Diploma Ayurvedic Practitioners Course Module 5 2 & 3rd ... · Ayurvedic Practitioners Course Module 5 2nd & 3rd February 2019 Course Materials . ... symptoms and treatment of Diabetes

Diploma

Ayurvedic Practitioners Course

Module 5

2nd & 3rd February 2019

Course Materials

AYURVEDA INSTITUTE UK

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Diabetes

Obesity

&

Heart disease

Diabetes


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Diabetes – the allopathic perspective The following italicized passages are taken from the NHS online service which provides information and advice to the public on the causes, symptoms and treatment of Diabetes. It is useful to review the allopathic understanding of the disorder and the approach taken to treatment both for comparative purposes and in order to better explain to the patient. Please note that not all information provided is replicated here and that highlights in bold have been added.

Type 1 diabetes Overview Diabetes is a lifelong condition that causes a person's blood sugar (glucose) level to become too high. The hormone insulin, produced by the pancreas, is responsible for controlling the amount of glucose in the blood. There are two main types of diabetes:

type 1 – where the pancreas doesn't produce any insulin type 2 – where the pancreas doesn't produce enough insulin or the body's cells don't react to insulin

Symptoms of diabetes Typical symptoms of type 1 diabetes are:

feeling very thirsty passing urine more often than usual, particularly at night feeling very tired weight loss and loss of muscle bulk

The symptoms of type 1 diabetes usually develop very quickly in young people (over a few days or weeks). In adults, the symptoms often take longer to develop (a few months). These symptoms occur because the lack of insulin means that glucose stays in the blood and isn’t used as fuel for energy. Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine. It's very important for diabetes to be diagnosed as soon as possible, because it will get progressively worse if left untreated. Causes of type 1 diabetes Type 1 diabetes is an autoimmune condition, which means your immune system attacks healthy body tissue by mistake. In this case, it attacks the cells in your pancreas. Your damaged pancreas is then unable to produce insulin. So, glucose cannot be moved out of your bloodstream and into your cells. Type 1 diabetes is often inherited (runs in families), so the autoimmune reaction may be genetic. It's not known exactly what triggers the immune system to attack the pancreas, but some researchers have suggested it may be a viral infection. If you have a close relative – such as a parent, brother or sister – with type 1 diabetes, you have about a 6% chance of also developing the condition. The risk for people who don't have a close relative with type 1 diabetes is just under 0.5%.


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Treating type 1 diabetes Diabetes can't be cured. Treatment aims to keep your blood glucose levels as normal as possible and control your symptoms, to prevent health problems developing later in life. If you're diagnosed with diabetes, you'll be referred to a diabetes care team for specialist treatment and monitoring. As your body can't produce insulin, you'll need regular insulin injections to keep your glucose levels normal. There are alternatives to insulin injections, but they're only suitable for a small number of patients. Complications of type 1 diabetes Diabetes can cause serious long-term health problems. It's the most common cause of vision loss and blindness in people of working age. Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year for diabetic retinopathy. Diabetes is the reason for many cases of kidney failure and lower limb amputation. People with diabetes are up to five times more likely to have cardiovascular disease, such as a stroke, than those without diabetes. Living with type 1 diabetes If you have type 1 diabetes, you'll need to look after your health very carefully. This means:

eating a healthy, balanced diet losing weight, if you're overweight, and maintaining a healthy weight stopping smoking (if you smoke) drinking alcohol in moderation taking plenty of regular exercise

Symptoms The symptoms of type 1 diabetes can develop very quickly (over a few days or weeks), particularly in children. In older adults, the symptoms can often take longer to develop (a few months). However, they should disappear when you start taking insulin and the condition is under control. The main symptoms of diabetes are:

feeling very thirsty urinating more frequently than usual, particularly at night feeling very tired weight loss and loss of muscle bulk itchiness around the genital area, or regular bouts of thrush (a yeast infection) blurred vision caused by the lens of your eye changing shape slow healing of cuts and grazes

When to seek urgent medical attention You should seek urgent medical attention if you have diabetes and develop:

a loss of appetite nausea or vomiting a high temperature stomach pain fruity smelling breath – which may smell like pear drops or nail varnish (others will usually be able to smell

it, but you won't)


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Hypoglycaemia (low blood glucose) If you have diabetes, your blood glucose levels can become very low. This is known as hypoglycaemia (or a "hypo"), and it's triggered when injected insulin in your body moves too much glucose out of your bloodstream. In most cases, hypoglycaemia occurs as a result of taking too much insulin, although it can also develop if you skip a meal, exercise very vigorously or drink alcohol on an empty stomach. Symptoms of a "hypo" include:

feeling shaky and irritable sweating tingling lips feeling weak feeling confused hunger nausea (feeling sick)

A hypo can be brought under control simply by eating or drinking something sugary. If it isn't brought under control, a hypo can cause confusion, slurred speech and eventually unconsciousness. In this case, an emergency injection of a hormone called glucagon will be needed. Glucagon increases the glucose in your blood. Hyperglycaemia (high blood glucose) As people with type 1 diabetes cannot produce any insulin, their blood glucose levels may become very high. When your blood glucose levels become too high, it's known as hyperglycaemia. The symptoms of hyperglycaemia may come on suddenly and include:

extreme thirst a dry mouth blurred vision drowsiness a need to pass urine frequently

Left untreated, hyperglycaemia can lead to diabetic ketoacidosis. This is a serious condition where the body breaks down fat and muscle as an alternative source of energy. This leads to a build-up of acids in your blood, which can cause vomiting, dehydration, unconsciousness and even death. Diagnosis It's important for diabetes to be diagnosed early so treatment can be started as soon as possible. Your urine sample will be tested for glucose. Urine doesn't normally contain glucose, but glucose can pass from the kidneys into your urine if you have diabetes. If your urine contains glucose, a specialised blood test known as glycated haemoglobin (HbA1c) can be used to determine whether you have diabetes. Glycated haemoglobin (HbA1c) test The glycated haemoglobin (HbA1c) test can be used to diagnose diabetes. It can also be used to show how well diabetes is being controlled. The HbA1c test gives your average blood glucose level over the previous two to three months. The results can indicate whether the measures you're taking to control your diabetes are working, by meeting agreed personal targets. If you've been diagnosed with diabetes, it's recommended that you have your HbA1c measured at least twice a year.


