Diabetes types, cause, symptoms, prevention and treatment

What is Diabetes?

• Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high.
• Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues.
• Glucose is also your brain's main source of fuel but too much sugar in your blood can lead to serious health problems.
• Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.
• Insulin is a hormone made by the pancreas, helps glucose from food to get into your cells to be used for energy.
• Sometimes your body doesn’t make enough or any insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.
• The underlying cause of diabetes varies by type. But, no matter what type of diabetes you have, it can lead to excess sugar in your blood.
• Untreated high blood sugar from diabetes can damage your nerves, eyes, kidneys, and other organs.

  

  glucometer

Government survey found 11.8% prevalence of diabetes in India

• Males showed a prevalence of diabetes (12%) as females (11.7%), the survey said.
• Nearly 40% of known diabetes were diagnosed 1-4 years back while 5.3% of known diabetes cases reported diagnosis within past one-year.

World Health Organization data on diabetes

About 422 million people worldwide have diabetes, particularly in low-and middle-income countries.

Read:- Diabetes cause, symptoms, prevention and treatment in Hindi

Diabetes types

There are a few different types of diabetes:

1.Type 1 diabetes 

• It is an autoimmune disease. The immune system attacks and destroys cells in the pancreas, where insulin is made. It’s unclear what causes this attack. About 10 percent of people with diabetes have this type.

  

  insulin

• Type-1 diabetes is an insulin-dependent diabetes, which means people having type 1 diabetes must take artificial insulin daily to stay alive.

2.Type 2 diabetes

• Type 2 diabetes, also called non-insulin-dependent diabetes results from the body’s ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.

  

  Type 2 diabetes

• You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people.
• It is the most common type of diabetes.
• This condition runs in families. Family members share genes that make them more likely to get type 2 diabetes and to be overweight.

3.Prediabetes 

• It occurs when your blood sugar is higher than normal, but it’s not high enough for a diagnosis of type 2 diabetes.
• People with prediabetes are, however, at risk of developing type 2 diabetes, although they do not usually experience the symptoms of full diabetes.

4.Gestational diabetes

• Gestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born.
  
• Insulin-blocking hormones produced by the placenta cause this type of diabetes.
• Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.

Diabetes causes

Cause of Type 1 diabetes 

• Type 1 diabetes occurs when your immune system, the body’s system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.
• Type 1 is thought to be caused by a combination of genetic and environmental factors.
• Weight has no role in developing type 1 diabetes.

Cause of Type 2 diabetes and prediabetes

• In type 2 diabetes body becomes resistant to insulin or when the pancreas is unable to produce enough insulin. Exactly why this happens is unknown.
• Although genetics and environmental factors, such as being overweight and physical inactivity, seem to be contributing factors.

Cause of gestational diabetes 

• Gestational diabetes is high blood sugar that you get only when you're pregnant.
• The word "gestational" means the time when the baby grows in the womb.
• About 3 to 5 out of every 100 pregnant women have this disease.
• During pregnancy, your body makes special hormones and goes through other changes, such as weight gain. Because of these changes, your body’s cells don’t use insulin well, a condition called insulin resistance.
• All pregnant women have some insulin resistance during late pregnancy.
• Most pregnant women can produce enough insulin to overcome insulin resistance, but some cannot. These women develop gestational diabetes.
• Being overweight or obese is linked to gestational diabetes.
• Having a family history of diabetes makes it more likely that a woman will develop gestational diabetes.

Diabetes symptoms

1. Frequent urination
2. Increased thirst
3. Feeling very tired 
4. Blurry vision

5. 

   Symptoms of diabetes

6. Slow healing of cuts and wounds or do not heal
7. Itching and frequent infections such as gums or skin infections and vaginal infections
8. Darkening of skin in areas of body creases
9. Tingling, numbness, or pain in the hands or feet
10. Always feeling hungry 

Risk Factors of diabetes

A.Risk factors of type 1 diabetes

Risk factors for type 1 diabetes are poorly understood. However Some known risk factors for type 1 diabetes include:

1.Family history

• Family history may be important in some cases of type 1 diabetes. If you have a family member with type 1 diabetes, your risk of developing it increases.
• Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition.

