KNOW ABOUT THE MOST IMPORTANT TEST FOR DIABETES CONTROL

Diabetes Mellitus, a chronic disease characterized by hyperglycemia of the eyes, heart, kidneys, blood vessels and other organ systems. The disease is accompanied by carbohydrate, lipid & protein metabolism disturbances.

Traditional methods of assessing glycemic control in diabetes such as taking a medical history, performing a physical examination and measuring blood and urine glucose, while extremely important for routine care have only limited value as indices of long term glycemic status.

It is only with the development of glycated Hb (GHb) testing that accurate, objective measure of long term glycemic status is possible.

The terms “glycated hemoglobin” also called glycohemoglobin or glycosylated Hb – refers to a series of stable minor Hb components that are formed slowly and non- enzymatic ally from Hb and glucose.

Of the fast moving Hb’s identified in the 1950’s, HbA1C is present in greatest quantity in both normal and diabetic individuals. HbA1C is formed by the non-enzymatic glycation of free amino groups at the ‘N’ terminal of the amino acid valine of the Hb “B” chain. The glucose remains bound during the erythrocyte life cycle. It is related to the degree of blood glucose level elevation and the time interval over which this occurs as well as the erythrocyte life span.

The HbA1C level correlates with the mean glucose concentration prevailing in the course of the patient’s recent history (approximately 6-8 weeks). Therefore provides much more reliable information for glycemic monitoring than do determination of blood glucose or urinary glucose.

Normal reference range is 4.3 to 6.0 %. However, good control for a diabetic patient is considered as, an HbA1C value below 7.0 %.

Glycohemoglobin is a valuable tool for assessing glycemic control and is routinely used in the care of persons with diabetes. Measurement of GHb has also shown useful research applications facilitating studies requiring objective assessment of long term glucose control. Reports have shown that regular monitoring of GHb among diabetic patients can facilitate changes in treatment schedule resulting in improved glycemic control.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Goal of treatment for Diabetes

The main goal of treating diabetes is to lower blood sugar to a normal level. Lowering and controlling blood sugar may help prevent or delay complications of diabetes such as heart disease, kidney disease, blindness and amputation.
High blood sugar can be lowered by diet and exercise and by certain medicines.

Treatment of Type 2 Diabetes with Sitagliptin (Januvia)
Type 2 diabetes is a condition in which body does not make enough insulin, and the insulin that body produces does not work as well as it should. Body can also make too much sugar. When this happens, sugar [glucose] builds up in the blood. This can lead to serious medical problems.

RECENT APPROACH FOR TYPE 2 DIABETES – SITAGLIPTIN (JANUVIA)
*Sitagliptin (Januvia) helps to improve the level of insulin after a meal
*It decreases the amount of sugar made by the body
*It works when blood sugar is high, especially after a meal. This is when the body needs the greatest amount of help in lowering blood sugar. It also lowers blood sugar between meals. *It is unlikely to cause low sugar [Hypoglycemia] because it does not work when blood sugar is low
*It can be used alone or in combination with certain other medicine that lowers blood
sugar along with recommended diet and exercise program

CANNOT BE USED FOR PEOPLE WITH THE FOLLOWING CONDITIONS
*Type I Diabetes [who needs only insulin]
*Diabetic Ketoacidosis [increased ketones in blood and urine]
*Any kidney problems or any post or present medical problems *Allergy to Sitagliptin
* Children below 18 years of age
* Pregnancy and breast feeding woman

DOSAGES
*100 mg tablet is available in the market
*Once a day by mouth with or without food
*Diet and exercise can help our body use its blood sugar better. We should follow the
recommended diet, exercise and weight loss program while taking Sitagliptin

SIDE EFFECTS
Like other medicines, may cause side effects. But it was usually mild and did not cause patient to stop taking Sitagliptin. The side effects reported in patient treated with Sitagliptin were similar to side effects in patient treated with a tablet containing no medication [a placebo].
When used with sulfonylurea like Daonil, low blood sugar [Hypoglycemia] due to sulfonylurea can occur. Lower doses of sulfonylurea medicine may be required.
When Januvia [Sitagliptin] and Metformin [like Glyciphage] were started together the following side effects were reported.
*Diarrhea
*Indigestion
*Flatulence
*Vomiting
*Headache

OTHER EFFECTS OF THE MEDICINE
*Allergic reaction
*Upper respiratory infection
*Stuffy nose and sore throat

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Garlic-based Drug can treat Diabetes Types I and II

A tablet-form garlic-based drug can treat diabetes types I and II, according to a new study.The drug is based on vanadium and allaxin, a compound found in garlic. The study has been published in the new Royal Society of Chemistry journal Metallomics. When Hiromu Sakurai and colleagues from the Suzuka University of Medical Science, Japan, gave the drug orally to type I diabetic mice, they found it reduced blood glucose levels .

