DR.S.G.SENTHIL KUMAR,FINAL MD (SIDDHA),

DEPT OF MARUTHUVAM.

I express my sincere gratitude to,

Prof. Dr. K.MANICKAVASAKAM, M.D(S),DIRECTOR & HOD OF DEPT OF MARUTHUVAM,NIS,CHENNAI.

Lect. Dr. T.LAKSHMIKANTHAM, M.D(S)Lect. Dr .H.VETHAMERLINKUMARI, M.D(S)Lect. Dr. H.NALINI SOFIA, M.D (S) DEPARTMENT OF MARUTHUVAM

The Tamilians who know about “persistent polyuria” named the disease “Megam”,

“Mathu” means “honey” (sweetness).

Madhumegam is a chronic metabolic disorder popularly called as "Neerizhivu" characterised by increased and frequent passing of urine, which is sweet in odour, resulting in gradual diminition of udalthathus.

According to Yoogi Vaithiya Chinthamani “Megam” is classified into 20 types. Among this,

Vatha- 4, Pitha- 6 and Kabha- 10

“Mathumegam” one among them under pitha.

Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.

The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.

The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.

Diabetes mellitus may present with characteristic symptoms such as thirst, polyuria, blurring of vision, and weight loss.

In its most severe forms, ketoacidosis or a non–ketotic hyperosmolar state may develop and lead to stupor, coma and in absence of effective treatment, death.

Often symptoms are not severe, or may be absent, and consequently hyperglycaemia sufficient to cause pathological and functional changes may be present for a long time before the diagnosis is made.

Blood glucose: GOD POD method OGTT HbA1c

Urine sugar: Benedict's Test

The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia or rarer disorders of carbohydrate metabolism.

Fasting plasma glucose should be below 110 mg/dl. Fasting levels between 110 and 125 mg/dl are borderline ("impaired fasting glycaemia") and fasting levels repeatedly at or above 126 mg/dl are diagnostic of diabetes.

The 2 hour OGTT glucose level should be below 140 mg/dl. Levels between this and 200 mg/dl indicate "impaired glucose tolerance". Glucose levels above 200 mg/dl at 2 hours confirms a diagnosis of diabetes.

Hemoglobin occurs in several variants; the one which composes about 90% of the total is known as hemoglobin A. A1c is a specific subtype of hemoglobin A.

Glucose binds slowly to hemoglobin A, forming the A1c subtype. The reverse reaction, or decomposition proceeds relatively slowly, so any buildup persists for roughly 4 weeks. Because of the reverse reaction, the actual HbA1c level is strongly weighted toward the present.

Some of the HbA1c is also removed when erythrocytes (red blood cells) are recycled after their normal lifetime of about 90-120 days.

Red cells live for 8 -12 weeks before they are replaced. By measuring the HbA1C it can tell you how high your blood glucose has been on average over the last 8-12 weeks.

A normal non-diabetic HbA1C is 3.5-5.5%. In diabetes about 6.5% is good.

The HbA1C test is currently one of the best ways to check diabetes is under control.

HbA1c Estimated average glucose

(%) (mmol/L) (mg/dL)

5 5.4 (4.2–6.7) 97 (76–120)

6 7.0 (5.5–8.5) 126 (100–152)

7 8.6 (6.8–10.3) 154 (123–185)

8 10.2 (8.1–12.1) 183 (147–217)

9 11.8 (9.4–13.9) 212 (170–249)

10 13.4 (10.7–15.7) 240 (193–282)

11 14.9 (12.0–17.5) 269 (217–314)

12 16.5 (13.3–19.3) 298 (240–347)

The Benedict's Test for Reducing Sugars is used to determine the presence of reducing sugars.

Reducing sugars are simple sugars and include all monosaccharides and most disaccarides.

Some examples of monosaccharides are glucose, fructose and galactose. Examples of reducing disaccharides are lactose and maltose.

blue-sugar absent; green-0.5% sugar; (Trace) yellow-1% sugar; (+) orange-1.5% sugar;(++) brick red-2 % or more sugar.(+++)

Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Gestational Diabetes Other types:

LADA (Latent Autoimmune Diabetes in Adults )

MODY (maturity-onset diabetes of youth)

Secondary Diabetes Mellitus

Was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes.

Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes.

It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin.

Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.

African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type 2 diabetes.

Type 2 diabetes is increasingly being diagnosed in children and adolescents.

Research studies have found that lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults.

These studies included people with IGT and other high-risk characteristics for developing diabetes.

Lifestyle interventions included diet and moderate-intensity physical activity (such as walking for 2 1/2 hours each week).

In the Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, the development of diabetes was reduced 58% over 3 years.

Type 2 Diabetes is one of the major health problems all over the world.

According to WHO recent estimates indicate there were 171 million people in the world with diabetes in the year 2000 and this is projected to increase to 366 million by 2030.

There were 32 million people with diabetes in India in 2000, which is projected to rise to 80 million by the year 2030.

Increase in prevalence is rapid in urban areas from 2% in 1970s to 12% in 2000 and as well in rural areas

The disease is reaching epidemic proportions because:

Rates of overweight/obesity have increased

We have become a physically inactive species

Our diets are increasingly unhealthy

Overweight and obesity are diagnosed by measuring weight and height (Body Mass Index (BMI)):

Weight in Kg/Height in metres2

Normal = 20-25

Overweight = 25-30

Obese = more than 30

Everyone should know their BMI!

