Diabetes- what it means to you ?

Everyone has glucose in their blood, whether or not they have diabetes. This glucose comes from food. When we eat, the digestive process breaks down food into glucose, which is absorbed into the blood in the small intestine. People who don't have diabetes rely on insulin, a hormone made in the pancreas, to move glucose from the blood into the body's billions of cells. But people who have diabetes either don't produce insulin or can't efficiently use the insulin they produce. Without insulin, they can't move glucose into their cells.

Glucose accumulates in the blood -- a condition called hyperglycemia ("hyper" = too much, "glycemia" = glucose in the blood) -- and over time, can cause very serious health problem. Although there are various types of diabetes but everyone with diabetes has one thing in common that they have little or no or reduced ability to move glucose/sugar from the blood stream into the cells which is essential because glucose is body's primary fuel

Types of Diabetes :



Idiopathic diabetes mellitus --- IDDM
NIDDM­­­----Secondary diabetes
Gestational diabetes




Symptoms :

Cases of mild to moderate Diabetes are usually diagnosed on a routine health check-up or during pre operative investigations done for fitness for surgical procedures. Patients may go to a physician for some chronic non-healing problem like itching, cough, or a non-healing wound. The patient may be asked for a routine sugar check-up and is diagnosed as a case of diabetes. The classical symptoms of diabetes may not be essentially present. At times diabetes may be suspected by observing the following symptoms:

When one looks for the symptoms of diabetes the common symptoms found are

For Type 1:

Excessive urination

Excessive thirst

Excessive hunger

Episodes of extreme weakness or even fainting




Type 2:

The need to urinate more than usual

Excessive thirst

Unusual weight loss

Feeling of being un-well/weak or tired

Blurred vision

Tingling or numbness in hands or feet


Frequent and recurring infections such as urinary tract infections, boils, and fungal infections

Difficulty with erections in men, and unusual vaginal dryness in women





Causes Of Diabetes :




An elaborate description of the causative factors of diabetes is done in the Ayurvedic texts. More stress has

been laid on sedentary habits, lack of exercise and the consumption of diets having high calorie value The

causative factors from Ahara (diet) includes the use of new grains (of recent time) of less than one year, use of

new peas, the use of sugar-cane juice, frequent use of milk and milk products, fresh wine, curd preparations,

meat soups of different animals residing near or in water. These causative factors are responsible for the

increase of the humor Kapha (Kapha dosha). Vihara (Behavioral patterns) includes excessive sleep during day

and night, lack of exercise, laziness etc. Even worry, grief, anger and anxiety are said to be among the

causative factors of Prameha in susce­ptible individuals.





Modern Views



According to the modern science though the exact cause of diabetes is not known but there are some

predisposing/risk factors which increase the chances of occurrence of the disease. These can be listed as:


Age: Increasing age.

Genetic or heredity factor: diabetes is one of the known diseases that runs in families.

Viral infections affecting especially the pancreas.

Poor diet (Malnutrition related diabetes).

Excessive and long-term consumption of sweet products (like Milk products) as per Ayurveda.

Being overweight or obese.

Leading a sedentary lifestyle. Lack of exercise, especially in those who are overweight, increases risk.

Stress.

Drug induced.




Modern management of diabetes:


The principles of management of diabetes in the modern medicine are basically to achieve an optimum control

of blood sugar levels. The measures that are commonly employed are three fold and can be listed below:

Diet control

Exercise

Drug management

Patient Education

1) The role of Diet in Diabetes:

Whatever diet may be prescribed or recommended for a patient of diabetes the common principles to follow are:

Reduction of weight.

Eating fewer sugary or fatty foods.

Reducing blood pressure.

Do not skip a meal.

Do not eat too often of outside food (Fast food etc) .

