In modern medicine diabetes is a burden upon health care facilities in all countries & its incidence is rising & it is estimated that in the year 2000, 171 million people had diabetes which is expected to double by 2030. This global pandemic principally involves type-2 DM. So prevention is the only way to have control over the global pandemic. It is possible if a satisfactory management schedule is implemented during the stage of Prediabetes (Purvarupa of Madhumeha).
What is prediabetes (Purvarupa of Madhumeha) ?
- Unlike many other chronic diseases, T2DM is not heralded by a discrete physiologic event which defines diagnoses; rather it sits at one end of a continuous glucose control spectrum with normal glucose control at the other. In-between these two boundaries exists a region of abnormal glucose control which is already characterized by concomitant insulin resistance & βcell-dysfunction but does not yet reach the criteria for T2DM.Those diagnosed with T2DM typically spend an extended period in this region of impaired glucose regulation, sometimes for more than a decade, before progressing to T2DM.
- This is a stage in which individuals are at greater risk of progressing to type 2 DM & have an increased risk of cardiovascular diseases & there is predominance of polydipsia, Burning -sensation in the palm and sole, numbness in palm and sole, Lassitude,etc.)
How can it be diagnosed ?
Diagnosis based on Symptoms :-
When a person is having the following symptoms :-
- Pipasa (Thirstyness)
- Karapada daha ( Burning sensation in the palm and sole)
- Karapada supata ( numbness in palm and sole)
- Alasya (Lassitude)
Diagnosis based on Biochemical estimation:-
When a person is having the following blood sugar level
- IFG = 100 – 125 mg/dl
- IGT = 140 – 199 mg/dl
- HbA1c = 5.7 – 6.4 mg/dl
How can it be prevented ?
Exercise for 30 min/d five times/week. The Diabetes Prevention Program (DPP) demonstrated that intensive changes in lifestyle (diet and exercise for 30 min/d fiv times/week) in individuals with IGT prevented or delayed the development of type 2 DM when implemented in the stage of increased risk of diabetes or pre-diabetes.
If a person possesses different types of strenuous exercise, unction, bath, a sprinkling of water over the body & application of ointment made by Usira,Ela, Aguru, Chandana etc, he never gets affected by this disease. 100 jojana ( 1000 miles) of walk should be completed in a year.
Limitation of exercise:
- Exercise should be continued until there is perspiration in the axilla,, forehead, tip of the nose etc.
- It should be continued until the development of aerophagia.
- It should be continued till the half of the body power is utilized.
Yoga is an ancient discipline to bring balance & health to the physical, mental, emotional & spiritual dimensions in an individual. This form of exercise acts via autonomic nervous system by deviating both sympathetic & parasympathetic indices toward more normal middle region of the reference values. Studies have shown that yoga decreases level of salivary cortisol, blood glucose, as well as plasma rennin levels, & 24 hour urine norepinephrine & epinephrine levels. Yoga significantly decreases HR, systolic & diastolic blood pressures.It has been observed that regular yogic practice at least 1 hour/ day is as effective as medical therapy in in controlling blood pressure . It retards progression of atherosclerosis in patients with severe CAD. Yoga exerts favourable effect on lipid profile by decreasing LDL & Tg levels. Yoga controls diabetes by increasing insulin sensitivity & decreasing fasting glucose levels.
The yogasanas like Ardha Matsyendrasan, Dhanurasana, Bhujangasana, Naukasana, Paschimotasana, Shavasana should be practised.
- Nutritional recommendations
- The hypocaloric diet that is low-carbohydrate. Fat in the diet (optimal % of the diet is not known; should be individualized).
- Minimal trans fat consumption.
- A Mediterranean-style diet rich in monounsaturated fatty acids may be better.
- Carbohydrate in the diet (optimal % of the diet is not known; should be individualized).
- Monitor carbohydrate intake with regard to calories.
- Sucrose-containing foods may be consumed but minimize intake.
- Use the glycemic index to predict how consumption of a particular food may affect blood glucose.
- Fructose preferred over sucrose or starch.
- Protein in the diet (optimal % of the diet is not known; should be individualized) Other components.
- Dietary fibre (25-40gm/day), vegetable, fruits, whole grains, dairy products, and sodium intake as advised for the general population.
- Nonnutrient sweeteners
- Routine supplements of vitamins, antioxidants, or trace elements not
- Salt- 5gm a day.
- Alcohol is not recommended.
- Reduction in waist circumference.
- Decrease weight by5% for overweight, 10% for obesity,15% for severe obesity & maintenance for at least one year.
Weight loss, of between 5 to 10% of initial body weight and maintenance, was a core component of all successful diabetes prevention programs.
- Translation of diabetes prevention into routine primary care.
- Identifying those at high risk.
- Smoking Cessation
- Administration of vitamin D.