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- Denis Giles
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Dr. Pankaj Aneja, Senior Consultant - Diabetes & Metabolic Diseases Max Super Speciality Hospital, Shalimar Bagh, New Delhi
Every year the number of diabetics increase at an alarming rate worldwide. The growing figures are not just shocking but it's also posing the greatest challenge to the healthcare industry. According to the International Diabetes Federation (IDF), there are some 387 million diabetics worldwide and this number is expected to shoot up to 592 million by 2035 out of which India alone is expected to have some 50 million cases. And, that's what makes us the diabetes capital of the world!
Basically, diabetes burden which also increases the economic burden in India results from various factors which include genetic makeup, modern lifestyle that is a combination of poor diet, sedentary lifestyle and lack of exercise, etc.
And what makes the situation worse is that more than 50% of people with diabetes in India remain undiagnosed. Be it due to lack of awareness or lack of resources. These individuals are also at danger mark for developing diabetes-related complications like CAD, cerebrovascular, or PVD and diseases like retinopathy, nephropathy, and neuropathy, etc.
However, if the past two decades have witnessed an increase in the number of diabetes patients, there has been some exciting advancements in the field of improved medications and new treatments due to a better understanding of the disease. In fact, the newer drugs available in form of injectable and oral anti-diabetes drugs are safer and have better control over the disease. These new class of medications are intended to boost insulin production, lower insulin resistance, reduce the production of glucose by the liver or slow down the absorption of carbohydrates by the intestine. In addition, most of these drugs are effective enough to restore normal blood glucose levels, and they do not have any effect on the progression of the disease. But again, their effect may vary from a patient to patient depending on the type or severity of diabetes.
However, the latest advancement in terms of anti-diabetes drugs is encouraging - better treatment options, improved monitoring devices and an understanding of how diet and exercise can impact diabetes are adding up to the positive outcomes for patients. But the decision about which medications are best suited depends on factors like, a patient's blood sugar level and health history, etc.
Use of Insulin And Other Injectable Drugs
Diabetes and insulin always go together. Basically, insulin is a hormone that utilizes the glucose from food so as to provide us energy. In type 2 diabetes, the pancreas either cease to make enough insulin or there is resistance to the effects of insulin or both. The treatment typically begins with oral metformin, a veteran drug that is considered to be the backbone of many diabetes treatment regimens. From there, different drug classes may be added to metformin, and for some patients, the use of insulin may become necessary.
In the past, insulin therapy was used as a last resort, but these days it's often prescribed at an earlier stage because of its benefits. In fact, it is must for the survival of people whose pancreas stop making insulin. Approximately 40-60% of type 2 diabetes patients use insulin to survive. So, advancement in insulin treatment benefits many diabetics, especially the ones with type 2. In newly diagnosed patients with type 2 diabetes, use of short-term insulin can prove beneficial but it has to be accompanied by a strict diet and regular exercise program.
In terms of new additions, the last one decade has witnessed new types of insulin flooding into the markets. These are variations of injectable insulin.
Apart from syringe, there's an insulin pen injector, which is a device that looks similar to an ink pen, except that the cartridge has to be filled with insulin.
Besides, a totally different form of insulin, which is inhaled human insulin is the recent advancement. It is rapid-acting insulin which a patient can inhale for instant relief.
In terms of other injectable drugs meant for diabetics, until recently all we had was insulin, but of late, there are various new additions that mimic natural hormones other than insulin. These hormones have different roles and additional benefits.
The drugs in this category aid in the regulation of blood sugar, appetite, losing weight, which can be beneficial for type 2 diabetes patients.
Monitoring
If you are diagnosed with diabetes then devoid of what medicines you have been prescribed, keeping a constant check on your blood sugar level every now and then is of utmost importance. Roughly two decades back people with diabetes monitored their disease with urine strips. Then with the advent of blood sugar monitor things became easier as people could then monitor their blood sugar levels as many times a day. However, the newest addition to this area has been the continuous glucose monitoring (CGM) device which has a tiny sensor that sits under your skin and it continually keeps a check on your sugar levels. It's convenient as you can even set alarms for low and high levels. It's a wonderful invention as this can save life of people who can’t sense when their blood sugar levels drop down.
