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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 16  |  Issue : 3  |  Page : 257-262

Integrated approach toward juvenile diabetes


1 Department of Rasayana Evam Vajikarana, KAHER's Shri BM Kankanawadi Ayurveda Mahavidyalaya, KLE Ayurveda Hospital, Belagavi, Karnataka, India
2 Department of Kayachikitsa, KAHER's Shri BM Kankanawadi Ayurveda Mahavidyalaya, KLE Ayurveda Hospital, Belagavi, Karnataka, India

Date of Submission13-Oct-2021
Date of Decision29-May-2022
Date of Acceptance02-Jun-2022
Date of Web Publication28-Sep-2022

Correspondence Address:
Arun Chougale
Head of the Department, Department of Dravyaguna, KAHER'S Shri BMK Ayurveda Mahavidyalaya; Consultant, Specialty Ayurveda Endocrinology, KLE Ayurveda Hospital, Shahapur, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_327_21

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  Abstract 


Introduction: This case demonstrates the therapeutic possibilities of the Ayurvedic mode of management in Juvenile diabetes where predictable treatment was incapable to withstand the desired dose and effects. Main Clinical Findings: A 25-year-old male patient suffering from uncontrolled sugar levels for 2 years and mild low backache for 8 years. Diagnosis: Prediagnosed case of Juvenile diabetes, taking substantial dose (84 units/day) of two different types of insulin injections. Intervention: After appropriate analysis of the patient based on Ayurvedic parameters, the patient was treated with a combination of panchakarma and shamana therapies along with his existing allopathic intervention. Lifestyle modifications and diet changes were also advised. Outcome: There was a reduction of 40 units of insulin dosage, which was assessed by the glucometer-guided random blood sugar at the time of discharge. Conclusions: Adaptation of Ayurvedic intervention can augment the treatment for Juvenile diabetes.

Keywords: Integrated management, juvenile diabetes, Krusha and Sahaja prameha, Madhumeha


How to cite this article:
Abhirami C M, Chougale A, Hiremath KV, Adarsh T, Syam R J. Integrated approach toward juvenile diabetes. J Ayurveda 2022;16:257-62

How to cite this URL:
Abhirami C M, Chougale A, Hiremath KV, Adarsh T, Syam R J. Integrated approach toward juvenile diabetes. J Ayurveda [serial online] 2022 [cited 2022 Nov 29];16:257-62. Available from: http://www.journayu.in/text.asp?2022/16/3/257/357301




  Introduction Top


Diabetes mellitus (DM) is a chronic metabolic illness, causing hyperglycemia. According to the WHO, the number of diabetes patients in the past decades raised from 108 million (1980) to 422 million (2014). In 2019, almost 1.5 million deaths had the direct cause as diabetes and its complications. It has numerous categories such as Type 1, Type 2, MODY (maturity-onset diabetes of the young), gestational, neonatal, diabetes due to secondary pathologies, etc. Type 1 DM generally known as insulin-dependent diabetes/juvenile diabetes is labeled by insufficient insulin formation. In Ayurveda, diabetes is connected with Madhumeha. Among 20 types of prameha, madhumeha derives under vataja type of prameha which is supposed to be asadhya (incurable) but anushangi (controllable). It is considered Mahagada by acharyas due to its bad prognosis. Numerous aspects are accountable for Prameha such as Garbhakala, Shaithilya, Meda Asarata, Kapha Prakopa, Mamsavaha srotodushti, Meda Vriddhi, Avyayama, Divasvapna, and Medovaha srotodushti, etc.[1] Ayurveda manuscripts elucidate two key categories of prameha such as Sahaja prameha and Apathyanimittaja prameha. Type 1 diabetes can be correlated with sahaja prameha. The prime features of sahaja pramehi will be krushata (lean) and rukshata (dry).


  Case Report Top


A 25-year-old Indian, unmarried, Hindu male patient, who is a known case of Juvenile diabetes and mild low back ache for 8 years has visited KLE Ayurveda hospital on June 10, 2020 with chief complaints of uncontrolled sugar level for 2 years and mild low back ache for 8 years.

After eliciting the history of the patient, it was noticed that he had inactive daily regimen with inappropriate food practices. The patient was a vegetarian, having a good appetite with more intake of fried-fatty diet and junk foods, etc. His bowel habits were consistent and clear, micturition frequency was 3–4 times/day and 2–3 times during the night. He had sound sleep and no remarkable addictions.

