Hello! Good Morning!
I am Dr. Anirban Biswas. I am an endocrinologist practicing in South Delhi. Today I am going to answer a few questions asked by my patients regarding new treatment modalities in diabetes and a few questions on insulin.
Q1. Mrs. Anshu Garg: Whether a person who is on insulin can be shifted to oral medicines?
Answer: My answer is “Yes. Why not?” We can always shift a patient from insulin to oral medicines if there are certain conditions which are fulfilled. We need to perform a few tests and based on that we can find out whether the pancreas are still active. I personally have shifted around more than 1000 patients who were on insulin to non-insulin based regimens or they have substantially lowered their insulin requirement and I have detailed all this in my website www.insulin.com. So, it is possible that there are newer drugs which can make it possible.
Q2. Mr. Atul Thakur: What are the newer medicines that can be used?
Answer: There are two classes of new medicines which have arrived. First are the gliptins which are based on the ingredient pathway and they act not necessarily on the pancreas. They act through the intestinal pathway of controlling sugar. Now let me explain you how this is possible. We all know that there is a test done in which we feed a patient 75 grams of glucose. This test is known as the Oral Glucose Tolerance Test (OGTT) and when scientists were replicating the OGTT through intravenous glucose, they were surprised to find out that only 25 grams of glucose is sufficient to replicate the graph of 75 grams of glucose in OGTT.
So, where does this 50 grams of glucose go, which was fed orally? Scientists asked this because both the graphs were similar. So the answer lies in ingredient pathway. So ingredient pathway was responsible for taking care of the 50 grams of extra glucose which had been fed orally. So, in this way we came to know about the ingredient pathway.
The other treatment modality which has arrived is the SGIT tool, the receptor inhibitor pathway which acts through the kidneys. It decreases the retention of glucose through the kidneys and increases the excretion of glucose through the kidneys and this results in fall in the sugar level in the patient’s body. It also causes some increment in the blood pressure and the cholesterol level also. So, these are the two essential newer modalities which have arrived.
Q3. Ravi Bhatnagar: What is CGMS?
Answer: CGMS is Continuous Glucose Monitoring Device. This has been found to be useful in not control of the sugar level like the fasting, BP and the HbA1c levels. Other than that, it has been found to improve the glycemic variability, i.e., the day-to-day variations of the sugar levels can be very easily found out, and this device is available and has been manufactured by Abbott. This is a very good sensor device which can be pain free and can be used in all the patients and I have used in my patients and have got excellent results.
With this I come to the end of today’s Questions & Answers and hope to see you soon.read more
Most of my patients send me their reports and tell and that they have a fasting sugar of 128 and a PP sugar of 142, whether they are diabetic or not. So, by listening today's topic, you will be able to know whether you are a diabetic or not. Let me tell you first that diabetes is a deadly disease and as you all know that India is a diabetic capital of the whole world. Every 7th second, one person dies due to diabetes in this world. And it is a huge burden on us. And most of the diabetic care and treatment is born by the patients in India. On an average Rs, 10,000 per year is the annual cost of the treatment without any complication. So, it is a huge amount, hence, we need to find out whether we have diabetes or not.
So, the first thing is that whether you have diabetes or not. So, the first question is that if anybody can have diabetes? So the answer to this question is that, yes anyone can suffer from Diabetes. There are some symptoms of Diabetes, those are;
- Weight loss
- Excessive urination
But often, diabetes is silent. It has been found out by various researchers that half of the population does not know that they are diabetic patients. Not only in India but also in the US. It is very important to find out that who are diabetic. It is a very simple way to find out whether you are diabetic, pre diabetic or have normal sugar level.
The value what I am going to tell you that how you get to know that you are diabetic.
- First thing is the fasting blood glucose. This can be done in any lab. So, you can go in the morning without taking any meal. One thing you need to remember that if your fasting blood glucose is less than 100 then it is normal. If your fasting blood glucose is between 100-126 mg then you are prediabetic. And if the fasting blood sugar is more than 126 then it means that you are a diabetic patient.
