Diabetes mellitus is a chronic disease involving abnormalities in the body’s ability to use sugar.
It is a clinical syndrome of hyper-glycaemia due to absolute or relative deficiency of insulin.
Diabetes is characterized by either:
An inability of the pancreas to produce insulin (type 1 or insulin-dependent diabetes mellitus) or an inability of insulin to exert its normal physiological actions (type 2 or non-insulin dependent diabetes).
Diabetes is often silent and may exist for many years without the individual’s noticing it.
Effects certain “target tissues,” that is, tissues which are vulnerable to the damaging effects of chronically high blood sugar levels. These target tissues are the eye, the kidney, the nerves and the large blood vessels, such as in the heart.
Both hereditary and environmental factors are responsible for its development and progression.
What is Insulin?
Insulin is a hormone produced by beta cells of the pancreas.
It regulates the metabolism of carbohydrates, fats and protein. Insulin maintain blood glucose level either by increased transportation of glucose from the blood and transport into liver, fat and skeletal muscle cells or inhibiting production and secretion of glucose by the liver into the blood.
Normal glucose and fat metabolism
After ingestion of a carbohydrate meal, insulin, the primary regulator of glucose metabolism, is secreted from pancreatic β cells in response to a rise in blood glucose.
This rise of blood glucose suppresses liver glucose production, results in net liver glucose uptake and stimulates glucose uptake in skeletal muscle.
Insulin is also the major regulator of fatty acid metabolism. High insulin levels after meals promote triglyceride accumulation, while in the fasting state, low insulin levels permit lipolysis and the release of free fatty acides and glycerol, which can be oxidised by many tissues.
Types of Diabetes Mellitus
- Immune-mediated (Type 1 diabetes)
- Insulin resistance (Type 2 diabetes)
- Gestational Diabetes
- Others (environment, genetic defects, infections, and certain drugs).
What is type-1 diabetes?
Type-1 diabetes is sometimes called juvenile diabetes, or insulin-dependent diabetes. It means that your body can’t make insulin. Insulin helps your body turn the sugar from the food you eat into a source of energy. Type 1 occurs more frequently in children and young adults, but accounts for only 5-10% of the total diabetes cases nationwide.
What happens in Type-1 diabetes Mellitus-
Insulin producing β-cells of pancreas are attacked by the antibodies. Auto-immune diseases are the kind of disease in which body’s immune system produces antibodies against body’s own tissue considering those as foreign body. These antibodies attack and destroy the body tissue. This same process in seen in type-1 diabetes mellitus where β-cells of pancreas are attacked by the antibodies result in decreased level of insulin hormone ultimately increased blood sugar level.
Patients with type 1 diabetes present when adequate insulin secretion can no longer be sustained. High glucose levels may be toxic to the remaining β cells, so that profound insulin deficiency rapidly occure. Hyperglycaemia leads to glycosuria (Glucose in urine) and dehydration, which in turn induces secondary hyperaldosteronism.
Unrestrained breakdown of fat and protein result in weight loss, increased gluconeogenesis and ketogenesis. When generation of ketone bodies exceeds their metabolism, ketoacidosis results. Secondary hyperaldosteronism encourages urinary loss of K+. Thus patients usually present with a short history of hyperglycaemic symptoms (thirst, polyuria, fatigue and infections) and weight loss, and may have developed ketoacidosis.
What is type-2 diabetes?
Type-2 diabetes results the two main pathological defects includes impaired insulin secretion through a dysfunction of the pancreatic β-cell, and impaired insulin action through insulin resistance.This results in imbalance in glucose metabolism.
Impaired secretion results in inadequate amount of insulin to lower down blood glucose level and insulin resistance to the cells results in decrease uptake of glucose by liver, muscles cells etc and increase release of glucose from liver into the blood.
Hyperglycaemia develops slowly, so that osmotic symptoms (polyuria and polydipsia) are usually mild. Thus, patients are often asymptomatic but usually present with a long history (typically many months) of fatigue, with or without osmotic symptoms. In some patients, presentation is late and pancreatic β-cell function has declined to the point where there is profound insulin deficiency. These patients may present with weight loss, although ketoacidosis remains uncommon.
For many persons with Type-2 diabetes, daily insulin supplementation is not required. Diabetes is managed by making moderate changes in diet and exercise.
Investigation for Diabets Mellitus
Urine dipsticks are used to screen for diabetes. Testing should ideally use urine passed 1–2 hrs after a meal, since this will maximize sensitivity. Glycosuria always warrants further assessment by blood testing; however, glycosuria can be due to a low renal threshold.
This is a benign condition unrelated to diabetes, common during pregnancy and in young people. Another disadvantage is that some drugs (such as β-lactam antibiotics, levodopa and salicylates) may interfere with urine glucose tests.
Ketonuria may be found in normal people who have been fasting, exercising or vomiting repeatedly, or those on a high-fat, low carbohydrate diet. Ketonuria is therefore not pathognomonic of diabetes but, if it is associated with glycosuria, diabetes is highly likely. In diabetic ketoacidosis , ketones can also be detected in plasma using test sticks.
