Diabetes mellitus is a clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin. Lack of insulin affects the metabolism of carbohydrate, protein and fat and can cause a significant disturbance of water and electrolyte homeostasis. Death may result from acute metabolic decompensation, while long standing metabolic derangement is frequently associated with functional and structural changes in the cells of the body, with those of the vascular system being particularly susceptible. The changes lead to the development of clinical complications of diabetes which characteristically affect the eye, the kidney and the nervous system.
World Diabetes Day (WDD) was created in 1991 by IDF and the World Health Organization in response to growing concerns about the escalating health threat posed by diabetes. World Diabetes Day became an official United Nations Day in 2006 with the passage of United Nation Resolution 61/225. It is marked every year on 14 November, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922.
NORMAL GLUCOSE AND FAT METABOLISM
In humans, blood glucose is tightly regulated by homeostatic mechanisms and maintained within a narrow range. A balance is preserved between the entry of glucose into the circulation from the liver, supplemented by intestinal absorption after meals and glucose uptake by peripheral tissues, particularly skeletal muscle. A continuous supply of glucose is essential for the brain, which cannot oxidize free fatty acids and relies upon glucose as its principal metabolic fuel
When food is consumed, Carbohydrates are broken down into glucose – by saliva and the gut and. Glucose enters the bloodstream. Pancreas responds to the presence of food by releasing the stored insulin hormone (phase 1 insulin response). Insulin controls the amount of glucose in the bloodstream at any given moment. Insulin allows glucose from the blood to enter into the body’s cells – where the glucose can be used for fuel. Insulin also allows glucose to be stored by muscles and the liver as glycogen. If needed, the stored glycogen can later be returned to the blood as glucose. If there is glucose remaining in the blood, insulin turns this glucose into saturated body fat.
Proteins in the meal also get broken down into glucose to some degree. However, this is a much slower process than it is with carbohydrates. After the body’s initial release of insulin, the beta cells in the pancreas start to develop new insulin which can be released as well. This is known as the phase 2 insulin response. As mentioned above, if glucose is taken from the blood to the point where blood sugar levels start to approach a low level, the body releases glucagon
TYPES OF DIABETES MELLITUS
TYPE 1 DIABETES MELLITUS: also called as or Insulin Dependent Diabetes Mellitus (IDDM) is a slowly progressive T-cell mediated autoimmune disease. Family studies have shown evidence that destruction of the insulin- secreting cells in the pancreatic islets takes place over many years. There is complete or near total insulin deficiency. Hyperglycemia accompanied by the classical symptoms of diabetes occurs only when 70-90 % of beta cells have been destroyed. In most patients genetic predisposition allows an environmental injury to initiate the immunity attack. Over 95% of patients with IDDM express the HLA-DR3, HLA-DR4 antigen or both. Presence of these antigens of beta cells causes autoimmunization. More than one gene is involved in predisposition of IDDM. Only 51% of the siblings of the patients develop the disease and 2% of the offspring. In more than 50% of monozygotic twins only one has the disease. Viral infections precipitates onset of IDDM. Clinical features include sudden onset, polydipsia (excessive thirst), polyuria (frequent urination), and increased appetite, craving for sweet foods, progressive loss of weight, lassitude, blurred vision and muscular cramps.
TYPE II OR NON INSULIN DEPENDENT DIABETES MELLITUS (NIDDM)
Type II diabetes mellitus is a more complex condition than Type 1 diabetes because there is a combination of resistance to the action of insulin in liver and muscle together with impaired pancreatic beta cell function leading to relative insulin deficiency. Insulin resistance appears to come first, and leads to elevated insulin secretion in order to maintain normal blood glucose levels. However, as mentioned above, this puts strain on the beta cells which can fail therefore reducing the number of active insulin producing cells, and a slowly progressive insulin deficiency develops. Type II diabetes mellitus is increasing more rapidly due to obesity caused by sedentary life habits and changed life style. The classical symptoms of diabetes mellitus are polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger), loss of appetite. NIDDM is also known as adult onset diabetes, maturity onset diabetes, ketosis resistant diabetes and stable diabetes. It occurs in people who are above 40 years of age and chances of occurrence increases with age.
