Effective medicine for Diabetes

What is Diabetes

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Full name of this physical disorder consists of two words. Diabetes’ and ‘Mellitus’. There is another word ‘Insipidus’ also aligned with the two words. In fact the word (or term) ‘Diabetes’, which owes its origin to Unani language, means ‘That which comes out or that which flows’ and the term ‘Mellitus’ (a word of latin origin) means ‘sugar’ or ‘honey’. Hence, the term ‘Diabetes Mellitus’ means flow of sugar. The Ayurvedic term ‘Madhumeha’ means ‘Rain of honey’ stands for ‘Sugar’. Hence, Diabetes Mellitus and ‘Madhumeha’ are synonyms and they convey the same sense. Diabetes Insipidus is characterized by the persistent excretion of excessive quantities of urine of low specific gravity but this is not a specific kind of ‘True Diabetes’. But when the urine is loaded with excessive content of sugar and the urinary flow, irrespective of the quantity passed in 24 hours, is also on higher side, it may be called of diabetic origin. Diabetes Insipidus can be deduced by excessive thirst and urinary flow in large quantity. When the body fails to utilize the released quantity of sugar, it spills over in to the blood stream and renders the blood laden with sugar. When blood fails to absorb sugar, the excessive quantity passes on to kidneys and loads the urine with sugar.

Do not infer diabetes when there is sugar in urine only but when blood-tests reveal presence of sugar therein (in the blood) then diabetes Mellitus (DM) will be a confirmed diagnosis, calling for a further thorough probe.

Mere presence of sugar in urine is no definite sign or symptom of diabetic status of a person. But, its presence in urine is a forewarning that something is wrong somewhere. And what is wrong and where, will be determined and disclosed by patient’s objective and subjective symptoms, as also by clinical tests. Merely a single test report should never form basis for confirmation of diabetes unless repeated tests, after a gap of 4-5 days, show presence of sugar in urine, then only patient’s blood sugar should be tested and if blood is also shown to have sugar, in that case it becomes a confirmed case for ‘Diabetes Mellitus’ calls immediately which for a doctor’s advice and guidance.

To repeat, mere passing of excessive amount of urine does not confirm diabetes and also large amount of sugar in urine is also not a confirmed symptom of diabetes. But presence of large percentage of sugar in urine and blood is really ‘Diabetes Mellitus’ which should be attended to, after proper investigations and tests.

There is, sometimes, confusion about ‘enuresis’ and diabetes. Enuresis is actually ‘bed wetting’ which often occurs in infants, young people or old persons and usually occurs at night. It is involuntary flow of urine passed while sleeping, especially when the patient is unable to control pressure or urine. In infants and children, it gets automatically cured but if it continues even in or upto old age, then causes may have to the traced to some other disorders.

Effective and Curable Medicines for Diabetes

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Diabetes is rightly claimed to be prominent silent killer disease, for the simple reason that it is the only disease which ranks only to cancer. It is a disease which has been baffling the patient and the medical profession alike, for its onset, progress and treatment, and also due to various hypothesis and causes which cause onset of this lingering and baffling disease. The doctor and the patient have to maintain a close contact, in order to avoid further complications. Most of the diabetics lead quite a healthy and fairly long span of life, provided they are motivated, and guided by their physicians, at regular intervals.

Our so- called high profile and modern life-style have further added to diabetic’s dilemma, confusion and lopsided approach. Mass of wanted/unwanted suggestions, myths theories and the so-called ‘effective and curable medicines’ have further complicated this already confused disease. We are today, as confused about diabetes as we were earlier, when diabetes was considered as an incurable and killer disease. Even uptil now there is no definite curative remedy which can rid the patient of this physical upset. Thus the patient becomes a confused entity (lot) due to the reason given above. Let us agree on one point, at least that diabetes is not, at all, curable, and is positively manageable, treatable and controllable, and the only condition is that the patient has to be under guidance, care of his physician. Further, there is no escape from periodical tests also. Any indiscreet deviation could suffice to further complicate the disease.

In order to get so- called ‘Permanent and Finally Curable remedies’ the patient, in his eagerness and anxiety, runs from pillar to post, to seek relief and cure, which (two) factors land him in a state of dismayed uncertainty. He fails to stick to one system of treatment or a single physician, because his anxiety and eagerness do not let him have any respite. In such an awkward situation he prefers to use ‘home remedies’, ‘Magical Cures’, quackeryemanating formulae.’ This way, his wayward and casual approach lands him into such a complicated state, from which he cannot make a retreat.

We can only advise the diabetics, with all the honest sincerity, that there is reason for them to get panicky, disgusted or become a social recluse. Reasonable and regular caution is and should be the watchword for all diabetics and laxity in abiding to lay-down principles and irregular approach should be given a go bye once forever. Do not be ever scared and horrified that you have a dreaded disease, instead assure yourself that you are having a disease which has definite treatment which you can control.

In this book and attempt has been made to educate the patient about causes, effects and complications, cautions, diet, medicines and above all certain myths about diabetes have been removed or, at least an effort has been made to reply to certain apprehensions and myths which often arise in a diabetic’s mind. The information disseminated in this book and the suggestions given, should serve as a guideline to the diabetic. Let us not lose sight of the fact that, unless and until a diabetic’s mind. The information disseminated in this book and the suggestions given, should serve as a guideline to the diabetic has strong mental will, positive approach, a desire to learn and follow prudently and discreetly the suggestion, he may not derive any benefits. Will to learn and determination to follow the advice of his doctor are unquestioned prerequisites not for diabetics alone but all patient s suffering from other ailments.

To add to the patient’s knowledge, charts on height, weight, diet, alternate diets and diet substitutes have also been given, which hopefully will serve as guidelines. Such guidelines are merely suggestions, based on mass usage thereof, but certain modifications and adjustments cannot be ruled out. Medicinal courses and the medicines have been suggested in should be the real guide for a diabetic patient.

Some of the unavoidable technical words had to be used in this book but, to obviate the said difficulty of readers, a glossary, explaining in simple words the meaning of such terms, has been given at end of the book, which way often be referred to, as and when required. Let us pray for welfare of all and disease for none:

‘Let all the person be happy, without diseases, look to brighter side and let no person have even on iota of pain.’

Symptoms of Diabetes

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From now onwards whenever and wherever the word ‘Diabetes’ is used, it will mean ‘Diabetes Mellitus (D.M) and it will also stand equally well for Glycosuria and ‘Diabetes Insipidus’ because symptoms, in the latter two disorders, will also be noticed is Diabetes Mellitus. It would be more correct and precise if we say that Diabetes (or true Diabetes) should mean to convey presence of sugar in blood and urine, along with undermentioned symptoms:-

SYMPTOMS

1. Excessive Thirst: The patient consumes large quantity of water, quite often and in short pauses.

2. Excessive urination: Patient goes to closet again and again, passes large amount of urine. Gets up frequently, at night to vacate bladder, and passes large quantities of water.

3. Excessive Hunger: Patient has a voracious hunger. He becomes a greedy later, if not a glutten, He eats too often and too much but, inspite of excessive eating, he feels hungry and demands food every now the then.

4. Getting Fatigued: He gets tired easily even after exerting a little and also gets out of breath.

5. Loss of Weight: Inspite of consuming large quantity of food and other eatables, he feels like taking food again and again but, despite all this, he continues to lose weight.

6. Pruritus: Pruritus in intense itching of skin. But, in diabetes, there is pruritus on and around genitals and the patient, in his eagerness to gain relief, goes on scratching until there is bleeding from his skin.

7. Eye Problems: His vision becomes opaque and hazy, his retina is adversely affected. The cataract has an earlier onset. His sight is masked, weak and fatigued. Neglect may lead to even total blindness.

8. Neuropathy: It is symptom which is characterized by weak and numb nerve-power. He often says that his calves and legs are weak and senseless, his thinking power has been adversely affected, his organs are not strong enough to carry the weight of his body.

9. Pain in Body: He often complains of pains all over the body, especially in legs.

10. Malaise: Patient remains gloomy, inert and runs away or shuns to do any labour. He is often in a state of run-down of body. Not only his body but his mood also shows a depressed state. And mentally also he remains in a ‘what to do’, ‘what next’ or ‘nothing to do’ mental framework. He becomes a schizophrenic embodiment.

11. Skin Infection: pimples, scratches, rough skin, dry skin, unhealthy skin are the usual symptoms.

12. Late Healing of wounds: This a common complaint on diabetics that their wounds do not heal quickly. In fact, diabetics develop low reactive power which fails to control infections, with the result the even small and ordinary infection-based or other wounds and injuries refuse to show any declining trend. The diabetics are warned to keep their feet well protected from injuries, burns, contusions, and other such maladies. If there is bleeding they must attend to the same, to have the bleeding stopped forthwith.

13. Sexual Apathy or Sexual Excitement: Male patients either lose their urge to perform sex acts or become repugnant to sex matters. Conversely, some of the patients get easily excited and yearn for satiation of their sexual desires.

14. Phimosis: It is common complaint with diabetic males whose prepuces get constricted and thus, can’t be drawn up the glans-penis. When the foreskin cannot be drawn back, after having been once drawn up, it is called ‘Para-Phimosis.’ If Phimosis be a complication of infancy stage, then it is of congenital origin and diabetes will further compound the already existing problem.

15. Diabetic Gangrene and infection of Toes: In diabetes any foot injury can assume highly serious form, if not treated properly and timely. If any injuries fail to heal then decay of the affected part may occur, which may result into cutting or amputation of toe or any other gangrenous or infected part.

16. Diabetic Coma: it may be cause either due to absence or lack of sugar in the body. We will discuss it, in details at some other place in this book.

The above mentioned symptoms are predominant, out of some of the many symptoms. It is not that all the patients may have all the aforesaid symptoms. Many my have all, some most of the said symptoms, while others may be having only a very few of them.

HEREDITY FACTOR IN DIABETES

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Heredity is said to be a potential factor for communication of diabetes from mother to her off-spring to her off-spring or if the parents, either both or either of them, has had diabetes, their children will also have diabetes. It is true, to some extent, that if an expectant mother is a diabetic, her off-spring will also be a certainly a diabetic. But results to the contrary have also come to light. Exceptions do prove the rules, but exceptions are the rules themselves. Let us not lose sight of the fact that an off-spring has fairly higher chances of imbibing and inheriting diabetes form its mother at the stage from which she has to offer to her off-spring. But, if the mother had diabetes during period of pregnancy, especially when clinical tests had not revealed anything to the contrary or say that there was presence of sugar in urine and blood, then the off spring is liable to inherit the disorder. But drug-induced diabetes is a transitory metabolic reaction only and even if the disorder is passed on to the off-spring, there is every chance that the infant will be a born diabetic, but his symptoms may subside or even disappear, after the time he gives up breast-feeding.

But mothers, who had been confirmed diabetics prior to conception, will definitely pass on such a disease to her off-spring. It is, therefore on detection of profanely, the mother’s sugar level’ must be maintained within normal ranges so that diabetes is not passes on to her foetus. If diabetes is kept under control, in that case, the infact may not have any symptoms of inherited diabetes, but a risk factor cannot, still, be ruled out.

It may be printed out that diabetes is not a communicable and infectious syndrome, like venereal diseases, AIDS, Tuberculosis etc. as it can’t be transmitted from one person to another. If the child was born as a non-diabetic but his parents were or are diabetics, then the child or a grown up young person will not have any diabetes. But it is also true, that children of diabetic parents are more prone to diabetes, because of the ‘risk factor’. It means that such children are in the ‘red’ and there is every risk of their getting diabetes. But, to say that all of them, will become diabetes, is not fair, except to mountain that they should remain on the guard and take all possible and necessary precautions so as to ward off risk of getting diabetes, for the simple reason that they have high ‘risk factor’ looming largely over them and, as such, parents have also a sacred and social obligation to educate, guide and motivate their children to avoid the causes which can cause such a silent killer to invade their body.

Father and mothers who are indolent, inactive, obese and drunkards eating too much and too often, avoiding and physical exercise, consuming carbohydrates, fats, least of fibre-based green vegetables and fruits, must exert caution and warn their children to keep away from such factors as are patient causatives of diabetes. You cannot have diabetes of yourself and your children cured but can definitely control it by proper treatment, caution, abstention and dietary control.

OBESITY

, joint affections, asthma and dyspnoea, problems in smooth walking, easy fatigue etc. Obesity means accumulation of extra fat on the entire body, especially on and around neck, waste, abdomen thighs and gluteal muscles. Fatness is caused by too much eating, frequent eating, excessive use of fats, carbohydrates, (including fructose glucose, crystal sugar, lactose, cereals, honey, jaggery confectionery’s sugar based products etc), thyroid’s malfunctioning etc. obesity is a common symptoms of senile and easy going, gluttons, inactive and ‘chair-borna’ persons. Obesity is such a diseases (disorder, symptom) that it gives birth to high blood pressure, heart problems, diabetes, gout

Causes of Diabete

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Like the symptoms, causes of diabetes are also not few and the mass of causes to which a patient may be subjected should and do, determine as to what is the cause that has triggered this disorder. Truly speaking discerning the cause/causes, is and arduous and laborious task which can be determined by the doctor only and that also , after careful examinations and clinical tests. In brief following factors may be responsible for causing diabetes:

(1) Inadequate secretion of insulin by an endocrine gland, called ‘Pancreas’ which is known as diabetes of pancreatic origin.

(2) Heredity factor.

(3) Obesity or Overweight.

(4) Dietary indiscretion or too much of eating.

(5) Carbohydrate-protein metabolism. Disturbed/imbalanced.

(6) Malfunctioning of other Endocrine Glands, like Thyroid, Pituitary & Adrenal.

(7) Alcohol

(8) Sugar takes in excess

(9) Drug induced diabetes etc.

Out of the above-mentioned factors, we can further shorten the said list with following major sub-headings.

(1) Heredity

(2) Obesity

(3) Diet & Food

(4) Endocrine Glands’ Malfunctioning

(5) Drug-induced Diabetes.

Now the above factors will be explained in details, under separate individual headings, at later stage.

FACTORS AND EFFECTS OF OBESITY

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It is the result of common nutritional disorders and is a trait of the affluent and rich societies since mortality factor is very much aligned to it. It is a breeding ground for most of the killer diseases, as also other ailments which one could avoid easily. Every cause gives rise to an effect and every effect in turn, is capable to causing other effects. The theory of cause and effect fully applies here. An effect must have a cause, similarly, all causes give rise to certain effects in medical parlance. It won’t be out of order to describe the factors which cause obesity which, as is generally and very rightly believed is the mother of many physical disorders (diseases) so, first of all, we will take up those factors.

FACTORS

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1. Energy-Intake: Imbalance between energy intake and expenditure thereof causes extra fat in the body, giving rise to many odd clinical signs & causes.

2. Heredity: It has been seen that, in certain, families, there is a tendency to fatness. Eating patterns, genetic factors and activity are closely related t economic, social and cultural factors and such factors are handed down from one generation to another. But, genetic factors do influence body fat and distribution thereof.

3. Endocrine Factors: This factor influences both pathological and physiological states. Hypogondalism, hypothyroidism and hypopituitarism are also contributory factors for causing obesity. Sometimes, Cushing’s syndrome is also accountable for obesity. On the contrary, clinical tests of certain person also do not reveal any endocrine disorder, leaving aside some glaring and rare exceptions. In women, obesity is a common symptom during menstrual periods-at the time of puberty, during menopause and during pregnancy.

4. Social Factors: Our audio-video publicity, in magazines, papers, T.V.radio and other such means have contributed a lot to the changes in our eating patterns, styles and habits. Eating an eatable of a particular brand had become a symbol of social status, problems multiply when we sacrifice out natural instincts to eat, to play second fiddle to fast food, junk food, fried food and canned pouched or bottled food. The bitterest fact is that hunger and satiety are compelled to be relegated to back-seat, instead we are led by external factors, like taste of food, availability and environment. Unluckily, obese persons are more prone to such pranks and temptations. What is required is, either it is not available or what is available is not required. In such case filling the belly seems to be the main object. Obeses persons eat more but have the lowest energy-expenditure. Imbalance between food (more) intake and less expenditure of energy which is main cause for obesity and resultant diseases.
Very often and especially in social gatherings and functions, obeses persons are indiscreet in eating those very food items which are harmful to them. Obese persons are generally avaricious people and they can’t control themselves. They are more led by taste than by necessity.

Expenditure of Energy: simple principle is to eat when you are hungry and never eat stomachful, but these golden principles are given a go-bye by the greedy obese persons. It is also an oft-repeated maxim that ‘After lunch, rests a while, and after dinner ‘walk a mile.’ But ‘rest’ does not and should mean a 2-3 hour sleep after lunch, rather it should be a ‘Nap’ only. Physical activity must commensurate with the amount of food intake. It should not however, construe that exercise will rectify all the dietary over-indulgence.

Obese have been seen to lead an inactive and inert life. When there is no physical activity to expend energy, generated by eating food, there is bound to be extra fat which, inturn, is enough capable to enlarge scope for host of diseases. In whatever form physical activity is resorted to, it must suffice to burn the calories generated by food-intake. It is no use over-loading your system with extra calories, when you do not have an urge to expend energy. It is a also maintained that thermic response to food may be less than normal in the obese persons, thus leading to greater and more conservation of energy.

Drug-Induced Obesity: Constant and prolonged use of oral contraceptives, insulin, steroids, and phenothiazines stimulate appetite and thus the patient is inclined to eat more. After pregnancy and delivery of child, especially when the confined and nursing mothers are given aforesaid medicines, there is every change of their gaining weight, and thus become obese. Pendulous abdomen and heavy back are the symptoms during postnatal period,

General: Obesity should not be confused with weight gain, because one can have over-weight due to retention of fluid in the body, due to renal, cardiac
or hepatic, and clinical tests hardly reveal such manifestations until there is increase, at least by about 15% of extra-cellular fluid.

Obese people should follow, as a matter of practice and conviction, certain norms and disciplines, such as health charts, weight charts, calorie-based diets, alternate diets, height and weight charts (please refer to relevant chapters and also at the conclusive stage of this book, for further guidance and knowledge) to work a scheduled plan so that they can shed their extra weight.

COMPLICATIONS OF OBESITY

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1. Disorders: Obese are more susceptible and prone to elevation of triglyceride and cholesterol (also known as ‘Hyperlipidaemia’), stones in gall bladder, hyperneusccalmia than general population. The said complications raise part in cases of non-insulin dependent diabetes mellitus (NIDDM) than insulin dependent patients.

2. Psychological Complexes: Because of their shabby-looking and bulging bodies, obese people avoid social gatherings ad functions. Others may like to meet them, even if for the sake of fun, but they would like to have company and the time, which they had to spend with meeting people, is utilized in eating (rather overeating). Young adult females feel ashamed abhor or avoid company, because of their none too-pleasant appearance and disproportionate bodies, they also develop sexual and physiosocial problems.

3. Mechanical Disabilities: These are nit ‘mechanical’ disabilities in literal sense of the term. Here the word ‘mechanical’ means the organic (not mechanical) disturbances of our physical system which emanate from obesity. These may include effort-onset breathlessness (Dyspnoea) enhanced susceptibility to other respiratory infections caused by interference with mechanism of respiration, of adipose tissue around the trunk. Abdominal and diaphragmatic hernia may also ensue, due to the very fact that abdominal muscles, supporting the Viscera and leg muscles (whose contractions promote venous return) are less efficient. Further, asteo-arthritis of knees, hips and lumbar-sacrel spine, apart from that in feet, are more common in the obese than with the non-obese, the latter are by no means immune to such disorders.

4. Disorders of Cardiovascular System (C.V.S.): Obesity puts extra weight and strain on heart, forcing it to work more than its capacity, as a result of which the heart also increases as the obesity and body-weight rise. Blood pressure (high) is a common problem, apart from substantial increase in cardiac output, blood volume and stroke volume. Main monster, which is responsible for causing many heart problems, is the thickening of blood vessels, narrowing of blood vessels, due to higher concentration of cholestoral. Ischalmia of heart is another complication of obesity which owes its origin to physical, inactivity apart from other factors.

5. Life expectancy: But for the side effects of obesity, the obese might have enjoyed longer span of life. 10-15% over-weight may not adversely affect much life span, but 30% increase in weight will reduce life span, and 40% increase will lead to 50% life span. The lower the weight (that weight within 10-15% increase is standard weight) the linger the life span.

6. Digestive complications: This again is a compound set of disorders like flatulence, burning sensation. Nausea or even vomiting, acidity, gastritis, gastralgia, gastrodynia, bilumy etc which are directly also related with over-eating and Physical inactivity. So the trio of overeating, physical inactivity and obesity should be handled judiciously and in a well thought out and planned way. There is, however, no room for laxity, indiscretion in food-intake, and physical activity. The obese should never adhere and resort to any so-called ‘Quick weight reducing’ methods which benefit none but the advertisers. First of all, single out the cause(s) which is /are considered to be responsible for adding to fat and , if the cause is attributed to any disease or other disorder, mere removal of the discerned cause, will pave way towards weight reduction. Further, never take any drug which claims to prove as a ‘wonder weight-reducing’ medicinal device. It has often been noticed that such drugs adversely affect appetite.

Obese people have plenty of time for eating, working, attending to functions and social gatherings, for useless and unproductive entertaining devices but, alas!, they have no time to devote to their health problems much less to shed down their weight or for any physical exertion. Even going to Gyms and so called Health Clubs have become a matter of social status and publicity but only a selected few go to such places to gain actual benefit. There is a mushroom growth of such health centres which are hardly of any benefit.

In order to get rid of many disorders, which often affect the obese and give rise to many other coincidental side-effects, should follow a course of dietary control and physical activity, in consultation with their dietician/doctor and also a person who could guide them, as to what exercise would be of use to them, keeping in view their physical status and health problems.

DIET (including carbohydrate metabolism)

Diet plays an important role in diabetes. It will depend on health status and also what amount of oral, drug(s) or insulin a patient takes. An attempt should be based on to a achieve a flat profile of glycaemia throughout the duration of 24 hours. By and large, dietary pattern is required to be modified quite often, in view of rise and fall of sugar levels in blood and urine. Once a dietary chart has been finalized, based on the condition of the patient, it should be closely and honestly followed by the patient. Any deviation, if desired or needed, should always be done in consultation with the attending physician, but never by the patient himself.

FACTORWS TO BE KEPT IN MIND, WHILE PRESCRIBING DIET

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It is pertinent to point out that specified diets charts cannot and should not be prescribed for two persons, alike, who may be having, if at all, identical symptom. Following factors must be kept in mind while prescribing a dietary regimen :

1) Age, sex, profession, health status, as also diabetic status of a person must be taken into consideration, while preparing a dietary chart.
2) Diet prescribed should be within financial reach of the patient. If costly food-items are prescribed, the patient may not be able to stick to it.
3) Diet must be related ot the quantum of physical labour put in by a patient. For instance, a laborer would require more and higher calorie, based diet than a person working in an office, similarly in IDDM cases, one must be careful not to keep oneself without food, especially after taking an insulin injection.
4) NIDDM patient’s diet will differ from Insulin dependent patient, because the latter will require more quantity of carbohydrate as compared to the former.
5) Prescribed diet should not be monotonous. In order to avoid such monotony, patient’s diet should often be substituted by alternate food items.
6) Food must be tasty, otherwise the patient may be compelled to violate the dietary restrictions. Diet- menus of breakfast, lunch, supper and dinner must be often changed, without sacrificing the basic requirements in this regard, so that the patient does relish his food, instead of thinking that he has been subjected to and forced into a dietary pattern to which he is averse.
7) Diet of a child, growing child, pregnant woman, workman, labourer and that of an office workers should be designed and tailored to meet his physical and professional requirements
8) Prescribed food should be liked by the person so as to satisfy his taste-buds or else he will be forced to seek deviation of his own choice.
9) Food must also be satiating, that is after taking his food, the patient should feel fully satisfied and also feel that his hunger has been satiated or else he will often eat more and more.
10) Calorie-based diet should be a complete blend of well-balanced carbohydrate, protein, fat, vitamins and minerals, in addition to green and fibre-based vegetables.
11) Constipation is a common and normal complication of diabetic and if the prescribed food does not have enough of roughage, his complication will become still worse. A diabetic’s diet must have plenty of fibre, green vegetables, low-carbohydrate, bran and citrus fruits.
12) A healthy person normally requires about 100 to 300 gms of carbohydrates, 50-80 gm protein, 50-100 gms of fats, in addition to green and fibre rich vegetables and fruits. A diabetic’s diet should have less of carbohydrates, but not less quantity of protein, rather protein-intake should be increased. Fat content will be determined by the level of cholesterol in the blood, as also heart condition, and digestive capacity of the patient.
13) Easy availability of prescribed food items is of almost necessity. If the prescribed item is cheaper and useful also, but is not available easily (or if available, at the exorbitant rates), the patients shall be obliged to bid good-bye to it. The patients with limited resources and the ‘have nots’ are as lucky as the ‘have’ are, hence the former will develop a sort of inferiority complex for his inability to procure. Such diverse situations should always be avoided, if not eliminated once forever.
14) Those addicted to drinking should gradually taper their alcohol intake, as sudden cessation/withdrawal may have some psychological, emotional and physical upsets.
15) Dieting restrictions should never develop a feeling of “going off my diet”, fear of under-eating or over-eating. Dr. Joseph I Goodman says “Nutritional neurosis and food faddism” “should not disturb and cause any fear to the diabetic patient, much so his rest of family members.”
16) Let the other family be started of such foodstuffs which are forbidden to a diabetic who, on certain gatherings may also join others in eating and drinking sessions, but imprudent discretion should not outweigh sense of proportion.
17) Now a word about sweets and alcohol, again quoting Dr.Goodman, “The medical evidence is clear: Neither sweets nor alcohol are, in themselves, harmful to diabetics. Since the forceable removal of these items form the diet can produce severe neurosis in diabetics and their families, this alone is an ample reason to make certain that the age-old stigma against such items is erased. But there is more. The evidence is also clear that the removal of such sources of carbohydrate from the diabetic’s diet can do physical as well psychological harm. It can result in dangerously lowered levels of energy on the one hand and increased levels of cholesterol and triglyceride (cholesterol-related fatty acid) on the other.”

STANDARD DIET FOR DIABETIC PATIENT

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There are no hard and fast rules to govern such a patient’s daily food requirements. It is height of imprudence to hold diet and the patient responsible for any fluctuations in blood sugar level, for the simple reason that diet is but one of the various factors that cause and precipitate onset of diabetes. Japanese, Germans, Negroes consume carbohydrates in much more quantity than the Indians, but incidence of diabetes is far less in the former and far greater in the latter. To hold excessive use of carbohydrates, as the only contributory cause and main culprit, for causing diabetes, is nullified by the aforesaid example.

