Home Remedies for Hyperglycemia

Blood Sugar Miracle

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Contraindications Precautions And Interactions

This drug is contraindicated in individuals who have had previous hypersensitivity reactions to pentamidine isethionate. Pentamidine isethionate is used cautiously in patients with hypertension, hypotension, hyper-glycemia, renal impairment, diabetes mellitus, liver impairment, bone marrow depression, pregnancy (Category C), or lactation.

Tests for urinary glucose

Ascorbic acid can also result in false positive tests for glucose in urine (Benedict's test, Clinitest) and blood. Any reports of glycosuria or hyperglycemia in patients taking ascorbic acid must therefore be regarded with suspicion unless a specific (for example chromatographic) test for glucose has been performed (9).

Grontologie Alert

Acetaminophen may alter blood glucose test results, causing falsely lower blood glucose values. Use with the barbiturates, hydantoins, isoniazid, and rifampin may increase the toxic effects and possibly decrease the therapeutic effects of acetaminophen. The effects of the loop diuretics may be decreased when administered with acetaminophen. Hepatotoxicity has occurred in chronic alcoholics who are taking moderate doses of acetaminophen.

Observational studies

In a large American study in 3234 non-diabetic people with a raised fasting blood glucose and a raised blood glucose 2 hours after a glucose load, diabetes occurred in 7.8 cases per 100 participants per year after a mean treatment period of 2.8 years with metformin 850 mg bd there were 11 cases per 100 participants per year after placebo and 4.8 cases per 100 participants per year after a life-style intervention program (8). Gastrointestinal symptoms were most frequent in those who took met-formin. In a later study, glucose tolerance tests were performed after a 14-day washout period of metformin and placebo in the patients who had not developed diabetes (9). Diabetes was more frequently diagnosed in the metformin group, but when the diabetes conversions during treatment and washout were combined, diabetes was still significantly less common in the metformin group.

Drug Administration Drug overdose

The elimination of caffeine has been described in a neo-nate weighing 1860 g, born at 31 weeks of gestation, after the accidental administration of 160 mg kg. The first serum concentration was 218 mg l at 36.5 hours after dosing. The half-life was 81 hours, the clearance 0.01 l hour (0.17 ml minute), and the volume of distribution 1.17 liters. Toxic manifestations were hypertonia, sweating, tachycardia, cardiac failure, pulmonary edema, and metabolic disturbances such as metabolic acidosis, hyperglycemia, and raised creatine kinase activity. An unusual feature of this infant's illness was gastric dilatation. These signs resolved by day 7 at a serum concentration of 60-70 mg l (39).

Pharmaceutical interest

Antidiabetes properties In regard to the antidiabetic property of Benincasa hispida (Thunb.) Cogn., a number of experiments conducted in vivo tend to demonstrate that the plant is inactive. An ethanolic extract of Benin-casa hispida (Thunb.) administered at a dose of 250 mg Kg orally to rats failed to lower blood sugar or to depress the peak value, after glucose load (Chandrasekar B etal., 1989).

Second Generation Effects Pregnancy

In a review of eight large-scale trials, four well-controlled studies did not show any benefit, whereas four others, which showed some benefit, were judged to be totally unsatisfactory, either because control was not strict enough or because inclusion and exclusion criteria were either not sufficiently well-defined or were scientifically unacceptable (142). The general consensus in earlier publications was that diuretics are useless, because they reduce the already lowered cardiac output in pre-eclamp-tic toxemia and so further reduce placental and uterine perfusion (143,144) diuretics do not alter the incidence of pre-eclamptic toxemia and eclampsia and they do not improve perinatal mortality or birth weight. Both the maternal adverse effects (hypokalemia, metabolic acido-sis, hyperglycemia, hyperuricemia, hemorrhagic pancreatitis, and even death due to abuse) and the fetal and perinatal adverse effects (hyponatremia, fetal dysrhyth-mias induced by hypokalemia, thrombocytopenia, and...

