1. This document discusses Prameha (diabetes) from an Ayurvedic perspective. It defines Prameha as a condition characterized by the excessive and frequent passing of urine that is sweet and sticky.
2. The causes of Prameha are described as vitiation of the three doshas (Vata, Pitta, Kapha) due to unhealthy lifestyle factors like excessive sleep, indulgence, and diet. The document outlines different types of Prameha classified by the color, smell, and characteristics of the urine.
3. Treatment principles focus on pacifying the aggravated doshas and eliminating toxic substances (ama) from the body. P
29. 1. In Kaphaja pramehas the vitiated dosa and dusyas have similar
attributes drugs prescribed in this condition allievate both dosa and
dusya,easily curable.
2. In Pittaja pramehas the vitiated dosa and dusyas have different
attributes ,so there is difficulty in managing the disease,it is said to
be Yapya{manageable} Pittajapramēhas are generally Yāpya, but, if
Mēdas is not affected much they become Sādhya.
3. In Vataja pramehas the vitiated dusya is deeper dhatus i.e majja,
ojas. many complications and serious in nature.so Asadhya.
Patient who suffers with Pramēha right from the time of birth and
those who are born of parents having Pramēha(hereditary) are not
curable because of the morbidity in their bīja.
31. DIABETES
Diabetes is a common life-long health condition.
Diabetes is a condition where the amount of glucose in your blood
is too high because the body cannot use it properly.
This is because your pancreas doesn’t produce any insulin, or
not enough
insulin, to help glucose enter your body’s cells – or the insulin that is
produced does not work properly (known as insulin resistance).
As of 2013, 382 million people have diabetes worldwide. Type 2
makes up
about 90% of the cases
In 2014, the International Diabetes Federation (IDF) estimated
that diabetes resulted in 4.9 million deaths.
TheWorld Health Organization (WHO) estimated that diabetes
resulted in 1.5 million deaths in 2012, making it the 8th leading cause
of death.
32. CLASSIFICATION
1. TYPE 1 DIABETES MELLITUS
2. TYPE 2 DIABETES MELLITUS
3. GESTATIONAL DIABETES
4. OTHER SPECIFIC TYPES
MODY {MATURITY ONSET DIABETES OF THE
YOUNG}
LADA {LATENT AUTOIMMUNE DIABETES OF
ADULT}
NEONATAL DIABETES MELLITUS[NDM]
5 WOLFRAM SYNDROME
6 ALSTROM SYNDROME
33. Type I -{IDDM,JUVENILE DIABESTES}
It occurs when the individuals own immune
system acts against pancreatic β-cell and
destroys it.
Causes- beta cell loss, severe insulin
secretary deficiency, genetic,
immunogenic
c/f- age below 20 yrs,
osmotic symptoms i.e. wt loss
dehydration,
35. • Type II-{NIDDM}
It is a disorder of metabolism of carbohydrate ,
protein and fat due to absolute or relative
deficiency of insulin secretion and with varying
degree of insulin resistance.
• Age 35-65 yrs
• Often obese
• Slow insidious
37. What is Insulin?
• Insulin is a hormone secreted by pancreatic
beta cells. It works as a chemical messenger
that helps your body use the glucose in your
blood to give you energy.
• You can think of it as the key that unlocks
the door to the body’s cells. Once the door
is unlocked, glucose can enter the cells
where it is used as fuel.
39. GESTATIONAL DIABETES {GDM}
• Gestational diabetes is a type of diabetes
that affects pregnant women, usually
during the second or third trimester.
40. MODY –
• MODY is a rare form of diabetes which is
different from both Type 1 and Type 2
diabetes, and runs strongly in families.
• MODY is caused by a mutation (or change) in
a single gene. If a parent has this gene
mutation, any child they have, has a 50%
chance of inheriting it from them. If a child
does inherit the mutation they will generally go
on to develop
• MODY before they’re 25, whatever their
weight, lifestyle, ethnic group etc.
41. LADA
• Latent autoimmune diabetes of adults is a
form of type 1 diabetes that occurs in
adults, often with a slower course of onset.
Adults with LADA may initially be
diagnosed as type 2 based on their age.
42. NEONATAL DIABETES
MELLITUS
• Neonatal diabetes is a form of diabetes that
is diagnosed under the age of
6months.change in gene affects insulin
production.It is different type of diabetes than
the more common type 1 as its not an
autoimmune and type 1 doesn’t affect anyone
under 6months.
• a) Transient neonatal diabetes
mellitus(TNDM)
• b) Permanent neonatal diabetes
mellitus(PNDM)
43. WOLFRAM SYNDROME
• Wolfram Syndrome is a rare genetic
disorder which is also known as -
DIDMOAD syndrome after its four most
common features (Diabetes Insipidus,
Diabetes Mellitus, Optic Atrophy and
Deafness).
44. ALSTROM SYNDROME
• Alström Syndrome is a rare genetically
inherited syndrome which has a number
of features-Retinal degeneration,Type
2DM, Hearing loss, Cardiomyopathy,
Renal (kidney) failure, Orthopaedic and
rheumatology problems
45. Clinical features• Unexplained weight loss
• Polyuria(increased urination)
• Polydipsia (increased thirst)
• Polyphagia(increased hunger)
• Fatigue
• Slow healing of cuts
• Ketosis [Type 1]
• Prolonged high blood glucose can cause glucose absorption in the lens of the eye,
which
• leads to changes in its shape, resulting in vision changes.
