Nearly half of human diabetic adults surveyed in the U.S. in 2002 used some form of complementary and alternative medicine.1 These approaches included herbs, chiropractic, yoga, acupuncture, homeopathy, biofeedback, chelation, energy healing, Reiki therapy, massage, hypnosis and more. A Canadian study indicated that people spent as much money on supplements as they did on prescription medications.2 Thus, veterinarians managing patients with diabetes now have one more key component to include in their client education meetings. Specifically, veterinarians need to find out whether the animal is receiving any herbal mixtures, as these could conceivably alter blood glucose levels and offset insulin requirements. At a seemingly unstoppable rate, herbals and nutraceuticals are growing in their numbers and claims including products promoted for diabetics. It is no wonder, then, that clients are beginning to ask about non-drug insulin alternatives. The prospect of giving their animal once- or twice-daily injections can be overwhelming, either emotionally or from a time-management perspective. However, no insulin alternatives deliver benefits proven to be as effective or reliable as insulin, and clients integrating these options should monitor their animal's blood sugar levels closely.3 Otherwise, uncertain outcomes could expose an animal to uncontrolled hyperglycemia. On the other hand, dangerously low blood glucose levels could result from additive effects. Further, the confidence that herbalists espouse based on "centuries of empirical evidence" cannot simply translate to veterinary practice. The same herbs advocated by herbalists for humans may undergo much different metabolic treatment by non-human physiologic processes. It is easy, though imprudent, to underestimate the capacity of herbs to reduce blood sugar levels. In fact, hypoglycemic coma has been reported to occur in a child after ingesting bitter melon.4 The accompanying table lists several botanicals commonly recommended for diabetics, although it represents merely a fraction of the growing gamut of products sought for sugar-lowering benefits. Some animals may be taking these substances for non-diabetic conditions; bilberry, for example, frequently appears in natural treatment regimens for ophthalmologic disorders. The familiar risks of unapproved products stem from the lack of independent regulation, quality assurance, and manufacturing oversight. For example, in 2000, the California Department of Health Services issued a warning from the state health director that five Chinese herbal mixtures targeted for diabetics contained the undisclosed oral hypoglycemic agents glyburide and/or phenformin.5 Crop-to-crop variations, the timing of harvests, and even changes in fertilizer usage can also alter the pharmacological makeup of botanical supplements. Selecting standardized medicinals diminishes this concern, though some herb enthusiasts argue that standardization offsets the plant's natural biochemical balance and thereby heightens the risk of toxicity. Finally, as animals become increasingly regarded as family members, the ethics of denying proper treatment (i.e., substituting alternative treatments for insulin in an insulin-dependent diabetic) could come into question, as it has in human pediatrics. In 1992 in the United Kingdom, the High Court found the parents of a 9-year-old diabetic girl guilty of manslaughter after they refused insulin and instead sought treatment with homeopathy.6 After six weeks of this misguided mismanagement, the girl lost one-third of her body weight. She arrived at the hospital in a diabetic coma and died four hours later. A happy medium can certainly be reached. Open communication between practitioner and client, full disclosure of known risks and the reality of unknown effects, and ongoing dialogue regarding the animal's health-care status will serve practitioners well in optimizing the management of diabetic animals. Who knows? Soon we may be seeing sugar-lowering ingredients appearing in all-natural, organic companion-animal diets, possibly disguised as spices, but designed to naturally regulate the diabetic animal consumer. Dr. Robinson, DVM, DO, Dipl. ABMA, FAAMA, oversees complementary veterinary education at Colorado State University. <HOME>
