Homoeopathic Repertorial approach in Diabetes mellitus

Dr Fathima Nashath A

Abstract
Diabetes mellitus is a chronic metabolic disorder characterized by high blood sugar levels, which can lead to various complications affecting multiple organ systems. Conventional medical management primarily focuses on controlling blood glucose levels through medication and lifestyle changes. However, there is growing interest in alternative approaches, including homeopathy, which offers a holistic and individualized treatment strategy. The homeopathic repertorial approach involves using a repertory, a reference book that catalogs symptoms and corresponding remedies, to identify the most suitable homeopathic medicines based on a patient’s unique symptom profile. This approach emphasizes treating the patient as a whole rather than just the disease, considering the psychological, emotional, and physical aspects of the individual. Recent studies have explored the potential of homeopathic remedies in managing symptoms and complications associated with diabetes mellitus, suggesting possible benefits in enhancing overall well-being and improving quality of life.

This article  discusses the role of the homeopathic repertorial approach in diabetes management, exploring its principles, methodologies, and potential therapeutic benefits, while also addressing the challenges and limitations faced in integrating this approach within conventional diabetes care.

DIABETES MELLITUS

pancreas

• The endocrine component of the pancreas consists of different types of cells: α-cells, β-cells, δ-cells and PP cells contained in the islets of Langerhans which constitute 1% of its weight
• There are 100,000 islets in the pancreas,
• and each islet contains 1000-3000 cells
• Thus altogether there are 100-300. million β-cells in the pancreas.
• 95% – exocrine function 5%- endocrine function
• The beta cells produce insulin, alpha cells produce glucagon, delta cells produce somatostatin and the PP cells produce pancreatic polypeptide.
• Pancreatic beta cells can store 200 units of insulin and can release 30-50 units of insulin per day

Diabetes mellitus

• Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia with or without glycosuria, resulting from an absolute or relative deficiency of insulin.
• factors contributing to hyperglycemia include
• reduced insulin secretion,
• decreased glucose utilization, and
• increased glucose production

Epidemiology

• The worldwide prevalence of DM has risen dramatically over the past two decades, from an estimated 30 million cases in 1985 to 463 million in 2019 .
• Based on current trends, the IDF projects that 642 million individuals will have diabetes by the year 2040 .
• Although the prevalence of both type 1 and type 2 DM is increasing worldwide, the prevalence of type 2 DM is rising much more rapidly, presumably because of dietary changes and increasing obesity, reduced activity levels as countries become more industrialized, and aging of the population.
• The incidence of type 1 diabetes has been increasing at a rate of 3% per year worldwide

CLASSIFICATION

The Classification suggested by American Diabetes Association (ADA) is called as the etiological classification of diabetes and has the two main types of diabetes labeled as

• type 1 DM/insulin dependent DM
• type 2DM/non insulin dependent DM
• gestational diabetes mellitus and
• the other specific types where a precise etiological factor is identified.

Type 1 DM develops as a result of autoimmunity against the insulin-producing beta cells, resulting in insulin deficiency.

Type 2 DM is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased hepatic glucose production.

Both type 1 and type 2 diabetes are preceded by a period of progressive worsening of glucose homeostasis, followed by the development of hyperglycemia that exceeds the threshold for clinical diagnosis.

In terms of type 2 diabetes, this phase is referred to as prediabetes and is more specifically classified as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)

GESTATIONAL DM

• Glucose intolerance developing during the second or third trimester of pregnancy is classified as gestational diabetes mellitus (GDM). Insulin resistance is related to the metabolic changes of pregnancy, during which the increased insulin demands may lead to IGT or diabetes.
• The American Diabetes Association (ADA) recommends that diabetes diagnosed within the first trimester be classified as preexisting pregestational diabetes rather than GDM.
• . Most women with GDM revert to normal glucose tolerance postpartum but have a substantial risk (35–60%) of developing DM in the next 10–20 years.
• In addition, children born to a mother with GDM also have an increased risk of developing metabolic syndrome and type 2 DM later in life.
• Currently, the ADA recommends that women with a history of GDM undergo lifelong screening for the development of diabetes or prediabetes at least every 3 years.

