Problems of diabetes have been growing in leaps and bounds. The Greek word diabetes means siphon, which first was given by Aretaeus of Cappadocia (150 A.D). Willis first observed that urine in diabetes is honey like (1674). Mathew Dobson demonstrated that sweetness of urine is sugar which is excreted from blood (1784).
The pancreas secretes exocrine digestive enzymes & endocrine hormones. The total islets are about 2 million. Gastrin, glucagon and insulin are secreted by A1, A2, and B cells respectably. The total beta cells weight is about 1.2 gm. The Islets of Langerhans stores insulin 150 units (about 6mg). Pro-insulin has 84 amino acids and its molecular weight is 9045. Insulin has 51 amino acids (A chain = 20, B chain= 31 amino acids), its molecular weight is 5000. Daily insulin requirement: 1mg=24 units (sufficient for 200 gm carbohydrates). Pancreas wt: 60 gm. Length: 15 cm. Shape: lady finger. Color: ash.
It is a constitutional disease affecting the entire body. It is a poly-endocrine gland disorder due to a multi-enzymes defect. It is a metabolic disorder related to inadequate production of insulin or insulin insensitivity of cells.
DM -Positive view
It is not a contagious disease. The major types are of lifestyle origin. Less than 4% of the total population is affected. Mild adult onset is easy to cure. All complications are preventable. Diabetes mostly occurs after middle age and comes on slowly.
Each human being (approx. 649 crores= 6.49 billion) has one disease or another.
DM -negative view
It is a chronic degenerative disorder involving almost all vital organs. It may be stable throughout one’s life. It is a disease of civilization (consumption of refined white starchy food, kola, consumption of sucrose >150gm/day, etc. raises the triglyceride levels and later leads to atherosclerosis). It may occur suddenly after a mental or any physical stress.
It may change to overt or to brittle type or even to coma suddenly by a precipitating factor like pregnancy, fracture or infection. It may persist as sub- clinical even for 15 years. It is a terrible disorder, responsible for 1 in every 8 deaths, 1 in every 3 cases of blindness.
Pregnancy risks: Chance of miscarriage, difficult labor, birth of over-weight baby, insufficient breast milk, neonatal death, developmental diseases, childhood headache, recurrent infection, increased hair growth, height gain, blindness, early development of glaucoma, premature cataract, etc.
Racial: Pima Indians, Fiji Indians, and Jews. Geographical: Mauritius (Coconut-Phosphorus, fish-high iodine). Nauru island (Phosphorus), Finland (Tobacco), East India (Arsenic-mustard, Argemona mexicona, Ergot contamination), south India (milk, Phosphorus), South Kerala (minerals-tapioca), north India (wheat -Uranium contamination, Ergot). It is calculated that > 8% of population in Kerala (India) are affected.
People in civilized societies are more susceptible to diabetes.
TYPE I- Insulin dependent.
A. Insulin dependent in children & juvenile
B. Insulin dependent in adult (thin build)
TYPE II– Non insulin dependent (adult onset)
Other non specific categories are genetic, latent, thin diabetic, obese diabetic, gestational, chemical, clinical, stable, brittle, overt, secondary pancreatic, secondary endocrinal, hepatic, dysenzymatic intercellular, auto immune diabetic, nutritional (protein -cystine) deficient, geographical (the pancreatic fibrocalcinosis- consuming the food items amara, tapioca, cassava, food containing hydrocyanic acid, phosphorus) etc.
Old Indian classification
Kafa (10 types): symptoms: sweet in mouth, running of nose, desire for sugar, distaste, dyspepsia, sleepiness, hair growth, etc.
Pita (6 types): symptoms: high BMR, dry throat, bladder pain, loose motion, etc.
Vata (4 types): symptoms: flatulence, tremor, pain, weight loss etc.
Diabetes is considered a chronic degenerative disease. Hyperglycemia occurs due to deficiency of insulin or difficulty in entry of glucose into the cell. The two major factors which stand out distinctly in causing diabetes are genetics and homoeostasis (life style). Many contributing factors may present in one individual.
