Diabetes Article

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Diabetes Mellitus and Homeopathy
Including its miasmatic background and treatment
- Dr. Deepak Sharma
INTRODUCTION
Diabetes mellitus is a disease which is known to everybody nowadays. It is to be noted with astonishment that DM has an attracting global importance as it is rocking the world as a non-infectious epidemic/pandemic. “SUGAR” is the common name given to DM by the Indian layman. Actually, it comprises a group of common metabolic disorders that share the phenotype of hyperglycemia (increased level of glucose in blood plasma). Nowadays, it is one of the leading causes of morbidity and mortality because Diabetes mellitus causes secondary pathophysiologic changes in the multiple organ system. Most likely, the complications of DM are adult blindness; non-traumatic lower extremity amputations (diabetic foot); end stage renal disease (ESRD); neuropathy etc. In the fore coming days it is presumed to be increasing day by day due to an increase in factors contributing to hyperglycemia, which may include dietetic irregularities, metabolic dysfunction, lack of exercise, stress, and busy lifestyle. As concerned about the cure of DM by Homoeopathy, it could be possible in the early stages but we can at least assure to give a peaceful and prolonged life to a diabetic patient.
ETIOLOGICAL CLASSIFICATION
Recent studies in the etiologies and pathogenesis of Diabetes mellitus lead to a revised classification. Recent changes in classification reflect an effort to classify DM as the basis of the pathogenesis process leading to hyperglycemia, as opposed to criteria such as age of onset or type of therapy. Some forms of Diabetes mellitus are characterized by an absolute insulin deficiency or a genetic defect leading to defective insulin secretion, whereas other forms share insulin resistance as their underlying etiology. Diabetes mellitus has two broad categories designated as type1 and type2.
TYPE 1 Diabetes mellitus (previously designated as IDDM): Type 1 DM is categorized into two subgroups, i.e., type 1A and type 1B. Type 1A results from autoimmune ß cell destruction, which usually leads to insulin deficiency; where as type 1B DM occurs due to lack of immunologic marker inductive of an autoimmune destructive process of the ß cells. Type 1 DM is hereditary in character and develops before the age of 30 years. The patient is young, lean and thin, and has an absolute requirement for insulin therapy.
TYPE 2 Diabetes mellitus (previously designated as NIDDM): Type 2 DM is characterized by a variable degree of insulin resistance, impaired insulin secretion, and increased glucose production. Type 2 DM more typically develops with increase in age; it also occurs in children, particularly in obese adults. It does not require insulin therapy.
GDM: This type of Diabetes mellitus is recognized during pregnancy. It is due to insulin resistance related to its metabolic changes.
MODY: It is a subtype of Diabetes mellitus is characterized by autosomal dominant inheritance, early onset of hyperglycemia and impairment in insulin secretion. It is also divided into MODY1, MODY2, MODY3, MODY4, and MODY5 according to genetic defect of beta cell function characterized by mutation in Hepatocyte nuclear transcription factor (HNF), glucokinase, HNF1 a, insulin promoter factor (IPF), HNF1 ß.
OTHER CAUSES:
• Drug or chemical induced Diabetes mellitus: Some drugs such as Nicotinic acid, Glucocorticoids, Thyroid hormones, Diazoxide beta-adrenergic agonists, Thiazides, ß blockers etc causes DM.
• Endocrinal Diseases: This includes Hyperthyroidism, Hyper secretion of Adrenal cortex, Hyperpituitarism, Cushing’s syndrome, Pheochromocytoma, Acromegaly, Somatostatinoma.
• Diseases of Pancreas: This includes Pancreatitis, Cystic Fibrosis, Hemochromatosis, Pancreatopathy, Cancer of pancreas, Pancreactectomy.
• Other Genetic Syndrome sometime associated with DM like as Down’s syndrome, Klinefelter’s Syndrome, Turner’s syndrome, Huntington’s corea.
