Definition of Diabetes 

Definition of Diabetes (Ziabetus) are as follows:

“Diabetes is a chronic disorder characterized by a high blood glucose level. The increased blood sugar level either results from inadequate insulin production or resistance of the body’s cells to the action of insulin.”

Pathophysiology 

 Diabetes is one of the significant diseases spreading in the US and worldwide. The body gland named the pancreas (banqaras) produces hormones like insulin in a healthy body. The abnormal function of the pancreas leads to an absolute or lack of insulin production. Insulin is an essential hormone for the body as it maintains blood sugar levels. Yet, abnormal blood sugar levels can damage organs (aaza), such as blood (dam) vessels and nerves. 

Diabetes (Ziabetus) can be dangerous if left undiagnosed and untreated. Moreover, it can cause diseases like heart attack, retinopathy (infection of the retina which results in impairment or loss of vision), kidney failure, and rarely coma. Ultimately, it leads to death.

What is insulin, and how does it work?

But what happens if the glucose level falls too low?

Normal blood sugar level amount:

Fasting plasma glucose (FPG)	Fasting plasma glucose (FPG)	A1C
Below 100 mg/dL	Below 140 mg/dL	Less than 5.7%

Blood sugar level of pregnant women with diabetes.  

	ADA (American Diabetes Association)	AACE (American Association of Clinical Endocrinologists)
Before Eating	70-130mg/dL	Less than 110 mg/dL
2 Hours After a Meal	Less than 180 mg/dL	Less than 140 mg/dL
A1C (HbA1c)	Less than 7.0%	Less than 6.5%

Blood sugar level of pregnant women with diabetes.   High blood sugar chart:  High blood sugar level called hyperglycemia to occur during diabetes mellitus. 

Blood Sugar Level Reading	Alert Level and Treatment Plan
180-250 mg/dL	Yellow Flag: Blood sugar is slightly above normal levels. High blood sugar levels indicate that the body does not have enough insulin or glucose-lowering medication. Levels may rise due to an absence of insulin or resistance to the action of insulin.  The Unani physician may provide individualized instructions. Visit your Unani physician if you have two or more unexpected blood sugars over 250 mg/dL.
Higher than 250 mg/dL	Red Flag: Blood sugar is extremely high and needs rapid treatment. More than two unexpected blood sugar readings above 250 mg/dL require medical attention.  Don’t exercise if your blood sugar is above 250 mg/dL. Try to drink plenty of water.

Low blood sugar chart:

Blood Sugar Level Reading	Alert Level and Treatment Plan
50 mg/dL or under	Red Flag: Blood sugar is excessively low and requires rapid medical assistance If a person cannot speak and/or is not conscious, seek medical assistance. Prohibit placing food or drink into the mouth. If a person is alert and able to speak clearly, re-test blood sugar level in 15 minutes. Try to bring back blood sugar levels with the help of medical assistance.
51-70 mg/dL	Red Flag: Blood sugar is below average levels and requires immediate treatment. Treat with carbohydrates and re-test in 15 minutes again. Repeat dietary therapy as needed to bring blood sugar within range.
71-90 mg/dL	Yellow Flag: Blood sugar levels should be observed and treated with a dietary supplement.  If you’re having symptoms of low blood sugar, treat with carbohydrates and test in 15 minutes again. The blood sugar level primarily lowers if you are late for your regular meal—no need to rush to emergency assistance.

 General Symptoms Of Diabetes (Ziabetus)

• Frequent Urination
• Excessive thrust
• Constant feeling of hungriness.
• Tiredness and weakness are common.
• Weight variation
• The low urge of Sex

General Causative Factors of Diabetes (Ziabetus)

• Psychological function (Infaalat-e-Nafsania) such as anxiety, tension, stress, and strain.
• Mood and temperament (Soo-e-Mizaj-e-Kuliya)
• Overeating
• Excessive alcohol use
• Sedentary lifestyle

Classification Of Diabetes (Ziabetus)

Unani Medicinal System classifies diabetes into four categories. Here are the four Unani categories of diabetes. Diabetes is of two types according to the presence or absence of sugar in the urine;

Diabetes Insipidus (Ziabetees Sada):

It is categorized by excessive urination and thirst; however, no abnormal sugar level is seen in the urine 2.  

