Medical Clinic

5 Essential Functions of Insulin

noreply@blogger.com (Dr Pushkar) — Mon, 10 Sep 2012 09:48:00 +0000

People suffering from Diabetes have either the lack of insulin or decreased insulin activity. Insulin is a vital hormone and functions of insulin are essential for life. It is a polypeptide hormone produced by beta cells of islets of Langerhans in Pancreas. It plays an important role in energy metabolism and general growth and development of our body.

Insulin acts in conjunction with Glucagon and other body hormones to maintain the blood glucose levels. Suboptimal glucose levels lead to either hypoglycemia or hyperglycemia both having profound implications on overall health and well being.

5 major functions of Insulin are :-

1) Glucose metabolism :- Insulin is a central figure in carbohydrate (principally glucose) metabolism. Its main function is to optimize and efficiently maintain the blood glucose levels in our body. Insulin optimizes the blood glucose levels by 3 main actions :-

a) Decreased production of glucose - It prevents the breakdown of glycogen to glucose and thus helps in achieving proper blood glucose level as well as maintaining high energy stores.
b) Increased breakdown of glucose - It increases active breakdown and consumption of preexisting glucose in blood. This helps in production of high energy substances like ATP.
c) Transport excess glucose to proper locations - Insulin also increases glucose receptors on tissues like adipose (fat) tissue and muscles thus facilitating its uptake. These tissues utilize excess glucose to create energy stores and for other purposes.

2) Fat Regulation :- Insulin inhibits breakdown of complex fats into free fatty acids. This helps in maintaining optimal free fatty acid level in blood and conserving high energy fat stores. Fats are also a part of important body structures like nerves, cell membranes etc.

3) Protein Metabolism :- Insulin is an anabolic hormone. It is known as a hormone of abundance. Because it helps in preserving all major nutrients like carbohydrates, proteins and fats. Abundance of Proteins is essential for body building. Proteins are building blocks in our body. Hence its efficient utilization is vital and insulin plays a very important role in it. It reduces protein breakdown as well as promotes its synthesis from other substances like amino acids. Insulin also increases protein synthesis by directly acting on genes.

4) Electrolyte Balance :- Insulin helps in restoring the Potassium balance by actively promoting its uptake in cells. Glucose and sodium uptake in cells are interlinked with water transport. Both these substances help maintain proper hydration. Thus by regulating blood glucose levels, insulin helps in maintaining adequate hydration and proper sodium balance.

5) Growth and Development :- Insulin due to its anabolic nature makes sure there is no scarcity of vital nutrients to body. This action is particularly important during fetal life and early childhood when there is high requirement of energy. It also stimulates production of certain growth factors by acting on genes. Without insulin, child's body growth may become subnormal.

Next we will discuss further more about Insulin like its types, adverse effects etc. and much more. Stay tuned.

What is Insulin? Insulin Synthesis, Human vs Animal Insulin

noreply@blogger.com (Dr Pushkar) — Wed, 29 Aug 2012 14:44:00 +0000

Diabetics use Insulin daily. So its important to know basics like - what exactly is Insulin? Here we will discuss about it and other Insulin basics like - How is it produced in our body? What are its sources and the differences between Human and Animal Insulin and get to know its structure.

What is Insulin?

Insulin is a polypeptide hormone secreted by Beta cells of Pancreas. Hormone is a vital substance produced in one part of the body transported through blood to act on the same or another part to alter (either increase or decrease) its functional activity. Peptide means a protein molecule made up of amino acids, the building blocks of proteins. Polypeptide indicates that it is made up of more than one peptides (see below).

3D structure of Insulin (image - BeautifulProteins)

How is Insulin produced in the body?

Insulin is a protein. Proteins are produced by protein synthesis. The process of protein synthesis is a complex one and involves multiple stages and subprocesses. After receiving an appropriate stimulus like increased glucose in blood, its synthesis begins.

Significant steps in this process are -

Copying the specific genetic (code) sequence from DNA -- Transcription
Translating the genetic sequence into large protein molecules - Translation
Breaking down the large protein into different molecules, structural changes other fine tuning - Post-translational modifications

All the following steps take place in Beta cells of Pancreas. After translation a protein called PreProInsulin is formed which gets converted into ProInsulin and then finally to Insulin. During this conversion (occurring in the 3rd stage), multiple other proteins are produced. These protein molecules are used to differentiate between endogenous and externally supplied Insulin.
ex. Protein-C.