• A number of skin rashes that can occur in diabetes are collectively known as
diabetic
• dermadromes.
• Symptoms may develop rapidly (weeks or months) in type 1 diabetes, while they
usually
• develop much more slowly and may be subtle or absent in type 2 diabetes
48. INSULIN SECRETION• Glucose from blood stream enters into beta
• cell by GLUT2(transporter) mechanism.
• 2. Glucose gets converted into pyruvic acid
• and then undergoes citric acid cycle
• &oxidative phosphorylation.
• 3. End product ATP is obtained.
• 4. Due to ATP formation ATP sensitive
• potassium channels gets closed.
• 5. Membrane depolarization occurs,by that
• voltage gated calcium channels are opened.
• 6. Influx of calcium takes place.
• 7. These calcium triggers the storage granules
• and by exocytosis insulin,c-peptide,amylin
• very little amount of proinsulin is released
• into the blood stream.
52. ORAL HYPOGLYCEMIC
• Insulin secretogogues
SR NO. Category GENERIC NAME
1 SULFONYLUREALS GLYMEPIRIDE,GL
YBURIDE
2 MEGLITINIDE REPAGLINIDE
53. INSULIN
• Insulin is usually given subcutaneously, either by injections or by an
insulin pump.
• They are rapid acting insulins, intermediate acting insulins and long
acting insulins.
• Overdose of insulin causes insulin shock-low blood
sugar,weakness,convulsions,coma.
• Insulin shock therapy or insulin coma therapy[ICT] was a form of
psychiatric treatment in which patients were repeatedly injected large
doses to produce daily comas,each coma lasts upto an hour and
terminated by intravenous glucose.
• Inhalable insulin is available in 1mg and 3mg,should be given 10min before
meal faster than regular insulin. Contraindicated in smokers, pulmonary
disorders.
54. Surgery
• Bariatric surgery (weight loss surgery) includes a variety of
procedures performed on people who have obesity. Weight loss is
achieved by reducing the size of the stomach
• Long-term studies show the procedures cause significant long-term loss of
weight, recovery from diabetes, improvement in cardiovascular risk factors
• A pancreas transplant is occasionally considered for people with type 1
diabetes who have severe complications of their disease.
• Vertical banded gastroplasty,Sleeve gastrectomy,Gastric bypass
surgery are some of the techniques.
Surgery improves type 2 diabetes in nearly 90 percent of patients by:
• a) Lowering blood sugar
• b) Reducing the dosage and type of medication required
• c) Improving diabetes-related health problems
• Many are able to maintain normal blood sugar levels with little or no
medications
• following surgery.
• Islet cell transplantation will be soon available to persons having TYPE 1.
56. Diagnosis & Investigations
• Diagnosis of diabetes is determined through A1C levels, fasting blood
glucose levels, oral glucose tolerance tests
• Criteria for diagnosis of diabetes are:
• A1C levels greater than or equal to 6.5%.
• Fasting blood glucose levels greater than or equal to 126 mg/dL.
• Blood glucose levels greater than or equal to 200 mg/dL following an
oral glucose tolerance test[GTT]
• Random blood glucose levels greater than or equal to 200 mg/dL.
• Glycated hemoglobin (A1C) test: This blood test indicates your average
blood sugar level for the past two to three months. It measures the
percentage of blood sugar attached to haemoglobin. The higher your
blood sugar levels, the more hemoglobin you'll have with sugar attached.
Diabetic 6.5%
• Prediabetic 5.7-6.5%
• Normal 5.7%
57. • Random blood sugar test:
• Diabetic 200mg/dl {11.1 mmol/L}
• Fasting blood sugar test:
• A blood sample will be taken after an overnight fast
• Normal 100mg/dl {5.6mmol/L}
• Prediabetic 100-125mg/dl {5.6 to 6.9 mmol/L}
• Diabetic 126mg/dl {7mmol/L} on two separate tests.
• Oral glucose tolerance test:
• For this test,person fast overnight, and the fasting blood sugar
level is measured.
• Then glucose is given, and blood sugar levels are tested
periodically for the next two hours,
• Normal 140mg/dl
• Diabetes 200mg/dl
• Prediabetic 140 to 200mg/dl
• In type 1
• DM urine is tested for the presence of ketone [ketonuria].
• Presence of autoantibodies are tested.
58. Complications
• 1. Microangiopathy-
• Diabetic nephropathy,
neuropathy and
retinopathy comes under
this category
• 2.Macroangiopathy-
• Cerebrovascular disease,
Peripheral vascular
disease and
Coronary artery disease
comes under this
category.
63. PATHYA-APATHYA• Patya- [Ca.ci.6:46-50]
• Āhāra
• Yavaudāna
• Sarodakam
• Kusodakam
• Triphala rasa
• Madhudakam
• Sidhu
• Barley soaked in the decoction of Triphala and kept overnight should be mixed
• with honey.
• Vihāra:
• Different types of Exercises, bath , Application of ointment made of uśīra,Tvak,
Ēla,
• Aguru, Candana etc.