Diabetes mellitus is a condition in which there is a chronically raised blood glucose concentration. It is caused by an absolute or relative lack of the hormone insulin; that is insulin is not being produced by the pancreas, or there is insufficient insulin or insulin action for the body’s need.
The Situation in India
The World health organization predicts that by 2025 India will have the largest number of diabetics in the world.
In India there are more than 19.4 million diabetics currently. The number is expected to increase to 57.2 million by 2025 and 80.9 million by 2030.
About 32 million people in India are suffering from diabetes and only one-third of them have been diagnosed. Of those diagnosed, only 5-7 million people receive treatments.
What is type-1 diabetes?
Type-1 diabetes is sometimes called juvenile diabetes, or insulin-dependent diabetes. It means that your body can't make insulin. Insulin helps your body turn the sugar from the food you eat into a source of energy. Type 1 occurs more frequently in children and young adults, but accounts for only 5-10% of the total diabetes cases nationwide.
Diabetes mellitus is a chronic disease involving abnormalities in the body's ability to use sugar.
Diabetes is characterized by:
Elevated blood sugars for months to years.
Both hereditary and environmental factors leading to its development and progression.
A relative or absolute deficiency of effective circulating insulin. Insulin is a substance made by the pancreas which lowers blood sugar in conjunction with meals. Diabetes is characterized by either: (1) an inability of the pancreas to produce insulin (type 1 or insulin-dependent diabetes mellitus) or an inability of insulin to exert its normal physiological actions (type 2 or non-insulin dependent diabetes).
Often recognized in patients and their families by excessive urination, thirst, weight loss and/or a lack of energy. But diabetes is often silent and may exist for many years without the individual's noticing it.
Effects certain "target tissues," that is, tissues which are vulnerable to the damaging effects of chronically high blood sugar levels. These target tissues are the eye, the kidney, the nerves and the large blood vessels, such as in the heart.
What is Diabetes insipidus?
A form of diabetes resulting from a deficiency of vasopressin (the pituitary hormone that regulates the kidneys); characterized by the chronic excretion of large amounts of pale dilute urine which results in dehydration and extreme thirst.
Why treat diabetes?
Good glycemic control has been clearly shown to reduce microvascular complications
in type 1 (DCCT) and in type 2 ( UKPDS) diabetes.
Reduction of macrovascular complications and treatment of other risk factors.
Diabetes and Blindness
Blindness in Diabetes is due to damage of nerves.
Each year 12,000 to 24,000 people lose their sight because of diabetes.
Diabetes is the leading cause of new blindness in people 20-74 years of age.
Heart Disease and Stroke
People with diabetes are 2 to 4 times more likely to have heart disease.
More than 77,000 deaths occur annually due to heart disease.
People with diabetes are 2 to 4 times more likely to suffer a stroke.
Kidney Disease from Diabetes
10 to 21% of all people with diabetes develop kidney disease
Diabetic nephropathy is the most common cause of end-stage renal disease, a
Condition where a patient requires dialysis or kidney transplant.
Nerve Disease and Amputation
About 60-70% of people with diabetes have mild to severe forms of nerve damage, which in severe forms can lead to lower limb amputations.
The risk of leg amputation is 15-40 times greater for a person with diabetes.
Each year 56,200 people lose their foot or leg to diabetes!
Impotence from Diabetes
Impotence affects approximately 13% of men who have type 1 diabetes and 8% men who have type 2 diabetes.
It has been reported that men with diabetes over the age of 50, have impotency rates as high as 50-60%.
MAJOR RISK FACTORS FOR DIABETES MELLITUS
Age
Lack of exercise
Family history
Hypertension
SOME MISCONCEPTIONS
Rice should not be taken
Fruits are banned
Potato is banned
Bitter fruits nullify sugar
Overeating on one day can be compensated by total fast next day.
MANAGEMENT OF DIABETES
OBJECTIVES OF TREATMENT OF DIABETES MELLITIS
To relieve symptoms.
