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Diabetes Mellitus : Definition
   
Western Medicine Chinese Medicine
Pancreatic Structure
Pancreas
Ampulla of Vater

Duodenum

Diabetes is a disease that is becoming increasingly common and progressively complicated. There were approximately 175 million people afflicted with diabetes worldwide, according to a 1994 report released during the 15th International Diabetes Federation Congress. Clinicians used to treat it as a disease of high blood glucose; however, we now view it as a disease of many factors, involving abnormal breakdown of fat, protein and glucose. Glucose is the sugar our body uses as energy for our cells. Current management involves controlling glucose levels to minimize complications in the finer blood vessels (microvasculature) as well as controlling other metabolic abnormalities such as high blood pressure, high cholesterol / triglycerides, or obesity to prevent complications in the bigger blood vessels (macrovasculature).

Diabetes mellitus is a term that was coined by Aretaeus the Cappadocian, a first century Greek physician. According to the physician, "diabetes" means "to flow through like a siphon", and "mellitus" meant "honey". He also described diabetes as a disease that led to "sweet urine" and "siphoning or melting down of the flesh and limbs into urine".

The definition and management of diabetes mellitus have changed over the years. We used to differentiate the two different types of diabetes by its time of onset. A patient was diagnosed with juvenile-onset diabetes if he was discovered to have high blood glucose during childhood. The patient would be diagnosed with adult-onset diabetes if he was discovered to have uncontrolled glucose during adulthood, usually when they were elderly.

However, there were many patients who fell in between the age groups. In the last decade, there has been a dramatic increase of diabetes among people in their 20s and 30s; therefore, the terms "juvenile-onset" and "adult-onset" diabetes have become obsolete.

Patients were also categorized into having "insulin dependent diabetes mellitus (IDDM)" or "non-insulin dependent diabetes mellitus (NIDDM)". However, there are many patients now receiving both oral medications as well as insulins in order to control their diabetes.

Individuals with diabetes are currently categorized has being Type 1or Type 2.

Type 1 diabetes results from an absolute lack of insulin.
Type 2 diabetes is due to a relative lack of insulin or insensitivity to the available insulin.

There are also other intermediate stages of the disease:.

Gestational diabetes occurs when a woman develops glucose intolerance only during pregnancy (this means her glucose levels rise higher due to physiological stress and the body is unable to secrete enough insulin to drive the glucose into the body's cells in order to utilize the glucose.) This is usually detected during or after the 2nd trimester and the woman carries a higher risk of developing diabetes later on in life.
Impaired glucose intolerance (IGT) or impaired fasting glucose (IFG), occurs when blood glucose is higher than normal, but not high enough to be classified as diabetes. Patients with IGT or IFG who continue to have uncontrolled glucose levels may eventually develop type 2 diabetes within 10 years.

Many view diabetes as a progressive disease that initially surfaces as impaired glucose intolerance with a high post-meal glucose. (This means the glucose level is abnormally high after eating a meal.) The high glucose levels continue to demand the pancreas to secrete more insulin resulting in a state of hyperinsulinemia. However, the body becomes resistant to the insulin, and later develops a relative lack of insulin, and high fasting (before eating) glucose levels. Typically this pattern presents itself as type 2 diabetes. Eventual exhaustion of the islet cells (a type of cell in the pancreas that makes insulin) leads to a final stage of definite or absolute lack of insulin with a typical presentation of type 1 diabetes.

Metabolic Defects in Type 2 Diabetes

Within a population, type 2 diabetes is much more common than type 1 diabetes. For example, there are approximately 16 million people afflicted with diabetes in the United States, with approximately 90 to 95% of the patients having type 2 disease while only 5 to 10% has type 1 disease. Epidemiological studies have also found that type 2 disease is more common among African-Americans, Hispanic-Americans, Native Americans, Asian-Americans, and Pacific Islanders. These ethinic populations are more at risk of developing diabetes probably due to a genetic predisposition as well as the rapid adaptations to western cultures that include high fat diet and sedentary lifestyles.

 

Huang Di Hei Jing (The Yellow Emperor's classic of Internal Medicine) is the earliest TCM theoretic book. It is divided into two parts Suwen (The Book of plain Questions) and Lingshu (The Book of Miraculous Pivot)

In ancient China, the word "diabetes" did not exist. However, an early definition of the illness can be found in the medical classic Huang Di Nei Jing (The Yellow Emperor's Classic of Internal Medicine) written during the Han Dynasty (approx. 200 BC). Under this book's Suwen (The Book of Plain Questions) section, diabetes was defined by the following symptoms "xiao ke" and "fei xiao," which translate into excessive drinking, and "ge xiao" and "xiao zhong," which mean excessive eating. According to the Suwen, additional clues to the disease include excreting large amounts of urine with sugar in it and weight loss. The ancient Chinese people also thought it was caused by improper diet and mainly affected the upper class. The Book of Plain Questions describes the diabetes sufferer as follows: " When, a person has eaten too much greasy and sweet food, the body produces dry-heat evils which causes qi to stay in the middle-burner of the body until finally the qi flows upward and spills over resulting in diabetes." The "Efficacious Formulae Recorded from Antiquity to the Present," penned by medical practitioner Zhen, Li-yan during the Sui Dynasty (589~618 AD), wrote that diabetes patients usually suffer from the following symptoms: "Frequent thirst that leads to excessive drinking, excessive urination, and urine that is sweet and without fat."

Diabetes is generally attributed to a deficiency of body fluids and the excessive accumulation of dry or heat evils inside the body. Dry and heat evils come from external environmental sources such as an improper diet and are transformed internally into disease causing factors such as a kidney yin deficiency. Dry and heat evils trigger certain organs in the body to react negatively. The organs that are most affected are the lung, stomach and kidney.
The Lungs: The lungs are responsible for the transformation and movement of water in the body. Dry-heat hurts the lungs and causes body fluid to flow straight down freely without being distributed to the rest of the body. This results in frequency in urination, thirst and excessive drinking, which are all symptoms of diabetes.
The Stomach: The stomach is a reservoir for food and drink. An intense stomach fire is caused by dry-heat which damages the stomach. As a result, the metabolic rate rises and triggers an increase in appetite and constipation. An increase in appetite is also another hallmark symptom of diabetes.
The Kidneys: Since the kidneys control water metabolism, deficiency of the kidney-yin and "virtual fire"(the heat developed inside the body by a relative excess of yang) creates dry and heat evils. This damages the "vaporization" function and results in the kidneys' failure to separate turbid water, which will be turned into urine and clean water, which is reused by the body. It also affects the opening and closing of the bladder. The end result is an excessive amount of urine, urinary frequency and the production of urine with traces of sugar.

Understanding water metabolism from a TCM perspective

In western medicine diabetes mellitus is a metabolic disorder that occurs when there is a chronically high level of glucose (sugar) in the blood caused by a deficiency or complete lack of insulin. The insulin deficiency and high glucose levels cause serious damage to the body over time if left untreated and in severe cases may cause death.

This western understanding of diabetes is not present in TCM. Its diagnosis is based on the clinical symptoms of diabetes such as excessive thirst, hunger and urination, which may or may not be accompanied by sudden weight loss. Depending on each individual's symptoms, it is further classified into four types of disharmony patterns discussed in the diagnosis section. Even though two people may be diagnosed with diabetes from a western perspective, these individuals may present with two different disharmony types from a TCM perspective and thus will be treated differently.