Featured Case

TITLE OF CASE

Standalone Ayurvedic management of Type 2 Diabetes mellitus - A case report

Dr Indu

ABSTRACT

A 41 year old female patient presented with a moderate increase in thirst, hunger, and frequency of micturition. The associated symptoms were mild tiredness and dryness of the mouth. She was diagnosed with Type II Diabetes mellitus 1 year back during a routine blood check-up. The patient is not under any medication and she noticed increased blood sugar variations. She approached Dr Indu for Ayurvedic management. Based on the clinical evaluation and HbA1c value, the Ayurvedic diagnosis was Prameha. The line of treatment followed was Prameha hara and Kaphamedo hara.  With three months of Ayurvedic treatment, supported by dietary and lifestyle modifications, she experienced a significant reduction in symptoms. The HbA1c recorded 7.6 at baseline, became 4 at endpoint. She stopped all the ayurvedic medicine after 4 months. 

KEYWORDS

Standalone, ayurveda, prameha, diabetes, case report, type 2 diabetes mellitus

INTRODUCTION

Diabetes is a chronic metabolic disorder, characterised by constant elevated blood sugar levels. This can be caused by various reasons, the improper breaking down of the body sugar and its absorption. The excess sugar is released into the blood stream, thus causing an elevated blood sugar level. There are 3 types of Diabetes:

Type 1- This is considered as an auto immune reaction, where the body stops producing insulin. 5-10 % diabetics are of Type 1. The symptoms develop very quickly, and children, teens and adults are diagnosed with this Type. There is no prevention yet identified for Type 1. 

Type 2- This is normally referred to as Adult onset Diabetes. Lack of Physical activity, obesity and unhealthy lifestyle are the risk factors for this Type of Diabetes. In the Pre-diabetes state, by adopting lifestyle changes and diet, this can be reversed. 90-95 % of the diabetics are of Type 2.

Type 3- Gestational Diabetes is normally referred to as Type 3. This prevails during pregnancy and after delivery, this is resolved in majority of the patients. But once the patient gets gestational diabetes, there is a possibility of becoming diabetic in the due course of time. Regular check up of blood sugar is advised. 

Diagnostic criteria- Hb A1C is considered as the main diagnostic parameter, for Diabetes Mellitus.  If the HbA1C is less than 5.7, it is normal. When the values are 5.7 to 6.4, it is considered to be Pre-diabetes. When the value is 6.5 and higher, then it is Diabetes. When the value is above 8, then it is considered to be poor control of Diabetes.

PATIENT INFORMATION

41 yr old female patient presented with a moderate increase in thirst, hunger, and frequency of micturition. Associated with mild tiredness and dryness of the mouth. She was diagnosed with Type II DM before 1 year during a routine blood check-up. The patient is not under any medication and she noticed increased glycemic variation.

Family History- Mother was diabetic

Food habits- Excess consumption of Non-veg, high fat diets. Irregular timings of meals  

CLINICAL FINDINGS

General examination was done, from the Ayurvedic perspective was done and documented.

Dosha- Kapha
Dhatu- Rasa medas
Mala- Mutra
Bhoomi Desha- Sadharana
Dehadesha- Basti
Rogibala- Madhayama
Rogabala- Madhyama
Kala- Kshanadi
Vyadhyavastha- Puranam
Anala- Madhyama
Jaranasakti- Madhyama 

Prakriti - Vata Kapha

Vayas - Madhyama

Satva - Madhyama

Satmya - Sarvarasa satmya

Ahara - Atimatra ahara sevana, Kheers, dadhi, Akaala bhojana, Atisnigdha ahara sevana

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter; The patient did not have any prior consultation or treatments. She was identified to have a very high blood sugar value during a routine check up and the biomedical diagnosis given was Type 2 Diabetes mellitus. 

Image 2. Blood reports - HbA1c, FBS and PPBS dated June 2020 added below 

Ayurvedic Assessment was done based on the presenting complaints, the confirmed biomedical diagnosis.

Differential Diagnosis- Does not apply as the patient came in with a definite diagnosis. 

Prognosis & Treatment available: In Type 2, making drastic changes in the diet and lifestyle can produce a major change in the Blood sugar levels. Exercise and less-carb diet is the key to maintaining the blood sugar levels under control. This helps in the Pre-diabetes phase. When the patient reaches the Diabetic phase, then medical intervention supported by diet and lifestyle is the treatment protocol. If the blood sugar remains elevated inspite of taking medicines, then it can cause complications like damage to the microvascular vessels. If the sugar level is alarmingly high then insulin injection may be advised. In this patient, the blood sugar value was high and required medical intervention.

THERAPEUTIC INTERVENTION

Please refer the tab ‘Treatment’ in the Portal.

FOLLOW-UP AND OUTCOMES

The patient had three follow ups and the blood sugar levels were monitored. 

Assessment: Both objective and subjective parameters were assessed to analyse the outcome of the ayurvedic treatment. 

Subjective parameters: After 2 weeks of starting ayurvedic treatments, she got symptomatic relief in hard bowel and increased thirst. After 4 weeks, got symptomatic relief from dryness of mouth. After 12 weeks, significant reduction in symptoms of  increased frequency of micturition. She got complete relief from constipation, and increased hunger. All the medicines were discontinued after 1 month. The patient is advised to come for a regular follow up. 

Objective parameters: The HbA1c, FBS and PPBS were recorded and tabulated. 

Table 1. The Subjective and Objective parameters tabulated date-wise, from the Doctor’s notes.

Image 3. Endpoint HbA1c, FBS and PPBS value dated August 2020. 

Clinician-based assessment; Significant reduction in symptoms
- reduced frequency of micturition
- reduced excess thirst and hunger
- constipation relieved

Patient-assessed; Not relevant

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- By monitoring the patient.

Adverse and unanticipated events; None reported

DISCUSSION ; 

The patient was diagnosed a year back, during a routine blood check up. But she did not take any medications. When she came for Ayurvedic consultation, she also had associated symptoms affecting her hunger and thirst and bowels. But with 14 weeks of treatment, which included only a single Kashaya, the HbA1c, FBS and PPBS could be brought to normal levels. The target of the medicine was Prameha hara and Kapha medo hara. 

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This case report demonstrates the successful ayurvedic management of a patient, with elevated sugar levels with a simple medicine and in a very short duration of time.

INFORMED CONSENT

Written consent obtained from patient for publishing of the case report in the Portal

ACKNOWLEDGEMENTS

None specified

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36 Suppl 1(Suppl 1):S67-S74. doi:10.2337/dc13-S067
2. Murthy AR, Singh RH. Concept of prameha/madhumeha (contradictions and compromises). Anc Sci Life. 1989;9(2):71-79.