Introduction

Aloe vera is an ancient plant well known for its medicinal properties. It belongs to the genus Aloe, which has almost 6500 species, but Aloe vera is the most popular one and is termed a “true Aloe”. It has been used for beauty, cosmetic, and health purposes in several cultures for ages: Greece, Egypt, India, Mexico, Japan, and China, and is planted globally because of its commercial and pharmaceutical value.

Aloe has three parts, rind, latex, and gel, and out of these, the gel is considered best for its health benefits. These benefits, according to multiple researches include, anti-inflammatory, anticancer, antioxidant, immunomodulatory, hepatoprotective, antiulcer, and antidiabetic. No wonder this plant is popularly known as the miracle plant.¹

History of aloe vera: a succulent miracle

Aloe vera has a long history of medicinal usage, and it has been found and described in many different cultures. Its biological activities have been well documented in a variety of research works. Following are numerous historical mentions of the use of Aloe vera.

• The first mention of aloe vera is found on the Sumerian clay tablet that dates back to 2100 B.C
• There are also many stories about its use by Queen Cleopatra VII (69-30 B.C.), as part of their regular beauty regimes and medicines
•  Aloe vera was highly valued by King Solomon (971-931 B.C)
• The Arabs called Aloe the “Desert Lily” for its internal and external uses
• In Chinese culture, Aloe vera has been an important ingredient in medical treatments since the times of Marco Polo expeditions. They named the plant “Method of Harmony”
• In Japan it was known as the “royal plant”, the juice was used as an elixir and the samurai used it for embrocations
• The Hindu people believed that Aloe Vera grew in the Garden of Eden and called it the “silent healer”
• The Russians called Aloe Vera “the Elixir of Longevity”
• The native American Indians used Aloe for its emollient and rejuvenating powers²

Understanding diabetes

Diabetes Mellitus is a common metabolic condition, with hyperglycemia as the main finding among the patients. Diabetes is considered to be one of the main public health problems. It is amongst the top 10 causes of death globally and the main cause of disability, morbidity, and mortality in terms of vascular, neurological, cardiac, and renal impairments.³

In 2017, the global prevalence of diabetes was estimated to be 476 million people, which is expected to reach 570.9 million by 2025 worldwide.⁴ There are several ways to categorise diabetes but simply we can divide diabetes into the following types:

Prediabetes

A state where blood sugar levels are higher than normal, but not high enough yet to be labelled as type 2 diabetes. The blood sugar level for this condition is 100 to 125 mg/dL.

Diabetes

When the blood sugar level rises above 126 mg/dL or higher. Diabetes can be of two major types.⁵

• Type 1 Diabetes Mellitus: This results from the body's failure to produce enough insulin
• Type 2 Diabetes Mellitus: This is a condition in which cells fail to respond to insulin properly because they become resistant to the action of insulin

Approaches to the treatment of diabetes mellitus

There are different approaches and lines of treatment for diabetic patients

1. Preserving pancreatic beta cells and improving their performance by making changes in your lifestyle in terms of diet and physical activity
2. Long-term use of medications, oral medicines, and insulin (given subcutaneously). These medicines can have side effects, such as an increased risk of being overweight, liver toxicity, and cardiovascular disease

The drugs used for the treatment of diabetes are not only expensive but also associated with multiple side effects. There is a need for alternative treatment for this metabolic disorder and the most favourable option would be medicinal plants, which are not only easily accessible but are known to offer dynamic health benefits. Aloe vera is one such example. Let’s explore this miracle plant's usefulness in managing diabetes. 

Role of Aloe vera in managing diabetes

How a spiky succulent bitter plant like Aloe vera could be your friend in managing your blood sugar levels? Is Aloe vera a medicinal plant? What exactly are medicinal plants and how do they help in ailments like diabetes? Let’s explore the realm of aloe vera as a medicinal plant and its remarkable role in the management of diabetes. Medicinal plants are defined as any plant or plant preparation(s) that provides health-promoting features and temporary relief or has beneficial therapeutic and or prophylactic properties.⁶ 

Aloe vera is one of the most popular medicinal plants, and scientific literature shows enough evidence for its beneficial effects. Several pre-clinical and clinical studies have been performed to evaluate the anti-diabetic potential of Aloe vera especially in pre-diabetics and type 2 diabetes mellitus.^7,8,9

