Management of Diabetes: A Review

 

Samidha Kamtekar*, Vrushali Keer

M.E.T Institute of Pharmacy, Bhujbal Knowledge Center, Bandra Reclamation, Bandra (W), Mumbai- 400050 Maharashtra, India.

 

ABSTRACT:

Diabetes mellitus is a chronic metabolic disorder that affects human body in terms of physical, psychological and social health. Carbohydrates are converted into simple sugars to provide a steady source of energy to all of our cells. Insulin is responsible for controlling the level of sugar in the blood that regulates the amount of sugar throughout the body. There are three main types of diabetes, namely type I diabetes, type II diabetes and gestational diabetes. Oral antidiabetic agents exert their effects by various mechanisms. The treatment with insulin or oral hypoglycemic agent on long term usage leads to increase blood sugar, drug resistance, adverse effects and complications which will further affect the immune system of body. To avoid such problems, it seems beneficial to use natural formulations for better management of diabetes mellitus. Hyperglycemia and oxidative stress are important components for the development of diabetic complications. Natural medicine contains various phytoconstituents such as polysaccharides, alkaloids, glycosides, saponins, flavonoids and tannins which are responsible for management of diabetes mellitus through multiple target mechanism.

 

 

 

INTRODUCTION:

Diabetes mellitus is a metabolic disorder of multiple aetiology characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, inulin action, or both.¹ Diabetes mellitus is derived from the Greek word diabetes meaning siphon - to pass through, referring to heavy thirst and frequent urination and the Latin word mellitus meaning honeyed or sweet. This is because in diabetes excess sugar is found in blood as well as the urine. Diabetes is becoming the third killer of the health of mankind along with cancer, cardiovascular and cerebrovascular diseases.² According to World Health Organization (W.H.O) report, number of diabetic patients is expected to increase from 171 million in year 2000 to 366 million or more by the year 2030.³

 

There are three main types of diabetes, namely type I diabetes, type II diabetes and gestational diabetes. In type I diabetes (juvenile), β-cell of pancreas does not produce insulin.

 

These patients have absolute insulin deficiency and are dependent on insulin replacement for life. Type II diabetes is accounting for about 90-95% of diabetic cases. The key components of type II diabetes are β-cell dysfunction causing impaired insulin secretion and increased need for insulin due to insulin resistance. Gestational diabetes is caused by hormonal changes during pregnancy or by insulin insufficiency.¹ Decreased physical activity, increasing obesity, stress and changes in food consumption have been implicated in this increasing prevalence in the past two decades.⁴

 

Symptoms of hyperglycemia include polyuria, polydipsia, polyphagia, weight loss, blurred vision. Impairment of growth and susceptibility to certain infection may also accompany chronic hyperglycemia. Acute, life threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis or nonketotic hyperosmolar syndrome.¹ Patients with diabetes experience significant morbidity and mortality from microvascular (damage due to small blood vessels) includes retinopathy, neuropathy and nephropathy and macrovascular (damage due to the arteries) complication includes heart attack, stroke and peripheral vascular disease. Acute complications include diabetic ketoacidosis, nonketotic hyperosmolar coma and diabetic coma.⁴

 

 

Figure 1: Possible molecular mechanism for diabetic complications.

Hyperglycemia in combination with oxidative stress triggers the detrimental pathways of polyol, PKC, AGE and hexosamine extending to consequences like redox imbalance, alterations in gene expression, modified transcription factors which further enhances oxidative stress leading to various diabetic complications. G-6-P: glucose-6-phosphate; DAG: diacyl glycerol; PKC: protein kinase C; ROS: reactive oxygen species; RNS: reactive nitrogen species; AGE: advanced glycation end products; NCV: nerve conduction velocity; NF-κB: nuclear factor kappa and MAPK: mitogen activated protein kinase.⁵

 

 

 

Table 1: Diagnostic criteria for diabetes

Category of a person	Fasting plasma glucose (mg/dl)	Oral glucose tolerance test [2h post load glucose] (mg/dl)
Normal	< 100	< 140
Prediabetes	100-125	140-199
Diabetes	≥ 126	≥ 200

 

Conventional antidiabetic drugs:

Regardless of the type diabetes, patients are required to control their blood glucose with medications and/or by adhering to an exercising program and dietary plan. If diet and exercise fail to control blood glucose at the desired level, oral antidiabetic medication is prescribed.⁴ There is a variety of conventional hypoglycemic medicines available in the market for the treatment and management of diabetes.

