Diabetes mellitus Health Dictionary

Etiology. The more severe form, in younger patients, needs insulin treatment, without which ketosis and diabetic coma are possible. The milder form in older patients can be managed with diet and hypoglycaemic agents. Now considered due to auto-immune attack on Islet of Langerhams cells in pancreas which secrete insulin. “The Pill” often raises blood sugar. Lack of trace minerals (chromium and zinc). Zinc is a component of insulin and Chromium produces enzymes to stimulate metabolism of sugars. Diabetes can cause heart attack, stroke, hardening of arteries, blindness. It is the leading cause of kidney failure and gangrene.

Symptoms. Great thirst. Urine of high specific gravity. Weakness, emaciation, skin ulcers, loss of tactile sensation in the fingertips (Vitamin B6). In men there may be inflammation of the glans penis and in women, itching of the vulvae. Boils are common. In spite of large appetite there may by severe weight loss. Magnesium deficiency.

Diabetics are subject to glaucoma and detachment of the retina. There is a high incidence of cataract of the eye. While surgery may be necessary, effective supportive herbal treatment can do much. Regular visits to the Hospital Specialist help detect in time future eye, kidney and circulation damage.

High fibre, low fat, high carbohydrate. To help control blood sugar a diabetic must avoid sweets.

Exercise lowers blood sugar.

Agents used with some success: Alfalfa, Damiana leaves, Fenugreek seeds, Aloe Vera juice, Dandelion, Fringe Tree, Guar gum, Garlic (anti-diabetic action shown by Dr Madaus, West Germany, 1967), Bilberry berries, Goat’s Rue (dried aerial parts reduce blood sugar BHP (1983), Olive leaves, onions, Nettles, Pipsissewa, White Horehound, Sweet Sumach, Jambul seeds rapidly reduce sugar in the urine. Karela. Gurmar, (Gymnema sylvestre) leaves are chewed in India to reduce sugar in the urine (mild cases). Balsam pear. Bitter melon (Momordica charastia).

Hypoglycaemic herbs can be effective where the pancreas still functions. Type 1 diabetes, suffered by children whose insulin-producing cells have been destroyed and who produce no insulin at all will always require administered insulin. Maturity-onset diabetes (Type 11) occurs in middle life, insulin- production being insufficient. This form is usually associated with obesity for which herbs are helpful.

Diabetics are specially prone to infections; a course of Echinacea at the onset of winter is beneficial. Coronary artery disease is common in diabetics (especially women) who may develop atherosclerosis at an early age. High blood pressure places undue strain upon kidneys which may excrete too much protein (Yarrow, Lime flowers, Hawthorn). Lack of sensation in the feet exposes the subject to unconscious bruising and injury from which septic ulceration may arise (Chamomile foot baths).

Alternatives. Liver herbs work positively on the pancreas. Diabetic cases should receive treatment for the liver also, Dandelion and Fringe Tree being a reliable combination. Dr John Fearn, California (Ellingwood) used Fringe Tree for all his cases of sugar in the urine: 10 drops, Liquid Extract, 4-5 times daily.

Tea. Equal parts: Peppermint leaves, Dandelion leaves, Goat’s Rue leaves. 1-2 teaspoons to each cup boiling water infuse 5-15 minutes. Cup 2-3 times daily.

Teas from any one of the following: Bilberry berries or leaves, Nettles, White Horehound, Alfalfa, Olive leaves.

Decoction. Fenugreek seeds. 2 teaspoons to each large cup water simmered gently 5 minutes. One cup daily, consuming the seeds.

Powders. Equal parts: Sweet Sumach, Jambul seeds, Dandelion. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Jambul, Fringe Tree, Goat’s Rue. Dose: 1 teaspoon thrice daily and at bedtime.

Tablets. Dr Alfred Vogel: tablet containing: Bilberry, Kidney Bean, Tormentil, English Walnut leaves, Alfalfa leaves, Cuckoo flowers.

Karela (Momordica Charantia) Hypoglycaemic action gave good results in clinical trials. Daily dose: 50/60ml fresh juice.

Evening Primrose. See entry.

Guar Gum. 5g unit dose sachets (Guarina) containing dispersible granules. This gum has shown beneficial effects for insulin-dependants.

