1. What is Diabetes Mellitus?
Diabetes mellitus is a metabolic disorder characterized by hyperglycemia, or elevated blood sugar levels, due to insufficient insulin production or action. Insulin is essential for the proper metabolism of carbohydrates, proteins, and fats. The absence or inadequate function of insulin disrupts these processes, leading to complications in water and electrolyte balance. Long-term hyperglycemia is linked to damage in various organs, especially the vascular system, eyes, kidneys, and nervous system, resulting in serious complications like diabetic retinopathy, nephropathy, and neuropathy.
NORMAL GLUCOSE AND FAT METABOLISM When we eat, carbohydrates are broken down into glucose by enzymes in our saliva and digestive system. This glucose enters the bloodstream. In response, the pancreas releases a stored hormone called insulin (phase 1 insulin response). Insulin helps control the amount of glucose in the blood by:
Allowing glucose to enter the body’s cells to be used as energy.
Storing extra glucose in the muscles and liver as glycogen.
If the body needs more energy later, the stored glycogen can be converted back into glucose. If there’s still extra glucose in the blood after storage, insulin converts it into body fat.
Proteins in food can also be broken down into glucose, but this happens more slowly than with carbohydrates.
After the initial release of insulin, the pancreas begins to produce more insulin (phase 2 insulin response) to continue managing blood glucose.
When blood sugar levels get too low, the body releases a hormone called glucagon, which turns stored glycogen back into glucose, raising blood sugar levels.
2. Why does Diabetes Occur?
Diabetes arises due to different underlying causes:
Type 1 Diabetes Mellitus (IDDM), also known as Insulin Dependent Diabetes Mellitus, is a slowly progressing autoimmune disease where the body's immune system attacks and destroys the insulin-producing cells in the pancreas (beta cells). This destruction happens over many years, eventually leading to a complete or near-total lack of insulin. High blood sugar levels (hyperglycemia) and the typical symptoms of diabetes appear only after 70-90% of these beta cells have been destroyed.
In most cases, people with a genetic predisposition to the disease experience an environmental trigger, like an infection, that starts the immune attack. Over 95% of people with IDDM have either the HLA-DR3 or HLA-DR4 antigen, or both, which contribute to this autoimmune process. Multiple genes are involved in the likelihood of developing IDDM, but not all family members of patients develop the disease. For example, only 51% of siblings and 2% of offspring get it. Interestingly, even among identical twins, over 50% of the time, only one twin develops the condition.Viral infections can trigger the onset of IDDM. Common symptoms include sudden onset of excessive thirst (polydipsia), frequent urination (polyuria), increased appetite (especially craving sweet foods), unexplained weight loss, tiredness, blurred vision, and muscle cramps.
Type II Diabetes Mellitus is a more complex condition than Type I because it involves both insulin resistance in the liver and muscles and progressive pancreatic beta cell dysfunction. Initially, insulin resistance causes the body to produce more insulin to maintain normal blood sugar levels, but over time, the strain on beta cells leads to their gradual failure, leading to a gradual decline in insulin production. Type II diabetes is becoming more common due to obesity, a sedentary lifestyle, and poor dietary habits. Common symptoms include frequent urination (polyuria), increased thirst (polydipsia), increased hunger (polyphagia), and loss of appetite. This type of diabetes is often referred to as adult-onset or maturity-onset diabetes and is more common in people over the age of 40, with the risk increasing as they age
3. Who is Affected by Diabetes?
Type 1 Diabetes:
This type typically affects children and young adults but can occur at any age. It is less common but has a sudden onset with symptoms like excessive thirst, frequent urination, unexplained weight loss, and fatigue.
Type 2 Diabetes:
This type generally affects adults over 40 years of age, though it is increasingly diagnosed in younger populations due to rising obesity and sedentary lifestyles. Risk factors include genetics, poor diet, lack of physical activity, and obesity. It tends to develop slowly and is more prevalent worldwide, especially in developing countries with changing lifestyles.
4. Where does Diabetes Impact the Body?
Diabetes affects multiple systems in the body, with impact on:
Metabolism: It disrupts the metabolism of glucose, fats, and proteins, leading to abnormal blood sugar levels and increased fat storage.
Vascular System: It causes damage to small and large blood vessels, leading to complications such as atherosclerosis, cardiovascular disease, and peripheral artery disease.
