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.
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
Lack of exercise
- 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.
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
- 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
a) Cereals and cereal products (mainly from whole grain cereals)
d) Fresh fruits
A diabetic patient can also take rice in the right amount preferably mixed with dahl or rajmah and green vegetables in consultation with physician.
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.
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 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.
Green leafy vegetables are good source of vitamins. Seasonal green vegetables are good source of Vitamin B complex and minerals.
Vitamins, Minerals, Antioxidants, Fibres, Low calories (Carbohydrate) etc.
FATS: ALLOWANCE- 15-25% of total calories. 3-4 TSF per day.
- 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.
SATURATED : MUFA : PUFA : : 1:1:1
MICRO NUTRIENTS (VITAMINS & MINERALS)
Deficiency in trace element like Chromium, Zinc and Magnesium are implicated in diabetes. Vitamin E is supplemented for antioxidants benefits.
Sodium content: Dietary intake of 1000mg/1000kcal, should not exceed 3000mg per day.
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.
Allowance – 15 to 20% of total caloric consumption per day and an adult needs 0.8 per kg weight of protein per day.
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
- 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
- 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.
- 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.
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).
- 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
Major used Homoeopathic medicines in Diabetes
Natrum sulph, Leptandra, Chionanthus, Ceanothus, Carduus marinus, Carlsbad,
Lycopodium, Chelidonium, Kali brom, Magnesia carb, Kali carb, Natrum phos
Iris ver, Pancreatin, Phosphorus, Baryta mur, Natrum sulph, Cortisone
Malnutrition in utero
Secale cor, Calc phos, Baryta carb
Tubercullinum, Syphillinum, Carcinosin, Cortisone etc.
Syzigium jambolium, Rauwolfia serpentine, Glycerinum, Uranium nitricum
Helonias, Secale cor, Hypericum, Ashwagandha, Kali. phos
Secale cor, Hypericum
Arnica montana, Belladona, Crot. horridus, Lachesis, Merc cor
Peri vascular diseases
Arnica Montana, Conium maculatum, Cuprum ars, Kreosotum, Lachesis
Merc sol, Proteus
Asparagus, B. coli, Candida albicans, Lycopodium, Lyco. Vir, Eup. Purp, Phaseolus
Phosphorus, Salicylic acid, Sulphur, Medorrhinum, Cuprum met, Terebinth
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 : China sulph
- Sciatica : Kreos
- Sweet smelling urine : Ferrum iod
- Gout : Lact ac, Natrum 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
- Saccharum officinalis
- Thuja occidentalis
- Natrum sulph
CALCAREA CARBONICA – Diabetes in the obese with extreme emaciation.
CINCHONA – Weakness with perspiration. Diabetes with a general bad state.
DIGITALIS & LACTIC ACID – Diabetes with emaciation
LAC DEFLORATUM – Diabetes with much emaciation. Diagnosis of sugar in urine.
OPIUM – Diabetes with debility
SYZIGIUM JAMBOLANUM & URANIUM – Increased thirst in diabetes
KREOSOTUM – General action in diabetic gangrene, Ulcer with offensive discharges.
Diseases of women.
FLOURIC ACID & AURUM METALLICUM – Diabetes associated with acquired or
ACID LACTIC & ELAPS – Strong elimination of uric acid in urine. Hypertension.
IGNATIA & NATRUM PHOSPHORICUM – Diabetes of nervous origin. Silent grief.
HELONIUS – Diabetes becoming rapidly grave.
PLUMBUM & AURUM METALLICUM – Diabetes with paralytic tendency.
LYCOPODIUM – Diabetes with hepatic insufficiency.
APIS MELLIFICA – Diabetes with pain in tendo- achilis.
LYCOPUS – Heart trouble in diabetes.
CHIONANTHUS – Diabetes with hepatic troubles.
SULPH IOD – Juvenile diabetes in emaciated patient. Hyperthyroidism. Weakness in
RADIUM BROMATUM – Diabetes. Haemoglobin and erythrocytes are increased and
the polymorphoneuclear neutrophiles remarkably so.
CARBO VEGETABILIS & ARSENICUM ALBUM- Gangrene of the toes.
NATRUM MURIATICUM- Hypoglycaemia and also in insulin dependent diabetes.
Diabetics who became tubercular.
THYROIDINUM – Diabetes with history of allergic urticaria. Stressful life
ACETIC ACID – Diabetes with anaemia & weakness.
ALLOXANUM- Diabetes specially with osteoporosis. Muscular weakness. Glycosuria
LACTIC ACID – Diabetes with profuse perspiration.
MEDORRHINUM- Diabetes; profuse and frequent urination with other urinary
URANIUM ARSENICOSUM – Diabetes with weakness and restlessness.
PHOPHORUS, IRIS VER, URANIUM – Chronic inflammation of pancreas in diabetes
CARBO VEGETABILIS, KREOSOTUM, SECALE COR – Humid gangrene of diabetics, collapse, persistent epistaxis
CALCAREA CARBONICA, CRATAEGUS, PHOSPHORUS, PULSATILLA
SULPHUR, URANIUM ARSENICOSUM, URANIUM NITRICUM
CARCINOSIN, NATRUM SULPHURICUM
Diabetes with melancholia, emaciation, thirst, restlessness – HELONIUS, CURARE, MORPH
Albuminuria associated with diabetes- ARSENICUM BROMATUM, PLUMBUM METALLICUM, MERCURIUS
Rheumatism with diabetes – LITHIUM, MEDORRHINUM, NATRUM PHOSPHORICUM, NATRUM SULPHURICUM
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.
Dr. Shubhamoy Ghosh.M.Sc, BHMS,BMCP, HEAD, Dept of pathology
M.B.H.Medical college & Hospital, Govt. of West Bengal.
Baidurjya Bhattacharjee, Student of 2nd B.H.M.S. 2008-09
Mahesh Bhattacharyya Homoeopathic Medical College and Hospital.