Featured Case

BIOMEDICAL DIAGNOSIS: Diabetes mellitus Type 2

ABOUT THE DISEASE:

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. The 64 year old male patient, the elevated blood sugar levels were discovered during a routine blood check up. He was asymptomatic. The FBS and PPBS were used as parameters to confirm the biomedical diagnosis as Type 2 Diabetes mellitus. 

Image 1. Baseline reports of FBS and PPBS dated 23.4.2023 

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. In this patient, there was no prior consultation or medication. He was asymptomatic, and it was during a routine check up, the elevated blood sugar levels were discovered. 

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

AYURVEDIC DIAGNOSIS: Prameha

ABOUT THE DISEASE:

The Biomedical diagnosis in this case report is Diabetes Mellitus Type 2.  The Ayurvedic physician has diagnosed this condition as Prameha. The specific type was not mentioned by the treating physician. 

The word Prameha is derived from Pra – means excess, Meha – ksharane - passing of urine. ‘Pra’ means excess and ‘Meha’ means ‘ksharaNe’ (ie) passing of urine. Prameha can be defined as the disease characterised by passing excess urine. The Classical Texts also mention the turbid appearance of the urine.

प्रभूताविल मूत्रता......

Apart from this, symptoms like Malina danta, hasta pada daha, deha chikkanata, trshna, madhurya asya, madhu samana varna, angagandha, shithilangata are also mentioned. 

Causative Factors: Lack of physical activity and inappropriate diet are the main causes. Kapha and medas are aggravated and dhatu shaithilya manifests. Prameha can be Sahaja (hereditary) or Apathya nimittaja (Unsuitable food and activities). Depending on the predominance of the Dosa, there are 20 types of Prameha listed in the textbooks. They are 10 Kaphaja, 6 Pittaja and 4 Vataja types.

Prognosis of Prameha: According to Caraka, in patients with early onset, is sthula and the origin of the disease is Apathyaja, it is sadhya. Pittaja and certain types of Kaphaja Prameha are yapya. This can be managed with palliative care. Vataja and Sahaja type of prameha, in a krsha, the prameha is said to be asadhya. The 64 year old male patient was asymptomatic, and the elevated blood sugar was discovered during a routine blood check up. The first consultation was Ayurveda. Based on the clinical evaluation and the blood reports, the Biomedical diagnosis was made as Diabetes mellitus type 2 and the Ayurvedic diagnosis was Prameha. The associated symptoms were Moderate increase in thirst, hunger, frequency in micturition.

Treatment & rationale for treatment: The patient is identified as Sthula pramehi or Krsha Pramehi. In sthula pramehi, अपतर्पणयुक्तिभिः is the treatment adopted. In a Krsha pramehi, अन्नपानप्रतिसंस्कृताभिः is the line of treatment followed. 

Rationale of treatment explained by the Physician: The prescribed medicines and the target of the medicine has been explained in detail by the treating physician. 

• Katakkhadiradi Kashayam – mentioned in Sahasrayogam, as a Pramehahara kashaya
• Chandraprabhavati – Described as Sarvaroga pranashini in Sahasrayogam. It acts on all the doshas. Also acts as a catalyst and as a Rasayana.
• Amrutadi Choornam- has content giloy, ginger, gokshura etc which are adaptogen, anti diabetic , antioxidant and immune stimulants in pharmacological action.
• D nil- proprietary medicine (AVP) controls the blood sugar levels.
• Phaltrikadi kashayam- This contains Triphala and haridra, mainly effective in diabetes and also urinary symptoms.
• Sreevaradi kashayam- acts as an anti diabetic .

Reference

Murthy AR, Singh RH. Concept of prameha/madhumeha (contradictions and compromises). Anc Sci Life. 1989;9(2):71-79.

OUTCOME MEASURES

The 64 year male patient was asymptomatic and during his routine blood investigation, elevated blood sugar levels were discovered. The first consultation was Ayurveda. Based on the clinical evaluation and the blood reports, the biomedical diagnosis was confirmed as Diabetic mellitus. The Ayurvedic diagnosis was Prameha and an integrative approach was adopted to manage this condition.

Assessment: As the patient was asymptomatic, only objective parameters were assessed to analyse the outcome of the ayurvedic treatment. 

Objective parameters: After undergoing two months of Ayurvedic treatment, along with diet, lifestyle modifications and Therapeutic Yoga, there was a significant reduction in his blood sugar levels, and were brought under good control. 

Table 1. Blood sugar values tabulated before, during and after treatment

The endpoint values depict that the blood sugar levels have come to good control. The significant change is seen in the FBS value than the PPBS. The patient is still continuing the Ayurvedic medicines and also Pranayama. He is advised to come for regular follow ups. 

Image 1. Midpoint evaluation of Blood sugar levels dated 14.5.2023

Image 2. Endpoint evaluation of Blood sugar levels dated 9.6.2023