Diabetes mellitus is a disease 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. “SUGAR” is the common name given
to DM by the Indian layman. Actually, it comprises a group of common
metabolic disorders that share the phenotype of hyperglycemia (increased
level of glucose in blood plasma). Nowadays, it is one of the leading
causes of morbidity and mortality because Diabetes mellitus causes
secondary pathophysiologic changes in the multiple organ system.
Most likely, the complications of DM are adult blindness; non-traumatic
lower extremity amputations (diabetic foot); end stage renal disease
(ESRD); neuropathy etc. 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. As concerned
about the cure of DM by Homoeopathy, it could be possible in the
early stages but we can at least assure to give a peaceful and prolonged
life to a diabetic patient.
Recent studies in the etiologies and pathogenesis of Diabetes
mellitus lead to a revised classification. Recent changes in classification
reflect an effort to classify DM as the basis of the pathogenesis
process leading to hyperglycemia, as opposed to criteria such as
age of onset or type of therapy. Some forms of Diabetes mellitus
are characterized by an absolute insulin deficiency or a genetic
defect leading to defective insulin secretion, whereas other forms
share insulin resistance as their underlying etiology. Diabetes
mellitus has two broad categories designated as type1 and type2.
TYPE 1 Diabetes mellitus (previously designated
as IDDM): Type 1 DM is categorized into two subgroups, i.e., type
1A and type 1B. Type 1A results from autoimmune ß cell destruction,
which usually leads to insulin deficiency; where as type 1B DM occurs
due to lack of immunologic marker inductive of an autoimmune destructive
process of the ß cells. Type 1 DM is hereditary in character
and develops before the age of 30 years. The patient is young, lean
and thin, and has an absolute requirement for insulin therapy.
TYPE 2 Diabetes mellitus (previously designated
as NIDDM): Type 2 DM is characterized by a variable degree of insulin
resistance, impaired insulin secretion, and increased glucose production.
Type 2 DM more typically develops with increase in age; it also
occurs in children, particularly in obese adults. It does not require
GDM: This type of Diabetes mellitus is recognized during pregnancy.
It is due to insulin resistance related to its metabolic changes.
MODY: It is a subtype of Diabetes mellitus is characterized by
autosomal dominant inheritance, early onset of hyperglycemia and
impairment in insulin secretion. It is also divided into MODY1,
MODY2, MODY3, MODY4, and MODY5 according to genetic defect of beta
cell function characterized by mutation in Hepatocyte nuclear transcription
factor (HNF), glucokinase, HNF1 a, insulin promoter factor (IPF),
• Drug or chemical induced Diabetes mellitus: Some drugs
such as Nicotinic acid, Glucocorticoids, Thyroid hormones, Diazoxide
betaadrenergic agonists, Thiazides, ß blockers etc causes
• Endocrinal Diseases: This includes Hyperthyroidism, Hypersecretion
of Adrenal cortex, Hyperpituitarism, Cushing’s syndrome, Pheochromocytoma,
• 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 FOR TYPE 2 Diabetes mellitus
• A strong family history
• Age = 45 years
• Previously identified IFG or IGT
• History of GDM
• Hypertension (Blood pressure = 140/90 mmHg)
• HDL cholesterol level = 35 mg/dl
• Triglyceride level > 250 mg/dl
• Polycystic ovarian syndrome
The prevalence of Diabetes mellitus in adults was 4 percent worldwide;
this means that over 143 million persons are now affected. It is
projected that disease prevalence will be 5.4 percent by the year
2025, with global diabetic population reaching to 300 million. The
rising prevalence of Diabetes mellitus in developing countries is
closely associated with industrialization and socioeconomic development.
Diabetes mellitus, a chronic disease once though to be uncommon
in the developing world has now emerged as an important public health
problem in Asia. An estimated 30 million persons in South-East Asian
region are affected at present. It is estimated that by the year
2025 there will be nearly 80 million diabetics in the region- the
highest among all WHO regions. Thus, the South-East region will
bear the maximum global burden of the disease. The result of prevalence
study of DM in India was systematically reviewed with emphasis on
these utilizing the standard WHO criteria for Diabetes mellitus
diagnosis. The prevalence of disease in adults was found to be 2.4
percent in rural and 4-11.6 percent. This indicates the potential
for further rise in prevalence of DM in the coming decades. It is
estimated that during 1997 about 102,000 persons died of DM in India
with about 1,981,000 DALYs.
The pathogenesis of each type of Diabetes mellitus is different
and discussed separately.
