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Diabetes Mellitus:
“the silent killer which kills part by part of
our life”
1
Dr. Vir Vikram Sharma
Prof. & Head
(Department of Pharmacology)
Genesis Institute of Dental
Science & Research
Mobile: +919878903414
Email: virvikram76@gmail.com
WHAT IS DIABETES ????
Diabetes means too much sugar (glucose) in the blood.
Sugar comes from the foods we eat like bread, cereals, pasta, rice, fruit,
starchy vegetables and dairy items.
Sugar is used by the body for energy— to run, skip, play and swim.
Insulin is a hormone that is made in the pancreas and works like a key to
a door – insulin opens the door of the cells of our body allowing the sugar
to go from the bloodstream into the cells where it is then used for energy.
If there is not enough insulin or if the insulin can’t open the door to the
cell, the sugar levels rise in the blood and diabetes occurs.
2
PREVELANCE OF DIABETES
3
According to WHO:
The number of people with diabetes has risen from 108 million in 1980 to
422 million in 2014 and may rise to 629 million in 2045. At the same
time, a further 352 million people with impaired glucose tolerance are at
high risk of developing diabetes (Paul and Alberti, 2016; IDF Diabetes
Atlas, 2017).
There is an urgency for greater action to improve diabetes outcomes and
reduce the global burden of diabetes now affecting more than 425 million
people, of which one-third are people older than 65 years (IDF Diabetes
Atlas, 2017).
The global prevalence of diabetes among adults over 18 years of age has
risen from 4.7% to 8.5% .
WHO projects that diabetes will be the 7th leading cause of death in
2030.
4
The above data affirms an abrupt rise in diabetes and forecast
for doubling the current numbers in many regions by 2045.
5
6
2017 2045
Rank Country/ territory Number of people with
diabetes
Rank Country/ territory Number of people
with diabetes
1 China 114.4 million 1 India 134.3 million
2 India 72.9 million 2 China 119.8 million
3 United States 30.2 million 3 United States 35.6million
4 Brazil 12.5 million 4 Mexico 21.8 million
5 Mexico 12.0 million 5 Brazil 20.3 million
6 Indonesia 10.3 million 6 Egypt 16.7million
7 Russian Federation 8.5 million 7 Indonesia 16.7million
8 Egypt 8.2million 8 Pakistan 16.1 million
9 Germany 7.5 million 9 Bangladesh 13.7 million
10 Pakistan 7.5 million 10 Turkey 11.2 million
Top ten countries for number of people with diabetes , 2017 and 2045
(IDF Diabetes Atlas - 8th Edition)
Pandemic diseases
7
TYPES OF DIABETES MELLITUS
8
9
SYMPTOMS OF DIABETES MELLITUS
10
BLOOD GLUCOSE LEVEL (RANGE)
11
WHAT IS INSULIN
Insulin is released from pancreatic beta
cell in response to high blood glucose
level and promotes the uptake of
glucose by different cells of the body.
12
13
HOW INSULIN REGULATES BLOOD
GLUCOSE LEVEL????
14
MECHANISM OF ACTION OF INSULIN
15
Broad spectrum antibiotics :
Amoxicillin
Tetracycline
Cephalosporin
Chloramphenicol
Erythromycin
Narrow spectrum antibiotics:
Penicillin –G
Cloxacillin
vancomycin
Bacitracin
Fluxacillin
16
Polyuria & Polydipsia
17
Polyphagia
18
DIABETIC NEPHROPATHY
19
DIABETIC NEUROPATHY
20
DIABETIC RETINOPATHY
21
Diabetic retinopathy caused by damage to the blood vessels of the light-
sensitive tissue at the back of the eye (retina).
At first, diabetic retinopathy may cause no symptoms or only mild
vision problems.
DIABETIC ENCEPHALOPATHY
22
Damage to the brain caused by diabetes. It can induce an altered mental
state, cognitive decline, changes in personality, memory lapses, or severe
impairment like dementia, and even seizures.
DIABETIC CARDIOMYOPATHY
23
Signs and symptoms:
Shortness of breath or trouble breathing, especially with physical
exertion.
Fatigue, Swelling in the ankles, feet, legs, abdomen and veins in
the neck.
