29 December, 2012


APPLE - அரத்திப்பழம், குமளிப்பழம்
APRICOT - சர்க்கரை பாதாமி
AVOCADO - வெண்ணைப் பழம்

B - வரிசை     
BANANA - வாழைப்பழம்
BELL FRUIT - பஞ்சலிப்பழம்
BILBERRY - அவுரிநெல்லி
BLACK CURRANT - கருந்திராட்சை, கருங்கொடிமுந்திரி
BLACKBERRY - நாகப்பழம்
BLUEBERRY - அவுரிநெல்லி
BREADFRUIT - சீமைப்பலா, ஈரப்பலா

C - வரிசை
CANTALOUPE - மஞ்சள் முலாம்பழம்
CARAMBOLA - விளிம்பிப்பழம்
CASHEWFRUIT - முந்திரிப்பழம்
CHERRY - சேலா(ப்பழம்)
CHICKOO - சீமையிலுப்பை
CITRON - கடாரநாரத்தை
CITRUS AURANTIUM - கிச்சிலிப்பழம்
CITRUS MEDICA - கடரநாரத்தை
CITRUS SINENSIS - சாத்துக்கொடி
CRANBERRY - குருதிநெல்லி
CUSTARD APPLE - சீத்தாப்பழம்

D - வரிசை
DEVIL FIG - பேயத்தி
DURIAN - முள்நாரிப்பழம்

E - வரிசை

F - வரிசை

G - வரிசை
GOOSEBERRY - நெல்லிக்காய்
GRAPE - கொடிமுந்திரி, திராட்சைப்பழம்
GRAPEFRUIT - பம்பரமாசு
GUAVA - கொய்யாப்பழம்

H - வரிசை
HANEPOOT - அரபுக் கொடிமுந்திரி
HARFAROWRIE - அரைநெல்லி

I - வரிசை

J - வரிசை
JACKFRUIT - பலாப்பழம்
JAMBU FRUIT - நாவல்பழம்
JAMUN FRUIT - நாகப்பழம்

K - வரிசை
KIWI - பசலிப்பழம்

L - வரிசை
LYCHEE - விளச்சிப்பழம்

M - வரிசை
MANGO FRUIT - மாம்பழம்
MANGOSTEEN - கடார முருகல்
MELON - வெள்ளரிப்பழம்
MULBERRY - முசுக்கட்டைப்பழம்
MUSCAT GRAPE - அரபுக் கொடிமுந்திரி

N - வரிசை

O - வரிசை
ORANGE - தோடைப்பழம், நரந்தம்பழம்
ORANGE (SWEET) - சாத்துக்கொடி
ORANGE (LOOSE JACKET) - கமலாப்பழம்

P - வரிசை
PAIR - பேரிக்காய்
PAPAYA - பப்பாளி
PASSIONFRUIT - கொடித்தோடைப்பழம்
PEACH - குழிப்பேரி
PERSIMMON - சீமைப் பனிச்சை
PLUM - ஆல்பக்கோடா
POMELO - பம்பரமாசு
PRUNE - உலர்த்தியப் பழம்

Q - வரிசை
QUINCE - சீமைமாதுளை, சீமைமாதுளம்பழம்

R - வரிசை
RAISIN - உலர் கொடிமுந்திரி, உலர் திராட்சை
RASPBERRY - புற்றுப்பழம்
RED BANANA - செவ்வாழைப்பழம்
RED CURRANT - செந்திராட்சை, செங்கொடிமுந்திரி

S - வரிசை
SAPODILLA - சீமையிலுப்பை
STAR-FRUIT - விளிம்பிப்பழம்
STRAWBERRY - செம்புற்றுப்பழம்
SWEET SOP - சீத்தாப்பழம்

T - வரிசை
TAMARILLO - குறுந்தக்காளி
TANGERINE - தேனரந்தம்பழம்

U - வரிசை
UGLI FRUIT - முரட்டுத் தோடை

V - வரிசை

W - வரிசை
WATERMELON - குமட்டிப்பழம், தர்பூசணி
WOOD APPLE - விளாம்பழம்

X - வரிசை

Y - வரிசை

Z - வரிசை


Hi everyone... welcome to my most colourful post
Cantaloupes - (1 wedge) 25 Calories

