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Introduction

Diabetes Mellitus, a chronic metabolic lifestyle disorder has become a global health concern in recent decades. In India, the Prevalence rate of Diabetes mellitus is estimated to be 11.4%1 The increasing prevalence of Diabetes Mellitus (DM) has positioned it as a major lifestyle disorder with multifactorial etiology. While genetic predisposition and unhealthy lifestyle choices (unhealthy diet and sedentary lifestyle) are well-known contributors, increasing evidence points toward psychological stress as a significant and often overlooked trigger., the role of psychological and physical stress in the pathogenesis of diabetes has gained significant attention. From a modern perspective, chronic stress triggers the hypothalamic-pituitary-adrenal (HPA) axis, elevating cortisol and catecholamines like adrenaline and noradrenaline which causes increase in blood sugar level and leads to Diabetes mellitus. In Ayurveda, diabetes – “Madhumeha”,linked to imbalances in Kapha and Vata doshas, along with Agni (digestive fire) dysfunction . It also recognize “Chinta” (excessive worry), “Manasika Nidana”  as contributing factors in the development of Madhumeha . There is a strong interplay between mental stress and metabolic dysfunction. Importantly, the article demonstrates how Ayurvedic therapies-particularly Pranayama, Shirodhara, and Abhyanga-can mitigate stress responses, restore doshic balance, and improve glucose metabolism. These interventions influence both psychological and physiological domains by regulating hormone levels, calming the nervous system, and enhancing insulin sensitivity.

Aim -To Explore the role of Stress in Diabetes Mellitus and its management  by Ayurveda.

Objectives – 1) To study role of  stress in Diabetes mellitus. 2) The management of stress by Ayurveda

Methods and Material

Data is collected from Classical literature – Ayurvedic Samhita and their commentaries and Modern text books. Database – Google Scholar, Pubmed and other data bases.

Discussion

Diabetes mellitus – Group of lifestyle metabolic disorder which is characters by chronic hyperglycemia with disturbance of carbohydrate , fats and protein metabolism due to absolute or relative deficiency of insulin secretion or and action . 2,3 Prameha is a group of metabolic disorders described in Ayurveda, Prameha  is characterized by excessive and abnormal urination (both quantity and quality). It is mainly caused by the vitiation of Kapha dosha along with Medas (fat) and Kleda (fluid imbalance). There are 20 types of Prameha . One of them is Madhumeha. It is described as a condition where the patient passes sweet urine, resembling honey ("Madhu").  Madhumeha closely resembles Diabetes Mellitus in modern medicine.

BSL is control by 2 group of hormones -

 1) Insulin - Decrease BSL   2) Cortisol , Adrenaline ,noradrenaline - Increase  BSL  Stress causes  Increase in the level of Cortisol , Adrenaline ,noradrenaline hormones which causes increase in blood sugar level and leads to Diabetes mellitus . Stress Hormone and Glucose Regulation Stress triggers a hormonal response that leads to an increase in cortisol and adrenaline levels. These elevated stress hormones interfere with the body's ability to use insulin effectively, resulting in insulin resistance. Additionally, they stimulate the liver to release more glucose into the bloodstream, contributing to elevated blood sugar levels. Chronic stress can therefore lead to persistently high blood glucose levels, a condition known as hyperglycemia, which increases the risk of developing type 2 diabetes mellitus.

 Ayurvedic interpretation  - In Ayurveda, body is considered as a conjugation of Panchamahabhuta, soul and mind. Stress can be interpreted in different ways according to Ayurveda. Stressors (stress inducing factors) recognized in Ayurveda can be - 1)Physical stress - Excessive exercise, trauma, fasting etc.

 2) Mental/ Psychological stress - Anger, fear, anxiety, grief etc.

3 ) Environmental stress - Exposure to intense heat of sun, high altitude etc.

Physical Stress and Diabetes Mellitus

Ayurvedic View: Physical stress, Sahasa cause depletion of Ojas which is the essence of Sapta Dhatus and represent the strength of body. Ojakshaya leads to Dhatu Kshaya and the person becomes weak and emaciated which causes Vataprakop  causing Vishamagni. Vishamagni causes Ama formation leading to Dhatu Dushti 11 .  If Medo Dhatu is affected, prodromal symptoms of Prameha can be seen. In Prameha Samprapti, it is told that Ojas, more precisely Apara Ojus is expelled out from the body through sweat and urine since Atipravarthi of Sweda and Mootra is seen in Prameha. So, Ojakshaya can lead to Madhumeha .

Modern View: In modern science, physical stress caused by overtraining or excessive exercise increases cortisol levels. This elevation in cortisol level enhances appetite, especially cravings for high-calorie food. That promotes fat redistribution, resulting in central obesity and insulin resistance. These metabolic disturbances elevate blood sugar levels, contributing to the onset of Diabetes Mellitus Mental Stress and Diabetes mellitus -

Ayurvedic View: According to Ayurveda, mental stress arises due to the vitiation of Manodoshas such as Krodha (anger)9 in Pitpradhan Prameha nidana  , Udvega (anxiety), and Shoka (grief)10 in Vataj prameha nidana. These emotions cause an imbalance in Sharir Doshas, leading to Agnimandya (weakened digestive fire) and the formation of Ama (toxins). The accumulated Ama tends to localize in Basti (urinary system), which results in Madhumeha (diabetes mellitus).