Hypoglycaemics (second degree). Allspice, Bugleweed, Burdock, Ginseng, Lily of the Valley, Wormwood, Nettles.

Diabetic gangrene. Tinctures: equal parts, Echinacea, Thuja. Internally and externally. Internal dose: 30- 60 drops.

Diabetic neuralgia. Cayenne pepper (Capsicum). Frequently successful.

American traditional. It is claimed that 500mg Bayleaf, Cinnamon, Cloves and Turmeric halve the need for insulin in diabetics.

Diet. Dietary treatment has changed over the past few years. Patients are now advised by the British Diabetic Association to eat food rich in complex carbohydrates (starches) and high in fibre as in wholemeal bread, oats and wholegrain breakfast cereals, wholewheat pasta, brown rice, beans and lentils, vegetables and fruit. Fat intake should be carefully watched (lean meat); skimmed milk, polyunsaturated or low-fat cheeses and salad dressings. Certain foods are known to encourage the pancreas to produce more insulin: banana, barley, cabbage, lettuce, oats, olive, papaya, turnip, sweet potato.

Coffee intake should be limited to prevent hypoglycaemic symptoms.

Barley. A study has shown that the use of barley flour as a substitute for wheat in bread helps to control diabetes, in Iraq. (Naismith D, et al, ‘Therapeutic Value of Barley in Management of Diabetes’: Annals Nutr Metab, 35, 61-64 1991)

Supplementation. Vitamins A, B-complex, C, D, E, F. Vitamin B6. Brewer’s yeast. Minerals: Chromium 50mcg; Manganese 15mg; Magnesium 300mg; Zinc 25mg; to normalise glucose metabolism.

Note: Over 400 traditional plant medicines have been documented for diabetes, but few have been evaluated for efficacy. In the undeveloped countries they are chiefly used for non-insulin dependent diabetes. (Diabetes Care, 1989, Sept 12, p553)

Insulin dependents. Whether adults or children, insulin dependents should under no circumstances discontinue insulin injections.

Treatment by or in liaison with general medical practitioner.

Information. British Diabetic Association, 10 Queen Anne Street, London W1M 0BD, UK. Send SAE. 

There are 2 main types of diabetes mellitus, both of which tend to run in families. Type 1 (insulin-dependent) diabetes is the less common form of the disorder and usually develops in childhood or adolescence. In this type of diabetes, insulin-secreting cells in the pancreas are destroyed, and insulin production ceases. Type 2 (noninsulindependent) diabetes generally develops gradually, mainly in people over the age of 40. Although insulin is still produced, there is not enough for the body’s needs as the tissues become relatively resistant to its effects. Symptoms may be present in only a 3rd of people with this type of diabetes; it is often diagnosed only when complications occur.

Treatment aims to keep blood glucose as normal as possible. It involves achieving and maintaining a normal weight, regular physical activity, dietary management, and, if necessary, treatments with antidiabetic drugs.

People with type 1 diabetes require regular insulin injections. Carbohydrate intake is spread out over the day, intake of fats should be kept low, and selfmonitoring of blood glucose levels is important. If the glucose/insulin balance is not maintained, hyperglycaemia or hypoglycaemia may develop.

Treatment of type 2 diabetes usually consists of dietary measures, weight reduction, and antidiabetic drugs, often hypoglycaemic drugs such as sulphonylureas. Some people eventually need insulin injections.

Complications of diabetes mellitus include retinopathy, peripheral neuropathy, and nephropathy. Ulcers on the feet are another risk. People with diabetes mellitus also have a greater risk of atherosclerosis, hypertension, other cardiovascular disorders, and cataracts.

With modern treatment and sensible self-monitoring, nearly all diabetics can look forward to a normal lifespan.

Insulin-dependent and non-insulindependent diabetes have a varied pathological pattern and are caused by the interaction of several genetic and environmental factors.

Insulin-dependent diabetes mellitus (IDDM) (juvenile-onset diabetes, type 1 diabetes) describes subjects with a severe de?ciency or absence of insulin production. Insulin therapy is essential to prevent KETOSIS – a disturbance of the body’s acid/base balance and an accumulation of ketones in the tissues. The onset is most commonly during childhood, but can occur at any age. Symptoms are acute and weight loss is common.

