prameha rog - diabetes mellitus treatment

UnPrameha – A Guide To Diabetes Mellitus (Prameha Rog)

Diabetes Mellitus, popularly known as diabetes or prameha rog in ayurveda, is a chronic condition that affects the body’s ability to absorb and utilize energy from the diet. It is a metabolic disorder that is typically characterized by the presence of high glucose levels in your blood i.e. high blood sugar (scientifically known as hyperglycemia). Over a longer period of time, the high blood sugar results in severe damage to different organs of the body and leads to serious complications like stroke, cardiovascular diseases, kidney failure, foot ulcer, damages to the nervous system and even eye damage.[1] It also leads to muscle wasting, slows down the healing of wounds in general and makes the patient more susceptible to infections.  At present there is no cure for diabetes. People diagnosed with the disease need to manage their health and lifestyle to keep the disease in control and stay healthy.

complications of diabetes mellitus (prameha rog)

Complications of diabetes

Role of Insulin in Prameha Rog

The level of glucose in the blood is controlled by a hormone called insulin and it is the deficiency in the production of insulin or its utilisation by the cells or both which results in diabetes.[2] Insulin is an endocrine hormone (released directly into the blood) which is secreted by the beta cells of the islets of Langerhans region of the pancreas. Insulin regulates the carbohydrate metabolism of the body resulting in the absorption and storage of energy from the food. It also has a role in fat metabolism and causes fats to be stored in the adipose tissue. Insulin secretion is often associated with abundance of energy.

When we intake energy rich food with huge amounts of carbohydrates; the pancreas secretes insulin in greater quantity which in turn promotes the uptake and use of glucose by the body cells. It also stores the excess glucose in the form of glycogen in liver, muscles and in the form of fats in adipose tissues. Insulin further prevents the breakdown of glycogen into glucose by the liver, thus maintaining the blood glucose level. (Insulin also has a major role in promoting amino acid utilisation of cells and prevents the breakdown of proteins from the cells.)

insulin

As insulin acts as the primary hormone which regulates the uptake of glucose by the body, its deficiency or ineffectiveness plays a major role in giving rise to diabetes mellitus.

“Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action.” –  American Diabetes Association

When the insulin secretion is insufficient, there is defect in the insulin or there is insulin resistance or insensitivity, it would affect the insulin absorption by the body cells as well as the storage in the liver and muscles. This results in constant high levels of glucose in the blood stream, insufficient protein synthesis and several metabolic problems. Diabetes patients often suffer simultaneously from deficiency in insulin secretion and resistance to insulin action. It often becomes difficult to pinpoint which one of these reasons is the actual cause of the high blood sugar levels.

Diabetes mellitus can be broadly classified into:

  • TYPE 1 diabetes
  • TYPE 2 diabetes
  • Gestational diabetes

TYPE 1 Diabetes:

Type 1 diabetes, known as the insulin dependent diabetes mellitus (IDDM) occurs due to the lack of insulin secretion by the pancreas. Type 1 diabetes is caused by damages to the beta cells of the pancreas or diseases that cause impairment to the pancreas leading to decreased insulin production. This disease often occurs in people with genetic predisposition. In such people the onset of the disease by destruction of the beta cells can be triggered by a number of factors including diet, viral infections or even on their own. It also occurs as an autoimmune condition where the body’s defence mechanism(antibodies) cause damage to the pancreas. Unlike Type 2 diabetes, the onset of Type 1 diabetes is not influenced by lifestyle.[3]

10% of diabetes mellitus cases in the Europe and the USA fall under this category. This disease is typically characterized by early onset developing in childhood and acquiring severity at puberty. Though it can affect both children and adults, the onset of the disease during the teenage years led to it being termed as juvenile diabetes mellitus. Type 1 diabetes may set in abruptly and very rapidly over a few days or even few weeks with:  1. sudden rise in blood glucose level, 2. utilization of fat for the body’s energy needs and formation of cholesterol by the liver, 3. destruction of the body’s proteins which is often characterized by sudden weight loss and severe fatigue.

TYPE 2 Diabetes:

Type 2 diabetes, known as the non-insulin dependent diabetes mellitus (NIDDM) occurs due to reduced sensitivity of body cells to insulin (insulin resistance) combined with the effects of decreased insulin secretion. Type 2 diabetes is by far the most common type of diabetes which accounts for 80%-90% of diabetes cases. The onset happens usually after age 40 and the disease develops between 50 to 60 years of age which led it to being termed as maturity onset prameha rog.

But with the rise in obesity, kids are developing the disease too at an alarming rate. In a contrast to Type 1 diabetes, in case of the Type 2 diabetes, initially there is an increased insulin concentration in the blood stream. This happens as a compensatory response by the pancreas to the insufficient glucose utilization and storage by the body cells and subsequent rise in blood glucose levels. However with the underlying cause being increasing insulin resistance of the body tissues and cells, the increased secretion of insulin by the pancreas too fails to regulate the blood glucose level and its proper utilization by body cells.