Human vs Animal Insulin

Human Insulin is made up of 51 amino acids. The closest variety resembling Human form are Bovine and Porcine Insulins. Bovine has 3 different amino acids while porcine has just 1 different amino acid as compared to Human Insulin. Previously Animal Insulins were used because they were cheaper and more easily available. But they cause serious allergic and hypersentivity reactions. With the use of Recombinant Technology, Animal ones have been replaced or are being replaced with Human Recombinant Insulin with almost negligible hypersensitvity reactions due to its highly purified nature.

What is Prediabetes? Risk factors and Prevention

noreply@blogger.com (Dr Pushkar) — Thu, 23 Aug 2012 13:17:00 +0000

We will discuss - What is Prediabetes? Who is at risk, how to prevent Prediabetes?

What is Prediabetes?

Prediabetes - As the name suggests, Prediabetes is a stage prior to full blown onset of Diabetes. It is based on the glucose levels in the blood. When blood glucose, tested by Fasting Plasma Glucose or Oral Glucose Tolerance Test are found to be higher than normal but below Diabetes levels, the condition is called Prediabetes. This term is synonymous with Impaired Glucose Tolerance (IGT), but now preferred over IGT for easy understanding.

Prediabetes - Facts

According to CDC,

79 million Americans suffer from Prediabetes
1 in 2 Elderly people ( age > 65) have Prediabetes
35% of adults (age>20) have Pre-diabetes
Only 7% of Pre-diabetics are aware about it.
30-50% of Pre-diabetics develop type 2 Diabetes in 5 yrs
Pre-diabetics are 5-15 times more likely to develop Diabetes

Who is at Risk of Prediabetes ?

Age more than 45 yrs
Overweight
Have a parent with Diabetes
Brother or sibling with Diabetes
Delivered a large baby or had gestational diabetes i.e. diabetes during pregnancy
Have a sedentary lifestyle
Eating junk food, western diet/processed food, food with poor quality fats.
Having an African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander racial or ethnic background.
Chronic smokers or chain smokers are at increased risk of Diabetes.

Simple measures to prevent Prediabetes :-

Regular Physical activity and weight loss is said to prevent or delay development of Diabetes in 58% people.
Modest (5-7%) weight loss is effective for prevention.
Exercising / Brisk Walking for two and half hours a week (150 min per week) can help prevent its progression.
Eating healthier food like fibres (fruits and veg), low amount of fats in diet, grains like Oat etc.
De-stress periodically.
Quit Smoking, it helps not only in Diabetes but all lifestyle disorders and cancers.

Those with Prediabetes must repeat Blood Glucose testing after 6 months. The measures listed above also help in prevention of other diseases like Hypertension, Heart Diseases, Stroke etc.

Top 10 Positive Things about Diabetes

noreply@blogger.com (Dr Pushkar) — Sun, 19 Aug 2012 06:13:00 +0000

Diabetes is not all gloom and doom. There are some positive things about Diabetes. Knowing them helps one cope better. Obviously there are many health related positives like weight loss, regular diet, but there is more to it than just health. Let's look at some key takeaways about Diabetes.

Diabetes can benefit all including you, your family and your community or a social circle.

Top 10 positive things about Diabetes :-

1) Dietary habits get disciplined :- It's not in human nature to control the desire to eat favourite junk foods. Diabetes forces this discipline upon you. Although reluctantly, everyone will accept that its a good habit and they always felt the need for it.

A Happy Diabetic

2) Weight loss :- As a Diabetic,1st advice you will get from all is to control your sugar levels. And 2nd is to lose weight.Therefore most Diabetics focus the most on these 2 things and they actually do very well after following this advice. It's a major benefit considering the positives it brings to your health profile. It reduces risk of acquiring other major illnesses. Overall fitness level too goes up.

3) Special food demands :- There is a palpable change in food habits after Diabetes. You get more say in the daily diet plan and it is often cooked after consulting you. Hence the prospects of getting your favourites improve.

4) Improved cooking skills :- Diabetes imposes several restrictions on many daily food items. Hence, it forces the homemaker to think out of the box, innovate. They later go on to make some great new recipes that are healthier and more delicious. One would not get to taste those recipes otherwise.

5) Family health improves :- While you get more say in daily diet, your prescribed food is served to the entire family. Diabetic diet being lighter and healthier benefits everybody. As the awareness about Diabetes increases, other members too adopt healthier lifestyles.

6) Regular health check-ups :- Health when normal is the most neglected part of life. Few people really appreciate their good health. Most take it for granted. They realize its value only when something goes wrong. This along with high expenses keeps majority away from regular health check-ups. After Diabetes, the frequency of health visits increase. This helps in early diagnosis and proper treatment of other disorders.

7) Fear of needles decreases :- Diabetics (especially those with type I) are forced to take Subcutaneous Insulin injections multiple times daily. Frequent blood glucose testing also involve needle pricks. Initially its a big hassle. Everyone hates it but after a few days people get accustomed to it. Thereafter their fear about needle pricks and injections decreases substantially.