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The HbA1c test can be carried out at any time of day and doesn't require any special preparation, such as fasting. However, it's less reliable in certain situations, such as during pregnancy. The advantages associated with the HbA1c test make it the preferred method of assessing how well blood glucose levels are being controlled in a person with diabetes. HbA1c is also increasingly being used as a diagnostic test for type 2 diabetes, and as a screening test for people at high risk of diabetes. Type 1 diabetes in children The majority of children who develop diabetes will have type 1 diabetes. You'll need to manage your child's condition as part of your daily life, but you'll be introduced to a specialist diabetes care team who can help you to come to terms with any challenges. Treatment There's no cure for diabetes, so treatment aims to keep your blood glucose levels as normal as possible and to control your symptoms to prevent health problems developing later in life. Type 1 diabetes occurs because your body doesn't produce any insulin. This means you'll need regular insulin treatment to keep your glucose levels normal. Insulin comes in several different preparations, each of which works slightly differently. For example, some last up to a whole day (long-acting), some last up to eight hours (short-acting) and some work quickly but don't last very long (rapid-acting). Your treatment is likely to include a combination of different insulin preparations. Insulin Insulin injections If you have type 1 diabetes, you'll probably need insulin injections. Insulin must be injected, because if it were taken as a tablet, it would be broken down in your stomach (like food) and would be unable to enter your bloodstream. Insulin injections are usually given by an injection pen, which is also known as an insulin pen or auto-injector. Sometimes, injections are given using a syringe. Most people need two to four injections a day. Insulin pump therapy Insulin pump therapy is an alternative to injecting insulin. An insulin pump is a small device that holds insulin and is about the size of a pack of playing cards. The pump is attached to you by a long, thin piece of tubing, with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach, but you could also insert it into your hips, thighs, buttocks or arms. The pump allows insulin to continuously flow into your bloodstream at a rate you can control. This means you no longer need to give yourself injections, although you'll need to monitor your blood glucose levels very closely to ensure you're receiving the right amount of insulin. Monitoring blood glucose If you have type 1 diabetes, your GP or diabetes care team will need to take a reading of your blood glucose level about every two to six months. The HbA1c test is used to measure blood glucose levels over the previous two to three months. HbA1c is a form of haemoglobin, the chemical that carries oxygen in red blood cells, which also has glucose attached to it. A high HbA1c level means that your blood glucose level has been consistently high over recent weeks, and your diabetes treatment plan may need to be changed. Your diabetes care team can help you set a target HbA1c level to aim for. This will usually be less than 59mmol/mol (7.5%). However, it can be as low as 48mmol/mol (6.5%) for some people.


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Monitoring your own blood glucose If you have type 1 diabetes, as well as having your blood glucose level checked by a healthcare professional every two to six months, you may be advised to monitor your own blood glucose levels at home. Even if you have a healthy diet and are taking tablets or using insulin therapy, exercise, illness and stress can affect your blood glucose levels. Other factors that may affect your blood glucose levels include drinking alcohol, taking other medicines and, for women, hormonal changes during the menstrual cycle. A blood glucose meter is a small device that measures the concentration of glucose in your blood. It can be useful for detecting high blood sugar (hyperglycaemia) or low blood sugar (hypoglycaemia). Treating hyperglycaemia (high blood glucose) Hyperglycaemia can occur when your blood glucose levels become too high. It can happen for several reasons, such as eating too much, being unwell or not taking enough insulin. If you develop hyperglycaemia, you may need to adjust your diet or your insulin dose to keep your glucose levels normal. If hyperglycaemia isn't treated, it can lead to a condition called diabetic ketoacidosis, where the body begins to break down fats for energy instead of glucose, resulting in a build-up of ketones (acids) in your blood. Diabetic ketoacidosis is very serious and if not addressed quickly, it can lead to unconsciousness and eventually death. The signs of diabetic ketoacidosis include:

frequently passing urine thirst tiredness and lethargy (lack of energy) blurry vision abdominal (stomach) pain nausea and vomiting deep breathing smell of ketones on breath (described as smelling like pear drops) collapse and unconsciousness

If you develop diabetic ketoacidosis, you'll need urgent hospital treatment. You'll be given insulin directly into a vein (intravenously). You may also need other fluids given by a drip if you're dehydrated, including salt solution and potassium. Treating hypoglycaemia (low blood glucose) If you have type 1 diabetes that's controlled using insulin or certain types of tablets, you may experience episodes of hypoglycaemia. Hypoglycaemia is where your blood glucose levels become very low. Mild hypoglycaemia (a "hypo") can make you feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary. If you have a hypo, you should initially have a form of carbohydrate that will act quickly, such as a sugary drink or glucose tablets. This should be followed by a longer-acting carbohydrate, such as a cereal bar, sandwich or piece of fruit. In most cases, these measures will be enough to raise your blood glucose level to normal, although it may take a few hours. If you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness. If this occurs, you may need to have an injection of glucagon into your muscle or glucose into a vein. Glucagon is a hormone that quickly increases your blood glucose levels.


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Other treatments Type 1 diabetes can lead to long-term complications. If you have the condition, you have an increased risk of developing heart disease, stroke and kidney disease. To reduce the chance of this, you may be advised to take:

anti-hypertensive medicines to control high blood pressure a statin, such as simvastatin, to reduce high cholesterol levels low-dose aspirin to prevent stroke angiotensin-converting enzyme (ACE) inhibitor – such as enalapril, lisinopril or ramipril if you have the

early signs of diabetic kidney disease Diabetic kidney disease is identified by the presence of small amounts of a protein called albumin in your urine. It's often reversible if treated early enough. Complications If diabetes isn't treated, it can lead to a number of different health problems. High glucose levels can damage blood vessels, nerves and organs. Even a mildly raised glucose level that doesn't cause any symptoms can have damaging effects in the long term. Heart disease and stroke If you have diabetes, you're up to five times more likely to develop coronary heart disease (CHD) or have a stroke. Prolonged, poorly controlled blood glucose levels increase the likelihood of developing atherosclerosis (furring and narrowing of your blood vessels). This may result in a poor blood supply to your heart, causing angina (a dull, heavy or tight pain in the chest). It also increases the chance that a blood vessel in your heart or brain will become completely blocked, leading to a heart attack or stroke. Nerve damage High blood glucose levels can damage the tiny blood vessels of your nerves. This can cause a tingling or burning pain that spreads from your fingers and toes up through your limbs. It can also cause numbness, which can lead to ulceration of the feet. Damage to the peripheral nervous system (the nervous system outside the brain and spinal cord) is known as peripheral neuropathy. If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation. Diabetic retinopathy Diabetic retinopathy is where the retina, the light-sensitive layer of tissue at the back of the eye, becomes damaged. The retina needs a constant supply of blood, which it receives through a network of tiny blood vessels. Over time, a persistently high blood sugar level can damage these blood vessels and affect your vision. Annual eye checks are usually organised by a regional photographic unit. If significant damage is detected, you may be referred to a doctor who specialises in treating eye conditions (ophthalmologist). Diabetic retinopathy can be managed using laser treatment if it's caught early enough. However, this will only preserve the sight you have rather than improve it. Kidney disease If the small blood vessels in your kidney become blocked and leaky, your kidneys will work less efficiently. It's usually associated with high blood pressure, and treating this is a key part of management. In rare, severe cases, this can lead to kidney failure. This can mean a kidney replacement, treatment with dialysis or sometimes kidney transplantation becomes necessary.