Pathophysiology of Type 1 Diabetes

• Type 1 diabetes is an autoimmune condition in which the body’s immune system attacks its own pancreatic beta cells.
• More specifically, the T-cells of the immune system destroy pancreatic beta cells in genetically predisposed individuals.
• This autoimmune attack damages the beta cells, preventing them from producing or releasing insulin.
• in type 1 diabetes the beta cells of the islets of Langerhans show reduction in number, degranulation and hyalinization.
• In recent onset type 1 DM lymphocytic infiltration of the islets occurs and this may be caused by viral infection.
• Inflammation is seen particularly around the beta cells only and not around the other types of cells.

Pathophysiology of Type 2 Diabetes

• In type 2 diabetes, insulin receptors on cell surfaces become resistant to insulin.
• This means that glucose cannot be taken up into the cell from the bloodstream
• Cells become deprived of glucose and blood sugar levels inappropriately rise.
• To compensate for insulin resistance and to maintain normal glucose levels, the pancreatic beta cells will initially increase insulin synthesis .
• The increase in insulin production and secretion is a temporary fix to overcome the lack of sensitivity of insulin and allow the body’s cells to take up glucose
• However, the increase in insulin production and secretion will eventually lead to accelerated beta cell changes and/or damage.
• This will cause a subsequent decrease in insulin production and secretion —type 2 DM

Vascular Changes

microangiopathy,

• there is specific involvement of the small blood vessels Venules, capillaries and arterioles etc.
• There is deposition of PAS (periodic acid Schiff) positive material in the capillary basement membrane.The basement membrane is thickened. Ultimately there is vascular occlusion.
• Microangiopathy is most marked in type 1, developing early in life but also occurs in type 2.

Macroangiopathy

• Occure in medium sized arteries such as the coronary, cerebral and peripheral limb vessels.
• There is increased risk of ischemic heart disease, cerebrovascular accidents and ischemia to the limbs with intermittent claudication and peripheral gangrene.

Retinopathy

• Diabetes mellitus produces a classical retinopathy. A specific change occurs in the vessels leading to loss of mural cells (pericytes).
• venous dilation and the appearance of small dot like micro aneurysms in the perimacular area
• Leakage of fluid in to retina-macular oedema
• As disease progress ,the BV that nourish the retina become swollen and distorted –reduced blood supply to the areas of retina. (The irregularly shaped white patches as a result of ischemia to the retinal nerve fibre layer—cotton wool spot)
• Neovascularization (growth factors released by the retina triggers the formation of new BV)
• As these BV are fragile,rupture of it leads to subhyaloid and vitreous hemorrhages .
  These new blood vessels can form scar tissue.Contracture of this scar tissue leads to retinal detachment

Renal lesion

• These are commonly seen in subjects who have had diabetes for over 15-20 years.
• Vascular changes include

(i) arteriosclerosis of the renal artery,

(ii) sclerosis of the arterioles and

(iii) glomerulosclerosis.

• Glomerulosclerosis may be nodular (Kimmelstiel-wilson lesion) or diffuse.
• There is accumulation of PAS positive eosinophilic material within the mesangium. There is thickening of the glomerular capillary basement membrane.
• The establishment of glomerulosclerosis is indicated by the presence of proteinuria. Further damage to the glomeruli results in the development of chronic renal failure.

Peripheral Nerves

• hyperglycemia and the defects in insulin function lead to oxidative and apoptotic stresses as well as activation of innate inflammatory factors.
• The infiltrated macrophages inside peripheral nerve cells trigger cytokine and chemokine production, promoting inflammation and nerve fiber damage.

CLINICAL FEATURES

• Around 50% of the cases present with the classical symptoms of polyuria, polyphagia and weight loss
• non-healing ulcers
• recurrent respiratory or urinary tract infections
• Rapid changes in refraction of the eyes
• steady and unexplained rapid weight loss
• increased tendency for fungal infections like moniliasis, balanoposthitis and vulvitis
• unexplained peripheral neuropathy=Tingling, numbness,burning sensation,weakness of limb etc.
• premature onset of ischemic heart disease, stroke or vascular occlusions
• history of overweight babies and recurrent fetal loss in women
• premature cataract often below the age of 50 years and retinopathy
• impotence in males, and
• any vague ill-health.
• Acanthosis nigricans -dark, thickened, and velvety patches of skin- is a cutaneous marker of hyper insulinemia

