Dr Sulabha G
Diabetes mellitus is a disease that is characterised by the presence by increased levels of sugar in the bloodstream (hyperglycaemia). There are approximately 180 million people, on earth, who are affected by diabetes. According to World Health Organisation, this number is going to get doubled by 2030. Homoeopathy cannot be a substitute for insulin but the role of homoeopathy is restricted to controlling the complications of diabetes. The treatment is mainly concentrate on functioning of pancreas in efficient insulin production.
Juvenile, type 1 diabetes, insulin, complications, Homoeopathy
Diabetes mellitus is a common disorder of children. Insulin is the hormone which controls the levels of glucose in the blood and it is produced by pancreas. In type 1 diabetes, it occurs due to an absolute deficiency of insulin secretion, in consequence with the destruction of the beta cells of the pancreatic islets. The disease leads to a number of short- and long-term complications. Type 1 diabetes is also called insulin dependent diabetes or juvenile diabetes since type 1 diabetes usually develops in children and teenagers. Type 1 diabetes mellitus is a chronic autoimmune disease with acute clinical presentation and immediate insulin requirement for survival. There will be an history of other autoimmune disorders in their family members such as autoimmune thyroid disease, celiac disease, pernicious anaemia, Addison disease, vitiligo, alopecia areata and autoimmune hepatitis.
The Indian council of Medical Research has started a registry for young diabetics in India. A study from Karnataka (2008) spanning 13 years reported an incidence of 3.7 (in boys) and 4.0 (in girls) per 100,000. A recent study from Haryana (2010) reported an overall prevalence of 10.2 per 100,000, with a six – fold higher prevalence in urban (26.6) as compared to rural (4.27) areas. India has a relatively lo incidence rate but in view of the large population, accounts for a very large absolute number of cases. There are about 100,00 children in India with type 1 Diabetes. It is estimated that one in every five children with type 1 diabetes worldwide is Indian. There is no sex difference in type 1 diabetes when onset is below the age of 15 years, above 15 years males have a higher incidence. There is a seasonal variation in the presentation with fewer cases presenting in summer months than in winter.
Type 1 diabetes mellitus is a chronic autoimmune disease so it affects only the beta cells, with gradual loss of insulin secretion. Few patients have a genetic predisposition to develop the disease. Autoimmune destruction is a slow process and decline in insulin production occurs over a period of months to years.
- Genetics – HLA-DR3 & HLA-DR4 (HLA – human leucocyte antigen) have increased risk of diabetes.
- Environmental factors – virus such as coxsackie and other enteroviruses are common to develop diabetes. But the congenital rubella infection directly predisposed to diabetes. Other environmental factors include early weaning to cow’s milk, toxins and stress.
- Vitamin D deficiency, nitrates in drinking water, early bovine milk protein exposure, early gluten exposure, omega-3 fatty acid deficiency, lack of breast feeding – other factors.
Insulin acts mainly on 3 tissues – liver, muscle & adipose tissue. It produces
- glucose uptake
- glycogen synthesis
- lipogenesis in liver
- stops gluconeogenesis
Insulin helps to produce glucose uptake and oxidation and glycogen synthesis in muscles. Glucose uptake and lipid synthesis occurs in adipose tissue. So, hyperglycaemia results from glycogenolysis, gluconeogenesis, lipolysis and absence of glucose uptake. There will be raise in regulatory hormone levels glucagon, epinephrine, cortisol and growth hormone which results in hyperglycaemic state. Lipolysis occurs by insulin deficiency and enhanced oxidation of fatty acids by glucagon. Glucagon induces the carnitine palmitoyl transferase system of enzymes which translocate fatty acids into mitochondria for beta oxidation and ketogenesis.
- Classical triad – polyuria, polydipsia, polyphagia
- Weight loss but with increased food intake
- Nocturnal enuresis (observation of ants collecting around urine)
- Blurring of vision
- Recurrent or persistent vaginal candidiasis
- Anorexia, vomiting, abdominal pain & distention when ketosis occurs
- Hepatomegaly due to fatty infiltration
- Tachypnoea with air hunger (kussmaul respiration) – metabolic acidosis
- Acetone odour to breath
- Breathlessness – rarely
BLOOD SUGAR LEVELS:
- Fasting blood sugar (FBS) – 70-100mg/dl – normal
FBS – 101-126mg/dl – early diabetes
FBS – more than 126mg/dl – diabetes
FBS – below 70mg/dl – hypoglycaemia
FBS – less than 50mg/dl – insulin shock
- Post prandial blood sugar (PPBS) – 70-140mg/dl – normal
PPBS – 140-200mg/dl – early diabetes
PPBS – more than 200mg/dl – diabetes
- Random blood sugar (RBS) – 70-140mg/dl – normal
RBS – more than 200mg/dl – diabetes
- Diabetes insipidus
- Renal glycosuria
- Fanconi syndrome
- Diabetic ketoacidosis
- Diabetic ketoacidosis
- Cerebral oedema
- Acute renal failure
- Hyperglycaemic hyperosmolar state
- Microvascular: nephropathy, retinopathy, neuropathy
- Macrovascular: myocardial infarction, stroke
- Other autoimmune disorders
- Skin & joint complications
- Predisposed to hypertension, dyslipidaemia & obesity
Abundant sugar in urine, increased and light coloured. Great thirst, but cold drink lies heavy on stomach, ascites and hydrothorax, oedema pedum, gangrenous ulcer, pale waxen skin, extreme prostration, decomposition of animal matter.
