Madhumeha (Diabetes mellitus)

Introduction

A medical condition in which body can’t produce enough insulin to process the glucose in the blood is known as diabetes. Diabetes has been known since the first century B.C.E., when a Greek physician, Aretus the Cappadocian, named it diabainein, meaning "a siphon," referring to the excessive urination associated with the disease. The word diabetes was first recorded in 1425, and in 1675, the Greek word mellitus,meaning “like honey,” was added, to reflect the sweet smell and taste of the patient’s urine. An unrelated and rare disorderSimilarly in Ayurveda a condition in which a person passes honey like (sweet) urine is called Madhumeha(Hyperglycemia) Reduced insulin production and decreased insulin sensitivity are the contributing factors for hyperglycemia. It is one among 20 types of Prameha (urological disorder) described in various Ayurvedic classics i.e. Charaka samhita, Sushruta samhita, Ashtanga sangraha, Madhava nidana, Yoga ratnakara etc.Ancient seers have narrated that excess use of guru (heavy to digest), snigdha (unctous), amla(Sour) and lavana(Salt) rasa, nav!nna (food prepared from newly harvested grains), new wine, Asya sukha (sedentary life style), atinidra (excess sleep), avyayama (lack of exercise), achinta (lack of mental exercise), obstaining from samshodhana (purification) therapy are the causes of Madhumeha.

Chronic hyperglycemia is associated with significant long term sequelae particularly damage or dysfunction of various organs especially the kidneys, eyes, nerves, heart and blood vessels. Diabetes is the seventh-leading cause of death, and is on the rise, both in developed and developing countries. It is the single most important metabolic disease that affects nearly every organ/ system in the body. Today diabetes affects more than 135 million people worldwide and that number is expected to increase to 300 million by 2025. India has the largest number of Diabetes patient in the world.  As per the data published by the International Diabetes Federation in the year 2006, the number of people with type 2 diabetes in India is around 40.9 million and this is expected to rise to 69.9 million by 2025. In India, about 10% elderly people aged 65 or more are suffering from diabetes.

classification

Diabettes is classified on the basis of its etiology

1. Type-I DM - Due to 'Beta' cell destruction, usually leading to absolute insulin deficiency.

2. Type-II DM - Due to variable degree of

i. Insulin resistance

ii. Impaired Insulin secretion

iii. Glucose intolerance and insulin resistance which generally increases with advancement of age.

3. Other specific types of Diabetes due to

i. Impaired Beta cell function due to genetic defects

ii. Impaired Insulin action due to genetic defects

iii. Diseases of pancreas

iv. Endocrinopathies

v. Drugs (chemically induced)

vi. Infections-Like congenital rubella, cytomegalovirus etc.

Risk factors

1. Family history

2. Obesity (BMI > 27kg/ m2)

3. Age > 45 years

4. Hypertension (B.P. > 140/ 90 mm of Hg)

5. HDL < 35mg/ dl and/ or triglycerides levels > 250mg/ dl

6. Habitual physical inactivity

Clinical features

1. Increased frequency of urine(Polyuria)

2. Increased appetite (Polyphagia)

3. Excessive thirst (polydyspia)

4. Turbidity in urine

5. Debility/ tiredness

6. Weight loss

7. Non-healing ulcer

8. Visual disturbances

9. Inflammation of glans penis

The presentation of symptoms in elderly patients with diabetes may be significantly different from the classic triad of polyuria, polydypsia, polyphagia and weight loss. They may present

with fatigue, anorexia, failure to thrive, loss of motivation, difficulty in concentration and urinary incontinence.