2. Genetics

• The presence of certain genes indicates an increased risk of developing type 1 diabetes.
• Type 1 diabetes is an autoimmune condition because it causes the body’s immune system to turn against itself. Autoimmune conditions that may increase your risk for type 1 include: Graves' disease, multiple sclerosis, and pernicious anemia.

 3.Viral infections

• In some research it has found that certain viruses may trigger the development of type 1 diabetes by causing the immune system to turn against the body.Example:- German measles, coxsackie, and mumps.

 4.Race/ethnicity

• Race may be a risk factor for type 1 diabetes. It’s more common in white people than in people of other races.

 5.Age

• Type 1 diabetes is also known as Juvenile diabetes due to its incidence in children.
• Type 1 diabetes can appear at any age, in children between 4 and 7 years old, and in children between 10 and 14 years old or more.

B.Risk factors of type 2 diabetes and prediabetes

• Type 2 diabetes is the most common form of diabetes. In type 2, the body can still make some insulin but is not able to use the hormone as effectively as it should.
• Type 2 diabetes has two types of risk factor, or those a person can take steps to avoid and those they cannot.

a. Non modifiable risk factors or Unavoidable risk factors

b. Modifiable risk factors or Preventable risk factors

a.Non modifiable risk factors or Unavoidable risk factors

There are various risk factors for type 2 diabetes, some of which you cannot avoid, including:

1.Family history

• The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes.
• You’re two to six times more likely to get Type 2 diabetes if you have a parent, brother, sister or child with diabetes.

2.Race/Ethnicity

• Although it's unclear why, people of certain races are at higher risk of type 2 diabetes including African-Americans, Hispanic Americans, Native Americans, and Asian Americans.

3. Age

• Your risk increases with age.You’re more at risk if you’re white and over 40 or over 25 if you’re African-Caribbean, Black African, or South Asian.

4. Polycystic ovarian syndrome

• For women, having polycystic ovarian syndrome, a common condition characterized by irregular menstrual periods, excess hair growth and obesity increases the risk of diabetes.

5. Gestational diabetes

• Gestational diabetes develops in some women when they are pregnant, if you have gestational diabetes you are more prone to develop type 2 diabetes.

6. Acanthosis nigricans

• If you have acanthosis nigricans a condition where dark, thick, velvety skin develops around the neck or armpits then you are at risk of type 2 diabetes

b.Modifiable risk factors or Preventable risk factors

There are some risk factors for type 2 diabetes that we can take steps to try and avoid, including:

1. Physical inactivity

• Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin so the less active you are, the greater your risk of type 2 diabetes.

2. Weight

• You are more at risk of type 2 diabetes if you are overweight, especially if you’re large around the middle or if you have belly fat.(diet to lose weight)

3. High blood pressure or Hypertension

• You are more at risk of type 2 diabetes if you have ever had high blood pressure.

4. Smoking

• Smoking is associated with a higher risk of Type 2 diabetes as well as heart disease and cancer.

5. Abnormal Cholesterol and Triglyceride level

• You are more at high risk of type 2 diabetes if you have low level of HDL called 'good cholesterol' or a high level of LDL called 'bad cholesterol' or high level of triglycerides.

6. Heart disease or Stroke

• People who have or had heart or blood vessel disease and stroke are at risk of type 2 diabetes.

Heart attack due to atherosclerosis in diabetic patient

We can reduce the risk of type 2 diabetes by altering some of these lifestyle factors, especially by improving our diet and physical activity.

