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A 45-year-old male patient pre-diagnosed with diabetes mellitus and on anti-diabetic medicines presented with frequent urination for 2 weeks associated with disturbed sleep, experiencing excessive thirst, fatigue, lethargy and loss of body weight. At the onset of symptoms, he had consulted an allopathic doctor who confirmed the Biomedical diagnosis as Diabetes mellitus. He started anti- diabetic medicines, but the symptoms persisted. Hence he decided to consult Dr Partap Chauhan for Ayurvedic management. The ayurvedic diagnosis was Madhumeha. The line of treatment followed was Vata- kapha shamana and Pitta- vata shamana. The treatment also targeted Sroto shodhana and rasayana karma. With 2 months of Ayurvedic treatment along with specific diet and lifestyle modifications, the frequency of urination during the night was reduced and the patient got significant relief from the associated symptoms. After 3 months of treatment, the patient had no specific symptoms. The HbA1c that was recorded as 13.6 at baseline became 6.1 at endpoint. The patient could stop all his anti-diabetic medications. This case report demonstrates the successful ayurvedic management of a case of Diabetes mellitus in a patient who was not getting satisfactory outcomes inspite of taking anti-diabetic medications.
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A 45-year-old male patient pre-diagnosed with diabetes mellitus and on anti-diabetic medicines presented with frequent urination for 2 weeks associated with disturbed sleep, experiencing excessive thirst, fatigue, lethargy and loss of body weight. At the onset of symptoms, he had consulted an allopathic doctor who confirmed the Biomedical diagnosis as Diabetes mellitus. He started anti- diabetic medicines, but the symptoms persisted. Hence he decided to consult Dr Partap Chauhan for Ayurvedic management. The ayurvedic diagnosis was Madhumeha. The line of treatment followed was Vata- kapha shamana and Pitta- vata shamana. The treatment also targeted Sroto shodhana and rasayana karma. With 2 months of Ayurvedic treatment along with specific diet and lifestyle modifications, the frequency of urination during the night was reduced and the patient got significant relief from the associated symptoms. After 3 months of treatment, the patient had no specific symptoms. The HbA1c that was recorded as 13.6 at baseline became 6.1 at endpoint. The patient could stop all his anti-diabetic medications. This case report demonstrates the successful ayurvedic management of a case of Diabetes mellitus in a patient who was not getting satisfactory outcomes inspite of taking anti-diabetic medications.
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Timeline
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Tabulated Summary
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Narrative
TITLE OF CASE
An integrative approach in management of Diabetes mellitus- a case report
Dr Partap Chauhan
ABSTRACT
A 45-year-old male patient pre-diagnosed with diabetes mellitus and on anti-diabetic medicines presented with frequent urination for 2 weeks associated with disturbed sleep, experiencing excessive thirst, fatigue, lethargy and loss of body weight. At the onset of symptoms, he had consulted an allopathic doctor who confirmed the Biomedical diagnosis as Diabetes mellitus. He started anti- diabetic medicines, but the symptoms persisted. Hence he decided to consult Dr Partap Chauhan for Ayurvedic management. The ayurvedic diagnosis was Madhumeha. The line of treatment followed was Vata- kapha shamana and Pitta- vata shamana. The treatment also targeted Sroto shodhana and rasayana karma. With 2 months of Ayurvedic treatment along with specific diet and lifestyle modifications, the frequency of urination during the night was reduced and the patient got significant relief from the associated symptoms. After 3 months of treatment, the patient had no specific symptoms. The HbA1c that was recorded as 13.6 at baseline became 6.1 at endpoint. The patient could stop all his anti-diabetic medications. This case report demonstrates the successful ayurvedic management of a case of Diabetes mellitus in a patient who was not getting satisfactory outcomes inspite of taking anti-diabetic medications.
KEYWORDS
Integrative, diabetes, prameha, ayurveda, case report, madhumeha, 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
The patient is a 45-year-old male patient pre-diagnosed with diabetes mellitus and on anti-diabetic medicines presented with frequent urination for 2 weeks associated with disturbed sleep, experiencing excessive thirst, fatigue, lethargy and loss of body weight. At the onset of symptoms, he had consulted an allopathic doctor who confirmed the Biomedical diagnosis as Diabetes mellitus. He started anti- diabetic medicines, but the symptoms persisted. Hence he decided to consult Dr Partap Chauhan for Ayurvedic management.
