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Introduction

Diabetes mellitus has recently gained national attention as the world's leading silent killer. According to WHO, India will have the fastest growing population of diabetics. is a fast-increasing metabolic disorder with multiple etiologies that is characterised by chronic hyperglycemia with abnormalities in carbohydrate, lipid, and protein metabolism as a result of the body's inability to produce enough insulin and/or use it efficiently. Between 1995 and 2025, the number of diabetic patients in India is predicted to increase by 195%. The problem with diabetes is that it is difficult to diagnose in its early stages. However, following an Ayurvedic preventative strategy from the start will help you avoid or control this ailment if you already have it.[1-3] It is a medical condition characterized by an accumulation of glucose in a person's urine and blood. This is referred to as hyperglycemia. Diabetes is derived from two words: diabetes (Greek for "siphon through") and mellitus (Latin for "sweetened with honey." Diabetes mellitus is a metabolic disease characterized by pancreatic dysfunction, which generates the hormone insulin. Diabetes mellitus, on the other hand, is now linked to madhumeha, the last stage of prameha. Madhumeha has become so popular that it is frequently used as a synonym for diabetes mellitus. It is crucial to recognize that madhumeha and diabetes mellitus are not the same thing. Diabetes and madhumeha or prameha should be linked based on a detailed evaluation of their pathogenesis.

Diabetes in Ayurveda

Diabetes is a metabolic disease that is not usually linked to a particular Ayurvedic condition. However, it can be connected to a range of illnesses based on its origin, pathogenesis, and clinical symptoms. The following conditions must be thoroughly investigated in order to establish links and treat diabetes and its complications.

• Sthaulya's Prameha
• Madhumeha
• Prameha

Sthaulya is one of the eight condemnable states of the human body (ashta-nindaniya), while prameha is one of the eight primary diseases (mahagada) by Indian physicians, reflecting the disease's severity and complexity. Prameha is classified as sahaja (genetic reasons) and apathyanimittaja (as a result of poor food and routines). Both sthaulya and apathyanimittaja prameha have a similar etiology and are caused by overeating (santarpanajanya) and fat buildup in the body (medopradoshaja). Both sthaulya and prameha are caused by genetics (bija-swabhava) and psychological variables [e.g. pleased life (harshanityama) and absence of mental tension (achintana). Sthaulya is a causative factor (nidanarthakararoga) of prameha in and of itself. The primary causes of sthaulya and apathyanimittaja prameha are kaphavardhakaa ahara-vihara (diet and lack of physical activity, which leads in energy surplus).[4-7] Overeating, medodhatwagni impairment, and a rise in meda dhatu are the causes of Sthaulya (fat tissue). Impaired medodhatwagni (both quantity and quality) pushes metabolism toward meda dhatu accumulation. It also produces a metabolic state in which the rest of the body's tissues suffer, including asthi, majja, and shukra dhatus. Sthaulya emerges as udara-parshwa-vriddhi and makes a person vulnerable to prameha. Other components necessary for Prameha progression include Bahvah abaddha meda (excess, aberrant, and unbound Meda dhatu), Bahu dravah shleshma (liquid nature of Kapha), and Sharir-shaithilya (looseness of body).

Roopa (Clinical features)[8-10]

According to Ayurveda

1. Malina danta - Tartar in teeth
2. Hasta pada daha -Burning sensation of hands and feet
3. Trishna - Excessive thirst
4. Madhu samana varna - Urine having colour of honey
5. Sweda - Excess perspiration
6. Anga gandha - Bad body odour
7. Madhuryamasya - Feeling sweetness in mouth
8. Prabhuta mutrata - Excessive urination
9. Avila mutrata - Turbid urination

According to Modern science

1. Polyuria (Excessive Urine)
2. Giddiness
3. Polyneuritis (Numbness)
4. Polyphagia (Excessive Hunger)
5. Polydipsia (Excessive Thirst)
6. Tiredness
7. Body ache

Treatment[11-14]

According to Ayurveda, the therapy of Prameha is based solely on the constitution of the individual. It is based on a complete change in the person's lifestyle; in addition to medicine and food, the patient is also recommended to live a healthy and active lifestyle. Mental elements of the condition are also emphasized.

