Article, Endocrinology

First report of hypoglycemia secondary to dandelion (Taraxacum officinale) ingestion

American Journal of Emergency Medicine (2010) 28, 111.e1-111.e2

Case Report

First report of hypoglycemia secondary to dandelion (Taraxacum officinale) ingestion

Abstract

Consumption of herbal remedies has become prevalent throughout the world and can be found easily over the counter. Many times, these are exempt from safety controls, and the consumption may cause adverse effects and complications. In this letter, we present a case of hypoglycemia due to the ingestion of dandelion.

A 58 year-old-woman with a known history of type 2 diabetes mellitus presented to the emergency department with a complaint of anxiety, diaphoresis, nausea, and palpitations. Her capillary finger stick glucose level was 42 mg/dL, and her symptoms resolved after administration of

1 g/kg of 20% dextrose. She had been using Neutral Protamine Hagedorn (NPH) insulin with a dose of 30 U in the morning and 18 U in the evening. A month ago, her insulin regimen was changed to 34 U in the morning and 20 U in the evening because of persistently high blood glucose levels with an average of 300 mg/dL. The dose adjustment resulted in a lower blood glucose levels, with an approximate average reading of 150 mg/dL and resolved her symptoms. However, 2 weeks before presenting to our emergency dapartment, she started to ingest dandelion (Taraxacum officinale), a kind of Herbal medicine that she ate with her salads. She started having hyperepinephrinemic symptoms of hypoglycemia for the 3 days before presentation, and her finger stick capillary glucose levels were 40, 42, and 44 mg/ dL for 3 days, respectively. Her symptoms did not abate even when she decreased the insulin doses to 30 U in the morning and 15 U in the evening. She denied inadequate food intake or dietary change, alcohol consumption, increased physical exertion, incorrect insulin dosing, or any new medications that may cause Drug interactions. Her vital signs were within normal limits, and there were no abnormal findings on physical examination. Her chest x-ray and Urine analysis were normal. The electrocardiogram was also normal. A complete blood count and blood chemistry were within normal ranges except blood glucose level. She was

discharged with instructions to stop her ingestion of dandelion. She had no hypoglycemic symptoms after the cessation of dandelion. A follow-up telephone interview with the patient revealed that she did not have any further hypoglycemic symptoms after cessation of dandelion.

Plants of the genus Taraxacum have long been used as medicinal herbs. A first reference to its application is reflected in its name, which is derived from the Greek words taraxis for inflammation and akeomai for curative [1]. Dandelion is used to treat Loss of appetite, dyspepsia, flatulence, gallstones, and constipation; it is also used as a bile stimulant, diuretic, circulatory tonic, skin toner, blood tonic, and digestive tonic. It is also used for the treatment of viral and bacterial infections as well as cancer [2]. A study by Cho et al [3] evaluated the possible antidiabetic effects of dandelion in streptozotocin-induced diabetic rats. It suggested that dandelion water extract supplement can improve lipid metabolism and is beneficial in preventing diabetic complications from lipid peroxidation and free radicals in diabetic rats. A study by Onal et al [4] found that dandelion has ? glucosidase inhibitor activity. One study reported decreased glucose levels in nondiabetic rabbits [5] and in normoglycemic and alloxan-treated hyperglycaemic rabbits, whereas another found no changes in mice [6].

Despite the demonstrated antidiabetic effects of dandelion in animal models, there are no human cases of hypoglycemia secondary to dandelion ingestion in the medical literature. ? Glucosidase activity or dandelion’s effect on lipid metabo- lism via lipid peroxidation or both mechanisms may be the possible causes of dandelion’s hypoglycemic effects. In conclusion, the consumption of dandelion as an herbal medication may cause hypoglycemia.

Erkan Goksu MD Cenker Eken MD Ozgur Karadeniz MD Oguz Kucukyilmaz MD

Akdeniz University School of Medicine Department of Emergency Medicine

Antalya, Turkey

doi:10.1016/j.ajem.2009.02.021

0735-6757/$ – see front matter (C) 2010

111.e2 Case Report

References

  1. Schutz K, Carle R, Schieber A. Taraxacum–a review on its phytoche- mical and pharmacological profile. J Ethnopharmacol 2006;107:313-23.
  2. Rodriguez-Fragoso L, Reyes-Esparza J, Burchiel SW, Herrera-Ruiz D, Torres E. risks and benefits of commonly used herbal medicines in Mexico. Toxicol Appl Pharmacol 2008;227:125-35.
  3. Cho SY, Park JY, Park EM, et al. Alternation of hepatic antioxidant enzyme activities and lipid profile in streptozotocin-induced diabetic rats by supplementation of dandelion water extract. Clin Chim Acta 2002;317:109-17.
  4. Onal S, Timur S, Okutucu B, Zihnioglu F. Inhibition of alpha- glucosidase by aqueous extracts of some potent antidiabetic medicinal herbs. Prep Biochem Biotechnol 2005;35:29-36.
  5. Akhtar MS, Khan QM, Khaliq T. Effects of Portulaca oleracae (kulfa) and Taraxacum officinale (dhudhal) in normoglycaemic and alloxan-treated hyperglycaemic rabbits. J Pak Med Assoc 1985;35: 207-10.
  6. Swanston-Flatt SK, Day C, Flatt PR, et al. Glycaemic effects of traditional European plant treatments for diabetes. Studies in normal and streptozotocin diabetic mice. Diabetes Res 1989;10: 69-73.