DIABESITY (DIABETES+OBESITY)
24
•It has long been known that overweight and obesity are predictors of
type 2 diabetes, and obesity is indeed an insulin resistant state.
•Particular people with central obesity, where fat collects around the
waist, are most likely to become insulin resistant.
MANAGEMENT OF DIABETES MELLITUS
25
26
Management of Diabetes
MANAGEMENT OF DIABETES MELLITUS
27
• Follow the diet, exercise, and treatment schedule as
prescribes by your physician.
• Don’t take some herbal or other types of alternate
medicine without consulting the medical expert.
MANAGEMENT OF DIABETES MELLITUS
28
MANAGEMENT OF DIABETES MELLITUS
29
• Health practitioners can help in early
detection and monitoring of Diabetes by
checking your blood glucose.
• They can give you an advice regarding the
best use of medicines, whether to take
before/after or with food, its possible side
effects, storage, etc.
• They can also help you to take your
medicines as per the treatment schedule.
MANAGEMENT OF DIABETES MELLITUS
30
R
INSULIN
DOSE
SYRINGE
TIME
MANAGEMENT OF DIABETES MELLITUS
31
Now Question Rise here how we
test
Anti-Diabetic Drugs ????
Solution is Pre clinical and clinical
studies
32
ANIMAL
MODELS
ANIMAL MODEL OF
DIABETES
33
I Chemically induced
1. Streptozocin (STZ) induced diabetes
2. Alloxan induced diabetes
3. Goldthioglucose induced diabetes
II Surgically induced diabetes
III Genetically induced diabetic animal model
IV Virus induced diabetic animal model
SOME COMMONLY USED LABORATORY
ANIMALS
34
Role of Herbs in the treatment of Diabetic
35
 Fenugreek seeds
 Jambul fruit
 Bael
 Garlic
 Aloe
 Vasica
 Oscimum sanctum
 Jambolana
 Momordica charantia
 Ocimum sanctum
 Phyllanthus amarus
 Pterocarpus
marsupium
 Tinospora cordifolia
 Trigonella foenum
graecum
 Butea monospermapalasa
 Camellia sinensis
 Capparis deciduas
 Caesalpinia bonducella
 Sagarghota
 Coccinia indica
 Emblica officinalis
 Dhatriphala
 Eugenia uniflora
 Eniocostema
 Ficus bengalenesis
 Gymnema sylvestre
 Hibiscus rosa-sinensis
 Ipomoea batatas
 Murraya koenigii
 Musa sapientum
 Phaseolus vulgaris Hulga
 Scoparia dulcis
 Swertia chirayita chirata
 Syzygium alternifolium
 Terminalia chebula
 Tinospora crispa
 Vinca rosea
 Withania somnifera
 Artemisia
 Areca catechu
 Beta vulgaris
 Boerhavia
 Bombax ceiba
 Annona squamosa sugar
These drugs are claimed to be devoid of any adverse effect(s)
however, these claims of efficacy and safety have not been
documented by controlled clinical trials.
Momordica charantica:
 Botanical Name : Momordica Charantia
 Family Name : Cucurbitaceae
 Common Name : Bitter Melon, Bitter Gourd, Balsam Pear,
Balsam Apple, Melega Saga
 Part Used : Fruits, Seeds
 Habitat : It is widely cultivated in India
 Product offered : Seeds, Fruits
Momordica charantica improves the glucose metabolism and thus
imparts a hypoglycemic effect in the diabetic patients.
36
(Radhakrishnan.,2014)
Emblica officinalis:
 Botanical Name : Emblica officinalis
 Family Name : Euphorbiaceae
 Common Name : Gooseberry, Phyllanthus, Emblica, Indian
 Gooseberry, Amla
 Part Used : Fruits
 Habitat : Northern and south western India
 Product offered : Seeds, Fruits
Amla is known for its numerous therapeutic effects including those
of usage in cardiovascular disorders, liver dysfunction, and for
inflammation.
37
(Radhakrishnan.,2014)
Tribulus terrestris:
 Botanical Name : Tribulus terrestris
 Family Name : Zygophllaceae
 Common Name : Land caltrops, Puncture vine, Fokhru
 Part Used : Fruits, Seeds
 Habitat : Throughout India, upto 5400m, as a
weed along roadsides and waste places
 Product offered : Seeds, whole plant, Fruits
It has been shown to increase the free serum testosterone and to be
effective in the treatment of sexual and erectile dysfunction by
conversion of its phyto-chemical derivative, protodioscine to
DeHydro Epi Androsterone (DHEA).
