Diabetes Mellitus

Diabetes Mellitus

1. Definition
   Diabetes Mellitus is a metabolic disorder in which blood sugar remains high for a long time because the body cannot make enough insulin, cannot use insulin properly, or both.

2. Causes / Etiology

• Family history and genetic predisposition
• Excess body weight (obesity)
• Lack of regular physical activity
• Diet rich in refined sugars and fats
• Chronic stress and certain infections

3. Types or Classification
   Type 1 Diabetes – an autoimmune disease where the pancreas’ beta cells are destroyed, so the patient needs insulin.
   Type 2 Diabetes – the body’s cells become resistant to insulin and the pancreas eventually makes less insulin.
   Gestational Diabetes – high blood sugar that appears during pregnancy and usually disappears after delivery.
   LADA (Latent Autoimmune Diabetes in Adults) – a slowly progressive autoimmune diabetes that starts in adulthood.
   MODY (Maturity‑Onset Diabetes of the Young) – a rare inherited form that begins before age 25 and follows an autosomal‑dominant pattern.

4. Pathology (step‑wise)
   Step 1 → Impaired insulin secretion (beta‑cell loss) or insulin resistance in peripheral tissues.
   Step 2 → Glucose cannot enter cells efficiently, so blood glucose rises (hyperglycaemia).
   Step 3 → Liver continues to produce glucose, and kidneys excrete excess glucose causing polyuria.
   Step 4 → Persistent high glucose activates harmful pathways (glycation, oxidative stress) leading to tissue injury and complications.

5. Clinical Features

General features

• Frequent urination (polyuria)
• Excessive thirst (polydipsia)
• Increased hunger (polyphagia)
• Unexplained weight loss
• General fatigue

Specific features

• Type 1: rapid onset, often in children or young adults, may present with ketoacidosis.
• Type 2: gradual onset, commonly seen in overweight adults, may be asymptomatic for years.

6. Complications

Acute

• Diabetic ketoacidosis (DKA) – severe insulin deficiency causing ketone buildup, abdominal pain, vomiting, and altered consciousness.
• Hyperosmolar hyperglycaemic state (HHS) – extreme hyperglycaemia with dehydration, mainly in older type 2 patients.

Chronic

Microvascular (small vessels)

• Diabetic nephropathy – kidney damage leading to protein in urine.
• Diabetic retinopathy – damage to retinal blood vessels causing vision loss.
• Diabetic neuropathy – nerve damage producing tingling, pain, or loss of sensation.

Macrovascular (large vessels)

• Accelerated atherosclerosis → coronary artery disease, stroke, peripheral arterial disease.

7. Diagnosis / Investigations

Routine tests

• Fasting plasma glucose (≥126 mg/dL confirms diabetes).
• Oral glucose tolerance test (2‑hour value ≥200 mg/dL).
• HbA1c (≥6.5 %) – reflects average glucose over the past 2‑3 months.

Special tests

• Urine dipstick for glucose, ketones and protein.
• Lipid profile to assess cardiovascular risk.
• Fundoscopic eye examination for retinopathy.
• Serum creatinine and micro‑albuminuria for renal assessment.

8. Management

General management

• Encourage regular moderate exercise (30 min most days).
• Weight reduction through balanced diet and lifestyle changes.
• Smoking cessation and stress reduction.

Modern treatment

• Oral hypoglycaemic agents (metformin, sulfonylureas, DPP‑4 inhibitors, SGLT‑2 inhibitors).
• Insulin therapy (basal, bolus, or mixed regimens) when needed.
• Continuous glucose monitoring (CGM) and insulin pump for selected patients.

Dietary advice

• Distribute carbohydrate intake evenly throughout the day.
• Prefer complex carbs, fibre‑rich vegetables, and low‑glycaemic index foods.
• Limit sugary drinks, sweets and saturated fats.
• Maintain adequate fluid intake, especially if polyuria is present.

9. Homeopathic Therapeutics (main remedies, each with 6‑7 points)

Syzygium jambolanum

• Excessive thirst and frequent urination.
• Urine sweet‑tasting, contains sugar.
• Marked weight loss despite good appetite.
• Burning sensation in the bladder.
• Useful when diabetes is associated with digestive disturbances.
• Improves overall vitality.

Urtica dioica

• High blood sugar with obesity.
• Reduces excessive appetite for sweets.
• Improves insulin sensitivity.
• Helpful in cases with itching and skin eruptions.
• Supports kidney function, reduces proteinuria.
• Beneficial for chronic fatigue.

Gymnema sylvestre

• Strong craving for sweets that is suddenly reduced.
• Lowers blood glucose levels gradually.
• Useful in type 2 diabetes with mild obesity.
• Improves digestion and reduces flatulence.
• Helps in restoring normal appetite.
• Supports peripheral circulation.

Phosphorus

• Diabetes with nocturnal polyuria (urination at night).
• Weakness and trembling of limbs.
• Tendency to develop kidney stones and proteinuria.
• Sensitive to cold, especially of the feet.
• Improves mental alertness and reduces anxiety.
• Useful when there is a history of chronic infections.

Calcarea carbonica

• Overweight diabetic with sluggish metabolism.
• Tendency to develop foot ulcers and poor wound healing.
• Excessive sweating, especially on the head.
• Craving for cold drinks, but feels better with warm fluids.
• Weakness in the lower limbs, prone to varicose veins.
• Improves bone health and reduces joint pain.