Diabetes Mellitus

Western Overview

Diabetes Mellitus is a common disease of the endocrine system.  One in every 20 people living in the U.S. have been diagnosed with the disease.  Non-insulin-dependent diabetes mellitus (NIDDM) accounts for about 90% of all cases, and is usually diagnosed in patients older than age 40.

Western Medical treatments for Diabetes Mellitus are often complicated by below normal blood sugar levels caused by accidental over-administration of insulin or mistimed injections, exercise, skipped or scanty meals.  Severely low blood sugar can be life-threatening, as energy starvation in the central nervous system may include mental impairment, confusion, lethargy, seizures, and in severe cases may cause hypoglycemic coma and death.

 

Traditional Chinese Medical Perspective

Chinese Medicine primarily utilizes herbal formulas to treat patterns fitting the profile of Diabetes Mellitus.  In China herbal formulas have been utilized to successfully reduce blood sugar in diabetic patients without side effects, especially for patients diagnosed with the more common NIDDM.

In Chinese Medicine the various presentations of Diabetes Mellitus are known as Xiao Ke Syndrome, which is classically differentiated into three kinds of patterns based upon the patient’s chief presenting symptom:

  1. Shang-Xiao: excessive thirst
  2. Zhong-Xiao: excessive hunger
  3. Xia-Xiao: frequent urination, often accompanied by turbid discharge

However this “Three Xiao” diagnostic method does not fit the realities of clinical practice, because most modern patients experience symptoms of all three.  After analyzing many clinical cases of NIDDM, diabetic symptoms are more accurately differentiated into eight patterns:

  1. Lu heat with fluids injury
  2. Lu and St dry heat
  3. Lv and Kd Yin deficiency
  4. Qi and Yin deficiency
  5. Yin and Yang deficiency
  6. Qi deficiency with phlegm-dampness
  7. Damp heat accumulation
  8. Blood stagnation.

Factors Contributing to Disease Onset:

  1. Constitutional Yin deficiency (Congenital Yin deficiency & Postnatal Yin injury)
  2. Sp Qi deficiency
  3. Dietary indiscretion (excessive intake of sweet and/or fatty foods)
  4. Emotional disturbances

 

Diagnosis

1. Major clinical manifestations

  • Frequent, copious urination
  • Excessive thirst
  • Excessive hunger
  • Rapid weight loss
  • Drowsiness, fatigue
  • Itching of the genitals and skin
  • Visual disturbances
  • Skin infections
  • Slow healing
  • Paraesthesias of the hands or feet

2. Laboratory diagnosis

  • Hemoglobin A1c levels above 6.0%
  • Fasting plasma glucose value is greater than or equal to 126 mg/dl.

Some mild diabetics will have normal fasting blood sugar, with values in the diabetic range only after meals.

 

Common Complications

Neuropathy

Pain in the legs and feet which often is worse at night, relieved by activity, and aggravated by cold.  Usually this is accompanied by paraesthesias and cramps.  Nerves of the arms, abdomen and back may also be affected.  Symptoms may include impaired heart function, slowed digestion, reduced or absent perspiration, severe edema, carpal tunnel syndrome, alternating diarrhea and constipation, urinary and fecal incontinence, and sexual impotence.

Retinopathy

Caused by narrowing, hardening, bulging, hemorrhaging or severing of the veins and capillaries of the retina.

  1. Earlier stage: diminished vision, contraction of the visual field, changes in the size of objects or aversion to light.
  2. Later stage: proliferative retinopathy, hemorrhages, retinal detachment and other serious forms of deterioration are observed, potentially leading to total blindness.

Arteriosclerosis

In diabetic patients this hardening usually occurs in the walls of arteries serving the lower extremities and is associated with peripheral vascular disease, it may produce disturbances in sensation (similar to neuropathy), decreased muscular endurance, limping, absence of peripheral pulses below the legs and possibly diabetic gangrene.

Nephropathy

The injury of nephropathy involves nephrotic hypertension, proteinuria and edema.

