Diabetes Mellitus

Homoeopathic Approch towards Diabetes Mellitus

What is D.M. ?

If we try and understand how & why D.M. occurs then I think, we will be able to care of the disease in a more efficient manner.

Concept of D.M. commonly known to every one is “there is rise in the Blood Sugar Level & the patient has to follow many dietary restrictions & a definite regimen.”

In fact a large portion of the food we consume is converted after digestion into a sugar called GLUCOSE. It is this sugar that acts as fuel for the body & from which we get energy essential for living. For this blood sugar to be utilized by body cells a hormone named INSULIN which is secreted by beta cells in the pancreas is an essential requirement. If due to some reasons the amount of this hormone produced by the body becomes less or it’s quality is not as good as per requirements, then this sugar in blood can not be utilized by body cells and hence starts accumulating in the blood itself & this results in D.M.

That is to say in spite of high blood sugar concentrations, the body of a diabetic person remains starving due to inability to utilize it. Bad effects of these two factors viz.–

  1. Excess sugar in blood and
  2. Tissue starvation

start taking place gradually in the body of a diabetic.

Important organs primarily affected are Eyes, Kidneys & Nerves. Although the blood sugar is controlled with the conventional treatment i.e. Hypoglycemic agents / Insulin, these medicines fail to control effects of tissue starvation as well as progress of disease & hence, failing to arrest the complications of disease completely which on the contrary Homoeopathy does.

Homoeopathic Treatment of D.M.

Yes, Homoeopathy treats D.M. in a better way & definitely avoids complications along with disease control. While treating with Homoeopathy according to standard Homoeopathic principles, prime importance is given to the patient along with his disease pathology.

We study the constitution of the patient (both Physical as well as Psychological). Development & alterations in the constitution since birth till date are studied. Life History is studied for any major diseases & important events giving rise to stress on the constitution so as to drift it from Normal to Abnormal (i.e. Diseased). Family history is studied in details for the Genetic back ground & predisposition to the diseases. Thus the constitution is deeply studied from all angles & in all respects & then the patient is prescribed medicine which is capable of covering all the above considered factors.

What happens with homoeopathic treatment

As soon as we start with Homoeopathic Treatment we don't expect immediate fall in BSL, because we don’t treat the BSL, but the patient.

Primarily patient starts feeling well, feeling a bit better in general. This is a very important subjective sensation called as feeling of well being. Homoeopathic medicine firstly, concentrates on the insulin function so that cells start utilizing the glucose in the blood & their starvation is stopped. As the effect of the medicine is gradually established the troublesome symptoms (e.g. burning of soles, nocturnal urination, excess hunger or thirst, irritability, etc.) start reducing in intensity, although they persist. Then some symptoms start disappearing occasionally. That is to say – frequency of symptoms gets altered & gradually starts dropping.

Although BSLs remain high in the initial period of treatment the complications due to cell starvation are definitely arrested & even can be reverted back as the insulin function is improved. Body’s coping process is improved & thus chances of going into complication are further reduced. Over a period, the patient keeps improving gradually in a general way. His post prandial BSLs & diurnal shoot ups are controlled first, although fasting BSLs remain on higher side. This can be well proved at this moment by drop in Glycosylated Hemoglobin which is a special test internationally approved. Once the BSLs are well controlled patient’s previous medications (e.g. Oral Hypoglycemic Agents / Insulin etc.) are tapered gradually & if possible, stopped completely. Once the BSLs are completely controlled with only homoeopathic medication for at least 6 months, dietary restrictions can be gradually released over a period, keeping watch on BSLs. If BSLs are within normal limits in spite of no restrictions, patient can be considered to be cured & homoeopathic medicines can also be gradually tapered & stopped. Patient is observed for at least next 3 years for general health & recurrence even after stopping the homoeopathic treatment.

Early detection & early treatment has a definite role in success rate of curability of the disease.

Prevention

Proper Homoeopathic Treatment is known to prevent the disease in genetically predisposed individuals. Incidence rate of D.M. can be substantially reduced in Persons with positive Family history by taking following precautions

  1. Dietary habits - e.g. excess of fasting, eating, oily, fatty, sweets etc.
  2. Regular exercise to controle

Diabetes mellitus is a disease which is known to everybody nowadays. Actually, it comprises a group of common metabolic disorders that share the phenotype of hyperglycemia (increased level of glucose in blood plasma).

