1

. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is

necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia).
Excess sugar is excreted in the urine (glycosuria). Symptoms include increased urine output,
thirst, weight loss, and weakness. Type 1, or insulin-dependent diabetes mellitus (IDDM), an
autoimmune diseases in which no insulin is produced, must be treated by insulin injections.
Type 2, or non-insulin-dependent diabetes mellitus (NIDDM), in which tissues do not respond to
insulin, is linked to heredity and obesity and may be controlled by diet; it accounts for 90% of all
cases, many of which go undiagnosed for years. Untreated diabetes leads to accumulation of
ketones in the blood, followed by acidosis (high blood acid content) with nausea and vomiting
and then coma A metabolic disorder arising from a defect in carbohydrate utilization by the
body, related to inadequate or abnormal insulin production by the pancreas
Heredity plays a major role in the origin of functional insufficiency of the islands of Langerhans
of the pancreas, which produce insulin; the functional insufficiency may result from a trauma,
inflammation, sclereosis of the pancreatic vessels, infections, intoxication, psychological trauma,
excessive consumption of carbohydrates, and overeating in general. The functional condition of
the other endocrine glandsthe pituitary, adrenals, thyroid, and so forthand the central and
autonomic nervous systems is another factor. Because of the insulin deficiency the liver and
muscles become unable to convert sugar into glycogen, and all t Moreover, glyconeogenesis also
takes place that is, sugar is formed from proteins and fats. As a result, sugar accumulates in the
bloodto as much as 0.2-0.4 g per 100 milliliters of blood or more (hyperglycemia). When the
amount of sugar in the blood is more than 0.18 g (kidney threshold), some of the sugar in the
renal tubules is not reabsorbed and is excreted in the urine (glycosuria).
In more severe cases, liver function weakens, glycogen ceases to be synthesized and
accumulates, and the products of protein and fat decomposition are no longer rendered harmless.
As a result, a substantial quantity of ketone bodies, especially acetoacetic and /3- hydroxybutyric
acids appear in the blood and then in the urine. The accumulation of these acids disturbs the acid-
base equilibrium, causing acidosis. Acidosis may result in a diabetic coma.
Diabetes mellitus patients suffer from an intensified appetite and thirst (hunger and thirst may
not be very intense in mild cases), increased excretion of urine (up to 58 liters a day) with a
high specific gravity, itching of the skin and external genitalia, inflammation of the oral mucosa,
pain along the nerve trunks (polyneuritis), and muscular and sexual weakness. The menstrual
cycle is disturbed in women; spontaneous abortions or stillbirths may occur in pregnant women.
The blood cholesterol level rises in diabetics, promoting the early onset of atherosclerosis, which
is often combined with hypertonia. Marked changes in the cardiovascular system, kidneys, and
eyes are among the serious complications of diabetes mellitus.
Treatment is individualized, taking into account the specific metabolic disorder. In mild forms, a
special diet is prescribed, taking into account individual energy expenditures, and exercise
therapy (especially for obese persons); in some cases, sugar-reducing sulfanilamide preparations
(which are particularly effective in elderly persons with a tendency toward obesity) are
prescribed. In moderate and severe forms insulin therapy is undertaken; long-acting insulin
preparations with a sugar-reducing action are used to prolong the action of insulin.
2

In Ayurveda Madhumeha has been described as one among the 20Types of Prameha & is a sub
type of Vatik Prameha in which patient passes excessive amounts of urine that tastes & looks
like honey
CLASSIFICATION OF MADHUMEHA:
In the Ayurvedic classics Madhumeha has been classified as follows on the basis of various
aspects.
1) On the basis of body constitution:
Sthula and Krisha: In Chikitsa sthana, Charaka has classified patients of Prameha into two main
groups viz. Sthula Pramehi and KrishaPramehi while describing line of treatment of Prameha.
(Ch. Chi. 6/15) Sushruta also mentioned that body constitution of Sahaja Pramehi is
usually Krisha (thin) and that of Apathya Nimittaja Pramehi is Sthula(Obese) (Su. Chi. 4/3).
1. On the basis of the etiological factors
1. Sahaja (Hereditary) :
It has been described by Sushruta and its etiology has been said to be Bija Dosha, the patients
being lean, thin and emaciated. (Su. Chi.11/03) Charaka also narrated Jatapramehi because of
Bija Dosha and has emphasized it as Kuala Vikara. This category of Prameha have been
Said to be incurable. (Ch.Chi.6/57). So it can be said that it has got genetic origin. This type can
be compared with Type 1 D.M.
2. Apathyanimittaja: (Acquired) (Su.Chi.11/03)
It has been narrated by Sushruta according to etiological factors. It can be further classified into
following two subtypes.
3. Avaranjanya and Dhatuapakarsanjanya: Avaranjanya pathogenesis occurs due to etiological
factors which lead to the vitiation /increase of Kapha, Pitta, Meda and Mansa which in turn
cause Avarana of Vata Dosha leading to its provocation and manifestation of Madhumeha. (Ch.
Su.17/78-81, A. H. Ni. 10/19).Dhatuapakarshanjanya pathology occurs due to depletion of
Dhatus because of the Vata vitiated etiological factors.(Ch.Ni.4/36, Ch.Chi.6/11). Vagbhata has
clearly mentioned the two types of Madhumeha: (A.H. NI 10/18-19)
1) Dhatukshyajanya Madhumeha
2) Avaranjanya Madhumeha

