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Diabetes mellitus

DEFINITION

It is a condition in which, there is large amount of sugar
(Glucose) in the blood. Although sugar is needed to provide energy to the body, it causes a problem when in excess.

In normal individuals, the food taken is digested and converted into glucose. Blood carries this glucose to the body cells. The cells use this glucose as a source of energy.

In people suffering from Diabetes Mellitus, this sugar is in excess due to deficiency of a hormone called Insulin, which is secreted by the cells of pancreas, an organ situated behind the stomach. Insulin is required for the entry of glucose in the cells where it is properly consumed.

In the absence or deficiency of insulin, the sugar cannot enter the cells and hence remains in high amounts in the blood.

When the accumulation of sugar in the blood reaches a certain limit, glucose appears in the urine.

Normally urine does not contain glucose, but when the glucose appears in the urine it draws out more water with it and hence there is excessive urination. Because of excesive urination, there is water loss, which in turn causes more thirst.

Even though the glucose content in the blood is in excess, the cells are deprived of the energy as due to the lack of insulin the cells are starved of glucose. This causes increase in appetite.Although the diabetic patients eat more, the cells never seem to get enough glucose. In desperation, to get energy, the starved cells begin using fats and proteins from the body, thereby causing loss of weight and tiredness leading to a greater risk of developing infection.

CAUSES-

It is yet not completely understood what causes Diabetes.

1) Heredity - Plays an important role in Diabetes Mellitus.

2) Age - It can occur at any age.

3) Sex - Prevalent more in females than males in other countries. In India, the incidence is more in males than females.

4) Weight - People who are overweight (Obese) are more prone to develop this illness.

5) Infection/Illness - Congeners to D. M.

6) Accidents.

7) Stressful situation.

TYPES OF DIABETES MELLITUS -

There are mainly two types of Diabetes Mellitus commonly seen -

1) IDDM (Insulin Dependent D. M.)

2) NIDDM (Non-Insulin Dependent D. M.)

1) IDDM-
This group of Diabetics are those who develop this illness in the early life. The people affected are generally young lean and thin.

These people do not make sufficient insulin in their Pancreas and hence have to depend on insulin given from outside. Their illness cannot be controlled without insulin.

This type of Diabetes mellitus is called as Insulin Dependent Diabetes Mellitus or Growth onset Diabetes.

2) NIIDM-
This group of diabetics consists of patients who develop this illness later in life, they are often overweight and may give family history of late onset Diabetes Mellitus.

It is also noted that this group of people may not be fat but have potbelly or abdominal obesity. These patients do produce insulin but require diet control, exercise and drugs to improve glucose utilization. They may also require insulin at any stage.

This type of Diabetes Mellitus is called as Non Insulin Dependent Diabetes Mellitus or Maturity onset Diabetes Mellitus.

SYMPTOMS-

Commonly seen symptoms of a Diabetic patient are as follows -
1) Excessive urination

2) Excessive thirst

3) Excessive hunger

4) Loss of weight

5) Feeling of tiredness/Debility

6) Irritability

7) Itching & frequent skin infections.

DIAGNOSIS AND INVESTIGATIONS-

Diagnosis of Diabetes Mellitus in uncontrolled state has no difficulty. Still a large number of diabetics go undiagnosed till some complication forces one's attention to the disease.

The person must be fasting overnight for at least 12 hours before the tests.

1) Examination of urine for glucosuria (presence of glucose in urine) midstream sample of urine should be collected for the test.

2) Estimation of blood glucose level in two stages - Fasting and 2 hours after taking 75 gms of glucose.

3) Glucose tolerance Test (GTT).

TREATMENT-

The main principle of the treatment is as follows -

1) Diet

2) Exercise

3) Drugs

1) Diet: -

The diabetic person can eat almost any food that other people normally eat provided the food is balanced and within the permissible caloric limits.

Food Exchange: - The idea of food exchange is to facilitate variation in the diet without disturbing the caloric intake. This enables the patient to make the diet exciting and match his own taste and needs. Otherwise the monotonous diet would make him frustrated and lose the interest of eating which should never be the case. He has to enjoy every foodstuff keeping in mind the caloric requirement.

Major groups: -

1) Cereals

2) Meat, fish and pulses

3) Milk and Milk products

4) Vegetables

5) Fruits

6) Oils, fats.

The exchange of food is permissible within the same group only. It is advised initially to weigh and measure cooked food. Once the patient is familiar with the household measures, he usually would himself judge the permitted amount of food.

The diabetic person often feels hungry in spite of eating permissible food. In such a case, he can take food which is low in calories and hence, is known as free food. These foodstuffs provide a feeling of fullness and satisfaction.

Low calorie foods/ free foods: -

1) Salads - Cucumber, Cabbage, lettuce, radish, Capsicum, Onion, Tomato

2) Plain Tea/Coffee without sugar

3) Plain lemon juice without sugar

4) Clear soups.

Ideally speaking the diabetic nutritional plan is balanced diet which helps the person to attain as well as maintain normal weight appropriate for his height, age and sex.

The diet would permit the person to eat everything except things containing sugar, jaggery, honey etc. He is permitted to eat sweet things once a while provided proper adjustments are made in the diet.

Failing to restrict himself the blood sugar can rise leading to long term complications which are irriversible. The diabetic diet must meet calorie requirements according to the needs of the patient (Thin, obese & underweight).

