A Comparative Study About Various Physical Exercise Therapy In the Treatment of Diabetes: a Critical Review

In recent years, there has been renewed interest in the treatment against different diseases using herbal drugs as they are generally non-toxic and World Health Organization has also recommended the evaluation of the effectiveness of plants in condition where we lack safe modern drugs. Plant derivatives with hypoglycemic properties have been used in folk medicine and traditional healing systems around the world (Yeh et al., 2003) from very ancient time. Despite the introduction of hypoglycemic agents from natural and synthetic sources, diabetes and its secondary complications continue to be a major medical problem to people (Ravi et al., 2005). Medicinal plants used to treat hypoglycemic and hyperglycemic conditions are of considerable interest to ethno botanical community as they are recognized to contain valuable medicinal properties in different parts of the plant. In traditional medicine diabetes mellitus is treated with diet, physical exercise and medicinal plants, even though, more than 1200 plants are used around the world in the control of diabetes mellitus and approximately 30% of the traditionally used antidiuretic plants were pharmacologically and chemically investigated (Alarcon-Aguilar et al., 2002). On the other hand, potential hypoglycemic agents have also been detected for more than 100 plants used in antidiuretic therapy. Traditional treatments may provide the valuable clues for the development of new oral hypoglycemic agents and simple dietary adjuncts. More than 100 medicinal plants are mentioned in the Indian system of medicines including folk medicines for the management of diabetes, which are effective either separately or in combinations (Kar et al, 2003). As per the ethno botanical literature on traditional phytotherapy of Indian medicinal plants, the species like Asparagus racemosus, Butea monosperma, Cathanranthus roseus, Coccinia indica, Gymnema sylvestre, Syzygium cumini and Momordica charantia are consistently used by the tribal communities for the treatment of diabetes as well as in modern medicine. There are many traditional systems of medicine in the world, each with different associated philosophies and cultural origins. Some of these, such as Tibetan traditional medicine, remain relatively localized in their country of origin; while others such as Ayurvedic will concentrate on the issue treatment of chronic diseases and heavy metal poisoning related to herbal traditional medicines. Ayurveda is the most widely practised of the Indian traditional medicine systems, but there are others such as Siddha and Unani which are also used in the Indian subcontinent. Anti-diabetic - Diabetes mellitus is a clinical syndrome characterized by inappropriate hyperglycemia caused Plant materials which are being used as traditional medicine for the treatment of diabetes are considered one of the good sources for a new drug or a lead to make a new drug. Plant extract or different folk plant preparations are being prescribed by the traditional practioners and also accepted by the users for diabetes like for any other diseases in many countries.

Plants are employed in treatment or as a remedial effect. As the man began to obtain closure acquaintance with his environment, he began to know more about plants. Plants are the oldest medicine known to mankind. These had been used by all cultures throughout history but India has one of the oldest, wealthiest and most diverse cultural living traditions associated with the use of herbal plants. Since the time of Charaka and Susruta numerous plants in diverse formulations have been used in various diseases. Plants have formed the basis of refined traditional medicine systems that have been in existence for thousands of year and continue to provide mankind with new remedies. Natural products and their derivatives represent more than 50% of all drugs in clinical used in the world. It is also fact that one quarter of all medicinal prescriptions are formulations based on substances resulting from plants or plant derived synthetic analogs. According to WHO, 80% of the population rely on plants derived medicine for their health care. Natural remedies from plants are considered to be effective and risk-free.

The carbohydrates we take as food is simplified to glucose molecules by various metabolic functions. This molecule serves as the source for energy or ATP production in the body required for vital functions. Insulin is a natural hormone secreted from the β‐ cells of pancreas which helps the cells to uptake glucose molecules from the blood stream. Hence deficiency of insulin results in the failure of glucose utilization by the cells and leading to its increased concentration in blood stream. This condition is known as diabetes. Insulin affects the metabolism of carbohydrate, fat, proteins and ion flux by attaching to the specific insulin receptor on the cell surface. This hormone interaction is irreversible and the insulin molecule remains chemically unaltered during this contact. The hormone receptor complex is then taken inside the cell by an endocytic mechanism and metabolised to free the insulin molecule to the membrane for re‐use .The glucose molecules are then oxidised to produce ATP or energy molecules. Insulin resistance is caused by the cell membrane. The excess of sugar or glucose in blood is excreted by kidney in urine.