Diagnosis

• Clinical history
• Blood test- FBS,PPBS,HBA1C,RBS
• RPG (random plasma glucose): If the RPG value is ≥200 mg/ dL (11.1 mmol/L) of blood, it indicates that the person has diabetes.
• Urine analysis
• Glucose tolerance test (GTT)- GTT is mainly used for diagnosis of diabetes whenblood glucose levels are equivocal, during pregnancy, or in an epidemiological setting to screen for diabetes and impaired glucose tolerance.

The blood sugar level is checked in the fasting state and then 2 hours after drinking a certain amount of glucose. It shows how the body processes glucose. If the 2-hour value is ≥200 mg/dL (11.1 mmol/L), it indicates the presence of diabetes.

• Glycated haemoglobin (HbA1C)

this test measures how well the blood sugar has been controlled over the past 3 months. If the HbA1C is ≥6.5% (47.0 mmol/ mol), it indicates the presence of diabetes

• C-Peptide test
• TO find out the amount of insulin body makes and to determine pancreatic beta cell function
• The normal range for C-peptide in a healthy person is 8–3.85 milligrams per   milliliter (mg/ml) or 0.26–1.27 nanomoles per milliliter (nmol/ml

Used for

• to diagnose type 1/type 2 dm
• to manage diabetes treatment (how much insulin produced, treatment plan)
• to find out cause of hypoglycemia( related to high insulin in body)
• to monitor insulinoma treatment

Complications

Acute Complications

1)Metabolic derangements

1. Diabetic ketoacidosis and coma.
2. Hypoglycemia
3. Hyperosmolar nonketotic coma
4. Lactic acidosis

2)Infections

1. a) Medical: Acute infections such as skin infections, respiratory tract infections, UTI et.

b)Surgical: Boils, carbuncles, cellulitis, superficial and deep abscesses, gangrene,

3. Acute events occurring as a result of the long-term complications

• Ischemic heart disease-acute
• Renal failure
• Peripheral vascular occlusion
• Loss of vision

3. Obstetric Complications
   

• Intrauterine fetal death
• Hydramnios, more frequent
• Higher frequency of pre-eclamptic toxemia
• Large baby (> 4 kg)
• Infections of the genital tract

Long-term Complications

1. Cardiovascular: ischemic heart disease, cerebrovascular accidents,etc,
2. Neurological: Peripheralneuropathycranial nerve palsies, urinary retention and incontinenceetc.
3. 3. Peripheral vascular diseases
4. Renal: Recurrent urinary infections, chronic pyelonephritis, diabetic glomerulosclerosis, end stage renal failure.
5. Ocular: Cataract, retinopathy,glaucoma, etc,
6. Respiratory: Pulmonary tuberculosis, other infections.
7. Alimentary: Xerostomia, stomatitis, gingivitis,dental sepsis, etc,
8. Bone and joints: Osteoporosis, osteoarthritis, and (Charcot’s joint).
9. Skin: Chronic fungal infections of skin, moniliasis, pruritus vulvae, etc,
10. Drug induced complications: Hypoglycemia, drug allergy, toxicity to liver and bone marrow

Management and Treatment

Treatment plan

• Diet/lifestyle Modification
• Exercise
• Medication

1)Diet/lifestyle Modification

• General dietary guidelines

Vegetable, fruits, whole grains, legumes, low-fat dairy products and food higher in fiber and lower in glycemic content;

• Fat in diet

Mediterranean-style diet rich in monounsaturated and polyunsaturated fatty acids • Minimal or no trans fat consumption.

The fat content of diet should be 20-25% of the total calories.

• Protein in diet

Protein intake should contribute to 12–20% of the total caloric intake.

Vegetable proteins(do not contain cholesterol) is good than animal protein. They have high fiber content. Animal protein is rich in saturated fats and tends to increase cholesterol and triglycerides.

• Carbohydrate in diet

In an attempt to reduce cardiovascular morbidity and mortality, ADA now recommend a liberalized use of carbohydrates in the diet up to 50-60% of the calories

Avoid fructose- and sucrose-containing beverages and minimize consumption of foods with added sugar that may displace healthier, more nutrient-dense food choices and elevate postprandial glycemia.

