Minimizing Hypoglycemia in Diabetes

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The US Department of Health and Human Services has identified hypoglycemia as one of the top three preventable and measurable adverse drug events in a recent article published in the December 11 issue of the Journal of Clinical Endocrinology and Metabolism.

Hypoglycemia is defined in

  • Level 1: Glucose < 70 mg/dL and ≥ 54 mg/dL
  • Level 2: Glucose < 54 mg/dL; needs immediate action.
  • Level 3: A severe event characterized by altered mental and/or physical status requiring assistance.

Remember the three measures:

Measure 1:

Identify high risk patients

  • First assess if the patient has experienced a previous Level 2 or Level 3 hypoglycemic event within the past year. If not, then proceed to;
  • Second, if the patient has a prescription for insulin and/or insulin secretagogues and has an A1c < 7% documented within the past 6 months. If not, then proceed to;
  • Third, if the patient has a prescription for insulin and/or insulin secretagogues and at least one relevant comorbidity.

Measure 2: Educate patients (65+) and care givers who are at greater risk for hypoglycemia

Measure 3: Encourage patients to report hypoglycemic events

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

People with diabetes must be cautious during Ramadan fasting: HCFI

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Precautions and consultation with physician are advised

New Delhi, 18th May 2019: India has the third-largest Muslim population according to statistics, and a majority of them will be fasting during Ramadan. This number will also constitute people living with diabetes and thus, the need of the hour is to fast while exercising caution. Fasting can bring about metabolic changes and they must adjust their diet plan during Ramadan.

There is a 12- to 15-hour gap in between meals which can become a problem for those with diabetes. It is therefore advised that they consume regular and timely meals. People with Type 1 diabetes are at a higher risk compared to those with type 2 when fasting during the holy month.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Ramadan this year will continue till the month of June and the fasting period will be longer due to daylight hours. It is imperative that people living with diabetes consult their doctor and monitor blood glucose levels regularly. People with type 1 diabetes and a history of recurrent hypoglycemia have a higher risk during fasting. In those with Type 2 diabetes, there is a likelihood of hypo- and hyperglycemia. A patient’s decision to fast should be made after ample discussion with his or her physician concerning the risks involved. Patients who insist on fasting should undergo pre-Ramadan assessment and receive appropriate education and instructions related to physical activity, meal planning, glucose monitoring, and dosage and timing of medications. The management plan must be highly individualized. Close follow-up is essential to reduce the risk for development of complications.

Some symptoms to be noted include fluctuating blood sugar levels, seizures and unconsciousness; blurry vision, headache, sweating, increased fatigue, and thirst. In case any of these persist, the patient should do away with fasting completely.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Thirty days of Ramadan in Islam; nine days of Navratra in Hinduism and forty days of Easter in Christianity are spiritual practices observed by respective religions. These are days of mind, body and soul detoxification observed as per religion defined rituals. Broadly, they involve restraining the ten senses during the fast period. One restrains from negative thoughts cum actions and indulges in positive thoughts cum actions.

In Ramadan, the one-month continuous fast detoxifies the mind, body and soul and reenergizes the human being. Taking precautions can help people exercise better control over their health conditions even during fasting.

Some tips from HCFI

  • Monitor blood sugar level frequently.
  • Do not overeat. Pay attention to body signals and understand hunger.
  • Make sure to break the fast with sugar-free and decaffeinated drinks to avoid dehydration
  • Consume sweets in a limited amount.
  • Make sure to include lot of fruits, vegetables, pulses, and curd in your diet
  • Allow a time interval of at least 2 hours between the meal and bedtime. It is a good idea to avoid complex carbohydrates right before bedtime.
  • Avoid deep fried foods. Also, make sure to time the consumption of starch-containing foods such as rice and rotis.

Chronic kidney disease can be debilitating in the longer term

Health Care, Heart Care Foundation of India, Medicine Comments Off

Babies born preterm may stand the risk of developing the condition later in life New Delhi, 2nd May 2019: Preterm and early term birth are strong risk factors for the development of chronic kidney disease (CKD) from childhood into mid-adulthood, suggests a study published in the BMJ. Preterm birth (before 37 weeks of pregnancy) interrupts kidney development and maturity during late-stage pregnancy, resulting in fewer nephrons forming (filters that remove waste and toxins from the body). Of all the patients who develop end stage kidney failure in India, only 10% to 15% get proper treatment. About 6000 undergo kidney transplant, 60,000 undergo hemodialysis, and another 6000 prefer to take peritoneal dialysis in a year. About six-lakh people die for want of renal replacement therapy. Of all the patients who develop end stage kidney disease, over 90% needing renal replacement therapy die because of inability to afford care and 60% of those who start on treatment drop midway due to financial reasons. As of May 2017, there are over 130, 000 patients receiving dialysis and the number is increasing by about 232 per million population! Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “CKD is characterized by a gradual loss of kidney function over time and may eventually lead to kidney failure, leading patients to undergo dialysis or a kidney transplant. The signs and symptoms are not noticeable until the disease is fairly well advanced, and the condition has become severe. By this time, most of the damage is irreversible. At an advanced stage of CKD, dangerous levels of fluid, electrolytes, and wastes can build up in the body. Those with underlying conditions such as diabetes, high blood pressure, cardiovascular disease, abnormal kidney structure, and a family history of the disease are at more risk. Additionally, those who smoke and are obese can also be potential candidates for CKD over the longer term.” Some symptoms of this condition include nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, decreased mental sharpness, muscle twitches and cramps, edema, persistent itching, chest pain, shortness of breath, and hypertension. Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Some key measures to keep kidney diseases at bay is to monitor and treat conditions and diseases like obesity and Dyslipidemia, respectively. If blood pressure and blood sugar can be kept under control, more than 50% of CKD can be prevented.” Some tips from HCFI.

  • Keep fit and active, it helps reduce your blood pressure and on the move for kidney health.
  • Keep regular control of your blood sugar level as about half of people who have diabetes develop kidney damage.
  • Monitor your blood pressure. It is also the most common cause of kidney damage. The normal blood pressure level is 120/80. Between this level and 129/89, you are considered prehypertensive and should adopt lifestyle and dietary changes.
  • Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with CKD. Reduce your salt intake. The recommended sodium intake is 5 to 6 grams of salt per day. In order to reduce your salt intake, try and limit the amount of processed and restaurant food.
  • Maintain a healthy fluid intake. Traditional wisdom has long suggested drinking 1.5 to 2 liters (3 to 4 pints) of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing CKD.
  • Do not smoke as it slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50%.
  • Do not take over-the-counter pills on a regular basis: drugs like ibuprofen are known to cause kidney damage and disease if taken regularly.

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