Diabetes Mellitus

Diabetes Mellitus – The Sweet and Silent Killer

Introduction :-

November 14th, World Diabetes Day (WDD) was created in 1991 by IDF (International Diabetes Federation) 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 .It is marked every year on 14th November, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922. The work was done under the directorship of John Macleod and with the help of James Collip for purification at the University of Toronto. 
November has been designated for diabetes awareness since 1975, according to the American Diabetes Association (ADA)Access to Diabetes Care is the theme for World Diabetes Day 2021-23.
The World Diabetes Day campaign aims to be the: 1. Platform to promote IDF advocacy efforts throughout the year.2. Global driver to promote the importance of taking coordinated and concerted actions to confront diabetes as a critical global health issue. The campaign is represented by a blue circle logo that was adopted in 2007. The blue circle is the Global symbol for diabetes awareness. 
India is the Diabetes capital of the world. Prevalence of Diabetes has increased alarmingly across all age groups in India, in younger population the rise is above 10% .Studies in different parts of India have demonstrated an escalating prevalence of diabetes not only in urban populations, but also in rural populations as a result of the urbanization of lifestyle parameters. The prevalence of pre-diabetes is also high. Recent studies have shown a rapid conversion of impaired glucose tolerance to diabetes in the southern states of India, where the prevalence of diabetes among adults has reached approximately 20% in urban populations and approximately 10% in rural population. As per the records, both Bangaluru and Kochi have a higher incidence of poorly controlled Diabetes. 
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.

Classification :-

Diabetes may be classified into, 
1. Pre-diabetes: This is a state when your blood sugar is higher than it should be but not high enough for your doctor to diagnose diabetes. Prediabetes can make you more likely to get type 2 diabetes and heart disease. 

2. Type 1 diabetes: Type 1 diabetes is also called insulin-dependent diabetes. It used to be called juvenile-onset diabetes, because it often begins in childhood. Type 1 diabetes can be due to an autoimmune condition. It happens when your body attacks your pancreas with antibodies. The organ is damaged and doesn’t make insulin.It can also be caused due to genetic defects in the cells of pancreas which produce insulin.

3. Type 2 diabetes: Type 2 diabetes used to be called non-insulin-dependent or adult-onset diabetes. But it has become more common in children and teens over the past 20 years, largely because more young people are overweight or obese. About 90% of people with diabetes have type 2.When you have type 2 diabetes, your pancreas usually creates some insulin. But either it’s not enough or your body doesn’t use it like it should. Insulin resistance occurs when your cells don’t respond to insulin, usually happens in fat, liver, and muscle cells.Epidemiological evidence and intervention studies clearly show that in humans saturated fat significantly worsen insulin-resistance, while monounsaturated and polyunsaturated fatty acids improve it through modifications in the composition of cell membranes which reflect at least in part dietary fat composition. 

4. Gestational diabetes: Pregnancy usually causes some form of insulin resistance. If this becomes diabetes, it’s called gestational diabetes.Doctors often spot it in middle or late pregnancy. Because a woman’s blood sugars travel through their placenta to the baby, it’s important to control gestational diabetes to protect the baby’s growth and development.Gestational diabetes is more of a risk for the baby than the mother. A baby might have unusual weight gain before birth, trouble breathing at birth, or a higher risk of obesity and diabetes later in life. The mother might need a cesarean section because of an overly large baby, or they might have damage to their heart, kidney, nerves, and eyes. 

5. Chemically induced diabetes: Some types of medication can cause blood sugar level to be higher than normal. Steroids, specifically cortisone or prednisone, are the most common cause of chemically induced diabetes.

Diabetes management :–

General: The most important thing to remember –

DERM- DIET- EXERCISE- RELAXATION- MEDICATION 

Clinical aspect and Homoeopathic management :- 

1.Increased thirst

2.Frequent urination

3.Bed-wetting in children who previously did not have bed-wetting.

4.Extreme hunger 

5.Unintended weight loss

6.Irritability and other mood changes

7.Fatigue and weakness

8.Blurred vision

9.Frequent infections

If any of these symptoms are seen, do consult a doctor.

Investigations:-

1.Urine and blood must be evaluated.

2.Fasting blood sugar

3.Post Prandial blood sugar

4.HbA1C

5.Ketone testing

6.Antibodies also have to be tested if Type 1 Diabetes is suspected,

-Islet cell cytoplasmic autoantibodies (ICA)

-Glutamic acid decarboxylase autoantibodies (GADA)

-Insulinoma-associated-2 autoantibodies (IA-2A)

-Insulin autoantibodies (IAA) 

Management :-

Homoeopathic medicines are selected after thorough case taking and repertorisation and given.

In type 1 Diabetes insulin must be administered according to the case, and once the patient starts recovering ,the dosage of insulin is reduced. 

In Pre-diabetic condition , a constitutional medicine will have to be administered after proper case taking and a thorough follow up is required along with life style changes and DERM. 

In Gestational diabetes also a symptomatic approach is essential along with administration of Constitutional medicine, if required. 

In Type 2 diabetes, Lifestyle changes with application of DERM ,Constitutional medicine and symptomatic management of complaints associated with diabetes viz. Neuropathy, vasculopathy, infections etc and follow up to check other complications. Though any polychrest remedy would have to be given according to constitution and symptom similarity

Some very common medicines which are usually indicated in Diabetes are, 

Uranium Nitricum

Acetic acid

Iodum

Helonias

Cephalandra Indica

Phosphorus

Acid Phosphoricum

Lycopodium

Lac defloratum

Natrum muriaticum, etc. 

If, the case is not effectively managed with Homoeopathic medicines Insulin must have to be administered. And the patient may have to be referred. 

Contributor- Dr. Surya S Nair