Hi Rochelle
here are some thoughts that may be of interest to you on the topic - not
suggestions for remedies or rubrics though
here is a medical description of what appears to be the pathology your
client presented with.
DME (Diabetic macular edema) is the result of retinal microvascular changes
that occur in patients with diabetes. Thickening of the basement membrane
and reduction in the number of pericytes is believed to lead to increased
permeability and incompetence of retinal vasculature. This compromise of
blood-retinal barrier leads to the leakage of plasma constituents in the
surrounding retina, resulting in retinal edema.
It definitely would be a good idea to impact on the acute aspect of this
process, to assist in avoiding permanent damage. Leela has provided the
rubrics from our reps that seem relevant to this.
However, before you go any further, i recommend you read Sankaran on this
topic - he has some very interesting information to take into consideration
about the complications of Diabetes. Particularly the idea of the blood
vessel problems being the precursor to raised levels of sugar in blood. This
may give more of a clue to treating this disease - if looking at causation -
susceptibility to thickening/permeability/changes of the blood vessels may
be the way to go - not easy i admit, but there are clues in our Materia
medica - so, rather than trying to reduce blood sugar levels, we should be
addressing the changes in the state and permeability of the blood vessels.
Any remedy we choose for the overall symptoms of diabetes that may be
characteristic to the patient may need to include sphere of action in Blood
vessels to have a chance of making any kind of permanent impact.
Obviously, the differences between Type 1 and 2 diabetes need to be
considered as well. Eg., if reducing weight in Type 2 more often than not
leads to reduction in blood sugar levels, then based on what Sankaran has
offered below, it seems that the effect of losing weight is directly
impacting the state of the blood vessels, possibly via affecting cell
permeability in general - allowing full function of the cells to resume -
ie., cell integrity/VF to be restored, and the affected organs to regain
better functioning. And this is without any homoeopathic intervention. But I
am going off in my own direction here, thinking out loud..................
I am going to look into this further myself - it has caught my interest.
I agree with his assessment of treating the present state - not the state
before the 'disease'. As Sankaran says, this is not logical.
I have copied from EH an extract from this section in his Spirit of Hom.
book - in the Philosophy section, (p.108), for those who may be interested
and do not have the book.
I hope this will help you with your decision on how to treat the patient as
a whole, for her diabetes if that is what you are aiming for, and also to
reduce oedema in the eye as an acute situation that may be of assistance in
the short term.
Best
Robyn
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The homoeopathic approach
TO DIABETES
There are many diseases for which, these days, people recognize the
superiority of homoeopathic treatment. Among such diseases are recurrent
colds, asthma, skin diseases, rheumatic disorders, etc.
However, there are some diseases for which most people think modern
medicine is better. Diabetes is one such disease. In this chapter, I wish to
share with you some facts about diabetes; where modern medicine stands and
how Homoeopathy differs. I am using diabetes as an example to show the
difference between the two systems in their approach to any pathology.
The old idea
If you ask an allopathic general practitioner what diabetes is, he will
tell you that it is increased blood sugar and that it is caused by
deficiency of insulin.
He will explain that there is an organ called the pancreas which produces
insulin. When we eat, various carbohydrates, sugar and starch are digested
in the intestines and simplified into glucose. This glucose is absorbed into
the bloodstream and carried to various parts of the body. Glucose is the
fuel or energy for various organs and cells in our body. But, for glucose to
go from the bloodstream into the cells, insulin is essential. If there is
not enough insulin, then glucose cannot enter the cells in the proper
amount. Thus, it remains in the blood and the blood glucose level rises.
When the glucose level rises beyond 180 mg/dl, the kidneys are given
instruction to throw out the excess sugar and so we find sugar in the urine
also.
The old idea was that diabetes is basically a disease of the pancreas, that
the primary problem is the deficiency of insulin, and the treatment consists
in controlling the blood sugar level. The normal blood glucose level ranges
from 80 to 120 mg/dl and the prevailing idea is that the blood sugar must be
tightly controlled. This control, according to general consensus, could be
achieved by three means:
– Diet: Diabetics are advised a diet low in starch as a counterweight to
the deficient action of insulin; no rice, no potatoes and no sugar.
– Pills: When diet fails to control blood sugar level, diabetics are put on
oral antidiabetic tablets. These (oral hypoglycemic) pills are meant to
reduce the blood sugar.
– Insulin: When even the tablets fail, direct supply of insulin through
injections is advised and is supposed to bring about good control.
