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One should know that type 2 DM is not only caused by beta cell dysfunction of pancreas. There are eight different organs of body involved in the pathophysiology of T2 DM.
1. Beta cells of pancreas, that they don’t produce enough insulin.
2. Alpha cells of pancreas produce disproportionately high glucagon as there is poor suppression of glucagon in the post meal phase, causing post prandial hyperglycemia.
3. Liver produces extra glucose causing high fasting blood glucose.
4. Skeletal muscles have poor uptake of glucose, which increases blood glucose.
5. Adipose tissue produces higher fatty acid.
6. Incretin hormone from intestine also show dysregulation (GLPl & GIP)
7. Kidney increase glucose reabsorption from proximal convoluted tubules
8. Brains satiety centers show dysregulation.
9. Thus, while treating a case of T2 DM, we should address all Eight Arms of, So called “Ominous Octet”.
Recorded at Akashwani Nagpur on the 30th August 2024
Anchor – Kalyani Gokhale
Speaker – Dr. Sunil Gupta -
The piece underscores the critical need for early blood sugar control to prevent long-term diabetes complications. Elevated blood sugar can harm organs such as the brain, eyes, heart, nerves and kidneys etc. With 20-30% of adults developing diabetes in a very young age, it is essential to manage blood sugar early to avoid the formation of Advanced Glycation End products (AGEs), which can Cause chronic complications of diabetes. Maintaining healthy blood sugar levels, cholesterol, and blood pressure heathy diet, exercise, managing stress, taking good sleep, and avoiding smoking and alcohol, is crucial. The "Hello Diabetes" campaign promotes primary and primordial prevention, encouraging healthy habits in children and pregnant women to reduce future risk of diabetes.
Follow key management recommendations of “ABCDEFGH” formula:
● A: To Keep A1C levels under 7%.
● B: To Maintain Blood Pressure less than 130/80 mm of Hg .
● C: Control LDL Cholesterol below 100 mg/dl and aim to bring is below 70 mg/dl
● D: Follow a Healthy Diet.
● E: Exercise for ~ 250 minutes per week.
● F: Frequent blood glucose monitoring.
● G: Engage in Good quality education programs.
● H: Stay Happy always.
Recorded at Akashwani Nagpur on the 9th August 2024.
Expert: Dr. Sunil Gupta
Anchor:
Producer: Vijay Rajput -
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Management of Diabetes is like a table supported by four essential pillars: Diet, Exercise,
Medications, and Monitoring, but this table is incomplete without a table top which is
“Education”.
Of these four pillars one of them is glucose monitoring which plays a critical role,
typically done through three methods:
1. Glucometers: Capillary blood glucose monitoring involves using a glucometer for precise
measurements, which can differ slightly from venous blood levels. Evert PWD’s should
learn Self-Monitoring of Blood Glucose (SMBG), this requires individuals to use a
glucometer at home for informed insulin dosage decisions.
2. HbA1c Monitoring: Measures long-term glucose levels, with an ideal level below 5.7% for
non-diabetics.
3. Continuous Glucose Monitoring System (CGMS): Emerging technologies in glucose
monitoring include interstitial glucose monitoring with sensors that provide real-time
data for up to 15 days, allowing for better management of blood sugar spikes. Invasive
methods, such as implantable sensors and non innovative devices like
glucose-monitoring watches and contact lenses, promise to enhance convenience in
diabetes management in future.
Dietary considerations are significant, especially regarding the glycemic index (GI) of foods like rice, which affects blood glucose levels. Consulting a dietitian for portion sizes tailored to individual needs is recommended.
Recorded at Akashwani Nagpur on the 26th July 2024.
