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All that you would like to know about Diabetes Mellitus

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What is Diabetes Mellitus?

Diabetes( dīəˈbētēz) mellitus (MEL-ih-tus), or simply, diabetes, is usually a lifelong (Chronic) group of diseases characterized by high blood sugar levels that result from defects in the body's ability to produce and/or use insulin. The reference of Diabetes is given as Prameha in Indian Scriptures.

References of  Prameha are found in Ancient Indian Scriptures like “Kaushika sutra” of “Atharva veda” (5000 B.C to 1500 B.C) , Agni purana, Garuda purana, Kautilya artha shashtra and the epic Ramayana (4000 B.C to 1000 B.C )providing evidence for descript ion and existence of diabetes (Madhumeha) which has beenrecognized and documented by man in that era. Information available in laghutrayis, bhruhatra yis, commentaries like-Dalhana etc,  

Diabetes is one of the first diseases described with an Egyptian manuscript from c. 1500 BCE mentioning “too great emptying of the urine.”The first described cases are believed be of type 1 diabetes. Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine attracts ants. 

The term "diabetes" or "to pass through" was first used in 230 BCE by the Greek Appollonius Of Memphis. The disease was rare during the time of the Roman Empire with Galen commenting that he had only see two cases during his career. Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500 AD with type 1 associated with youth and type 2 with being overweight.  The term "mellitus" or "from honey" was added by the Britain John Rolle in the late 1700s to separate the condition from diabetes insipidus which is also associated with frequent urination

Thus, the term diabetes is the shortened version of the full name diabetes mellitus. Diabetes mellitus is derived from:

  • the Greek word diabetes meaning siphon διαβαίνω - to pass through
  • the Latin word mellitus meaning honeyed or sweet

This is because in diabetes excess sugar is found in blood as well as the urine. It was known in the 17th century as the “pissing evil”.

Ayurvedic Authority Charaka defined Diabetes in  300-500 CE as follows :-

प्रकर्षेणप्रभूतं, प्रचुरंवारंवारंवामेहति, मूत्रत्यागंकरोतियस्मिन्रोगेप्रमेह: |

The disease in which, person is passing excessive, increased and turbid urination is known as ‘Prameha’.

Diabetes is called Prameha in Ayurveda. A detailed description of the disease and its treatment can be found in Atharva Veda, which originated between 3000 BC and 1500 BC. More urine than the actual intake of water is cited as the simplest sign of diabetes in Ayurveda.

Ayurvedic System of Medicine clearly defines Diabetes.  Diabetes Mellitus was known to Indian Civilization since vedic period by the name Asrava (Prameha).  Diabetes is also known as Madhumeha. Diabetes is also called Maharoga (Major Disease) as almost all parts of the body and every cell of human physiology are affected. It also disturbs 5 sheaths of the body – annamaya kosha{Food sheath}, pranamaya kosha{Energy sheath}, manomaya kosha{Mind Sheath}, vijnana maya kosha{Intellectual Sheath} and anandamaya kosha{Bliss Sheath}. 

Insulin is a hormone produced by the pancreas in our body to control blood sugar. Diabetes mellitus can be caused by too little insulin, resistance to insulin, or both.

To understand diabetes mellitus, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.

An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

Mechanism of insulin release in normal pancreatic beta cells - insulin production is more or less constant within the beta cells. Its release is triggered by food, chiefly food containing absorbable glucose.

 

 

People with diabetes mellitus have high blood sugar because their body cannot move sugar into fat, liver, and muscle cells to be stored for energy. This is because either:

  • Their pancreas does not make enough insulin
  • Their cells do not respond to insulin normally
  • Both of the above

Diabetes (from al-Greek. διαβαίνω - turn overlapping) - a derivative of the Greek word "diabayno", which means "going through something, through", "flowing"  .Doctor Areteus Cappadocia (30-90AD)  observed the symptoms of polyuria in patients, which links to the fact that the fluid entering the body, flow through it and stand unchanged  .  Aretaeus did attempt to treat it but could not give a good prognosis; he commented that "life (with diabetes) is short, disgusting and painful. In 1600, the n. e. added to the word diabetes mellitus (from Lat.  mel - honey ) to indicate diabetes with a sweet taste of urine  - diabetes .Syndrome of diabetes  was known in ancient times, but up to the XVII century the differences between diabetes insipidus and diabetes was not known  . In the XIX - early XX century there were extensive work on diabetes insipidus, syndrome of a relation with the pathology of the central nervous system and the posterior lobe of the pituitary gland (supraoptic nucleus of the hypothalamus-pituitary supraoptiko → tract →neurohypophysis

According to Ayurveda, diabetes mellitus indicates a failure of the mechanism which regulates sugar in the body. It is primarily a kafa (one of the basic body constituents) disorder involving obesity and excess consumption of kafa aggravating foods, for example, sweets. An increase of kafa in the body results in an impairment in the functioning of the pancreas. Kafa then enters other dhatus (tissues), thus resulting in diabetes.

