Presented at the European Congress of Homeopathy, Riga, Latvia, May, 2011
“If someone wishes for good health, one must first ask oneself if he is ready to do away with the reasons for his illness. Only then is it possible to help him.” – Hippocrates
This sentence truly applies to a patient of Diabetes mellitus who is finding it increasingly difficult to do away with the reasons for his illness, given the changes in life style, the abundance of denatured food, stress and strain of modern life and the eddy around which he has to revolve himself!
Diabetes Mellitus is a heterogeneous chronic metabolic disorder characterized by hyper-glycemia resulting from a defect in Insulin action and or deficiency of Insulin secretion. It is a systemic and multi-faceted condition that affects each cell in the body and also the mind.
Diabetes mellitus is a syndrome – ubiquitous and dynamic. The prevalence of diabetes in adults was 4 percent worldwide; this means that over 143 million persons are now affected. It is projected that disease prevalence will be 5.4 percent by the year 2025, with a global diabetic population reaching to 300 million. WHO predicts that India will have the largest number of diabetics, around 80.9 million, by 2030. Worldwide, every ten seconds, at least one person dies from diabetes and its complications (Siegel & Narayan, 2008).
In view of the alarming rise of diabetes, the holistic therapy of homeopathy should not lag behind and every effort should be made to utilize its benefits for the sake of ailing humanity. The questions that baffle a conscientious homeopath are – What is diabetes? Is diabetes-increased blood sugar or is it vascular changes? Which is the cause and which is the effect? Is it inherited? Is it psychosomatic? What role do emotions play? What role does life style plays? What should the diet be? Are diabetic pills to be lauded or banned? Is insulin therapy as dramatic as it was made out to be? Is mere control of blood sugar level, a real solution?
Research findings in conventional medicine put toward the limitations and side effects of hypoglycemic agents, insulin therapy, zinc overdose and also side effects of sweeteners. A homeopath should know their side effects as he is confronted with people who are consuming these agents. Artificial sweeteners such as Saccharin, Aspartame, Acesulfame potassium, Sucralose, and Neotame, Cyclamate, Fructose, Sorbitol, Fructofiber, and Civiocid are often used and some of them are found to be carcinogenic.
Oral hypoglycemic agents were clinically tried in America. They put 205 patients on placebo and 205 patients on the pills for an eight-year period. Heart attacks were three times more frequent in the experimental group, than in those on placebos. It is said that increased BSL leads to heart attacks, but researchers found that the very pills which control the sugar, cause heart attacks.
Dr. Manu Kothari, one of the distinguished physicians of India, writes, “We seem to know that there is diabetes and there are anti-diabetic drugs. But I think we are kidding! Diabetes is a multi faceted problem. Protein metabolism is disturbed, fat metabolism is disturbed, sugar metabolism is disturbed, arterial health is disturbed. At the moment we have only one parameter, glucose level. So we give a drug to bring the glucose to the doctor’s desired level, not necessarily to the patient’s comfort. And you call it curing diabetes, treating diabetes! You’re kidding”. Dr. Manu Kothari points out thatDM is not a specific disease pathology, but the innate program of an individual that embraces protein, fat & carbohydrate metabolisms.As a parallel event, DM controls the course of a wide variety of tissues, esppecially blood vessels, either primarily and /or as a consequence of the metabolic, vascular and nervous personality of an individual. For this very reason, its course and cure are unknown and shall remain so.
On this background, the success of homeopathy has to be measured in terms of maintaining blood sugar level, prevention and management of complications – Macrovascular / Microvascular / Neuropathic, and their consequences in multiple vital organs. The role of Constitutional, Intercurrent and organ remedies and the importance of miasmatic assessment in the clinical stages of complications should become mainstay of homeopathic management. The homeopathic approach towards each patient is essentially holistic and more so in DM.
The Seven Factors and Homeopathic Remedies
The following seven factors are implicated in the etio-pathogenesis of Diabetes mellitus, according to ‘The American Diabetes Association: A new etiologic classification system for diabetes mellitus is listed below with corresponding prominent homeopathic remedies.
