Club DBP

For treatment of Diabetes and Blood Pressure

This club was formed, keeping in view the impact of these silent killers which often ignored in the conspicuous state, in the wake of rush and stress of day to day activities, has succeeded in creeping into our society and affecting the productivity of normal individuals. These two diseases which are mainly lifestyle related disorders need a constant monitoring, medication and counseling so that the patient gets cured in a gentle way without developing pathology or other side effects on other organs which normally happens in these diseases.

The club, still in its developing stage is a concept of providing treatment and relief, increasing self confidence and improving productivity of our members. The package of treatment is mainly based on our mode administration of homoeopathic medicine along with a regimen of diet, exercises and natural supplements. Besides this, our experts give individual attention to the patients so that healing is promoted in a very natural way.

Diabetes

Blood pressure (BP)

 

 


Diabetes


Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, which result from defects in insulin secretion, or action, or both. Diabetes mellitus, commonly referred to as diabetes, means “sweet urine.” Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine. Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes mellitus, the absence or insufficient production of insulin causes hyperglycemia. Diabetes mellitus is a chronic medical condition, meaning it can last a lifetime. Insufficient production of insulin (either absolutely or relative to the body’s needs), production of defective insulin (which is uncommon), or the inability of cells to use insulin leads to hyperglycemia and diabetes mellitus. This latter condition affects mostly the cells of muscle and fat tissues, and results in a condition known as “insulin resistance.” This is the primary problem in type 2 diabetes. The absolute lack of insulin, usually secondary to a destructive process in the pancreas, is the particular disorder in type 1 diabetes.

Classification of diabetes mellitus:


There are two causes of diabetes mellitus:
•     Primary
•     Secondary

Primary diabetes mellitus: There are two major types of primary diabetes mellitus, called type 1 and type 2. Type 1 diabetes mellitus was also called insulin dependent diabetes mellitus (IDDM), or juvenile onset diabetes mellitus. In type 1 diabetes mellitus, the pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin. Abnormal antibodies have been found in patients with type 1 diabetes. Antibodies are proteins in the blood that are part of the body’s immune system. The patient with type 1 diabetes must rely on insulin medication for survival.

Type 2 diabetes mellitus was also referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM). In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately. In many cases this actually means the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells) these larger quantities of insulin are produced as an attempt to get these cells to recognize that insulin is present. In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective, and occur late in response to increased glucose levels. Finally, the liver in these patients continues to produce glucose despite elevated glucose levels.

Type 2 diabetes mellitus is of three types :

•     Obese
•     Non-obese
•     MODY (Maturity Onset Diabetes Mellitus)

Secondary diabetes mellitus: “Secondary” diabetes mellitus refers to elevated blood sugar levels from another medical condition. Secondary diabetes mellitus also develops when the pancreatic tissue responsible for the production of insulin is absent because it is destroyed by disease, such as chronic pancreatitis, haemochromatosis, neoplastic disease, trauma, or surgical removal of the pancreas(pancreatectomy). Diabetes can also result from other hormonal disturbances, such as excessive growth hormone production (acromegaly), Cushing’s syndrome, hyperthyroidism, glucagonoma and conditions of severe burns where there is increase of glucagons, cortisol and catecholamines occur. In addition, certain medications may worsen diabetes control, or “unmask” latent diabetes. This is seen most commonly when steroid medications (such as prednisone), thiazide diuretics and phenytoin are taken.

Candidates for diabetes screening

1.   Presence of suggestive symptoms.
2.   Obesity (especially if centrally distributed)
3.   Positive family history
4.   Women with a morbid obstetric history or with large babies
5.   Recurrent skin or genital infections.
6.   High risk populations (African-Americans, Latinos, Native Americans)
7.   The elderly (>60 years)
8.   Presence of other risk factors for atherosclerosis.

Mechanism of development of diabetes mellitus

Type 1

Less insulin (B-cells destroyed) à destroyed by Autoimmune diseases and viral infection by cox sackie virus. (Susceptibility depends on HLA – related genetic factor located on chromosome 6.

Certain environmental, immunological and genetic factors are also responsible for development of Type 1 diabetes mellitus.

Type 2

Not modified factors : Genetic, age and gender.

Partly modified factors : Hypertension, obesity, smoking, hyperlipidaemia, ischaemic heart disease.