2) Exercise in therapy of diabetes:



In NIDDM patients, regular exercise forms an important component of therapy along with dietary regulation

and oral hypoglycemic agents. Appropriate monitoring should be done to avoid complications. Exercise should

not be recommended in all IDDM patients but efforts should be made to make it possible for those who want to

exercise to be able to do so as safely as possible.



General Principles for exercise in Diabetics:

To be effective exercise must be performed regularly. Choose an exercise that one enjoys and which suits the

needs of individual patients. Daily exercise is preferable, however for the desired metabolic effect it should be

undertaken for at least 3-5 days per week. The duration should be 15-60 minutes. The ideal time is on an

empty stomach in the morning or evening. Any exercise should have a warming up and cooling down period of

5-10 minutes. Most diabetics may need to reduce the dose of insulin and oral drugs when they exercise

regularly.


The best exercise recommended to a diabetic stepwise increasing exercise plan of aerobic exercise. Plain brisk

walking is the simplest and safest of all excises. It can be started by anyone. Aerobic (isotonic) exercises like

walking, running cycling, jogging, swimming, skipping and games like badminton, tennis and basketball

stimulate the cardio respiratory system and increase the utilization of glucose to a great extent. Isometric

exercises like weight lifting, sustained handgrip must be avoided in diabetics as they increase the arterial

pressure.



The Ayurvedic mode of management of Diabetes


Since thousands of years the ancient physicians of this great nation have been successfully treating Prameha

with the Ayurvedic measures and drugs. Many drugs have already been screened for the their anti-diabetic

property/blood sugar lowering property. The importance of diet and exercise is also stressed in Ayurveda. The

Ayurvedic diet regimens and the recipes may serve as a good replacement for the Diabetic patient. Though

many of the diabetic drugs that are used today have a good sugar lowering (Hypoglycemic property they

essentially act at the basic pathology. This helps in controlling the diabetes and not only the blood sugar. The

management modalities can be categorized as:



Vyaayam (Exercise),

Pathya (dietary regulation),

Panchakarma (Bio-purification procedures) and

The use of therapeutic measures (Medicines).

The herbal drugs used in the management of Prameha are bitter, astringent and pungent in taste.

Individual herbs that are extensively used in the management of diabetes:



1. Eugenia jambolana:(Jamun beej churna) Dry seed powder of Jamun fruits have to be used in a dose of one-

teaspoon twice/thrice daily with lukewarm water.



2. Gymnema sylvestre: (Gudmar patra churna) Dry leaves of this plant have to be used one teaspoon daily with

lukewarm water. The leaves when chewed render the mouth tasteless to sweet for 45 min to one hour.



3. Pterocarpus marsupium (Vijaysar kashtha churna) Bark of this plant is available in the form of powder.

Cubicals or Vijaysaar glasses are also very popular. The piece of Vijaysaar is kept in water overnight or water

is kept in the glass is consumed early morning on empty stomach. One should discard these cubicals or glasses

once there is no colour change observed in water.



4.Ficus bengalensis (Nyagrodha twaka churna) This is banyan tree bark. A decoction of bark is to be prepared

and consumed twice daily in a dose of 40 to 80ml. The decoction is prepared by taking around 25-50gms of bark

to which 4 cups of water are to be added. It is heated to make one cup, which has to be consumed.



5. Shilajeet Popularly known as Rock salt, various reputed companies have Granular or powdered form of

Shilajeet available. Though not very useful in reducing the blood sugar it is an excellent remedy to for loss of

libido in males and in case of generalized weakness.



6. C. Tamal (Tejpatra) This is very commonly used as a spice in preparing food products. A diabetic patient

may make a point to add the leaves of this plant in his food. Also the powder of leaves may be consumed.



7. Fenugreek seeds (Methi churna) Seeds of Methi have to be soaked in warm water overnight and chewed

early in the morning with warm water. One may take powder of these seeds with warm water twice daily.

Methi powder may be added to the wheat flour to prepare chapattis.