It is not possible to prescribe a calorie-based diet for such and every diabetes patient. It is neither feasible nor advisable, for the simple reason that every patient’s life style, food-patterns, amount of labour expended during work-period or quantum and duration of rest, habits of a person, apart from age sex etc. differ. So, a uniform dietary pattern cannot be worked out. For instance, if a diabetic person, working in an office, takes to a field job or traveling job, his calorie intake will naturally vary and such a suddenly changed situation. If he sticks to his physician’s dietary directions, he will, in all probability, fall a prey to hyperglycemia. If reverse is the case, he is liable to suffer from hyperglycemia in such a situation, the patient has to be his own master because in a lowered sugar level,. He may even meet his end if he is not fully aware of crisis management of such odd situations.

A WORD OF CHEER FOR THE DIABETICS

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They are strict conformists to their eating patterns, rather better than the non-diabetics. They are cautious and punctual also. They take their doctor’s advice in right earnest and comply with the same. When a patient is admitted to some hospital, he is kept on closely measured diet but despite this, the blood/urine sugar levels do fluctuate, despite regular monitoring and medical care though his physical activity remains constantly the same. If in such a controlled and monitored situation, a patient can have the said fluctuations in blood and urine sugar levels then who is to blame-the patient or his doctor? It is certain that doctor and his attendants should shoulder the responsibility. Further dilemma is that ignoring the same anticipated supposed amount of physical activity coupled with normal workload of the dietician and the doctor prescribe the same diet when, infact, the situation has dramatically taken a turn about. So, dietary restrictions and prescription thereof to a diabetic patient does not seem to hold the ground, in view of the above quote instance.

Departure form normal food pattern is no crime nor should it be condemned. It is not physically possible for a diabetic or his family members to strictly stick or remain glued to a set pattern of precise measurement of food intake or complex food exchanges and meticulous calorie counting . Whenever there is any fluctuation noticed in sugar levels, the doctor, at once, concludes that the patient has deviated from his counsel. But, it is generally not the case.

“Certain dietary pattern, the complexity and confusion of the diets are not the only self-defeating factors. Quite often the diets call for types of foods or preparation so different from the family routine that they become disruptive. The inclusion of expensive diets can become a financial burden. And, most important, too often doctors and dieticians fail to a diet to fit the bodily requirements and life style of the patient.” And continuing his observation Dr. Goodman goes on to add that “Men who require 2500 or even 3500 calories per day, for example, are given diets containing only 1800 calories. Such errors made for thin men as well as for heavy, women as well as (for) children. Why?” Dr. Goodman’s ideas conform to what has been written and stressed upon heretofore.

In view of the above, calorie-based diet is no criterion for control diebates nor is it a fool-proof method. Its basic motive and concept are really laudable, but its prudent applicability has often been abused and distorted.

While prescribing a calorie-based diet, the following considerations must be kept in mind. Some of the points, mentioned hereunder, may look to be a rehash/recapitulation of what has already been said (and more so when opinions differ on this aspect)

DIETARY REGIMEN SHOULD BE BASED ON FOLLOWING FACTORS:

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1) Duration of diabetes affection and ravages wrought by it on various organs of the body.
2) Age, sex, profession and health status of the patient.
3) His age, life style, dietary pattern, financial position.
4) Diet should be nutritious, devoid not only of monotony but should also be tasty and satiating.
5) It should not disturb family budget and dietary pattern of a family.
6) It should be complete and well-balanced, as for as suitable blend of carbohydrates, protein, fat, vitamins and minerals are concerned.
7) Present diabetic status should form basis for dietary regimen.
8) Only minimal and very essential/reasonable conditions should be put in the patient so that there is no room left for his wrong & voluntary deviations.
9) Patients should be guided to adjust his diet as per his glucose level in blood and urine. This is called self-management technique.
10) Dietary regimen should not force the patient to become a social recluse.
11) Care must he taken to ensure that dietary regimen is not allowed to stretch to a fasting (or still worse to starvation) and clearly advised neither to be too indulgent nor instinctive. A middle path, balancing of both the facts, should be carved out and followed strictly, leaving enough scope for the marginal and emergent situations.
12) Any sudden deviation should always be avoided.
13) The members of the family should also be guided properly about the safeguards and precautions while preparing for and serving food to a diabetic.
14) Gradual withdrawal from certain food items, if prohibited or considered harmful, should be stressed upon and , in this aspect, patient and his family members cooperation is of utmost help.

DIET FOR CHILDREN

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While prescribing a calorie-based diet for the young ones, following points may be borne in mind:
1) If dietary restrictions are put on a child, it should always be kept in mind that the young one has been subjected to this agonizing malady and should not be made to suffer either mentally or physically. Further his diet should be designed in such a way that his needs for maturation, growth and development must not be hampered.
2) IDDM is a serious problem for the child and his parents, because he has to take injections regularly and after injections have been taken, he must be given a high calorie-based diet otherwise his blood sugar level will fall and hypoglycaemia stage may ensue. Food, prescribed for the child, must meet his physical, sport-related exercise based needs.
3) They should eat before and if needed during period of competition and there is no reason why a diabetic child should not participate in sports, attend to his normal study courses and other daily chores but the only pre-requisite is that his diet must be tackled to meet all his such and all other requirements. No diet should be prescribed which fails to meet a child’s requirements of body, might, intellect and an all-round development.

Note:- How much calorie is required per day for a certain type of diabetics, can be determined and decided by a dietician and physician, keeping in view the factors mentioned heretofore. But, for the convenience of the patients, diet charts, based on calorie-based diets are merely suggestive and do not and cannot have relevance to actual calorie requirement of a person. At best, they are only guiding indictors and should also be deemed to be so. The readers may refer to such charts to get a first-hand and basic knowledge and guidance about diet and calories, given at end of this book.

SUGAR DISORDER DUE TO ENDOCRINE GLAND’S MALFUNCTIONING

Following endocrine glands are said to cause diabetes, if their secretion is not normal.
1. pancreas
2. Thyroid _ This aspect will be dealt with, in details, later on.
3. Pituitary
4. Adrenal.

Metabolic Factors in Diabetes

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Our body is, as is well known, cell-based entity. In order to keep alive and in functioning condition cells play an important part and they can function only when they are nourished and compensated by various food constituents, like carbohydrates, protein, fats, vitamins and minerals, for which various chemical processes take place, within out body, thus enabling it to receive energy. Energy is generated by various food constituents, as indicated above. Body uses and utilizes these food-stuffs as fuel which gets exhausted (or burnt) by oxygen and the resultant end product emerges as energy, heat, carbon dioxide and water. Energy is a motivating factor which helps the body to perform its various functions.

CARDOHYDRATE METABOLISM

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Carbohydrate is a major part of out food, which, is derived from potatoes, sugar and sugar-based food items, like sugar-cane juice, crystal sugar, jaggery and unrefined sugar, fruits like grapes, mangoes etc. in fact, even oranges, limes, peaches, lichies, loquats, berries etc. also have enough portion of sugar contents. Among cereals, wheat flour contains maximum amount of carbohydrates, as also its bi-products.

The starch, generated by the food we take, when intermingles with various enzymes, present in out intestines and end-product of this chemical process is glucose. Glucose remains stored in our liver and is released only when our body needs it. Glucose, after being absorbed into intestines, travels to liver and remains stored there in the form of glycogen which remains stored therein until and unless body-cells need it to provide energy to body. When body-cells need it, it gets converted into glucose and its unutilized portion enters the blood stream for onward travel to body-cells. Fats and protein also generate glucose.
Entire quantity of glucose generated by food does not convert into glycogen due to various metabolic factors. Liver has limited storage capacity and entire quantity of glucose, when it fails to convert it into glycogen and the liver also fails to store it, then the excess quantity of glucose (140mg per 100 It.) passes on to urine, and thus there is presence of sugar in the urine. Further, various enzymes and secretions, including insulin, also mix up with the blood stream and try to control absorption of sugar in the blood. But, due to lack or insufficient secretion of insulin, the sugar (glucose) release is passed to blood steam which also causes rise in blood sugar level. Presence of sugar in urine and blood will suffice to confirm diabetic status of a person. Due to metabolic disturbance in sugar absorption, certain functions of the body are affected, giving rise to various symptoms, which have already been pointed out earlier. A gram of carbohydrates generates about 4 calories.

Due to above carbohydrate factor, consumption of much sugar is considered to be the chief cause of diabetes, Excess of sugar is not a true and definite indication of DM, for the simple reason, that if a person consumes abnormal amount of sugar producing foodstuff, the excessive amount (after the body has already utilized its required quantity to meet its purpose) of sugar will pass on to urine but when the person returns to normal intake of carbohydrates, his urine will not show any presence of sugar. But, if the blood also shows higher glucose presence, then only it is a true case of DM, when blood sugar level crosses is normal (optimum) range, then the extra unconsumed sugar appears in urine. As for blood sugar tests and their details, we will take up its details, later on, so as to give one and all a clear pathological picture on clinical tests etc.

It is not that the carbohydrate factor is the only factor in diabetes. As maintained earlier, insufficient amount of insulin release by the pancreas, further complicates and precipitates sugar-absorption process. For instance, if one takes sugar in excess but his pancreas release sufficient amount of insulin to help quick absorption of glucose (sugar), then there won’t be any amount of extra unabsorbed sugar which could ever pass on to blood stream. Conversely, if a patient’s body generates sufficient amount of glucose but his body requirement is not in proportion, to the amount of glucose(or glycogen, stored in the liver) generated and, above all, the secretion of insulin is in larger quantity, then the patient is bound to have hypoglycemia (low sugar content in the body). The following comparison will clarify out view point.
a) More intakes of carbohydrates generate larger quantity of glucose. Liver stores glucose according to its retentive capacity. Excess generation but non-retention of glucose passes on to blood stream and there is lack of insulin to absorb it. Hence sugar passes on to urine and blood, causing a state of hypoglycemia.
b) Even if there is higher quantity of sugar, due to excessive intake of carbohydrates and liver also stores glucose as per its retentive capacity. The excess quantity of glucose is released in the body via blood steam. Now, even if the glucose requirement of body is high along with higher secretion of insulin, the glucose released by liver and also the excessive quantity is absorbed by higher quantity of insulin-release. In such a situation, the body cells do not get sufficient glucose to feed various body-organs and as a result of which sugar/glucose level falls down below normal limits which, in turn, result in hypoglycemia. Both the aforesaid, hyper and hypoglycemia states do not augur well for a person’s health condition. Hence, both extremes should be avoided or at best, an honest effort must be directed towards avoidance of such high and low sugar levels.

It does not mean that energy-generating carbohydrates are not useful for the body because our body does not and cannot function without energy which is provided by food, rich in carbohydrates. Energy, generated by food, is the end-product of glucose. For the diabetics, a tapered quantity of glucose can be can be determined by present state of blood sugar level. Persons with low sugar content in their blood will require higher intake of sugar-rich carbohydrates to compensate for the low sugar levels.

It may be noted that the sugar obtained from fruits is called ‘Fructose’. From the milk it is called lactose and that which is obtained from sugar etc. is called ‘Glucose’. As for the sugar content, glucose, fructose and lactose in descending order should be termed as highest, high and low. Certain fruit sugars, like grapes and mangoes, have high percentage of sugar content.

Generally 60% of the foodstuff eaten should consist of carbohydrates, 40% of protein and 20% of fats, providing also sufficient extra quantity for vitamins and minerals. But above mentioned percentage will require to be tapered according to condition of the patient. Thus, obese and hyperglycemias will require less carbohydrates and hypoglycemia, and weak persons will require higher percentage of carbohydrates. Calories required by a person, during 24 hours, will actually determine ratio of said essential food constituents and nutrients.

PROTEIN METABOLISM

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Main component of protein is amino acids which are off-shoots of Nitrogen, Sulphur, Carbon, Hydrogen and oxygen, that is , when these elements combine together, they give birth to amino acids which, in turn, are the main stay of protein. Proteins are converted into amino acids by the body’s chemical processes which help to build up, strengthen and sustain tissue in the body. Not only that, amino acids re-build up the worn out and impaired tissues, especially during disease and old age. Extra amount of amino acids are converted into glucose by the liver. Nitrogen is an important constituent of protein, which is excreted via urine in the form of urea. In diabetics, proteins, instead of breaking into amino-acids, break into glucose which helps, the blood sugar level to rise. Excess of protein also damages the kidneys, enhances albumin and creates various disorders of digestion. But all said and done, tissues and muscles do require protein for growth of body tissues and for their repair when damaged.

Protein is abundantly found in soyabean, vegetables, animal sources like milk, butter, other milk products, eggs, fish, meats, pulses, maize, corn, grams etc. For the vegetarians soyabean, pulses and milk are the best sources of protein, and for non-vegetarians fish and eggs are the best sources. In food, protein should form 40% part of a diet. In any case, escape of protein, through urine, should always be guarded against, otherwise protein urea may result in, damaging various vital parts within the kidney, sometimes in conjunction with other-precipitants.

During growth stage, protein is required in higher quantity for proper growth of body, along with other necessary nutrients. In health, the body converts protein into amino-acids which serve to strengthen the tissues but, in diabetes, amino-acids are converted into sugar. Due to limited retentive storage capacity of the liver, the sugar, so produced, finds its way into the blood steam along with sugar generated by carbohydrates, as a result of which excess quantity of sugar gets spilled over to blood stream, causing rise in blood sugar level. The fact is that liver fails to convert excessive amino-acids to glucose. From infancy to old age protein continues to remain an essential nutrient for the body. One gram of protein supplies 4 calories and, in dietary charts, its various sources are utilized to make up for protein supply and supplementation job.

PROTEIN METABOLISM

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FAT METABOLISM

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Like protein, animal food and vegetable foods supply fats to the body. Fat contains maximum of calories (9 calories in a grain). Fat supplies more energy to body, as compared to carbohydrate and protein, and this is why its percentage is the lowest in dietary charts, excepting a very few and rare cases where fat intake is more. Fat, taken into the body by food, is converted into fatty acid ad glycerol which deposits in various body orgains. If there is sufficient amount of carbohydrate stored in the body, then extra carbohydrates are also converted into fat. In a healthy person’s body, fat expenditure (or burning or consumption of fat)produces water, energy and carbon dioxide. But, during diabetes and starvation situations and due to lack of presence of carbohydrates in the body, the fast, instead of converting into the said three bi-products convert into ketone bodies, thus giving rise to symptoms of diabetic ketoacidosis/ketosis.

In addition to production of ketone bodies (1) Acetone (2) Acetoacetic acid and (3) Beta (b) hydroxybutyric acid are produced by lack of carbohydrates. Abnormal amounts of acetoacetic acid also arise in the body due to inadequate amount of carbohydrates and increased amount of fats are used for energy build up. Excessive presence of the said three constituents (factors) results in their expulsion through urine. Such a situation gives rise to a serious disorder, called ‘Acidosis” in which condition, the acetones are expelled by the urine. If such an abnormal condition is allowed to continue, the patient slips into ‘diabetic coma’. Such an extreme situation should never be allowed to develop and if developed, should be treated without any delay.

Fats can be divided into saturated and unsaturated varieties. For a diabetic, heart patient, and patient of blood pressure, arterio-sclerosis, coronary heart disease, with high cholesterol, saturated fat is a poison. In fact, all the aforesaid disorders, in one way or the other, are caused by high consumption of saturated fats which are found, in plenty, in vegetable oils and animals meats. Such patients should always adhere to a low-fat or a totally fat-free diet, and all the necessary fats should be obtained from milk (skimmed), soyabean milk and above all, vegetable oils like from sunflower oil and til oil, groundnut oil which do not saturate in the system. Of all these sun-flower oil (refined) is said to be the best.

I had read somewhere that, in Germany, Germans use sun-flower oil to ward off and cure heart disorders. Take 10 ml (one tablespoonful) sunflower oil, without washing your mouth, in the morning, on rising (nothing should be take before that). Revolve the contents for 10 minutes in the water and rinse your mouth with lukewarm water thereafter. Later on, you may use toothpaste or any other means to cleanse your mouth with lukewarm water. But, it has be continued for a fairly long time. It is said to activate and regenerate blood vessels of the heart. Further, it may also be of use to asthmatic patients.

GENERAL HINTS ON DIETARY INTAKE

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There cannot be any pattern which should guide and govern dietary pattern for all diabetes, for uniform application, for the simple reason that dietary recommendations for children, growing young persons, obese, pregnant diet may not be suitable for the other. Dietary regimen and intake will depend on the chemical symptoms and findings. Following hints, on diet intake are only general guidelines and may have, often, to be modified in accordance with diabetic status of a patient. In a diabetic patient, proper consideration, as to diet intake, should be based on chemical finding, age, sex general health status of a person, his profession and energy expenditure availability, affordability and financial status etc.

DIET FOR IDDM PATIENTS (including children)

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(1) Such patients must take sufficient food after insulin injection because insulin lowers blood sugar level instantly and to offset the effects thereof, food must be taken, with reasonable amount of carbohydrate, to compensate for the ravages caused by insulin. Insulin is given to growing children and also to indoor patients due to be operated (who are diabetic). In such a situation, blood sugar level should be continuously watched and, if necessary, matched by proper and requisite intake of food.
(2) For growing children, it is a knotty problem because if we reduce their diet quantity, they will get weak and be unable to carry out their studies, games and other physical activities. Child’s physical and mental activities and faculties must be preserved.
(3) The parents should educate, guide and mentally prepare the child about his having diabetes and precautions and restrictions he would be required to follow, without creating any fear in his mind (called a Diabetic Niurosis). A child (1-10 years) will require 1000 calories diet, and after he has crossed 10 years, addition of 100 calories per year of age, should be added. And for 11 years onwards a diet having 2000 calories will suffice. From 15th year, add 200 calories for boys and 100 calories for girls (per year of age).
(4) It is not possible to restrict a child from taking sweets or sugar. Strenuous exercises and games, where too much energy is expended, should be compensated by (Before and after physical exercises and games) food items like biscuits, sandwich, matthi, Bara, samosa etc. In any case, hypoglycemia states should not be allowed to surface, because child cannot be expected to self-management of such extreme stages. The child should not suffer from ‘Fear psychosis’. As the sugar level is controlled, insulin intake will be tapered and as a result thereof, the child can return to his near normal diet, but precaution is still a watchword. So, while prescribing diet for an insulin dependant child, factors like his age, health, infection to certain diseases expected and actual amount of labour put in, his study-load etc. should be borne in mind.
(5) periodical guidance is a pre-requisite for the IDDM patients because, as soon their blood sugar changes (whether higher or lower) , his insulin and diet intake would required to be changed as per chemical tests. The child should never feel let down or dismayed. Instead his moral should always be boosted.
(6) As for the elderly IDDM patients, management is not difficult but expert counseling cannot be ruled out. Regular check-ups, chemical tests, constant or periodical contact with the physician and strick regimentation are all the more necessary, Elderly persons can easily follow the instructions of their doctors. They, too, should restrict excessive food which is rich in carbohydrates but not after taking the insulin injections, they must take enough food to offset bad effects of insulin. In any case extreme situations should always be prevented from happening and if any such situation occurs, timely action by reducing or taking excessive intake will meet the emergent crisis.

DIET FOR NIDDM PATIENTS

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(1) As said earlier, to lay blame squarely, on low or high blood sugar levels on diet-intake is height of imprudence. NIDDM patients have to depend oral drugs, along with dietary regimen. Such patients are generally aged above 35/40. in such patients diet plays an important part, in controlling or aggravating diabetic symptoms, but diet control is not the only means to control diabetes. Persons, who are obese and senile, should be more careful because, if they eat too much but do not resort to physical mobility, they will have their blood sugar raised to even dangerous levels. Neither food control nor only drug-use can help to control diabetes. There is sufficient evidence to prove that, in most of the diabetic cases, much improvement has been achieved by diet control alone. In such a situation oral drugs were never required which clearly means that diabetes in such patients was due to relaxations in diet but as soon as dietary indiscretion were given a go-bye, the disorder was controlled.
(2) NIDDM patients, id on oral medicines, should not allow gap between medicine and food. If the gap gets prolonged, sugar level in blood may fall. But, that does not construe that they should overeat or take meals stomachful. They should take plenty of green leafy and fibrous vegetables, citrus fruits, protein-enriched but low-fat and carbohydrate-based diet.
(3) Diet intake should also meet requirements, for diet to be taken, if the patient has blood pressure, constipation, any heart problem, any nervous disorder or any other disease. The diet should be nutritious, tasty, affordable, not monotonous and, above all, should conform to diabetic status of a patient. Timely food-exchanges are quite essential to retain taste buds. In eating, avoid monotony at all costs.
(4) Those who can afford may switch over to juices of vegetables and fruits (which do not contain sugar), coupled with protein-enriched but low-caloried cereals. Main purpose is to cut down intake of carbohydrates but then its total elimination can spell disaster on many health fronts. So, don’t totally avoid taking carbohydrates. Instead taper down their quantity. Avoid fats as for as possible. Diet relaxation may be required when sugar level falls down, when high carbohydrate diet will be required as an exception, but never as a rule.

DIET FOR BORDERLINE DIABETIC CASES

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Such persons are not confirmed patients of diabetes and rise in sugar levels can be attributed to sudden mental stress and strain, drug-induced diabetes and to some extent, to dietary changes. Such persons can be subjected to diabetes at any time. Marginal rise in blood sugar level should be watched for some time and the patient should never be put unnecessarily to any dietary or antidiabetic drugs. If it has been caused by some overuse of some drug or reaction thereof, effect is nullified. Hence, any haste in diet modification should be avoided, unless and until it has been established beyond doubt, that diet was the only culprit. It may be noted that in such borderline cases, a constant watch and monitoring is necessary, leaving no room for hypothetical forebodings.

It has been seen that indoor patients, due to diet modification and medical treatment during their incubation or pre-operative and post-operative periods may show slight rise in their blood sugar level. But, when they resume their normal chores they have no such odd problem. To be on the cautions side, such patients (?) should slightly taper down their carbohydrate intake and also keep a close watch over their sugar levels. Unless confirmed, by chemical findings, no dietary modification should ever be advised.

COMMON GUIDELINES, ON DIET, FOR ALL DIABETICS

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To sun up what has been written earlier and also, in addition to other point, following hints may be of some use:

(1) Always take meals at the same time daily. There may be save circumstantial delay due to which diet may have to be delayed but such delays should not be a permanent feature of daily life.
(2) Occasional diet changes should be made so as to avoid motonomy of eating same type of diet each day.
(3) Breakfast/morning diet, lunch, supper, dinner should never have repetition of the same eatable item. Let in be replaced by another food item, having equivalent calorie value.
(4) Never eat stomachful, rather take your diet in divided quantity at different times. The reason is that, if you take plenty of food items at one serving , Your blood sugar will amazingly rise up. But, on the contrary, if you take diet (say 5-6 times) in divided and measured quantity, your blood sugar will rise proportionel which is known as sustained rise is sugar level. Sustained rise is always preferable to sudden rise.
(5) Some experts say that diabetics should, as matter of habit, eat after every two hours in very limited quantity each time. If such a regulated time-bound chart, coupled with measured ad minimal quantity of food items could be worked out and practiced then, body will automatically adjust itself to scheduled and time-bound diet-intake. If such a pattern could be feasible, the patient will have sustained rise in blood sugar level which is often within sustainable limits.
(6) Diabetics should never take any anti-diabetic oral drugs on empty stomach. They must eat something before taking such drugs. It should be made a routine practice. If drug intake is conformed with food intake, there cannot be any confusion and fear of sudden repetition of dose, due to forgetfulness, can also be avoided.
(7) For IDDM patients it is of utmost importance to have diet, after taking insulin injections, otherwise a hypoglycaemia state may ensure causing his insulin injection before boarding the plane but did not ear any late. By the time he landed from his plane he was over perhaps as a result of hyperglycaemia. Such patients must keep some sweet stuffs with them whether they are IDDM or NIDDM patients. We repeat hypoerglycaemia is far more dangerous than hyperglycaemia.
(8) self- management of diet is the key-word for the diabetics. They should themselves make all efforts to procure, preserve and consume all the requisites which have been prescribed for them. They should also educate their family members about the dietary schedules, timings and restrictions so that the meetings, at launching table, are enjoyable and without acrimony.

Symptomatic Complications in Diabetes

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RENAL THRESHOLD

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The said term is of no consequence to a confirmed/prospective diabetic. It simply means that there is a simultaneous rise of sugar in the urine alongwith rise in sugar in the blood. Generally, there is hardly any rise of sugar in urine when blood sugar level remains upto 150-160 but when it exceeds that limit, there will be corresponding rise of sugar (glucose) content in the urine also. A trace of sugar in urine does indicate that blood sugar level has exceeded the normal limits. As the level of sugar rises in blood, so does the sugar level rise in urine too which position is taken to be ‘Normal Renal Threshold’ and anything contrary to the above facts will point out to ‘Disturbed Renal Threshold’.

There are certain exceptions to two varying situations described heretofore, that is to say that, in some patients, rise in blood sugar level may not show even a trace of sugar in urine and also, in other patients, reverse may be the case. A diseased or infected kidney may be said to be cause for the aforesaid two variable situations. The diabetics need not bother or get unduly worried about the said variations, as it is the job of the physician to look to such technicalities.

If, however, the renal threshold is low but the urine test in diabetes indicates presence of glucose in blood it clearly indicates that urine test is not only misleading but also points an accruing finger on the lab technician (s). It is also true that renal threshold of each patient varies – one may be normal for the one may be abnormal threshold for the other and vice versa. Urine tests after regulated gaps, will indicate an individual’s own renal threshold. But, all said and done, it cannot be said with certainty that glucose tests in urine and blood samples could be real parameters of renal threshold. Better, rely on your blood sugar tests, as amount of glucose spillover to urinary stream may be misleading. So, true diabetes can be detected by presence of glucose in blood only.

KETONE BODIES IN BLOOD AND URINE - KETOACIDOSIS

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It is a serious condition occasioned by lack of insulin which emanates from use of its own fat by the body to form acids and ketones. Ketones are the outcome of acid substances which are formed when body fat is used to provide energy to the body. The said situation arises due to prolonged fasting, starvation and hunger. Sometimes ketones are seen to develop in pregnant women and children due to strict dieting measures in order to get slim or lose weight.

If glucose and ketones appear in urine tests, it is a clear indication of poor diabetic control, even if their presence may be short-lived or transitory. Too much adherence to street dietary regimen, each or total absence of insulin, weight-reducing measures, calorie-based low carbohydrate diet are said to be causes of ketones. So, diabetic patients must not stretch their dietary regimen and calorie-based process to such an extent that starvation-like situation does occur, so that the body does not start utilizing its own (body) fat to meet energy demands of the system. Though simultaneous presence of ketones and glucose in urine is a rarity (because ketones surface when there is starvation stage and glucose, is present due to lack of insulin and excessive intake of carbohydrates.

