Diabetes

 Do you know what is meant by diabetes mellitus? Diabetes mellitus is derived from the Greek word diabetes meaning siphon – to pass through and the Latin word mellitus means honeyed or sweet.

Diabetes is a chronic disease marked by high levels of sugar in the blood. Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. The pancreas does not make enough insulin. The muscle, fat, and liver cells do not respond to insulin normally. 

Types          

There are three main types of diabetes-

• Type 1
• Type 2
• Gestational

Causes of Diabetes

Type 1 ( IDDM )

 Type 1 diabetes is usually a progressive autoimmune disease, in which the beta cells that produce insulin are slowly destroyed by the body’s own immune system.    

• Genetics — At least 18 genetic locations, labelled IDDM1 – IDDM18, are related
• Viral infections — Enteric viruses- Coxsackie viruses; mumps and congenital rubella                                    
• Age — Appears between infancy and the late 30s, most typically in childhood or adolescence
• Race — Found among Caucasian youth
• Early infancy illness
• Diabetic father
• Mother age>30 years
• Mother having pre-eclampsia during pregnancy
• Autoimmune disorders — Grave’s disease, Hashimoto’s, thyroiditis, Addison’s disease, Multiple sclerosis, or Pernicious anaemia

Type 2 ( NIDDM ) 

 Type 2 diabetes is caused by insulin resistance, in which the body does not properly use insulin.

• Genetic — Genetic mutations likely affect parts of the insulin gene and various other physiologic components involved in the regulation of blood sugar.
• Poor diet — Diets high in refined foods and sweets low in fresh fruits, vegetables, whole grains, and lean protein
• Sedentary lifestyle
• Overweight or obese
• Old age — Diabetes is more common in people aged 50 or older
• High alcohol intake
• Race — African- American, Hispanic/Latin American, American-Indian, Alaska Native, Asian-American.
• High blood pressure
• Gestational diabetes
• Baby birth weight> 9 pounds
• Polycystic ovary syndrome
• Acanthosis nigricans (dark, thickened skin around neck or armpits)
• Blood vessels diseases
• Depression — Severe clinical depression may modestly increase the risk for type 2 diabetes.            
• Schizophrenia.

Symptoms and signs

 IDDM(type1)

1. Being very thirsty
2. Deep, rapid breathing
3. Dry skin and mouth
4. Feeling hungry
5. Feeling tingling in feet
6. Feeling tired
7. Flushed face
8. Fruity breath odour
9. Having blurry eyesight
10. Increased urination
11. Losing weight without trying
12. Nausea or vomiting
13. Stomach pain

NIDDM ( TypeII )

1. Acanthosis, characterized by velvety, dark-coloured patches of skin
2. Blurred vision
3. Erectile dysfunction in men
4. Excessive thirst
5. Fatigue
6. Increased urination
7. Itching
8. Severe gum problems
9. Unusual sensations(tingling or burning, in the extremities)
10. Vaginal yeast/ fungal infections under the breasts/in the groin in women
11. Weight gain in children   
12. Weight loss in adults

Investigations

1. FBS
2. RBS
3. Glycosylated haemoglobin or haemoglobin A1c
4. Oral glucose tolerance test
5. Urine c/e —especially for ketone bodies.

Treatment

Type 1 diabetes

1. Medicines
2. Eating a consistent, healthy diet according to weight and size

Type 2 diabetes 

• Lose weight, if obese and begin an exercise program.
• Oral medication
• Eat a healthy diet Engage in moderate physical activity

Ayurvedic control of Diabetes

Useful drug formulations – 

• Chandrabrabha vati 
• Arogyavardhini vati
• Shilajit Vati
• Trivanga bhasma
• Basant Kusumakar Ras
• Tarkeshwar ras
• Sidha Makadhawaj

Useful Herbs For Diabetes

• Jambul (Eugenia jambolana)Powder from Jamun core is useful. 
• Gurmar(gymnema sylvestre).
• Bitter Gourd/bitter melon (Momordica charantia)
• Bel (Aegle marmelos).
• Fenugreek (Trigonella foenum graecum)
• Turmeric
• Neem.
• Triphala
• Shilajit

Some tips to keep control of this sugar disease.