Atypical antipsychotic drugs

Amisulprid, aripiprazole, clozapine, olanzapine, quetiapine, risperi-don, and ziprasidone are called atypical or second-generation antipsychotics. Compared with classical antipsychotics (butyrophenones, phenothiazincs), they have fewer neurological side cffccts (extrapyramidal or dyskinctic symptoms) and most of them have a relatively higher affinity for serotonin receptors than for dopamine receptors, resulting (apart from amisulprid and, as a transient effect, in rispcri-don) in a lower or insignificant prolactin increase. Therefore, a change from phenothiazines to atypical neuroleptics may result in an unwanted pregnancy. An increased risk of hyperglycemia or glucose intolerance in pregnant women who are using clozapine or olanzapine has been observed. Weight increase may result with these drugs, and with quetiapine and risperidone (Gentile 2004). Glucose intolerance and excessive weight increase are risk factors for the outcome of pregnancy. On the other hand, a lower birth

Antidiabetic Activity

Noninsulin-dependent diabetes mellitus is one of the most common disorders worldwide 42 . It is a group of metabolic disorders characterized by hyperglycemia. The metabolic disorders include alterations in the carbohydrate, fat, and protein metabolism associated with absolute or relative deficiencies in insulin secretion and or insulin action. Along with hyperglycemia and abnormalities in serum lipids 43 , diabetes is associated with microvascular and macrovascular complications, which constitute the main cause of morbidity and mortality of diabetic patients 44 .

Adverse Reactions

The two major adverse reactions seen with insulin administration are hypoglycemia (low blood glucose or sugar) and hyperglycemia (elevated blood glucose or sugar). The symptoms of hypoglycemia and hyper-glycemia are listed in Table 49-1. Hyperglycemia may occur if there is too little insulin in the bloodstream in relation to the available glucose (hypoinsulinism). Hyperglycemia may occur

Ongoing Assessment

The nurse must assess the patient for signs and symptoms of hypoglycemia and hyperglycemia (see Table 49-1) throughout insulin therapy. The patient is particularly prone to hypoglycemic reactions at the time of peak insulin action (see the Summary Drug Table Insulin Preparations) or when the patient has not eaten for some time or has skipped a meal. In acute care settings, frequent blood glucose monitoring is routinely done to help detect abnormalities of blood glucose.

TABLE 501 Activity of Glucocorticoids in the Body

Action is decreased, and blood pressure falls. Facilitates the breakdown of protein in the muscle, leading to increased plasma amino acid levels. Increases activity of enzymes necessary for glucogenesis producing hyperglycemia, which can aggravate diabetes, precipitate latent diabetes, and cause insulin resistance A complex phenomena that promotes the use of fat for energy (a positive effect) and permits fat stores to accumulate in the body, causing buffalo hump and moon- or round-shaped face (a negative effect).

Drug administration route

In general, intensive therapy produces lower blood glucose concentrations and HbA1c concentrations. This may result in worsening of proliferative retinopathy (155), or weight gain M14.42.9 . Pens can develop inaccuracies in rare instances, which may be unnoticed by the patient (156). Clogging of the system is often the cause. The result is diabetic coma or ketoacidosis, but this is not more frequent than with other systems. When needles are not regularly renewed, infections may emerge. Continuous subcutaneous insulin infusion has been reviewed (168,169). Probably more than 100 000 patients in the USA are using it. Some studies have shown no difference in mean glucose concentration or HbA1c compared with intensive treatment, but most have shown a slight difference favoring continuous subcutaneous infusion. With fast-acting analogues the postprandial glucose peaks are lower. In one study, when insulin delivery was intentionally interrupted, the increase in glucose concentrations or the...

Interactions Of Ginseng With Drugs

Ginseng is a widely used herbal product in China, other Asian countries and also in the United States. For thousands of years, the common people in China have used ginseng as a tonic. The Chinese ginseng that grows in Manchuria is Panax ginseng. However, the ginseng that grows in North America is Panax quinquefolius. The common preparation of ginseng is ginseng root. Ginseng is promoted as a tonic and also as a reliever of stress. Ginseng may also be effective in the treatment of mild hyperglycemia. In Germany, it is indicated to combat lack of energy. Ginseng contains saponins known as ginsenosides.

Comparative studies

The short action of insulin lispro can then be extended by the addition of protamine zinc insulin. In a 3-month study in addition to a once-daily injection of protamine zinc insulin, at each meal insulin lispro or insulin lispro + protamine zinc insulin was injected the postprandial blood glucose concentration was lower, but the post-absorptive glucose concentration was higher in the insulin lispro-only group there was no difference in HbA1c. The addition of protamine zinc insulin (30 at breakfast, 40 at lunch, and 10 at dinner) improved post-absorptive glucose and HbA1c (12).

