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Homeopathy Drugs in DIabetes

Diabetic remedies can be classified in to six groups –
1. Acids: (debility or persistent weakness. Acid will act preventably against acidosis which is the greatest danger of diabetic mellitus) 
Acetic acid - weakness. Great thirst. Edema. Dyspepsia Profuse urination. Urine pale. Hot dry skin and profound debility.
Lactic acid – diabetic mellitus with marked polyurea. Thirst, nausea, weakness, voracious appetite, constipation, dry skin and tongue and occasional gastralgia are the commonly presenting symptoms. 
Phosphoric acid – urine increased, milky in colour and contain much sugar. Diabetic with great debility, and bruised feeling in muscles. Loss of appetite. Increased thirst. Face is pale, sick looking, eyes are sunken and surrounded by bluish rings. Sexual power deficient. 
Nitric acid – - Diabetes with debility and cachexia. Skin have a tendency to develop ulcerate which bleed easily are painful as if due to multiple needle pricks.
Picric acid -- A remedy of the degeneration of nerves with paralysis acts especially on the lumbosacral nerves, goes towards paraplegia. Nervous debility. Great weakness of the lower limbs with the sensation of drawing and heaviness of the legs.
Carbolic acid – Diabetes with tendency to paralysis, weakness of the heart. Weak pulse. Respiratory troubles. Great prostration and stupor. Desire for stimulants. 
Flouric acid -- diabetic mellitus with circulatory troubles of the lower extremities; atony of blood vessels and capillaries. Tendency to diabetic ulcers.

2. Metals:
Aurum met – Diabetic mellitus with hypertension. 
Argentum met – urine is profuse turbid and have sweet odour. Micturition is frequent and is especially during night. Anxiety and pressure in the pit of the stomach, want of breath. 
Argentum nitricum -- suited to persons who are mentally and physically exhausted. Dried, emaciated, old looking persons due to long continued mental strain. Craving for sweets. Nervous. Impulsive, wants to do things in a hurry. Intolerance of heat. Profuse urination. Impotence. Dyspepsia, belching accompanies all most all complaints. 
Uranium nitricum -- it has polyurea, polydipsia and dryness of skin and mouth. It is said that if given in 3 X trituration, it lessens the sugar and the quantity of urine. The patient, in spite of good appetite and thirst emaciates. For all complication of diabetes such as diabetic nephropathy, hypertension etc. unable to retain the urine without pain. Impotence. 
Vanadium – Degeneration of arteries. Arteriosclerosis; fatty heart.
Plumbum met -- lowness of spirit, anxiety and melancholy, diminished vision, dryness of mouth.
Cup ars -- Diabetes mellitus with urine of high density of foetid smell like onion especially when there is acetoneurea. Acidosis.
 
3. Other minerals: 
Ars alb - - In diabetes it is indicated by weakness and prostration; especially when the prostration alternates or coexists with restlessness. Increased thirst—drinks often but of small quantity of cold water at a time. Diabetics with tendency to develop gangrene. Humid gangrene with pain and horrible putrid smell. 
Sulphur -- Drinks much but eat less. Weakness and goneness especially in the stomach towards 11 am, compelling the patient to eat something for amelioration. Profuse and light coloured urine. Abscesses, furuncles or anthrax.
Phosphorus – deep action on the pancreas. A remedy for all sorts of degeneration. Diabetes complicated with digestive troubles. Exaggerated hunger, which reappears just after meals. Unquenchable thirst for cold drinks. Debilating diarrhoea without pain followed by great weakness after stools. Impotency after an exaggerated desire, with lascivious dreams and involuntary seminal loss.   Sensation of numbness. Eye troubles. Cataract. Lesions of the retina and optic nerves. 
Silicea -- By its suppurative tendency Silicea will very often-indicated in diabetes. 
Natrum mur-- It is indicated by polyuria and polydipsia; the patient drinks often and much and urinate abundantly. Eat well but becomes emaciated. Sweat while eating; sexual weakness; weakness after coition. Troubles of visual accommodation. General depression. 
Iodum – Voracious appetite and great thirst. Great debility, sweat by the least effort. Suits also to diabetics who become tubercular. Rapid emaciation. The hunger is such that the patients are anxious while waiting for the meals. Impotency. 
Causticum--   suits to paralysis of diabetics with numbness. Emaciation. Possibility of ocular troubles. Cataract. 
Natrum sulph -- The remedy frequently indicated in diabetes. Diabetes with polyurea, abdominal distension; hydrogenoid constitution. Tendency to localized rheumatism. Diabetes associated with gout and rheumatisms.