It is estimated that more than 200 species of plants exhibit anti-diabetic properties. Plants keep on playing a vital role in the treatment of diabetes. There is increase demand in industry to use substitute approaches to treat diabetes, such as plant-based medicines, is also due to the side effects related with in dissimilar diseases had been mentioned in Rigveda and later in Atharva Veda (1200 B.C.). The medicinal plants were regrouped and Nagarjuna while expurgation Susruta Samhita mentioned the existence of active pharmacological materials in bark, leaf, flower, fruit, rhizome etc. Spaced out from the above leads, the wealth of herbal plants in diseases was obtained from Ayurved, Unani, Sidha, Ethno medicine and Folklore. Many traditional medicines in use are obtained from medicinal plants, minerals and natural matter. The World Health Organization (WHO) has listed 21,000 plants, which are used for medicinal purposes around the globe. More than 400 herbal plants with glucose-lowering likely are known. Herbal plants have been used for several years by different cultures in the region of the world for the cure of diabetes. Herbal plants continue to play an important role in diabetes, particularly in developing countries where most people have inadequate resources. Synthetic hypoglycemic agents in existing use for the treatment of diabetes generate staid side effects. Traditional medicinal plants have the advantage of having little or no side effect.

1. Acacia catechu (Mimosaceae) - It commonly known as Khair in Hindi and Nalla Sandra in Telgu. It is mainly distributed in India, Pakistan, Nepal and China. The bark and heartwood of the plant mainly used for the treatment of diabetes. 2. Alpinia galangal (L). Sw. (Zingiberaceae) - It commonly known as Bara kalisan in Hindi and Dumparastramu in Telgu. The plant is mainly distributed in India in Assam, Meghalaya and Tamil Naidu. Rhizomes of the species mainly used in treatment of diabetes. 3. Cassia auriculata Linn.(Caesalpiniaceae) - It commonly known as Mature tea tree in English; Tarwar in Hindi and Awal in Gujrati. It is mainly distributed in Central Provinces, Western Coast, South India and Ceylon. The flower buds of the plant mainly used in the treatment of diabetes. 4. Cassia glauca Lam (Caesalpiniaceae) - The plant is commonly known as Kondatantemu in Telgu, Kovalai in Tamil and Vellatakara in Marathi. It is mainly distributed throughout the India and in Tropical Asia and Australia. The bark and leaves of the plant prescribed in diabetes. in English; Jambuda in Gujrati. It is mainly distributed throughout the plains from the Himalayas to South India. Juice of the fruit is used as antidiabetic. 6. Ficus bengalensis (Moraceae) - The common names of plant is Vata in Sanskrit and Vada in Hindi. It is mainly found in lower Himalayas region. Infusion of the bark reducing the blood sugar level. 7. Ficus glomerata (Moraceae) - It is commonly known as Udumbara in Sanskrit and Gular in Hindi. The plant is mainly found in all parts of India. Fruit and sap extracted from the trunk of the tree efficacious in diabetes. 8. Gymnema sylvestre (Asclepiadaceae) - It is commonly known as Dhuleti in Gujrati and Maehasing in Hindi. It is mainly distributed in Tropical region of Africa and Asia. Leaves of the plant mainly used in diabetes. 9. Musa sapientum (Musaceae) - It is commonly known as Vana laxmi in Sanskrit and Kela in Hindi. The plant is mainly cultivated throughout the India. Unripe fruit used as vegetable for diabetes. 10. Psidium guyava (Myrtaceae) - It is commonly known as Perala in Sanskrit; Amrut in Hindi. It is mainly cultivated nearly all over India and common in Bengal. Water in which fruit is soaked is good for thirst in diabetes.

As diabetes is not completely curable it needs a life time commitment to do what is necessary to control diabetes. With proper management it can be controlled to a greater extent. All of these factors are interconnected. And in the case of Type‐2 diabetes, it can be totally controlled in some cases with diet and exercise. Daily monitoring of blood glucose level with a glucometer. • Insulin injections and other medications to be taken as directed. • Managing of diet and weight control. • Managing a daily exercise plan. • Daily monitoring and managing of skin and foot care. • Daily oral hygiene. • Regular visits to the eye doctor as well as the dentist. Diabetes can be managed with various types of medications

• Exogenous insulin.

• Oral hypoglycaemic agents.

• Alternative medicines like herbal treatments, Yoga, Unani medicines etc.

The NAPRALERT database lists over 1200 species of plants representing 725 genera in 183 families extending from the marine algae and fungi with antidiabetic activity. Over half of these have been used ethnopharmacologically in traditional medicine as antidiabetics, and some 50% of these traditional remedies have been studied experimentally.

cajan (L.)Millsp.,Coccinia indica Wight & Arn., Caesalpinia bonducella (L.) Roxb., Ficus bengalensis L., Gymnema sylvestre R. Br., Momordica charantia L., Ocimum sanctum L., Pterocarpus marsupium Roxb., Tinospora cordifolia (Wild.) Hook.f. & Thomson, etc., are most commonly used species in traditional medicine as antidiabetic agents.

