OATS (AVENA SATIVA)

Oats were defined as "eaten by people in Scotland, but fit only for horses in England." The Scotsman's retort to this is, "That's why England has such good horses, and Scotland has such fine men!"

Oats is a recent addition to our menu. Oats is a European and North American crop. It was not considered as important as wheat or barley in the olden days. Oats were mostly weed like plants. It is said that Oats were first brought to North America with other grains in 1602 and planted on the Elizabeth Islands off the coast of Massachusetts. As early as 1786, George Washington sowed 580 acres to oats. By the 1860s and 1870s, the westward shift of oat acreage in the United States had moved into the middle and upper Mississippi Valley, which is its major area of production today. Russia, Canada, the United States, Finland, and Poland are the leading oat producing countries.

Oats has been used as livestock and human foods since ancient times. It has been used as pasture, hay or silage. Oat straw has been used as bedding for livestock.

There has been an increase in oats used for human food in recent years. Oat Bran has received considerable attention from the medical community for its role in reducing blood cholesterol. Nutrition experts believe that Beta glucans, the water-soluble fibres present in oat bran inhibit cholesterol, which helps prevent heart disease. Several breakfast cereals and bread products are made from oat flour and rolled oat products.
Oats might help reduce cholesterol and blood sugar levels and control appetite by causing a feeling of fullness. Oat bran might work by blocking the absorption from the gut of substances that contribute to heart disease, high cholesterol, and Diabetes

Dr.Riyaz Sheriff

The Hindu - My article

This came at the most perfect time for me. I had just been thinking of writing a blog post about Medical Second Opinion. Geetha Padmanabhan apporached for my views on second opinion..

The Result

Just a second! - The Hindu

I appreciate The Hindu for their futuristic thinking.

I specially thank Geetha Padmanabhan for handling this topic elegantly.

WORLD DIABETES DAY - GOOD NEWS!

November 14^th…. Things that come to our mind – CHILDRENS DAY - HOLIDAY

Other minor things that happened on this day

• 1922 – The BBC begins radio service in the United Kingdom
• 1967 – American physicist Theodore Maiman is given a patent for his ruby laser systems, the world's first laser.
• 2001 – War in Afghanistan: Afghan Northern Alliance fighters take over the capital Kabul.
• 2003 – Astronomers Michael E. Brown, Chad Trujillo, and David L. Rabinowitz discover 90377 Sedna, a Trans-Neptunian object.
• 2008 – The first G-20 economic summit opens in Washington, D.C.
• 2010 – Germany's Sebastian Vettel of Red Bull Racing wins Formula One's Drivers Championship to become the sport's youngest champion.
• 2012 – Israel launches a major military operation in the Gaza Strip, as hostilities with Hamas escalate.

Finally

World Diabetes Day.. November 14^th

Everybody talks about it. All Diabetes Centres use this opportunity to advertise.

All leading Diabetologists give interviews in Harvard Engish…

Then comes November 15^th..

Everything is forgotten till next year..

But this year Times of India had published an article on NON INVASIVE GLUCOMETERS… yes!! Exactly!! You might not need blood or prick yourself to find out the blood sugar values…

I am very excited about this article because I had written a blogpost on NON INVASIVE GLUCOMETERS  in February 2013

 PAIN -FREE BLOOD SUGAR MONITORING

PAIN- FREE BLOOD SUGAR MONITORING

PAIN- FREE BLOOD SUGAR MONITORING

Here is the article from TOI for those of you who missed!!

 Healthcare has advanced rapidly in the past few decades, but it is still impossible for patients to escape the needle. Studies show that up to 10% of the world’s population, especially diabetics, have an intense fear of needles and would go to any extent to avoid them. To put an end to this phobia, several novel non-invasive techniques have been developed to test blood sugar levels in diabetics.

