Prediabetes

[KarunaPandey]

Sir my age is 40. In my blood test after eating its given 284. So cn i take bitter gourd juice regularly. plz suggest.

[cure Administrator]

Karuna Ji... 2 hrs after food 284 is not at all good sign....you may take karela juice or any other things as per your wish... but what is most important is to cut down your carbs below 100 Gms daily...

Just do that and you will be out of all troubles...

[aps261 in reply to cure]

YOU ARE DIABETIC PL CONSULT DIABTOLOGIST(ALLOPATHY)AND START TEKING MEDICINE. DO NOT EXPERIMENT WITH AYURVEDIC DRUG AND OTHER DRUG.

[suramo Star in reply to aps261]

aps261

i wouldn't want her to start medicines. But a strict diet management. She will not need drugs.

Let her tell us about her profile and test reports.

[dharmendrapanchal in reply to suramo]

first get glycemic parameter in target. keep monitoring, take medicine as support till your diet work and gradually withdraw. please dont adveise blindly not to take medicine. after all our aim should be first to get HbA1c to 7 by any mean.

[suramo Star in reply to dharmendrapanchal]

dharmendrapanchal

Thank you for joining. Welcome aboard.

Yes. You are right but mostly prescribed drugs are those whipping pancreas. Su drugs that the endocrinologists prescribe. So not good imho (in my humble opinion ). Also if the person is well determined to reverse D whenever he/ she finds high bs he/ she would pay still more attention to the diet part. Controlling bs with drugs may make one complacent and relax on diet part. Mentality you know that eat whatever you want and drugs are there to control D. Further high bs levels for a few days more won't cause very big harm and with rigorous diet management bs comes under control in 10-12 weeks.

So now we have two views. Control first with drugs or try diet first and then add drugs.

Investigations yes.

Her no 284 pp are not ve..ry high. Also we should know about her height weight eating habits etc.

Also we advocate lower targets for a1c 5.6. Too stringent but real.

[dharmendrapanchal in reply to suramo]

only sulfonylureas and glinides are insulin secretogoges (whips pancreas). we have in todays era many other modern class of drugs which are not whiping your pancreas. please...

[suramo Star in reply to dharmendrapanchal]

dharmendrapanchal

Yes. But let's agree to disagree.

"DPP-4 inhibitors work by blocking the action of DPP-4, an enzyme which destroys the hormone incretin.

Incretins help the body produce more insulin only when it is needed" and

Glp1 agonists "The glucagon-like peptide-1 (GLP-1) receptor agonists are a new class of injected drugs for the treatment of type 2 diabetes. They mimic the action of GLP-1 and increase the incretin effect in patients with type 2 diabetes, stimulating the release of insulin."

Now remains pioglitazone. Acts on liver to increase uptake but most disreputed. Acarbose group scarcely prescribed. But whipping pancreas is not the only reason but a disease / condition if can be cured / controlled without medicine why not try that - diet -first ?

[cure Administrator in reply to suramo]

Bhai suramo let us first understand what is real problem....why sugar level is going high...

once we know the reason then doctor may prescribe medicine...

but without proper medical examination...and tests it is not advisable to take medicines...

so let us first understand what are the tests she should under go to know the exact problem...

[suramo Star in reply to cure]

cure

Gm bade bhaiya.

Very right. Patient examination and knowing patient 's profile is of utmost importance. But once sugar is high one can start diet management by the time doctor is consulted and all the reports get done. There is no harm.

[dharmendrapanchal in reply to suramo]

I do not say no to diet therapy. rather diet and physical activity are first basic and forever step in management, but not the only steps.

eg., if one has fever of 101*F due to malaria, we along with antimalarial we have to give paracetamol as support till antimalarial works. like wise till diet and physical activity works, we need support of different class of drug to control glucotoxicity. as person starts improving life style, we can taper and off the drugs..

[cure Administrator in reply to dharmendrapanchal]

but here problem is unique...

the medicines which are prescribed are increasing his insulin level...

His problem is not insulin production...as is case with T1... but his problem is insulin sensitivity...

And we are forcing his tired beta cells to produce more... and pushing his towards burning his beta cells forever...

Further his problem is with sugar dump....

what could be the reason for liver dumping sugar?? can we address the issue??

Isn't even with all these drugs... we are just addressing fever....and not malaria

[Hidden in reply to cure]

cure

The entire issue us non acceptance of Low carb based diet

Hence to steer clear of this issue more & more pills & insulins are pumped in.

Its only the Lab value which is important with main stream. As long as the normal levels (elevated ADA levels) are shown its ok.

Who is bothered about the very basic issues of D. If complications happens its the fault of the patient or the disease itself.

D is an insurance policy for those who treat them as they are ensuring an earning for next couple of decades..

[dharmendrapanchal in reply to suramo]

also we have one more novel class of drug that is SGLT 2 inhibitors.

[suramo Star in reply to dharmendrapanchal]

dharmendrapanchal

Every drug has side effects. May be serious many times.

