Diabetes is an important human ailment afflicting many from various walks of life in different countries. In India it is proving to be a major health problem, especially in the urban areas. Though there are various approaches to reduce the ill effects of diabetes and its secondary complications, herbal formulations are preferred due to lesser side effects and low cost.
One of the etiologic factors implicated in the development of diabetes and its complications is the damage induced by free radicals and hence an antidiabetic compound with antioxidant properties would be more beneficial.
Diabetes is a chronic disorder of carbohydrate, fat and protein metabolism characterized by increased fasting and post prandial blood sugar levels. Studies conducted in India show that it is increasing rapidly in the urban population. It is estimated that there are approximately 33 million adults with diabetes in India. This number is likely to increase to 57.2 million by the year 2025.
Diabetes mellitus is a complex metabolic disorder resulting from either insulin insufficiency or insulin dysfunction. Type I diabetes (insulin dependent) is caused due to insulin insufficiency because of lack of functional beta cells. Patients suffering from this are therefore totally dependent on exogenous source of insulin while patients suffering from Type II diabetes (insulin independent) are unable to respond to insulin and can be treated with dietary changes, exercise and medication.
Diabetes Type II is the more common form of diabetes constituting 90% of the diabetic population. Symptoms for both diabetic conditions may include: (1) high levels of sugar in the blood; (2) unusual thirst; (3) frequent urination; (4) extreme hunger and loss of weight; (5) blurred vision; (6) nausea and vomiting; (7) extreme weakness and tiredness; (8) irritability, mood changes etc.
Free radicals are capable of damaging cellular molecules, DNA, proteins and lipids leading to altered cellular functions. Studies reveal that antioxidants capable of neutralizing free radicals are effective in preventing experimentally induced diabetes in animal models as well as reducing the severity of diabetic complications.
In diabetic patients, extra-cellular and long lived proteins, such as elastin, laminin, collagen are the major targets of free radicals. These proteins are modified to form glycoproteins due to hyperglycemia. The modification of these proteins present in tissues such as lens, vascular wall and basement membranes are associated with the development of complications of diabetes such as cataracts, microangiopathy, atherosclerosis and nephropathy. During diabetes, lipoproteins are oxidized by free radicals. There are also multiple abnormalities of lipoprotein metabolism in very low density lipoprotein (VLDL), low density lipoprotein (LDL), and high density lipoprotein (HDL) in diabetes.
Lipid peroxidation is enhanced due to increased oxidative stress in diabetic condition. Apart from this, advanced glycation end products (AGEs) are formed by non-enzymatic glycosylation of proteins. AGEs tend to accumulate on long-lived molecules in tissues and generate abnormalities in cell and tissue functions. In addition, AGEs also contribute to increased vascular permeability in both micro and macrovascular structures by binding to specific macrophage receptors. This results in formation of free radicals and endothelial dysfunction. AGEs are also formed on nucleic acids and histones and may cause mutations and altered gene expression.
Patients of diabetes either do not make enough insulin or their cells do not respond to insulin. In case of total lack of insulin, patients are given insulin injections. Whereas in case of those where cells do not respond to insulin many different drugs are developed taking into consideration possible disturbances in carbohydrate-metabolism. For example, to manage post-prandial hyper-glycaemia at digestive level, glucosidase inhibitors such as acarbose, miglitol and voglibose are used. These inhibit degradation of carbohydrates thereby reducing the glucose absorption by the cells. To enhance glucose uptake by peripheral cells biguanide such as metphormine is used. Sulphonylureas like glibenclamide is insulinotropic and works as secretogogue for pancreatic cells.
There are certain limitations of these medicines like high cost and side effects such as development of hypoglycemia, weight gain, gastrointestinal disturbances, liver toxicity etc.
Based on involvement of oxidative stress in complicating diabetes mellitus, we can use suitable antidiabetic and antioxidant therapy to treat diabetes
Bitter gourd powder lowers blood and urine sugar levels. It increases body’s resistance against infections and purifies blood. Bitter Gourd has excellent medicinal virtues. It is antidotal, antipyretic tonic, appetizing, stomachic, antibilious and laxative. It contains compounds like bitter glycosides, saponins, alkaloids, reducing sugars, phenolics, oils, free acids, polypeptides, sterols, 17-amino acids including methionine and a crystalline product named p-insulin. It is reported to have hypoglycemic activity in addition to being antihaemorrhoidal, astringent, stomachic, emmenagogue, hepatic stimulant, anthelmintic and blood purifier.
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