To have smooth control of blood sugar in normal range (attain and maintain).
To attain and maintain ideal or near ideal body weight.
To ensure normal growth pattern in children.
To maintain good metabolic control throughout pregnancy for safe delivery.
To ensure normal growth pattern in foetus in a pregnant woman.
To monitor target organs regularly in order to prevent, arrest, postpone or revert the complications.
DIET
The goal of diet therapy is to obtain an ideal body weight by consuming the desired amount of calories, ideal body weight & body mass index
Ideal Body Weight (in kg) = (Height in cms – 100) x 0.9
Body Mass Index = Weight in kg / (Height in Metres ) squared
Normal = 17-27 (in male)
= 17-25 (in female)
Lean (under weight) < 17
Overweight > 27-32
Obesity > 32
Encourage
Whole food high in fibre
Low animal fat intake
No added salt
Avoidance of sweets
World Health Organisation recommendation
CARBOHYDRATES : Allowance: 60-65% of total calories
Sources:
a) Cereals and cereal products (mainly from whole grain cereals)
b) Pulses
c) Beans
d) Fresh fruits
e) Vegetables
A diabetic patient can also take rice in the right amount preferably mixed with dahl or rajmah and green vegetables in consultation with physician.
FIBRES
TYPE-1 FIBRES :
These are water insoluble fibers-cellulose, hemi cellulose & lignin.
SOURCE: Cereals and millets.
BENEFITS: Decrease the intestinal transit time, increase the fecal bulk and therefore this is useful in constipation.
TYPE-II FIBRES:
These are water soluble fibres- pectin, gums and mucilage.
SOURCE: Vegetable, fruits & legumes.
BENEFITS: 1. These are more effective in controlling blood glucose and triglycerides.
2. These provide Omega 3 (W3) fatty acids and antioxidants.
FRUITS
Fruits are must for a diabetes patient and should be included in a meal plan.
However bananas, mangos, grapes and jackfruits are not recommended for a diabetic patient.
Fruit allowance: one fruit of one variety in the recommended amount at a time. Fruit juice is not recommended.
VEGETABLES
Green leafy vegetables are good source of vitamins. Seasonal green vegetables are good source of Vitamin B complex and minerals.
Vegetables provides
Vitamins, Minerals, Antioxidants, Fibres, Low calories (Carbohydrate) etc.
FATS: ALLOWANCE- 15-25% of total calories. 3-4 TSF per day.
FAT SOURCES
Visible Fats,
Invisible Fats,
Saturated Fats,
Unsaturated Fats – sources are mainly Mono-Unsaturated Fatty Acid(MUFA) or Poly-Unsaturated Fatty Acid (PUFA) and do not have any deleterious effect on lipid profile if consumed in moderate amount..
Artificial sweetening agents
Caloric (fructose, sorbitol, manitol, xylitol, hydrogeneted, starch hydroplysates) should be avoided and non caloric saccharine, aspartame play a dominant role.
Spices and condiments
Fenugreek seeds : Provides soluble fibre, W3FA , Triglyceride and Cholesterol
Clove (long) & Turmeric (Haldi) : Antioxidant activity controlling free oxygen radical damage.
Garlic : 1-3 gms per day, fibrinolytic activity.
Onion : 20-30gms per day, decrease platelet aggregation, decrease blood sugars and lipids.
PROTEINS :
Allowance – 15 to 20% of total caloric consumption per day and an adult needs 0.8 per kg weight of protein per day.
SOURCES:
1. First class proteins (Animal proteins)
a. Non-Vegetarian- eggs, mutton, chicken, fish, pork.
b. Vegetarian – Milk, curd, paneer.
2. Second class proteins- soybeans, grams, dahls, peas, beans, nuts (dry fruits)
3. Third class proteins:- Cereals – oats, barley, ragi, wheat and rice.
Meat had got high fat content while dahl has got high protein content.
Protein intake should be reduced in renal failure while increased during pregnancy stage.