Hypoglycemia

This can be caused either by over-administration of insulin or high blood concentration of oral hypoglycemic drugs relative to blood sugar: skipping meals or heavy exercise can in this way cause low blood sugar.  Beginning with mild hunger, dizziness, sweating, palpitations and mental confusion can quickly follow, leading to loss of consciousness and even death if untreated.

Infections

Diabetics are more likely to suffer problems caused by usually benign bacteria and viruses than the rest of the population.  Common infectious agents may include asymptomatic bacteriuria, infections of the lower extremity, re-activation of tuberculosis, group B strep and post-surgical infections.

Digestive Disorders

Diabetics are more likely than the general population to report a number of digestive conditions, including ulcers, irritable bowel syndrome, abdominal pain, constipation, diarrhea and gallstones.

Ketoacidosis

This is caused by a lack of insulin leading to a build-up of ketones.  Excessive ketone bodies are formed by the biochemical imbalance in uncontrolled or poorly managed diabetes. It can directly cause a diabetic coma.

 

Differentiation of Diabetes Mellitus Patterns

1. Lung Heat with Fluid Injury

Indications: excessive thirst or strong desire for drink is predominant, accompanied by dry tongue and throat, frequent and copious urination, aversion to heat and enjoys cold, irritability, spontaneous sweating, excessive hunger, emaciation and fatigue.  Patient may also experience constipation, or shortness of breath, possibly with large amounts of phlegm.

2. Lung and Stomach Dry Heat

Indications: excessive thirst and frequent hunger are predominant, accompanied by hot breath, foul oral smell, emaciation, frequent and copious urination. Possibly also: dry stools, irritability, gum infection or toothache.

3. Middle Jiao (Digestive) Qi Deficiency with Phlegm Dampness

Indications: thirst without desire to drink, reduced appetite, bloating, oppression in the chest and upper abdomen (especially after meals), shortness of breath, fatigue, overweight, loose stools.  Some patients also experience bad breath, incomplete bowel movements or constipation.

4. Damp Heat Accumulation in the Middle Jiao (Digestive Organs)

Indications: thirst and hunger with no strong desire to either eat or drink, bitter and sticky taste in the mouth, fullness and oppression in the upper and lower abdomen, heaviness and fatigue especially in the extremities, scanty and dark urine.  Some patients will experience either extreme thirst, an extreme feeling of “oppressive fullness,” irritability, dizziness or a feeling of sore, heavy muscles and extremities.

5. Qi and Yin Deficiency

Indications: reduced appetite, excessive thirst with desire for warm drink, frequent and copious urination, pale complexion, SOB, weak voice, severe fatigue, spontaneous sweating, weight loss, constipation and a feeling of heat emanating from the cheeks, hands and possibly feet.  Some patients will present instead with obesity and a feeling of bloating and chest oppression.  Others may experience night sweats, and still others neuropathies.  Another subset of this pattern may suffer from dizziness, insomnia, tinnitus and lower back or knee pain.

6. Lv and Kd Yin Deficiency

Indications: frequent and copious urination is predominant, the urine is often turbid (cloudy) as if containing grease and possibly smells sweet; accompanied by dry mouth and tongue, dizziness, tinnitus, dry skin, emaciation, fatigue, weakness and soreness in the lower back and knees, with a feeling of heat emanating from the cheeks, hands and possibly feet.  In addition to the above patients may experience a more extreme feeling of heat and irritability, coupled with insomnia or night sweating.  Others may suffer from dizziness and headache.

7. Kd Yin and Yang Deficiency

Indications: excessive thirst, frequent and copious urination with turbid and thick urine. Accompanied by dry mouth and tongue, dark and weathered complexion, fatigue, aversion to cold, cold limbs (especially the legs and feet) with hot hands.  Male patients may suffer from impotence and premature ejaculation, or irregular menstruation with low sexual drive in female patients.  Some patients report severe weakness or soreness in the lower back and legs, or chronic diarrhea and fatigue.

8. Qi and Yin Deficiency with Blood Stagnation

Indications: Dry mouth, thirst, fatigue, dizziness, headache, oppression and pain in the chest, emaciation, dry, dark and scaly skin, numbness, tingling, stabbing pain and muscle spasms in the limbs that worsen at night, purple lips and nails.  Possibly also cold extremities, severe headache or dizziness.