• Other components

The dietary salt should be less than 6 g/day. In the presence of hypertension or renal failure it should be reduced to around 3 g/day.

Avoid tobacco use and harmful use of alcohol.

Manage stress.

Exercise

• Walk 3 km on level ground over a period of 45 minutes
• Swim for 30 minutes at average speed without cardiovascular distress.
• Cycle on level ground at 8 km/hour for 30 minutes.
• Yoga exercises

Medication

Oral hypoglycemic agents,

• Glibenclamide
• Glimepiride
• Repaglinide
• Nateglinide
• Metformin etc.

Insulin therapy

Indications :-

• All type 1 diabetes patients.
• In type 2 diabetes patients

1. During episodes of metabolic complications like diabetic ketoacidosis, lactic acidosis.
2. During infections, myocardial infarction, stress, surgery, renal insufficiency or infective hepatitis.
3. During pregnancy
4. When diet, exercise and oral hypoglycemic agents fail to achieve euglycemia
5. Lean type 2 diabetes patients with very high blood glucose levels at onset
6. Even in non-diabetics, when the blood glucose level rises under stress such as myocardial infarction or septic shock, insulin is used to lower blood glucose

REPERTORIAL APPROACH

SYNTHESIS REPERTORY

• GENERALS – DIABETES MELLITUS
• NAT-S ,SYZYG,TER
• URINE-SPECIFIC gravity-increased
• ARN,COLCH
• GENERALS-WOUNDS-heal tendency to-slowly
• HEP,LACH,NIT-AC,PETR,SIL,SULPH
• GENERALS,DM,Pancreas; from complaint of
• Iris,pancr,phos
• GENERALS,DM,accompanied by,abdomen distention of;tympanitic
• Uran-n
• GENERALS,DM,accompanied by,ankle;swelling of the
• Arg-met
• GENERALS,DM,accompanied by,feet,numbness of
• Helon
• GENERALS,DM,accompanied by,abscess
• Ars
• GENERALS,DM,accompanied by,paralysis
• Cur
• GENERALS,DM,accompanied by,psoriasis
• Mang-acet
• GENERALS,DM,accompanied by,acne
• Ars-br
• GENERALS,DM,accompanied by,albuminuria
• Helon
• GENERALS,DM,accompanied by,apoplexy
• Con
• GENERALS,DM,accompanied by,boils
• Anthraci,anthraco
• GENERALS,DM,accompanied by,eczema
• Ins
• GENERALS,DM,accompanied by,gallstone
• But-ac
• GENERALS,DM,accompanied by,gangrene
• Ars,sec
• GENERALS,DM,accompanied by,gastric disorder
• Uran-n
• GENERALS,DM,accompanied by,glycosuria;true
• Ph-ac
• GENERALS,DM,accompanied by,hypertension
• Sec
• GENERALS,DM,accompanied by,hyperthyroidism
• Kali- iod
• GENERALS,DM,accompanied by,leukorrhea
• Abrom-a
• GENERALS,DM,accompanied by,respiration asthmatic
• Nat-s
• GENERALS,DM,accompanied by,thirst
• helon
• GENERALS,DM,accompanied by,skin itching of the
• Con,graph,sul-ac
• GENERALS,DM,accompanied by,ulcers
• Sec,syzyg
• GENERALS,DM,accompanied by,UTI
• Canth,helon,rhus-a
• GENERALS,DM,accompanied by,urine,constant urging
• Nat-p
• GENERALS,DM,accompanied by,vulva itching
• Pic-ac,sep
• GENERALS,WEAKNESS,diabetes mellitus in
• Arg-met,ars.lac-ac
• GENERALS,DM,children in
• Calc-p,crat
• GENERALS,DM,inflammation of CNS after
• Lycps-v
• GENERALS,DM,insulin dependent
• Ins,nat-p,sulph
• GENERALS,DM,rapidly;developing
• Cur,morph
• GENERALS,FAMILY HISTORY of ,DM
• Carc,sacch,thuj
• GENERALS,NEUROLOGICAL complaints,accom by,DM
• Helon
• GENERALS,SHOCK,followed by,DM
• Op

