Diabetes Melitus and Herbal Medicine

Kelompok 10
Definition
a group of common metabolic disorders that share the
phenotype of hyperglycemia
DM type I :
Complete Insulin Deficiency
DM Type II:
heterogeneous group of disorders characterized by variable degrees of
insulin resistance, impaired insulin secretion, and increased glucose
production
Longo Dl, Kasper DL, Jameson JL, et al. Harrisons Principles of Internal Medicine. 18
th
ed. US:
McGraww Hill Companies, Inc. 2012
Classification
DM type I :
Complete Insulin Deficiency

DM Type II:
heterogeneous group of disorders characterized by variable degrees of :
insulin resistance,
impaired insulin secretion,
increased glucose production
Longo Dl, Kasper DL, Jameson JL, et al. Harrisons Principles of Internal Medicine. 18
th
ed. US:
McGraww Hill Companies, Inc. 2012
Pathophysiology DM Type II
Insulin
Resistance
Glucose
tolerance
normal
Compensatory :
Insulin
Hyperinsuli
nemia
The Islets unable
to sustain
hyperinsulinemic
state
IGT
Develops
PPBG
Insulin
Secretion
Hepatic
Glucose
Production
Overt Diabetes
with fasting
hyperglycemia
cell
failure
Longo Dl, Kasper DL, Jameson JL, et al. Harrisons Principles of Internal Medicine. 18
th
ed. US: McGraww Hill
Companies, Inc. 2012
Clinical Studies potential links between herbal therapies and
improved blood glucose control

Plants have anti-diabetic properties include:
Aloe vera
Bilberry extract
Bitter melon
Cinnamon
Fenugreek
Ginger
The Global Diabetes Community. Herbal and Natural Therapies.
http://www.diabetes.co.uk/Diabetes-herbal.html
Classification of Herbal Medicine
Herbal medicine can be broadly classified into the following
categories according to their mode of action:
a) Drugs acting like insulin
b) Drugs acting on insulin secreting beta cells
c) Drugs modifying glucose utilization
d) Drugs showing adrenomimeticism
e) repairing pancreatic beta cells
f) cAMP (2nd messenger) stimulatorsthe beta-cells


g
g) renal glucose resorption inhibitors
h) herbal drugs providing certain necessary elements like calcium,
zinc, magnesium, manganese and copper for the beta cells
i) drugs regenerating and/or repairing pancreatic beta cells
j) effectors of size and number of cells in the islets of langerhans,
k) glycogenesis and hepatic glycolysis stimulators,
l) drugs preventing pathological conversion of starch to glucose by
inhibition of galactosidase, glycosidase & alpha-amylase,
m) drugs preventing oxidative stress that is possibly involved in
pancreatic -cell dysfunction found in diabetes


Herbal alternatives and management for diabetes, Evidence based herbal drug standardization approach in coping with challenges of
holistic management of diabetes: a dreadful lifestyle disorder of 21st century http://www.jdmdonline.com/content/12/1/35
The various contraindications of herbal
medicines

a) Being self prescribed, quality assurance is not guaranteed and
also may interact with other drugs
b) contraindications of herbal drugs and associated unusual
beliefs
c) contain powerful, pharmacologically active compounds that
needs to be evaluated for drug-drug interactions
d) usually cause hepatic and renal problems if taken in excess; due
to lack of pharmacodynamics and pharmacokinetics data and slow
clearance rate from the body
e) difficulty in identification of the causative agent associated with
the adverse reactions encountered as these often contain multiple
ingredients
f) lack of standardization while the formulation of herbal drug i.e.
delivery system for particular target is generally not validated
g) mode of action of herbal plant constituents is not clear enough
to support therapeutic utility.



Contraindications of herbal alternatives, Evidence based herbal drug standardization approach in coping with challenges of holistic
management of diabetes: a dreadful lifestyle disorder of 21st century century http://www.jdmdonline.com/content/12/1/35

