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| Hpathy Ezine - June, 2006 | |||||||||||||||||||||||
Diabetes Mellitus and HomeopathyIncluding its miasmatic background and treatment - Dr. Deepak Sharma | |||||||||||||||||||||||
INTRODUCTION Diabetes mellitus is a disease which is known to everybody nowadays. It is to be noted with astonishment that DM has an attracting global importance as it is rocking the world as a non-infectious epidemic/pandemic. “SUGAR” is the common name given to DM by the Indian layman. Actually, it comprises a group of common metabolic disorders that share the phenotype of hyperglycemia (increased level of glucose in blood plasma). Nowadays, it is one of the leading causes of morbidity and mortality because Diabetes mellitus causes secondary pathophysiologic changes in the multiple organ system. Most likely, the complications of DM are adult blindness; non-traumatic lower extremity amputations (diabetic foot); end stage renal disease (ESRD); neuropathy etc. In the forecoming days it is presumed to be increasing day by day due to an increase in factors contributing to hyperglycemia, which may include dietetic irregularities, metabolic dysfunction, lack of exercise, stress, and busy lifestyle. As concerned about the cure of DM by Homoeopathy, it could be possible in the early stages but we can at least assure to give a peaceful and prolonged life to a diabetic patient. ETIOLOGICAL CLASSIFICATION Recent studies in the etiologies and pathogenesis of Diabetes mellitus lead to a revised classification. Recent changes in classification reflect an effort to classify DM as the basis of the pathogenesis process leading to hyperglycemia, as opposed to criteria such as age of onset or type of therapy. Some forms of Diabetes mellitus are characterized by an absolute insulin deficiency or a genetic defect leading to defective insulin secretion, whereas other forms share insulin resistance as their underlying etiology. Diabetes mellitus has two broad categories designated as type1 and type2. TYPE 1 Diabetes mellitus (previously designated as IDDM): Type 1 DM is categorized into two subgroups, i.e., type 1A and type 1B. Type 1A results from autoimmune ß cell destruction, which usually leads to insulin deficiency; where as type 1B DM occurs due to lack of immunologic marker inductive of an autoimmune destructive process of the ß cells. Type 1 DM is hereditary in character and develops before the age of 30 years. The patient is young, lean and thin, and has an absolute requirement for insulin therapy. TYPE 2 Diabetes mellitus (previously designated as NIDDM): Type 2 DM is characterized by a variable degree of insulin resistance, impaired insulin secretion, and increased glucose production. Type 2 DM more typically develops with increase in age; it also occurs in children, particularly in obese adults. It does not require insulin therapy. GDM: This type of Diabetes mellitus is recognized during pregnancy. It is due to insulin resistance related to its metabolic changes. MODY: It is a subtype of Diabetes mellitus is characterized by autosomal dominant inheritance, early onset of hyperglycemia and impairment in insulin secretion. It is also divided into MODY1, MODY2, MODY3, MODY4, and MODY5 according to genetic defect of beta cell function characterized by mutation in Hepatocyte nuclear transcription factor (HNF), glucokinase, HNF1 a, insulin promoter factor (IPF), HNF1 ß. OTHER CAUSES: • Drug or chemical induced Diabetes mellitus: Some drugs
such as Nicotinic acid, Glucocorticoids, Thyroid hormones, Diazoxide
betaadrenergic agonists, Thiazides, ß blockers etc causes
DM. RISK FACTORS FOR TYPE 2 Diabetes mellitus • A strong family history EPIDEMIOLOGY The prevalence of Diabetes mellitus in adults was 4 percent worldwide; this means that over 143 million persons are now affected. It is projected that disease prevalence will be 5.4 percent by the year 2025, with global diabetic population reaching to 300 million. The rising prevalence of Diabetes mellitus in developing countries is closely associated with industrialization and socioeconomic development. Diabetes mellitus, a chronic disease once though to be uncommon in the developing world has now emerged as an important public health problem in Asia. An estimated 30 million persons in South-East Asian region are affected at present. It is estimated that by the year 2025 there will be nearly 80 million diabetics in the region- the highest among all WHO regions. Thus, the South-East region will bear the maximum global burden of the disease. The result of prevalence study of DM in India was systematically reviewed with emphasis on these utilizing the standard WHO criteria for Diabetes mellitus diagnosis. The prevalence of disease in adults was found to be 2.4 percent in rural and 4-11.6 percent. This indicates the potential for further rise in prevalence of DM in the coming decades. It is estimated that during 1997 about 102,000 persons died of DM in India with about 1,981,000 DALYs. PATHOGENESIS The pathogenesis of each type of Diabetes mellitus is different
and discussed separately.