RISK FACTORS FOR TYPE 2 Diabetes mellitus
• A strong family history
• Obesity
• Age = 45 years
• Previously identified IFG or IGT
• History of GDM
• Hypertension (Blood pressure = 140/90 mmHg)
• HDL cholesterol level = 35 mg/dl
• Triglyceride level > 250 mg/dl
• Polycystic ovarian syndrome
EPIDEMIOLOGY
The prevalence of Diabetes mellitus in adults was 4 percent worldwide; this means that over 143 million persons are now affected. It is projected that disease prevalence will be 5.4 percent by the year 2025, with global diabetic population reaching to 300 million. The rising prevalence of Diabetes mellitus in developing countries is closely associated with industrialization and socioeconomic development. Diabetes mellitus, a chronic disease once though to be uncommon in the developing world has now emerged as an important public health problem in Asia. An estimated 30 million persons in South-East Asian region are affected at present. It is estimated that by the year 2025 there will be nearly 80 million diabetics in the region- the highest among all WHO regions. Thus, the South-East region will bear the maximum global burden of the disease. The result of prevalence study of DM in India was systematically reviewed with emphasis on these utilizing the standard WHO criteria for Diabetes mellitus diagnosis. The prevalence of disease in adults was found to be 2.4 percent in rural and 4-11.6 percent. This indicates the potential for further rise in prevalence of DM in the coming decades. It is estimated that during 1997 about 102,000 persons died of DM in India with about 1,981,000 DALYs.
PATHOGENESIS
The pathogenesis of each type of Diabetes mellitus is different and discussed separately.
TYPE 1: This type of DM is characterized by an absolute lack of insulin, which is why patient always wants insulin. It is previously called as IDDM. The absolute lack of insulin is due to the beta cell destruction. There are three main mechanisms responsible for beta cell destruction that is genetic susceptibility, autoimmunity, and environment insult. These factors of genetic predisposition and environmental insult causes unnecessary immune response against normal functioning beta cells. This immune response triggers the auto immunity, which causes beta cell destruction. When complete destruction of beta cells occurs, no insulin secretion occurs in the bloodstream that causes type 1 Diabetes mellitus.






TYPE 2: Type 2 Diabetes mellitus is characterized by decrease in beta cell secretion of insulin or a decrease response of the tissues to respond to insulin, i.e. insulin resistance. The main factor involved in the pathogenesis of type 2 Diabetes mellitus is environmental factor. Obesity is one of the most important causes although genetic predisposition is also important which causes deranged insulin secretion and cause hyperglycemia. This hyperglycemia causes ß cell exhaustion and decrease in insulin secretion. Other metabolic disturbances cause reduced responsiveness of tissues to insulin action called as insulin resistance. It is a major factor in the development of type 2 Diabetes mellitus.














Gestational Diabetes mellitus (GDM): GDM is a prodromal form of type 2 DM being unmarked by pregnancy. Pregnancy is associated with insulin resistance that necessitates an increase in insulin production to maintain euglycemia (a normal insulin concentration of glucose in blood). Placental hormones that rise late in pregnancy induce the insulin resistance in GDM. Gestational Diabetes mellitus itself is typically found late in the second or early third trimester. Some studies suggest that there is an exaggeration of the pregnancy induced insulin resistance in GDM, but it appears that the major determinant of whether a woman develops DM is likely insulin reserve. This reserve is blunted in women with GDM. In severe GDM an element of glucose toxicity supervenes which may further blunt the insulin sensitivity. The elevated free acids that are also found in GDM may be a further cause of insulin resistance as may be a manifestation of the disease process itself. Thus, GDM is similar to type 2 DM with insulin resistance and impaired insulin secretion, and persistence of these abnormalities postpartum contributes to the increased risk of type 2 DM in the long term.
DIAGNOSIS
New revised criteria for the diagnosis of DM from the expert panel of WHO and National Diabetes Data Group emphasize the FPG as the most reliable and convenient test for diagnosing Diabetes mellitus in asymptomatic individual.