- The second way to know whether you are diabetic or not is the HBA1C. It is also known as Glycosylated Haemoglobin. Again it is a routine test which is done in all the labs. If the value of HBA1C is below 5.7 then you are non-diabetic, if the HBA1C level is between 5.7- 6.5 then you are prediabetic. And if the HBA1C level is above 6.5 then you are a diabetic patient.
- The other test is OSTT, which is done at a certain level when there is some amount of doubt. The Oral GTT test is by means 75 g of glucose is fed to you and the sugar is checked after 2 hours. So, after 2 hours of feeding the glucose, if the sugar level is less than 140 then you are normal. If the sugar level is between 140-200, then you are prediabetic, and if the value is more than 200 then you are diabetic.
Which individual should get screened for diabetic and pre diabetic?
Any individual above the age of 40 years. And from your weight and height, anybody can calculate the BMI ( Body Mass Index). If the BMI is more than 23 then you should go for screening even if your age is not 40+. If you have symptoms of Diabetes, or if any blood relative is having diabetes or is pre-diabetic should go for a checkup.
And last but not the least, who has a history of GDM i.e, Gestational Diabetes Mellitus which is very common in females throughout the whole world, after the pregnancy they should regularly get screened for diabetes. So these are the people who should get screened for Diabetes. And by getting a screen from Diabetes we can save ourselves from the complications of Diabetes.
Diabetes can cause so many complications, especially the cardiac and heart-related complications. You can have a stroke, heart attack, neuropathy, kidney failure, also you can have blindness or retinopathy, amputations i.e, your arm or leg can be cut because of diabetes.
So friends may be with this I can conclude that you have learnt something from my talk. And please remember that you should get yourself screen with diabetes. Next I will talk about the type of Diabetes.
If you want to consult me or have any query, You can contact me through Lybrate.read more
Here are some facts & Myths about Diabetes
Hello. Good Afternoon. I am Dr. Anirban Biswas. I am a diabetologist. I am practicing at Fortis Hospital. I want to discuss with you a few facts about Diabetes.
As you all know friends that diabetes is a leading cause of mobility in India. There are, basically, two types of diabetes; one is Type 1 Diabetes which is insulin dependent and usually occurs in small kids and children. The other one is Type 2 Diabetes which is mainly in adults and can be treated without the need of insulin. Now, first of all, we should focus what are the symptoms of diabetes. The symptoms of diabetes are weakness, lethargic, and you are not able to do your daily activity and second is that you are feeling irritable and disturbance in sleep, excessive thirst and hunger and frequent visits to the loo as you are not doing it earlier. You are having frequent breakages in you are sleep and you have to go to the toilet even at night time.
You may have non-healing ulcer, or skin infections which are not healing, you can also have other disturbances like visual disturbances and urinary infection or chest infection which is taking enough time to heal. All these symptoms can lead to diagnosis of diabetes and sudden loss of weight is also seen in few adults. So if you have diabetes, the best test to do is fasting and PP Sugar. Fasting sugar could be less than 110 and the PP sugar which is done after two hours of having your breakfast should be less than 140. If one of them is high then it is known as pre-diabetes then it is followed by a HbA1c test. HbA1c test is a glycosylated hemoglobin which tells us about the average blood sugar which is present in our body in the last three months. It should be less than 6 in case of a normal individual.
If it is more than that then you are either a pre-diabetic or diabetic. so, now coming to the treatment and modification part; the first thing that doctors advise is that insulin resistance is there so to break the insulin we have lose weight and for that we have to do regular exercise and control in our diet. The diet should be such that it should include all the course grain, milk, fruits, vegetables, sprouts and less of carbs, maida, processed food, fatty, oily should be avoided. The other focus should be on exercises as we all know that a 30 minute exercise and even 10000 steps everyday can reduce our insulin resistant drastically. If we can do all these things and it reduces our sugar then it is very well otherwise we have to take medicines and for that you have to visit any doctor.
The complications of diabetes basically it is known as diabetic triopathy. Diabetes is basically a vascular disease and has microvascular defects which causes disease in the retina, small vessels of the heart and brain and kidneys are involved and because this the patients weasel equity can go low and that is known as diabetic retinopathy. It is usually diagnosed by frequent eye checkups and the second disease which is known as chronic renal failure, for this also you have to go for the KFT test or even a better test is there which is known as microalbumin creatinine ratio and the third is diabetic neuropathy which is which causes pain and tinian sensation in the nerves. For this we have to take some medicines and vitamin B12 supplements along with diabetic supplements.
