Diabetes is a chronic metabolic disorder characterized by high blood sugar levels. It has become a major public health issue globally as rates of diabetes have risen significantly in recent decades due to increasing rates of obesity and sedentary lifestyles. In India, over the past 70 years life expectancy has increased significantly due to public health measures but non-communicable diseases like diabetes, heart disease, and cancer now pose major health challenges as rates of these conditions have also increased substantially. Proper management of diabetes and prevention of complications like damage to nerves, eyes, and kidneys will require a renewed focus on lifestyle factors, public health initiatives, and management of comorbidities.

1. Updates in Diabetology :
An Ayurvedist’s perception
Sathya N. Dornala
Swami Vivekanand Ayurvedic Panchakarma Hospital, Delhi – 95
9313707117 // rasayana @ gmail.com

2. Copyright & Disclaimer
 All material in this presentation particularly
ACRONYMS and other unique thought contents
may be copied, reproduced, distributed,
republished, displayed, posted or transmitted in
any form or by any means with proper citation.

4. This editorial was published on the occasion of
World Health Day - April 7, 2016.
Ayurveda is not mentioned in the article

6. Introduction
 India’s greatest achievement – LONGER LIVES
 Immunization & Nutrition
 Successful in Adding years to life (Lifespan) –
but forgot to achieve Life to years (Health span)
in terms of LSD/CNCD – CVD, Cancer, Diabetes, COPD
Year 1947 1960 1980 1990 2000
2016
(Men)
2016
(Women)
Avg. LE in
Years
31 42 48 58.5 62 66.9 70.3
Ministry of Health & Family welfare, Govt. of India 2015
India : Health of the Nations states Nov 2017

7. Nov 2017

8. National Health Policy 2017
shifting focus from “sick-care” to “wellness”
 Union Cabinet approved NHP on 15.3.2017.
 Broad principles of the policy is centered on Professionalism,
Integrity and Ethics, Equity, Affordability, Universality, Patient
Centered & Quality of Care, Accountability and Pluralism.
 Main objective is to achieve the highest possible level of good
health and well-being, through a preventive and promotive
health care orientation in all developmental policies, and to
achieve universal access to good quality health care services
without anyone having to face financial hardship as a
consequence.
 To reduce premature mortality from CNCD by 25 % by 2025.
http://pib.nic.in/newsite/PrintRelease.aspx?relid=159376

9. Epidemiology &
Public health

10. Transformation of the WORLD
Digitalization Diabetization

11. World Health Day
 The theme of World Health Day 1981 was “Health for all
by year 2000 AD”.
 The theme of World Health Day 2018 is: Universal health
coverage: everyone, everywhere. The slogan is “Health
for All”.

12.  HFA (2000); MDG - 8 (2015) to SDG-17 (2030)
 Goal 3: Ensure healthy lives and promote well-being
for all at all ages
 Target : By 2030, reduce by 1/3rd premature
mortality from NCDs through prevention and
treatment and promote mental health and well-being

13. World Diabetes Day
 On December 20, 2006, the United Nations (UN)
passed a resolution to designate November 14 as
World Diabetes Day.
 First commemorated on November 14, 2007.
 Official UN symbol for diabetes – Blue ring
 Family and Diabetes (Theme of 2018 and 2019)

14. Sanjay Kalra, Banshi Saboo1, Rakesh Sahay, Deepak Khandelwal3, Vipin Talwar4, A. G. Unnikrishnan. The rule of two-thirds in diabetes
epidemiology. Indian Journal of Endocrinology and Metabolism / Jan-Feb 2017 / Vol 21 | Issue 1
INDIA+BETES – Rule of 2/3

15. Global Burden of Diseases 2015 : Lancet

16. TOP TEN DRUG SALES

17. Metabolic syndrome (MetS)
 MetS is the name for a
group of risk factors that
raises your risk for heart
disease and other health
problems, such
as diabetes and stroke.
Metabesity
Metabetes
www.nhlbi.nih.gov