• Juice of Bitter melon/Karela (30 ml) may be taken on an empty stomach daily in the early morning. Crush the bitter melon into a grinder after separating its seeds. A little bit of water may also be added. Sieve this to have juice.
• Ground bay leaf & Aloe Vera: The mixture of ground bay leaf (1/2 tbsp), turmeric (1/2 tbsp) and aloe vera gel (1 tbsp) if taken twice a day before lunch and dinner, is helpful to control sugar in the blood thus effective for the problem.
• Methi Seeds: Fenugreek seeds or their combination with ayurvedic herbs are useful remedies to lessen the signs and symptoms of diabetes. 
• Grind seeds of Methi (100 gm) and turmeric (25gm) are taken along with a glass of milk twice a day.
• Soaked fenugreek seeds in warm water overnight followed by chewing it in the morning.
• Soak 4tbsp of the seeds in 300 ml water overnight. Crush them in the morning and strain the mixture. Drink it daily for 3 months.
• Chapattis are also prepared by adding methi powder.
• The seed powder of Eugenia jambolana (1 tsp) twice a day along with lukewarm water is good for curing it. The chewing of Jamun leaves prevents the conversion of starch into sugar.
• The juice of Amla (Emblica officinalis) (20 ml) twice a day is good for diabetic patients. The powder of Amla fruit may also be taken twice a day.
• The decoction of the bark of ficus bengalensis is consumed (50 ml) twice a day. Preparation method: 20 gm of ficus bark is heated in 4 glasses of water. When the mixture remained approx. of 1 glass, it may be taken after making it cold.
• Cinnamon powder: This is one of the important natural home remedies. 
•  First, take one litre of drinkable water. Add 3-4 tbsp of cinnamon powder and heat it for 20 minutes. Strain the mixture and made it cool. Drink it every day.
• Vijaysar Churna: Pterocarpus marsupium is helpful in curing diabetes mellitus. Pterocarpus marsupium bark may be taken in the form of powder twice a day. The cube of vijaysar may be kept in water overnight. Drink it in the morning empty stomach. Patients also like to take cubes of vijaysar.
• Triphala: Triphala along with other ingredients are useful in lowering the sugar levels in the blood.  The decoction of equal parts of Triphala, the root of barberry, colocynth and moth (20ml) may be taken along with turmeric powder (4gm) twice a day.
• Snake gourd: Decoction of equal part of Patola (a variety of small cucumber-snake gourd), Neem, the fruit of embolic myrobalan and stem of Guduct (14 to 28 ml.) be taken thrice a day.

Yoga and Diabetes

Surya Namaskar

The sun salutation is a highly effective exercise for those with diabetes as it is considered to be a complete body exercise. Doing this for 15 minutes every morning can make a huge difference in increasing the metabolism rate of the body.

Vrikshasana

It helps stimulate the hormonal secretion of the pancreas.

• Stand straight and keep your feet close to each other. Your knees, legs and hands should be held straight.
• Now bring your right foot and keep it on your left thigh. Try to make a right angle. If you are unable to keep your foot on the thigh, try to keep your foot on the left leg wherever you feel comfortable and maintain balance. But remember your right toe should point downwards. Your body balance should depend on the left leg.
• Join your palms and bring them to the middle of your chest and keep the figure pointing upwards.
• Slowly move your hands overhead.
• Raise your arms over your head. Your arms should be slightly bent.
• Stand straight, look in front and try to be relaxed.
• Stay in this position for about 10 seconds. Breathe normally.
• Slowly bring your hands to the middle portion of the chest same as before, bring your right leg to the ground and come back to the starting position.
• Repeat the same procedure with the other leg.
• Try to repeat the whole procedure two to three times.

Dhanurasana (Bow pose)

Improves the functioning of the pancreas and intestines. This helps in controlling blood sugar levels. Organs like the liver, pancreas and enzyme-producing organs will function actively by practising this asana.

• Lie on your stomach with your feet hip-width apart and your arms by the side of your body.
• Fold your knees and hold your ankles.
• Breathing in, lift your chest off the ground and pull your legs up and back.
• Look straight ahead with a smile on your face. Curve your lips to match the curve of your body.
• Keep the pose stable while paying attention to your breath. Your body is now taut as a bow.
• Continue to take long deep breaths as you relax in this pose. But don’t get carried away. Do not overdo the stretch.
• After 15 -20 seconds, as you exhale, gently bring your legs and chest back to the ground.
• Release the ankles and relax.