C. Risk factors of gestational diabetes

The known risk factors for Gestational Diabetes Mellitus(GDM) including:

1. Family history of diabetes mellitus
2. Previous history of gestational diabetes
3. Overweight or obesity before pregnancy
4. Excess weight gain during pregnancy
5. Advance maternal age more than 35 years
6. Previous history of congenital anomaly
7. Pregnancy induced hypertension
8. Previous history of unexplained fetal death
9. Previous history of macrosomia (fetal macrosomia" is used to describe a newborn who's significantly larger than average)
10. Having poly cystic ovarian syndrome
11. Sedentary life style (A sedentary lifestyle is a type of lifestyle involving little or no physical activity)
12. Number of previous pregnancies (more number of pregnancies-more chances of developing GDM)

Prevention of Diabetes

• While family history or genetics plays an important role in the development of diabetes, people still have the ability to influence their health to prevent type 2 diabetes. Although there is no known way to prevent type 1 diabetes.
• We will focus on ways to control risk factors for type 2 diabetes, prediabetes and gestational diabetes.

1. Losing weight and keeping it off

• Excess body fat, particularly if stored around the abdomen, can increase the body’s resistance to the hormone insulin. This can lead to type 2 diabetes.So Weight control is an important part of diabetes prevention.

2. Physical activity or Exercise regularly

• Exercise has many health benefits, including helping you to lose weight and lower your blood sugar level.

• Moderate physical activity on most days of the week helps manage weight, reduce blood glucose levels and may also improve blood pressure and cholesterol.These factors will lower your risk of type 2 diabetes.

3. Following a healthy eating plan

• Reduce the amount of fat in your diet, especially saturated and trans fats. Eat more fruit, vegetables and high-fibre foods.

4. Don't smoke

• Smokers are two times more at risk to develop diabetes as non-smokers.

5. Follow a Very-Low-Carb Diet

• Following a ketogenic or very-low-carb diet can help keep blood sugar and insulin levels under control, which may protect against diabetes.

6. Managing cholesterol levels

• You are more at high risk of type 2 diabetes if you have low level of HDL called 'good cholesterol' or a high level of LDL called 'bad cholesterol' or high level of triglycerides.BY taking care of cholesterol you may reduce risk of diabetes.

7. Avoid processed food

• Minimizing processed foods and focusing on whole foods with protective effects on health may help decrease the risk of diabetes.

8. Limit your alcohol intake

• Excess consumption of alcohol can lead to weight gain and may increase your blood pressure and triglyceride levels and thus type 2 diabetes. So by avoiding alcohol intake you people can decrease risk of diabetes.

9. Managing blood pressure

• Blood pressure can be controlled by regular exercise a balanced and low salt diet, keeping healthy weight and taking proper medication.
• Managing blood pressure can reduce risk of type 2 diabetes.

10. Natural herbs to prevent diabetes type 2 

1. Curcumin- It is a component of the bright gold spice turmeric. It has strong anti-inflammatory properties and very effective against arthritis and may help reduce inflammatory markers in people with prediabetes. It is believed that it may decrease insulin resistance and reduce the risk of diabetes progression.
2. Barberine- Berberine seems to slightly reduce blood sugar levels in people with diabetes. Also, some early research suggests that taking 500 mg of berberine 2-3 times daily for up to 3 months might control blood sugar as effectively as metformin.
3. Aloe vera- It is one of the oldest plants used in traditional medicine. The gel present inside the aloe vera leaf has been used for long time for its soothing and healing properties. It might also help to manage blood sugar according to various recent studies.
4. Fenugreek- Fenugreek is an herb that may help to treat diabetes by lowering blood sugar after meals. You can use fenugreek to help lower blood sugar after meals by taking supplements, adding fenugreek to recipes, or by drinking it as a tea.
5. Ginger- It has been shown to help reduce blood sugar levels and help regulate insulin response in people with diabetes.

Complications of Diabetes

A.Complications of Diabetes(Type 1 & 2)

• There are many complications of diabetes that develops gradually. Longer duration diabetes with poorly controlled blood sugar have higher risk of complications.