In the earlier stages, the high blood sugar can be combated by medications and other measures that improve the insulin sensitivity of the body cells. However, if left untreated for a long time, the disease causes further damage to the pancreas and the body as a whole. In the later stages of Type 2 diabetes as the pancreatic beta cells become exhausted, gradually the insulin production diminishes.

Type 2 diabetes is primarily a lifestyle and genetic disorder with ‘obesity’ being a major factor in the development of the disease. Lack of physical activity, stress, urbanization and poor diet are other contributing factors. Calorie rich foods like sweetened drinks, foods having saturated and trans-fatty acids increase the risk of development of the disease.

type 1 vs type 2 diabetes

Type 1 and Type 2 diabetes comparison

Gestational diabetes:

Gestational diabetes occurs during pregnancy and is found in 2%-10% of pregnancies. It is similar to Type 2 diabetes with a combination of insufficient insulin secretion as well as insulin resistance. This type of diabetes often disappears post delivery but in 5% to 10% of cases, the women develop Type 2 diabetes eventually. This can happen few weeks after delivery, or months or years later. It develops in middle or late pregnancy. In this disease the risks to the unborn are greater than the risks to the mother. As the high blood sugar gets circulated from the mother to the child, it is very important to control the disease for the baby’s proper development.

Signs and Symptoms of Diabetes Mellitus

Diabetes mellitus (prameha rog) can remain undetected for long silently destroying the body, often referred to as ‘the other silent killer’. However the disease can be diagnosed through several signs and symptoms which develop rapidly in case of Type 1 diabetes, while the onset is relatively gradual in case of Type 2 diabetes with the symptoms even being absent initially. There three main symptoms of diabetes include polyuria, polydipsia and polyphagia accompanied by unexplained weight loss.

Polyuria: Polyuria is a condition characterized by the formation and passage of a high volume of urine, more than 2.5-3L in a day.[4] Diabetes mellitus causes osmotic diuresis leading to increased urine formation.

Polydipsia: This condition is characterized by increased thirst resulting in increased water intake. It is one of the primary symptoms of diabetes and is also evident in patients who have uncontrolled diabetes or fail to take their medication properly.

Polyphagia: Polyphagia refers to increased hunger. This increase in appetite and subsequent increase in food consumption is a typical characteristic of diabetic mellitus. Due to insulin resistance or lack of insulin secretion when the glucose from the food is unabsorbed by the body cells, it creates a deficit in energy. As a result, there develops a need for the body to consume more food in short intervals to fulfil the energy needs but instead of reducing the hunger, it often adds to the blood glucose levels.  Type 2 Diabetes Symptoms | Diabetes Warning Signs

Other symptoms of diabetes (prameha rog) include blurred vision, fatigue, sudden weight loss, general itching, slow healing of wounds, frequent infections, nausea, tingling sensation or numbness of hands and feet. Constant high blood sugar levels often cause glucose absorptions in the eye lens leading to change in its shape which alters normal vision.

Type 1 diabetes is also easily detectable by the presence of acetone breath in patients. The small quantities of acetoacetic acid in the blood stream get converted into acetone in patients with severe diabetes resulting in acetone breath.

main symptoms of diabetes

illustration by Mikael Häggström

 

Diagnosis

In a normal person the fasting blood sugar level recorded early in the morning is around 80-90mg/dl with 110mg/dl being the upper limit. The glucose tolerance test sees a rise upto 120-140mg/dl. People having fasting glucose levels from 110 to 125mg/dl are said to be in the prediabetes stage having impaired fasting glucose. When the fasting glucose level crosses 126mg/dl in a person, it is diagnosed as diabetes mellitus or prameha.[5]

Complications

Persistent high blood sugar levels cause a lot of damage to the body over a period of time. Chronic high concentration of glucose causes injury to the tissues. When the blood sugar is left uncontrolled over a long period of time, the blood vessels in several tissues throughout the body start functioning abnormally. It causes severe damages to the heart, eyes, brain, kidneys and nervous system. Diabetes increases the risk of cardiovascular diseases with heart attacks accounting for 75% of deaths. Damages to the blood vessels of the brain increases the risk of stroke. Diabetic retinopathy results from damages to the blood vessels of the retina which can ultimately lead to blindness.

An increasingly common occurrence in today’s times, damages to the kidneys results in diabetic nephropathy which may eventually progress into chronic kidney disease requiring dialysis and even kidney transplant. The high glucose concentration also induces abnormal function of peripheral nerves resulting in peripheral neuropathy and also autonomic nervous system dysfunction. Patients may suffer from loss of sensation in hands and legs, impaired cardiovascular reflexes and loss of bladder control. In severe diabetes, simple infections often flare up and turn dangerous causing life risk. For example a simple foot ulcer can take the form of a severe infection even leading to gangrene. Researchers estimate the diabetic foot which occurs in 15% of diabetics may rise to 25% in future.

