Introduction
 
Diabetes is a complex group of diseases with a variety of causes. People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia. This high blood sugar produces the symptoms of frequent urination, increased thirst, and increased hunger.  There are three main types of diabetes type 1 diabetes: results from the body's failure to produce insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". Type 2 diabetes; results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes also with an absolute insulin deficiency. This form was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or "adult-onset diabetes". Some people show signs of both type 1 and type 2 diabetes. Gestational diabetes is the third main form and occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level.

Diabetes is related to disorder of metabolism the way by which body uses digested food for generates energy for its normal functioning. The digestive tract breaks down the various types of carbohydrates sugars and starches which found in different types food materials into glucose, a form of sugar that enters in to the bloodstream. With the help of the insulin hormone, cells throughout the body absorb glucose and use it for energy. The symptoms of diabetes develop when the body doesn’t make enough insulin or is not able to use insulin effectively, or both. Insulin is made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood. If beta cells don’t produce enough insulin, or the body doesn’t respond to the insulin that is present, glucose builds up in the blood instead of being absorbed by cells in the body, leading to diabetes. 

As time passes, high levels of blood glucose starts damaging the nerves and blood vessels, emerging the complications of heart disease, stroke, kidney disease, blindness, dental disease, and amputations. Other complications of diabetes may include increased susceptibility to other diseases, loss of mobility with aging, depression, and pregnancy problems. Prevention and treatment often involve a healthy diet, physical exercise, not using tobacco, and being a normal body weight. Blood pressure control and proper foot care are also important for people with the disease. Type 1 diabetes must be managed with insulin.

Diagnosis of Diabetes

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following

• Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl)
• Plasma glucose ≥ 11.1 mmol/l (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test
• Symptoms of hyperglycemia and casual plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
• Glycated hemoglobin (Hb A1C) ≥ 6.5%.

A positive result should be confirmed by a repetition of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.  According to the current definition, two fasting glucose measurements above 126 mg/dl (7.0 mmol/l) are considered diagnostic for diabetes mellitus.

Per the World Health Organization people with fasting glucose levels from 6.1 to 6.9 mmol/l (110 to 125 mg/dl) are considered to have impaired fasting glucose. People with plasma glucose at or above 7.8 mmol/L (140 mg/dL), but not over 11.1 mmol/L (200 mg/dL), two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease. The American Diabetes Association since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9 mmol/l (100 to 125 mg/dl). 

Management of Diabetes

Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management of diabetes basically concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible, without causing hypoglycemia. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes).

Learning about the disease and actively participating in the treatment is vital for people with diabetes, since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels. The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher. Attention is also paid to other health problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Specialized footwear is widely used to reduce the risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence for the efficacy of this remains equivocal, however. 

Ayurvedic Management of Diabetes

Since ancient times, plants have been an exemplary source of medicine. Ayurveda and other Indian literature mention the use of plants in treatment of various human ailments. India has about 45000 plant species and among them, several thousands have been claimed to possess medicinal properties. Research conducted in last few decades on plants mentioned in ancient literature or used traditionally for diabetes have shown anti-diabetic property. The present paper reviews 45 such plants and their products (active, natural principles and crude extracts) that have been mentioned/used in the Indian traditional system of medicine and have shown experimental or clinical anti-diabetic activity. Indian plants which are most effective and the most commonly studied in relation to diabetes and their complications are: Allium cepa, Allium sativum, Aloe vera, Cajanus cajan, Coccinia indica, Caesalpinia bonducella, Ficus bengalenesis, Gymnema sylvestre, Momordica charantia, Ocimum sanctum, Pterocarpus marsupium, Swertia chirayita, Syzigium cumini, Tinospora cordifolia and Trigonella foenum graecum. Among these we have evaluated M. charantia, Eugenia jambolana, Mucuna pruriens, T. cordifolia, T. foenum graecum, O. sanctum, P. marsupium, Murraya koeingii and Brassica juncea. All plants have shown varying degree of hypoglycemic and anti-hyperglycemic activit.

Ayurvedic System of Medicine clearly defines Diabetes.  Diabetes Mellitus was known to Indian Civilization since vedic period by the name Asrava (Prameha).  Diabetes is also known as Madhumeha. Diabetes is also called Maharoga (Major Disease) as almost all parts of the body and every cell of human physiology are affected. It also disturbs 5 sheaths of the body – annamaya kosha{Food sheath}, pranamaya kosha{Energy sheath}, manomaya kosha {Mind Sheath}, vijnana maya kosha{Intellectual Sheath} and anandamaya kosha{Bliss Sheath}. According to Ayurveda, prameha is divided in 4 major types (and total 21 types) Kapha type (again divided into 10 types) Pitta type (again divided into 6 types), Vata type (divided into 4 types) Juvenile diabetes for children (for unhealthy practices of parents and/or due to the sins of past-birth). The main causes of prameha (diabetes) are lack of exercise and consumption of excess food having ushna, snigdha and guru nature. Foods that increase kapha, medhas and mootra are the major factors for prameha.