  

  complications of diabetes

• Some complications of diabetes are life threatening. The Complications diabetes can be divided in to two parts:-

1. Long term diabetes complications

2. Short term diabetes complications

1. Long term diabetes complications

Cardiovascular disease:- 

• Heart and blood vessel disease are common problems for many people who have uncontrolled blood sugar. You are two times more at risk of heart problems and strokes as people who don’t have the condition diabetes. Cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis).

Diabetic neuropathy:- 

• Nerve damage from diabetes is called diabetic neuropathy. Nearly 50 percent people with diabetes have some form of nerve damage. The tiny blood vessels feed your nerves especially in your legs, so if the blood vessels are damaged, then the nerves will eventually be damaged as well.This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.People with diabetes should regularly examine their feet.If left untreated, you could lose all sense of feeling in the affected limbs.

Vision problems:- 

• Most people with diabetes will develop some form of eye disease (diabetic retinopathy) causing reduced vision or blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma. Keep your risk of glaucoma, cataracts and other eye problems low with regular checkups.

Kidney disease or diabetic nephropathy:- 

• Diabetic nephropathy is a leading cause of chronic kidney disease. The kidneys contain millions of tiny blood vessel clusters called glomeruli that filter waste from your blood. Uncontrolled diabetes cause damage to tiny blood vessels in the kidneys leading to the kidneys becoming less efficient or to fail altogether, which may require dialysis or a kidney transplant. Keep your diabetes and blood pressure under control to lower the chance of getting kidney disease.

Stroke:- 

• People having diabetes are two to four times more likely to have a stroke. This is because excess glucose in the body can lead to more fatty deposits or clots in the walls of the blood vessels. The clots can cause narrowing or blockages in your blood vessels, which could eventually stop the flow of oxygen to the brain and cause a stroke. Maintain target levels for blood glucose, blood pressure, and cholesterol to reduce your risk of stroke.

Erectile dysfunction:- 

• Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse which can be a complication of diabetes. It is actually a form of neuropathy.

Gastroparesis or stomach paralysis:- 

• Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. Symptoms include heartburn, nausea, vomiting, and feeling full quickly when eating. Diabetes is the most common cause of gastroparesis, according to various studies.

Sleep apnea:- 

• Sleep apnea is a sleep disorder where a person has pauses in breathing. Each pause can last for a few seconds to a few minutes. In the most common form, this follows loud snoring. Sleep apnea is a common problem among patients with Type 2 diabetes.

Infections:- 

• Patients with poorly controlled diabetes mellitus are prone to bacterial and fungal infections. Individuals with diabetes have an increased susceptibility to mucocutaneous fungal infections (eg, oral and vaginal candidiasis).

Immune dysfunction:- 

• Immune dysfunction is another major complication and develops from the direct effects of hyperglycemia on cellular immunity. Diabetic patients are particularly susceptible to bacterial and fungal infections.

2.Short term diabetes complicatios

a.Hypoglycemia:- 

• Hypoglycemia is low blood glucose . It is possible for your blood glucose to drop, especially if you are taking insulin or drug that make your body produce insulin throughout the day. With these medications, if you eat less than usual or were more active, your blood glucose may dip too much. Other possible cause of hypoglycemia is intake of too much alcohol (alcohol keeps the liver from releasing glucose).

Symptoms of hypoglycemia that are easy to recognize:-

• Rapid heartbeat
• Sweating
• Whiteness of skin
• Anxiety
• Numbness in fingers, toes, and lips
• Sleepiness
• Confusion
• Headaches
• Slurred speech

b. Hyperosmolar Hyperglycemic Nonketotic Syndrome:-

• Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), also known as Hyperosmolar Hyperglycaemic State (HHS) is a dangerous condition resulting from very high blood glucose levels. If left untreated it can cause death.

Symptoms of Hyperosmolar Hyperglycaemic State (HHS):-

• Blood sugar level of 600 milligrams per deciliter (mg/dL)
• Excessive thirst
• Dry mouth
• Increased urination
• Warm, dry skin
• Fever
• Drowsiness, confusion
• Hallucinations
• Vision loss
• Convulsions
• Coma

c. Diabetic ketoacidosis (DKA):-

• Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones due to lack of insulin.