Family History- Both his parents have diabetes. His father was diagnosed in 1999, and his mother was diagnosed in 2021.
No relevant genetic or surgical history
Psychosocial History- Stressed. Sleep- disturbed due to frequent urination during night.
Addiction- Alcohol- occasional
CLINICAL FINDINGS
General examination was done.
TIMELINE
Image 1. Timeline of events added below
DIAGNOSTIC ASSESSMENT
Modern Diagnostic parameter; The blood reports prior to starting the Ayurvedic treatments were noted as the Baseline. The patient had a confirmed Biomedical diagnosis as DM, based on his HbA1c value.
Image 2. Blood reports dated 6.6.2022 at baseline
Ayurvedic Assessment was done based on the presenting complaints, the confirmed diagnosis from the allopathic physician
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, in August 2022, inspite of taking anti-diabetic medicine, his HbA1c was recorded as 10.5 indicating a poor sugar control.
THERAPEUTIC INTERVENTION
Please refer the tab ‘Treatment’ in the Portal.
FOLLOW-UP AND OUTCOMES
Both objective and subjective parameters were assessed to analyse the outcome of the ayurvedic treatment.
Subjective parameters: The symptoms were assessed through out the treatment.
Objective parameters: The HbA1c value was also showing a decrease in levels. The last follow up was in November 2022, where the HbA1c was recorded as 6.1 indicating a good control. He was free from all his symptoms.
Clinician-based assessment; After 2 months of Ayurvedic treatment with specific diet and lifestyle modifications while continuing the anti-diabetic medications, the frequency of urination during the night was reduced and the patient got significant relief from the associated symptoms. After 3 months of treatment, the patient had no specific symptoms, the frequency of micturition became normal and the patient could stop the concomitant medications. In the repeat blood investigations done in further follow-ups, the blood sugar levels were within normal limits.
Patient-assessed; Not relevant
Midpoint evaluation:
Image 3. CGM Report dated 14th June to 28th June 2022
Endpoint Evaluation:
Image 4. Blood report dated 7.11.2022 at endpoint
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 on anti-diabetic medications, but stilll the HbA1c was still showing a poor sugar control. He started Ayurvedic treatments in June 2022. The treating physician targeted at pacifying the aggravated dosas- Vata-Kapha and Pitta- Vata. Apart from this, srotoshodhana and rasayana was also planned. The last follow up by the patient recorded the HbA1c value as 6.1 indicating a good control. Regular follow ups are advised.
PATIENT’S PERSPECTIVE
Not available.
LEARNING POINTS/TAKE HOME MESSAGES
The general consensus on the treatment of type 2 diabetes is that lifestyle management is at the forefront of therapy options. This case report demonstrates the successful integrative management of Diabetes mellitus in a 45-year-old male patient with poorly controlled diabetes even with conventional medicine. The patient could stop all the medicines and is now maintaining a normal blood sugar level with diet and exercise.
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
- American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36 Suppl 1(Suppl 1):S67-S74. doi:10.2337/dc13-S067
- Murthy AR, Singh RH. Concept of prameha/madhumeha (contradictions and compromises). Anc Sci Life. 1989;9(2):71-79.
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Immersive Learning
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Modern Diagnosis
BIOMEDICAL DIAGNOSIS: Diabetes mellitus
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. In this patient, the diagnosis was confirmed with HbA1C recorded as 11.5 at Baseline (2019).
When the value is above 8, then it is considered to be poor control of Diabetes. The 37 year old male patient was put on Insulin injection for 3 months, to bring the blood sugar under immediate control, and then started with anti-diabetic medicine. He did not take the medicine for 6 months, without any medical advise and the blood sugar levels started fluctuating again.
In this case report, a 45-year-old male patient pre-diagnosed with diabetes mellitus and on anti-diabetic medicines presented with frequent urination for 2 weeks associated with disturbed sleep, experiencing excessive thirst, fatigue, lethargy and loss of body weight. At the onset of symptoms, he had consulted an allopathic doctor who confirmed the Biomedical diagnosis as Diabetes mellitus. He started anti- diabetic medicines, but the symptoms persisted. Hence he decided to consult Dr Partap Chauhan for Ayurvedic management.