Glucose tolerance is classified in to three categories based on the FPG
• FPG < 110 mg/dl is considered as normal
• FPG = 110 mg/dl but < 126 mg/dl is defined as IFG (Impaired Fasting Glucose)
• FPG = 126 confirm the diagnosis of DM
IFG is a new diagnostic category analogous to IGT, which is defined as the plasma glucose level between 140mg/dl and 200mg/dl, 2 hour after a 75gm oral glucose load.
A random plasma glucose concentration = 200 accompanied by classic symptoms of Diabetes mellitus, for example polydipsia (increased thirst), polyuria (increased micturation), polyphagia (increased appetite), weight loss is sufficient for the diagnosis of DM.
The two-hour plasma glucose commonly referred to post parendial is still a valid mechanism for diagnosing DM but is not recommended as a part of routine screening.
CLINICAL FEATURES
Type 1 DM Type 2 DM
Increased thirst
Increased micturation
Weight loss in spite of Increased/normal appetite
Fatigueness
Nausea
Vomiting Increased thirst
Increased micturation
Increased appetite
Blurred vision
Slow healing infections
Fatigueness
Impotency in men

MIASMATIC BACKGROUND
Diabetes mellitus comprises the pseudopsoric miasm. The pseudopsoric miasm is also known as Tubercular miasm. It is a combination of both Psora and Syphilitic miasm. Tubercular miasm is usually characterized by a “problem child” i.e. slow in comprehension, dull, unable to keep a line of thought, unsocial, morose. He/she gets relief from offensive foot or axillary sweat which when suppressed often induces lung troubles or some other severe disease. The patient's mental symptoms tend to be ameliorated by an outbreak of an ulcer. The slightest bruise suppurates; the strong tendency is to the formation of pustules. As a general rule, the patient is very intelligent, keen observer and a programmatic planner who wants his life always busy but possesses a sedentary lifestyle.
INDICATION OF MIASM
As the miasm progress and predominates, weight loss, depreciation and destruction are the first indication of this miasm. Other indications are cosmopolitan habits, mentally keen but physically weak. Symptoms are ever changing. Rapid response to any stimuli (e.g. any slightest change of weather or atmosphere). Emaciation instead of taking proper diet and drink, tendency to cough and cold easily, desire and craving for unnatural things to eat, with desires and cravings for narcotics such as tea, Coffee, tobacco and any other stimulants have often their origin in psoric or tubercular miasm. They sometimes have constant hunger and eat beyond their capacity to digest or they have no appetite in the morning but hunger for other meals.
COMPLICATIONS OF Diabetes mellitus
The complications of Diabetes mellitus are categorized into two main groups i.e. Acute and Chronic complications. The acute complications are due to metabolic disturbances. These include DKA (Diabetic Ketoacidosis) and Nonketotic Hyperosmolar state.
The chronic complication are also categorized into two broad groups
1. Micro vascular complications: These include Ophthalmic Disorders (Retinopathy, Macular edema, Cataract, Glaucoma), Neuropathy (Peripheral neuropathy, Sensory and Motor polyneuropathy), and Nephropathy (ESRD).
2. Macro vascular complications: These include Coronary Artery Diseases (CAD), peripheral vascular disorders, and cerebrovascular diseases.
3. Other complications include Gastroparasis, Diarrhea, Uropathy, Sexual dysfunction and Dermatologic complications like eczema, cellulites, and gangrene of distal part of limbs (Diabetic foot).
MISAMATIC DISCUSSION ON COMLICATIONS OF Diabetes mellitus
As I discussed in the 'miasmatic background' section, DM has a psorosyphilitic background. As the syphilitic miasm becomes predominant the complications arise. The acute complications are of the psoric character because they have metabolic disturbances while the chronic complications are associated with syphilitic background or as a result of a mixture of two. As the strong syphilitic character is going to destruction and degeneration it leads to mixed miasmatic diseases. These diseases are more difficult to cure especially when they go to irreversible changes. When the syphilitic miasm is dominant in the condition of chronic complications the condition should become violent. At this stage the individual needs a complete Miasmatic and Therapeutic treatment.