Ketoacidosis is an abnormal situation when there is depletion of sodium and potassium in the blood. Concentration of potassium in the plasma depends on glycogen and protein and hormone concentration on one hand, and urinary excretion on the other. Within 2-3 hours of use of use of insulin, fall in plasma potassium may be precipitated. Three conditions are said to be responsible for ketoacidosis:

i. Administration of potassium-free fluid causes dilution of extra-cellular potassium.
ii. As a result of insulin therapy, movement of potassium is caused into the cells, and finally
iii. Continuous renal loss of potassium.
Earlier may diabetic patients used to die from this disease but, now, the discovery and use of insulin has almost prevented deaths due to this complication. Mainly it is the potassium loss which is responsible in causing such a serious upset. Now, hardly a fraction (say merely 2%) of diabetic patients die due to this disorder. Since negligence. The patients should always be aware of the onset development of this complication.

HYPOGLYCAMIA

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This is a diabetic disorder which is caused by low concentration of glucose in the blood. It is triffered by insulin reaction or not taking diet after insulin injections, or when dietary regimen is stretched to the point of starvation or when there is a longer gap between oral antidiabetic drugs and food intake or long stretched fasting.

If there is no adequate supply oxygen and glucose to the brain, it can’t function. If brain is not fed with sufficient and requisite supply of glucose its normal activity will come to standstill, if glucose, level is allowed to be very low. If such an unwarranted situation is allowed to continue and is not checked in good time due to dropping of glucose below dangerous and critical levels) many serious repercussion may occur such as:-

Raped pulsation or tachycardia, pounding pulse, headache, general run-down condition when the patient thinks he is about to skin, hunger, pallor, acute anxiety and restlessness, Nervousness, nausea, vomiting (though rare), blurred vision, trembling etc.

If the above ‘initial warning signals’ are ignored or no remedial steps are taken without delay then the aforesaid symptoms are followed by the undernoted symptoms such as poor co-ordinations, inappropriate behavioral disorder, crying, irritability, hyper-excitability, drowsiness, confusion, fatigue, short-term memory failure, lack of concentration, loss of consciousness, (generalized) convulsive movements.

It is a reassuring sign that all the above mentioned ‘initial’ and later ‘warnings signals and signs’ can be immediately encountered or overcome within a few seconds, if the hypoglycaemic patient or the person showing the foregoing symptoms, is given sugar in any form whatsoever. He may be given sugar in liquefied form, (as in cold drinks), toffees, corn syrup or any other syrup, glucose, honey, sugarcane juice or juice of some fruit that carries maximum amount of fructose (fruit sugar).

In our opinion crystal sugar or glucose, dissolved in water can provide instant relief and freedom from all the odd symptoms, because liquid sugar metabolises instantly. If such a vehicle is not handy, then any other item may be given. It after 5-10 minutes the situation does not improve repeat the dose until complete relief is attained and the patient comes back to his formal/normal condition. All failing give I.V. glucose drip.

All such patients are advised to keep sugar or any sugar based source with them always, so that in case of any acute crisis he could manage the problem himself. The patient should never let such a serious situation to arise because a delay of even a few cases may even cause death.

IDDM patients and those who are taking high doses of anti-diabetic drugs should be extra cautious and should remain guarded and well equipped against such acute situations. Not only among diabeties but such symptoms may be noticed in non-diabetics also, especially if the latter keep without food for long time or take their food after long intervals or resort to repeated & prolonged fastings. Treatment for both the cases is the same.

HYPERGLYCAEMIA (IDDM NIDDM)

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The term ‘Hyperglycaemia’ signifies high percentage of glucose in the blood and its clinical syndrome is known as ‘Diabetes Mellitus’ and thus, both the terms are synonymous and convey same import in common parlance. Absolute or relative lack of insulin effects of carbohydrate metabolism, inclusive also of fat, protein water and electrolytes, metabolism may lead to serious grave consequences. Such metabolic effects often lead to irreversible, permanent, structural and functional changes in the body-cells, which prominently manifest themselves in the form of susceptibility of vascular system. Such changes, in turn, further lead to development of well-defined clinical disorders often termed as ‘diabetic complications’ which enormously effect kidneys, eyes and nervous system.

As our aims is to disclose every possible fact with regard to hyperglycaemia, it won’t be out of place to mention and magnify on following points Diabetes is classified as under:
A. Primary Diabetes and
B. Secondary diabetes and most of the cases, in fact rather the majority of cases, belong to above mentioned two main categories which are being detailed here-under:

PRIMARY DIABETES

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Primary diabetes falls under two such categories viz.
i. Insulin dependent diabetes Mellitus (IDDM) also called IDDM (Part I)
ii. Non Insulin dependent diabetes Mellitus (NIDDM) which also known NIDDM (Part II)
The groupings have been made for the sake of clinical convenience only. Type I occurs in persons under 50 years, and often terminates into a quick death, if not treated with insulin alone or with addition of oral anti-diabetic drugs. Children juveniles, adolescents and growing children also generally imbibe Type I
Type II (NIDDM) generally occurs in the elderly and middle-aged persons but they can survive for a lengthy span of life, with use of oral medications, food & dietary regimen, physical exercise etc. Heredity and environmental factors account for onset of diabetes in to IDDM & NIDDM patients though their pattern of onset, progress (and deduce, if at all) is at variance with aetiology of both the types.

SECONDARY DIABETES

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This type of diabetes results from recognisable pathological process or secondary to or as a consequence of treatment of some other disordered condition. This type has very few numbers of diabetic patients. Secondary diabetes may stem from the following aetiological factors (or contributory causes):

i. Diabetes of pancreatic origin: As a result of inflammation of pancreas (pancreatitis) haemochromatosis and cancer thereof, pancreas releases impaired secretion of insulin, resulting in pancreatectomy (removal of pancreas by surgical means) which removal, in turn, leads to onset of diabetes due to total depletion in insulin release.

ii. Adrenaline Factor: Adrenaline by increasing the breakdown of liver glycogen and by suppressing secretion of insulin causes rise in concentration of blood glucose. Diabetic patients are more susceptible to tumours with high incidence which is uncommon in non-diabetics.

iii. Thyroid Hormone: Hypothyroidism (Excessive secretion of thyroid hormone) will aggravate diabetic state as is evidenced by impaired glucose tolerance in thyroid patients.

iv. Liver Problems: Hepatitis and cirrhosis of liver also cause impaired glucose tolerance and this help the diabetes to set in.

v. Gestational Diabetes: This is due to inherited tendency to develop hyperglycemia (diabetes) in pregnancy. It is happens that, during normal pregnancy period, there is an increased production of hormonal antagonists to insulin which demands an increased rate of release/secretion of Insulin. But a diseased pancreas often fails to meet this demand.

vi. Latrogenic Factors: Diabetes might be precipitated by use of certain therapies notably & primarily cortico-steroid therapy or/and use of thiazide diuretics.

vii. Insulin Antagonists: Due to abnormal concentrations hormones, antagonistic to the action of insulin in the blood circulation, may cause onset of diabetes.
viii. Growth Hormones: These hormones are capable of causing diabetes in about 30% of the cases where there is presence of acromegaly (Abnormal growth and enlargement of bones and soft parts of the face and extremities). Even this may occur to experimental animals.

ix. Adresocortical Hormones: Cortisol raises the concentration of glucose in the blood by inhabitation of glucose by the peripheral tissues. Trauma of physical injury and /or use of corticosteroids may also show impaired tolerance to carbohydrates, thus paving the way for onset of diabetes.

IDDM (Juvenile onset Diabetes)

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Persons (during first forty years of their life) having less than normal or normal weight generally develop diabetes. Such patients develop severe & acute diabetic symptoms after several weeks or months. If these patients are not treated without delay or at the appearance of initial symptoms, or if use of insulin is not started is discontinued, the patient may develop ketoacidosis which may prove, and often does, (prove) fatal. IDDM can only be controlled by use of insulin with requisite dietary regulation.

NIDDM

It usually occurs in persons who are elderly or middle-aged, or at the most who are not below 40 years of age. This is also called ‘maturity among the grown up and elderly (above 40). A few points may be of interest and benefit to the patients :
1) It can be controlled in 60% of the cases by dietary control only.
2) 20% of the cases can be controlled by the use of oral hypoglycaemic drugs alongwith dietary control.
3) Rest of the 20% cases are necessarily required to be put on insulin and dietary modifications, sometimes, hypoglycaemia drugs are also given alongside insulin. This category belongs to young patients.
4) Either due to too much medication or due to total lack, or still worse due to delay or negligence, a person belonging one group may pass on permanently or temporarily to another group.
5) NIDDM patients are more prone to side-effects, diabetic complications, sudden changes in blood glucose levels, but such ranges can be attributed to indiscreet and imprudent dietary regimen, missing the drugs or taking the drug in excess of the prescribed quantity and dosage. So, such patients must always remain on the guard against negligence, excess or lassitude factor which can affect the onset of symptoms, either way.
6) One must be regular in taking one’s diet and drugs and on no occasion, prescribed parameters should ever be transgressed and overstepped.
7) Such patients who indulge in irregularities should, instead of blaming once their doctors, own the themselves because, it is they alone and none else, who have cause unpalatable and odd situations to surface.
8) NIDDM patients should always adhere, to a regulated and modified schedule and get in touch with their doctors periodically for checkup and proper guidance, in connection with their food and drug intake. Such patients do enjoy a longer span of life as compared to IDDM patients but both have to remain always and fully on the guard.
9) It is very difficult to control diabetes children and old persons (but middle-aged diabetes, maturity onset diabetic list, can be controlled easily), the main reason is certain in-built faddism in certain patients and pattern and style of living one’s own life.

Fears Myths Allayed About Diabetic Infections and Complications

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Infection Factor

TUBERCULOSIS:

According to Dr.M.D. siperstein, an unquestioned authority of diabetes, opines that “diabetics are no more susceptible to infection than other individuals” but despite this, a pseudo fear psychosis has been overtly or covertly, spread that diabetics are more susceptible to infections like inflammations relating to boils (called also carbuncles) than non-diabetics but it is a misplaced and unfounded myth. Even infection to tuberculosis (called earlier a killer disease) is now a misplaced and unfounded view. The diabetic complications do not cause T.B. but if T.B.was a complication prior to detection of diabetes, then it may create a few problems. Prior to discovery of anti-diabetic drugs and insulin, such apprehensions might have been true but now, all such apprehensions are totally baseless. In fact, various disciplines and new modes of treatment and medicines have greatly improved physical resistance to aforesaid complications prior to discovery of anti-diabetic drugs and insulin, such apprehensions might have been true but now, all such apprehensions though, rare exceptions cannot be ruled out but the fact remains that diabetic patients, being more cautious and careful, are far less exposed to all said and other infections. If a pre-existing, confirmed case of T.B. has no diabetic patients, being more cautious and careful, are far less exposed to all said and other infections. If a pre-existing, confirmed case of T.B. has no diabetic symptoms, he way not be infected with diabetes. Similarly, conversely, if a non-tubercular patient has diabetes, it should not be construed that, as a result of diabetes, he can have T.B., or else diabetes, can cause T.B.

WOUND HEALING

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It is a relative term only and should be used in that sense only, whether the patient is diabetic or not. It is still a lurking myth among some physicians, even now, that a diabetic poorly heals, particularly in uncontrolled diabetes, is not fortified by any cogent basis. In 1942, Dr. Greene (of Iowa city) maintained that ‘wounds healed as well in the diabetic, as in the normal individual. His most starting revelation that “those diabetics with the highest blood sugars healed most rapidly of all!” should prove an eye-opener for the sceptic and disinformation spreading persons.

Dr .Greene further advancing his observations opined that “Recognizing that the lower extremities of the human body present a special situation which predisposes to slow healing, irrespective of diabetic control. There are certain factors, still unexplained, which delay healing in the lower third of the legs and in the non-diabetic” and to Dr,Greene’s observation, based on his practical experience. Dr. Goodman, ratifying the said observations, himself agreeing to his findings, goes on to add that. “It is fair to state that, under equivalent conditions, the diabetic can and does heal as rapidly as the normal individual.”

Let us concede without fear of reservation or contradiction, that practical experiences and observations of medical authorities, deserve to be not only heeded properly but also need to be disseminated to potential diabetics, at whichever stage their disordered symptoms stand, that they need not be unduly nervous or anxious of the prolonged late healing of their wounds so do not get panicky or worry-stricken if you (diabetics) have wounds. Instead have yourself treated by your physicians and there is no wonder that you may heal even much earlier that the non-diabetics or, at least, you won’t trail behind the latter.

DIFESTIVE DISORDERS

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Intestinal injections, constipation, loose motions, flatulence, intestinal worms, dyspepsia, gastritis, gastralis, bloating of abdomen are some of symptoms of all those persons who eat too much and too often, but do not take to physical activity or exercise. It is unjust to single out diabetics only for the aforesaid disorders. Rather, on the contrary, diabetics (excepting the factor of physical mobility/sedentary habits), being extra careful are less susceptible than the non-diabetics. But proper caution should never be lost sight of.
All normal persons and patients (more so diabetics) do know what suits them or what does not suit them. Try to be your own guide and masters i.e. try to adhere to the prescribed dietary pattern and avoid which does not suit or is prohibited. Your doctor is not going to help you, unless you, yourself are careful about your health. Your doctor can only a motivate, guide and induce you, but he cannot compel you to follow his instructions. Do not be apprehensive, even for a while, that your diabetic status has caused or is capable for causing any digestion-related problems. It is a myth and an unfounded belief and, above all, a misplaced apprehension which should either be entertained not nurtured or allowed to adversely affect you mentally and physically.

ATHEROSCLEROSIS/ARTERIOSCLEROSIA/ARTERIAL DISEASE

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Due to calcification and thickening in the arteries causes loss of elasticity in the walls of arteries. It occurs equally among diabetics and non-diabetics rather no age, sex or group or community is immune from it may be a difference of degrees. This disorder is an underlying lesion of stroke and heart disease. But, to say that diabetes causes atherosclerosis is still a hypothetical cause which has ye to be substantiated. But it cannot be denied that diabetes and atherosclerosis are, at least, statistically associated. Diabetics account for double the number of deaths, caused by heart attack or other heart diseases. Diabetics are more prone to coronary heart disease and more so women.
Despite all the said revelations, it is yet to be established if there is any affinity between diabetes and heart disease, particularly atherosclerosis. But there is hardly any justification to burden the diabetic and his family member with association between the two diseases. But, since the ‘risk factor’ is involved, the diabetics are advised to adhere to strict or at least reasonable or desired, control over diet. Further, the diabetic must get himself periodically examined medically to rule out any possibility of such or any other complication. Taper to large extent, fat and carbohydrates intake. In any case, do not let cholesterol deposit in arteries, have resort to physical exercises. All necessary and possible precautions should always be taken, though bearing in mind that there is no evidence or proof to sustain the concept that heart disease is caused by diabetes.

Eye sight / Retinopathy: There is a general belief that diabetes affect eye-sight and damages retina (which is a photographic plate at the back of the eye). In a lately detected stage or in prolonged uncontrolled diabetes, retina of the eye may grey damaged. But it takes a fairly long time to develop, and still longer time to ascertain and pin-point the damaged caused to it. It is perchance that a patient visits an eye-specialist to redress of some other eye complication and his doctor points out to retinal damage or to the stage at which it has reached. To allay his doubts, the doctor aks for urine test and if the urine test shows positive presence of sugar in urine, the patient is tested for blood glucose test. If both the urine & blood tests are positive then the patient is a confirmed diabetic. Now, at this stage, the patient comes to know that he has bad diabetes. But, by the time it is detected, much damage had already occurred, not only to eyes but also to other vital organs. The only main point in diabetes is that its detection is quite often too late and the patient is generally unaware of the ravages already caused by it.

An organ in the eye, called retina, is responsible for focusing the image on the retina, can also be adversely affected, causing blurred or hazy vision. Such a change is a purely temporary phase and can be rectified by wearing glasses.

Rapid change in glass number is also quite frequently visible. In order not to allow such a situation occur, the diabetic patient should, as a matter of regular check-up, should have his eyes tested, when all the eye problems could be easily detected and corrective measures advised in good time. It is not proper and fair to inculcate a feeling of fear-psychosis in the patient’s mind but, at the same time, he must be cautioned and warned against present and future eye complications.

To put the matter straight, the capillaries in the retina can be damaged, causing to weaken and bleed, and this is not an uncommon predicament. In case, this situation continues and progresses, new blood vessels may from on retinal surface and also in the vitreous humor in the centre of eye, causing further bleeding and blurred vision. Sometimes the bleeding is again absorbed and the vision clears. But in other cases, the retina may get detached or torn, due to the bleeding which may cases, the retina may get detached or torn, due to the bleeding which may cause the scar tissue to contract. Even high blood pressure can cause damage to retina, or still worse total blindness may also follow as a consequence thereof. So, try to keep your blood pressure also under control.

The diabetics should not get scared by the above mentioned eye complications. But, there is no reason for complacency also, as proper timely and corrective measure can prevent or minimize further complications, if not totally cure them. But, patient’s knowledge and education are utmost importance. The attending doctors can play effective and useful role in educating their patients. All said and done a visit to the eye-specialist after every 3-4 months, or when some unusual symptoms surface, is advised.

NEUROPATHY

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By the term ‘diabetic neuropathy’ is meant, in short, damage to nerves which is also known us ‘preipheral diabetic neuropathy’ in which condition the nerves of extremities, especially lower extremities, are affected. The patient may have pain in calves, heels and feet and may often say that he is losing legs’ or ‘his legs are unable to keep pace with him.’ These are some of averments of diabetics. The patients may also complain of numbness in lower legs. Pain in legs points to diabetic neuralgia. Lack of proper blood circulation may also lead to such a situation. But, all such signs can be easily controlled if glucose level is controlled. As soon as it is achieved, such symptoms would automatically disappear. Diabetic neuropathy is a transitory or short-lived symptom and is not a permanent complication, so to say.

NEPHROPATHY

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In Nephropathy, the kidney gets damaged as do nerves in neuropathy. If blood sugar level is allowed to remain unstable and uncontrolled for a much longer period, and sugar is excreted by the kidneys through urine and also when vital fluids, due tot malfunctioning of the kidney, escape through urine. Kidney is such a perfect filter that it does not allow anything to escape, except only the waste products of the body, thus keeping our body free from harmful toxins. Excess concentration of sugar in urine retards filtering function of the kidneys, with the result that vital elemental fluids, so necessary for functioning of our body, are lost to our body. A diseased kidney has to exert strenuously to perform its functions but, in the process, gets damaged due to various toxins in the blood. Much of the damage, so caused, can be rectified if the sugar content in blood & urine remains within normal limits. Imbalance of various salts also damages the kidney in addition t presence of uric acid, urea etc.

MENTAL SYMPTOMS/FEAR PSYCHOSIS

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Mind is the driving force of the body. All our functions are controlled by mind. Brain is the manifest form of mind. Mind controls various thinking processes and thus motivates the brain to function, ordering its various organs of the body to function and attend to certain emergent crisis states.
Dr.Joseph Good man has coined an excellent term; this is “Diabetic Neurosis,” for the emotional disturbance which the diabetic and his near and dear ones have to undergo. It is not the disease as such, but the fear psychosis that haunts the patient and his relatives alike, diabetes is a source of extra and utmost caution for the diabetic. Merely imagination of deprivation from sweets, social functions, drinks, tasty meals control and other restrictions and above all fear of insulin injections is enough to drive him out of his wits, rather shattering his psyche. Rest of the members of diabetic’s family also get nervous that if they stick to their former eating patterns or if they too have to overhaul/wrap up their dining table menus, entire family will be disturbed.
Diabetes should be taken in its stride by the diabetic and his family. Both should be reassured that this is not a dreaded or frightening disorder and that, with desired control of diet, proper medicines, it is treatable and controllable. The diabetic must not suffer from diabetic neurosis, a sense of social and dietary deprivation, a good –bye to good eating and drinking ice creams and sweet stuff etc. Fear of disease and its imaginary side-effects is not a reality and should be spurned aside like a myth or a fictional episode.
Short-term memory failure is not a usual symptom with diabetics alone, it is a disorder that can happen to even ‘normal’ or ‘healthy’ persons. In a word, we can say that the patient and his family need not to over-react to a disease which is controllable with prescribed ‘Do’s’ and ‘Dont’s’ patience, perseverance and precaution are necessary, instead of fear and fright. Most of the diabetics enjoy a fairly. Long spell of life like any other healthy person, if proper safeguards are taken along with plenty of self-confidence control.

DENTAL PROBLEMS

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Unfortunately, the dentists and general physicians favour the idea (theory) that diabetics are easily exposed to tooth-decay, bleeding from gums, caries, crumbling teeth and other dental problems. This is only a hoax, without any scientific basis. Dr. Jack Samuels and his associates, after carrying an impartial study, have succinctly opined that, “the diabetic was in no way, more susceptible to dental ills than anyone else, given adequate dental attention. The dentist and his patient need have no fear.”
Normal dental care and hygiene are equally of utmost necessity not only to diabetics, but to all other persons also. So, diabetics do not have an increased predilection to dental hazards, as explained earlier.
Before we conclude this chapter on the complication of diabetes, it is necessary, for the diabetic and his family members, not to be mentally excited or unnecessary worked up but, instead, face the problem in a planned, cheerful and well-monitored method. If there is no willful departure from the prescribed rules, there is no reason for arising of any complication because, if diabetes remains controlled within normal clinical limits, then side-effect are not likely to surface or if, at all, they surface their intensity will be mild and thus, could be managed easily.
Mental tension, anxiety add to rise in glucose in blood & sugar. Hence by having a positive approach, major portion of the battle can be easily surmounted. There is no cause for panic or haste. Simply stick to your normal routine work, and forget about the future complications.

DIABETIC LEG ULCERS

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Generally leg ulcers occur due to venous disease (50%), arterial disease (10%), mixed arterial venous disease (25%) and the remainder due to some unidentified causes. Bacterial infections, traumatic effects, chronic boils and surrounding small boils or eruptions, use of oral or local drugs etc may cause onset of ulcers. Such leg ulcers are more common in middle-aged persons. Apart from infection, diabetes is considered to be major causative. Such patients should always protect their feet and lower legs from injuries. They should not walk on foot (bare foot) , on rough and uneven grounds, come into contact with sharp instruments or be crushed by some machine vehicle or any other such object. When diabetes is under control such ulcers do show a declining trend, and heal also but any neglect may lead to amputation of the affected organ. Such ulcers must be cleaned, disinfected and dressed with an antiseptic agent, and well protected form hear, dust and frost bite. Extreme conditions of heat and cold can further complicate the problem. Care should be taken to ensure elimination of any precipitatory factors and antagonistic factors. Do not leave anything to chance.

Foot Ulcers: Similarly, foot ulcers also need to be attended to and treated without delay. Possibility of ulcers in the obese is a greater than others, especially if the obese are diabetics also. Dibeties foot, a common complication, can be easily inferred from pink skin, warmth, diminished sensation, painless ulceration, digital gangrene, callus formation, clawed toes, neuropathic oedema. If there is much and extensive tissue and, or boney destruction, amputation may be required and if so, it must not be delayed healing period I quite long, and during course of treatment even a NIDDM patient may have to be put on insulin and hypoglcaemic drugs to meet exigencies of the situation. Proper control is of paramount necessity if one wishes to promote healing or halt further infection.

Impotency: Impotency occurs in 25% of diabetic cases. It can be physical or mental or even both (psychosomatic impotency). Patient has strong sexual desire but his semen dribbles away as soon he gets sexually excited or even when he attempts to have coitus. This gives a sense of inferiority to such a person. The organ may be in erectile position, desire may also be intense but sexual act cannot be done. Hormonal changes can also be one of causes of diabetic impotency. So, endocrine gland factor should also be investigated. Sexual function is also affected by antihypertensive drugs like methyldopa & deta-adrencoceptor. Surgical interference is not equired in such cases.

Phimosis: This is one of the complications to which some patients are amenable of. Foreskin of glans penis gets thickened and thus cannot be drawn back. In paraphumosis, the skin can be drawn back though with some effort and pain, but retraction is difficult. In phimosis even passing of urine can pose problems. In such a case surgical resort is required, especially one can neither pass urine nor cohabitate. Both the complications need to be attended to and treated quickly.

Stomatitis: it means inflammation of whole of sub-mucous portion of the mouth when tongue and surrounding areas are purple red, with small eruptive pimples, when even slightly cold or warm water is also intolerable salt and spices further aggravate the trouble. Normal eating is also effected. The tongue is dry. These symptomatic symptoms often torment a diabetic. The cause is often attributed to malnutrition, including lack of vitamin b-complex. Sometimes even hot food and drinks, local applications and irritants cause stomatitis which is also indicative of poor healing and diet. Diabetic persons should ensure proper hygiene of their mouth, take plenty of green & leafy vegetables, having fibre. Riboflavin can cure this complication. Sine sore and swollen mouth is liable to affect process of digestion, hence it should be treated without any delay. All hot, pungent, irritating spicy things should be avoided. Rinse your mouth with mixed with boric acid after which pure glycerine may be applied. If neglected or allowed to prolong, it may turn into aphthuous stomatitis when superficial and painful ulcers may emerge. Cancer of the tongue or entire sub-mucous portion may also set in as a terminal manifestation.

Skin Infections : Skin of a diabetic is generally found to be dry and rough-may be due to diet factor, insufficient secretion from sebaceous glands and lack of water-content in the body. Dryness of hair and skin is a common complaint with diabetics. Their skin is more susceptible to changing weather conditions, effects of cosmetic applications, certain vegetations and the odour flowing therefrom, reactions due to oral and local, use of drugs, contact dermatitis, exposure to gas etc. skin infections are too numerous to be counted or mentioned. Best method is to keep it neat, clean and dry by using bland and non-irritating agents. Avoidance of immediate causes or precipitatory factors is a pre-emptive method. But, never delay, ignore, neglect any odd skin symptom. Perfect hygiene and regular care will spare the agony of many future complications.
Our purpose and intention is neither to scare the patient nor to crate and psychic phobia, but to enlighten, within the ambit of our competence, so that the ravages and complications, generally caused by this ‘silent killer’,are taken note of by the patient and his family members. If any disorder is detected and then treated in time, before it is late, much effort, money and agony of all concerned can be saved and damage avoided.
Patients in their interest, are advised not to delay or linger on the complications, instead they should, at once, get in touch with their doctors so that timely corrective/curative steps are taken. Every symptom and cure may be evasive and eluding in some complex cases. But, by proper education, guidance, motivation and monitoring most of the complications can be taken care of by the patients themselves, as the maxim goes to prove that ‘being forewarned is fore-armed.’ In fact, young ones, pregnant ladies and old persons should be more careful to infective disease along with diabetic complications though persons of other categories need not be, in any way, careless and complacent.

Clinical Aspects of Diabetes

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There are many clinical tests to determine whether a person is diabetic or not. As the presence of some symptoms is a pointer to presence of sugar in urine in the patient. Following course for clinical tests will prove to be an indicator to present diabetic or non-diabetic status of a person.