Expert: Dr. Sunil Gupta
Anchor: Swati Huddar
Producer: Vijay Rajput -
Everyone should be aware of the fact that “Diabetes increases the infection and infection increases the diabetes. Thus, both need intensive management strategies simultaneously. People with Diabetes must take special care of themselves, just like we care for our family members. Diabetes can be thought of as a child with slightly lower immunity, especially during the rainy season when the risk of infections—whether bacterial, fungal, or viral—rises significantly. To manage diabetes effectively during any active infection Basal Bolus Insulin Therapy is one of the best treatment regimens. Basal insulin provides steady, consistent insulin whether food is consumed or not, while bolus Insulin helps to manage blood sugar levels after eating. Despite common myths, insulin is a safe and powerful treatment, often outperforming oral medications. During the monsoon, primary prevention is key—maintaining hygiene and avoiding outside junk or processed foods is crucial. Even minor symptoms like fever, cold, or cough should prompt immediate consultation with a doctor, as small infections can quickly escalate into serious conditions. Proper blood glucose management is essential for infection prevention, and adult vaccination, including the pneumococcal, influenza, hepatitis B, and herpes zoster vaccines, plays a vital role in safeguarding people with diabetes' health.
Recorded: Akashvani Nagpur
Anchor - Swati Huddar
Speaker - Dr. Sunil Gupta
Producer: Vijay Rajput -
This podcast was being broadcasted live from the venue Hotel of Hello Diabetes
Academia 2024 at Ramdaspeth, Nagpur featuring insights from Dr. V. Mohan (Padma
Shri), Dr. Shashank Joshi (Padma Shri), Dr. Vijay Vishwanathan, and Dr. Sunil Gupta.
Diabetes management is a costly endeavor, and the financial burden increases
significantly with complications affecting vital organs like the kidneys, heart, brain, liver,
and nerves. These complications can also place a heavy strain on families and may lead
to severe outcomes, including death. Therefore, Dr. Vijay Vishwanathan emphasized the
importance of focusing on prevention rather than solely addressing complications. This
involves both primary prevention to avert the onset of diabetes and secondary
prevention to manage complications if diabetes is already present.
Dr. V. Mohan highlighted that while medicine contributes only 10% to diabetes
management, education and awareness play a crucial role, accounting for 80-90%.
Effective management involves adhering to the ABC mantras—HbA1c, Blood Pressure,
and Cholesterol—and maintaining discipline through diet, exercise, and lifestyle
adjustments.
Dr. Shashank Joshi advocated for a healthy lifestyle, including regular physical activity,
adequate sleep, and mindful eating, to prevent and manage diabetes. He also points out
the importance of addressing asymptomatic complications and managing sugar
cravings through consistent lifestyle changes.
Dr. Sunil Gupta emphasized upon getting connected to people at large through such
education programs. “People who knows the most... Live longest” he added the quote of
Prof. Elliott Joslin who is known as the father of Diabetes in the World.
Speaker: Dr. V. Mohan, Dr. Shashank Joshi, Dr. Vijay Vishwanathan and Dr. Sunil Gupta
Anchor: Purva Kulkarni
Producer: Vijay Rajput -
While there are many varieties of salt available, it’s crucial to focus on how much we consume, especially for those with high blood pressure or kidney issues, who should limit their intake to about 3 grams daily. Although all salts contain similar sodium and potassium levels, rock salt offers additional micronutrients, making it a healthier option when used in moderation.
Frozen shoulder is another concern, particularly for people with uncontrolled diabetes, as it restricts shoulder movement and causes significant pain. Physiotherapy, often required for 3-4 months, is the best treatment and should be applied to both shoulders to prevent recurrence, highlighting the importance of blood sugar management and avoiding painkillers.
During the monsoon season, it's essential to choose healthier foods, such as green tea, steamed vegetables, fiber-rich foods, and soups, rather than high-calorie fried items. The lockdown period showed that those who maintained good diabetes control experienced fewer complications, underscoring that diabetes itself isn’t harmful—it's the lack of discipline and neglect in managing health that poses risks. With proper care and consistent healthy, dietary and lifestyle habits, managing diabetes effectively becomes more achievable.