18. Etymology & Definition

19. What is Diabetes ?
Metabolic disorder of multiple
aetiology characterized by chronic
hyperglycaemia (raised blood sugar)
with disturbances of carbohydrate, fat
and protein metabolism resulting from
defects in insulin secretion, insulin
action, or both. (WHO 1999)

20. What is Diabetes ?
 Diabetes is a serious, chronic disease that occurs
either when the pancreas does not produce
enough insulin (a hormone that regulates blood
glucose), or when the body cannot effectively use
the insulin it produces.
(WHO Global report on diabetes 2016)

22. Nomenclature of DM is still relevant?
 The term "diabetes mellitus (sweet
polyuria)" was coined in the 18th century
when they had no knowledge of blood
glucose or carbohydrate metabolism.

23. Hyperglycemic syndrome /
Metabetes
 DM comprises a group of disorders involving
distinct pathogenic mechanisms with
hyperglycemia as the common denominator.
(J. Ethnopharmacol. 71, 343–347.)

24. DM - Digestion & Metabolism
 Digestion refers to how the body processes food
in the gastrointestinal (GI) tract and eliminates
food waste via the intestines.
 Metabolism refers to how the cells utilize the
energy we have absorbed from food during
digestion.

25. Nidana / Etiology
Classical & Contemporary

26. D Diet & Dietary habits / D-Vitamin or Chromium deficiency / Dadhi
I
Insulin insufficiency or resistance / Intestinal microbiome / Inheritance /
Ikshu vikara
A
Antibiotics and other medicines like statins / Advanced Glycation End
products / Asyasukham / Anupa rasa payamsi
B BMI high / Blood pressure high
E EDC and hormones & Endocrine disorders mainly PCOS
T Thyroid problems (Hyper and Hypo)
E Environments (Obesogenic and Diabetogenic) & Environmental factors
S Sedentary life / Stress / Smoking / Soya oil / Swapna sukham
Acronym of Etiology

28. Is sugar the new tobacco ?

29. GUZZLING WATER
 EXCESS INTAKE OF WATER
 People in hot, dry climates and athletes have an increased need
for water and people with certain disease do better with
increased fluid intake, they found. But for average healthy
people, more water doesn’t seem to mean better health,
researchers said JOURNAL OF AMERICAN SOCIETY OF NEPHROLOGY
 When u take lot of water, kidneys put out more urine but not
more toxins in the urine (Dr.Stanley Goldfarb, University of Pennsylvania)
 // atyambu panam ajeernakaram //
 // madhumehi jalam manda machereth //
 // udakam kledananam //
 // Srita sheetah jalam //

36. SEDENTARY
HABITS

40. Medical corruption
 It is simply no longer possible to believe much of
the clinical research that is published, or to rely
on the judgment of trusted physicians or
authoritative medical guidelines. I take no
pleasure in this conclusion, which I reached slowly
and reluctantly over my two decades as an editor
of The New England Journal of Medicine.
Dr. Marcia Angell, a Senior Harvard Lecturer and
former Editor of the NEJM

41. PATHOPHYSIOLOGY
SAMPRAPTHI
Triumvirate to Ominous Octet

42. Blood Sugar
The World’s Greatest Scapegoat.

43. Pathogenesis of type 2 diabetes:
the triumvirate.
Ralph A. DeFronzo Diabetes 2009;58:773-795©2009 by American Diabetes Association

44. The ominous octet.
Ralph A. DeFronzo Diabetes 2009;58:773-795©2009 by American Diabetes Association

45. PURVA RUPA
Prediabetes
&
Next diabetes

46.  Gamanath Sthanam (tends to stay while walking)
 Sthanath Aasanam (tends to sit while standing)
 Aasanath Sayanam (tends to lie down while sitting)
 Sayanath Swapnam (tends to sleep while lying down)
PRE – DIABETES / PURVA RUPA

47. PRE – DIABETES / PURVA RUPA
BODILY MARKERS
 Buffalo Hump in the upper back
 Double Chin
 Darkening & Thickening
of the Skin at the Nape of the
Neck
Symptoms of Insulin resistance –
Likely to develop diabetes over 5
years
AIIMS & FORTIS HOSPITAL, DELHI
BIO MARKERS
 Characterized by increased
reaction rates b/w sugars
(Hexosamines) & proteins in
the body.
 O – linked b-N-
Acetylglucosamine (O-
GlcNAc) modification -
Reliable test to spot the
disease in early stage
 Gerald Hart,Johns Hopkins
University, Baltimore, USA

