The management of Type 1 Diabetes Mellitus (T1DM) in children is a challenging process for the parents that involves understanding the complexities of insulin therapy, monitoring blood glucose, and following a nutritional and exercise plan. Due to the need of lifelong injections, parents often resort to the use of Complementary and alternative medicine (CAM) [1].

An 8-year-old boy was diagnosed elsewhere with T1DM, and initiated on premixed insulin therapy two months before presentation. However, parents started using ayurvedic drugs (Tablet Debix, Sandu Pharmaceuticals Ltd, Goa, and Tablet Chandraprabha Vati, Divya Pharmacy, Uttarakhand) bought over the counter along with insulin. Each tablet was given twice daily. Ten days prior to presentation at our hospital, he developed pain abdomen and non-bilious vomiting. There was history of constipation but no abdominal distension, fever or altered sensorium. There was no history of pica or environmental exposure to chemicals. He was operated for ileoileal intussusception elsewhere but pain abdomen persisted. Lead toxicity was suspected in view of ayurvedic medication use. Blood lead level (BLL) was 73 µg/dL (normal<5 µg/dL). He was then referred to our hospital. The general physical examination was unremarkable, except for pallor. The repeat BLL was 63 µg/dL. A conservative plan was followed as he showed symptomatic improvement. Chemical analysis of Debix and Chandraprabha Vati tablets revealed lead content of 2.87 and 2.29 µg/g, respectively; the total lead intake amounted to 6.1 µg/day. On day-9 of hospitalization, BLL was 20 µg/dL. Other laboratory investigations showed hemoglobin of 7.8 g/dL, HbA1c 11.8% and positive GAD-65 autoantibodies. He was discharged on basal bolus insulin regimen after two weeks of hospital stay. At follow up 3 months later, the BLL was 2 µg/dL and HbA1c was 8.2%.

The use of CAM is common (18% and 56% in different studies) in children with T1DM [1]. Such products are often promoted as ‘natural’ or ‘safe’, and relatively inexpensive ‘cure’ [2]. However, several CAM including ayurvedic products available over the counter or on the internet contain lead, mercury, or arsenic much above their acceptable levels, and their use may result in potentially serious complications [2]. There are several reports of lead toxicity after the use of ayurvedic drugs in adults with diabetes [2-5]. The usual gastrointestinal manifestations of lead toxicity are abdominal pain, nausea, vomiting and constipation.

The use of CAM is largely unregulated in India [2]. There is an urgent need for rigorous pharmacological and toxicological studies to ensure purity, safety and efficacy of these widely available products.

Acknowledgements: Prof. Savita Verma Attri and Mr Vivek Singh Malik, Biochemistry Laboratory, Department of Pediatrics, PGIMER, Chandigarh for carrying out the chemical analysis of the drugs.

1. Uslu N, Bayat M. The use of complementary and alternative medicine in children with type 1 diabetes mellitus. J Tradit Med Clin Natur. 2018;7:265.

2. Kesavadev J, Saboo B, Sadikot S, Das AK, Joshi S, Chawla R, et al. Unproven therapies for diabetes and their implications. Adv Ther. 2017;34:60-77.

3. Desai A, Staszewski H. Ayurvedic remedy for diabetes as a cause of lead poisoning: a case report. Am J Med. 2012;125:e3-4.

4. Gupta N, Goswami B, Singh N, Koner BC, Garg R. Lead poisoning associated with ayurvedic drug presenting as intestinal obstruction: A case report. Clin Chim Acta. 2011;412:213-4.