TYPE 1: This type of DM is characterized by an absolute lack of
insulin, which is why patient always wants insulin. It is previously
called as IDDM. The absolute lack of insulin is due to the beta
cell destruction. There are three main mechanisms responsible for
beta cell destruction that is genetic susceptibility, autoimmunity,
and environment insult. These factors of genetic predisposition
and environmental insult causes unnecessary immune response against
normal functioning beta cells. This immune response triggers the
auto immunity, which causes beta cell destruction. When complete
destruction of beta cells occurs, no insulin secretion occurs in
the bloodstream that causes type 1 Diabetes mellitus.
TYPE 2: Type 2 Diabetes mellitus is characterized by decrease in
beta cell secretion of insulin or a decrease response of the tissues
to respond to insulin, i.e. insulin resistance. The main factor
involved in the pathogenesis of type 2 Diabetes mellitus is environmental
factor. Obesity is one of the most important cause although genetic
predisposition is also important which causes deranged insulin secretion
and cause hyperglycemia. This hyperglycemia causes ß cell
exhaustion and decrease in insulin secretion. Other metabolic disturbances
cause reduced responsiveness of tissues to insulin action called
as insulin resistance. It is a major factor in the development of
type 2 Diabetes mellitus.
Gestational Diabetes mellitus (GDM): GDM is a
prodromal form of type 2 DM being unmarked by pregnancy. Pregnancy
is associated with insulin resistance that necessitates an increase
in insulin production to maintain euglycemia (a normal insulin concentration
of glucose in blood). Placental hormones that rise late in pregnancy
induce the insulin resistance in GDM. Gestational Diabetes mellitus
itself is typically found late in the second or early third trimester.
Some studies suggest that there is an exaggeration of the pregnancy
induced insulin resistance in GDM, but it appears that the major
determinant of whether a woman develops DM is likely insulin
reserve. This reserve is blunted in women with GDM. In severe
GDM an element of glucose toxicity supervenes which may further
blunt the insulin sensitivity. The elevated free acids that are
also found in GDM may be a further cause of insulin resistance as
may be a manifestation of the disease process itself. Thus, GDM
is similar to type 2 DM with insulin resistance and impaired insulin
secretion, and persistence of these abnormalities postpartum contributes
to the increased risk of type 2 DM in the long term.
New revised criteria for the diagnosis of DM from the expert panel
of WHO and National Diabetes Data Group emphasize the FPG as the
most reliable and convenient test for diagnosing Diabetes mellitus
in asymptomatic individual.
Glucose tolerance is classified in to three categories based on
• FPG < 110 mg/dl is considered as normal
• FPG = 110 mg/dl but < 126 mg/dl is defined as IFG (Impaired
• FPG = 126 confirm the diagnosis of DM
IFG is a new diagnostic category analogous to IGT, which is defined
as the plasma glucose level between 140mg/dl and 200mg/dl, 2 hour
after a 75gm oral glucose load.
A random plasma glucose concentration = 200 accompanied by classic
symptoms of Diabetes mellitus, for example polydipsia (increased
thirst), polyuria (increased micturation), polyphagia (increased
appetite), weight loss is sufficient for the diagnosis of DM.
The two-hour plasma glucose commonly referred to post parendial
is still a valid mechanism for diagnosing DM but is not recommended
as a part of routine screening.
|Type 1 DM
||Type 2 DM|
Weight loss in spite of Increased/normal appetite
Slow healing infections
Impotency in men
Diabetes mellitus comprises the pseudopsoric miasm. The pseudopsoric
miasm is also known as Tubercular miasm. It is a combination of
both Psora and Syphilitic miasm. Tubercular miasm is usually characterized
by a “problem child” i.e. slow in comprehension, dull,
unable to keep a line of thought, unsocial, morose. He/she gets
relief from offensive foot or axillary sweat which when suppressed
often induces lung troubles or some other severe disease. The patient's
mental symptoms tend to be ameliorated by an outbreak of an ulcer.
The slightest bruise suppurates; the strong tendency is to the formation
of pustules. As a general rule, the patient is very intelligent,
keen observer and a programmatic planner who wants his life always
busy but possesses a sedentary lifestyle.