48. Next Diabetes…Hypothyroidism
 Indian Thyroid Society identified Thyroid as
“Next diabetes”
 Around 4.2 crore Indians suffer from thyroid
related disorders -
 January - Think Thyroid Month (Indian
Thyroid Society -ITS)
 Fatigue, Wt. gain, Intolerance to cold,
Sleepiness, Depression, Enlarged thyroid
(goiter), Dry coarse skin & hair, Hoarse voice,
forgetfulness and constipation.


49. Symptomatology

51. Symptoms of Diabetes
 Classic Symptoms of diabetes mellitus are
 3 “Polys” – Polyuria, Polydipsia, Polyphagia
 Asymptomatic

52. Classification

53. Yoshio Goto. Epidemiological Problems in Diabetes Mellitus. Tohoku J. exp. Med., 1983, 141, Suppl., 1-19

54. Etiological classification
 Type 1 (Autoimmune & Idiopathic), Type 2 & Other
specific types (mainly Gestational diabetes). (WHO
1999 to till date)
 Contemporarily individual subjects may move from
one type to another in either direction.
 Persons who have, or who are developing, DM can be
categorized according to the clinical characteristics,
even in the absence of information concerning the
underlying etiology.
 If the etiology of a diabetic state (genotype) is the
same, the clinical features of the disease (phenotype)
are not always necessarily similar.

55. Ayurvedic classification
Krisha prameha
– (Asthenic
diabetes)
Sthula prameha
– (Sthenic
diabetes)
Sahaja or
Beejadoshaja
(Genetic)
Apathyanimittaja
(Acquired)

56. Complications

57. Triopathy – Major complications
Neuropathy
Retinopathy
Nephropathy
AMA Arch Intern Med. 1954;94(6):931–941

58. J Am Soc Nephrol. 2016 Oct;27(10):3153-3163. Epub 2016 Apr 14.
JAMA Intern Med. 2016 Feb;176(2):238-46. doi: 10.1001/jamainternmed.2015.7193.
J Nephrol. 2016 Oct;29(5):611-6. doi: 10.1007/s40620-016-0309-2. Epub 2016 Apr 12.

59. Statin use and the risk of
kidney disease
 A large, 8-year retrospective study with a median 6.4-year follow-up
associated long-term statin use with an increased risk of kidney
disease
 Statin users, compared with case-matched controls who didn't use
statins, showed a 30% to 36% greater prevalence of kidney disease
during follow-up
 The overall cohort comprised 43,438 individuals: 13,626 statin users
and 29,812 nonusers.
 The researchers analyzed healthcare data from 2003 to 2012 from 30-
to 85-year-olds who lived in the San Antonio,
Acharya T, Huang J, Tringali S, et al. Statin use and the risk of kidney disease with long term follow-up (8.4-
years study). Am J Cardiol 2015; DOI: 10.1016/J.AMJCARD.2015.11.031.

60. Constipation, Kidney Disease
May Be Linked
 Individuals with constipation had a 13% higher
likelihood of developing chronic kidney disease
and a 9% higher likelihood of developing kidney
failure compared with individuals without
constipation, report investigators.
 More severe constipation was linked with an
incrementally higher risk for both chronic kidney
disease and kidney failure.
K. Sumida, M. Z. Molnar, P. K. Potukuchi, F. Thomas, J. L. Lu, K. Matsushita, K. Yamagata, K. Kalantar-Zadeh, C. P. Kovesdy. Constipation and Incident CKD. Journal of
the American Society of Nephrology, 2016; DOI: 10.1681/ASN.2016060656

61. Diabetic dermadromes –
Prameha pitika?
 Acral dry gangrene
 Carotenosis
 Diabetic dermopathy
(shin spots)
 Diabetic bulla
 Diabetic
cheiroarthropathy
 Malum perforans
(trophic ulcer)
 Necrobiosis lipoidica
 Scleredema
 Waxy skin
 Limited Joint Mobility