Modern View: From a modern perspective, chronic mental stress activate hypothalamus pituitary adrenal axis which  secrete Glucocorticoid and catecholamine . 

This Glucocorticoid -Cortisol

1) It stimulate gluconeogenesis and decreases level of glycogen which leads to hyperglycemia 6 .

2) It also causes Decrease or inhibition of  glucose uptake by muscle and other cells which leads to hyperglycemia 6 .

3) It causes Beta cell dysfunction and decreases the  insulin secretion which causes increase blood sugar level .

4) It antagonise metabolic action of insulin that leads to hypergycemia 7,8

5) ItImpaired incretin effect and leads increase insulin resistance which causes increase in level of blood sugar. Thus  Elevated cortisol levels raise blood sugar levels, eventually contributing  ultimately to the development of Diabetes Mellitus. Management of Stress by Ayurvedic Way – Pranayam - Regulates the Nervous System -Pranayama techniques like alternate nostril breathing and Bhramari pranayama can influence the autonomic nervous system, balancing the sympathetic (fight-or-flight) and parasympathetic (rest-and-relax) responses. Reduces Stress Hormones: Certain pranayama practices can help lower the levels of stress hormones like cortisol. Calms the Mind and Body: Deep, controlled breathing promotes a sense of calm and relaxation, counteracting the effects of stress and anxiety. Improves Sleep Quality- Pranayama can help regulate sleep patterns, leading to better sleep quality, which is often disrupted by stress.

Increases Concentration and Focus -Regular practice can improve mental clarity and concentration, making it easier to manage stressful situations.  Promotes Emotional Balance - By calming the mind and body, pranayama can help individuals develop greater emotional resilience and better manage negative emotions. Abhyanga – It stimulates nerve ending in skin and sending signal to central nervous system .This signals trigger relaease of endorphin which have pain relieving and mood boosting effect . It stimulates relaease  of happy hormones like Endorphine, Serotonin and Dopamine  which improves mode and reduces stress 12 . It lowers stress hormones like Cortisol. Physical Relaxation-The warm oil and gentle massage movements help soothe muscles, relieve tension, and improve flexibility, easing physical symptoms of stress. Mental Calming - Abhyanga's rhythmic strokes and the aromatic oils used can calm the mind, reduce anxiety, and promote a sense of tranquility, helping to alleviate mental stress. Nervous System Support -Abhyanga helps to balance and calm the nervous system, which can be overactive during periods of stress, leading to a more balanced and relaxed state, Emotional Balance . The relaxing effects of Abhyanga can improve sleep quality, which is often disrupted by stress . Dosha Balancing - In Ayurveda, Abhyanga is used to balance the three doshas (Vata, Pitta, and Kapha), which are believed to govern different aspects of our physical and mental well-being. By balancing these doshas, Abhyanga can help to reduce stress and promote overall health. Shirodhara –Shirodhara, a traditional Ayurvedic therapy a significant role in stress management by pro-moting deep relaxation and mental clarity. The treatment involves the rhythmic pouring of warm, medicated oil onto the forehead, inducing a calming effect on the nervous system This helps to alleviate symptoms of anxiety, insomnia, and other stress-related conditions. It calm the Nervous System- It stimulates the nervous system, promoting relaxation and reducing overstimulation. The treatment helps to quiet the mind, reduce racing thoughts, and alleviate feelings of anxiety and irritability, leading to improved mental clarity. Improving Sleep Quality by activating Vagus nerve and trigger Peripheral nervous system. making it beneficial for those struggling with insomnia.  It reduces the impact of stress on mental and physical health.Hormonal Balance -  shirodhara can influence the pituitary and pineal gland and play role in regulating hormones , which potentially leads to better emotional balance. It lower Cortisol level, It produces Melatonin a hormone play crucial role in sleep. It regulate Serotonin level which is associated with mood and happiness. It increases dopamine level which is linked to mood and motivation.  13

Conclusion

Stress plays a significant role in the onset and progression of Diabetes Mellitus Modern research and Ayurvedic wisdom both acknowledge the deep interconnection   between the mind and body in chronic diseases like diabetes. Ayurveda emphasizes not only the management of physical symptoms but also the restoration of mental balance. Therapies such as Shirodhara, Abhyanga, and Pranayama have shown remarkable benefits in reducing stress, balancing doshas, and enhancing insulin sensitivity. These interventions not only help regulate blood sugar levels but also rejuvenate the nervous system and calm the mind. Ayurvedic therapies offer promising, non-pharmacological options that deserve more recognition and integration in modern clinical practice.