Abstract

Diabetes mellitus is progressively increasing worldwide and India is considered as Diabetes capital of the world with a projected incidence of 109 million by 2035, as this disease of luxury is affecting even down trodden daily wage earner hard workers and both sexes equally due to emergence of toxic non-nutrients in the diet, drinks and oil solely caused by rampant use of fertilizer, chemicals, pesticides, hormones, preservatives and processing. In addition, patients showing increased tolerability to high blood sugar level and growing resistance to continuing drug create suspicion regarding etio pathogenesis of hyperglycaemia. Objective of the study: To ascertain the incidence of diabetes mellitus among hard workers and pathophysiology of increased tolerance to high blood sugar level. Material & method: For the purpose 20,000 population of 20 Dalit hamlets and 10 villages of Nawada district aged > 35 years were interrogated thoroughly, examined clinically and screened for blood sugar urine sugar and other bio parameters. In addition patients of Diabetes mellitus attending Institute Of Applied Endocrinology and Aarogyam Punarjeevan Patna 14 were also evaluated accordingly. Result: Study reveals adjuvant hepatogogue with antidiabetic drug and dietary restriction check circadian variation of blood sugar and ensures blood sugar bioregulation with continued tapering of anti-diabetic dose without any consequent sequel or adversity. Toxic non-nutrient dietary constituents suppress secretion and production of GLP 1 in the L cells of mucosal lining of the small intestine and stimulate production of Dipeptidyl peptidase 4 which further increases GPL 1 degradation resulting in decrease in volume of insulin secreting β cells in the pancreas and decline in insulin release manifesting as hyperglycemia while altered hepatic profile and better glycemic control on adjunction of hepatogogue with antidiabetic drug and restricted first diet to 100 calories suggest hyperglycaemia as a combined effect of hepatic and pancreatic dysfunction. In addition no patients were given any anti diabetics without repeated screening for fasting, post prandial, before and after lunch and dinner to adjudge any circadian variation. Majority patients of study group had complete bioregulation of blood sugar without any adjuvant or adversity. Conclusion: Thus in present scenario prior to advocation of anti-diabetic drugs in newly detected cases and alteration in dose of antidiabetic drugs in old diabetics Patients must be reassessed after due change in –Diet, life style, stress redressal  Timely advocation of drugs and diet to ensure blood sugar bio regulation.