Nocturnal Leg Cramps Relieved with Nisha-Amalaki as ‘Add on Therapy’ in Diabetes Mellitus

Abstract

Eighty-year-old female physician sought consultation for continued use of Nisha-Amalaki (N-A), which had relieved her Nocturnal Leg Cramps (NLCs). She had well-controlled hypertension (HT) for 28 years and diabetes mellitus for 26 years, and experienced occasional NLCs since the age of 35 years without a need of any pharmacotherapy. For increased NLCs frequency and severity post diagnosis of diabetes, she recently started N-A (500 mg) once daily. She was already on
metformin (500 mg) twice a day, glimepiride (0.5 mg) once a day, telmisartan (40mg) + hydrochlorothiazide (12.5 mg) once a day, and cilnidipine (5 mg) once a day, along with nutritional supplements (multivitamin, vitamin-B12, and calcium 500mg once daily). HbA1c was maintained between 6–6.9% and fasting blood sugar (FBS) between 114–126 mg%. There was no Retinopathy (RP) or nephropathy (NP). Her NLCs almost disappeared in four weeks and she has now continued
N-A for the last nine months. At this point, glimepiride 0.5 mg after dinner to reduce FBS and HbA1c, and aspirin 75mg to improve microcirculation, were added. Most practicing physicians, as in this case, are satisfied if the HbA1c is maintained below 7% and hope to avoid the risk of hypoglycemia, which can also be harmful. Recent literature shows that RP, NP, and peripheral neuropathy (PN) start after HbA1c crosses 6% and may rise sharply after 8%. The purpose of this case report is to encourage a stricter control of HbA1c and highlight that NLCs could indicate early PN.