Abstract
The pancreas is an organ located behind the lower part of the stomach, in front of the spine and plays a vital role in diabetes. In type 1 diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked them. In type 2 diabetes, the pancreas loses the ability to secrete enough insulin in response to meals. Homoeopathy is considered as one of the very best alternative system for treating Diabetes Mellitus & its complications. This article review about clinical presentation of different complications of diabetes mellitus with general management and homoeopathic way of treatment.
Introduction
Diabetes mellitus (DM), commonly referred to as diabetes, is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. DM is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.
There are three main types of diabetes mellitus:
· Type 1 DM results from the pancreas's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.
· Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is excessive body weight and not enough exercise.
· Gestational diabetes is the third main form and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.
The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Chronic complications occur due to a mix of microangiopathy, macro vascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage.
ACUTE COMPLICATIONS OF DIABETES MELLITUS
Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma.
Diabetic ketoacidosis
Ketoacidosis is much more common in type 1 diabetes than type 2. Diabetic ketoacidosis is an acute and dangerous complication that is always a medical emergency and requires prompt medical attention. Low insulin levels cause the liver to turn fatty acid to ketone for fuel (i.e., ketosis); ketone bodies are intermediate substrates in that metabolic sequence. This is normal when periodic, but can become a serious problem if sustained. Elevated levels of ketone bodies in the blood decrease the blood's pH, leading to this condition. On presentation at hospital, the patient is typically dehydrated and breathing rapidly and deeply. Abdominal pain is common and may be severe. The level of consciousness is typically normal until late in the process, when lethargy may progress to coma. Ketoacidosis can easily become severe enough to cause hypotension, shock, and death. Urine analysis will reveal significant levels of ketone bodies (which have exceeded their renal threshold blood levels to appear in the urine, often before other overt symptoms). Prompt, proper treatment usually results in full recovery, though death can result from inadequate or delayed treatment, or from complications (e.g., brain edema)
Hyperglycemia hyperosmolar state
This is more common in type 2 diabetes than type 1. Nonketotic hyperosmolar coma is an acute complication sharing many symptoms with diabetic ketoacidosis, but an entirely different origin and different treatment. A person with very high (usually considered to be above 300 mg/dl) blood glucose levels, water is osmotically drawn out of cells into the blood and the kidneys eventually begin to dump glucose into the urine. This results in loss of water and an increase in blood osmolarity. If fluid is not replaced (by mouth or intravenously), the osmotic effect of high glucose levels, combined with the loss of water, will eventually lead to dehydration. The body's cells become progressively dehydrated as water is taken from them and excreted. Electrolyte imbalances are also common and are always dangerous. Urgent medical treatment is necessary, commonly beginning with fluid volume replacement. Lethargy may ultimately progress to a coma.
Hypoglycemia
Hypoglycemia is low blood glucose (blood sugar). It is possible for blood glucose to drop, especially if person taking insulin or a diabetic drugs (those make your body produce insulin throughout the day). With these medications, if person eat less than usual or were more active, then blood glucose may dip too much. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and too much alcohol (alcohol keeps the liver from releasing glucose).
The signs and symptoms of low blood glucose are easy to recognize: Rapid heartbeat, Sweating, Whiteness of skin, Anxiety, Numbness in fingers, toes, and lips, Sleepiness, Confusion, Headache, Slurred speech. Mild cases of hypoglycemia can be treated by drinking orange juice or eating a glucose tablet—those will quickly raise blood glucose level. In severe cases, an injection of glucagon (a hormone with effects largely opposite to those of insulin) or an intravenous infusion of dextrose is used for treatment, but usually only if the person is unconscious. In any given incident, glucagon will only work once as it uses stored liver glycogen as a glucose source; in the absence of such stores, glucagon is largely ineffective. In hospitals, intravenous dextrose is often used.
Diabetic coma
Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of the acute complications of diabetes: Severe diabetic hypoglycemia, Diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion, Hyperosmolar nonketotic coma in which extreme hyperglycemia and dehydration alone are sufficient to cause unconsciousness.
CHRONIC COMPLICATIONS OF DIABETES MELLITUS
Long-term complications of diabetes develop gradually. The longer diabetes — and the less controlled blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include: Microangiopathy & Macrovascular disease
· Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). Diabetic cardiomyopathy, damage to the heart muscle, leading to impaired relaxation and filling of the heart with blood (diastolic dysfunction) and eventually heart failure; this condition can occur independent of damage done to the blood vessels over time from high levels of blood glucose
· Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation.
· Erectile Dysfunction: Estimates of the prevalence of erectile dysfunction in men with diabetes range from 20 to 85 percent when defined as consistent inability to have an erection firm enough for sexual intercourse. Among men with erectile dysfunction, those with diabetes are likely to have experienced the problem as much as 10 to 15 years earlier than men without diabetes
· Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
· Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
· Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
· Skin conditions. Diabetes may leave more susceptible to skin problems, including bacterial and fungal infections.