Santarpanjanya and Apatarpanjanya : This type of classification
is described by Charaka.
1. Avaranajanya /Santarpanajanya (Ch. Su.17/78-81)
2. Dhatukshayajanya /Apatarpanajanya (Ch.Ni. 4/36-37)
Classification is mainly based upon the over nutrition and under nutrition. So Santarpanajanya
Madhumeha can be correlated with Avaranajanya Madhumeha and Apartarpanajanya can be
correlated with Dhatu-Apakarshanajanya Madhumeha
2. On the basis of Sadhya / Asadhyata :
Utpatti Vishishta Anilatmaka: Asadhya (Ch. Chi. 6/34).
Vatanubandhita Kapha-Pittaja: Yapya (Ch. Chi. 6/52).
Vata Avarana Janya: Kriccha Sadhya (Ch. Su. 17/78-81).
Agni:
Madhumeha is a complex metabolic disorder which results from the Dhatwagnimandya. All the
metabolic activities are governed by Agni and its derangement leads to so many metabolic
disorders and Madhumeha is one of them. Agni functions at the level of Jatharagni, Bhutagni and
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Dhatwagni. When they function properly, each & every Dhatu is nourished & formed properly.
But when there is derangement in these Agni, then Dhatu are not nourished & formed properly.
In case of Avaranajanya Madhumeha due to Kaphakara Nidana,Dhatvagnimandya & particularly
Medodhatvagnimandya develops and due to this, excessive but Sama Medodhatu is formed
leading to more vitiation of specific Dhatu which obstructs the Gati of Vata leading to its
provocation. Due to this provocation of Vata Jatharagni gets stimulated leading to increased
appetite. This cycle goes on. Therefore, in
Madhumeha the Dushya Dushti mostly occurs in the form oVriddhi Dhatvagnimandya. Due to
Medodhatvagnimandya there is less nourishment to further Dhatus which results into Kshaya
Lakshana of Majja and Shukra Dhatu.
E) Ama :
Sushruta has illustrated the role of Ama in the pathogenesis of various disorders. He mentions
that the Samprapti of Prameha takes its origin from the Ama only. He states
; q; , .

; ,; ;
(Su. Ni. 6/4)
That is from the very beginning, Agnimandya has been developed due to Guru, Snigdhadi Ahara
and Avyayamadi Vihara which leads to production of Ama. Dalhana adds that not only Dosha
but Meda Dhatu is in the Ama form. Hence Ama is a part and parcel of Samprapti. Ama means
Aparinamitta. Anything which remains in undigested form, being
harmful to the body is Ama. It is Apakva (undigested), Asyaukta(Shithila), Durgandhi, Picchila
in nature and it produces Gatrasada. In the Samprapti of Madhumeha, we also get the dominance
of Ama regarding Kapha Dosha, Meda Dhatu, Mamsa Dhatu, and Kleda. The undigested Kapha
and Meda acts as Ama vitiating the Mutravaha Srotasa leading to Madhumeha. This vitiation is
in the form of Srotasa obstruction.

