SSSHHH.... ITS NOT PERFECTLY NORMAL!!!

Today we are going to talk about the least spoken yet very common complication of Diabetes … Erectile Dysfunction (E.D) or in simple terms Sexual dysfunction…

PAINLESS INSULIN DELIVERY SYSTEM

Medicine aims to alleviate the pain and distress. Many diseases scourged mankind for ages. Marvellous inventions and discoveries have been made in the field of medicine right from the very early times. The significant ones that changed history as we know it today are

• Antiseptics
• Antibiotics
• Anaesthesia
• Anti-Rabies vaccination
• Insulin

Medicines which can be taken orally are well accepted by patients. Injections play a major role during Surgeries (Anaesthesia), acute emergencies and in cases of severe infections where we want the drug to take an immediate effect . One life saving medicine which doesn’t come under any of the above mentioned categories is Insulin. Many people have lost their lives to acute hyperglycemia (High Sugars). Those affected by the non insulin dependent type of Diabetes (Type2) suffered the long term complications of elevated blood sugars.

Paul Langerhans

Islets of Langerhans

It was the discovery of Insulin secreting cells in the pancreas by Langerhans which paved way for future research. Banting and Best provided us with a cure in a bottle – INSULIN. This saved millions of lives and continues to do so.

Porcine Insulin

Bovine Insulin

We have come a long way from crude Porcine, Bovine insulin to designer insulin. As the years passed safe insulin was developed. These were devoid of side-effects, much safer to use and more stable are various temperatures. So with this weapon we are ready to heal the world of Diabetes?? Oh No.... Wait.... There is one more problem....

LATEST TREND - SEND OUT EXCESS SUGAR IN URINE!

New member of the squad against Diabetes!

Canagliflozin 

• Invokana
• Invokamet (Cangliflozin + Metformin)

Canagliflozin is a newest member in treatment of Type 2 Diabetes. This drug can be used as adjuvant to Diet & Exercise.

Canagliflozin inhibits Sodium Glucose Transport protein Sub type 2. This protein is responsible for reabsoption of sugar in the kidneys.

By stopping the activity of Sodium Glucose Transport Protein -2 (SGLT-2) will result in loss of glucose in urine. Canagliflozin can help lose about 80-120mg/dl sugar. Additional benefits are better control of Hypertension due to osmotic diuresis and weight loss. 

Half life of Canagliflozin is upto 12hours, Hence a twice daily dosage is preferred.

Canagliflozin comes in  the strengths of 50mg and 150mg

A recent welcome addition is introduction of Invokamet (Canagliflozin + Metformin)

The available combinations are 

Canagliflozin 50 mg + Metformin 500mg

Canagliglozin 50mg + Metformin 1000mg

Canagliflozin 150 mg + Metformin 500mg

Canagliglozin 150mg + Metformin 1000mg

Since most of our patients require twice daily metformin this combination will help give better sugar control. 1 Tablet with advantage of two drugs. 

This drug may help patients attain a better control of blood sugars.
Chances of hypoglycemia are relatively less

This Drug cannot be used in patients with Renal failure, Hypotension and Type 1 Diabetes!

Some patients ( ~5%) may experience the side effects like Female genital mycotic infections, Urinary tract infections and increased urination.

My previous write up about Canagliflozin - CLICK HERE!

This drug being marketed by Johnson & Johnson is expected to come to India soon.

More in news from Johnson & Johnson - JNJ

Dr.Riyaz Sheriff
R.S. Clinic

HBA1C

HbA1c. How many of us know exactly what this means?

Now all standard Diabetes centers, Hospitals and Clinicians have started recommending this test for their Diabetic patients. It would be apt to say that HbA1c is considered a gold standard investigation for diagnosis , Treatment and Followup of Diabetic patients. 

So what is HbA1c? 

It is a blood test which will give you an average sugar control for the past three months. It is otherwise called Glycated Hemoglobin or Glycosylated haemoglobin or glyycohemoglobin. This Glycated Hemoglobin comprises of HbA1c, HbA1a, HbA1b, HbS,HbC and HbF. HbA1c is more specific among the other mentioned components.

HbA1c has been used in many international studies for assessment of risk of developing complications of Diabetes. The normal level of HbA1c in a non-diabetic patient should range between 4.0-6.0%. 

American Diabetes Association  recommended the use of HbA1c as a diagnostic marker for diabetes & prediabetes in 2010. People with HbA1c of 6.5% and above are to be diagnosed as diabetes and HbA1c between 5.7-6.4%  are considered to be at risk of diabetes.

The target HbA1c in a Diabetic patient is <7% 

HbA1c is definitely a very good tool in the hands of the clinicians to provide a better control over diabetes. But, we also need to know factors that can affect this blood test. 

What will show faulty higher HbA1c readings?

HbF and HbG

Uraemia

Lead poisoning

Hypertriglyceridaemia

Alcoholism

Opiate addiction

Iron deficiency state

Postsplenectomy

Hyperbilirubinaemia

Chronic aspirin therapy

What will show faulty lower HbA1c readings?

HbS and HbC

Haemolytic anaemia

Pregnancy

Acute or chronic blood loss

Methods used for estimating HbA1c

Ion exchange chromatography

High-performance liquid chromatography

Isoelectric focusing

Agar gel electrophoresis

How frequent do we need to estimate HbA1c?

Usually, it should be done every 3 months and when controlled after every 6 months. In pregnancy

for tight control, monthly determination is necessary. In pregnancy a better marker of sugar(Glycemic) control is estimation of serum fructosamine.

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