Cherry 2.4 Calories (per piece)

Lemon 20calories

Mango 40 calories ( per piece)

Raisins 5 calories ( per piece)

Raspberry 1.1 calories

Apple 95 calories

Apricots 30 calories

Avacado 150calories

Banana 107 calories

Cherry tomato 2calories

Clementine orange 24 calories

Figs 10calories 

Grapes 3calories (Per piece)

Honeydew Melon 36 calories (per wedge)

Kiwi 34 calories

black berry 1 calorie

Nectarine 25calories

Olives 6.8 calories

Orange 65 calories

Peach 35 Calories

Pear 45 calories

Pineapple 50calories

Plum 25calories

Prunes 9 Calories

Strawberry 2.7calories

Tangerine 26calories

Tomato 9calories

27 December, 2012


There are instances when the doctors prescribe mixed insulins.
Nowadays insulins are available in premixed forms like 30:70 , 50:50, 70:30 but these insulins are slightly costly.
Some patients still prefer to buy short acting and intermediate acting insulins separately and mix them before injecting.
Here is the methodology for mixing insulins
  1. Draw air into syringe in an amount corresponding to the prescribed dose of cloudy insulin and inject it into cloudy insulin bottle. DO NOT DRAW INSULIN. Pull out the syringe.
  2. Draw air into the syringe in an amount corresponding to the prescribed amount of clear insulin. Inject the air into the clear insulin bottle and invert the bottle and draw the required amount of clear insulin.
  3. Now insert the needle into the cloudy insulin bottle and draw exactly the required amount of insulin. 
  4. pull out the needle. Now your insulin is ready for use.
If by mistake you have drawn too much of cloudy insulin you cannot correct the mistake. Discard the insulin and start over the procedure again. do not try injecting back this mixture into cloudy insulin bottle. The concentration of insulin will change leading to Incorrect dosing and sometimes life threatening complications.


Wash your hands properly before injecting

Make sure that the strength mentioned on syringe and insulin bottle
are the same (40 IU syringe for 40IU insulin)

If you are using cloudy insulin invert the vial couple of times to mix
the contents
Draw air into syringe in an amount corresponding to prescribed dose of insulin
Slowly inject the air into vial held vertically at eye level
Draw the required amount of insulin and gently tap the syringe to get
rid of air bubbles
If there is excess inject the excess of insulin into vial and pull out
the syringe
lift up the skin at the injection site in a broad fold and inject the
needle in to subcutaneous tissue
inject the insulin slowly
leave the needle insitu for 10 seconds and pull out the needle slowly
inject at differnt sites everyday to avoid insulin related skin lesions


Store insulin in fridge. ( recommended temperature is 2-8 degree C)
Do not keep insulin in freezer or chill tray
Do not use insulin which is frozen
If you cannot store your insulin in refrigerator, keep it in cool and dry place
Keep insulin away from direct sunlight
Do not expose insulin to high temperatures. eg. in glove compartment
of car, near cooking range, on top of electronic equipment
when travelling by air insulin should be carried in hand baggage.
carry a prescription with you whenever you travel.

26 December, 2012


Dr. Michael Somogyi speculated that hypoglycemia during the late evening induced by insulin could cause a corrective hormone response that produces hyperglycemia in the early morning. This phenomenon was
named as Somogyi phenomenon. Patients with somoygi phenomenon have a higher fasting blood sugar levels. It is a common mistake that the patient increases night dose insulin to control the fasting values but
still lands up with higher fasting values!
The causes of Somogyi phenomenon include

  • Excess or ill-timed insulin
  • Missed meals or snacks
  • Inadvertent insulin administration.

Somogyi phenomenon is probably rare. It occurs in diabetes mellitus type 1 and is less common in diabetes mellitus type 2. If the cause is found out early and treated the prognosis for Somogyi phenomenon is
excellent, and there is no evidence of long-term sequelae.


