Concept and Therapeutic Approach of Intermediate Hyperglycemia with Special Reference to Unani Medicine

Abstract

Intermediate Hyperglycemia is a category of glucose tolerance representing an intermediate stage between normal glucose tolerance (NGT) and diabetes. Within this category are two subcategories: impaired fasting glucose (IFG; 100 –125 mg/dl) and impaired glucose tolerance (IGT; defined as a 2-h oral glucose tolerance test (OGTT) plasma glucose concentration of 140 –199 mg/dl). Intermediate Hyperglycemia is not specifically mentioned in Unani medicine, however some classical Unani physicians have described the initial symptoms and factors leading to the pathology. In Unani medicine the risk factors are described in terms of ‘Su-e-mizaj’ as per the concept of Tibb. So, it is considered in the context of Zeyabutus which is described as a disease which develops due to Su-e-mizaj haar (abnormal hot temperament) by the majority of scholars. The two major pathophysiologic defects responsible for losing glucose tolerance are insulin resistance and β-cell glucose insensitivity, both appearing in subjects of Intermediate Hyperglycemia. Symptoms mentioned in Unani medicine may be increased frequency of micturition (ants and flies are attracted to urine), increased thirst, nocturia, dryness of mouth and whole body, fatigue, loss of weight, malaise, cramps in lower extremities.
 The drug based approach for management of Intermediate Hyperglycemia is associated with inherent drawbacks, including toxicity, tolerability, cost and efficacy. Oral hypoglycemic drugs are also associated with various side effects as Biguanides cause gastrointestinal upsets, anorexia, nausea, diarrhea and lactic acidosis. There are a number of single Unani drugs like Jamun (Syzigium cuimini), Karela Bark or Bitter Gourd (Momordica charantia), Neem (Azadirachta indica), Methi (Trigionella foenum), Bael Leaves (Aegle marmelos), Kalonji (Nigella sativa), Tabasheer (Bambusa arundinaceae), Gurmar booti (Gymmema sylvestre) and compound formulations like Qurs Ziyabetus, Qurs Tabasheer, Qurs Kafoor, Qurs Gulnar.