Diabetes mellitus

Diabetes mellitus is a metabolic disorder which is known to everybody nowadays. It is to be noted with astonishment that DM has an attracting global importance as it is rocking the world as a non-infectious epidemic/pandemic., it is one of the leading causes of morbidity and mortality because Diabetes mellitus causes secondary pathophysiologic changes in the multiple organ system. In the forecoming days it is presumed to be increasing day by day due to an increase in factors contributing to hyperglycemia, which may include dietetic irregularities, metabolic dysfunction, lack of exercise, stress, and busy lifestyle.. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime. The rising prevalence of Diabetes mellitus in developing countries is closely associated with industrialization and socioeconomic development.India fastly emerging as diabetic capital of world after china.

Most common types are

Type1 or insulin dependent diabetis: Also called juvenile onset diabetes mellitus. In this type, the pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin. The patient with type 1 diabetes must rely on insulin medication for survival

Type 2 diabetes or non-insulin dependent diabetes mellitus : Also called adult onset diabetes mellitus. In this type, patients can still produce insulin, but do so relatively inadequately for their body’s needs. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body called insulin resistance (particularly fat and muscle cells). In addition to this, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control.

Gestational diabetes: Diabetes can occur temporarily during pregnancy. Significant hormonal changes during pregnancy can lead to blood sugar elevation in genetically predisposed individuals. Gestational diabetes usually resolves once the baby is born. However, 25%-50% of women with gestational diabetes will eventually develop type 2 diabetes later in life, especially in those who require insulin during pregnancy and those who remain overweight after their delivery.

CAUSES:

Drug or chemical induced Diabetes mellitus: Some drugs such as Nicotinic acid, Glucocorticoids, Thyroid hormones, Diazoxide betaadrenergic agonists, Thiazides, ß blockers etc causes DM.

Endocrinal Diseases: This includes Hyperthyroidism, Hypersecretion of Adrenal cortex, Hyperpituitarism, Cushing’s syndrome, Pheochromocytoma, Acromegaly, Somatostatinoma.

Diseases of Pancrease: This includes Pancreatitis, Cystic Fibrosis, Hemochromatosis, Pancreatopathy, Cancer of pancreas, Pancreactectomy.

Other Genetic Syndrome sometime associated with DM like as Down’s syndrome, Klinefelter’s Syndrome, Turner’s syndrome, Huntington’s corea.

Risk Factors

  • Obesity
  • Increasing Age
  • History of Gestational diabetis
  • Hypertension (Blood pressure = 140/90 mmHg)
  • low HDL cholesterol and high LDL level
  • Triglyceride level > 250 mg/dl
  • Polycystic ovarian syndrome
  • Sedentary life
  • Unhealthy eating habits
  • Life style habits like smoking, drinking alcohol
  • Toxic exposure such as pesticides, chloro floro carbons, toxic heavy metals (Hg, Pb, As,Cd etc.)
  • Stress— following surgery, trauma etc.
  • A strong family history

Classical Symptoms

  • Age – Poor sperm motility, DNA fragmentation.
  • Temporary and life style causes
  • Emotional stress
  • Sexual issues
  • Testicular over heating
  • Substance abuse
  • Smoking
  • Malnutrition and Nutrient Deficiencies
  • Obesity
  • Bicycling
  • Genetic Factors
  • Environmental Assaults
  • Free radicals [oxidants]
  • Exposure to estrogen like hormone disrupting chemicals
  • Industrial chemicals
  • Radiation treatment
  • Medications : Anabolic Steroids, Azulfidine, Methadone, Folex, Aldactone etc
  • Use of mobile 4 hours or more than 4 hours per day will decrease the sperm count. Damage could be caused by the electromagnetic radiation emitted by handsets or the heat they generate.

Diagnosis

  • The fasting blood glucose test is the preferred way to diagnose diabetes.sample is taken after the person has fasted overnight (at least 8 hours), Normal fasting plasma glucose levels are less than 100 milligrams per deciliter (mg/dl). Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes.
  • A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or higher indicates diabetes.
  • oral glucose tolerance test is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic ovary syndrome.
  • Hemoglobin A1c (A1c) gives a more reasonable and stable view of what’s happening over the course of time (three months), and the value does not bounce as much as finger stick blood sugar measurements. In most labs, the normal range is 4%-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it’s less than 7.0% (optimal is <6.5%). studies have shown that there is about a 10% decrease in relative risk for microvascular disease for every 1% reduction in A1c. Data also sugg ests that the risk of macrovascular disease decreases by about 24% for every 1% reduction in A1c values.

