Sunday, January 09, 2011

Diabetes or Prameha


Diabetes is a metabolic disorder where in human body does not produce or properly uses insulin, a hormone that is required to convert sugar, starches, and other food into energy.

Diabetes mellitus is characterized by constant high levels of blood glucose (sugar).

Human body has to maintain the blood glucose level at a very narrow range, which is done with insulin and glucagon.
The function of glucagon is causing the liver to release glucose from its cells into the blood, for the production of energy.


There are three main types of diabetes : 

1. Type 1 diabetes  
2. Type 2 diabetes  
3. Gestational diabetes 

 

1. Type 1 diabetes :

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency.

This type of diabetes can be further classified as immune-mediated or idiopathic.

The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss is a T-cell mediated autoimmune attack. 

There is no known preventive measure against type 1 diabetes. 
Most affected people are otherwise healthy and of a healthy weight when onset occurs. 
Sensitivity and responsiveness to insulin are usually normal, especially in the early stages.

Type 1 diabetes can affect children or adults but was traditionally termed "Juvenile diabetes" because it represents a majority of the diabetes cases in children.

2. Type 2 diabetes :
Type 2 Diabetes is also called non insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes.
Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. 

Type 2 diabetes is the most common type.

In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity. 
At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver.

 

3. Gestational diabetes :

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness.

It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery.

Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. 
About 20%–50% of affected women develop type 2 diabetes later in life.

Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. 

Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations.
Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction.

In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. 
Labor induction may be indicated with decreased placental function. 
A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.


Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

Causes :
Following is a comprehensive list of other causes of diabetes: 

01. Hereditary or Inherited Traits : 
It is strongly believed that due to some genes which passes from one generation to another, a person can inherit diabetes. It depends upon closeness of blood relationship as mother is diabetic, the risk is 2 to 3%, father is diabetic, the risk is more than the previous case and if both the parents are diabetic, the child has much greater risk for diabetes.

02. Age : 
Increased age is a factor which gives more possibility than in younger age. This disease may occur at any age, but 80% of cases occur after 50 year, incidences increase with the age factor.

03. Poor Diet (Malnutrition Related Diabetes) : 
Improper nutrition, low protein and fiber intake, high intake of refined products are the expected reasons for developing diabetes. 

04. Obesity and Fat Distribution : 
Being overweight means increased insulin resistance, that is if body fat is more than 30%, BMI 25+, waist grith 35 inches in women or 40 inches in males. 

05. Sedentary Lifestyle : 
People with sedentary lifestyle are more prone to diabetes, when compared to those who exercise thrice a week, are at low risk of falling prey to diabetes. 

06. Stress : 
Either physical injury or emotional disturbance is frequently blamed as the initial cause of the disease. Any disturbance in Cortiosteroid or ACTH therapy may lead to clinical signs of the disease. 

07. Drug Induced: 
Clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel) and ziprasidone (Geodon) are known to induce this lethal disease. 

08. Infection : 
Some of the strephylococci is suppose to be responsible factor for infection in pancreas. 

09. Sex : 
Diabetes is commonly seen in elderly especially males but, strongly in women and those females with multiple pregnancy or suffering from (PCOS) Polycystic Ovarian Syndrome. 

10. Hypertension : 
It had been reported in many studies that there is direct relation between high systolic pressure and diabetes. 

11. Serum lipids and lipoproteins : 
High triglyceride and cholesterol level in the blood is related to high blood sugars, in some cases it has been studied that risk is involved even with low HDL levels in circulating blood. 

Signs and Symptoms :

In both types of diabetes, signs and symptoms are more likely to be similar as the blood sugar is high, either due to less or no production of insulin, or insulin resistance. 
In any case, if there is inadequate glucose in the cells, it is identifiable through certain signs and symptoms. 
These symptoms are quickly relieved once the Diabetes is treated and also reduce the chances of developing serious health problems.

Diabetes Type 1:
In type 1, the pancreas stop producing insulin due to autuimmune response or possibly viral attack on pancreas. 
In absence of insulin, body cells don’t get the required glucose for producing ATP (Adenosin Triphosphate) units which results into primary symptom in the form of nausea and vomiting. 

In later stage, which leads to ketoacidosis, the body starts breaking down the muscle tissue and fat for producing energy hence, causing fast weight loss. 
Dehydration is also usually observed due to electrolyte disturbance. 
In advanced stages, coma and death is witnessed.

Diabetes Type 2 : 
01.  Increased fatigue : 
Due to inefficiency of the cell to metabolize glucose, reserve fat of body is metabolized to gain energy. When fat is broken down in the body, it uses more energy as compared to glucose, hence body goes in negative calorie effect, which results in fatigue. 

02. Polydipsia : 
As the concentration of glucose increases in the blood, brain receives signal for diluting it and, in its counteraction we feel thirsty. 

03. Polyuria: 
Increase in urine production is due to excess glucose present in body. Body gets rid of the extra sugar in the blood by excreting it through urine. This leads to dehydration because along with the sugar, a large amount of water is excreted out of the body. 

