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Diabetes Mellitus : Diagnosis
   
Western Medicine Chinese Medicine

There are various methods to evaluate and diagnose diabetes: detection of typical symptoms such as random glucose level, fasting glucose, two-hour post-load glucose level, and HbA1c (an indicator of glycemic (glucose) control over a 3-4 month period). According to the 1985 World Health Organization (WHO) report, diabetes is defined by:

A fasting plasma glucose (FPG) of 140 mg/dl (7.8 mmol/l) or greater
A 2-hour plasma glucose (2-h PG) post 75-gm of oral glucose tolerance test (OGTT) level of 200 mg/dl (11.1 mmol/l)
Both of the above

However, the latest American Diabetes Association (ADA) expert committee finds that there is a greater degree of hyperglycemia amongst patients who have FPG of 140 mg/dl or higher than those who have 2-h PG of 200 mg/dl or higher. Almost all patients with FPG 140 mg/dl or higher have 2-h PG levels of 200 mg/dl or higher. However, not all patients with 2-h PG of 200 mg/dl or higher have FPG of 140 mg/dl or higher. Therefore, the ADA currently recommends the diagnosis of diabetes be based on a lower level of FPG.
A patient is diagnosed with diabetes if he has typical hyperglycemic symptoms with a random plasma glucose of 200 mg/dl (11.1 mmol/l) or greater, confirmed on a subsequent day by one of the following criteria:
Typical symptoms of diabetes plus a random plasma glucose of 200 mg/dl (11.1 mmol/l)
A fasting (at least 8 hours of no caloric intake) plasma glucose of 126 mg/dl (7 mmol/l) instead of 140 mg/dl
A 2-hour post load glucose level of > 200 mg/dl (11.1 mmol/l) after a 75-gram anhydrous glucose load.


 
 

TCM practitioners will diagnosis diabetes according to its clinical symptoms and further characterize it by the disharmony pattern an individual displays.

Diabetes, as is commonly understood from a western medicine perspective, is largely dependent on western methodologies for diagnosis. (See western medicine diagnosis section.)

TCM Examination Techniques:
Diagnosis in TCM is based on four examination techniques. The first is "questioning." The TCM practitioner will want to know what the individual's current complaints are, and their family's medical history. The second technique is "observation." Physical features of the body such as the face, tongue, hair, nails, sputum (mucus that is coughed up) and examining the area of pain all offer clues to the problem. The tongue is particularly useful gage to assess illness because it is seen as a window to look at the functioning of internal organs. The third technique is "hearing and smelling." Smelling the sputum and breath and listening to the sounds coming from the chest offer additional clues. The last technique used in examination is "touching." Feeling the pulse is a cornerstone of TCM diagnosis and gives the TCM practitioner a lot of information about the body's imbalance.

In TCM theory, diabetes is characterized by a combination of symptoms below:

Excessive eating
Excessive drinking
Excessive urine
Wasting of body tissues or weight loss

Note: If a TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she will recommend the individual see a western doctor for further follow up. When an individual experiences severe symptoms like those listed above, it should be taken very seriously, and the appropriate medical care should be sought out preferably in an emergency setting.

The four Types of Disharmony Patterns Even though diabetes can be diagnosed from the above symptoms, the information gathered from the TCM physical examination is used to determine which type of disharmony pattern an individual has. This is important because at the various stages of a disease, a varicty of disharmony patterns are present which require different types of therapy. This is the reason two individuals with the same disease may be treated very differently by their TCM practitioner.

1. Yin Deficiency and Heat Excessive Type
  In TCM, yin deficiency commonly refers to a deficiency of yin fluids such as blood and body fluids. Without sufficient nourishment by these fluids, excitatory functions (heat excessive manifestations) become dominant and lead to symptoms of fever, thirst or increased appetite.
2. Deficiency of Qi and Yin Type
  Qi can be interpreted as the "life energy" or "life force," that flows within us. Deficiencies in qi and yin result in organ dysfunction. In diabetes, the most affected organs are the lungs, stomach and kidneys.
3. Blood Stasis and Internal Obstructed Type
  This refers to a state where the blood cannot circulate smoothly, and is usually accompanied by qi stagnation. The organs lose nutrients from the blood, which cause symptoms like numbness in the limbs or localized tissue death. For example, people with diabetes may suffer from ulcerations in their legs and feet due to poor blood supply.
4. Deficiency of Yin and Yang Type
  The body's physiological functions (yang) and physical forms (yin) are maintained in constant balance to achieve health. When vital qi is severely deficient for a long time, this type will develop. It is a more general type of deficiency that can occur in many diseases such as diabetes.

Other Related Disharmony Patterns: Accumulated Internal Wet Heat Type Improper diet is one of the causes of diabetes from a TCM perspective. This impairs the proper functioning of the spleen and stomach, which leads to formation of wet and heat evils. These evils affect the fluid metabolism inside the body, and diabetes symptoms like excessive thirst and hunger can appear.

Diabetes should be differentiated from hyperthyroidism (over-functioning of the thyroid gland)

Sometimes it is difficult to distinguish diabetes from hyperthyroidism since both share similar symptoms. In both conditions there may be the presence of an increased appetite associated with weight loss. Diabetes patients are frequently thirsty, and excrete an excessive amount urine with glucose (sugar) present in it. However, people suffering from hyperthyroidism experience irritability, excrete loose yellow stools, and have eyelid retraction and eyeball protrusion. Individuals with this condition may also suffer from a rapid and forceful heartbeat, and swelling of the thyroid gland in the neck. To safely make the distinction, laboratory examinations of the blood and urine can be done to diagnose these two conditions.