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Foot problems Damage to the nerves of the foot can mean small nicks and cuts aren't noticed and this, in combination with poor circulation, can lead to a foot ulcer. About 1 in 10 people with diabetes get a foot ulcer, which can cause a serious infection. Sexual dysfunction In men with diabetes, particularly those who smoke, nerve and blood vessel damage can lead to erection problems. This can usually be treated with medication. Women with diabetes may experience:

a reduced sex drive (loss of libido) reduced pleasure from sex vaginal dryness a reduced ability to orgasm pain during sex

If you experience a lack of vaginal lubrication, or you find sex painful, you can use a vaginal lubricant or a water-based gel. Miscarriage and stillbirth Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If your blood sugar level isn't carefully controlled immediately before and during early pregnancy, there's also an increased risk of the baby developing a serious birth defect. Living with Your diabetes care team As type 1 diabetes is a long-term condition, you'll be in regular contact with your diabetes care team. Your GP or diabetes care team will also need to check your eyes, feet and nerves regularly because they can also be affected by diabetes. Lifestyle changes Healthy eating Eating a healthy, balanced diet is very important if you have diabetes. However, you don't need to avoid certain food groups altogether. You can have a varied diet and enjoy a wide range of foods as long as you eat regularly and make healthy choices. You can make adaptations when cooking meals, such as reducing the amount of fat, salt and sugar you eat, and increasing the amount of fibre. You don't need to completely exclude sugary and high-fat foods from your diet, but they should be limited. The important thing in managing diabetes through your diet is to eat regularly and include starchy carbohydrates, such as pasta, as well as plenty of fruit and vegetables. If your diet is well balanced, you should be able to achieve a good level of health and maintain a healthy weight. Regular exercise As physical activity lowers your blood glucose level, it's very important to exercise regularly if you have diabetes. Like anyone else, you should aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week.


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Don't smoke If you have diabetes, your risk of developing a cardiovascular disease, such as a heart attack or stroke, is increased. Limit alcohol If you have diabetes and decide to drink alcohol, avoid drinking more than the recommended daily amounts, and never drink alcohol on an empty stomach. Depending on the amount you drink, alcohol can cause either high or low blood glucose levels (hyperglycaemia or hypoglycaemia). Men and women are advised not to regularly drink more than 14 units a week. Vaccinations Regular eye tests If you have type 1 diabetes, you should be invited to have your eyes screened once a year to check for diabetic retinopathy. It can occur if your blood glucose level is too high for a long period of time (hyperglycaemia). Left untreated, retinopathy can eventually lead to sight loss. Diabetes and pregnancy Pregnancy You'll need to tightly control your blood glucose level – particularly before becoming pregnant and during the first eight weeks of your baby's development – to reduce the risk of birth defects. You should also:

check your medications – some tablets used to treat diabetes may harm your baby, so you may have to switch to insulin injections

take a higher dose of folic acid tablets – folic acid helps prevent your baby developing spinal cord problems, and it's recommended all women planning to have a baby take folic acid; women with diabetes are advised to take 5mg each day (only available on prescription)

have your eyes checked – retinopathy, which affects the blood vessels in the eyes, is a risk for all people with diabetes; as pregnancy can place extra pressure on the small vessels in your eyes, it's important to treat retinopathy before you become pregnant Type 2 diabetes Causes of type 2 diabetes Type 2 diabetes occurs when the body doesn't produce enough insulin to function properly, or the body's cells don't react to insulin. This means glucose stays in the blood and isn't used as fuel for energy. Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. It's far more common than type 1 diabetes. Treating type 2 diabetes As type 2 diabetes usually gets worse, you may eventually need medication – usually tablets – to keep your blood glucose at normal levels. Complications of type 2 diabetes Diabetes can cause serious long-term health problems. It's the most common cause of vision loss and blindness in people of working age. Diabetes is also responsible for most cases of kidney


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failure and lower limb amputation, other than accidents. People with diabetes are up to five times more likely to have cardiovascular disease, such as a stroke, than those without diabetes. Preventing type 2 diabetes If you're at risk of type 2 diabetes, you may be able to prevent it developing by making lifestyle changes. These include:

eating a healthy, balanced diet losing weight if you're overweight, and maintaining a healthy weight stopping smoking if you smoke drinking alcohol in moderation taking plenty of regular exercise

Living with type 2 diabetes If you already have type 2 diabetes, it may be possible to control your symptoms by making lifestyle changes. This also minimises your risk of developing complications. Symptoms The symptoms of diabetes include feeling very thirsty, passing more urine than usual, and feeling tired all the time. The symptoms occur because some or all of the glucose stays in your blood and isn't used as fuel for energy. Your body tries to get rid of the excess glucose in your urine. The main symptoms, which are common to both type 1 diabetes and type 2 diabetes, are:

urinating more often than usual, particularly at night feeling very thirsty feeling very tired unexplained weight loss itching around the penis or vagina, or frequent episodes of thrush cuts or wounds that heal slowly blurred vision – caused by the lens of the eye becoming dry

These signs and symptoms aren't always as obvious, however, and it's often diagnosed during a routine check-up. This is because they are often mild and develop gradually over a number of years. This means you may have type 2 diabetes for many years without realising it. Early diagnosis and treatment for type 2 diabetes is very important as it may reduce your risk of developing complications later on. Hyperglycaemia Type 2 diabetes occurs when the pancreas, a large gland behind the stomach, can't produce enough insulin to control your blood glucose level, or when the cells in your body don't respond properly to the insulin that is produced. This means your blood glucose levels may become very high, and is known as hyperglycaemia. Hyperglycaemia can occur for several reasons, including:

eating too much being unwell ineffective diabetes medication, or not taking enough

Hyperglycaemia causes the main symptoms of diabetes, which include extreme thirst and frequent urination.


