DIABETES MELLITUS usually starts much earlier than the patients become aware of it. The first symptoms are vague and general to such a degree that they may be applied to other diseases, especially to diseases of the digestive organs.
Consequently we have to examine the urine in all cases whatsoever, before giving any advice or any treatment. Not to do, I must say, would be an inexcusable mistake.
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Diabetes mellitus begins with disorders of the digestive organs. The patient at first complains of uneasiness, painful sensations and tightness in the region of the liver and of the stomach, accompanied by irregular opening of the bowels, sometimes by acid eructation and vomiting of a brownish, very bitter tasting liquid. The patient complains of headache, sleeplessness, intense fatigue, giddiness, buzzing in the ears, weakness of the eyes, palpitation of the heart, burning sensations in the heads and feet; simultaneously the mental condition of the patient gets entirely altered.
Certainly all these symptoms are of an entirely general nature and may be found also in many other diseases. But if the disease progresses, we get confronted with a very characteristic symptoms, i.e. the strikingly increased thirst, especially after eating and during the night.
Naturally the patient is constantly seeking to allay it, and the quantity of liquid consumed is proportional to the amount of urine passed.
According to the increased secretion of urine the patient has to urinate very often, especially during the night, again and again interrupting the patients sleep. As a rule the average quantity of the urine during twenty-four hours amounts to 3-5 pints. But there are cases in which the quantity may be much greater. I remember patients secreting nearly 12 pints urine daily. The urine is usually clear, pale in colour, has a sweet taste and is of high specific gravity (1030 to 1050).
When diabetic urine is boiled with cupric salt, which has a bluish of green color, the latter is reduced to a cuprous salt having a brown or yellow colour, and a process depending upon this chemical reaction from the usual method of recognizing and estimating the amount of sugar present in the urine. The sugar can also be tested by measuring the amount of carbonic acid gas set free on fermentation by yeast and by the extent to which a specimen of the urine rotates the pane of polarized light. The quantity of sugar passed in twenty-four hours may vary from a few ounces to several pounds, and it is, of course, markedly increased after sugary or starchy food has been taken. In light cases of diabetes the urine contains only 2 to 1 per cent. sugar, in the most serious cases 10 per cent. or even more; in these serious cases there is also albumen in the urine. In such serious cases the urine contains two other components, i.e. acetone and acetone-acetic acid; their presence in the urine we may conclude already from the winy smell of the urine or from the patients breath.
If the patients breath has the characteristic unpleasant pomaceous smell, we may be sure that acetone and acetone-acetic acid are not only in the breath, but also in the urine of the patient. Whoever has repeatedly perceived that smell will always recognize it, hence it is called the acetone-smell.
As a rule the skin of the diabetic patient is dry and harsh with a peculiar papery consistency. Owing to the poor vitality of the tissues, various skin eruptions appear, boils and carbuncles being especially common and, in the fact, sometimes giving the first signs of the presence of the disease. The sugar deposited from the urine is very liable to cause itching about the groins and eczema of various parts of the body is set up by the presence of sugar in the sweat. There is a special tendency to gangrene of the skin of the feet, commencing with the toes, and this from is a very serious complication of diabetes and a not uncommon from of fatal issue.
Regarding the nervous symptoms I have already mentioned the general symptoms as there are a certain feebleness, exhaustion, dislike of physical or intellectual work, great weakness after the slightest exertion, sensation of formication and numbness in the limbs, headache, depression. But one symptom of the nervous system is a very characteristic one, i.e. the typical neuralgia, especially frequently affecting the sciatic nerve, usually called ischias or sciatica.
Whenever it affects both sides, it may be an early symptom of the diabetes; besides the sciatica there are also cases with neuralgia in the occiput or in the face as well as cases of a specific migraine (sick headache). In other cases of diabetes we find paralysis of the limbs.