AYURVEDIC CONCEPT OF DIABETES DIABETES MELLITUS
Madhumeha in Ayurveda is generally correlated with Diabetes mellitus. WHO has projected India with the fastest growing diabetic population. The word Prameha literally means “to flow” which is derived from the Sanskrit root “Mih–Sechane”. The Sanskrit term Meha literally means to micturate. The verbal Mehanam signifies urination. It (Prameha) is qualified by prefix “Pra” meaning excess both in quantity and frequency. It is also a Maharoga, because it affects most vital organs of the human body and every cell of human physiology. The ancient Ayurvedic physicians described not only the sweetness of the urine as one of its major symptoms, but also the relationship of the disease to the disturbance of the five sheaths of the body.
- Annamaya kosha (Food sheath)
- Pranamaya kosha (Energy sheath)
- Manomaya kosha (Mind sheath)
- Vijnanamaya kosha (Intellectual sheath)
- Anandamaya kosha (Bliss sheath)
CAUSES
Aharaja (Dietetic)
- The food stuffs which has properties of Brmhana (containing more carbohydrate and fat than proteins)
- Predominantly of sweet, salt tastes
- Snigdha guna (which increases kapha dosa, medo dhatu and mutra mala)
- Heavy foods
- Sithaveerya (cold in nature and action)
- Amla rasas (consisting more acidic properties)
- Unboiled, unfried, unroasted foods
- Curd, milk products
- Improper food habits
- Meat of aquatic animals if taken in excess quantities
- Freshly harvested foods and grains (navannapana)
- Consumption of sweet food articles (gudavikrita)
Viharaja (Lifestyle and Habits)
- Excessive sleep
- Excessive Rest
- Day sleep
- Lack of exercise
- Lack of cleanliness and hygiene
- Lack of purificatory procedures
- Sitting idle
- Lethargy
CLASSIFICATION OF PRAMEHA
PHYSICAL
Apatarpana Uthaja prameha – the lean diabetic
Santarpana Uthaja prameha – the obese diabetic
AETIOLOGICAL
Sahaja Prameha – congenital
Apathyaja nimittaja Prameha – due to dietitic errors
Based on Dosha
Though prameha is a disease involving all the three doshas ie. vata, pitta and kapha , predominance of anyone dosha and dushya enables its classification into
Vataja Prameha
Pittaja Prameha
Kaphaja Prameha
These are futher subdivided into Vataja (4 types), Pittaja(6 types) and Kaphaja (10 types).
Clinical features: the characteristic features of all the types of Prameha are
- Prabhuta mutrata/ excessive urination
- Avila mutrata/ turbid urine flow
- Medo dushti lakshana/ symptoms of medo dhatu (adipose tissue) vitiation
Complications of Prameha
- Diabetic carbuncle (prameha pidaka)
- Constipation (malabandha)
SAMPRAPTI OF PRAMEHA
Prameha is a disease involving vata, pitta and kapha dosha with predominance of kapha dosha. Here the liquid (drava) attribute of kapha dosha gets aggravated due to the aforesaid causative factors, leads to the interaction with dosha and dushya. The quantitative and qualitative increase in the properties of kapha dosha leads to pramehas.
INVOLEMENT OF OJUS IN PRAMEHA
Ojus is the essence of life, an extract of the seven dhatus (elements) represented as bala (strength) of the body. The ojus in the healthy person determines the physical, psychic, sensory and motor functions of the body. The biochemical component of the body is reddish, white, and slightly yellowish in colour and is residing in the heart and other vital organs of the body. If ojus is disturbed, degeneration occurs and results in decreased life span. In Prameha the ojus or life essence is expunged from the body through all nine orifices, especially through urine and sweat.
Ojas gets imbalanced in prameha in two ways:
- Through obstruction in blood vessels (srotorodha)
- Through degeneration of the body components or dhatukshaya
This can cause both cardiac as well as disorders in the nervous system. All this is ojakshaya meaning imbalanace in ojus.