Standard dipstick testing will detect urinary albumin > 300 mg/L but smaller amounts (microalbuminuria) require specific sticks or laboratory urinalysis.
Laboratory blood glucose testing is cheap and highly reliable.
Glycated haemoglobin (Hb) provides an accurate and objective measure of glycaemic control over a period of weeks to months.
The non-enzymatic covalent attachment of glucose to Hb (glycation) increases the amount in the HbA1c fraction relative to nonglycated adult Hb (HbA0). The rate of formation of HbA1c is directly proportional to the blood glucose concentration; a rise of 1% in HbA1c corresponds to an increase of 2 mmol/L (36 mg/dL) in blood glucose.
HbA1c concentration reflects blood glucose over the erythrocyte lifespan (120 days); it is most sensitive to glycaemic control in the past month.
Diagnosis of Diabetes Mellitus
WHo recommended following criteria for diagnosis of diabetes Mellitus
|Condition||2 hour glucose||Fasting glucose||HbA1c|
|Normal||<7.8 (<140)||<6.1 (<110)||<42||<6.0|
|Impaired fasting glycaemia||<7.8 (<140)||≥6.1(≥110) & <7.0(<126)||42-46||6.0–6.4|
|Impaired glucose tolerance||≥7.8 (≥140)||<7.0 (<126)||42-46||6.0–6.4|
|Diabetes mellitus||≥11.1 (≥200)||≥7.0 (≥126)||≥48||≥6.5|
Conventional treatment for Diabetes Mellitus
Following Medicines are used for diabetes along with dietary restrictions.
Agents used in diabetic therapy include the following:
- Meglitinide derivatives
- Alpha-glucosidase inhibitors
- Thiazolidinediones (TZDs)
- Glucagonlike peptide–1 (GLP-1) agonists
- Dipeptidyl peptidase IV (DPP-4) Inhibitors
- Selective sodium-glucose transporter-2 (SGLT-2) inhibitors
- Bile acid sequestrants
- Dopamine agonists
Diabetes Mellitus- Homeopathy Treatment & Homeopathic Remedies
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines for diabetes mellitus are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The homeopathic remedies for diabetes mellitus given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a homeopathic remedy for diabetes mellitus. To study any of the following remedies in more detail, please visit our Materia Medica section. None of these homeopathic medicine for diabetes mellitus should be taken without professional advice.
This remedy is praised in diabetes originating in dyspepsia. It has polyuria, polydypsia, dryness of the mouth and skin. It causes sugar in the urine. No remedy gives such universally good results; it lessens the sugar and quantity of the urine. It is when the disease is due to assimilative derangements that Uranium is the remedy, and symptoms such as defective digestion, languor, debility and much sugar in the urine, enormous appetite and thirst, yet the patient continues to emaciate.
It corresponds to diabetes of nervous origin; the urine is increased, perhaps milky in color and containing much sugar. It suits cases due to grief, worriment and anxiety, those who are indifferent and apathetic, poor in mental and physical force. It is unquestionably curative of diabetes mellitus in the early stages, great debility and bruised feeling in the muscles. There will be loss of appetite, sometimes unquenchable thirst and perhaps the patient will be troubled with boils. When patients pass large quantities of pale colorless urine or where there is much phosphatic deposit in the urine it is the remedy.
Useful in diabetes and pancreatic diseases. Sudden and extreme dryness of the mouth and marked physical restlessness are also guiding symptoms to this remedy, especially with a dark watery stool. Dr. P.Jousset reports positive success where the mouth is dry; frequent, abundant urination and tendency to skin eruption.
An exceedingly good remedy in the gastrohepatic variety of diabetes and good results often follow its use. It has a fine clinical record. The symptoms are: urinates copiously and freely, urine light yellow and saccharine, thirst, nausea, debility, voracious appetite and costive bowels. Dry skin, dry tongue, gastralgia.
Should not be neglected in this disease. No remedy has dryness of the lips as a symptom of hepatic disorder more marked than Bryonia, and this is often one of the first symptom of diabetes. There is a persistent bitter taste, the patient is languid, morose and dispirited, thirst may not be extreme nor the appetite voracious, the patient may lose strength through inability to eat.
Long before the discovery of Insulin Dr.Pierre Jousset of Paris prepared a pancreatic juice on a glycerine basis which he administered to diabetic patients in doses of 10 or 20 drops a day in water and had results sufficiently good to consider pancreatic juice, orally administered, as a remedy of great value in diabetes. Dr. Cartier, his practical successor, praised it insisted on smaller doses given by mouth as larger doses and hypodermic injections of it had no effect in ordinary diabetes. Baker advises the homoeopathic strengths of Insulin 3d to 30th and reports happy results therefrom. Great care must be taken not to overdose. Boericke says that it maintains the blood sugar at a normal level and the urine remains free of sugar. Epileptic convulsions and mental derangements have been produced by hypodermic use of this hormone.