The ability to suppress insulin release is an important physiologic response that people with type 1 Diabetes cannot carry out. Defense against hypoglycemia involves production of glucose from non-carbohydrate sources (gluconeogenesis and glycogenolysis) This mechanism is dependent on an intact glucose sensor system in the CNS, pancreas, and afferent nerves.


• The first to act and the most important hormone is Glucagon. Glucagon acts on the liver to stimulate glycogenolysis and gluconeogenesis
Epinephrine increases the delivery of substrates from the periphery, decreases insulin release, stimulates glucagon release, inhibits glucose utilization by several tissues, and stimulates a warning system with sweating, anxiety, and tachycardia.
Cortisol may aid in prolonged and severe cases of Somogyi phenomenon by blocking glucose use and stimulating hepatic glucose output
• Growth hormones are similar to those of cortisol


Laboratory studies for identifying Somogyi phenomenon include fasting blood glucose, nocturnal blood glucose, HbA1c, and frequent glucose sampling. The fasting blood glucose level is expected to be inappropriately elevated due to hormonally induced rebound. A glucose reading in the middle of the night will disclose hypoglycemia as a result of insulin therapy. This will establish the diagnosis. Obtaining an HbA1C level may be helpful if it is within the reference range or low despite an elevated fasting glucose level. It supports the concept of a rebound fasting hyperglycemia in the face of normal glucose control. An elevated HbA1C does not rule out Somogyi phenomenon.

Frequent glucose monitoring may be necessary to confirm the diagnosis and look for other periods of hypoglycemia that may lead to rebound hyperglycemia. Frequent hypoglycemia is responsible for hypoglycemic unawareness, which may cause the typical symptoms of hypoglycemia to be missed.

Treatment & Management
Somogyi phenomenon should be suspected in patients presenting with atypical hyperglycemia in the early morning that resists treatment with increased insulin doses.

If nocturnal blood sugar is confirmatory or if suspicion is high, reduce evening or bedtime insulin. Clinical signs, including weight gain, normal daytime blood sugar levels, and relatively low HbA1c,
suggest over treatment.

We insist every patient to go for SMBG (self monitoring of blood glucose) and 7 point blood sugar charting. This will help identify somogyi phenomenon early and manage it efficiently. Controlling of fasting blood sugar is essential as there is evidence linking increased fasting blood sugar levels to microvascular complications.

01 December, 2012


India is the world leader in diabetes. People with diabetes are more prone infections. Pneumococcal infections are a common cause of morbidity and mortality, and people with diabetes are more prone to develop pneumococcal infections. With the availability of the pneumococcal vaccine, most international organizations now recommend that people with diabetes should be vaccinated against pneumococcal disease.  The two major types of diabetes are type-1 (insulin-dependent) diabetes mellitus, which is due to destruction of insulin producing cells in the pancreatic islets, and type-2 (noninsulin-dependent) diabetes mellitus, which is characterized by insulin resistance, often associated with other features such as obesity, hypertension, dyslipidemia, and accelerated arteriosclerosis.

Patients with diabetes have higher risk for bacterial and viral infections. The most common infections are preventable bacterial infections of the skin, the urinary tract, and the respiratory tract. Apart from the morbidity associated with the long term complications of Diabetes infections with influenza and pneumococcus contribute to the overall morbidity and mortality in diabetes patients.

Diabetes mellitus has been identified as an independent risk factor for developing respiratory tract infections. Streptococcus pneumoniae remains the major cause of pneumonia in spite of widespread vaccination. Apart from pneumonia and its complications, viz., empyema and lung abscess, the pneumococcus also causes other clinical syndromes such as sinusitis, otitis media, tracheobronchitis, bacteremia, meningitis and peritonitis, some of which have high case fatality rates. Diabetes is a well-known risk factor for pneumococcal infection.