MANAGEMET OF PRAMEHA
According to Ayurveda the line of treatment of Prameha is strictly based on individual constitution and the following factors-
- The prakruti (body constitution) of the patient
- Dosha predominance of disease
- Dushya vitiation
- Obstruction in channels
- Manasika prakruti (mental constitution) of the patient
- Ahara (diet)
- Vihara (behavior and lifestyle activities)
- Hereditary factors
TREATMENT
- Nidana parivarjana – Avoidance of etiological factors like faulty lifestyle and faulty dietary habit
- Aushadha – medical management katu (spicy) tikta (bitter), kashaya rasa(astringent)
Two varieties of diabetics (pramehi) as classified in Ayurveda comprise, obese – strong (sthula and balavan) and thin-weak (krisha).
Sodhana Treatment – bio-cleansing procedures (panchakarma)
- For obese and strong with optimal strength having intense of doshas, purification of the body is advocated. It begins with which is aimed at reducing the obesity of the patient (apatarpana chikitsa). This is dependent on the predominant dosha, in Kaphaja by emetics (vamana) and Pittaja by purgation (virechana). Snehana karma (oleation) should be done prior to shodhana Generally swedana (fomentation) is contraindicated in prameha as profuse sweating is one of the symptoms of prameha.
- For lean and weak diabetics can undergo milder cleansing procedures followed by the treatment to nourish the body with specific management (santarpana chikitsa) as well as a diet which increases dhatus in the body.
Both types of diabetics successively treated with distinct therapy and diet regimen. Exercise and diet are important adjuncts to the primary treatment of diabetes. Diet is prescribed according to age, body constitution of the patient, season and environmental conditions.
Single plant drugs
- Amalaki (Emblica officinalis )
- Meshasringi (Gymnema sylvestre)
- Karavellaka (Momordica charantia)
- Methika (Trigonella foenum-graecum)
- Shilajit (Black bitumen)
- Vijaysara (Pterocarpus marsupium)
- Jambu (Syzygium cumini)
- Patra (Cinnamomum tamala)
- Tvak (Cinnamomum zeylanicum)
- Guduci (Tinospora cordifolia)
- Bimbi (Coccinia indica)
- Khadirasara (Acacia catechu)
- Katphala (Myrica esculenta)
- Kakamaci (Solanum nigrum)
- Devadaru (Cedrus deodara)
MEDICINES
- Chandraprabha Vati : 1 to 2 tablet (500mg); twice daily
- Silajitwadi Vati : 1 to 2 tablets (125 mg) twice daily
- Mehari Vati : 1 to 2 tablets twice daily
- Saptacakra Ghana Vati : 1 to 2 tablets twice daily
- Phalatrikadi Kwatha : 15 ml + 45 ml lukewarm water; twice daily before food
- Kathakakhadiradi Kwatha : 15 ml + 45 ml lukewarm water; twice daily before food
- Vasanta Kusumakara Rasa : 125-250 mg once daily
- Vangabhasma: 125-250 mg once daily
- Trivanga Bhasma : 125 mg twice daily
- Gokshuradi guggulu : 1 to 3 gram twice daily with Pashanabheda decoction
- Nisamalaki Curna : 2 to 3 grams; twice daily
- Lodhrasava : 30 ml twice daily after food
- Dantyasava : 30 ml twice daily after food
- Madhukasava : 30 ml twice daily after food
- Devadarvyadiarishta : 30 ml twice daily after food
- Lodhrarishta : 30 ml twice daily after food
Kaphaja prameha :
- Bhadrashree kashaya : 15 ml + 45 ml lukewarm water; twice daily before food
- Chavyadi kashaya : 15 ml + 45 ml lukewarm water; twice daily before food
Pittaja prameha
- Chathusaram kashaya : 15 ml + 45 ml lukewarm water; twice daily before food
- Trijatakam kashaya : 15 ml + 45 ml lukewarm water; twice daily before food
Vataja prameha :
