Diabetes

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. You can also have pre-diabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having pre-diabetes puts you at a higher risk of getting type 2 diabetes. 

Why is it bad?  

When the body is unable to efficiently incorporate glucose from the blood into the cells where it is needed, glucose stays in the blood, where it can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. In addition, the cells don’t receive the energy they need to function properly. Pregnant women can also get diabetes, called gestational diabetes.  

1. Excessive urine formation & Frequent urination. 
   
2. Burning of palms and soles. 
   
3. Increased hunger 
   
4. Excessive Thirst. 
   
5. Sweet taste to mouth etc. 
   
6. Weight Loss  
   
7. Blurry Vision  
   
8. Wounds that take time to heal  
   
9. Skin Infections 
   
10. Unexplained extreme fatigue  
    

Type 1 diabetes

Type 1 diabetes is caused by the immune system destroying the cells in the pancreas that make insulin. This causes diabetes by leaving the body without enough insulin to function normally. This is called an autoimmune reaction, or autoimmune cause, because the body is attacking itself. 
The following triggers may be involved: 

• Viral or bacterial infection 
  
• Chemical toxins within food

Type 2 diabetes

Type 2 diabetes is primarily a lifestyle disease, people with certain genetic disposition are more at risk. The factors that increase the chances of developing the condition are. 

1. Obesity 
   
2. Living a sedentary lifestyle 
   
3. Increasing age 
   
4. Bad diet

Gestational diabetes  

The causes of diabetes in pregnancy also known as gestational diabetes, remain unknown. However, there are a number of risk factors that increase the chances of developing this condition: 

• Family history of gestational diabetes 
  
• Overweight or obese 
  
• Suffer from poly cystic ovary syndrome 
  
• Have had a large baby weighing over 9 lb
• Causes of gestational diabetes may also be related to ethnicity - some ethnic groups have a higher risk of gestational diabetes.

Some studies have suggested that frequent consumption of processed meats may increase the risk of type 2 diabetes. Meats, especially processed meats, contain many pro-inflammatory chemicals that can contribute to a chronic state of inflammation in the body. 

Connection to Mind Body constitution [TBC] 

Kapha pradhan prakriti are prone to diabetes. However diet, lifestyle and psychological health have significant relation with manifestation of diabetes, irrespective of prakriti.  

Type 2 diabetes is primarily an imbalance, or excess, of the Kapha dosha, which consists of the earth and water elements. Kapha governs the physical structure of our body and several metabolic processes, but when it builds to excess, can manifest in weight gain, lethargy, allergies, and resistance to change. Kapha Diabetes is treatable through diet and exercise, it is where diabetes clogs the system and is a disease of excess. It used to be a disease that mainly occurred in older patients, but it is now rising dramatically in children and adolescents, a population that is much more sedentary and overweight than previous generations. 

Overeating is sometimes provoked by an imbalance in the Vata dosha, which can easily become aggravated. When people with Vata imbalances overeat to soothe themselves, Kapha can in turn become imbalanced and, over time, contribute to the development of type 2 diabetes. However Ayurveda considers type 1 diabetes to be primarily an imbalance of the Vata dosha. Vata and Pitta Diabetes deplete the  nervous system, Pitta Diabetes can be controlled with strict management whereas Vata Diabetes is much harder to treat and stabilize. 
 

Glycated hemoglobin (A1C) test.

This blood test, which doesn't require fasting, indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached.

• An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes.
• An A1C between 5.7 and 6.4 percent indicates prediabetes.
• Below 5.7 is considered normal.

Blood Sugar Test

Random blood sugar test: A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.

Fasting blood sugar test: A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.  Incorrect - current WHO parameters differ. Also 126 will still be borderline so one cannot say diabetes immediately. Needs to be evaluated further.

Oral glucose tolerance test: You fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.

• A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal.
• A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes.
• A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.

Urine Tests

Urine tests may be done in people with diabetes to evaluate severe hyperglycemia (severe high blood sugar) by looking for ketones in the urine. Ketones are a metabolic product produced when fat is metabolized. Ketones increase when there is insufficient insulin to use glucose for energy.

Urine tests are also done to look for the presence of protein in the urine, which is a sign of kidney damage. Urine glucose measurements are less reliable than blood glucose measurements and are not used to diagnose diabetes or evaluate treatment for diabetes. They may be used for screening purposes.

Known medicines and how they work

Formulas and their actions

Sulfonylureas:  glimepiride, glipizide, glyburide. Among the oldest diabetes drugs still used today. They work by stimulating the pancreas with the help of beta cells. This causes your body to make more insulin.