8) Helps understand people :- Diabetes, these days is one of the best conversation starters. It gets people going. Diabetics get a point to make while Non-Diabetics find it intriguing. It piques their interest to know how you are managing it. These conversations later on turn into friendly chat and thus the social circle expands.

9) Become motivated in life :- Adversity always brings the best out of people. Thoughts about Diabetes cripples people at first. Later people learn about it. They accept it as a challenge and get motivated to deal with it.

10) Promotes Social Harmony :- In daily life, normal health brings numerous advantages that people take it for granted. After people get diagnosed with diabetes, they feel humbled. Their attitude towards the disabled, handicapped and not so lucky ones change. Their sensitivity towards social issues increases. They become more empathetic and develop an urge to do more.

Next time someone tells you Diabetes is really bad, shoot this mail at 'em....

Diabetic Complications | 6 Major Complications of Diabetes

noreply@blogger.com (Dr Pushkar) — Wed, 15 Aug 2012 05:17:00 +0000

Complications of Diabetes Mellitus are serious and well known. Spectrum of Diabetic complications is vast, from being most trivial to life threatening. Long term Diabetics are at very high risk of complications if they lack blood sugar control (more likely) and sometimes even otherwise (less likely). High BP and Cholesterol are the other two major harbingers. Inevitably Diabetics fall prey to its complications after several long yrs. According to WHO, Diabetes is predicted to become the seventh leading cause of death in the world by the year 2030.Total deaths from diabetes are projected to rise by more than 50% in the next 10 years. Hence its very essential to have proper understanding and accurate knowledge of when to seek medical intervention. Specifically those who have co-existing diseases like Hypertension, Thyroid disorders or Heart diseases or Kidney problems are at increased risk and should exercise extreme caution and follow the medical advice diligently.

Major Complications of Diabetes Mellitus

Heart Disease

It is a common complication of DM and in most cases inevitable in the end. It is #1 cause of death in Diabetics. Cardiovascular disease is responsible for between 50% and 80% of deaths in people with diabetes. Among the Heart diseases, most common is Ischemic Heart Disease also referred to as Coronary Artery Disease. It includes terms like Angina Pectoris, Myocardial Infarction. Colloquial term in use is “heart attack”. Other heart diseases that can occur are Hypertension, Cardiomyopathy, Valvular Heart Diseases etc. Many of us have heard about people suffering or dying on account of a heart attack. It occurs due to deposition of fat rich substances called plaques in the major arteries supplying the heart, causing blockages and irregular supply of blood to the heart. This results in decreased capacity of heart to pump blood to the entire body. Due to gradually increasing workload there is Heart failure and the pumping capacity falls substantially resulting in damage to vital organs like Brain, Kidney, Muscles etc. Person loses his ability to exercise and any effort results in severe chest pain, difficulty in breathing (dyspnea) and sometimes syncope or even frank stroke and paralysis. This process ends up in a multi-organ failure and eventually death.

Stroke / Cerebrovascular episode

Diabetes exposes an individual to sudden stroke on account of 2 reasons – one as described above due to heart failing to pump and other due to blockage of vessels that supply blood to brain. This can lead to a variety of manifestations from difficulty in speech to tongue / mouth deviation, headache, sensory loss and frank paralysis. Neurologic symptoms like paralysis may or may not recover completely.

Diabetic Retinopathy / Eye Disorders
Diabetes is one of the leading causes of blindness worldwide. Long term diabetics suffer from chronic damage to micro-circulation of the eyes and thereafter re-development, both cause decrease in vision and other visual problems like pain, increased eye pressure, flashes, lens damage etc. This spectrum of changes is known as Diabetic Retinopathy. Diabetes can also cause other eye disorders like Cataract, Glaucoma etc.

Diabetic Neuropathy
Also known as Peripheral neuropathy. DM after several years begins to affect peripheral nerves and causes decreased sensation. It usually starts from foot and gradually involves nerves of legs, arms and other parts of the body. This can lead to severe inability to perform daily activities. Frequent slipping of the footwear while walking is an early indicator of loss of sensation to toes and foot.

Diabetic Nephropathy / Chronic renal failure (CRF)
Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008.
Diabetes causes chronic damage to kidney. It causes deposition of certain substances in filtration apparatus of Kidney which decrease its capacity to filter the blood and excrete toxic substances. In addition, Kidney has a vital role in maintaining the fluid and electrolyte balance. Decreased kidney function causes abnormalities in fluid and electrolyte balance and subsequent acidotic state and sodium, potassium and calcium imbalances occur. These electrolytes are required for proper functioning of Heart, respiration, overall nutrition and many other important body processes. Accumulated toxic substances damage other organs like Brain, Liver, Heart and Kidney itself causing slow progression of disease and eventually the filtering stops and Kidney function ceases. This leads to end-stage renal disease (ESRD), dialysis and eventually death.