Sign and symptoms of diabetic ketoacidosis (DKA):-

• Excessive thirst
• Frequent urination
• Nausea and vomiting
• Abdominal pain
• Weakness or fatigue
• Shortness of breath
• Fruity-scented breath
• Confusion
• High blood sugar level (hyperglycemia)
• High ketone levels in your urine

B.Complications of gestational diabetes

• Although most women with gestational diabetes deliver healthy baby but poorly managed blood sugar level can cause problems to mother as well as baby.

Complications that may effect the baby

• Macrosomia - Excessive birth weight and very large baby may need cesarean section to deliver.
• Hypoglycemia - Risk of low blood sugar level in the baby after birth
• Risk of premature birth
• Risk of respiratory distress syndrome
• Type 2 diabetes in later life
• Risk of still birth at the end of pregnancy

Complications that may effect the mother

• Preeclampsia- Preeclampsia is a condition during pregnancy where there is a sudden rise in blood pressure and swelling, mostly in the face, hands, and feet.
• Risk of future diabetes - One who have gestational diabetes, are more likely to get it again during a future pregnancy and also more likely to develop type 2 diabetes as get older.

C.Complications of prediabetes

• Risk of developing type 2 diabetes

Diagnosis and tests in Diabetes mellitus

How is diabetes diagnosed?

The following tests are used for the diagnosis of diabetes:

1. Fasting blood sugar test (FPG):- 

• A fasting plasma glucose test measures your blood glucose after you have gone at least 8 hours without eating.
• This test is used to detect diabetes or prediabetes.
• A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal.
• A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes.
• If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

2.Oral glucose tolerance test (OGTT):-

• The OGTT requires you to fast for at least eight hours before the test.
• Your plasma glucose is measured immediately before and two hours after you drink a liquid containing 75 grams of glucose dissolved in water.
• If your blood sugar level is between 140 and 199 mg/dL 2 hours after drinking the liquid, you have a form of prediabetes called impaired glucose tolerance or IGT, meaning that you are more likely to develop type 2 diabetes but do not have it yet.
• A two-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.

3. Random blood sugar test (RPG):-

• A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) or 11.1 millimoles per liter (mmol/L) or higher suggests diabetes.

4. Hemoglobin A1c (HbA1c):-

• The hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months. It's also called HbA1c, glycated hemoglobin test,and glycohemoglobin.
• This blood test, which doesn't require fasting. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.
• The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached.
• An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes.
• An A1C between 5.7 and 6.4 percent indicates prediabetes.
• Below 5.7 is considered normal.

Criteria for the Diagnosis of Prediabetes and Diabetes :-

Name of test	Normal	Prediabetes	Diabetes
Fasting plasma glucose (FPG) in mg/dl	Less than 100 mg/dl	Between 100-125 mg/dl	126 mg/dl or higher
Oral glucose tolerance test (OGTT) in mg/dl	Less than 139 mg/dl	Between 140 to 199 mg/dl	200 mg/dl or higher*
Random plasma glucose (RPG) in mg/dl	Less than 140 mg/dl	Between 140-199 mg/dl	200 mg/dl or higher**
Hemoglobin A1c (HbA1c) in percent	Less than 5.7%	Between 5.7 to 6.4%	6.5% or higher

* Result should be confirmed by repeating test.

** Only diagnostic in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis.

Diabetes treatment

 Treatment of type 1 diabetes

• Lack of insulin production by the pancreas makes Type 1 diabetes is particularly difficult to control.
• Insulin is the main treatment for type 1 diabetes. It replaces the hormone your body isn’t able to produce.
• If you have type 1 diabetes, you have to take insulin because your body no longer makes it. You will need to take insulin several times during the day, including with meals. 