8. Momordica chirantia Karvellaka (Karella) Juice of Karela should be taken early in the morning in a

quantity of 20 ml. The dried whole fruit powder can also be consumed in the dose of ½ to 1 teaspoon twice

daily.



9. Embelica officinalis (Amala) When fresh Amla are available one may take Amla juice 20 ml daily or

otherwise powder of Amla fruits may be taken twice daily.



10. Curcuma longa (Haridra) Haldi powder along with Amla juice is a very good combination in patients of

Diabetes. It is especially useful in prevention as well as treatment of patients of Diabetic eye disease. Haldi can

be put in milk as well.



11. Kirat tikata (Chirayata) A decoction of this plant is to be taken daily early morning. It is a very popular

remedy used in all parts of the country for various skin disorders and hence forms a perfect remedy for skin

infections in Diabetics .




An ayurvedic physician may advice some good Ayurvedic drugs even in patients who do not respond

to the oral hypoglycemic drugs or even insulin. These are then termed as adjuvant ayurvedic drugs. Not only

do these help in lowering the blood sugar but also prevent the long-term complications of diabetes. We shall

name some of these combinations/preparations:



Chandraprabha vati: In a dose of 500 mg twice or thrice daily. This is specially used in patients having

Diabetes with Urinary tract infection or in females having leucorrhoea. This can be used along with
Gorshuradi guggul in the same dose.


Trivang Bhasma: This is a combination of three bhasmas namely Naga, Vanga and Yashaha Bhasma. It is to be

taken in a dose of 125mg twice daily available in the form of powder. It is very useful in conditions where there

is excessive urination, Male sexual problems as well as to treat generalized weakness.



Dhatri Nisha: A combination of Haldi powder and Amla Rasa and has to be taken early morning and is

especially useful in Diabetic eye condition.



Vasant kusumakar rasa: A very useful tonic for diabetics especially useful in the stage of complications it has

to be consumed in a dose of 125 mg twice daily. Along with having a general tonic effect it also helps in

Diabetic eye condition and in preventing various conditions developing due to Nerve weakness.


Many of the well-known pharmaceutical companies have also come up with good Anti diabetic herbal

combinations. These preparations have been extensively clinically and scientifically studied at various centers

and have proven their efficacy. They are easy to administer and their dose may be well regulated. These

preparations have to be preferably consumed as per the advice of the physician. The well-known combinations

available today include :


Hyponidd (Charak Pharma)

Diabecon (Himalaya Drugs Co)

Asanad (Arka Shala)

Cogent Db

Glucomap (Map)

Karnim (Universal Medikit)

Debix (Sandu Brothers)

Ilogen Excel (Pankaj Kasturi)

Madhunshini Vati ( Patanjali Pharmacy)




Other associated conditions with diabetes and its management:


Diabetes is a long lasting and a chronic disease. A patient of diabetic may suffer from some very distressing

symptoms so much so that he even forgets of his diabetic in agony of this complain. A physician has to look for

the safe management of these symptoms that shall not affect the diabetic status as well as not have a long-term

complication.


We shall discuss some of these complaints and try to see how they can be managed.

1) Diabetes with Arthritis: Yograj guggul, freshly prepared decoction of Dasamoola, Rasna saptak, a paste

of sunthi or Dasang lepa may be applied on the affected joint.


2) Diabetes with constipation: Powders like Gandharva haritaki, Isabgool, Panchaskar, Hingvastak can be

used to relieve constipation.


