Diabetes mellitus is defined as a metabolic disorder of multiple aetiologies that is characterized by chronic hyperglycemia (increased blood sugar) with disturbances in the metabolism of carbohydrate, fat, and protein which results from defects in insulin production, insulin action, or both from the beta cells of the pancreas.
The long-term effects of diabetes include damage, dysfunction, and failure of various organs in the body. The long-term effects include:-
- The progressive development of retinopathy with potential blindness
- Nephropathy that may lead to renal failure
- Neuropathy with the risk of foot ulcers
- Charcot’s joints
- Features of autonomic dysfunction
- Sexual dysfunction.
Table of Contents
Causes and risk factor for diabetes mellitus
Diabetes, either type 1 or type 2, has equally strong genetic and environmental risk factors, an interaction of which leads to the clinical expression of the disease. The genetic susceptibility for type 1 is associated with certain human leukocyte antigen (HLA) combinations (DR3+DR4) and the environmental insults are rather ill-defined.
Possibility of some aspects of diet and viral infections triggering an autoimmune exposure causing specific destruction of the β-cells of the pancreas has been proposed.
Type 2 diabetes has a more complex etiopathology. Though it has a strong genetic basis, as shown by its hereditary nature, the major susceptibility genes have not yet been identified. Racial predisposition as seen in Asian populations also is common.
The environmental factors showing a strong association with diabetes are
- Increasing age
- Family history of diabetes
- Unhealthy diet
- Physical inactivity
- Insulin resistance
- Adverse intrauterine environment
- Stress factors.
The pathophysiology of type 2 diabetes includes
- Impaired insulin secretion,
- Impaired insulin action,
- Insulin resistance and
- impaired incretin effect on the β-cell function and
- Non-suppression of the action of α-cells, with rising blood glucose levels.
Symptoms of diabetes mellitus
- Increased thirst with dry mouth
- Polyuria (increased frequency of urination)
- Nocturia (increased frequency of urine in the night)
- Fatigue and lethargy
- A noticeable change in weight (usually weight loss)
- Blurring of vision
- Pruritus vulvae (itching in female genital)
- Balanitis (genital candidiasis)
- Hyperphagia; a predilection for sweet foods
- Mood change,
- Difficulty in concentrating,
Investigations for diabetes mellitus
For diabetes mellitus, testing the urine for the presence of glucose with dipsticks is a common screening method for detecting diabetes.
Ketone bodies can be identified by the nitroprusside reaction, which measures acetoacetate, using either tablets or dipsticks
Standard dipstick testing for albumin detects urinary albumin at concentrations > 300 mg/L, but smaller amounts (microalbuminuria, Box 17.21, p. 480) can only be measured using specific albumin dipsticks or by quantitative biochemical laboratory measurement.
Blood glucose can also be measured with colorimetric or other testing sticks, which are often read with a portable electronic meter.
Diagnostic criteria:- (venous plasma glucose)
- Fasting hyperglycaemia:- Fasting- 110-125mg/dL ; After 2 hours- <140mg/dL
- Impaired glucose intolerance:- Fasting- <126mg/dL ; After 2 hours- 140-199mg/dL
- Diabetes:- Fasting- >= 126mg/dL ; After 2 hours- >= 200mg/dL
The diagnostic criteria for diabetes mellitus in pregnant women’s are more strict and precise than those recommended for non- Pregnant women’s. Pregnant women who have abnormal glucose tolerance should be referred urgently to a specialist unit (obstetric and gynecologist) for full evaluation for diagnosing diabetes mellitus.
Once the diagnosis for diabetes mellitus gets confirmed, the patient is referred for other investigations which include plasma urea, creatinine and electrolytes, lipids, liver, and thyroid function tests, and urine testing for ketones, protein or microalbuminuria
Treatment to treat diabetes using Leech therapy
For diabetes patients, first-line therapy involves lifestyle modification and change in their diet. Second-line therapy includes educating the patient that people with diabetes should understand their disorder and should learn to handle all aspects of their management as comprehensively and quickly as possible.