Halasana (Plough Pose)

It stimulates the pancreas, and spleen and activates the immune system by massaging all the internal organs including the pancreas. It improves kidney and liver functioning and strengthens the abdominal muscles. It also rejuvenates the mind.

• Lie on your back with your arms beside you, palms downwards.
• As you inhale, use your abdominal muscles to lift your feet off the floor, raising your legs vertically at a 90-degree angle.
• Continue to breathe normally and support your hips and back with your hands, lift them off the ground.
• Allow your legs to sweep at a 180-degree angle over your head till your toes touch the floor.
• Your back should be perpendicular to the floor. This may be difficult initially, but make an attempt for a few seconds.
• Hold this pose and let your body relax more and more with each steady breath.
• After about a minute (a few seconds for beginners) of resting in this pose, you may gently bring your legs down on exhalation.
• Avoid jerking your body, while bringing the legs down.

Ardha Matsyendrasana (Half Twist Pose)

This asana massages the kidneys, pancreas, small intestines, gall bladder and liver, helping to stimulate digestion and squeeze out toxins. Useful for diabetics, with a concentration on the pancreas. Increases the elasticity of the spine, and tones the spinal nerves.

• Sit on the carpet, and stretch the legs straight.
• Fold the right leg. Keep the right leg’s heel touching the left leg’s knee.
• Take the right hand to the back of the waist twisting your trunk, spread your palms inside and place it on the carpet.
• Bring the left hand close to the right knee and hold the right leg’s ankle or big toe with the left hand.
• Twist the head and shoulder to the right side and look straight to the right shoulder’s side (i.e back side)

Kapalbhati 

Kapalbhati is said to have distinct mental, physical and spiritual benefits.

• The breathing technique involves “active exhalation and passive inhalation”. During inhalation, the stomach sinks in and vice-versa during exhaling. This stomach movement is therefore beneficial for the muscles around it, including that of the liver and pancreas.
• Regular practice of kapalbhati is beneficial for belly fat loss and thus helps to manage diabetes.
• The technique involves forceful breathing which strengthens the lungs and increases their capacity.
• Practising Kapalbhati helps in removing blockages in the heart and lungs.
• It activates the brain cells and improves memory and concentration power.
• It regulates body metabolism and balances hormones.

Home Remedies and food for Diabetes

Foods which should always be included in the Diabetes diet are as follows:    

• High Fiber Food — Aim for 50 grams of fibre a day, but start slowly. Load up on beans, vegetables and fruits.

• Eat Whole Grains

Whole grains could effectively regulate the glycemic response, increase insulin sensitivity, improve pancreatic β-cell functions and increase insulin secretion. Whole and multi-grain bread, whole wheat pasta, brown rice, low-fat and multigrain crackers, low sugar, whole grain cereals, oatmeal, bran, buckwheat: low-fat, whole grain baked goods with added bran or oat bran, pasta, high fibre cereal, corn, oatmeal, millet, barley and rye.

According to Ayurveda…. barley (yava) is the best grain for managing diabetes. Ayurveda prescribes old rice (purana shali), as one of the cereals beneficial to diabetic patients.

• Choose Fruits And Vegetables

Regular consumption of various fruits and vegetables in diabetic patients can lead to improved glycemic control, reduced HbA1c and triglyceride levels, enhance antioxidant defence system, attenuated oxidative stress and inflammatory markers, and decreased risk of diabetic complications(retinopathy and the burden of carotid atherosclerosis).

The fruits with a low glycemic index include

• apples
• peaches
• pears
• grapefruit
• grapes
• oranges
• melon
• dried apricots
• raisins
• kiwi
• berries, cranberry, blackberries, black raspberries, blueberries, red raspberries, strawberries, cherries, barberries
• plums
• litchi fruit
• pomegranates
• bananas
• avocadoes
• guava
• papaya
• jackfruit
• watermelon
• dates
• figs
• Jamun
• Indian gooseberry or amla
• wood apple
• lotus.

Avoid fruit juices. Instead opt for whole fruits, as they contain more fibre and are more filling.

Eat green leafy vegetables; eat in abundance fresh vegetables like

• tomato
• cucumber
• carrot
• broccoli
• cabbage
• cauliflower
• spinach
• kale
• collard
• squash
• green beans
• sweet potatoes
• pumpkin
  Avoid white potatoes.