38
Trigonella foenum graecium:
 Botanical Name : Trigonella foenum gracum
 Family Name : Fabaceae
 Common Name : Fenugreek, Greek Hayes, Alholva, Bird’s,
Foot, Boyutu, Chinagreye, Fenegriek,
 Part Used : Leaves, Seeds
 Habitat : Kashmir, Punjab and upper
gangetic plains and other Indian regions
 Product offered : Seeds, whole plant, Fruits
Several studies indicated the hypoglycemic and hypo-lipidemic
properties of fenugreek seeds suggesting that fenugreek may help
to control diabetes.
39
To study the Reno-protective effect of some medicinal plants
extracts in experimentally induced nephropathy
Momordica charantia Emblica officinalis
Tribulus terrestris Trigonella foenum graecium
alone and in combination, in two models of nephropathy in rats.
If a synergistic action of combining two products is documented,
it would permit use of smaller dose of individual drug and a
concomitant decrease in blood concentration dependent adverse
effects.
40
41
PAPER PUBLISHED:
Fig. 32. Gross morphological sections of kidneys.
REFERENCES:
Virdi J, Sivakami S, Shahani S, Suthar AC, Banavalikar, MM, Biyani MK.2003. Antihyperglycemic effects of three extracts
from Momordica charantia. Journal of Ethnopharmacology 2003; 88: 107–111.
Shibib BA, Khan LA, Rahman R. Hypoglycemic activity of coccinia indica and Momordica charantia in diabetic rats:
depression of the hepatic gluconeogenic enzymes glucose-6-phosphatase and fructose-1,6- bisphosphatase and elevation
of both liver and red-cell shunt enzyme glucose 6-phosphate dehydrogenase. Journal of Biochemistry 1993; 292: 267–
270.
Srivastava Y, Venkatakrishna-Bhatt H, Verma Y, Venkaiah K, Raval BH. Antidiabetic and adaptogenic properties of
Momordica charantica extract: an experimental and clinical evaluation. Phytotherapy Research 1993. 7: 285–289.
Garg AN, Kumar A, Nair AGC, Reddy AVR . Determination of minor and trace elements in Trifala - A herbal preparation. J.
Radioanal. Nucl, Chem.2005; 263(3):751-758.
Ibn-e-sina . Al-Qanun fit-tib [Arabic tranalation, ebrahim shamsedine], Alaalami Beirut library Press 2005; 4: 420.
Sabu MC, Kuttan R . Anti-diabetic activity of medicinal plants and its relationship with their antioxidant property. J.
Ethnopharmacol. 2002; 81(2):155-160.
Brown GA, Vukovich MD, Martini ER, Kohut ML, Frank WD, Jackson DA. Endocrine and lipid responses to chronic
androstenendiol- herbal supplementation in 30–58 year old men. Journal of the American College of Nutrition 2001;
20(5): 520–528.
Lin ZX, Hoult JR, Raman A. Sulphorhodamine B assay for measuring proliferation of a pigmented melanocyte cell line and
its application to the evaluation of crude drugs used in the treatment of vitiligo. Journal of Ethnopharmacology 1999;
66(2): 142–150.
43
REFERENCES:
Shirani G, Ganesharanee R. Extruded products with fenugreek (Trigonella foenum graecium), chickpea and rice: physical
properties, sensory acceptability and glycaemic index. J Food Engin 2009; 90: 44–52.
Moosa AM, Rashid MU, Asadi AZS, Ara N, Uddin MM, Ferdaus A . Hypolipidemic effects of fenugreek seed powder.
Bangladesh J Pharmacol 2006; 1:64–67.
Basch E, Ulbricht C, Kuo G, Szapary P, Smith M. Therapeutic applications of fenugreek. Altern Med Rev 2003; 8:20–27.