Peripheral Arterial Disease (PAD)

Overtime the peripheral vessels of the body like those supplying blood to arms and legs also suffer damage and subsequently develop blockages. This gradual decrease causes no or little symptoms initially but after prolonged period, it leads to pain on walking short distance, intermittent claudication. Gradually, Pain keeps on increasing and walk able distance keeps on decreasing thereafter gangrene of the limb ensues. Gangrenous parts need to be amputated or it may spread to healthy tissues.

Apart from those 6 common complications, diabetes causes several other serious and non serious complications like fungal infections, skin disorders, decreased immune function etc..
These will be discussed later. We will also learn how to prevent these complications, so stay tuned.

Source :- CDC, WHO

Diabetes type 2 - Risk factors, Prevention

noreply@blogger.com (Dr Pushkar) — Mon, 13 Aug 2012 07:13:00 +0000

Type 2 diabetes is much more common than Type 1 Diabetes. It is relatively well known. Type 2 Diabetes accounts for nearly 90-95% of cases of Diabetes Mellitus (DM). It affects both men and women with slight bias towards elderly males. Criteria for diagnosis includes blood sugar testing and measuring HBA1c levels.

Age of onset :- Type 2 DM is a disease primarily affecting middle aged and elderly people. As per ADA (American Diabetes Association), as much as 27% of elderly individuals (age >65) are affected with Diabetes. But recently a rising trend has been observed in younger population especially among Obese Adolescents.

Risk Factors :- Certain factors are associated with heightened risk of diabetes. Prominent amongst them are

Smoking
Obesity
Sedentary Lifestyle
Hyper-Cholesterolemia
High Blood Pressure
Family History
Older Age
Race/Ethnicity

Other minor ones include PCOS - Polycystic Ovarian Syndrome (in elderly women), Gestational diabetes (pregnant women) etc.

Pathogenesis/Mechanism :-

Type II DM develops due to 2 main pathologies (both may co exist) -

Beta Cell Destruction - Insulin producing cells get damaged hence insulin secretion is lower than normal and hence sugar levels remain high.
Insulin Resistance - Insulin levels are Normal or high, but body cannot utilize Insulin due to either defect in Insulin itself or in Cellular Receptors that bind Insulin.

Signs and Symptoms
We have discussed signs and symptoms in detail before.They are more or less same as in type 1 diabetes. Increased thirst, hunger, frequency of urination, tingling and numbness of feet, decreased vision, skin rashes etc are the common ones.

Prevention :-
This where a major difference lies between Type I and Type II Diabetes. Thankfully type II Diabetes is much more preventable than is type I. Prevention of emergence of risk factors is the key, it is an example of Primordial Prevention. Those with a family history must take extra care and undergo periodic Blood Sugar, BP and Cholesterol checks after age of 35.

Important preventive measures include -

Healthy diet - reduction of fat and addition of fibres
Regular BP, Blood Glucose and Blood Cholesterol checks.
Mild to moderate exercise.
Weight loss
Periodic relaxation to avoid stress.

Small changes at macro level (community/population) can make a substantial difference to the outcome. Ex.-

Small modifications in family diet can benefit everyone in the family.
Developing a habit of regular exercise in school and college students is an excellent strategy to counter its emergence in adolescents.
Elderly support groups can teach each other the aspects of effective sugar and BP control, likewise women can share their tips to make healthier and tastier food. These small measures can substantially help in reducing the overall disease burden.

Treatment :-
Type 1 patients are exclusively dependent on Insulin while this is not the case with type 2 diabetics. Oral hypoglycemic drugs are the ones prescribed to most patients, though later on Insulin may be required to maintain the sugar control. Diabetics are advised to maintain their meal patterns and regular medications to avoid fluctuations in sugar levels. Surgical procedures if required are carried out under Insulin cover and then reverted to routine drugs.

Complete treatment of Diabetes Mellitus

We will discuss about the very important complications of diabetes in the next post. Stay tuned.

Type 1 Diabetes Mellitus | Insulin dependent Diabetes Mellitus

noreply@blogger.com (Dr Pushkar) — Thu, 09 Aug 2012 08:25:00 +0000

Diabetes Mellitus is of 2 types - Type 1 Diabetes and Type 2 Diabetes. Whenever people talk about Diabetes in common parlance, almost every time they intend to speak about type 2 Diabetes because Type 2 Diabetes is much more common and known to people, than is type 1. Both have very different causes and treatment plans, prevention aspects also vary significantly. So its essential to understand the difference between the two.