Biguanides: metformin. Decrease how much sugar your liver makes. They decrease how much sugar your intestines absorb, make your body more sensitive to insulin, and help your muscles absorb glucose.

Thiazolidinediones (Tzd): pioglitazone, Actosgeneric.  Work by decreasing glucose in your liver. They also help your fat cells use insulin better. These drugs come with an increased risk of heart disease.

Alpha-glucosidase inhibitors: Acarbose, Miglitol. These medications help your body break down starchy foods and table sugar. This effect lowers your blood sugar levels. For the best results, you should take these drugs before meals

Meglitinides: nateglinide. These medications help your body release insulin. However, in some cases, they may lower your blood sugar too much.

Combination of sulfonylureas plus metformin

Medical Interventions

Interventions may be needed for when diabetes is severe and risk of associated complications are high

Insulin

Insulin injection is used to control blood sugar in people who have type 1 diabetes (condition in which the body does not make insulin and therefore cannot control the amount of sugar in the blood) or in people who have type 2 diabetes that cannot be controlled with oral medications alone. 

Insulin injection is used to take the place of insulin that is normally produced by the body. It works by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar. All of the types of insulin that are available work in this way. The types of insulin differ only in how quickly they begin to work and how long they continue to control blood sugar.

Insulin Pumps

An insulin pump is a battery operated portable device about the size of a pager, worn externally to deliver a continuous amount of fast-acting insulin. The wearer can also administer extra (bolus) doses of insulin when needed by pushing a button on the pump. Insulin pump treatment is a type of intensive insulin therapy requiring multiple insulin injections.

An insulin pump attempts to mimic the function of a normal pancreas by delivering a basal insulin dose, and bolus doses at mealtime when blood glucose (sugar) levels rise above normal. Unlike the pancreas, insulin pumps don’t automatically deliver the appropriate amount of insulin based on what the user has eaten. Users, with the help of their healthcare team, must program the doses themselves

While an insulin pumps gives better control and higher lifestyle freedom to a diabetes patient, it can also lead to occasional infections and is an expensive option.

Transplantation

A transplant of the pancreas is usually reserved for those with type-1 diabetes and serious complications. Typically, part or all of a new pancreas is surgically implanted. The old pancreas is left alone; it still makes digestive enzymes, even though it doesn’t make insulin. Most organs are obtained from someone who has died but has decided to be an organ donor.

Pancreas transplant can enable patient to enable normal blood glucose level without the need for taking insulin. This can result in the symptoms of diabetes stabilising, not getting worse and even improving in some cases - especially those with nerve damage.  However this is a risky surgery and Transplant patients must take powerful immunosuppressant drugs to prevent rejection of the new pancreas.

An alternate option being tried by some of the hospitals is Islet Transplants.  Islets are clusters of cells in the pancreas that make insulin. In people with type 1 diabetes, islet cells are destroyed. Only 1-2% of the pancreas is made up of islet cells. In pancreatic islet transplantation, cells are taken from a donor pancreas and transferred into another person. Once implanted, the new islets begin to make and release insulin. Transplanting islet cells has several advantages over transplanting a pancreas. It is a minor surgical procedure, is less expensive, and is probably safer.

Bariatric Surgery

Bariatric surgery includes a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach or by resecting and re-routing the small intestine to a small stomach pouch. Gastric bypass surgery often improves the symptoms of type 2 diabetes, even before patients start to lose weight.

After gastric bypass, the small intestine spontaneously begins to produce a molecule called GLUT-1 that helps the body use glucose. This happens most likely because the intestine has to work harder to do its job, for example to absorb the nutrients or move the food further down. Also, it may be that the mechanical stress of 'dumping' the food directly to the intestine, since the stomach is bypassed, contributes to these changes.

For severe diabetes, the benefits of surgery may far outweigh the complications associated with it.

An important part of managing diabetes, as well as your overall health — is maintaining a healthy diet, calm mind and staying physically active. Many people are able to manage their diabetes with dietary changes, especially when these changes are made early on in the development of the disease. In fact, when early intervention is made with diet, people with pre-diabetes can prevent development of the disease itself.

Healthy eating

Contrary to popular perception, there's no specific diabetes diet. You'll need to center your diet on whole foods -  more fruits, vegetables, lean proteins and whole grains — foods that are high in nutrition and fiber and low in fat and calories — and cut down on saturated fats, refined carbohydrates and sweets.