Monitoring and Managing Adverse Reactions

When the androgens are administered to a patient with diabetes, blood glucose measurements should be done frequently because glucose tolerance may be altered. Adjustments may need to be made in insulin dosage, oral antidiabetic drugs, or diet. The nurse monitors the patient for signs for hypoglycemia and hyper-glycemia (see Chap. 49).

Other features of the patient

Adverse effects due to drug-drug interactions are not expected in diabetic patients using insulin and oral hypo-glycemic drugs that are not metabolized by CYP3A4 (for example tolbutamide, gliclazide, glibenclamide, glipizide, and metformin). The pharmacokinetic and safety data from clinical trials and postmarketing surveillance have been reviewed to assess the safety of itraconazole in diabetic patients with onychomycosis or dermatomycosis (54). Postmarketing surveillance, including all adverse event reports in patients taking itraconazole concomi-tantly with insulin or an oral hypoglycemic drug, revealed 15 reports suggestive of hyperglycemia and nine reports suggestive of hypoglycemia. In most patients there was no change in antidiabetic effect. From clinical trials in 189 diabetic patients taking itraconazole for various infections, one itraconazole-related adverse event was recorded this was a case of aggravated diabetes in a renal transplant patient who was also taking...

General Information

Four children developed malathion intoxication after hair-washing with a solution containing malathion (50 in xylene) for the purpose of louse control (1). Hyperglycemia and glycosuria were found in all cases. One child, described in detail, was in coma and did not respond to pain stimuli other symptoms included severe

Combinations of oral hypoglycemic drugs

This subject has been reviewed in relation to combined oral therapy. In a systematic review of 63 studies with a duration of at least 3 months and involving at least 10 patients at the end of the study, and in which HbA1c was reported, five different classes of oral drugs were almost equally effective in lowering blood glucose concentrations (29). HbA1c was reduced by about 1-2 in all cases. Combination therapy gave additive effects. However, long-term vascular risk reduction was demonstrated only with sulfonylureas and metformin.

General adverse effects

The most frequent adverse effect of meglitinides is hypo-glycemia. The overall incidence of hypoglycemia with repaglinide is similar to that reported with sulfonylureas, but the incidence of serious hypoglycemia is lower. Other adverse effects are respiratory tract infections and headache. Cardiovascular events and cardiovascular mortality are not different from those in users of sulfonylureas. In Europe, repaglinide is contraindicated in patients with severe liver dysfunction and it is not recommended in people over 75 years old in America the advice is to use repaglinide cautiously in patients with impaired liver function and there is no restriction on its use in elderly patients. In renal impairment, the half-life of repaglinide is prolonged. Reasons for withdrawal are hyperglycemia, hypoglycemia, and myocardial infarction (38).

Organs and Systems Metabolism

Repaglinide has a short duration of action and improves postprandial hyperglycemia, a potential risk factor for cardiovascular changes (39). In a double-blind, multiple-dose, parallel-group study repaglinide stimulated mealtime insulin secretion (40). Bouts of hypoglycemia were equally frequent with placebo and repaglinide. When repaglinide was added to NPH monotherapy in patients with HbA1c over 7.1 for 3 months, 38 of the patients had an HbA1c below 7.1 (41). The incidence of hypo-glycemia did not change.

Uses cardiac stimulant Crystodigin Lanoxin Digibind

Toxins include Na+ and K+ channel blocking. Intoxication by the proteinaceous toxins mentioned above will produce symptoms of severe local pain (due to other compounds in the venom), sweating, nausea, cramps, hyperglycemia, and respiratory distress. It is well to note here the difference between a venom and a toxin. A venom is a mixture of compounds which each have its own biological action and the chemicals often act in concert to enchance the toxic effects. A toxin is one of the components of a venom, a distinct chemical entity, frequently a protein. It is isolatable and it usually exerts a single biochemical action.

Thiazides and Related Diuretics

Concurrent use of the thiazides with allopurinol may increase the incidence of hypersensitivity to allopurinol. The effects of anesthetics may be increased by thiazide administration. The effects of anticoagulants may be diminished when they are administered with a thiazide diuretic. Because thi-azide diuretics may raise blood uric acid levels, dosage adjustments of antigout drugs may be necessary. Thiazide diuretics may prolong antineoplastic-induced leukopenia. Hyperglycemia may occur when the thiazides area administered with the antidiabetic drugs. Synergistic effects may occur when the thi-azide diuretics are administered concurrently with the loop diuretics, causing profound diuresis and serious electrolyte abnormalities. There is an increased risk of glycoside toxicity if the patient experiences hypokalemia while taking the thiazide diuretics.