Type 1 Diabetes and its monikers -

Early onset Diabetes Mellitus / Juvenile onset Diabetes Mellitus
Insulin dependent Diabetes Mellitus (IDDM)
Auto immune Diabetes mellitus

How do you get Diabetes type 1 ?

Most people believe Diabetes can only be due to lack of exercise, unhealthy eating or by putting on weight. No! None of it causes Type 1 Diabetes. Its actually caused by a combination of genetics and unknown environmental factors. Their is a genetic derangement, which when triggered by some unknown environmental factors or agents, cause autoimmune destruction of insulin producing Beta cells of pancreas. As a result insulin production goes on decreasing & Diabetes symptoms appear when more than 70-80% of cells are destroyed. This also explains the variable age of onset, as the time taken to reach that level of destruction varies from person to person. But it happens much earlier than type 2 Diabetes, hence most people get type 1 Diabetes in childhood or early adulthood. Hence the term Early onset Diabetes Mellitus.

Type 1 Diabetes (figures vary on individual basis)

What symptoms and signs does it show?

Here are the detailed signs and symptoms of diabetes. In type 1 DM, classical triad of polydipsia (increased thirst), polyphagia (incresed hunger) & polyuria (frequent urination) is usually present. Additionally,in Type 1 DM, due to severe lack of insulin, sugar levels can rise to very high levels, which may cause a serious condition called Diabetic Ketoacidosis ( DKA) resulting in severe dehydration and even coma. Hypoglycemic symptoms like mental confusion, extreme fatigue, loss of consciousness may also occur on insulin overuse and inappropriate dietary habits. Also, Insulin is a major hormone participating in the growth and development of the body. Hence if their is very early onset (in early childhood), growth retardation may also occur. Type 1 DM is diagnosed on basis of sugar levels in blood (oral glucose tolerance test) and urine. Also, ketone levels are important if DKA is suspected.

What is treatment of type 1 DM ?

Simple! There is lack of insulin in body, hence what we should do is supplement it from our side. Blood Glucose levels must be checked regularly to adjust and stabilise Insulin requirement and avoid hyper or hypoglcemia. In addition, regular eye check-ups are advised due to fear of Diabetic retinopathy.

Prevention is unfortunately not an option currently but researchers are actively trying to find a vaccine against type 1 DM.

What complications can occur due to type 1 DM?

Diabetic Ketoacidosis is the most serious and feared complication. Others major ones are Retinal damage (Diabetic Retinopathy) , Damage to Peripheral Nerves and Blood vessels (Peripheral Neuropathy), Heart Disease and Stroke. Apart from these major ones, other minors include skin rashes, poor wound healing, gastric symptoms etc. We will cover them in detail in future posts.

We will be glad to answer any queries that you may have. Remember to share this info with your online friends and family.

What are the types of Cancers? | 10 most common types of Cancers

noreply@blogger.com (Dr Pushkar) — Sun, 19 Feb 2012 17:19:00 +0000

Different types of Cancers

Cancer is a very broad topic. It involves numerous types all of which have extremely diverse causes, signs and symptoms, pathological features & require specific investigations and treatment. We will discuss about the 10 most common types of cancers based on their prevalence worldwide. Along with it, the important subtypes that form the vast majority of cases.

Cancer involves almost all organs and tissues, hence cancer typing is based on the specific organ it affects. ex. Lung Cancer, Prostate Cancer, Skin Cancer, etc.
Further subtyping is done according to the cell line which is defective. ex Small cell cancer, B cell Lymphoma, Granulosa cell tumor, Germ cell tumor, etc.

10 most common types of cancers and their subtypes:-

We have moved the cancer section of this site to our new blog - Please find this article here:-
Tumors | Cancers

Treatment for Diabetes Mellitus

noreply@blogger.com (Dr Pushkar) — Thu, 16 Feb 2012 13:02:00 +0000

Early diagnosis of Diabetes Mellitus and its treatment is very important. Typically the course of diabetes is chronic but without early treatment, chances of developing complications early is significant. Diabetes treatment is a lifetime affair but if managed and followed well, there is little or no deterioration in the quality of life for a long period.

Principles of treatment of Diabetes Mellitus :-
1) Control of hyperglycemia and related symptoms.
2) Reduce or eliminate the complications
3) Allow the patient to achieve a normal lifestyle.