The proportion of energy derived from the food is as follows: -

Proteins - 15%

Fats - 30 - 35%

Carbohydrates - 55%

The diet presented to the patient should not interfere with lifestyle of the patient. Diabetic people are asked to eat at short intervals i. e. not to keep long gaps between two meals to avoid lowering of blood sugar

Fibre Supplement in Diet: - It is basically an indigestible form of carbohydrate, which is present in number of foodstuff such as wholegrain flour, cereals, wheat bran, legumes, vegetables.

It helps in controlling blood sugar by slowing absorption of carbohydrates. In addition high fibre helps in satisfying hunger, reducing high cholesterol and preventing constipation.

Alcohol: - It provides empty calories (Calorie without any nutritional value) and hence should be avoided as far as possible. If one can do without it then nothing like it. But sometimes it might be advisable to allow consumption of hard liquor than that of sweet wineor Beer.

Drinks should not be taken on empty stomach and the quantity should not exceed 2 pegs/day. Instead of oily and spicy snacks normally served with the drinks, diabetics should eat salads. The diabetics should avoid fasting as it alters the body metabolism.

2) Exercise: -

Controlled exercise plays an important role in diabetic management. It helps to increase glucose utilization, tones up the body and improves circulation. It helps to build stamina and above all,it provides a source of well being. The exercise should be done daily. The exercise intensity or duration should not vary from day to day. One must keep sugar handy to overcome hypoglycemia (excessive lowering of sugar level). Change of exercise should be considered under doctor's advice.
Brisk walking, Jogging, Swimming and Cycling are the best exercises one can think of doing. These exercise are very important for the Calorie consumption.

Symptoms of Hypoglycemia (Lowering of Blood Sugar): -

1) Sweating
2) Trembling
3) Hunger
4) Anxiety
5) Confusion
6) Drowsiness
7) Speech difficulty
8) Inability to concentrate
9) Nausea
10)Tiredness
11) Headache

3) Drugs: -

The oral hypoglycemic agents (OHA) are the medicines taken orally to reduce the blood sugar. They are mainly used in NIDDM.

Insulin: -

It is a hormone produced by beta cells of pancreas an organ situated behind the stomach. The first insulin was available in 1921, which was extracted from the pancreas of cattle and pigs.

With the advancement of Science, human insulin was first introduced in eighties. The normal line of treatment followed is roughly as follows -

1) Diet

2) Diet + OHA

3) Diet + Insulin

4) Diet + Insulin + OHA

Type I Diabetes Mellitus :- Requires Insulin only

Type II Diabetes Mellitus:- Requires insulin when the OHA fail to control the blood sugar as in conditions like :-

1) Infection, fever
2) Major surgery
3) Stressful condition
4) Pregnancy

HOMOEOPATHIC REMEDIES

Note -
It is a MUST to continue the antidiabetic drugs even after starting homoeopathic treatment as these drugs have to be tapered down under a medical consultants advice before stopping the treatment, as the abrupt stoppage of these drugs can aggravate the preexisting disease.

Bryonia, Helonias, Lycopodium, Phosphorus, Phosphoric acid, Plumbum, Uranium Nitrate, Syzygium, Coca, lactic acid and Insulin.

Even though constitutional remedy is the best way of treating this chronic disease, there are some more specific remedies in the Materia Medica for Diabetes Mellitus.

Syzygium Jambolium -
Should be given in mother tincture form or powder form.
Very fast diminution and disappearance of sugar from urine.
Also reduces the increasing level of blood sugar and glycosuria.
Very large amount of urine causes great thirst.
Prickly heat in the upper part of body.
Old non-healing ulcers of skin.
Weakness and emaciation.

Insulin -

Useful in Diabetes Mellitus with skin affection
Like- skin irritation, boils, ulceration, acne, carbuncles with itching eczema.
If administered at suitable intervals in Diabetic Mellitus, the blood sugar & urine sugar may remain at normal level.

Avoid - Overdoses (causes weakness)

Uranium Nitricum -

Great emaciation & debility.
Generalised oedema & swelling.
Excessive thirst with nausea & vomiting.
Voracious appetite & eating followed by flatulence.
Profuse urination with burning in urethra.
Unable to retain urine.
Acrid urine. Dry skin and mouth.
Complete impotency in males.
Given in low potencies.

Helonius -

Profound depression.
Patient is always doing something to keep his mind busy.
Urine contains phosphates & sugar & albumin.
Great weakness & loss in weight.
Night urination.
Diabetes during pregnancy.
Continuous restlessness >> Keeping busy or occupied.

Lactic acid -

This acid is found in butter milk.
Very good in gastro hepatic variety of Diabetic Mellites.
Light yellow coloured urine.
Frequent and large quantity.
Dry skin and dry tongue.
Increased appetite copious salivation.
Constipation. Stool small and hard.
Morning sickness >> eating.

Phosphoric Acid -

Diabetes of nervous origin
Caused by- grief, worry and anxiety.
Patient. is indifferent to everything.
Apethetic from unusual struggling with adverse circumstances. Severe mental and physical stress.
Loss of appetite.
Unquenchable thirst.
Urine in large quantities, colourless contains phosphates.
Male impotency

BIOCHEMIC REMEDIES

Natrum muriaticum -

Polyuria- Frequent urination,
unquenchable thirst.
Loss of appetite and sleep.
Debility and emaciation,
<< on alternate days.
Increase in desire for salt.
Throbbing headache,
depressed females who want to be alone and cry.

Natrum Sulph-

Chief remedy when there is deficiency of insulin by pancreas. Disturbed digestion and acidity.
Depressed with suicidal instinct.
Brown bitter coating on tongue.
Increasing thirst for cold drinks.

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