.1. SOMATOSTATIN
Somatostatin inhibits GH secretion, and regulates the secretion of
insulin and glucagonfrom islets. It is secreted by D cells of the islets.

2.2

PANCREATIC POLYPEPETIDE
Pancreatic polypeptide regulates gastro intestinal secretion, by

increasing calcium absorption by small intestine and re-absorbtion of

calcium by kidney. It is produced by F cells of pancreas.

2.3 GLUCAGON
Glucagon is the hyperglycemic, glycogenolytic factor of the pancreas. The
hyperglycemic effect of some pancreatic extracts due to presence of this
hormone was first noted by Kimball and Murin in the year 1923.

2.4 INSULIN
Banting and Best (1922) succeeded in extracting insulin from
pancreas. Insulin is a small protein comprising 51 amino acids residues
synthesised in the beta cells of the islets of langerhans via its precursor,
proinsulin.

3. MODE OF ACTION OF INSULIN

Insulin acts in several ways to reduce circulating blood glucose levels.
It enhances cellular uptake of glucose from the blood in many tissues,
particularly skeletal muscle and adipose tissue. It also stimulates glycogen
production and inhibits glycogen breakdown in muscle and hepatocytes.

4.TYPES OF DIABETES
Diabetes basically can be categorized into two types (WHO, 1985).
Diabetes insipides and Diabetes mellitus.

4.1 DIABETES INSIPIDUS (DI)

It is due to the deficiency of hormone vasopressin, produced by the
middle or intermediate lobe of the pitutary gland.

4.2 DIABETES MELLlTUS (DM)

Von Mering and Minkowski (1890) demonstrated the relationship of
pancreatic hypo-function and diabetes mellitus. Diabetes mellitus is a
group of metabolic diseases characterized by high blood sugar (glucose)
level, which results from defects in insulin secretion or action or both.
Diabetes mellitus in India is slowly becoming a killer disease next to
coronary heart disease and has attacked 40 million persons. Nearly 10-13%
of urban population and 4 to 6 % of the rural population of India have
diabetes.
5. TYPES OF DIABETES MILLITUS
There are several types of diabetes.

The following classification

system for diabetes was endoned by the board of directors of the American
Diabetes Association at its 1979 annual meeting and also by the World
Health Organization (1994).
5.1 TYPE I
Insulin dependent diabete mellitus (IDDM) is characterized by beta
cell destruction caused by an auto immune process usually leading to
absolute insulin deficiency. Type I diabetes occurs in 20% of all diabetic

patient. Type I is insulin-dependent diabetes, and it can occur at any age,

though it mostly occurs in youth.
5.1.1 SYMPTOMS OF TYPE I DIABETES MELLITUS

Increased thirst

Increased urination

Weight loss in spite of increased appetite

Fatigue

Irritability

Nausea

Vomiting

5.2 TYPE 2 NON-INSULIN DEPENDENT

Type 2 DM or NIDDM is characterized by insulin resistance in
peripheral tissue and an insulin secretory defect of the J3 cell. Insulin
resistance and hyper insulinimia eventually lead to impaired glucose
tolerance. Defective J3 cells become exhausted, further fueling the cycle of
glucose intolerance and hyper glycemia. Resistance to the action of the
insulin results in decrease in the ability of skeletal muscle to store glucose.
Type 2 occurs in 75% of all diabetic patients, The American Diabetes
Association further divides this category into sub types that include obese
non-insulin dependent diabetes and non-obese, non- insulin-dependent
diabetes Type 2 diabetes is much more common than Type I.

5.2.1 SYMPTOMS OF TYPE 2 DIABETES MELLlTUS

Increased thirst

Increased urination

Increased appetite

Fatigue

Blurred vision
5

Slow healing infection

Impotence in men

Itching

Drowsiness

Tingling and numbness in hands and feet

Excess weight

Insulin Dependent
(Type 1)
Age of onset

How noticed

Family Background

Usually
during
youth, but can occur
at any stage
Usually
appears
abruptly
and
progress rapidly
Diabetes not always
present
in
other
family members

Treatment

Insulin injections are

necessary.
Diet ,
Exercise
and
Emotional
Control
are necessary

Complications

Problems
affecting
blood vessels, eyes ,
Kidneys , and Nerves
May occur at any age
Not Necessarily

Linked to Obesity

5.3 SPECIFIC GROUPS OF DIABETES

6

NonInsulin
dependent
(Type II)
Usually during adult
hood: more common
in older people
Gradual in onset; the
disease
may
go
unnoticed for years
Often
diabetes
present
other
members
of
the
family
Insulin injections are
not always necessary.
Oral Medications are
sometimes
recommended . Diet ,
Exercise
and
Emotional Control are
necessary
Problems
affecting
blood vessels, eyes ,
Kidneys , and Nerves
May occur at any age
80% of are overweight
at time of diagnosis.