KENT REPERTORY

• URINE,SUGAR
• BOV,HELON,LYC,PH-AC,PHOS,TARENT,TER,URAN-MET
• URINE,SPECIFIC GRAVITY,increased
• ARN,COLCH
• GENERALS,WOUND,heal,slow to
• HEP,LACH,NIT-AC,PETR,SIL,SULPH

BBCR

• URINE,Saccharine
• ARS,NAT-MUR,PH-AC,SULPH,THUJ,

TPB

• URINE,Glycosuria
• Ars,uran

BOERICKE REPRTORY

• URINARY SYSTEM,Diabetes,sugar

MURPHY

• CLINICAL,-Diabetes mellitus
• BOV,CARC,HELON,LYC,PHOS,PH-AC,PLB,SYZYG,TER,URAN-N
• CLINICAL,-Diabetes mellitus,acidosis with – nat-p
• CLINICAL,-Diabetes mellitus,debility with – acet-ac,carc,insulin,op,ph-ac
• CLINICAL,-Diabetes mellitus,diarrhea, chronic with – insulin
• CLINICAL,-Diabetes mellitus,hepatitis with – insulin
• CLINICAL,-Diabetes mellitus,neuropathy with – cur,insulin,phos
• CLINICAL,-Diabetes mellitus,gouty symptom with –insulin,lac-ac,nat s
• CONSTITUTION, Diabetes mellitus in
• Arg,ars,carc,coca,lac-ac,PHOS-AC,PHOS
• URINE,SPECIFIC GRAVITY,urine,increased
• ARN,COLCH
• CLINICAL,WOUND,general, slow to heal
• CALEN,CARC,HEP,LACH,NIT-AC,SIL,SULPH

COMPLETE REPERTORY

• URINE,SUGAR
• CLINICAL,DIABETES mellitus ,type 2
• CLINICAL,DIABETES mellitus ,type 2,amenorrhea with, – uran-n(2)
• CLINICAL,DIABETES mellitus ,type 2,boils,successive with –NAT-P(3)
• CLINICAL,DIABETES mellitus ,type 2,death of loved one after –kali-br(2)
• CLINICAL,DIABETES mellitus ,type 2,lung complaint in – CALC-P(3)

OTHER REPERTORIES

CLARKE J, Clinical repertyory

• Clinical –D- diabetes mellitus – op, uran-n

PHATAK, Concise repertory

• D-Diabetes mellitus –BOV,HELON,LYC,PH-AC,PHOS,TARENT,TER,PLB,URAN-N
• D-Diabetes mellitus,children in-crat
• D-Diabetes mellitus,boils,successive with – nat-p
• D-Diabetes mellitus,lung affection with – calc-p

Miasmatic approach

• According to H.A Robert- the diabetic patient is as a rule strongly tubercular ;sometimes in these conditions there is a strong taint of the sycotic which make the condition more violent.
• According to Banerjea – diabetes included under psoro-syphilitic clinicals

THERAPEUTICS

Uranium nitrate

• This remedy is praised highly by Hughes and others in diabetes originating in dyspepsia.
• It has polyuria, polydypsin, dryness of the mouth and skin. It causes sugar in the urine.
• Laning said that no remedy gives such univer- sally good results;
• he recommended the 3x trituration.
• It is when the disease is due to assimilative derangements that Uranium is the remedy, and symptoms such as defective digestion, languor, debility and much sugar in the urine, enormous appetite and thirst, yet the patient continues to emaciate.

Phosphoric acid

• corresponds to diabetes of nervous origin; the urine is increased, perhaps milky in color and containing much sugar.
• It suits cases due to grief, worriment and anxiety, those who are indifferent and apathetic, poor in mental and physical force.
• It is unquestionably curative of diabetes mel litus in the early stages
• There will be loss of appetite, sometimes un- quenchable thirst and perhaps the patient will be troubled with boils. When patients pass large quantities of pale colorless urine or where there is much phosphatic deposit in the urine it is the remedy. It thus may be a remedy in the form known as diabetes insipidus.

Phosphorus.

