15 - Diabetes Flashcards by Sam Myers

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

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What are herbal remedies?

Substances derived from plants used for medicinal properties

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What are the pharmacists’ responsibilities with NHPs

Safety first !!
Assessment
Education - Practical tips
Support - Empowerment

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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

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What is the active component in french lilac/goat’s rue?

A guanidine

**Where metformin came from - type of biguanide

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Is French Lilac/Goat’s Rue recommended ?

too toxic for regular treatment - DO NOT USE

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Possible actions of Alpha-lipoic Acid-Thioctic Acid ?

improves insulin sensitivity and glucose disposal

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SE of Alpha-lipoic Acid-Thioctic Acid ?

nausea, dizziness and skin rash

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Interactions with Alpha-lipoic Acid-Thioctic Acid ?

diabetes meds
chemotherapy
thyroid disease

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Alpha-lipoic Acid-Thioctic Acid:

Possibly safe when ?

when used orally appropriately from 4 months - 4 years (NOT SAFE OVER 4 YEARS)

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Alpha-lipoic Acid-Thioctic Acid:

Effective?

possibly effective for diabetes

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What is the active component of Glucomannan ?

non absorbed polysaccharide

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MOA of Glucomannan

delays glucose absorption

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SE of Glucomannan

Laxitive effect, esophageal and gastrointestinal obstructions reported with tablet form

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Is Glucomannan safe?

safe when used as food or in powder or capsule form for up to 4 months

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Is Glucomannan effective?

possibly effective

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Drug interactions with Glucomannan?

decreases absorption of other meds and fat soluble vitamins

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What is Chromium ?

Essential trace element required for normal glucose metabolism

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Action of Chromium?

Reduce Fasting Blood Glucose, Insulin and A1C

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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