Oral antidiabetic agents exert their effects by various mechanisms: ⁶

a)      Stimulation of beta cells in the pancreas to produce more insulin (sulfonylureas and meglitinides).

b)      Increasing the sensitivity of muscles and other tissues to insulin (thiazolidinediones).

c)      Decreasing gluconeogenesis by the liver (biguanides).

d)      Delaying the absorption of carbohydrates from the gastrointestinal tract (alpha glucosidase inhibitors).

e)      Stimulation of incretin, GLP-1 to release more insulin (Di-peptidyl peptidase (DDP)-4 inhibitors).

 

Due to their drawbacks, ranging from the developing of resistance and adverse effects to lack of responsiveness in large segment of patient’s population.⁴ Around 3.2 million deaths every year is attributable to complications of diabetes. ⁷

 

The side effects or complications associated with diabetes pharmacotherapy can be divided into three categories as: ⁷

a)      Common side effects include hypoglycemia or extremely low blood sugar (symptoms include profuse sweating, tremor, shakiness, dizziness, hunger, mental confusion, coma and a rare risk of stroke or death), gastrointestinal side effects (abdominal pain, nausea, vomiting, diarrhea, gassiness and bloating), edema (fluid in legs and ankles), increase in bad cholesterols (LDL).

b)      Uncommon side effects include congestive heart failure, anemia and allergic reactions.

c)      Rare side effects include thrombocytopenia (low blood platelet counts), lactic acidosis (buildup of acid in the blood), leucopenia (low white blood cell counts), macular edema (eye problems) and liver disease/ liver failure.

 

Natural medicines in management of diabetes:

The associated complications of synthetic drugs have lead to a shift towards locating natural resources showing antidiabetic activity. Some herbs have beta-cells regeneration stimulating power while some herbs are reported to possess antioxidant activity, cholesterol-lowering action and restore the liver glycogen level in addition to maintaining normal blood sugar level.²

 

The present treatment of diabetes is focused on controlling and lowering blood glucose to a normal level. The mechanisms of the natural medicines to lower blood glucose are: ¹¹

a)      To stimulate cell of pancreatic islet to release insulin.

b)      To resist the hormones which rise blood glucose.

c)      To increase the number or rise the appetency and sensitivity of insulin receptor site to insulin.

d)      To decrease the leading-out of glycogen.

e)      To enhance the use of glucose in the tissue and organ.

f)       To clear away free radicals, resist lipid per oxidation and correct the metabolic disorder of lipid and protein.

g)      To improve microcirculation in the body.

 

Herbal medicines can be broadly classified into the following categories according to their mode of action: ⁷

a)      Drug acting like insulin (Momordica charantia and Panax ginseng). ⁹

b)      Drugs acting on insulin secreting beta cells (Pterocarpus marsupium, Syzygium cumini and Allium cepa). ⁹

c)      Drugs modifying glucose utilization (Zingiber officinale, Cyamopsis tetragonolobus and Grewia asiatica). ⁹

d)      Drugs showing adrenomimeticism, pancreatic beta cell potassium channel blockers, cAMP (2^nd messenger) stimulators.

e)      Renal glucose reabsorption inhibitors (Fraxinus excelsior and Lepidium sativum). ¹⁰

f)       Herbals drugs proving certain necessary elements like calcium, zinc, magnesium, manganese and copper for beta cells.