Specific groups of diabetes accounts for 5% of all diabetic patients.

These are categorized further as:

1. Malnutrition related diabetes mellitus (MRDM)

2. Diabetic associated with other condition and syndrome
(a)

Pancreatic disease

(b)

Disease of hormonal aetiology

(c)

Chemical induced diabetes

(d)

Abnormalities of insulin or its reception

(e)

Certain genetic syndrome

(f)

Miscellaneous

5.4 GESTATIONAL DIABETES

Refer to hyperglycemia occurring for first time in pregnancy. During
normal pregnancy insulin sensitivity is reduced through the action of
placental hormone and this impairs glucose tolerance. The insulin secreting
cells of pancreatic islets are unable to meet this demand in woman
predisposed to develop diabetes. Repeat pregnancy may increase the
likelihood of developing irreversible diabetes, particularly in obese woman.

6. CLINICAL CLASSIFICATION OF DIABETES MELLITUS

Clinically diabetes mellitus have been classified into two main groups

6.1 PRIMARY (IDIOPATHIC)

Constitute the major group, exact cause is not known but metabolic
defect due to insufficient insulin is one of the reasons. The idiopathic OM
is of two clinical types:

(i)

"Juvenile" -onset diabetes: called as type - I - IDOM (insulin

dependent)
(ii)

Maturity- onset diabetes: Type 2 NIDOM (non- insulin dependent)

6.1.1 FACTORS RESPONSIBLE FOR IDIOPATHIC DIABETES MELLlTUS

1. Heredity: Diabetes mellitus has a heredity component and often runs
in families. If both mother and father are diabetic. There are more
than 80% chances that their children will also be diabetic.
2. Autoimmunity:
autoimmune

Insulin

disorder

dependent

and

has

juvenile

found

to

type
co-exist

may
with

be

an

other

autoimmune disorder like lymphocytic and plasma cells infiltrations in

pancreas.
3. Infections: Certain viral infection may precipitate juvenile type.
Antibodies to coxsackie Bu virus have been found in young juvenile
type.
4. Obesity: Majority of middle ages_ maturity-onset diabetes are "obese",
and "stress" during pregnancy may also precipitate.
5. Diet: Over eating and under activity are also predisposing factors in
elderly middle aged maturity onset diabetes.

6.2 SECONDARY
This forms an inner group. Diabetes is secondary to some other disease.
The different types of secondary diabetes are as follows:
1. Pancreatic diabetes: Pancreatic diabetes leads to pancreatites,
haemochromatosis and malignancy of pancreas.
2. Abnormal concentration of antagonistic hormones: The abnormal
concentration of antagonistic hormones develops due to diabetes
leads to hyperthyroidism, hypercorticism like Cushing's disease and

syndrome, hyper pitutarism like acromegaly and increased glucagon

activity.
3. Iatrogenic: Iatrogenic diabetes may be genetically susceptible and is
precipitated by therapy like corticosteroids.

7. HOMEOSTASIS
REGULATION OF BLOOD GLUCOSE (HOMEOSTASIS)
Blood glucose level is maintained within physiological limits 60 to 100 mg%
(true glucose) fasting state and 100 to 140 mg% following ingestion of a
carbohydrate containing meal by a balance between two sets of factors:

(1)

Rate of glucose entrance into the blood stream and (2) Rate of removal from
the blood stream.

8. ABNORMALITIES IN BLOOD GLUCOSE LEVELS

Increase in blood glucose level above normal is called hyperglycemia.
Decrease in blood glucose level below normal is called hypoglycaemia.
8.1 HYPERGLYCEMIA
Chronic hyperglycemia causes damage to the eyes, kidneys, nerves, heart
and blood vessels.
Causes of hyperglycemia: Most common cause is diabetes mellitus
in which the highest values for fasting blood glucose is obtained,
which vary from normal to 500 mg% and over, depending on the
severity of the disease.

Emotional stress can increase the blood glucose level.

In pancreatitis and carcinoma of pancreas some increase in

fasting blood glucose may occur.

A moderate hyperglycemia may also be found in some
intracramial

disease

such

as

meningitis,

intracramial tumors and haemorrhage.

