Aqueous Extract of Herbal Mixture Along with Allopathic Drugs for The Contorl of Diabetes Mellitus: A Case Report

 

 

 

 

 

pH

 

Measurement of pH of urine indicates the nature of urine whether it is acidic or alkaline. pH test provides information related to the problem in the urinary tract or kidneys. In general, pH of urine ranges from 4.5 to 8.0. Analysis of pH of urine presented in Table 3 and all fresh urine samples (January 2018, January 2019, March 2021 and April 2023) were exhibited the pH was 5.5. It clearly demonstrates that urine was in acidic nature. Here also, after consumption of water soaked fenugreek seeds or aqueous extract of herbal mixture did not change the pH of urine.   

Urine glucose (Sugar)

 

Glucose (Sugar) in urine analysis is an indication of the amount of sugar present in the urine. Generally it is termed as glycosuria. Mostly, the absence of glucose in the urine considered as normal. The normal range of glucose in urine stays between 0 to 0.8 mmol/L. The presence of glucose in urine presented in Table 3 and all samples (January 2018, January 2019, March 2021 and April 2023) exhibited the absence of glucose in urine. It indicated that urine glucose level was normal.

 

Urine Protein

           

Proteins are important molecules which are essential to work body properly. Proteins are present in the blood and blood circulates proteins to all parts of the body. The blood is cleaned by kidney and in cleaning process small amount of waste protein is found in urine. If kidneys are not functioning properly then there is a chance of leaking of protein in urine. If the high amount of protein leaked in urine suggests improper functioning of kidney. The normal range of protein in urine is less than 1 g per day. The presence of protein in urine illustrated in Table 3 and it was nil for January 2018. Similarly all other fresh urine samples such as January 2019, March 2021 and April 2023 also exhibited the absence of protein in urine. It indicated that urine protein level was normal.

Pus cells

Presence of pus cells in urine is a medical disorder which causes white blood cells in the urine or pee. The normal range of the pus cells in urine is 0 to 5 hpf (high power field). Pus cells analysis of urine is presented in Table 3 and it was 0.2 hpf for January 2018. It clearly suggested that there was no urinary track infection. Similar investigations were performed in January 2019, March 2021 and April 2023 and the almost similar observations were obtained.

Epithelial cells

Epithelial cells that generally come from skin, blood vessels, urinary tract, organs etc. The normal range of epithelial cells present in the urine sample is 15 to 20 cells per high power field (hpf). A small number of epithelial cells present in urine indicates kidney, blood vessels, urinary track are functioning very well. If more than 15 renal tubular epithelial cells per hpf present in urine means your kidneys are not working properly. Presence of large number epithelial cells in urine may be a sign of infection, kidney disease, or another serious medical condition. The epithelial cells in urine analysis presented in Table 3 and it was 1.1 hpf for January 2018. Similar investigations were performed in January 2019, March 2021 and April 2023 and were the 0.2, 2.6 and 2.4 respectively. It depicted that functioning of kidneys was normal.

Red blood cells

Red blood cells (RBC) present in urine indicates acute or chronic diseases. Generally, healthy person doesn’t show presence of RBCs in urine. Threshold value of RBC is up to 4 hpf (high power field) and is considered as normal. RBC cells in urine analysis is presented in Table 3 and it was nil for January 2018. Similar investigations were performed in January 2019, March 2021 and April 2023 and the observations were the same. It illustrated that functioning of kidneys was normal.

Casts 

Generally urinary casts are observed under microscope. Basically, it is nothing but the clusters of urinary particles such as cells, fat bodies, microorganisms etc. Urinary casts inform about functioning of kidney. Normal range of casts present in urine stands between 0 to 2 casts per low power field of the microscope. Casts in urine analysis reported in Table 3 and it was nil for January 2018. It revealed that functioning kidneys is normal. Similar investigations were performed in January 2019, March 2021 and April 2023 and the observed casts were nil.   

Crystals

In general, too many minerals observed in urine may clump together with other substances and form solid crystals. Sometime crystals form stones and urinary tract may cause blockages. Normal range of crystals in urine is less than 40 mg/L of urine daily. Crystals in urine analysis is presented in Table 3 and it was nil for January 2018. It illustrates that functioning of kidneys is normal. Similar investigations were performed in January 2019, March 2021 and April 2023 and the observed crystals were nil.

DISCUSSION

Oxygen is one of the most important elements for the survival of the human body. Human cells use oxygen to generate energy but simultaneously it produces few free radicals. At high concentrations of free radicals they start to generate oxidative stress and this stress start to damage human cell structures. Simultaneously this stress start to develop ailments in human body such as diabetes, cancer, arthritis, aging, autoimmune disorders, cardiovascular and neurodegenerative diseases [15].

