FOOT CARE GUIDELINES:

• Wash and dry feet well every day
• Wear well fitting shoes and clean, dry, cotton shocks.
• Never walk barefoot.
• Follow the contour of toe when trimming toe nails. To prevent ingrown nails, do not cut into the corners.
• Apply moisturizing lotion daily.
• Avoid using lotions that are perfumed or that contain alcohol.
• See a podiatrist regularly for removal of corns, warts and calluses.
• A yearly foot evaluation is recommended.
• Buy shoes mid day, when feet are their largest. Break in new shoes gradually.
• Leather shoes will stretch and mold to the foot and provide less pressure areas.
• Notify your health care provider within 24 hours if your foot becomes infected or injured.
• Keep the area clean, dry and covered.
• Apply antibiotic ointment and gauze wrap as needed. Try to stay off the foot as much as possible until it is evaluated.

Situations in which diabetics should avoid vigorous physical activities

Physical activities cannot be the same for every one all the time, in some special cases especially In type 1 diabetes, exercise can worsens hyperglycemia (>300mg/dl) and ketosis. Vigorous activities are best avoided.
Things to be noted in:
Hypoglycemia
Patients on insulin are at risk, added carbohydrate consumption is required if pre-exercise glucose levels are less than 100mg/dl and for patients on other medicines, preventive measures are not required
Retinopathy
Vigorous aerobic or resistance exercises- contraindicated and there is a risk of developing vitreous hemorrhage or retinal detachment.
Peripheral neuropathy
Excess physical activities may lead to loss of protective sensation; also there is a high risk of skin break down, infection and Charcot joint destruction. It is best advised to go for non- weight bearing exercises like Swimming, bicycling, arm exercises etc.
Autonomic neuropathy
Physical activities here can increase the exercise induced injury and also it can decrease cardiac responsiveness, postural hypotension, impaired thermoregulation, impaired night vision due to impaired pupillary reaction and unpredicted carbohydrate delivery from gastroparesis.
The best solution is to individualize the physical activity according to the cardiac status.
Some Special precaution to be kept in mind
**Feet should be inspected for any cuts blisters and infection
**Avoid exercises in extreme hot and cold climates
**Avoid exercises during periods of poor metabolic control
Benefits of exercise
**Improvement in insulin sensitivity
**Reduction of height
**Reduction in weight
**Improvement in lipid profile
**Improvement in cardiovascular function
**Sense of well being

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

Will buccal insulin succeed in the market…..?

Oral Recosulin is a rapid mist technology which allows precise insulin dose delivered via simple, cosmetically acceptable metered dose inhaler in form of fine aerosolized droplets directly into the mouth. This technology utilizes the formation of micro fine thin membranes to encapsulate and protect the insulin molecule. The system introduces fine particulate aerosol at high velocity (100 miles per hour) into the patient’s breath. The mouth deposition is dramatically increased compared with conventional technology. This oral aerosol formulation is rapidly absorbed through the bucal mucosal lining and in the oropharynx region. It provides the plasma insulin levels necessary to control postprandial glucose rise in diabetic patients.

This novel, pain free, oral insulin formulation has a critical series of attributes:
1. Rapid absorption
2. Simple (user-friendly) administration technique
3. Precise dosing control
4. Bolus delivery of drug

Dosage and administration:
One puff of oral-recosulin delivers 10 units of regular insulin. Approximately 1 unit of regular insulin is absorbed into systemic circulation of patient after taking 1 puff of oral-recosulin.
The patient should be relaxed and breathing normally. The mouth piece of the device placed in mouth at the end of normal exhalation. The patient sprays oral-recosulin into the mouth. Patient is asked to hold breath for 5 second (by counting slowly to 5)
This procedure is repeated until correct numbers of puffs are administered.
It is recommended that oral-recosulin be given in divided doses with 50% of the dose before the meal and remaining after the meal.

The indications of oral-recosulin are:
1. Oral-recosulin is indicated depending on the type of diabetes.
2. It is recommended as bolus insulin for use with basal insulin for better compliance and control of postprandial glucose rise.
3. It can be used in combination with sulfonylureas, metformin and pioglitazone and other anti-diabetic agents for glycemic control in patients who do not achieve satisfactory glycemic control with oral therapy alone.
4. It can be used for insulin initiation in patients needing insulin for diabetes control.
5. It can be used for control of postprandial hyperglycemia in igt patients not adequately managed with standard treatment protocol.
6. It can be used for achieving glycemic control in ifg patients not adequately managed with standard treatment protocol.

Unique features:
It has been shown to be fast, flexible, safe and simple. Most important it is well accepted by both patients as well as doctors
1. Needle free, pain free therapy: intensive diabetes therapy requires at least 3-4 injections per day. Oral-recosulin provides needle free administration of insulin for treatment of diabetes
2. Rapid insulin absorption: oral-recosulin is absorbed in blood stream faster than injected insulin
3. Short duration of action: acts similar to rapid acting insulin analogue for control of postprandial glucose rise.
4. No risk of hypoglycemia: rapid absorption avoids prolonged tail exceeding postprandial state as common with subcutaneous insulin.
5. Higher patient compliance: needle free, pain free insulin therapy should increase compliance
6. Better quality of life: the small size of device makes it convenient to carry anywhere and to use comfortably in public. Since dosing time before meal is greatly reduced this offers a more flexible lifestyle. The improved compliance, which leads to a better quality of life.

The Debate
--> Though the main advantage of Oral Buccal insulin is to avoid injection prick, a long acting/intermediate insulin has to be injected anyway. So injection cannot be completely avoided.
--> Moreover when only 1 unit of insulin is systemically absorbed with 1 puff, it will be cumbersome for a patient requiring >10 units of insulin. So its difficult for patients who need >20 units of insulin
--> The droplets may not be deposited in the lung parenchyma but there is no literature to explain their deposition elsewhere in the respiratory tract during accidental inhalation.
--> As insulin treatment has to be continued for years together, the long term effect particularly carcinogenic effect on the buccal mucosa is unknown.
--> It’s bioavailability while taking hot or cold food is not known
--> The cost of a single puff is more than rs.1000. A patient may need at least 20-25 puffs/day minimum. So the daily expenditure for insulin is very high
--> In a country like USA where insurance covers a patient’s expenditure on hospitalization & medicine, exubera (nasal insulin) was not affordable. Similarly buccal insulin which carries same disadvantages like exubera may have to struggle in the market to establish its place
--> Probably the time will give us the result.

Onset of action - 10 minutes
Peak level - 50 minutes
Duration of action - 150 minutes
Bioeffectiveness - 7-10% of s.c. injected insulin when given in same dose

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