KRIYAKRAMA IN THE TYPE 1 DIABETES MELLITUS (T1DM) IN CHILDREN

KRIYAKRAMA USED IN THE MANAGEMENT OF TYPE 1 DIABETES MELLITUS (T1DM) IN CHILDREN

• Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune condition leading to destruction of pancreatic beta cells, resulting in absolute insulin deficiency.

• In Ayurveda, it can be correlated with Madhumeha, a type of Prameha, particularly of Vataja origin.

• Management involves a multimodal approach including Shodhana (bio-purificatory) and Shamana (palliative) therapies.

• Two important Kriyakrama in Ayurvedic management are:

  • SHODHANA CHIKITSA

  • SHAMANA CHIKITSA

SHODHANA CHIKITSA (PURIFICATORY THERAPY)

• Indicated in samyak bala yukta bala madhumehi—patients with sufficient strength and kapha/mamsa meda dushti.

• Aims to remove the mala (toxins) and correct the dosha imbalance, especially Kapha and Meda.

TYPES OF SHODHANA THERAPIES USED IN T1DM

1. VIRECHANA (PURGATION THERAPY)

   • Removes excess Pitta and Meda dosha.

   • Drugs: Trivrit lehya, Avipattikar churna, Aragvadha.

   • Indicated in Kapha-pitta dominant Madhumeha.

   SHLOKA
   प्रमेहे वमनं पित्ते विरेचनमनुत्तमम्।
   बस्तिः सर्वेषु शस्तः स्यात् स्नेहो मारुतके हितः॥
   (Ashtanga Hridaya, Uttarasthana 12/40)

2. BASTI (MEDICATED ENEMA)

   • Especially useful in Vataja Madhumeha.

   • Niruha and Anuvasana Basti prepared with Tikta and Katu rasa dravyas help pacify vitiated Vata.

   • Common drugs: Dashamoola, Musta, Guduchi, Triphala.

   SHLOKA
   बस्तिरेव हि वातार्तानां श्रेष्ठः सर्वपरिकरः।
   तस्मात्सर्वप्रमेहेषु बस्तिः कार्यः विशेषतः॥
   (Charaka Samhita, Chikitsa Sthana 6/51)

3. RAKTAMOKSHANA (BLOODLETTING) – Rarely used but mentioned in certain cases with dushta rakta.

INDICATIONS FOR SHODHANA IN T1DM

• Presence of meda, kapha, or pitta dushti

• Obese diabetic children (suggestive of Kapha-predominant phenotype)

• Non-responding cases to Shamana Chikitsa

SHAMANA CHIKITSA (PALLIATIVE THERAPY)

• Aimed at controlling symptoms, especially excessive urination, thirst, weight loss, and improving digestive and metabolic strength.

• Suitable for children with less strength, or in early and mild forms of the disease.

KEY PRINCIPLES

• Use of tikta, katu, kashaya rasa dravyas

• Promoting agni deepana, kapha-vata pacification

• Emphasis on regular use and pathya ahara-vihara

IMPORTANT HERBAL FORMULATIONS (AUSHADHA YOGA)

1. NISHAKATHAKADI KASHAYA

   • Ingredients: Haridra, Kataka, Daruharidra, Triphala

   • Action: Kleda shoshana, kapha-pitta hara, rakta-purifier

2. GUDUCHYADI KASHAYA

   • Ingredients: Guduchi, Triphala, Vatsaka

   • Action: Rasayana, Agnivardhaka, Srotoshodhaka

3. CHANDRAPRABHA VATI

   • A herbo-mineral preparation used as mutrala, deepana, and Vata-pacifier

4. SHILAJATU

   • Potent Rasayana and Yogavahi

   • Enhances insulin activity, improves glucose metabolism

   SHLOKA
   प्रमेहं हन्ति मेहांश्च शक्तिं पुष्टिं च वर्धयेत्।
   बलं वर्णं च मेधां च शिलाजतु रसोत्तमम्॥
   (Rasaratna Samuchchaya 23/35)

AHARA AND VIHARA

• Pathya Ahara: Yava, Kodo, Kulattha, Mudga, Shigru patra, Karela, Methika

• Apathya: Gudam, Dadhi, Anupa mamsa, Snigdha ahara

• Lifestyle: Regular exercise (Vyayama), Dinacharya, avoiding Divaswapa

MODERN PEDIATRIC INSIGHTS ON T1DM MANAGEMENT
(As per Nelson Textbook of Pediatrics and IAP Guidelines)

• T1DM is due to autoimmune destruction of beta cells → leads to absolute insulin deficiency

• Onset typically between 4–15 years of age, often with polyuria, polydipsia, weight loss

• Requires life-long insulin therapy

  • Basal-bolus regimen or insulin pump therapy

  • Regular blood glucose monitoring and HbA1c assessment

• Medical Nutrition Therapy (MNT): Age-appropriate, calorie-balanced meals with carbohydrate counting

• Exercise: Encouraged under supervision; monitor for hypoglycemia

• Complications: DKA (Diabetic Ketoacidosis), growth retardation, microvascular issues if uncontrolled

• Education: Continuous caregiver and patient training for insulin use, glucometer handling, dietary adjustment