3) Diabetes with burning sensation in the soles and palms: this can be well managed with Mangista Ghana

vati, chandrakala rasa, Chandraprabha vati, pravaal pisti, Guduchi satva etc


4) Diabetes with cough: Diabetic patient suffering of chronic cough may given powders of Yasti madhu,

Kantakari, Vasa, Shati etc. Ayurvedic cough syrups available in the market are not safe to be taken by a

diabetic patients


5) Diabetes with excessive thirst: Excessive thirst may be managed with the use of cold infusions (heema) of

Dahayanak, usheera, Chandan etc. Praval, Guduchi, may also be used


6) Diabetes with excessive urination: excessive urination can be treated with the use of Trivang bhasma,

jasad bhasma, etc


7) Generalised weakness and fatigue are the usual symptoms that can be treated with the use of herbs like

shatavari, Ashvagandha, Bala Yastimadhu. Complications like tapyadi loha, Vasant kusumakar rasa are also

very effective


8) Impotency is a very distressing symptom of a diabetic patient. By assessing the age of the patient they may

be advised Ashwagandha, Kaucha beeja, musali etc.

Scientific back-up of some extensively researched herbs


GUDMAR (Gymnema sylvestre)



Gymnema sylvestre stimulates insulin release in vitro by increased membrane permeability.
Persaud SJ, Al-Majed H, Raman A, Jones PM.

It appears to correct the metabolic derangements in diabetic rabbit liver, kidney and muscle.

This herbal therapy appears to bring about blood glucose homeostasis through increased serum insulin levels

provided by repair/regeneration of the endocrine pancreas.

Gymnema therapy appears to enhance endogenous insulin, possibly by regeneration/revitalisation of the

residual beta cells in insulin-dependent diabetes mellitus.. This is supported by the appearance of raised

insulin levels in the serum of patients after Gymnema supplementation.

Studies suggest that the component of Gymnema sylvestre inhibits the increase in the blood glucose level by

interfering with the intestinal glucose absorption process




Jamun & Nyagrodha

Hypoglycemic activity of Eugenia jambolana and Ficus bengalensis: mechanism of action.
Achrekar S, Kaklij GS, Pote MS, Kelkar SM.
Biochemistry Division, Bhabha Atomic Research Centre, Bombay, India.



Karella (Momordica charantia)

Ahmed I, Lakhani MS, Gillett M, John A, Raza H

Diabetes Res Clin Pract 2001 Mar;51(3):155-61

Hypotriglyceridemic and hypocholesterolemic effects of anti-diabetic Momordica charantia (karela) fruit extract

in streptozotocin-induced diabetic rats. . These results suggest that M. charantia fruit extract exhibits

hypolipidemic as well as hypoglycemic effects in the STZ-induced diabetic rat.

Bangladesh Med Res Counc Bull 1999 Apr;25(1):11-3



Effect of Momordica charantia (Karolla) extracts on fasting and postprandial serum glucose levels in NIDDM

patients.
Ahmad N, Hassan MR, Halder H, Bennoor KS.



Department of Pathology, Sher-e-Bangla Medical College, Barisal.

wThis hypoglycaemic action was observed in 86 (86%) cases. The results indicated that there was a significant

(Student's t-test, P < 0.004) increase in the number of beta cells in M. charantia-treated animals when

compared with untreated diabetics, however, their number was still significantly less than that obtained for

normal rats.






NEEM

Indian J Physiol Pharmacol 2000 Jan;44(1):69-74 A study of hypoglycaemic effects of Azadirachta indica

(Neem) in normaland alloxan diabetic rabbits.

Khosla P, Bhanwra S, Singh J, Seth S, Srivastava RK.

Hypoglycaemic effect was observed with Azadirachta indica when given as a leaf extract and seed oil, in

normal as well as diabetic rabbits The data suggests that A. indica could be of benefit in diabetes mellitus in

controlling the blood sugar or may also be helpful in preventing or delaying the onset of the disease KIRAT

TIKTA

Swerchirin induced blood sugar lowering of streptozotocin treated hyperglycemic rats.
Saxena AM, Bajpai MB, Mukherjee SK.
Central Drug Research Institute, Lucknow, India.

It has a very significant blood sugar lowering effect in fasted, fed, glucose loaded, and tolbutamide pretreated

albino rat models.





