Microvascular complications include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure and to nerves (neuropathy) leading to abnormal and decreased sensation, usually in a ‘glove and stocking’ distribution starting with the feet, later often fingers and hands; but potentially in other nerves leading to impotence and diabetic foot disorders includes intermittent claudication (exertion-related leg and foot pain) & severe infections leading to amputation.

Macrovascular complications include cardiovascular diseases such as heart attacks, (to which accelerated atherosclerosis is a contributor). These conditions can occur independent of damage done to the blood vessels over time from high levels of blood glucose.

Acute complications of diabetes, such as diabetic ketoacidosis or hyperosmolar coma, are part of the complications spectrum. Increasingly, “non-traditional” diabetes-related complications are being recognised, given their frequent co-occurrence with and in some cases their exacerbation by diabetes, as well as their impact on outcomes for individuals with diabetes. These include complications related to insulin resistance and the metabolic syndrome, including obstructive sleep apnoea, polycystic ovary syndrome, gout, the common diastolic dysfunction in diabetic cardiomyopathy, and non-alcoholic fatty liver disease (NAFLD). Indeed, NAFLD is more common in people with type 2 diabetes, and diabetes accelerates NAFLD to its more severe form of non-alcoholic steatohepatitis.11

For most patients, we will be attempting to prevent onset of diabetes complications, and screening for their occurrence to better target and intensify therapy for complications that are detected. To prevent onset of complications in most patients & preventing the worsening of complications will be the aim.

AyurVAID’s treatment modality for preventing diabetes complication is treat the root cause of diabetes, so that the further manifestation of complication could be prevented; as the pathology for all complications involves the pathological constraints of diabetes itself in a larger scale. So the internal medications and therapies, if judiciously administered after assessing the diabetes mellitus patient’s individual clinical condition, can help prevent further progression into complications or postpone the onset of them. Along with these the proper Diet, exercise, yogic practices can all benefit, helping to counteract the disease from different angles.

Therapies like Yapana Vasti (medicinal enema) and Dhāra (pouring of medicinal liquid in a particular fashion), detoxification procedures like Vamana &Virechana (procedural induction of vomiting and loose motion) to control the disease from the root. So a patient of diabetes mellitus if undergoes above procedures at intervals can lead a life free from complications of diabetes and also the complications. If manifested, treatment towards the same could bring satisfactory improvement in quality of life. Netra tarpana for retinopathy changes(procedure of pouring medicated oil over closed eyes), abhyanga, lepa (application of medicated paste over body) and seka(pouring of medicated liquid over body) for neuropathy changes, and Yapana Vasti (medicinal enema) for nephropathy changes are employed.

Click here for AyurVAID Diabetes Microsite

Signs and symptoms of complications of Diabetic mellitus

Diabetes and the Eyes:
It can cause a number of eye problems, some of which can lead to blindness if not addressed. The eye disorders include:

• Glaucoma: Pressure build-up in the eye, which damages optic nerves, leading to Vision loss.
• Cataracts: The eye’s clear lens clouds, blocking light. Leads to problems driving at night such as glare from oncoming headlights, problems with glare during the day, Double vision while looking through the eye with a cataract (like a superimposed image). Sudden changes in glasses prescription.
• Diabetic retinopathy: Typical symptoms of retinopathy include: Sudden changes in vision, Blurred vision, Pain in the eye, seeing spots, Loss of vision, Double vision, Floaters in your vision, Night vision loss.

Heart disease and Diabetes:

• Caused by partially or total narrowing or blocking of the blood vessels by fatty deposits to your heart, leading to a heart attack – when the blood supply to your heart is reduced or cut off

Kidney Disease and Diabetes: High levels of blood sugar can put extra stress on the kidneys. After years of damage, the kidneys start to leak useful proteins in the urine, leading to a condition known as microalbuminuria. When kidney disease is diagnosed later, during macroalbuminuria, end-stage renal disease (ESRD) usually follows.

• Kidneys lose their filtering ability.
• Waste products begin to build up in the blood.
• Finally, the kidneys fail.
• ESRD

Diabetes and nerves (Diabetic neuropathy):

High blood glucose damages blood vessels that carry oxygen and nutrients to the nerves,thereby impair the nerves’ ability to transmit signals. Symptoms of neuropathy include numbness and sometimes pain in the hands, feet, or legs. Nerve damage caused with internal organs such as the digestive tract, heart, and sexual organs, causing indigestion, diarrhea or constipation, dizziness, bladder infections, and impotence. In some cases, neuropathy can flare up suddenly, causing weakness and weight loss. Depression may follow.

Disability-adjusted life-years (DALYs) are projected to rise for diabetes; it has been predicted that diabetes will have the highest national disability score for any chronic illness from 2016. In addition, there are increasing direct health and resource costs attributed to diabetes, with this increasing burden; the challenge has never been greater to prevent diabetes and related complications. Complications of diabetes are a significant cause of morbidity and mortality

Risk Factors of Diabetic Complications

The important time-related variables were found to be duration of diabetes for retinopathy, age for macrovascular disease, duration and age at diagnosis of diabetes for sensory neuropathy, and age for renal impairment. Positive independent associations between diabetic control (glycosylated hemoglobin) and retinopathy and between diabetic control and macrovascular disease are seen. Plasma cholesterol (positively) and high-density lipoprotein cholesterol (negatively) were related independently to both macrovascular disease and renal impairment.