Non-insulin-dependent diabetes mellitus (NIDDM) (maturity-onset diabetes, type 2 diabetes) may be further sub-divided into obese and non-obese groups. This type usually occurs after the age of 40 years with an insidious onset. Subjects are often overweight and weight loss is uncommon. Ketosis rarely develops. Insulin production is reduced but not absent.

A new hormone has been identi?ed linking obesity to type 2 diabetes. Called resistin – because of its resistance to insulin – it was ?rst found in mice but has since been identi?ed in humans. Researchers in the United States believe that the hormone may, in part, explain how obesity predisposes people to diabetes. Their hypothesis is that a protein in the body’s fat cells triggers insulin resistance around the body. Other research suggests that type 2 diabetes may now be occurring in obese children; this could indicate that children should be eating a more-balanced diet and taking more exercise.

Diabetes associated with other conditions (a) Due to pancreatic disease – for example, chronic pancreatitis (see PANCREAS, DISORDERS OF); (b) secondary to drugs – for example, GLUCOCORTICOIDS (see PANCREAS, DISORDERS OF); (c) excess hormone production

– for example, growth hormone (ACROMEGALY); (d) insulin receptor abnormalities; (e) genetic syndromes (see GENETIC DISORDERS).

Gestational diabetes Diabetes occurring in pregnancy and resolving afterwards.

Aetiology Insulin-dependent diabetes occurs as a result of autoimmune destruction of beta cells within the PANCREAS. Genetic in?uences are important and individuals with certain HLA tissue types (HLA DR3 and HLA DR4) are more at risk; however, the risks associated with the HLA genes are small. If one parent has IDDM, the risk of a child developing IDDM by the age of 25 years is 1·5–2·5 per cent, and the risk of a sibling of an IDDM subject developing diabetes is about 3 per cent.

Non-insulin-dependent diabetes has no HLA association, but the genetic in?uences are much stronger. The risks of developing diabetes vary with di?erent races. Obesity, decreased exercise and ageing increase the risks of disease development. The risk of a sibling of a NIDDM subject developing NIDDM up to the age of 80 years is 30–40 per cent.

Diet Many NIDDM diabetics may be treated with diet alone. For those subjects who are overweight, weight loss is important, although often unsuccessful. A diet high in complex carbohydrate, high in ?bre, low in fat and aiming towards ideal body weight is prescribed. Subjects taking insulin need to eat at regular intervals in relation to their insulin regime and missing meals may result in hypoglycaemia, a lowering of the amount of glucose in the blood, which if untreated can be fatal (see below).

Oral hypoglycaemics are used in the treatment of non-insulin-dependent diabetes in addition to diet, when diet alone fails to control blood-sugar levels. (a) SULPHONYLUREAS act mainly by increasing the production of insulin;

(b) BIGUANIDES, of which only metformin is available, may be used alone or in addition to sulphonylureas. Metformin’s main actions are to lower the production of glucose by the liver and improve its uptake in the peripheral tissues.

Complications The risks of complications increase with duration of disease.

Diabetic hypoglycaemia occurs when amounts of glucose in the blood become low. This may occur in subjects taking sulphonylureas or insulin. Symptoms usually develop when the glucose concentration falls below 2·5 mmol/l. They may, however, occur at higher concentrations in subjects with persistent hyperglycaemia – an excess of glucose – and at lower levels in subjects with persistent hypo-glycaemia. Symptoms include confusion, hunger and sweating, with coma developing if blood-sugar concentrations remain low. Re?ned sugar followed by complex carbohydrate will return the glucose concentration to normal. If the subject is unable to swallow, glucagon may be given intramuscularly or glucose intravenously, followed by oral carbohydrate, once the subject is able to swallow.

Although it has been shown that careful control of the patient’s metabolism prevents late complications in the small blood vessels, the risk of hypoglycaemia is increased and patients need to be well motivated to keep to their dietary and treatment regime. This regime is also very expensive. All risk factors for the patient’s cardiovascular system – not simply controlling hyperglycaemia – may need to be reduced if late complications to the cardiovascular system are to be avoided.

