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.