URINE TEST (ROUTINE TEST)

Overnight urine should be voided early in the morning, after getting up, and the specimen be taken to the clinical lab. If the result shows even a trace of urine, a repeat test (or even 2 or 3 tests) is called for. If after 2-3 three tests the urine shows 0.5% presence of sugar in the urine, then it must be followed by a blood test for detection of sugar.
Note:- It may be noted carefully that the bottle in which specimen of urine is collected should be thoroughly sterilized, leaving no room for any doubt whatsoever. Some persons say that fresh urine specimen should be tested for sugar for the simple reason that specimen of overnight urine may be masked with certain casts in the urine, and true picture may nor emerge, thus complicating and confusing diagnosis. Specimen of fresh urine should be taken, when the patient is on empty stomach, it is suggested than mere trace of sugar is urine should not be taken a as conclusive proof of diabetes.

BLOOD TEST

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In some patients fasting glucose level is quire high while in others it may not show much rise in P.P.stage (post parendial), i.e. after taking meals. In random blood tests, sugar level may be much higher but all such findings do not lead to any emergence of true diabetic status of a patient. So, as a first step, following course may be adopted.

(1) BLOOD SUGAR TEST (FASTING)
Blood sample is taken, when the patient is on empty stomach. Fresh urine sugar is also tested when blood sample is taken for testing purpose. As described earlier, glucose rise in urine must also commensurate with rise in blood sugar. It will also indicate whether the patient is having a normal renal threshold. In certain cases renal threshold may be disturbed.

Glucose Test Result (mg/100ml)

Normal Diabetic
Fasting 60-80 100-120
(2 hours after taking glucose) 120 180
P.P 60-100 Below 140

Note:- Oral glucose should be 1 gm per kg of body weight. Intermediate glucose levels deserve further evaluation. Urine test, taken at fasting and also on taking glucose will determine and point out sugar level in urine which should be compatible with rise/fall of blood sugar levels. Any variation in comparative values should be taken seriously. Treatment should not be started from results of first test itself.

GLUCOSE TOLERANCE TEST (G.T.T)

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G.T.T. is necessary in uncontrolled diabetes. G.T.T. will reveal the low and high peaks of rise and fall in glucose levels. It will also point to the time of absorption and release of glucose by the system. It is considered to be the most accurate test which reveals a clear diabetic status of a patient.

First, samples of blood and urine are taken on empty stomach. Thereafter, 1gm of glucose is given per kg body weight, then after half an hour (upto two hours and in certain cases even upto three hours) blood and urine samples are taken and the respective readings are noted down. But, W.H.O.studies have recommended that only one test, (two hours after taking glucose) will suffice to know the exact position and status of a person. They consider this to be the most accurate method.

BLOOD SUGAR TEST AFTER TAKING MEALS (PP)

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First specimens of urine and blood are taken on fasting level. Thereafter, the patient is asked to take his normal meals. Next test is carried out after 1 hour 45 minutes or two hours. Accuracy of this result is sometimes doubted, for the simple reason that patients generally do not follow a uniform pattern on diet. Variations in food will result in variable test results. Ideal fasting level (NORMAL) result should be between 80-120 mg/dl and result after two hours or 1 hour 45 minutes should between 120-140. even 140 mg is considered to be normal, W.H.O. studies further reveal that P.P. level is tolerable even upto 200 mg but any reading beyond this is a definite indication to confirm presence of diabetes.

Note: In certain cases, G.T.T. or P.P. tests may rule out presence of glucose in the blood but the urine test may show presence of glucose in the urine (especially when glucose level remains normal in the blood). In such a case (provided the tests are fully reliable and dependable) one should infer renal glycosuria. But before jumping to any final conclusion, it is necessary to ascertain and find out if-
i. The patient passes glucose in urine, in the first urine in the morning or
ii. Whether it was on fasting or whether.
iii. It was traced after taking meals
If during G.T.T. there is presence of sugar (glucose) only in the urine (but not in the blood), then it is indicative of low renal threshold, so to say, which points to diseased state of kidneys. Patients who pass sugar in urine during ‘fasting’ state only (but not in P.P.tests), there is no cause for any anxiety. But if sugar is passed after taking meals it is a sure and certain indication of a diabetic status. No firm opinion should ever be formed, merely on the basis of a single urine and /or blood test of the patient.

GLYCOSYLATED HAEMOGLOBIN (HbA

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Of all the tests, it is the most reliable, precise and test, especially on a rapidly fluctuating glycaemia states or even in cases of uncontrolled diabetes. Fluctuations in glucose level reading can be erroneous or even misleading, due to errors and variations in insulin dose, meals oral ant diabetic drugs & amount of exercise. HbA will give a clear average out of all the peaks and low levels (troughs) of the blood glucose over a period of 2-3 months before the test is actually undertaken.

Haemoglobin A is a component of the red pigment in the blood which carries oxygen from lungs to other body organs, HbA can be measured as a percentage of all the Hb. Present, by means of various laboratory methods. Total amount of HbA present is in direct proportion to the average blood glucose during the past 3 months life span of the HbA that contains in the blood, red blood corpuscles (R.B.Cs ). Following values may be of interest:

i. Persons without diabetes : Normal values 6 to 8 %
ii. In persons who have recently been diagnosed as diabetics or persons with poorly controlled diabetes: values may range from 20 to 25%
iii. In well-controlled diabetics : 6 to 8.5%
iv. In persons with to low glucose levels: The value may be below 6% which is an abnormal average (This is due to excessive insulin intake by injections).
All the aforesaid various levels give average over the 2-3 months’ period, prior to HbA test.

SELF-TESTS

In market ‘diastic’ brand sticks are available by which one can measure glucose level (in percentage) in urine and blood. A chart of various colours is given, with which colour of urine is to be matched. Similarly, there are glucometres also available. But, to our mind one cannot be sure of the accuracy of the results which could be misleading also, as one has to closely adhere to the instructions, (failing which results may not be precise)

SYMPTOMS CALLING FOR CLINICAL TESTS

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To rule out or confirm presence of diabetes, following symptoms should suffice for a clinical investigation :-
i. When a person eats too much and too often/
ii. If he passes large quantity of urine at short intervals.
iii. If he drinks too much water, at short intervals
iv. If he experiences dryness of mouth, inspite of drinking large quantity of water.
v. If there is pruritus on and around genitals.
vi. Rough and dry skin.
If the said symptoms are prominent, it should be taken as an indication of probable presence of sugar. So, as a first step, go in for a routine urine examination and if there is even 0.5% sugar in urine, then, to make doubly sure, get the urine examined twice after pause of a day, followed by a third test on the third day. If all the clinical tests point out to presence of urine, then, have your blood tested for presence or otherwise of sugar (glucose) in blood. First blood sugar test should be on empty stomach, followed by another test after taking meals (that is, test should be carried after 1-2 hours of taking meals). Positive results will confirm diabetic status of the patient.

In certain cases, sugar level may rise only after taking meals but may be normal/near normal on fasting level. In such a case, after careful adherence to diet control, P.P.sugar may also normalize. In borderline cases, (in fasting or P.P.test results), one or two more tests may be had with marginal cut in sugar intake. Where, there is incidence of rapid rise or fall in blood sugar readings, G.T.T. test should be carried to determine as to after which time the sugar level rises/falls.

Confirmed diabetics should, at regular intervals (say at least once in a month) get their blood tested and adjust their diet, exercise and drug according to advice & guidance of their doctors.

If tests reveal presence of sugar in urine but absence thereof in the blood, then it should be viewed more seriously, as detailed earlier. We repeat that mere or occasional presence of urine sugar is not a case of ‘true’ or ‘confirmed’ diabetes, unless there is presence of sugar in blood and the latter one is a true sign of ‘true and confirmed’ Diabetes Mellitus.

As for self-tests, it can only be pointed out that such tests are neither precise nor are they reliable as they merely point out, if at all, to near about indications only and thus, are no substitutes for actual blood sugar tests, carried out by a reliable and dependable laboratory.

Finally, le the test be carried out at two /three different laboratories and result should be matched. If the results are in reasonable proximity to each other, there is no reason for authenticity of test results, but high difference in results, is bound to create confusion which should be dispelled. Tests carried out in big public hospitals are often found to be unreliable and inaccurate, for the simple reasons that, due to messing up of hundreds of samples (specimens) chances of wrong labeling, erratic tests and inaccuracy cannot be rule out. It is not that an accusing finger is raised towards public hospitals which have to carry out large number of tests, hence chances of ‘human failure’ or a ‘slip’ cannot be ruled out, due to rush of work.

Treatment of Diabetes Through Various Pathies

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(I) ALLOPATHIC TREATMENT

Allopathic system is based on clinical findings, aspects and mechanical findings. The patients is often subjected to various tests, X-Rays, ultrasonic tests, and particularly the tests on diseased organs (like kidneys, heart, brain, digestive organs, urinary system, respiratory system). There is hardly any doubt that the relative tests, as and when ordered, desired or required, do disseminate and unravel certain physical abnormalities which could not be known through conventional outmoded, obsolete devices. The findings enable the physician/surgeon to decide upon a precisions mode of further treatment. Allopathy has made tremendous progress in clinical precisions and many a precious life has been saved due to novel and latest diagnostic methods. But, due to high cost of such tests and investigations, general public has not been able to derive much benefit, as all such devices are not cost-effective. Utility of a diagnostic test is one thing, but patient’s capacity to pay for them is quite another. Many poor persons die an untimely death, merely due to the fact that their pockets are not large enough to absorb the financial burden of such investigations.

As already mentioned, diabetic patients are mainly classified under two groups in so far as allopathic treatment is concerned.
i. Insulin dependent Diabetes Mellitus (IDDM)
ii. Non- insulin dependent Diabetes mellitus (NIDDM)
In first category come children in growth stage, juvenile and adolescents and persons under 40, patients who develop diabetes prior to or during post-operative stages and in this last category Insulin is needed to control emergent diabetic occurrences or if the patient develops diabetes as a result of use of some medicines. Such a type of diabetes occurs due to some shock, bereavement, shock etc. or even due to operation phobia or post operative complications. Since, little children and growing persons are generally victims of such a type, it is rightly termed as ‘Growth onset Diabetes Mellitus’ or ‘Juvenile Diabetes Mellitus’. If too many restrictions are put on young and growing persons, their growth process will be adversely affected, because nor can their diet, games and study patterns be changed. In such cases, use of insulin becomes a necessity, for the aforesaid reasons.

WHAT IS UNSULIN

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In 1922, A teenager, Leonard Thompson, was laid up gravely perilous state with diabetes when DRs.Frederick Benting and Charles Best injected an extract, obtained from panceas of an animal and surprisingly showed improvement, and finally, within a few days of treatment, was able to gain his strength and weight. This way, a new hope come to light for the despaired multitude of diabetics. The discovery of insulin extract was a medical miracle and wonder which was hailed as a miraculous discovery in the realm of medical world-a potent vehicle in the hands of doctors to treat their diabetic patients with insulin injections. Since it was miracle, both Dr. Banting and Dr. Best were, rightly bestowed with a noble prize-a well recognized honour.

After 75 years of constant and progressive use, insulin has come to stay. Since the discovery of insulin, experts have worked out and still continue to work relentlessly, a wide variety of insulins of meet needs of their diabetic patients. Now a variety of insulins have been introduced for use by certain types of patients, depending on an individual patient’s requirement as to quantity & frequency of use of insulin. Following types of insulin are available:-
11) Rapde-acting or short-acting Insulins :-
a) Regular
b) Semi-Lenten

2) Intermediate acting Insulin :
a) Globin
b) NPH (150 PHANE)
c) Lente
3) Long acting Insulin
a) Protamine Zinc
b) Ultra-Lente

Concentration of Insulin: There main concentrations viz. U-40 (Red label), U-80 (Green label) and U-100 (Black label) are available in the market, whose labellings have been done to pin point quantity and concertratin of insulin under each variety, or to put in differently we can discern form each label as to how much (“Pure insulin”) liquid volume each preparation has or what is the concentration of or how much pure insulin a preparation contains. Following points will further clarify what has been said heretofore:-
1. U- 100 Preparations – In such a variety each CC of the liquid contains 100 units of Insulin.
2. U-80 Preparation – In these preparations each CC of the same liquid contains 80 units of insulin.
3. U-40 Preparation: Herein each liquid CC contains 40 Units of insulin.

Availability of the above mentioned preparations in different insulin concentrations, enables the doctor to determine as to what quantity and at which intervals in a day, a diabetic patient will require insulin, taking into consideration all the relevant factors. Previously, insulin syringes either U-40 or U-80, were used by the patients but there was enough room for confusion-the patients has been using though by mistake or under confusion the wrong scales and injecting themselves with ‘half’ or, still worse, twice the prescribed dose. In the latter stage, such patients had to undergo an ‘Insulin shock’.

To rule out possibility of any danger fear of overdose and confusion in the use of insulin, preparations and syringes in U-40 and U-80 concentrations are being gradually phased out. U-40 and U-80 are being substituted, rather have already been by U-100 reusable and disposable syringes in which only the desired and needed doses are actually delivered, dispelling and ruling out possibilities of inaccuracy and overdose or any other confusion. Due to decimal system, U-100 syringes and preparations the patient won’t have any confusion. Use of such U-100 syringes and preparations will be useful for the physician also, because the doctor can have no danger in shifting his patient to highly purified U-100 product. Mere reduction in liquid volume will do, instead of affecting an actual change in insulin dosage required by a patient. It will also ensure proper control in the administration and management of IDDM patients.

Now 1-CC (100 units) disposal syringes, 1-CC (100 units) glass syringes and the 0.5 0 CC (50 units) disposable syringes, 0.35 CC (35 units) glass syringes are available. Out of which the patient can pick up any type of syringe to commensurate with insulin dosage. Diabetics of IDDM type are scared of the phobia that needles would break, bend or twist, but all such fears are baseless because, with proper care and caution, the patient cannot encounter any one of such problems.

Fears & Myths: It may be pointed out that refrigeration of insulin is not, at all necessary, because insulin does not deteriorate at room temperature hence there is any necessity for the diabetics to carry thermos or ice-bags. Ice-boxes to store insulin while proceeding on tour or travel.

2. People are scared of air bubbles which rise in the syringe and they are neither harmful nor dangerous. Such apprehension, like any other, is an off-shoot of patient’s lack of proper education. There is another fear, in the minds of patients and their relatives, that extra insulin should be the syringe. There is no need, at all, to give a second ‘small short’. In fact, there is no danger from air (whether a single bubble be avoided in the syringe. It is better to be informed and trained how to avoid air and bubbles in the syringe. It due to fear of an air bubble, an extra dose, though neither called for nor required, is given in smaller than the normal dose, then (in the case) there is no cause for alarm but if the extra dose exceeds or even matches the prescribed dose, in that eventuality, the physician of the patient must be consulted without delay, because injected extra insulin dose may cause hypolycaemia and other fall-out symptoms and complications.

3. The diabetes patient should himself learn the art of injecting himself. If he is dependent on any family member, nurse or doctor, for this purpose the chances are that, when he himself is required to take an insulin dose, there may not be any one near him, thus losing time of dose of insulin injection. Hence, the IDMM patient should himself learn and practice how to inject. Dependence, in such matters, is not good. Moreover, if the patient develops the latter practice, he will make sure that there is no chances of injection vials from a reliable chemist and, that too, manufactured by some reputed and established pharmaceutical company only.

Caution: Heat destroys effectivity and medicinal value of insulins, hence they should be always stored in a cool place. But, if at all, it is required to be kept in a refrigerator, it should be stored at a temperature where it does not freeze. If it is necessary to carry it during journey it should be wrapped with a water-soaked piece of cloth or in a pro-cooled thermos flash, so that temperature remains the same. It is very essential in hot climates, though moderately cold room temperature will suffice to preserve it, even though, some deviating opinion might have been expressed earlier, in this regard. The whose modus operandi is to keep insulin away from heat and heat conditions. In cold regions even normal room temperature will serve the purpose.

Note: No diabetes patients should himself adjust his done of insulin, simply in accordance with the above table, as it can prove fatal. Hence, always seek proper guidance from your physician who is the best judge to decide as to how much dose you require and after what gap/duration.

DOSE OF INSULIN
In order to determine precise dosage for a particular patient, initially it should be started on error and trial methods which will finally point no near-precise dose of insulin required to be prescribed to a patient. Once a particular dosage has been determined and prescribed, the reaction thereof, on the patient, or its acceptability should be closely watched & monitored, leaving no room for any ‘chance’ or ‘slip’ or ‘miscalculation’. In order to switch over to long-acting insulin, no undue haste should be exercised before giving it a fair trial.

Higher doses of insulin may be needed in disordered condition, like infective fevers, pregnancy, cortico-steriod therapy, excessive dietary intake, hyperthyroidism, presence of ketone bodies, obesity etc. on the contrary, tapered doses of insulin are required after taking to physical exercise, on reduced dietary intake, on using anti-diabetic drugs are also given in addition to insulin to augument the effect of insulin or when insulin is required to be given in lower doses/concentrations, but oral tablets are also required to be used.

IMPORTANT POINTS TO REMEMBER

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1. Dose & frequency of insulin cannot be decided in one go, rather patient has to visit the doctor again, and again. So that it is finally decided what dose and concentration will actually suit a patient.
2. Patient should be properly educated about technique of injection of insulin, so that he has not to depend on others for this purpose.
3. Patient should be fully aware of the kind of insulin given to him and also for the duration of its effect.
4. How and when carbohydrate should be taken will depend on the type of insulin and its effect.
5. Reduced dose of insulin would automatically need a reduced diet.
6. Urine sugar tests are necessary to determine the type & concentration of insulin units.
7. Once a patient becomes dependent on insulin, its sudden cessation should never be resorted to by the patient himself, except under clear guidance and instructions from his doctor.
8. If a combination of short-term and long-term insulins fails to show positive results and also there is no marked improvement in sugar level (P.P.Test) then carbohydrate intake should be reduced in the diet.
9. Amount of physical labour, put in by a patient, should always be taken into consideration while dividing dose of insulin, diet and carbohydrate. This point has been discussed earlier, in sufficient details, hence repetition does not seem necessary.
10. Patients who are under-weight and prone to some sort of infections, like T.B. or Broncho-Pneumonia and where there is presence of acetones in the urine, will necessarily require insulin.
11. In other countries, some brand names may be different from those of ours. But the generic brand is the same. Hence, the types of insulins, available in our country, have been given in the table on preceeding page. This however, does not exclude the other types which might have been introduced in other countries or very recently introduced in our country.

REACTIONS OF INSULIN (HYPOGLYCAEMIA )

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About hypoglycemia, we have already mentioned since this is a fall out symptom, (and quite serious one) to both the IDDM & NIDDM patients, more particularly in IDDM patients, hence it won’t be out of place to remind the patients, once again, about the ravages it is capable of causing and often with serious consequences.
‘
Symptoms of Hypoglycaemia Other Symptoms
(Primary symptoms) (Secondary Symptoms)
1. Listleness unconsciousness 1. Unbearable itching
(Prunitis) in the skin
2. Rapid palpitation of heart 2. Urticaria/hives
3. Excessive Perspiration 3. Nausea
4. Conclusions/Trembling 4. Vomiting
5. Excessive hunger 5. Bloating of
Abdomen
6. Staggering gate 6. Loose Motions
7. Mental instability and/or 7. Black or dark blue disorientation, short-term spots on the skin,
Memory failure about/on a part
Which has been
needled
8. Fits 8. Fat-shedding
9. Comatose (diabetic coma) 9. Putting on extra
Fat
10. Blurred vision 10. None

)

REMEDIAL STEPS (IN HYPOGLYFAEMIA

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Long acting insulin injections (particular P.Z.I.), can cause headache, fatigue, vomiting etc. Such a situation develops when blood sugar level falls below 70mg/100ml. and if this level touches down to 59mg or still lower, the patient is in for dire consequences, as he may slip into coma. Before such an alarming situation develops, try to pre-empt the exigency by going sugar-mixed liquid, fruit juice, pure sugar, without delay. If done so, it will spare the patient himself, family members and his physician from serious anxiety.

Above symptoms generally develop if insulin dose is exceeded or meals are not taken after insulin injections. If hypoglycaemia occurs almost at the same time daily, then such a situation can be averted by taking carbohydrates, prior to anticipated onset of low sugar in blood. IDDM patients must carry sugar-cubes, sugar-candy, or toffees or sweets (or sugar in any form) so that they can make use of the same, as soon as initial symptoms appear. But, the doctor must be consulted immediately or at the largest after such hypoglycemic states. Any delay in resorting to corrective methods can prove fatal or leave back serious complications.

Patients should always immediately heed to ‘early warning signals’ of hypoglycaemia and take corrective measures, and nip the problem in the bud. If the early warning signals (which is nature’s own unique way to caution a human being) are ignored, then the patient may have drowsiness, confusion, inappropriate and unusual behaviour, hype-excitability, lack of nerve power etc.

CONCLUDING INFORMATION ON INSULIN

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The foregoing information may be summed up, of course, with some additional points, in the following manner, which should always be taken note of.

About insulin
1. Available insulin, in the market, contain bovine, porcine or human insulin, which are obtained from pancreas of cattle and pigs respectively.
2. Insulin preparations are most usefully classified according to their duration of action, apart from their origin.
3. short-acting insulins include acid soluble and neutral soluble, and have duration of action approximately upto 8 hours, with a peak between 2 and 8 hours.
4. Intermediate and long-acting insulins contain Isophane Insulin (known as NPH) and insulins zinc suspensions which have an approximate action range from one to four hours, and can last upto 36 hours. In addition to the above, there are also stable pre-mixed preparations which contain fixed ratio of neutral soluble and isophane insulins which give a biphed action. The speed of onset of action will depend on the ratio in which soluble insulin is present in such preparations.

Uses: To treat diabetic cases which require to be treated with insulin.

SPECIAL PRECAUTIONS
1. Be careful if a switch over from bovine to porcine or from animal to human insulin is required, particularly with regard to dosage determination. Fully ensure that previous site of injections is changed and one site should not be used earlier than a month. Only one injection area should be used only once in a month.
2. throughout the period of pregnancy, a good and continuous control of insulin dependant patient must be ensured, otherwise the pregnant mother may pass on the risk of diabetic symptoms to her off-spring. At least, a risk-factor is greatly involved in an unmonitored diabetic case.
3. if corticosteroids and diuretics are to be given, in addition to insulin therapy, dose of insulin should be increased according to and depending on individual requirement in each case.

COMMERCIAL BRANDS AVAILABLE

Animal Insulins: 1. Actraphane (Highly purified porcine netural insulin 30%
Isophane insulin 70%) Injection
2. Actrapid (Highly purified pork neutral insulin Injection) 40
Units per ml Inj.
3. Actrapid-MC (Highly purified monocomponent pork neutral
Insulin) 40 units available per ml. Injection.
Human Insulins: 1. Human Actraphane (Highly purified human insulin as 30%
Neutral soluble insulin and 70% Isophane Insulin) available in
40 units per ml.inj.
2. Human Actrapid (Highly purified human neutral insulin) 40
Units available and 100 units per ml. inj.
3. Human Monitored (Highly purified human insulin zinc
Suspension) available in 40 units available in and 100 units per
ml. inj.

OTHER TYPES OF INSULINS AVAILABLE

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Available in 40, 80 units concentrations, duration of their action is indicated within brackets as under.

Solube
Available in 40 units and 80 units per ml. injections (6-8 hours)

Zinc Suspension
Available in 40 and 80 units per ml. Injections (Approximately 30 hours)

Isophane
Available 40 units per ml. Injections (18-28 hours)

Protamine Zinc
Available in 40 units per ml. Injections (about 24-36 hours)

Drug Interactions
Oral contraceptives, cortico-steroids, thyroid hormones, theazide diureties, Beta adrenergic blocking indications.

Additional Drug Reactions
Local hypodystrophy, angineurotic oedema, urticaria, local reactions on injection sites.

Contra Indicated – in hypoglycaemia.
Note: It may be stressed, once again, that how much, what, at what time, with how much duration an insulin injection is to be taken by a diabetes patient should always, be determined by a doctor. The patient on his own, should never venture to take upon himself the role of a doctor whose advice, monitoring and guidance must be handy to the patient. Moreover, insulin therapy can have very serious complications and side-effects; hence the patient must take his doctor into confidence about any unusual development of a symptom. It is the doctor only who could decide as to whether a patient requires insulin therapy or not but, in no case, should that be an option of the patient. All the instructions regarding diet, carbohydrates, insulin injections (their usage, dosage, frequency and direction of action etc.) should always be carefully complied with by the patient. Do not be misled by canvassing insistence of the chemists for use of a particular commercial brand (in IDDM patients, there is hardly any possibility of crisis situations which as when and if occur, can be managed with rapport between doctor and his patient.

ORAL ANTIDIABETIC DRUGS

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NON-INSULIN DEPENDANT DIABETS MELLITUS
(NIDDM) ALLOPATHIC THERAPY

Even in projected cases of IDDM patients, attempts should be made, as a fast step, to have the control of diabetes through control of diet. But since, control through diet alone, is a bit tedious and lengthy process. These is hardly any need for trial in cases where children, young people, pregnant women, operatable cases or terminal cases are involved. There is hardly any patient’s life could be saved or, at least, the complications could be minimized. In such critical and sensitive cases, palliation should be the sole aim, by whichever method possible. The patient is not concerned with which method he is being treated; his only concern, as also of his relatives, is as to how quickly his grave symptoms subside.
About insulin therapy, with regard to IDDM patients, foregoing details will suffice to enlighten such diabetic patients. In this chapter, we will spell out details, to a reasonable extent, as far as oral anti-diabetic allopathic drugs are concerned. It has been observed that NIDDM patients are able to control diabetes, by adhering to diet control measures only and 60% of such cases do respond to low carbohydrate intake, including other necessary precautions. Those who are unable to have an effective diabetic control through diet can achieve the desired objective by taking oral antiglycaemia drugs, apart from diet control. The latter category of patients responds to diet control-cum-oral drugs application and thus 20% of such patients are seen to control their diabetes. After above mentioned two categories, the third category belongs to rest of 20% patients who have no option but to resort to insulin therapy, for which reference may be made to the preceeding chapter on IDDM.
Oral drugs can be divided into two main categories viz.
(1) Sulfonylureas
(2) Biguanides

Sulfonylureas: These drugs cause lowering of the blood glucose by stimulating the release of insulin from a patient’s own pancreas. But, in order to obtain release of insulin from the patient’s own pancreas, it is very necessary that the patient’s pancreas must be in a position to make and store insulin. Oral drugs help the pancreas in stimulating their action so that the stored insulin is released into the blood stream. If the insulin content is made, stored and released by the pancreas, then the blood sugar (glucose) level can be easily brought down, of course, if coupled with diet control. Such a possibility is possible chiefly in those diabetic patient s who have developed diabetes only after, or say mainly after 40 or 50 years of their age. This is the reason why it is termed, and quite rightly so, as ‘maturity onset diabetes not responding to diet control measure alone.