In previous work they had discovered the vanadium-allaxin compound treated both diabetes types when injected, but this new study shows the drug has promise as an oral treatment for the disease. Type I diabetes (insulin dependent) is currently treated with daily injections of insulin, while type II (non-insulin dependent) is treated with drugs bearing undesirable side-effects - however - the researchers believe neither treatment is ideal. The researchers aim to test the drug in humans in future work.

Source- Medindia.com

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

In many developing countries, children with diabetes suffer because insulin and other diabetes supplies are not affordable or sometimes not even available.
The International Diabetes Federation's Life for a Child Program supports the care of close to 1000 children in the following countries: Tanzania, Rwanda, Democratic Republic of Congo, Nigeria, Azerbaijan, Nepal, India, Sri Lanka, Philippines, Papua New Guinea, Fiji, Uzbekistan, Bolivia, Mali, Ecuador, Sudan and Cameroon.

Participants in the Life for a Child Program partially-sponsor the neediest children at diabetes centers in these countries. This sponsorship enables the children to receive the clinical care and diabetes education they need to stay alive. The centers provide thorough clinical and financial feedback.

The goals of the Program are to provide:
* Sufficient insulin and syringes
* Blood glucose monitoring facilities
* Appropriate clinical care
* HbA1c testing
* Diabetes education
* Technical support for health professionals (if requested)

Some centers need support for all these areas; others need support for some components.
Many children with diabetes in developing countries die soon after diagnosis. Many others face the burden of complications while still young. Life for a Child encourages governments to establish appropriate care to safeguard the future of children with diabetes.

Funds are donated by the International Diabetes Federation through sale of World Diabetes Day merchandizing, individuals, associations, Rotary International, and companies working in diabetes. Most individual donors contribute a dollar a day. Support is provided to recognized diabetes centers to purchase insulin and syringes, and provide monitoring and education. Financial trails and the health outcomes of the children are carefully monitored.
Our goal is to double the number of children supported by the end of 2008. Help us save children with diabetes. Donate online at http://www.lifeforachild.org/ or through the purchase of World Diabetes Day merchandize.
Source: www.lifeforachild.org
Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

MV Hospital Promotes Prevention of Childhood Obesity and Diabetes

Dr Vijay Viswanathan

Hospital for Diabetes & Diabetes Research Centre, Chennai and the WHO collaborating centre in India, launched a campaign titled ‘Campaign on Prevention of Childhood Obesity and Diabetes’ to address this concern. A manual detailing facts and guidelines on prevention of obesity for children was also launched to help cultivate long-term weight control. The manual, an awareness handbook on the subject in the country— Manual on Prevention of Childhood Obesity—was launched by Thangam Thennarasu, Honorable Minister of Education, Tamil Nadu.

Dr Vijay Viswanathan, Managing Director, MV Hospital for Diabetes, said, "The increase of obesity in children in India especially in the urban areas is quite alarming. Therefore, we decided to concentrate on the food habits of children and assist parents in providing their children with a healthy nutritious diet. The manual also has guidelines on physical activity and routines that would not over-stress the child but help stay fit." He requested the Government of Tamil Nadu to support the Institute in performing an impact assessment in the state. The study would form a base for understanding the need for awareness on prevention of childhood obesity and diabetes not just in the state, but for the entire country, he said. "We are planning to submit a memorandum to the Government in this regard and hope to launch the project soon," Dr Viswanathan added.

EH Bureau

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Key messages 2008

Diabetes in Children and Adolescents Diabetes is one of the most chronic diseases of childhood. It can strike children of any age including infants and toddlers. World Diabetes Day focuses on children and adolescents to raise awareness of the diabetes and its impact on children. Every child has a right to a long and healthy life.