• High blood pressure: That means blood pressure over 140/90.
• Low levels of HDL (“good”) cholesterol and high levels of triglycerides.
• Gestational diabetes. If you had diabetes while you were pregnant, you had gestational diabetes. This raises your chances of getting type 2 diabetes later in life.
• Sedentary lifestyle. You exercise less than three times a week.
• Family history. You exercise less than three times a week.
• Polycystic ovary syndrome Women with polycystic ovary syndrome (PCOS) have a higher risk.Lifestyle modifications such as weight control, increased physical exercise, and smoking cessation are also potentially beneficial in preventing diabetes mellitus and coronary artery disease.

Diagnosis and Lab investigations:

Testing

Testing is extremely important to determine the stage of the disease and in selection of appropriate treatment options. Diabetes complications can be postponed if early monitoring of the blood sugar levels to normal or near normal levels is encouraged. Testing can include blood tests and/or Doppler such as:

Investigations towards diabetes status:

• FBS- fasting blood glucose
• PPBS- Post prandial blood glucose
• OGTT- oral glucose tolerance test
• HBA1C- Glycosalated Haemoglobin
• Serum Insulin
• Fasting lipid profile (LDL, HDL, triglycerides)

Diabetic nephropathy:

• Urine albumin/ microalbumin levels
• Serum creatinine
• Blood urea
• GFR- Glomerular Filtration Rate
• Serum electrolytes- sodium, potassium

Diabetic retinopathy:

• Fundoscopy
• Vision acquity tests

Diabetic Neuropathy:

• Blood Pressure
• Nerve conduction Study
• EMG
• Biothesiometer for assessment of various sensations.

Diabetic cardiomyopathy:

• ECG
• Echo cardiography

Diabetic carbuncles and ulcers :

• Ankle-brachial pressure index
• Doppler probe
• Doppler duplex arterial scanning
• Arteriography

Ayurveda Treatments

Ayurveda Concept

Diabetes in ayurveda is called as Madhumeha in ayurvedic classics.The disease prevents with prabhoota (excessive) frequency and turbidity of urine. The disease is the resultant of increased function of vata either as a result of excessive tissue depletion (Dhatu kshaya janya Madhumeha) or as a result of obstruction of channels of circulation (Avaarana janya madhumeha). In any of these forms the increased vata brings down the anabolic tissue elements to be shed as waste in urine. This leads to depletion of the necessary tissues in body leading to many complications of Diabetes mellitus in long run. The causative factors (nidana), dosa(vata, pitta & kapha), and dhusya (improper tissue elements) if they are vitiated to a higher degree the complication manifests, thus in a diabetic patient maintainance of the nidana, dosa, and dhusya in their normalcy is targeted.

To prevent onset of complications in most patients & preventing the worsening of complications will be the aim.

Ayurveda approach to medical management

AyurVAID’s treatment modality for preventing diabetes complication is treat the root cause of diabetes, so that the further manifestation of complication could be prevented; as the pathology for all complications involves the pathological constraints of diabetes itself in a larger scale. So the internal medications and therapies, if judiciously administered after assessing the diabetes mellitus patient’s individual clinical condition, can help prevent further progression into complications or postpone the onset of them. Along with these the proper Diet, exercise, yogic practices can all benefit, helping to counteract the disease from different angles.

Therapies like Yapana Vasti (medicinal enema) and Dhāra (pouring of medicinal liquid in a particular fashion), detoxification procedures like Vamana &Virechana (procedural induction of vomiting and loose motion) to control the disease from the root. So a patient of diabetes mellitus if undergoes above procedures at intervals can lead a life free from complications of diabetes and also the complications. If manifested, treatment towards the same could bring satisfactory improvement in quality of life. Netra tarpana(pouring ) for retinopathy changes(procedure of pouring medicated oil over closed eyes), abhyanga(massage), lepa (application of medicated paste over body) and seka(pouring of medicated liquid over body) for neuropathy changes, and Yapana Vasti (medicinal enema) for nephropathy changes are employed.

All these treatment procedures every 3 or 6 months once based on the severity and continued intake of oral medications to counteract blood sugar levels and preventive medications for diabetes complications along with proper diet, exercises all aid in controlling diabetes adding life to the years in a diabetic patient.

Treatment specific information

The nature of the disease necessitates long run treatment protocol with continuous internal medications regular therapies. The patient need to be on achara rasayana(behavioural rejuvenatives) naimittikarasayana (rejuvenation therapy specific to the disease like use of shilajatu, loha, etc) during the convalescence also.

Case Studies

AyurVAID treatment for Transient ischemic attack,UMN facial palsy, diabetes mellitus and hypertension

A patient walked into AyurVAID with the complaints of weakness of the left side of the body since the past 3 years .It was also accompanied by headache with exaggeration and remission since the past 2 years. He also faced difficulty in complete closing of left eye. It was associated with occasional watering since the past 2 years and numbness of lips and tongue.