04. Polyphegia :
The hormone insulin is also responsible for stimulating hunger. In order to cope up with high sugar levels in blood, body produces insulin which leads to increased hunger. 

05. Weight flactuation : 
Factors like loss of water (polyuria), glucosuria , metabolism of body fat and protein may lead to weight loss. Few cases may show weight gain due to increased appetite. 

06. Blurry vision : 
Hyperosmolar hyperglycemia nonketotic syndrome is the condition when body fluid is pulled out of tissues including lenses of the eye, which affects its ability to focus, resulting blurry vision. 

07. Irritability : 
It is a sign of high blood sugar because of the inefficient glucose supply to the brain and other body organs, which makes us feel tired and uneasy. 

08. Infections : 
The body gives few signals whenever there is fluctuation in blood sugar (due to suppression of immune system) by frequent skin infections like fungal or bacterial or UTI (urinary tract infection).

09. Poor wound healing : 
High blood sugar resists the flourishing of WBC, (white blood cell) which are responsible for body immune system. When these cells do not function accordingly, wound healing is not at good pace. Secondly, long standing diabetes leads to thickening of blood vessels which affect proper circulation of blood in different body parts.  

Complications : 
Diabetes is the primary reason for adult blindness, end-stage renal disease (ESRD), gangrene and amputations.  

Overweight, lack of exercise, family history and stress increase the likelihood of diabetes.  

When blood sugar level is constantly high it leads to kidney failure, cardiovascular problems and neuropathy.  

Patients with diabetes are 4 times more likely to have coronary heart disease and stroke. 

In addition, Gestational diabetes is more dangerous for pregnant women and their fetus. 

Management :
Though, Diabetes mellitus is not completely curable but, it is controllable to a great extent. So, you need to have thorough diabetes information to manage this it successfully. The control of diabetes mostly depends on the patient and it is his/her responsibility to take care of their diet, exercise and medication. Advances in diabetes research have led to better ways of controlling diabetes and treating its complications. Hence they include:

1.New improved Insulin and its therapy, (external and implantable insulin pumps) have advanced well to manage elevated blood sugars without any allergic reactions. 

2. Oral hypoglycemic drug, controls diabetes type 2.   

3. New improved blood glucose monitor (new device for self blood glucose monitoring), and hemoglobin A1c laboratory test to measure blood glucose control during previous 3 months.

Ayurvedic View :   

Causes :
"Aashyasukham swapnasukham dadhinigramyoodkanuprasaa pyaamsi Navaaanpaanam gudvayikritam ch prameha hetu kapahakrich swaramn."
                                                                                                   (Charaka Samhitha)

1. Inactivity
2. Excessive sleep
3. Excessive use of curd
4. Meat soup of the domestic, aquatic and marshy animals, 
5. New cereals and drinks
6. Products of gud or jaggery
7. All other kapha - promoting regimens

Purva roopa :
1. Prabhutavilamootrata (polyuria): Swedawaha srotoavrodha causes increased urinary out put with turbidity

2. Madhuratava in mutra : Glycosuria

3.Dantadiham mala sanchaya: Due to ama, deposits are seen in mouth

4. Panipada daha : Abundance of unutilized glucose in the blood. This causes disturbance in the equilibrium of dhatus and doshas in the body exposing body to further complications. It gives rise to padapani daha, which means burning sensation of feet and palm.

5.Chikkanta - Stickiness.

6. Trishna (Thirst and Polydipsia) : In the process of lypolysis, more water is utilized which results into activation of thirst center in the brain.

7. Swadasyata : Sweetness is experienced in the mouth due to increase in the sugar level.

Types :

Hetu Bhedas (As per etiology) 
1. Sahaja prameha : Juvenile or congenital diabetes
2. Kulaja : Familial
3. Apathyaja : Due to improper dietary habits

Deha Prakrthi Bhedas (As per features of the body) :
1. Sthula pramehi : Obese-related
2. Krisha pramehi : Leanness-related


Muthra Vikara Bhedas (As per urinary abnormality) :

Kaphaja : 
Kapha causes pramehas by affecting medhas thus altering lipid metabolism), muscles and body fluid situated in urinary bladder. 

They are of ten types as: 

01. UDAKA MEHA (Chronic nephritis, Diabetes insipidus) - 
In this type, patient urinates a white coloured water like urine without any smell.
02. ISKHU MEHA (Alimentary glycosuria) - In this type, patient urinates sticky urine which is like sugarcane juice. 
03. SAANDRA MEHA (Phosphaturia) - Viscous urine
04. SAANDRA PRASAADA MEHA - Having solid precipitate
05. SUKLA MEHA - (Chyleuria, albuminuria) - White urine
06. SUKRA MEHA (Spermaturia) - Urine with semen
07. SITA MEHA - Cold urine 
In this type, patient urinates again and again, many times.
08. SHANER MEHA - Delayed and very slow impulse of urination.
patient urinates in less quantity without any urge and difficulty.
09. LALA MEHA (Albuminaria) - Saliva-like urine
10. SIKTA MEHA (Lithuria) - Urine with gravels

Pittaja : 
Pitta aggravated by hot things causes the same by affecting medas, muscles and body fluid situated in urinary bladder. 

