Non Allopathic 'Medicines'
in Diabetes Mellitus:
The Choice is Yours

GR Sridhar, Endocrine and Diabetes Centre, Visakhapatnam-530002
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Diabetes mellitus is a syndrome resulting from absolute or relative deficiency of the hormone insulin. Its prevalance in India is increasing over time. Asian Indians, both native and emigrant, are particularly susceptible to the disease (1).

Diabetes mellitus has been called the most complex to manage of all common metabolic disorders. There are few conditions where the patient is expected to so actively participate in managing the disease; fewer still are conditions where continuous awareness about the how, why and when of one's lifestyle is so closely interwoven: be it in the regularity and discipline in diet, physical exercise, or testing of ones tissue fluids (urine and blood) (2)..

Once it sets in, seldom does diabetes ever go away. Often it is silent, announcing itself by the presence of complications -- involving the small vessels of the eye, kidneys or nerves; along with associated conditions of raised blood pressure, lipids in blood, obesity and cigarette smoking, diabetes often leads to macroangiopathy as well, of the brain, heart and blood vessels of the limbs.

Understandably, for a condition that is so prevalent, silent and relentless in the absence of aggressive treatment measures, patients often clutch at cures that promise liberation from this 'disease of discipline.'

Management of diabetes comprises measures to balance the available insulin in the body with its needs. The three cardinal ones include

  1. Diet: ingestion of adequate calories to reach and maintain ideal body weight. The calories must have optimal proportions of carbohydrates (60%), fats (<30%) and proteins, spread out throughout the day to avoid hypoglycemia, should glucose lowering medicines be used. Simple sugars such as sucrose and glucose are not taken so that wide swings of glycemia do not occur. In print, the specifications may appear daunting, but most Indian diets, with subtle alterations, such as restriction of fats and simple sugars are diabetic diets.
  2. Exercise: Regular aerobic exercises improve insulin sensitivity, burn out calories, maintain cardiovascular fitness, and improve psychological well-being.
  3. If (a) and (b) together are unable to achieve euglycemia, medicines are added. Adults, who comprise the majority of Indian diabetics (5), usually have, at least in the early course of their disease, some amount of circulating insulin. Oral hypoglycemic agents try to correct the mismatch between insulin availability and its need.

Oral hypoglycemic agents are usually effective in lowering blood glucose in adults, at least early in the course of diabetes. However over the course of time, they fail, in up to 80% of individuals at the end of ten years, a condition named secondary failure.

It is then, and in certain other special situations that the hormone secreted by the pancreas, insulin, which must be replaced. Being a peptide, insulin is destroyed in the gut when taken orally; therefore it is injected into the sub-cutaneous tissue from where it is slowly absorbed into the circulation. Aside from the discomfort of the hypodermic pin-prick, the major deterrant of insulin for most people, is the strict regimen it entails.

Unlike a normal pancreas, which senses ambient glucose levels continuously and releases insulin as needed, the injected insulin continues to circulate no matter what the blood glucose levels. Efforts are needed to match the blood glucose with insulin, by attempts to regulate the time and amount of meals. Despite attempts, including self home blood glucose monitoring, there are many variables that make it difficult to precisely match the insulin dose with blood glucose. Too little insulin and the glucose levels are high; too much and they plummet. It is this Hobsons choice, which makes glycemic control difficult, though not impossible (6).

It is perceivable that lack of understanding about diabetes, the frustration in having to follow life-style measures as well as the looming risk of long-term complications, force one to look for permanent cure of diabetes, or at least for less rigid measures in management. Unfortunately there are no cures; nor is there a let-up from discipline. Allopathic system of management may not be easy, but at least there is evidence that it works.

Besides control of blood glucose, life-style alterations and control of other risk factors such as high blood lipid levels are an integral part of managing diabetes.

Among our patients, 10-27% were known hypertensive, only 11-48% were performing regular physical exercise; a quarter and a third of men were smokers and currently using alcoholic beverages respectively. Correcting each of these risk factors needs will-power and life-style modifications rather than anything else.

We now have unequivocal evidence that tight glycemic control can and does prevent or postpone the onset of diabetes complications. Most Indian patients are adults, in whom control can be achieved by a judicious blend of diet exercise and life-style measures, unlike the multi-million budged of DCCT which looked at insulin dependent diabetic patients.

True, traditional systems of treatment may have much to offer for areas and diseases where there is no access to the so called modern medical treatment. But diabetes is not one of them, at least, not any more. Work is in progress to see whether, how and when indigenous drugs are effective in managing diabetes mellitus (7,8,9,10), and to draw specific guidelines, to avoid risk of complications due to addition of unknown chemicals (11). Besides, the ayurvedic system of medicine advocates life-style measures to avoid mental stress, partake in physical activity, before giving medicines for relief of the disorder (12). Few tested, well established non-allopathic systems offer medications along without attendant lifestyle modification. To that extent, there is no contradiction in the traditional and allopathic systems of medicine for managing diabetes mellitus.

Herbs are considered mostly harmless, and their fine-tuned therapeutic uses lost in the mist of history. Gone are the precise, careful and expert directions that once existed, a result of evolution over hundreds of years. Efforts are on to bring back traditional medical system on a biological foundation, and re -discover what was earlier known, by experience and intuition. Use of herbal medicines may need to be streamlined. We may yet find a biological basis for homeopathy (13,14). Until then, let us be cautious in exposing ourselves to unknown or unproven therapies for those disorders which can be corrected with effort perhaps, but correctable nonetheless.

References

  1. Sridhar GR Diabetes Bulletin 1986, 6(4): 7-14
  2. Veena LM. Psychosocial correlates of living with diabetes. PhD thesis submitted to Andhra University, December 1997
  3. Sridhar GR Intl J Diab Dev Countries 1996, 16: 108-13
  4. The Diabetes Control and Complications Trial Research Group: . N Engl J Med 1993; 329:977-86
  5. Sridhar GR Diabetes Bulletin 1987, 7(3): 109-111
  6. Raghuram TC,Sharma RD, Sivakumar B et al. Phytotherapy Res 1994; 8:83-6
  7. Zhang LH, Xiao PG. Phytotherapy Res 1993; 7:217-22
  8. Mukherjee SK, Chandrasekar B, Mukherjee B. Diabetes in the Indian scene (ed. Samal KC). Diab Assoc India, Cuttack; 1987; pp131-8
  9. Keen RW, Deacon AC, Delves HT, Moreton JA, Frost PG. Postgrad Med J 1994; 70:113-4
  10. Sudarshan SR. The Treatment. (In) Diabetes (Prameha). Kalpatharu Research Academy, Bangalore 1992; pp12-19
  11. Davenas E, Beauvais F,Amara J, OberbaumM, Robinzon B, Miadonna A, Tedeschi A, Pomeranz B, FOrtner P, Belon P,Laudy SJ, Poitevin B, Benveniste J. Nature 1988; 333:816-8
  12. Sinha S. . Natl Med J India 1988;1:242
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