Overview

Diabetes is a medical condition in which the body cannot produce enough insulin to process glucose in the blood. It is the seventh-leading cause of death worldwide and is increasing in prevalence in both developed and developing countries. Diabetes affects nearly every organ and system in the body.

In Ayurveda, diabetes is referred to as Madhumeha (Hyperglycemia), characterized by the passage of sweet (honey-like) urine. Contributing factors include reduced insulin production and decreased insulin sensitivity. Chronic hyperglycemia can cause long-term damage to the kidneys, eyes, nerves, heart, and blood vessels.

Classification

• Type I Diabetes Mellitus
• Type II Diabetes Mellitus
• Other specific types of Diabetes

Risk Factors

• Family history of diabetes
• Obesity (BMI > 27 kg/m²)
• Age over 45 years
• Hypertension (B.P. > 140/90 mmHg)
• Low HDL (< 35 mg/dl) and/or high triglycerides (> 250 mg/dl)
• Habitual physical inactivity

Clinical Features

• Increased frequency of urination (Polyuria)
• Increased appetite (Polyphagia)
• Excessive thirst (Polydipsia)
• Turbidity in urine
• Debility or tiredness
• Weight loss
• Non-healing ulcers
• Visual disturbances
• Inflammation of the glans penis

Note: Elderly patients may present differently, with fatigue, anorexia, failure to thrive, loss of motivation, difficulty in concentration, and urinary incontinence.

Complications

• Burning sensation (neuropathy) in palmar and plantar regions
• Boils and carbuncles
• Gangrene
• General debility
• Retinopathy
• Renal tissue damage (Nephropathy)
• Cardiovascular diseases

Investigations

• Plasma glucose measurement:
  • Random blood sugar (RBS)
  • Fasting blood sugar (FBS)
  • Postprandial blood sugar (PPBS)
• Urine routine and microscopic examination
• Glycosylated hemoglobin (HbA1c)
• Lipid profile

Diagnosis

Diagnosis is made by corroborating clinical symptoms with plasma glucose levels:

• Fasting plasma glucose > 126 mg/dl after overnight fasting
• Random plasma glucose > 200 mg/dl
• Two-hour postprandial glucose > 200 mg/dl

Management Approaches

Prevention

• Healthy diet suitable for the patient
• Daily routine (Dinacarya) and seasonal regimen (Ritucarya)
• Regular physical activity (brisk walking, swimming, other calorie-consuming exercises)
• Regular use of Rasayana drugs
• Restriction of sugar, sugar products, fried foods, and dairy products
• Limiting alcohol, excess oil, ghee, milk, sugarcane products, cakes, and meat
• Avoidance of daytime sleep and laziness

Medical Management

• Nidana Parivarjana (avoidance of etiological factors)
• Samshodhana Chikitsa (bio-cleansing therapies), followed by Samana Chikitsa (palliative therapy) as indicated
• Drug therapy tailored to patient condition and Ayurvedic principles