Past illness history of the patient revealed that the patient was suffering from Juvenile Diabetes for 6 years and was on insulin therapy for the same. He was taking two types of insulin twice daily – Biphasic isophane (20 units) and isophane insulin (22 units). The patient also had a fall 8 years back and since then, he is also suffering from mild low backache. His family history revealed that his mother is a known case of DM.

His blood investigations on the date of admission (June 10, 2020) showed HbA1C-9.4% and his MRI of the LS spine taken on February 01, 2019, showed the following impression:

  • Old fracture of L5 vertebral body with the decrease in vertebral body weight
  • Mild diffuse disc bulge was noted at L5-S1 causing indentation on the subarachnoid space.


An overall examination states that entire vitals are within standard limits. The patient's body mass index (BMI) was 18 with a height of 173 cm and a weight of 59 Kg. Systemic inspection disclosed no significant abnormalities.

The detailed ayurvedic examination regarding Dashavidha and Ashtavidha pareeksha are explained in [Table 1].
Table 1: Dashavidha and Ashtavidha pareeksha

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Diagnosis

Insulin-dependent diabetes (Juvenile) relatively can be correlated with Sahaja Prameha in specifically to Krusha (Akruthi) and Vataja Prameha (Dosha).

Treatment strategy

Following oral medications were administered for 10 days from the 1st day of admission:

  • Cap Ksheerabala 101 – 3 capsules in the morning on empty stomach with hot water
  • Cap MM (Proprietary medicine) – 1 capsule each at noon and evening after food for the first 3 days, later changed to two capsules thrice daily for the next 10 days.


Panchakarma therapies given for 12 days from the day of admission were:

  • Sarvanga Mridu Abhyanaga with Ksheerabala taila (for 11 days)
  • Dashamoola Parisheka (5 days)/Shashtika shali Pinda sweda (5 days) (Alternatively)
  • Takradhara with Amalaki churna mishrita takra (for 11 days)
  • Kati Basti with Visha Garbha Taila (for 11 days).


Yogasanas advised were:

  • Vakrasana
  • Jathara Parivartanasana
  • Katipindamardanasana
  • Pavanamuktasana
  • Savasana


Physiotherapy

The patient was also subjected to Physiotherapy, focusing on the back ache which was an associated complaint.

The Detailed timeline of intervention is mentioned in [Table 2].
Table 2: Timeline of Interventions

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By 8 am, Navana uppittu was given to the patient, followed by Herbal tea. Haridra ksheerapaka was given by 11:30 am. Lunch was served by 1 am which included Jower rotti, Sabji, Haridra anna, and Kulatha yusha. Herbal tea was again given by 4 pm. The patient was given a dinner comprising Godhuma rotti, Sabji, Dashamula Yavagu by 7:30 pm. All the above-mentioned diet was followed throughout the course of the treatment schedule. The patient was also instructed to strictly avoid potato, rice, and sugar products which is having a high glycemic index.

Observation

  • As the patient was on insulin therapy, depending on the patients' subjective symptoms and GRBS value, insulin dosage was tapered sequentially (20%–30% of the previous dose).
  • The patient showed improvement in laboratory parameters, i.e., GRBS values on daily basis.


Overall improvement

Apart from the diabetic investigation parameter, the patient also had 40% relief from back ache as a result of the treatment. The details of Insulin dosage reduction dosage and GRBS values are mentioned in [Table 3] and [Table 4] respectively.
Table 3: Insulin Reduction Chart

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Table 4: GRBS Values

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  Discussion Top


Madhumeha is a vata pradhana tridoshaja vyadhi. Among the two foremost classifications of prameha, Sahaja prameha can be understood as krisha, dhatukshaya janya, and Apatyajanya prameha.[2] Vataja pramehi is said to be incurable or extremely difficult to cure. Due to the heterogeneous treatment link of Dosha and Dushya, it is well-thought-out to be Mahavinashkari.

In the present case of Madhumeha which is having vata predominant condition, application of vatahara chikitsa internally and externally as per chikitsa sutra of Krusha prameha appears suitable with our hypothesis. The same was applied with ksheerabala taila abhyanga externally and cap ksheerabala 101 internally (shamananga sneha). Hence, in combination, they have shown virtuous outcome in this case. Bahya and Abhyantara snehana treatment itself is best Dhatunaam prabalam (provides strength to the tissue and sensitizes the body to synthetic insulin) and Shadindriya prasadaka (which is upright for sense organs, particularly retinopathy). It nurtures the physique (Tarpayati) and plays a foremost part in regularizing metabolic activity (Jeevayati).[3] It also possess rasayana (rejuvenation) effect.