Complications of Diabetis

Acute complications

Diabetic ketoacidosis(DKA): Mostly Seen in patients with type1 DM with missed dosage of insulin ,Symptoms include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death.

Hyperosmolar coma: In patients with type 2 diabetes, stress, infection, and medications (such as corticosteroids) can also lead to severely elevated blood sugar levels. Accompanied by dehydration, Like diabetic ketoacidosis, it is a medical emergency

Hypoglycemia means abnormally low blood sugar (glucose): In patients with diabetes, the most common cause of low blood sugar is excessive use of insulin or other glucose-lowering medications, presence of a delayed or absent meal or sudden excessive physical exertion. Blood glucose is essential for the proper functioning of brain cells. Therefore, low blood sugar can lead to central nervous system symptoms such as: dizziness, confusion, weakness, and tremors.

Chronic complications of diabetes

Microvascular complications: These include Ophthalmic Disorders (Retinopathy, Macular edema, Cataract, Glaucoma), Neuropathy (Peripheral neuropathy, Sensory and Motor polyneuropathy), and Nephropathy (ESRD).

Macrovascular complications: These include Coronary Artery Diseases (angina or heart attack), peripheral vascular disorders(claudication), and cerebrovascular diseases(stroks).

Other complications include Gastroparasis, Diarrhea, Uropathy, Sexual dysfunction and Dermatologic complications like eczema, cellulites, and gangrene of distal part of limbs (Diabetic foot).

Treatments at detoxification centre:

Ozone therapy in Diabetes

  • Major auto ozone injection or Intravenous infusions of ozonated saline
  • Rectal ozone insufflations
  • Minor autohaemotherapy with ozone
  • Ozone bagging or ozone local application in diabetic wounds.
The bio chemical improvement after ozone therapy include
  1. Fall in blood glucose
  2. Fall in triglyceride levels
  3. Fall in serum cholesterol with increase in HDL cholesterol
  4. Fall in glycosalated haemoglobin (HbA1c) level( thus improve tissue oxygenation)

Number of ozone sessions, mode of treatment and dosage depends upon the type of diabetis and its complications. Owing to the hypoglycemic effect of ozone, during the treatment it is necessary to carry out a continual control over the blood level of glucose as well as to correct the dosage of sugar-reducing preparations used.

Acupuncture in diabetes

What we know of as diabetes today, is known in Traditional Chinese medicine as Wasting and Thirsting Disease. Though acupuncture can be very helpful in treating the symptoms of diabetes, it is not a cure for diabetes.According to Traditional Chinese Medicine, diabetes is caused by an imbalance of the cyclical flow of Qi within the meridians and organ systems

In treating diabetes, Acupuncture offers a way to address each patient individually to eliminate the symptoms associated with diabetes and reduce the need for insulin. The treatment for diabetes will focus on regulating the circulation of blood and Qi and balancing the organ systems to improve pancreatic function and address internal heat and the depletion of fluids.

Acupuncture treatment is most effective for those have had diabetes for only a few years, and have a milder disease manifestation. Diabetic acupuncture is also most effective in treating diabetes in younger individuals. Diabetics receiving acupuncture also experience a decline in cholesterol levels and have fewer complications of diabetis, such as cardiovascular diseases,peripheral neuropathy, eye pathologies.

Acupuncture can also help diabetics in the following ways: Attenuate symptoms of polyphagia, (impulse to overeat), polydipsia, (excessive thirst), enhance blood outflow and regulate vascular peripheral resistance, increase cell proliferation, and prevent slowing of motor nerve conduction.

DIET AND NUTRITIONAL PLAN:

Proper nutritional management or food plan is essential for better glucose control. This in turn helps to reduce the risk of diabetic complications. Daily consistency regarding the types of food including in the meal, their nutritional information, and the time at which they are consumed will help to normalize the blood glucose levels.

The common meal planning tips are:
  • Avoid saturated fats and oils; instead of that use unsaturated oils found in olive oil, nuts, and canola oil
  • Moderate salt and salty food consumption, especially when high blood pressure is present.
  • Watch the amount of protein-rich food.
  • Incorporate high-fiber food such as grains, raw vegetables and fruits (fruit is better than the fruit juice).
  • Spread your daily carbohydrate intake through the day. Don’t eat too much carbohydrate at any time.

EXERCISE PLAN:

Physical activity is recommended for everyone. It should take place any time when a person can and is willing. The minimum time recommended is about 30 minutes; three or more times a week. Activity can include moderate walking and household chorus, such as gardening and cleaning as well as jogging, biking, dancing and other sort of exercises.

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