1. Abrus precatorius L. (Fabaceae). Local Name: Kundumani. The plant is a climber commonly known as Wild Liquorice and found through the plains of India. Leaf of this plant is mixed with the leaves of Andrographis paniculata, Gymnema sylvestre and seeds of Syzygium cumini. The mixture is shade dried and ground into powder and taken orally along with cow’s milk. Dosage: About 50 ml of mixture is taken twice a day before food for 120 days.

The plant is annual herb found in the hedgerows throughout the plains in India and commonly cultivated in gardens. Leaf is shade dried, powdered and taken orally along with cow’s or goat’s milk. Dosage: 2 teaspoon of powder is taken twice a day after food for 2-3 months. 3. Andrographis paniculata (Burm.f.) Wall. ex Nees (Acanthaceae). Local Name: Periya nangai. The plant is annual herb (Commonly known as King of Bitters) found in the hedgerows throughout the plains in India and cultivated in gardens. Leaf is shade dried, powdered and mixed with boiled rice and cow’s milk and taken orally. Dosage: 50 ml of mixture is taken thrice a day after food for 120 days. 4. Canthium parviflorum Lam. (Rubiaceae). Local Name: Sakkarai kovaimaram. A shrubby and woody plant found throughout the Western Ghats. Shade dried leaf powder is mixed with cup of water or goat’s or cow’s milk or boiled rice and taken orally. Dosage: One or two teaspoon is taken early in the morning regularly until cure 5. Costus speciosus (Koenig.) J. E. Smith (Costaceae). Local Name: Kostak-kilangu. A tuberous fleshy herb, plentifully found in north India and in the Western Ghats the plant is seen in hilly areas. Fresh rhizome is ground into a paste and taken orally. Dosage: 20-25 gm is taken thrice a day after food for 2 months. 6. Gymnema sylvestre (Retz.) R. Br. ex Schultes (Asclepiadaceae). Local Name: Siru kurinjan. A climbing shrub commonly found in the plains of central and southern India. Dried leaves are pounded and the fine powder thus obtained is taken orally along with milk. Dosage: About 50 ml is taken twice a day after food for 120 days to treat diabetes. 7. Memecylon umbellatum Burm. f. (Melastomataceae). Local Name: Sakkarai vaembu. A bushy small tree found in the hilly areas of Western Ghats. Shade dried leaf powder is mixed with cup of water and boiled rice and kept overnight and taken orally. Dosage: One teaspoon is taken early in the morning for forty days or until cure. 8. Momordica charantia L. (Cucurbitaceae). Local Name: Kaattu pagar-kai. The plant is commonly known as Bitter guard and has Unripe fruits are taken orally along with food. Dosage: 2-3 fresh unripe fruits are taken at any time per day for 3 months. 9. Syzygium cumini (L.) Skeels. (Myrtaceae). Local Name: Naaval maram. The plant is large tree and commonly known as Jambolan or Black Plum found throughout the plains. Juice extracted from the leaf is mixed with honey or cow’s milk and fresh fruits are taken orally. Dosage: 2 teaspoon of juice is taken twice a day after food for 3 months. It is one of the significant antidiabetic plant and it has long been reported for its use in many pharmacological activities mainly diabetes. During the last four decades, numerous folk medicine and scientific reports on the antidiabetic effects of this plant have been cited in the literature. Clinical and experimental studies suggest that, different parts of the plant especially fruits, seeds and stem bark possess promising activity against diabetes mellitus. S. cumini exerts a dual effect namely a combination of mechanism of action of sulfonylurea and biguanids and may bring about its hypoglycaemic action through stimulation of surviving ß cells of islets of langerhans to release more insulin.

The study of ethnomedical systems and plants as therapeutic agents is of importance in addressing health problems of traditional communities. Among the plants used by traditional healers (Kanis and Paliyars), most of the plants have been used in folk medicine and traditional healing systems around the world from very ancient time. The wealth of tribal’s knowledge on medicinal plants points to a great potential for research and the discovery of new drugs to fight diseases including diabetes, obtaining new foods and other new uses. Instead of trying to identify the active components of herbs through massive collection of plants from natural sources, it is better to start investigating the efficacy of the medicinal plant based on the traditional healthcare practices by indigenous people. Traditional plants or herbal formulations might offer a natural key to unlock diabetic complications. Now a time traditional plants or herbal products had been recommended for treatment of diabetes. The potency of herbal drugs is significant and they have negligible side effects than the synthetic anti-diabetic drugs. There is an increasing demand by patients to use the natural products with anti-diabetic activity. In recent time there has been renewed interest in the plant

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