GENERIC AND TRADE BRANDS

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Many brands available in trade, are supplied by various pharmaceutical companies of repute. Trade names of drugs are given first, followed by the ingredients or actual constituents, as given within brackets:-
1. Copamide Tabs – 250mg Tabs (chlorpropamide) used for maturity onset Non-Ketotic diabetes, unresponsive phenformin diet control.
2. DBI Tabs – (25 mg Tabs) (Phenformin Hcl)- For maturity onset diabetes mellitus responding inadequately to dietary treatment either alone or in combination with sulphonylureas.DBI-TD Caps – 50 mg caps (phenformin Hcl)-used for symptoms identical to DBT taps.
3. Daonil Tabs – 5 mg Tabs (Glibenclamide) –used for NIDDM, NIDDM-Type II patients.
4. Diabinese -100mg, 250mg Tabs (chlorpropamide)- For Maturity onset NIDDM cases.
5. Diamicron – 80 mg Tabs (Gliclazide) – for use in maturity onset NIDDM cases.
6. Diaphage – 500 mg or 850 mg Tabs (Metformin Hcl)- used for maturity onset diabetes responding inadequately to dietary treatment, either alone or with sulphonylureas. Also used as an adjuvant therapy in IDDM patients, particularly in the obese.
7. Euglucon – Same as Daonil Tabs
8. Glide – 5 mg Tabs (Glippizide)usded NIDDM patients
9. Glucagon – 1 mg per ml Injection (Glycogen as Hcl ) –used in severe hypoglycaemic conditions.
10. Glyciphage – 500 mg Tabs (Metformen hcl) – details same as for diaphage tabs.
11. Glynase – F or details see ‘Glide’ above.
12. Rastinon – 500 mg Tabs (Tolbutamide) –used in patients with NIDDM only) probable dose of each medicine. It may be carefully noted that the patient must consult his doctor, before opting for any dosage of any medicines. Only easily available and popular oral drugs are being mentioned as name of popular brand followed after generic band.

There may be some other popular brands but basic (generic) ingredients remain the same. Some new breakthrough is always possible, in view of sustained and painstaking research work being carried out in the western countries.

BIGUANIDES PREPARATIONS:

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These include Metformin and Phenformin drugs which are their generic names. Metformen exerts its effect primarily by increasing the peripheral uptake of glucose. It also enhances intestinal absorption of glucose, if given in large doses; as such its action is in contrast to sulphonylureas. The added advantage of its use is that it does not bring down the blood glucose levels in non-diabetics.

Uses: It is used in the treatment of diabetes mellitus as a primary therapy, in combination with insulin therapy or sulphonylureas.

Contra-indications: Risk of producing lactic acidosis is much more in Metformin than with use of Phenformin. It is more useful in obese and overweight diabetic patients and is used mainly in persons under 65 years, or in cases of renal & hepatic insufficiency, cardiovascular disease, pancreatitis, tissue hypoxia pulmonary embolism, excessive intake of alcohol or concomitant use of diuretics.

Phenformin is said to be comparatively much safer than Metformin, as it does not cause sudden fall in blood sugar level nor is it specifically meant for the obese only. Both are used in ‘Maturing Onset, NIDDM cases, responding inadequately to the dietary treatment, either alone or with sulphonylureas. But phenformin is contra-indicated in metabolic acidosis, infection, coma, gangrene, during or immediately after surgery, shock and hypoxaema, and also not in any cordial, hepatic or renal diseases.
Drug Interactions: Alcohol, diuretics, anti-coagulants.
Side-effects: These include nausea, vomiting, loss of appetite (Anorexia) loose motions metallictaste in the mouth, general weakness, skin eruptions, vassels or even urticaria. Possibility of lactic acidosis is more with phenformin than with the use of Metformin the latest side-effect can occur with the use of both drugs, but less with Metformin.

Dose:

Metformin: Usually 250 mg twice and daily after meals. The dose may be gradually increase even upto 3 gms, (in divided doses), if the situation warrants. As for tapering or enhancing the dose and its frequency, the patient’s doctor is the best guide.

Phenformin: It in available in 25mg tabs or in 50 mg capsules of long-acting duration. 25mg tablets may be taken 1-4 times daily, but must not exceed 100mgs, in total, per 24 hours. As for DBI , T.D.Caps, (Phenformin) usual daily dose is from 50-150mg, during 24 hour’s period but any change in dose & frequency, should always have sanction of the patient’s physician. Both Metformin and phenformin preparations should never be taken on empty stock. Best and preferred time is to take them after breakfast daily. This rule should also be followed by the patients who take sulphonylurea preparations. As a matter of principle, no anti-diabetic drug should ever be taken on an empty stomach. In case of any side-effect or reaction or changer in symptoms, the attending physicans’s must be informed at once, and his advice followed in its entirety.

Homeopathic Treatment of diabetes

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WHAT IS HOMEOPATHY?

In Homeopathy, objective and subjective symptoms are not of much consequence, as it is a medical discipline which attributes origin of the symptoms to mental conditions of the mind. It is a cardinal maxim which describes “Healthy mind in a healthy body.”, and from this observation one can easily derive the conclusion that, remain in a healthy frame, health of mind and body cannot be denied. It is the mind which governs the body, controls its various functions, affects its various states of its metabolic effects. If the body is sound and healthy, the mind will also remain sound and healthy. Conversely, if the mind itself is diseased, it will have adverse effects on the body. So, in order to enjoy a disease-free, healthy and sound span of life, both mind and body must work in unison otherwise desired balance, between mind and body will be disturbed, thus giving rise to certain symptoms which trigger many symptoms which, in turn, cause many disorders to surface.
In Homeopathy, it is not that merely a disease or mass of symptoms are treated. In fact, it is the man, as a whole, that is treated. The reason being that it is not only the body which is not at ease, rather it is also the whole mental frame of the individual which is also not at ease. So, effort should be directed towards treating the disorders through mind. There is an old belief that our dietary patterns govern functioning of out mental facilities and functions. Certain types of foods agitate various functions of the body, thus also affecting the mind. So, there must be a suitable balance and complete affinity among the trio, mind, body and food. We have mentioned ‘Food’ because in diabetes, food is singled out as the prime cause for diabetic conditions and resultant complications.

Remember, when treating a patient, we are not treating his disease but treating the man as a whole. When there is pain in some part of the body, it is not only the body or that particular organ which is painful, in fact, it is the entire body which is affected thereby.

Symptoms: Homeopathy is a branch of medical science which is based on symptoms, though merely noting down symptoms should not be the sole aim of the doctor. Certain symptoms are felt and described by the patient, certain symptoms are felt by the patient but he is unable to spell out or describe the same and, finally a few symptoms do not fall under these two categories and the physician should have the ability and competence to observe, discern and classify such unmanifested symptoms(Latent symptoms).

HOW TO TAKE A CASE:

Case taking is both a tedious, arduous, but an interesting job. While relating his symptoms the patient must be clear in his mind, true, honest, forthright and non-secretive and must not conceal his any symptom from his doctor. The doctor should allow the patient the freedom of uninterrupted speech, and the patient must never gain an impression that the doctor:
1. did not give him sufficient time and opportunity to speak out his mind or.
2. did not give him a patient hearing or
3. (The doctor) was in an unusual haste and was inattentive, insensitive or adopted a casual approach.
4. was not sympathetic and finally.
5. was lying more on his capacity to pay than to heed to his averments, so on and so forth,
6. put him certain unpalatable and offensive questions which he (the doctor) could have easily avoided or he was taken for a ride.

Anyone of the aforesaid allegations, so to say, will suffice to torpedo a confidence building exercise and a viable healthy doctor-patient relationship which are so essential for a smooth mutual understanding.

HOW TO ELICIT INFORMATION (SYMPTOMS)

The doctor must ensure that his efforts, to elicit cogent and relevant information in his symptoms and history, should always be viewed by the patient as ‘friendly and sympathetic.’ The doctor is not like a lawyer or a policeman, he is like a sympathizer and, as such, his probing questions should never offend his patient. Following points should from basis for preparing case history of a patient.
1. “The patient should be allowed to tell his own story, stating what he feels and the particular symptoms he is most anxious to get rid of.”
2. “He (The doctor) lets you (Patient) have your say” (Dr. Clarke)
3. “If the doctor cannot see much more than the patient can tell him, he is not much of a doctor.” Dr. J.H. Clarke.
4. “But, the patient’s story provides not only the foundation, but also the outline which the imagination of the physician must fill in. it is on this power of correctly filling in the lines and the colors of a case that success in the art of case-taking of the physician largely depends.) (Dr.J.H.Clarke)

FOR THE PHYSICIAN

When the patients has finished his story, then comes the turn of the physician who should record, bearing in mind that following points on which be should focus his attention by recording from the patient.
(1) His past history and (2)(His) family history, (3) The cause (s) of his (patients) trouble, if ascertainable (4) Times of aggravation and amelioration (5) His desires and aversions (6) His state of mind and mental (7) and also examine him physically. (8) All other points, incidental to the main symptom, should also be taken into consideration and finally (9) Totality of the symptoms (Please read below for details). Then, the doctor should prepare a summarized repertory of the patients symptoms (10) Preservation of the record.

Totality of symptoms: Dr. J.H.Clarke further points out that to the totality of symptoms, as explained by Dr. Hahnemann “that this totality –that is the sum total of the sensations and observable changes in the organism, constitutes the concrete problem in every case, with which we have to deal, no matter what name the academicals may give to it.”
“Disease is an invisible thing” a Hahnemann puts it “and this vital fact must never be forgetten that Disease Is the Derangement of the invisible vital force.” And to further his concept of a disease Dr.Clarke goes on to say, basing his concept of a modern simile (that is the symptoms constitute a moving picture like the figures on the screen of a cinema)as under. “The visible and tangible part of the human body is the screen, the appearances and sensations of the diseased vital force are the “Symptoms” and are analogous to the moving figures, but the operators producing the hidden from the audience. All the same, it is by looking on the screen that you can read the story of the changes in the invisible life-force in away (which) you could not do by going behind the screen.” Hence “the totality of the symptoms constitutes the disease as out senses apprehend it. The academic name (which) we give to it, is a secondary matter”.

Hahnemann, when being asked by one his patients as to what his diseases was, and what he was going to give me, shot back that “The name of your disease is no concern of mine, and the name of the medicine I give is no cercern of yours.” “In fact, in a nutshall “the totality of the signs, pains and sensations is , for practical purpose, the concrete problem, and the less we trouble about the film and the light, the more clearly shall we be able to follow the story and discern out actual task” (Dr.J.H.Clarke).

The foregoing opinions, of established authorities, are meant to guide the patient and the physican alike. The patient must disclose his symptoms clearly and without holding back any fact and the physician is also not expected to draw hasty conclusions, without taking into consideration all the relevant factors and points. The patient is like a client and the physician is his legal advisor. If the patient is unable to disclose all the facts, the legal advisor won’t be able to prepare & present a well prepared and flawless case. Both, thus, must supplement each other of course, the ability of the physician lies in extracting all the points & facts, without offending his patient, which have evaded disclosure by the patient.

VITAL FORCE

Our body, unless abused beyond measure, will continue to serve us and discharge its all the functions properly. But what makes the body function? The simple reply is that it is the vital force (which some prefer to call as autoimmune system) within the body. When this vital force is weakened or diseased, consequent upon some physical problem, the body either stops to function or malfunctions. Homeopathic medicines try to revive and regenerate this vital force to sustain the body-functions and also fight again invasions by foreigh bodies/ infective diseases. When this vital force is returned to its normal former rhythrn, all the body functions re-start functioning as heretofore.

An example will clarify the said point. For instance a person is having acute/chronic constipation which is only a symptom but not a disease. Constipation could be caused by various factors. The homeopathic medicines will remove the basic cause (s), such as dietary problems, weak peristaltic action of intestines, rectum and anus. When such causes are removed, affected organs will resume normal functioning, the problem of constipation will be automatically solved. In a way, by homeopathic medicines, vital force of digestive (excretory) organs has been revived. Instead of giving some laxative or purgative, which can temporarily provide relief but cannot cure (because, in the latter case, we have failed to touch the root cause).

HOMEEOPATHY AND CLINICAL TESTS

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A question is often asked whether the homeo-doctors should take assistance and base their diagnosis on the results of clinical & pathological labs. Honesty speaking when nature disseminates its bounties without any discrimination, on all beings, out of which the human being, is the finest form of good’s architecture and when such a person discovers certain medicines, drugs, surgical techniques, various standards on pathology or reveals new vistas, then what is the harm if a person takes advantage from such discoveries. The reason being that such discoveries were not meant for a particular nation, people, region or place. Hence all Homeo medical practitioners should always utilize such or any other device which can help his patient. Ultimately, sole aim of all systems of medicine and their practitioners is to relieve the humanity from pangs of pain and agony.

HOMEOPATHIC VIEW OF DIABETES

Aetiology: “Diabetes is a hereditary disease. It is more common in men than women (Ratio of 3:1). It usually manifests itself from 14th to fiftieth year and is rare in old age. It seems to be quite frequent in childhood when it assumes an exceptional gravity. Diabetes is a very common disease in cold and damp countries. It is observed, however, also in hot climates. Diabetes has also been attributed to feculent (i.e. having sediment) and vegetable regimen. But certain religious sects, abstaining themselves from meat the whole year round, are hardly affected by this disease. The abuse of wine, of cold drinks (acid drinks plays a more important role in the production of diabetes. Sedentary habits and professions predispose to the disease. It is very frequent amongst Hebrews, English, French and the Dutch.” (Dr. P. JOUSSET)

“Mental preoccupation and moral emotions should be considered among the causes of diabetes. Damp cold and chilling of the body, while perspiring, are also favorable circumstances, leading to the development of the disease.”

“Diabetes is due to an excess of sugar produced by the liver, and to the non-combustion of this excessive sugar. Sugar is mixed with the arterial blood and is partly eliminated by the urine… this exaggerated glycogen function of the liver is thought to be due to the influence of nervous irritation, which begins at the fourth ventricle.”

Underlined causes are considered by Dr.Jousset as the major causes which cause sugar to appear in blood and urine. Most of the causes do fall in line with the allopathic aetiology of diabetes.

HOW TO RECOGNISE DIABETES

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In his monumental book ‘practice of Medicine’ Dr. Jousset gives following symptoms which should from basis for recognizing diabetes’ presence:
1. Increased thirst,
2. Changes in the urine,
3. Diminution in sexual desire and power,
4. Successive appearance of boils and carbuncles
5. A continuous weak feeling & Drowsiness
6. In spite of great feeling of an increase in appetite, a certain degree of emaciation takes place.
7. There is almost from the very onset, a change in the temperament and disposition.
8. the patients are choleric, to the point of violence, suspicious and hypochondrial.
9. Micturition is very profuse, more so than the liquid ingested. It is paler, becomes turbid on cooling, resembling then, like water mixed with honey, and loses the odour. Although clear, it is heavy, its specific gravity ranging from 1027 to 1060. Clinical analysis reveals a quantity of glucose varying from 1/30th to 1/7th.
10. As for glycosuria (presence of glucose in the urine), it can occur in diseases that interfere with respiration, like asthma, pthisis etc. in neurosis hysteria and epilepsy. It can also occur in certain physiological conditions, like pregnancy and lactation, old age, in the foetus, after the ingestion of a considerable quantity of syrup of syrup or honey, after violent emotions etc.

DIABETIC FORMS/STAGES

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(1) Common From: It begins mostly from 40th to 50th year. It is commonly found in those who seem to passes a very strong constitution and those who are stout, strong and have a well-developed body structure and also those endowed with ragged health. Diabetes, in these subjects, may persist for an extremely long period, and with hygienic precautions followed perseveringly, this disease is compatible with long life.
Diabetics are subject to accidents which are not always avoidable.
This particular, stage may result in :
i. Gingivitis, with expulsion of teeth.
ii. Itchy and scaly eruptions on skin, especially on the hands, with dryness of the skin, great sensitiveness to cold as well as to heat, pruritus of the vulva..
iii. Impotency with the symptoms of spermatorrhea
iv. Urethritis, blenorrhoea, phimosis, presbyopia, anaurosis, cataract. But, the above-mentioned complications are not fatal and, thus differ from those grave accidents such as boils, gangrene and cerebral affections. Other complications can be named as boils, carbuncles, gangrene (of skin, extremities, pulmonary) diabetic or acetonemic coma (which occurs when volume of urine is diminished but the quantit of sugar excreted remains the same). It may also occur after the excessive fatigue or despression of the Nervous system, and often dyspnoea, irregular pulse, diarrhea, vomiting, convulsion may also accompany it.

(2)Cachetic Stage: pulmonary phthisis and albuminuria are the usual causes of this stage. In diabetic, phthisis patient becomes rapidly emaciated, with complete exhaustion, with poor appetite and digestive disturbances, cough, repeated blood vomiting colliquative diarrhea, and may terminate in speedy death. But, when albuminurea is present the patient can have oedema, puffiness of face, progressive decrease quantity of urine, headache, visual disturbances, eclampic abrupt attacks, abruptly ending in death.

(3) Consumptive Form: it begins with excessive thirst, excessive hunger, progressive emaciation. In this consumptive form, diabetic affections ate quite rare. Pulmonary pthisis is a predominant complication which often appears before end of the first year, with an alarmingly rapid course. The latter condition occurs generally in those who have been weakened by excessive loss of vital fluids and privations. This is diabetes of the poor, undernourished and the deprived whereas the former form often infects the rich, well to do and healthy persons.

(4) Accidental Form: This is also called ‘Being Form’ of diabetes by some authors and is often easily recognized by easy and spontaneous disappearance of sugar from the urine. This form is found, generally, in healthy persons and can be treated (if not cured) by some infallible remedies. Benign form has all the salient symptoms of diabetes, such as excessive abnormal thirst and appetite, weakness, furuncles etc.

(5) Acute Form: It is also called ‘Fulminant Form’ and is characterized by raped and intense occurrences but is rarest of all forms. In a few weeks of its onset, symptoms, peculiar to diabetes, appear very suddenly, such as carbuncles phlagmonous inflammation, acutepthisis, pulmonary gangrene etc.

(6) Irregular or Abnormal Form: This form is not covered by any of the forementioned forms. In this course, there is irregular course of appearance and symptoms are unusual. It may be caused by chronic charohoea, gout, or even fairly long intervals of perfect health. Neurosis gives a peculiar feature to abnormal diabetes, in which hypochondria, hysteria and insanity occur together or alternatively, with usual diabetic symptoms. In addition, there is an abnormal sexual desire which is in contradistinction with the habituel frigidity of diabetes. Its onset, development and symptoms are so slow that clinical tests often required to pinpoint presence of this form.

(7)Azoturic Form: The symptoms appear like diabetic symptoms but, in fact, point out to presence of excess of urea, instead of sugar, its accompanying symptoms include loss of taste, paroxysmal headache, neuralgic pains, insomnia, colour blindness, vertigo, mental weakness, loss of memory, trembling. It occurs mostly in men, between the age of 20 and 40 years. The usual causes are (That is the exciting causes) are fright, grief, excessive venery, repeated pregnancies and women, emotions, alcoholism. To avoid any possible misgivings and confusion, azoturic from has been mentioned simply to distinguish it from diabetes mellitus/insipidions.

BODY-PORGANS AFFECTED BY DIABETES

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We still grope in the dark about the possible causes leading to diabetes, especially when there are host of hypothetical factors which are said or supposed to trigger this. So far it is an unresolved and complex problem which still continues to defy any permanent relief to the suffering multitude. Various systems of treatment claim to ‘Cure’ diabetes but, to say the least, they have only been able to ‘treat’ and control only (of course, with certain restrictions) but ‘cure’ is still a far cry, not to speak of the research work being done in many advance countries. Medical research work is going on relentlessly to provide permanent relief the suffering humanity but, the fact of the matter still remains, that we are still naïve and novice, as we were heretofore. This is the only disease which adversely affects many vital organs of the body, mind and intellect.

The malady is said to be dependent upon functional organic (or of both) diseases such as those belonging to lungs, heart, spleen, pancreas pituitary gland, supurarenal capsule, kidneys, liver. Dr. George Royal had dwelt upon such aspects which can be reproduced, with slight modifications, where required as under. The morbid changes found in the above-mentioned organs or tissues and attributed to the diseases are as follow:
LUNGS:-Diabetic pthisis, Emboli of the blood vessels and lastly, gangrene (of lungs)

HEART: - Arterio-Sclerosis/Athero-Sclerosis, hypertrophy, fatty degeneration and fatty heart.

KIDNEYS: - Hyaline changes in the epithelium of the tubes, and fatly degeneration, chronic interstitial nephritis, simple catarrhal Nephritis.

LIVER: - Cells found to be nucleated, enlarged and globe-shaped, blood cells destroyed, giving a pigmented appearance in spots, cerrhosis, sometimes entire organ being enlarged and fatty.

PANCREAS: - In majority of cases, morbid changes are found in large number of diabetic cases, such as inflammation of lobe, chronic and interstitial nature, and finally fatly degeneration and cancer may also appear.

STOMACH: - Catarrhal gastritis which may be followed by dilation thereof.

SKIN: - Pigmentation with marked and prominent appearance of bronzed spots which are found when the liver is involved. Dryness of skin, itching and pruritus.

NERVOUS SYSTEM: - Tumours, hardening and degeneration of the spinal chord, extreme hyperaemea and oedema of the meninges.

BLOOD: - General anaemia, glycogen found within the leucocytes, urea in excess, diminished alkalinity, blood lepoids increased in severely diabetic subjects, doubled fat.
Dr. Royal has made certain very cogent and interesting revelations about the diet factor, food-faddism, certain races/countries which are easily or not, at all, affected by the so-called dietary regimen. Hence, it won’t be irrelevant to quite excerpts from his writings: -
1. No disease has more theoretical causes than diabetes.
2. There is no other such large group of theories, about any subject containing so few solutions which have been clearly and definitely established.
3. we were born diabetics but we never die of diabetes, there always being some complication which carries the diabetics off
4. Japanese have rarely diabetes thought they live chiefly on fish and rice.
5. The Hebrew race suffers most from this disease, than any other race.
6. The Negroes, though eating sugar with impunity, do rarely suffer from diabetes.
7. Exemption, from diabetes, is one of the compensations which the poor labour class has over the luxurious and the well-to-do class.
8. Americans suffers far less than the French and the Indian, even though it is on the ever-increase in these all the three countries.
9. The Spare & Skinny are far less victims than the obese, fat and flabby.
10. We congratulate the children in rarely having this disease and yet, the percentage of mortality among children is over 20 times as large as among adults.
11. Many a diabetic wonders whether an attack of malaria, rheumatism, syphilis etc. were merely suppressed, and is now appearing in the form of diabetes (Refer to Dr. Hanhemann’s ‘Theory of Miasm’)-such being considered or made out to be predisposing factors (for causing diabetes).

HOMEOPATHIC TREATMENT OF DIABETES

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Before suggesting any homeo remedy for treatment of diabetes, following points should not be lost sight of:
1. There is no use in harping and focusing upon the stages of onset, development, progress of the disease,
2. Individualism of the case is of utmost importance. No case should ever be generalized.
3. No inference or hasty conclusion should be drawn on vague symptoms but following symptoms should never be ignored/neglected.
i. Quantity of urine passed and frequency.
ii. Get the urine tested first and if the test result is positive, the same should be followed by blood glucose test.
iii. Specific gravity of the urine should be noticed and watched.
iv. Reaction is generally, rather always, acidic.
v. Albumin’s escape should be viewed seriously.
vi. Heart, kidney, digestive, respiratory and nervous systems functioning and their complications, if any, deserve to be attended to with utmost urgency.
vii. State of appetite and aversion and desires for certain eatables should be carefully noted.
viii. Personal habits, food-faddism, alcohol consumption, smoking, sedentary life style etc. should always be taken into account.
For more details, other than the ones mentioned above, earlier relevant context (s) may be gone through, before any medicine is prescribed. Aforesaid points should serve as a guideline.
In the remedies, mentioned below, name of the remedy is given first, followed
by generally recommended and often used potency, leading symptoms (in so
Far as diabetes is concerned), drug relationship and drug affinity. Except
Where otherwise mentioned or not, all drug should be given 4-6 hourly.

ARSENIC ALBUM (3, 6, 30)

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In healthy persons, it persons, it produced glycosuria, when give in toxic or non-toxic form (in doses). It acts on all tissues and organs and has particular elective affinity for nervous system, brain and glandular organs. It relieves weakness/emaciation, irritable stomach, strong burning and shooting pains, irritable stomach and intense thirst. Symptoms begin with irritability and finally end up in coma. Depending upon the patient’s condition any potency from 3rd to 1000th will benefit the patient. Arsenic patient is sensitive to disorder, and is disturbed by disorderly behaviour, set-up, is sophisticated and likes & appreciates finer and decent values and objects. He is prone to skin disease. While prescribing this remedy, mental symptoms and drug picture should determine its choice. Give 200th once/twice a week, or 1000th ( IM) after 10-15 days-only a dose once.

CUPRUM ARSENICUM (3)

In effect, it comes next only to Arsenic Album. It can be used in frequency, with much success when there are cramps in legs (or in lower extremities), aggravation (<) at night and amelioration (>) by heat. Profuse amount of sugar suddenly drips down to scanty flow, drowsiness with tendency to coma, varicose, ulcers having gangrenous tendency.

PHOSPHORIC ACID (Q OR IST IN 10-15 DROP DOSES)

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It is a boon when nervous system gets under stress due to tension and sexual excesses. Worry and overwork sexual excesses < the symptoms. Urine is expelled in large quantities and is loaded with sugar, oxalates and phosphorus. Its ranking symptoms is Apathy-the patient fails to realize nor does not seem to care about his condition.

ARGENT NITRATE (30TH)

Seats of action of this remedy are nervous system and mucous membranes. Mental depression and apprehension are the ranking symptoms. Weakness of nervous manifests in the form of trembling. Mucous membrance of the stomach is affected most, giving rise to nausea, vomiting, tremulous weaknes, painful distension of abdomen, eructation of gas and burning sensation. Ravenous hunger and desire for sweets are the two symptoms found to be common in Argent and diabetes, and this drug cures them. There is profuse flow of urine, though percentage of sugar is quite low.

LYCOPODIUM (30TH)

It is useful in flatulency, gas formation in stomach and abdomen. Even after eating a little the patient has a sense of fullness if not while eating. The lips are dry. Mouth is also dry. Skin also dry, region of liver is painful, the stools are dry, hard and large. Urine is dark, scanty and loaded with sugar and uric acid crystals. There is uncontrollable sexual desire but without any erectile power but Lycopodium will restore such power and also satiate sexual hunger.

SYZYGIUM JAMBOLANUM (Q-5 DROPS, 3-4 TIMES DAILY)

This medicine is prepared from fruit obtained from the jambolin tree. It is considered to be an almost a specific medicine which contains sugar in urine and blood, Dr. Willain Boreicke eulogises,about this drug, in these words: “No other remedy causes in so marked degree the diminution of disappearance of sugar in the urine.” And further adds, it also curves. “Prickly heat in upper part of the body, small red pimples itch violently, Great thirst, weakness, emaciation, very large amount of urine. Specific gravity, high, old ulcers of the skin. Diabetic ulceration. The seeds powdered, ten grains three times a day, also the tincture.”