Those who are overweight/obese

People with a family history of diabetes

Women who had diabetes during pregnancy or have had a baby weighing more than 9lbs

Physically inactive people

Certain ethnic groups (african, american indian, asian)

People who have high blood pressure or high cholesterol

Age more than 45 years

Risk of Type 2 Diabetes can be reduced:

Losing weight

Taking regular exercise : walking for 30 mins per day

Eating healthier food:

Less fat (burgers, fries, crisps, sweet foods)

More fibre (fruit and vegetables, wholegrain alternatives for rice, bread)

Cutting down on alcohol consumption

Micro vascular/neuropathic Macro vascular

Retinopathy Nephropathy Peripheral neuropathySensory lossMotor weakness Autonomic neuropathyPostural hypotensionGI problems Foot diseaseUlceration Arthropathy

Coronary circulationMyocardial ischemia

Cerebral circulationTransient ischemic attackStroke

Peripheral circulationClaudicationIschemia

Complications can be delayed/prevented by:

Controlling blood sugars: sticking to diet/exercise programme, taking medication as prescribed

Controlling blood pressure: diet, salt restriction, medication

Controlling cholesterol levels: diet (fibre foods etc)

Stopping smoking

Siddha Allopathy

Udal perukkum Obesity

Neer peruki ilium Polyuria

Naa varatchi Dryness of mouth

Neervetkai Thirst (polydipsia)

Neer peruki ilium Polyuria

Padukkayil kidathal General weakness

Udal sorvu General tiredness

Kazhalai katti Diabetic ulcers

Udal melivu Weight loss

Elaippu noi and death PT and death

The major components of the treatment of diabetes are:

Diet is a basic part of management in every case. Treatment cannot be effective unless adequate

attention is given to ensuring appropriate nutrition.

Dietary treatment should aim at:◦ ensuring weight control◦ providing nutritional requirements◦ allowing good glycaemic control with blood

glucose levels as close to normal as possible◦ correcting any associated blood lipid

abnormalities

The following principles are recommended as dietary guidelines for people with diabetes:

Dietary fat should provide 25-35% of total intake of calories but saturated fat intake should not exceed 10% of total energy. Cholesterol consumption should be restricted and limited to 300 mg or less daily.

Protein intake can range between 10-15% total energy (0.8-1 g/kg of desirable body weight). Requirements increase for children and during pregnancy. Protein should be derived from both animal and vegetable sources.

Carbohydrates provide 50-60% of total caloric content of the diet. Carbohydrates should be complex and high in fibre.

Excessive salt intake is to be avoided. It should be particularly restricted in people with hypertension and those with nephropathy.

Physical activity promotes weight reduction and improves insulin sensitivity, thus lowering blood glucose levels.

Together with dietary treatment, a programme of regular physical activity and exercise should be considered for each person. Such a programme must be tailored to the individual’s health status and fitness.

Daily exercise Like brisk walking, jagging, swimming, skipping

Chooranam Kudineer Parpam and chendooram Ilakam

Mathumega choornam Seenthil choornam Naval choornam Santhana podi Sirukurinjan choornam Kadalazhinjil choornam Keezhanelli choornam Thiripala choornam Vallarai choornam

Nilavembu kudineer Avirai kudineer Seenthil kudineer

Poora parpam Apraga parpam Velli parpam Silasathu parpam Padikara parpam

Apraga chendooram Gantha chendooram Arumuga chendooram Nava uppu chendooram

Lavanka ilakam Vivathi ilakam Thetran ilakam Senkottai ilakam

UDAL KATTU MARUNTHU

SARAM SULPHUR (GANTHAGA PARPAM,RASAYANAM,SUDAR THYLAM )

SENEER IRON AND STEEL (PARPAM AND CHENDOORAM)

OON SILVER (VELLI PARPAM AND CHENDOORAM)

KOZHUPPU GOLD (THANGAM PARPAM,CHENDOORAM,MATHIRAI)

ENBU GOLD

MOOLAI LEAD AND COPPER (FIRST LEAD AND THEN COPPER)

SUKKILAM LEAD AND COPPER

Sulfonamide drugs were the first antimicrobial drugs, and paved the way for the antibiotic revolution in medicine.

A sufonamide derivative used for its anti bacterial effects in typhoid patient produced hypoglycemia. This observation led to the development of sulfonylureas.

They act by increasing insulin release from the beta cells in the pancreas.

Lodoicea maldivica

Kingdom:Plantae Angiosperms Monocots Order:Arecales Family:Arecaceae Subfamily:Coryphoideae Tribe:Borasseae Genus:Lodoicea Binomial name: Lodoicea maldivica

a tall, stout, fan palm, Lodoicea maldivica, of the Seychelles Islands, having nuts that are the largest seeds of any plant, often weighing 50 pounds (22.6 kg).

The fruit is bilobed, flattened, 40 to 50 cm long ovoid and pointed, and contains usually one but occasionally two to four seeds.

The epicarp is smooth and the mesocarp is fibrous.

The endosperm is thick, relatively hard, hollow and homogenous.

The species is grown as an ornamental tree in many areas in the tropics.

The fruit is used in Ayurvedic medicine and also in traditional Chinese medicine.

In food, it is typically found as flavor enhancers for soups in southern Chinese cuisine.

In siddha the endosperm is used for diabetes. 30ml decoction Price: 1100$- 1700$

Thank You