TYPE 2: Type 2 Diabetes mellitus is characterized by decrease in beta cell secretion of insulin or a decrease response of the tissues to respond to insulin, i.e. insulin resistance. The main factor involved in the pathogenesis of type 2 Diabetes mellitus is environmental factor. Obesity is one of the most important cause although genetic predisposition is also important which causes deranged insulin secretion and cause hyperglycemia. This hyperglycemia causes ß cell exhaustion and decrease in insulin secretion. Other metabolic disturbances cause reduced responsiveness of tissues to insulin action called as insulin resistance. It is a major factor in the development of type 2 Diabetes mellitus.
Gestational Diabetes mellitus (GDM): GDM is a prodromal form of type 2 DM being unmarked by pregnancy. Pregnancy is associated with insulin resistance that necessitates an increase in insulin production to maintain euglycemia (a normal insulin concentration of glucose in blood). Placental hormones that rise late in pregnancy induce the insulin resistance in GDM. Gestational Diabetes mellitus itself is typically found late in the second or early third trimester. Some studies suggest that there is an exaggeration of the pregnancy induced insulin resistance in GDM, but it appears that the major determinant of whether a woman develops DM is likely insulin reserve. This reserve is blunted in women with GDM. In severe GDM an element of glucose toxicity supervenes which may further blunt the insulin sensitivity. The elevated free acids that are also found in GDM may be a further cause of insulin resistance as may be a manifestation of the disease process itself. Thus, GDM is similar to type 2 DM with insulin resistance and impaired insulin secretion, and persistence of these abnormalities postpartum contributes to the increased risk of type 2 DM in the long term. DIAGNOSIS New revised criteria for the diagnosis of DM from the expert panel
of WHO and National Diabetes Data Group emphasize the FPG as the
most reliable and convenient test for diagnosing Diabetes mellitus
in asymptomatic individual. IFG is a new diagnostic category analogous to IGT, which is defined as the plasma glucose level between 140mg/dl and 200mg/dl, 2 hour after a 75gm oral glucose load. A random plasma glucose concentration = 200 accompanied by classic symptoms of Diabetes mellitus, for example polydipsia (increased thirst), polyuria (increased micturation), polyphagia (increased appetite), weight loss is sufficient for the diagnosis of DM. The two-hour plasma glucose commonly referred to post parendial
is still a valid mechanism for diagnosing DM but is not recommended
as a part of routine screening. CLINICAL FEATURES
MIASMATIC BACKGROUND Diabetes mellitus comprises the pseudopsoric miasm. The pseudopsoric miasm is also known as Tubercular miasm. It is a combination of both Psora and Syphilitic miasm. Tubercular miasm is usually characterized by a “problem child” i.e. slow in comprehension, dull, unable to keep a line of thought, unsocial, morose. He/she gets relief from offensive foot or axillary sweat which when suppressed often induces lung troubles or some other severe disease. The patient's mental symptoms tend to be ameliorated by an outbreak of an ulcer. The slightest bruise suppurates; the strong tendency is to the formation of pustules. As a general rule, the patient is very intelligent, keen observer and a programmatic planner who wants his life always busy but possesses a sedentary lifestyle. INDICATION OF MIASM As the miasm progress and predominates, weight loss, depreciation and destruction are the first indication of this miasm. Other indications are cosmopolitian habits, mentally keen but physically weak. Symptoms are ever changing. Rapid response to any stimuli (e.g. any slightest change of weather or atmosphere). Emaciation instead of taking proper diet and drink, tendency to cough and cold easily, desire and craving for unnatural things to eat, with desires and cravings for narcotics such as tea, Coffee, tobacco and any other stimulants have often their origin in psoric or tubercular miasm. They sometimes have constant hunger and eat beyond their capacity to digest or they have no appetite in the morning but hunger for other meals. COMPLICATIONS OF Diabetes mellitus The complications of Diabetes mellitus are categorized into two main groups i.e. Acute and Chronic complications. The acute complications are due to metabolic disturbances. These include DKA (Diabetic Ketoacidosis) and Nonketotic Hyperosmolar state. The chronic complication are also categorized into two broad groups 1. Microvascular complications: These include Ophthalmic Disorders