INSULIN (3X-30X)

Insulin is an aqueous solution and active principle from the pancreas which affects sugar metabolism. Legendary Dr.Boericke maintains, “Besides the use of insulin in the treatment of diabetes restoring the lost ability to oxidize carbohydrate and again storing glycogen in the liver, some use of it homeopathically has been made by Dr. W.F.Baker, showing its applicability in acne, carbuncles, erythema with itching eczema. In the gouty transitory glycosuria when skin manifestations are persistent, give three times daily, after eating. Give a persistent case of skin irritation, boils or varicose ulceration with polyuria,it is indicated.”

If administered at suitable intervals in diabetes mellitus, the blood sugar is maintained at a normal level and the urine remains free of sugar. “Overdosage is followed by weakness and fatigue and tremulousness and profuse sweating.” So, its dose must never be exceeded, rather, it should be tapered and unfrequented.

EQUISETUM (6, 30)

When there is profuse urination and is difficult to control and the patient has to rush and hurry to the closet, a few doses, at an interval of ever 10-11 minutes, can be given to control frequency and excessive quantity of urine.

URANIUM NITRATE (6, 30)

Drs. Hughes T.F.Allen, Jousset, Dickinson and host of other have got satisfactory results from the use of this medicine when there was sugar in urine and blood, appetite perverted, digestion out of order, gas in the stomach, dryness of skin and mucus membranes. It will cover most of the symptoms of the diabetics.

BIOCHEMIC COMBINATION NO-7 (6x)

This is a sort of combination of some useful and suitable salts which cover most of the diabetic symptoms. It has to be used in 6x potency and 4 tablets should be take 3-4 times daily for about 3-4 months, without a break. It will correct and rectify the ravages caused by onslaught of diabetic attack, restore normal functioning of heart, kidneys, brain, liver, blood and circulation in general, improve general state of health and restore normalcy but, quick results may not ensue.

NATRUM SULPH & NATRUM PHOS 6X

These two drugs are also inducted in biochemic combination No-7. Despite that, these are the two biochemic salts which specifically reduce sugar in urine and blood and also regulate and normalize urinary flow. They are to be taken combined (2 tabs each) 3-4 times daily and continued for 3-4 months or until improvement is noticed but should, later on, be tapered instead of suddenly stopping the medication.

MORE INFORMATION BIOCHEMIC THEORY ON DIABETES

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There is hardly any Homeopath who can depend solely on 12 biochemic tissue remedies, as propounded by Dr. Sehussler but the affectivity of all such tissue salts has already been proved beyond a shadow of doubt, with the result that biochemic tissue remedies are part and parcel of homeopathic armoury of medicines. There is no exaggeration in saying without fear of being contradicted, that tissue remedies and homeopathic remedies. In fact, reciprocally supplement each other and no homeopath can do away with either of the disciplines.

Biochemic combination No.7 is comprised of (i) Calcarea Phos (ii) Ferrum Phos (iii) Kae Phos (iv) Natrum Phos and (v) Natrum Sulph. In their book, the twelve tissue remedies, Drs. Willian Boericke and Willis Dewey, have classically unravelled in their own inimitable style of master craftsmen, have taken pains to explain the viewpoint of a writer on the biochemic treatment of diabetes. We reproduce as to how a biochemist has to say about the diabetes, in so far as its treatment under the tissue remedies is concerned:

“Lactic acid is composed of carbonic acid and water and must be split upon its way to the lungs. This is done by the catalytic action of sodium phosphate (Natrum Phos) in the blood. Any deficiency of sod. Phos will cause a disturbance in the water in the system by allowing an excess of lactic acid to accumulate. Nature, in her effort to eliminate the water, produces the symptoms called diabetes.”

“But while a lack of sod phos is the principal cause of diabetes, the chief remedy is sod phos, because it regulates the supply of water in the blood. Sod phos also gives oxygen so necessary for the process of the decomposition of sugar, and thereby, prevents its reaching the kidneys as sugar, and also thins so its normal consistency, bile that the become dissipated from a lack of sod phos.”

“If a case of diabetes has advanced to any considerable degree, the kidneys will have become inflammed by the lactic acid and sugar that passes through them. This injury to the tissue of the kidney calls upon the red which will, in most cases, cause a deficiency in that inorganic salt. Nature, in her efforts to supply iron, will probably draw on the nerve fluid, Potassium Phosphate (Kali Phos) will be too rapidly consumed, and the patient suffers from nervous prostration.”

For diabetes Mellitus, therefore, the biochemic treatment would be through phosphates of sodium, Iron and Potassium and Sulphate of Sodium, detailed as under.

(1) POT. PHOSPHATE (KALI PHOS):
Meant for functional disturbance of nerve centres caused by demand on the blood for pot. Phos, producing sleepleness and varacious hunger, pot. Phos is an infallible remedy. It establishes normal functioning of medulla oblongata and pneumo-gastric nerve which latter acts on stomach and lungs.

(2) SODIUM CHLORIDE (NAT.MUR)
For the great thirst, emaciation and despondency. It equally distributes the water in the system and quickly restores the normal condition.

Note: -
1. Where two or more phosphates are required and indicated, they should be combined but (Nat Sulph) Sod. Sulphate and Sod. Chloride (Nat Mur) should always be given separately in solutions. Give calcium phosphate (Calcarea Phos), after each meal, in a small dose when there is great emaciation or/and poor appetite
2. In my opinion, diet cuts but little figure in the treatment of diabetes except as to the amount of food taken. The main object is to have the food digest. Diabetic patients should never overeat; better eat six times daily than overeat once. Of course the diet of fat, meats or greasy food cannot be beneficial for the very important fact that it overworks the liver, causes a deficiency and consequent thickening of bile and mucus, and sometimes a crystallization of cholestrin in gall-duct which gives rise to symptoms called hepatic colic, jaundice and bilious headache.”
Dr. P.Jousset and his son experimented on presence of sugar in Urine/Blood and claimed that the following recommended pattern can benefit, to enormous extent, the diabetics (which to our mind are merely recommendations) but may benefit to some cases.

MORE HOMEPATHIC REMEDIES

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1) Beer yeast:
“It affects total disappearance of sugar from urine. It contains a ferment which converts starch into alcohol. Two tablespoonfuls (20ml) should be taken immediately after meals.”
(2) Pancreatic extract & Hepatic Extracts:
“Give 40drops of pancreatic juice (extract) one day and 40 drops of liver (hepatic) extract of extract the next day (that is to be given alternatively each day) after meals.”
(3) Peroxide of Hydrogen (H2 O2)
“Given internally burns the sugar, with marked relief in inveterate cases, and also when accompanied with emaciation.” (Dose not given) it should be used only under medical advice.

(4)Mineral Waters
“The alkaline natural spring waters are very often prescribed in the treatment of diabetes. But, we generally prefer sea or mountain air to the most famous alkaline springs (spring water), to diabetics who are free from chest troubles.”

NUX VOMICA (6.12 OR 30)

Nux Vom is useful to those diabeties who often indulge in overeating, alcohol consumption, tobacco, use of drugs, lead sedentary life, are debauches who keep awake at nights, have torpid liver, weak digestion, with flatulent dyspepsia, do not do any physical labour, eat too much of fats, sugar, starch and spices, have constipated bowels. In short, it is by far the best remedy for the elements arising from so-called modern and advance life-style and for all ills inherited from weakness and sedentary life style, out of which diabetes is a leading disorder. Give 6th potency, 3-4 times daily. Some say, rather maintain can confirm, that a dose of sulphur (30th) in the morning and a dose of Nux Vomica (6th or 30th) at night, before retiring to bed. In acute and serious cases its tincture (Q) should be given, 3-4 times daily.

OPIUM (6TH)

It markedly alleviates the thirst and, in some cases it diminishes sugar, even if temporarily. It is also useful in chronic and habitual constipation, when the patient has no urge to evacuate his bowels, for days together.

HELONIAS (6TH, 30TH):

Useful in the initial stage of diabetes, when patient passes sugar in urine, in large quantities and frequently, lips dry and adhere to each other, has unquenchable thirst, restlessness, emaciation, mental agitation, tendency to weep and symptoms of gout also are prominent and, in addition, there are casts in the urine.

MERC. SOL (30 TH)

Patient is always thirsty, even though tongue remains moist, urine secretion exceeds the quantity of water intake, there is a frequent desire to pass urine, tongue has imprints of teeth on both sides. Sugar intake aggravates symptoms and also diabetic symptoms aggravate at night, when he lies on right side.

MEDORRHINUM (30TH 200TH)

Even after taking meals, the patient feels as if he had eaten nothing great liking for sweets, weakness and fatigue, feeling of an internal chill, complaints aggravate from morning till evening ,feels relieved by lying on chest or when placing his head on knees, sea-shore walking also ameliorates symptoms.

GRAPHITES (30TH)

More useful in skin infections, itching, eczema, (moist and oozing sticky and adhesive fluid), in constipation, delayed menses, aversion to coitus, ladies who are timid, scared and hesitate, are of very vascillating and indecisive nature, remain sad and morose always, weep when music is played, have fissured fingers which bleed also due to some injury, vomiting during menstrual period. Suits best the ladies than gents.

ARSENIC BROMIDE (Q)

Useful in both varieties (insipidus and mellitus); diabetes when body weight continues to shed, (without cause), with excessive thirst. Give 3 drops in water 3-4 times daily. Meat diet is recommended, while using this medicine.

LACTIC ACID (30TH)

Useful when there is gout alongwith diabetes, tongue extremely dry, excessive appetite, vomiting, but abates after taking meals, gouty pains with much, weakness in joints, shoulders wrists and knees. Should be used, preferably under medical supervision.

LECITHIN

Increases Red Blood Corpuscles in the blood, removes constipation, serves as a tonic, discharge of sugar, food casts and phosphates with urine, brain power is exhausted and tired, Neurosis, sleeplessness (Insomnia), forgetfulness, extreme prostration, cannot breathe fast, weakness etc.

CEPHALANDRA INDICA (Q)
It is not an old remedy and its reference is also found in the books of modern homeopaths more, though passing references thereto are not being ruled out. Useful, when large quantities of urine are passed every 3-4 hours, or even earlier, patient feels weak and exhausted after passing urine, urine contains much sugar (in one case 43 gr per ounce) alongwith indicant (though rarely), high specific gravity. Give 5 drops of tincture (Q) with fresh water 3-4 times a day or else may be alternated with syzygium J.Q-5 drops of each twice daily – on alternate timings. In addition thirst, burning sensation, dryness, loss of weight may also be noticed in addition to above mentioned symptoms.

CHAMOMILIA – (30TH)

It is useful when diabetes is caused by faulty functioning of liver, flatulency, pain in abdomen, mental agitation and angry mood, restlessness. 4 doses daily (4 hourly dose).

TARENTULA HISPANIA (30TH)

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Free and enormous passage of urine which is loaded with sugar. Patient is restless, weak, confused, sad and depressed. He is a man of agitated and peevish nature, his mood changes abruptly,, pretends that he always continues to suffer, is sex-ridden and lascivious, experiences pain, soreness all over his body. Consolation and music provide him relief but any sort of sympathy compels him to weep.

Note: In most of the remedies, mental symptoms have been predominantly mentioned and highlighted. The reason, for doing so, is that, in homeopathic treatment mental symptoms determine choice of a proper remedy. If mental symptoms of a particular remedy fail to match with the patient’s mental symptoms, the remedy (selected remedy) will never show desired results. It is repeated once again that it is the mind that drives the body. An acting mind cannot serve the body.
2. In Homeopathy, there are a number of other remedies which have not been mentioned here due to space crunch and also that most of them are not so significant or used in practice as the above mentioned remedies are and, the latter ones, meet mostly bulk of diabetic symptoms.
3. Dose, in each remedy, its frequency and duration of continuation of a remedy or other remedies will depend on status of the disease and condition of the patient. Hence, the above-mentioned doses and potencies may differ from one patient to another and, thus, only the physician of the patient can truly and effectively guide his patient. For further knowledge of the remedies the readers will do well to refer to Dr. Willian Boericke’s ‘Pocket Book of Mateira Medica with Repertory’, which, to out mind, will prove useful for every household.

GUIDELINES FOR USE OF HOMEOPATHIC MEDICINES

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As far as possible, an effort has been made to give a reasonable account of homeopathic treatment along with causes, symptoms, diagnosis etc. There are certain cardinal rules, for use of homeo medicines and treatment which should be borne in mind, which are listed below for the benefit of the readers.
1. Before homeo treatment is started, it is always advisable to start with 3-4 doses of Nux Vomica so that effects of previous medicines are offset. This is particularly essential where an allopathic treatment has already been in use.
2. Best time to take a dose is to start with the first dose early in the morning on empty stomach, as first thing in the morning after rinsing of mouth with non-fragrant cleansing agents.
3. Half an hour, before and after taking the medicine nothing should be eaten or drunk.
4. During the course of homeo treatment, no other medicine, belonging to allopathy, should be taken, except under medical advice only.
5. All homeo medicines should be fully protected from dust light, fragrance, scents, sun-rays, and also there is no necessity, at all for keeping such medicines in the refrigerator or exposed to hot climatic. In damp climates, care should be taken that moisture or moist climate do not cause any harm to medicines. In rains and rainy season also keep the medicines well protected.
6. No magical effects should be expected from homeo treatment, particularly when it is followed after the allopathic treatment, as it takes time to ward off the pervious effects of allopathic medicines.
7. potency, frequency and duration of each remedy may have to be varied often, depending on the condition of the patient and status of the disorder.
8. certain remedies run concurrently with other remedies which are complementary to each other. In such cases, the former should follow the principle remedy. Remedies which are inimical, should neither be taken before or after the principle remedy. In fact, inimical remedies must be avoided, at all costs.
9. All the intermediary complications, as and when they surface during course of treatments, should be immediately attended to.
10. Garlic, onion and other pungent or scented or fragrant articles, should not be used, at least in raw form. They may be used, if unavoidable, in cooked form.
11. Potencies :
a) 6th, 12th, 30th or mother tinctures or 1x, 3x, 6x, or 30x potencies are low potencies and may be repeated at an interval of 4-6 hours. In acute or serious states, low potencies may be repeated even after a gap of 10-15 minutes or even earlier when the grave situation has already occurred.
b) 200th potencies should be used once a week only. Modern homeo doctor, sometimes, deviate form the standard norms and often give 200th potency with a gap of 30-60 minutes in a day (say 3 does after a gap of 30-45 or 60 minutes)
c) 1000th potency should be given once only in 10-15 days.
d) Potencies from 10,000 onwards should be used only once in a month. Repetition of dose should be resorted to, only after effect of first dose has been exhausted.
e) Potencies from 1, 00,000 onwards (above 1cm) should be rarely used, and that also not earlier than 45-60 days gap. Potencies, from 10m onwards (10,000) do require an expert physician’s advice and guidance.

12. Cautions on use of certain specific remedies.
a) Never give Calcarea carb before sulphur or and never use Lycopodium after sulphur.
b) Never use Rhus Tox and Apis before or after each other, as they are inimical to each other.
c) Ignatia and Nux Vomica are never to be followed by each other.
d) Drosera, Lachesis, Nux Vom and sulphur should not be repeated quite frequently.
e) If sulphur is given in the morning and Nux Vomica at night, it will prove very beneficial. These too medicines, if taken, as advised above, for a few days, will relieve the patient from many disorders
f) When symptoms agree, but even the well selected remedies fail to show any favourable outcome, in that case, give a dose of sulphur 30. it will pave the way for the selected remedy to act and also, in addition cause appearance and surfacing symptoms which remained dormant, so far/heretofore.
g) Keep away Camphor and kreosote-Qmdicines from all other medicines.
h) Homeopathic and Biochemic remedies can be used in conjunction, as they are not inimical, rather they aid and supplement each other.
13. Do not use milk with Bromium.
14. Avoid in addition to garlic & onions, use of asafetida, camphor, Tea, Tabacco,
Beer or any spirituous liquor.
15. Higher doses of silicea can cause reappearance of suppressed symptoms of
tuberculosis.
16. In chronic cases, never start treatment with Lycopodium.
17. In inflammatory swelling of joints, use of kali Carb may prove fatal even.
18. Medicines (Remedies) prepared from snake poisons, like lachesis, crotalus,
Should not be used in mother tincture (Q) form or in lower forms. All such
medicines should be used with extreme caution.
19. Study carefully remedies like Aconite, Bellodonna, Bryonia, Conium, Calcarea
Carb, Calcarea Phos, Dulcamara, Ignatia, Kali Phos, Lachesis Merc Solubles,
Nux Vomica, Opium, Pulsatilla, Rhus Tox, Sepia, Veratim Album, Wyethia,
Zincum Phos/Zincun Met etc.

Ayurvedic Treatment of Diabetes

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Ayurvedic is the science of life, age, rather a way to live long, healthy and disease less method to enjoy long span of life. Our ascetics were so far-sighted and prudent that they devised devices to maintain a healthy way to live life. There is hardly any disease which our ayurvedic treatises have not mentioned and suggested remedies to get rid of even the so-called ‘incurable’ diseases which still baffle the humanity. It seems quite surprising how our ancient seers, with very sparse and limited resources and opening at their command, could manage to devise and disseminate such a vast vista of knowledge. It is a tribute to our ancient values that even in remote corners of our country, domestic medicines are still a source of treating most of the ailments which continue to torment and affect all persons. The application of herbs, condiments, vegetables, fruits and various recipes, even now, form basis of our domestic treatment of diseases which owe their organ to the knowledge disseminated by our indigenous medicinal system that is Ayurveda.

It is a common knowledge how our saints and seer has shed their physical ailments by using herbs and vegetables available to them, in those backward days. Ayurveda has been handed down to us, from generation to generation and, thus, the ancient knowledge got embedded into our life style and pattern. History of Ayurveda speaks of volumes about its origin, progress and resultant invasion by other systems of medicines. Only Chinese, Egyptian and Unani systems of medicine can vie with it, and not any one of the modern disciplines of treatment.

WHAT IS AYURVEDIC THEORY

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Ayurveda is based on three basic (humours) factors which govern, control, cause various functions of the body which are:
1. Vaata (wind, Air)
2. Kaph (Phlegm)
3. Pitta (Bile)
All the three, combined together, form a trinity and are called three ‘Doshas’ (Tridoshas) whose imbalance is considered to be the basic cause of human (Physical or bodily) sufferings. The body does not, rather cannot, have any disease when these three elements continue to nurture and feed the body and thus, no infection can ever adversely affect functioning of any organ of human body. Certain relaxations of diet, habits, climatic effects, natural calamities, indiscreet and imprudent use of certain drugs, under eating or over-eating indulgence in such eatables/drinks which are inimical or unacceptable to our body system, certain mental and psychic upsets disturb (Proportionate disturbances) the three doshas, paving the way for physical illnesses.

Illness is nothing but the result of flouting the laws of nature, ignoring nature’s forewarning signals. Any deviation or divorce from nature’s laws with impunity invite and precipitate causes of a disordered state. The more we withdraw from the lap of nature, the more we fall prey to its ravages which manifest themselves in the form of diseases.

Simple principle is that if a person gets diseased by abusing nature, it is only the nature and its various abundant resources which are capable of restoring us to a healthy state. So, and very rightly so, the ayurvedic system of medicine depends largely and mainly on nature’s booties to prepare medicines.

Further, the herbs and vegetations, growing on a particular soil only are capable of curing illnesses of the residents residing on that soil. Nature is so kind, benevolent and considerate for its inhabitants that it vegetates only such food items which could benefit the residents of a particular region. Perhaps, that may the only reason why the term ‘Regional food and food habits’ is often used.

BASIC & FUNDAMENTA; TENETS OF AYURVEDA

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The three diagnostic tenets, already described, signify the following facts.

1. VATA (Wind): Air and ether, the two combinations of universe, form basis of vata which forms an important part of the ‘Tridoshas’. Wind is of five kinds viz. Prana, Udan, Vyana, Samana, and apan. Now all the five subdivisions of Vata are briefly dealt with, as follows.
a) Prana vayu: it helps in breathing process, helps to swallow, digest and regulates and governs various cardiac (heart) functions. Its chief function lies in harmonious functioning and maintenance of heart, mind, arteries, intellect, veins and arteries, nerves and nervous system in order.
b) Udan Vayu: It is responsible for production of speech (vani) and various sounds (naad), to keep and maintain strength of the body and also to impart strength and sustenance to intellect, memory and mind.
c) Samana vayu: It helps to control equilibrium in production and distribution of flow of liquids in the body, to assist the digestive system by supplying requisite enzymes for digestion of food. It separates food particles – the useful ones being utilized by the body and the waste products are dispatched to intestines for expulsion. Urine flow, its secretion and excretion are also governed by it. In a nutshell, it regulates our entire digestive system, helps in expulsion of faecal and toxic matters.
d) Apan vayu: Entire excretory system of the body is controlled and governed by it. It completes the undone job of saman vayu. Apan vayu is situated in lower portion of digestive system. It controls, excretes and regulates expulsion, retention and production of faeces, urine and semen. It can hold back faeces, urine and semen for a specific period only but, after that, it helps these elements to get excreted through various openings (orifices) of the body. Apan vayu is very important as retention of such excretions can cause untold discomfort and disease to the body. It should as a rule, remain below the lower abdomen but, if it makes an upward move, it can depress the diaphragm.
e) Vyana vayu: It circulates throughout within the human body and nourished the body, by carrying various juices and blood to various organs of the body to enable it to function properly. It, in fact, controls motor (Mobile) functions of the body. It also causes the secretion of perspiration through pores of skin, helps closing and opening process of eye-lids alongwith movement of body organs.

2. Pitta (Bile): Like vata, Pitta has also subdivisions such as Pachak, Ranjak,
Sadhak, Bhrajak.
a) Pachak Pitta: Its main function is to help in the digestion of food. Its segregates the juicy and waste parts of food, thus helping the other parts of pitta to have normal functions.
b) Ranjak pitta: When the juice of food travels from stomach to liver, this (Ranjak) Pitta imparts colour to the former.
c) Sadhak pitta: of all the forms of Pitts, its is of the finest quality, and is seated in the heart, helping also intellect and memory to normally perform their functions.
d) Alochak Pitta: Normal vision in the eyes is maintained due to alochak pitta only. But for this kind (from) of pitta, our vision might have been adversely affected.
e) Bhrajak Pitta: It seat of action is skin which assumes its colour from Bhrajak Pitta only.
3. Kapha (phlegm): Like vata & Pitta, kapha is also another important humour and is sub-divided into kledaka, Avalambak, Bodhak, Tarpaka and Shushak (Phlegm) Kapha (s). Its salient and predominant feature is Agni or fire.
a) Kledak kapha: It moistens the food in the stomach, and its specific humid properties help other types of kaphas (Phlegms) to nourish.
b) Avalmbak pitta: It is seated in the thorax. It gives protection to heart from excessive heat, by its cooling effect and provides strength to the heart.
c) Bodhak Kapha: Its seat is from tip of the tongue to the throat. Any substance, coming into its contact, will be moistered by it, apart from determining and knowing taste of (the same) ingested eatable. It also helps to restore increase appetite.
d) Shushak Kapha: This humour is seated in major joints of the body and helps to keep them in mobility duly moistened. To our mind, synovial fluid in the joints is analogous to this form of pitta, the absence or lassitude of which takes away mobility of the joints and they crack and pain, on slightest motion even.
e) Tarpak kapha: It provides cooling effects to organs of the body, like sense of hearing and sight.

BODY AND ITS CONSTITUENTS

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Human body is composed of bones, flesh, bone marrow, semen, tissues, bile, phlegm, water, wind, different minerals, chemicals, arteries, veins, nerves, capillaries etc. principal organs like brain, lungs, heart, liver, stomach, intestines, sexual organs and excretory organs function in a unified pattern and style and all the functions occur in such a unison and harmony that one wonders how silently, faithfully, regularly and sincerely all organs discharge their respective functions unless, of course, these are abused and disturbed by our indiscreet actions.

Nature of human beings is governed by three Gunas (qualities or tracts) viz sattva, Rajas and tamas and the ages at childhood, youth, middle and old age are governed and motivated by these (or any one of the above) tracts. Diseases or emanating sources thereof stem from the three gunas. One person may be sattavik vritti is tendency. orientation of a person and his nature (pravritti) is also determined by his infliction to anyone of the gunas. The ayurvedic physician, while examining the pulse of a patient, will immediately conclude as to from which dosha his body is ailing and also that to which guna he belongs. The vaidya knows well what is the cause responsible for his patient’s ailment. Thus, he would try to establish a proper equilibrium between the three doshas. He will not only discern from the pulse, but also examine his heart, digestive system, respiratory system, condition of tongue, capacity of the patient, his desires and aversions his dietary menu, his mental state and his tracts.
He will also take into consideration his family history, the environment and climate in which he resides, his social background, his profession and its demands on his health, age, sex etc. In ayurvedic system, a person is treated as a whole and emphasis is on rooting out the basic cause of the disorder, instead of giving only palliatives or some tranquillsers. In cases of emergency, he may have to resort to such short cut methods but, in the long run, he will be relying on the actual basic cause of the disorder, instead of giving only palliatives or some tranquillsers. In case of emergency, he may have to resort to such short cut methods but, in the long run, he will be relying on the actual basic cause.
Materia medica of ayurveda dwells upon the Rasas (or juices or extracts/essences) which are derived from vegetables, fruits, meat, grains, animal foods like classified butter, milk, curd, whey etc. It is the food which causes most of the ailments. So, the ayurvedacharya will, first of all, look into eating habits of a patient. In his view, wrong food causes most of the ailments and when such food, or even the normal food, when it remains undigested, causes many serious complications which, in turn, can cause other physical problems.
Human being, according to Ayurveda, is a part of the greatest power (the supreme reality) and is endowed with qualities of supreme power, five elements (Panch Bhutas) constitute this body (earth, fire, water, sky and air). When the five elements combine life comes into being but, when these five elements disintegrate, death occurs. These five essential are essential attributes of nature (prakriti) or environment (paryavaran). Again recapitulating what has been mentioned earlier, we return to trinity of vata. Pitta and kapha which is said to be combination of certain other constituents which are mentioned as per following details.
1. Vata (wind) is a combination of air and ether (akaash)
2. Pitta (bile) is an amalgamated form of earth and fire (Prithvi and Fire)
3. Kapha (Phlegm) is a combination of water (jal) and ether.