Controversy Use of Herbal Medicine
ayurvedic and oriental medicine treating serious conditions such as diabetes,
health experts in the west sceptical about their reported medical benefits.
Argument :
Herbal Med Hypoglicemic effect
Herbal Med + Diabetes Med
dangerously low levels of Glucose
the risk of other diabetes complications
The Global Diabetes Community. Herbal and Natural Therapies.
http://www.diabetes.co.uk/Diabetes-herbal.html
Anti Diabetic Herbs in Indonesia, Sambiloto
(Andrographis paniculata)
"Andrografolid with the main fitochemical can decrease glucose level in
blood and can express the GLUT-4 in DM 1, dosen Fakultas Farmasi
UGM in paralel session of the 4th Riset Industri Indonesia
Purified Isolat andrografolid (sambiloto extract) that given to the mice
shows the hypoglicemic activities in DM mice with insulin resistence. It
is effective to decrease LDL and Triglycerides level in blood, but has no
effect in cholesterol and weight.
Combination between purified extract and metformin (biguanide) shows
less effectiveness than using single using of sambiloto.
Andrografolid decreases blood glucose level in DM type 2 with insulin
resistence by increasing expression of GLUT 4 protein in muscle tissues
Sambiloto, Obat Herbal Anti Diabetes Mellitus http://www.suaramerdeka.com/v1/index.php/read/sehat/2012/12/09/887/Sambiloto-Obat-
Herbal-Anti-Diabetes-Melitus .
Fenugreek (Type 1 and 2 diabetes)
Helps lower blood glucose by slowing down digestion and
absorption of carbohydrates.
Study research :
1. Adding 100 grams to the daily diet of patients with type 1
diabetes significantly reduce fasting blood glucose,
improved glucose tolerance, lowered total cholesterol, LDL,
and TG.
2. Adding 15 grams into meal of patients with type 2 diabetes
reduced post meal blood glucose.
Cassia Cinnamon (Cinnamon bark)
Research :
Daily intake 1, 3, or 6 grams after 40 days shown reduce serum
glucose, TG, LDL, total cholester among 60 middle-aged
patients.
Consuming 1 gram perday can increase insulin sensivity.
Consuming 6 gram shown slows stomach emptying and
significantly reduces post prandial blood glucose
Bitter melon (In type 2 diabetes)
The fruit contains :
Charantin blood glucose lowering effect
Vicine
Polypeptide-p
Lectin reduce blood glucose and supressing appetite.
Bilberry (Vaccinium myrtillus)extract
Effect :
Retinopathy strengthening of blood vessels in the retina and
reduced hemorrhaging.

Preventive and Protective Properties of Zingiber officinale (Ginger) in Diabetes
Mellitus, Diabetic Complications, and Associated Lipid and Other Metabolic
Disorders: A Brief Review.

Zingiber officinale (ginger) has been used as herbal medicine to treat various ailments
(penyakit) worldwide since antiquity (zaman purbakala). Recent evidence revealed the
potential of ginger for treatment of diabetes mellitus. Data from in vitro, in vivo, and
clinical trials has demonstrated the antihyperglycaemic effect of ginger. The
mechanisms underlying these actions are associated with insulin release and action,
and improved carbohydrate and lipid metabolism. The most active ingredients
in ginger are the pungent(tajam) principles, gingerols, and shogaol. Ginger has shown
prominent(mencolok) protective effects on diabetic liver, kidney, eye, and neural
system complications. The pharmacokinetics, bioavailability, and the safety issues
of ginger are also discussed in this update.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519348/
GINGER

Ginger
Function :
1. Gingerols - the major active component - can increase
uptake of glucose into muscle cells without using insulin.
2. Led to a 35 % drop in blood glucose level and 10 % increase
in plasma insulin level
Evaluation of the Nutritional and Metabolic
Effects of Aloe vera
Aloe vera has a long history of popular and traditional use. It is used in traditional
Indian medicine for constipation, colic, skin diseases, worm infestation, and
infections (Heber 2007). It is also used in Trinidad and Tobago for hypertension
(Lans 2006) and among Mexican Americans for the treatment of type 2 diabetes
mellitus (DM; Coronado et al. 2004). In Chinese medicine, it is often
recommended in the treatment of fungal diseases (Heber 2007). In Western
society, Aloe vera is one of the few herbal medicines in common usage, and it
has found widespread use in the cosmetic, pharmaceutical, and food industries.
The conditions for which clinical trials of Aloe vera have been conducted include
skin conditions, management of burn and wound healing, constipation, DM, and
gastrointestinal disorders.
http://www.ncbi.nlm.nih.gov/books/NBK92765/
Herbal Medicine: Biomolecular and Clinical Aspects. 2nd
edition.
Benzie IFF, Wachtel-Galor S, editors.
Boca Raton (FL): CRC Press; 2011.
Penggunaan Obat Herbal dan Konvesional
secara bersamaan
Penelitian yang dilakukan di 11 Puskesmas, Kecamatan Kota
Depok, dari bulan Maret sampai Mei 2012, pada pasien DM
tipe 2.
Responden 101
52,47% pengguna antidiabetes herbal
71,70% dari pengguna antidiabetes herbal masih menggunakan
ADO
Dengan daun sirsak, daun salam, dan kulit manggis tiga
terbanyak antidiabetes herbal yang digunakan.
Adhitia. Efek Perseptif Antidiabetes Herbal bersamaan dengan Obat Antidiabets Oral Pada Pasien Diabetes elitus
Tipe 2 Di Puskesmas Kotamadya Depok. Universitas IndonesiaI; 2012.
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