It results from defects in insulin secretion (type 1), insulin action (type 2), or combination of these factors.

PATHOGENESIS

1. Type I DM

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 cause 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.

2. Type II DM

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.

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.

COMPLICATIONS OF DM

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. Microvascular complications:

These include Ophthalmic Disorders (Retinopathy, Macular oedema, Cataract, Glaucoma), Neuropathy (Peripheral neuropathy, Sensory and Motor polyneuropathy), and Nephropathy (ESRD).

2. Macrovascular complications:

These include Coronary Artery Diseases (CAD), peripheral vascular disorders, and cerebrovascular diseases.

3. Other complications:

These include Coronary Artery Diseases (CAD), peripheral vascular disorders, and cerebrovascular diseases.Gastroparasis, Diarrhoea, Uropathy, Sexual dysfunction and Dermatologic complications like eczema, cellulites, and gangrene of distal part of limbs (Diabetic foot).These include Ophthalmic Disorders (Retinopathy, Macular oedema, Cataract, Glaucoma), Neuropathy (Peripheral neuropathy, Sensory and Motor polyneuropathy), and Nephropathy (ESRD).

4. Macrovascular complications:

These include Coronary Artery Diseases (CAD), peripheral vascular disorders, and cerebrovascular diseases.

5. Other complications:

Gastroparasis, Diarrhoea, Uropathy, Sexual dysfunction and Dermatologic complications like eczema, cellulites, and gangrene of distal part of limbs (Diabetic foot).

this the leading cause of end-stage renal disease. (ESRD) Nephropathy is the deterioration of the kidneys & also one of the most significant long-term complications in terms of morbidity and mortality for patients with diabetes, where majority belonging to NIDDM. But the risk of developing nephropathy is higher in IDDM (30%) than in NIDDM (10%). The clinical and morphologic features of diabetic nephropathy are similar in IDDM and NIDDM.

Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria (>300 mg/d or >200 mcg/min) that is confirmed on at least 2 occasions 3-6 months apart, a relentless decline in the glomerular filtration rate (GFR), and elevated arterial blood pressure. The risk is higher if blood-glucose levels are poorly controlled. Further, once nephropathy develops, the greatest rate of progression is seen in patients with poor control of their blood pressure. Also people with high cholesterol level in their blood have much more risk. Microalbuminuria is the first manifestation of injury to the glomerular filtration barrier and predicts the development of overt nephropathy.

Pathophysiology

The earliest morphologic abnormality in diabetic nephropathy is the thickening of the glomerular basement membrane (GBM) and expansion of the mesangium due to accumulation of extracellular matrix. The glomeruli and kidneys are typically normal or increased in size initially, thus distinguishing diabetic nephropathy from most other forms of chronic renal insufficiency, wherein renal size is reduced (except renal amyloidosis and polycystic kidney disease). Electron microscopy provides a more detailed definition of the structures involved. In advanced disease, the mesangial regions occupy a large proportion of the tuft, with prominent matrix content. Further, the basement membrane in the capillary walls (the peripheral basement membrane) is thicker than normal.

Three major histological changes

  • Mesangial expansion is directly induced by hyperglycemia, perhaps via increased matrix production or glycosylation of matrix proteins.
  • GBM thickening occurs.
  • Glomerular sclerosis is caused by intraglomerular hypertension (induced by renal vasodilatation or from ischemic injury induced by hyaline narrowing of the vessels supplying the glomeruli).

The exact cause of diabetic nephropathy is unknown, but various postulated mechanisms are hyperglycemia (causing hyperfiltration and renal injury), advanced glycosylation products, and activation of cytokines.

Hyperglycemia increases the expression of transforming growth factor-beta (TGF-beta) in the glomeruli and of matrix proteins specifically stimulated by this cytokine. TGF-beta may contribute to both the cellular hypertrophy and enhanced collagen synthesis observed in persons with diabetic nephropathy.