The use of 2DE as a tool towards diagnostics and disease description

Type II diabetes (non-insulin-dependent diabetes mellitus, NIDDM) is a heterogeneous disorder with several metabolic abnormalities including hyperglycemia, hyperinsulinemia and dyslipidemia which are the results of the combination of insulin resistance (acquired) and impaired insulin secretion (genetic) 18 . The first approach for the treatment of patients with NIDDM is to reduce metabolic abnormalities through diet control and exercise 19 . When they fail, additional therapeutic approaches to improve glycemic control are used to increase insulin secretion and diminish insulin resistance. Thiazolidine-diones (Thzs) are oral antidiabetic agents that improve insulin action and decrease plasma glucose, insulin and triglycerides content. Unfortunately, the mechanisms of action of Thzs are not well defined. As Thzs have higher effects in obese animals, we treated lean vs. genetically obese C57 Bl 6 mice8' with troglitazone. Pharmacological and toxic...

Susceptibility Factors Age

Serious difficulties arise in giving theophylline to premature neonates. These are explained by peculiarities in biotransformation in prematurity. Transformation of theophylline to caffeine in premature neonates is explained by the lack of enzymes for desmethylation and C-hydroxylation and by predominant N-methylase activity. High serum caffeine concentrations have been found in two studies of premature newborns with respiratory disturbances who had received theophylline (SEDA-4, 3) caffeine and theophylline synergism was incriminated in the development of toxic reactions in these children. In another study, there was clinically significant hyperglycemia in 13 of preterm infants who received theophylline (30). Blood glucose concentrations should be monitored in preterm infants who receive theophylline. There is some evidence (SED-10, 5) that administration of 4.5 mg kg of theophylline followed by a maintenance dose (1.2-1.52 mg kg every 8-12 hours) is most likely to correct...

Miscellaneous Antineoplastic Drugs

When asparaginase is administered to a patient with diabetes, the risk for hyperglycemia is increased a dosage adjustment of the oral antidiabetic drug may be necessary. Glucocorticoids decrease the effectiveness of aldesleukin. When aldesleukin is administered with antihypertensive drugs, there is an additive hypotensive effect. Etoposide may decrease the immune response to live viral vaccines.

Experimental Antidiabetic Plants

Bnouham et al. 64 examined antidiabetic effect of an aqueous extract of the aerial parts of Urtica dioica (nettle), a plant used in eastern Morocco for both diabetes and hypertension, on hyperglycemia induced by oral glucose tolerance test (OGTT) and on alloxan-induced diabetic rats. The authors showed a strong antihyperglyce-mic effect of the plant (250 mg kg-1) during the first hour after glucose loading in rats under OGTT (33 versus control) but a lack of hypoglycemic effect in alloxan-induced diabetic rats. Furthermore, intestinal glucose absorption was significantly reduced in situ in jejunum segment, which suggests that the extract may act on glucose homeostasis via an extrapancreatic mechanism.

Drug Drug Interactions Beta blockers

The risk of hyperglycemia or hypokalemia is increased if corticosteroids are given simultaneously (for example for asthma). In 24 healthy subjects randomized to salbutamol 5 mg, fenoterol 5 mg, or isotonic saline before and after a course of prednisone 30 mg day for 1 week, changes in plasma potassium and glucose after the nebulized beta-agonist were significantly greater after treatment with prednisone (33). Baseline potassium concentration fell from 3.75 to 3.50 mmol l. The lowest mean plasma potassium occurred 90 minutes after fenoterol with prednisone pretreatment (2.78 mmol l).

Prostaglandins in cardiovascular disease

Congenital cardiac malformations (6,7). The most frequent adverse effects during prolonged treatment are diarrhea, necrotizing enterocolitis, cortical hyperostosis (8-10), fever, respiratory depression and apnea, and seizure-like activity (11). The frequency of adverse effects is not necessarily reduced with low-dose intravenous or oral administration (12). Maternal fetal hyperglycemia due to reduced insulin secretion is rare, except in the infants of diabetic mothers (13). Less common adverse effects include gastric outlet obstruction due to antral hyperplasia (14).