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Causes Type 2 diabetes occurs when the pancreas doesn't produce enough insulin to maintain a normal blood glucose level, or the body is unable to use the insulin that is produced (insulin resistance). The pancreas is a large gland behind the stomach that produces the hormone insulin. Insulin moves glucose from your blood into your cells, where it's converted into energy. In type 2 diabetes, there are several reasons why the pancreas doesn't produce enough insulin. Risk factors for type 2 diabetes Three of the main risk factors for developing type 2 diabetes are:

age – being over the age of 40 (over 25 for people of south Asian, Chinese, African-Caribbean or black African origin, even if you were born in the UK)

genetics – having a close relative with the condition, such as a parent, brother or sister weight – being overweight or obese

Genetics Genetics is one of the main risk factors for type 2 diabetes. Your risk of developing the condition is increased if you have a close relative such as a parent, brother or sister who has the condition. The closer the relative, the greater the risk. A child who has a parent with type 2 diabetes has about a one in three chance of also developing the condition. Being overweight or obese You're more likely to develop type 2 diabetes if you're overweight or obese. For most people in the UK, a body mass index (BMI) of:

25 or above puts you in the overweight range 30 or above puts you in the obese range

However, some groups have a higher risk of developing type 2 diabetes: Asians with a BMI score of 23 or more are at increased risk of developing type 2 diabetes Asians with a BMI of 27.5 or more are at high risk of developing type 2 diabetes

Fat around your tummy (abdomen) particularly increases your risk. This is because it releases chemicals that can upset the body's cardiovascular and metabolic systems. This increases your risk of developing a number of serious conditions, including:

coronary heart disease stroke some types of cancer

Measuring your waist is a quick way of assessing your diabetes risk. This is a measure of abdominal obesity, which is a particularly high-risk form of obesity. Some groups have a higher risk of developing type 2 diabetes, based on their waist measurements:

women with a waist size of 80cm (31.5 inches) or more Asian men with a waist size of 89cm (35 inches) or more white or black men with a waist size of 94cm (37 inches) or more

Use the BMI calculator to find out if you're a healthy weight for your height. Exercising regularly and reducing your body weight by about 5% could reduce your risk of getting diabetes by more than 50%. Other risks Your risk of developing type 2 diabetes is also increased if your blood glucose level is higher than normal, but not yet high enough to be diagnosed with diabetes. This is sometimes called pre-diabetes, and doctors sometimes call it impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT). Pre-diabetes can progress to type 2 diabetes if you don't take preventative steps, such as making lifestyle changes. These include eating healthily, losing weight if


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you're overweight, and taking plenty of regular exercise. Women who have had gestational diabetes during pregnancy also have a greater risk of developing diabetes in later life. Diagnosis It's important for diabetes to be diagnosed early so treatment can be started as soon as possible. Your urine sample will be tested for glucose. Urine doesn't normally contain glucose, but glucose can overflow through the kidneys and into your urine if you have diabetes. If your urine contains glucose, a specialised blood test known as glycated haemoglobin (HbA1c) can be used to determine whether you have diabetes. HbA1c as a diagnostic test In 2011 the World Health Organization (WHO) recommended that HbA1c could also be used to help diagnose type 2 diabetes in people who aren't known to have the condition. An HbA1c level of 6.5% (48mmol/mol) or above indicates type 2 diabetes. Although there's no fixed point to indicate when someone has pre-diabetes, a UK expert group has recommended that an HbA1c level of 6-6.4% (42-47 mmol/mol) would indicate that a person has a high risk of developing diabetes. Glucose tolerance test (GTT) A glucose tolerance test (GTT), sometimes known as an oral glucose tolerance test (OGTT), can show if your body is having problems processing glucose. Before having the test, you'll be asked not to eat or drink certain fluids for 8-12 hours. You may also need to avoid taking certain medications before the test, as they may affect the results. Treatment Treatment for diabetes aims to keep your blood glucose levels as normal as possible and control your symptoms to prevent health problems developing later in life. Making lifestyle changes If you're diagnosed with type 2 diabetes, you'll need to look after your health very carefully for the rest of your life. Three major areas that you'll need to look closely at are:

eating healthily losing weight if you're overweight exercising regularly

You may be able to keep your blood glucose at a safe and healthy level without the need for other types of treatment. Lifestyle changes Diet Increasing the amount of fibre in your diet and reducing your sugar and fat intake, particularly saturated fat, can help prevent type 2 diabetes, as well as manage the condition if you already have it. You should:

increase your consumption of high-fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables

choose foods that are low in fat – replace butter, ghee and coconut oil with low-fat spreads and vegetable oil

choose skimmed and semi-skimmed milk, and low-fat yoghurts


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eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers grill, bake, poach or steam food instead of frying or roasting it avoid high-fat foods, such as mayonnaise, chips, crisps, pasties, poppadoms and samosas eat fruit, unsalted nuts and low-fat yoghurts as snacks instead of cakes, biscuits, bombay mix or crisps

Weight If you're overweight or obese – you have a body mass index (BMI)of 30 or over – you should lose weight by gradually reducing your calorie intake and becoming more physically active. Losing 5-10% of your overall body weight over the course of a year is a realistic initial target. You should aim to continue to lose weight until you've achieved and maintained a BMI within the healthy range, which is:

18.5-24.9kg/m² for the general population 18.5-22.9kg/m² for people of south Asian or Chinese origin – south Asian includes

people from Bangladesh, Bhutan, India, Indian-Caribbean, Maldives, Nepal, Pakistan and Sri Lanka Physical activity Being physically active is very important in preventing or managing type 2 diabetes. For adults who are 19-64 years of age, the government recommends at least:

150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity – such as cycling or brisk walking – a week, which can be taken in sessions of 10 minutes or more, and

muscle-strengthening activities on two or more days a week that work all major muscle groups – the legs, hips, back, tummy (abdomen), chest, shoulders and arms An alternative recommendation is to do at least:

75 minutes of vigorous-intensity aerobic activity, such as running or a game of tennis every week, and muscle-strengthening activities on two or more days a week that work all major muscle groups – the

legs, hips, back, abdomen, chest, shoulders and arms Medicines for type 2 diabetes Type 2 diabetes usually gets worse over time. Making lifestyle changes, such as adjusting your diet and taking more exercise, may help you control your blood glucose levels at first, but may not be enough in the long term. You may eventually need to take medication to help control your blood glucose levels. Initially, this will usually be in the form of tablets and can sometimes be a combination of more than one type of tablet. It may also include insulin or another medication that you inject. Metformin Metformin is usually the first medicine used to treat type 2 diabetes. It works by reducing the amount of glucose your liver releases into your bloodstream. It also makes your body's cells more responsive to insulin. If you're overweight, it's also likely you'll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldn't cause additional weight gain. However, it can sometimes cause mild side effects, such as nausea and diarrhoea, and you may not be able to take it if you have kidney damage. Sulphonylureas Sulphonylureas increase the amount of insulin that's produced by your pancreas. Examples include:

glibenclamide gliclazide glimepiride glipizide gliquidone


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You may be prescribed one of these medicines if you can't take metformin or if you aren't overweight. Pioglitazone Pioglitazone is a type of thiazolidinedione medicine (TZD), which make your body's cells more sensitive to insulin so more glucose is taken from your blood. It's usually used in combination with metformin or sulphonylureas, or both. It may cause weight gain and ankle swelling (oedema). You shouldn't take pioglitazone if you have heart failure or a high risk of bone fracture. Gliptins (DPP-4 inhibitors) Gliptins work by preventing the breakdown of a naturally occurring hormone called GLP-1. GLP-1 helps the body produce insulin in response to high blood glucose levels, but is rapidly broken down. By preventing this breakdown, the gliptins (linagliptin, saxagliptin, sitagliptin and vildagliptin) prevent high blood glucose levels, but don't result in episodes of hypoglycaemia. You may be prescribed a gliptin if you're unable to take sulphonylureas or glitazones, or in combination with them. They're not associated with weight gain. SGLT2 inhibitors SGLT2 inhibitors work by increasing the amount of glucose excreted in urine. They may be considered to treat type 2 diabetes if metformin and DPP-4 inhibitors aren't suitable. The three SGLT2 inhibitors that may be prescribed include:

dapagliflozin canagliflozin empagliflozin

Each medication is taken as a tablet once a day. The main side effect is a higher risk of genital and urinary tract infections. GLP-1 agonists GLP-1 agonists acts in a similar way to the natural hormone GLP-1. They're given by injection and boost insulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes ("hypos"). Insulin treatment If glucose-lowering tablets aren't effective in controlling your blood glucose levels, you may need to have insulin treatment. Treatment for low blood sugar (hypoglycaemia) If you have type 2 diabetes that's controlled using insulin or certain types of tablets, you may experience episodes of hypoglycaemia. Mild hypoglycaemia (a "hypo") can make you feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary. If you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness. If this occurs, you may need to have an injection of glucagon into your muscle or glucose into a vein. Glucagon is a hormone that quickly increases your blood glucose levels. Other treatments If you have type 2 diabetes, your risk of developing heart disease, stroke and kidney disease is increased. To reduce your risk of developing other serious health conditions, you may be advised to take other medicines, including:

anti-hypertensive medicines to control high blood pressure a statin, such as simvastatin or atorvastatin, to reduce high cholesterol low-dose aspirin to prevent a stroke an angiotensin-converting enzyme (ACE) inhibitor, such as enalapril, lisinopril or ramipril, if you have the

early signs of diabetic kidney disease Diabetic kidney disease is identified by the presence of small amounts of albumin (a protein) in your urine. If treated early enough, it may be reversible.


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Monitoring blood glucose levels Diabetes sick day rules If you need to take insulin to control your diabetes, you should have received instructions about looking after yourself when you're ill – known as your "sick day rules". The advice you're given will be specific to you, but some general measures that your sick day rules may include could be to:

keep taking your insulin – it's very important not to stop treatment when you're ill; your treatment plan may state whether you need to temporarily increase your dose

test your blood sugar level more often than usual – most people are advised to check the level at least four times a day

keep yourself well hydrated – make sure you drink plenty of sugar-free drinks keep eating – eat solid food if you feel well enough to, or liquid carbohydrates such as milk, soup and

yoghurt if this is easier check your ketone levels if your blood sugar level is high


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Diabetes – the Ayurvedic perspective Nidhana

Love for food coupled with sedentary lifestyle

Having pleasurable daytime sleep

Excessive consumption of dairy products eg. milk, cake etc

Consumption of meat from village animals eg. chicken, goat etc.

Excessive consumption of fresh water fish

Excessive consumption of fresh fruit and vegetables

Excessive consumption of cane sugar and jaggery

Kapha producing foods such as dense carbohydrates Samprapti Due to the above causes, the water element in the body is aggravated. This creates an imbalance in the pitta dosha as the fire element is reduced and the water element is increased

(fire , water ). As a result, when the digested nutrients pass through the dhatu level, extra lubricant (kledaka) is deposited in the mansa and medas tissues. When this happens continuously the srotas leading to the lower dhatu levels (asti, majja, sukra) can be blocked. The three lower dhatu can become malnourished which causes problems in each dhatu level. Vata becomes aggravated as a result of the obstruction and is drawn to the apana area (its own site) which leads to constipation. Aggravated vata stimulates samana vata by increasing the digestive fire creating excess hunger. This hunger is uncontrollable because it is caused by the body. Aggravated vata in the apana vata area draws out water (kledaka) from the mansa and medas dhatu and is absorbed by the kidneys and contaminates the urinary system. This produces glucose in the urine. If this continues, in addition to the glucose, protein can be found in the urine as a result of mansa tissues breaking down (creating water soluble proteins). The higher dhatu levels become saturated as a result of the obstruction in the dhatu srotas which produces glucose in the blood.


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Samprapti (diagram I):

JATARAGNI

(stomach)

SARA

KITTA

Further

digestion

Excreta

FOOD


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Samprapti (diagram II):

EARTH

FIRE

AIR

SARA

PANCHABUTA

AGNI

(Cloma Agni /

pancreas

(vishama agni)

FIVE

ELEMENTS

WATER

ETHER

Disorder starts

Water Fire


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Samprapti (diagram III)

Effects on sapta dhatu & complications

RASA

MANSA

MEDAS

FIVE

ELEMENTS

RAKTA

ASTHI

MAJJA

SUKRA

Sugar present

Infection / fungus

First weight

Then weight

Glucose

Hyperglycaemia

First muscle

Then muscle

Weakens, pain

Calcium

Immunity

SROTAS BLOCKED

Libido

Infertility

Impotence


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Excess water element in pitta dhatus (mansa and medas)

This liquefies or loosens the mansa and medas dhatus and they are unable to hold their form / state

The srotas become blocked with the liquefied pitta

Initially due to the blockage of the srotas the upper dhatus become plumped up and the patient puts on weight

The excess water then begins to melt the dhatus, loosening the tissues

This causes weight loss and loss of muscle tone

Subsequently this affects the other dhatus

Asthi dhatu is affected because of blocked srotas – malnutrition occurs and calcium to the bone is reduced leading to osteoporosis and joint pain

Majja dhatu is also affected and is unable / has reduced capacity to produce immunity

This may cause problems in the eyes as diabetic retinopathy

As immunity is reduced the patient is more prone to flu / cold and other disorders

When sukra dhatu is affected it can cause infertility / low libido / tiredness

Ojas is also affected and reduces immunity / increases tiredness / lack of enthusiasm / depression

Due to the blocked srotas, the excess water / kledaka can travel to the upper dhatus (vimarga gamana) and there is an upwards overflow

This can cause excess glucose to be present in the rakta dhatu / blood as hyperglycaemia

Rasa dhatu is affected – present with sweet smell and pungent taste – it can result in fungul disorders / thrush / excessive sweating / bad breath / skin disorders

Due to the blockage of the srotas and the consequent lack of nutrition, apana vata becomes imbalanced and it absorbs the excess water to the pelvic area (pakvashu) and directs it to the kidneys. This causes the patient to have more frequent urination

The urine is contaminated with the liquid that comes from the dhatu levels with excess sugar (created by the breakdown of mansa and medas)

The aggravated apana vata signals to samana vata and causes increased hunger to the patient

The continued absorption by apana vata of the water made from the broken down mansa and medas tissues eventually creates protein in the urine and ketoacidosis

At this stage the disorder becomes incurable and is called nephritis or inflammation of the kidneys