g)      Increasing the size and number of cells in the islets of Langerhans (Withania somnifera). ¹¹

h)      Glycogenesis and hepatic glycolysis stimulators (Momordica charantia). ¹¹

i)       Drugs preventing pathological conversion of starch to glucose (Syzygium cumini and Vinca rosea). ¹⁰

j)       Inhibition of α-amylase (Phyllanthus amarus). ¹²

^k)           Inhibition of α- glucosidase and β-galactosidase (Chaenomeles sinensis). ¹³

l)       Drugs preventing oxidative stress that is possibly involved in pancreatic beta cell dysfunction found in diabetes.

m)     Cortisol lowering activities (Inula racemosa, Boerhaavia diffusa and Ociumum sanctum). ¹¹

n)      Improvement in digestion along with reduction in blood sugar and urea (Aegle marmelos). ¹¹

o)      Protective effect on the destruction of the beta cells (Thea sinensis). ¹¹

 

The plant constituents under the category of polysaccharides, peptides, alkaloids, glycopeptides, triterpenoids, amino acids, steroids, xanthones, flavonoids, lipids, phenolics, coumarins, iridoids, alky disulphides, inorganic ions and guanidines are reported to have antidiabetic activity.⁷

 

Table 2: The phytoconstituents responsible for antidiabetic activity and their mode of action^{7, 8}

Phytoconstituents	Mode of action
Polysaccharides	Increases the levels of serum insulin, reduce the glucose levels and improve tolerance of glucose.
Alkaloids	Inhibits alpha glucosidase and decrease glucose transport through the intestinal epithelium.
Imidazoline compounds	Stimulates insulin secretion in a glucose dependent manner.
Flavonoids	Suppresses the glucose level, reduces plasma cholesterol and triglycerides significantly and increase their hepatic glucokinase activity probably by enhancing the insulin release from pancreatic islets.
Saponins (Triterpenoids + steroidal glycosides)	Stimulates the release of insulin and blocks the formation of glucose in the blood stream.
Tannins	Restore function of beta cells and enhance their release of insulin.
Dietary fibers	Effectively absorbed glucose, retard glucose diffusion and inhibit the activity of alpha amylase and may be responsible for decreasing the rate of glucose absorption and concentration of postprandial serum glucose.

 

Natural medicines:

Acacia arabica (Babul):

Botanical name: It consists of bark Acacia arabica Wild, belonging to family Leguminosae.

Phytochemistry: (+)-Catechin, (-)-epicatechin, (+)-decatechin, epigallocatechin, quercetin, gallic acid, (+)-leucocyanidin gallate, sucrose and tannin.¹⁴

Mode of action: The hypoglycemic effect of aqueous extract (hot and cold water) and hydroalcoholic extract of Acacia arabica was investigated. Oral administration of cold water extract of Acacia arabica bark to diabetic and normal rats at a dose of 400 mg/kg body weight resulted in significant reduction of blood glucose, cholesterol, creatinine and triglycerides level than aqueous and hydroalcoholic extract.¹⁵

 

Asphaltum (Shilajit)

Botanical name: Asphaltum is a mineral pitch ejected from crevices of rocks.

Phytochemistry: Shilajit contain 84 types of minerals in natural ionic form which are very vital for maintaining the equilibrium of energy metabolism in our body. Shilajit, fulvic acid, dibenzo-α-pyrones, humic acid, hippuric acid and trace elements (Fe, Ca, Cu, Zn, Mg, Mn, Mo, P).¹⁶

Mode of action: Fulvic acids helps in preventing and combating free radical damage to pancreatic islet B cells.

Fulvic acid significantly increases superoxide dismutase (SOD) activity.¹⁷ Shilajit is a powerful antioxidant that has the added benefit of being able to cross the blood-brain barrier. Antioxidants can safely neutralize a free radical without becoming a free radical them self. Shilajit was found to lower serum cholesterol, liver cholesterol, serum triglycerides and serum phospholipids in test subjects feed high cholesterol diet. It is adaptogen that helps to combat immune disorders, urinary tract disorders, nervous disorders and sexual dissatisfaction. It also promotes strong bones and heals damages muscle tissues, osteoarthritis and porous.¹⁸

 

Bombax ceiba (Cotton silk tree):

Botanical name: It contains leaves of Bombax ceiba belonging to family Malvaceae/ Bombacaceae.

