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Ozone therapy in DiabetisMellitus and its complications

What is diabetes?

Diabetes mellitus is a metabolic disorder which is known to everybody nowadays. It is to be noted with astonishment that DM has an attracting global importance as it is rocking the world as a non-infectious epidemic/pandemic. “SUGAR” is the common name given to DM by the Indian laymanNowadays, it is one of the leading causes of morbidity and mortality because Diabetes mellitus causes secondary pathophysiologic changes in the multiple organ system. In the forecoming days it is presumed to be increasing day by day due to an increase in factors contributing to hyperglycemia, which may include dietetic irregularities, metabolic dysfunction, lack of exercise, stress, and busy lifestyle.. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime. The rising prevalence of Diabetes mellitus in developing countries is closely associated with industrialization and socioeconomic development.India fastly emerging as diabetic capital of world after china.

 

Classification(eitiological)

Type1 or insulin dependent diabetis: Also called juvenile onset diabetes mellitus. In this type, the pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin. The patient with type 1 diabetes must rely on insulin medication for survival. In autoimmune diseases, such as type 1 diabetes, the immune system mistakenly manufactures antibodies and inflammatory cells that are directed against and cause damage to patients' own body tissues. here the beta cells of the pancreas, which are responsible for insulin production, are attacked by the misdirected immune system. It is believed that the tendency to develop abnormal antibodies in type 1 diabetes is, in part, genetically inherited, Exposure to certain viral infections (mumps and Coxsackie viruses) or other environmental toxins may serve to trigger abnormal antibody responses that cause damage to the pancreas cells where insulin is made. Some of the antibodies seen in type 1 diabetes include anti-islet cell antibodies, anti-insulin antibodies and anti-glutamic decarboxylase antibodies. These antibodies can be measured in the majority of patients, and may help determine which individuals are at risk for developing type 1 diabetes

 

Type 2 diabetes or non-insulin dependent diabetes mellitus : Also called adult onset diabetes mellitus. In this type, patients can still produce insulin, but do so relatively inadequately for their body's needs. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body called insulin resistance (particularly fat and muscle cells). In addition to this, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control.
type 2 diabetes occurs mostly in individuals over 30 years old and the incidence increases with age, first time in the history of humans, type 2 diabetes is now more common than type 1 diabetes in childhood. Most of these cases are a direct result of poor eating habits, higher body weight, and lack of exercise.

Gestational diabetes: Diabetes can occur temporarily during pregnancy. Significant hormonal changes during pregnancy can lead to blood sugar elevation in genetically predisposed individuals. Gestational diabetes usually resolves once the baby is born. However, 25%-50% of women with gestational diabetes will eventually develop type 2 diabetes later in life, especially in those who require insulin during pregnancy and those who remain overweight after their delivery.

OTHER CAUSES:

Drug or chemical induced Diabetes mellitus: Some drugs such as Nicotinic acid, Glucocorticoids, Thyroid hormones, Diazoxide betaadrenergic agonists, Thiazides, ß blockers etc causes DM.

Endocrinal Diseases: This includes Hyperthyroidism, Hypersecretion of Adrenal cortex, Hyperpituitarism, Cushing’s syndrome, Pheochromocytoma, Acromegaly, Somatostatinoma.

Diseases of Pancrease: This includes Pancreatitis, Cystic Fibrosis, Hemochromatosis, Pancreatopathy, Cancer of pancreas, Pancreactectomy.

Other Genetic Syndrome sometime associated with DM like as Down’s syndrome, Klinefelter’s Syndrome, Turner’s syndrome, Huntington’s corea.

 

RISK FACTORS FOR TYPE 2 Diabetes mellitus

  • A strong family history
  • Obesity
  • Increasing Age
  • History of Gestational diabetis
  • Hypertension (Blood pressure = 140/90 mmHg)
  • low HDL cholesterol and high LDL level
  • Triglyceride level > 250 mg/dl
  • Polycystic ovarian syndrome
  • Sedentary life
  • Unhealthy eating habits
  • Life style habits like smoking, drinking alcohol
  • Toxic exposure such as pesticides, chloro floro carbons, toxic heavy metals (Hg, Pb, As,Cd etc.)
  • Stress--- following surgery, trauma etc.