Change in viewpoint
As explained, it was commonly believed that diabetes is due to lack of
insulin. This was the idea until the time when there emerged certain methods
of finding out exactly how much insulin there is in the blood. When these
methods were discovered (i.e. radio-immuno assay), it was found to the
great surprise of the investigators that in the majority of diabetics, the
amount of insulin in the blood was normal and even sometimes more than
normal. Therefore, diabetes could be classified into two types:
– In which insulin is lacking: Type 1 diabetes or juvenile diabetes, which
usually occurs at a young age.
– Where insulin was normal: Type 2 or maturity onset type diabetes, which
begins usually after the age of thirty or so.
Regarding maturity onset diabetes, since no deficiency of insulin is found
in most cases, it was suggested that probably there is a defect in the
insulin receiving power of the tissues, that the number of insulin receptors
is less. This is still a speculation.
A very significant discovery
The first thing any doctor advises on seeing a diabetic is tight control of
blood sugar. He will say: “If you don’t control the sugar level, you will
develop complications.” The only acute complication of high blood sugar is
coma. See what Harrison (“Textbook of Internal Medicine”) says:
“Maturity onset diabetics develop not ketoacidotic coma but hyperosmolar
coma, which develops at a blood sugar reading of 1000 to
1600 mg/dl.”
Thus, coma is very rare in the adult who has developed diabetes. It is the
juvenile diabetic who can develop coma when the insulin intake falls short
of the requirement. Even in these cases, the incidence of death due to coma
is only 1% if treated correctly.
So, diabetologists are not so worried about coma. The worry is about
chronic complications of diabetes. These are changes in the eye
(retinopathy), changes in the kidney (nephropathy), changes in the nerves
(neuropathy) and changes in the heart (ischemic heart disease). The basic
cause of these complications is a change in the blood vessels which occurs
in diabetics. This is called microangiopathy and can be assessed by
measuring the thickness of the capillary basement membrane.
It was presumed that these changes occur because of high blood sugar.
Therefore, it was thought that by controlling the sugar level, these changes
would not occur. However, certain significant discoveries were made that
upset this idea. The first was made by a renowned diabetologist named
Siperstein.
Siperstein found that these changes of microangiopathy occurred even before
the blood sugar actually developed. He measured the capillary basement
membrane thickness of potential diabetics, i.e. those people who are very
likely to develop increased blood sugar after the age of thirty-five to
forty. When he measured their basement membrane thickness, long before they
developed this increased blood sugar, he found that it was already
thickened.
The significance of this discovery
Siperstein’s discovery meant that microangiopathy, which was until now
considered to be a complication of blood sugar, occurred long before the
increase in blood sugar. Siperstein speculated that perhaps microangiopathy
is the fundamental trouble in diabetes and high blood sugar itself is a
complication of microangiopathy. The question, which comes first,
microangiopathy or sugar, is like asking which came first, the chicken or
the egg. This question is hotly debated in the diabetes circle of the world
today, i.e. are complications like retinopathy, nephropathy and heart
disease caused by high blood sugar or not?
Other scientists started finding evidence that blood sugar control may not
be related to these changes. For instance, Knowles found that in large
number of juvenile diabetics, the complications occurring in controlled
diabetes on the one hand, and uncontrolled diabetes on the other, were the
same. Then again, it was found that in certain races, the complications are
more or less similar, though blood sugar may fluctuate. Also, in diabetic
twins, complications are almost the same though their blood sugar may be
totally different. This means that these complications are probably
inherited separately along with the blood sugar, and that they are not
dependent so much upon the control of blood sugar. It is generally
acknowledged that these changes in diabetics do develop despite tight
control of blood sugar. The best that the diabetologists can say is that
controlling the sugar probably slows down the rate of these changes, but
even this is not very certain.
Let us consider the different forms of treatment now in vogue for reduction
of blood sugar and control diabetes. The first is diet control.
Diet
Previously, doctors used to advise a typical diabetic diet low in starch.
The moment high blood sugar is detected, a doctor would immediately advise:
no rice, no potatoes and no sugar.
Now, they found that those diabetics on this typical diet have the highest
rate of heart disease in the world, whereas African and Asian diabetics, who
have never seen a dietician or a physician in their life, seem to have
little incidence of coronary heart diseases. This means that a diet which is
given to reduce sugar in order to prevent heart disease, causes heart
disease. That is why now a very high starch diet has been recommended and
found to be most successful in preventing heart disease.
It has been found that in maturity onset diabetics, reduction of weight
cures diabetes. Therefore, in obese diabetics one must be strict in diet. In
diet, it is necessary to cut the total number of calories.