Profuse, turbid sweetish urine, < at night, sometimes like whey, it distresses him at night, has to rise so often, emaciation and great weakness, face pale and sallow, scrotum and feet oedematous and itching, pruritus scrotum, foetid taste in mouth, disposition to gangrene.
Glycosuria when lungs are implicated, diminishing the quantity of urine lowering its specific gravity, sore aching in bladder, < after urinating, involuntary sighing, chronic cough of consumptives, who suffer with cold feet, profuse sweat in phthisis.
Perfect depression of the trophic nervous system. Heaviness all over, with drowsiness, depression of spirits, head feels confused and dull, dim sightedness, bitter taste, appetite with sensation of fullness, intermittent, hard dry stool, frequent and copious emission of hot, clear urine, bruised sensation in chest and all along the back, physical exhaustion, worse from rest, great itching of genitals during and after micturition.
Despondency and peevishness, dimness of eyes, livid gray complexion, readily bleeding gums, sweetish taste, constipation, violent urging to urinate, with copious discharge, impotence, difficult suffocative breathing, laming pain and weakness in back and extremities, gangrene, emaciation with muscular relaxation.
Peevish and depressed in mind, thirst and hunger constant, but worse at night, flatulence, faeces small in quantity, want of natural warmth, sexual desire and power gone, lithic acid gravel, pulmonary phthisis, great emaciation, mental and nervous bodily exhaustion.
Good livers and sedentary habits. Acidity with dyspeptic troubles, constriction of the throat, dry cough, pains in the back, numbness, paretic condition of the lower extremities, after ineffectual desire to urinate, frequent and more copious urination than could be expected from the quantity of liquid taken, sexual desire strong, spinal lesions exciting cause.
Neurogenic glycosuria. Debility from loss of animal fluids, bad effects from grief, anguish, sorrow and care. All the joints feel bruised, very sensitive to fresh air, lassitude and heaviness, weakness of mind, falling out of hair, dimness of eyes, excessive thirst, eructation from acids, pressure in stomach, hard difficult stool, shortness of breathing, urine thick, like milk (chyluria) or lime water with whitish curds with stringy, bloody lumps or clear and containing much sugar, pain in back and kidneys, dull pressure in bladder, great weakness and emaciation.
Diminishes the amount of urine secreted and causes sugar to disappear.
Lassitude, debility, despondency, dimness of mind and sight, itching over the whole body, flatulency upward and downward, and stitches in hepatic region, skin completely inactive, cold and dry, large quantities of sugar in urine, typhoid condition.
Inability to concentrate the mind, dull, languid mind, relieved by frequent micturition, despondency, wearied of life, obscuration of sight, sunken features, lips cracked and slightly bleeding, epistaxis, spongy gums, tongue dry and red, foul breath, hunger and thirst with debility, aversion to meat, rancid or acrid eructation, burning in stomach and hypochondria, albuminuria with frequent micturition.
Defects of digestion and assimilation, hepatogenic diabetes. Causes sugar to be deposited in the urine. General languor, debility, cold feeling, vertigo, purulent discharges from eyelids and nostrils with ulceration of cheeks from acrid discharge, copious salivation, vomiting with great thirst, putrid eructation, urgent desire to evacuate bladder and rectum, frequent micturition, cough with purulent discharge from nostril, lung infiltrated with gray tubercles, stiffness in loins, languor on rising from bed, with fishy smell of urine, prostration, and restless at night.
- Parthasarathy, A., 2008. IAP textbook of pediatrics. 7th ed. jaypee.
- essential pediatrics. 8th ed. CBS Publishers.
- Hahnemann,S., 1984.Materia Medica Pura.New Delhi:Jain Publishing Co.,Vol.1
- Clarke, J.,1996.A Dictionary of Practical Materia Medica.New Delhi:B.Jain Publishers Pvt Ltd,Vol 1,2
Dr SULABHA G MD PART I
Dept Of Organon Of Medicine & Homoeopathic Philosophy
Father Muller Homoeopathic Medical College, Deralakatte, Mangalore, Karnataka