• Useful in diabetes and pancreatic diseases, especially in those of a tuberculous or gouty diathesis. The pancreatic involvement will call attention to Phosphorus..
• urine profuse, pale, watery; or turbid,whitish, like curdled milk, with brickdust sediment .
• Indicated in diabetic neuropathy and retinopathy

Natrum sulphuricum

• corresponds to the hydrogenoid constitution, with dry mouth and throat.
• Hinsdale reports good results with This remedy.
• It has polyuria, intense itching of the skin, especially upon the upper surface of the thighs.
• It is the Tissue Remedy of diabetes.

Arsenicum

• useful in carbuncles and diabetic gangrene with cadaverous odor and burning pains which are better by heat. Ulcers on toes and soles with wooden feeling in soles
• Sudden and extreme dryness of the mouth and marked physical restlessness are also guiding symptoms to this remedy, especially with a dark watery stool.
• Hepatic origin of diabetes due to chronic alcoholism
• Neuropathy – The patient complains of burning pains especially in the palms and soles which are better by heat. Neuralgias and multiple neuritis

Lactic acid

• An exceedingly good remedy in the gastro Hepatic variety of diabetes and good results often follow its use.
• It has a fine clinical record. The symptoms are:urinate copiously and freely, urine light yellow and saccharine, thirst, nausea, debility, voracious appetite and costive bewels. Dry skipn dry tongue, gastralgia.

Acetic acid

• Acetic acid is also a valuable diabetic remedy, and it has passing of large quantities of pale urine, intense thirst, hot, dry skin and marked debility.
• Abundant sugar in urine, great thirst, but cold drink lies heavy on stomach.

Bryonia alba

• No other remedy has such dryness of the lips as a symptom of hepatic disorders as Bryonia has, and this is often one of the first symptoms of diabetes.
• There is a persistent bitter taste in mouth. Patient is languid, morose, dispirited. Patient emaciates and may lose strength due to inability to eat.

Chionanthus

• Chionanthus is a remedy used by the Eclectic School upon the indications of thirst, frequent and copious urine; constipation with stools light colored, devoid of bile.
• Diabetes with hepatic troubles, enlarged liver and spleen

Insulin

• Long before the discovery of Insulin Dr. Pierre Jousset of Paris prepared a pancreatic juice on a glycerine basis which he administered to diabetic patients in doses of 10 or 20 drops a day in water and had results sufficiently good to consider pancreatic juice, orally administered, as a remedy of great value in diabetes.
• Baker advises the homeopathic strengths of Insulin 3d to 30th and reports happy results therefrom. Great care must be taken not to overdose.
• Boericke says that it maintains the blood sugar at a normal level and the urine remains free of sugar.
• Supposed to be specific and useful in case of carbuncles resulting from DM.

Argentum nitricum

• Diabetes of nervous and gastric origin in patients who are mentally and physically exhausted.
• Dried emaciated persons due to long continued mental work. Craving for sweets. Nervous, impulsive, want to do things in a hurry. Intolerance of heat.
• Dyspepsia, belching accompanies all gastric complaints. Profuse urination, impotence, irregular blotches over the skin.

Causticum

Diabetic neuropathy with paralysis and numbness. Cracking in knees. Stiff muscles with sensation as if the tendons were shortened. Paralysis ameliorated by cold applications even by cold drinks. Emaciation. Cataract

Plumbum metallicum

• Hering considered Plumbum one of the most important remedies in diabetes mellitus.
• Diabetes with paralytic tendency.
• Urine albuminous with low specific gravity,c/c intersticial nephritis
• dryness of mouth; dry, cracked tongue, great exhaustion; impotence; excessive emaciation; great hunger; Chronic lead-poisoning produces a perfect picture of glycosuria and of morbus Brightii .

Ceanothus americanus

• Diabetes in persons with splenic troubles, enlargement and pain in the left side of the abdomen which is worse lying on the left side.
• Green frothy urine which contains sugar.
• Diabetes complicated with hypertension

Helleborus niger

• The symptomatology of this remedy corresponds to one of the acute medical emergencies – Diabetic Pre-coma – most commonly due to hypoglycaemia either due to inadequate oral intake or an overdose of insulin or oral hypoglycaemic agents.
• The patient picks at his lips and clothes. There is a constant chewing motion of the jaw. Sighing respiration with slow, small, soft pulse. The patient shrieks and shouts; he cannot be fully aroused.
• Another characteristic symptom is that the patient greedily swallows water even when unconscious.