Diabetic patients have a normal response to pneumococcal vaccination, and vaccination is a cost-effective preventive strategy. Immunization with Pneumococcal Polysaccharide Vaccine (PPV, which includes 23 purified capsular polysaccharide antigens representing 85-90% of the serotypes of S. pneumoniae) in diabetic patients significantly reduces morbidity and mortality related to pneumococcal disease.  The 23 valent PPV (PPV23) can be given as a subcutaneous or intramuscular injection (preferably in the deltoid muscle or lateral mid thigh).  The antibody response after a single dose of PPV begins 7-10 days after vaccination

During influenza outbreaks, pneumococcal vaccines may be useful in preventing secondary pneumococcal infections. CDC's Advisory Committee on Immunization Practices (ACIP) recommends a single dose of PPSV23 for all people 65 years and older and for persons 2-64 years of age with certain high-risk conditions. The vaccine is generally safe, but mild local side effects may be seen. Injection site reactions consisting of pain, soreness, erythema, warmth, local indurations occur. Fever is the most common side effect.

Indian Recommendations

The Geriatric Society of India recommends the use of PPV for

persons aged 50 years and above and

Persons aged 2 years or above with certain underlying medical conditions such as diabetes.


A one-time revaccination is recommended by the ADA and ACIP for individuals >64 years of age, previously immunized when they were <65 years of age, if the vaccine was administered >5 years ago.

Should All Diabetic Patients Receive Pneumococcal Vaccination?

Diabetes is in itself a risk factor for invasive pneumococcal infection. In addition, there exist a substantial number of diabetic patients who have other co-morbidities like renal complications, coronary artery disease, COPD, chronic liver disease, malignancies, etc. For this subset of diabetic patients, pneumococcal vaccination should be recommended on priority by virtue of being at more risk than those with diabetes alone. The final decision lies with the treating physician as invasive pneumococcal infection is not so common in India.

21 November, 2012


Obstructive sleep apnea (OSA) or obstructive sleep apnea syndrome is the most common type of sleep disorder caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation. These pauses in breathing, called "apneas" typically last 20 to 40 seconds.
  • Unexplained daytime sleepiness
  • Restless sleep
  • Loud snoring (with periods of silence followed by gasps). 
  • Morning headaches
  • Insomnia
  • Trouble concentrating
  • Mood changes such as irritability, anxiety and depression
  • Forgetfulness
  • Increased heart rate and/or blood pressure
  • Decreased sex drive
  • Unexplained weight gain
  • Increased urination and/or nocturia
  • Frequent heartburn or gastroesophageal reflux disease
  • Heavy night sweats.
                             The normal sleep/wake cycle in adults is divided into REM (rapid eye movement) sleep, non-REM (NREM) sleep, and consciousness. NREM sleep is further divided into Stages 1, 2 and 3 NREM sleep. The deepest stage (stage 3 of NREM) is required for the physically restorative effects of sleep. NREM stage 2 and REM, which combined are 70% of an average person's total sleep time, are more associated with mental recovery and maintenance. During REM sleep in particular, muscle tone of the throat and neck, as well as the vast majority of all skeletal muscles, is almost completely attenuated, allowing the tongue and soft palate/oropharynx to relax, and in the case of sleep apnea, to impede the flow of air to a degree ranging from light snoring to complete collapse. In the cases where airflow is reduced to a degree where blood oxygen levels fall, or the physical exertion to breathe is too great, neurological mechanisms trigger a sudden interruption of sleep. These arousals rarely result in complete awakening, but can have a significant negative effect on the restorative quality of sleep. In significant cases of OSA, one consequence is sleep deprivation due to the repetitive disruption and recovery of sleep activity.

  • avoiding alcohol
  • Avoiding medications that relax the central nervous system (for example, sedatives and muscle relaxants),
  • losing weight
  • quitting smoking.
  • Some people are helped by special pillows or devices that keep them from sleeping on their backs, or oral appliances to keep the airway open during sleep.
  • continuous positive airway pressure (CPAP), in which a face mask is attached to a tube and a machine that blows pressurized air into the mask and through the airway to keep it open.
  • There are also surgical procedures intended to remove and tighten tissue and widen the airway, but none has been reproducibly successful.