Recorded on 28/06/2024 -
Snoring is often being mistaken for a deep sleep, but it is not true. Snoring can be a sign of Obstructive Sleep Apnea (OSA), which is a risk factor for diabetes, hypertension, cardiovascular disease, obesity, infertility perioperative complications etc. Adequate sound sleep of 6-8 hours is essential for a good health. Uncontrolled blood sugar & blood pressure in people with diabetes with OSA can automatically be managed to a large extent with the adequate treatment of OSA. Lifestyle modification, regular exercise, weight reduction and the use of C-PAD plays a key role in the management of OSA and Diabetes.
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People at large know, that alcohol causes liver damage and few are also aware of having liver injury due to viral infection (Hepatitis / Jaundice). But, very few people know that 50 to 70% of People with Type 2 Diabetes can develop fatty liver due to uncontrolled blood glucose and / or obesity. Unfortunately, few of them may progress to cirrhosis of liver, and rarely Hepatocellular Carcinoma (Cancer of Liver)
Long- standing uncontrolled diabetes increases the risk of small and large vessel diseases involving kidney, eyes, nerves, heart brain & feet. But, do you know that people with Pre- diabetes have higher chances of developing macro vascular (big vessel) disease. So, life style modification is the key to success. Alcohol and tobacco in any form should be stopped completely. Finally, To protect your Liver heart, kidney, eyes and other organs keep your blood sugar, cholesterol, blood pressure, and weight under control. Recorded 26/04/2024. -
Summer has Started. All of us will be planning to travel to some places. People with Diabetes should practice smart travelling. Some precautions should be taken, when you are travelling with Diabetes. While Travelling, always carry extra medicines, your Diabetes Identity Card, Glucometer, Ketone strips, healthy snacks & the most important is to visit your Doctor, get your all necessary tests done and take consent of your Doctor for the safe travelling. Regularly monitor your blood glucose even when you are travelling, Check for Hypoglycemia Carry Sports Shoes, Copy of your medical File, drugs for first aid care etc. Keep your medicines in the handbag. Insulin should not be kept in checked in luggage while travelling by air. Similarly during car travel avoid storing insulin in glove box, as the engine temperature, might affect the quality of insulin. Similarly, avoid exposure of insulin to direct sunlight. Simple precautions will help you to enjoy the safe travel. Recorded on 12.04.2024.
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Holi, the festival of colours can surely be enjoyed by people with diabetes with mindful eating, good glycaemic control and portion control. Diabetes should be managed with 7 basic colors of Holi. First color is Diet, as almost all cases of prediabetes and many cases of diabetes can be managed with diet therapy alone. The second color is Exercise, ie brisk walk daily for 30-40 minutes or 150 minutes per week. Third color is the oral glucose lowering drugs to control blood glucose and can be used as single drug or combination of two or more drugs. Fourth color is the Insulin, when oral drugs alone fail to control diabetes in people with long duration of diabetes, insulin therapy is used in combination with oral drugs to manage blood glucose of people with Type 2 diabetes. Fifth color is the yoga or any meditation to control stress. 6th color is regular monitoring of blood glucose to keep check on your daily glycemic profile. The most important 7th color is the awareness on the evidence based knowledge to live happy colourful & a healthy life with diabetes. Recorded on 22nd March 2024.
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Globally 8th March is marked as the “International Women’s Day”, while in India 10th March is being recognized as National “Gestational Diabetes Mellitus (GDM) Awareness day” on the occasion of birthday of Dr. V. Seshiah (Padmashri), who has done the pioneering work in the field of pregnancy diabetes in our country.
High blood glucose in mother during pregnancy enters into foetal circulation which stimulates beta cells of foetus to secret insulin, causing hyperinsulinemia in the developing foetus. This increases the risk of developing non-communicable diseases like diabetes, obesity, hypertension & heart disease in their adolescent & adult life. Early detection & intense treatment of high glucose of pregnancy can save these children from developing diabetes in future, which is termed as “Primordial Prevention”. Thus every pregnant woman should be screened for diabetes at the first antenatal visit.
Also, 50% of GDM women develop frank diabetes in 1-5 years after delivery. So, after delivery every GDM women should screen herself for diabetes after 6 weeks, 6 months and then annually to avoid future complications.