Free radicals are mainly responsible for the development of diabetes mellitus. Diabetes mellitus is occurred due to misbalance between generation and decomposition of free radicals. Basically, Free radicals are a group of atoms, molecules, or molecular fragments possessing one or more unpaired electrons in the outer shell of aromatic nucleus. Excessive production of free radicals decompose biomolecules e.g. lipids, proteins, DNA etc. Free radicals are highly active due to the presence of unpaired electron in their structure [16].  Mainly, there are two types of free radical reactive species e.g. Reactive oxygen species (ROS) and Reactive nitrogen species (RNS). Reactive oxygen species (ROS) includes Superoxide radical (O2?−), Hydroxyl radical (OH?), Peroxyl radical (ROO? ), Alkoxyl radical (RO?), Hydroperoxyl radical (HO2?), Lipid peroxyl radical (LOO? ) and Reactive nitrogen species (RNS) comprises Nitric oxide radical (NO? ) and Nitrogen dioxide radical (NO2?). In general, free radicals are generated in human body by two ways such as internal or external sources. In the human body, Mitochondria, NADPH oxidase, Lipoxy genases are main internal sources of free radicals whereas environmental pollutants, cigarette smoke, radiation, certain drugs, industrial solvents, alcohol, ultraviolet light, pesticides, and anesthetic solvents are the external sources of free radicals [17].

Antioxidants play very important role in controlling diseases such as Diabetes mellitus, High blood pressure, Cancer, Alzheimer, Parkinson etc. Antioxidants are defined as the natural or synthetic materials that protect body cells from free radicals. Basically, antioxidants are chemicals that bind with free radicals and nullify their effects. Antioxidants have lot of importance from human health point of view. This is because they reduce free radicals, stimulate the growth of normal cells, protects cells from abnormal aging, helps to fight against age related molecular degeneration, supports immune system of the body etc..Principally, they worked as free radical scavengers and also they can prevent and repair damage of cells caused by free radicals [18].

Phenolic compounds play very important role in human health. This is because they possess anti-aging, anti-inflammatory and antioxidant properties. In addition to that, there are several relevant antioxidant enzymes to counter oxidants. According to structural formula of phenolic compound, they exhibit at least one hydroxyl group substitution on aromatic ring. Phenolic compounds include polyphenols, flavonoids, phenolic acids and tannins which inhibit α-glucosidase and α-amylase. Basically, these enzymes are responsible for the digestion of dietary carbohydrates to glucose. These phenolic compounds are also useful to chelate heavy metal ions namely iron and copper ions. These metal ions form chelates with functional groups such as hydroxyl and carboxyl [19].

Allopathic treatment

In 2014, the symptoms of diabetes mellitus were observed and were confirmed by pathological tests. Thus, medical doctor prescribed Gluconorm SR 500 for diabetes mellitus control along with high blood pressure medicines. The variety types of allopathic drugs are used to treat diabetes mellitus such as biguanide, sulfonylureas, alpha-glucosidase inhibitors, thiazolidinediones, gliptins etc. The medicines prescribed during a period of 2017 to 2023 based on the treatment of diabetes mellitus are listed in Table 1. Most commonly used allopathic drug is Metformin to treat the first-line therapy for diabetes mellitus. This is because of extensive safety margin, decreases hepatic glucose production and mildly affects peripheral resistance [20].

HERBAL TRETAMENT ALONGWITH ALLOPATHIC MEDICINES   

Fenugreek seeds

Lock-down process of COVID-19 was started in India in March 2020. According to that situation, we started to think about the herbal based supplementary medicine along with allopathic medicines for the control of diabetes mellitus as home remedy. According to literature search, fenugreek seeds are highly useful from diabetes control point of view. Basically, it classified as a family of Trigonella foenum-graecum. The oral consumption of fenugreek seeds is highly useful for diabetic patients to control sugar levels. The chemical composition of fenugreek seed was performed by Yasothai R. (2012) [21] and it composed of crude protein, crude fibre, nitrogen free extract, neutral detergent fibre, acid detergent fibre, hemicelluloses, calcium, phosphorus, zinc and iron. The analysis report of aqueous extract of fenugreek seeds suggest that it contains alkaloids, flavonoids, carbohydrates, phenolic compounds and tannins, terpenoids, saponins, amino acids, protein, glycosides, steroids etc [22].

In June 2020, patient started to consume orally 5 g of overnight water soaked fenugreek seeds (methi grains) as supplementary herbal medicine along with regular allopathic medicines of diabetes mellitus. Fenugreek seeds (methi grains) treatment was continued for almost 9 months.  In March 2021, pathological tests were performed as regular yearly check-up and sugar analysis results of fasting and post-prandial sugars were 132 and 192 mg/dL respectively. The obtained results indicate that sugar levels were on higher side. Hence medical doctor replaced Gluconorm  SR 500 and Tiban M 20/500 by Vylda M (50/500) and glizid 30 tablet respectively  by keeping the other regular allopathic medicines same.