    Conventionally, diabetics check blood sugar levels by pricking their finger with a needle to take a drop of blood for testing. “Pricking your finger multiple times a day is painful, time consuming, and can cause calluses and sensitive fingers. It is difficult if the patient has visual limitations, As a result, many patients avoid or limit blood glucose monitoring.

    Alternative methods like near infrared spectroscopy (NIR) can be used instead, say doctors. “NIR is still in the trial stages and determines glucose levels through the skin using varied light waves. Non-invasive devices that measure blood sugar levels include Glucotrack, which can be imported from abroad. It is a small sensor that is clipped to the earlobe and connected to a handheld control and display unit. It uses ultrasound, electromagnetic readings and thermal technology to obtain blood glucose readings,”

    Mass screening devices have also been developed to test a large number of patients in clinics. The Government General Hospital uses a device called EZ Scan to screen patients. “Close to 1,000 patients come to the Institute of Diabetology in GH every day, so it is difficult to screen all of them personally. With the new machine, the patients have to place their hands and feet on electrodes and their height, weight and age is recorded. Based on the sweat secretion, the device gives the results within two minutes,” he said.
    Machines can also determine blood glucose levels from the skin fluorescence, said head of Madras Diabetic Research Foundation Dr Mohan. “We use the SCOUT DS machine on which patients place their hands. Light from the machine enters the skin and scatters on the tissue. The sugar levels are read from the skin fluorescence,” he said.
    Dr Mohan’s clinic also uses Diagnoptics AGE Reader, a noninvasive equipment that diagnoses the risk of diabetes and its cardiovascular, nephrological and neurological complications by measuring accumulation of advanced glycation endproducts. “These new methods are precise, reliable and save a lot of time. Above all, the patient is relieved from the prick of the needle,” he said. 

Thank you TOI for this article.....

Although many machines mentioned are still in the experimental stages there is light at the end of the tunnel...

Dr.Riyaz Sheriff M.B.B.S.,PGDHS(Diab).,CMD

LOSE WEIGHT!

One of the major reasons for increased medical problems is Obesity
There are many ways in which a person can lose weight. Results may vary depending on diet and physical activity.

When it comes to safer medicines to tackle obesity one name stands out among various pharmacological agents available

"ORLISTAT"

The original product introduced was XENICAL

in India this drug is sold in various names. Here is the list of them....

COBESE, JM-SLIM, LIPOCUT, LIPOPHAGE, OBELIT, OBETY, OBFREE, OLISAT, ORLE, ORLEAN, ORLICA, ORLID, ORLIFE, ORLIMAC, ORLISS, REESHAPE, TROYSLIM, VYFAT, ZEROFAT

What is this drug??

Orlistat is a drug designed to treat obesity. It isalso known as tetrahydrolipstatin.  It is marketed as a prescription under the trade name Xenical by Roche. It acts by reducing the fat absorption from our diet and reducing the caloric intake.

Orlistat is the derivative of lipstatin, a potent inhibitor of pancreatic lipases isolated from the bacterium Streptomyces toxytricini. The effectiveness of orlistat in promoting weight loss is definite, orlistat in addition to lifestyle modifications, such as diet and exercise, lose about 2–3 kilograms. Orlistat also modestly reduces blood pressure, and appears to prevent the onset of type 2 diabetes, whether due to weight loss itself or to other effects.

Orlistat works by inhibiting gastric and pancreatic lipases, the enzymes that break down triglycerides in the intestine. When lipase activity is blocked, triglycerides from the diet are not hydrolyzed into absorbable free fatty acids, and are excreted undigested instead. Only trace amounts of orlistat are absorbed systemically; the primary effect is local lipase inhibition within the GI tract after an oral dose. The primary route of elimination is through the feces.

Side effects-

Steatorrhea (oily, loose stools with excessive flatus)

 fecal incontinence and frequent or urgent bowel movements.

Precautions

Absorption of fat-soluble vitamins and other fat-soluble nutrients is hampered. A multivitamin tablet containing vitamins A, D, E, K, and beta-carotene should be taken once a day, at bedtime, when using orlistat.