 
Classical symptoms

  • Age – Poor sperm motility, DNA fragmentation.
  • Temporary and life style causes
  • Emotional stress
  • Sexual issues
  • Testicular over heating
  • Substance abuse
  • Smoking
  • Malnutrition and Nutrient Deficiencies
  • Obesity
  • Bicycling
  • Genetic Factors
  • Environmental Assaults
  • Free radicals [oxidants]
  • Exposure to estrogen like hormone disrupting chemicals
  • Industrial chemicals
  • Radiation treatment
  • Medications : Anabolic Steroids, Azulfidine, Methadone, Folex, Aldactone etc
  • Use of mobile 4 hours or more than 4 hours per day will decrease the sperm count. Damage could be caused by the electromagnetic radiation emitted by handsets or the heat they generate.

Diagnosis

  • The fasting blood glucose test is the preferred way to diagnose diabetes.sample is taken after the person has fasted overnight (at least 8 hours), Normal fasting plasma glucose levels are less than 100 milligrams per deciliter (mg/dl). Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes.
  • A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or higher indicates diabetes.
  • oral glucose tolerance test is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic ovary syndrome.
  • Hemoglobin A1c (A1c) gives a more reasonable and stable view of what's happening over the course of time (three months), and the value does not bounce as much as finger stick blood sugar measurements. In most labs, the normal range is 4%-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it's less than 7.0% (optimal is <6.5%). studies have shown that there is about a 10% decrease in relative risk for microvascular disease for every 1% reduction in A1c. Data also sugg ests that the risk of macrovascular disease decreases by about 24% for every 1% reduction in A1c values.

Complications of Diabetis

Acute complications:

Diabetic ketoacidosis(DKA): Mostly Seen in patients with type1 DM with missed dosage of insulin ,Symptoms include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death.

Hyperosmolar coma: In patients with type 2 diabetes, stress, infection, and medications (such as corticosteroids) can also lead to severely elevated blood sugar levels. Accompanied by dehydration, Like diabetic ketoacidosis, it is a medical emergency

Hypoglycemia means abnormally low blood sugar (glucose): In patients with diabetes, the most common cause of low blood sugar is excessive use of insulin or other glucose-lowering medications, presence of a delayed or absent meal or sudden excessive physical exertion. Blood glucose is essential for the proper functioning of brain cells. Therefore, low blood sugar can lead to central nervous system symptoms such as: dizziness, confusion, weakness, and tremors.

Chronic complications of diabetes

Microvascular complications: These include Ophthalmic Disorders (Retinopathy, Macular edema, Cataract, Glaucoma), Neuropathy (Peripheral neuropathy, Sensory and Motor polyneuropathy), and Nephropathy (ESRD).

Macrovascular complications: These include Coronary Artery Diseases (angina or heart attack), peripheral vascular disorders(claudication), and cerebrovascular diseases(stroks).

Other complications include Gastroparasis, Diarrhea, Uropathy, Sexual dysfunction and Dermatologic complications like eczema, cellulites, and gangrene of distal part of limbs (Diabetic foot).

Complication due to treatment(insulin injections, oral hypoglycemic agents)