• Aloe vera has been reported to reduce fasting plasma glucose levels and increase insulin levels 
• It restores the pancreatic cells both qualitatively and quantitatively
• It improves insulin secretion through reduced oxidative stress and inflammatory markers

The science behind Aloe vera’s antidiabetic role

Let’s try to understand how Aloe exhibits its diabetic-friendly tactics:

• Anti-inflammatory properties: Chronic inflammation is associated with insulin resistance, a key factor in the development of type 2 diabetes. Aloe vera reduces inflammation and may help improve insulin sensitivity
• Improved insulin sensitivity: Aloe vera may enhance insulin sensitivity and cells respond better to insulin. This can help regulate blood sugar levels more effectively
• Antioxidant effects: Aloe vera is rich in antioxidants, such as vitamins C and E. These antioxidants help bring down oxidative stress which plays an important role in the progression of diabetes and its complications
• Glucose-lowering compounds: Aloe vera contains compounds like acemannan, a polysaccharide that may have glucose-lowering effects
• Lipid-lowering effects: Aloe vera helps lower lipid levels and manage dyslipidemia. Maintaining healthy lipid levels is important in diabetes management
• Intestinal health improvement: There is evidence to suggest that a healthy gut microbiota can positively influence glucose metabolism and insulin sensitivity. Aloe helps in regulating a healthy gut environment¹⁰

Active phytochemicals responsible for anti-diabetic effects

The active ingredients in Aloe vera that may contribute to its potential anti-diabetic effects include.¹⁰

Scientific research showing evidence of antidiabetic role of Aloe vera

1. This study was conducted in 2015, a double-blind randomized controlled trial of people showing pre-diabetes symptoms, where the use of Aloe vera extract (300 mg) could revert impaired blood glucose within four weeks.¹¹

2. In another systematic review published in 2022, focussed on the potential effect of Aloe vera and its active components in improving diabetic dyslipidemia evidence strongly suggests that the oral administration of Aloe vera may be effective in improving blood glucose balance and lipid metabolism.⁸

3. Another systematic review of search engines (like PubMed, Embase, and Cochrane Central Register) of Controlled Trials in January 2016. A total of five randomized controlled trials (RCTs) involving 415 participants were included. Data showed that aloe vera might reduce the levels of fasting blood sugar, HbA1c, and triglyceride and increase the levels of HDL in prediabetes and early non-treated diabetic patients.¹²

Side effects associated with Aloe vera

Ingestion of Aloe vera may cause multiple side effects. These side effects are because of certain compounds such as polysaccharides and phenolic chemicals, especially anthraquinones. Some of these side effects are as follows.¹³

• Diarrhoea
• Abdominal pain
• Nausea
• Hypokalaemia
• Kidney failure
• Hypersensitivity reaction, and
• Phototoxicity 

FAQs

What are other diseases cured by Aloe vera?

Aloe vera has been used in different skin conditions, especially for the treatment of chronic wounds. Topical use of Aloe is promoted for acne, lichen planus, burning mouth syndrome, burns, and radiation-induced skin toxicity. Oral use of Aloe is endorsed for weight loss, hepatitis, diabetes, and inflammatory bowel disease.¹⁴

Who should not take Aloe vera?

High doses of Aloe vera can be dangerous. People with renal failure, heart conditions, haemorrhoids, and electrolyte imbalance should avoid Aloe vera. The ingestion should also be avoided in pregnancy and lactation.¹⁵

Are there any drug interactions of Aloe vera with other drugs?

• Application of aloe to skin: there may be increased absorption of steroid creams such as hydrocortisone
• Oral intake of Aloe may reduce the effectiveness and may increase the adverse effects of digoxin and digitoxin, due to its potassium-lowering effect
• Combined use of Aloe vera and furosemide may increase the risk of potassium depletion
• It lowers blood sugar levels and thus may interact with oral hypoglycemic drugs and insulin¹⁶

Summary 

Aloe vera has been studied for its potential benefits in managing diabetes, particularly in prediabetic and type 2 diabetic individuals. It has different bioactive compounds that exert this antidiabetic effect and manage to maintain blood sugar at a normal level. This blood sugar lowering effect is due to a combination of several phenomena such as antiinflammatory, enhancing sensitivity to insulin, antioxidants, and maintaining gut health.

Although the literature shows a large number of studies supporting the role of this miracle plant in managing diabetes, it's important to note that while some studies suggest positive effects, more research is needed to establish definitive conclusions. Individuals should consult healthcare professionals before relying on aloe vera for diabetes management.