Complications associated with diabetes


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Diabetes is a tri-doshic disorder. Whilst kapha plays a major role, kapha, pitta and vata are vitiated and affect all dhatu levels in the body. As a result diabetes is associated with a lot of disorders and each dhatu has its own imbalance:

Diabetic neuropathy

Diabetic retinopathy

Diabetic ketoacidosis

Diabetic carbuncles / boils

Diabetic osteoarthritis

Diabetic obesity

Diabetic hyperglycaemia

Diabetic neurosis

Diabetic wounds

Diabetic thrush

Diabetic infertility

Diabetic muscle wasting disorder

lack of libido / impotence Categories of diabetes

1. Kapha disorders – 10 2. Pitta disorders – 6 3. Vata disorders – 4

Prodromal signs & symptoms

1. Coating on the teeth 2. Coating on the tongue 3. Looseness of the joints 4. Softness of the skin 5. Thirst 6. Sweet taste in the mouth

Stages of the disorder according to dosha


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1. Kapha stage

10 types of kapha diabetes

curable as it is caused by increased kapha

treated by reducing kapha

(type 2 diabetes in allopathy)

2. Pitta stage

6 types of pitta diabetes

incurable

can only be managed

cure is difficult as pitta and kapha dissimilar (when kapha - pitta & vice versa)

(Type 1 diabetes – autoimmune disorder in allopathy)

3. Vata stage

4 types of vata diabetes

incurable

poor prognosis o nephritic syndrome o ketoacidosis o coma o gangrene

Common signs & symptoms

frothy / unclear urine

colour of urine different

joint pains

urgency / frequency / quantity of urine increases

thirst

urination during the night Signs and symptoms according to dosha

Kapha diabetes o Loss of taste o Indigestion


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o Sleepiness o Cough / congestion o Itchiness around groin area

Pitta diabetes o Excessive sweating o Bad odour o Feeling hot o Excessive thirst o Craving for sour taste

Vata diabetes o Dizziness o Pins and needles o Constipation o Depression o Heart pain o Dribbling o Pain in body o Insomnia o Dryness of the body o Dry cough o Difficulty in breathing

Treatment

Every type of diabetes is difficult to cure because all three doshas are vitiated and all seven dhatus affected

Can be cured or managed with more effort from the doctor and the patient over a long period of time

Lifestyle and dietary factors to avoid

Being seated for long periods without movement

Daytime sleeping

Fresh grains / fresh fruit / fresh vegetables

Dairy products

Suppression of urge to urinate

Smoking

Saunas

Blood letting


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Alcohol / vinegar / fermented food

Sesame oil / alkaline food / ghee / jaggery

Acidic foods

Sugar cane / sugary foods

Carbohydrates

Village animals / fish Chikitsa

If the patient is overweight and has strength can carry out detoxification treatment (shodana) – vamana / virechana

If the patient is emaciated and weak due to the disorder, rejuvenation treatment is necessary (vrunghana)

The patients urine and stools can contain nutrition and ojas (extracted from the dhatus) and because of that strong purgatives and diuretics should not be prescribed)

External oleation and internal oleation (anuvasana vasthi – medicated oil enemas) can be administered

Overweight / strengthened person – Apatarpana (detox / langana) Santarpana (rejuvenation)

Lean / weak person – Santarpana Apatarpana Medicines

Kerala tablets / vegetable

Gotukola tablets / vegetable

Triphala tablets

Red rice soaked in triphala decoction, cooked then honey added

Hinguwastaka choorna

Nimbadee choorna

Chandanadee choorna

Cinnamon powder soaked with old honey (1/2 teaspoon once a day)

Black pepper + ginger + long pepper + honey (trikatu) - can aggravate vata


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Diet Patients with type 1 diabetes are unlikely to seek alternative treatments as they are already insulin dependent. Type 2 diabetes is treatable with diet and simple remedies. Patients should keep a record of their blood sugar levels and a food diary. Initially no changes should be made to their allopathic prescription until the patient’s blood sugar level drops to a normal level. Preferred foods:

Oily fish - Tuna - salmon - sardine

Red meat eg. beef

Fruit - Avocado - Papaya - Apples - (Avoid – mango / banana / grapes / pears (ripe) - (Occasional – strawberry / blackberries / blueberries)

Grains

- Old grains / sun dried grains (roasted grains can be used if not available) - Oats - Oatmeal - Arta flour (unrefined) - Moong beans - Chick peas - Quinoa - Buckwheat - Chia seeds

Vegetables

- Pumpkin - Butternut squash - Cooked greens - Cooked beans - Cooked broccoli - Cooked cabbage


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- Cooked leeks

Condiments/oils - Old honey - Mustard oil

Tastes - Bitter - Kariwela - Gotukola - Rocket - Watercress - Kale


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Obesity

Obesity – the allopathic perspective The following italicized passages are taken from the NHS online service which provides information and advice to the public on the causes, symptoms and treatment of Obesity. It is useful to review the allopathic understanding of the disorder and the approach taken to treatment both for comparative purposes and in order to better explain to the patient. Please note that not all information provided is replicated here and that highlights in bold have been added.

Overview The term "obese" describes a person who's very overweight, with a lot of body fat. It's a common problem in the UK that's estimated to affect around one in every four adults and around one in every five children aged 10 to 11. Defining obesity There are many ways in which a person's health in relation to their weight can be classified, but the most widely used method is body mass index (BMI). BMI is a measure of whether you're a healthy weight for your height. You can use the BMI healthy weight calculator to work out your score. For most adults, a BMI of:

18.5 to 24.9 means you're a healthy weight 25 to 29.9 means you're overweight 30 to 39.9 means you're obese 40 or above means you're severely obese

BMI isn't used to definitively diagnose obesity, because people who are very muscular sometimes have a high BMI without excess fat. But for most people, BMI is a useful indication of whether they're a healthy weight, overweight or obese. A better measure of excess fat is waist circumference, which can be used as an additional measure in people who are overweight (with a BMI of 25 to 29.9) or moderately obese (with a BMI of 30 to 34.9). Generally, men with a waist circumference of 94cm (37in) or more and women with a waist circumference of 80cm (about 31.5in) or more are more likely to develop obesity-related health problems. Risks of obesity It's very important to take steps to tackle obesity because, as well as causing obvious physical changes, it can lead to a number of serious and potentially life-threatening conditions, such as:

type 2 diabetes coronary heart disease some types of cancer, such as breast cancer and bowel cancer stroke


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Obesity can also affect your quality of life and lead to psychological problems, such as depression and low self-esteem (see below for more information about the health problems associated with obesity). Causes of obesity Obesity is generally caused by consuming more calories – particularly those in fatty and sugary foods – than you burn off through physical activity. The excess energy is stored by the body as fat. Obesity is an increasingly common problem because for many people modern living involves eating excessive amounts of cheap, high-calorie food and spending a lot of time sitting down, at desks, on sofas or in cars. There are also some underlying health conditions that can occasionally contribute to weight gain, such as an underactive thyroid gland (hypothyroidism). Treating obesity The best way to treat obesity is to eat a healthy, reduced-calorie diet and exercise regularly. To do this you should:

eat a balanced, calorie-controlled diet as recommended by your GP or weight loss management health professional (such as a dietitian)

join a local weight loss group take up activities such as fast walking, jogging, swimming or tennis for 150 to 300 minutes (two-and-

a-half to five hours) a week eat slowly and avoid situations where you know you could be tempted to overeat