In view of his symptoms and condition, AyurVAID decided to use the treatment of ‘Avarnajanya vata vyadhi, Arditham, Prameham and Vyana prabala’ for a period of 6 days along with a duration of follow up that would last for three months.

The medical strategy adopted included:

• Vata samana by snigdha sweda, along with moordhni thaila (sirovasti) which was followed by nasyam
• Internal medication for vatahara purpose which prevented further progress of the condition.

The treatment was a success and at the time of discharge numbness and pain on the affected side reduced considerably. Mukha abhyanga, Pratimarsha nasyam, and internal medication during follow-up period was expected to impart reasonable strength to eye muscles, thus epiphora was reduced. BP and vitals were stable at the time of discharge. However, Allopathic medicines for DM and HTN were to be continued.

Findings &Conclusions:

Patients with Hypertension and presenting with features with TIA need to be monitored regularly for further attack of TIA. Also all measures to prevent further episodes of the same is to be done. The treatmenthas given reasonably good relief to the present status.However regular review and Pathya is expected to give better relief.

AyurVAID treatment for Psoriasis and Diabetes mellitus

A 56 year old female patient walked into AyurVAID with the complaints of blackish scaly skin lesions along with burning sensations. She also had itching in the extensor aspect of upper and lower limbs for over a year. Other ailments included constipation, general debility and weakness.

In view of her symptoms and condition, AyurVAID decided to use the treatment of ‘Kitibha with Prameha’ for a period of 12 days along with a duration of follow up that would last for three months.

The medical strategy adopted included:

• Bahu doshavastha, Shareerasodhana in the form of Aarohana snehapaanam followed by Virechana.
• This was followed by Bahya Chikitsa like takra dhara in the preview of both Prameha and Kitibha.
• Internal medication on regular follow-up basis with a view of sthoka sthoka dosa nirharana was done for betterment in order to prevent remission in the future.
• Patient was advised to continue the Allopathic OHD for Glycemic control.

The treatment was a success and at the time of discharge the patient was asymptomatic, while her general health had also improved. There were vast improvements in the patient’s skin condition and she no longer reported itching and burning sensations.

Findings & Conclusions:

Skin complaints are generally considered to be chronic in nature requiring long term treatment and also the chances for remission is very high. So regular review along with strict pathya (congenial diet regimen) as prescribed by the medical team is expected to yield better results and also prevent the remission of complaints in the future.

A bunch of diseases-Hypothyroid-Diabetes Mellitus-Knee pain-Skin lesions

Brief Medical History

Presenting Complaints with severity and episode duration

1. C/o pain in both the knee joints since last 5 years, associated with stiffness, grating sound in knee when climbing stairs, restriction of knee movement while flexing.
2. C/o pain in low back region since last 2 years.

History of present illness( vedana vruttanta) patient was apparently normal before 5 years. Gradually she developed pain in right knee joint later involved the left knee also which was associated with stiffness, grating sound in knee when climbing stairs, restriction of knee movement while flexing.pain was more during the evening hours and on standing for long hours. Patient used to find relief with symptoms by relaxing for few hours. But now the pain doesn’t subside even with rest and for which patient had taken symptomatic treatment with allopathic medicines.As she didn’t observed considerable improvement she has consulted here.

Past history:

Patient is a known case of Diabetes Mellitus since 20 yrs, and hypothyroidism since 8 yrs and is on medication for the same
Current medication :

For Diabetes Mellitus :

• Glycomet GP 2 forte 1-0-1

along with Ayurvedic medications

• i.e Shiva gutika 1-0-1
• Asanadi kashayam + Shadanga kashayam – 15ml -0-15ml before food

For Hypothyroidism : Thyronorm tab 50 mcg once daily in morning.

Conclusion

Patient observed improvement in the scorring of Womac scale which showed improvement from a score of 57.6 before treatment to 81.8 after treatment. The significant improvement is due to the effect of janu basti and matra basti together along with the given internal medications. The review done after 15 days of treatment showed no relapse and maintainance of health condition of the patient.

Diabetes Mellitus

Brief Medical History

A 27 year old female of Indian origin residing in USA, a known case of Diabetes Mellitus since 4 years, came to AyurVAID Hospitals with several associated problems

Present Complaints:

1. Hypotension
2. Obesity
3. Stress and Depression since 6 years.

Conclusion

After Treatment, there was an overall improvement in patient’s condition. Her FBS has reduced from 264 mg/dl to 157mg/dl and PPBS from 403 mg/dl to 207mg/dl, only with the administration of Ayurveda medicines. Her stress level has reduced from 10 to 3 on VAS scale (0-10) and BMI from 23.2 to 22.1. There was significant improvement in her appetite, sleep, bowels and dry skin. There was overall improvement in in body heaviness and urine frequency.

Diabetes is an enormously complex heterogeneous condition that involves many genes, molecules and organ systems. Ayurveda management consisting of internal medicines and purification procedures has an effective role in arresting the evolving pathogenesis of diabetes, successfully delays its complications, and also enhance QoL and wellbeing.

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