Complications

In later stage of diabetes mellitus the following complications may appear

1. Burning sensation (neuropathy) over palmar and plantar region

2. Boils and carbuncles

3. Gangrene

4. General debility

5. Retinopathy

6. Renal tissue damage (nephropathy)

7. Cardiovascular diseases

Investigations

Disease Specific

i. Measurement of the plasma glucose level

a. Random blood sugar (RBS)

b. Fasting blood sugar (FBS)

c. Post prandial blood sugar (PPBS)

ii. Urine routine and microscopic

iii. Glycosylated haemoglobin (HbA1c)

iv. Lipid Profile

Other related Investigations

i. Blood urea and serum creatinine

ii. E.C.G.

iii. Fundus examination

iv. Serum electrolytes

Diagnosis

The diagnosis is made by corroborating  symptoms and  plasma glucose levels

1. Fasting plasma glucose > 126 mg/dl after an overnight fasting (or)

2. Random plasma glucose > 200 mg/dl (or)

3. Two hours prandial glucose > 200 mg/dl

Management approaches

a. Prevention

1. Use of various preparations made from yava (barley), mudga (green gram), old rice,bitter gourd, drum-stick, methi(fenugreek), patola (snake gourd), pumpkin, cucumber, bimbi,watermelon, buttermilk, triphala etc. are beneficial as preventive measures for borderline diabetic patients

2. Dinacharya (daily regimen) and ritucary! (seasonal regimen)

3. Regular exercise/ increase in calorie consuming activities (Brisk walking, swimming,etc.)

4. Regular use of rasayana drugs (Amalaki ras!yana etc.)

5. Restriction in intake of sugar/ sugar products, fried food and dairy products

6. Restriction in the use of different types of wine, excess use of oil, clarified butter, milk,sugarcane products, cakes and the meat of domestic and aquatic animals

7. Avoidance of day sleep and laziness

b. Medical management

Line of treatment (Charaka Samhita, Chikitsa Sthana.6/ 15)

1. Nidana parivarjana (avoidance of aetiological factors) – Avoidance of Tubers, sweets, dairy products, soft drinks, fried foods and sweet fruits like mango, banana, custard apple and date..

2.  If patient is obese then Samshodhana chikitsa (bio-cleansing therapies) in the form of vamana, virechana, vasti are to be performed, however this need to be decided by the qualified physician of Ayurveda. If patient is lean and thin then only Shamana chikitsa (Palliative therapy) is recommended.

3.  Drug therapy - In Ayurveda most of the drugs indicated in diabetes mellitus may act on beta cell of pancreas thus improve insulin production/ increase insulin sensitivity. The following drugs/ formulations are useful to control type II diabetes mellitus. In case of type I diabetes mellitus, these drugs/ formulations may be used as a supportive therapy in addition to conventional insulin therapy to prevent long term complications.

4.   Smple medicinal Plants and their use

Plant name

Dosage (per dose)

Vehicle

Duration

AmalakI /Amla(Phyllanthusemblica Gartn.) Powder of dried seedless fruit

3 - 6 gm

Warm water

90 days

Haridra (Curcuma longaLinn.) Powder

1 - 3 gm

Luke warm water

90 days

Jambu/jamun (Syzygium cumini(Linn.) Skeeds-Powder

3 - 6 gm

Water

90 days

Meshsrigi/Gudmar (Gymnemasylvestre R.Br.)Powder of whole plant

3 - 6 gm

Water

90 days

Methika/Methi (Trigonellafoenum-graecum Linn.) Powder of seeds

3 - 6 gm

Water

90 days

Vijayasara /bijak(Pterocarpusmarsupium Roxb.)Powder of heart wood

3 – 6 gm

 

Water

90 days

Karvalli/Karela(memorandia

Charantia linn.)Juice

10-20Ml

Water

90 days

Note-Take cooked rice with ghee in case of any untoward effrct of over dose

Saptachakra(salacia chinancis Linn.)Decocction of root

50-100ML

Water

30 days

Note-Avoid during pregnancy

Bimbi(Coccinia indica. W&A.)Juice of Leaf/Root/Fruit

10-20Ml

Water

60days

Formulations

Drug

Dosage (per dose)

Vehicle

Duration

Nishaamalakadi Churna

3 - 6 gm

Honey

90 days

Triphaladi churna

3 - 6 gm.