“If you educate a man, you educate a man but if you educate a woman, you educate the generations,” said Dr. Gupta, on this occasion, while emphasizing upon the mission education of hello diabetes. Recorded on 8th March 2024. -
Amongst, known people with diabetes, 50% of them are women. These women are more prone to have hypertension, coronary artery disease stroke, cancer etc., versus non-diabetic women of the same age. Most of the young women with diabetes can get married and get conceived with proper care of blood glucose, blood pressure, cholesterol & weight. But preconception counselling is must and they should visit their diabetologist before getting conceived to take fitness for pregnancy.
According to the ICMR data, published in Lancet Journal (2023), 101 million people have diabetes and approximately 140 million have pre-diabetes in India. Almost 50% of these people with pre-diabetes are likely to develop diabetes in next 5-10 years. Thus, it is important for all of us to focus on prevention strategies for this group of people. Recorded on 23rd February 2024. -
Traditionally, it is presumed that diabetes, if seen in children and young adults will expectedly a case of Type 1 Diabetes Mellitus (Insulin Dependent Diabetes Mellitus), while those who develop in middle and old age will be Type 2 Diabetes Mellitus. But nowadays, many people are developing Type 2 DM between 20-35 years of age, and due to childhood obesity, Type 2 DM is also seen in the teenagers. There is another type, which is called as 1.5 diabetes, this is a slowly progressing disease, which behaves as Type 2 DM in the beginning but becomes Type 1 Diabetes Mellitus after 1-2 years and they have GAD-65 Antibody positive. It is also called as LADA (Latent Autoimmune Diabetes in Adult or slow onset Type 1 DM). Serum C-peptide levels, GAD-65 antibody and clinical features that can differentiate Type 1 DM v/s Type 2 DM, when present in young age. Recorded on the 12th January 2024
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Sitting is a new Tobacco. If you are sitting for a long time, you are likely to enter into a high risk zone of developing diabetes & other co-morbid diseases. So try to be physically active & if you are in a sitting job, try to get-up and move after every 1 hour. To check whether you are diabetic or not, get your Glycosylated Haemoglobin A1c (GHb%) test or Oral Glucose Tolerance Test (OGTT) with 75gm of glucose. OGTT is the gold standard for the diagnosis of diabetes, informed Dr. Sunil Gupta. Answering on a query online, Dr. Kavita expressed that calories distribution is different for different person and also depends on whether you are sedentary or moderate or hard worker. While answering a question on millets, she said that people with diabetes may consume millets as they are rich in fibre & micronutrients. The post prandial blood sugar spikes, can be controlled by splitting of meal or changing the order of the meals, she added. Diabetes is your life partner and one should take it’s care with utmost personal attention, quoted Dr. Gupta.
Recorded on 9th February 2024. -
Everyone is aware of Type 1 DM (Insulin dependent diabetes, seen commonly in children) & Type 2 DM (usually seen in adults & majority are controlled on oral drugs & Lifestyle Modification ). Gestational Diabetes Mellitus (GDM) is a kind of diabetes, which appears in the 2nd or 3rd trimester of pregnancy and disappears after delivery. GDM occurs when the woman’s beta cells are notable to overcome the antagonism created by the anti-insulinplacental hormones of pregnancy. Which causes increase in the blood glucose during pregnancy. Women with a history of GDM are at increased risk of future diabetes; predominately type 2 diabetes, as are their children. Almost every 5th or 6th pregnancy women in India, may have GDM. Diabetes In Pregnancy Study Group of India (DIPSI) recommends fasting or non-fasting Oral Glucose Tolerance Challenge Test with 75g of glucose with a cut-off of ≥ 140 mg/dl after 2-hours, Every pregnant woman should be screened for glucose intolerance in the first trimester itself. If found negative, the screening test is to be performed again at 24th – 28 th week and finally around 32 nd – 34 th week. Once diagnosis is made, Medical Nutritional Therapy (MNT) is advised initially for two weeks. If MNT fails to achieve control i.e., FPG ≥ 90mg/dl and/or 2 hr PPG ≥120mg/dl, oral drugs or insulin may be initiated.Recorded on 28th January 2022.
