About Avandia and Sulfonylurea.

Dear All,
               Two very significant developments happened recently,though long expected.Rosiglitazone(Avandia) has been cleared of its bad label and it's restrictions have been removed.The FDA committee did not find any evidence about the drug's cardiovascular(Heart) adverse effects.I am sure we shall have another old drug in our therapeutic arsenal.I felt from the beginning that,this molecule was the victim of some bad publicity or unproven trial results which were done in a haste.Any ways we shall be little cautious in future and keep in mind the likely adverse events following the introduction of antidiabetic medications.
              Another news is the results of a study done at our University(Cardiff),which showed that, Sulfonylurea drugs such as Glibenclamide and others, when used as first line treatment in T2DM patients were associated with more mortality figures than Metformin use as first line drug.It needs to be confirmed with a long standing trial.But I feel,it is expected because of the mechanism of action of the former group of medications.Some of these drugs could impair the myocardial ischaemic preconditioning.Now what it does mean ? How it impacts a diabetes patient ?
             Sulfonylurea drugs act via Potassium channels of the beta cells.They also do have this action on simillar channels of heart muscle cells.Just understand that,it is precisely because of this action that,Glibenclmide and other sulfonylureas have some critical effect when one person has ischaemic preponderance.Now studies have shown that,these drugs when used as first line drugs,they tend to increase the mortality rate when compared to other drugs.
            I believe that,Metformin and Glitazones are better.GLP-1 analogs and DPP inhibitors like gliptins are yet to be widely available and cost effective.Sulfonylureas should be used along with Metformin as added agents when MF fail to bring down the BG levels.
            There are lot of misconceptions and myths surrounding Insulin initiation and usage.Let me address these issues in my next post.
             Wish you all a happy and prosperous new year 2014. 

World Diabetes Day

Dear All,
               Today is World Diabetes Day.It is frightening to know that,India is the second leading country in diabetic population.According to the 2012 IDF statistics,6.30 crore people of our country are suffering from Diabetes(9.3% prevalence) and nearly 51% of them are unaware of being diabetic.So you can imagine their disease status.Evidence has shown that,complications would have already set in by the time diabetes is diagnosed.
               So it is our duty to educate all about this menace and if possible to prevent or control the diabetes and its complications.India is likely to become the diabetes capital of the world in near future and it is our responsibility to see that it does not materialize.
                      I request all of you to educate your friends and relatives to get checked for the presence of diabetes and lipid abnormality,get their BP monitored and engage in regular exercises.Ask your children to not to eat junk food and be active physically.That is the only way one could prevent this monster from engulfing you.
             
                    

How do you keep yourself fit and trim

Dear All,
                I am coming back after a long time.Been busy with some things.But as promised, I am going to provide some tips to keep yourself fit and trim.First and second and third  and last thing is watch what you eat and how much you eat.Keep yourself physically active.Keep yourself mentally positive.
                Exercise improves the insulin sensitivity.It also modifies lipid abnormalities and hypertension.The magnitude of reduction in BG level is related to the duration and intensity of physical exercise.This is mainly due to attenuation in hepatic glucose production.Muscle glucose utilization also contributes to reduction in BG levels. Exercise also helps us to spend the calories.So if you would like to loose weight or stay fit it is better to attend to your calorie intake.

                How one does calculate the calorie requirement for his/her age,build and activity.
The formula is as follows:
It is called BMR(Basal Metabolic Rate):

It is expressed in Kcal/day.
Men: 66.5 + (13.75 x Wt) + (5.003 x Ht) - (6.755 x Age)
Women:655.1 + (9.563 x Wt) + (1.850 x Ht) - (4.676 x Age).
Wt:In Kgs of actual body weight.
Ht:In Cm
Age in years.
 Our calorie needs increase as our activity level increases.
Sedentary (No or little activity)= BMR x 1.2
Lightly Active(Some physical activity 1-3 times per week) = BMR x 1.375
Moderately Active(Exercise 3-5 days/week) = BMR x 1.5
Very Active(Exercise 6-7 days/week) = BMR x 1.725.
Heavy Physical Training = BMR x 2.

              Those who intend to loose weight should consume around 200 Kcals less than their actual daily requirement.It not advisable to loose more than 200 Kcals per day.
             You get these information in the web and also in some smartphone applications.So it is easy to get the knowledge but you need only some motivation to incorporate them in your life style.

Serving size or Porsion Size.

