Diabetic Neuropathy


A 46 year old male of Indian origin, a known case of Diabetes Mellitus since 16 years been on allopathic medications, came to AyurVAID Hospitals with several associated problems

Present Complaints:

  1. Sleeplessness
  2. Numbness in the palm
  3. Pain in calf muscles
  4. Pigmentation of skin
  5. Increased uric Acid and creatinine levels

First consultaion AVHD:4/10/14

Patient is a known case of Diabetes for past 16 yrs and has been on allopathic medications.He has pai n inthe calf muscles since about 6 yrs and increased blood pressure levels since 5 yrs.He also has elevated serum creatinine and uric acid levels.He occasionally has pain in the cervical region .

Past history:K/C/O DM,HTN,Neuropathy,Nephropathy,Maculopathy,Elevated Serum Creatinine and Uric Acid levels.Laser treatment for eye 3 yrs back

H/O:Cholelithiasis in 2010

Family History:HTN,CVA,DM

Current medication: Tab Cardace (Ramipril)OID, Tab Nemicard or Nebicard (Nebivolol) 2.5 g, Tab Ecospirin Gold (Atorvastatin) OID, Tab Trigenta 5 (Linagliptin) OID 1-0-0,Digtore 10 BID, Reminyl-D (Galantaine) OID,Insulin (Humaloy (Insulin Pump)160-165 IU

Clinical Status

Allopathy Ayurveda
Vital Parameters
  • BP:140/80
  • Pulse:76
  • Weight:74.5kg
  • BMI:31.43
Asta Sthana Pariksha
  • Nadi:
  • Malam:Saama
  • Mutra:Athi
  • Jihva:
  • Shabda
  • Sparsha
  • Drik
  • Akruti:Pravara
Examinations
  • GC:Fair.
  • CVS:NAD
  • CNS:
  • RS:NAD
  • PA:NAD
Dasa Vidha Pariksha
  • Prakriti:Kapha pitha
  • Vikriti:Vatha,Pitha
  • Sara:Madhyama
  • Samhanana:Madhyama
  • Pramana:Pravara
  • Satmya:Lavana sthmya
  • Satva:Madhyama
  • Aharashakti:Madhyama
  • Vyayam Shakti:Mahyama
  • Vaya:Madhyama
  • Desha:Pitha,Madhyama desa bala
  • Kala:16 years,Sharath ruthu,Vyaktha
Lab Tests:

Lab Investigations 28/8/14 13/10/14
FBS mg/dl 214 90
HBA1C % 11.4 10
Fasting insulin mc U /mL 150 124.3
TLC gm/dl - 13100
ESR 80 70 m /hr
S.Triglycerides mg/dl 210 170
LDL 72 78
HDL 34 25
Urine Protien and Sugar ++++ Protien Traces Glucose negative
Urea mg/dl - 48
S.Creatinine 1.8 5/10/14-1.3
13/10/14-1.4
Uric acid mg/dl 8.0 9.40 mgm/dl
Total Bilirubin - 0.8
Direct Bilirubin - 0.3
Indirect Bilirubin - 0.5
Total Protein - 7.6
GGT - 60
HB gm% 10.60 12.8
Rogi Bala- Madhyamam
Roga Bala- Balwan
DSQ findings       Rating
  • ADRS       Ultra High
Nidana Panchaka
  • Nidana:Ahitha ahara,Rathri jagarana,Asya sukha,Beeja Dosha,Sthoulya,Ati chinta
  • Purvaroopa: Prabhootha mootrata
  • Roopa:Anga marda, Anga sada, Prabhootha mootrata
  • Updrava:Sthouya, Hasta suptata
  • Arishta Lakshana: Nil
  • Samprapti Dosha: Vata Pita
  • Dushya: Rasa, Meda, Kleda, Mamsa, Lasika
  • Ama: Jatharagnimandhya janya ama.
  • Srotas: Rasa, Mamsa, Meda and Mutra.
  • Sroto Dushti Prakara:Sanga.


Roga Samprapti Flow Chart:

Nidana Sevana
|
Kapha aggravation
|
Vitiates Moothrasaya gata kleda,mamsa,lasika.
|
Vitiates Mutra vaha srotas
|
Further vitiates with involment of vatha leads to Angasada, Angamarda,Suptata,Sthoulya,Prabhuta Mutrata.
Differential Diagnosis with reasoning
DM
Insomnia
Differential Diagnosis with reasoning
Prameha
Madhumeha
Evidence Based Diagnosis with References
DM+Insomnia
Evidence Based Diagnosis with References
Madhu meha + Nidra nasha
Details of Allopathy medicine if continued
Tab. Cardace 1-0-0,
TabNebicard 2.5 g,
Tab Ecospirin Gold 0-0-1 ,
Tab Trigenta 5 1-0-0,
Tab Digtore 10 1-0-1,
Tab Reminyl-D 1-0-0,
Insulin (Humalog (Insulin Pump)160-165uts
• Tab Cardace reduced 1/2 tab from 8/`10/14 onwards.
• Insulin dose was reduced from 165 units to approximately 120 units per day.
Details of Insulin Pump:Medtronic minimed Paradigm MMT-715 Pump
Humalog Lispro 100 u/mL
Chikitsa Vivechana: Type – IPT
Duration – 4/10/14 to 18/10/14
Primary Treatments:Snehapana
Udwarthanam+Bashpa sweda,Seka
Main Treatments:Virechanam,Yogavasthy,
Post Treatments:Thalam
Internal medications
Dates Total Insulin units/24 hrs
5/10 165
6/10 124
7/10 125.5
8/10 119.75
9/10 119
10/10 -
11/10 116
12/10 70
13/10 106.5
14/10 120
15/10 115
16/10 120
17/10 124
18/10 117
Chikitsa Paddhati with details of dose of medicine
From Date To Date Procedure Treatment Medicines
4/10/14 9/10/14 Sneha pana Dhanwantara Ghrita
4/10/14 18/10/14 Udwarthana + Bashpa swedam Ellumnisadi Ch. +Triphala Ch.
10/10/14 Virechanam Avipatti Ch.
11/10/14 16/10/14 Yoga Basti Erandmooladi Kashaya
11/10/14 17/10/14 Kaya seka Dhanwantaram + Narayana Taila
4/10/14 17/10/14 Mukhalepa Elaadi Churnam
4/10/14 17/10/14 Hasta-pada Abhyanga Dhanwantaram +Prabhanjana thaila
4/10/14 17/10/14 Thalam Amlakadi yoga
- Medications:

From 4/10/14 to 18/10/14 and after the treatment also.

  • Punarnavadi Kashayam 15 ml+5 ml warm water on empty stomach at 6AM and 6 PM
  • Kataka khadiradi kashayam 15 ml+45ml warm water twice daily before food at 11.30 AM and 7.30 PM
  • T.Liv 52 1 tab thice daily after food
  • Amritha choornam 1 tsp with hot water twice daily before food (12.15 AM 7.45 PM)
  • Elaneer Kuzhambu 2 drops as anjana followed by eye wash with normal temperature water
  • Asanavilwadi thailam for external application on head one hour before bath
  • Dhanwantharam thaila, for external application on body one hour before bath.

Referral Opinion Sought if any Not required.

Integrated View

Ayurveda approach of Ahara, Vihara, Aushadh and Kriya effectively managed the disease of diabetes and corrects the metabolism to maintain sugar levels.

  • Samyak Lakshanas achieved
  • Samyak Snigdha Lakshanas achieved on 9/10/14.He got 15 vegas for virechanam,Samyak Shudhi lakshanas were achieved.
  • Other outcomes
Outcome Parameters BT AT Follow-up
Sleep (Nidra) Disturbed (duration ~ 3 hrs) Sleep quality improved (duration ~ 6-7 hrs) Improved and sound
Appetite (Agni) Vishama Sama Sama
Bowels (Mala) Regular Regular Regular
Urination (Mutra) Prabhuta Prabhuta Normal
Stress (Manas) Restless Moderate Mild
Pulse 76 72 72
Weight, Kg 74.3 kg 70.6 70.1
BMI 31.2 29.4 29.1
Pain in calf region 2 1 1
Tiredness Yes No No
Desire to sit down or lie down Yes No No
Numbness in palms Present Reduced Absent

Condition during IP stay:

4/10 5/10 6/10 7/10 8/10 9/10 10/10 11/10 12/10 13/10 14/10 15/10 16/10 17/10
FBS mg/dl 90 181 196 81 131 155 154 137 100 165 101 144 91
Urin output D >6 N 1-2 D 4-5 N 1-2 D 4-5 N 1 D 4-5 N 1 D 5-6 N 1 D 4-5 N 1 D 5-6 N 1 D 4-5 N 1-2 D 3 N 1 D 4-5 N 1-2 D 4-5 N 1-2 D 4-5 N 1-2 D 4-5 N 1-2 D 4-5 N 1-2
BP 130/90 110/70 110/70 110/70 110/70 110/60 100/80 110/70 130/90 140/90 110/70 130/90 120/80 140/90

Standardised Outcome Scales

Standard Outcome scale 4/10/14 17/10/14
S-LANSS Pain Score 6
Pittsburgh Insomnia Rating Scale 67 74

Ayurveda effectively treats diabetes and its complications by improving body’s metabolism and addressing the root cause to maintain the normal sugar levels and prevent further complications.


* Outcomes may vary from person to person

Disclaimer: * Outcomes may vary from person to person