*No child should die of diabetes
*Diabetic Ketoacidosis (DKA) is the most common cause of death and disability in children with *Type 1 diabetes around the world Children die because their families cannot afford the medication they need
*Many children with diabetes in developing countries die soon after diagnosis
*Despite modern treatment, over 50% of children with diabetes develop complications 12 years after diagnosis
*More than 200 children develop Type 1 diabetes every day
*Diabetes is different for children
*Diabetes affects children of all ages
*All diabetes is on the rise in children
*Diabetes is increasing in children and adolescents
*Care for children is best when a multidisciplinary approach is adopted involving health professionals from all areas that concern children
*A child's access to appropriate medication and care should be a right not a privilege Diabetes costs more than money
*Children with diabetes can live full, healthy, and productive lives
*Over 50% of Type 2 diabetes can be prevented
*Diabetes brings different challenges at different ages Diabetes hits the poorest hardest.

The World Diabetes Day campaign in 2007 and 2008 aims to:
Increase the number of children supported by the International Diabetes Federation's Life for a Child Program Raise awareness of the warning signs of diabetes Encourage initiatives to reduce diabetic ketoacidosis (DKA) and distribute materials to support these initiatives Promote healthy lifestyles to help prevent Type 2 diabetes in children.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Common Myths on Diabetes Mellitus

Ignorance in case of diabetes in not bliss. So, be informed about the common myths related to diabetes.
*Sugar causes diabetes
Type 1 diabetes is caused by genetic factors combined with environmental triggers. Type 2 diabetes is caused by a combination of genetic and lifestyle factors. Diabetics do not need to stop eating foods that are concentrated sources of sugar, but they can eat small amounts of sugar.
*Diabetics can’t eat sweets or chocolates
Small quantities of sweets and chocolates are occasionally OK as a part of a healthy eating and physical activity plan.
*Diabetics have to eat special foods
Like everyone, people with diabetes have to eat healthy. That means a diet low in saturated fat and high in fibre and whole-grain foods.
*You can never catch diabetes
You can never catch diabetes. It is not contagious like cold and cough.
People can have a “touch of diabetes”You can’t have mild or borderline diabetes. All diabetes is serious and, if not managed properly, can lead to serious complications.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

School kids to get kits to detect diabetes early

This article was published in Times of India on Nov 12, 2008
After three months of falling ill constantly, a CBSE school student recently found that her blood sugar has caught up to 550

“The diagnosis that she was diabetic was made after three months. This goes to show that awareness about diabetes is very low in school. We want to try and turn this situation around,” said Dr Vijay Viswanathan, Head, MV hospital for Diabetes and Diabetes research centre, at the launch of ‘Slim and Fit’ program for students.

“Under this initiative, we will be distributing small kits worth Rs 1,500 to the 112 CBSE schools and 12 Kendriya Vidyalayas. Each kit will contain a glucometer and several educational charts explaining the symptoms of Type 1 diabetes and illustrating a food pyramid. We also have material to help teacher’s measure obesity in children. We will train school authorities on how they can use these kits,” he added.

The diabetologist cited a study the centre conducted among school students in the city from October 2007 to March 2008, which measured trends for obesity among students from lower socio-economical schools (LSES) to higher socio-economical schools (HSES). “Around 300 students between 8 and 18 years of age were studied from LSES and HSES. It was found that 22% of girls from HSES were overweighed when compared to 9% from those of LSES. Similarly for boys it was found to be 13% and 7% respectively. On analyzing the reason for obesity among children, we found it was entirely due to lifestyle changes. Students from HSES engaged in less physical activities and watched TV for more time than those from LSES,” he said.

Referring to the success of a similar program in Singapore three years ago, Dr Viswanathan said it had effected changes in the school curriculum, canteen policies and infrastructure. School authorities choose to install drinking water taps all over the school to discourage students from drinking fizzy soft drinks, he added.

“We are concerned about the health of our students and have issued circulars to CBSE schools requesting that they substitute junk food in canteens with healthy alternatives. In fact, we hope that the sahodaya cluster (group of schools in different regions of the city) will take up the issue at their meetings,” said S Nagaraju , regional director, CBSE.