Bariatric Surgery
If you have type 2 diabetes and your body mass index (BMI) is greater than 35, then you may be at a higher risk of developing cardiac or Kidney infections. Hence for your well being, it is advisable for you to consider weight-loss surgery. Post surgery not only your sugar levels will return to normal but it will help you lead a normal healthy life. But before going ahead consult with your Diabetologist as there are certain risks involved with this surgery.
Nonpharmacologic Therapy in Diabetes
Apart from taking antidiabetic medicines, lifestyle modifications are necessary for the management of diabetes. This includes healthy eating, not skipping meals, regular exercise, stress management, and avoidance of tobacco/alcohol. The aim of dietary management is to achieve and maintain ideal body weight, and desirable lipid profile.
Also, regular exercise has shown improvement in blood glucose levels, reduction in cardiovascular risk factors helps in weight loss, and above all improve total well-being.
Diabetics and Pregnancy
Women with type 2 diabetes need to be extra careful while they are pregnant as they may need to alter their treatment during pregnancy. women require insulin therapy during pregnancy.cholesterol-lowering medications and some blood pressure drugs can't be used during pregnancy.
If a woman has symptoms of diabetic retinopathy, it may worsen during pregnancy, therefore, it is advisable to visit an ophthalmologist during the first trimester and also at one year postpartum.
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- Denis Giles
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With the advancements in the field of Oncology, Nuclear imaging tests have proven to be a game changer for the treatment of cancer. With its precision and accuracy, PET scans have been advantageous for the oncologists in deciding the due course of treatment.
Positron emission tomography (PET) scans can show up a cancer, reveal the stage of the cancer, show whether the cancer has spread, help doctors decide on the most appropriate cancer treatment, and give doctors an indication on the effectiveness of ongoing chemotherapy. A PET scan several weeks after starting radiation treatment for lung cancer can indicate whether the tumor will respond to the treatment.
The machine detects pairs of gamma rays that are emitted indirectly by a tracer (positron-emitting radionuclide), which is placed in the body on a biologically active molecule. The images are reconstructed by computer analysis. Modern machines often use a CT X-ray scan which is performed on a patient at the same time in the same machine.
A PET scan uses radiation, or nuclear medicine imaging, to produce 3-dimensional, color images of the functional processes within the human body. Also can be used to diagnose a health condition, as well as for finding out how an existing condition is developing and to see how effective an ongoing treatment is.
Patients are told to not consume any food for at least four to six hours prior to a scan, but to drink plenty of water instead. PET scans are not painful and once the scan is complete, patients can go home. Patients should drinks lots of liquid afterward to flush the radioactive drugs from system
Before carrying out a PET scan, a radioactive medicine is produced in a cyclotron (a type of machine). The radioactive medicine is then tagged to a natural chemical. This natural chemical could be glucose, water, or ammonia. The tagged natural chemical is known as a radiotracer. The radiotracer is then inserted into the human body. When it is inside, the radiotracer will go to areas inside the body that use the natural chemical. For example, FDG (fluorodeoxyglucose - a radioactive drug) is tagged to glucose to make a radiotracer. The glucose goes into those parts of the body that use glucose for energy. Cancers use glucose differently from normal tissue - so, FDG can show up cancers. It detects the energy emitted by positively-charge particles (positrons). As the radiotracer is broken down inside the patient's body, positrons are made. This energy appears as a 3-dimensional image on a computer monitor. The image reveals how parts of the patients body function by the way they break down the radiotracer. A PET image will display different levels of positrons according to brightness and color.
PET Vs X-rays and MRI
PET scans are used alongside X-rays or MRI (magnetic resonance imaging) scans. They are used to make a diagnosis or to get more data about a health condition. They are also useful in finding out how effective current treatment is. The biggest advantage of a PET scan, compared to an MRI scan or X-ray, is that it can reveal how a part of the patient's body is functioning, rather than just how it looks. Medical researchers find this aspect of PET scans particularly useful. A CT or MRI scan can assess the size and shape of body organs and tissue, but cannot assess its function, which a PET scan does. In other words, MRI or CT scans tell you what an organ looks like, while a PET scan can tell you how it is working.
