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Flashcards in 15 - Diabetes Deck (48):
1

List examples of natural health products

-Vitamins and Minerals
-Herbal Remedies
-Homeopathic medicines
-Traditional medicines such as TCM
-Probiotics, amino acids and essential fatty aids

2

What are herbal remedies?

Substances derived from plants used for medicinal properties

3

What are the pharmacists' responsibilities with NHPs

-Safety first !!
-Assessment
-Education - Practical tips
-Support - Empowerment

4

What are concerns that ppl have with NHPs

-Side effects
-Drug Interactions
-Impurities
-Many different names for products
-May copy, increase or oppose the effects of drugs
-Many unanswered questions regarding safety, efficacy, dosing, drug interactions

5

What is the active component in french lilac/goat's rue?

A guanidine

**Where metformin came from - type of biguanide

6

Is French Lilac/Goat's Rue recommended ?

too toxic for regular treatment - DO NOT USE

7

Possible actions of Alpha-lipoic Acid-Thioctic Acid ?

improves insulin sensitivity and glucose disposal

8

SE of Alpha-lipoic Acid-Thioctic Acid ?

nausea, dizziness and skin rash

9

Interactions with Alpha-lipoic Acid-Thioctic Acid ?

-diabetes meds
-chemotherapy
-thyroid disease

10

Alpha-lipoic Acid-Thioctic Acid:
Possibly safe when ?

when used orally appropriately from 4 months - 4 years (NOT SAFE OVER 4 YEARS)

11

Alpha-lipoic Acid-Thioctic Acid:
Effective?

possibly effective for diabetes

12

What is the active component of Glucomannan ?

non absorbed polysaccharide

13

MOA of Glucomannan

delays glucose absorption

14

SE of Glucomannan

Laxitive effect, esophageal and gastrointestinal obstructions reported with tablet form

15

Is Glucomannan safe?

safe when used as food or in powder or capsule form for up to 4 months

16

Is Glucomannan effective?

possibly effective

17

Drug interactions with Glucomannan?

decreases absorption of other meds and fat soluble vitamins

18

What is Chromium ?

Essential trace element required for normal glucose metabolism

19

Action of Chromium?

Reduce Fasting Blood Glucose, Insulin and A1C

20

Side effects of Chromium ?

Well tolerated, headache, insomnia, sleep disturbances, irritability and mood changes

21

Safety of Chromium ?

likely safe orally when used short term. has been safely used in doses up to 1000 mcg/day up to 6 months

22

Is Chromium effective ?

Possibly effective 40-80% of patients have improved glucose tolerance
*Thought to be effective only in deficiency

23

Active components of bitter melon ?

-charantin
-polypeptide P
-vicine

24

Possible actions of bitter melon

-increased insulin secretion
-tissue glucose uptake
-decreased gluconeogenesis

25

SE of bitter melon

-diarrhea
-GI upset and pain
-two cases of hypoglycaemic coma in children drinking tea

26

Safety of bitter melon ?

possibly safe when used orally up to 3 months

27

Is bitter melon effective?

insufficient reliable evidence to rate

28

_____ _____ is an insulin like protein, common in India

bitter melon

29

Possible actions of Fenugreek ?

seeds contain 50% fibre and pectin delays gastric emptying, slowing glucose absorption, increase insulin secretion

30

SE of Fenugreek

flatulence, diarrhea, hypersensitivity reactions

31

Avoid Fenugreek in those with _____ allergy

peanut

32

Is Fenugreek safe in pregnancy ?

NO - Unsafe

33

_____ is a reasonable time frame to do A1C

3 months

34

Active component of Ginseng

Ginsenosides

35

Possible actions of Ginseng ?

increases glucose transport and uptake, modulates insulin secretion

36

SE of Ginseng?

nervousness, excitation, headache, hypertension, insomnia

37

Interactions with Ginseng?

May interfere with anticoagulation

38

Safety considerations with Ginseng?

Concern with adulteration (failure to meet standards). Use for short term only up to 12 weeks

39

Efficacy of Ginseng ?

possibly effective, evidence limited

40

Active component of Cassia cinnamon?

polyphenolic polymers

41

Possible action of Cassia cinnamon ?

enhance insulin action, increases glucose uptake

42

SE of Cassia cinnamon ?

well tolerated

43

High amounts of Cassia cinnamon can cause ?

hepatotoxicity

44

What do you do if a patients wants to use a herbal therapy?

-encourage patient to get as much reliable information about the herbal remedy (indications for use, interactions, possible side effects)

45

What should our patients know before choosing a non-Rx product?

-Will it affect blood glucose levels?
-Does it interact with diabetes medications?
-Are the ingratiates safe for a person with diabetes to use safely?

46

How do you use NHPs safely ?

-Work with/inform healthcare providers
-Products with NPN number or EN number
-Encourage single ingredient products
-Encourage small starting dose determine effects/side effects
-Help patients learn to spot false claims
-Avoid products and promoters who make claims such as quick and effective cure-all, totally safe, all natural and no side effects, no risk, money back guarantees

47

Are NHPs recommended for diabetes?

NHPs are not recommended for glycemic control for individuals with diabetes as there is insufficient evidence, at this time, regarding efficacy and safety
-HCPs should ask about the use of these NHPs

48

Summary of NHPs

-Natural is not always safe
-New regulations
-Little scientific evidence - help patients investigate
-Potential to affect blood glucose
-Encourage use with not instead of conventional meds
-Encourage blood glucose monitoring
-Encourage recording effects; if no results discontinue