Thank you. If you have any query or you need to consut me then you can contact me through Lybrate. Thanks a lot.
Today I am going to discuss with you about thyroid disease as you know thyroid disease is very common these days and most of the patients when they check their TSH is high, doctors suddenly declare that they have hypothyroidism. Now basically you have to understand what is thyroid disease? Thyroid is a disease which is a cause of a poor functioning of thyroid glands. It is a butterfly shaped organ which is located in our throat, basic function of a thyroid gland is to produce thyroid hormone and when thyroid hormone is deficient it is known as hypothyroidism. Basically the T4 and T3 are the active thyroid hormones.
TSH is a thyroid stimulating hormones which is not secreted by the thyroid gland but it is secreted by the pituitary gland. In response to the lesser secretion of thyroid, it is a feedback mechanism which is developed in our body. So whenever a patient has hypothyroidism, T3 and T4 levels are low or normal. TSH is high and it is compensating for the lack of the thyroid hormones. So this stage is known as sub-clinical hypothyroidism. And the symptoms of sub-clinical hypothyroidism is that patients may have sudden weight gain, patient may feel weak, lethargic, dryness of skin, patients may have other difficulty in managing their memory, routine activities, issues with their sexual and hormonal problems as well, heat and cold intolerance may also be there. So all these things are very common with thyroid patients, most of the patients come with the problem of weight and usually thyroid patients improve after substituting the thyroid hormone which is in the form of tablets.
Now a days, once a weekly tablets are also available for thyroid. Many of the doctors and patients don’t know but I have started once weekly which has a very good response and better come plans and I recommend the patients to take once weekly. Management of thyroid is easy but dose has to be titrated with frequent checkup of the thyroid function. And I am organizing thyroid checkup camps in my clinic on regular basis. The other problem of thyroid is hyperthyroidism which is the reverse of the hypothyroidism and in this, thyroid gland secretes the excessive thyroid hormone which causes the reverse action like weight loss, increases basal metabolism rate, eyes may start to protrude. These are the symptoms of hyperthyroidism. For this also, treatment is available.
Other things we should be careful about is that if we are having thyroid problem then we should avoid having too much of soya product and few vegetables like cabbage, cauliflower and broccoli and we should take our medicine regularly.
If you have any queries regarding thyroid, you can please contact me through Lybrate.
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Treatment Of Erectile Dysfunction
Treatment Of Male Sexual Problems
Treatment Of Female Sexual Problems
Thyroid Problems Treatment
Thyroid Disorder Treatment
Diabetic Diet Counseling
Urinary Incontinence (Ui) Treatment
Adult Diabetes Treatment
Type 1 Diabetes Treatment
Type 2 Diabetes Treatment
Management of High-Risk Pregnancy
Treatment Of Foot Infection
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Patient Review Highlights
I was having therdiabetes, but the symptoms were not very visible. Anirban Biswas guidance has helped me immensely and has helped gain confidence. Hygiene is very important, and I must Irene Hospital was extremely clean. As someone I knew, consulted therAnirban Biswas and they referred us. Not only he is very calm and composed, but is also a very understanding doctor. I was suffering from diabetes for such a long time. In order to diagnose my problem completely he asked me a number of questions.
the problem with my low sugar initially, was not that severe but then it became worse. All the staff members were very helpful. Over the period of time the low sugar treatment has helped me a lot. The Irene Hospital is decorated very nicely and doesn't look like a hospital. Never once that I felt that Dr Biswas is getting impatient, rather he has always responded to my each and every doubt with immense patience.
I was very depressed as I was suffering from hypothyroid. I was in too much pain because of this problem, but even after consulting a number of doctors, I was not getting any relief. I consulted Dr Anirban who is a knowledgeable Endocrinilogist. On the very first day he identified my problem. Thanks to him I am much better now. The lab in the Irene Hospital was very clean and well managed.
