I would discuss three key points with Mrs. THZ:
- the reliability of internet information and how to make decisions about its value and veracity;
- herbal medicine efficacy in relation to diabetes; and
- herbal medicine safety.
The internet is both a blessing and curse when it comes to health care information. Some sites contain information written by health care professionals, which is very useful and accurate, whereas other sites contain information that is merely advertisements. My first suggestion is to find a registered herbalist or naturopath who specializes in herbal medicine and discuss this topic with them.
Herbal medicine, sometimes known as phytotherapy, can be broadly defined as the science and art of using botanical medicines to prevent and treat illness and the study and investigation of these medicines. Many herbal medicines have been investigated under randomized controlled trial conditions and found to have significant pharmacological blood glucose-lowering effects. Herbal medicines such as fenugreek (Trigonella foenum), ivy gourd (Coccinia indica), American ginseng (Panax quinquefolius), Gymnema sylvestre and bitter melon (Momordica charantia) have been shown to lower blood glucose levels in clinical trials (Yeh et al. 2005). In addition, some herbal medicines have been shown to improve peripheral circulation, such as ginkgo biloba and horse chestnut extract (Braun 2007).
As with all medicines, the expected therapeutic benefits must be weighed against the potential risks. Some herbal medicines can cause significant drug interactions and adverse reactions, but when used correctly under the guidance of a knowledgeable health care professional, the risks can be minimized. In the case of using hypoglycemic herbal medicines, professional supervision and frequent self-monitoring are advised to ensure that the intended outcome is achieved in a safe way.
These points are all very important. I would also explain that most of the trials of herbal medicines are in type 2 diabetes. It is not clear whether Mrs. THZ actually has diabetes, and if so, what type she has or whether she is on any conventional medicines or uses other CAM. I would also advise her to inform her conventional health professionals if she does decide to use CAM.
Complementary and alternative therapies Key Points
Health professionals must be non-judgmental about people's decision to use complementary therapies.
- People with diabetes frequently use complementary therapies for a variety of reasons not only to reduce blood glucose.
- Health professionals should ask about complementary therapy use.
- Complementary therapies should be used within a quality use of medicines framework.
- Not all complementary therapies are medicine.
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The aims of the book are to: (1) address commonly encountered diabetes management problems; (2) develop comprehensive responses from a range of relevant health professionals who suggest management approaches relevant to their area of practice. The speciﬁc health professionals who provide comments about each case depend on the speciﬁc clinical issue; and (3) stimulate thought and discussion.
The target readership is health professionals from a range of professional backgrounds and general as well as specialist professionals such as general practitioners, nurses, dietitians, and podiatrists. The book will be particularly useful for beginner practitioners specializing in diabetes. In addition, it will provide suggestions or food for thought for more experienced practitioners. The cases will be excerpts from the book are all real and are presented exactly as the information was received from the person making the referral. General practitioners, diabetes educators and people with diabetes referred most of the cases; some were self-referrals by people with diabetes. They represent referrals to various diabetic health professionals and concern commonly encountered clinical issues.
Next Week: Case Discussion #25
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