The diabetic pills
The next method of controlling blood sugar is the use of oral hypoglycemic
agents. These diabetic pills were subjected to a clinical trial in America:
the University Group Diabetes Programme, which involved medical departments
of leading American universities. They put 205 patients on placebo and 205
patients on the pills for an eight year period. To their surprise they found
that among those taking the pills, heart attacks were three times more
frequent than among those taking placebos. They had said that blood sugar
must be controlled otherwise it will lead to heart attacks, and they found
that the very pills which control the sugar cause heart attacks. It is like
saying that “the diabetic pills control the sugar but kills the patient.”
The U.G. D.P. recommended that at least some varieties of the pills be
banned. Most authorities today do not recommend the pills but use them only
as a last resort if diet fails and insulin therapy is not possible.
Is insulin the final answer ?
Let us go now to the most dramatic treatment of diabetes, i.e. insulin
therapy. In the body, insulin is manufactured by the pancreas. When the
sugar level in the blood increases, as after a meal, insulin is also
secreted more. Thus hypoglycemia (low sugar) and hyperglycemia (high sugar)
are prevented. At present, in insulin therapy of a diabetic, such adjustment
is impossible. Therefore, there are likely to be periods of hyperglycemia
and hypoglycemia. Hypoglycemia can cause permanent neurological damage,
among other effects. It can also cause coma and death. Besides these, it can
cause the Somogyi effect which leads to more severe hyperglycemia.
It is a matter of debate whether high sugar (below the coma level) can
cause complications. But it is certain that low sugar is very dangerous.
Therefore, fewer and fewer physicians now insist on tight control of blood
sugar.
Now we use human insulin. There are some impurities in the insulin
available today, which can have their own side-effects. Zinc which is used
in insulin preparation can, as homoeopaths know, cause its own
symptomatology. hyperinsulinaemia (high insulin level in the blood) is known
to cause vascular changes and it is suspected that at least some of the
vascular complications in diabetics could be due to insulin therapy.
What is diabetes ?
Is diabetes increased blood sugar or is it vascular changes? Which is the
cause and which is the effect? What is the cause of diabetes? Is it
inherited? Is it due to lack of insulin? What should the diet be? Are
diabetic pills to be lauded or banned? Is insulin therapy as dramatic as it
was made out to be?
These are the problems diabetologists face today. No wonder Joslin, the
pioneer among diabetologists, confessed that really we cannot answer the
question: What is diabetes? In order to understand this question, let us
look at a few facts.
In the Pima Indian race of the United States, diabetes is common but heart
attacks are rare. In the same country 75% of diabetics die of heart attacks.
Natal Indian and Black South Africans have similar diets with respect to
the proportion of carbohydrates, proteins and fat, but vascular
complications are rare in the South African with diabetes, while they are
common in the Indian.
Thus, we can see that the diabetes of the Pima Indian is different from
that of the American, and that of the black South African. Diabetes is not
one disease, but it is different in different patients. Even in the ultimate
stage of diabetic coma, we can find that one diabetic is different from the
other in response to therapy.
Diabetes is different in each patient. The cause is different. The effects
are different. The course is different. Hence, the treatment must be
different in each individual patient.
The limitations of allopathic treatment
The authorities on diabetes now realize that the insulin level is normal in
many maturity onset diabetics. They speculate that there may be some lack of
the insulin receiving apparatus, but they have not found any way to correct
this. They found that the diabetic pills are doing more harm than good, so
they switched over to insulin, but they find that this cannot give perfect
control, and that insulin has its own side-effects. Finally, after so much
struggle when they managed to control the sugar, they found that all the
chronic changes of diabetes are taking place despite the control!
The homoeopathic approach
Kent, the master homoeopath, said a century ago what modern medicine claims
to have discovered recently. He said: “The person who says diabetes disease
is insane in medicine, talk of a species of diabetes.”
In Homoeopathy, we do not fall into the trap of arguing what is diabetes –
the sugar or the vascular changes. We say both are a part of the diabetic
process.
Each patient has a specific constitution. By this, we mean that each person
has a specific individual body, mind and disease. That is why different
people get diabetes at different times, of differing severity, with
different complications, and with varying response to the same treatment. In
Homoeopathy, we try to find a medicine to suit the mental disposition, the
physical attributes, as well as the various complications of the patient.
That is why a homoeopath will select a different remedy for different
patients with diabetes.