The most frequent causes are heredity, gestational changes, obesity (80%), lack of exercise, consuming excess of refined carbohydrates and saturated fat; Nutritional deficiency (Vitamin B1, B12, C, A, E; Niacin, Chromium, Zinc, Mg, K, Mn, selenium); Pancreatic insufficiency (coffee, alcohol, tobacco, stress through adrenal over activity); Sudden sympathetic over activity, spinal T6 -T10 lesion; Severe infection; Hepatic insufficiency-fatty liver, liver damage, cirrhosis, insulin antibodies-anti insulin liver enzymes; Renal insulin loss, poor toxin elimination; Endocrinal imbalance-excess of thyroxin (rapid glucose absorption from Gastro intestinal tract- >1.84 gm / hour / kg), Growth hormone with low liver hexokinase, GH with low insulin (low entry to cell- < 1.84 gm / hour / kg), glucagon (liver glycogenolysis) and adrenaline (neoglucogenesis- protein); Chemical contamination: tobacco, alloxan, uric acid, urate, acetate, sulphate, phosphate, lactate, citrate; Drugs: toxicity of beta blockers and calcium blocker (inhibit insulin secretion) etc.
Digestion and metabolism
Intake of high fat in childhood creates over stress on the pancreatic digestive enzyme system. Thus it causes depression on both digestive & hormonal cells.
Mal digestion is occurs first due to insufficient production of pancreatic enzymes. The fat molecules (large size) formed by insufficient fat digestion are involved later in the genesis of atherosclerosis. The protein molecules formed by insufficient protein digestion cause both the production of organic acid and auto immune reactions. Diabetes is not simply a disorder of the pancreas.
The Lens, RBC’s, myelinated nerves, cells of kidney, testis etc. receive more sugar passively and are more sensitive to insulin. This excess of glucose is converted partly to insoluble fructose and sorbitol. Later it is crystallized locally. Thus the oxygen caring capacity of RBC is reduced. Oxygen and glucose are essential to RBC.
Glycogen is formed from Glucose-6-Phosphate which is primarily synthesized inside the cells from glucose with hexokinase. The liver stores glycogen, about 50 gm to 300 gm. Glucose is also formed from ketones (G-6-P via lactic acid) at muscle with insulin.
Diabetes is not just a disorder of carbohydrate metabolism. It affect lipid and protein metabolism also. It affects all organs of the body. The body utilizes energy in diabetes poorly from carbohydrate and more from fat and protein. The items promoting the anaerobic glucose metabolism are glucagon (liver glycogenolysis), insulin, hexokinase, and vitamin C. Vitamins like niacin, B12, B1 and some enzymes are essential for aerobic metabolism
Other factors promoting glycogenolysis are starvation, hypoglycemia, adrenalin (muscle), lack of insulin (muscle) and glucagon.
Lactic acid, Ketones & Cholesterol
Lactic acid formed by glycogenolysis enters into blood circulation. Lactic acid is produced by heavy exercise also. Cardiac muscles use it for aerobic metabolism. The liver takes it for glucose formation. Lactic acidosis is usually developed in starvation, hypoxia, liver damage and high muscular exertion.
1/3 glucose and 2/3 fatty acids are formed from catabolism of fat and that enter into circulation. ¼ of these fatty acids go to the liver and combine with apoprotein (from ribose sugar) and finally reach adipose tissues (as HDL- low molecular size). Fatty acids, Alcohol, acids etc more quickly enter into adipose cells than glucose. The remaining 3/4 of fatty acids persists in circulation and may deposit in liver cells and on vessel walls or excrete through bile.
Fat, protein and carbohydrates jointly participate in metabolism at the liver with oxygen. Improper metabolism of any one will cause the production of metabolites like ketones, cholesterol and organic acids. Ketones produced in the liver normally enter inside the muscle cell with insulin. Ketones are water soluble, so a large portion is lost through urine. More ketones and cholesterol are formed within liver cells by deficiency of insulin, coenzyme A and oxygen.
Arteriosclerosis denotes sclerosis of the middle coat of the artery. The fat molecules formed by insufficient fat digestion are primarily involved in the development of atherosclerosis. Injected insulin quickly enters the circulation and produces hypoglycemia and local vascular changes more than endogenous insulin in the presence of hyperlipidemia.
Coronary artery disease occurred in > 15% of total heart diseases. Central obesity promotes ischemia and atheroma of pancreatic vessels and thus it may cause hyperglycemia.
Vascular degeneration is also developed by continued consumption of sympatholytics. Atherosclerosis is also related to changes in haemostasis: Items promoting clotting are cold, coffee, Ca++, vitamin K (alfalfa), protamine (trout fish) etc.