Dashamoola parisheka & Shashtika shali pinda sweda were administered on alternate days. The moola dosha of prameha is kapha (santarpana janya) and the current case was vataja prameha (apatarpanajanya) along with avarana pathology. This highlights the need of ruksha & snigdha chikitsa which were needed in parallel to regulate both kapha & vata dosha. Hence vyatyasa chikitsa was implemented which is considered as an adoption of alternative treatment as per the need.[4]

Dashmoola pariseka acts like neurostimulator which eventually helps to relieve peripheral neuropathy complaints which is considered the most common complication of uncontrolled diabetes. Furthermore, this procedure was mainly adapted to control mainly kapha dosha lakshanas,[5] as in this case, the patient was habitually taking four doses of insulin injections without altering the sites which may end up into muscle hypertrophy. Altogether Abhyanga, Pariseka and Pinda sweda probably helped to inhibit the hypertrophic phenomena.

Shashtika shali pinda sweda is the best vatahara and brumhana treatment, the most indispensable therapy needed in the above case as the patient was krusha pramehi having low BMI. It will aid to improve dhatukshaya avastha.[6]

Takradhara with Amalaki choorna decreases the sympathetic nervous stimulation, thereby reducing the rate of metabolic activities and glucose release into the blood and regulates diabetes. Various researches proved that Takradhara can reduce blood glucose levels and cortisol hormone level.[7]

The major ingredients of capsule MM (proprietary medicine) such as Vrushyagandha (Withania coagulens), Sapthachakra (Salaceae chinensis), Asana (Pterocarpus marsupium), Jambu (Syzygium cumini), Guduchi (Tinospora cordifolia), and Haridra (Curcuma long) having potential anti-diabetic properties as per the recent research activities concerned. The probable hypothesis guides that this formulation sensitizes the synthetic insulin and stimulates the beta cells of the pancreas and sequentially, there is a reduction of insulin units in the present case.

Along with the above interventions, regular Yoga and Diet, followed by the patient were also to be well thought out for encouraging results.


  Conclusion Top


Case report assessment disclosed the decrease in the dosage of insulin, i.e., biphasic 16 units and isophane 24 units (total 40 units reduction) inferred that appropriate application of panchakarma and shamana therapies of Ayurveda treatment modalities positively augment the sensitivity of insulin and thereby benefits to stimulate the production of natural insulin and in turn decreases the quantity of synthetic insulin's essential dosage. It also prevents the probable complications in case of Type I diabetes, i.e., Sahaja, Krusha/Apatarpanajanya Prameha.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Limitations

The case observation was only grounded on glucometer-guided random blood sugar values. For additional justification, we can complement with tests such as urine sugar and HbA1C values.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Shukla RN, Singh S. Ayurveda view on Prameha W.S.R. To role of genetics factors. World J Pharm Med Res 2020;6:115-7.  Back to cited text no. 1
    
2.
Bharadwaj R, Gangary SK. Ayurvedic management of diabetes mellitus type-II: A case study. J Ayurvedic Herb Med 2020;6:60-2.  Back to cited text no. 2
    
3.
Verma J, Mangal G. New perspectives of Ksheerabala Taila (oil): A critical review. Int J Ayurveda Tradit Med 2019;1:25-31.  Back to cited text no. 3
    
4.
Sakkari R, Phatage PD, Chetan M: Vyatyasa Chikitsa; A Critical Review. International Ayurvedic Medical Journal 2018;6:1515-8.  Back to cited text no. 4
    
5.
Mishra A, Sanakal AI, Prashanth AS. Comparative Clinical Study to Assess the Effect of Dhanyamla Dhara and Dashamoola Kashaya Dhara In Signs And Symptoms of Diabetic Sensory Neuropathy. International Ayurvedic Medical Journal. February 2020;8:2719-24.  Back to cited text no. 5
    
6.
Kalpana, Amit Mukherjee, Mukund Supekar; Patra Potali Pinda Sweda and Shashtika Shali Pinda Sweda: A Comprehensive. International Ayurvedic Medical Journal 2018;6:1046-52.  Back to cited text no. 6
    
7.
Arabi H, Jigeesh P. P; An Open Label Randomised Comparitive Study on Sarvanga Takradhara Against Siro Takradhara in Diabetic Peripheral Neuropathy (DPN). International Ayurvedic Medical Journal 2020;8:2734-40.  Back to cited text no. 7
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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