SOURCES OF AYURVEDIC MEDICINES

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Basic ingredients, from which medicines are processed, are herb vegetable fruits, minerals, certain other materials, and are available in the form of pills, tablets, syrups, liquieds, quaths (decoctions) rasayans (tonics), emulsions, pastes (awaleha), asavas, pulverizations (powders) essences etc. It is for the vaidya to decide what sort of medicine could suit a particular individual, in what quantity and what frequency

HOW TOEXAMINE A PATIENT

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An expert Ayurvedic physician (Vaidya) will, first of all, examine the patient by touch, physical inspection and prudent and reasonable questioning (but never a patient should be cross examined or agitated to the point of fury) but unpalatable words must always be avoided, at all costs.
First of all the physician puts his three fingers (from the thumb side) on patient’s right wrist, (on the blood vessel which starts from end of the thumb). Pulsation under the index finger will indicate vata dosha (disturbance of wind), under the middle sugar, it will indicate pitta-dosha, and pulsation under the ring finger will indicate kapha dosha. Pulsation under the middle finger will indicate sound health of a person. Any lack of equilibrium or variable pulsations will enable the physician to determine real cause of his patient’ s complaint. It is said that best results and diagnosis can be achieved when a patient is examined in the morning, on empty stomach, when physical status is normal. Inspection of pulse, physical examination and questioning will enable and experienced physician to deduce actual and real cause of the disease. An adept physician has eight ayurvedic branches at his command, to treat his patients, as per details below:
1. General medicine
2. Surgery and various medicines connected with surgery
3. Medicines pertaining to eyes, ears, nose, mouth and throat (ophthalmic, E.N.T. and mouth)
4. Psychiatric (Maansik) medicines
5. Paediatrics and Midwifery
6. Toxicology
7. Rejuvenating medicines
8. Aphoridiasic medicines
Perhaps, this is the reason why Ayurveda is rightly called the ‘Science of eight branches’ (Asthaang Ayurveda)
An experienced vaidya is now armouned with latest pathological tests and various diagnostic investigations devices which should always be availed of and no element of hesitancy should ever mask his approach. In addition, he should also take into consideration the elements of person’s nature & temperament, time, space, environments place. Resorting to short-curs should not be the tract of a vaidya. His aim ought to be to eradicate the disease once and forever, no matter the duration of time taken to achieve his end.

AYURVEDIC TREATMENT OF DIABETES

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We reiterate that diabetes is not curable but is only controllable through treatment, if the patient heeds to the advice of his Physician and follows his instructions entirety, Doctor-Patient relationship and mutual understanding and considerate and prudent approach can go a long way in solving this, so far unresolved, disorder which is rightly called a silent-killer like hypertension, cancer and other such lingering diseases.

AYURVEDIC VIEW POINT OF DIABETES (KINDS OF DIABETES)

1. Premeha : It literally means excess of rain which denotes flow of urine. In a nutshell it means excessive flood of urine which does not contain sugar. The patient passes large quantities of water-life urine, at short intervals and gradually emaciates.
2. Madhumeha : It literally means ‘Rain of honey’. ‘Rain denotes flow of urine, in excess (or in particular) and the word ‘Madhu’ stands for ‘Sugar or glucose’. In all, at means passing large quantities of urine which is thickly loaded with glucose. When premaha and Madhumeha are not controlled in time, the sugar contents pass on to the blood stream, affecting all the body organs. In ayurveda, there is hardly any difference in the teems ‘sugar in urine’ or ‘sugar in blood. When the body fails to absorb sugar in the blood also fails to halt and utilize sugar in its stride, the excessive quantity of sugar is excreted by the kidneys, through urinary discharge. To sum up true diabetes an only be gauged, when there is sugar in the blood. Presence of sugar, in both blood and urine, further confirms diabetic status of a person, urine in sugar can be gauged from appearance of colours of the urine, as shown below:
Blue Colour : No (Nil) Sugar
Green Colour : 0.5% Sugar (approx)
Yellow Colour : 1% Sugar
Pink Colour : 1 to 1.l/2% Sugar
Red Colour : 2% Sugar (approx)
Dark Red : Over 2% Sugar

Urine tests, by using ‘diastic sticks, can be easily done at home by the patient himself. When the sugar level rises in blood beyond 160-180mg, the kidneys start releasing sugar through urine also but every patient is a rule unto himself. It may be notes out ‘diabetic test’ is not considered to be a reliable test.

CAUSE OF DIABETES ACCORDING TO AYURVEDA

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1. It is phlegm, disease. Excessive use of eatables which precipitate and cause rise in phlegm should be avoided in all circumstances.
2. Sedentary persons are more and too often animal meats.
3. Consuming too much and too often animal meats.
4. Use of milk and milk-products, crystal sugar, jaggery, sweets in excess,
5. Continuously sitting at one place and position and sleeping during day cause increase in phlegm in the body with resultant rise in sugar in blood/urine.
6. Too much use of pungent, spicy, dry, cold eatables, free and frequent indulgence in sexual acts, inability to discharge urine and stools, shock and worry, exposure to extreme hot and cold conditions hyperexcitability, bleeding in excess, abnormal life-style and gluttony habits, easy-going nature, lack of physical activity or else too much of exercise, etc. also cause diabetes.
7. Eating too much of starchy, fatty and carbohydrate based eatables, in one form of the other.
8. Obesity, whether hereditary or acquired.

SYMPTOMS OF DIABETIC PATIENTS

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i. Its origin is due to excess of vata & cough (air and phlegm) in the body. When its origin is due to vata, the patient is compelled to pass urine frequently and in large quantities which render him weak, and pushing the retentive capacity of his bladder to dangerous ends.
ii. Urine is alkaline, sweetish, yellow, thick and flies and ants get attracted to it due to its sweet smell and nature.
iii. Patient is always hungry and thirsty, in spite of excessive intake of food and water liquids.
iv. Gradual loss of weight and strength.
v. A diabetic patient prefers sitting to standing and also sleeping to sitting (may be due to lack of his body strength, weak legs, pain in calves and general run-down condition)
vi. Consistency in semen and vigour gradually diminished, rendering him impotent-both physically & sexually.
vii. The patient ignores ‘nature’s initial warning signals and symptoms’, thus inviting chronic stage of diabetes which, by the passage of time, becomes chronic and untreatable.
viii. If fasting glucose test reveals glucose beyond 100/110 mg, it is a definite indication of presence of diabetes mellitus and if the P.P. test reveals presence of sugar beyond 140/160, it indicates rise of sugar, in blood, after taking meals.
Presence of sugar in blood is a definite indication of DM, but mere presence of sugar in urine only should not lead to any definite diabetic status of a patient. Repeated tests of blood and urine are advised to confirm the diagnosis.
In ayurveda, diabetes is of 20 types viz (i) 10 types are caused by kapha (ii) 6 by bile and (iii)4 by wind. Urine examination and other allied symptoms of diabetes will determine, as to which of the three is the real contributory cause. Following dietary regimens are said to benefit in a particular causative factor.

In phlegmatic diabetes: The patient should resort to physical labour/exercise, deep introspection, journey, and roughage-creating and dry eatables, goat’s milk, juice of meat, rest worryless attitude. Care should be taken that wind producing palatable are taken, but not those which produce phlegm.

In bilious diabetes: Avoid pungent, heavy, fatty, acidic and spicy objects.

In wind laden diabetes: Things such as potatoes, curd, whey, potatoes, rice etc should be avoided.

Do’s & Don’ts: Try to keep your digestion in order, bowels should be regular and no constipation should occur. Take to physical exercise so that the food is fully digested and appetites remain normal. Do not lead a sedentary life. Try to shed weight, either through diet control or through
Some sort of physical activity. Avoid coitus and let not your semen be wasted away, even if the sex desire is uncontrollable. The obese should take only fat and starch free diet, rough grains should be used in diet. Take to walking. But, to the weak and lean persons, give nutritious diet, some amount of fat. Sweet, in any form whatsoever should be avoided, except sparse use of old honey (in moderate quantity only). Following medicines may be continued for 21, 42 or 96 days, or even for longer periods, depending on condition of the patient and stage of the disease.

MEDICINES

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GENERAL MEDICINES
1. Powder of Triphala, 4 gms, with honey (twice daily).

2. Purified Shilajit one gm with old honey, once or twice daily in 24 hours.
3. Juice wheat (100 ml) with sugar candy.

4. Triphala and Trikata powders, each 1 gm with cow’s milk.

5. Juice of Inner portion of Neem’s rind with sugar-candy.

6. Anyone of the following medicines:
(i) Abharak Bhasma (ii) Bang Bhasma (iii) Heri shankar Rasa (iv) meghanada Rasa (v) Bangeshwar Rasa. Anyone of the above medicines or may be combined with the other, if situation demands. Each to be taken takes from 0.250mg to 0.500 mg with old honey (details in Bhaishajya Ratanavali)

7. Howsoever uncontrollable and intractable the diabetes may be Ina
Patient, the best (but also the lestest) medicine is vasant kusumakar
Rasa which can control diabetes in a short time. In addition, it will ensure
and restore normal functioning of all the vital organs as also build up
General strength, vigour and vitality of the body. It will also rejuvenate the
Entire physical system. In a way, this medicine will overhaul system. Due
To its hefty cost factor, very few people can afford it. The mid-way is that
This medicine should be continued for 5-7 days, followed by
chandraprabha vati for 10/15 days. After use of Chandra prabhu vati,
Basant Kusmakar Rasa may be restarted. This mode of treatment will cut
down cost factor. The dose may be tapered and frequency altered after
Improvement is noticed.

8. Chandra prabhu vati: This is called a ‘Poor man’s remedy,’ as Basant Kusumakar Rasa is a rich man’s remedy. It also removes urinary problems like hesitancy, frequency, burning sensation, elimination of albumin, sugar in the urine. It can also be used in conjunction with the medicine mentioned in no 6 above.

9. Reduce to powder the inner shell (of stone) of Pipal tree, jambolin, mix with Haldi (Turmeric, ) Gurmar Booti (herb), powder of palash, neem leaves or their juice, juice o fripe bael, leaves of bael, juice of Karela (Bitter Gourd)- Pulverise and reduce to paste form so that pills could be processed. Take a pill (500 mg 1 gm) 4 times daily with fresh water or cow’s milk.

10. Powder of turmeric (Haldi) 20 gms. White pepper (Dakhani or safed Mirch), 5 gm power of Methi (Fenugreek). Mix all the ingredients Daily dose is one teaspoon each in the morning and evening/night with hot or lukewarm milk. Watch blood pressure and also if bowels functioning normally.

11. Powder of Methi (Fenugreek) one teaspoonful with water of milk, twice daily, giving a gap of (interval of) 10-12 hours between each dose.

12. Immerse seeds (one TSP) of fenugreek in a glass of water at night, let it remain immersed in water overnight. Take the (soaked) seeds, early in the morning, on empty stomach. Make sure that you use water also while chewing the seeds. Since fenugreek seeds are a bit bitter, their remaining immersed in water, will take off its bitter taste. But, our advice is that bitter taste should never be subordinated to the efficacy and utility of a remedy. It holds good for other such (bitter) objects too.

13. Chew 5-6 fresh and green leaves of bael, 2-3 times a days and let in the juice thereof which is also said to reduce sugar in urine and blood.

13(A). Proprietory Preparations
Our modus operandi is not to serve the cause and propagate for ayurvedic medicines manufacturing companies or for that matter, of eve any of the individuals but, we wish to see that every patient is relieved of his agony which is a source of torture not only for the patient but also for his well-wishers, relatives, friends as well. Patient’ sues and the benefits, occurring from the aforesaid and following brands preparations, would prove efficacy and utility of a medicine.
(1) Diabenese (2) Madhumehari (3) Diabetrex strong (4) Diabnil and many more.

14. Whichever medicine or a combination of medicines one opts for, a tablespoon of Devadaravarishta (mixed with at least 3-4 times quantity of water), after meals is much to be recommended.

15. Shakhahooli, Ashwagandha, Sheetal Cheeni, Gurmar should be pulverized in equal quantities. Take 2-3 gms with fresh water daily.

16. Juice of fresh Amlas (10ml) mixed with old honey is also said to be useful in diabetes.

17. Vasant Kusumakar Ras, Jambul stone, Gurmar herb 1gm each per dose, with honey – in the morning and evening.

18.To Gurmar and Jambul stone and vrihad Bangeshwar Ras (1gm each) to be taken as above.

19. If extract/juice of fresh karela (bitter gourd), without removing seeds and peeling off, is taken daily once in the morning (100-150ml), on empty stomach, it will remove sugar. Quantity may be slashed down when sugar level, in urine and blood tests, returns to normal. Those who cannot take bitter things can take pickle of bitter gourd which may be eaten along with meals. Bitter gourd is not available throughout the year. In order to solve this problem, its green vegetable throughout the year. In order to solve this problem, its green vegetable should be dried, under shade (after being shild into small pieces). When fully dried, it should be reduced to powder form. Normal dose is ½-1Teaspoonful with fresh water twice a day.

Fcod:
1. Food regimen is equally necessary alongside the medicinal treatment. Do not use wheat flour or maida (finely ground wheat) which contains carbohydrate in abundance. It should be avoided or else gram flour be added to it use maize or barley flour in place of wheat flour.
2. Occasionally add Desighee (clarified butter) to your meals (5-10 gms/ml) to your diet, as it does not saturate. Always use unsaturated oils as medium of cooking.
3. Avoid sweet contents form your dietary schedule. Eliminate crystal sugar.
4. Pulses, sprouted grains, porridge, soyabean should find a important role in a diabetic’s diet.
5. Take plenty of green, leafy and fibre-enriched vegetable which can be taken in cooked or raw form, or used even as salads.
6. patients with kidney problems should never ear tomatoes and spinach.
7. All starch-based, richly fatty and sweetmeats should be given a go-bye.
8. Only citrus fruits like Lime, Orange, Louqats, Nashpati, should be taken, but Mangoes, Grapes, Leechies, Guavas, Apples should be avoided.
9. Abstain from spicy, junk, fast foods, tinned or bottled drinks, meats, or unhygienic fruit or vegetable juices.
10. Alcoholic drinks, use of drugs, use of tobacco in any form purgatives to relieve constipation, all types of jams, sweet sausages, syrups, vinegar should be eliminated from dietary menu.

Dosage and Repetition of dose

Dose and its frequency should always be based on factors like state of health, diabetic status, diabetic complications etc. hence every case is to be individualized and thus no fixed dose can be recommended or/and advised. The aforesaid quantities of dosage are merely indications and, as such, should never be taken as fixed parameters. Even persons having their symptoms identical cannot be given the same dose, for reasons mentioned above.
An expert ayurvedic physician can easily prescribe the requisite dose and its frequency for each individual patient separately, taking into account all the basic requirements. The diabetics are advised, in their own interest, that it is always prudent and advisable to remain under guidance and supervision of a qualified ayurvedic physician who will not only guide you, but will also take into account other factors and complications, if any. This advice applies equally in case of other systems of medicine also.

Yoga And Diabetes

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Definition: ‘Yoga’ means to ‘Joint’, that is, that which joins ‘atma’ and ‘Parmatma’ (the supreme power and the individual). Yoga is not merely a way to some postures (Asanas), to keep the body fit and trim but to unite the purush (vyakati or a individual) Prakriti (Nature) and Parmatma. Yoga conjoins and establishes an equilibrium, affinity among all the said elements of universe. It purifies mind, body ad intellect, thus enabling each one of them to perform individual function.

That is attaining control over mental leanings is called ‘Yoga’ which is not alien to Hindu culture and civilization. The great ascetic Patanjali, systemized and categorized in a lucid and scientific way, various disciplines treatises. In short, yoga modifies controls and disciplines various risings and fluctuations of mind. As is well known it is the mind alone which governs, controls and regulates various functions of our body. In away all the body functions get subordinated t command of the mind.

Four paths of yoga : Yoga helps a person to attain his desired aims by resorting to four paths as follows :
1. Karma Yoga
2. Raja yoga
3. Bhakti yoga and
4. Gyan yoga
To lead a peaceful and meaningful life, one can choose anyone of the said four paths, according to his approach, aptitude and temperament. For a person, karma yoga is the best and that is why, Lord Krishna dwelt upon, at length, in Bhagvatgita, alongwith Bhakti yoga and Gyan yoga. Next to Karma Yoga comes Bhakti Yoga which can be treaded only when the disciples unconditionally surrenders himself to God. Bhakti can be possible only by undaunted and unshakable faith in God. This path is far easier that the Gyan Yoga. In Gyan Yoga, one normally revels into ‘Ifs’ and ‘Buts’, and logic forms major part of it . logic is an argument which gives birth to debates and discussions, coupled with inhibitions and suspicion of the follower, resulting in a argumentative and critical approach. A Gyan Yogi suspicion. A Karma Yoga is humble but a Gyan Yoga generally is self-centred and egoistic. Raja Yoga is governed by intellect but the Karma Yoga is governed by mind and heart.

ASHTANG YOGA

Of the four paths mentioned above, one can adopt any path according to his inclination and capacity (including capability) but eight practices are essential to all the adherents of the four Yogic paths. These are eight essential practice which are mandatory for a practitioner.
1. Yama (Ethical Principles)
2. Niyama (Rules of conduct and Individual duties)
3. Asana (Body Postures)
4. Pranayam (Breath Control)
5. Pratyahaar (Sense of withdrawal from worldly objects and belongings)
6. Dharna (Concentration) or some call it conviction/firm view also
7. Dhyan (Mediation)
8. Samadhi (God realization)
Undermentioned four yogic methods cover the aforementioned eight essential disciplines of Yoga.
1. Yama and Nujama are covered by Gyan Yoga.
2. Asanas and Pranayam are covered by Hath Yoga.
3. Pratyahaar is covered by Karma Yoga and
4. Dharma, Dhyan and Samadhi are taken care of by the Raja Yoga. All these yogic disciplines help one to attain peace, mental discipline, discretion and quietude and thus, in a way, change the whole life style of a person.

YOGA AND BODY

Basic aim of yoga is to mould the body, as per the mental and physical practices for acquiring the supreme bliss. An ailing body cannot discharge the various functions and , thus , cannot serve its master-the human being. If body is not in order or in sound health, mind will also remain disturbed. Hence, an equilibrium and suitable balance between body and mind is of prime importance.
The homeopathic basic concept is nearest to the Yogic theory because the former also is decidedly of the view that first of all mind should be treated. Once the mind is sound and healthy, it would take care of the body. But, in turn, an ailing body cannot take care of mind. In fact, health of mind and body is reciprocally dependent on each other, for each supplements and supports functioning of the other. If the vehicle (body) is out of control or in bad shape, an adept driver will manage to drive it. Conversely, if the driver (mind) is novice and naïve, he will not be able to run even the best possible vehicle.
Now a word about Yama (Ethical/social Principles). Yamas are further divided into five under-noted sub-divisions viz.
1. Ahinsa (Non –violence/Mercy to living being)
2. Satya (Truth)
3. Asteya (Non-Steeling)
4. Brahmacharya (Celibacy or sex-mortality)
5. Aparigraha (Non-Hoaring tendency)

ASANAS IN YOGA

Yoga Asanas (postures) have been derived on an analogy from certain articles used in daily life, animals and birds because while performing a particular Asana, the pose attained/formed during on asana resembles shape/form, or at least, a physical resemblance identical to living bird or animal or some object.
According to pandit Jawahar Lal Nehru, ‘But the old asana method is perhaps more typical of India and seems to fit in with the spirit of her philosophy. There is poise in it and an unruffled calm, even while it exercises the body. Strength and fitness are gained, without any waste of energy or disturbance of the mind. And, because of this, the asanas are suited to any age, and some of them can be performed even by the old. There are large numbers of these asanas. For many years now I have practiced a few simple selected ones, whenever I have had the chance, and I have no doubt that I have profited greatly by them, living as I often did in environments unfavorable to the mind and the body.”
If a busy person like Nehru, could derive benefits from performing certain asanas, to keep his body and mind in happy and fit frame, then why could not you and I ?
Dr. Rajendra Prasad opined, “……I am fully convinced that this is the best system of physical culture and from all angles, superior to other systems. One of the salient features of the system is that it is, from all angles, a complete and comprehensive system based on scientific principles. It has a unique feature of influencing each and every part of the body and keeping it in perfect health. Besides being scientific, it is natural also. It is the simplest and most inexpensive way of keep it fit.”
The averments of our too legendary national leaders is no less a tribute to Yoga.

PRELIMINARY REQUIREMENTS TO PERFORM ASANAS

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(1) TIME : Best time to perform asanas is early in the morning –that is much earlier before sun-rise say between 4.00 a.m. and 6.00 a.m. when air is pure and fresh, atmosphere is quiet, calm, serene and undisturbed-free from any sort of pollution. Then, the next best time is towards the evening when the sun is about to set.

(2) SEASON AND PLACE : There is controversy as to the most suitable place where asanas should be practiced. During the summer period, asanas should be practiced under shade of a tree but, in beginning of winter, best time is when rays of the rising sun are visible. But in severe and extreme cold conditions, asanas should be practiced in a well-ventilated room. In rainy season, it is better to do asanas under a covered (roofed) portion which should be open from all sides. A garden, green park, or bank of a river or an open place is an ideal place. Due to paucity of space these days, one can practice asanas in one’s own room whose windows should be opened to let in fresh air and light. The place where asanas are performed should be neat, clean soft and dry. Spread some folded sheet. Blanket on the floor, if asanas are to be done on ground.

(3) CLOTHES: clothes worn should be loose and according to external factors governing weather. Loose and easy worn clothes will enable will also be smooth and unhindered. It is advisable to bear minimum clothes on the body so that fresh air and sun-rays can have salutary effect on the body. Dress should be soft, easy and comfortable and in no way, the body should feel tightened or over draped.

(4) If asanas are practiced after taking a bath, it is the best way. But, in any case, ensure that call of nature has been fully answered. Cleanse mouth, eyes, throat, ears, nose and hands after attending to call of nature. Some expects differ on prior bathing. They maintain that, during the process of performing asanas, the body sweats profusely and certain toxins are also excreted by the body. Hence, taking bath 30-45 minutes after the exercise is the best method. It will rid the body of foul smell, sweat odour etc. It should be borne in mind that bath is never taken immediately after finishing the asanas. There must be a gap of an hour in-between.

(5) Never do any asana when the body is diseased, as an ailing body will not be able sustain and bear aftermath (of effects) of asanas.

(6) Asana are not meant to tire you, rather they are tailored to tone up your body, brian and intellect. So, never exceed your individual capacity. Avoid exertion in any sort of discomfort, immediately discontinue to practice any asana. Instead practice a relaxed posture (Shavaasan-corpse pose) to soothe down and normalize your breath, blood pressure, fatigue and other types of discomfort. Regular adherence to yogic asanas will bring Suppleness, flexibility and strength to your body.

(7) Practise sukhaasna or Shavaasna before and after performance of routine asanas. It will rejuvenate, energise and render your breathing normal. Conclusion of asanas must be followed by shavaasna, if the latter is not possible prior to starting practice of asanas.

(8) Before deciding to embark upon practicing asanas, it is always better to seek guidance and advice from an experienced yoga teacher. It is most important when a person has any acute or chronic disease, in which case the yoga expert will ordain and tailor his advice, keeping in view physical health status of the seeker.

(9) Only one asana should be preformed once, which may be followed by other asanas. Movement of limbs, from start to finish, should be uniform, rhythmic and slow. If you are ever in a hurry, do not do any asana. One should not stay in the final position of an asana, for more than a few seconds, before he relegates/returns to the pre-asana position.

(10) Never be in a hurry, as you are not completing an academic course. You can always taper down the number of asanas and can also reduce repetition number of an asana. It is always better to defer than rushing through prescribed/stated whatever, whichever and whenever you perform an asana, it must be complete. It is better to complete a single asana in a hush. But, never sacrifice proper technique to hurried methods.

(11) fasting is a good device as it purges and cleans the body of toxins and foreign matters. But if you feel weak, after completing a fast abandon your asana programme (s) until you regain normalcy. Persistence with a weak body, couple with practiced of asanas, will only spell disaster as, ultimately, you will be a dismal loser.

(12) Never practice pranayam (holding of breath) when there is soot, dust, smoke, storm etc. If dust-storm surfaces during an asana, at once abandon your practice and seek refuge in a non-polluting and dust free place. Avoid vitiated and polluted environs for pranayam.

(13) Your diet should be simple, well balanced light, nutritious and satiating to your temperament and taste (diet during illness is an exception)

(14) Certain asanas are and can be easily linked to some physical ailments. So, such ailing persons are advised, in their own interest, to seek the expert advice of an yogic expert as to which asanas he should opt for.

(15) Massaging the body once a week is quite beneficial and no exercise/asana should be done the day when body is massaged. In winter sunbath or basking in the sun will bestow immense advantages.

(16) Asanas are not physical exercise or like any game or sport, It is not meant to build up your body like a wrestler, boxer, team player, swimmer, or any other player, rather it is a way to sublimity, self-purification, physical and mental well-being –a way to rid you of the poisons which cause tremendous health hazards. So, those who wish to take this unique method of physical/mental fitness and uplift for a ride or wish to substitute it for any other pattern of health promotion, are better advised not to practice yoga.
After spelling out, in a reasonable detail, various essential aspects of yoga, we will now try to deal with application of yogic kriyas and asanas, so far as its utility to diabetes is concerned.
Readers are advised to go through, once again, on the process of digestive system (In the initial portion of this book) which forms the core of basic causes of diabetes.

DIABETES AND (YOGA) ASANAS

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Like Ayurvedic, Yoga also believes that the diabetic disorder stems from dietary indiscretions and pancreatic malfunctioning, as a result of which the food eaten is not digested properly, enzymes and amino acids fail to mix up with the food, insulin released is showed down or is not sufficient enough for the body to control sugar metabolism. In addition, retentive capacity is also adversely affected which causes escape (or release) of sugar therefrom, in excess of the quantity required by the body to convert sugar into energy.

Yogacharya Bhagwan Dev has rendered a yeoman’s service in disseminating and propagating varios aspects on Asanas in yoga. Other learned authorities have also tried, in their inimitable style to explain relevant yogic aspects, for the benefit of the mankind. He has advised the diabetics to practice regularly following asanas to get rid of diabetes or whichever suits them:-

i. Sarvangasana
ii. Bhujangasana or Sarpasna (Snake-Posture)
iii. Dhanurasana (Bow-Posture)
iv. Shalabhasana (Lotus Posture)
v. Pashchimottanasana and to the above list have been also added:
vi. Ardhamatsayendrasana
vii. Process of compression of stomach.
viii. Sukhasana or Shavasana (corpse or relaxation posture)

SARVANGASANA

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Process: The name, itself is indicative of the fact that this asana covers whole body organs. Due to lying down on ground and raising up of whole body, it has been also named so.
Lie flat on ground, keeping erect both feet and whole body. First take a deep breath, then exhale gradually. Now very slowly raise both legs, with both feet stuck together, and raise the legs upto waist. When the legs are erect, try to slowly raise up the portion of body, resting on ground, supporting the waist with both the hands, elbows remaining fixed to the ground. Fix your eye-sight towards your feet. It will be noticed that weight of whole body is resting on neck, shoulders and elbow. When one gets adept in the above posture, both the legs can be brought towards your forehead, making an effort to touch the ground with feet. Alternatively, in an advance stage, keep one leg straight and bring the other leg towards your head, trying to touch the ground.

