Introduction Fenugreek (Trigonella foenum-graecum) seeds are widely used for their hypoglycemic properties, which are attributed to bioactive compounds that enhance insulin secretion and sensitivity and reduce hepatic glucose production. While these effects may complement conventional antidiabetic therapies, concomitant use may increase the risk of severe hypoglycemia. Objective This paper investigates incidents of hypoglycemic coma linked to the concurrent use of fenugreek seeds and premixed insulin, based on four case reports from an ethnobotanical study of diabetic patients. Methods An ethnobotanical survey was conducted in several healthcare facilities in the Rabat–Salé–Kénitra region of Morocco among diabetic patients reporting fenugreek use. Data regarding the form, mode of administration, dose of fenugreek, and its concomitant use with antidiabetic medications were collected using a semi-structured questionnaire. Plant samples were botanically authenticated, and the causality between fenugreek intake and hypoglycemic events was assessed using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) standardized causality assessment method. All participants provided informed consent. Results Four patients receiving insulin therapy developed hypoglycemic coma while concomitantly consuming fenugreek seeds in various traditional forms and doses. The temporal relationship and clinical evolution supported a possible-to-probable causal association, consistent with synergistic glucose-lowering mechanisms, including potentiation of insulin activity, delayed intestinal glucose absorption, and enhanced insulin signaling. Conclusion To the best of available knowledge, this is the first report documenting such an interaction. These findings highlight that the concomitant use of fenugreek and insulin may precipitate life-threatening hypoglycemia. Healthcare professionals should actively inquire about medicinal plant use, closely monitor glycemic control, and counsel patients regarding potential herb–drug interactions. Strengthened pharmacovigilance, phytovigilance, and patient education are essential to ensure the safe integration of medicinal plants into diabetes management. This work provides clinically relevant evidence supporting safer integrative practices in diabetes care across diverse healthcare settings worldwide today.

Fenugreek-associated hypoglycemic coma: potentiation of insulin therapy in diabetic patients

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2026年6月18日

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Souad Skalli

摘要

Introduction

Fenugreek (Trigonella foenum-graecum) seeds are widely used for their hypoglycemic properties, which are attributed to bioactive compounds that enhance insulin secretion and sensitivity and reduce hepatic glucose production. While these effects may complement conventional antidiabetic therapies, concomitant use may increase the risk of severe hypoglycemia.

Objective

This paper investigates incidents of hypoglycemic coma linked to the concurrent use of fenugreek seeds and premixed insulin, based on four case reports from an ethnobotanical study of diabetic patients.

Methods

An ethnobotanical survey was conducted in several healthcare facilities in the Rabat–Salé–Kénitra region of Morocco among diabetic patients reporting fenugreek use. Data regarding the form, mode of administration, dose of fenugreek, and its concomitant use with antidiabetic medications were collected using a semi-structured questionnaire. Plant samples were botanically authenticated, and the causality between fenugreek intake and hypoglycemic events was assessed using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) standardized causality assessment method. All participants provided informed consent.

Results

Four patients receiving insulin therapy developed hypoglycemic coma while concomitantly consuming fenugreek seeds in various traditional forms and doses. The temporal relationship and clinical evolution supported a possible-to-probable causal association, consistent with synergistic glucose-lowering mechanisms, including potentiation of insulin activity, delayed intestinal glucose absorption, and enhanced insulin signaling.

Conclusion

To the best of available knowledge, this is the first report documenting such an interaction. These findings highlight that the concomitant use of fenugreek and insulin may precipitate life-threatening hypoglycemia. Healthcare professionals should actively inquire about medicinal plant use, closely monitor glycemic control, and counsel patients regarding potential herb–drug interactions. Strengthened pharmacovigilance, phytovigilance, and patient education are essential to ensure the safe integration of medicinal plants into diabetes management. This work provides clinically relevant evidence supporting safer integrative practices in diabetes care across diverse healthcare settings worldwide today.