Diabetic Neuropathy

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Table of Contents
Casestudies of Contents

Brief Medical History

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 consultation AVHD:4/10/14

Integrated Summary

Patient is a known case of Diabetes for past 16 yrs and has been on allopathic medications.He has pain in the 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:74.5 kg
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 Test:

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 Protein sugar 

++++

Protein 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,
Tab Nebicard 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

Dhanwabtara 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 thrice 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.

Outcome

  • 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
70.6kg
70.1kg
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
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

Conclusion

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

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