Phytochemistry: Shaminin, mangiferin. ¹⁹

Mode of action: Shamimin, a C-flavonol glucoside from Bombax ceiba leaves showed significant potency as a hypotensive agent at the doses of 15 mg/kg, 3 mg/kg, 1 mg/kg and significant hypoglycaemic activity at 500 mg/kg in Sprague-Dawley rats.¹⁹ 

 

Butea monosperma (Kamarkas):

Botanical name: It contains of gum of Butea monosperma belonging to family Fabaceae.

Phytochemistry: Tannins, pyrocatechins, leucocyanictin. ²⁰

Mode of action: Gum is applied for cracks on foot sole. Gum is astringent to bowel, good in stomatitis, cough, pterygium, corneal opacities and cures excessive perspiration.²⁰

 

Emblica officinalis (Amla):

Botanical name: It contains dried fruits of Emblica officinalis belonging to family Euphorbiaceace.

Phytochemistry: Gallic acid, ellagic acid, phyllemblic acid, corilagic acid, emblicanin A and B, pedunculagin, puniglucanin, vitamin C, alkaloids such as phyllantidin and phylantine.²¹

Mode of action: Amla possesses anti-diabetic effects through their antioxidant and free radical scavenging properties. Amla has been reported to prevent/reduce hyperglycemia, cardiac complications, diabetic nephropathy, neuropathy, cataractogenesis and protein wasting.²²

 

Eugenia jambolana (Jambul):

Botanical name: It contains seed of Eugenia jambolana (Syzygium cumini) belonging to family Myrtaceae.

Phytochemistry: Alkaloid- jambosin, glycoside- jambolin or antimellin, beta sitosterol, tannin.²³

Mode of action: Quantitative determinations of Syzygium cumini seeds showed that defatted seeds and aqueous soluble gummy fibers (44%) from seed significantly lowered the blood glucose level and improved glucose tolerance in alloxan induced diabetic rats whereas aqueous insoluble fibers do not have significant hypoglycemic activity. Hypolipidaemic effect of ethanolic extract of seed was also evident from fall in total serum cholesterol/ HDL cholesterol ratio, serum LDL cholesterol level and lowering activity of HMG Co-A reductase in alloxan diabetic rats. Ethanolic extract of Eugenia jambolana seed kernel lowering the increased oxidative stress involved in pathogenesis and progression of diabetic tissue damage. This activity was observed when an increase in levels of plasma glucose, vitamin-E, ceruloplasmin, lipid peroxides and a decrease in levels of vitamin-C and glutathione observed in diabetic rats, recover back to the normal levels after treatment with Eugenia jambolana seed kernel extract. Ethanolic extract of Eugenia jambolana seed kernel also lowering the thiobarbituric acid reactive substance (TBARS) and increased in reduced glutathione (GSH), superoxide dismutase (SOD) and catalyze (CAT).²⁴

 

Ficus bengalensis (Indian banyan tree):

Botanical name: It contains bark of Ficus bengalensis belonging to family Moraceae.

Phytochemistry: 5,3- Dimethyl ether of leucocyanidin 3-o-β-D-galactosyl cellobioside,  5,7- Dimethyl ether of leucoperalgonidin 3-o-α-L- rhamnoside, bengalenoside.²⁵

Mode of action: Oral administration of aqueous extract to fed, fasted and  glucose loaded diabetic rats significantly decreased the  blood glucose level at 5 hours and restored the levels of  serum electrolytes, glycolytic enzymes and hepatic cytochrome P-450 dependent enzyme systems and decreased the formation of liver and kidney lipid peroxides at the end of 12 weeks. The water extract of bark of Ficus bengalensis has significant hypolipidaemic effects.²⁶

 

Gymnema sylvestre (Gurmar):

Botanical name: It consists of leaves Gymnema sylvestre belonging to family Ascepidaceae.