European Commission (2004) Opinion of the Scientific Committee on Toxicity, Ecotoxicity and the Environment on The
BUAV European Coalition to End Animal Experiments Report: The Way Forward - Action to End Animal Toxicity Testing,
available at: http://europa.eu.int/comm/health/ph_risk/committees/sct/documents/out217_en.pdf. Accessed: 2nd June
2015.
Roe FJC. Influence of animal species, strain, age, hormonal, and nutritional status, in Experimental Toxicology, The Basic
Issues, 2nd Edition, Anderson D and Conning D (Editors) (Cambridge: The Royal Society of Chemistry), 1993; 23–34.
Morris T, Goulet S, Morton D. The international symposium on regulatory testing and animal welfare: recommendations
on best scientific practices for animal care in regulatory toxicology ILAR J 43, Supplement: 2002;S123–5.
Hawkins P, Morton DB, Bevan R et al. Husbandry requirement for rats, mice, dogs and non-human primates used in
telemetry procedures Seventh Report of the BVAAWF/FRAME/RSPCA/UFAW Joint Working Group on Refinement, Part B.
Lab Anim 2004;38: 1–10.
Koeter HBWM . The OECD Test Guidelines Program and animal welfare concern: how to avoid major animal suffering, in
Humane Endpoints in Animal Experiments for Biomedical Research, Hendriksen CFM and Morton DB (Editors) (London:
Royal Society of Medicine Press), 1999; 13–14.
44
45
46
Thank You

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Diabetes a slient killer

  • 1. Diabetes Mellitus: “the silent killer which kills part by part of our life” 1 Dr. Vir Vikram Sharma Prof. & Head (Department of Pharmacology) Genesis Institute of Dental Science & Research Mobile: +919878903414 Email: virvikram76@gmail.com
  • 2. WHAT IS DIABETES ???? Diabetes means too much sugar (glucose) in the blood. Sugar comes from the foods we eat like bread, cereals, pasta, rice, fruit, starchy vegetables and dairy items. Sugar is used by the body for energy— to run, skip, play and swim. Insulin is a hormone that is made in the pancreas and works like a key to a door – insulin opens the door of the cells of our body allowing the sugar to go from the bloodstream into the cells where it is then used for energy. If there is not enough insulin or if the insulin can’t open the door to the cell, the sugar levels rise in the blood and diabetes occurs. 2
  • 3. PREVELANCE OF DIABETES 3 According to WHO: The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 and may rise to 629 million in 2045. At the same time, a further 352 million people with impaired glucose tolerance are at high risk of developing diabetes (Paul and Alberti, 2016; IDF Diabetes Atlas, 2017). There is an urgency for greater action to improve diabetes outcomes and reduce the global burden of diabetes now affecting more than 425 million people, of which one-third are people older than 65 years (IDF Diabetes Atlas, 2017). The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% to 8.5% . WHO projects that diabetes will be the 7th leading cause of death in 2030.
  • 4. 4 The above data affirms an abrupt rise in diabetes and forecast for doubling the current numbers in many regions by 2045.
  • 5. 5
  • 6. 6 2017 2045 Rank Country/ territory Number of people with diabetes Rank Country/ territory Number of people with diabetes 1 China 114.4 million 1 India 134.3 million 2 India 72.9 million 2 China 119.8 million 3 United States 30.2 million 3 United States 35.6million 4 Brazil 12.5 million 4 Mexico 21.8 million 5 Mexico 12.0 million 5 Brazil 20.3 million 6 Indonesia 10.3 million 6 Egypt 16.7million 7 Russian Federation 8.5 million 7 Indonesia 16.7million 8 Egypt 8.2million 8 Pakistan 16.1 million 9 Germany 7.5 million 9 Bangladesh 13.7 million 10 Pakistan 7.5 million 10 Turkey 11.2 million Top ten countries for number of people with diabetes , 2017 and 2045 (IDF Diabetes Atlas - 8th Edition)
  • 8. TYPES OF DIABETES MELLITUS 8
  • 9. 9
  • 10. SYMPTOMS OF DIABETES MELLITUS 10
  • 11. BLOOD GLUCOSE LEVEL (RANGE) 11
  • 12. WHAT IS INSULIN Insulin is released from pancreatic beta cell in response to high blood glucose level and promotes the uptake of glucose by different cells of the body. 12
  • 13. 13 HOW INSULIN REGULATES BLOOD GLUCOSE LEVEL????