Following methods are used in treatment :-
a) Diabetes education :- Person with diabetes should be educated about various signs and symptoms, self glucose monitoring, insulin self-injection, skin and foot care and hypoglycemic episodes.

b) Exercise :- Exercise forms an important part of prevention and treatment not only in Diabetes but also in other lifestyle related diseases like obesity, hypertension, stroke and other heart diseases. ADA recommends a min of 150min/week of exercise distributed over a period of at least 3 days. But it is important to monitor glucose before, during and after exercise. In case glucose level is high exercise should be delayed and if its low sugar based drink should be taken. Insulin doses should be reduced and its injections should be avoided in the exercising part.

c) Diabetes diet :- Optimal caloric intake coordinated with other aspects of Diabetes therapy is known as medical nutrition therapy. Following a proper diet plan is vital.

(click to enlarge)

d)Medications :- Type 1 Diabetes Mellitus patients are exclusively dependent on insulin. Appropriate insulin regimens including combinations of long and short acting insulin are devised considering the patient's glycemic control and the dietary pattern. Type 2 diabetes patients require insulin only during acute episodes or mostly after a long period 10-15 yrs. So glucose lowering agents form the mainstay of the therapy. These drugs act either by reducing glucose production or by increasing its absorption via increase in insulin secretion or other mechanisms. One important thing about these drugs and insulin is that there is always a risk of having hypoglycemia. Especially when drug intake pattern or dietary pattern gets changed hence random changes in drugs or diet should be avoided as far as possible. We will discuss about the specifics of medications in subsequent posts.

e) Psychosocial aspect :- Given the profound impact of diabetes on life, it is very important. Persons having diabetes should understand that they are important members of the team. Achieving normoglycemia can be difficult or there may be deterioration in medical condition without any cause. Emotional stress can worsen the symptoms. Also eating disorders are relatively common in individuals with Diabetes.

We will discuss about the complications, their treatment and follow up/ongoing medical care in patients of Diabetes subsequently.

Meanwhile send us your views and queries, help others by sharing and tweeting this important information.

Diagnosis of Diabetes | Criteria for Diabetes

noreply@blogger.com (Dr Pushkar) — Tue, 14 Feb 2012 13:44:00 +0000

Diagnosis of Diabetes Mellitus is based on testing of Glucose tolerance. Degree of glucose tolerance is determined by a fixed criteria. Based upon the degree of tolerance, results are grouped as normal glucose homeostasis, impaired glucose homeostasis or Diabetes Mellitus. Impaired glucose hemostasis is a condition also popularly known as Pre-Diabetes, Impaired Fasting Glucose IFG, Intermediate Hyperglycemia (WHO). The tests have to be often repeated once or twice to confirm the diagnosis as the disease has profound implications on future lifestyle of the patient.

Who should be be tested? Screening is recommended in following conditions.

Obese or overweight individuals
Those having positive family history or have siblings with Diabetes.
Persons with Hypertension (>140/90)or other cardiovascular conditions
Individuals known to have high triglycerides (> 250 mg/dL (2.82 mmol/L)) or low HDL cholesterol level < 35 mg/dL (0.90 mmol/L).
Those having repeated infections, wounds healing poorly or dental conditions.
Any other medical or genetic conditions known to be associated with Diabetes.
Women suffering from Polycystic ovarian syndrome (PCOS) or those who have given birth to a large baby. (wt > 4kg/9lb)
Based on ethnicity (African American, Latino, Native American, Asian American, Pacific Islander).

Glucose tolerance can be tested in 3 ways :-

Fasting plasma glucose (FPG) - Person should not have taken food or drink in the past 8 hours.
Oral Glucose tolerance test - Person is tested twice for plasma glucose levels - fasting (as above) & post prandial (2 hrs after a glucose containing meal or a beverage)
Random plasma glucose - Also known as casual plasma glucose test as it is done as when needed.

Glycated hemoglobin (HBA1C) test - This test measures the glycemic control of the person over the past 8 weeks & hence gives a complete picture about glycemic levels over a sustained period. It is also helpful in known diabetics to test the effectiveness of medications.

Diagnostic Criteria :-

Abnormal glucose homeostasis is defined as :-

a) FPG = 5.6–6.9 mmol/L (100–125 mg/dL), which is defined as IFG.
World Health Organization uses an FPG of 6.1–6.9 mmol/L(110–125 mg/dL)

b) Plasma glucose levels between 7.8 and 11 mmol/L (140 and 199 mg/dL) following an oral glucose challenge.

Further we will discuss about the treatment of diabetes. If you like this post please share it with your friends on facebook, twitter or other platforms with buttons given below.