The most serious symptom of the disease is the so-called diabetic coma; it usually begins with some slighter general nervous symptoms as there are headache, nausea, a certain unrest, oppression and anguish, very soon increasing and aggravating. the patient gets delirious, jumps out of the bed and gets excited to such a degree that he behaves as raving mad. As soon as the excitation has passed away, a characteristic enervation and somnolence sets in, aggravating in the most serious cases up to complete unconsciousness and to that deathlike sleep, called coma. The patients breathe extremely deeply and noisily, their faces get bluish red, cyanotic, the pulse is very much accelerated and low, the temperature decreasing.
Such a coma may continue for several days, but in the majority of cases it starts like an apoplexy. In any case the coma always is the most alarming and the most fateful symptom, it is due to a self-poisoning as a result of the absorption of the waste products of metabolism or of the products of decomposition within the intestine. In nearly all cases the coma is the consequence of inappropriate nourishment, especially of too much meat and eggs. The patient overloads the digestive organs with nourishment which cannot be digested, slags remain, poisoning the central nervous system.
Diabetes, as a rule, advance comparatively slowly, except in the case of young people, in whom its progress is apt to be rapid. Indeed, in a general way, it is more serious, the younger the subject of the disease. Various complications arise in its course; some of them I have already mentioned; as one of the most alarming complication I will call attention to the cataract, followed by dimness and loss of sight, furthermore to inflammatory chest affections, of which pulmonary consumption is the most common and is a frequent termination of diabetes. Occasionally death occurs from exhaustion or from the coma diabeticum spoken of above. But the majority of cases continue suitable diet and treatment for many years without materially getting worse, and in a great number of cases complete cure apparently takes place. The most unfavorable cases are those in children, also cases in which the disease has already become of severe character, and has established before it has been recognized.
There is no other disease in which diet is of such a decisive importance as it is in diabetes. It would be a serious mistake to prescribe schematically the same diabetic diet for all cases; each case has to be treated individually according to the age, weight and activity of the patient as well as to the stage reached by the diabetes. The amount of energy that must be supplied by the food in order to carry on the vital processes of life, such as body warmth, the action of the heart, he such as body warmth, the action of the heart, the movements of the chest, in breathing, and the chemical activities of the secreting glands, is, for an adult of about 140 lbs. in weight, approximately 1,600 calories daily. For a patient, lying quietly in bed, little more is needed; for sedentary occupations such a patient requires about 2,000 calories, while if he is doing muscular work, the equivalent of 3,000 calories is needed. I desist from discussing that problem thoroughly, though it is of the greatest importance.
Generally speaking the diabetic diet ought to be composed of albumen. green vegetable and fats. Uncooked food ought to be the main constituent; especially I call the attention to uncooked fermented cabbage, plentifully containing vitamins, mineral salts and an insulin-like body; I usually prescribe 1 to 2 lbs. daily. Furthermore, once or twice weekly, the patient ought to take only fruit, especially berry fruits; owing to their abundance of bases, they alkalize the acids and diminish the demand for albumen. Green vegetables, especially green beans, salads, onions, horseradish, celery, carrots, radish, potatoes baked in their jackets, fresh cucumbers, nuts, especially walnuts, oatmeal porridge, old and very well toasted rye-bread, cream cheese, fresh butter, daily one to two large spoons of walnut oil and the yolk of an egg, mixed with lemon juice, are of the greatest value for the patients. For, generally speaking, vegetable albumen is more wholesome to the diabetic patient than animal albumen; at least sausage ought to be prohibited.
Regarding the beverages I must call the attention to the wholesome effect of the various herbal teas, as there are hips, leaves of bilberries, bean-skins, dandelion; furthermore we ought to give berry fruit juices, lemon, mineral waters, sea-water preparations, buttermilk. I am giving to all my patients, as I have already mentioned in my paper on goitre (No. 4 of the journal), the Adinolan tea; due to its constituents it has the best effect on the metabolism. it purifies the whole body and stimulates the vital reactions of the patient.