Items promoting bleeding are heat, insulin, urea, melilotus, dicoumarol, acids, salicylates (China, aloes, and salix nigra), tea -xanthonine etc.
Potassium exists inside as the cell constant. 1/3 of Potassium is in ionic form and involved in interchanges across the cell with insulin.
Tachycardia may occur in hypokalemia developed by either high insulin (tissue entry) or proteinuria. Chest discomfort with bradycardia occur more in hyperkalaemia (renal failure, infarction, tissue damage).
SIGNS AND SYMPTOMS
Glucose Tolerance Test: Take low caloric diet with 150-250 gm carbohydrate for 10 days. Test plasma glucose and urinary sugar after 10 hour fasting. Take carbohydrate 1.75/kg with 300ml water. Test plasma glucose and urinary sugar after ½ hour and after 2 hour. The test is considered negative if fasting < 126 %, PPBS after 1/2 hours < 180% and PPBS after 2hour < 126%.
Peripheral blood sugar: FBS at finger tip artery is slightly lower than venous blood. Post prandial blood sugar is slightly high at finger tip (artery). Plasma sugar (vein) is > whole blood sugar.
Glucose with more water is lost through urine when renal threshhold to sugar becomes low. Polyuria also leads to loss of water soluble vitamins and minerals. The symptoms developed are due to abnormal inter-cellular metabolism, haemo concentration, dehydration, hyperlipidemia, hyperketonemia, acidosis, Low BP, loss of electrolytes like K+, protein, phosphate with fluids etc. Weight loss is due to neoglucogenesis developed by insulin deficiency. Acidosis and ketosis (symptoms-nausea, hyperventilation, and coma) occur from catabolism of protein and fat respectively.
Drugs like Chloral hydrate, menthol
Premonitory symptoms are weakness, excessive sweating, offensive body odor, flabby skin, and debility etc. Common symptoms are raised blood sugar, excessive hunger, polyuria, excessive thirst, dry skin, itching, glycosuria, symptoms of autonomic neuropathy- paresthesia, numbness, tingling sensation, glove and stoking sensation, wasting of muscle, painful neuropathy, weakness, weight loss, and less longevity, etc.
Other signs and symptoms are due to its complications like retinopathy, special sense disorder, peripheral angiopathy, dermatitis, cardiovascular degeneration (slow onset), renal disorder, etc.
Old rules of treatment
Strong constitution: Eliminate all the toxins through nearest orifices or through large orifice (anus and urethra).
Weak constitution: Symptomatic measures.
Early and mild Stage: Similar treatment (Holistic, new rational, suitable, homoeopathy, favorable, drop- minimum cold drugs for cold diseases; minimum hot drugs for hot diseases). Cold items are sweet, bitter, astringent (all three orally) and salt (through stomach). Hot items are pungent, bitter and astringent (through stomach); sour and salt (orally).
Stage sub acute: opposite- antipathy (old rational – cold drugs for hot disorder, hot drugs for cold disorder. Take similar therapy after preliminary amelioration.)
Intractable and late stage: different, multiple treatment.
Incurable: suppressive treatment.
HOMEOSTASIS and HOMOEOPATHY
Man gets disease both from changes in homeostasis and fate. The human organism has a four level structure: physical, emotional, intellectual, and vital force. These 4 planes are altered by changes in homeostasis (self aiding mechanism) through the mode of living, work, climate, place, diet and regimen etc. Humans have to expel the own waste as well as the toxins of foreign organisms which accompany it. Treatment has to be holistic.
The duty of the individual is to take sufficient oxygen and optimum food (quality & quantity) according to age, season and diseases; expel all the waste from tissues, keep the optimum tissue constants, keep optimum fluid Ph, practice proper work, upgrade the general health periodically and enjoy the optimum duration of the life. Diabetes is the disease of homoeostasis.
The entire universe is composed of two essential entities – matter and energy. Hunans can be considered as a microcosm and the entire universe is present in the human body in different forms.
According to the old south Indian medicine, the human body is composed of five elements namely Space, Air, Fire, Earth and Water. These are in particular proportions in the various tissues of each individual. The individual is not only a conglomeration of skin, flesh and bone but it has a mind, an intellect and a vital force. If its equilibrium, the homoeostasis is maintained well, the person remains healthy.
According to Greek medicine there are four humours- phlegm, blood, yellow bile and black bile, which are produced during the processes of digestion and metabolism. These remain in a definite proportion and regulate the physiological functions.