They are of six types as :

01. KSHARA MEHA (Alkanuria) - Urine like alkali
02. KAALA MEHA (Indikanuria) - Black urine
03. NILA MEHA (Indikanuria) - Blue urine
04. HARIDRA MEHA (Biluria) - Turmeric-like urine
05. MANJISHTA MEHA (Urobilinuria) -
In this type, patient urinates urine red in colour along with very foul smell. 
06. RAKTA MEHA (HAEMETURIA) - Urine is deep red

Vataja : 
Vayu, on relative diminution of other two doshas, draws on the dhatus in urinary bladder and thus causes Prameha. Prameha caused by vata and associated with pain has blackish or reddish urine. 
They are of four types as:

01. MAJJA MEHA (Albuminuria) - Urine with majja
02. VASA MEHA (Lipuria) - Urine with vasa
03. HASTI MEHA (Prostatitis) - Urine with lasika.
In this type, patient urinates urine in a very large quantity just like an elephant.

04. MADHU MEHA (Diabetes mellitus) -In this type, patient urinates urine which is of whitish or yellowish in colour and rough in nature.

Management :
Diet :
Follow the kapha-pacifying diet.

Avoid excess intake of sweets, carbohydrates, and dairy products. 

Take more fresh vegetables and bitter herbs. 

Other useful foods include: roasted or fried barley, corn flour, light, bitter vegetables, barley porridge, ghee, rice, and herbs like gokshura, gudmar, triphala, musta, cardamom, fenugreek, or coriander, mixed with honey.  

Barley is the main food to heal urinary diseases. 
Eliminate all objects that contain sugar from diet, like wheat, rice, potato, sugar, sugar cane and its juice, jaggery , sweet fruits. 

Reduce fats, especially butter and ghee from diet. 

Take barley soaked in a triphala decoction overnight, then mixed with honey and eaten several times a day. 

Orange, and lemon, may be taken as and when needed. 

Take bitter melon, in any form, without any fear, and Jamun and powder of its seed.
 

Take plenty of green vegetables, black gram, soy, fish etc.
Reduce weight.

Avoid sleeping during daytime.

Avoid smoking.

Commen Remedies :  
01. The best remedy for this disease is Karela. Eat Karela as often as you can. Take 1 tablespoon of Karela juice daily to control your sugar level.  
 
02. Take 1 tablespoon of Amla juice and 1 mix it with 1 tablespoon of Karela juice. Take it regularly. 

03. Boil the 5 leaves each of Tulsi, Neem, Jamun, Bel, with 4 seeds of pepper in a glass of water and drink two times a day. (Persons with high blood pressure should avoid it) 

04. Spend 45 minutes to one hour taking a good brisk walk every day. 

05. Take raw onion daily in any form. It has diuretic and digestive properties which help to control the sugar levels. 

06. The powder of seeds of Fenugreek (Methi) taken two to three times a day helps control the sugar in blood and urine.  
07. Garlic every day early in the morning in an empty stomach will help. 
08. Crush Jamun seeds and make powder. Take one or two spoons of the powder with water for four weeks. 
09. Boil 15 fresh Mango leaves in 1 glass of water. Leave overnight. Filter this water and drink first thing in the morning.

10. Take decoctions of triphala, fenugreek, musta, arjuna, sandalwood, lodhra, ajwan, gokshura, vidanga, guduchi, haritaki, and chitrak. 

Useful Plants :
01. Amalaki : Emblica officinalis - നെല്ലിക്ക 
02. Haritaki : Terminalia chebula - കടുക്ക
03. Bibhitaki : Terminalia bellirica - താന്നിക്ക
04. Haridra : Curcuma longa - മഞ്ഞള്‍
05. Asana : Pterocarpus marsupium - വേങ്ങ
06. Guduchi : Tinospora cordifolia - ചിറ്റമൃത്
07. Arjuna : Terminalia arjuna - നീര്‍ മരുത്
08. Methika: Trigonaella foenugraecum - ഉലുവ
09. Khadira: Acacia catechu - കരിങ്ങാലി
10. Musta: Cyperus rotendus - മുത്തങ്ങ
11. Aristaka: Azadirachta indica - ആര്യ വേപ്പ്‌
12. Gokshura : Tribulus terrestris - ഞെരിഞ്ഞില്‍
13. Saptarangi : Casearia esculenta - ചെറു കരണ്ടി
14. Karela : Momardica charantia - പാവല്‍
15. Bhunimba : Andrographis paniculata - നില വേപ്പ്‌
16. Jambu : Syzygum cumini - ഞാവല്‍
17. Daruharidra : Berberis aristata - മരമഞ്ഞള്‍
18. Shatavari : Asparagus racemosus - ശതാവരി
19. Guggul : Commiphora mukul - ഗുല്‍ഗുലു 

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19 comments:

  1. Diabetes is the primary reason for adult blindness??? explain how???

    main cause of diabetic related blindness is glaucoma and diabetic retinopathy. and its only 2% (WHO-NPCB survey 86-89) of total adult blindness in India. The main cause of blindness in adult is still cataract.

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