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                                                        DIABETES MELLITUS

Diabetes mellitus (DM) is a group of metabolic disorders characterized by increased level of blood sugar, and is due to defect in insulin secretion or insulin action or both.

Classification of DM

TYPE 1- IDDM- insulin-dependent diabetes mellitus.

TYPE 2 –NIDDM-non insulin-dependent diabetes mellitus.

AETIOLOGY AND PATHOGENESIS OF DIABETES

In both types of diabetes, environmental factors interact with the genetic susceptibility to determine which people develop the clinical syndrome, and the timing of its onset. However, the underlying genes, participating in environmental factors and pathophysiology differ substantially between type 1 and type 2 diabetes. Type 1 diabetes was previously termed ‘insulin-dependent diabetes mellitus'(IDDM) and dependent diabetes mellitus’ (IDDM) and is invariably associated with profound insulin deficiency requiring replacement therapy. Type 2 diabetes was previously termed ‘non-insulin-dependent diabetes mellitus'(NIDDM mellitus’(NIDDM) because patients retain the capacity to secrete some insulin, but exhibit impaired sensitivity to insulin (insulin resistance) and can usually be treated without insulin replacement therapy. However, up to 20% of patients with type 2 diabetes will ultimately develop profound insulin deficiency requiring replacement therapy so that IDDM and NIDDM were misnomers.

TYPE 1 DIABETES

In type 1 DM the body fails to produce the sufficient amount of insulin. It is usually seen in children and young adults.

Causes

Genetic factors

Autoimmunity

Environmental factors like-

a-Viruses-congenital rubella, mumps, etc.

b-Chemicals like Nitrosourea,  Rodenticide, etc. are associated with increased risk.

c-Stress in early life.

d-Bovine serum albumin is one of the important constituents of the cow’s milk, and it is said to a triggering factor for type 1 diabetes mellitus.

Type 2 DM

It is due to defective production of insulin and also due to increased tissue resistance to insulin.

Causes

Genetic factors

Obesity

Increased dietary intake

Physical inactivity

Low level of vitamin D, copper and chromium

Clinical features

Increased urine output.

Increased thirst

Increased appetite

Pruritis of external genital part of female

Erectile dysfunction or loss of libido

Blurring of vision

Investigation

Random blood glucose-it can be done on any day, and the level should be below 140 mg.

FBS-fasting blood-glucose level-blood examination is done after 12 hours of fasting. Normal level is below 110 mg.

PPBS-post prandial blood glucose- measured after 2 hours after a meal. Normal level is below 140 mg.

Oral glucose tolerance test-done in patients with no symptoms of diabetes but having family history of DM, type 2, women with diabetes during pregnancy (Gestational diabetes) , women who gave birth over-weight  babies, and obesity with belly fat.

HbA1c-it gives the blood-glucose level of over last 3 months.

Management of diabetes mellitus

Type 1 diabetes is incurable. Along with insulin supplementation, homeopathic medicines can be tried to boost up the immunity of children. By this, the patients can be kept healthy and the quality of life can be improved. Besides this, unwanted infection can also be prevented.

Type 2 DM

The primary aim should be lifestyle modification. For that regular exercise at least half an hour per day for most of the days and with strict diet control.

All kinds of fatty foods and sugars should be avoided. Plenty of fiber foods, especially vegetables should be included in the diet.

Try stress reducing techniques like yoga and meditations.

The aims of homeopathic medicines are to control the blood-sugar level and prevent complication, thereby to improve the quality of life. First approach is to try homeopathic remedies like uranum nitricum, potentised insulin, acid phos, syzygium, etc. to control the blood-sugar level.

The second approach is after controlling the blood-sugar level, a constitutional/ /miasmatic remedy is selected by considering of the physical, mental peculiarities, also giving importance to family history. By this approach, the blood sugar can be kept within controlled level and also can prevent the complications. But one thing should be kept in mind that DM of both types is at present incurable. The only thing by treatment, whatever system it may be, is to keep the level of blood glucose within the normal limits, and thereby make the person to lead a normal ‘healthy life’

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                                                          GOITRE

Enlargement of the thyroid gland is called as goitre. The enlargement may be the single lobe or both lobe, and it may be a single nodule or multiple nodules.

Thyroid gland situates in front of neck and has two lobes.  Thyroid gland is butterfly shaped, and it produces hormones, which have a major role in the metabolism of the whole body.

Simple nodular goitre

Usually occur between the age of 15 and 25 years. It occurs often during pregnancy. On examination, the gland is soft to touch and feels tightness in the neck when swallowing.

Blood examination of T3, T4, and TSH is normal. Usually after a period the thyroid may reduce to normal size and in rare cases, the gland may become multinodular after 10-20 years.

Multinodular goitre

In multinodular goitre, is there is an increased risk of thyroid cancer.

Multinodular goiter is usually diagnosed in patients with thyrotoxicosis, large goitre with or without tracheal compression.

Very large goitre may compress the windpipe or trachea, and there is a difficulty in swallowing. Hoarseness may also occur.

Management

If the goitre is small, no treatment is needed, but annual checkup is necessary. If large one and symptomatic, that is if it causes symptoms like difficulty in swallowing, and compression of trachea surgery is needed.

