As a chronic metabolic disease, Diabetes Mellitus is one of the major community health concerns in the 21st century. DM is categorized by enhanced blood glucose levels and reduced insulin sensitivity.

By Maryam Ehsan1, Wafa Majeed1,2, Hafiza Arooj Kanwal1, Ambreen Mehmood Awan1, Saad Tariq1


Decreased plasma concentrations of insulin are responsible for metabolic abnormalities, as well as insulin blockage in target tissues, adipose tissue, and genetic factors.

Type 1 Diabetes Mellitus (DM):

Type 1 DM induced by autoimmunity:

Type 1 DM is brought about by immune system destruction of insulin-producing beta cells in the pancreas by both T-cell-mediated inflammatory reaction and beta-cell reactions. To protect the pancreatic tissues from T cell-mediated death there are two pathways, the first is to regulate the effector T- cell responses, and the second is resistance to T cell-mediated death. For example, Graves’ infection, hepatitis, and pernicious anemia are likewise normal among these self-immune system type 1 diabetic patients.

Idiopathic type 1 DM:

A wide variety of type 1 diabetes of unknown origin (idiopathic) has been discovered, which is less severe than autoimmune type 1 diabetes and is not caused by autoimmunity. The majority of individuals with this condition are African, American, or Asian, and they have varying degrees of mental illness, episodic insulin deficiency, and ketoacidosis.

Fulminant type 1 DM:


Ketosis develops shortly after the onset of hyperglycemia, with elevated glucose levels (> 288 mg/dL), an indication of undetectable insulin production, and C-peptide levels. With no apparent autoantibody against beta cells, an antiviral immune-mediated reaction could trigger pancreatic beta-cell death through an increased invulnerable reaction.

Type 2 Diabetes Mellitus:

Diabetes mellitus (DM) is an endocrine metabolic disorder that can be characterized by persistent high glucose that affects insulin action, insulin secretion, or both. DM is mainly associated with metabolic abnormalities in carbohydrates, lipids, and proteins. The primary cause of type 2 diabetes is insulin resistance.

Insulin resistance and signaling pathways:

Diabetic progressions, including hyperglycemia, have been related to abnormalities in the insulin-dependent protein kinases signaling pathway. This pathway helps in insulin discharge from cells by releasing different incretin protein kinases, like protein kinase C (PKC), and serine/threonine kinase, which hydrolyzes a side-effect in IRS proteins that are engaged with the digestion to insulin. These are all instances of complicated cell metabolic changes that happen in an assortment of tissues, generally the muscles and liver. Under the various condition, non-insulin-dependent kinases including G protein-coupled receptor kinase 2 can phosphorylate the two -insulin-responsive substrates and AMP-activated protein kinase.

Other types of diabetes mellitus:

Monogenic diabetes:

Newborn diabetes, which begins before the age of six months, and is linked with the Maturity Onset Diabetes of young people (MODY), which begins just as early as 25 years, are the two types of monogenic diabetes. The activation of the homeodomain transcription factor PDX1 is needed for beta-cell growth, and a variation in the genetic makeup causes Maturity Onset Diabetes, with reduced PDX1 expression prior to initiation of DM.

Gestational Diabetes:

Hyperglycemia during pregnancy has increased adverse maternal and fetal outcomes. Gestational diabetes may be associated with maternal age, polycystic syndrome, and obesity (Galtier, 2010). It can be complicated by preeclampsia, hypertension, and hydramnios. Women with GDM and their offspring have an enhanced risk of developing type 2 DM in the future.

Diagnostic indicators for diabetes:

The HbA1c test or the determination of glucose concentrations (FPG or OGTT) are used to diagnose diabetes mellitus. A fasting glucose value of 126 mg/dL, plasma glucose of 200 mg/dL following 2-hour OGTT, an HbA1c of 6.5 percent, or an irregular fasting blood glucose of 200 mg/dL; all are linked with indications of hypertension.

Dietary Supplements:

Dietary supplements are essentials that our body needs in little amounts to perform certain functions which serve as an antioxidant. Dietary supplements promote health when taken according to their requirement. They are most typically used as coenzymes and cofactors in metabolic activities, and hence aid in the support of basic biological reactions. Multivitamin pills have been studied as effective prevention and therapy compounds for the treatment of diabetes, as well as for frequent diabetic complications.


Transition metals chromium (Cr3+), a trace element, is a necessary nutrient for humans. It effects lipids, carbohydrates and protein metabolism. Supplementary chromium has been seen in normal, elderly, and type 2 diabetic people to lower fasting glucose, improve glycemic control, lower insulin levels, and lesser cholesterol and triglycerides while increasing HDL cholesterol.


Insulin regulates the movement of magnesium from the extracellular to intracellular space, and intracellular Mg2+ concentration regulates insulin activity and blood pressure. Insulin resistance is caused by a lack of magnesium, and insulin resistance lowers magnesium levels tremendously. The administration of low-dose oral magnesium to T2D patients has been shown to increase insulin sensitivity and metabolic management.


Nicotinamide adenine dinucleotide or NADH supplement regulates the insulin secretion. NADH is formed from NAD+. Nicotinamide controls blood sugar levels, reduces oxidative stress, protects beta-cells and DAG production. The availability of NAD+ in target tissues improves insulin sensitivity and reduces diabetes burden and associated metabolic disorders.


Phytochemical pharmaceutical remedies are usually applied in elective treatment for glucose management. A few dietary modifications have been shown to aid people with diabetes, either because of their strength or because of their remedial effect on glucose digestion. Cr, nicotinic acid, and magnesium are three of the most important nutritional supplements. Other common diabetic optional medications include needle therapy, hydrotherapy, yoga, and chromotherapy.


Maryam Ehsan1, Wafa Majeed1,2, Hafiza Arooj Kanwal1, Ambreen Mehmood Awan1, Saad Tariq1

1Institute of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan

2Department of Pharmacy, University of Agriculture, Faisalabad, Pakistan