INDICATION OF MIASM
As the miasm progress and predominates, weight loss, depreciation
and destruction are the first indication of this miasm. Other indications
are cosmopolitian habits, mentally keen but physically weak. Symptoms
are ever changing. Rapid response to any stimuli (e.g. any slightest
change of weather or atmosphere). Emaciation instead of taking proper
diet and drink, tendency to cough and cold easily, desire and craving
for unnatural things to eat, with desires and cravings for narcotics
such as tea, Coffee, tobacco and any other stimulants have often
their origin in psoric or tubercular miasm. They sometimes have
constant hunger and eat beyond their capacity to digest or they
have no appetite in the morning but hunger for other meals.
COMPLICATIONS OF Diabetes mellitus
The complications of Diabetes mellitus are categorized into two
main groups i.e. Acute and Chronic complications. The acute complications
are due to metabolic disturbances. These include DKA (Diabetic Ketoacidosis)
and Nonketotic Hyperosmolar state.
The chronic complication are also categorized into two broad groups
1. Microvascular complications: These include Ophthalmic Disorders
(Retinopathy, Macular edema, Cataract, Glaucoma), Neuropathy (Peripheral
neuropathy, Sensory and Motor polyneuropathy), and Nephropathy (ESRD).
2. Macrovascular complications: These include Coronary Artery Diseases
(CAD), peripheral vascular disorders, and cerebrovascular diseases.
3. Other complications include Gastroparasis, Diarrhea, Uropathy,
Sexual dysfunction and Dermatologic complications like eczema, cellulites,
and gangrene of distal part of limbs (Diabetic foot).
MISAMATIC DISCUSSION ON COMLICATIONS OF Diabetes mellitus
As I discussed in the "miasmatic background" section,
DM has a psorosyphilitic background. As the syphilitic miasm becomes
predominant the complications arise. The acute complications are
of the psoric character because they have metabolic disturbances
while the chronic complications are associated with syphilitic background
or as a result of a mixture of two. As the strong syphilitic character
is going to destruction and degeneration it leads to mixed miasmatic
diseases. These diseases are more difficult to cure especially when
they go to irreversible changes. When the syphilitic miasm is dominant
in the condition of chronic complications the condition should become
violent. At this stage the individual needs a complete Miasmatic
and Therapeutic treatment.
Before we are going to start treatment of DM, it is very essential
to know about proper nutrition and exercise plan for diabetic patient
to reduce the prevalence and incidence of complications. It must
also include preventive plan for an individual.
• Diet and Nutrition plans
• Exercise plans
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.
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.
|The benefits of exercise include:|
Improved blood sugar control
Lower blood pressure
Lower cholesterol level
Improved muscle strength and tone
Improved digestion and appetite control
Improved mood, attitude
Increases energy level
When starting an exercise plan, be sure to warm up, set a comfortable
pace, wear good shoes and drink plenty of water. Make it as enjoyable
as possible without overdoing it. A good partner will make it easier
to commit to it. Be cautious with the duration and intensity of
the exercise; then gradually increase the length of the activity
by a few minutes every week.
WHEN NOT TO EXERCISE:
• If you are ill.
• In extreme heat or cold.
• During peak insulin action times.
• If your blood sugar is high exercise will usually help
bring it down; but if your blood sugar is over 250mg/dl do not
As Homoeopathy is not a science of therapeutics, it is concerned
with totality of symptoms or individuality. As regarding the cure
of DM by homoeopathic medicine, the individual needs the complete
miasmatic and constitutional therapy in the very early stage.
If we are going through complete miasmatic study of the individual
in early stages then we can easily find out about the disease for
witch an individual is prone to suffer. Then, we can apply the antimiasmatic
therapy as a preventive measure which causes a decline in the tendency
for the progression of the miasm.
The main antimiasmatic remedies for Tubercular miasm are:
“A” Grade: Agar, Ars-i, Aur, Bac,
Calc-c, Calc-p, Car, Hep, Iod, Kali-c, Kali-p, Lyc, Med, Nat-s,
Phos, Puls, Sep, Sil, Stann, Sulp, Thuj, Zinc.
“B” Grade: All-c, Ant-i, Ars, Bap,
Bar-m, Bry, Bufo, Calc-s, Carb-v, Chin, Dulc, Kreos, Nat-m, Nit-ac,
Ph-ac, San, Sep.
If family history presents: Carc, Sacch, Thuj.
I found over 50 remedies for DM but when totality of symptom agrees
every medicine from Materia Medica can be employed. However, only
a smaller group is employed most frequently such as -
Acetic acid (Glacial acetic acid) 6, 30: Large
quantity of pale urine, unquenchable thirst, and great debility.