According to Ayurveda, prameha is divided in 4 major types (and total 20 types)

  • Kapha type (again divided into 10 types)
  • Pitta type (again divided into 6 types)
  • Vata type (divided into 4 types)
  • Juvenile diabetes for children (for unhealthy practices of parents and/or due to the sins of past-birth)

The main cause of prameha (diabetes mellitus) are lack of exercise and consumption of excess food having ushna, snigdha and guru nature. Foods that increase kapha, medhas and mootra are the major factors for prameha (Diabetes Mellitus).

Better understanding of diabetes mellitus rests upon knowledge of the basics of carbohydrate metabolism and insulin action. Following the consumption of food, carbohydrates are broken down into glucose molecules in the gut. Glucose is absorbed into the bloodstream elevating blood glucose levels. This rise in glycemia stimulates the secretion of insulin from the beta cells of the pancreas. Insulin is needed by most cells to allow glucose entry. Insulin binds to specific cellular receptors and facilitates entry of glucose into the cell, which uses the glucose for energy. The increased insulin secretion from the pancreas and the subsequent cellular utilization of glucose results in lowered of blood glucose levels. Lower glucose levels then result in decreased insulin secretion.

If insulin production and secretion are altered by disease, blood glucose dynamics will also change. If insulin production is decreased, glucose entry into cells will be inhibited, resulting in hyperglycemia. The same effect will be seen if insulin is secreted from the pancreas but is not used properly by target cells. If insulin secretion is increased, blood glucose levels may become very low (hypoglycemia) as large amounts of glucose enter tissue cells and little remains in the bloodstream.

Following meals, the amount of glucose available from carbohydrate breakdown often exceeds the cellular need for glucose. Excess glucose is stored in the liver in the form of glycogen, which serves as a ready reservoir for future use. When energy is required, glycogen stores in the liver are converted into glucose via glycogenolysis, elevating blood glucose levels and providing the needed cellular energy source. The liver also produces glucose from fat (fatty acids) and proteins (amino acids) through the process of gluconeogenesis. Glycogenolysis and gluconeogenesis both serve to increase blood glucose levels. Thus, glycemia is controlled by a complex interaction between the gastrointestinal tract, the pancreas, and the liver.

Multiple hormones may affect glycemia. Insulin is the only hormone that lowers blood glucose levels. The counter-regulatory hormones such as glucagon, catecholamines, growth hormone, thyroid hormone, and glucocorticoids all act to increase blood glucose levels, in addition to their other effects.

Insulin is the principal hormone that regulates uptake of glucose from the blood into most cells (primarily muscle and fat cells, but not central nervous system cells). Therefore, deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus.

Humans are capable of digesting some carbohydrates, in particular those most common in food; starch, and some disaccharides such as sucrose, are converted within a few hours to simpler forms, most notably the monosaccharide glucose, the principal carbohydrate energy source used by the body. The rest are passed on for processing by gut flora largely in the colon. Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage.

Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of insulin from the β-cells and in the reverse conversion of glycogen to glucose when glucose levels fall. This is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin. Glucose thus forcibly produced from internal liver cell stores (as glycogen) re-enters the bloodstream; muscle cells lack the necessary export mechanism. Normally, liver cells do this when the level of insulin is low (which normally correlates with low levels of blood glucose).

Higher insulin levels increase some anabolic ("building up") processes, such as cell growth and duplication, protein synthesis, and fat storage. Insulin (or its lack) is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction, and vice versa. In particular, a low insulin level is the trigger for entering or leaving ketosis (the fat-burning metabolic phase).

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or resistance), or if the insulin itself is defective, then glucose will not have its usual effect, so it will not be absorbed properly by those body cells that require it, nor will it be stored appropriately in the liver and muscles. The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.

When the glucose concentration in the blood is raised to about 9-10 mmol/L (except certain conditions, such as pregnancy), beyond its renal threshold (i.e. when glucose level surpasses the transport maximum of glucose reabsorption), reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotic ally from water held in body cells and other body compartments, causing dehydration and increased thirst.