Treatment Initiation And Dose Titration

Psych Drug Monitoring

Somatic Treatment of Schizophrenia. Also refer to Table 1-1 and the following First episode-Group(G) 2 Persistent suicidal ideation or behavior-G3 Persistent hostility and aggressive behavior-G3 Tardive dyskinesia-G2 all group 2 drugs may not be equal in their lower or no tardive dyskinesia liability and G3 History of sensitivity to extrapyramidal side effects-G2 except higher doses of risperidone History of sensitivity to prolactin elevation-G2 except risperidone History of sensitivity to weight gain, hyperglycemia, or hyperlipidemia-G2 ziprasidone or aripiprazole Repeated nonadherence to pharmacological treatment-G4 (taken from the Practice Guidelines for the Treatment of Patients with Bipolar Disorder, Second Edition from the American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, Copyright 2004). FIGURE 1-1. Somatic Treatment of Schizophrenia. Also refer to Table 1-1 and the following First episode-Group(G) 2...

Polyclonal antilymphocyte immunoglobulins

Patients treated with combined antilymphocyte anti-thymocyte globulin preparations from immunized horses (37). Immediate adverse effects include leukopenia and thrombocytopenia, fever, arthralgia, rash, urticaria, hepatotoxicity, hyperglycemia, hypertension, and diarrhea (38). A later adverse effect is serum sickness. Many of the effects may be due to an increase in tumor necrosis factor (39).

Diabetes mellitus and pregnancy

Diabetes mellitus is the collective name for heterogeneous disturbances of metabolism which all are characterized by chronic hyperglycemia. In essence, there are three different types. While type I is caused by a disturbed secretion of insulin, type II and gestational diabetes are characterized by a disturbed action of insulin. Both causes can also occur simultaneously. Achieving and maintaining euglycemia throughout gestation is the aim of diabetes therapy, because diabetic fetopathy appears to be due to fetal hyperglycemia and hyperinsulinemia, secondary to maternal hyperglycemia. Fetal hyperinsulinemia leads to hyperplasia and hypertrophy of islet cells, and increases the risk of respiratory distress syndrome (RDS). Children of mothers with insufficient blood sugar control during pregnancy have an increased risk of becoming obese during puberty or in early adulthood, or of developing diabetes or an imbalanced glucose tolerance.

Swertia chirayita Roxb Lyons

An ethanolic extract of Swertia chirayita (Roxb.) Lyons lowers blood glucose levels in alloxan diabetic albino rats. (Ajit K etal., 2003). The active principle is not known, but one might suspect a lipophilic substance, as maximal activity is reported from hexanic fractions (Sekar BC etal, 1987). Could it beaxanthone with a-glucosidase inhibitory activity

Topical administration to the eye

Since glucocorticoids reduce the immunological defences of the body to most types of infection, their use in the eyes should be monitored carefully. When long-term use is necessary, even with oral or inhalation therapy, eye examination should be performed every 6 months. The ophthalmological follow-up of patients using topical glucocorticoids should include tonometry at least twice a year, careful slit-lamp examination for early signs of herpetic or fungal keratitis and for changes in the equatorial and posterior subcapsular portions of the lens, examination of pupillary size and lid position, and staining of the cornea to detect possible punctate kerati-tis. Blood glucose concentrations should be checked if there are symptoms that suggest hyperglycemia.


While abacavir has been associated with hyperglycemia in individual cases (10), there were no significant effects on blood glucose concentration in clinical trials. A 47-year-old man, with normoglycemia and no family history of diabetes mellitus, who was taking highly active antiretroviral therapy, was given abacavir for treatment intensification. He became lethargic and hyperglycemic. Despite metformin and glibenclamide, the hyperglycemia continued. Abacavir was withdrawn, and within 2 weeks his blood glucose concentration returned to baseline and the hypoglycemic drugs were withdrawn. This patient was also taking hydrochlorothiazide, but the time-course of onset and resolution were consistent with abacavir-induced hyperglycemia.