Basic Physiology

Well, let’s dive deep into the diabetes insipidus (Ziabetees Sada). Diabetes insipidus is distinct from commonly occurring diabetes as it does not associate with the pancreas. It is neither due to beta cell destruction of the pancreas nor resistance to the action of insulin. However, the antidiuretic hormone (ADH) vasopressin conserves body water by reducing loss in urine. ADH binds to the V2 receptor in the kidney to increase water permeability and reabsorption in the collecting tubule.  In diabetes insipidus (Ziabetees Sada), low secretion of ADH occurs due to kidney insensitivity. The absence of ADH leads to less absorption power (Quwwat e Jazbiyah) of the collecting tubule. Eventually, it causes impermeability. 

Types of Diabetes Insipidus

There are mainly four types: 

• Central Diabetes Insipidus occurs due to damage of the hypothalamus or posterior pituitary gland. Further, it may occur due to a hindrance in the production of ADH hormone.
• Nephrogenic Diabetes Insipidus occur due to kidney malfunctioning of utilizing vasopressin. It can occur despite the presence of vasopressin. It may be due to a defect in gene or mutation in the kidney. 
• Dipsogenic Diabetes Insipidus occurs due to a defect in the thirst mechanism. Basically, it reduces vasopressin secretion and increases urine output. 
• Gestational Diabetes Insipidus occur during pregnancy. Sometimes, it produces generation to generation. 

Signs and Symptoms (Khiffat and Shiddat) 

General signs and symptoms (khiffat and shiddat) of Diabetes Insipdus (Ziabetees Sada) are as follows:

• Polydipsia: A condition where a person has increased thirst and craving for ice water. 
• Polyuria: A condition when a person urinates more than usual. Average individual urinates 4 to 10 times a day. 
• Dehydration: a condition when a person has loss of electrolytes and symptoms, e.g., dry mouth, low blood pressure(hypotension), and muscle pain. 

Diagnostic Test for Diabetes Insipidus (Ziabetees Sada)

• Urine: Analysis of the concentration of urine via urinalysis. 
• Blood: Test the blood for osmolarity of the plasma. Analyze the electrolyte concentration, blood glucose level, and plasma ADH or AVP hormone level. 
• Fluid Deprivation test: Restrict the water intake to indicate the cause of polyuria (excess urination). 
• Brain imaging: Technique e.g., MRI or fMRI 

Diabetes mellitus (Ziabetees Shakri):

 It is exemplified by excessive thirst and urination, along with the presence of abnormal sugar levels in the urine 3.  Diabetes Mellitus (Ziabetees Shakri) is mainly categorized into 2 different types:

• Type 1 Diabetes
• Type 2 Diabetes 

Type 1 Diabetes 

 In type 1 diabetes, insulin-producing cells are destroyed, thus eliminating insulin production. The disease occurs due to the absolute absence of insulin due to beta cell destruction. It occurs during childhood or puberty. 

Signs and Symptoms (Khiffat and Shiddat)

General signs and symptoms (khiffat and shiddat) of Diabetes Mellitus (Ziabetees Shakri) are as follows

• polydipsia 
• polyphagia 
• weight loss 

Types of Type 1 Diabetes

It is of two forms:

• Immune-Mediated Diabetes occurs due to autoimmune deficiency, resulting in insulin deficiency. It is 85% to 90% detected through fasting hyperglycemia test. 
• Idiopathic Diabetes occurs due to the absence of endogenous insulin. It is characterized by permenant ketoacidosis and insulinopenia.  

 Types 2 Diabetes 

It occurs due to insulin resistance with relative insulin deficiency. Type 2 diabetes is caused by genetic factors, age, or obesity. It commonly occurs after age 35

 Diagnostic Tests for Diabetes Mellitus (Ziabetees Shakri)

• Fasting plasma glucose test: Measure blood level at a single point for the test, fast for at least 8 hours. 
• A1C test: Analyze the average blood glucose level over the past 3 months. A1C isn’t accurate with the anemic patient. 
• Random Plasma Glucose Test: You don’t need to fast overnight in this case. The test conducts after the symptoms of diabetes.  
• Oral Glucose Tolerance Test: Fasting for at least 8 hours. Take a blood sample after every 2 to 3 hours. 

Unani Insight Ziabetus is also of further two types; Ziabetees Haar: In this type of Ziabetees, acute symptoms such as Kasrat-e-Baul (increased urination) and Atash-e-Mufrit (excessive thirst) occur. Ziabetees Barid: In Ziabetees Barid, thirst and urine frequency are relatively minor.