Benefits : It ignites appetite, improves digestion, blackens grey hair, fluffy skin becomes solid and lustrous, increases strength and resistance of body, regulates thyroid functioning, improves eye-sight, spleen and liver problems decline, facial blemishes are removed, face assumes luster, rejuvenates man’s sexual power, night-pollution diminishes. It is a boon for intellectuals, advocates, lawyers, busy business executives and students.
It removes constipation, dyspepsia, indigestion, appendicitis, deformity in organs, premature old age, asthma, cough, skin infections, impurities of blood, malfunctioning of pancreas, controls sugar metabolism, menstrual problems, eye and brain problems, headaches etc.
Person with weakened heart, high blood pressure and hyperthyroidism should not resort to this asana, except when a yoga expert gives a nod.

BHUJANG/SARPASANA

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Since the posture resembles a cobra with an erect hood, it has been very rightly designated as ‘Sarpasana’

PROCESS : First of all, lie flat on your stomach, knees, feet and nose touching the ground. Join and keep tight both the big toes. Place both hands near either side of forehead. Now stretch both hands backwards in the direction of waist. Then gradually raise your neck and torso (upto the navel) to such an extent, that whole body-weight rests on both the hands. Ensue that the navel touches the ground and also the body portion, below the navel remains touching the ground at 180 (in a straightline). Make sure that your ears remain touching your shoulders.
Stay for about 2-5 minutes in the above position by now inhaling (Poorak kriya), retain the breath (Kumbhak Kriya) for about 2 minutes or till before a feeling of suffocation sets in. while returning to the original position, release the breath (Rechak Kriya). During the whole process, eyes must remain affixed upto the ceiling of roof. It should be very gradual and in a natural way. Never overtax yourself. Duration of the posture can be increased or slashed down, depending upon individual capacity, strength and resistance.

Benefits : It is equally beneficial for all the family persons and yogis (ascetics). This asana imparts flexibility and strength to erector spine, lumber sacrel portion, sacrum, shoulder blades, cervical portion. It fortifies and lubricates ligaments, nerves muscles, tissues with enormous supply of rich blood. Entire nervous system attains long life, becomes stronger ad agile, especially sensory nerves. Due to extra abdominal pressure, digestion gets improved and even chronic constipation is removed. All complaints of chest, lungs and back are dispelled. It regulates menstrual problems & complexities. It also removes flatulence after meals, body is rendered agile. People with kapha (Phlegm) and Pitta (Bite) can get enormous relief from this asana. It not only regulates functioning of the heart but also imparts strength and resistance to it.
Pregnant ladies or persons with slipped-disc or lumbago should not do this asana, even if and even when advised by anyone.

DHANURASA (BOW-SHAPE POSTURE

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This asana has been named after Dhanurasana because the body shapes like a bow, when practicing it.

Process : Lie down on ground, your stomach touching the ground. Join both the feet and hold them with your hands. Now exhale breath (rechak) and taking a firm grip on the toes, draw your body backwards, that is try to raise and stretch your head towards your feet, as conveniently and slowly as you can. Try to keep your eyes straight and fixed. Now retain (Kumbhak) breath and remain in the said posture for some seconds. The moment one starts feeling suffocated, try to regain original position, by releasing the breath very gradually. Give a pause and repeat the whole process once again. Be careful not to be hasty, rather entire procedure should be done with utmost comfort, without any jerk or strain on any organ.

Benefits: It reduces (sheds) extra fat from the abdomen. Also expels wind and relieves abdominal pain and discomfort, arouses healthy appetite, expels putrid and foul smelling wind, removes dyspepsia, strengthens heart and regulates pulse. Removes all throat problems, modifies and improves voice respiratory process is improved, improves vision of eyes, maintains and cultivates facial glow. Eye ailments do not surface, trembling of feet and hands is also removed, due to stretching effect in recti muscles and due to abdominal pressure digestive juices are crated for further mix-up with food particles. This asana gives combined effects and benefits of ‘Shalabhasan’ (which will be explained later) and ‘Bhujangasan’. By doing this asana alone, there is no need to practice both the said asanas. Pain in knees and leg muscles, in feet, in femur and tibia bones is also relieved. This asana is very beneficial for ladies as it tones functions of uterus and vagina, regulates, menstrual flow and other disorders, it rectifiers defects in ovaries and restores their normal functioning. Pregnant ladies should never attempt this asana or any asana which exerts pressure on their abdomen. Persons with backache and slipped-disc should not also practice this asana.

PASHCHIMOTTANASANA

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(Posterior Stretching Posture)

Process : you should first of all attain shavasana (corpse pose) to be described in next pages) and then set in the same asana. Join backs of the hands and take the arms in- between the legs. Now catch hold of the big toe with three fingers (Index, middle and ring fingers in that order). Keep the thumbs and the adjoining fingers towards the soles. While keeping the heels as much inward as possible, ensure that the sole remain flat on the ground. Straighten the spinal chord by pushing the chest outward. Now very slowly take the feet forward, while keeping the big toe protruding outward. After your legs have been stretched forward completely, bend your trunk so that your forehead rests on the knees. Remain in the final pose for a few seconds, and then retrace to original starting position, but slowly and gradually. This may stiffen your feet, knees, hips and back to some extent. To remove the stiffness, give these organs a vigorous palm-massage to ensure regular flow of blood. This development is merely a transitory phase and should not cause any concern.

Benefits: This asana tones up entire nervous system, removes all digestive troubles, increases height of children. It also purifies Ida and Pingla Nadis, as far as spiritual view-point is concerned.
The above asana should not be attempted by pregnant ladies, those having lumbago, low back-ache, slipped disc. Since most of the diseases are caused by constipated bowels and indigestion, this asana will remove both said disorders. Ladies can do it, after delivery period is over. It will shed extra fat and fluffiness from their abdomen & waist.

SHALABHASANA (KAMALASANA

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It is known or called as Shalabh or Kamalasana, as the feet attain form of a ‘lotus’, while practicing it.
Process : First sit with affordable ease on the floor, keeping both the legs straightened. Join both feet. Now place left foot on right thigh and right foot on the left thight. Both the heels should remain on either side of the navel, that is navel should remain exactly in the centre where both the heels cross each other. Now place hands on knees, head, chest and waist and back should be erect (straight at 90). Both the knees should be touching the floor. Keep your eyes normally closed. Now try to concentrate and meditate. Do not let your wayward thoughts wander. Padmasana can be a convenient meditating pose, even for an hour or so, but the duration should be gradually increased from one minute, at the first instance.

Benefits: This asana is very useful for mental workers, for meditation, concentration. For students it is a boon, because it imparts them requisite concentration for studies and assists them in observing celibacy, in addition to preserving their semen and other vital forces. It is enemy of ‘Tridosha’ (Wind Phlegm and bile), gives peace and tranquility, adds years to life-span, memory is improved. Removes stomach and various digestion related disorders. Uterine problems are eliminated. Persons of all ages, even children and aged persons can practice this asana to derive worldly, physical and spiritual gains. Hardly and other asana can compete with it, as far as concentration and mediation are concerned. It also arouses ‘kundalini’ prowess, if rules of yama, Niyama are closely followed.

SHAVASANA (OR CORPSE-POSE)

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It is known as ‘Shavasana’ because in this pose, the practitioner attains pose as if a dead body lies on the floor. It is, by far, the best asana for complete relaxation of body, mind and intellect. Perhaps, that is the reason it is also called a ‘Sukhasana’ which means an asana which provides relief (a tension free state).

METHOD :
Lie flat on your back or on your spine. Join the heels keeping toes apart and arms running or resting alongside the body. Fingers should remain loosely joined and palms should be rested on the ground. Now close the mouth, breathing only through your nose. Tongue should be drawn in, within teeth-socket, resting the upper jaw on the lower jaw. After attaining the above described posture, try your best to relax your whole body from head to toes.

Mentally imbibe a feeling that you have relaxed your body from top to bottom from the remotest part to the farthest part. If some stiffness is felt, give a gentle push to your legs, bringing them back to previous position and relax. After you have relaxed your heels and toes, now try to relax your. Your knees, hips, naval portion, chest, shoulders and the forehead. The said organs should be relaxed one by one till you feel that each and every organs of your body (from toes to head) is relaxed fully.

When the physical aspect of relaxation is over, new switch on your attention to breathing process. Start breathing in gradual, relaxed, rhythmic and uniform manner. Slowly breathe through your nostrils very slowly, without creating any hissing sound. Breath should be suspended for a few seconds, without causing any choked situation. Feel and breathe normally and slowly. Finally retain the breathe in the lungs for a convenient time and then release/exhale. Let the mind and body remain absolutely calm and relaxed.

Benefit :
Shavasana takes away your physical fatigue and relieves you of mental tension, thus completely relaxing and pacifying your agitated nerves. Since anxiety, worry and tension are said trigger diabetes, this asana will relieve diabetics symptoms and concommitant symptoms, especially if mental tension is the cause.

ARDHAMATSAYENDRA ASANA

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This asana has been named after the name of the great Guru (Teacher) Machhander Nath whose ardent disciple was none other than the famous Guru Gorakh Nath. It has been eulogized as the best and most effective method to get rid of the monster disease called ‘Diabetes’.

Process : Sit in a relaxed pose on the floor. Turn your right leg from your knees and rest the heel in between rectum, below testicles and perineum. After this, raise your left leg, semi fold your leg so that the hind and upper part of your heel touches the patella (knee-bone) of the already twisted and folded right knee. Now try to place your left hand (from the back-side) on your right thigh and keep your right hand on your right knee. This way your neck and head will get directed paralled to your left shoulder. Body should not be bent, but may be slighted twisted to facilitate to attain an exact posture. Keep your spine erect. The grip on your right knee should be free and your left hand, on the right knee should remain firmly placed thereon. In this process the left hand rests on the right thigh and your right hand should be gripping the already be folded left knee. The right hand will touch the left knee, from the outside of left knee. Ensure that, even while turning to your side, chest must remain unbent and straight. When all is done, try to look to your left side straight in the direction of your shoulders. One should remain in this position for some time-as far as convenient when the first postural asana is complete, the reverse posture should be attempted-now it would be in the context of folding of the left leg. Rest of the process (in relation to changed side and position) is as described above.

Benefits: It activates your pancreas, thus causing release of insulin, It also regulates and strengthens metabolic functioning of liver, spleen, intestines, stomach, activates digestive juices for quick absorption with food taken. It also removes acidity, flatulence, heart burning, backache, pain and stiffness of joints and bones, relaxes muscles and tones up muscular activity, regulates circulation of blood, feeds and nourishes every and each smew of the body. Its keeps your body, mind and brain in excellent health harmony. You will feel mentally and physically relieved, relaxed and also feel that you are gaining energy, vigour and strength. This asana should be practiced daily. One or two asanas will not yield desired results.

Note: Seek guidance from a yoga teacher, since this a bit difficult posture to practice.

GOLDEN RULES FOR A HEALTHFUL LIFE

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1. Rise early in the morning daily, as early rising keeps one health fit and agile.
2. Cultivate the habit of having morning walk which will tone up your body and also refreshen your mind. By doing so, you will exhale more oxygen. Persons, who are unable to have a walk, due to some physical problem, are advised to do some moderate and sustainable exercises indoors.
3. Sun-bath and air-bath are also useful for health.
4. To purify blood and strengthen your lungs, rather to fortify and regulate the respiratory process, deep-breathing is very necessary. It will also enable to improve your circulation of blood.
5. Throat, mouth, tongue teeth should be cleaned daily. Nothing should ever be taken into your mouth unless you have hygienically brushed and cleansed your above organs.
6. Try to avoid hot-water bath. If some urgency is ever felt, take bath with luke-warm water. But, try to cultivate the habit of taking bath with cold and fresh water, as it enhances circulation of blood.
7. Eat only when you feel that your body requires food to satiate your body requirements. Never eat stomachful, hastily or in a huff. Each morsel should be chewed and masticated, and emulsified to such an extent that it descends only in the liquid or semi-paste form into your stomach.
8. Fasting means giving rest to your body, and regularizing after your body has been abused by over-eating. Fasting is meant to purify body, mind and intellect, to give your body much deserved/desired rest and respite form over-eating . It is the easiest way to rectify dietary blunders and indiscretions. If you fast in the morning and then, overload your stomach in the evening, entire purpose of keeping fast is lost.
9. Avoid synthetic clothes, as also tight and uncomfortable dress which tends to cause tension to you. Dress should be comfortable, easy, loose and well-looking.
10. The room, where you lie, should be airy, ventilated, open neat and clean letting in plenty of air and sun-rays. Try to have sound, undisturbed and carefree sleep. Try to keep your mind free from all worries, anxieties and hassles.
11. Develop the habit of standing and sitting in an erect spinal posture. Do not walk stoop-shouldered or bent like an arrow.
12. Sexual indulgence and abstinence should be avoided, as both the extremes are harmful.
13. Calls to nature should never be delayed or suppressed.
14. While sleeping always keep your face exposed and uncovered to fresh air.
15. Never shirk physical exercises. Devote and keep apart a specified time duration for this purpose.
Above, rules for keeping fit and healthy, are tip of an iceberg only. Regularity must form a part of one’s daily chores, in all facets of life. Regularity must not be confused with punctuality.

Naturopathy And Diabetes

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Nature is a word that encompasses anything and everything under the sun. Even human temperament, likes and aversions denote personal (trait) nature of a person. Man, being by far the best gift of nature, has given us fruits, vegetables tress flowers, plants, air light soil, water, heat and other climatic conditions which govern out pattern of life and, thus without nature, life on earth would never have been possible. Despite all the scientific advances and breaking of new vistas and breakthrough in many fields, out actions still remain subordinated and subservient to nature.
Nature has certain laws and regulations of its own. As long as we function within the ambit of its tenets we rarely fall ill but, the moment wa try to be over smart or play havoc with it or flout, overtly or covertly, its regulations, we invite untold misery, illness, and problems for s, and the totality of full-out outcome is too horrible to imagine. Nature is always kind to us but, by our imprudent and indiscreet actions, we violate its rules, there by offending it, without foreseeing the ravages to which we can be subjected. So, remaining closer to nature, spells happiness and all-round prosperity but even slight detour or deviation, will spell untold disaster and horrifying results.

FUNDAMENTALS OF NATUROPATHY

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1. “Early to bed and early to rise makes one healthy, wealthy and wise.”
Is anoft-repeated adage but very few people practice or heed to the inherent massage which refers to, in fact, proper and sound sleep, full relaxation of body, mind and brain. If sleep is unrefreshing and inadequate, one will get up as a fatigued, tired and almost like an ailing person. He will have headache, constipation, lethargy to run away from normal work-load and daily routine. If one is not physically healthy, he won’t be able to attend to his work, and if he fails to discharge his assigned jobs, he will ruin his financial status too. So, health and wealth are correlated. A wise person will take care of both. The father of modern medicine, Hippocrates had delated that “Natures are physicians of out disease’ which means that only nature can cure us.

2. Air, Water and Heat : We may do for a while without, heat, but we cannot live without air and water. Heat is due to sun which provides energy to all the living beings, including vegetations. No growth of any plantation can take place without heat and light of sun, water is required for nourishment of plants and air is the only available force of sustenance of our body. So, nature in her benevolence, bestowed these three elements to all living beings in plenty. Various seasons,climatic changes are also essential for our survival. Had there been no winter, the snow would not have been on the high mountains. If there was no heat, the snow could not melt and release water into rivulets, rivers and other sources would have depleted to dangerous levels. Different seasons are meant to serve the human needs in respect of water, heat, rain and air, changes in season fortify our body to bear thermic fluctuations.

3. Theory of Five elements: Air, water, space, and earth when combined together, result in formation of the human body but, when these five elements disintegrate, death occurs when all the five constituents join their fountain-heads from which all the five constituents join their fountain-heads from which each one had originated and emanated. Earth, in spite of bearing all the oddities and the absurdities of human beings, continues to serve all and one. Earthly mother is compared to earth get annoyed or displeased only when their patience is exhausted by erratic acts of its children (we, the human beings and all the creatures).

4. Herbs, vegetables fruits etc: Nature has given us so much in different forms of vegetations, including food grains and cereals. In fact, most of the Ayurvedic, Homeopathic mother tinctures and other medicines, Unani medicines, some herbal based Allopathic medicines owe their existence to vegetations and, but for their existence, mankind would never have been free from disease, mental disorders, and other infirmities. Had there been no vegetables, pulses and food grains, our dining tables and kitchens would have borne not even a resemblance of their present form. But, sadly enough, we are driving ourselves away from the lap of nature whose products we have vitiated and spoiled by resort to artificial chemical means and the brunt of their blunders. We have vitiated every gift of nature viz vegetation, water, air, environment and resultant consequences are too horrifying and regrettable.

HOW TO GET RID OF TOXITY

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Due to our eating habits, certain poisons continue to accumulate in our body. Initially their presence remains oblique and dormant and no discomfort is felt, natural auto-immuno system of the body manages to take bold of such toxins. But, when the body is unable to hold on to such toxins beyond a certain period, the toxins spill over to other vital organs, thus giving rise to various disorders which, in common parlance, are referred to as ‘diseases’. Those who often fall prey to loose motions or constipation are warned not to ignore such a disorder, as it is an invitation to many other serious disorders. As a first step, secure proper and timely evacuation of bowels. When bowels are normal, no worm or any toxin can ever manifest human body. A toxin free system is a prerequisite to good health.

NATURAL MEANS TO TREAT DIABETES

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Instead of treating the symptoms, Naturopath aims to eradicate the root cause of disease, for the simple reason that it strikes at the root and not on the branches. If root is properly nourished, all the parts of tree will automatically blossom. Nature cure, like Ayurvedic, believes that wrong living way, wrong food cause constipation which, in turn, gives rise and birth to other disorders of which diabetes is one disorder.

Main purpose is to purge out toxins from the body so that adversely affected organs resume functioning normally, as heretofore, and the damaged already done to the physical system is repaired and proper and efficient management of body is restored. When the principle cause is removed, diabetes will stand retreated, by practicing the following natural methods.

NATURAL METHODS

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(1) ENEMA

Liquid is to be inserted per rectum in the body for which cold or lukewarm water (1/2 to 1 liter) mixed with a few drops of lemon (if tolerated well), is required. The nozzle, tube of rubber and container should be fully and properly sterilized before use. Lie flat on the ground, insert the nozzle from the anus to rectum, and gradually let in water. Do not be in a hurry so that water is not pushed into the stomach in a hush or undue hurry. Buttocks should remain about 5-6 inches above the floor-level. Vessel should be hanging down from a wall, dully supported with and fixed through a strong iron nail. As is done before injecting allow some water to flow out from the nozzle so that, when inserted, the water should gain free and uninterrupted entry into the abdomen.
Water should be retained in the abdomen for such a time till the pressure to evacuate builds up in bowels and visit the closet only after an urge to do so has arisen. Do not use force or unduly exert for expulsion of faces. If it is desired to ensure scavenging of intestines also use plain/or lemon juice mixed cold water (tepid water) only and enhance water quantity from 2 to 21/2 liters.
Best course will be to visit the closet when there is gurgling sound and resultant pressure and urge to let out water (when water will gush out with force taking with it all the obnoxious matters).
Best course will be to visit the closet when there is gurgling sound and resultant pressure and urge to let out water (when water will gush out with force taking with it all the obnoxious matters).
Some people use soap and /or said to also with the water but both are said to harmful and unnatural means. Choicest device is to use clean. Fresh, cold water only for the desired purpose.

(2) HIP-BATH

The hip-bath technique is devised for those who have retention of urine, pass urine with pain and discomfort, there is burning sensation or cutting pain in the penis, when one has to strain a lot and, despite utmost and prolonged exertions, urine is passed in droplets only. This condition is mostly seen in kidney infections, urinary and renal stones. In addition to urinary complaints, whole abdomen seems too bloated and enlarged (not referring to pregnant ladies), hardness, locking up of wind, irregular bowels etc. In back pain (lumbago) and other hip lower spine, pelvic-girdle complaints, hip-bath will prove to be a boon. It will cleanse and purge out and also ensure flow of urine. In addition to relieving other incidental complaints.
Take a tub about 6 feet in length and 2 to 3 feet in width, one side should be comparatively higher than the other end. Fill in water to such an extent that the hip portion remains immersed in water (that is your body also curved like a low. Rub gently the portion, from navel down to public region, back side, sides of waist but gentle pressure should be exerted while massaging. Massage, preferably with a soft towel, for 1-2 minutes and sit in the tub, initially for 4-5 minutes, extending the duration in accordance with capacity, condition and requirement of an individual. Rest of the body should be rubbed vigorously and then washed properly. In winter, wrap in a blanket or put on a gown. After the bath in tub is over, normal and usual bath may be taken but gap between both the baths should be at least, two hours. After the bath, take only very light and easily digestible eatables/drinks. Hip-Bath can be repeated as and when required.

(3)USUAL OR NORMAL BATH

Taking bath daily is not a ritual, it is a prime health requirement also. Bathing, in itself, is an exercise, (except for heart patients) because you clean your body, from head to feet. By soaping you remove dust and bad wet odour and other foreign particles which cling to your body due to pollution contact, smoke, soot, dust particles etc. in addition, bathing process also increases circulation of blood in the whole body, in addition to exercise of other body limbs. While taking bath make sure that each skin fold, nose, ear, throat, tongue, private parts, fingers of hands and feet etc should be properly washed/cleaned. Mere showering of the body will not do. Remember, massage of soles and palms, the two extremities of the body, is necessary for proper circulation of blood to each and every part of the body. All pores of the body will get opened during bathing process.
In Hindu religion, bathing has been given such a prime importance that, form birth to death, it is enjoined on an individual as a duty (a religions duty and hygienic habit). It is simply to highlight the importance of bathing. Cold bath is the best as it pushes up circulation of blood. It is claimed, and quire rightly so, that if one takes bath, before retiring to bed, the body will be free from tension & fatigure, and sound sleep will be induced and many physical problems will hopefully, subside. In any case avoid exposure to cold conditions.

(4) SPONGING

Body is generally sponged with a soft towel, often dipped in water, in case of fever, particularly for the infants, old and aged persons, bed-ridden and /or hospitalized patients, in certain conditions of pregnant and confined ladies. Care should particularly be taken in winter and exposure to cold conditions should be avoided. If body is sponged with hot or luke warm water, then first of all wrap the body with a blanket and request someone to sponge the body, from feet upwards with a water-soaked towel, for about 20-30 minutes, making sure that all the limbs of body are fully sponged. After sponging process is over, clean and dry up whole body with a dry towel. It is better to sponge at noon time.

(5) SUN BATH AND OIL MASSAGE

In Indian homes, it is still a practice to massage the body with sarson (mustard) oil in case of elders and with olive oil tender infants and babies. Massage with light hands so that oil gains entry, through pores, into the skin. When massaging process is over, bask in the sun for an hour or so, to till one can bear to expose body to sun-rays, ensuring fully that your back-side faces the sun and not your front side. Sun-bath takes away impurities of skin and provides necessary vitamins to body. After the sun-bath, apply some non-irritant soap of good quality to your body and then bathe with tepid fresh or luke-warm water.

(6) STEM BATH

Take a vessel and boil water in it. Place the hot water container under a charpoy (cot). Spread some cloth for covering the cot from all sides. Now the patient should lie on the cot. His face and neck should not be covered but his entire (rest of his body) should be wrapped with a blanket. Make sure that neither the steam escapes out nor does the cold wind enters from any direction. The steam bath should be given as long as the patient can easily tolerate it. Some people put some leaves of neem (margosa) into the water so that body is rendered free from infections but then, it is not a matter of choice but only if condition demands. When the heat subsides, the patients body should be dried with a soft towel. Some people prefer the patient to drink about 300ml of water (cold water) before start of the steam process (so that thermic temperature is not disturbed in the brain). But it is still hypothetical exercise. Same advantage can be derived by using a chair which is made of cane. Here the patient has to sit and hot water vessels should be put under the chair. (Rest of the process is the same, as done in case of a cot). Exposure to cold must be fully ruled out and to attain it, steam-both should be given in a closed but ventilated room (not with keeping doors & windows open).

(7) FASTING

Fasting not only purifies the body but also purifies the spirit of a person. Fasting will relieve person from excesses done during eating. Fast should start from the morning and last till the evening. In –between nothing is generally taken. But, if needed water or some liquid may be taken after 4-6 hours. Fast is not intended to starve a person but to undo the wrongs done to the body by adopting uncalled for & excessive dietary indiscretions. For diabetics, it is necessary that fast should never be stretched to such a the bowels, removes constipation, excretes toxins from the body. I have seen do more harm than good. Ladies, due to religious bent of mind or due to fads keep on fasting which often results in weakness, low blood pressure and sometimes even permanent loss of appetite.
During the fast, lime water may be taken or milk may also be used. When the fast is broken, only light and easily digestible food should be taken. Porridge, knichri, curd, soup of vegetables, juice of fresh and ripe fruits, milk, salads may be taken, after the fast is broken but no greasy, fat, spicy food should be taken. Diabetics should refrain from sugar and other sources of carbohydrate. They can have protein-enriched diet, with low carbohydrate content. Anti-diabetic drugs or Insulin should never he used during fast, as it may instantly bring down sugar level in the blood or even acetones may pass through urine. It must be ensured that fasting process is in accordance with health condition, age, sex, weight of a prospective adherent to fasting. We repeat, fasting should never result in starvation, weakness or hypoglycaemic condition, suppression of thirst or not attending to nature’s calls or your daily chores. Reduce time or suspend it as soon as some odd. unusual symptom develops.

FOOD : Naturopathy recommends whole flour of gram or wheat, from which bran has not been separated. Flour, without brain, is difficult to digest and causes constipation, inactivity of bowels, flatulence and heaviness on the chest. Rice should also be hand-beaten and not polished or separated from husk by means of grinding mills. So, unmilled rice is considered to be an ideal choice not only for diabetics but for all others. (Through rice is forbidden in diabetes). Never wash rice with water.
Vegetables should be taken as fresh and raw as possible. Vegetables may be washed before cutting or shredding but once cut, they should not be washed. If they are washed their vitamins and nutrients will wash away. Certain vegetables may be washed before cutting or shredding but once cut, they should not be washed. If they are washed their vitamins and nutrients will wash away. Certain vegetables do not require to be peeled. Similarly, fruits should also be used in raw form but citrus fruits, mangoes etc need to be peeled off but fruits, with soft and tender rind (skin), should never be peeled. Avoid using any spices to fruits. Take then in raw from.
Mix up vegetables and fruits to form healthy, nutritious and tasty salads. Green leaves should also be utilized for the salad. Add some lemon juice and salt to it, but not pungent spices.
Diabetics are advised to eat never stomachful, rather they can eat even after a gap of 2-3 hours, as it will relieve the stomach from unnecessary load and also that there will be sustained and almost uniform rice of glucose in the blood. Food substitutes should often be tried to avoid monotony in diet. A change-over from grains to fruits or even vice rersa or mixture there of should be tried. For more information, reference may be made to foregoing and following pages, in the relevant context.

What is Diabetes?

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