Possible interactions with other drugs-

Reduces plasma levels of cyclosporine
impairs absorption of Amiodarone

Orlistat better avoided in -

• Malabsorption
• Hypersensitivity to orlistat
• Reduced gallbladder function
• Pregnancy and breastfeeding

HOW WE GET FOOLED!!!

The US-FDA  has cracked down on  alternative or natural treatment for diabetes, including ayurvedic and homeopathic remedies. Fifteen companies in the US, including some that procure alternative diabetes medications from India, have been warned by the FDA, asking them to stop sale in the US claiming to treat, cure, and prevent diabetes.


Foreign and domestic companies whose products claiming to mitigate, treat, cure or prevent diabetes and related complications, were sold online and in retail stores have been asked to tell FDA  within 15 days how they will correct the violations.

The FDA has also advised consumers not to use these or similar products because they may contain harmful ingredients or may be otherwise unsafe, or may improperly be marketed as over-the-counter products when they should be marketed as prescription products.

Many of the illegally sold products include claims such as "prevents and treats diabetes," and "can replace medicine in the treatment of diabetes," FDA said.

These illegally sold products, according to FDA, include Dietary supplements and Ayurvedic products described as "medicine of the healing arts that originated in India" with claims to treat, cure, and/or prevent diabetes.

This is what a responsible country does....

What do we do????

Get fooled by advertisements...

we see pamphlets in all colors stuck on road claiming to cure hydrocele without surgery, diabetes without tablets, hernia without surgery. Recently some have gone to the extent of treating cancer and AIDS.

Wake up!! Don't be Fooled!! Think logically!! Act rationally!!

You might want to read this!!

VOICES FOR PIOGLITAZONE

Pioglitazone finally had some supporters.

Here is an article from HINDU

Govt should reconsider ban on diabetes drug, say doctors | Business Line

INDIAN EXPRESS

Ban on anti-diabetes drug pioglitazone shocks doctors

ZEE NEWS

Doctors flay blanket ban on diabetes drug Pioglitazone

MUMBAI MIRROR

Choice before diabetics: Painful insulin or costly but less-effective drugs

SAKAL TIMES

Diabetes expert demands withdrawal of ban on pioglitazone


with the way our cost of medication is going up drugs like these should not be banned. I sincerely feel Pioglitazone needs a second chance in the Indian market.

RIP PIOGLITAZONE - YOUR SERVICES WILL BE REMEMBERED!

THREE DRUGS TO FACE THE GUILLOTINE TODAY

1) PIOGLITAZONE
2)ANALGIN
3) DEANXIT..

I personally feel pioglitazone deserves a chance. every drug has side effects. To suggest it with caution is the Doctor's responsibility. Newer drugs are hard to come by these days.The ones that come are pretty costly. How will a middle class patient survive? Hopefully government reconsiders this decision.

INSULIN TIMINGS!

Many of our Patients are on insulin. The most common reason why insulin does not control blood sugar is that we do not understand the dynamics of insulin. Here I have put a concise format so that everybody can understand which insulins has to be taken when....

Insulin preparation	Generic name	Onset	Peak	Duration
Rapid-acting	Insulin Aspart	5-10 minutes	1-3 hrs	3-5 hrs
	Insulin Lispro	< 15 minutes	½-1½ hrs	2-4 hrs
	Insulin Glulisine	< 15 minutes	½-1½ hrs	1-2½ hrs
Short-acting	Regular	½-1 hr	2-3 hrs	3-6 hrs
Intermediate- acting	NPH	2-4 hrs	4-10 hrs	10-16 hrs
Long-acting	Insulin Glargine	1 hr	No peak	24 hrs
	Detemir	1-2 hrs	No peak	6-23 hrs, depending on dose
Combinations	70% NPH +30% Regular	½-1 hr	There are2 peaks: 2-3 hrs &4-10 hrs	10-16 hrs
	70% Aspart Protamine +30% Aspart	5-10 minutes	There are2 peaks: 1-3 hrs &4-10 hrs	10-16 hrs
	50% Lispro Protamine +50% Lispro	< 15 minutes	There are2 peaks: ½-1½ hrs &4-10 hrs	10-16 hrs
	75% Lispro Protamine +25% Lispro	< 15 minutes	There are2 peaks: ½-1½ hrs &4-10 hrs	10-16 hrs

Feel free to tell me if this helps!!