9

encephalitis,

Anaesthia can also increase blood glucose depending on the

degree and duration of anaesthia.

Asphyxia may also increase blood sugar level.

8.2 HYPOGLYCAEMIA
Hypoglycaemia may be considered to be present when the blood glucose is
below 40 mg% (true glucose).
Causes of hypoglycaemia

Most common cause is the over dosage of insulin in treatment of

diabetes mellitus

Low

blood

glucose

are

often

found

in

severe

liver

disease,

hypopitutarism (Simmond's disease) and hypoadrenalism (Addison's

disease).

Spontaneous hypoglycaemia in childhood may be due to deficiency of

glucagon production.

Severe exercise may produce hypoglycaemia due to depletion of liver

glycogen hypoglycaemia is also found in some of the glycogen storage
disease (GSDs) as in VonGierke's disease.

Hypoglycaemia has also been found to be associated with alcohol

ingestion.

9. GLYCOSURIA
Glycosuria is defined as the excretion of glucose in the urine. In
normal individuals, glycosuria occurs when the venous blood glucose
exceeds 170 to 180 mg/l 00 ml. This level of the venous blood glucose is
termed as the "Renal threshold", for glucose. Excretion of abnormal
amounts of glucose in the urine may be due to two types of abnormalities.
(a) Increase in the amount of glucose entering in the tubule/ml

10

(b) Decrease in the glucose reabsorption capacity of the renal tubular

epithelium.

10. GLYCEMIC INDEX (GI)

The glycemic index is a ranking of carbohydrates based on their
immediate effect on blood glucose levels. It compares food gram for gram of
carbohydrates. Carbohydrates that break down quickly during digestion
have the highest glycemic indexes.

11. GLYCEMIC LOAD (GL)

Glycemic load builds on the glycemic index to provide a measure of
total glycemic response to a food or meal.
Glycemic load = GI (%) x grams of carbohydrate per serving

One unit of GL is similar to glycemic effect of one gram glucose.

12. CONCLUSION

There is no cure for diabetes. The immediate goals are to stabilize

blood sugar level and eliminate the symptoms of high blood sugar. The long
term goals of treatment are to prolong life, relieve symptoms and prevent
long term complications such as heart disease and kidney failure. Basic
diabetes management skills will help to prevent the need for emergency
care. The skills include :

How to recognize and treat low blood sugar (Hypoglycemia) and high
blood sugar
(Hyperglycemia)

11

What to eat and when

How to take oral medication or insulin

How to test and record blood glucose

How to test urine or ketones

How to handle sick days

Where to buy diabetes supplies and how to store them

Medications to treat diabetes include insulin and glucose lowering

pills called oral hypoglycemic agents. The people with type 1 diabetes
cannot make their own insulin, so daily insulin injections are required. The
people with type 2 diabetes make insulin but cannot use it effectively.
Insulin is delivered by injections one to four times a day. Sometimes
different types of insulin are mixed together in a single injection.
Most type 2 diabetic will require more than one medication for good
blood sugar control within three years of starting their first medication.
Plants based medicinal products have been popular all over the world
for centuries. In diabetics, some herbal alternatives are proven to provide
symptomatic relief and assists in the prevention of the secondary
complications of the disease. Some herbs have also been proven to help in
the regeneration of beta cells and in overcoming insulin resistance.
Besides helping to maintain normal blood sugar level, several of these
herbs are also reported to posses antioxidant and cholesterol lowering
action. These herbs therefore, have multi-faceted roles to play in the
management of diabetes. The herbal preparation are also free from side
effects commonly encountered with conventional therapies. This is
evidenced by their long history of safe use and the lack of undesirable side
effects observed in clinical trials performed with therapeutically effective
doses on diabetes.
The importance of antidiabetic plants in the development of economic
12

and effective treatment for diabetes, currently estimated to affect over 30

million

people

worldwide,

has

been

recognized

by

World

Health

Organisation.'
The antidiabetic plants contain the following compounds with
antidiabetic activity. The compounds are inorganic ions, coumarins, lipids,
f1avonoids,

steroids,

peptides,

amines,

terpenoides,

glycopeptides,

alkaloids, complex carbohydrates and others.