Phytochemistry: Gymnemic acid, Gurmarin, gymnemagenin, stigmasterol, lupeol. ²⁷

Mode of action: Gymnema leaf extract, notably the peptide ‘Gurmarin’, has been found to interfere with the ability of the taste buds on the tongue to taste sweet and bitter. Gymnemic acid has a similar effect. It is believed that by inhibiting the sweet taste sensation, people taking it will limit their intake of sweet foods and this activity may be partially responsible for its hypoglycemic effect. Gymnema sylvestre leaves helps in lowering serum cholesterol and triglycerides. ²⁷

There are some possible mechanisms by which the leaves extract of G.  Sylvester or (Gymnemic acid) possess its hypoglycemic acid effects are: ²⁷

a)      It promotes regeneration of islet cells.

b)      It increases secretion of insulin.

c)      It causes inhibition of glucose absorption from intestine.

d)      It increases utilization of glucose as it increase the activities of enzymes responsible for utilization of glucose by insulin-dependent pathways, an increase in phosphorylase activity, decrease in gluconeogenic enzymes and sorbitol dehydrogenase.

 

Holarrhena antidysentrica (Indrajav):

Botanical name: It contains bark of Holarrhena antidysentrica belonging to family Apocynaceae.

Phytochemistry: Conessine, kurchine, nor-conessine, 7-α- hydroxyconessine kurcholessine.²⁸

Mode of action: Methanolic extract of Holarrhena antidysentrica bark in alloxan induced diabetes mellitus rat brings about its antihyperglycemic action may be through potentiation of pancreatic secretion of insulin from the remnant beta-cells of islets. It could also be due to extra-pancreatic mechanisms like enhanced glycogenesis or decreased glycogenolysis by liver. It may be due to enhanced transport of blood glucose to peripheral tissues as seen by stimulatory effect on glucose uptake in rat diaphragm or due to inhibition of α-glucosidase.²⁹

 

Momordica charantia (Karela):

Botanical name: It contains fruits of Momordica charantia belonging to family Cucurbitaceae.

Phytochemistry: Alkaloid: momordicin, glycoside: momordin, charantin.³⁰

Mode of action: M. charantia, its extracts and isolated components are believed to exert their hypoglycaemic effects via different physiological and biochemical processes such as insulin secretagogue like effect, stimulation of skeletal muscle and peripheral cell glucose utilization, inhibition of intestinal glucose uptake, inhibition of hexokinase activity, suppression of key gluconeogenic enzymes (glucose-6-phosphatase and fructose-1, 6-bisphosphatase), improve glucose oxidation through the shunt pathway by activation of glucose-6-phosphate dehydrogenase and preservation of pancreatic islet cells and their functions. Momordica charantia extracts, particularly the saponins fraction, have lipid- lowering effects resulting from inhibition of pancreatic lipase activity and subsequent decreased lipid absorption.  ^{31, 32}

 

Pistacia integerrima (Crab’s claw):

Botanical name: It contains leaf galls of Pistacia integerrima belonging to family Anacardiaceae.

Phytochemistry: Pistagremic acid, α-pinene, β-pinene, α-phellandrene, δ-carene, pistacigerrimones A, B & C.

Mode of action: Pistacia integerrima is an important traditional herbal drug, which is used in oxidative stress and has potential to counter hyperuricemia. It is also used for treatment of liver disorders. Pistagremic acid (PA) was isolated from the dried galls extract of P. integerrima. Strong α-glucosidase inhibitory potential of PA was predicted using its molecular docking simulations against yeast α-glucosidase as a therapeutic target. Significant experimental α-glucosidase inhibitory activity of PA confirmed the computational predictions.³³

 

Plumbago zeylanica (Doctorbrush):

Botanical name: It contains roots of Plumbago zeylanica belonging to family Plumbaginaceae.