Before discussing the Homoeopathic treatment of diabetes, I call attention to yeast as to a remedy of the greatest importance. It is indeed a tonic roborant as well as a remedy for the whole constitution of the patient; also, in serious cases its effect is such a striking one that no homoeopath ought to slight it. By giving 20-30 gr. daily we may, even in serious cases, save insulin, Insulin is the principal remedy not only in allopathy, but it is also used by a great number of homoeopaths. I refer only to Stiegele, the most prominent German homoeopath, who is of the opinion that Homeopathy is not able to replace the insulin; but, as the effect of the insulin is only a short one, Homoeopathy has supplement it. Certainly, a great many homoeopaths refuse insulin at all. I will not discuss thoroughly all the pros and cons of the insulin question. In my opinion, we so not need it in light cases, but I would not like to miss it in serious cases, especially in cases of coma; the homoeopath, who in coma cases would not given insulin, would be responsible for the patients death. Furthermore, we dare not to stop insulin entirely at once in patients who up to the beginning of the homoeopathic treatment have been using insulin for a long time. I remember such a tragedy.
Some years ago I was consulted by a patient, 40 years of age, who has suffered from diabetes for twelve years and was doing very well, thing daily 250 units insulin. He never had any serious complication and was able to work. When I saw him first he was in good condition, all his organs without any pathological condition; the urine was without albumen, containing 2 to 4 per cent. sugar, no acetone; the polyuria mounted up to 24 daily. As this case seemed to be a very light one, I told the patient to stop the insulin injections and to take only the Homoeopathic drugs; I gave Natrum sulf. O two doses every forenoon and Lycopodium 10x two doses during the after noon. Three days later the patient was suffering from severe headache, nausea, restlessness, aggravating from hour to hour; in spite of clinical treatment the most serious coma developed from which the patient did not recover; he died after twenty hours. There can be no doubt the death of that patient was due only to the abrupt discontinuance of the insulin; such a case, though it may be an exception, ought to be an earnest warning to all homoeopaths.
The homoeopathic treatment of diabetes has to be based on the fact that the glycosuria is only symptom of the disease; to find the most suitable drug for the patient we have to keep in mind the whole constitution of the patient; i.e. we have to consider not only the physiological cases we have to treat the constitution of the patient rather than the glycosuria. That point is very important, especially here are far reaching points of view. I refer at fist to Sulphur; it is also a constituent of the insulin-molecule, having far reaching connections with the metabolism, especially with the oxidizing process; it provokes symptoms on the skin and in the links, so frequently in diabetic patients; furthermore, there is the same psychical irritability, voracious or loss of appetite, sleeplessness; a single dose of Sulphur 200x will in a great many cases prove to be helpful. In cases of a hydrogenoid constitution. I prefer Natrum sulph - 6x twice daily, these are patients whose tongue is brownish coated, dry; bitter taste; mouth and pharynx very dry, disorders of the liver, gall bladder and bowels; dropsy, oedema.
Phosphorus is one of our most valuable drugs, being connected with the metabolism of the fats and with the storing of glycogen; it is especially indicated in cases, complicated by gout, tuberculous and other diseases of the bronchial ways or the lungs. Instead of Phosphorus itself we may give Kalium phos, Ferrum phos or Calcium phos.
Acidum phos is indicated in cases where the nervous symptoms are to be considered first, especially in cases, due to grief, care and trouble, the patients are indifferent, unconcerned about their family; there is a great mental and physical weakness, loss of appetite, but extremely increased thirst. Many furuncles. Urine very much increased, much sugar, many phosphates; the urine has a pale, milky colour. Before the micturition anguish, after it burning.
Acid. phos 3x-6x is especially indicated in diabetic children, suffering from stomach troubles, or having grown up too quickly.
Acid aceticum 6x-12x suitable to patients suffering from great anaemia and weakness, polyuria, face emaciated, salivation, burning thirst, vomiting after each meal, pyrosis, increased acidity in the stomach; burning pains in the stomach.