Oral anti-diabetic drugs are given to the patients who are with severe symptoms of diabetes mellitus at the time of diagnosis.
In parallel with the treatment of diabetes mellitus, other risk factors for complications of diabetes need to be addressed, including treatment of hypertension and dyslipidemia, and advice on smoking cessation.
Leech therapy for diabetes mellitus
Leech therapy has been used in treating various diseases. This therapy has been used since the traditional time and now also this treatment is used for treating many diseases including diabetes mellitus.
In leech therapy or hirudotherapy, species of the leech is used for medical use, in which leech is able to suck blood up to 12-15 ml from the body to maintain the normal function of the body.
Leech therapy is specially adapted for treating the diabetic wounds where the surgery is the only option and in case of diabetic foot ulcer where gangrene takes place, amputation (cut off) of the affected part is the only option.
Need for therapy for diabetes mellitus
In diabetes, Mellitus patient has a high blood sugar level which makes the blood more thick than the normal (viscus blood). Due to this thick blood patients have increased chances of developing blood clots in the arteries and veins.
Leech therapy is given to these patients to reduce the thickness of blood and prevent complications. As leech saliva contains hirudin which prevents the blood clot. Leech therapy is also given in the patient of diabetes mellitus who has poor wound healing, diabetic foot ulcer, and diabetic foot gangrene.
Leech therapy also helps to stimulate the liver and pancreas to regulate the normal formation of insulin by its own and also leech therapy helps in improving the metabolism in the body.
Leech therapy procedure for diabetes mellitus
Before starting with the leech therapy for diabetic foot, the legs and feet are washed properly. Now the leeches are applied on the legs. If they are not sticking on the legs than a small prick is done so that a small amount of blood comes out which will help leeches to attach on the leg.
Some patients feel the sensation on their leg just like mosquito bite while some patient doesn’t feel any pain due to anesthetic property present in the saliva of blood.
Leeches are left for one to two hours till their size becomes three to four times of their original size. After which leeches fell down by own or should be separated very delicately.
A small amount of blood can come out from the leech bite area which can be soaked by the dressing of the part. For natural healing of the leech bite, the honey is applied to the parts which prevent further oozing of the blood and natural healing takes place.
The result can be seen from the very first night of leech therapy.
Benefits and side effects of leech therapy for diabetes mellitus
Here are the side effects and benefits of leech therapy for diabetes mellitus.
Leech therapy helps in
- It suppresses the blood clotting mechanism in diabetic patients.
- helps to maintain the normal flow of blood.
- helps in diluting the blood.
- relieves the pressure on the heart and blood vessels.
- increases the energy level in the patients of diabetes mellitus.
- improves the breathing problem in diabetic patients.
- prevents the amputation of the leg due to increased blood sugar which causes diabetic foot ulcers.
- It has an anti-inflammatory property that prevents diabetic neuropathy.
- Leech therapy decreases the pain in the wound.
- Leech therapy clears the necrotizing area present due to increased blood sugar.
- The patient can have severe bleeding which can cause anemia in them.
- Due to high blood sugar, these patients are more prone to infections which can be caused by the bacteria present on the leech.
- Diabetic patients wound does not heal easily, so the leech bite from which oozing of blood took place may not get heal properly due to increased blood sugar.
- Some patients can be allergic to the active components of the saliva and can have hypersensitive reactions.
- The patient can have scarring at the site of the leech bite.
Complications caused due to diabetes mellitus are now next to cancer. Due to high blood sugar, various other organs in the body are also affected. The patient normal life is also affected due to which diabetic patient routine life is also affected.
When a diabetic patient is under modern medical treatment, the doctor told them to take medicine for reducing the high blood sugar and for maintaining it within the normal range.
If the blood sugar level always remains high from the normal range than these patient has increased chances for developing complications.
Leech therapy when given to the patient of diabetes it improves the blood sugar level and even cures the complications of diabetes in which the doctor told them amputation is the only choice to save their life.
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