(219) Diabetes: Patterns and Formulas

[HB KIM]

DEFINITION AND SYMPTOMS
Diabetes Mellitus, is a disease in which the pancreas produces insufficient amount of insulin, or in which the cells fail to respond appropriately to insulin. Insulin is a hormone that helps the cells to absorb glucose (sugar), so that it can be used as a source of energy. In people with diabetes, glucose levels build up in the blood and urine, causing excessive urination, thirst, hunger, and problems with fat and protein metabolism. Diabetes mellitus differs from the less common diabetes insipidus, which is caused by lack of the hormone vasopressin (ADH), which controls the amount of urine secreted.

TYPES
Type 1:  Diabetes is classified into two types. In Type 1 diabetes, formerly called insulin-dependent diabetes mellitus (IDDM) and juvenile-onset diabetes, the body does not produce insulin or produces it only in very small quantities. Symptoms usually appear suddenly, typically in individuals under 20 years of age. Most cases occur around puberty and around age 10 to 12 in girls and age 12 to 14 in boys. In the United States Type 1 diabetes accounts for 5 to 10 percent of all diabetes cases. In Canada, Type 1 diabetes accounts for about 10 percent of all diabetes cases.
Type 2: In Type 2 diabetes, formerly known as non-insulin-dependent diabetes mellitus (NIDDM) and adult-onset diabetes, the body's delicate balance between insulin production and the ability of cells to use insulin goes wrong. The symptoms or characteristics of Type 2 diabetes include those found in Type 1 diabetes, as well as repeated infections or skin sores that heal slowly or not at all, generalized tiredness, and tingling or numbness in hands or feet.

SIGNS AND SYMPTOMS: Increased thirst, a frequent urge for urination, hunger, a flu-like feeling, including weakness and fatigue, unexplained weight loss, blurred vision, irritability, slow healing of cuts and bruises, tingling or numbness in hands or feet, red, swollen and tender gums, recurring infections of the gums, skin, vagina or bladder


COMPLICATIONS
Short-term complications: low blood sugar, high blood sugar
Long-term complications: nerve damage, kidney disease, eye disease, cardiovascular disease, increased risk of infection



DIFFERENTIAL DIAGNOSIS AND FORMULAS
In Oriental Medicine, Diabetes is categorized under "Xiao Ke". 

1. LU Heat with Fluid Deficiency
S/S: thirst with desire to drink even after drinking, dry and heat sensation in the throat, polyuria, red tongue, lack of saliva, thin yellow coating, rapid pulse

Modified Xiao Ke Fang (Dan Xi Xin Fa, 1481)
Huang Lian
Tian Hua Fen
Ou Jie
Sheng Di
Sheng Jiang
+
Mai Men Dong
Xuan Shen
Ge Gen

2. ST Heat
S/S: thirst with drinking lots of water, hungry easily even after big meal, thin body, dry stool, frequent urination, red tongue, yellow coating, slippery and rapid pulse

Modified Yu Nu Jian (Jing Yue Quan Shu, 1624)
Shi Gao  9-15g
Shu Di Huang  9-30g
Mai Men Dong  6g
Zhi Mu  4.5g
Niu Xi  4.5g
+
Xuan Shen
Jue Ming Zi

3. Qi and Yin Both Deficiency
S/S: mental fatigue, tiredness, shortness of breath worse with exertion, weakness of lower limbs, dryness of mouth and throat, five palms heat, drinking lots of water, polyuria, slight pale tongue with teeth mark, thin white coating, lack of saliva, thready pulse

Modified Ren Shen Bai Hu Tang (Za Bing Yuan Liu Xi Zhu, 1773)
Ren Shen  6g
Zhi Mu  10g
Shi Gao  15g
Tian Hua Fen  10g
Ge Gen  10g
Mai Men Dong  8g
Dan Zhu Ye  8g
Geng Mi  20g
+
Huang Qi
Sheng Di Huang
Xuan Shen

4. Yin and Yang Both Deficiency
S/S: Pain on the lower bak and knee, aversion to cold, cold limbs, spermatorrhea, impotence, frequent urination during night time, dizziness, tinnitus, dark face, slight pale and swollen tongue, white coating, deep and week pulse.

Modified Jin Gui Shen Qi Wan (Jin Gui Yao Lao, 3rd century)
Sheng Di Huang  24g
Shan Yao  12g
Shan Zhu Yu  12g
Fu Ling  9g
Ze Xie  9g
Mu Dan Pi  9g
Gui Zhi  3g
Fu Zi  3g
+
Gou Qi Zi
Tu Si Zi
Huang Qi
Ba Ji Tian