MANAGEMENT
Before we are going to start treatment of DM, it is very essential to know about proper nutrition and exercise plan for diabetic patient to reduce the prevalence and incidence of complications. It must also include preventive plan for an individual.
• Diet and Nutrition plans
• Exercise plans
DIET AND NUTRITIONAL PLAN:
Proper nutritional management or food plan is essential for better glucose control. This in turn helps to reduce the risk of diabetic complications. Daily consistency regarding the types of food including in the meal, their nutritional information, and the time at which they are consumed will help to normalize the blood glucose levels.
The common meal planning tips are:
• Avoid saturated fats and oils; instead of that use unsaturated oils found in olive oil, nuts, and canola oil
• Moderate salt and salty food consumption, especially when high blood pressure is present.
• Watch the amount of protein-rich food.
• Incorporate high-fiber food such as grains, raw vegetables and fruits (fruit is better than the fruit juice).
• Spread your daily carbohydrate intake through the day. Don’t eat too much carbohydrate at any time.
EXERCISE PLAN:
Physical activity is recommended for everyone. It should take place any time when a person can and is willing. The minimum time recommended is about 30 minutes; three or more times a week. Activity can include moderate walking and household chores, such as gardening and cleaning as well as jogging, biking, dancing and other sort of exercises.
The benefits of exercise include:
Improved blood sugar control
Weight loss
Lower blood pressure
Lower cholesterol level
Improved circulation Improved muscle strength and tone
Improved digestion and appetite control
Better sleep
Improved mood, attitude
Increases energy level
When starting an exercise plan, be sure to warm up, set a comfortable pace, wear good shoes and drink plenty of water. Make it as enjoyable as possible without overdoing it. A good partner will make it easier to commit to it. Be cautious with the duration and intensity of the exercise; then gradually increase the length of the activity by a few minutes every week.
WHEN NOT TO EXERCISE:
• If you are ill.
• In extreme heat or cold.
• During peak insulin action times.
• If your blood sugar is high exercise will usually help bring it down; but if your blood sugar is over 250mg/dl do not prefer exercise.
TREATMENT
As Homoeopathy is not a science of therapeutics, it is concerned with totality of symptoms or individuality. As regarding the cure of DM by homoeopathic medicine, the individual needs the complete miasmatic and constitutional therapy in the very early stage.
MIASMATIC TREATMENT:
If we are going through complete miasmatic study of the individual in early stages then we can easily find out about the disease for witch an individual is prone to suffer. Then, we can apply the antimiasmatic therapy as a preventive measure which causes a decline in the tendency for the progression of the miasm.
The main antimiasmatic remedies for Tubercular miasm are:
“A” Grade: Agar, Ars-i, Aur, Bac, Calc-c, Calc-p, Car, Hep, Iod, Kali-c, Kali-p, Lyc, Med, Nat-s, Phos, Puls, Sep, Sil, Stann, Sulp, Thuj, Zinc.
“B” Grade: All-c, Ant-i, Ars, Bap, Bar-m, Bry, Bufo, Calc-s, Carb-v, Chin, Dulc, Kreos, Nat-m, Nit-ac, Ph-ac, San, Sep.
If family history presents: Carc, Sacch, Thuj.
THERAPEUTIC TREATMENT:
I found over 50 remedies for DM but when totality of symptom agrees every medicine from Materia Medica can be employed. However, only a smaller group is employed most frequently such as -
Acetic acid (Glacial acetic acid) 6, 30: Large quantity of pale urine, unquenchable thirst, and great debility.
Abroma augusta (Olatkambal) ?, 2X, 3X: Frequent and profuse urination, dryness of the mouth and great thirst, urination leads exhaustion, Fishy odor of the urine, Diabetes mellitus and insipidus.
Argentum Metallicum (Silver) 6, 30, 200: Polyuria, frequent urination, urine profuse at night, turbid and sweetish odor, restless sleep, frightful dreams, edematous swollen feet, flatulent distention of abdomen.