Mode of treatments for Diabetes in USM

Unani treatment for diabetes are as follows. Unani System of medicine include 4:

• Ilaj-bil-Tadbeer (Regimental therapy)  
• Ilaj-bil-Ghiza (Dietotheraphy)  
• Ilaj-bil-Dawa (pharmacotherapy)  
• Ilaj-bil-yad/jarahat (Surgery) 

Regimental therapy (Ilaj-bil-Tadbeer)

Ilaj-bil-Tadbeer is a therapy that depends on non-medical treatment. In this case, you need to maintain a patient’s habitat, lifestyle, and dietary habits. Hence, ilaj bil tadbeer is a rudimentary Unani treatment for diabetes. For diabetes, the patient should maintain: 

• Daily exercise (Riyaazat) 
• Proper sleep cycle
• Proper Diet (Ghiza)
• Proper water intake 
• Message (Dhalak) prolonged massage reduces the fat of the body and enhances weight gain in premature infants.

Dietotheraphy (Ilaj-bil-Ghiza)

Unani practitioner advises a proper dietary plan as ilaj bil Ghiza. However, diet therapy is effective Unani treatment for diabetes. The patient is treated by taking a proper diet. Some of the dietary substances are recommended while some are prohibited. A list of restricted or recommended is mentioned below. 

Dietary Recommendations For Diabetes (Ziabetus)

• Fruits and vegetables
• Whole-grain bread, brown rice, and oatmeal
• Low-fat dairy including milk, yogurt, cheese, eggs, nuts, and fish, as well as beef.
• Use artificial sweeteners
• Sugar-free ice-cream

Following dietary recommendations is an efficacious Unani treatment for diabetes.

Dietary Restrictions For Diabetes (Ziabetus)

• White potatoes
• Corns
• White rice
• Beets
• White bread
• Soda
• Candy
• Baked foods
• White flour
• Refined sugar Certain times, you need to prohibit yourself from eating agents that can worsen your ailment. So, it is a part of Unani treatment for diabetes.

Pharmacotherapy (Ilaj-bil-Dawa)

Ilaj bil Dawa includes crude drugs and medicinal compounds. The treatment of diabetes through medicines is Unani treatment for diabetes via pharmacotherapy. The single herbs and medicinal compounds are suggested down below: 

Single Herbs For Diabetes

• Fenugreek Seed (Trigonella foenum-graecum)
• Cinnamon (Cinnamomum verum)
• Negella (Nigella sativa)
• Salajeet (Mineral wax)
• Bael Fruit (Aegle marmelos L.)
• Dactylorhiza (Dactylorhiza praetermissa)
• Sweet Fruit (Gymnema sylvestre)
• Carom Seeds (Trachyspermum ammi)
• Greater Galangal (Alpinia galanga)
• Fig (Ficus carica)
• Water Chestnut (Eleocharis dulcis)
• Gum Arabic (Acacia senegal)
• Garden Asparagus (Asparagus officinalis)
• Cumin (Cuminum cyminum)
• Tamarind (Tamarindus indica)
• Prunes (Prunus subg.)
• Emblic Myrobalan (Phyllanthus emblica)

Unani Compound For Diabetes (Ziabetus)

• Dawa-i-Ajeeb Ziabetts
• Habbe Rasaut Khas
• Qurs Zamurd
• Qurs Baiza Murgh
• Habbe Amber Momyai
• Jawarish Anarain

Unani physicians have principles for pharmacotherapy. Mizaj-e-Advia (Drug Temperament) There are four temperaments (Mizaj), i.e., hot, cold, wet, and some neutral. Each drug has its own temperament. The drug is given to the patient opposite to his disease temperament.  Darjaat-e-Advia (Potency of Drugs) Four temperament (Mizaj) has four grades of drugs according to the potency. Grade 1 degree is lowest in potency, while fourth is the highest.

Surgery (Ilaj-bil-yad/jarahat )

Ilaj bil jarahat was mostly used in ancient times. Nowadays, only minor surgeries are in practice. Surgeries are mainly taken place when the disease can not be treated with any other mode of treatment. Surgery is an Unani treatment for diabetes at crucial stages.  EndNote: Unani medicines should be taken under the guidance of a certified Unani Physician. In order to get optimum results, patients are required to follow the regimen strictly.