The Causes of Cancer

noreply@blogger.com (Dr Pushkar) — Mon, 13 Feb 2012 14:46:00 +0000

After knowing the basics about cancer, lets move on to the main causes of cancer. What are the main reasons behind such uncontrolled proliferation of cells? Normally division of cells is under control of various genes which are known as tumor suppressor genes. There are also other counterparts which promote cell proliferation known as Proto-oncogenes. But both those processes are well regulated and there are multiple checks which prevent or repair the damage. Hence for cancer to occur there has to be some defect in either Tumor Suppressor Genes or Proto-Oncogenes.

Causes of Cancer

We have moved the cancer section of this site to our new blog - Please find this article here at

Tumors | Cancers

What is Cancer ?

noreply@blogger.com (Dr Pushkar) — Mon, 13 Feb 2012 08:34:00 +0000

Skin Cancer (credit :about-child.com)

What is Cancer? Cancer is like a modern day pandemic. Pandemic is a type of epidemic which transcends continents. There are innumerable types of cancers. Lack of knowledge about cancer is a major problem. Early diagnosis and treatment is of paramount importance and can make a difference between life and death. Through this series of posts about cancer, we intend to provide our users with all the information they need to understand prevent cancer.

We have moved the cancer section of this site to our new blog - Please find this article here at

Tumors | Cancers

Signs and Symptoms of Diabetes Mellitus

noreply@blogger.com (Dr Pushkar) — Sun, 12 Feb 2012 08:23:00 +0000

We discussed in our previous post about what exactly is Diabetes? So now lets discuss what are the main signs and symptoms of Diabetes Mellitus. How does it manifest? We know it causes derangement in sugar levels of the body. Sugar, principally Glucose is the main source of energy for our body. But both increased glucose (Hyperglycemia) and decreased glucose (Hypoglycemia) levels in blood are harmful to many organs. In Diabetes, lack of insulin causes hyperglycemia responsible for most of the signs and symptoms. Hypoglycemia occurs in Diabetics due to medications and inappropriate dietary habits.

Signs and Symptoms of Diabetes Mellitus :-

Signs and Symptoms of Diabetes Mellitus

Frequent urination :- Water retention is an important function of Kidney. Water retention is co-related with the absorption of glucose and sodium. In Diabetes there is excess Glucose excretion in urine, condition termed as Glycosuria. Hence there is also excess excretion of water, resulting in increased urine output known as Polyuria.
Increased thirst :- Naturally as there is increased water loss, there is increased requirement for water consumption to avoid dehydration. It is known as Polydipsia.
Extreme hunger :- Insulin redistributes glucose from blood to the tissues. Hence in Diabetes there is decreased availability of glucose to cells and tissues as most of the glucose is present in blood. Other neural mechanisms are responsible for hunger. This increased appetite is known as Polyphagia.

Polyuria, Polydispsia and Polyphagia are classical symptoms of Diabetes Mellitus.

Other signs and symptoms are as follows :-

Blurred or distorted vision - Sudden change in vision
Infections - Frequent acute infections occur. These may precipitate complications.
Skin changes - Skin becomes dry or waxy. Variety of skin rashes & ulcers occur in diabetics.
Poor wound healing - Frustrating pace of healing causes significant morbidity.
Sensory changes - Decreased sensation or feeling of numbness or tingling may occur in hands & feet.
Improper Breathing - Kussmaul's Breathing (seen in complications of diabetes).
Weight changes - Type I patients experience weight loss while type II patients are obese.

Other non specific symptoms like lethargy, gastric symptoms like nausea, vomiting etc may also occur sometimes. Most diabetics also have co-existing entities like Hypertension, Thyroid Disorders etc.

It is important to note that many diabetics (especially type II patients) have prolonged symptom free periods as we said before. Symptom free periods correlate with good control over blood glucose level and proper diet. Hence these two things form an important part of therapy.

In subsequent posts we will discuss more about diagnosis (criteria for diagnosis), treatment and complications of Diabetes. Stay tuned for in depth information about Diabetes. Tell us what you would like to know more Diabetes. Share it with your friends and family and send us your responses and queries through comments or via email.

Hypertension - Classification & Risk Factors

noreply@blogger.com (Dr Pushkar) — Fri, 10 Feb 2012 15:52:00 +0000

Hypertension or high blood pressure is a long standing disease affecting middle aged to elderly people. It doubles the risk of having other Heart Diseases, Renal Failure and Peripheral Arterial Disease. Large proportion of people suffering from high blood pressure remain untreated. About 1 billion people today suffer from hypertension & by 2025, it is estimated every 1 in 4 people will be suffering from it. Approximately 8 million people die annually due to hypertension.