Types of Insulin and How They Work:-

1. Rapid-acting insulin:- It starts to work within 15 minutes,peak effect within 1 hour and its effects last for 3 to 4 hours.
2. Short-acting insulin:- It is also called regular insulin starts to work within 30 minutes, peak effect in 3-4 hours and lasts 6 to 8 hours.
3. Intermediate-acting insulin:- Starts to work within 1 to 2 hours, peak effect within 4 to 12 hours and lasts 12 to 18 hours.
4. Long-acting insulin:- It starts to work a few hours after injection and lasts for 24 hours or longer.

Note:- Always follow your doctor’s advice on when and how to take your insulin. 

Treatment of type 2 diabetes

List of type 2 diabetes medicine:-

Sometimes type 2 diabetes can be managed by making healthy food choices and being more physically active. If lifestyle changes aren’t enough to lower blood sugar, then effective people need to take medication.

• These drugs lower your blood sugar in many ways:-

1. Alfa-glucosidase inhibitors (AGIs):-

• AGIs are also called starch blockes they reduce post meal blood glucose levels
• They don’t have a direct effect on insulin secretion or sensitivity.
• They work by slowing down the digestion of carbohydrates found in starchy foods.

Some examples of Alfa-glucosidase inhibitors

• Acarbose
• Miglitol

2.Biguanides:- 

• These drugs work by reducing the production of glucose from digestion.
• Reduce the amount of glucose liver makes.
• Metformin is the only biguanide currently available in most countries for diabetes treatment.

3.Dipeptidyl peptidase 4 (DPP-4) inhibitors:-

• Also known as gliptins.
• Improve blood sugar without making it drop too low.
• They stimulate insulin secretion and inhibit glucagon secretion by elevating endogenous GLP-1 concentrations without an intrinsic hypoglycaemia risk.
• GLP-1, is a hormone involved in glucose removal from the gut.

Some examples of gliptins:-

• Linagliptin
• Saxagliptin
• Sitagliptin etc.

4.Glucagon-like peptide (GLP-1):-

• GLP-1 is an incretin, an intestinal hormone secreted after nutrient ingestion that increases glucose-stimulated insulin secretion by pancreatic β cells, which is secreted by the intestinal L cells in the distal small intestine and proximal colon.

Some examples of glucagon like peptide:-

Dulaglutide Exenatide liraglutide

5.Meglitinides (glinides):-

• These drugs stimulate your pancreas to release more insulin.

Some examples of Meglitinides:-

• Nateglinide
• Repaglinide

6.Sodium-glucose cotransporter-2 inhibitors(SGLT2 inhibitors):-

• SGLT2 inhibitors, also called gliflozins.
• These drugs  inhibit reabsorption of glucose in the kidney and therefore lower blood sugar.
• Release more glucose into the urine.

Some examples of gliflozins:-

• Canagliflozin 
• Dapagliflozin

7.Sulfonylureas:-

• They act by increasing insulin release from the beta cells in the pancreas.

Some examples of Sulfonylureas:-

• Glyburide
• Glipizide
• Glimepiride

8.Thiazolidinediones:-

• Also called glitazones.
• They work by reducing the body’s resistance to insulin, the hormone is allowed to work more effectively at improving blood glucose control.
• Help insulin work better.

Some examples of glitazones:-

• Pioglitazone
• Rosiglitazone

People may need to take more than one of these drugs. And some people with type 2 diabetes may also need to take insulin too.

Herbal medicines for diabetes treatment and prevention:-

1.Aloe Vera:-

• Aloe vera is a common plant with many different uses.
• Many people are aware of its benefits for skin care like healing, rejuvenating and soothing properties and the sap of aloe vera is known for its laxative effect.
• Beside its uses in skin care, for healing and as laxative some studies suggest that the juice from the aloe vera plant can help lower blood sugar in people with types 2 diabetes. The dried sap of the aloe vera plant has traditionally been used to treat diabetes in middle east.
• You can use its juiced pulp in a drink or smoothie or by taking capsules that contain aloe as supplements.

2.Cinnamon:-

• Consuming about half a teaspoon of cinnamon per day can result in significant improvement in blood sugar, cholesterol, and triglyceride levels in people with type 2 diabetes.
• Research has suggested that cinnamon lower blood sugar levels by increasing insulin sensitivity.