Chikitsasutra (Line of treatment) and Chikitsa (Specific treatment) are the two divisions of
this foremost part. Both these are explained very well in classics.
CHIKITSA SUTRA:
..'/ , +]'/ 'q.).'/ +|,
'''
(q(( )= 'q., ', (,/|( ,,'
+/'., (Ch.Chi.6/15)
Charaka has categorized Patients of Prameha into two types,
1) Those who are obese and strong, and
2) Those who are emaciated and weak.
Patients who are emaciated and weak should be administered nourishing therapy and who
are obese and strong should be administered Shodhana (elimination) therapy. After
Shodhana therapy, Shamana Chikitsa is to be followed. Sushrutacharya also says that
Sahaja Meha Rogi will be Krisha & Apathyanimittaja Rogi will be Sthula.
(Su.Chi.11/4; A.H.Chi.12/1]
Vagbhata further opines that Krisha patient should be given nourishing drugs and diet.
q(,,,./.|/ .,,,='|/ 'q
4

(A. H. Chi. 12/38)
This is the general principle of treatment in Prameha and the
same principle applies to Madhumeha.
Madhumeha can be treated in this way although it is described as
incurable. In Pratyakhyeya Vyadhis, disease can be controlled by proper
management.
Its treatment can be discussed under following headings:
Nidanaparivarjana.
Treatment According to Dosha.
Nidanaparivarjanam :
This is the first and foremost principle to be followed in
every disease. Charaka has mentioned that the etiological factors
responsible for the disease Prameha should be avoided. Avoidance of
these etiological factors is the prime treatment. (Ch. Chi. 6/53).
Along with Nidanaparivarjanam proper diet management is
necessary. This diet management should be according to body
constitution.
There is a reference in the Avarana chapter of Charaka chikitsa 28/195 that if vayu is associated
with Ama then therapies prescribed for Prameha,Vatika Disorders and Adiposity are to be
So the Shamana oushadis explained in Sthoulya adhyaya can be administered like
Vidanga choorna
Vidanga lauham
Vyoshadi saktu
Amruta Guggulu
Navaka Guggulu
Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose
caused by excessive insulin. Hypoglycemia due to excess insulin is the most common type of
serious hypoglycemia. It can be due to endogenous or injected insulin.
y Hypoglycemia due to endogenous insulin
Congenital hyperinsulinism
o Acquired forms of hyperinsulinism
o Insulinomas (insulin-secreting tumors)
Islet cell adenoma or adenomatosis,Islet cell carcinoma
o Autoimmune insulin syndrome
o Noninsulinoma pancreatogenous hypoglycemia
o Reactive hypoglycemia (also see idiopathic postprandial syndrome)
o Gastric dumping syndrome

y Drug induced hyperinsulinism
o Sulfonylurea,Aspirin,Pentamidine,Quinine,Disopyramide
o Bordetella pertussis vaccine or infection
5

o
y Hypoglycemia due to exogenous (injected) insulin
Insulin self-injected for treatment of diabetes (i.e., diabetic hypoglycemia
In general, most signs and symptoms can be attributed to (1) the effects on the brain of
insufficient glucose (neuroglycopenia) or (2) to the adrenergic response of the autonomic

In ayurveda signs of Prana vayu occlusion by Udana vayu like
y loss of function of different functions of the body
y Karma ojo bala varnanam nasha
y Even Death can be considered for understanding Hyperinsulinaemic
Hypoglycaemia.sprinkling with cold water is considered to be beneficial.

PRAMEHA PIDAKA
One of the main Dusya described by Caraka. He narrated it especially in Kaphaja Prameha and
Avaranjanya Madhumeha. Mamsa and Kapha having same qualities. They both give strength to
the body. When get vitiated, Mamsa losses its normal consistency and develops Shaithilya and
provide space in between for the occumulation of morbid matter. That inturn results into the
Putimamsa Pidika (Ca.Ni. 4/8). "Mamsaleshu Arakasheshu" (Ca. Su. 17/82).Mamsa dushti can
be compared to deranged protein metabolism which is an integral part of Diabetes Mellitus.
Lack of insulin depresses transport and uptake of amino acids in periferal tissue leads to
elevated circulating amino acids in extracellular space particularly alanine. Glucocrticoid activity
predominate having catabolic action on peripheral tissue protein releaving more amino acids in
Blood.Amino acids breakdown in liver results in increased production of urea N these free
amino acids can be compared with abadha mamsa . Putimamasa and pidaka are the morbid
states of mamsa dhatu . Two major changes takes place in mamsa dhatu these are protein
degradation and reduction in its blood supply, Both these along with elevated blood sugar level
form a favorable media for the growth and multiplication of the microorganism The results are
putrefaction and evolution of multiple septic foci in mamsa dhatu. Diminished protein synthesis
hampers the healing process and these complications adopt chronic course .



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