Ayurveda recommends all types of bitter vegetables as some of the best vegetables for diabetics. Bitter vegetables include bitter gourd, fenugreek, pointed gourd, garlic, cluster fig tree or Indian fig.

You can also have bitter greens like arugula, kale, dandelions and beet greens.

• Add Spices

The anti-diabetic effects of spices include short-term hypoglycemia and long-term improved glucose tolerance activities. A number of condiments and spices have been reported to possess potential anti-diabetic agents.

These include:

• pepper
• asafoetida
• aloe
• Ocimum
• eugenol
• fenugreek seeds
• garlic
• onion
• turmeric
• cumin seeds
• ginger
• curry leaves
• cinnamon
• mustard
• coriander

• Select Milk + Dairy

Milk and yoghurt with less than 1% fat and cheese should be 10-20% milk fat. They are rich in protein and calcium, and studies show they help people to lose weight. Diets that include plenty of dairies may fight insulin resistance, a core problem behind diabetes. In addition to calcium, many fortified dairy products are a good source of vitamin D.

• Fish — Fish is rich in omega-3s (polyunsaturated fat) which help to protect against heart disease in people with diabetes.

• Pulses + Legumes

Legumes have a low glycemic index and are high in fibre and phytochemicals. This makes them a functional food for diabetic patients.

The hypoglycemic effect of beans (via inhibition of α-amylase and β-glucosidase activity) has been reported as being similar to those of anti-diabetic drugs. Including beans like pinto, dark red kidney and black beans in the diet effectively helps weight management, attenuates postprandial glycemic response and improves dyslipidemia.

Have beans (black, pinto, kidney, garbanzo, white beans and soybeans), peas, split peas, lentils and non-fat soy products for diabetic management.

According to Ayurveda, split green gram beans, Bengal gram, horse gram and pigeon peas can also be taken for diabetes management.

• Go Nuts                       

Almonds, pistachios, walnuts and hazelnuts are commonly used nuts. Most current evidence reveals that consumption of nuts in type 2 diabetic patients other than improving the overall diet quality also has beneficial effects on postprandial glycemic response following high-carbohydrate meals. They also improve insulin resistance. Habitual intake of nuts could help to effectively manage weight, especially in diabetic patients.

• Unsalted Seeds

Flaxseeds, pumpkin seeds and sunflower seeds are filled with good fats like omega 3 fatty acids, protein, and fibre that work together to keep blood sugar low and stave off heart disease.

According to Ayurveda, lotus or water lily seeds can also be taken. Lotus seeds may be eaten cooked or raw. They are used extensively in Ayurvedic medicine.

• Oils + Fats

According to Ayurveda, mustard oil is the best. but a few others are also good. These include-

• Olive
• canola
• soybean
• sesame
• sunflower oils (3 tsp or less per day),
• non-hydrogenated soft margarine
• low-calorie dressings and mayonnaise
• light peanut butter
• nuts (watch salt and calories)
• fat removed gravy can be taken.

•   Snack Foods — Popcorn without salt, butter, or hydrogenated oils is a good choice. Choose low-fat, low-sugar snack foods.

Diabetic Complications

Diabetes brings with it lots of complications. These include-

• Atherosclerosis
• Carpal tunnel syndrome
• Colorectal cancer
• Coronary artery disease
• Dementia
• Depression
• A diabetic hyperglycemic hyperosmolar coma
• Diabetic Ketoacidosis
• Diabetic Nephropathy
• Diabetic Neuropathy
• Diabetic Retinopathy
• Eating Disorders
• Erection problems
• Foot ulcers and Amputation
• Hearing loss
• Hyperlipidemia
• Hypertension
• Hypoglycemia
• Infections of the skin, female urinary tract, and urinary tract
• Nonalcoholic fatty liver disease
• Osteoporosis
• Periodontal disease
• Peripheral vascular disease
• Stroke
• Uterine cancer

Prevention

1. Intensive control of blood glucose and keeping glycosylated haemoglobin (HbA1c) levels below 7%.
2. Managing risk factors for heart disease-
   Blood pressure, S. Cholesterol, S. triglyceride
3. Maintaining an ideal body weight
4. An active lifestyle
5. Routine tests for Kidneys
6. Routine eye-checkup
7. Thorough dental cleaning and exam.