  • 14. 14
  • 15. MECHANISM OF ACTION OF INSULIN 15 Broad spectrum antibiotics : Amoxicillin Tetracycline Cephalosporin Chloramphenicol Erythromycin Narrow spectrum antibiotics: Penicillin –G Cloxacillin vancomycin Bacitracin Fluxacillin
  • 16. 16
  • 21. DIABETIC RETINOPATHY 21 Diabetic retinopathy caused by damage to the blood vessels of the light- sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems.
  • 22. DIABETIC ENCEPHALOPATHY 22 Damage to the brain caused by diabetes. It can induce an altered mental state, cognitive decline, changes in personality, memory lapses, or severe impairment like dementia, and even seizures.
  • 23. DIABETIC CARDIOMYOPATHY 23 Signs and symptoms: Shortness of breath or trouble breathing, especially with physical exertion. Fatigue, Swelling in the ankles, feet, legs, abdomen and veins in the neck.
  • 24. DIABESITY (DIABETES+OBESITY) 24 •It has long been known that overweight and obesity are predictors of type 2 diabetes, and obesity is indeed an insulin resistant state. •Particular people with central obesity, where fat collects around the waist, are most likely to become insulin resistant.
  • 25. MANAGEMENT OF DIABETES MELLITUS 25
  • 27. MANAGEMENT OF DIABETES MELLITUS 27 • Follow the diet, exercise, and treatment schedule as prescribes by your physician. • Don’t take some herbal or other types of alternate medicine without consulting the medical expert.
  • 28. MANAGEMENT OF DIABETES MELLITUS 28
  • 29. MANAGEMENT OF DIABETES MELLITUS 29 • Health practitioners can help in early detection and monitoring of Diabetes by checking your blood glucose. • They can give you an advice regarding the best use of medicines, whether to take before/after or with food, its possible side effects, storage, etc. • They can also help you to take your medicines as per the treatment schedule.
  • 30. MANAGEMENT OF DIABETES MELLITUS 30 R INSULIN DOSE SYRINGE TIME
  • 31. MANAGEMENT OF DIABETES MELLITUS 31
  • 32. Now Question Rise here how we test Anti-Diabetic Drugs ???? Solution is Pre clinical and clinical studies 32 ANIMAL MODELS
  • 33. ANIMAL MODEL OF DIABETES 33 I Chemically induced 1. Streptozocin (STZ) induced diabetes 2. Alloxan induced diabetes 3. Goldthioglucose induced diabetes II Surgically induced diabetes III Genetically induced diabetic animal model IV Virus induced diabetic animal model
  • 34. SOME COMMONLY USED LABORATORY ANIMALS 34
  • 35. Role of Herbs in the treatment of Diabetic 35  Fenugreek seeds  Jambul fruit  Bael  Garlic  Aloe  Vasica  Oscimum sanctum  Jambolana  Momordica charantia  Ocimum sanctum  Phyllanthus amarus  Pterocarpus marsupium  Tinospora cordifolia  Trigonella foenum graecum  Butea monospermapalasa  Camellia sinensis  Capparis deciduas  Caesalpinia bonducella  Sagarghota  Coccinia indica  Emblica officinalis  Dhatriphala  Eugenia uniflora  Eniocostema  Ficus bengalenesis  Gymnema sylvestre  Hibiscus rosa-sinensis  Ipomoea batatas  Murraya koenigii  Musa sapientum  Phaseolus vulgaris Hulga  Scoparia dulcis  Swertia chirayita chirata  Syzygium alternifolium  Terminalia chebula  Tinospora crispa  Vinca rosea  Withania somnifera  Artemisia  Areca catechu  Beta vulgaris  Boerhavia  Bombax ceiba  Annona squamosa sugar These drugs are claimed to be devoid of any adverse effect(s) however, these claims of efficacy and safety have not been documented by controlled clinical trials.