Sorry for being absent for a long time.I do not offer any excuses.I shall say just sorry.I was in the last post,mentioning about glycaemic index and glycaemic load.Little confusing ? right!
    So What to eat ? and how much?.That’s the most common question or the doubt every diabetic patient has in mind.I have seen many physicians advise to stop eating carbohydrates completely.It is not correct and a wrong advice.Please remember that,carbohydrates are the most energy rich food components in our diet and most affordable.What I advise my patients to do is to eat the most healthy food possible and to eat enough to meet our daily energy requirements.That is depending on our daily activities and basic build.In case you are advised to loose weight,please remember to eat less calories than you need for the day.That way,you burn your fat sources.It is easy to advice,isn’t it !!.No I am not doing just that,all of you might have heard of food guide pyramid.Some body said it is for healthy people.Right? No you are wrong,it is for all,including diabetes patients.Only if you have complications involving the kidneys because of diabetes or hypertension(Raised BP),then take care about your protein intake.You need to consult your physician before following any diet.It is always better to restrict your salt intake.It is not only because of BP but also,salt would hold back the water content in the body and in-turn all hydrophilic components in our body.It results in weight gain and that weight gain would increase insulin resistance.
         How to go about dietary changes ?You must have heard  of  carbohydrate counting.That is the best method but need some training to master it.Once you know how to count your carbohydrate intake,then you do not feel diabetes as a burden at all.You will enjoy your life as any other person around you.But it needs some interactive sessions with your dietitian.A small tip from my side is,each 15gm of CHO is considered as a serving and Food guide pyramid would mention the total number of servings need to be taken.Most of the packaged food items have CHO servings mentioned in the label.Please remember that,if the fiber content is more than 5 gm,please remember to subtract it from the total CHO grams for the calculation of carbohydrates.
          But if you feel not comfortable with it,think of the plate method.It is otherwise called as portion size.I have put up image for the plate method.I shall in coming days brief you all on different calorie requirements for different levels of activity. 
         The images have been taken from web sources and I am thankful to the original contributors.I have just placed them here for convenience and I don't take credit for them.

Glycaemic Index of Foods

Glycaemic index is the comparative effect of the food on blood glucose levels on consumption as to 50gm of glucose.Food items are ranked on a scale from 0-100 based on the extent to which they raise the blood glucose level after eating.Food with high GI get rapidly digested and absorbed and thus result in marked raise in blood sugar levels.Low GI foods,slowly digested and absorbed,thus produce slow and gradual raise in blood glucose and insulin levels after eating.This will prevent sudden load on beta cells of the pancreas which produce insulin.

Low GI foods improve both blood glucose and lipid control and are recommended.They also are useful for weight control as they delay the hunger and control appetite.I shall give a list of low and high GI foods.Please remember that it is not a complete list and GI would change depending on the food preparation.Also bear in mind that,low GI foods taken in a large quantity would increase the overall glycaemic load, which is not advisable.Those who are more interested to know about GI can refer to these links:

www.glycemicindex.com

Please not that,dairy products have low GI and whenever you add milk to any food items like Corn flakes,Porridge etc,it would delay the absorption and have a low GI.All pulses have low GI and because of their highly bioavailable proteins they are more preferable than any other protein sources.

Glycaemic Index List.

The impact of good diet and lifestyle changes.

Hello All,
               Sorry,I could not post all these days.We have received a rather good news from ADA,Scientific Sessions.Studies have shown that,in those with a condition called Pre-Diabetes(Those with impaired fasting blood glucose levels or impaired glucose tolerance during OGTT),development of frank diabetes could be prevented by vigorous attention to diet and lifestyle changes.What I mean to say that,even if you are declared to have impaired fasting or 2-hr postmeal blood sugar levels, don't get panic.Development of diabetes could be prevented by keeping the blood glucose levels under control with the help of dietary changes and exercise.
                     In my next post,I shall give a list of food items with low glycaemic index,which would help those on Insulin and those, who want to control their diabetes with diet alone.

 Dr.Prabhakar Mallya.

How to prevent type 2 diabetes?

             Before I advise those with diabetes,I would like to advise those without it to how to prevent diabetes.Studies have shown that,South Asian people are five times more likely to develop type 2 diabetes than white population and they develop this a decade earlier.They also develop diabetes at a lower level of obesity.The reasons for this are many,but to list a few

1.Genetic and ethnic preponderance.

2Abundance of processed,high fat and high sugar foods.

3.Reduced amount of energy expenditure compared to previous years.

4.We see a lot of our children spending time in front of TV and computers than at the playground.

5. Our job requirements force us to take up fast foods than conventional foods prepared from fresh vegetables and food items.So we consume high calorie,high fat,high density convenience foods more often.We ask for jumbo sized pizzas,burgers,pastries etc.

             So first step to prevent diabetes and hypertension is to avoid junk foods and go out and walk everyday.Our elders have said “Take the breakfast like an emperor,lunch like a king and dinner like a beggar” ,but we are eating the other-way round.The idea is very simple, consume maximum calories when you are about to spend them,not when you are going to rest.Accumulation of intra-abdominal fat is an independent Diabetogenic risk factor.Current smoking is associated with increased risk of ischaemic stroke.The risk is increased exponentially with number of cigarettes smoked.

            I hope starting from today,you will take steps to avoid at least some of the risk factors I mentioned above.

Dr.Prabhakar Mallya.