Genetic defects of ß-cell function or in insulin action:Desoxyribonucleicum acidum (DNA), Nosodes: Carcinocinum, Medorrhinum, Tuberculinum, Syphilinum
DM resulting from diseases of exocrine pancreas: Ars alb, Bar mur, Calc ars, Carb an, Carb veg, Conium, Hydrastis, Iodum, Iris ver, Kali bich, Kali iod, Merc sol, Natrum sulph, Nux vom, Pancreatinum, Parathyreoidinum, Phosphorus, Uranium nitricum
DM resulting from endocrinopathies: Bar-carb, Carcinocinum, Pituitaria posterior, Corticotropinum (ACTH), Cortisonum (Cortisone and Corticoids), Adrenalinum, Iodides, Ferrums, Nat-mur, Sepia, Thyroidinum, Phosphorus
Drug/Chemical induced: Agaricus, Agnus cast, Arsenic album, Bryonia, Camphor, Carbn-sulph., Carb-veg, China off, Coffea, Corticotropinum, Cortisonum, Hydrastis can, Kali-iod, Lachesis, Laurocerasus, Mag-sulph, Nat-mur, Nit acid, Nux vomica, Opium, Phos-acid, Pulsatilla, Secale cor, Sulphur, Thuja, Thyroidinum
Infections: Carcinocinum, Medorrhinum, Tuberculinum, Syphilinum, Silicea, Parotidinum, Penicillinum, Streptococcinum, Staphylococcinum
Gestational DM (GDM):Lacticum acidum, Helonias, Sulphur
Immune-mediated diabetes: The role of constitutional therapeutics and the remedies as listed under no.1.
Most genetic defects in insulin action involve the insulin receptor. The metabolic consequences of these defects range from modest hyperglycemia to severe diabetes. Although the constitutional remedy approach has to be underscored here, the use of intercurrent remedies must be emphasized. Diabetes has also been regarded as an autoimmune disease and the role of DNA has been increasingly observed in genetic and autoimmune disorders. P. Robbins who did a wonderful proving of DNA suggests, “This remedy would be good for genetic damage.” Bladder – urination – urging to urinate – frequent and scorbutic gums are reliable proving symptoms of DNA. Family history of serious diseases and past history of multiple infections (like Carcinocinum) are key indicators for selecting DNA. I recall a case of Juvenile Diabetes with non-healing ulcer on the dorsum of the leg, where the best indicated remedies failed to act, but a dose of DNA 200 healed the wound.
The Nosodes, the multi-polychrests, assume a very important place in clinical practice. A nosode is a blend of the disease-potential and the host-response; hence, it represents the dynamic potential of germ, host and their inter-action to become a powerful and complex healing force to meet the inveterate morbific conditions like DM. The incidence of cancer is increasingly found in the family tree and in order to deal with the cancer miasm, which is responsible for bringing onto the fore a condition like diabetes, Carcinocinum must be used. In a case of diabetic ulcer with a history of cancer in the family, where the life and death issue was the prominent one, Crot. horridus 10M, three hourly, during acute crisis, followed by Carcinosinum not only saved the amputation of the feet but has kept the patient alive and healthy until now (see photographs). Who can forget the inter-relation between tuberculosis and diabetes? A diabetic person is prone to infections and more to tubercle bacilli. Further, the emaciation which a DM patient exhibits is typically tubercular in nature as are also the many complications. Hence the intercurrent use of Tuberculinum helps a diabetic patient in many ways.
A case of carbuncle that was being partially helped by Tarentula cubensis finally resolved under the action of Tuberculinum. Syphilinum, a representative of syphilitic miasm, is a major remedy that can be interpolated when a case manifests syphilitic miasmatic complications that carry a patient towards destruction. I remember a case of a young perverted psychotic with homosexual and incendiary impulses, addicted to narcotics and diagnosed as a juvenile diabetic, who presented with fistula-in-ano, that yielded finally to Syphilinum, when Fluoric acid did only lip service.
Insulin is required in this group and no homoeopath should try to reduce it in an abrupt way. However, side effects of Insulin can be treated with homoeopathic remedies and Insulin in potentized form can be used. Apart from side effects like allergic reactions, thickening of skin, weight gain, peripheral oedema, lipodystrophy at injection sites, and IgG and IgM against insulin (I-G Insulin antibodies of high levels lead to immune-mediated Insulin resistance), new research suggests that Lantus, an artificial form of insulin, may increase the risk of developing cancer.Anotherstudy suggeststhatinsulin use increases the risk of colon cancer. Hence, Carcinocinum and Scirrhinum should assume a place in all diabetics who become insulin dependent.Hyperinsulinemia, a side effect of insulin, is known to cause vascular changes and it is suspected that at least some of the vascular complications in diabetics could also be due to insulin therapy. A point of note is that the long-term safety of Insulin analogues has not yet been established and there is growing evidence of mitogenic effects.