4. The vegetables: 
Cephalandra indica -- diabetis mellitus associated with biliousness, abscess, boil and carbuncles. Profuse urination making the patient weak with dryness of mouth and lips. Considerable thirst often worse after urination. The whole body burns like fire, relieved by cold bathing.
Syzygium jambolanum -- it is capable of reducing the amount of sugar in the urine especially when used in tincture or lower trituration. Great thirst, weakness and emaciation. Patient passes large quantities of urine of high specific gravity. Old ulcers of skin. Diabetic ulcers. 
Chimaphilla -- It affects much the kidney and causes troubled and foetid urine, difficulty or burning. It has been used by the Allopaths in diabetes. 
Rhus aromatica – Diabetes with pale urine, very abundant, of high density. Frequent albuminuria.
Bryonia – Suits to the thirst of the diabetics. Drink much at a time but at long intervals. Dryness of lips, of the mouth and of the throat. Liver sensitive and painful. Weakness, vertigo stomach sensitive to touch.
Chionanthus – Diabetes with hepatic troubles; polyurea of high density containing sugar and biliary pigment at the same time or much urobiline. 
Iris ver – Main affection on the pancreas. 
Lycopodium -- Hepatic insufficiency associated to diabetes. Often suits to benign diabetes with insufficient liver and sexual weakness. 
China – Suits to persons who have become weak due to constant loss of sugar. Great sensitiveness to air current, to cold and to touch 
Colchicum—Association of gout or rheumatism and of diabetes. Urine contains blood, albumin and sugar. Weak heart. Pain in the extremities by the least movement. Dry mouth. Thirst. Great prostration, sensation of intense coldness and tendency to collapse. 
Coca – diabetes mellitus with impotence. No appetite except for sweet. 
Curara -- A remedy indicated in cases of nervous origin. Paralysis of flaccid muscles with diminution or abolition of reflexes, which is found in polyneuritis  
Nux vom -- Sedentary life. Desire for stimulants. Frequent constipation, inefficacious urging. This remedy is suited to patients who make irregularities in food and persons who have taken excessive drugs.
Phaseolus -- Diabetes with palpitations. Weak and soft pulse and a sensation of approaching death.
Lycopus virginica – Diabetes with profuse urine. Rapid and painful heart. Weak and intermittent pulse. 
Opium—Prostration and tendency to coma. Torper, stertorous respiration. Dark red colour of the face. Dry mouth. Great thirst. Constipation without desire. Suits especially to diabetic coma.    
Secale cor -- Tendency rather to dry gangrene. Diabetes with debility, emaciation in spite of good appetite and excessive thirst. Tongue dry and cracked. Formication and numbness of the extremities. Sensation of burning, wants to be uncovered however the parts exposed are cold to touch, petechies, livid or blackish spots. Great aversion to heat 
Helonias - dull, gloomy, irritable. Melancholy. Impotence. Patient is better when keep busy. Urine albuminous, phosphatic, profuse and clear and contains sugar. 
Helleborus niger – Indicated in grave cases leading to agony. Muscular weakness, unconsciousness, involuntary movements of hands. Very foetid breath. Tongue and lips are dry, cracked. Red tongue pale face. Tendency to oedema.  
 
5. From Animal kingdom: 
Moschus -- Diabetes with abundant urine and sexual weakness inspite of the desires, which are violent and persistent. Premature senility. Violent spasmodic tendency with muscular stiffness, trembling and weakness. Anxiety with hiccough and palpitations. Diabetes accompanied by nervous complications.
Crotalus horridus – Grave cases with albuminurea, high coloured urine. Palpitation. Tendency to haemorrhages. 
Lachesis -- Excessive loquacity. Dreams of death, of his own death, dreams of funerals. Hyperesthesia of skin and cannot bear to have any part of body, specially the neck. Amelioration during menses. Aggravation during sleep. 
Tarentula -- With intense restlessness. Vertigo and palpitations. 
Elaps -- Nausea and vomiting. Sensation of intense coldness in the stomach. Headache, vertigo and aversion to light. 
Lac defloratum – Profuse urine, head ache with throbbing in the temples. Prostration constipation.
 
6. Organo therapic remedies: 
Insulin -- it should be prescribed in grave cases of diabetes, in lean and thin consumptive patients and also in coma. 
Pancreatin -- Diabetes of recent onset. Not only it diminishes the sugar in the urine, but also help in restoring the strength and vigour, which disappeared. 
Adrenalin--   Diabetes with troubles of adrenal gland, kidney and pancreas. Rise of arterial tension. Slow pulse.
Urea -- Has been used in albuminuria in tuberculosis as well as in diabetes with constant result.
Lecithin -- It may be used in albuminuria, in glycosuria and especially in phophaturia. Impotency. Pale face. Anorexia. Thirst. Desire for wine and coffee. Tendency to tuberculosis. Weakness
  
7.Biochemic Remedies for Diabetes Mellitus:
Nat mur-Indications are already mentioned above.
Nat sulph
Kali phos – Nervous prostration, weakness, sleeplessness and voracious hunger (used intercurrently).
Kali mur – Excessive sugar level with great emaciation.
Kali sulph
For skin complications of diabetes mellitus.
Calc sulph  
Calc phos -- Polyurea with much thirst Great weakness. Dryness of mouth and tongue. Flabby sunken abdomen. Glycosurea when lungs are affected. 
Ferrum phos – Diabetes with quickened pulse. As an intercurrent remedy. 
  
Insulin:  
Attempts at improving purity have led to the production of chromatographically purified monocomponent insulin and human insulin
(which resembles the product of human bete cell structurally).
Human insulin are most potent and most rapidly acting preparation available at present. Allergic manifestations are also minimal.

