L15-Diabetes Flashcards
what % of pts dont tell their phys about their NHP use?
Implications for HCPs?
70% (but use is high!!)
- safety first
- assessment, education and support! (those who support have better outcomes; builds trust and relationships)
List main concerns w NHPs.
- se, di, impurities
- many diff names for products (common, botanical, scientific)
- may copy, increase or oppose effects of drug
- many unanswered q’s on safety, efficacy, dosing and DIs
- lack of standardization
- lack of scientific studies
- there are diff terminologies that can lead to confusion: natural, alternative, complementary
- sme drugs that can affect blood gluc levels
What leads to lack of STD-ization?
-leads to changes in potency, efficacy, ect
>where the plant is grown, how it is stored, the part of the plant, how it is prepared, ect
List NHPs.
- French lilac
- Alpha-lipoic acid-thioctic acid (ALA)
- Glucomannan
- Chromium
- Bitter melon
- Fenugreek
- Ginseng
- Cassia Cinnamon
- Others!
- French Lilac/ Goat’s Rue
Scientific name?
AI?
Recipe?
SN: Galagae Officinalis
AI: galagine (a guanidine)-> has effect in vitro
-medieval recipe BUt is too toxic for regular tx therefore DO NOT use
- French Lilac/ Goat’s Rue
Recipe to make available! Would you recommend?
NOOOOO
-medieval recipe BUt is too toxic for regular tx therefore DO NOT use
- ALA
Effectiveness?
POSSIBLY EFFECTIVE
-P Effects: improves insulin sensitivity, glucose disposal
>no changes in fasting plasma levels for glucose or insulin
>need more evidence
- ALA
SAFETY?
POSSIBLY SAFE
for 4m-4y (DM is LT condition)
- ALA
SE?
DI?
- se: nausea, dizziness, and skin rash
- DI: diabetes meds, chemo, thyroid disease
- possibly safe when used orally appropriately from 4m to 4y
- Glucomannan
Describe!
MOA?
(konjac, amorhophallus konja)
AI: non absorbed polysaccharide
-Action= delays glucose absorption
-this is a fibrous material: does have some effect bc it is recommended for pts w DM to increase their fibre intake
- Glucomannan
Found in ____
PGX
- Glucomannan
Safeness?
- SAFE up to 4m (in food, caps)
- SE: laxative effect, esophageal & GI obstructions reported w tablet form
- decreases absorption of other meds and fat soluble vitamins
- Glucomannan
Effectiveness?
POSSIBLY EFFECTIVE.
-reduced primary end points
(serum fructosamine, total:HDL ratio and SPB compared to placebo)
-did not effect LDL, HDL, TGs, glucose, insulin and DBP
- Chromium
Describe!
MOA!
=essential trace element required for normal glucose metabolism
-MOA: reduce FBG, insulin, A1C
- Chromium
Safety?
LIKELY SAFE
- Short-term (up to 6m)
- SE: well tolerated, headache, insomnia, sleep disturbances, irritability and mood changes
- Chromium
Effectiveness?
POSSIBLY EFFECTIVE
- 40-80% of pts have improved glucose tolerance (thought to be effective only in deficiency)
- findings limited as >50% studies were of poor quality, used different formulation, or used doses in populations that have little chromium in their diet
- Bitter melon
(momordica charantia)
- AIs: charantin, polypeptide P and vicine
- possible actions: increased insulin secretion, tissue glucose uptake, decreased gluconeogenesis
- Bitter melon
(momordica charantia)
- AIs: charantin, polypeptide P and vicine
- possible actions: increased insulin secretion, tissue glucose uptake, decreased gluconeogenesis
- Bitter melon
Safety?
POSSIBLY SAFE
- up to 3m
- SE: diarrhea, GI upset and pain, 2 cases of hypoglyc coma in children drinking tea
- Bitter melon
Effectiveness?
- Insuff reliable evidence to rate, shitty studies
- after 3m no change in A1C or FBG
- Fenugreek
Describe
(Trigonella foenum-graecum, greek clover)
AI: 4- hydroxyisoleucine, sotolon and Trigonelline
-possible actions: seeds contain 50% dibre and pectin delays gastric emptying, slowing flucose absorption, increase insulin sectioni
- Fenugreek
Safety?
- GRAS (avoid in peanut allergy)
- unsafe in preg
- se: flatulence, diarrhea, hypersensitivity
- Fenugreek
Effectiveness?
POSSIBLY EFFECTIVE
-again is a fibrous material, so it makes sense that it may help out w diabetes control)
- Ginseng
describe
(panax ginseng, panax quinquefolius)
AI: ginsenosides
-possible actions: increases glucose transport and uptake, modulates insulin secretion
- Ginseng
safety!
- concern w adulteration; use for short term only yp to 12wks
- se: nervousness, excition, headache, HTN, insomnia
- DIs: may interfere w anti-coag
- Ginseng
Effectiveness!
POSSIBLY EFFECTIVE
- evidence limited
- the initial study did show some initial effects BUT when we went to test again (even using the same tabs from the same manufacturer) and could not get the same results bc even these tabs were diff (lack of standardization)
- Cassia cinnamon
Describe!
(chinese cinnamon, cassia bark, cinnamomum aromaticum)
-MUST be cassia type
AI: polyphenolic polymers (hydroxychalcone)
-possible action: enhance insulin action, increases glucose uptake
- Cassia cinnamon
Safety!
GENERALLY RECOGNIZED AS SAFE (GRAS)
BUT can cause some tox in some pts w prolonged se of excessive amounts
-se: well tolerated
- Cassia cinnamon
EFFECTIVNESS
POSSIBLY INEFFECTIVE
-all HYPE YO
- OTHERS
LIST
- Allium sativum (garlic)
- Aloe Vera
- Banaba
- Opuntial streptacantha (prickly pear cactus,Nopal)
- Coccina indica (Ivy Gourd)
- Gymnema sylvestre (symnema)
- Vanadium
if a pt comes in w increasing FBG levels, what should we do as a pharmacist?
- ask them if they have started any NHPs or other products lately
- ask them adherence
- have htey stopped anything/ any changes
CASE 1: T.R -72 yr old T2DM not well controlled (A1C 8.9%), co-morbid a fib, hyperlipidemia, osteoarthritis, depression -Medication List: >Metformin >Cozaar >Warfarin >Digoxin >Lipitor >Paxil >Tylenol -NHP: St. J's wort, asian ginseng, glucosamine
- St johns wort - interact w bp meds, affect dig, INR
- Asian ginseng can be used for DM and increased nrg
- glucosamine used for jt pain
Note: IMPORTANT TO DO research in products, if you do make changes, dont make too many (bc you may not know what the cause is so you want to slowly change and find out the problem
What to do if a pt wants to use an herbal therapy?
What should they know before hand?
-encourage pt to get as much reliable info about the herbal remedy (indications for use, interactions, possible se)
- will it affect blood gluc levels
- dose it interact w DM
- are the ingredients safe for a person w DB to use?
safe use of NHPs
-work w/ inform HCPs
-products w NPN # or EN #
-encourage single ingredient products
-encourage small starting dose determine effects/ se
-help pts 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 se
>no risk, money back guarantees
have any NHPs been shown to lower A1C?
-by 0.5+ % in trials lasting 3+m in adults w T2D, but most are single small trials so it would be premature to recommend their widespread use
-HCPs should always ask about the use of NHPs since some may result in se or DI
(78% of pts w DM reported taking a NHP for various indications)
-NOT recommended for glycemic control for indivs w DM as there is insuff evidence at this time (efficacy and safety grade D)