Iodine 12x-200x increased appetite, skin very dry, many nervous symptoms, disorders of the glandular system and of the liver metabolism.
Secale 3x. Emaciation, gangrene of the toes, extremities cold; worse by heat.
Bryonia2x-6x. Very thirsty, lips very, bitter taste the patients are weakened, peevish, sad, appetite normal, disorders of the liver.
Uranium nit3x-12x. Suitable to cases due to disorders of the assimilation, characterized by disposition to ascites or to general dropsy, great weakness, indigestion, urine increased, acid, very much sugar in the urine, burning sensation in the urethra, very thirsty, mouth dry, emaciation in spite of good appetite.
Syzygium jambolanum O-12x improves the general condition of the patient, decreases the quantity of the sugar of the blood as well as of the urine; suitable to patients suffering from thirst, great weakness and emaciation; furunculosis; specific gravity of the urine very high.
Plumbum 30x. According to Hering one off the most important remedies, especially suitable to patients suffering from nervous troubles and constipation.
Arsen. 6x-200x. very thirsty; emaciation; especially for cases of gangrene.
Acidum lacticum 3x-6x Suitable to patients suffering from disorders of the liver and of the whole digestive system, very thirsty, appetite very much increased, nausea vomiting; urine in profusion, clear yellow, sweetishly smelling.
Acidum aceticum 4x-6x. Suitable to serious cases, especially to patients suffering from the stomach, burning pain, burning thirst, pyrosis, vomiting after each meal, salivation; anaemia of a high degree, greatest weakness, skin very dry, sweat, face emaciated, wax-coloured; polyuria, urine very light and pale.
Podophyllum 3x-6x. Bitter taste, tongue white coated, disorders of the liver, batter by pressing the region of the liver.
Argent. met 6x. Polyuria, urine cloudy, sweetishly smelling, micturition frequent and abundant.
Argent. Nit 4x-5x. Patient has a great longing for sweets, though they are making worse all troubles; disorders of the stomach, eructation; feet very cold. Better by eructation, fresh air, cold and pressure.
Chionanthus3x-10x. Sensation of great dryness, not improved by water, pinching pains in the umbilical region, enlargement of the liver, jaundice, constipation, stools whitish grey, mellow; diseases of the pancreatic and other glands. Urine bilious with very much sugar high specific gravity, dark brown colour.
Lycopodium 10x-12x. Suitable to the well-known Lycopodium constitution; I have learned by my own practice, that at least 40 per cent of the diabetic patients have very characteristic Lycopodium symptoms; in all these cases Lycopodium, especially given alternating with Natrum sulfuricum , improved the diabetic condition of the patients very quickly.
In cases of coma diabeticum we my give drugs like Echinacea, Belladonna, Helleborus niger, Hyoscyamus, Cuprum met, Opium or Acidum muriaticum. But I must repeat: I would not dare to rely upon the homeopathic drugs alone in such serious cases, but would rather give high doses of insulin.
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The following homoeopathic medicine has been extremely useful .a) CODEINUM when there is excessive skin irritation (Itching due to diabetes mellitus).b) PHOSPHORIC ACID when diabetes mellitus starts after some nervous exhaustion, working too hard or disappointment in relationship.c) Remedies like GUN POWDER, STAPHYLOCOCCINUM AND MELALEUCEA ALTERNIFOLIA are extremely useful for diabetic carbuncle and gangrene.d) Remedies like UREA PURA, AMPELOPSIS QUINQUEFOLIA are extremely useful for diabetic nephropathy
Ratanhia in Diabetes - Diabetes: with emaciation and weakness. limbs sore and aching. Great appetite: insatiable thirst and constant dryness of mouth. Frequent urging to urinate, scanty discharge; or passes large quantities of light coloured urine. Excruciating pain after stool with fissures of anus. Violent itching of rectum. Fissures of anus and nipples.