Explaining the link between blood sugar and diabetes, Shreya Ganguly, a student of class XI at St John’s secondary school, Mandaveli, said “We prepared for the event with the help of information from internet. Together with the talks conducted here, we do have a greater awareness about the importance of cutting down junk foods.”

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website.

Feet First

Source: Times of India
The boots of the city's policemen, part of the uniform introduced by the British, are now a major worry for them. Around 80% of police personnel in the city, according to sources at the police hospital, either have vascular problems or develop corns because of these boots.

They are unsuitable for the city's weather conditions and cause conditions like varicosis (enlargement of varicose vein which circulates blood from the legs) and varicose ulcers. The latter ailment, like diabetic ulcers, could lead to amputation if not treated on time, sources told TOI.

"The badly-fitting boots obstruct the re-flow of blood from the legs. Compounding this is the excess sweating caused by the boots of inferior quality leather. This leads to skin irritation which then turns into rashes and wounds, causing ulcers. We perform varicose ulcer surgeries on a weekly basis," a doctor at the police hospital said.

Police personnel, especially those in the lower ranks, are forced to wear these boots, sourced and supplied to them by the department.

Given that varicose ulcer is a major health hazard, policemen with the problem are urged to get admitted to hospital and undergo treatment. "We dress up the wound if it is at the beginning stage and make them lie down with their legs lifted up. They need a fair amount of rest in this position," doctor said.

More hospitalizations mean more trouble for the already short-staffed city police. "Some of the sick policemen approach us for postings at police outposts in hospitals so that they can get medical aid fast," a senior official said.

"The boots are of poor quality and often we do not get boots of our size. Some of those that are of the correct size do not fit properly. The leather is also of inferior quality. We are forced to wear these boots for long hours and very often we get skin rashes due to excess sweating in the extreme hot climate," a constable said.

Many constables told TOI that they dumped the boots provided by the department and bought better products from the open market. "We spend money from our pocket and purchase boots in the open market. Many of us have suffered from these boots for the past few years and we do not want to take anymore risks. The authorities are aware of the problem but they are not ready to rectify it," an inspector said.

To tackle these kinds of problems MV Hospital for Diabetes and Diabetes Research Centre, Royapuram Chennai headed by Dr Vijay Viswanathan provides routine integrated examination of the feet of diabetic patients. New types of foot wear are prepared at M.V.Hospital, Royapuram with technical assistance from Central Leather Research Institute (CLRI) Chennai for diabetic patients with foot complications.

Also special foot wear made up of new types of insole materials for patients with high risk foot. Lightweight, inexpensive and aesthetically appealing, this footwear will be extremely beneficial to diabetes that require specialized footwear to prevent pressure points on the feet from developing into calluses and ulcers that could get infected.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Monsoon sets in and so do foot infections

This article has been published in Deccan Chronicle on Sept 12, 2008
Be Alert
-->About 50 per cent of all non-traumatic amputations are due to diabetes-related foot ulcers.
-->Globally, an amputation is performed due to foot infection, every 30 seconds.
-->Patients should never walk bare foots, even inside the house. They should wear right footwear, preferably made of microcellular rubber.

With the onset of rain city doctors are witnessing a sharp upswing in the number of diabetics’ patients with foot infections-and a gross lack of awareness is to blame, they say.

“The feet are highly vulnerable to infection in diabetics due to a nervous condition called ‘neuropathy’ that causes loss of sensation,” said Dr Vijay Viswanathan, Diabetologist, MV Hospital for Diabetes, where at least two major amputation are performed everyday.

While 40 percent of all patients develop neuropathy within five to ten years of developing diabetes, smoking and excessive alcohol speed up the process.

The monsoon triggers a spurt of foot infection with people wading in water, and staying in wet shoes and shocks, inviting fungal infection between the toes. Patients who do not have their diabetes under control are the worst hit, as even a tiny pinprick can cause devastating damage. Infections like ‘athlete’s foot’ can be very harmful in a diabetes patient, as their healing capacity is low.

“Several patients get infected when they mistakenly cut into the skin, while trimming their toes nail. Diabetes with neuropathy should only file their nail do not cut them,” cautions Dr Ratnavel, Professor of Dermatology and Cosmetology, Stanley Medical College.