JUSTIFIED?

One small question to all of you.. All of us follow western  guidelines for treatment of Indian patients. Will western guidelines match the profile of Indian patients? Why we don't have guidelines for many diseases in India. What is preventing us from developing our own guidelines?

What's your opinion?

Note- I am not against guideline from another country. It's my humble opinion that blindly following guidelines will not be appropriate. Docs tend to do so.. guidelines should match our population, eating patterns, BMI, climatic conditions etc etc....

GASTRO & URINARY SYMPTOMS IN DIABETES

Long standing Type 1 & Type 2 Diabetes affects the motility of gastrointestinal and genito-urinary tracts. Patients may present with symptoms like

Gastrointestinal

Delayed emptying of stomach

• Anorexia

• Nausea

• Vomiting

• Early satiety

• Abdominal bloating

Altered small & large bowel motility

• Constipation

• Diarrhoea

Genitourinary symptoms

Cystopathy

• Inability to sense full bladder

• Failure to void completely

• Incontinence

• Recurrent urinary tract infection

Erectile dysfunction

• Failure to sustain erection

• Reterograde ejaculation

Female sexual dysfunction

• Reduced sexual desire

• Dyspareunia

• Reduced vaginal lubrication

TREATMENT

• CONTROL BLOOD SUGARS

• SMALLER FREQUENT MEALS

• DRUGS TO INCREASE MOTILITY OF INTESTINE (CONSULT YOUR DOCTOR)

• DIABETIC DIARRHOEA CAN BE MANAGED BASED ON THE ETIOLOGY

• CYSTOPATHY

• TIMED VOIDING

• SELF CATHETERISATION

• ERECTILE DYSFUNCTION

• 5 PHOSPHO-DIESTERASE INHIBITORS

• SEXUAL DYSFUNCTION IN FEMALES

• VAGINAL LUBRICANTS

• TREATMENT OF VAGINAL INFECTIONS

• SYSTEMIC / LOCAL ESTROGEN REPLACEMENT THERAPY

BEWARE!

STOP DIABETES!!

Hello everybody!

Hope you all are enjoying life!

Over the past 3years I have written my small bit about Diabetes. I have written about Diabetes, Its Manifestations, Complications, Treatment options and also about the drugs and devices we can expect in future. But we live in an era of prevention it’s a crime if I don’t talk about it.

Diabetes cannot be cured but can surely be prevented!!!

Why talk about prevention?

In the city where I live around 20% people are diabetics. That’s close to 1.2million diabetics in the City of Chennai alone. Out of this big number approximately 50% will be taking treatment and only 50% of these patients will be on regular treatment.  I feel that this number is only the tip of the iceberg.

 The real area of concentration should be those who are at risk of developing diabetes and those in PREDIABETES. Prediabetes stage can be as long as 10 years. This gives us the most valuable time to correct the risk factors for developing Diabetes. If these clients (I address this group as clients because technically speaking they are not suffering from disease) undergo proper testing we can delay the progression of Prediabetes to diabetes and in some cases even prevent the conversion of Prediabetes to diabetes.

What do we get by doing so??

First Satisfaction that I have helped somebody!

Next we can provide them a Healthy, Productive & Stress free life!

We can also reduce the economic burden (because finally Money Matters!!)