· Hearing impairment. Hearing problems are more common in people with diabetes.
· Alzheimer's disease. Type 2 diabetes may increase the risk of Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.
· Abnormal immune responses The immune response is impaired in individuals with diabetes mellitus. Cellular studies have shown that hyperglycemia both reduces the function of immune cells and increases inflammation.
· Respiratory infections such as pneumonia and influenza are more common among individuals with diabetes. Lung function is altered by vascular disease and inflammation, which leads to an increase in susceptibility to respiratory agents. Restrictive lung disease is known to be associated with diabetes. Lung restriction in diabetes could result from chronic low-grade tissue inflammation, microangiopathy, and/or accumulation of advanced glycation end products. In fact the presence restrictive lung defect in association with diabetes has been shown even in presence of obstructive lung diseases like asthma and COPD in diabetic patients.
· Lipohypertrophy may be caused by insulin therapy. Repeated insulin injections at the same site, or near to, causes an accumulation of extra subcutaneous fat and may present as a large lump under the skin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action.
Complications of gestational diabetes
Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for mother and baby.
Complications in baby can occur as a result of gestational diabetes, including:
Excess growth. Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth.
Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.
Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
Death. Untreated gestational diabetes can result in a baby's death either before or shortly after birth.
Complications in the mother can also occur as a result of gestational diabetes, including:
Preeclampsia. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
Subsequent gestational diabetes. Once you've had gestational diabetes in one pregnancy, more likely to have it again with the next pregnancy. Also more likely to develop diabetes — typically type 2 diabetes — as get older.
DIAGNOSIS & PROGNOSIS
Glycated hemoglobin (HbA1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher blood sugar levels, the more hemoglobin have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal. This test is useful for diagnosis and also prognosis of treatment undergone
MANAGEMENT
Prevention is the optimal approach to managing the microvascular complications of diabetes. The two main approaches to preventing retinopathy and nephropathy are intensive glycemic control and aggressive control of hypertension. Intensive glycemic control has been the most effective approach to preventing neuropathic complications of diabetes.
Diet and exercise play a key role in controlling blood sugar levels and reducing your weight, blood pressure and cholesterol levels, in turn preventing any further kidney damage. Steps may include:
Ø Exercising regularly, if possible for 30 minutes a day.
Ø Eating at least five portions of fruit and vegetables a day.
Ø Increasing the amount of starchy carbohydrates in diet.
Ø Choosing to eat carbohydrates that release energy slowly such as porridge oats, brown rice and pasta, lentils and beans and avoiding those that release energy quickly such as white bread and white rice.
Ø Reducing the amount of sugar, fat and salt in your diet.
Ø Stop smoking.
Ø Cutting down on alcohol.
Ø Monitoring and controlling your blood sugar levels if you have diabetes.
Ø Limit the amount of foods containing high levels of protein, sodium, potassium or phosphate.
The following measures are advisable in diabetes patients:
Ø Tighten up your blood sugar control.
Ø Blood pressure lowering if high.
Ø Stop smoking.
Ø Exercise.
Ø Lipid lowering treatment.
HOMOEOPATHIC MANAGEMENT
Homoeopathy considers life style, diet habits, other physical symptoms along with clinical history of diabetes in order to control the sugar levels as well prevent diabetic complications like heart diseases, diabetic kidney disease, diabetic neuropathy and retinopathy etc. Following remedies are quite helpful to treat the symptoms and condition related to complications.