According to Pubmed, "Blood pressure (BP) is a measurement of the force against the walls of your arteries as your heart pumps blood through your body." It varies according to the state of heart, contracting or relaxing, hence it is recorded in form of 2 measurements known as systolic, when the heart is contracting and diastolic when its relaxing. Normal blood pressure is 120 systolic, 80 diastolic written as 120/80.

Hypertension can be of two types :-

Primary/Essential Hypertension :- No underlying medical cause. 90-95% cases are of this type.

Secondary Hypertension :- Secondary to other medical disorder.

Classification of Hypertension

What are the risk factors for hypertension?

There are several factors that puts one to risk. Most important of them are :-

Alcohol and Smoking - Tobacco is a very important risk factor for number of diseases most prominently for Cancer and Heart disease. Smoking more than 15 Cigarettes a day significantly increases the risk of hypertension. Surprisingly, non habitual smokers are at more risk than habitual ones. Alcohol addiction too causes number of diseases affecting multiple organs. Smoking & alcohol additive, that is risk compounds if both are present.
Sedentary Lifestyle and Stress - Modern day affluent lifestyle which does not involve much physical activity is responsible for both hypertension and diabetes. High stress levels promote hypertension through unknown mechanism, but it is responsible for multiple hormonal changes and it perhaps worsens other risk factors.
Diet - High Salt intake is the most important dietary factor but others including Vitamin D deficiency, low intake of Calcium, Potassium and Magnesium have also been implicated. High Fat intake and high blood Cholesterol promote Atherosclerosis, the pathological process responsible for Hypertension, Stroke and various other Cardiovascular complications.
Obesity - High body weight predisposes to all lifestyle diseases including Diabetes, Hypertension and other cardiovascular diseases.
Genetic and Environmental factors - Multiple complex genetic modifications cause hypertension along with other symptoms.
Drugs and other medical disorders - Many drugs like Ibuprofen, Oral Contraceptive pills, Pseudoephedrine (nasal decongestant) etc cause hypertension. Hypertension can also be secondary to medical disorders like Thyroid Disorders, Tumors, Adrenal Hormone Abnormalities, Neurological Disorders. Pregnancy can also cause hypertension known as Pregnancy Induced Hypertension (PIH).

What is Diabetes?

noreply@blogger.com (Dr Pushkar) — Thu, 09 Feb 2012 08:30:00 +0000

Sugar and Diabetes

Diabetes is the one of the most common diseases worldwide. It has a long course and stays with the patient almost all through his/her life, although many diabetic patients have prolonged symptom free periods but complete cure in most cases remains elusive. One good thing about it is if kept in control, symptom free periods can be long & patients life remains absolutely normal. To begin with diabetes, few terms need to be understood.

Diabetes - When we say Diabetes, we intend to say Diabetes Mellitus. There's another disease called Diabetes Insipidus which has a different cause and a different pathology.

Diabetes Mellitus is disease where your body (blood and urine) sugar levels get deranged (hypoglycemia and hyperglycemia) due to lack of an hormone named Insulin. Insulin also has other functions hence diabetes can present with a variety of symptoms and signs.

Pancreas - It is the organ which secretes insulin. Pancreas also secretes other hormones which help in digestion of food.

Diabetes type I or Insulin dependent Diabetes Mellitus (IDDM). As the name suggest "Insulin dependent", patient is completely dependent on external insulin because there is no or very little insulin produced by the body. This form of Diabetes is seen at early age, hence it is also known as Juvenile onset Diabetes Mellitus.

Diabetes type II or Non Insulin dependent Mellitus (NIDDM). In this type, usually patients have normal or even high levels of insulin but the function of insulin is deranged. However in later stages, there may be decrease in insulin levels as well. This type mostly presents at a later stage of life, hence also called as Late Onset Diabetes Mellitus.

There's another special variant which typically presents in pregnancy known as Gestational Diabetes Mellitus.

Enough for the theoretical part, we will continue with Diabetes series in later posts.
Here are some grave Facts about Diabetes Mellitus from credible sources like WHO, National Institute of health NIH (US) :-

Estimated cases of diabetes worldwide is 346 million.
Diabetes affects 8.3% (25.8 million) of US population.
90% of cases are of type II Diabetes Mellitus.
Deaths due to Diabetes are projected to rise 50% in next 10 years.
50% of people with diabetes die due to Cardiovascular complications (Stroke, Heart Disease...)
China is projected to lose $558 billion between 2006 & 2015 due to Diabetes and its related complications.
China has become Diabetes Capital of the world with 90 million cases (took the notorious title from India in 2011 according to IDF,International Diabetes Federation)

India specific stats:-

India has about 61.3 million cases of Diabetes.
It affects about 9% urban population & 3% of rural population.
Ernakulam, district of Kerala has highest prevalence of around 20% of population.