Introduction

Diabetes is a chronic metabolic condition characterized by hyperglycaemia, polyuria, polydipsia, polyphagia which can gradually lead to significant harm to the eyes, kidneys, blood vessels, heart and nerves. About 830 million people globally have diabetes, the majority living in low-and middle-income countries. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades 9.^[1]At present, there are 537 million adults between the age group of 20 and 79 living with diabetes, representing 1 in 10 people globally. This number is projected to grow to 643 million by 2030 and 783 million by 2045.^[2] It is said that three in four adults suffer from diabetes who resides in middle income and low-income countries.^[3] Diabetes was responsible for 6.7 million deaths in the year 2021 which accounts to one death for every five seconds.^[4] A huge amount of around 966 billion US dollars was spent for the same in the year 2021.^[5] The prevalence is expected to increase in many folds because of sedentary lifestyle, lack of physical activity and lack of awareness. It becomes a challenge to the clinical practitioner just to relay only on medications for this condition so it is crucial to speed up the implementation of effective non-pharmacological treatments for all individuals with diabetes.

Successful diabetes management aims to keep plasma levels within the normal physiological range, akin to those of a healthy non-diabetic person, without increasing the risk of hypoglycemia. Maintaining this normal plasma glucose levels is influenced by dietary nutrient intake, physical activity, calm mind and this will regulate the hormones like insulin which regulate the glucose balance. Therefore, the management of diabetes includes a multidimensional approach which includes the theory of Pancha Kosha. This Pancha Kosha theory has been explained in Mandukya Upanishad. According to this theory the body can be divided into five layers they are Annamaya Kosha, Pranamaya Kosha, Manomaya Kosha, Vijnyamaya Kosha, Anandamaya Kosha. All these Koshas can be broadly classified into three main categories, Sthoola Sharira which mainly contains the physical entity of an individual, Sukshma Sharira the subtle inner part and the Karana Sharira the cause of the body.^[6]

4. Vijnyamaya Kosha

It is the second inner most layer of the body and considered as powerful when compared with that of the outer three. It can be correlated with Chitta and Buddhi. Chitta refers to memory and Buddhi refers the sense of differentiating between the right and the wrong. The word meaning of Vijnyana means Vishesha Jnana ‘the righteous knowledge’. This sheath reflects the intelligence and consciousness that constitutes the discerning part of the mind, underlying its processing and thinking functions. It is responsible for knowing, deciding, judging, and making concrete decision.^[11]

5. Anandamaya Kosha

Ananadamaya Kosha is the deepest and most powerful layer of the body. It is the nearest Kosha to the Atman. Ananda is the highest level of our existence. This Kosha reflects the three divine qualities of the Soul: Sat, Chittaand Ananda. Sat signifies a belief in truth and its timeless nature. Chitta represents being alive and conscious, enabling appropriate interactions with various situations. Ananda refers to ever joyfulness.^[12]

Role of each Kosha in the management of diabetes

1. Annamaya Kosha

Annamaya Kosha includes the gross physical body. So non-pharmacological interventions like Ahara, Vihara, Shadkriya, Asana and Mudra in all these aspects one individual has to rectify his lifestyle.

Ahara: Yava, Shashtika Shali, Godhuma, Shyamaka, Mudga, Ajamamsa, GramyaKukktamansa, Patola, Shighru, Karavellaka, Tanduliyaka, Koshataki, Kakamachi, Jambu, Dadima, Amalaki, Tinduka.^[13] Diet with low glycemic index has to be consumed.

Vihara: Acharya Sushruta advised to walk 100 Yojana in 100 days which means one has to avoid the lethargic lifestyle and lead a healthy one.^[14]

Kriya: Nauli, Agnisara, Shankha, Prakshalana, Kunjala Kriya.^[15]

Asana ^[16]: Sukshma Vyayamafollowed by

Standing series: Suryanamaskara, Padahastasana, ParivruttaTrikonasana, Ardha Chakrasana, ArdhakatiChakrasana, Trikonasana

Diet: In Ayurvedic science diet has been given a lot of importance and has been termed as Mahabeshaja by Acharya Kashyapa. Here the dietary pattern should be the frame work of what an individual has to consume including the timing of eating, the portion size, and number of times that individual has to consume the food. Consideration on the food type and all the macro and micro nutrients has to be done.^[20] Food which has low glycemic index has to be consumed.

Vihara: walking helps in the maintenance of blood glucose levels.^[21]

Shatkriya: It repairs abnormalities in metabolism and restore normal functions of all tissue.^[22]

Asana: They decrease the blood sugar levels by improving the functioning of the glands, internal organs.^[23]

Mudras: Consistent practice of these mudras enhances metabolic rates, supports weight loss, and lowers sugar levels.^[24]

• Pranamaya Kosha

Engaging in controlled breathing techniques like Pranayama positively impacts an individual's mental state by reducing anxiety and stress, enhancing feelings of well-being, and helping to maintain hormonal balance.^[25]

Acupuncture: Acupuncture and other agents which reduce the blood glucose were proven to be effective in the management of blood glucose levels.^[26] Acupuncture may be a beneficial complementary approach for managing type II diabetes mellitus.^[27]

Acupressure: Self-acupressure can serve as an effective, easy-to-use, and cost-effective complementary treatment for regulating blood glucose levels in people with type 2 diabetes, enabling patients to carry it out on their own without requiring a visit to a healthcare provider.^[28]

• Manomaya Kosha

Color therapy: In chromotherapy, diabetes is often associated with a deficiency of orange and yellow hues in the body. Treatment methods include using light filtered through different colored glasses and utilizing water infused with these colors for external or internal application.^[29]