3.Bitter melon:-

• Bitter melon, also known as bitter gourd or karela (in India), is a unique vegetable-fruit that can be used as food or medicine.
• In addition to being a food ingredient, bitter melon has also long been used as a herbal remedy for a range of ailments, including type 2 diabetes.
• A staple of traditional Chinese medicine, bitter melon is believed to relieve thirst and fatigue, two possible symptoms of Type 2 diabetes.
• The fruit contains at least three active substances with anti-diabetic properties, including charanti, which has been confirmed to have a blood glucose-lowering effect, vicine and an insulin-like compound known as polypeptide-p.

4.Fenugreek:-

• Fenugreek is an aromatic plant that has been used as a medicine and as a spice for thousands of years in the Middle East.
• As well as being a popular cooking ingredient, fenugreek has a number of health benefits,as it may help delay or prevent the onset of type 2 diabetes.
• Fenugreek seeds are high in soluble fibre, which helps lower blood sugar by slowing down digestion and absorption of carbohydrates This suggests they may be effective in treating people with diabetes.

5.Curcumin:-

• It is a component of the bright gold spice turmeric. 
• It has strong anti-inflammatory properties and very effective against arthritis and may help reduce inflammatory markers in people with prediabetes. 
• It is believed that it may decrease insulin resistance and reduce the risk of diabetes progression. 

 6. Barberine:-

• Berberine seems to slightly reduce blood sugar levels in people with diabetes. 
• Also, some early research suggests that taking 500 mg of berberine 2-3 times daily for up to 3 months might control blood sugar as effectively as metformin. 
• Be aware that this herb can interfere with metabolism of traditional pharmaceuticals and should never be taken while pregnant. 

 7.Holy basil:-

• Studies in animals suggest that holy basil may increase the secretion of insulin.
• A controlled trial of holy basil in people with type 2 diabetes showed a positive effect on fasting blood sugar and on blood sugar following a meal.
• This herb is commonly used in India as a traditional medicine for diabetes.

8.Ginger:-

• It has been shown to help reduce blood sugar levels and help regulate insulin response in people with diabetes.
• Several studies suggested that ginger may improve long-term blood sugar control for people with type 2 diabetes.

9.Psyllium:-

• A plant fiber found in various laxatives preparations and fiber supplements, psyllium has also been used to treat diabetes historically by lowering both cholesterol and blood sugars.
• Several studies show that people with type 2 diabetes who take 10 grams of psyllium every day can improve their blood sugar and lower blood cholesterol. 

10. Okra:-

• Okra is commonly known as ladyfinger.
• Evidence of okra having anti-diabetic properties has increased in recent years, with multiple laboratory and animal studies confirming okra as a potent blood glucose-lowering (or anti-diabetic) food.
• The superior insoluble fibre contained in okra is believed to help stabilize blood glucose by slowing the rate at which sugar is absorbed from the intestinal tract.

11. Apple Cider Vinegar:-

• There are many evidence-based approaches to using ACV.
• Taking 2 tablespoons before bedtime can reduce your morning fasting sugar levels.
• Even better, 1-2 tablespoons of ACV taken with meals can decrease the glycemic load of a carbohydrate rich meal. 

12. Neem (Azadirachta indica):-

• Almost all parts of the neem tree- leaves, flowers, seeds, fruits, roots and bark have been used traditionally for a variety of treatments; be it inflammation, infections, fever, skin diseases or dental disorders. 
• Some studies have claimed that certain compounds of Azadirachta indica (Neem) could be of benefit in diabetes mellitus in controlling the blood sugar. 
• According to a study published in the Indian Journal of Physiology and Pharmacology, neem may also prove helpful in preventing or delaying the onset of the disease. 
• In the journal Studies on Ethno-Medicine, neem leaf powder was found to control diabetic symptoms on non-insulin dependent male diabetics too.

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