Arsenicum album (Arsenic trioxide) 6, 30: Urine scanty, burning albuminous, ascites, all prevailing debility, restlessness, burning thirst, drinks often but little at time.
Codeinum (An Alkaloid from Opium) 3X, 3: Sugar in urine, quantity of urine increased, great thirst, it is said to control disease.
Cephalandra indica (Telakucha) ?, 1X, 3X: DM and insipidus with profuse urination; weakness and exhaustion after urination; sugar in the urine.
Gymnema sylvestre (Meshasringi or Gurmar) ?, 3x, 6: Is almost specific for DM called as “Sugar Killer” diminishes sugar in urine; Profuse miturition loaded with sugar, extreme weakness after passing large quantities of urine. Polyuria; day and night.
Helleborus (Snow-rose) 3X, 3: Frequent urging to urinate but small quantities emitted, profuse urination, urine pale and watery, dropsical swelling.
Helonias-Chamailirium (Uricorn-root) ?, 6: DM and insipidus, urine profuse and clear, phosphatic and albuminous, great thirst, restlessness, profound melancholy, irritable, boring pain across the lumbar region.
Insulin 3X, 6X: Supposed to be specific and useful in case of carbuncles resulting from DM.
Lacticum acidum (Lactic acid) 6, 30: Frequent passing of large quantities of sugar in urine, great thirst, rheumatic pains in joints.
Natrum Phosphoricum 6X, 12X and Natrum Sulphuricum 3X, 12X, 30: They are of great value in diabetes. Profuse urination, urine loaded with bile, lithic deposition in urine, sedentary habits especially when there is a succession of boils.
Phosphoricum acidum (Phosphoric acid) 2X, 30: Frequent and profuse watery urination, milk-like urine, great debility.
Phosphorus 3, 30: DM in phthisis in impotency, urine contain large amount of salt in the morning and excess of sugar in the evening.
Plumbum Metallicum (Lead) 6, 30: Urine frequent, scanty, albuminous, low specific gravity.
Rhus aromatica (Fragrant sumach) ?: Large quantity of urine, urine pale, albuminous, specific gravity low.
Syzygium Jambolanum (Jambol seeds) ?: It has a specific action in diminishing and causing to disappear the sugar in urine, great thirst, and weakness, urine in very large quantities, specific gravity high. Ten drops to be taken twice or thrice daily.
Uranium Nitricum (Nitrate of Uranium) 3X, 30: Profuse urination, debility, acid in urine, incontinence, unable to retain urine, excessive thirst, diarrhea of the dyspepticus.
Terebinthinum (Turpentine) 3, 6: Profuse, cloudy, smoky, and albuminous urine, sediments like coffee grounds, haematuria.
Other valuable medicines are: Arsenicum Iodatum; Aurum metallicum; Boricum acidum; Bryonia alba; Chamomilla umbellate; Chionanthus virginica; Coca (Erythroxylon coca); Crotalus horridus; Curare; Iris versicolor; Kreosotum; Morphinum; Nux Vomica; Pancreatinum; Silicea terra; Strychninum arsenicosum.
REFERENCES
Principle of Internal Medicine Harrison 15th Edition Vol. 2.;
Illustrated Pathology Robbins 6th Edition;
Preventive and Social Medicine Park 17th Edition;
Treatment from Epitome of Homoeopathic Practice by M. Bhattacharya;
Miasm and their effect on human organism by Raju Subramanium;
Internal Medicine Davidson 19th Edition;
Newer Horizon in Type2 Diabetes Mellitus;
Indication of Miasm Harimohan Chaudhary;
Chronic Miasm J.H. Allen;
Materia Medica Boericke;
Materia Medica J.H. Clark;
Prescriber J.H. Clark;
Prescriber H.C. Allen;
Soul of Remedies by Dr. R. Shankran;
Synthesis Repertory George Vithoulkas 8.0 Version;
Repertory by Robin Murphy Synoptic key by Boger ;
Also search at homoeopathy.com; homeopathy.org; diabetesindia.com; medindia.com; and many more.