12 November, 2012


                 Cannabis is commonly used to prepare Bhang, Hasish, Hash, Marijuana, Charas & Ganja. All these names are familiar to most of us. No No! I don’t mean we use it, but somewhere or the other we would have definitely heard about it. Cannabis grows like any other plant in most parts of the world. The key ingredient is THC – TetraHydroCannabino. This results in relaxed state of mind, lowering of worry, hunger and finally the person falls asleep. Cannabis can be smoked or consumed. The effects of THC last for 2-3hours when smoked, and for 24hours when ingested. The stems of Cannabis (Hemp) are used to prepare ropes.

Cannabis has been tried as medicine also. It is said to activate receptors in body, control vomiting, affect appetite, control cancer symptoms. Cannabis has also been tried in treating pain, anxiety and muscle spasticity.

Flowers, Buds, Leaves, Dried plant material, Resins, Powder and Oil are used.

 Known to India for more than 5000 years.  This wonderful plant has been mentioned in our ancient literature for its magical properties. Vedas refer to cannabis as one of the five sacred plants. It has been referred as a source of joy giver, happiness and liberator. In old times cannabis was used to relieve people from fear. Mythology says that once Lord Shiva was wandering in fields after a family tiff, he got tired and slept off near some leaves. On getting up he had those leaves and felt rejunuvated. After this incident it seems Lord Shiva made cannabis his favourite food.

                In the middle ages soldiers drank Bhang prepared from cannabis before going for battle. Bhang is prepared by mixing Nuts, Spices, Sugar, and Cannabis and is boiled in milk or yogurt. This preparation can also be rolled and eaten as small balls. Other preparations are ganja and charas. Cannabis is used in several parts of the country for religious purposes.



                The bad effect of these drugs is well known and has been publicised in the media very well. So I am not gonna go into details of drug abuse in general population but restrict myself to specific effects of these drugs in Diabetes.

Illicit drug use is extremely common amongst young people including many with type 1 or type 2 Diabetes. Cocaine, heroin and ecstasy appear to most severely affect glycemic control and the number of emergency hospital admissions and long-term complications. In addition, clinic attendance is much worse in illicit drug users. Some studies suggest that the onset of diabetes may be hastened by regular use but further research is needed. Questioning patients with diabetes regarding illicit drug use and adopting a non-judgemental approach would seem to be appropriate.



Smokers have 3 times more risk of developing Diabetes compared to general population

Drug addicts develop diabetes earlier compared to general population

Risk of developing diabetes is more when drug abuse is combined with alcohol abuse (>15 alcohol beverages per week)

Risk is more when bad habits are combined with Obesity and family history of Diabetes

Drug abusers have poor glycemic control, tend to ignore their treatment regimens, have erratic lifestyle and do not attend reviews regularly. Final effect is they have high HbA1c.


COCAINE – Acts as CNS stimulant. It also acts on adrenal medulla to release hormones which in abnormal amounts can lead to disastrous effects. These hormones increase blood glucose levels by altering carbohydrate metabolism, they inhibit insulin secretion.  Final effect – increased glucose production and decreased glucose clearance.

HEROIN – acts on opoid receptors in the body. Heroin stimulates both insulin & glucagon. There is defective pancreatic beta cell response to glucose stimulation.

ECSTASY – used most commonly as recreation drug. Diabetics using this drug are at risk of developing ketoacidosis and hyponatremia.

OTHER DRUGS – there have been some reports of associated serious hypoglycaemia.


                The data regarding drug abuse in India is minimal. I have not come across any statistics which deals with drug abuse in diabetics in India. But that doesn’t mean no diabetic in India is addicted to drugs. We do not bother to go into relevant details and ask leading questions regarding drug abuse. Reason may be due to social stigma or maybe fear of losing the patient. Well in this article I have put in some facts of drugs and also their effects in diabetes. I hope there will be population based studies to give attention to this problem in the future.

06 November, 2012


Hi all

I was debating in my mind for the past few days if this post is necessary . Finally i decided!! It is my duty to convey my thanks to the website and people behind it. This website has given my blog some meaning.