According to Ayurveda, Diabetes  is a metabolic disorder reflecting in abnormality of urine. This is similar to Diabetes Mellitus with modern parlance. Modern medicine considers this as metabolic disorder, characterized by hyperglycaemias, glycosuria and disturbance in the insulin mechanism.

Causes of Diabetes:

आस्यासुखंस्वप्नसुखंदधीनिग्राम्यौदकानूपरसा: पयांसि |
नवान्नपानंगुडवैकृतंप्रमेहहेतुकफकृच्चसर्वम् ||
(Ref: Charak Samhita Chi. Chapter 6/ Verse 4)

  •  Sedentary lifestyle
  • Lack of exercise
  • Excessive use of curds, meat soup of the domestic, aquatic and marshy animals
  • Excessive use of Milk and Dairy products
  • New cereals/ New grains ( Cereals/ Grains which are using within a year of its production)
  • New drinks (Drinks which are using within a year of its production)
  • Products of Jaggery
  • Intake of food having cold, oily and sweet properties and
  • Other remaining products which can produce ‘Kapha’
  • Heredity is also an important etiological factor

Premonitory Symptoms of Diabetes:

  • Sweating
  • Foul smell of the body
  • Slackness in the hands and feet
  • Liking for comfort in lying and sleeping
  • Smearing in the heart, eyes, tongue and ears
  • Feeling of heaviness in the body( may  be due to overweight)
  • Excessive growth of hairs and nails
  • Liking for cold
  • Dryness in throat and soft palate
  • Sweetness in the mouth and
  • Burning sensation in palms and feet
  • Excess appetite and thirst are also found. (Charaka Samhita Chi. 6/12-14)

Symptoms of Diabetes:

सामान्यंलक्षणंतेषांप्रभूताविलमूत्रता(Madhav Nidan Prameh/6)

Excess and turbid urination as well as increased urination is the common symptom of all types.
Other symptoms are due to improper formation of almost all the tissues in the body. These include debility, various pathological changes in colour and smell of the urine, skin disorders, impotency and heart disorders due to arteriosclerosis. If the disease is not properly treated, complications like hypertension, obesity, hyper cholesterol and heart problems develop quickly.

Classification of Diabetes:

According to Ayurveda, ‘Prameha’ is divided in three types.

1) Kaphaja Prameha (Diabetes of ‘Kapha’ predominance):
Again it is subdivided in ten subtypes.  i.e.  Udakameha, Ikshumeha, Sandrameha, Sandraprasadameha, Shuklameha, Shukrameha, Shitameha, Siktameha, Shanaimeha and Alalameha.

2) Pittaja Prameha (Diabetes of ‘Pitta’ predominance):
Again it is subdivided in six subtypes.  i.e.  Ksharameha, Kalameha, Nilameha, Raktameha, Manjishthameha and Haridrameha.

3) Vataja Prameha (Diabetes of ‘Vata’ predominance):
Again it is subdivided in four subtypes.  i.e.  Vasameha, Majjameha, Hastimeha and Madhumeha.

According to modern contrive, Diabetes mellitus is of two types- Primary and Secondary.
Primary variety is again subdivided in 1) IDDM- Insulin dependent diabetes mellitus or juvenile diabetes and 2) NIDDM- Non insulin dependent diabetes mellitus or adult onset.

Secondary diabetes can be caused by a wide range of health problems that damage, injure, interfere with, or destroy the pancreas. For example, secondary diabetes may develop from inflammation of the pancreas (pancreatitis), or cystic fibrosis. Some conditions increase the body's need for insulin, such as the overproduction of growth hormone or cortisol. Some medicines may also affect how the body uses insulin or prevent the pancreas from producing enough insulin.

Ayurveda, a holistic approach to medicine that originated in India thousands of years ago, can be an effective means of treating diabetes. The word ayurveda comes from the sanscrit words ayur (life) and veda (knowledge) -- or, "the science of life". Ayurvedic medicine is based on the belief that all living things are made of up the five elements of earth, water, fire, air and space; that there are three types of energy present in all living things -- called vata, pitta and kapha -- and that disease is caused by an imbalance in these energies.

According to ayurveda, diabetes can be traced to an imbalance of kapha energy, which is comprised of the elements earth and water. Holistic practitioners attribute the development of diabetes to a decrease in digestive fire, or "agni," and thereby a diminished ability of the body to metabolize energy and eliminate toxins.