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As the festive season approaches, it is important for people with diabetes (PWD) to celebrate festival with a balance approach. Sankranti is marked by the exchange of a typical sweets (laddu & chikki) made of Til and Gud (Sesame & Jaggery). Sesame seeds (Til) have many benefits to and is good source of iron, magnesium, vit –B, protein, fibre and calcium. Jaggery is rich in iron & has thermogenic effect. PWD should avoid sweets in all such occasions. Rarely if you consume in a very small amount, it should not be taken immediately after the meal, and should be taken 3-4 hrs after the meal. Mindful eating is the success mantra to enjoy festive seasons without disturbing blood sugar level. Monitor blood sugars regularly, stay physically active and stay hydrated.
You can do additional exercise to burn the extra calories consumed during celebration of the festival.
Recorded January 14, 2022. -
Type 2 diabetes is multifactorial ailment. Genes, age, obesity, dietary habits, lifestyle, physical activity and many more factors are responsible for diabetes occurrence. Many people have positive family history (genetic risk), but still don’t develop diabetes, because they protect themselves from environmental risk factors. Diet play an important role like, healthy breakfast is very important to start the day- said Dr. Kavita Gupta. She also added seasonal fruits can be taken in moderation if blood sugars are under control. Dr. Sunil & Dr. Kavita Gupta appealed that, every person with diabetes and their caretakers should take a pledge as a part of new year resolution that they will not call themselves as patient, will eat healthy at interval of 3-4, hours will practice regular exercise, take medicines on time, will check my blood glucose at home regularly, will take care of their feet, always carry glucose to avoid low sugars, will carry their Diabetic Identity card, will do regular annual checkups & will educate others for their healthy future. Eat less, walk more, sleep well & smile is the mantra to healthy lifestyle said Dr. Gupta.
Broadcasted on: 29/12/23 -
In India 101 millions people above 18 year age have diabetes & 135 millions have pre diabetes (> 18yrs age) thus, almost every 4th adult have some form of dysglycemia. Earlier data showed that diabetes prevalence in urban people is 10-12% and in rural it is around 6-8 %. Uncontrolled diabetes is mostly associated with complications related to heart, eyes, kidneys, nerves etc. All these complications are preventable through control of blood glucose, blood pressure, lipids & following healthy lifestyle. Type 2 diabetes & pre-diabetes, if detected early, can be prevented by lifestyle modification. Dr. Gupta said that “Genes are the loaded guns and it is the environment which pulls the trigger.” More over diet & exercise play an utmost important role in achieving glycemic, lipid & blood pressure targets, expressed by Dr. Kavita, They added that “Man is the only animal who eats even if he is not hungry”, thus, the awareness should start from schools to prevent childhood obesity. Which ultimately leads adult obesity, diabetes & other non-communicable diseases.
Broadcasted on - 8th Dec 2024 -
The prevalence of obesity is increasing globally, which increases the risk of type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular diseases etc. Around 70 % of people with diabetes are either overweight or obese. In last 1-2 decades, obesity is also affecting children / people with T1DM, primarily due to changing dietary habits and poor exercise compliance. Individuals with T1DM who are overweight/ obese, have clinical features of insulin resistance (as that of Type 2 DM), are known as "double diabetes". It is challenging for a person with double diabetes to achieve reasonable glycemic control. A sedentary lifestyle, a high-calorie diet rich in fats and simple sugars, and a low-fibre diet in T1DM also lead to poor metabolic control, weight gain, and other disorders like depression that further aggravate the condition. Proper treatment & lifestyle modification helps to achieve better control.
To prevent double diabetes, every child / person with T1DM should practice regular outdoor sports or regular exercise. They should consume healthy diet through the concept of mindful eating. Yoga may compliment for the better management of double diabetes….!
Broadcasted on 24.11.2023
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