DIABETES MELLITUS

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Diabetes

Ques. 1  What is Diabetes Mellitus?

Ans.       This is a clinical syndrome characterised mainly by polyuria, polydipsia and polyphagia due to relative or absolute deficiency of insulin.

Aetiology : Age – middle age group, Sex-both sexes. Exact cause is unknown. The associate factors are:

  1. Hepatic disorders.
  2. Stress & strain-both physical and mental.
  3. Various drugs, steroids, thiazide diuretics etc.
  4. Destruction of insulin secreting basophilism, thyrotoxicosis etc.
  5. Pregnancy-due to hormories antagonizing insulin or due to lowering of renal threshold level of sugar.
  6. Habits-overeating (fats etc.).

Types :

  1. Potential diabetics-hereditory.
  2. Latent diabetics- abnormal glucose tolerance persons.
  • Resistant diabetics.
  1. Juvenile onset type-insulin dependent.
  2. Adult or maturity onset type- usually not insulin dependent.
  3. Brittle diabetics.

Pathology : Insulin is secreted by Beta-islets of Langerhans in pancreas. Sufficient secretion of this hormone keeps blood sugar level well the renal threshold so that little sugar is normally excreted in urine. In the deficiency of insulin blood sugar level becomes higher, partly by conversion of fats and proteins into sugar and partly by hampered utilization at cellular level. When raised level does not cross renal threshold, no sugar is excreted. This state is called latent diabetes. When blood sugar level crosses the renal threshold, sugar appears in the urine thus making condition clinically existent. This state is known as manifest diabetes or clinical diabetes.

Note:- Normally more  glucose n blood means more insulin and vice versa, fall in blood sugar liberates adrenalin which restores normal blood sugar level by glycogenolysis in liver, ACTH and cortical steroids also help in the maintence of normal blood sugar level.

Clinical Features : Onset – usually gradual (rarely acute).

Symptoms are: –

  1. Polyphagia-voracious appetite, particularly for sweets, feeling hungey within a short time of a full meal.
  2. Pain in extremities.
  3. Recurrent boils, carbuncles and other infections.
  4. Amenorrhoea in women and imprtency in males.
  5. Coma, severe neuropathy of retinopathy may be the first symptoms.
  6. Non-healing of wounds.
  7. Lassitude, general weakness, progressive loss of weight, strength and general weakness, progressive loss of weight, strength and energy and ready fatigue due to loss of glucose and tissue protein breakdown.
  8. Polyuria – pale, clear large quantities of urine of high Sp. Gr. (1030-1050) ; nocturia.
  9. Polydipsia due to dehydration.
  10. Pruritus vulvae or balanitis.
  11. Failing vision, cataract formation.
  12. Failing memory, inability to concentrate.

Signs – There may  be absence of physical signs in cases of mild and moderate severity, otherwise –

  1. Skin – loose, shallow, often a yellow tint, specially on hands and face,
  2. Tongue –dry (index of dehydration ). Later red and beefy,
  • Diminution or absence of tendon reflexes or vibration sense,
  1. Complications – may provide the first sign.
  2. Patient appears debilitated and wasted or obese,
  3. Face – pinched and pale,

Diagnosis :

  1. Urine test : Sp. Gr. Usually over 1020, Reaction-acidic, Benedict’s test positive. Sodium nitroprusside test-acetone may or may not be present.
  2. Blood test : Alkali reserve – lowered. Sugar – Above 120 mg/100 ml (latent) : above 180 mg / 100ml. (clinical).
  3. Confirmed by glucose tolerance test or more easily by post prandial blood sugar estimation.

Complications:

  1. Sexual and genital-impotency and sterility.
  2. Pulmonary – T.B.
  • Pregnancy- Dystocia, repeated abortions, still-births, deformed body, eclampsia.
  1. Skin – infections i.e. boils, carbuncles etc.
  2. Complications due to drugs-Hypoglycaemic coma, allergic reactions etc.
  3. Keto acidosis.
  • Generalised arteriosclerosis of coronary arteries. Cerebral arteries limb arteries etc.
  • Renal – Pyelonephritis renal arteriosclerosis, papillitis necroticans (uraemia), albuminuria, K.W. Syndrome.
  1. Nervous – Peripheral neuritis, Autonomic imbalance, diabetic amyotophy.
  2. Ocular-Diabetic cataract, diabetic retinopathy-retinitis proliferans, punctuate haemorrhages and exudates, loss of vision. Iritis Rubeosa.
  3. Surgical complication.