You may also benefit from receiving psychological support from a trained healthcare professional to help change the way you think about food and eating. If lifestyle changes alone don't help you lose weight, a medication called orlistat may be recommended. If taken correctly, this medication works by reducing the amount of fat you absorb during digestion. In rare cases, weight loss surgery may be recommended. Other obesity-related problems Obesity can cause a number of further problems, including difficulties with daily activities and serious health conditions. Day-to-day problems related to obesity include:

breathlessness increased sweating snoring difficulty doing physical activity often feeling very tired joint and back pain low confidence and self-esteem feeling isolated

The psychological problems associated with being obese can also affect your relationships with family and friends, and may lead to depression. Serious health conditions Being obese can also increase your risk of developing many potentially serious health conditions, including:

type 2 diabetes – a condition that causes a person's blood sugar level to become too high high blood pressure high cholesterol and atherosclerosis (where fatty deposits narrow your arteries), which can lead

to coronary heart disease and stroke


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asthma metabolic syndrome – a combination of diabetes, high blood pressure and obesity several types of cancer, including bowel cancer, breast cancerand womb cancer gastro-oesophageal reflux disease (GORD) – where stomach acid leaks out of the stomach and into

the oesophagus (gullet) gallstones – small stones, usually made of cholesterol, that form in the gallbladder reduced fertility osteoarthritis – a condition involving pain and stiffness in your joints sleep apnoea – a condition that causes interrupted breathing during sleep, which can lead to daytime

sleepiness with an increased risk of road traffic accidents, as well as a greater risk of diabetes, high blood pressure and heart disease

liver disease and kidney disease pregnancy complications, such as gestational diabetes or pre-eclampsia (when a woman experiences

a potentially dangerous rise in blood pressure during pregnancy) Obesity reduces life expectancy by an average of 3 to 10 years, depending on how severe it is. It's estimated that obesity and being overweight contribute to at least 1 in every 13 deaths in Europe. Outlook There's no "quick fix" for obesity. Weight loss programmes take time and commitment, and work best when fully completed. The healthcare professionals involved with your care should provide encouragement and advice about how to maintain the weight loss achieved. Regularly monitoring your weight, setting realistic goals and involving your friends and family with your attempts to lose weight can also help. Remember that even losing what seems like a small amount of weight, such as 3% or more of your original body weight, and maintaining this for life, can significantly reduce your risk of developing obesity-related complications like diabetes and heart disease. Causes Obesity is generally caused by eating too much and moving too little. If you consume high amounts of energy, particularly fat and sugars, but don't burn off the energy through exercise and physical activity, much of the surplus energy will be stored by the body as fat. Calories The energy value of food is measured in units called calories. The average physically active man needs about 2,500 calories a day to maintain a healthy weight, and the average physically active woman needs about 2,000 calories a day. Poor diet Obesity doesn't happen overnight. It develops gradually over time, as a result of poor diet and lifestyle choices, such as:

eating large amounts of processed or fast food – that's high in fat and sugar drinking too much alcohol – alcohol contains a lot of calories, and people who drink heavily are often

overweight eating out a lot – you may be tempted to also have a starter or dessert in a restaurant, and the food

can be higher in fat and sugar eating larger portions than you need – you may be encouraged to eat too much if your friends or

relatives are also eating large portions drinking too many sugary drinks – including soft drinks and fruit juice comfort eating – if you have low self-esteem or feel depressed, you may eat to make yourself feel

better


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Unhealthy eating habits tend to run in families. You may learn bad eating habits from your parents when you're young and continue them into adulthood. Lack of physical activity Lack of physical activity is another important factor related to obesity. If you're not active enough, you don't use the energy provided by the food you eat, and the extra energy you consume is stored by the body as fat. The Department of Health recommends that adults do at least 150 minutes (two-and-a-half hours) of moderate-intensity aerobic activity, such as cycling or fast walking, every week. This doesn’t need to be done all in one go, but can be broken down into smaller periods. For example, you could exercise for 30 minutes a day for five days a week. If you're obese and trying to lose weight, you may need to do more exercise than this. It may help to start off slowly and gradually increase the amount of exercise you do each week. Genetics Some people claim there's no point trying to lose weight because "it runs in my family" or "it's in my genes". While there are some rare genetic conditions that can cause obesity, such as Prader-Willi syndrome, there's no reason why most people can't lose weight. Medical reasons In some cases, underlying medical conditions may contribute to weight gain. These include:

an underactive thyroid gland (hypothyroidism) – where your thyroid gland doesn't produce enough hormones

Cushing's syndrome – a rare disorder that causes the over-production of steroid hormones Treatment Your GP can advise you about losing weight safely by eating a healthy, balanced diet and regular physical activity. They can also let you know about other useful services, such as:

local weight loss groups – these could be provided by your local authority, the NHS, or commercial services you may have to pay for

exercise on prescription – where you're referred to a local active health team for a number of sessions under the supervision of a qualified trainer Diet There's no single rule that applies to everyone, but to lose weight at a safe and sustainable rate of 0.5 to 1kg (1lb to 2lbs) a week, most people are advised to reduce their energy intake by 600 calories a day. A healthy diet should consist of:

plenty of fruit and vegetables plenty of potatoes, bread, rice, pasta and other starchy foods (ideally you should choose wholegrain

varieties) some milk and dairy foods some meat, fish, eggs, beans and other non-dairy sources of protein just small amounts of food and drinks that are high in fat and sugar

Try to avoid foods containing high levels of salt because they can raise your blood pressure, which can be dangerous for people who are already obese. Read some tips for a lower-salt diet. You'll also need to check calorie information for each type of food and drink you consume to make sure you don't go over your daily limit.