How does the PET works?
A small quantity of radiotracer is either injected into the patient's arm or breathed in as a gas. The radiotracer may take anything from 30 minutes to 90 minutes to reach the targeted part of the body during which patient is asked to stay still and not talk. When a patient is ready they will be taken to the room where the PET scan is and will lie down on a cushioned examination table and images of the body are taken.
While the scan is in process, it is vital that the patient keep as still as possible. Depending on which part of the body is being scanned, the whole process takes from about 30 to 60 minutes. A buzzer is given to the patients to alert the staff if felt unwell.
Most patients can go home as soon as the scan has been done. Doctors advise people to consume lots of liquids to flush the radioactive drugs out of their system more quickly. Experts say the radiotracers should have left the body completely within three to four hours after entering the body.
The author of this article is Dr Geeta Kadayaparth, Surgical Oncology and Dr Abhishek Gupta, Nuclear Medicine,Max Hospital,Vaishali
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- Denis Giles
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Dr. Ankur Sethi MD Paediatrics, Atlanta Hospital, Ghaziabad
The winter season brings a nip and chill in the air and the onset of various woes associated with it. The cold air gets heavier leading to greater hanging of these pollutants at the breathing height. The viruses in this changing weather happily proliferate and add to the sufferings of the population.
Children are always the worst sufferers of these changes leading to a multitude of problems. Owing to their delicate systems, low immunity and narrow airway tracts children are especially prone to various ailments.
Adverse Respiratory Effects
Upper Respiratory
Otitis
Tuberculosis
Acute Pulmonary Hemorrhage
Pneumonia
Bronchiectasis
Sudden infant death syndrome
Changes in lung function
Asthma/Bronchospasm/ Allergies
can be pictured as a pyramid shown here.
Everyone is affected by the adverse health effects of winter and pollution to some extent. And these problems are increasing with each passing year.
While most people think of only pneumonia and asthma as a result of these factors, there are other ailments which can occur.
Use of biomass and solid fuels for household cooking and heating is associated with increase in acute respiratory infections – the leading cause of death in children under 5 years.
Indoor air pollution with environmental tobacco smoke is linked to acute otitis media.
Outdoor exposure to ozone is linked to bronchospasm and asthma attacks in some children.
Exposure to indoor moulds is associated with acute pulmonary hemorrhage among infants.
High exposure to particulate and second hand smoke is associated with sudden infant death syndrome (SIDS).
Thus, environmental health problems contribute very significantly to “burden of disease” in childhood. According to World Health Report, besides under nutrition, and safe water supply, air pollution is the third most important factor contributing to poor health.
Reasons why children are more vulnerable
Higher Exposures because they spend more time outside
Inhale more pollutants per kilogram of body weight than do adults
Because airways are narrower, irritation can result in proportionately greater airway obstruction.
Interventions Recommended:
We expect the government and administration to shoulder all the responsibility for preventing these problems. No doubt, major policy changes with respect to industrial and vehicular pollution, burning of leaves and garbage, transport and infrastructure planning falls in their domain. But, as individuals we can take certain steps to decrease these problems:
Make efforts at individual and family level to avoid increasing pollution at home and surroundings.
Properly clothe children and protect them from exposure to cold winds.
Avoid visits to over congested places, where exposure to infections from others is common.
Wash hands frequently and especially after contact with someone who has running nose or cough and fever.
Avoid exposure to smoke of any kind especially in indoor environment.
Provide proper nutrition for optimal growth and development.
Last, but very important, properly and timely immunization of children with all available vaccines.
Seek early consultation with your pediatrician at the onset of any significant illnesses in the children.
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- Denis Giles
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Quite a few decades ago I moved to the city of Bombay with a few rupees in my pocket and started peddling the product I was selling, from door to door. In one of the homes,I met a doctor, who became a close friend. “Bob!” said Dr Ashok Desai as we sat in his home cum dispensary and I sipped tea his wife Meena so kindly had made for me, “In this city you can fool people once and get away, but you can’t fool them a second time!”
