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!