Zinc plays a key role in the synthesis and action of insulin, both physiologically and in the pathologic state of diabetes. I must mention zinc toxicity. Excess of zinc may lead to copper deficiency and may also inhibit the anti-carcinogenic effect of selenium. The other toxic effects are electrolyte imbalance, respiratory distress, pulmonary fibrosis, intestinal bleeding, thrombocytopenia, hypotension, tubular necrosis with renal failure, pancreatitis, gastric ulcer, muscular Inco-ordination, dizziness, anemia, reduction in chemo-taxis, phagocytosis, and platelet aggregation.
The relationship between diabetes, insulin and zinc (Zn) is complex with no clear cause and effect relationships. Since Zn plays a clear role in the synthesis, storage and secretion of insulin, as well as conformational integrity of insulin in the hexameric form, the decreased Zn, which affects the ability of the islet cell to produce and secrete insulin, might then compound the problem, particularly in Type 2 diabetes. Some researchers conclude that zinc atoms, not the insulin molecule itself, provide the switch-off signal from the beta cell to the alpha cell to initiate glucagon secretion during hypoglycemia.
I recommend Zincum salts in homeopathy for the states of both deficiency and excess of zincum.
Diseases that damage at least 60-70% of the pancreas (islet cells) can cause diabetes in any individual. Individuals with genetic risk factors for T2DM are more susceptible to developing diabetes from pancreatic damage. Trauma/pancreatectomy, Pancreatitis, Hemochromatosis, Cystic fibrosis and Neoplasia are implicated in DM. We have on our record a case of chronic pancreatitis where pain in abdomen was present at 3-4 am and it was associated with Type2 DM, and Kali bich helped the case not only in controlling blood sugar level but also in alleviating the pain and discomfort in the abdomen. Another case of chronic pancreatitis with uncontrolled diabetes, characterized by profound weakness and emaciation improved with Uraniumnitricum 30 given once daily for over 3 months. The following indications of Uran-nit. are worth mentioning.
Causes glycosuria and increased urine.
Is known to produce nephritis, diabetes, degeneration of liver, high blood pressure and dropsy.
Enormous appetite and thirst, yet the patient continues to emaciate.
Debility, languor and tendency to ascites.
Suited to DM originating in dyspepsia or assimilative derangements.
Chronic pancreatitis (Ref. A Select Homoeopathic Materia Medica Part III and Repertory, unpublished)
Counter regulatory hormones (epinephrine, glucagons, cortisol and growth hormone) antagonize the action of insulin. Diabetes and insulin resistance are associated with a number of endocrine disorders of these hormones, like Acromegaly, Cushing’s syndrome, Glucagonoma etc., largely through their stated counter regulatory effects.
The author has no experience in treating a case of diabetes with this cause. But a case can be cited where a patient developed Cushing’s syndrome and avascular necrosis of the head of the femur and diabetes due to prolonged systemic therapy with corticosteroids for Sarcoidosis. His chronic constitutional remedy was fished out as Magnesium muriaticum and intercurrents were Thyroidinum and Cortisone, for antidoting the crude steroids. These three remedies helped to tide over the crisis though the drug-induced pathologies were irreversible.
Factor 4 – Drug/Chemical induced
There are numerous drugs that are associated with either diabetes or impaired glucose tolerance. They act either by decreasing insulin production and secretion, decreasing insulin sensitivity, or altering the ability of insulin to regulate metabolism.
Drug/chemical induced DM is a cause of concern today and many culprits have been recognized: Nicotinic acid, Glucocorticoids, Thiazide diuretics, ß-adreneric agonists, Protease inhibitors, Pentamidine, Thyroid hormones, Alpha-interferon, Clozapine, Alloxan, Beta-blockers etc. Recent evidence suggests that even in normal doses the most frequently used ?-blocker Atenolol (Tenormin) carry an unacceptable risk of provoking type 2 diabetes. Numerous medications used to treat HIV infection have been associated with diabetes. The research study with the oral drug ‘Avandia’ has revealed that it increased the risk of heart attacks by 43 percent and of death from heart problems by 64 percent
Our homeopathic pharmacy should possess all tautopathic remedies to deal with diseases brought on by the drug miasm. Apart from the heavy metals that are indicated for chemical damage, I request our readers to focus on Carboneum sulph as it covers the causative elements and degenerating pathologies. A Select Homeopathic Materia Medica lists under Carbn-s., “The jet-set, addicts of alcohol, tobacco, narcotics; absorbing aluminium, lead (from cosmetics etc.) and other chemicals”.