I heeded his advice and built a successful business.
In the political results that have just come out, I see how true the latedoctor’s words are. Our nation believed each promise made in 2014, and today the results show most didn’t believe them a second time!
I was called to accompany a group of residents who had a water problem in their society. I decided to go as an observer. “Did you se the newspapers?” asked the secretary to the gathering, “Our city has received only 20% water!” Now as a newspaper columnist, I knew he was referring to a report about the drought in Marathwada. It had nothing to do with Mumbai whose lake capacity being around 14.2 million litres, had received over 13.2 million litres, with a small shortfall of 7%, only in the month of September!
Yet, I saw protestors swallowing his words and even shuddering as the secretary warned them of riots on the streets of Mumbai as people would fight for water tankers!
In our country, in the last four years of believing a lie, much damage has been done to our delicate fabric as divisions have formed deeply and widely and purposefully.
Which brings me to a question, “How do we prevent the Chanakyas from getting away with their first lie?” Because, between the time of the first lie and the second, irreparable damage has been done.
I believe we should be vigilant. That however convincing the rhetoric, the speech and the tone of delivery, we need to question the content!
I watched that day in the meeting as a very convincing, and considerate tone had members believing how lucky they were with the little water they were receiving. If they had only studied the facts, if they had only compared their situation to the neighboring housing societies, they would have gone home not placated but demanding their rights!
The Chanakyas of today’s world use cunning, they use your insecurities, they use fear, and pretend to everyone they are saviors! But if you don’t want to learn your lesson too late, if you don’t want to see destruction before you realise what is happening, start using your mind to question, analyze, and refute, not just accept and wallow in the fantasies painted so charmingly for you..!
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- Denis Giles
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Bruised, battered and beaten, a tired nation stares back at me. “What’s wrong?” I ask concerned.
“We can’t take being pushed, pulled and pummeled every moment of the day!” cries the nation, “Either it’s a lynching mob stringing up someone, or government agencies being manhandled by a meddlesome centre, or currency snatched out of the hands of the poor!We are tired!”
“Broaden your vision!” I tell the nation sternly, “Look at what is floating there above the clouds, dwarfing even Trumps New York statue! Look at the world record it has created, and yet you say, you are fatigued and tired? Raise your eyes and see the loftiness of our achievements!”
“Farmers are committing suicide!Riots and morchasfor more reservations break the fibre that holds us together!” cries the tired voice.
“Imagine the speed of the bullet train!” I reply, “Picture the world looking at us enviously, as this technological marvel races from city to city and back!”
“Look at the speed of those motorbike riders and scooterists!” whispers the nation, “All of them riding on pavements or on the wrong side of the road in your biggest cities, knowing no policeman will stop them, as today the mobs rule!”
“Just imagine our country,” I said proudly, “a nation which will have one single diet followed by all the people, where fruits and vegetables will be our only food. One nation, one diet! What a picture of culinary unity we will be to all the world!”
“Hear the poor!” whispers the nation, “As their pangs of hunger are replaced by forces of misguided communal anger! As drinking water pleas get exchanged for one religion for all! Where, a roof over their heads is forgotten, for mandir or masjid! Where local leaders who can’t repair potholes rush to construct religious structures elsewhere!”
I look at the nation, as it stares back at me helplessly, “Read how we are becoming the fastest progressing nation!” I cry, “That soon, we will replace half the world or more, the way we are going!”
The nation shakes its head and staresaghast at me, “Progress for whom?” asks the nation, “For a people who by then will be too petrified to speak up? With courts filled with judges, who have been handed their verdicts beforehand? With police instructedwith which community to arrest and whomto free?”
I look menacingly at the nation and say severely, “You need to broaden your vision!”
“I have been broadened to breaking point!” sighs the nation, “And any more stretching, will tear apart the delicate threads that bind me as one unitedcountry!”
I laugh mirthlessly as I salute the statue and the train, steadying myself, as I feel the seams of my nation rupturing under me..!
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