Signs and symptoms

Kidney failure provoked by glomerulosclerosis leads to fluid filtration deficits and other disorders of kidney function. There is an increase in blood pressure (hypertension) and of fluid retention in the body (oedema). Other complications may be arteriosclerosis of the renal artery and proteinuria (nephrotic syndrome). Throughout its early course, diabetic nephropathy has no symptoms. They develop in late stages and may be a result of excretion of high amounts of protein in the urine or due to renal failure

  • swelling, usually around the in the mornings; later, general body swelling may result, such as swelling of the legs
  • foamy appearance or excessive frothing of the urine
  • unintentional weight gain (from fluid accumulation)
  • (poor appetite) and (general ill feeling) eadache
  • frequent hiccups
  • generalized itching
  • Lab Findings---
  • Urinalysis -- proteinuria varying from 150 mg/dL to greater than 300 mg/dL, glucosuria, and occasional hyaline casts. Microalbuminuria is defined as albumin excretion of more than 20 mcg/min.
  • A 24-hour urinalysis for urea, creatinine, and protein is extremely useful in quantifying protein losses and estimating the GFR.
  • Renal ultrasound -- Observe for kidney size, which is usually normal to increased in the initial stages and, later, decreased or shrunken with chronic
  • renal disease. Rule out obstruction.
  • Kidney biopsy.

Homoeopathic approach to diabetic nephropathy:

Each patient has a specific constitution. By this we mean that each person has specific, individual body, mind & disease. That is why different people get diabetes at different times, of different severity, with different complications & with varying response to the same treatment. Each patient suffering from diabetic nephropathy is differently presents in front of us. The cause is different as well as the effects are different & the course is different. Hence the treatment must be different in each individual patient of diabetic nephropathy.

STRESS

Recent findings in modern medicines emphasize the psychosomatic factor in DM. it has been repeatedly verified that stress is a primary contributor to the diabetic process. If stress is removed, there is significant improvement. With every stage of diabetic complication the stress factor gets increasing so stress causes diabetic nephropathy & it again increases the stresses. Each patient has its own individual stress factors, whether minor or major, that is aggravating all his sufferings. We should identify all these stressers & other causative factors which are the root cause of the disease & treat it with similimum. Homoeopathy is the only way to take over all the stressers & causative factors of patient of diabetic nephropathy & can control his glucose level & restores the health. It also prevents the patient to enter in further complications of diabetic nephropathy. That is also without any side effects so Homoeopathy makes his life peaceful though along with DM.

When we diagnose a patient as diabetic nephropathy, we are considering only the tip of iceberg, which we can see, but the origin is much deeper & hidden. Here we need holistic approach. Where diabetic nephropathy is not the thing to be treated; it is the man suffering from it. In Homoeopathy, we try to find a medicine to suit the constitution of the patient, the physical attributes as well as the various complications of the patient. That is why a homoeopath prescribes a different remedy for different patients with diabetes. Homoeopathy treats the constitution of a person. Constitution of a person is a combination of his mind & body. His mind and body have to work in synchronization with each other.

Every constitution has its own characteristics. They are to be identified and the treatment should be based on these characterizing features.

This includes study of

  • LIFE SPACE - (PSYCHO-SEXUAL & SOCIO ECONOMIC STATUS)
  • THOUGHTS
  • GENETIC PREDISPOSITION
  • INTER PERSONAL RELATIONSHIPS
  • BEHAVIORAL TYPE
  • MIASMATIC CLEAVAGE
  • PHYSICAL CONSTITUTION
  • PHYSICAL GENERAL SYMPTOMS
  • GENERAL MODALITIES
  • PARTICULAR SYMPTOMS

After we study and analyse each case according to above mentioned points we get

With this trio, we can get the similimum of the patient. The similimum not only relieve the present symptoms of diabetic nephropathy, but it also prevents the recurrence of the state of the disease & help the basic constitution to achieve homoeostasis with the stress factors.

In order to achieve all this, we prescribe...

  1. Acute indicated remedy
  2. Anti-miasmatic remedy
  3. Deep acting constitutional therapy
  4. Correction in diet and regimen

Usually every patient with DM is advised to be strict control on his diet for all through his life. But I suggest them to be strictly control diet only for 3-6 months according to his improvement. Once the patient settled with Homoeopathic medicine by getting control & maintain the glucose levels, I used to suggest them to have their normal diet with a limitation on starchy food.

Purpose behind this is only, that my patient should get full nourished diet. The continuous, long time strict diet control may hamper his heart, circulation, his energy levels & it may produce hypoglycaemia & which can be more dangerous to his health.





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