For a homoeopath, diabetes is not the thing to be treated, it is the man
suffering from it. Recent findings in modern medicine emphasize the
psychosomatic factor in diabetes. It has been repeatedly verified that
stress is a primary contributor to the diabetic process. If stress is
removed, there is a significant improvement. Stress, as we homoeopaths know,
comes from our false perception of reality, that is what we call disease.
Each diabetic has his own individual disease state that is aggravating his
diabetes, besides other things. The homoeopath aims to identify the disease
state and treat it with the similar remedy. When the disease state is
removed, the diabetes loses its grip like a creeper without a stick.
Treating the present state
The body and the mind have both possibly gone through several states in the
past, each of which has left a mark. It is also possible that these states
now exist in a silent form alongside the dominant state. In the body, the
signs of such states which existed in the past can often be seen. For
example, the presence of the typical warts, corrugated nails and a hairy
body give ample evidence that at some time the person was in a Thuja state.
However, at present these are not the prominent symptoms. Right now, the
person has tremendous restlessness, thirst for sips frequently, loss of
weight and severe burning in an eruption which is better from warmth. The
present symptoms indicate Arsenicum album, despite the fact the Thuja signs
still exist. However, they are neither active nor predominant, and therefore
not the present state of the person. Our totality should be the totality of
the present.
It is reasonable to assume that a similar thing takes place in the mind
too. Here again, we may see remnants of past states. In the former Thuja
person, the fixity of ideas, the sense of brittleness, etc., may still be
found, although in a less prominent form. If we ask leading questions in
this direction, we may elicit positive answers, not so strongly, but they
will nevertheless be positive. Combined with the physical remnants like
warts, we may be tempted to consider this a Thuja case if we do not see that
the symptoms we have taken into account are not the one that predominate at
present. What dominates is the tremendous anxiety with restlessness, the
mistrust, the fear of being robbed and the fear of death, symptoms which are
much more in tune with the predominant and present physical state. Together
they make the totality of the present state, to which we have to direct our
treatment.
Does this mean we have to keep changing the remedy every minute since moods
keep changing? No, a remedy is not selected on the mood. The mood is often
dependent on the situation. From the mental symptoms which are prominent at
the moment, we have to identify those features which are unsuitable or out
of proportion to the situation. The totality of these features will indicate
the basic delusion or, in other words, the false perception of the present.
This is what needs to be treated. So, we have to see what it is in the
person that is not adapted to the present situation. When we are able to see
this, it will become clear that the state does not change as often as we
think; the changes are only superficial and the basic state (which comes
from the basic delusion) remains the same, even though there may be
different expressions depending on the situation. For example, a patient who
was formerly in the Calcarea carbonica state, with its desire for security,
its many fears, timid nature, stubbornness, etc., and physically with
features like obesity, desire for sweets and eggs, sweating on the scalp,
etc., will have some of these features in a less intense form even when he
goes into a state of Stramonium. At this time, however, these will not be
the prominent features. Now, we will see violence, terror, the cornered
feeling, the desire to escape, etc. The patient will come and shriek:
“Doctor, this cold is killing me, do something about it immediately.” He may
still answer in the positive for obesity, timidity or desire for sweets, but
these are not the prominent or predominant features now. If we fix our mind
on Calcarea carbonica we shall see only that, but if we set our minds on the
patient, we shall be able to see the present state which is Stramonium.
This understanding should make us cautious, especially with patients who
have had multiple states in the past. They are likely to answer positively
to leading questions about any of these states. So, we must be careful to
observe what is predominant now, without classifying the patient into some
idea of a remedy.
The question arises, what would happen if, instead of treating the present
state, we give a remedy that suits the previous state (which may still be
there in a silent form)? There are some who may feel that in not so serious
circumstances, this would also benefit the patient, and that the state that
you treat (even if it is silent) would respond and get less intense.
Though still open to this idea, I feel that it is not too logical. For
example, if a person is in a Stramonium state of terror and has a silent
Calcarea carbonica state in the background, what would happen if we give him
the latter remedy?
It would be like asking a person who is terrified: “Why are you timid, why
do you need security?”, instead of asking him: “ Why are you terrified? Why
are you so mortally afraid?” To the former question, there would be some
hint of response as if it strikes a chord somewhere in the distance, but
this effect is not going to be so beneficial to the patient, even in terms
of diminishing the silent state. It is as if this is not the right question
for the moment, and so it is likely to be dismissed without producing any
appreciable effect anywhere.
I feel, therefore, that we have to concentrate only on the present state.
The way to do this is to be an unprejudiced observer of what is happening in
the present and of what is not adapted to the present situation. Such
unprejudiced observation is a fundamental requisite of good case taking.
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