Tiban is an anti-diabetic medicine and basically it contains teneligliptin drug. Teneligliptin is an anti-diabetic drug and it inhibits dipeptidyl peptidase-4 enzyme. This drug controls the serious complications of diabetes such as kidney damage and blindness. Most importantly it reduces livers glucose production and releases more insulin from the pancreas [23]. Glizid 30 (Glicazide 30) drugs are coming under class of medicines called as sulfonylureas. It is specifically used to control blood sugar levels in case of diabetes mellitus. Important thing is that, this drug prevents serious complications of diabetes like kidney damage, blindness, nerve problems and loss of limbs. The prime role of Gliclazide 30 is to increase the amount of insulin production resulting lower blood glucose levels [24].

Aqueous extract of herbal mixture treatment along with allopathic medicines

Consumption of overnight water soaked fenugreek seeds experiment was failed to control sugar levels. Then we started to think about alternative herbal supplementary medicine to control the diabetes mellitus. Literature search was performed to see the herbal powder or seeds to control the diabetes mellitus. According to literature search, we decided to prepare a new formulation derived mixture of ginger, clove, cinnamon, black pepper and black tea powder. These herbals were boiled in aquaguard purified water for 15 min. and filtered aqueous extract was consumed orally by mouth, because all these herbals possess very good antioxidant and antidiabetic properties.

Ginger 

Basically, ginger is a potential herb and classified under class of Zingiberaceae family. It is used worldwide due to its excellent properties such as antibiotic, antimicrobial, antioxidant, anti-inflammatory etc. Principally, this herb improves immunity power of the body and helps to eliminate toxic products from the body. Presently, this herb is used in the treatment of Cancer, Alzheimer, blood circulation, blood pressure, cholesterol etc. Chemical composition of ginger displays approximately 50% carbohydrates, 9% protein and free amino acids, 6 to 8% fatty acids and triglycerides, 3 to 6% ash and 3 to 6% crude fibre. From the micronutrients content point of view, it consists of number of useful micronutrients like potassium, magnesium, copper, manganese and silicon. Potassium and manganese are highly useful micronutrients which help to increase immunity power and fight against disease. Ginger composed of main antioxidant called as gingerol. Basically, it is a phenolic compound. On degradation, it forms other products such as shogaols, zingerone, paradol etc. Bioactive compounds like zingerone and shogaols are found in small amounts in fresh ginger whereas it is found in large amounts in extracted products [25].

Cinnamon

Cinnamon is a sweet spice and mostly used as food flavors. This spicy herb has main composition of camphor in root, cinnamaldehyde in bark and euganol in leaf. Cinnamon possesses useful properties of medicine. It also exhibits health benefits properties such as antioxidant, anti-inflammatory, antidiabetic, antimicrobial, anticancer, lipid-lowering, and cardiovascular disease lowering. It has also some additional health useful properties to cure neurological disorders such as Parkinson and Alzheimer's diseases. The phytochemical analysis of cinnamon bark displays the presence of alkaloids, flavonoids, coumarin, tannins, terpenoids, saponin, glycoside, anthrocyanin and phenolic compounds [26].

Mineral determination data of cinnamon showed composition of metals such as iron (7.0 mg/g), zinc (2.6 mg/g), calcium (83.8 mg/g), chromium (0.4 mg/g), manganese (20.1 mg/g), magnesium (85.5 mg/g), potassium (134.7 mg/g) and phosphorus (42.4 mg/g). Cinnamon also exhibits important minerals like iron (Fe) which is useful for red blood cells production, potassium (K) is essential for body fluids and cell, control blood pressure and heart mechanism, and magnesium and cobalt induce enzyme work. Daily consumption of small amount of cinnamon helps to improve digestion, control glucose level and defects system in body [27]. 

Clove

Clove is most important herbal bud and exhibits antioxidant, antimicrobial, antibacterial, antifungal, antiviral and anticarcinogenic properties. The major compounds of the clove buds are 3-allyl-6-methoxyphenol, eugenol acetate, 2-pentanone, 4-hydroxy-4-methyl and caryophylene. Mainly, it consists of 70 % to 90 % eugenol as major constituent in clove oil and 15 % to 20 % of the total weight of the dried clove flower buds. The major mineral content (per 100 gm) in clove is potassium 1.020 to 1,296 mg, calcium 632 mg, magnesium 259 mg and iron 11.8 mg.