• In Sthulya (Obese) - The therapy should primarily focus on optimal fat utilization, i.e. he should be given: a). Shodhana (purification process), b) Apatarpana - body weight reduction by food restriction or medications, Vyayama (exercise), and so on. Fasting, diet management, cleansing treatments (vamana, virechana, Basti), and physical activity are all recommended.
• According to Ayurveda one should start with light diet (laghu bhaksha, laghu ahara) and then gradually increase the quantity of food. It is a rule that one should keep complete attention on the condition of Agni i.e. digestion. Diabetes being a disease of deranged metabolism, special attention should be kept on the condition of digestion and metabolism.
• Aharaja Apathya (Dietary factors to be avoided in excess) - Shuka Dhanya (Cereals), Aromatic Rice (Basmati), Bread, Noodles, Pasta, Pulses, MadyaVarga (Drink), alcoholic drinks, Sweet alcoholic drinks, Soft drinks, Soda, Cold drinks, etc.[15]
• Viharaja Apathya (Lifestyle factors to be avoided in excess) - Atimatra sevana (excessive eating), Aasyasukham (continuous sitting), Swapnasukham excessive sleeping ), Avyayam (lack of exercise and physical activity ), Diwaswapa (sleeping in the daytime), Aalasya (lazyness), etc.

Yogasanas[16-18]

• Utthita Trikonasana
• Parivritta Trikonasana
• Prasarita Padottanasana
• Jathara Parivartanasana
• Pavanamuktasana
• Bhujangasana
• Dhanurasana
• Ardha Matsyendrasana

Drugs

Single formulations:

1. Guduchi swarasa (Tinospora cardifolia)

2. Amalaki Curna (Phyllanthus emblica)

3. Karavellaka Phala Curna (Momordia charantia)

Compound preparations

1. T. Chandraprabha, 500 mg twice a day with water/milk.

2. T. Vasant kusumakara Ras, 125 mg twice a day with Honey.

3.Praval bhasma,

4.Mehmudgara (BR)

Kwatha (decoction)

1.Darvi,Surahwa,Triphala,Musta

2.Triphala,darvi,Vishala,Musta.

Discussion

Diabetes is a major cause of death, morbidity, and health-care expenses. The 2011 United Nations High-Level Meeting on Noncommunicable Diseases (NCDs) established a global goal of halting the growth in age-standardised adult diabetes prevalence to 2010 levels by 2025. There are two sorts of disorders that affect urine. Mutra Apravrittaja Rogas, or disorders that cause reduced urine production, and Mutratipravrittaja Rogas are disorders that cause an excess of urine, with Prameha being a Mutratipravrittaja roga. Mutraghata and Prameha both have their residences in Basti. Prameha is further subdivided into 20 kinds based on physical urine abnormalities. However, ignoring all Prameha may result in Madhumeha in the long run. Kaphajameha with Mutra Madhurya (Glycosurea) as the presenting characteristic causes Dhatukshaya and vata vitiation, eventually leading to Madhumeha. Similarly, Kaphapitta Kshaya causes chronicity in a Kapha-PittaPramehi, and Dhatukshaya causes Vata aggravation, culminating in Madhumeha Vataja Meha. 8 Acharya Sushruta and Acharya Charaka's observations were highly explicit when categorizing the varieties of Prameha based on onset as Sahaja and Sthula Pramehi, respectively, which have comparable meanings in modern science. Madhumeha is caused by all Ahara-vihara (diet and lifestyle elements) that have snigdha (unctuous), sita (cold), guru (heavy), picchila (slimy), madhura (sweet), slaksa (smooth) qualities, as well as those that promote kapha and vitiate dushya. 

If a person is found to be at high risk, they should have periodic biochemical examinations, plasma glucose levels (fasting and PP), plasma lipids (cholesterol and triglycerides), plasma insulin levels, lifestyle intervention (diet and exercise, as well as ayurvedic drugs), and prophylactic panchakarma (after proper assessment). The primary goal is to prevent Meda, Kleda, and Kapha dushti, and Prameha nidana parivarjana should be performed by doing proper Dinacharya, Ahara, Vigorous Vyayama, and Yoga Asanas.[19-23]

Conclusion

Diabetes affects practically every aspect of life. It can develop a variety of health issues over time, including neuropathy, nephropathy, and retinopathy. It impairs peripheral blood flow and microvasculature, resulting in end organ damage. Diabetes during pregnancy can pose complications for both the mother and the fetus. However, most of these issues are avoidable with prompt action. It might be connected with sthaulya, kaphaja prameha, or madhumeha, depending on the clinical signs. Diabetes should not always be treated as madhumeha, but an alternate diagnosis of one of the conditions described above should be considered. Diabetes mellitus, according to Ayurveda, is not a disease that can be healed solely via medication or dietary changes. 

Though it is a Yapya (not totally curable / difficult to cure) ailment, the aforementioned treatment procedure will not only cure the individual, but will also safeguard the person from living a long, healthy, and valuable life.