(Retinopathy, Macular edema, Cataract, Glaucoma), Neuropathy (Peripheral
neuropathy, Sensory and Motor polyneuropathy), and Nephropathy (ESRD). MISAMATIC DISCUSSION ON COMLICATIONS OF Diabetes mellitus As I discussed in the "miasmatic background" section, DM has a psorosyphilitic background. As the syphilitic miasm becomes predominant the complications arise. The acute complications are of the psoric character because they have metabolic disturbances while the chronic complications are associated with syphilitic background or as a result of a mixture of two. As the strong syphilitic character is going to destruction and degeneration it leads to mixed miasmatic diseases. These diseases are more difficult to cure especially when they go to irreversible changes. When the syphilitic miasm is dominant in the condition of chronic complications the condition should become violent. At this stage the individual needs a complete Miasmatic and Therapeutic treatment. MANAGEMENT Before we are going to start treatment of DM, it is very essential to know about proper nutrition and exercise plan for diabetic patient to reduce the prevalence and incidence of complications. It must also include preventive plan for an individual.
DIET AND NUTRITIONAL PLAN: Proper nutritional management or food plan is essential for better glucose control. This in turn helps to reduce the risk of diabetic complications. Daily consistency regarding the types of food including in the meal, their nutritional information, and the time at which they are consumed will help to normalize the blood glucose levels. The common meal planning tips are:
EXERCISE PLAN: Physical activity is recommended for everyone. It should take place
any time when a person can and is willing. The minimum time recommended
is about 30 minutes; three or more times a week. Activity can include
moderate walking and household chorus, such as gardening and cleaning
as well as jogging, biking, dancing and other sort of exercises.
When starting an exercise plan, be sure to warm up, set a comfortable pace, wear good shoes and drink plenty of water. Make it as enjoyable as possible without overdoing it. A good partner will make it easier to commit to it. Be cautious with the duration and intensity of the exercise; then gradually increase the length of the activity by a few minutes every week. WHEN NOT TO EXERCISE:
TREATMENT As Homoeopathy is not a science of therapeutics, it is concerned with totality of symptoms or individuality. As regarding the cure of DM by homoeopathic medicine, the individual needs the complete miasmatic and constitutional therapy in the very early stage. MIASMATIC TREATMENT: If we are going through complete miasmatic study of the individual in early stages then we can easily find out about the disease for witch an individual is prone to suffer. Then, we can apply the antimiasmatic therapy as a preventive measure which causes a decline in the tendency for the progression of the miasm. The main antimiasmatic remedies for Tubercular miasm are: “A” Grade: Agar, Ars-i, Aur, Bac,
Calc-c, Calc-p, Car, Hep, Iod, Kali-c, Kali-p, Lyc, Med, Nat-s,
Phos, Puls, Sep, Sil, Stann, Sulp, Thuj, Zinc. THERAPEUTIC TREATMENT: I found over 50 remedies for DM but when totality of symptom agrees every medicine from Materia Medica can be employed. However, only a smaller group is employed most frequently such as - Acetic acid (Glacial acetic acid) 6, 30: Large
quantity of pale urine, unquenchable thirst, and great debility. REFERENCES Principle of Internal Medicine Harrison 15th Edition
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