Treatment

Usually, simple nodular goitre needs no treatment if it is small. But sometimes it may show a tendency to increase in size. In such cases, homeopathic remedies can be tried. Homeopathic remedies are usually very effective in simple nodular goitre. Homeopathic medicines like Conium mac, Spongia, Iodum, etc. can be tried. There is a rule for prescribing Iodum as described in materia medica.

Multinodular goitre needs regular follow up. Medicines like Conium, Hydrastis, Fucus, etc. are usually indicated. In short, homeopathy is found very effective in the treatment not only to reduce the size, but also it prevents from progressing to cancer of thyroid.

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                                                            HbA1c

HbA1c is the term related to diabetes mellitus. It is also known as glycated hemoglobin.

RBC-Red Blood Corpuscles carries blood throughout the body. These red blood cells contain hemoglobin. When blood sugar in the body goes in an uncontrolled level, the sugar (glucose) combines with hemoglobin and becomes glycated.

So the level indicated how far your blood glucose is controlled for the last 2 to 3 months.

The normal level is below 6%

The level between 6 to 6.4 % means pre diabetes.

And the level above 6.5% or above is confirmed diabetes.

When the level of the normal value goes up, it indicates that the risk of complication is also high.

The complications may be-

Diabetic nephropathy,

Diabetic retinopathy

Diabetic neuropathy

Women with diabetes planning for pregnancy or even pregnant women should keep the HbA1c level below 6%. And it is advisable to monitor HbA1c level monthly. It prevents the risk of congenital abnormalities in baby.

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                                                            HYPOTHYROIDISM

Hypothyroidism is a clinical condition that results from the decreased production of thyroid hormones. Females are more commonly affected.

Causes of hypothyroidism

Idiopathic-here the exact cause is not identified.

Surgical removal of the thyroid gland

Iodine deficiency

Hashimoto's thyroiditis

Cancer of the pituitary gland

Hypothyroidism by birth-congenital hypothyroidism

Certain drugs like Lithium, Amiodarone etc.

Clinical features

A variety of signs and symptom are produced by hypothyroidism.

General symptoms like-

Ò      Fatigue

Ò      Weight gain

Ò      Goitre

Ò      Increased level of cholesterol

Ò      Cold intolerance

Skin symptoms like-

Ò      Dry and rough skin

Ò      Hair falling

Ò      Facial puffiness

Ò      Baggy eye lids

Ò      Vitiligo (whitish discoloration of skin)

Hear symptoms like-

Ò      Decreased heart beat (bradycardia)

Ò      Angina

Ò      Cardiac failure

Psychiatric symptoms like-

Ò      Depression

Neuromuscular symptoms like-

Ò      Generalized body aches and pain

Ò      Carpal tunnel syndrome

Ò      Muscle pain and stiffness

Ò      Hoarseness of voice

Gastrointestinal symptoms like-

Ò      Constipation

Blood-related changes like-

Ò      Anaemia –iron deficiency anaemia

Reproductive symptoms like-                

Ò      Infertility

Ò      Impotency

Ò      Increased flow of menses

Ò      And developmental delay like-

Ò      Growth retardation

Ò      Delayed puberty

Ò      Mental retardation

Investigations

1-TFT-thyroid function test

The result may be-

a-elevated TSH and normal T4 level-subclinical hypothyroidism

b-raised TSH and decreased level of T4 and free  T4-primary hypothyroidism.

c-TSH within normal or below normal range and reduced level of free and total level- secondary hypothyroidism.

2-Increased level of serum cholesterol

3-ECG- bradycardia

4-Thyroid antibodies

Treatment

Homeopathy has very effective medicine not only to control but also for the complete cure of hypothyroidism. Once it is cured the medication can be stopped permanently. Homeopathic medicines are completely free side effects and patient can use it very safely.

Like other systems of medicines, there is no specific medicine for hypothyroidism. Since the hormones affect the metabolic functions within the body, the signs and symptoms vary from individual to individual. So by considering the symptoms and signs that are peculiar to the patient in treatment, and by eliminating the common symptoms in the disease a medicine is selected, which will definitely correct the metabolism there by the complete cure of the disease.

Homeopathic medicines have to be taken for a few months to the complete recovery of hypothyroidism,

Usual remedies are Thyroidinum, Iodum, Calc carb, Spongia, etc.

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                                                         THYROTOXICOSIS        

Thyrotoxicosis causes a group of symptoms due to hyper metabolisms and hypersensitivity. And this entire syndrome occurs due to the excessive amount of thyroid hormones.

Causes of thyrotoxicosis

Multinodular goitre

Graves’s disease

Drug induced

Sub acute thyroiditis

Symptoms of thyrotoxicosis

Ò      Lose of weight in spite of normal or increased appetite.

Ò      Fatigue

Ò      Heat intolerance

Ò      Palpitation

Ò      Tremor

Ò      Irritability

Ò      Vitiligo

                                               Graves’ disease

Graves’ disease is the most common manifestation of thyrotoxicosis.

Graves’ disease is more common in women of 30-50 years. And it is unusual before puberty.

Clinical features of Graves’ disease

Ò      Weight loss with increased appetite

Ò      Fatigue and weakness

Ò      Impotency

Ò      Gynecomastia

Homeopathic treatment

Since thyrotoxicosis is due to hormonal changes and also there is multisystem involvement treatment should be based on the miasmatic level. Homeopathic medicines can be tried as such or can be continued along with allopathic medicines.

Medicines-Natrum mur, Calc carb, Iodum, Thyroidinum, etc.

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