Never thought I will suffer from something like thyroid disorders. I had lost hope, but the thyroid disorders treatment given by Dr Anirban has helped me regain my confidence. I owe him a big thanks for making me fine again. He doesn't just randomly prescribes medicines, but first properly diagnoses the problem. The facilities available in the Irene Hospital are very nice.
My sugar problem was increasing day by day despite of taking many precautions. I consulted Dr Anirban and I am almost my normal self post the treatment. In the past i consulted so many doctors, but nobody was able to help me with my sugar, but he has helped me immensely. He is well aware about innovative techniques to treat problems.
. I was in so much pain due to my muscle cramps. I consulted Dr Anirban. Thanks to him I am much better now. He handled my case with ease and I am perfectly fine now. He is very professional and is a really patient listener. The entire Irene Hospital is very nicely designed.
I was feeling very lethargic and my weight was increasing . I was very depressed due to my condition. I consulted Dr Anirban, he told me that I am suffering from Underactive Thyroid. His treatment suited me the best. I owe him a big thank for the treatment.
dr Anirban Biswas gave me Adult Diabetes Treatment r. he has in depth knowledge and ensures that he explains the problem in detail.he definitely is aware about the latest and advanced ways to treat serious cases. His clinic is at Irene Hospital in kalkaji
Eqbal Jawed Khan
An Excellent Doctor with great capability of understanding of medical problem. He empathises with you while listening and gives the best solution giving best prescription and treatment with every option available.
I found the answers provided by the Dr. Anirban Biswas to be professional, practical, knowledgeable, very helpful and caring. Thankyou for your valuable response sir
Dr Anirban Biswas is the best doctor for diabetes. controlled my fathers sugar without insulin and brought his creatinine down from 1.8 to 1.3 within 4 months
Mohd Kamran Siddiqui
A very good treatment as well as he is a very good human being too and he has opened a very good clinic with good number of patients. God bless you sir
Dr Anirban Biswas is seasoned Physicians, very patient friendly, simple and dedicated for patients care. Good dr for cardio and diabeties patients.
Very good doctor .I was recommended by one of my friends. After only a single visit ,my blood sugar levels are controlled. Definitely recommend
I found the answers provided by the Dr. Anirban Biswas to be knowledgeable, sensible and caring. Sir kindly elaborate CBT little more,Thanks
Dr. Anirban Biswas provides answers that are very helpful, knowledgeable, professional and well-reasoned. Thanks for the quick reply!
Dr. Anirban Biswas provides answers that are sensible, professional and very helpful. Thank you Doc for your motivational advice..
I found the answers provided by the Dr. Anirban Biswas to be very helpful, knowledgeable and professional.
Very well experienced and thorough medic with insight to Daibetes and related ailments.
Very good doctor. 5/5 Recommended for Diabetes.
This is 100% recommended place to visit
his vision is excellent.
Individuals from all age groups have been affected by obesity and diabetes. Anxiety and depression are also on the rise. Other lifestyle disorders like Alzheimer's disease, Stroke, Arteriosclerosis, Hypertension, Hypothyroidism, Cancer (mostly skin and lung), Cardiac problems, Renal failure, Chronic Liver problems, cannot be neglected either.
Hi Sir, I have got thyroid and taking Tablet as per details. My weight is stable at 114 kg. I'm under Dr. supervision. Dr. has said as he has tried weight control tablet but not effective. Now Dr. want to start GLP 1. Is this ok any side effect and is this ok. Please advice.
Type 1 diabetes is commonly referred to as juvenile diabetes and is mostly witnessed among young people. It can also occur in adults. In this condition, the body doesn’t produce enough insulin or completely stops producing insulin. The immune system, which saves the body from foreign microbes, attacks the cells that are responsible for producing insulin. The treatment methods include taking insulin shots, oral insulin intake, taking healthy diet, increased physical activity and controlling blood pressure and cholesterol levels.
Type 2 diabetes is a condition wherein the body refuses to use insulin in order to carry glucose to each and every cell of the body. The pancreas try to produce more insulin in order to counter the condition but soon give up due to an increased blood pressure. The treatment plan includes medication, making lifestyle changes, and controlling blood-sugar and cholesterol levels.