Wearing wrong footwear, not drying wet foot properly and walking bare foot even inside house are the most common reason for foot infections. A rise in the incidence of foot ulcer is also seen in summer, when people tend to visit temples, bare foot.

“Foot infections often recur, sometimes even thrice a year. Each time, the infected part has to be cut into, sutured and dressed. Hospitalization is required and the patient has to shell out a minimum of Rs 60,000. All for a condition that can be prevented with little care” Dr Vishwanathan concludes.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Vaccum Assisted Closure (VAC)

The latest in Diabetic foot wound healing ……..now at M.V. Hospital

Diabetic foot ulcer is a cause for enormous suffering, loss in economic productivity and mortality. The outcome is poor because of the severity of the disease. Management is often sub optimal because of poor understanding of the subject and it is unfashionable and generally omitted from professional training and largely neglected in research. The result is that ignorance is endemic; management is guided by belief and habits more than by evidence and research allocation is minimal. The technology has been revolutionized and recent advances are a boon to man-kind. One such example is VACCUM ASSISTED CLOSURE device which works on the principle of negative pressure wound therapy (NPWT). It involves the delivery of intermittent or continuous sub-atmospheric pressure through a specialized pump connected to the wound surface maintaining a closed environment. The pump is connected to a canister, which serves to collect wound discharge and exudates. Studies have shown that VAC therapy system yielded a higher proportion of healed wounds, faster time to wound closure, a more rapid and robust granulation tissue response and reduced risk for a second amputation. Keeping pace with time and technology, the VAC system has been introduced recently at our centre. We at M.V. Hospital are using this technology in treating diabetic foot ulcers and have achieved good results. VAC therapy is indicated in larger, deeper and partial foot amputation wounds. However, they are contraindicated in small wounds responding to debridement.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Know about the important test for Diabetes Control – Glycosylated Hemoglobin ( Hba1c)

Diabetes Mellitus, a chronic disease characterized by hyperglycemia of the eyes, heart, kidneys, blood vessels and other organ systems. The disease is accompanied by carbohydrate, lipid & protein metabolism disturbances. Traditional methods of assessing glycemic control in diabetes is by analyzing the medical history, performing a physical examination and measuring blood and urine glucose, while extremely important for routine care have only limited value as indices of long term glycemic status. It is only with the development of glycated Hb (GHb), testing that accurate, objective measure of long term glycemic status is possible.

The terms “glycated hemoglobin” also called glycohemoglobin or glycosylated Hb – refers to a series of stable minor Hb components that are formed slowly and non- enzymatically from Hb and glucose. Of the fast moving Hb’s identified in the 1950’s, HbA1C is present in greatest quantity in both normal and diabetic individuals. HbA1C is formed by the nonenzymatic glycation of free amino groups at the ‘N’ terminal of the amino acid valine of the Hb “B” chain.

The glucose remains bound during the erythrocyte life cycle. It is related to the degree of blood glucose level elevation and the time interval over which this occurs as well as the erythrocyte life span. The HbA1C level correlates with the mean glucose concentration prevailing in the course of the patient’s recent history (approximately 6-8 weeks). Therefore provides much more reliable information for glycemic monitoring than do determination of blood glucose or urinary glucose.

Test Principle
The HbA1C determination is based on the turbidimetric inhibition immunoassay for haemolysed whole blood. The HbA1C in the sample reacts with the anti HbA1C antibody to form a soluble antigenantibody complex. The polyhaptens react with excess anti HbA1C antibodies to form an insoluble antibody polyhapten complex, which can be determined turbidimetrically. Liberated Hemoglobin from the haemolysed sample is correlated to a derivative having a characteristic spectrum and subsequently determined.

Normal reference range is 4.3 to 6.0 %. However, good control for a diabetic patient is considered as, an HbA1C value below 7.0 %. Glycohemoglobin is a valuable tool for assessing glycemic control and is routinely used in the care of persons with diabetes. Measurement of GHb has also shown useful research applications facilitating studies requiring objective assessment of long term glucose control. Reports have shown that regular monitoring of GHb among diabetic patients can facilitate changes in treatment resulting in improved glycemic control.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website.