63. Management

64. Guidelines for HbA1c Targets in T2D
 American College of Physicians
 GS 1: Clinicians should create personalized goals for
glycemic control in PwT2D.
 GS 2: Clinicians should aim to help their PwT2D
achieve an HbA1c level between 7% and 8%.
 GS 3: If a PwT2D achieves an HbA1c level <6.5%,
clinicians should consider de-intensifying
pharmacologic therapy.
 GS 4: In treating PwT2D, clinicians should aim to
minimize symptoms related to hyperglycemia.
Ann Intern Med. doi:10.7326/M17-0939 ; March 6, 2018

65. Current management
challenges
 optimizing the use of currently available therapies to
ensure adequate glycemic, blood pressure, and lipid
control and to reduce complications;
 educating patients on diabetes self-management;
 improving patient adherence to lifestyle and
pharmacologic interventions;
 reducing barriers to the early use of insulin; and
 improving the delivery of health care to people with
chronic conditions.

66. Reasons for Alternative
approaches
 Relieve or prevent treatment
side effects
 Reduce side-effects of
prolonged use.
 Enhance tolerance of
conventional therapy
 Promote relaxation
 Reduce stress
 Relieve pain
 Improve Appetite & Sleep
 Enhance quality of life
• Improve immune function
• Alter disease progression
– Prevent recurrence
– Prolong survival

69. DIET & DIabETes

70. DIET & DIabETes

71. DASH diet
 Dietary Approaches to Stop Hypertension
 Dietary Approaches to Stop Hyperglycemia
 On January 3, 2018, DASH was named the number 1
for "Best Diets Overall", "For Healthy Eating", and
"Best Heart-Healthy Diet"; and tied number 2 "For
Diabetes"(out of 40 diets tested) in the U.S. News &
World Report's annual “Best Diets” rankings.
"U.S. News Reveals Best Diets Rankings for 2018".

73. Gurucha apatarpanam
Navanna-GS; Purana Sali-LS
Madhu new-GS; purana-GA
Godhuma-GS; Yava-LA
SAMTARPANA
High Glycemic Index foods
APATARPANA
Low Glycemic Index foods
GURU Fat rich diet Protein rich diet
LAGHU Carbhohydrate rich
diet
High fiber diet

74. DI.E.T for Management
 Dietary intervention (Pathyapathya ahara)
 Exercise (Pathyapathya vihar)
 Treatment (Chikitsa/Oushadhi)

75. Trayopastambha
(Tripod of Life )
AHARA
FOOD
NIDRA
PROPER SLEEP
BRAHMACHARYA
SELF DISCIPLINED LIFE

76. समकालीन Trayopastambha
(Tripod of Modern Life )
for prevention & control of DM
AHARA
FOOD
NIDRA
PROPER SLEEP
VYAYAMA
EXERCISE

77. Ayurvedic Management
 Claiming One medicine for DM is not Ayurveda.
 Allopathization of Ayurveda in DM management
considering Blood sugar as target & prescribing
tikta ras dravyas

78. Ayurveda inclusive Diabetes
ecosystem
 Diabetes mellitus, being a multifactorial disease, demands
multiple therapeutic approaches.
 Diabetes ecosystem is exploring diabetes and its
relationships with surrounding multiple factors in
causation, progression, regression, complications,
management, and so on.
 Ayurveda inclusive Integrative and comprehensive
healthcare model i.e., Diabetes management ecosystem is
only the possible solution to ‘setebaid’.

79. Conclusion
 80% of premature heart disease, stroke and diabetes
can be prevented. (WHO)
 Loosing India ness - INDIA HAS STARTED TO APE THE WEST BLINDLY
 Health is wealth, but Wealth is not Health
 We R Running behind the Taste
 Diseases R Running behind us
 No Hard & Fast rule - Calorie intake should be balanced
with calorie expenditure
 Diabetes education - ongoing process

80. Prof. Dr. Sathya N. Dornala
9313707117
rasayana@gmail.com