Largely modified factors : Lack of exercise, anxiety, mentality etc.

Clinical features:

The early symptoms of untreated diabetes mellitus are related to elevated blood sugar levels, and loss of glucose in the urine. High amounts of glucose in the urine can cause increased urine output (polyuria) and lead to dehydration. Dehydration causes increased thirst and water consumption (poludipsia). The inability to utilize glucose energy eventually leads to weight loss despite an increase in appetite (polyphagia). Some untreated diabetes patients also complain of fatigue, nausea, and vomiting. Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas leading to itching in those areas. Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated glucose levels can lead to lethargy and coma (diabetic coma).

Complications of diabetes mellitus:

1.   Severely elevated blood sugar levels due to an actual lack of insulin or a relative deficiency of insulin.

2.   Abnormally low blood sugar levels due to too much insulin or other glucose-lowering medications.

The common complications are :

1.   Vascular
2.   Renal
3.   Ocular
4.   Neurological
5.   Skin
6.   Infections
7.   Reproductive problems
8.   Metabolic problems

Insulin is vital to patients with type 1 diabetes. Without insulin, patients with type 1 diabetes can develop severely elevated blood sugar levels. This leads to increased urine glucose, which in turn leads to excessive loss of fluid and electrolytes in the urine. Lack of insulin also causes the breakdown of fat cells, with the release of ketones into the blood. Ketones turn the blood acidic, a condition called diabetic ketoacidosis. Symptoms of diabetic ketoacidosis include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death. Diabetic ketoacidosis can be caused by infections, stress, or trauma.

In patients with type 2 diabetes mellitus, stress, infection, and medications (such as corticosteroids) can also lead to severely elevated blood sugar levels. Accompanied by dehydration, severe blood sugar elevation in patients with type 2 diabetes mellitus can lead to an increase in blood osmolality (hyperosmolar state). This condition can lead to coma (hyperosmolar coma).

Hypoglycemia means abnormally low blood sugar (glucose). In patients with diabetes, the most common cause of low blood sugar is excessive use of insulin or other glucose-lowering medications, to lower the blood sugar level in diabetic patients. Sometimes, low blood sugar can be the result of an insufficient caloric intake or sudden excessive physical exertion. Blood glucose is essential for the proper functioning of nerve cells in the brain. Therefore, low blood sugar can lead to nervous system symptoms such as dizziness, confusion, weakness, and tremors. Untreated, severely low blood sugar levels can lead to coma, seizures, and, in the worse case scenario, irreversible brain death.

The chronic complications are related to blood vessel diseases and are generally classified into small vessel disease, (microvascular disease) and large vessel disease (macrovascular disease) involving the heart and blood vessels. Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels, leading to coronary heart disease (angina or heart attack), strokes, and pain in the lower extremities because of lack of blood supply (claudication). The other complications include diabetic retinopathy, diabetic nephropathy, diabetic neuropathy.

Diagnosis:

When symptoms suggest diabetes the diagnosis may be confirmed by finding glycosuria, with or without ketonuria, and a random blood glucose concentration greater than 14 mmol/l.  The following tests are conducted for detection of sugar in blood:

•     Urine testing
•     Oral Glucose Tolerance Test (OGTT)

Diagnostic criteria for diabetes mellitus by OGTT, using the indicator of glucose concentration mmol/l of the venous blood:

Condition                   Normal        Diabetic

Fasting                      <6.1            >7.8

2 hrs after glucose     <8.9            >11.1

Non-drug management:

Changes in life style are the cornerstone of treatment. Pharmacological intervention for individuals unable to adopt life style changes. Diet management can control diabetes by controlling the Blood Sugar Level (BSL) and controlled exercise. It should be considered that the level of BSL should not be high and the fluctuation should be less. Diet management is done under the following heads:

1. The diet should provide adequate energy so that the person is not weakened. The daily calorie requirement is calculated according to the built and the activity of the body. Care should be taken that over weight persons should eat less.

2. There should be proper proportion of carbohydrate, proteins and fat in the diet. Carbohydrate should comprise 50-60% of energy intake, protein should comprise 10-15% of energy intake and fat should comprise 20-30% of energy intake. Thus according to this, a person requiring 2000 cal, his diet will comprise of 275 gm of carbohydrate, 75 gm of protein and 65 gm of fat. Saturated fat should be restricted to less than 10% of the calorie intake and mono saturated fat should be increased depending upon the need to limit carbohydrate. Sodium should also be restricted in patients prone to hypertension.

