Diabetes mellitus is a metabolic disorder marked by hyperglycemia, classified into Type 1, Type 2, gestational, and secondary categories. The document discusses the causes, diagnostics, management approaches, and recent advancements in diabetes treatment, including pharmacological and naturopathic interventions. It highlights the importance of maintaining HBA1c, blood pressure, and cholesterol levels for a healthy life.

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2. INTRODUCTION
• Diabetes mellitus is a metabolic disorder characterized by common feature of
hyperglycemia with disturbance of carbohydrate , fat and protein metabolism.
• Depending on the cause, it may be broadly classified into two main categories
• 1. TYPE 1
2. TYPE 2
3. GESTATIONAL
4. SECONDARY
Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2019– ADA,

5. RISK FACTORS

6. SYMPTOMS

7. PATHOPHYSIOLOGY
• INSULIN SECRETION:
Preproinsulin (86 aa)
proteolysis R. Endoplasmic reticulum
Proinsulin
further clevage
Insulin Golgi apparatus
(21aa) A chain B chain (30 aa)
C peptide
• C peptide – less succeptable to degradation in liver
• C peptide is used as a marker to distinguish the externally administered insulin and endogenously
secreted insulin

9. • TYPE I DM:
1. Genetic Factor - HLA DR 3& 4
(Short arm of Ch 06 (HLA DR3 -5 fold risk & HLA DR4 7 fold risk)
(Human Leukocyte Antigen)
2. Auto Immunity
(Auto T cells and Bcells, islet cell antibodies – 90% 1 year before
Cytokines – beta cell destruction)
3. Environmental Factors
(race, ethnicity, hybrid foods, polluted water, soil)

10. • GLUT 4 – skeletal muscles, adipose
• GLUT 2 – beta , liver cells
• GLUT 1 – all cells, especially brain.

11. CRITERIA FOR DIAGNOSIS (ADA)

12. DIAGNOSIS
• HbA1C
• FBS
• PPBS
• RBS
• Urine Analysis
• HOMA-IR index
HOMA IR calculated with FBS and Insulin level (0.5 – 1.4)
Low level – high sensitivity
High level – low sensitivity (resistance)

13. COMPLICATIONS

14. INTEGTARED APPROACH

15. • CONVENTIONAL
MANAGEMENT

16. • GIP - they slow the rate of absorption of
nutrients into the blood stream by reducing
gastric emptying and may directly reduce
food intake.

17. • INCRETINS
• Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels by
stimulating the insulin secretion.
• Some incretins (GLP-1) also inhibit glucagon release from the alpha cells of the islets of Langerhans.

18. • SGLT 2 INHIBITORS • AFREZZA

19. • BCG VACCINE
BCG vaccine- body’s reg T cells are increased thereby decreasing the auto T cells. TNF is also increased, HbA1C
reduced.

20. • STEM CELL THERAPY • TRANSPLANTATION

21. RECENT ADVANCEMENTS
• INSULIN PUMP • BARIATRIC SURGERY

22. • NATUROPATHIC
MANAGEMENT

23. HYDROTHERAPY
TITLE AUTHOR CONCLUSION
Immediate hypoglycaemic effect
of two selective
Hydrotherapeutic procedures in
non insulin dependent Patients
of diabetes mellitus.
SUJATHA DINESH,
J Res Educ Indian Med,
2014
Neutral douche and Gastrohepatic pack can play a
important role in lowering the raised blood glucose
levels in patients with NIDDM.
Effect of cold hip baths on blood
glucose levels in patients with
type 2 diabetes mellitus: a pilot
study
A Mooventhan,
Diabetes and
Metabolism , 2019
• Doubling the metabolic rate
• TRPM8 (transient receptor potential melastatin
8) activation is associated with ‘browning’ of
white adipose tissue and acceleration of energy
utilization.
• CHBs are reported to promote parasympathetic
activation which, in turn, is known to promote
insulin secretion.
• exposure to cold (14–15℃) induces a 43%
increase in insulin sensitivity