‘Food is medicine, Medicine is food’
The properties of food and drugs were described on the basis of taste. Taste treatment is based on the two forces which existed in nature : the hot and the cold.
Inflammation, fever, urticaria, herpes, pox, jaundice, eczema, piles, asthma, allergy, tuberculosis, emaciation, graves diseases, Addison’s diseases, abscess, scurvy stroke, ulcer, etc. are examples hot disorders.
Depression, obesity, constipation, numbness, epilepsy, dementia, impotence, paralysis, cardiac sinus arrest, bronchitis and dropsy are cold disorders.
The treatment was mainly focused on eliminating the impure material through the nearest orifice in early stages, or through opposite orifices with many drugs. The last one results in loss of too much normal body fluid.
Tastes were grouped to hot and cold. Hot drugs were used for early hot diseases. Each drug has its own characteristics (ascertained only by truly proving on healthy man -Hahnemann) besides its taste and other physical qualities.
|SWEET||QUALITY||Happiness, good complexion, gives body shape, black hair, wide forehead, growth, strength, smiling, wisdom, memory power, telling soft words, acting nature, excessive politeness, burning sensation and convulsion; aversion to bitter, dreams of lake and water, voice, formation of fluid, wound & bone healing, neutralizes poison, nullifies thirst.|
|Toxic symptom||Growth of muscle in mouth and pharynx, obesity, sleepiness, idleness, scrofulosis, pharyngitis, adhesion of vessels|
|Decreased symptom||Asthenia, depression|
|SOUR||Quality||Fearless, proud, cleanliness, adventure personality, dream stars, desires meat, desires sweets, movable eyes, small eyes, yellow vision, promotes appetite, special senses and heat; salivation, helps swallowing, mucus secretion, expulsion of toxic gases, promotes liver function, offensive sweat, black mole.|
|Toxic symptom||Short sight, dental irritation, polydipsia, heartburn, acidity, anemia, cachexia, flabby muscles, burning sensation on throat, bleeding, suppuration|
|Decreased symptom||Anorexia, dysphagia|
|SALT||Quality||Fear, neutralize other tastes, salivation, correct obstruction of other channels, moistness, peristalsis, antispasmodic, reduce stiffness, laxative, increased BMR, moist skin, antiseptic, progeria, joint pain, loose joint, worse in summer.|
|Toxic symptom||Fainting, anger, burning, sensation, alopecia, cannitis, reduces special senses, thirst, dislodgement of teeth, senility, acidity, ichthyosis, eczema, suppuration, arthritis, bleeding|
|PUNGENT||Quality||Bad complexion, selfish, faithless, uses rough words, tendency to theft, cunning, laziness, desire to satisfy special senses, hiding tendency, desire for food, desires luxury, desires sweets, desires meat, dreams of sky, sounds are unbearable, round eye, makes mouth clean, coryza, appetite, food absorption, elimination of waste, wound healing, cure itching, blood purifier, promotes thrombolysis, antiseptic, tendency to constipation, dry stool, rough skin|
|Toxic symptom||Fainting, asthma, thirst, burning in throat, stabbing pain in leg, tremor, asthenia, emaciation|
|Decreased symptom||Pruritus, skin disorder|
|BITTER||Quality||Homeostasis, cure faintness, promotes digestion, cures itching, fever, and dermatitis, reduces fat, pus, secretion and excretion, germicide, acts before meals..|
|Toxic symptom||Giddiness, vertigo, dry mouth, dehydration, deficiency of fluids, emaciation, atherosclerosis|
|Decreased symptom||Syncope, burning, fever, pruritus|
|ASTRINGENT||Quality||Sedative, dryness, constipation, stiffness|
|Toxic symptom||black complexion, hemiplegia, convulsion, spasm, dry mouth, aphonia, flatulence, emaciation, arteriosclerosis, obstruction of channels|
|Decreased symptom||Diarrhea, sweat, bleeding|
HOMEOPATHY & SUSCEPTIBILITY
The homeopathy is based on principle that the morbific agent capable of producing symptoms on healthy human being can cure the same disease when given in tiny dose. The most verified drugs (hot or cold) are used for diseases (hot or cold) with single and tiny doses. The medicine with tiny dose is more effective in susceptible individual.