SODIUM : < 6 g/day
hypertensive diabetic, < 3 g/day
RECOMMENDATIONS
ALCOHOL : In moderation; restricted entirely in insulin induced hypoglycaemia, neuropathy, hyperlipidaemia.
SMOKING & TOBACCO : Avoid.
VITAMINS : Supplements unnecessary.
MANAGING YOUR DIABETES
Exercise regularly to stay healthy.
About 2500 yrs ago, ancient Indian physician Shushruta stressed upon the importance of exercise in the treatment of diabetes. Shortly after the discovery of insulin in 1922, it was shown that exercise potentiates the effect of insulin.
Exercise in association with balanced diet remained an important tool in the management of type-2 diabetics because of its beneficial effect on insulin sensitivity & hypoglycaemia.
Benefits of exercise
Helps in long term glycaemic control.
Reducing body weight.
Reducing requirement of OHA and/or Insulin.
Improvement in hypertension.
Improvement in lipid profile.
Improvement in cardio-vascular function.
Increase body fitness and stamina.
Increase sense of well-being.
Improves quality of life.
It has a special role to play in the prevention of atherosclerosis and ageing.
EXERCISE & INSULIN
EXERCISE CAUSES:
Increase in sensitivity of muscles to Insulin.
Increase in Insulin action by increasing :
In insulin binding receptors sites in the muscle and increasing the number of receptors.
In cytoplasmic and mitochondrial activity.
In muscles, capillary density.
In GLUT-4 protein & mRNA.
Response To Exercise Depends On
DIABETIC STATUS OF THE PATIENT.
BLOOD GLUCOSE LEVEL.
AVAILABILITY OF INSULIN.
STATE OF HYDRATION.
Evaluation Of The Patient Before Exercise
Careful screening for the presence of macrovascular & microvascular complications is needed that may be worsened by the exercise.
Fair control of diabetes is to be ensured.
History of drug intake & its effect on exercise is to be kept in mind.
Time Of Exercise
Ideal time is morning, if this is not possible then the evening or both.
Have an empty stomach or take small snacks before exercise (to prevent hypoglycaemia).
Exercise after meals to be avoided.
Risk Of Exercise
HYPERGLYCAEMIA : In poorly controlled diabetes patient.
KETOACIDOSIS
HYPOGLYCAEMIA : In tightly controlled diabetics.
HEART ATTACK : Sudden Myocardial Infarction in patient with silent Myocardial Ischaemia.
SUDDEN BLINDNESS : In diabetics with Proliferative Diabetes Retinopathy due to vitreous haemorrhage.
FOOT CARE
Regular foot care is a must in diabetes to avoid amputations.
PRACTICAL TIPS: For Patients
Never walk with bare feet – indoors or outdoors
Use clean socks/stockings that absorb sweat. Avoid nylon
Footwear should neither be very tight nor very loose
Before wearing shoes, look & feel inside for rough surfaces & pebbles (In diabetic neuropathy the pain sensation often is dulled and diabetics have been known to walk for days with nails or pins stuck in the feet).
INSPECT FEET
Look for breaks in skin, cuts, scratches, blisters, sores
If need be use a magnifying glass (especially if retinopathy is present)
Check for temperature changes
Medical attention needed, if foot injuries do not heal within 2-3 days
Strong medicines, corn caps, warts removers should be used except under medical supervision
Regularly wash feet every evening
Use mild soap
Soak feet in tepid water (not hot) for not more than 5 minutes
Pay special attention to the skin between the toes and dry them properly with a soft towel
Apply a moisturising cream or lotion to keep your skin supple
Good preventive foot care can save a leg from amputation
Treatment of diabetes in modern medicine
Lifestyle management
Oral hypoglycaemic agents
Insulin therapy
Exercise
Major used Homoeopathic medicines in Diabetes
Liver complications
Natrum sulph, Leptandra, Chionanthus, Ceanothus, Carduus marinus, Carlsbad,
Lycopodium, Chelidonium, Kali brom, Magnesia carb, Kali carb, Natrum phos
Podophyllum etc.