                I completed my UG in 2005 and joined a tertiary care centre in the department of General Surgery. I had an opportunity to treat various kinds of Diabetic wounds. This continued for nearly 3 years. In this period i was able to understand the basic problem responsible for the wounds- its none other than the patient himself! With life long medication, meaningless restrictions, lack of understanding of the disease and lack of proper counselling all contribute to Diabetic wounds and also other complications of Diabetes. What little can i do to stop it? Only option that came to my mind was that i need to specialize in Diabetes treatment so that i can do something more on the preventive aspects.

                I was lucky enough to get placement in one of chennai’s best diabetology hospitals.  While working in this esteemed institution i completed my Post Graduation in Diabetes. Now i had the knowledge & experience to treat Diabetes but i wanted to cover a much larger segment of the society. How do i do it?

Run camps?

Conduct CME?

Mail everybody?

Keep talking to patient and his family?

These are good but not practically effective so i wanted to harness the power of internet. Wanted more people to listen and read about diabetes, have better understanding... result of this small desire – www.riyazsheena.blogspot.com i started posting like crazy. Few people visited my site.. only Few people!! Hey that was not the idea... this number of people i could have covered in my clinic... why waste time on internet....slowly my frequency of posts dropped.... this lead to lesser number of people peeping into my blog.. page clicks dropped to single digits!!

Nobody is interested in Diabetes!

Nobody knows my blog!

Nobody knows i exist!

At this point of time when i was nearly about to stop posting in my blog my dear friend Dr.Roshan Radhakrishnan who is a avid blogger himself introduced me to www.indiblogger.in from the time i entered this wonderful website everything was easy

Creating an i.d – easy

Attaching my blog – easy

Popularising my posts – easy

Getting people to read my blog – easy

Now my page clicks have increased. More people are visiting my blog. Many people are reading and commenting on my posts.. so.... the purpose of creating this blog is complete!

Thanks Indiblogger!!

28 October, 2012

what can we expect in future??

Light waves and ultrasound will replace needles in this new glucometer. This glucometer indirectly measures the glucose levels of a patient's arterial blood as opposed to measuring it directly through a blood sample. This apparatus generates a combination of light waves and ultrasound from a probe that is placed under the tongue of person to measure vital signs on the patient. On the tip of the probe there are 2 sets of small light-emitting diodes (LEDs). The first LED emits light in the red spectrum of light and the second set of LEDs emits infrared (IR) light wavelengths. Also at the end of the probe there is an ultrasound transducer/detector used to capture the reflection signature of the sound waves that occur in the saliva medium of the mouth. The emitted red (R) and infrared (IR) lights from the probe bounce from the patients tongue and the reflected light signals are received by a photo detector. The R/IR ratio together with the sound waves is computed to reveal the amount of glucose in the patient’s blood. The amount light absorbed/reflected is different and it varies depending on what it encounters: tongue tissues, saliva, dead skin cells and most importantly by blood (both venous and arterial). The combined ultrasound waves can distinguish the signals that correspond to pulsating arterial blood and allow the photo detector to look at only these variable absorptions of light waveforms. This new generation of glucometer using light and sound replaces needles in diabetic glucose monitoring and will permit a continuous signal feedback to control insulin pumps.
it is still in experimental stage but if this dream comes true so many of our patients will have a better quality of life!!

21 October, 2012


How did the term ‘Quack’ come into existence?
‘Quack’ is the German word for mercury or quicksilver (quacksalber) The term was applied to Paracelsus, a Swiss physician & alchemist and his followers because of their extensive use of this metal. Originally the word quack was applied to those who poisoned their patients with mercury.

Who is a ‘Quack’?
In modern times, quack refers to, “A person who does not have knowledge of a particular system of medicine but practices in that system and a mere pretender of medical knowledge or skills.”(Supreme Court of India)

Are we all doing enough to curb this deep rooted problem?? There have been raids on clinics and many quacks have been booked... but within a short span of time that quack opens the clinic in the same place and patients still go to him... how does this work?? Are people so dumb...?? or does he heal with magical powers??

here are the articles regarding quacks in Times of India

01 October, 2012


Adhesive capsulitis of shoulder/ Frozen shoulder

Frozen shoulder is adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain. Movement of the shoulder gradually reduces and finally end up in severe restriction of movement of shoulder joint. Patient develops a constant pain which is worse at night and in cold weather. The pain is more severe whenever the blood sugars are high. The exact reason for adhesive capsulitis / frozed shoulder is not known. Risk factors involved are

Ø  Diabetes

Ø  Stroke

Ø  Trauma

Ø  Lung disease

Ø  Connective tissue disorders

Ø  Heart disease

The condition very rarely appears in people under 40.