FENUGREEK

Effect of Trigonella foenum graecum (Fenugreek) on blood glucose in normal and diabetic rats.
Khosla P, Gupta DD, Nagpal RK.
Department of Pharmacology, Pt. B. D. Sharma Medical College, Rohtak.

Trigonella foenum graecum (Fenugreek) was administered at 2 and 8 g/kg dose orally to normal and alloxan

induced diabetic rats. It produced a significant fall (P < 0.05) in blood glucose both in the normal as well as

diabetic rats and the hypoglycemic effect was dose related.

Abdel-Barry JA, Abdel-Hassan IA, Al-Hakiem MH.
Department of Chemistry, College of Science, University of Basrah, Iraq.

Hypoglycaemic and antihyperglycaemic effects of Trigonella foenum-graecum leaf in normal and alloxan

induced diabetic rats.





GUDUCHI

Antioxidant activity of Tinospora cordifolia roots in experimental diabetes.
Prince PS, Menon VP.
Department of Biochemistry, Annamalai University, Tamil Nadu, India.



The research is concluded in The effect of Tinospora cordifolia was as effective as glibenclamide. It may be

concluded that extracts of the leaves of Tinospora cordifolia have an insulin-like action and can significantly

reduce the blood glucose in normal rabbits and in alloxan-induced diabetic rabbits.





VIJAYASAR

Indian J Med Res 1998 Jul;108:24-9

An active constituent of Pterocarpus marsupium, (-)-epicatechin (1) in,low doses, has been reported to reverse

hyperglycemia in alloxan diabetic rats when given before or within 24 hr after the dose of alloxan. The

antihyperglycemic activity of ethanolic extract of Vijaysara bark at the dose of 0.25 g/kg b.w. was found to be

more effective than that of glibenclamide and metformin.

Vijayasar is useful in the treatment of newly diagnosed or untreated mild NIDDM patients



HONEY

1) JPMA 39: 107, 1989).

Acta Diabetol Lat 1988 Jul-Sep;25(3):197-203

Oral administration of pure small or large-bee honeys in 5 ml/kg/doses could not produce a significant (P

greater than 0.05) increase in glucose levels in normal and alloxan-diabetic rabbits (Akhtar MS, Khan MS.)

pure natural honeys in low doses may be recommended as a source of carbohydrates and even as a sweetening

agent in place of sucrose to the human patients suffering from diabetes mellitus

Metabolic effects of honey (alone or combined with other foods) in type II diabetics. 1) honey and bread produce

similar degrees of hyperglycemia in type II diabetics. 2) Fat-rich foods added to honey do not alter the total

hyperglycemic effect but result in higher triglyceride and insulin serum concentrations.

2) Samanta A, Burden AC, Jones GR Diabet Med 1985 Sep;2(5):371-3

It is suggested that honey may prove to be a valuable sugar substitute in diabetics, and that both the GI and PI

should be used in the analysis of food.

3) Ionescu-Tirgoviste C, Popa E, Sintu E, Mihalache N, Cheta D, Mincu I.iabetologia 1983 Feb;24(2):80-4

Counting the blood glucose increase after glucose as 100%, the corresponding increases in glycaemia for other

carbohydrates were: fructose, 81.3%; lactose, 68.6%; apples, 46.9%; potatoes, 41.4%; bread, 36.3%; rice, 33.8%;

honey, 32.4% and carrots, 16.1%.



What stages one should expect Ayurvedic Medicines to be effective?


Newly diagnosed mild to moderate diabetic mellitus.

Non-Insulin Dependant Diabetes.

Postprandial Blood sugar should not be very high (below 450-mgm%).

Obese Diabetics.

Uncomplicated Diabetes mellitus.

Those in whom there is a secondary failure: in such cases Ayurvedic drugs can be combined to their regular

allopathic hypoglycemic medicines.

In case of Diabetic Complications some good remedies are available for early nephropathies, neuropathies and

retinopathies. Research is on to find solution to many of these problems of Diabetes.