Phytochemistry: naphthaquinones are plumbagin, biplumbagin, chitranone, coumarins: selesin, xanthyletin, other compounds are β-sitosterol, bakuchiol, isoorientin.³⁴

Mode of action: Plumbago zeylanica has antihyperglycemic effect on diabetes induced animals. The ethanol extract of Plumbago zeylanica root on key enzymes of glycolysis and muscle hexokinase, phosphofructokinase, pyruvate kinase lactate dehydrogenase activities were diminished in diabetic rats. Plumbago zeylanica extract has hypolipidaemic and antiatherosclerotic activities. Plumbagin, an active principle isolated from Plumbago zeylanica brings about a definite regression of atherosclerosis and prevents the accumulation of cholesterol and triglycerides in liver and aorta. The isolation and spectral data for new flavonoid 2-(2, 4-Dihydroxy-phenyl)-3, 6 trihydroxy chromen-4-one from the roots of P. zeylanica were determined and the antioxidant activity was studied by free radical scavenging and superoxide radical scavenging methods.^{34, 35}

 

Pongamia glabra (Karanja):

Botanical name: It contains seed of Pongamia glabra belonging to family Fabaceae.

Phytochemistry: alkaloids: demethoxy-kanugin, karanjin, isopangaflavone, pongapine, glabrin, kanjone, flavonoid: glabrachalcone and isopongachromene.³⁶

Mode of action: Pongamia glabra seed hydroalcoholic extract exhibited a significant dose dependent antihyperglycemic activity compared to diabetic control in streptozotocin and alloxan induced hyperglycemic rats. Serum urea, serum creatinine, serum cholesterol and serum protein level were reduced in a dose dependent manner by the extracts at the dose of 100 mg/kg, 250mg/kg and 500 mg/kg during treatment period.³⁷

 

Pterocarpus marsupium (Vijaysar):

Botanical name: It contains heartwood of Pterocarpus marsupium belonging to family Leguminosae.

Phytochemistry: Pterostilbene, liquiritigenin, isoliquiritigenin, pterosupin, (-)-epicatechin, kinotannic acids, marsupsin, carsupin, pterosupin. ³⁸

Mode of action: ^{38, 39}

Polyphenolic compounds:

a)     The active constituents of Vijaysar are polyphenolic compounds which significantly lowers the blood glucose level of hyperglycemic due to an increase in insulin secretion and its impaired glycogen synthesis in the liver.

b)    It modulates tissue glucose utilization in insulin-dependent tissues.

c)     It slows the development, progression and severity of cataract, a common complication of chronic diabetes. 

d)    It helps to reduce the glucose absorption from the gastrointestinal tract and improve insulin and pro-insulin levels. 

e)     It is effective in beta cell regeneration and has also been found to have a hypocholesteremic effect.

f)     It shows significant reduction of glycosylated hemoglobin and an increase in total hemoglobin level.

Alkaloids (0.4%):

a) It significantly lowers the high blood sugar level in body.

b)It raises the blood pressure and indirectly on sympathetic nerves.

 

Santalum album (Sandalwood):

Botanical name: It contains heartwood of Santalum album belonging to family Santalaceae.

Phytochemistry: Sesquiterpenols: α-santalol, β-santalol, sesquiterpenenes: santalenes.⁴⁰

Mode of action: Sandalwood oil shows an indirect antioxidant activity by increasing the glutathione-S-transferase (GST) activity and the acid soluble SH level in the liver of Swiss albino mice. Santalum album petroleum ether fraction has potential anti hyperglycemic and anti hyperlipidemic activity that can help in overcome the insulin resistance.^{40, 41}

 

Swertia chirata (Chirata):

Botanical name: It contains whole plant of Swertia chirata belonging to family Gentinaceae.

Phytochemistry: Mangeferin, sawertiamarin, amarogentin, methylswertianin, bellidifolin, balanophonin, oleanolic acid, maslinic acid, sumaresinolic acid, ophelic acids, chiratin. ⁴²

Mode of action: Swertia chirata helps in stimulating insulin production, enhancing glycolytic enzymes, inhibiting α-glucosidase and other enzymes such as maltase, sucrase, isomaltase and aldose reductase and indirectly by its antioxidant capacity and analgesic, anti-inflammatory, antiatherogenic, cardioprotective and antihyperlipidemic properties.⁴³

 

Terminalia chebula (Haritaki):

Botanical name: It contains dried fruits of Terminalia chebula belonging to family Combretaceae.