Indications:
All IDDM patients – all stages, particularly during complications.
In NIDDM patients during episodes of metabolic complications
Infections, myocardial infarctions, after surgery etc.
Pregnancy
When diet, exercise and oral hypoglycemic agents fail to achieve euglycemia
When NIIDM patients with very high blood glucose 
MRDM patients. (Malnutrition related diabetes mellitus)

Specific indications for human insulin: 
1. Gestatational diabetes mellitus / acute infections / surgery complications / acute metabolic complications 
Resistant to other type of insulin
Allergic reaction to other preparations.

Insulin therapy:
Insulin therapy should be designed so as to give basal physiological insulin level with peaks occurring after meals. This can be achieved by combining soluble insulin with long acting or intermediate- acting insulin in different ways. 
Common dosage schedules are given below  
1. Single daily dose of soluble and intermediate- acting insulin before breakfast.
2. Single dose of intermediate- acting insulin before breakfast.
3. Split dose of soluble and intermediate acting insulin before breakfast and dinner, and
4. Soluble insulin given before each meal and a dose of intermediate –acting insulin at bed time
At present premixed insulins containing 30% soluble and 70 % long acting insulins are available commercially.
Dosage: 
Insulin requirement is to be determined by trial and error for each since the dosage regimen varies widely. It is ideal to start with a small dose and gradually increase at intervals of 2-3 days till the optimum dose is achieved. Insulin has to be given subcutaneosly except under special indications.
The peak action varies with the route of administration-

Route of administration Peak action
---------------------------------------------------------
Sub cutaneous 2 – 4 hours
Intramuscular                                         1 –2 hours
Intravenous A few minutes upto 15 minutes
Sites of injection:
Anterior abdominal wall, and lateral aspect of thigh and arms are chosen for sub cutaneous injection by the patient on a regular basis.  
Ordinarily insulin is given as single daily or multiple injections. While starting a patient on insulin therapy soluble insulin is employed to determine his daily requirement. Soluble insulin is given subcutaneously in 3 doses 30 minutes before breakfast, lunch and dinner. Then blood glucose is estimated in the fasting state, 1 ½ hour post lunch and 1 ½ hour post dinner. If the fasting blood glucose is high, increase the morning dose of insulin. If the post lunch blood glucose is high, increase the prelunch dose of insulin. If the post dinner blood glucose level is high, increase the pre dinner dose of insulin. 
Once all these values are in the normal range. i.e. Fasting blood sugar level below 120 mg/ dl and post prandeal below 140 mg/ dl, the total dose of insulin is calculated. It is advisable to give 2/3 of these as intermediate acting and 1/3 as short acting insulin; the total dose to be given 30 - 45 minutes before breakfast. 
Complications of insulin therapy: 
Hypoglycemia
Allergic manifestations
Local effects—lipoatrophy (atrophy    of subcutaneous fat at the site of injections)
Visual disturbances
Insulin resistance (may be due to obesity, anti- insulin antibodies, other endocrinopathies, malignancy, abnormality of receptor number and functions, lipo atrophy etc.)

   COMPLICATIONS OF DM 

Acute complication
Metabolic
Diabetic keto acidosis                 
Lactic acidosis
Hypoglycemia
Non-ketotic hyperosmolar coma
Infective episodes
Systemic infection
Pneumonia and bronchopneumonia
Urinary tract infection
Skin infections
Fungal infections—moniliasis, systemic fungal infections, mucor mycosis.
Surgical complication 
Boils, carbuncles, diabetic gangrene
 
Long-term complication
Cardio vascular
Ischemic heart disease
Cerebro vascular accident
Atheroma
Hypertension
Occlusion of blood vessels leads to gangrene

Central nervous system
Peripheral neuropathy--- sensory, motor or mixed.
Monneuritis multiplex.
Autonomic neuropathy.
Cerebro vascular occlusion
Diabetic amyotrophy

Excretory system-kidney 
Recurrent urinary tract infections
Chronic pyelonephritis
Diabetic glomerulosclerosis
Renal failure
Papillitis necroticans
 
Eyes  
Cataract
Retinopathy
Iridocyclitis
Glaucoma
Changes in refraction
 
Respiratory system  
Pulmonary tuberculosis
Alimentary tract
 
Stomatitis
Xerostomia
Dental sepsis
Halitosis
Loosening of teeth
Paralytic ileus
Nocturnal diarrhea
Hepatic enlargement
Gastric distension
 
Bone and joints
Osteoporosis
Neuropathic joints
 
Skin 
Trophic ulcers of the feet
Monilial infection of the genitalia
Pruritus vulvae
 
Complication due to treatment 
Hypoglycemia
Drug toxicity  
 
References: - 
Textbook of medicine – K. V. Krishna das,
Harrison’s principles of medicines
Davidson’s principles and practise of medicines
Park’s textbook of preventive and social medicines
Diabetes mellitus - F. Bernoville
Homoeopathic treatment diabetes mellitus – Dr. Kamal Kansal
Pocket manual of material medica – William Boricke

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