Pancreatic drugs
Iris ver, Pancreatin, Phosphorus, Baryta mur, Natrum sulph, Cortisone
Malnutrition in utero
Secale cor, Calc phos, Baryta carb
Amyloid disease
Tubercullinum, Syphillinum, Carcinosin, Cortisone etc.
Hypertension
Syzigium jambolium, Rauwolfia serpentine, Glycerinum, Uranium nitricum
Secale cor
Diabetic neuropathy
Helonias, Secale cor, Hypericum, Ashwagandha, Kali. phos
Diabetic retinopathy
Secale cor, Hypericum
Vitreous haemorrhage
Arnica mont, Belladona, Crotalus horridus, Lachesis, Merc cor
Peri vascular diseases
Arnica Montana, Conium maculatum, Cuprum ars, Kreosotum, Lachesis
Merc sol, Proteus
Diabetic nephropathy
Asparagus, B. coli, Candida albicans, Lycopodium, Lyco. Vir, Eup. Purp, Phaseolus
Phosphorus, Salicylic acid, Sulphur, Medorrhinum, Cuprum met, Terebinth
Impotency
Acon nap, Cannabis sat, Coca, Conium mac, Cuprum met, Eup purp, Helonias, Kali carb
Moschus, Sulphur , Phosphoric acid
Other complications and homoeopathic treatment
Prostatomegaly : eup purp, Phaseolus
Caries teeth : Ac. sulph
Spongy gums : Syz. jamb
Psoriasis : Mang. acet
Cataract : Saccharum alb
Amblyopia : Sacch. alb
Muscular cramps : Chin. sulph
Sciatica : Kreos
Sweet smelling urine : Ferr. iod
Gout : Lact ac, Nat sulph, Phase, Phos
Gall stones : But.ac
Arteriosclerosis : Aur, Chlorpr , Plum ,Syz
Black spots : Ars, Kreos, Kres, Secale cor
Hyperthyroidism: Kali iod
Ankle swelling : Arg met , Sacch alb
Dropsical scrotal swelling : Arg met
Family history of diabetes
Carcinosin
Saccharum officinalis
Thuja occidentalis
Natrum sulph
To be remembered:
Homoeopathic medicines are applied particularly on the basis of totality of symptoms.
Proper exhaustive case taking should be done.
The totality of symptoms must be the ultimate guide and the physician must be strictly unprejudiced. According to condition of patient and the stage of the disease proper potency may be given.
There is no fixed miasmatic condition responsible for the development of Diabetes mellitus. It is the patient’s individuality, miasmatic background and accessory circumstances which will decide what type of symptom will produce in one patient at one time. So, if the patient is psoric or psoric predominance is noted, then the psoric symptomatology of the Diabetes may be observed, in that patient and just like that the syphilitic and sycotic patient, will produce the syphilitic and sycotic symptomatology of the disease respectively.
Proper anamnesis of the patient may give the right direction to the path of similimum.
Constitutional Homoeopathic treatment is the mandatory way to treat the patient along with the proper management. If palliation is needed then homoeopathic palliation after short case taking will prove more beneficial. If there is not a single characteristic found (the indications), even after very careful and exhaustive case taking, then it may be assumed that the case is totally incurable.
In the Insulin dependent Diabetes never stop the insulin suddenly without going through the regular monitoring of the blood sugar level. Glycosalyted Hb1Ac will give you the prognostic view of the disease in a better manner. Along with the Homoeopathic constitutional treatment you can continue insulin in case of
Type – I diabetes (IDDM). If you think patient is improving then you can refer the patient to his allopathic physician to decrease the insulin if necessary.
Acknowledgments:
Dr. Shubhamoy Ghosh.M.Sc, BHMS,BMCP, HEAD, Dept of pathology
M.B.Homeopathic Medical College & Hospital, Govt. of West Bengal.