Treatment for this condition includes

ü  Better control of blood sugars

ü  NSAIDS and pain killers

ü  Physiotherapy

ü  Massage

ü  Hydrodilation

ü  Manipulation under anesthesia

25 September, 2012


Hi everybody,

This is going to be my 100th post on my blog. Gonna be a pretty long one..I have been thinking about future of diabetes!! No No not the diabetic patients, i mean physicians treating diabetes, what will be the fate of ever growing number of diabetes clinics. In the early 90’s Diabetes was considered a disease of the affluent, an urban epidemic but the current experience says Diabetes affects everyone , rich or poor, urban, rural or even the tribal... with a scenario like this it is obvious that there would be mushrooming of clinics and centres to treat this epidemic. End result is heavy competition! This has now come to such an ugly phase where labs start offering multiple tests at a very low rate. This situation makes me think

Have  all lab owners become too decent to forget all their profits and work for the benefit of public?

Lab reagents have all of a sudden become cheap?

If lab tests are so cheap were we all getting cheated all these years?

Or is there a real big compromise on the quality of reporting?

                Well the last one sounds logical to the reasoning mind.. if the 4th option is the answer then how to deal with the situation in the absence of a WORKING centrally controlled monitoring system.. The answer is again simple! Don’t get fooled by ads. Go by the quality of lab. Am not supporting labs with exorbitant rates. I am just telling make sure you get good quality reports even if you pay a little more!

                Next most important aspect in Diabetes is the high degree of confusions and myths among the general population. Most common questions are

1)      When do i suspect diabetes?

2)      How to diagnose/ confirm diabetes?

3)      How does a patient go about doing this test?

4)      If am diabetic what do i do next?

5)      How does a patient monitor his/her diabetes?

6)      How much time to give your doc before switching over?

7)      How do you know that you are on the correct treatment?

8)      When do we use insulin?

There might be many more questions but i personally feel these 8 questions are more important in Diabetes. To answer all these questions without bias is a difficult task. Why??? Because each of these questions have some international guidelines as an answer. But in a country like India how much of these guidelines can be followed in routine practice? What do i do now? Well i won’t talk about guidelines here but will discuss these topics in a more practical way (obviously will keep all required guidelines in the back of my mind).

So lets start!

1)      When do i suspect diabetes?

(Every obese person is a Diabetic unless proved otherwise)

Age more than 40

Overweight  (height in cms – 100 = ideal body weight)

All people in desk jobs. Here i would like to add that guidelines say all those with less physical activity are at risk. With such rampant disorder like diabetes i feel this criteria is literally useless. Everybody should suspect diabetes whether he is a CEO of an company or Manual Labourer.

                                Family history of diabetes

                                Ladies who have had Gestational diabetes (treated at that time with just diet or with insulin. The risk is the same!)

                                Of course everybody knows, poor wound healing, blurring of vision & recurrent infections

`                               patients on steroids for other disorders like asthma, arthritis, post transplant patients etc

                                Patients with other endocrine disorders.

2)      How to diagnose/ confirm diabetes?

Tough decision both for the physician and the patient. Recent guidelines say we can use HbA1c as a diagnostic tool. But i would prefer to use the age old glucose tolerance test (GTT). Only difference is that i would prefer to take 3 samples instead of the conventional 5 samples.

Why should i prick the patient thrice?

HbA1c  estimated using HPLC method is most reliable. The fact is not many labs in our country use this method.

By doing GTT i can diagnose the earliest stage in prediabetes (known as IFG – impaired fasting glucose)

Personally i feel that by combining GTT (3intervals ) and HbA1c i can diagnose the patient’s glycemic status. If i advise the patient only fasting and post prandial blood sugar i have to repeat the test thrice to report diabetes with confidence. That would make is 6 pricks. So GTT once a year till the patient is diagnosed Diabetic is always better.