- Khadiradi kashaya : 15 ml + 45 ml lukewarm water; twice daily before food
- Mustabhayadi kashaya : 15 ml + 45 ml lukewarm water; twice daily before food
YOGASANAS
- Yogamudra- Psychic union pose
- Halasana – Plough pose
- Mayurasana – Peacock pose
- Matsyasana – Fish pose
- Sarvangasana- Shoulder stand
- Ardha matsyendrasana- Half spinal twist
- Bhujangasana – Cobra Pose
- Paschimottanasana – Seated Forward Bend
- Shavasana- Corpse pose
- Padmasana- Lotus pose
- Uttanapadasana- Raised leg pose
- Naukasana- Boat pose
SAMPLE MENU OF 1500 CALORIES DIABETIC DIET
| Cooked Food | ||
| Vegetarian | Non-Vegetarian | |
| BED TEATea/Coffe | 1 Cup | 1 Cup |
| BREAKFASTToastEgg (half boiled)Milk | Two–1 cup | Two–– |
| Tea/ coffeeOrange | –One | 1 cupOne |
| LUNCHRicePhulkaSambharSpinachCurdTomato/ CucumberPickle | 2 kgOne1 K1K½ KONE1 piece | 2 kgOne1 K1K¼ KONE1 piece |
| EveningTea/ coffeeUpma | 1 cup¾ K | 1 cup¾ K |
| DINNERPhulka (Chappathi with fenugreek seeds)Green gram dalCauliflower curryFish/ Chicken curryRoasted pappadTomato/ cucumber | Three1K1K–OneOne | Four–1K2 piecesOneOne |
| BEFORE GOING TO BEDMilk | 1 cup | ½ cup |
| *1K equals 1 katori/ bowl*oil for cooking should be 4 tea spoon for vegetarians and 5 tea spoon for non vegetarians |
Diabetes can be controlled by giving comprehensive attention to three aspects ie. Ahara (diet), Vihara (exercise) and Oushadha (medicine).PATHYA
Diet to be followed
- Katu(spicy), Tikta bitter), Kashaya Rasa(astringent), Ushna (hot), Laghu( light), Ruksha(dry) foods
- Cereals: Old rice (Oriza Sativa) Rice, Barley (Hordeum vulgare) Godhuma (wheat) Kodrava (grain variety–Paspolum scrobiculatum)
- Pulses : Adhaki (red gram-Cajamus cajan) Kulattha (horse gram) Mudga (green gram), gram
- Dietary articles prepared with yava (barley), mudga (green gram), purana sali (old rice)
- Leafy green vegetables, radish, bitter gourd, ash gourd, snake gourd, cucumber, – Fenugreek leaves, cabbage, eggplant, beans, lady’s finger, onion, green tomatoes, garlic, snake gourd
- Fruits: apple, orange, guava, papaya, pomegranate, citrus fruit, gooseberry
- Oils : soybean oil, sunflower oil, mustard oil, Nikumbha (Danti- Baliospernum montanum), Ingudi (Balanitis aegyptiaca), Atasi (Linum usitatisimum)
- Wheat, rice, corn, bread to be taken in limited quantities
- Thin buttermilk
- Clear soups
- Lime juice without sugar
- Plain tea/ coffee
- Prefer lean meats like fish, chicken (60 g)
- Remove skin of chicken and it should be cooked with less oil
- Milk (skimmed) should be taken moderately
Exercises
- Brisk walking
- Jogging
- Bicycling
- Swimming
- Playing badminton and tennis
APATHYA
Diet and activities to be avoided
- Sugar, jaggery, sweets, sweet biscuits, sweet juices, jams, jellies, chocolates and honey
- Bakery products such as cakes, pastries, cream biscuits etc.
- Concentrated milk preparations such as pedha, burfee, ice-creams etc.
- Fatty meat cuts, organ meat such as liver, kidney, brain, heart, egg yolk , red meats such as mutton, pork, beef etc.
- Synthetic soft drinks and fruit juices
- Saturated fats like vanaspathy, dalda, ghee and butter and nuts and oil seed such as groundnuts and coconut etc.
- Dry fruits: pistachio, almonds and cashews
- Roots and tubers : potato, sweet potato, yam, colocasia/ taro
- Fruits: mango, banana, sapota/ sapodilla , grapes, custard apple and jackfruit
- Oils extracted from animals, butter, curd and egg yolk
- Mental stress, day sleep and awakening in night