Factor 5 – Infections
The host resistance to infection in diabetes and the influence of an acute infection upon the endocrinologic-metabolic status of the diabetic patient is an interesting study for a homeopath. Infection tends to occur with greater frequency and severity in diabetic patients than in non-diabetic. The occurrence of infection in a diabetic patient perpetuates a vicious cycle, in which infection results in uncontrolled hyperglycemia, which in turn causes further aggravation of infections. The WHO has included diabetes in its classification of secondary immunodeficiency diseases. The impairment of a wide range of functions in neutrophils and macrocytes (Macrophages) including chemotaxis and adherence phagocytosis and intracellular killing of microorganisms and also impairment in the movement of phagocytic cells are the factors that explain the increased susceptibility to infection.
Homeopathically, it is the tubercular miasm which is chiefly responsible for host susceptibility in diabetes. Let us take an example of Silicea, our surgeon’s knife.Silicea is born with a defective mesenchymal system i.e. with loose, poorly functioning connective tissues. This affects the system in many ways as connective tissues play a vital role in metabolic, defensive and hemopoietic functions. Silicea is a Tuberculo-syphilitic remedy and is useful in many neuropathic and dermatological complications of diabetes. We have found it, as a very useful remedy in Juvenile diabetics who develop recurrent infections, are malnourished and don’t put on weight.
Parotidinum can be thought of when diabetes has developed after mumps. Dr. P. I. Tarkas mentions Medorrhinum for the same. People with diabetes, and those who use medications such as steroids, are at higher risk for invasive disease from group A streptococcal infections.I often make use of Streptococcinum in such cases. I would like to mention a case of urinary tract infection due to group B streptococcus in a pregnant lady, with gestational diabetes, who responded to Pyrogenium 1M, given six hourly for 4 days. Tuberculinum has been my sheet anchor in boosting the immunity against pyogenic infections.
The statistics indicate that ‘about one-third to one-half of women who have gestational diabetes will have it again in a later pregnancy. And up to 50 percent of women with gestational diabetes will develop diabetes at some point in the future’. These cases need constitutional homoeopathic treatment and the repertory indicates three remedies – Lacticum acidum, Helonias and Sulphur.
About Helonias, there is an interesting rubric ‘Sadness, diabetes, during’. So the combination is – sadness, diabetes and pregnancy. Allen’s Key Notes lists the following indications, “Diabetes: first stages; urine profuse, clear, saccharine; lips dry, stick together; great thirst; restlessness; emaciation; irritable and melancholy. Albuminuria: acute or chronic; during pregnancy, with great weakness, languor, drowsiness; unusually tired, yet knows no reason”. Pierce Willard in ‘Plain Talks on Materia Medica with Comparisons’ writes, “It produces depression both of the body and the mind; there is profound melancholia, with “desire to be alone” (Hale); they are irritable and fault-finding and intolerant of the least contradiction”. When I treat modern women, I find a striking correspondence in Helonias.
The IMP Factor: The Role of Emotions
The role of emotional factors in the etiology of diabetes has been a source of debate. However, personality traits of diabetic patients have been studied and many researchers have noted similarities of configuration. The influence of emotional stress upon sugar metabolism has also been examined. Many investigators have observed definite connections and inferences go in favour of homeopathy’s holistic approach towards a patient of diabetes. To cite the recent research findings:lower than average blood glucose values at baseline were associated with higher scores for the personality domain of neuroticism and several specific traits including anxiety, angry hostility, depression, self-consciousness, and vulnerability but were associated with lower scores for the trait of altruism.
It has often been assumed that patients who repeatedly go into acidosis despite careful efforts at regulation, suffer from metabolic eccentricities that make them react severely to slight changes in diet, insulin intake, exercise, or emotions. Susceptibility to infection may be held responsible. The importance of emotional disturbances has been appreciated, and the acidosis has, at times, been attributed directly to the effects of emotional factors upon the metabolic processes. Let me point out some cases of acidosis from my practice. A colleague of conventional therapy once referred a case. The case was interesting in the sense that the referred woman was admitted five times in his hospital for diabetic acidosis within a span of two months. Every time the relatives narrated the history that the patient and her husband were not on good terms and whenever big quarrels occurred, the patient went into metabolic acidosis. Natrum muriaticum, given on the basis of totality of symptoms not only stopped the recurrent episodes of acidosis but her susceptibility to infections was reduced. The blood sugar level also maintained at normal levels. Another case was of juvenile diabetes of a young chap of 21 years. He was diagnosed to have JDM at 14 years and was maintaining well on Inj. Insulin. A touchy, introverted, shy young man, for whom the home was as if hell; no love from parents, constant quarrels, father alcoholic, mother materialistic. He was harbouring resentment and feelings of abandonment and had to sustain the blow of divorce. His mother found a new man within a year and our patient was left alone. He got acquainted with a new girl friend and life became smooth with her. Alas, on one fine day she left him. This was the big assault. Since then infection, increase in blood sugar, acidosis and then hospitalization became a vicious cycle. Carcinocinum made him altogether a different man along with psychotherapeutic sessions. He was determined to find himself, to find his potential and to use the ‘go’ in his life. The reasons for selection of Carc. were family history of cancer, increased susceptibility to infection, the chronic state taking on an acute, severe episode, and an intense abandoned feeling. Synthesis Repertory mentions Carc. under the rubric, Acidosis.
