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Managing Clinical Problems in Diabetes, Case Study #24: The Internet and Herbal Treatments

Oct 3, 2011

Edited by Trisha Dunning AM, RN, MEd, PhD, CDE, FRCNA and Glenn Ward MBBS, BSc, DPhil (Oxon), FRACP, FRCPath


Mrs. THZ self-referred to a diabetes educator for advice.  “I have been reading about herbs to treat diabetes on the internet. Can you tell me which ones are safe to use? Do they work? Where should I get them?”….

Complementary therapist

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. 

Diabetes educator 

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.

Anderson JW, Nicolosi RJ, Borzelleca JF (2005) Glucosamine effects in humans: a review of effects on glucose metabolism, side effects, safety considerations and efficacy. Food Chemical Toxicology 43(2): 187–201.

Bakker SJL, Bilo HJG (2006) Chromium treatment has no effect in patients with poorly controlled, insulin-treated type 2 diabetes in an obese western population: a randomized, double-blind, placebo controlled trial. Diabetes Care 29: 521–525.

Bjelakovic G, Nikolova D, Gluud LL et al. (2007) Mortality in randomised trials of antioxidant supplements for primary and secondary prevention. Systematic review and meta-analysis. Journal of the American Medical Association 297: 842–857.

Braun L (2006) Complementary medicine and safety. Chapter 3 in Dunning T (ed) Complementary Therapies in the Management of Diabetes and Vascular Disease: A Matter of Balance. Wiley and Sons, Oxford, pp 36–47.

Braun L, Cohen M (2007) Herbs and Natural Supplements – An Evidence-based Guide (2nd edn). Elsevier, Sydney.

Di Vincenzo R (2006) Nutritional therapies. Chapter 5 in Dunning T (ed) Complementary Therapies in the Management of Diabetes and Vascular Disease: A Matter of Balance. Wiley and Sons, Oxford, pp 77–146.

Egede L, Xiaobou Y, Zheng D et al. (2002) The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Diabetes Care 25: 324–329.

Egger G, Cameron-Smith D, Stanton R (1999) The effectiveness of popular non-prescription weight loss supplements. Medical Journal of Australia 171: 604–608.

Kleefstra N, Houweling ST, Jansman FG et al. (2006) Chromium treatment has no effect in patients with poorly controlled, insulin treated type 2 diabetes in an obese western population: a randomized double-blind, placebo-controlled trial. Diabetes Care 29: 521–525.

Kumar D, Bajaj S, Mehrotra R (2006) Knowledge, attitudes and practice of complementary and alternative medicines for diabetes. Public Health 120: 705–711.

Liu S, Lee I-M, Song Y et al. (2006) Vitamin E and risk of type 2 diabetes in the women’s health study randomised controlled trial.Diabetes 55: 2856–2862.

Lloyd P, Lupton D, Wiesner D et al. (1993) Choosing alternative therapy: an Australian study of sociodemographic characteristics and motives of patients resident in Sydney. Australasian Journal of Public Health 17(2): 135–144.

McCarty M (1995) Anabolic effects of insulin on bone suggests a role for chromium picolinate in preservation of bone density. Medical Hypotheses 45(3): 241–246.

McKay D (2007) Vitamin E supplementation. An update. Alternative Medicine Alert 10(4): 37–42. Natural Medicines Comprehensive Database (2006) (

Preuss HG, Wallerstedt D, Talpur N et al. (2000) Effects of niacinbound chromium and grape seed proanthacyanidin extract on the lipid profile of hypercholesterolemic subjects: a pilot study. Journal of Medicine 31(5–6): 227–246.

Recommended reading

Braun L, Cohen M (2006) Herbs and Natural Supplements. Elsevier, Sydney.

Dunning T (2006) Complementary Therapies in the Management of Diabetes and Vascular Disease: A Matter of Balance. Wiley and Sons, Oxford.


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

For more information on the book, just follow this link to, Managing Clinical Problems in Diabetesalt

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