Diabetes is one of the world’s most serious health problems. Recent projections suggest that the disorder will affect nearly 240 million individuals worldwide by 2010 – double its prevalence in 1994. The incidence of insulin-dependent diabetes is rising in young children; they will be liable to develop late complications.

Although there are complications associated with diabetes, many subjects live normal lives and survive to an old age. People with diabetes or their relatives can obtain advice from Diabetes UK (www.diabetes.org.uk).

Increased risks are present of (a) heart disease, (b) peripheral vascular disease, and (c) cerebrovascular disease.

Diabetic eye disease (a) retinopathy, (b) cataract. Regular examination of the fundus enables any abnormalities developing to be detected and treatment given when appropriate to preserve eyesight.

Nephropathy Subjects with diabetes may develop kidney damage which can result in renal failure.

Neuropathy (a) Symmetrical sensory polyneuropathy; damage to the sensory nerves that commonly presents with tingling, numbness of pain in the feet or hands. (b) Asymmetrical motor diabetic neuropathy, presenting as progressive weakness and wasting of the proximal muscles of legs. (c) Mononeuropathy; individual motor or sensory nerves may be affected. (d) Autonomic neuropathy, which affects the autonomic nervous system, has many presentations including IMPOTENCE, diarrhoea or constipation and postural HYPOTENSION.

Skin lesions There are several skin disorders associated with diabetes, including: (a) necrobiosis lipoidica diabeticorum, characterised by one or more yellow atrophic lesions on the legs;

(b) ulcers, which most commonly occur on the feet due to peripheral vascular disease, neuropathy and infection. Foot care is very important.

Diabetic ketoacidosis occurs when there is insu?cient insulin present to prevent KETONE production. This may occur before the diagnosis of IDDM or when insu?cient insulin is being given. The presence of large amounts of ketones in the urine indicates excess ketone production and treatment should be sought immediately. Coma and death may result if the condition is left untreated.

Symptoms Thirst, POLYURIA, GLYCOSURIA, weight loss despite eating, and recurrent infections (e.g. BALANITIS and infections of the VULVA) are the main symptoms.

However, subjects with non-insulindependent diabetes may have the disease for several years without symptoms, and diagnosis is often made incidentally or when presenting with a complication of the disease.

Treatment of diabetes aims to prevent symptoms, restore carbohydrate metabolism to as near normal as possible, and to minimise complications. Concentration of glucose, fructosamine and glycated haemoglobin in the blood are used to give an indication of blood-glucose control.

Insulin-dependent diabetes requires insulin for treatment. Non-insulin-dependent diabetes may be treated with diet, oral HYPOGLYCAEMIC AGENTS or insulin.

Insulin All insulin is injected – mainly by syringe but sometimes by insulin pump – because it is inactivated by gastrointestinal enzymes. There are three main types of insulin preparation: (a) short action (approximately six hours), with rapid onset; (b) intermediate action (approximately 12 hours); (c) long action, with slow onset and lasting for up to 36 hours. Human, porcine and bovine preparations are available. Much of the insulin now used is prepared by genetic engineering techniques from micro-organisms. There are many regimens of insulin treatment involving di?erent combinations of insulin; regimens vary depending on the requirements of the patients, most of whom administer the insulin themselves. Carbohydrate intake, energy expenditure and the presence of infection are important determinants of insulin requirements on a day-to-day basis.

A new treatment for diabetes, pioneered in Canada and entering its preliminary clinical trials in the UK, is the transplantation of islet cells of Langerhans from a healthy person into a patient with the disorder. If the transplantation is successful, the transplanted cells start producing insulin, thus reducing or eliminating the requirement for regular insulin injections. If successful the trials would be a signi?cant advance in the treatment of diabetes.

Scientists in Israel have developed a drug, Dia Pep 277, which stops the body’s immune system from destroying pancratic ? cells as happens in insulin-dependent diabetes. The drug, given by injection, o?ers the possibility of preventing type 1 diabetes in healthy people at genetic risk of developing the disorder, and of checking its progression in affected individuals whose ? cells are already perishing. Trials of the drug are in progress.