The Personality characters in Diabetes
Before we contemplate the personality characters, we must acknowledge the symbolic language of the pancreas. The pancreas is linked to the solar plexus that deals with emotions, wishes and intellectual activities. The pancreas represents the sweetness of life.According to human symbolic language of the pancreas- sweetness, love, the basic complex emotion, has a prominent role to play in diabetes. Diabetics are found to be more emotional and harbor many wishes for themselves and others. They tend to reproach themselves with discontentment of others. They spend much energy fulfilling the inner need of their emotions and there is associated inner sadness from an unrequited love. Juvenile diabetes may occur in those children who feel insufficiently acknowledged. In short, the problems of the pancreas stem from individuals not believing they deserve love. There is a huge inability to feel part of the whole and give and receive in a balanced way.
Some deeper insights are needed to understand the concept of love in diabetes. Don’t discard them as metaphysical. We have enough threadbare through islets of Langerhans, insulin deficiency and others. Notice that diabetics are alarmingly increasing in the world. The concept of love is central to understanding and managing diabetes. If we, as homeopaths, view ourselves as holistic prescribers, we can’t brush aside the role of emotions and resolve the conundrum of diabetics.
Sugar, Love and Diabetes
Sugar is a material synonym for love and hence, it can be equated to love, and love is a sweet feeling for human beings. Not being able to metabolize sugar is an effect from not being able to get love. Just as diabetics cannot integrate sugar in the food, it is difficult for them to integrate or accept love. Diabetes is particularly related to feeling either a lack or an over abundance of sweetness in our lives. Glycosuria amounts to running out (failure) of love. Diabetics can’t assimilate sugar; it passes straight through, to be excreted back out again. Behind the desire of diabetics to enjoy sweet things and their inability to assimilate and absorb them, stands an unsatisfied desire for love, along with an inability to accept love and absorb it unreservedly. In an adult, diabetes is often associated with obesity and this shows the link between overeating to make up for the lack of love or nourishment and an inability to receive love.While presenting the parallels between insulin in language (Latin word insula = island i.e. Islets of Langerhans) and characters of diabetics, Dr. Michael Lincoln, in ‘Messages from the Body’ suggests that individuals with diabetes are “islands unto themselves”- i.e. “from birth they learn to fend for themselves. Basically, they feel they have to rear themselves.” Therefore, when they’re not able to find nurturance, relevance or validation from outside themselves, they become self-made. This process is likely to be traumatic, which reinforces a belief that there’s no sweetness in life. Dr. Lincoln further adds that due to guilt feeling and lack of value, life loses its sweetness. This lack of sweetness and a deep longing for “what might have been” may cause malfunction of the pancreas, because the pancreas requires the emotion of joy to function properly.
Diabetes leads to over-acidification of the whole body. Acid is a symbol of aggression. Diabetes depicts this aggression in the form of inflammations (-itis, the war) and destructive pathologies. The sugar level in our blood relates to the amount of sweetness and love in our lives and to the opposite, anger and sourness. There is always polarity between love and aggression, between sugar and acid. The body warns – those without love become sour. Metabolic acidosis consequent to emotional excitement is a good example.
Based on the above-mentioned human symbolic language and the concept of love, the author found that out of 270 cases of mature onset diabetes, 206 cases (76.2 %) have, in one way or other, unresolved problems stemming from love. They represent the theme – lack of love or affection. The author observes that in most of the patients love remains unused, accumulating and running as if sugar in the blood.
In this study it was found that there is also resentment at having to take responsibility, a desire to be loved but not to give love, to be cared for without having to give. It was found that diabetics often feel emotionally isolated, unable to give of themselves, a kind of emotional selfishness. They demand to be loved without having to give back. Balance and stability is simply out of the question.
Evolving the Therapeutic Index of Remedies
In order to evolve the therapeutic index of polychrest remedies in diabetes, the following steps are listed.