15 - Diabetes Flashcards
List examples of natural health products
- Vitamins and Minerals
- Herbal Remedies
- Homeopathic medicines
- Traditional medicines such as TCM
- Probiotics, amino acids and essential fatty aids
What are herbal remedies?
Substances derived from plants used for medicinal properties
What are the pharmacists’ responsibilities with NHPs
- Safety first !!
- Assessment
- Education - Practical tips
- Support - Empowerment
What are concerns that ppl have with NHPs
- Side effects
- Drug Interactions
- Impurities
- Many different names for products
- May copy, increase or oppose the effects of drugs
- Many unanswered questions regarding safety, efficacy, dosing, drug interactions
What is the active component in french lilac/goat’s rue?
A guanidine
**Where metformin came from - type of biguanide
Is French Lilac/Goat’s Rue recommended ?
too toxic for regular treatment - DO NOT USE
Possible actions of Alpha-lipoic Acid-Thioctic Acid ?
improves insulin sensitivity and glucose disposal
SE of Alpha-lipoic Acid-Thioctic Acid ?
nausea, dizziness and skin rash
Interactions with Alpha-lipoic Acid-Thioctic Acid ?
- diabetes meds
- chemotherapy
- thyroid disease
Alpha-lipoic Acid-Thioctic Acid:
Possibly safe when ?
when used orally appropriately from 4 months - 4 years (NOT SAFE OVER 4 YEARS)
Alpha-lipoic Acid-Thioctic Acid:
Effective?
possibly effective for diabetes
What is the active component of Glucomannan ?
non absorbed polysaccharide
MOA of Glucomannan
delays glucose absorption
SE of Glucomannan
Laxitive effect, esophageal and gastrointestinal obstructions reported with tablet form
Is Glucomannan safe?
safe when used as food or in powder or capsule form for up to 4 months
Is Glucomannan effective?
possibly effective
Drug interactions with Glucomannan?
decreases absorption of other meds and fat soluble vitamins
What is Chromium ?
Essential trace element required for normal glucose metabolism
Action of Chromium?
Reduce Fasting Blood Glucose, Insulin and A1C
Side effects of Chromium ?
Well tolerated, headache, insomnia, sleep disturbances, irritability and mood changes
Safety of Chromium ?
likely safe orally when used short term. has been safely used in doses up to 1000 mcg/day up to 6 months
Is Chromium effective ?
Possibly effective 40-80% of patients have improved glucose tolerance
*Thought to be effective only in deficiency
Active components of bitter melon ?
- charantin
- polypeptide P
- vicine
Possible actions of bitter melon
- increased insulin secretion
- tissue glucose uptake
- decreased gluconeogenesis
SE of bitter melon
- diarrhea
- GI upset and pain
- two cases of hypoglycaemic coma in children drinking tea
Safety of bitter melon ?
possibly safe when used orally up to 3 months
Is bitter melon effective?
insufficient reliable evidence to rate
_____ _____ is an insulin like protein, common in India
bitter melon
Possible actions of Fenugreek ?
seeds contain 50% fibre and pectin delays gastric emptying, slowing glucose absorption, increase insulin secretion
SE of Fenugreek
flatulence, diarrhea, hypersensitivity reactions
Avoid Fenugreek in those with _____ allergy
peanut
Is Fenugreek safe in pregnancy ?
NO - Unsafe
_____ is a reasonable time frame to do A1C
3 months
Active component of Ginseng
Ginsenosides
Possible actions of Ginseng ?
increases glucose transport and uptake, modulates insulin secretion
SE of Ginseng?
nervousness, excitation, headache, hypertension, insomnia
Interactions with Ginseng?
May interfere with anticoagulation
Safety considerations with Ginseng?
Concern with adulteration (failure to meet standards). Use for short term only up to 12 weeks
Efficacy of Ginseng ?
possibly effective, evidence limited
Active component of Cassia cinnamon?
polyphenolic polymers
Possible action of Cassia cinnamon ?
enhance insulin action, increases glucose uptake
SE of Cassia cinnamon ?
well tolerated
High amounts of Cassia cinnamon can cause ?
hepatotoxicity
What do you do if a patients wants to use a herbal therapy?
-encourage patient to get as much reliable information about the herbal remedy (indications for use, interactions, possible side effects)
What should our patients know before choosing a non-Rx product?
- Will it affect blood glucose levels?
- Does it interact with diabetes medications?
- Are the ingratiates safe for a person with diabetes to use safely?
How do you use NHPs safely ?
- Work with/inform healthcare providers
- Products with NPN number or EN number
- Encourage single ingredient products
- Encourage small starting dose determine effects/side effects
- Help patients learn to spot false claims
- Avoid products and promoters who make claims such as quick and effective cure-all, totally safe, all natural and no side effects, no risk, money back guarantees
Are NHPs recommended for diabetes?
NHPs are not recommended for glycemic control for individuals with diabetes as there is insufficient evidence, at this time, regarding efficacy and safety
-HCPs should ask about the use of these NHPs
Summary of NHPs
- Natural is not always safe
- New regulations
- Little scientific evidence - help patients investigate
- Potential to affect blood glucose
- Encourage use with not instead of conventional meds
- Encourage blood glucose monitoring
- Encourage recording effects; if no results discontinue