3. The patient should be encouraged to take food at frequent intervals consisting of 3 meals and 3 snacks, but the total of energy intake should not increase the calculated amount. This ensures that there is not much fluctuation in the BSL.

4. Carbohydrates with low Glycemic Index (G.I.) should be permitted. Rice and wheat do not vary much in their carbohydrate content, but that rice his high G.I. and wheat has low G.I. When a graph of glycemic index of rice and wheat is drawn, it is found that the areas covered by both the triangles is the same. This indicates that the amount of intake of sugar is the same.

5. Diet should be planned, and the exchanges in the calorie of the different food item should be done for the patient so that the calorie intake does not vary with the different items.

6. As regards the sweetening agent, there is no medical restriction, but these agents maintain the craving for sugar. It is seen that persons who do not use these agents, develop less craving for sugar with the passage of time.

Exercise prescription:

1.Type:Aerobic strongly preferred. Avoid heavy lifting, straining and valsalva maneuvers that raise B.P.

2.Intenstity: Increase pulse rate to at least 120-140 mm of Hg, depending upon age and cardiovascular state of patient.

3.Frequency: 3-4 days per week

4.Duration – 20-30 minutes preceded and followed by stretching and flexibility exercises for 5-10 minutes.

Thus we see that so many myths regarding the dietary restrictions in diabetes become clear.

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Blood pressure (BP)

Blood pressure (BP) is the amount of force blood exerts on the walls of the arteries and veins. BP depends on the force and rate of the contraction of the heart as it pumps oxygenated blood from the left ventricle (compartment) of the heart into the arteries and the resistance to that flow. The amount of resistance depends on the elasticity and diameter of the blood vessels and how much blood is flowing through them.

Blood pressure is dynamic; it rises and falls depending on a person’s level of activity, time of day, and physical and emotional stresses. In healthy people, it is largely controlled by the autonomic nervous system, regulated by hormones produced by the adrenal gland that affect the amount of sodium, potassium, and fluids excreted by the kidneys (which affects the volume of blood) and is altered by decreasing and increasing the rate of the heart and dilating or constricting the blood vessels. When one or more of the regulating factors is not able to respond appropriately to the demands of the body, then the pressure of the blood may become persistently increased.

High Blood Pressure (Hypertension)

Hypertension is an intermittent or persistent elevation of the blood pressure (systolic blood pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg) or (a systolic and diastolic pressure of 20 mm Hg above the normal baseline pressure).

Causes

In most cases, the cause of hypertension is idiopathic (not known). This form of high blood pressure is called essential or primary hypertension.

Although it may not be possible to identify the cause, there are several things that are known to increase the risk of developing hypertension and that are known to exacerbate it when it is present. These include:


Hypertension may also be due to an identifiable underlying condition. This form of high blood pressure is called secondary hypertension. It is important to identify these underlying conditions as they may be able to be resolved and/or controlled, allowing the blood pressure to return to normal or near normal levels. These conditions include:


Symptoms

Hypertension often remains asymptomatic until complications develop. It is usually discovered on blood pressure measurement during routine examination.

When the pathologic process is accelerated, malignant hypertension may result and the blood pressure becomes extremely high and nephrosclerosis, encephalopathy, and cardiac failure rapidly ensue.

Management

 

Low Blood Pressure (Hypotension)

A blood pressure less than 120/80 millimeters of mercury (mm Hg) is now considered normal and optimal for good health.

Low blood pressure, also called hypotension, is blood pressure that is low enough that the flow of blood to the organs of the body is inadequate and symptoms and/or signs of low blood flow develop.

Symptoms

Low blood pressure can signal an underlying problem, especially when it drops suddenly or is accompanied by signs and symptoms such as:


Causes

Other causes of dehydration include exercise, sweating, fever, and heat exhaustion, or heat stroke.

Bseides these, Blood Pressure is also depressed by no. of cardiac causes including weakening of heart muscles, inflammation of heart muscles, pulmonary embolism etc. Overdose of some medicines esp. digioxin and beta blockers tend to lower the blood pressure.

Management

 

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