  • Hypoglycemia
  • Drug toxicity

Ozone therapy in Diabetes

  • According to Frank Shallenberger, M.D., H.M.D., director of the Nevada Centre of Alternative and Anti-Aging Medicine in Carson City, Nevada,Hypoxia is the cause of diabetis. ozone can produce remarkable improvements in both the major and secondary symptoms of adult- onset diabetes. The connection between the ozone and diabetes is the blood circulation
  • A prime reason the red blood cells in the diabetic's blood are unable to release their oxygen is that a key molecule called 2,3-diphosphoglycerate, or 2,3-dpg for short, is in reduced supply. Under normal conditions, 2,3-dpg stimulates red blood cells which carry oxygen to deliver it to the tissues; but if there isn't enough of this molecule in the system, the red blood cells can't deliver the oxygen.
  • When ozone is intrduced--that is,
  • more oxygen-into the blood, more 2,3-dpg is produced and the oxygen-delivery system and the efficiency of blood circulation start to improve. The ozone also appears to enhance the activity of cellular metabolism, the continual conversion of food into energy.
  • Levels of ATP, an important molecule which stores energy in the cells, are also enhanced through ozonation. Among other functions, ATP helps each cell maintain the integrity of its membrane, thereby enabling it to regulate the passage of materials into and out of the cell
  • Oxidative stress is suggested to have an important role in the development of complications in diabetes. Because ozone therapy can activate the antioxidant system, influencing the level of glycemia and some markers of endothelial cell damage
  • Ozone treatment improved glycemic control, prevented oxidative stress, normalized levels of organic peroxides, and activated superoxide dismutase.
  • Ozone increases penetrance of cell membranes for glucose by stimulating pentose phosphate cycle and aerobic glycolysis, which are suppressed in diabetes, and this induces a decrease in the hyperglycemia due to improvement in the release of glucose to the tissues.
  • intensify the production of glutathione, which participates in the synthesis of glycogen and fat from glucose as well as in the synthesis of proteins. Glucose oxidation occurs including the end products. As a result, the main function of carbohydrates - energy supply - is restored. The energy deficiency of the tissues is eliminated. The way of endogenic production of glucose from glycogen and protein is inhibited i.e. the gluconeogenesis is suppressed. The breakdown of protein is decreased, and the catabolic processes are suppressed. Lipid peroxidation returns to normal. Thus, ozone performs a number of functions characteristic of insulin.
  • By inducing a decrease in the hyperglycemia, an increase in the release of glucose to the tissues, by improving oxygen supply and by removing hypoxia conditions, ozone therapy prevents the development and progress of processes associated with insufficient supply of glucose to the cell: sorbitol accumulation in the tissues that leads to cataract, neuropathies, microangiopathies; formation of glucoseaminoglycanes which are responsible for arthropathies; synthesis of glycoproteins that results in the progression of angiopathies.
  • As a preventive and therapeutic method ozone therapy is used in elderly diabetes patients suffering from atherosclerotic disturbances of the cardiovascular system such as ischemic heart disease, discirculatory encephalopathy, occlusive arterial atherosclerosis of the lower extremities.
  • immunomodulating effect of Ozone therapy is particularly important for insulin-dependent form of disease when owing to antigens and antibodies in autoimmune and virus-induced forms of disease the cytotoxic reaction results in the destruction of B-cells. These forms are characterized by the production of insulin-inactivating antibodies.

Treatments in ozone therapy:

  • Major auto ozone injection or Intravenous infusions of ozonated saline
  • Rectal ozone insufflations;
  • Minor autohaemotherapy with ozone;
  • Ozone bagging or ozone local application in diabetic wounds.
The bio chemical improvement after ozone therapy include:
1. Fall in blood glucose
2. Fall in triglyceride levels
3. Fall in serum cholesterol with increase in HDL cholesterol
4. Fall in glycosalated haemoglobin (HbA1c) level( thus improve tissue oxygenation)

Number of ozone sessions, mode of treatment and dosage depends upon the type of diabetis and its complications. Owing to the hypoglycemic effect of ozone, during the treatment it is necessary to carry out a continual control over the blood level of glucose as well as to correct the dosage of sugar-reducing preparations used.

DIET AND NUTRITIONAL PLAN:

Proper nutritional management or food plan is essential for better glucose control. This in turn helps to reduce the risk of diabetic complications. Daily consistency regarding the types of food including in the meal, their nutritional information, and the time at which they are consumed will help to normalize the blood glucose levels.

The common meal planning tips are:

  • Avoid saturated fats and oils; instead of that use unsaturated oils found in olive oil, nuts, and canola oil
  • Moderate salt and salty food consumption, especially when high blood pressure is present.
  • Watch the amount of protein-rich food.
  • Incorporate high-fiber food such as grains, raw vegetables and fruits (fruit is better than the fruit juice).
  • Spread your daily carbohydrate intake through the day. Don’t eat too much carbohydrate at any time.

EXERCISE PLAN:

Physical activity is recommended for everyone. It should take place any time when a person can and is willing. The minimum time recommended is about 30 minutes; three or more times a week. Activity can include moderate walking and household chorus, such as gardening and cleaning as well as jogging, biking, dancing and other sort of exercises.