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Diet programmes and fad diets Avoid fad diets that recommend unsafe practices, such as fasting (going without food for long periods of time) or cutting out entire food groups. These types of diets don't work, can make you feel ill, and aren't sustainable because they don’t teach you long-term healthy eating habits. Very low calorie diets A very low calorie diet (VLCD) is where you consume less than 800 calories a day. These diets can lead to rapid weight loss, but they aren't a suitable or safe method for everyone, and they aren't routinely recommended for managing obesity. Exercise Reducing the amount of calories in your diet will help you lose weight, but maintaining a healthy weight requires physical activity to burn energy. As well as helping you maintain a healthy weight, physical activity also has wider health benefits. For example, it can help prevent and manage more than 20 conditions, such as reducing the risk of type 2 diabetes by 40%. The Chief Medical Officers recommend that adults should do at least 150 minutes (two-and-a-half hours) of at least moderate-intensity activity a week – for example, five 30-minute bouts a week. Something is better than nothing, and doing just 10 minutes of exercise at a time is beneficial. Moderate-intensity activity is any activity that increases your heart and breathing rate, such as:

brisk walking cycling recreational swimming dancing

Alternatively, you could do 75 minutes (one hour, fifteen minutes) of vigorous-intensity activity a week, or a combination of moderate and vigorous activity. During vigorous activity, breathing is very hard, your heart beats rapidly and you may be unable to hold a conversation. Examples include:

running most competitive sports circuit training

You should also do strength exercises and balance training two days a week. This could be in the form of a gym workout, carrying shopping bags, or doing an activity such as tai chi. It's also critical that you break up sitting (sedentary) time by getting up and moving around. Medication Many different types of anti-obesity medicines have been tested in clinical trials, but only one has proved to be safe and effective: orlistat. You can only use orlistat if a doctor or pharmacist thinks it's the right medicine for you. In most cases, orlistat is only available on prescription. Only one product (Alli) is available over the counter directly from pharmacies, under the supervision of a pharmacist. Orlistat works by preventing around a third of the fat from the food you eat being absorbed. The undigested fat isn't absorbed into your body and is passed out with your faeces (stools). This will help you avoid gaining weight, but won't necessarily cause you to lose weight. When orlistat should be used Orlistat will usually only be recommended if you've made a significant effort to lose weight through diet, exercise or changing your lifestyle. Even then, orlistat is only prescribed if you have a:

body mass index (BMI) of 28 or more, and other weight-related conditions, such as high blood pressure or type 2 diabetes


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BMI of 30 or more Dosage and duration of treatment Treatment with orlistat should only continue beyond three months if you've lost 5% of your body weight. It usually starts to affect how you digest fat within one to two days. If you haven't lost weight after taking orlistat for three months, it's unlikely to be an effective treatment for you. Consult your doctor or pharmacist, as it may be necessary to stop your treatment. Side effects Common side effects of orlistat include:

fatty or oily stools needing the toilet urgently passing stools more frequently an oily discharge from your rectum (you may have oily spots on your underwear) flatulence (wind) stomach pain headaches upper respiratory tract infections, such as a cold

Surgery Weight loss surgery, also called bariatric surgery, is sometimes used to treat people who are severely obese. Bariatric surgery is usually only available on the NHS to treat people with severe obesity who fulfil all of the following criteria:

they have a BMI of 40 or more, or between 35 and 40 and another serious health condition that could be improved with weight loss, such as type 2 diabetes or high blood pressure

all appropriate non-surgical measures have been tried, but the person hasn't achieved or maintained adequate, clinically beneficial weight loss

the person is fit enough to have anaesthesia and surgery the person has been receiving, or will receive, intensive management as part of their treatment the person commits to the need for long-term follow-up

Bariatric surgery may also be considered as a possible treatment option for people with a BMI of 30 to 35 who have recently (in the last 10 years) been diagnosed with type 2 diabetes. In rare cases, surgery may be recommended as the first treatment (instead of lifestyle treatments and medication) if a person's BMI is 50 or above. Treating obesity in children Treating obesity in children usually involves improvements to diet and increasing physical activity using behaviour change strategies. The amount of calories your child should eat each day will depend on their age and height. Children over the age of five should ideally get at least one hour (60 minutes) of vigorous-intensity exercise a day, such as running or playing football or netball. Sedentary activities, such as watching television and playing computer games, should be restricted. The use of orlistat in children is only recommended in exceptional circumstances, such as if a child is severely obese and has an obesity-related complication. Bariatric surgery isn't generally recommended for children, but may be considered for young people in exceptional circumstances, and if they've achieved, or nearly achieved, physiological maturity.


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Obesity - the Ayurvedic perspective Obesity and diabetes are similar types of disorder in Ayurveda as the main dosha imbalance is kapha dosha. Diabetes can further develop to imbalance all dosha and dhatu levels causing a lot of complications. Diabetes appears as a complication of obesity, although both have lots of similarities. Medas dhatu is described as two types in Ayurveda:

- Banddha meda – solid fat of the body (saturated fat) - Abanddha meda – free or mobile fat (unsaturated fat)


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Obesity involves the unsaturated fat in the body which is mobile. Physiologically the human body is made to deposit fat in the abdomen area (omentum). When excess fat forms, the first signs appear as abdominal distention. The second place it appears is in the bone marrow. Up to a certain point fat is deposited in the body and there is no obvious harm. It affects mainly the appearance of the person and can lead to psychological problems like depression. When all the srotas are blocked by meda dhatu and the excess deposits in the medas tissues, the lower level dhatu can experience some complications to begin with such as joint pain. The upper level dhatu can become over nourished and create soft skin and soft sub-cutaneous tissue as well as a plumped muscular system and redness to the skin When the disorder develops further it may block all the channel systems and cause problems to the circulatory system (vata). This can stimulate the digestive fire and increase the appetite and absorption. As a result of the rapid digestion, the patient craves more food and they consume greater quantities of food. In due course as this continues it may obstruct all channels and cause more damage to health including coronary heart disease, stroke, diabetes and even death. Nidhana 1. lack of or no physical exercise 2. sleeping during the daytime 3. consuming kapha provoking food 4. consuming too many sweets 5. drinking a lot of fruit juice and fruits Samprapti Due to the above factors kapha can become aggravated in the body and it circulates in the srotas. This can lead to deposits of excess fat in the medas dhatu and blockage of the srotas. This affects the lower dhatu levels and obstructs the flow of vata. As a result, vitiated vata accumulates in the apana vata area. The accumulated vata in the apana vata area increases the samana vata and causes aggravation which leads to increased hunger and causes the patient to eat more. The more advanced this cycle is, the harder to break it:

a. Due to increase in the appetite, it is more difficult to reduce the intake of food b. Under nourished lower dhatu begin to cause pain in the joints and disables the patient

from physical exercise


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Morbid obesity

- B – breast - B – buttocks - T – thighs - A – abdomen

Complications

Breathlessness

Polydipsia

Polyphagia

Drowsiness

Sleepiness Treatment

Sweet, savoury and salty cravings are treated with astringent, pungent and bitter tastes. Care must be taken not to aggravate vata in the process.

o Cut down on kapha foods o Increase pitta foods o Reduce water intake and increase food intake o Reduce sweet tasting foods o Reduce intake of fruit and vegetables

Balance the agni / digestive fire

Unblock the channels

Enema (to release the vata)


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Documents

Diploma Ayurvedic Practitioners Course Module 5 2 & 3rd ... · Ayurvedic Practitioners Course Module 5 2nd & 3rd February 2019 Course Materials . ... symptoms and treatment of Diabetes