3)      How does a patient go about going this test?

Whenever you plan to do GTT – DO NOT GO ON DIET, DO NOT JOIN A GYM, SLEEP WELL BEFORE THE DAY OF TEST.  Follow a normal diet and exercise pattern. On the day of test go on empty stomach ( minimum 8-10 hours fasting). The technician will first draw bllod and then give you 75gms of glucose. DONT GULP IT ! drink it in sips. If you try to gulp it you will have nausea and vomiting. You can have water during the test period.






The second sample will be taken after 1 hour and again after 2 hours. So the total duration of test is 3 hours.

4)      If am diabetic what do i do next?


In the initial consultation go through investigations of diabetes and also the baseline functions of organs that might be affected in Diabetes.

These include


                Urine routine

                Blood urea

                Serum creatinine

                Spot microalbuminuria


                Liver function test

Blood profile


                Lipid profile




                Baseline ECG



Blood vessels


Eye screening

Dental screening

These investigations will help you and your doc to compare the changes from the baseline. This will go a long way in deciding the correct line of treatment. Whenever you check blood sugars always check fasting and post prandial blood sugars. Never estimate fasting or post prandial alone. The values may be misleading!

5)      How does a patient monitor his/her diabetes?

Very simple!

Buy a glucometer, calibrate it. Check your blood sugars twice weekly. Check blood sugar if you are feeling hypoglycaemic. Check blood sugars if you feel your sugar might be high.

Check HbA1c once in every 3 months

Check your lipid profile, spot microalbumin once in 6 months.

Check your liver function test, hemogram, urine complete, ECG , Doppler, biothesiometry once a year.

Get your eyes and teeth screened once a year.

Consider the cost involved in doing these tests as investments for your healthy future and not as mere expenditure.

Disclaimer – the periodicity of the test may vary depending on the medication you are taking for diabetes, hypertension and cholesterol.

6)      How much time to give your doc before switching over?

Tricky question!!!

                I might get beaten up by my colleagues for my answer! But what the heck!!

Here it goes

Actually there is no time frame .

Consider changing your doctor if

                He does not explain you Diabetes

                Does not give you proper instructions on diet

                Does not tell you how to take the tablets

                Does not mention & insist on the time gap between taking tablets and food

Does not tell you to repeat HbA1c every 3 months

Keeps changing tablets every visit despite good sugar control

Does not provide you a mode of contacting him in case of doubt. ( email or contact person in his absence)

Does not explain symptoms of hypoglycaemia and what to do at that time.

Now again coming back to time frame , before taking a decision ask yourselves one question...

have you followed all instructions given by your doc at all times? If you have neglected your doc’s advice even once then the mistake is on your part.

If you feel you have followed everything strictly then i feel 3 visits spaced 2 months apart with adequate investigations should put you on the right track.

7)      How do you know that you are on the correct treatment?

HbA1c  less than 7 or showing a decreasing trend

No or very minimal hypoglycaemic symptoms

Other parameters are also taken care of

No retinal changes during yearly reviews

No microalbuminuria

Treatment is always combined with insulin sensitizers ( unless contraindicated)

8)      When do we use insulin?

If your initial blood sugars are very high in type 2 diabetes. It is definitely possible to step down from insulin to tablets after satisfactory blood sugar control.

                Insulin is not addictive

                Insulin is not habitual, so don’t be scared!

Type 1 diabetes

Uncontrolled blood sugars

Pregnancy ( remember baby is more important)

Steroid usage

Planning for surgery

While treating ulcers , wounds, infections

Fluctuating sugars

There is also a view that using insulin intermittently will give some rest to the overworked pancreatic beta cells. There has been evidence that patients on intermittent insulin do better with oral tablets for diabetes.

                Thanks for your patient reading! I am sure that this post would have been helpful to atleast some of you. Every diabetic would have faced one of these questions some time or the other. Feel free to comment. I have presented this topic in a way i feel is simple. I hope all of you find it easy to understand.  Feel free to contact me for any queries at riyaz.arka@gmail.com