24. TITLE AUTHOR CONCLUSION
The comparison of effects of
Contrast bath on circulation
of contralateral lower limb in
Type 2 Diabetic and healthy
women.
Zohreh,
Journal Of Rehabilitation
Science And Research, 2016
Contrast bath increases the digitalis pedis
pulse rate, local temperature by improving
the peripheral blood circulation in DM
patients and this effect is maintained for
longer duration when compared to control.
Whole body heat exposure
modulates acute glucose
metabolism.
Amy L Kimbal,
Int Jour Hyperthermia, 2018
Whole body heat exposure increases the
insulin sensitivity and brings sympathetic
and parasympathetic balance.
Effect of Steam Sauna Bath on
Fasting Blood Glucose Level in
Healthy Adults.
Vandana V, Prathap
Indian J Med Biochem, 2018
When given three times a week there is a
significant reduction in the fasting blood
glucose levels.

25. TITLE AUTHOR CONCLUSION
1. Emphasis of Naturopathy in
the Management of Type 2
Diabetes Mellitus
2. Effect of Two Months
Naturopathy Treatment in
Non Insulin Dependent
Diabetes Mellitus Patients.
3. Role of Naturopathy on
physical and Biochemical
Parameters in patients with
Type 2 DM
Rukamani Nair et al.,
JMSCR, 2016
Rukamani Nair et al.,
JMSCR, 2017
Rukmani Nair et al.,
Indian journal of
Traditional
Knowledge, 2019
COLD HIP BATH:
It excites the contraction of muscular
structures of viscera including, liver,
pancreas, bladder.. and thus helps to
improve their function.
MASSAGE:
The stress regulatory mechanism of
massage might be attributed to control of
stress hormone, permitting the body to use
insulin more effectively
MUD THERAPY:
The mud application to abdomen increases
the peripheral circulation, metabolic rate
and helps to reduce blood glucose levels.

26. MASSAGE
TITLE AUTHOR CONCLUSION
Tactile massage improves glycaemic
control in women with type 2 diabetes: a
pilot study
Andersson,
Pract Diab Int, 2004
There is a significant B-HbA1c reduction,
The possible mechanism might be the influence of tactile
massage on hypothalamo pituitary- adrenal axis, can
produce endocrine disturbances with consequent effects
on glucose metabolism.
How Effective is Swedish Massage on
Blood Glucose Level in Children with
Diabetes Mellitus?
Firoozeh Sajedi,
Acta Medica Iranica,
2011
Full body massage, exercise and diet modification to
children with diabetes mellitus , has lowered the anxiety
and stress hormones and improved clinical course
Effects of tactile massage on metabolic
biomarkers in patients with type 2
diabetes
Wändell,r
Diabetes and Metabolism
, 2013
There is a significant reduction in the BMI, FBS, HbA1C,
HOMA IR, with increase in serum insulin, and adinopectin
levels
Effects of Thai Foot Massage on Balance
Performance in Diabetic Patients with
Peripheral Neuropathy: A Randomized
Parallel-Controlled Trial
Uraiwan Chatchawan
Med Sci Monit Basic Res,
2015
The results of this study suggest that Thai foot massage is
a viable alternative treatment for balance performance,
ROM of the foot, and the foot sensation in diabetic patients
with peripheral neuropathy.

27. MAGNETOTHERAPY
TITLE AUTHOR CONCLUSION
The effect of electric field, magnetic
field, and infrared ray combination
to reduce HOMA-IR index and GLUT
4 in diabetic model of Mus
musculus.
Warani D, Husen S A
Lasers Medical Science ,
2019
Combined treatment of electric field, magnetic
field, and infrared ray have potential to reduce
insulin resistance due to improving blood
circulation and increasing intracellular Ca2+
level.
There is a significant reduction in fasting blood
glucose level and HOMA-IR index
(Insulin resistance can be quantified from high
number of HOMA-IR index and observed from
glucose transporter 4 (GLUT-4) translocation
on membrane of skeletal muscle cells.)
Transcranial Magnetotherapy in the
treatment of Psychosomatic
disorders in children with Type 1
Diabetes Mellitus
Yu.Filina
Neuroscience and
Behavioural Physiology ,
2010
With magnetotherapy treatment for 12 mins
there is a significant change in mood, behaviour,
activity of subcortical functions (memory,
emotion, hormonal balances, pleasure).