According to Ayurveda the line of treatment of prameha is strictly on individual’s constitution.

1) The prakrithi of the patient
2) Dosha predominance of disease
3) Dooshya vitiation
4) Obstruction in srothus
5) Manasika Prakrithi
6) Ahara & Vihara
7) Hereditary factors etc…

In general Diabetes Mellitus {Vathaja prameha} Patients are advised to have Bhrimhana medication & diet which increases dhathus in the body.

Herbs useful in treatment of Diabetes:

Latin Name: Pterocarpus marsupium – leguminosae
Rasa (Taste): Kashaya (Astrigent), Tikta (Bitter)
Guna (Characteristics) – Lakhu (Light), Ruksha (Rough)
Veerya (Potency) – Sheeta (Cold)
Vipaka (Post digestion effect) – Katu (Pungent)

Actions according to Ayurveda:

• Rasayana: Vijaysar rejuvenates each and every cell of the body.
• Raktasodhana: Vijaysar purifies the blood and removes all toxins from it.
• Krimirogahar (Antihelmenthic): Vijaysar is very useful in diseases which originate from external causes like infection, worm infestation etc.
• Pramehaghna: Vijaysar is useful in all disease which involves discoloration of urine including diabetes (Madhumeha).

Diet in Diabetes

Proper nutrition is essential for anyone living with diabetes. Control of blood glucose levels is only one goal of a healthy eating plan for people with diabetes. A diet for those with diabetes should also help achieve and maintain a normal body weight as well as prevent heart and vascular disease, which are frequent complications of diabetes.

There is no prescribed diet plan for those with diabetes. Rather, eating plans are tailored to fit an individual's needs, schedules, and eating habits. A diabetes diet plan must also be balanced with the intake of insulin and oral diabetes medications. In general, the principles of a healthy diabetes diet are the same for everyone. Consumption of a variety of foods including whole grains, fruits, non-fat dairy products, beans, and lean meats or vegetarian substitutes, poultry and fish is recommended to achieve a healthy diet.
Many experts, including the American Diabetes Association, recommend that 50% to 60% of daily calories come from carbohydrates, 12% to 20% from protein, and no more than 30% from fat. People with diabetes may also benefit from eating small meals throughout the day instead of eating one or two heavy meals. No foods are absolutely prohibited for people with diabetes, and attention to portion control and advance meal planning can help people with diabetes enjoy the same meals as others in the family.

Modern Medications 
Currently, one goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia. Adequate control of diabetes leads to lower risk of complications associated with unmonitored diabetes including kidney failure (requiring dialysis or transplant), blindness, heart disease and limbamputation. The most prevalent form of medication is hypoglycemic treatment through either oral hypoglycemics and/or insulin therapy. There is emerging evidence that full-blown diabetes mellitus type 2 can be evaded in those with only mildly impaired glucose tolerance.

Patients with type 1 diabetes mellitus require direct injection of insulin as their bodies cannot produce enough (or even any) insulin. As of 2010, there is no other clinically available form of insulin administration other than injection for patients with type 1: injection can be done by insulin pump, by jet injector, or any of several forms of hypodermic needle. Non-injective methods of insulin administration have been unattainable as the insulin protein breaks down in the digestive tract. There are several insulin application mechanisms under experimental development as of 2004, including a capsule that passes to the liver and delivers insulin into the bloodstream. There have also been proposed vaccines for type I using glutamic acid decarboxylase (GAD), but these are currently not being tested by the pharmaceutical companies that have sublicensed the patents to them.

For type 2 diabetics, diabetic management consists of a combination of diet, exercise, and weight loss, in any achievable combination depending on the patient. Obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. Weight reduction and exercise improve tissue sensitivity to insulin and allow its proper use by target tissues. Patients who have poor diabetic control after lifestyle modifications are typically placed on oral hypoglycemics. Some Type 2 diabetics eventually fail to respond to these and must proceed to insulin therapy. A study conducted in 2008 found that increasingly complex and costly diabetes treatments are being applied to an increasing population with type 2 diabetes. Data from 1994 to 2007 was analyzed and it was found that the mean number of diabetes medications per treated patient increased from 1.14 in 1994 to 1.63 in 2007.

Patient education and compliance with treatment is very important in managing the disease. Improper use of medications and insulin can be very dangerous causing hypo- or hyper-glycemic episodes.

Ayurvedic Medicine helpfull in Diabetes:
• Basant Kushmakar Rash.
• Manmanth Rash
• Chandraprabha Vati
• Faltrikadi Kwatha
• Trivang Bhasma
• Trifala Churna
• Sansamani Vati
• Amrita Guggulu
• Shudha Shila Jatu
• Abhrak Bhasma
• Naag Bhasma
• Gudmar Churna
• Vijay Shaar Churna and Kwatha