Medicine | Indication |
Arsenicum Album | Agitation tendency to move from one place to another, great anxiety, prostration, useful in diabetic neuropathy there ardour and/or numbness in limbs. |
Lycopodium Clavatum | Diabetes. Anger during disease. Lost of self confidence. The right side conditions works well and thus improve the liver and kidney functioning as conditions Neuropathy above all of the autonomic nervous system where there is constipation due to inactivity of the rectum. Impotence. Intense desire for sweets. |
Phosphorus | Tuberculinic patient, tall, slender, with strait chest or nervous and weak people. Works efficiently in the liver and kidney improving the hypercholesterinemia. It is also a large drug bleeding anywhere body by avoiding significantly the cerebral vascular event. Albumin in urine. Depression and high stress. Retinopathy. |
Phosphoricum acidum | Diabetic neurosis. Weak and thin with presence of urine sugar. Polyuria. Diarrhea or constipation. Impotence. Depression. Weakness of memory. Inability to concentrate. |
Lacticum Acidum | Diabetes. Presence of blood sugar. Thirst. Voracious hunger. Abundant urine. Rheumatic pain. |
China officinalis | Weakness for loss of fluids. Bleeding. Tympanites. The expulsions of gases do not produce improvement. Loss of vision. Ringing in the ears. Canine hunger. Extreme sensitivity to touch in diabetic neuropathy. |
Nitricum acidum | Diabetic nervous, irritable. Strong smell like horse urine. Skin cracks and fissures. Ulcers by arterial insufficiency. Weakness. Condylomas and warts. |
Aceticum acidum | Very weakened patient which thins quickly. With edema or anasarca. |
Ignatia | Diabetic with marked signs of sadness and the silent penalty provision. Want to be alone. Profound sighs. Weakness in the mouth of the stomach. Empty feeling in the stomach. Bipolarity. Shock disorders. In neuropathy acts on the spinal marrow and affects both motor nerve as sensitive. Tremor by penalties or scares or by parasites. Hysteria. |
Natrum sulphuricum: | Useful in diabetic neuropathy that affects the autonomic nervous system. Diarrhea aggravated by the morning of begin to move. Borborigmos on the right side of the abdomen in the ileocecal region. Productive cough aggravated by wet time. |
Thuja | Diabetes in patients with sycosis. Polyneuritis with great pain. Polyps. Warts. In the mental area with special illusions: believes that his body and limbs are glass. Thinks he has a live animal inside abdomen. It is obsessive. |
Lachesis Trig | Loquacious, diabetic patients with circulatory problems. Diabetes in menopause. Diabetic Gangrene. Useful in the brain vessel event. Upper digestive tube (bowel) hemorrhages. Retinal hemorrhages. Varicose ulcers, diabetic gangrene and treatment of cerebral vascular event. |
Abroma Augusta Q | Increased thirst, ravenous hunger, increased urination, loss of weight, debility. Has increased urination both day and night. mouth is dry, feels thirsty after urination, feels exhausted after urination, urine has a fishy smell, burning sensation in urethra, in the mouth of prepuce there are whitish ulcers which is caused by passing of sugar in urine, cannot retain urine. |
Cephalandra Indica Q | Burning sensation all over the body, mouth is very dry, increased thirst ,wants to drink more water at a time, worse after urination, increased urination, feels tired and exhausted after passing urine, traces of sugar are present in urine. |
Gymnema sylvestre Q | The taste of sugar is lost on chewing the leaves and the taste of bitter stays on for a long time. Increased micturition, sugar in urine, feels weak after passing urine, urine is white in colour, and burning sensation is present in the body. |
Syzygium jambolanum Q | The fruit, which is the edible part, is used as a remedy for diabetes in india. Hansen mentions that he has cured diabetic ulcers by using syzygium, increased thirst and increased micturition which was for every two hours during both day and night, dry mouth. |
Momordica charantia Q
| Indicated for diabetes, increases insulin production by increasing the pancreatic beta cells. Increases the growth hormone and prolactin levels and decreases the blood sugar levels. |
Galega officinalis
| Galega officinalis and its various extracts and components are believed to exert their hypoglycaemic effects via different physiological, pharmacological and biochemical modes. The possible modes of the hypoglycaemic actions of Galega officinalis and its various extracts and compounds are its hypoglycaemic effect stimulation of peripheral and skeletal muscle glucose utilization, inhibition of intestinal glucose uptake, inhibition of adipocyte differentiation, suppression of key gluconeogenic enzyme, stimulation of key enzyme of HMP pathway, and preservation of islet β cells and their function |
Curare
| Mouth is dry, thirst is increased mainly during the nights and evening, sugar is present in urine, weight loss, frequent micturition that is clear. |
Insulinum
| Insulin in potency is useful in cases of diabetes says muzumder. Insulin 30 or 200 , given for three times a day will reduce the leels of blood sugar. Even six months after the doses are reduced or stopped, the blood sugar levels will remain normal. Vertigo when hungry, burning in soles, drowsiness are some indications of insulin. |
Pancreatinum
| It is an extract of salivary and pacreatic glands of sheep or ox. It is indicated in diabetes and pancreatic diseases; this remedy is being used successfully in conditions arising because of diseases of the pancreas. |
Uranium nitrate
| Ineffectual urge to urinate and defecate, increased urination, urine smells fishy, loins are stiff, during the night feels restless, in the face and scalp there is burning sensation, eructations are putrid in nature, during the day has shivering, increased salivation Polydypsia, dryness of skin and mouth, sugar in urine, debility, languor, in spite of increased thirst and appetite patient looses weight.
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Conclusion
Diabetic mellitus is supposed to be a constitutional disease, so treatment also should be constitutional to prevent there complications. Normal levels can be absolutely attained and maintained if Homoeopathic treatment is started earlier. In Homoeopathy, medicines are highly individualized to the patient and this will help, Homoeopathic constitutional treatment for diabetes controls side effects of the disease.