Phytochemistry: Chebulagic acid, chebulinic acid, corilagin, gallic acid.⁴⁴

Mode of action: Terminalia chebula extract: ⁴⁵

a)      Stimulates insulin secretion from the remnant β-cells or from regenerated β-cells.

b)      Decreases  glycosylated hemoglobin with concomitant increase in the level of total hemoglobin,

c)      Enhances the hexokinase activity due to the activation of mRNA coding.

d)      Reduces the lactate dehydrogenase (LDH) activity is probably due to regulation of nicotinamide adenine          dinucleotide/ reduced nicotinamide adenine dinucleotide (NAD⁺/NADH) ratio by oxidation of NADH.

e)      Modulates and regulates δ activities of the two gluconeogenic enzymes (glucose-6-phosphatase and fructose-1,6-biphosphatase), either through the regulation by 3’,5’-cyclic adenosine monophosphate (cAMP) and any other metabolic activation or inhibition of glycolysis and gluconeogenesis.

f)       Restores the level of hepatic glycogen by means of decreasing the activity of glycogen phosphorylase and increasing the activity of glycogen synthase.

g)      Inhibits effect on carbohydrate hydrolyzing enzymes like α-amylase and α-glucosidase.

 

Tribulus terrestris (Gokaru):

Botanical name: It contains whole plant of Tribulus terrestris belonging to family Zygophyllaceae.

Phytochemistry: Protodiosin, β-sitosterol, stigmasterol, chlorogenin, rutin, alkaloid: harman and harmol, steroidal glycoside: neohecogenin glucoside and tribulosin.  ^{46, 47}

Mode of action: Furostanolic type of saponins present in Tribulus terrestris increasing the amount of luteinizing hormone (LH), motivate spermatogenesis and result in stimulation of testosterone. Methanolic extract of Tribulus terrestris showed significantly decreased in blood glucose level and glycosylated hemoglobin in rats. Methanolic extract of saponins of Tribulus terrestris were found to significantly lower serum total cholesterol, low density lipoprotein cholesterol and liver total cholesterol, triglycerides in diet induced hyperlipidemia in mice. Decreased systolic blood pressure was reported with the treatment of lyophilized aqueous extract of tribulus fruits. Hydroalcoholic lyophilized extract of whole plant of Tribulus terrestris showed cardioprotective function.⁴⁷

 

Woodfordia fruticosa (Fire flame bush):

Botanical name: It contains whole plant of Woodfordia fruticosa belonging to family Lythraceae.

Phytochemistry: Woodfordin A-I, isoschimawalin A, β-caryophyllene, α-pinene.⁴⁸

Mode of action: Ethanolic extract enhanced the hepatic hexokinase activity, resulting the increase in glycolysis and peripheral glucose utilization, increased plasma insulin decreases gluconeogenesis by decreasing the activities of key enzymes such as glucose-6-phosphatase, fructose-1,6-biphosphatase, phosphoenolpyruvate carboxykinase and pyruvate carboxykinase, increase in liver glycogen levels, antioxidant activity act by inhibition of free radical formation and lipid peroxidation in liver.⁴⁹

 

CONCLUSION:

Diabetes mellitus is a metabolic disorder of endocrine system. It is characterized by hyperglycemia, glycosuria, hyperlipidemia, polyuria, polyphagia, polydipsia, negative nitrogen balance and sometime ketonemia, Hyperglycemia (high blood glucose level) that result from defects in insulin secretion, or defective response of insulin, or both. Oral hypoglycemic agents are useful in the treatment of diabetes but their use is restricted by pharmacokinetics properties, secondary failure rates and accompanying side effects. This has highlightened the importance and relevance of natural medicines. Natural medicines have hypoglycemic effects which can also be used to treat various types of secondary complications of diabetes mellitus.

 

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Received on 15.07.2014                Modified on 12.08.2014

Accepted on 18.08.2014                © RJPT All right reserved

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