Diabetes :: Homoeopathic approach in management of Diabetes Mellitus – 2

Investigations are required to make diagnosis, and to know the status of blood sugar levels:

DIAGNOSE

* When two fasting plasma glucose level of 126 mg/dl (7.0 m mol/I) or higher.
* Two 2 hour post prandial plasma level of 200 mg/dl (11.1m mol/L) or higher.

Indications for glucose intolerance test
a) Glycosurea with or without ketones found in routine urine test.
b) Random plasma glucose 6.0 to 13.0 mmol

DIFFERENT LEVELS OF PLASMA SUGAR
Fasting-
110-125 mg/dl – Impaired fasting glucose.
126 mg/dl or above – Diabetes mellitus.
Post prandial –
Below 140 mg/dl 200 mg/dl – Impaired glucose tolerance.
2000 mg/dl or above – Diabetes Mellitus.

Complication of Diabetes Mellitus:-
* Acute.
* Chronic.

Acute complication of Diabetes Mellitus:
* Diabetic Ketoacedosis.
* Hyperosmolar non-ketoic coma.
* Lactic acidosis
* Hypoglycemia.

Long term complication of Diabetes Mellitus:-
* Micro vascular complications.
* Macro vascular complications.

ACUTE COMPLICATIONS
Hyperosmolar non-ketoic coma –
Clinical features –
* Elderly mildly diabetics.
* Profound dehydration.
* Elevated osmolarity.
* Absence of ketosis.
* Variable neurological signs.
* Polyuria, polydypsia and increased letharginess are prodromal.
* Frequently associated with infection.

Hypoglycemia_
Predisposing factors-
* Delaying or skipping meals.
* Decreased carbohydrate intake.
* Increase in the dose of insulin or OHDs.
* Decrease in the dose of insulin.
* Sick days.
* Undue or unexpected strain after taking insulin or OHDs.
* Alcohol consumption.

CLINICAL FEATURES OF HYPOGLYCAEMIA
Neuroglycopenic Adrenergic
Fainting Hunger
Yawning Perspiration
Weakness Rise in blood pressure
Tingling in the fingers Tremors
Diplopia Headache
Hysterical behavior Palpitation
Disorientation Anxiety
Mental confusion Nervousness
Convulsions
Coma

LONG TERM COMPLICATIONS
Macro-vascular complications-
* Coronary heart disease.
* Acute myocardial infarction.
* Peripheral arterial disease.
* Cerebro-vascular diseases.
* Hypertension.
* Dyslipidaema

Micro-vascular complications:-

Bio-chemistry-
1. Polyol pathway.
2. Protein kinase C activity
3. Non enzymatic glycation.
Types of micro-vascular complications:-
* Neuropathy.
* Nephropathy.
* Retinopathy.

Diabetic neuropathy:-
classification-
* Focal neuropathy.
* Distal symmetrical polyneuropathy.
* Acute painful sensory neuropathy.
* Motor neuropathy.
* Autonomic neuropathy.

Neuropathy:-
Stages of Diabetic Nephropathy

Stag Designation Main CFR B.P. Albumin
e characteristics
I Hyperfunction Large kidneys 150+ Normal may be
hypertrophy and glomerular size increased
II Normoalbuminur NAE with/with- Normal Normal (often
ia out hyper increased in
filtration stress situations
III Incipient Presistently elevated 130 20-200 microgram
UAE 160 minute
IV Overt Clinical proteinuria 10-130 Hyper- > 200 microgram
ension minute
V Uremia End stage renal 0-10 B.P. is Decreased
failure high due to nephron closure

Diabetic retinopathy:
Clinical features_
* Transient disturbances of refraction usually refraction.
* Gradual loss of vision.
* Sudden painless loss of vision.
* Appearance of floaters.
* Chronic pain and redness.
* Field defects.
* Impaired night vision.

Classification of Diabetic retinopathy
* Background retinopathy.
* Pre-prolifertative retinopathy.
* Proliferative retinopathy.
* Advanced diabetic eye disease.
* Maculopathy.

Management-
As the condition type 2 diabetes mellitus or non insulin dependent diabetes mellitus is a chronic disease and affect the individual as a whole, so the homoeopathic system of therapeutics, which is based on the holistic concept can provide an efficacious therapy to control the condition. Being a homoeopathic physician our aim should not be only to bring down the blood sugar level but to take care of fundamental cause and disease process completely and not only the ultimate cause of disease.
Managing patients with the diabetes mellitus effectively requires a great deal of time, effort and patience. The task of rendering quality care to our diabetic patients is stupendous and challenging.

The standard procedure for treatment of type 2 diabetes (formerly knows as non insulin dependent diabetes mellitus) follows a stepwise progression starting from non-pharmacological measures like-
* Diet.
* Exercise.
* weight control.
* Health education.

If the desired targets of glycaemia are not achieved from the above mentioned factors to get a metabolic control, then the pharmacological measures should be taken. If the targets of normoglycaemia are still not achieved then the insulin has to be started.
The progressive hyperglycemia of type 2 diabetes mellitus (formerly knows as non insulin dependent diabetes mellitus) requires a stepwise care and approach with a treatment being modified and added to over time.

AIM DIAGNOSIS PROCEDURE

Relieve symptoms, Diet, exercise, weight Move to next stage
improve glycaemic control and health education if there is inadequate
control, enhance control of glycaemia or inadequate
quality of life. relief of symptoms.

Oral agent
Insulin or insulin plus an oral agent