Dr. Pranav Bhagwat,
H.O.D. Of Eye, ENT,
Gomantak ayurveda college, shiroda, goa.
DIABETES MELLITUS or type 2 diabetes is a dreaded disease. Its nick name is “ SILENT KILER” and is enough to describe its exact pathogenesis in the body and all its activities therein and thereafter. There is increasing incidence of the cases with diabetes in India. So much so that India is the world capital of diabetics.
Diabetes mellitus is a clinical syndrome characterized by high blood glucose level due to absolute or relative deficiency of insulin. This can arise in many different ways. For example the type 1 diabetes may be due to immune mediated pathology, where as other types may be due to genetic defects, pancreatic disease, drug induced, etc. But the most common is the adult –onset type 2 diabetes. In this type there is resistance to actions of insulin which leads to increase in insulin secretion in order to maintain normal blood glucose level. The insulin is secreted by beta cells of pancrease. However in susceptible individuals the pancreatic beta cells are unable to sustain the increased demand for insulin. Eventually, than the blood glucose rises which needs the treatment either in the form of control diet or along with oral anti diabetic drug or insulin.
Though genetic factor are important in the etiology of type 2 diabetes, epidemiological studies provide evidence that this is associated with over eating, especially when combined with obesity and under activity.
Pathology The diabetic pathology affects the metabolism of carbohydrate, fat and protein, and can cause a significant disturbance of water and electrolyte homeostasis. These long standing metabolic derangements are frequently associated with functional and structural changes in the cells of the body, with those of the vascular system being particularly susceptible. These changes lead to the development of clinical complications of diabetes which charactesticaly affect the eye, kidney and the nervous system.
Diabetic eye disease- It mainly affects two parts in the eye viz. –the lens and the fundus. The lens become opaque early to the age and thus gives rise to cataract. The changes in fundus are called as diabetic retinopathy and are the most common cause of blindness in the age group of 20-65yrs. The present description is limited to the scope of diabetic retinopathy and its ayurvedic treatment.
Risk factors - The risk factor for this condition are as follows –the duration of diabetes is most important as the chances of getting DR is 50% in first 10 yrs and increases to 90% after 30yrs. Neverthless poor control of blood sugar level poor control of blood pressure, Smoking, obesity and high lipid levels are also contributing to increased risk.
Changes in eye - The major changes responsible for DR are called as Micro angiopathy.The small blood vessels in retina called as retinal capillaries undergo changes that cause decreased oxygen transport and retinal ischemia (loss of blood supply to retina) .The two main consequences of these changes are (1) formation or opening of pre existing bypasses called as shunts, (2) formation of new blood vessels called as neo vascularisation.
Along with these changes there is physical weakening of the capillary wall and break down of inner blood retinal barrier (which separates blood contents from retinal cells) resulting into development of intra retinal hemorrhages and retinal oedema. In the more severe types the new blood vessels are formed on the iris giving rise to increased pressure in the eyeball (glaucoma).
Types - There are 4 types of retinopathies (1) background (2) maculopathy (3) pre proliferative retinopathy (4) proliferative retinopathy. Out of these the last 3 are sight threatening and need immediate attention.
Management - It is advised that each and every diabetic irrespective of, his age or sugar level or absence of symptoms must undergo examination of eyes every 6-12 months. The present management method includes use of photo coagulation and vitrectomy. Though these are effective they do not alter the pathogenesis of the disease. The ayurvedic principles of management play a very crucial role in this context. Ayurvedic medicines act on micro angiopathies and correct the health of capillaries. They also help in establishing blood retinal barrier reducing the oedema.The judicious use of detoxification procedure in ayurveda such as virechana, nasya; along with special eye ‘kriya kalpas’ stops the bleeding from retina and revitalizes the retina reducing the chances of recurrence. The therapeutic measures also include gradual and greater lowering of blood sugar levels as it helps in the increased insulin sensitivity. Neverthless the gradual control reduces the chances of production of hemorrhages which is associated with the rapid lowering of blood glucose.
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