Helonias dioica

• Diabetes, first stages ; urine profuse, clear, contains sugar. Albuminuria with great weakness
• Lips dry, stick together: great thirst, restlessness ; emaciation; irritable and melancholy.
• Patient is better when kept busy.
• Feet feel numb when sitting-diabetic neuropathy

Morphinum

• A most useful remedy for diabetic neuropathy. Intensely painful neuralgias better by hot applications. Multiple neuritis.
• Diabetic Pre-coma and Coma with very dry mouth and great thirst. Difficult swallowing from paralysis of the pharynx; better hot drinks, worse solids.

Secale cor

• An excellent remedy for diabetic gangrene
• Dry gangrene of toe. Dusky blue tinge.
• Skin feels cold to touch yet covering not tolerated. Warmth aggravation.

MOTHER TINCTURES

Abroma augusta q

• It is an excellent remedy where the quantity of sugar is excessive and the urine is loaded with high specific gravity
• Patient passes large quantity of clear urine at night, excessive thirst, insomnia and prostration are other marked features.
• Patient is averse to do any physical or mental labor

Cephalandra indica q

• It is a great homoeopathic drug for Diabetes mellitus, associated with biliousness, abscess, boils and carbuncle
• profuse urination making the patient weak with dryness of mouth and considerable thirst, often worse after urination.
• The whole body “burns like fire”, relieved by cold bathing.

Gymnema sylvestre Q

• It is almost specific for diabetes called as “Sugar Killer”
• urine is loaded with sugar, with high specific gravity .
• after passing urine patient feels extremely weak. Profuse urination, passes several times a day and in copious quantity.
• There is a burning all over the body, diabetic carbunces.
• Dose :5 drops thrice daily

Syzygium Jambolanum Q

• It is capable of reducing the amount of sugar in the urine, especially when used in tincture form or very low trituration
• great thirst, weakness, emaciation.
• Patient passes large quantity of urine of high specific gravity.
• diabetic ulcer and gangrene
• Dose :5 drops 4 times daily

Rhus aromatica Q

• Renal and urinary affection especially diabetes
• Large quantities of urine with low specific gravity

Memordica charantia Q

• An excellent specific remedy for diabetes

Echinacea Q

• Diabetic gangrene :Emitting a foul smell from the gangrene. Use internally and externally.
• It act as a cleaning and antiseptic agent.

JOURNAL

1)Diabetes mellitus – Defining scope and clinical approach for homoeopathic management

• Published in ijrh
• M. L. Dhawale Memorial Trust, Mumbai

Abstract

• The study was undertaken to explore if there was a definite role of homoeopathic medicines in the management of Diabetes Type 2 and, if so, to determine the role of Constitutional and Organ remedies in its management.
• 90 patients were studied by Randomized Single Blind Clinical Trial by dividing them into three groups – Constitutional, Organ and Placebo.
• At the end of the trial 70% from the constitutional group improved as compared to 10% from the Organ remedy group and 7% from the placebo group

Conclusion

• Homoeopathic Medicines are effective in the management of Diabetes Mellitus Type 2.
• Both Constitutional and Organ remedies have been found useful in the management of Diabetes Mellitus Type 2 but, constitutional medicines give a sustained relief in the symptoms and in the blood sugar levels on long term management. Organ remedies are useful in the reduction of blood glucose levels in the short term management of Diabetes Type 2.
• Calcarea carb., Nat. mur. and Silicea were the most frequently indicated constitutional remedies
• Syzygium jamb. was the most frequently indicated organ remedy.
• 200 C potency was required in most of the cases

2)Diabetic foot ulcer treated with the homoeopathic medicine Lachesis mutus in millesimal potencies: A case report

• Published in ijrh
• Lalith Singh ,Raja Manoharan ,Niharika Shaw ,Saleem Ansari
• National Institute of Homoeopathy, Kolkata, West Bengal, India.