Abroma augusta (Olatkambal) ?, 2X, 3X: Frequent
and profuse urination, dryness of the mouth and great thirst, urination
leads exhaustion, Fishy odour of the urine, Diabetes mellitus and
Argentum metallicum (Silver) 6, 30, 200: Polyuria,
frequent urination, urine profuse at night, turbid and sweetish
odour, restless sleep, frightful dreams, edematous swollen feet,
flatulent distention of abdomen.
Arsenicum album (Arsenic trioxide) 6, 30: Urine
scanty, burning albuminous, ascites, all prevailing debility, restlessness,
burning thirst, drinks often but little at time.
Codeinum (An Alkaloid from Opium) 3X, 3: Sugar
in urine, quantity of urine increased, great thirst, it is said
to control disease.
Cephalandra indica (Telakucha) ?, 1X, 3X: DM and
insipidus with profuse urination; weakness and exhaustion after
urination; sugar in the urine.
Gymnesa sylvestre (Meshasringi or Gurmar) ?, 3x,
6: Is almost specific for DM called as “Sugar Killer”
diminishes sugar in urine; Profuse miturition loaded with sugar,
extreme weakness after passing large quantities of urine. Polyuria;
day and night.
Helleborus (Snow-rose) 3X, 3: Frequent urging to
urinate but small quantities emitted, profuse urination, urine pale
and watery, dropsical swelling.
Helonias-Chamailirium (Uricorn-root) ?, 6: DM and
insipidus, urine profuse and clear, phosphatic and albuminous, great
thirst, restlessness, profound melancholy, irritable, boring pain
across the lumbar region.
Insulin 3X, 6X: Supposed to be specific and useful
in case of carbuncles resulting from DM.
Lacticum acidum (Lactic acid) 6, 30: Frequent passing
of large quantities of sugar in urine, great thirst, rheumatic pains
Natrum Phosphoricum 6X, 12X and Natrum
Sulphuricum 3X, 12X, 30: They are of great value in diabetes.
Profuse urination, urine loaded with bile, lithic deposition in
urine, sedentary habits especially when there is a succession of
Phosphoricum acidum (Phosphoric acid) 2X, 30: Frequent
and profuse watery urination, milk-like urine, great debility.
Phosphorus 3, 30: DM in phthisis in impotency,
urine contain large amount of salt in the morning and excess of
sugar in the evening.
Plumbum metallicum (Lead) 6, 30: Urine frequent,
scanty, albuminous, low specific gravity.
Rhus aromatica (Fragrant sumach) ?: Large quantity
of urine, urine pale, albuminous, specific gravity low.
Syzygium Jambolanum (Jambol seeds) ?: It has a
specific action in diminishing and causing to disappear the sugar
in urine, great thirst, and weakness, urine in very large quantities,
specific gravity high. Ten drops to be taken twice or thrice daily.
Uranium nitricum (Nitrate of Uranium) 3X, 30: Profuse
urination, debility, acid in urine, incontinence, unable to retain
urine, excessive thirst, diarrhea of the dyspepticus.
Terebinthinum (Turpentine) 3, 6: Profuse, cloudy,
smoky, and albuminous urine, sediments like coffee grounds, haematuria.
Other valuable medicines are: Arsenicum iodatum;
Aurum metallicum; Boricum acidum; Bryonia alba; Chamomilla umbellate;
Chionanthus virginica; Coca (Erythroxylon coca); Crotalus horridus;
Curare; Iris versicolor; Kreosotum; Morphinum; Nux vomica; Pancreatinum;
Silicea terra; Strychninum arsenicosum.
Principle of Internal Medicine Harrison 15th Edition
Illustrated Pathology Robbins 6th Edition;
Preventive and Social Medicine Park 17th Edition;
Treatment from Epitome of Homoeopathic Practice by M. Bhattacharya;
Miasm and their effect on human organism by Raju Subramanium;
Internal Medicine Davidson 19th Edition;
Newer Horizon in Type2 Diabetes Mellitus;
Indication of Miasm Harimohan Chaudhary;
Chronic Miasm J.H. Allen;
Materia Medica Boericke;
Materia Medica J.H. Clark;
Prescriber J.H. Clark;
Prescriber H.C. Allen;
Soul of Remedies by Dr. R. Shankran;
Synthesis Repertory George Vithoulkas 8.0 Version;
Repertory by Robin Murphy Synoptic key by Boger ;
Also search at homoeopathy.com; homeopathy.org; diabetesindia.com;
medindia.com; and many more.
DR. DEEPAK SHARMA