Diabetic Neuropathy

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 consultaion 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 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

AllopathyAyurveda
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 Investigations28/8/1413/10/14
FBS mg/dl21490
HBA1C %11.410
Fasting insulin mc U /mL150124.3
TLC gm/dl-13100
ESR8070 m /hr
S.Triglycerides mg/dl210170
LDL7278
HDL3425
Urine Protien and Sugar++++Protien Traces Glucose negative
Urea mg/dl-48
S.Creatinine1.85/10/14-1.3
13/10/14-1.4
Uric acid mg/dl8.09.40 mgm/dl
Total Bilirubin-0.8
Direct Bilirubin-0.3
Indirect Bilirubin-0.5
Total Protein-7.6
GGT-60
HB gm%10.6012.8
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
DatesTotal Insulin units/24 hrs
5/10 165
6/10124
7/10125.5
8/10119.75
9/10119
10/10 -
11/10116
12/1070
13/10106.5
14/10120
15/10115
16/10120
17/10124
18/10117
Chikitsa Paddhati with details of dose of medicine
From DateTo DateProcedureTreatment Medicines
4/10/149/10/14Sneha panaDhanwantara Ghrita
4/10/1418/10/14Udwarthana + Bashpa swedamEllumnisadi Ch. +Triphala Ch.
10/10/14VirechanamAvipatti Ch.
11/10/1416/10/14Yoga BastiErandmooladi Kashaya
11/10/1417/10/14Kaya sekaDhanwantaram + Narayana Taila
4/10/1417/10/14MukhalepaElaadi Churnam
4/10/1417/10/14Hasta-pada AbhyangaDhanwantaram +Prabhanjana thaila
4/10/1417/10/14ThalamAmlakadi 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 anyNot 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.

Outcomes

  • 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 ParametersBTATFollow-up
Sleep (Nidra)Disturbed (duration ~ 3 hrs)Sleep quality improved (duration ~ 6-7 hrs)Improved and sound
Appetite (Agni)VishamaSamaSama
Bowels (Mala)RegularRegularRegular
Urination (Mutra)PrabhutaPrabhutaNormal
Stress (Manas)RestlessModerateMild
Pulse767272
Weight, Kg74.3 kg70.670.1
BMI31.229.429.1
Pain in calf region211
TirednessYesNoNo
Desire to sit down or lie downYesNoNo
Numbness in palmsPresent Reduced Absent

Condition during IP stay:

4/105/106/107/108/109/1010/1011/1012/1013/1014/1015/1016/1017/10
FBS mg/dl901811968113115515413710016510114491
Urin outputD >6 N 1-2D 4-5 N 1-2D 4-5 N 1D 4-5 N 1D 5-6 N 1D 4-5 N 1D 5-6 N 1D 4-5 N 1-2D 3 N 1D 4-5 N 1-2D 4-5 N 1-2D 4-5 N 1-2D 4-5 N 1-2D 4-5 N 1-2
BP130/90110/70110/70110/70110/70110/60100/80110/70130/90140/90110/70130/90120/80140/90

Standardised Outcome Scales

Standard Outcome scale4/10/1417/10/14
S-LANSS Pain Score6
Pittsburgh Insomnia Rating Scale6774

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

Disclaimer: * Outcomes may vary from person to person