Gestational diabetes is observed in many pregnant women. The hormones produced during pregnancy can block insulin to be used by the body. While insulin resistance is common during pregnancy, failure of the pancreas to fill in the additional insulin in the body can result in gestational diabetes. Women who are overweight are more likely to develop this condition. Although gestational diabetes goes automatically after the baby is born, it often recurs in the form of type 2 diabetes in a later stage of life.
Risk factors for diabetes
- Weight: Being overweight is a primary risk factor for diabetes. An increased amount of adipose tissue increases the risk of insulin resistance by the body. It is therefore essential to shed as much weight as one can to avoid diabetes.
- Inactivity: Immobility increases the risk of diabetes in a person. It stacks up glucose in the body, making it difficult for the body to use glucose and convert it into energy. A daily routine which is devoid of physical activity ensures fat storage in the body, which can turn into type 2 diabetes.
- Family history: Diabetes, especially type 2, is closely linked with family history. If a person has diabetes, it is very likely that his immediate family or extended family has a history of diabetes.
- Ethnicity: African-Americans, people from the Indian subcontinent, Latinos, etc., are more likely to suffer from diabetes compared to their American or European counterparts. Lifestyle and eating habits are the major reasons for diabetes in these races.
- Age: Age has a direct correlation with diabetes. The age group of 45–65 is considered to be more diabetes-prone. Inactivity, immobility, and an increase of sugar intake are some of the primary reasons for developing diabetes in this age group.
I'm 65 years old. I am suffering from diabetes. My fasting sugar is 151 mg/dl. And pp sugar reading is 361 mg/DL. HBA1C is 6.3. I am taking regular medicine and doing regular exercise. What is the reason for fluctuations. Do I need to change medicine? All the time HBA1C is well within limits.
I am 65 and is diabetic for the last 24 years my sugar level is 7.7 hba1c. When I want to enjoy with my partner I couldn't have erection and than I have to change my mood. Please let me know which tablets I should take ,how ,when and for how many days. Presently I am taking confido of himalaya .but no use.
The lifestyle condition, diabetes, is occurring in a substantial percentage of the population across the world, and quite a lot of research goes into the treatment options. If you experience a weight gain as you started taking medication for diabetes and wondering if there could be a correlation between the two, your observation is most likely correct as studies report that diabetic medication in some rare cases can lead to weight gains in some patients.
Weight gain due to insulin
- Insulin is used to control blood glucose levels by enabling glucose absorption in the body. However, excess glucose in the blood can sometimes be not used as energy by the muscles and is often stored as fat. Moreover, many patients that take insulin to reduce blood sugar levels might be taking too much insulin, which leads to increased appetite, and it makes them eat much more than they normally would. If you happen to be putting on weight while being on insulin, it is recommended to consult your physician immediately to help control weight gain.
- As the insulin runs through its course of treatment and reduces the blood glucose levels in the body, it should reduce an adult's appetite to normal, and the cravings for food will also reduce over time. It is also to be noted that low levels of blood sugar due to an overdose of insulin can lead to increased appetite and ask your physician to revise the insulin dosage can help.
Weight gain due to Sulphonylureas
- Sulphonylureas is one of the most commonly prescribed medications for blood glucose control that works by stimulating a patient's pancreas to produce higher levels of insulin. By doing so, the body has access to more insulin, and it helps transfer glucose out of the blood and into cells which can be used as energy. Just like the health risks that are associated with taking insulin, if you happen to be putting on weight because of Sulphonylureas, you need to visit your physician immediately to seek treatment and bring the symptoms in check.
- Steroid hormones are also recommended by many physicians in cases of high blood glucose, and they can have the same symptoms and effects as insulin or Sulphonylureas. Lower insulin levels always need to be supported by a healthy diet and proper lifestyle changes to allow the treatment to be effective.
So, if you notice any signs of weight gain while undergoing treatment for diabetes, you should consult your physician at the earliest to avoid further complications. It is important to not to cut back on the dosage of the prescribed medications to deal with the weight gain issue as it will not help and consulting a physician is the right way to go about it.