  • 36. Momordica charantica:  Botanical Name : Momordica Charantia  Family Name : Cucurbitaceae  Common Name : Bitter Melon, Bitter Gourd, Balsam Pear, Balsam Apple, Melega Saga  Part Used : Fruits, Seeds  Habitat : It is widely cultivated in India  Product offered : Seeds, Fruits Momordica charantica improves the glucose metabolism and thus imparts a hypoglycemic effect in the diabetic patients. 36 (Radhakrishnan.,2014)
  • 37. Emblica officinalis:  Botanical Name : Emblica officinalis  Family Name : Euphorbiaceae  Common Name : Gooseberry, Phyllanthus, Emblica, Indian  Gooseberry, Amla  Part Used : Fruits  Habitat : Northern and south western India  Product offered : Seeds, Fruits Amla is known for its numerous therapeutic effects including those of usage in cardiovascular disorders, liver dysfunction, and for inflammation. 37 (Radhakrishnan.,2014)
  • 38. Tribulus terrestris:  Botanical Name : Tribulus terrestris  Family Name : Zygophllaceae  Common Name : Land caltrops, Puncture vine, Fokhru  Part Used : Fruits, Seeds  Habitat : Throughout India, upto 5400m, as a weed along roadsides and waste places  Product offered : Seeds, whole plant, Fruits It has been shown to increase the free serum testosterone and to be effective in the treatment of sexual and erectile dysfunction by conversion of its phyto-chemical derivative, protodioscine to DeHydro Epi Androsterone (DHEA). 38
  • 39. Trigonella foenum graecium:  Botanical Name : Trigonella foenum gracum  Family Name : Fabaceae  Common Name : Fenugreek, Greek Hayes, Alholva, Bird’s, Foot, Boyutu, Chinagreye, Fenegriek,  Part Used : Leaves, Seeds  Habitat : Kashmir, Punjab and upper gangetic plains and other Indian regions  Product offered : Seeds, whole plant, Fruits Several studies indicated the hypoglycemic and hypo-lipidemic properties of fenugreek seeds suggesting that fenugreek may help to control diabetes. 39
  • 40. To study the Reno-protective effect of some medicinal plants extracts in experimentally induced nephropathy Momordica charantia Emblica officinalis Tribulus terrestris Trigonella foenum graecium alone and in combination, in two models of nephropathy in rats. If a synergistic action of combining two products is documented, it would permit use of smaller dose of individual drug and a concomitant decrease in blood concentration dependent adverse effects. 40
  • 42. Fig. 32. Gross morphological sections of kidneys.
  • 43. REFERENCES: Virdi J, Sivakami S, Shahani S, Suthar AC, Banavalikar, MM, Biyani MK.2003. Antihyperglycemic effects of three extracts from Momordica charantia. Journal of Ethnopharmacology 2003; 88: 107–111. Shibib BA, Khan LA, Rahman R. Hypoglycemic activity of coccinia indica and Momordica charantia in diabetic rats: depression of the hepatic gluconeogenic enzymes glucose-6-phosphatase and fructose-1,6- bisphosphatase and elevation of both liver and red-cell shunt enzyme glucose 6-phosphate dehydrogenase. Journal of Biochemistry 1993; 292: 267– 270. Srivastava Y, Venkatakrishna-Bhatt H, Verma Y, Venkaiah K, Raval BH. Antidiabetic and adaptogenic properties of Momordica charantica extract: an experimental and clinical evaluation. Phytotherapy Research 1993. 7: 285–289. Garg AN, Kumar A, Nair AGC, Reddy AVR . Determination of minor and trace elements in Trifala - A herbal preparation. J. Radioanal. Nucl, Chem.2005; 263(3):751-758. Ibn-e-sina . Al-Qanun fit-tib [Arabic tranalation, ebrahim shamsedine], Alaalami Beirut library Press 2005; 4: 420. Sabu MC, Kuttan R . Anti-diabetic activity of medicinal plants and its relationship with their antioxidant property. J. Ethnopharmacol. 2002; 81(2):155-160. Brown GA, Vukovich MD, Martini ER, Kohut ML, Frank WD, Jackson DA. Endocrine and lipid responses to chronic androstenendiol- herbal supplementation in 30–58 year old men. Journal of the American College of Nutrition 2001; 20(5): 520–528. Lin ZX, Hoult JR, Raman A. Sulphorhodamine B assay for measuring proliferation of a pigmented melanocyte cell line and its application to the evaluation of crude drugs used in the treatment of vitiligo. Journal of Ethnopharmacology 1999; 66(2): 142–150. 43
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