how to get rid of multiple needle pricks to check blood glucose

Diabetes patients need regular blood glucose check specially if glucose levels are fluctuating.But practically it is inconvenient to use glucometer every time and everywhere.Pricking multiple times is painful.Sometime glucometer shows error-blood sample is too less,battery is low,glucometer strip is not properly inserted requiring another test adding to frustration and cost of glucose monitoring.There is a solution to it- CGMS (continuous glucose monitoring sensor) technology.Here are FAQ on this technique.

Q- What is CGMS?

Ans- CGMS is a sensor based technique where glucose is checked every 15 minutes by the sensor avoiding multiple needle pricks.

Q-Where is sensor put?

Ans- Sensor is put into skin mostly at back of arm.

Q-Is it painful?

Ans-It is one time prick with automatic machine and pain is less than finger needle prick.

Q-How it works?

Ans-It measures and records glucose data every 15 minutes.That sensor data is captured by Bluetooth technology and studied on mobile like instrument or can be downloaded on computer in the form of graphs.

Q-Can I take bath while sensor is attached on the skin?

Ans- yes it is water proof.

Q-How long it works?

Ans- It works for 2 weeks

Q-Is it costly?

Ans- No.It records more than 1000 reading which if measured by glucometer will cost much more than CGMS.

Ask your diabetologist about it if it suits your requirement.

why quality of diabetes care so poor even in those who can afford it

Even in the capital of India with top most doctors and state of the art hospitals & clinics,the quality of diabetes care remains poor.This is not because patients cant afford the cost of diabetes care.The results of the article published in diabetes care clearly says very few diabetes patients are getting their HbA1c done.The reason may be lack of a diabetes team and comprehensive care delivery approach.This can be addressed with maintaining the electronic records with reminders for regular follow up visits and devising a comprehensive diabetes package including check up for blood sugars as well as assessing diabetes complications.The link to the article is given below.

http://care.diabetesjournals.org/content/29/11/2341

Cholesterol is not the reason for heart attack or blocked arteries!

Everything US says is not right!But we are fascinated anything which western countries declare.One of this is - cholesterol is a major cause of coronary heart disease.The US government has finally accepted that cholesterol is not a nutrient of concern doing a U-turn on their warnings to us to stay away from high-cholesterol foods since the 1970s to avoid heart disease and clogged arteries.

The US Department of Agriculture, which is responsible for updating the guidelines every five years, stated in its findings for 2015: "Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day.

"The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol, consistent with the AHA/ACC (American Heart Association / American College of Cardiology)

The Dietary Guidelines Advisory Committee will, in response, no longer warn people against eating high-cholesterol foods and will instead focus on sugar as the main substance of dietary concern.

Dr. George V. Mann M.D. associate director of the Framingham study for the incidence and prevalence of cardiovascular disease (CVD) and its risk factors states: Saturated fats and cholesterol in the diet are not the cause of coronary heart disease.That myth is the greatest deception of the century, perhaps of any century."Cholesterol is the biggest medical scam of all time"

Experts say that there is nothing like LDL(bad cholesterol) or HDL(good cholesterol). 

So what exactly is the reason in food for coronary heart disease- its the ratio of                  omega 6: omega 3.Higher ratio goes in favor of production of pro inflammatory prostaglandins and subsequent more risk of vessel inflammation irrespective of cholesterol profile.

how to adjust insulin while travelling long haul journeys

Insulin needs to be adjusted while travelling long haul journeys;travelling east will shorten one's day and hence reduced dose of insulin is required. Travelling west means longer day and insulin dose to be increased.

weight reducing medicines,their efficacy and side effects

Weight loss drugs should be started if BMI(body mass index) more than or equal to 27 kg/m2 with one or more obesity associated co-morbid conditions (e.g., type 2 diabetes. hypertension, and dyslipidemia) and by patients with BMI more than equal to 30 kg/m2 who are motivated to lose weight.The approved drugs are:
1.Orlistat
Doses- 60mg or 120mg three times a day (during or up to 1 h after a  meal)
Average weight loss in one year-2.5 kg (60 mg); 3.4 kg (120 mg)
Common side effects- Abdominal pain/discomfort, oily spotting/stool, fecal urgency, flatulence, malabsorption of fat soluble vitamins (A, D, E, K) and medications (e.g., cyclosporine, thyroid hormone replacement, or anticonvulsants),potentiation of the effects of warfarin
Uncommon/serious side effects-Liver failure and oxalate nephropathy.

2.Lorcaserin
Dose- 10 mg twice daily
Average weight loss in one year-  3.2 kg
Common side effects- Hypoglycemia, headache, fatigue
Uncommon/serious side effects-Serotonin syndrome , suicidal ideation, heart valve disorder ,bradycardia

3.Phentermine/topiramate combination
Dose: 3.75 mg/23 mg once a day for 14 days, then increase to 7.5 mg/46 mg once a day. Maximum dose: 15 mg/92 mg once a day.
Average weight loss in one year- 6.7 kg with 7.5 mg/46 mg dose; 8.9 kg with 15 mg/92 mg
Common side effects-Paresthesia, xerostomia(dry mouth), constipation, headache
Uncommon/serious side effects-Topiramate is teratogenic and has been associated with cleft lip/palate

4.Naltrexone/bupropion combination
Dose- 8 mg/90 mg tabs Maximum dose: two tablets  twice daily for a total daily dosage of naltrexone 32 mg/bupropion 360 mg
Average weight loss in one year-2.0–4.1 kg with 32 mg/360 mg
Common side effects-Nausea, constipation, headache, vomiting
Uncommon/serious side effects-Depression,precipitation of mania, contraindicated in patients with a seizure disorder

5.Liraglutide (injection in pen form)
Dose: 3 mg s.c. once a day (maintenance dose achieved after starting from lower doses)
Average weight loss in one year-5.8–5.9 kg
Common side effects-Hypoglycemia, nausea, vomiting, diarrhea, constipation, headache
Uncommon/serious side effects-Pancreatitis, thyroid C-cell tumors in rodents, contraindicated in patients with personal/family history of medullary thyroid carcinoma or MEN2(multiple endocrine neoplasia), acute renal failure

Why sugars are not under control even with regular insulin doses- Its a common problem that despite taking heavy dose of insulin, some patient will have uncontrolled sugars.Here asking about the technique of insulin will be very helpful instead of blindly further increasing the dose of insulin.This hardly takes 2 minutes even in a busy OPD. To save time doctors can have ready made instruction sheets to be given to the patients.This will help in adequate management of diabetes.I see almost every third patient on previously insulin therapy, using it in an improper way.Though patient will say- doctor I am chronic patient of diabetes,I know very well how to take insulin shots.Here comes the importance of counseling.And insulin doses can be decreased.It will not take time before patient says to his friend circle that this particular doctor has brought down my insulin units!

Low Testosterone Increases Risk of Atherosclerosis for Men with Diabetes

Low Testosterone Increases Risk of Atherosclerosis for Men with Diabetes