Now the children are become hyper susceptible in this era because of vaccination procedure. Younger generation is also hyper susceptible due to the industrial, automobile and agricultural pollutions as well as radiation hazards. Too many crude drugs were forced to ban from market due to this hyper susceptibility. At same time homeopathic dilution are become more effective to all age groups with the side benefits.
Homeopathic dilutions can be grouped into four categories- Q-3c, 3c-6c, 6c-12c and above 12c. The potency selection is based on the susceptibility of the individual and quality of the medicine.
Homeopathic medicine helps to expel the body toxins through the nearest orifice and promotes the immune mechanism. The physician prefers the drug acting on the exact opposite orifices or opposite pole only when nearest orifices are unknown or are blocked. The medicines also can be grouped into two classes- Hot and cold. Some medicines can be grouped into the sympathetic and para are sympathetic group. The cold diabetes in early stages can be defined as a state of tissues with lack of sweet (glucose) inside; i.e., a state of tissues with another taste. The tissues can produce symptoms of bitterness or astringency. It can be treated with bitter itself or with a similar drug -homoeopathcity. Sweet is similar to bitter & astringent orally in its cold manifestation. Pungent is similar to sour & salt for its hot manifestation.
The primary medicines for diabetes with cold symptoms are bitter and astringent drugs (proved) through mouth. The primary medicines for diabetes with hot symptoms are pungent, sour, and salt drugs (proved) through mouth.
|Elements||Earth and water||Fire and water||Fire and earth||Fire and air||Air and space||Air and earth|
|Fingers||Ring finger and Little finger||Thumb and Little finger||Thumb and Ring finger||Thumb and Fore finger||Fore finger and Middle finger||Fore finger and|
|Properties||Cold, soft, |
Promote downward movement. Close upper orifice and valve.
Open lower orifice. Sticky.
It is present blue and black soil
Beneficial for treatment in early stage, disorder of lower spine.
Promotes protein digestion.
Liquid stool. Induce vomiting, sepsis, thirst, bleeding, and pain.
It is present in red soil
Beneficial for disorder of rain season, adult disorder.
Less movement. Induce vomiting.
It is present in sea shore soil
Less flexible, light.
Promote outward movement, fluid circulation, sweating and sneezing.
Beneficial for treatment in late stage, disorder of upper spine
less nutritive, micro, rough, and light.
Induce vomiting. Open valves. Close external orifice.
It is present in yellow soil.
Beneficial for treatment in chill-fever, late stage, neck disorder, obesity, stroke, old age and winter.
less nutritive, sticky, light, retained property,
Promotes gases movement.
It is present in white soil.
Beneficial for treatment in late stage
|Energy||Sweet > Sour > Salt > Pungent > Bitter > Astringent|
|Absorption||Salt > Sour > Pungent > Bitter > Sweet > Astringent|
|Season||Bitter (late winter) Astringent (spring), Pungent (summer), Sour (rainy), Salt (autumn), Sweet (winter)|
Primary prevention: Discourage marriage between blood relations.
Childhood: Avoid sweets. Get early diet education. Optimum food intake: 40 calories/kg including high protein diet.
Adulthood: Avoid lazy life style. Prefer the food style based on age, sex, constitution, climate and labor. Take a minimum quantity of common salt. Control overstress & sex sense. Protect the pancreas, liver, intestine and adrenals from over exhaustion. Eliminate the body toxins on last 15 days of all six seasons.
Secondary prevention: Take early and prompt homoeopathic treatment to avoid retinopathy, renal failure, autonomic neuropathy, boils, recurrent infections, atherosclerosis, gangrene, amputation etc. while maintaining good health and optimum blood sugar level.
INSULIN DEPEDENT DIABETES MELLITUS
Treatment should be under strict medical supervision. Start with regular insulin in small doses, i.e. 8 units twice daily before food if weight loss, glycosuria > 2%, and RBS > 250 % persist even after 20 to 30 days of medicinal therapy. Make change to intermediate or Lente (insulin in zince suspension) in single dose on next morning. Those who prefer lunch take NPH or regular. Those who take heavy dinner prefer PZI. Those who take 3 equal diets prefer intermediate acting insulin (70:30) or two equal doses of regular insulin. Those ready to restrict starch, take Lente in single dose. Avoid insulin if sensitivity develops with insulin < 16 units (hypoglycemic symptom or low blood sugar level).