Image 1. Blood Investigation report dated 6.6.2022 at baseline
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, in August 2022, inspite of taking anti-diabetic medicine, his HbA1c was recorded as 10.5 indicating a poor sugar control.
Reference
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36 Suppl 1(Suppl 1):S67-S74. doi:10.2337/dc13-S067
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Ayurveda Diagnosis
AYURVEDIC DIAGNOSIS: Madhumeha
ABOUT THE DISEASE:
The Biomedical diagnosis in this case report is Diabetes Mellitus Type 2. The Ayurvedic physician has diagnosed this condition as Madhumeha. Madhumeha is a type of Vataja Prameha.
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. In this case report, a 45-year-old male patient pre-diagnosed with diabetes mellitus and on anti-diabetic medicines presented with frequent urination for 2 weeks associated with disturbed sleep, experiencing excessive thirst, fatigue, lethargy and loss of body weight. At the onset of symptoms, he had consulted an allopathic doctor who confirmed the Biomedical diagnosis as Diabetes mellitus. He started anti- diabetic medicines, but the symptoms persisted. Hence he decided to consult Dr Partap Chauhan for Ayurvedic management. As the physician has specified this as Madhumeha, this is asadhya from the ayurvedic perspective.
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: Here, the treatment was internal medications. The logic of using medicines and their targets as explained is tabulated below.
Table 1. The medicines, therapies and the rationale for choosing them
Image 1. Specific Diet recommendations and lifestyle changes to be followed
Reference
Murthy AR, Singh RH. Concept of prameha/madhumeha (contradictions and compromises). Anc Sci Life. 1989;9(2):71-79.
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Treatment
Name of Medicine Dosage Form Dosage Mode of Administrtation From - To (Date) Medicine Reference Madhumehantak Curna + Pramehantaka Curna + Rejuva Curna + Udumbara ghana satva Curna Samyoga 2 Teaspoon Oral, twice daily before food 2022-06-08 - 2022-09-19 Ayurvedic Patent & Proprietary Medicine Diaboherb Tablet 1 Oral, twice daily after food 2022-06-08 - 2022-09-19 Ayurvedic Patent & Proprietary Medicine Chandraprakash Rasyan Tablet 1 Oral, twice daily after food 2022-06-08 - 2022-09-19 Ayurvedic Patent & Proprietary Medicine Mahasudarshan Ghanvati Tablet 1 Oral, twice daily after food 2022-06-08 - 2022-09-19 Ayurvedic Patent & Proprietary Medicine Diatreen tab Tablet 1 Oral, twice daily after food 2022-06-08 - 2022-07-13 Ayurvedic Patent & Proprietary Medicine Stress Free Tab Tablet 2 Oral, twice daily after food 2022-06-08 - 2022-07-13 Ayurvedic Patent & Proprietary Medicine Diabetes Tab Tablet 1 Oral, twice daily after food 2022-07-13 - 2022-09-19 Ayurvedic Patent & Proprietary Medicine -
Outcome Measures
OUTCOME MEASURES
In this case report, a 45-year-old male patient pre-diagnosed with diabetes mellitus and on anti-diabetic medicines presented with frequent urination for 2 weeks associated with disturbed sleep, experiencing excessive thirst, fatigue, lethargy and loss of body weight. At the onset of symptoms, he had consulted an allopathic doctor who confirmed the Biomedical diagnosis as Diabetes mellitus. He started anti- diabetic medicines, but the symptoms persisted. Hence he decided to consult Dr Partap Chauhan for Ayurvedic management.
Assessment: Both objective and subjective parameters were assessed to analyse the outcome of the ayurvedic treatment.
Subjective parameters: After 1 month of treatment, there was a significant relief in fatigue and lethargy. After 2 months, the frequency of urination reduced. After 3 months, there were no specific symptoms. The patient stopped all anti-diabetic medicines.
Objective parameters: The HbA1c, Average Blood Glucose (ABG) and Weight were recorded at baseline and endpoint to assess the outcome of ayurvedic treatment.
Table 1. Date wise parameters recorded at baseline and endpoint
DATE
HBA1C
ABG
WEIGHT
8.6.2022
13.6.
343.6
71 kg
7.11.2022
6.1
128
74 kg
Image 1. Mid point evaluation of Average Blood Glucose (CGM Analysis) dated 14.6.2022 to 28.6.2022
Image 2. Blood investigation reports dated 7.11.2022 at endpoint
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