Abstract

• This case report presents a case of a diabetic patient complaining of a foot ulcer for the past nine years, following the bite of a mongoose.
• On the basis of totality of symptoms, individualised homoeopathic medicine Lachesis mutus was prescribed. The ulcer improved in three months after homoeopathic medication without the use of any external application. The improvement has been depicted in this case report through pictographic evidence.
• The subjective assessment of the case was done using Outcomes Related to Impact on Daily Living (ORIDL) and Modified Naranjo Criteria for Homoeopathy
• (MONARCH) was used to evaluate the causal-effect relationship in the case, which showed a score of +3 and +8, respectively.
• The improvement in the ulcer was also assessed through photographs.

Patient Information

• A 52-year-old male, farmer by profession, presented in OPD of the National Institute of Homoeopathy, Kolkata, on August 16th, 2022 with the complaint of ulcer and swelling on the left great toe and over the medial malleolus of the right foot with an electric sensation-like pain radiating upwards in both legs. The ulcer reported to be painless with irregular margins and sloping edges with the base containing a variable amount of slough, necrotic tissue, exudate and blackish discolouration. of the skin around the ulcers.
• There was an offensive yellowish thick discharge from the ulcer.The patient developed this wound over the left great toe after a mongoose’s bite nine years ago, which never recovered fully, and aggravated in the past year. He had used several ointments externally for treating the ulcer but in vain.
• patient was diagnosed with diabetes mellitus type 2, 15 years ago.
• His blood sugar level was noted to be 147 mg/dL while fasting and 216 mg/dL in the post-prandial period.

Clinical findings

• On general physical examination, the patient appeared anxious. He was of moderate stature and weighed 68 kg. His tongue was dry, trembling and got caught between his teeth while protruding tongue for long. His face was sufficiently flushed. No signs of anaemia, cyanosis or hyperbilirubinaemia could be traced. No arteries or veins were engorged, nor any lymph nodes were swollen.

Generals

• The patient was irritable and anxious about his health condition.
• He used to get angry easily, He was bothered about no one taking care of his disease seriously or taking care of him.
• He was forgetful. He was also loquacious and could not bear any tight clothing on his body.
• He had some unusual fear of snakes also as mere imagination of snakes would give him goosebumps.
• His appetite was more than usual, with intolerance to hunger. The patient had a strong desire for warm food and sour things.
• Thermally, the patient was hot but had a tendency to catch cold easily with profuse, offensive sweat.
• The sleep of the patient was sound but he had frequent dreams of snakes

Therapeutic intervention

• The selection of the remedy was done based on repertorisation by RADAR software version 10.0[9] using the Repertory of J.T kent.
• 16 doses of Lachesis mutus 0/1 were prescribed,followed by 0/2 16 d0ses upto———-o/8 16 doses.Six globules (Globule No. 20) of each potency were dispensed in 100 ml of distilled water. Ten drops of rectified spirit were added as a preservative. The patient was asked to take medicine every morning on an empty stomach after ten downwards succussions and report after one month.
• The cleaning of the wound was advised twice daily with normal saline

Conclusion

• This case of DFU showed promising results from internal medication. The homoeopathic treatment of DFUs can result in reduced hospitalisation, lesser cost of treatment and also bring down amputation rates of DFU patients, thus recommending more focus on further research of managing DFUs with Homoeopathy.

REFERENCES

• Harrison’s principles of internal medicine
• Textbook of medicine K.V.Krishna das
• Synthesis repertory-Dr,Frederik schroyens
• Homeopathic medical repertory-Robin murphy
• Repertory of homeopathic materia medica J.T.Kent
• Boenninghausen’s Therapeutic pocket book
• Bger boenninghausen’s characteristics and repertory
• Boericke repertory with materia medica
• Complete dynamics
• Radar software
• Practical homeopathic therapeutics W.A.Dewey
• Mother tincture & low potency prescription –Dr.S,K.Gopi
• Kansal Kamal ,Homoeopathic Treatment of Diabetes Mellitus
• The principles and art of cure by homeopathy-H.A.Robert
• Miasmatic prescribing -Dr.S.K.Banerjea
• www,ijrh,org

Dr.Fathima Nashath A
PG Scholar, Govt Homoeopathic Medical College Calicut
Under the Guidance of Dr Mansoor Ai KR
Email : nashath987@gmail.com