Another important part of healthy eating is to maintain a rhythm around your meals -- both timing and quantity. It is imperative that we don’t eat food when we are not hungry, which otherwise leads to a problem of excess and puts undue strain on nutrition metabolism in our bodies.

Physical activity

Everyone needs regular aerobic exercise, and people who have diabetes are no exception. Exercise lowers your blood sugar level by moving sugar into your cells, where it's used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells.

Increasing physical activity helps reduce excess Kapha dosha. However, vigorous exercise is not always recommended, especially in diabetic individuals who are frail or thin (where obesity does not play as much of a role). Choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes or more of aerobic exercise most days of the week. Bouts of activity can be as brief as 10 minutes, three times a day. If you haven't been active for a while, start slowly and build up gradually.

Yoga can be very helpful in pushing towards the prakriti equilibrium and giving relief, specific Asanas that can help are mentioned in subsequent sections.

Calm Mind

The liver serves as a storehouse for glucose, keeping it in a concentrated form called glycogen. It breaks down small amounts of glycogen all the time, releasing glucose into the bloodstream to nourish the brain, nerves, heart and other “always active” organs. The liver’s release of glucose depends largely on the presence of certain hormones. Of all the hormones in the body, only insulin causes the liver to take sugar out of the bloodstream and store it in the form of glycogen. All the other hormones—including stress hormones, sex hormones, growth hormones and glucagon—cause the liver to secrete glucose back into the bloodstream.

Stress can cause a significant and prolonged increase in the blood sugar level, calming our mind through regular practice of meditation can help us regulate the glucose/glycogen metabolism better.

Supporting Yoga and exercises

There are specific yoga postures that offer the greatest benefits with the least amount of stress. Some of these poses include:

• Surya Namaskar (Sun Salutation series) is an extremely beneficial yoga practice for high blood sugar as it improves the blood circulation of pancreas and enhances utilization of insulin in the body.
• Seated forward bend (paschimottanasana): Tone up the abdominal and pelvic organs. Intestines and gall bladder are smoothly pressed and stimulated.
• Tree pose (vriksasana)
• Warrior I and II (virabhadrasana I and II)
• Extended side angle (utthita parsvakonasana)
• Bridge pose (setu bandha sarvangasana)
• Alligator twist (jathara parivartasana)
• Relaxation pose (savasana)

For most people, it’s best to aim for moderate exercise for a total of thirty minutes a day, at least five days a week. 

Since diabetes is mainly an excess of Kapha dosha, a Kapha-pacifying diet is recommended to keep diabetes under control.  

The Ayurvedic perspective on balancing Kapha is consistent with modern western medicine’s current understanding of the proper diet for diabetes, which recommends minimizing simple carbohydrates, fats, and other heavy foods while increasing “lighter” foods such as beans (as the main protein source), whole grains, and lighter fruits and vegetables

A diet high in legumes, fruits, and vegetables is also beneficial in the prevention and management of diabetes. Like whole grains, these foods tend to be high in fiber, and prevent the rapid release of glucose into the blood, thereby preventing rapid release of insulin as well. 

• Gurmar (Gymnema Sylvestre): Known as sugar destroyer, this herb stimulates insulin secretion, increases the effects of circulating insulin, and decreases blood glucose levels. It has also been shown to have a protective effect on the pancreas, which is the organ that produces and secretes insulin. Gymnema sylvestre seems to increase the sensitivity of the tissue to insulin, which helps the body use glucose for energy.
• Fenugreek (Trigonella Foenum-graecum): have a high fiber content, and several components of the seed have been identified as having direct glucose-lowering effects. Studies have shown that daily use of fenugreek seeds can decrease insulin resistance and improve blood sugar control.
• Cinnamon: stimulates insulin receptors on the cells, as well as acting directly on our DNA to “turn off” genes that are responsible for deactivating insulin receptors on our cells. These actions make it much easier for cells to take up glucose, thus reducing blood sugar levels.
• Karela (bitter gourd): works by decreasing absorption of glucose from the intestine, stimulating insulin secretion and increasing uptake of glucose into muscle cells.
• Kanduri (ivy gourd): The juice of this food contains an enzyme that humans naturally produce that breaks down sugars. Extracts of the root and leaf have been shown to lower blood sugar levels
• Ginger: Drinking hot ginger tea with meals helps stimulate slow digestion. Drink 2–3 cups of ginger tea daily. Yes but tea north advisable along with food.
• Almonds: eating almonds with a carbohydrate significantly lowers the release of sugar into the blood, similar to the addition of cinnamon to a meal.