Black Pepper

The black pepper is known as black gold or king of spices. This is most commonly used spice in the world because it has very high commercial, economic, nutritional, and medicinal value. Traditionally, this herb is also mainly used for the treatment of various diseases such as cough, cold, dyspnoea throat diseases, intermittent fever, dysentery, stomach-ache, worms and piles etc. The chemical composition of black pepper shows mainly phenolic compounds like flavonoids, carotenoids, terpenoids etc. Black pepper shows the chemical composition such as 37.4% carbohydrate, 25.5% proteins, 23.6% fibres, 4.7% moisture, and 5.3% fats. Mineral composition of black pepper displays includes 0.66% potassium, 0.20% calcium, 0.16% phosphorus and 0.16% magnesium [28]. Piperine is a most important alkaloid found in black pepper which helps to increase the absorption of selenium, vitamins, and other nutrients. According to analysis report, the amount of piperine present in black pepper was around 3.92%. Important property of the black pepper is stimulate saliva secretion, which increases the production of digestive juices, responsible for breaking down proteins, increasing digestibility and reducing the possibility of heartburn and other gastrointestinal issues [29].

Black tea powder

Black tea powder is most popular drink in the world. Tea drinks are prepared from dried leaves of tea plant. It contains considerable amounts of proteins, amino acids, fibres, lipids, sugars, vitamins, minerals, alkaloids, polyphenols, flavins and saponins. It exhibits antioxidant and cancer prevention properties. The black tea also found some important minerals such as calcium, magnesium, sodium, potassium and manganese [29].

CONCLUSION

The allopathic medicines are most important medicines from health point of view. From the diabetes mellitus control point of view, Metformin is prime allopathic medicine. But continuous consumption of the metformin becomes less effective. In that case, supplementary allopathic medicines need to be included. Basically, allopathic medicines have lot of side effects, and the inclusion of additional allopathic medicine will increase more side effects. To control the side effects the allopathic drugs, herbal based extracts are highly useful. In this research study, aqueous extract of herbal mixture based on ginger, cinnamon, clove, black pepper and tea powder were used to control diabetes mellitus along with allopathic medicines. These herbal drugs help to control diabetes mellitus. Most important thing is that, allopathic medicines work only on single target whereas herbal medicines work on multiple targets at a time. Allopathic medicines produce results immediately where as herbal medicines give results slowly. From the diabetes mellitus point of view, the consumption of aqueous extract of the herbal mixture along with allopathic medicines showed considerable control on sugar level. According to the present investigation, there was considerably reduction in fasting, post-prandial, HbA1c sugar levels and SGPT. The creatinine and uric acid were also under control. Microscopic examination of urine analysis showed color, appearance, urine glucose, urine protein, pus cells, epithelial cells, RBC, casts, and crystals were normal. Present research article suggest that this information may be highly useful to health care professionals to develop new evidence based herbal medicine to control diabetes mellitus. From the conclusion point of view, lot of research study is needed to apply the above aqueous extract of herbal mixture to control diabetes mellitus. Present herbal mixture is highly useful to control diabetes, but along with this herbal mixture the patient has to take proper diet, execution of exercise and sufficient sleep which will help to control diabetes effectively.

CONFLICT OF INTEREST

The author declares that there is no conflict of interest.

FUNDING SOURCE

No external funding was received for this research work. Pathological analysis and allopathic medicines were provided by NCL Medical Centre, Pune, India.

ACKNOWLEDGEMENTS

The author is thankful to medical doctor Dr. Vineet Rao (MBBS, DNB, Jupiter Hospital,  Baner, Pune – 411045, India) for prescribing allopathic medicines for diabetes Mellitus. The author is also grateful to Dr. (Mrs.) Jyotsna Chitalkar (MBBS, DNB, NCL Medical centre, Pashan Road, Pune – 411008, India) for prescribing diabaetic allopathic medicines and also pathological tests assessment.  The author also pleased to the staff of the pathology section of NCL medical centre, Pune, India for providing all pathological analysis time-to-time. Author finally thanks to Director, National Chemical Laboratory, Pune for his continuous support to NCL medical centre, Pune, India.

AI USE STATEMENENT

The author declares that no artificial intelligence (AI) or AI-assisted tools were used in the writing, data analysis, or creation of figures for this manuscript. All aspects of this research, including manuscript preparation, method generation, data collection, data analysis and manuscript writing, were performed solely by the author without assistance from AI technologies.

AUTHORSHIP CONTRIBUTION 

Nayaku Chavan was responsible for conceptualization, investigation, data collection, data analysis, and original manuscript writing. 

ABBREVIATION

HbA1c - Glycated hemoglobin, SGPT - Serum Glutamic Pyruvate Transaminase, RBC - Red blood cells, IDF - International Diabetic Federation, DM - Diabetes mellitus, ICMR - Indian Council of Medical Research, NCL - National Chemical Laboratory, ALT - Alanine aminotransferase,  DNA - Deoxyribonucleic acid, ROS - Reactive oxygen species.

DATA AVAILIBITY

All data generated or analyzed during this study are included in this published article. 

SUPPLEMENTARY MATERIALS

No supplementary material is associated with this article.

 

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