Luke warm water/honey

90 days

Chandraprabha vati

250- 500 mg

Water

90 days

Suddha Shilajit

500mg-1gm

Luke warm water/Milk

90 days

Nisha Katakadi kashaya

20-40Ml

Luke Warm water

90 days

Phal trikadi kwath

15-30Ml

Luke warm water

Alternate days for 7days

Ayaskrity

20-30

Ml.

90days

Shilajtwadi lauha

250-500 mg

Asana kwatha

7       days

Above formulations may be used Initially 2 times in a day after meal for 15 days followed  Continuation may be based on the condition of patient and physician's direction.

NOTE: Out of the drugs mentioned above any one of the drug or in the combination may be prescribed by the physician.The duration of the treatment may vary from patient to patient. Physician should decide the dosage (per dose) and duration of the therapy based on the clinical findings and response to therapy.

Research evidences has shown significant improvement from the use of Vijayasara (Pterocarpus marsupium) Ayush-82(An combination of the plants developed by CCRAS), Bimbi(Coccinia indica) have shown   improvement in the diabetic patients.

C. Yogic practices: Lean diabetic patients may be advised to perform specific yoga positions that are believed to benefit them with the least physical stress. Certain postures are believed to stimulate the  pancreas and improve its function.

 The following yogic practices are beneficial in diabetes mellitus; however, these should be performed only under the guidance of qualified Yoga therapist. Duration of each exercise should be decided by the Yoga therapist.

1. Katiichakr!sana,Tdasana, Pavanamuktasana, Gomukhasana,Shalabh!sana, Vakrasana,Shas!nkasana, Dhanurasana, Mayur!sana, Pashchimottanasana,ushtrasana etc

2. Bhastrika, Bhramari,Suryabhedana pranaama.

3. Kunjala,shankhakha prakshalana, Vastra dhauti

Counselling - Advice the patient to

1. Do physical activity at least for 30 - 60 minutes daily

2. Increase the use of barley, wheat, mudga and roasted chana (bengal gram) in diet

3. Limit the use of potato, rice, milk, milk products and oily foods

4. Take utmost care of personal hygiene especially of feet and hand

5. Avoid any injury and immediately consult in case of injuries/ skin infections

6. Avoid tobacco and liquor consumption in any form

7. Restrict or stop intake of sweets

8. Regular monitoring of blood glucose level and medical checkup

a. Glycosylated haemoglobin (HbA1c) test twice in a year

b. Eye examination annually

c. Foot examination twice in a year/ daily by the patient

d. Renal function screening yearly

e. Blood pressure quarterly

f. Lipid profile annually

g. Cardiac check up once annually

Indications for referral:

a. Renal failure, severe infections

b. Associated with complications (diabetic foot, coronary artery disease, diabetic nephropathy, diabetic neuropathy, diabetic retinopathy etc.) and non respose of medication

Rferences

1-Flexible dose open trial of Vijayasara in cases of newly diagnosed non-insulin dependent Diabetes Mellitus - ICMR collaborating centres, Central Biostatistical monitoring unit, Chennai & Central technical coordinating unit, ICMR, New Delhi.

2-S. M. Kamble et al, (1996) Efficacy of Coccinia  indica W. & A. in Diabetes mellitus, Journal of Research in Ayurveda and Siddha, Vol. XVII, No. 1-2, pp77-84.

3-CCRAS Research - An Overview, Central Council for Research in Ayurveda and Siddha. Janakpuri, New Delhi.

4-AYURVEDIC MANAGEMENT OF SELECT  GERIATRIC DISEASE CONDITIONS,CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHA,Department of AYUSH, Ministry of Health & Family Welfare,Government of India, New Delhi - 110 058  

 

  • PUBLISHED DATE : Feb 12, 2016
  • PUBLISHED BY : Zahid
  • CREATED / VALIDATED BY : Janardan Panday
  • LAST UPDATED ON : Feb 12, 2016

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