Therapeutic studies

In another randomized trial, the effects and adverse effects of early dexamethasone on the incidence of chronic lung disease have been evaluated in 50 high-risk preterm infants (8). The treated infants received dexa-methasone intravenously from the fourth day of life for 7 days (0.5 mg kg day for the first 3 days, 0.25 mg kg day for the next 3 days, and 0.125 mg kg day on the seventh day). The incidence of chronic lung disease at 28 days of life and at 36 weeks of postconceptional age was significantly lower in the infants who were given dexametha-sone, who also remained intubated and required oxygen therapy for a shorter period. Hyperglycemia, hypertension, growth failure, and left ventricular hypertrophy were the transient adverse effects associated with early


The use of postnatal glucocorticoids in very premature infants is controversial although dexamethasone reduces bronchopulmonary dysplasia, it has been associated with severe adverse effects (348). In 220 infants with a birth-weight of 501-1000 g randomized to placebo or dexa-methasone (0.15 mg kg day for 3 days and tapering over a period of 7 days) the relative risk of death or chronic lung disease compared with controls was 0.9 (95 CI 0.8-1.1) at 36 weeks of gestational age (304). Infants treated with dexamethasone were less likely to need supplementary oxygen. Dexamethasone was associated with increased risks of hypertension (RR 7.4 95 CI 2.7, 20.2), hyperglycemia (RR 2.0 95 CI 1.1, 3.6), spontaneous gastrointestinal perforation (13 versus 4 ), lower weight, and a smaller head circumference.

Other Effects

TCA's can cause gynecomastia and amenorrhea in some patients, while SSRIs can cause increased prolactin levels causing mammoplasia and galactorrhea in both men and women. SSRIs have also been known to reduce blood glucose levels, though this is rare. Nefazodone has been associated with rare cases of life-threatening liver failure, and has been removed from the market in many European countries. As a result, nefazodone should not normally be considered for use before other antidepressants.


Diazoxide has a diabetogenic effect on the metabolism (Sweetman 2002). Case reports showed hyperglycemia not only in pregnant women, but also in their newborns (Milsap 1980, Neuman L979). Therefore, the thiazide der vate, diazoxide, is also used as an oral antihypoglycemic.


Insulin is a hormone manufactured by the beta cells of the pancreas. It is the principal hormone required for the proper use of glucose (carbohydrate) by the body. Insulin also controls the storage and utilization of amino acids and fatty acids. Insulin lowers blood glucose levels by inhibiting glucose production by the liver.


Like the sulfonylureas, the meglitinides act to lower blood glucose levels by stimulating the release of insulin from the pancreas. This action is dependent on the ability of the beta cell in the pancreas to produce some insulin. However, the action of the meglitinides is more rapid than that of the sulfonylureas and their

Nh Nh Ncnhcnh2

Other than the sulfonylureas, only guanidines have the ability to lower blood sugar values. This led to several clinically useful biguanides such as the phenethylbiguanide phen-formin (Table 11-7). The drug does not stimulate insulin secretion. Its mechanism of action has not been elucidated. Though effective, it was withdrawn (1978) from the U.S. market because of an occurrence of lactic acid acidosis in some patients that resulted in high mortality. A dimethyl analog, metformin (Glucophage), has been introduced (1995) with a somewhat better safety profile (Table 11-7).

Glucose metabolism

Glucocorticoids probably have more than one effect on carbohydrate metabolism. An increase in fasting glucagon concentration has been observed in volunteers given pre-dnisolone 40 mg day for 4 days, and this effect may be involved, alongside gluconeogenesis, in glucocorticoid-induced hyperglycemia. Some newer glucocorticoids have been claimed to have smaller effects on blood glucose (as well as less salt and water retention), but further studies are needed to confirm whether this interesting therapeutic approach has been successful (SEDA-13, 353). The risk of hyperglycemia requiring treatment in patients receiving oral glucocorticoids has been quantified in a case-control study of 11 855 patients, 35 years of age or older, with newly initiated treatment with a hypo-glycemic drug (SEDA-19, 375) (104). The risk for initiating hypoglycemic therapy increased with the recent use of a glucocorticoid. The risk grew with increasing average daily glucocorticoid dosage (in mg of hydrocortisone...

Momordica charantia

Oral formulations of Momordica charantia (karela fruit, bitter melon) have hypoglycemic activity in non-insulin dependent diabetes mellitus (8,9), and can interfere with conventional treatment with diet and chlorpropamide (10). In 15 patients aged 52-65 years a soft extract of M. charantia plus half doses of metformin or glibenclamide or both in combination caused hypoglycemia greater than that caused by full doses during treatment for 7 days (11). Subcutaneous injection of a principle obtained from the fruit may lower blood glucose concentrations in juvenile diabetes.