Differential Diagnosis (other causes of Glycosuria) :

  1. Pregnancy glycosuria – Due to low renal threshold ; blood sugar, both fasting and post-prandial normal.
  2. Endocrine disorders – Hyperthyroidism, Hyperpituitarism, Adrenal cortical tumours, etc.
  3. Potential diabetes – Glycosuria closely related to diet, disappearing with slight dietary sugar restricted.
  4. Renal glycosuria – Blood sugar normal, not progressive.
  5. Emotional glycosuria – Disappears on tranquilizer administration.

Prognosis : Prognosis is good in all the mild types. In severe cases also prognosis is favourable under skilled treatment with careful and restricted dieting plus insulin, provided patient becomes conscious in his after treatment.

Management :

  1. Prevention of complications,
  2. Insulin / oral hypoglycaemic agents,
  • Avoidance of sedentary life advised for regular exercise, maintenance of appropriate body weight,
  1. Diet – Adequate caloric value, restriction of carbohydrates (sugar free diet), regular dietary habit,
  2. A dequate control of hyperglycaemia and glycosuria,

Ques. 2        Which Homoeopathic remedies are advisable?

Ans.       The Homoeopathic remedies which are advisable are:-

  1. ARSENICUM – Insatiable thirst, restlessness and prostration. Vomiting immediately after eating or drinking. Frequent urging with profuse discharge of urine. Feet and legs swollen. Watery diarrhoea.
  2. PHOS. ACID – Perfect indifference, with silent sadness. Craves something refreshing, juicy, hawks up tough white mucous. Frequent profuse emissions of watery urine which forms white cloud; urine contains sugar. Complete impotence. Diarrhoea without weakness.
  • LACTIC ACID – Excessive thirst ; frequent and copious micturition: urine contains sugar; obstinate constipation; tongue dry, debility and emaciation : feels constantly tired and exhausted from slightest exertion.
  1. ACETIC ACID –Abundant sugar in urine, increased and light-coloured, great thirst, but cold drink lies heavy on stomach ; ascites and hydrothorax, oedema pedum ; gangrenous ulcers; pale waxen skin.

Ques. 3  Which Biochemic Remedies are advisable?

Ans.       The Biochemic Remedies which are advisable are :-

  1. NATRUM MUR. – Diabetes mellitus; polyuria; unquenchable thirst ; emaciation, loss of sleep and appetite ; great debility and despondency.
  2. KALI MUR – Excessive and sugary urine. Great weakness and somnolence.
  • CALC.PHOS. - Glycosuria when lungs are implicated. Polyuria, which weakness, much thirst, dry mouth and tongue ; flabby, sunken abdomen ; craves bacon and salt.
  1. FERRUM PHOS –Diabetes mellitus, when there is a quickened pulse or when there exists pain, heat or congestion in any part of the system.

Indication of a diet chart for a diabetic patient (for an adult)

Vegetarian

  • Breakfast : Toast 2. or Atta-60gm.; Chhana-50gm. ; Boiled vegetables-100gm. : Tea with Sorbitol (saccharine)-1 cup; Milk (skimmed)-1 glassful. Lunch : Rice or Atta-70gm.; Dal-1 cup. ; Chhana curry-100 gm.; Green vegetables-250gm.; Sour curd-1 cup.
  • Afternoon tiffin : Cream cracker biscuits – 2; Cucumber-1 ; Tea with sorbitol -1 cup.
  • Dinner : Atta-70gm.; Green vegetables – 250 gm. ; Channa curry-50gm.

Non-Vegetarian :

  • Breakfast- Toast 2 oz or Atta-60 gm. ; Egg-1 ; Cream cracker biscuits-2 ; Tea with sorbitol- 1 cup. Lunch – Rice or Atta-70 gm. ; Green vegetables – 250 gm. ; Dal -1 cup ; Fish/meat-100 gm. ; Sour curd- 1 cup.
  • Afternoon tiffin-Cream cracker biscuits-2 ; Chhana-100 gm.; Cucumber-1 ; Tea with Sorbitol-1 cup. Dinner – Atta 70 gm. ; Fish or meat-100 gm. ; Green vegetables-250 gm.

NOTE : - Must avoid of sugar & its products, sweet, vegetables, and most of the underground vegetables. Use fructose or sorbitol instead of sugar.

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