28. ACUPUNCTURE
TITLE AUTHOR CONCLUSION
Effect of Needling at CV-12
(Zhongwan) on Blood Glucose
Levels in Healthy Volunteers: A
Pilot Randomized Placebo
Controlled Trial
Sriloy Mohanty , A. Mooventhan
Journal of Acupuncture and
Meridian Studies, 2016
The results of this present study showed
that a 20- minute single session needling at
CV-12 acupuncture point without any
stimulation (manual or electrical)
produced a mild reduction in RBG levels in
healthy volunteers.
(CV 12 - it is considered a therapeutic point
for diseases of the digestive organs such as
the stomach, pancreas, and spleen)
Clinical study on acupuncture
and moxibustion for Diabetes
H Liao,
Chinese Acupuncture, 2007
Acupuncture, moxibustion or both when
given, the results are clinically significant
and better result is obtained when both
acupuncture and moxibustion is given.

29. YOGA
TITLE AUTHOR CONCLUSION
Effect of 12 weeks of yoga on
quality of life and Indian
Diabetes risk score in
Prediabetic and Diabetic Indian
Young Adults: RCT
Parvati Pal, G S Keerthi,
Journal of Clincal &
Diagnostic Research,
2017
12 week yoga therapy improved the QoL
among diabetics and attenuated the risk
among prediabetes individuals.

30. TITLE AUTHOR
Adherence to yoga and its resultant effects on blood glucose in Type 2
diabetes: A community-based follow-up study
Praveen Angadi, Aarti Jagannathan
International Journal Of Yoga, 2017

31. TITLE AUTHOR
Integrated Yoga and Naturopathy module in management of Metabolic
Syndrome: A case report
Swathi Gowda,
Journal of Ayurveda and Integrative Medicine, 2017

33. DIET
TITLE AUTHOR CONCLUSION
Effectiveness of Antihyperglycemic
Effect of Momordica charantia:
Implication of T-Cell Cytokines
Rufine Fachinan,
Evidence-Based
Complementary and
Alternative Medicine
TH2-immunosuppressive action of M. charantia
fruit juice could be beneficial to prevent infiltration
and destruction of 𝛽-cells by T-lymphocytes in
pancreas and therefore prevent hyperglycemia.
Bitter melon (Momordica charantia):
A review of efficacy and safety
Ethan Basch,
American Journal Of
Health System And
Pharmacology, 2003
Decrease hepatic gluconeogenesis,
increase hepatic glycogen synthesis,
increase peripheral glucose oxidation in
adipocytes.
Effects of meal replacement therapy
on metabolic outcomes in Thai
patients with type 2 diabetes: A
randomized controlled trial
Apussanee
Boonyavarakul,
Nutrition and Health,
2018
Short-term conventional low-Glycemic Index diet
control showed decreased BW, BMI, HbA1c, total
cholesterol and triglycerides and also great
decrease in LDL levels
Do Cinnamon Supplements Have a
Role in Glycemic Control in Type 2
Diabetes – A Narrative Review?
Rebecca B. Costello,
J Acad Nutr Diet, 2007
Among 11 RCTs reviewed, 10 showed significant
change in FBS and HBA1C, and the doses varies
from 1.2 to 6gm/d.

35. • Targeting AMPK signaling pathway
by natural products for treatment
of diabetes mellitus and its
complications, Tanuj Joshi, Cellular
Physiology , 2018

36. • Polyphenols and Glycemic Control , Yoona Kim, Jennifer B. Keogh and Peter M. Clifton, Nutrients, 2016

37. • Circulating levels of antioxidant Indoleproprionic acid are associated with higher gut
microbiome diversity, Menni C , 2019
• Gut microbiota – tryptophan metabolism – end product (IPA) – important regulator for
insulin resistance.
• Faecalibacterium and Coprococcus – Abdominal Obesity
• Lachnospiraceae – visceral fat deposition
• 6% change in flora – 1% change in metabolism

38. MANITAIN YOUR HbA1C
BLOOD PRESSURE
CHOLESTEROL
TO HAVE A HEALTHY LIFE