Lybrate.com has a nexus of the most experienced Homeopaths in India. You will find Homeopaths with more than 36 years of experience on Lybrate.com. You can find Homeopaths online in Hyderabad and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.
Book Clinic Appointment
Chin Reduction Treatment
Weight Management Treatment
Asthma Management Program
Hair Restoration Techniques
Head And Neck Pain Treatment
Treatment of Migraine Treatment
Nosebleed (Epistaxis) Treatment
Treatment of Thyroid Disease in Children
Thyroid Disorder Treatment
Thyroid Problems Treatment
Viral Fever Treatment
Submit a review for Dr. P KalpanaYour feedback matters!
My beard is not fully growing only on the sides of my faces and under chins little bit. Please help me.
I have developed some sort of sweeling on my lower lip or can say a lip sore. Its there since 3 days. What should I do for that?
My mother recently had stroke and brain hemorrhage. She is now Lil stable but her weight is gaining a lot. She can't walk coz swelling feet. Her weigh is now 83kg she is 50years old. What should we do for her weight loss.
I service in school and 150km far away from my place. I do the updown daily. Because of that I suffer with severe back pain and headache. Please give me a proper solution.
Last period ended on 10th of Feb 2015 and I had intercourse from 13th till 19th alternate days. And today I hve got my periods may I know the reason?
My husband is celiac disease from two years every after two month he is suffering from lose motion. He start losing his weight feeling low. This all happen for one month taking medicine from our general physician again he is normal. Again 45 to 69 days same problem starts pl help me.
From last week I am feeling heavy head when I wake up at morning & its continue to whole day. Also feeling pain in eye when I try to working in front of computer or using mobile phone. Always feel like sleepy. What is the cause & what is the best treatment for this.
New path to blood sugar control
Most dm drugs make pancrea to increase insulin other act on liver other act on body cell
To date, two of these new drugs have been approved by the u. S. Food and drug administration for treating type 2 diabetes. The first, canagliflozin (invokana®), was cleared last march; the second, dapagliflozin (farxiga®), was approved just this week.
Both drugs are so-called sglt2 inhibitors that act by blocking the kidneys’ reabsorption of sugar, or glucose. The result is that more glucose is released in the urine and the patient’s blood glucose level goes down — a major goal of diabetes treatment.
Most other available drugs for diabetes work by targeting the liver, pancreas or gut to improve insulin sensitivity, reduce insulin resistance or stimulate insulin secretion. In contrast, sglt2 inhibitors work completely independent of insulin.
The two new medications, which are taken by mouth in pill form, are approved for use as stand-alone drug therapy, in addition to changes in diet and increased exercise, or in combination with other drugs for diabetes. Their approvals were based on multiple clinical studies — nine for canagliflozin and 16 for dapagliflozin — showing that they effectively lowered hemoglobin a1c, a measure of average blood sugar level over the previous three months.
A surprise effect on the waistline
An added benefit is that sglt2 inhibitors are associated with modest weight loss. For instance, patients shed from 2.8 percent to 5.7 percent of body weight in clinical studies of canagliflozin.
“The weight loss is an appealing side effect of sglt2 inhibitors, especially in the growing population of obese individuals with type 2 diabetes,” says cleveland clinic endocrinologist mary vouyiouklis, md. “aside from metformin, which occasionally results in modest weight loss, other oral drugs used to treat type 2 diabetes are weight-neutral or can cause weight gain.”
Safety profile: keeping an eye on heart effects
Another potential benefit is also a potential adverse effect: the fact that sglt2 inhibitors have a mild diuretic effect (i. E, tend to increase urination). This results in lowering of blood pressure, which can be good for some patients who have high blood pressure but can also cause lightheadedness, dizziness or even fainting in other individuals. Dr. Vouyiouklis says caution is needed before these drugs are started in any patients at particular risk of the latter effects, such as the elderly or patients taking diuretics or multiple drugs for blood pressure.
The drugs’ other most common side effects in clinical trials — genital yeast infections and urinary tract infections — are also related to the fact that they act via the kidneys. Both drugs posed a low risk of hypoglycemia, the dangerously low blood sugar episodes associated with some diabetes therapies.
However, the new drugs were found to modestly increase levels of ldl (“bad”) cholesterol, which could be a concern because patients with diabetes are already at increased risk of heart disease. The potential for increased rates of heart attack, stroke and other cardiac events is being specifically monitored in large ongoing studies of both canagliflozin and dapagliflozin, but full results are not expected for several years.
Ongoing bladder safety scrutiny with dapagliflozin
Additionally, patients taking dapagliflozin in clinical trials showed a small increase in bladder cancer diagnoses compared with control patients. In fact, dapagliflozin was rejected for approval by the fda two years ago because of concerns over bladder cancer and liver toxicity.
The agency’s concerns about these risks were eased by additional data from dapagliflozin’s manufacturer this time around, but the drug’s approval included a requirement that it be studied for bladder cancer risk in patients in ongoing trials as well as in new animal studies looking specifically at effects on the bladder.
Canagliflozin does not appear to be associated with bladder cancer or liver toxicity, the fda concluded.
More agents in the pipeline
Several other sglt2 inhibitors may soon be available as well. One of them, empagliflozin, is in late-stage studies, and the fda is expected to decide on its approval by the end of march.
Who should get these drugs, and when?
Dr. Vouyiouklis says obese patients with type 2 diabetes and normal kidney function stand to benefit most from sglt2 inhibitors. In general, these drugs seem to be best tolerated by patients with normal kidney function and less well tolerated by those with moderate kidney disease (they should not be used by patients with severe kidney disease). They are not approved for use by pregnant women, patients under 18 or individuals with type 1 diabetes.
“Although sglt2 inhibitors are approved for use as single drug therapy, metformin remains my choice for first-line oral therapy,” says Dr. Vouyiouklis. “Because sglt2 inhibitors are relatively new and their long-term effects are not yet known, I prefer to reserve them for use as add-on therapy. I believe they will be a useful addition, especially in obese patients who are seeking to lose weight.”