Take the regular insulin 16 units +16 units +16 units if the blood sugar persists >400%. Take the regular insulin 16 units +0+16 units on next day if sugar is absent in night. Take PZI 16 units +0+0 if sugar is absent in early morning. Prefer PZI 20units or lent 16 units on next day if sugar is present at night. Stop insulin treatment if sugar is absent in urine
Treatment should be under intensive medical supervision only. Give regular insulin 10 units as bolus. Give 20 units insulin /hour intravenously for 6 hours. Test blood and urine. If >300% or if coma persists give 20 units intramuscularly. If it <300% give 12 units regular insulin subcutaneously in 12 hour intervals. Give saline infusion 1 liter in first 15 minutes. Give 1 litter in next 1 hour. Then give 500ml/hour. Total infusion is about10 liter within 16 hours advisable. Prefer Lent 20 units or regular 15 units with PZI 5 units as single dose (Mixogaurd) on next morning if sugar in urine is negative and blood sugar is < 250%. Dextrose therapy is essential with insulin to prevent hypoglycemia if blood sugar <300%. Give one liter 5% dextrose in first hour. Then give 500ml/hour for 10 hours. Give plasma expanders like egg white or milk after regaining conscious.
Ketoacidosis without coma
Give the insulin intramuscularly in small doses about < 20 units / hour for 4 hours in Ketonuria & Ketosis. Test blood and urine for sugar & acetone. Give long acting insulin (Lente) 20 units or regular insulin 15 units + PZI 5 units as single dose subcutaneously in next morning. Stop insulin if BS < 250% and acetone absent in urine. Give saline as advised for coma. Give beverage containing glucose80 gm, Kali phosphate 2gm and Kali citrate 4gm to prevent hypoglycemia.
Prefer needle No.26 for injecting regular insulin and No. 27 for PZI. Prefer insulin in the dose of 4, 8, 12, 16 units etc. from 40 units and 80 units /ml vials and 10 units, 15 units, 20 units from 100 units /ml vial. Pork insulin is more potent, Beef insulin is more allergic. Don’t mix lent with other insulin. Don’t mix with pork and beef insulin.
Incidence of Hypoglycemic coma is more common than hyperglycemic coma. It usually develops when the dose of insulin is too high. Regular Insulin is day insulin (noon). NPH is slightly slower than regular insulin, so hypoglycemia occurs in after noon. PZI makes hypoglycemia after evening (night insulin).
As pancreatic insulin first goes to the liver, the major portion of it is utilized in the liver. Chances of cerebral hypoglycemia are less on endogenous insulin. Insulin hypoglycemia depends on the dose, quantity of food taken, body activity and body mass.
On excess of insulin injection, the glucose concentration inside the brain cells (Osmolality) becomes higher than the extra cellular fluid. So excess of the fluids enters into the brain cells. Thus the cells of Pons and medulla are enlarged or ruptured in acute hypoglycemia.
Hypokalemia tachycardia, ventricular fibrillation, convulsion & sudden death may occur. Give glucose drinks or milk with sugar in emergency. Keep optimum blood osmolarity: 2 x Na (2 X 140meq/L) + glucose) /18 (180meq/L/18) + urea / 2.8 (28meq/L/2.8)= 300 meq/L
Insulin formula is C 254 H 377 O 65 N 65 S 6.
Hormonal antagonists are Growth hormone (GH is a Hexokinase inhibitor. Insulin is GH inhibitor), ACTH, thyroxin, adrenaline (adrenal tumor), exogenous insulin and excess of Glucose-6-Phosphate inside the cell.
Non hormonal antagonists are plasma globulin, plasma albumin, ketones, organic acids (Insulin requirement is directly concerned with H ions), insulinase, liver globulin, sunlight (summer proteinuria), hypo K+ (nephropathy), etc.
The autonomous nervous system plays an important role in physiological functions through the neuro-hormonal and enzymatic systems. The majority of primary symptoms in diabetes are due to dehydration and electrolyte imbalance as well as autonomic dysfunction. Next to renal and retinal complications, the involvement of nerves is most common. Increased glucose levels in neurons and Schwann cells lead to edema and result in demyelinating degeneration. It also causes anoxia of the vasa vasorun. Neuritis develops due to reduction of myo-inositol in nerves, hypoxia, reduction of amino acids, excess of glycogen, thickness of nerve membranes, etc.
Anesthesia, hyperesthesia, paresthesia, burning and stabbing pain, muscle wasting, painless arthropathy, etc.