35 % more patients acheived glycemic control with proper sleep (8 hours /day). melatonin (altonil ) can be used for mild - mod insomnia in diabetic patients without any side-effects
Lionel Messi is arguably one of the greatest player in football history. did you know that he was short statured in his adolescence and even could have stopped playing football? his club sponsored his treatment with growth hormone and rest is history. watch how messi changed from smallest to greatest player in this world
The body produces a number of chemicals called hormones which are essential for the regulation of various functions including growth and metabolism. These hormones are produced by endocrine glands which are located in various parts of the body. One such important gland is the pituitary gland which produces the important growth hormone. This is essential for regulating optimal growth during the growing years and for maintaining proper amounts of body fat, muscles, and bones in the later years of life.
Causes: Deficiency of the growth hormones can occur due to a number of causes, some of which are listed below. It can be congenital (present at birth) or acquired later in life.
The congenital issue could be due to problem in the pituitary gland structure, leading to complete absence or reduced secretion of the hormone.
With age, there is a decrease in the amount of secretion. However, infections, injuries, brain tumors, surgery and radiation can also lead to altered amounts of secretion.
Symptoms: While growth hormone deficiency can occur at any age, symptoms differ depending on the age when the deficiency sets in.
In the early ages:
- Lower rate of growth for a given age
- Delayed developmental milestones
- Delayed onset of puberty
- Short stature/reduced height
- Younger looking compared to other children their age
- Fat deposition around the waist
- Delayed dental development
When the deficiency sets in during the later years, there is
- Low energy levels, constant tiredness
- Decreased strength
- Decreased exercise tolerance
- Decreased overall muscle mass
- Thin and dry skin
- Increased fat deposition and weight gain around the waist
- Changes in social behavior including alternate cycles of anxiety and depression
- Lack of motivation
- History of pituitary tumors
- High levels of fat and cholesterol
The diagnosis depends on the age of the person
- Blood tests are carried out to check the hormone levels in circulation
- In children, in addition to the hormone levels, x-rays to see the status of growth plates is very helpful.
- An insulin hypoglycemia test where insulin is given intravenously to see the levels of the growth hormone after 30 minutes.
- Total cholesterol levels, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, and triglyceride levels can be used to supplement the above tests.
- CT scan and/or MRI of the brain may be needed if tumors are suspected.
Treatment: Once diagnosed, replacement therapy is given as shots a few times a week under the skin. This restores normal growth and helps in controlling the symptoms in adults too.
In cases of tumor, radiation or surgery may be required, but most cases are managed with hormone replacement.
Watch out for the symptoms if your child has delayed developmental milestones and early intervention can help restore growth and function to normal levels. In case you have a concern or query you can always consult an expert & get answers to your questions!
Cushing’s syndrome occurs due to abnormally high levels of the hormone cortisol. This can happen for a variety of reasons. The most common cause is overuse of corticosteroid medications.
Your adrenal glands produce cortisol. It helps with a number of your body’s functions, including:
Regulating blood pressure and the cardiovascular system
Reducing the immune system’s inflammatory response
Converting carbohydrates, fats, and proteins into energy
Balancing the effects of insulin
Responding to stress
Your body may produce high levels of cortisol for a variety of reasons, including:
The most common cause of Cushing’s syndrome is the use of corticosteroid medications, such as prednisone, in high doses for a long period. High doses of injectable steroids for treatment of back pain can also cause this syndrome.
Other causes include:
Pituitary gland tumor in which the pituitary gland releases too much adrenocorticotropic hormone, which is also known as Cushing’s disease
Adrenal gland abnormality or tumor
Symptoms of Cushing’s Syndrome:
The most common symptoms of this condition are:
- Weight gain
- Fatty deposits, especially in the midsection, the face and between the shoulders and the upper back (causing a buffalo hump)
- Purple stretch marks on the breasts, arms, abdomen, and thighs
- Thinning skin that bruises easily
- Skin injuries that are slow to heal & acne
- Fatigue, bone loss & muscle weakness
- Increased thirst & urination
- Women may also notice extra facial and body hair, as well as absent or irregular menstruation.
Men may also have:
Children with this condition are generally obese and have a slower rate of growth.