Diabetics also experience episodes of emergencies. In patients of Type 1 diabetes, and under certain circumstances in patients of Type 2 diabetes ketoacidosis[6] occurs as a life threatening complication. In this condition, the lack of insulin leads to the increase in fat metabolism which releases keto acids. In such a situation the increasing formation of keto acids combined with the dehydration of the body due to polyuria causes severe acidosis. Vomiting, deep and rapid breathing, confusion are common symptoms of the condition. And if the pH falls below 7, it may lead to acidotic coma and even death. Treatment involves injection of insulin to reduce formation of keto acids and intravenous fluids to correct dehydration.

A rapid fall in blood sugar termed hypoglycaemia sometimes causes mild effects like sweating, unease and trembling. Serious effects include unconsciousness, seizures and rarely brain damage and death. The condition can be reversed by giving glucose to the patient. [7]

Treatment and Control of diabetes

Diabetes mellitus is slowly turning into a global epidemic with the perils of modern lifestyle acting as major contributing factors. In USA alone the disease acts as the 7th leading cause of death. Nearly one third of the US population is affected by diabetes. You can also find a guide on Ayurvedic Treatments for Diabetes Mellitus at Pubmed

The prevalence of the disease varies with ethnicity.[8] American Indians, African Americans, Hispanics, Asian Americans and Alaskan natives are at a higher risk of developing diabetes than white Americans.[9] Actually there is a evidence report on Ayurvedic Interventions for Diabetes Mellitus

Diabetes mellitus is a lifelong condition which is non-curable at present (except in very specific situations), but a combination of medication, proper diet and healthy lifestyle can keep the disease in check. Continuous assessment and monitoring of the disease is the key to a healthy and long life for a diabetic and to achieve that knowledge about the disease and treatments is necessary.Proper communication with a team of experts and following their advice can surely help in combating diabetes.

The primary therapy for diabetes is lifestyle modification. While obesity, high cholesterol, hypertension, smoking and lack of physical activity are familiar causes of the disease, increasing stress levels are also leading to the progression of the disease. A balanced and nutritious diet along with regular physical activity and exercise helps to keep the body weight as well as the blood glucose levels in check. Physical activity increases the glucose requirements of the body cells and hence more glucose is drawn from the blood stream resulting in the lowering of the blood sugar level.

The diabetic diet

Eating right is half the battle won in diabetes or prameha rog in ayurveda. Understanding carbohydrates and how much of what type of carbohydrate you can include in your diet is essential. Sugar should be replaced with artificial sweeteners as much as possible. The desserts and sweets should be saved only for special occasions. Fruits, vegetables, fibres and proteins form the basis of a diabetic diet. A diabetic should opt for non-starchy vegetables and make fresh fruits an alternative to desserts.

Proteins are an important part of a diabetic food plan; patients should opt for lean proteins and low fat dairy products. Dark green leafy vegetables, citrus fruits, beans, tomatoes, sweet potatoes, fat free milk and yoghurts, whole grains, berries, nuts and fish rich in omega 3 fatty acids are some the diabetic super foods which provide key nutrients like vitamins A, C, E, potassium, calcium,  magnesium and a healthy amount of fiber.

There are some useful herbs such as

  • Jambhul (Eugenia jambolana)Powder from jamun core is useful.
  • Gurmar(gymnema sylvestre).
  • Bitter Gourd/bitter melon (Momordica charantia)
  • Bel (Aegle marmelos).
  • Fenugreek (Trigonella foenum graecum)

which helps in treating diabetes or prameha rog. You can also check out these 10 food that helps you lower your blood sugar.

 

Anti diabetic medications help in lowering blood sugar levels. Type 1 diabetes is treated with insulin; a combination of regular and synthetic insulin is used in the treatment. In Type 2 diabetes several oral medications are used which play various roles like increasing insulin secretion or enhancing the sensitivity of the body cells to insulin. Insulin supplementation is also carried out, in advanced stages of the disease, along with oral medications.

References:

  1. About Diabetes World Health Organization.
  2. Insulin Dependent Diabetes Mellitus Volume 85, Issue 3, p291–297, 3 May 1996
  3. Diabetes World Health Organization
  4. Polyuria The Merck Manuals
  5. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications, WHO, 1999
  6. DKA (Ketoacidosis) & Ketones American Diabetes Association
  7. Hypoglycemia National Institute of Diabetes and Digestive and Kidney Diseases
  8. Incident Type 2 Diabetes Mellitus in African American and White Adults, Frederick L. Brancati JAMA. 2000;283(17):2253-2259. doi:10.1001/jama.283.17.2253.
  9. The Disparate Impact of Diabetes on Racial/Ethnic Minority Populations, Edward A. Chow, MD, Henry Foster, MD, Victor Gonzalez, MD and LaShawn McIver, MD, MPH

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