Detect Prediabetes and you reduce

• ·         Stress due to health related issues
• ·         Expenditure on medication
• ·         Expenditure on visits to clinic
• ·         Expenditure on blood tests
• ·         Needle pricks
• ·         Leave from work
• ·         Irritability
• ·         Inferiority complex
• ·         Chances of developing Sexual problems
• ·         Chances of developing Hypertension
• ·         Chances of getting a Heart attack
• ·         Chances of developing Neuropathy, Retinopathy & Nephropathy
• ·         Stress to the partner and family
• ·         Insurance premium (just kidding!!)

So how exactly we find out Prediabetes??

Simple!!

Go to a certified lab and do OGTT (Oral Glucose ToleranceTest) 3 intervals.

Sample 1 - Blood test taken in fasting

Sample 2 - one hour after taking 75gms of glucose

Sample 3 - 2 hours after the fasting sample.

 It’s always a good habit to combine this test with HbA1C.

People tell me doing OGTT is tough...

Its al in the way you see it...

Normally we do fasting and postprandial blood sugars

OGTT is just one extra prick but.....

This test can tell you with high level of confidence about your Sugar status.

So THINK....... PLAN...... TEST .......& PREVENT when you have the chance!!

Further Reading!!!

HbA1C

Diabetes Commercialised

sexual problems

Diabetes risk factors

Metabolic syndrome

CANAGLIFLOZIN - ONE MORE SOLDIER TO BATTLE DIABETES!

 Canagliflozin - This new compound has been recently approved by FDA for use in Diabetes.


Technically speaking it’s a Selective sodium-glucose transporter-2 (SGLT2) inhibitor.

This group of drugs are considered to provide a novel approach to treatment of Diabetes.


 So what do these drugs do?


To put in very simple terms these drugs reduce the tolerability of kidney to sugar in the system so more amount of sugar is excreted in the urine thereby reducing the levels of glucose in the blood.


Many molecules are under research and some of them have reached the stage of clinical trials


To name a few


Remogliflozin
 

Sergliflozin
 

Dapagliflozin

Many other molecules are yet to be named...


The one successful candidate which had obtained FDA approval is Canagliflozin.


As I said earlier it’s a Selective sodium-glucose transporter-2 (SGLT2) inhibitor indicated as an adjunct to diet and exercise in treatment of Type 2 Diabetes


Dosage is 100mg per day taken before first meal of the day. Dose can be raised upto 300mg/day.


As like any other medicine known to man this drug also comes with some side effects


Around 10% patients, especially the females faced problems with associated genital fungal infections. Other minor (1-6%) side effects were increased urination, fungal infections in males, vulvovaginal pruritis, thirst, constipation, nausea, and abdominal pain


LIKE FOR ANY OTHER DRUG EVEN THIS DRUG HAS TO BE TAKEN UNDER PROPER MEDICAL SUPERVISION


We are yet to get reports about long term safety and about the usage of this drug in pregnant women and children. Also before we start using this drug we will have to see the effect of this drug in Indian population. So till we get the results let’s keep our fingers crossed and hope that this drug or other molecules of this family succeed. These drugs will give us more confidence to deal with Diabetes in a much more affective way and give all our dear patients a better future!

ANNOUNCEMENT!

HI ALL,

I am very happy to share with you all that i will be posting my Microbiology related posts in my blog named "LITTLE ONES AROUND US"

I thought that adding Microbiology to this site would dilute the whole purpose of this blog (TO CONCENTERATE FULLY ON DIABETES AND ITS RELATED ASPECTS)

Hope you all will give the same love and support to my new blog as well!!

Dr.Riyaz Sheriff

CHOCOLATES IN DIABETES!

Eating chocolates spoils your blood sugar control!!

True!

But there is one kind of chocolate that will benefit you..

THE DARK CHOCOLATE

Advantages

• Dark chocolate contains 70-80% cocoa
• Good source of antioxidants
• Improves blood flow
• Helps in release of endorphins, makes you feel happy
• Helps reduce insulin resistance
• Hardens tooth enamel
• Rich in vitamins and minerals

Dark chocolate has many benefits but is also rich in fat.... So careful with the quantity!