Organs: Diabetes significantly affects organs such as the eyes (causing retinopathy), kidneys (leading to nephropathy), and nerves (resulting in neuropathy).
5. When do Complications Arise?
Complications of diabetes typically arise when blood glucose levels remain uncontrolled over a prolonged period. These complications can be acute, such as diabetic ketoacidosis, or chronic, such as damage to the vascular system and organs. In Type 1 diabetes, symptoms appear when 70-90% of pancreatic beta cells have been destroyed. In Type 2 diabetes, complications often develop gradually over years of insulin resistance and beta cell decline.
Ayurvedic Concept of Diabetes (Madhumeha)
What is Diabetes in Ayurveda?
Diabetes mellitus is referred to as Madhumeha in Ayurveda, part of the group of diseases called Prameha, meaning "to flow excessively." The condition is recognized for its impact on most organs and every cell of the body. In Madhumeha, the urine becomes sweet, a major symptom described by ancient Ayurvedic physicians, along with disturbances in the five sheaths of the body: Annamaya (food), Pranamaya (energy), Manomaya (mind), Vijnanamaya (intellect), and Anandamaya (bliss).
Why Does Madhumeha Occur?
According to Ayurveda, Madhumeha is caused by an imbalance in the three doshas (vata, pitta, and kapha), with kapha dosha predominating.
Diet (Aharaja): Consuming foods high in carbohydrates and fats, sweets, cold foods, acidic foods, unprocessed foods, curd, milk products, and excess consumption of newly harvested grains.
Lifestyle (Viharaja): Lack of exercise, excessive sleep, daytime naps, lethargy, and poor hygiene practices contribute to the onset of Prameha.
Who is Affected?
People with certain dietary habits or lifestyles are at risk. Obesity and sedentary lifestyles are common risk factors, and Prameha can be classified into two physical types:
Lean diabetics (Apatarpana Uthaja Prameha)
These individuals have a deficiency of kapha, making them more susceptible to the adverse effects of Type 1 diabetes, where insulin deficiency leads to weight loss and weakness.
Obese diabetics (Santarpana Uthaja Prameha)
These individuals have an excess of kapha dosha, leading to obesity and high strength. They are prone to developing Type 2 diabetes.
There are also congenital (Sahaja) and lifestyle-induced (Apathyaja) forms, with further classification based on doshas (Vataja, Pittaja, and Kaphaja types).
When Does it Occur?
Madhumeha can develop progressively due to a combination of poor diet, inactivity, and genetic predisposition. The condition worsens as doshas become imbalanced, and the kapha dosha particularly increases due to the disease's causes.
Where is the Impact Felt?
Prameha affects multiple systems and organs, including the kidneys (excessive urination), fat tissue (medo dhatu), and vital organs. It can lead to complications such as diabetic carbuncles and constipation. The body’s essence of life, Ojas, gets expelled through urine and sweat, leading to both cardiac and nervous system issues.
Why Does it Happen?
Imbalances in the body’s doshas, especially kapha, lead to Prameha. The disease is also linked to obstruction in the blood vessels (srotorodha) and degeneration of the body's elements (dhatukshaya), which cause further health issues like cardiac and nervous disorders.
Management of Prameha in Ayurveda
Ayurveda emphasizes personalized treatment based on factors like the patient’s prakruti (body constitution), dosha predominance, channel obstructions, and mental constitution. Key management strategies include:
Nidana Parivarjana: Avoiding the causes, like faulty diet and lifestyle.
Aushadha (Herbal Treatment): Using bitter (tikta), spicy (katu), and astringent (kashaya) herbs.
How is Treatment Done?
For Obese Diabetics: Intensive detoxification (bio-cleansing) procedures such as emetics (vamana), to reduce excess kapha and body fat. This is typically done in cases where there is excessive dosha accumulation and purgation (virechana) for pitta imbalance are recommended. Oleation (snehana) is done before cleansing.
For Lean Diabetics: Milder cleansing followed by santarpana (nourishment therapy) is used to strengthen and nourish the body.
Why are Diet and Exercise Important?
A proper diet and regular exercise play a vital role alongside treatment. Diets are tailored to the patient’s age, body constitution, and environmental conditions, ensuring effective management of diabetes.
Ayurvedic management of diabetes involves a holistic approach, combining dietary regulation, herbal remedies, detoxification therapies, and lifestyle modifications. Treatment is customized based on the individual's constitution and the stage of the disease, ensuring a balance of doshas and sustained health.
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