When is amputation needed in diabetic patients?

Amputations are required when1. Bones or joints are severely infected such that they will not respond to even long term antibiotics. 2. Part of the foot or toes have effectively ‘died’ as in what we call gangrene. If the gangrenous portions get infected, amputations are necessary to prevent further spread of infection.

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What is the TCM basis behind an individual having diabetes?

In TCM, we actually do not have the term diabetes, but it is closely associated with a condition known as ‘Xiao Ke’. ‘Xiao’ literally means emaciation (being abnormally thin) and ‘Ke’ means thirst. This condition is characterized by excessive thirst, excessive hunger, excessive urination and unexplained weight loss. These symptoms can also be observed in diabetic patients, hence we commonly refer diabetes as ‘Xiao Ke’ in TCM. A person’s health is determined by the balance of Yin and Yang in the body.

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Can I rely only on TCM treatment to keep my diabetes under control?

This greatly depends on the type and stage of diabetes that you are diagnosed with. For Type 1 diabetes in which the body does not produce enough insulin to control blood sugar, lifelong insulin therapy would be needed. Type 2 diabetes starts off with insulin resistance, where the cells in your body aren’t responding to the insulin produced, and may be accompanied with a lack of insulin as the disease progresses.

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How does TCM classify Diabetes? Is Type 1 and Type 2 Diabetes distinguished in TCM?

Diabetes is closely related to the condition ‘Xiao Ke’ in TCM. It is characterized by the four primary symptoms – excessive thirst, excessive thirst, excessive hunger, excessive urination and unexplained weight loss. Since both types of diabetes can present with these symptoms, TCM sees them as the same condition. The primary cause of both types of diabetes is Yin deficiency and Heat. TCM diagnosis focuses on the syndrome of an individual instead of the disease or condition.

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How is pre-diabetes and diabetes linked? Why is one curable while the other is chronic?

Pre-diabetes can be seen as the early stage of diabetes. Pre-diabetes is the stage where your blood sugar levels are higher than the normal range but have not reached the diabetic range. It is not a disease on its own, but rather viewed as an increased risk for diabetes. Both pre-diabetes and diabetes are both chronic conditions that are incurable. Management of both is targeted at controlling blood sugar levels, to lower the risk of developing complications.

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Is there a recommended TCM diet for someone with pre-diabetes?

I would advise your aunt to lower her sugar and carbohydrates intake, and to include whole grains in her meals instead of refined carbohydrates. She can choose wholemeal bread instead of white bread, and brown rice instead of white rice. On top of controlling her carbohydrate intake, there are some common herbs which she can include in her diet to nourish her Yin. She can make herself soups using Kudzu Root or Chinese Yam 2-3 times a week. She can also consider replacing her carbohydrates in some meals with Chinese Yam as it is a low GI food.

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Why are my eyes getting worse in spite of well controlled diabetes?

Thank you for your question. First of all, congrats on improving your diabetic control! Dropping your Hba1c from 9% to 5. 9% is an amazing conscientious effort on your part. 1. What I could not understand is that, how come my blood sugar was well control (5. 9%) but yet there is a deterioration in my eye condition? With too well controlled sugars, you can certainly get tingling sensations which is related to low blood sugar, or hypoglycaemia. It’s your body’s way of telling you that you need to eat.

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What should I do next if I'm worried that I have symptoms suggestive of diabetes?

Thank you for your question and I can understand your concern. The simplest way to check whether you have diabetes, is to arrange a fasting blood test with your local GP surgery. You will need to fast for 10-12 hours (overnight) and then have the test done prior to consuming any food or drink. There are some risk factors that come to mind, namely, do you have a family history of diabetes, are you carrying more weight that you should be (i. e. elevated BMI), have you been taking any supplements or medications, such as steroids, to help your gym activities?

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Dr Dinesh Sirisena

Sport Medicine

How can TCM help with pre-diabetes?

Abnormal blood sugar levels, whether pre-diabetes or diabetes, are seen as a result of disharmony in the body’s Yin and Yang, and the malfunctioning of our five organs. A TCM physician will assess your condition by asking you about your general well-being and other symptoms that you might present with. He will then diagnose you with a syndrome, which describes the specific disharmony in the body. A treatment will be formulated that is tailored specific to your individual condition.

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How does TCM treat diabetes?

Truth to be told, diabetes cannot be found in ancient TCM literatures. However, a condition called “Xiao Ke” (Wasting-Thirst) was mentioned in the Yellow Emperor’s Classic of Internal Medicine written in Han Dynasty (黄帝内经), which has records of the following symptoms: frequent thirst, excessive hunger, sweet-tasting urine, and weight loss. Doesn’t it sound exactly like the diabetes that we know? Therefore, diabetes may be treated under “Xiao Ke” which arises due to a deficiency in body fluids with production of dry heat.

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How to reverse or prevent diabetes?

Great question and very pertinent given the current fight against diabetes. While I won’t repeat Dr Abel’s advice, I would suggest EXERCISE and WEIGHT LOSS. In patients with early type II diabetes, these have been found to help with control and progression of the diesease and in some cases it can lead to patients not needing medication. Of course this needs to be combined with sensible eating and monitoring. Perhaps seeing someone to help you with this would be good, particularly if you haven’t developed type II diabetes. Hope this helps.

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Dr Dinesh Sirisena

Sport Medicine

How can TCM help with Type 1 Diabetes?

Type 1 diabetes patients produce little or no insulin, therefore causing their blood glucose level to be poorly regulated [1]. Clinically, patients may experience symptoms like [2]: excessive thirstiness, frequent urination, extreme hunger, fatigue, unintended weight loss etc. In TCM, these symptoms are often related to a condition called “xiao ke” (消渴) which means wasting and thirstiness [3]. “Xiao ke” is often related to the imbalance of the lungs, stomach and kidney [4].

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How should I arrange the timing of my meals to best manage my diabetes?

Diet control definitely plays a big part in managing diabetes. Since carbohydrate is the main nutrient that raises blood sugar levels, we should focus on the intake of carbohydrates. First of all, diabetic patients should decrease their intake of sugar and refined carbohydrates. This includes white rice and white bread. They have high glycemic index (GI), meaning that they can make your blood sugar levels shoot up very quickly. You should stick to low GI food, which includes oatmeals, brown rice, wholemeal bread, legumes and nuts.

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What are the acupoints associated with diabetes?

We know that the treatment principle is to replenish Yin and clear Heat. Hence, the acupoints selected would follow this principle. You can use these 3 acupoints found on your legs. First would be Di Ji on the inside of the calf. This is located around 4 fingers-width from the crease behind your knee and directly behind the shin bone. Second would be San Yin Jiao, also on the inside of the calf. This is found 4 fingers-width above the highest point of the inner ankle and behind the shin bone. These acupoints both nourish Kidneys Yin.

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How does cupping help with diabetes?

Cupping is a form of TCM treatment which involves the use of heat and glass cups to create a suction force on the skin. This aims to increase the circulation of Qi and Blood, and remove external pathogenic factors like Cold, Heat and Dampness from the body. It is typically used to address pain conditions such as muscle aches, sprains and rheumatism. However, it can also be done for general wellness, to balance the Yin and Yang energy of an individual. In this aspect, cupping can also be done for diabetic patients to rectify the imbalances in them.

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