PAIN- FREE BLOOD SUGAR MONITORING

Hi all,

Maybe a year back I had put up a post on Non invasive glucometer of the future. It’s every patient’s dream to check his blood sugars without pain. We, doctors would always be happy to provide such a painless option to the patient. It would also help us in better treatment. There are so many companies trying different technologies for non invasive measurement of blood sugars. Finally I found one which sounds promising. I felt it’s worth a share with you people.

This particular glucometer is from a company called Grove instruments. The device uses near-infrared (NIR) spectroscopy to read the Blood Glucose Level. For the device to function properly and give accurate readings, the grey slot of the device must be placed over high blood flow area, such as the finger or the earlobe. It takes a real-time Blood glucose level from the blood using light.  The current international standard requires glucometer to differ from the blood standard by less than 20% before the instruments is released to the public for mass usage. The data from the clinical trials shows that Grove’s device has a mean average relative difference (MARD) of 8 to 12%.  Grove Instruments has maintained this MARD for the past two years.

Grove instruments claim that this is the first true non-invasive device that has a shot of making it to mass production for human usage. The other key aspect to this device is the time it takes to produce a result, 20 seconds or less. That is quicker than an individual can prick their finger and take a reading; making Grove’s device more time efficient, cleaner, and less painful than the current state of BGL testing. By having this device as a means of BGL testing, the average number of times a day an individual checks their BGL should move closer to the recommended four times a day. This technology has been patented. It is supposed to have cleared all safety standards and will be in mass production soon. I am trying to get it touch with the company to find out when this machine will be available in the market. Will update you people as soon as I get some good news

Till then..... Bye

Enjoy life!! 

EVERY MAN'S DREAM!!

The Guy's Rules
At last a guy has taken the time to write down this all Finally, the guys' side of the story. We always hear "the rules" from the female side. Now here are the rules from the male side. These are our rules! Please note.. these are all numbered "1" ON PURPOSE!


1. Men ARE not mind reader

1. Shopping is NOT a sport. And no, we are never going to think of it that way.

1. Crying is blackmail.

1. Ask for what you want. Let us be clear on this one: Subtle hints do not work! Strong hints do not work! Obvious hints do not work! Just say it!

1. Yes and No are perfectly Acceptable answers to almost every question.

1. Come to us with a problem only If you want help solving it. That's what we do. Sympathy is what your girlfriends are for.

1. A headache that lasts for 17 months is a problem. See a doctor.

1. Anything we said 6 months ago is inadmissible in an argument. In fact, all comments become null and void after 7 Days.

1. If you won't dress like the Victoria's Secret girls, don't Expect us to act like soap opera guys.

1. If you think you're fat, you probably are. Don't ask us.

1. If something we said can be interpreted in two ways and one of the ways makes you sad or angry, we meant the other one .

1. You can either ask us to do something Or tell us how you want it done. Not both. If you already know best how to do it, just do it yourself.

1. Whenever possible , Please say whatever you have to say during commercials.

1. Christopher Columbus did NOT need directions and neither do we.

1. ALL men see in only 16 colors, like Windows default settings. Peach, for example, is a fruit, not! A color. Pumpkin is also a fruit. We have no idea what mauve is.

1. If it itches, it will Be scratched. We do that.

1. If we ask what is wrong and you say "nothing," We will act like nothing's wrong. We know you are lying, but it is just not worth the hassle.

1. If you ask a question you don't want an answer to, Expect an answer you don't want to hear

1. Don't ask us what we're thinking about unless you are prepared to discuss such topics as football, cars, bikes or games

1. You have enough clothes.

1. You have too many shoes.

1. U r in shape. Round IS a shape!

1. Thank you for reading this. Yes, U may have to sleep on the couch tonight if u pass this on; But did you know men really don't mind that? It's like camping.