To combat the complications of diabetes mellitus a number of plant
products not only in the form of drugs but as food can be included in diet.
Higher fibre foods like fruits, vegetables, whole grains and whole pulses like
rajma, chana, mungbean, etc regularly prevents unnecessary fluctuations
in blood sugar level, as it has a low glycemic index. Pulses like soybeans are
highly beneficial to diabetics, as they help the cell to accept insulin more
easily. This leads to quicker blood sugar control. A number of commonly
available plants like Asparagus, Inula, Mimosa ,etc. can also be taken in the
form of drugs to normalise the blood sugar content.
Hence, this article deals with a number of antidiabetic plants with
their chemical constituents, which further help the researcher to carry out
innovative research in the development of antidiabetic drugs.

13

APPENDIX

List of some common medicinal plants used in the treatment of diabetes

Sl.

Plant name

Common name

Family

Part used

No
1
2

Abrus precatorius
Adhatoda zeylanica

Kunni
Adalodakom

Papilionaceae
Acanthaceae

Leaves
Roots

3
4
5
6
7
8
9

Aerva lanata
Aloe vera
Artocarpus heterophyllus
Azadirachta indica
Boerhaavia diffusa
Calotropis procera
Cassia fistula

Cherula
Kattarvazha
Plavu
Veppu
Thazhuthama
Erikku
Kanikonna

Amaranthaceae
Liliaceae
Moraceae
Meliaceae
Nyctaginaceae
Asclepiadaceae
Caesalpiniacea

Leaves
Leaves
Leaves
Leaves
Leaves
Roots
Leaves
Fruit

10
11
12

Centella asiatica
Cinnamomum verum
Coccinea grandis

Kudangal
Karuva
Koval

e
Apiaceae
Lauraceae
Cucurbitacae

Leaves
Bark
Root, Leaves,

Rubiceae
Elaeocarpaceae
Gentianaceae
Gentianaceae
Liliaceae
Asclepiadaceae
Rubiaceae
Lythraceae

fruit
Seeds
Aerial parts
Whole plant
Aerial parts
Whole plant
Root
Aerial parts
Leaves
&

Cucurbitaceae
Moringaceae

fruits
Fruit
Fruits,

13
14
15
16
17
18
19
20
21
22

Coffea arabica
Elaeocarpus serratus
Enicostemma axillare
Exacum bicolor
Gloriosa superba
Hemidesmus indicus
Ixora coccinea
Lagerstroemia reginae
Momordica charantia
Moringa oleifera

Coffee
kara
Vellaruku
Kannamthali
Menthonni
Naruneendi
Chethi
Poomaruthu
Paval
Moringa

&

23
24
25
26
27
28

Musa sapientum
Phyllanthus emblica
Piper longum
Piper nigrum
Rauvolfia serpentina
Saraca asoca

Vazha
Nelli
Tippali
Black pepper
Sarpagandhi
Asokam

Musaceae
Euphorbiaceae
Piperaceae
Piperaceae
Apocynaceae
Caesalpiniacea

Leaves, Stem
Root & stem
Fruit
Fruit
Plant
Root
Flower

29
30

Syzygium cumini
Zea mays

Njara
Mays

e
Myrtaceae
Poaceae

Seed & Fruit

Styles

14

15

13. REFERENCES

Alarm, M.M., Siddiqui, M.B. and W. Hussain 1990.

Treatment of

diabetes through herbal drugs in rural India. Fitoterapia, LXI

(3) : 240-242.
Druryi, M.I. 1979. Diabetes mellitus, Black Well, Oxford.
Jain, S.K. 1991. Dictionary of Indian Folk medicine and Ethnobotany.
Deep publications, New Delhi.
Kirtikar K.R. and B.D. Basu 1980.

Indian Medicinal Plants.

Lalit

Mohan Basu Publications, Allahabad.

Orient Longman 1995. Indian medicinal Plants vo.1-5.
Panja, A.K. and B.L. Kaur, 2001. Complications of Diabetes Mellitus
vis-a-vis concept of Vatavridhi in Premeha.
International Seminar on Ayurveda.

In :Second

Organised by Jamnagar

Ayurved University, Jamnagar.

Raghunathan, K. 1987.

Medico-Ethnobotanical surveys and their

role in research in Ayurveda. In Jain, S.K.(ed.) : A manual of

ethnobotany, Jodhpur 79-93.
Rizwana Mubeen, Sadiya Famitha , Athiya Khanum , Irfan Ali Khan
and S.Y.Anwar 2005

Anti Diabetic Plants of India Ukaaz

Publications , Andra Pradesh India. pp 108-200.

Satapathy, K.B., Nanada, G.C.and P.K. Chand 2003.
Diabetics. Divya Prakashnee, Bhubaneswar.

16

Plants for