FDA Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood

"The U.S. Food and Drug Administration (FDA) is warning that the type 2 diabetes medicines canagliflozin, dapagliflozin, and empagliflozin may lead to ketoacidosis, a serious condition where the body produces high levels of blood acids called ketones that may require hospitalization. We are continuing to investigate this safety issue and will determine whether changes are needed in the prescribing information for this class of drugs, called sodium-glucose cotransporter-2 (SGLT2) inhibitors.

Patients should pay close attention for any signs of ketoacidosis and seek medical attention immediately if they experience symptoms such as difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness. Do not stop or change your diabetes medicines without first talking to your prescriber. Health care professionals should evaluate for the presence of acidosis, including ketoacidosis, in patients experiencing these signs or symptoms; discontinue SGLT2 inhibitors if acidosis is confirmed; and take appropriate measures to correct the acidosis and monitor sugar levels."

Also t2d are already passing glucose in urine. What is the rationale of such treatment ? Wouldn't more sugar in urine invite other complications like UTI and septicemia, sometimes life threatening ?

[suramo Star in reply to dharmendrapanchal]

dharmendrapanchal

Let our ignorant people learn that they must modify their lifestyle to get protected from the complications of D. Giving them an idea that there are pills to control sugar is harmful because the psyche of them is such that they will take pills and go on eating everything.

When i advise D patients to cut down roti, rice, potato, sugar etc their first question is " then what to eat !". I tell them first you stop eating wheat etc you will find the answer what to eat. There are plenty of substances to eat. Only you have to change the habit. Once you start taking tea without sugar or a sweetner ( only stevia is allowed ) i assure you after some time you will not like the taste of sweet tea. Take veg without roti or rice and enjoy their natural taste. You have to modify cooking. Advice coconut oil for cooking and there is sharp rejection. But once you start cooking with co i assure you you will enjoy as much.

Fight against D starts with mindset - determination. Then everything becomes easy.

[dharmendrapanchal in reply to suramo]

ACARBOSE OR VOGLIBOSE very useful in our patients AND is frequently prescribed drug by Diabetologist or Endocrinologist.

[suramo Star in reply to dharmendrapanchal]

dharmendrapanchal

😃😃😃😃😃🐒🐒🐒🐒

"Acarbose inhibits enzymes (glycoside hydrolases) needed to digest carbohydrates, specifically, alpha-glucosidase enzymes in the brush border of the small intestines, and pancreatic alpha-amylase. Pancreatic alpha-amylase hydrolyzes complex starches to oligosaccharides in the lumen of the small intestine, whereas the membrane-bound intestinal alpha-glucosidases hydrolyze oligosaccharides, trisaccharides, and disaccharides to glucose and other monosaccharides in the small intestine. Inhibition of these enzyme systems reduces the rate of digestion of complex carbohydrates. Less glucose is absorbed because the carbohydrates are not broken down into glucose molecules."

😁😁. What's the fun giving carbs in food and then stopping absorption ? I'm sure these carbs would pass out in stool.🐒🐒🐒. Better don't give carbs.😂

[suramo Star]

KarunaPandey

If you are thinking that karella juice will cure your D come out of delusion. Take it but as cure said low carb diet is the solution.

[KarunaPandey in reply to suramo]

Do I need to take bitter gourd juice everyday

[Luckysugar in reply to KarunaPandey]

How are you Karuna? How long have you been diagnosed? Would you like to share with us your diabetes conditions or recent report of your HbA1c? Or simply tell us how do you normally control your blood sugar? It's your choice to drink the bitter gourd juice but I can't tell you how as I have no experience on this juice.

[suramo Star in reply to KarunaPandey]

KarunaPandey

Yes but make sure you don't get gi problems which sometimes go unnoticed or thought to be good. For example increase frequency of stool may be considered good by many people.

[makarim]

Madam You take karela juice no problem but more important is to cut down carb to 100 grams from all sources. Thanks

[dharmendrapanchal]

please don't chase only one time sugar level. try to explore your problem, know the severity, find out the root cause and treat it. meet diabetologist and get investigated first.

[cure Administrator in reply to dharmendrapanchal]

Welcome to group dharmendrapanchal ji....

We really need medical professionals like you to guide us...

What preliminary test would you like to suggest Karunaji to get done to asses her exact condition???

[dharmendrapanchal in reply to cure]

HbA1c, C-peptide level, Urine Albumin:Creatinine Ratio, Urine routine examination, S. Creatinine with eGFR, Lipid Profile, Vibration Perception Threshold, Eye Fundus Examination, ECG, TMT.

To assess comorbidities further we need to check TSH, CBC, B12, D3, HsCRP, S.testosterone level (free and total) in male.

thanks...

[cure Administrator in reply to dharmendrapanchal]

Thank you sir...

Based on her c peptide levels if we find her fasting insulin is high... still doctor will advise her to go for sulfonylurea ???

[dharmendrapanchal in reply to cure]

that is the real problem..

BUT if HbA1c is high one may require either insulin on SU to controll glucotoxicity.

[cure Administrator in reply to dharmendrapanchal]

sir but pp 284 is not life threatening in short term...

In most of the cases...insulin level is high...and real problem is not insulin secretion..but problem is with insulin sensitivity/resistance..

As per standard medical practice if patient is prescribed with pancreas whipping drugs...will it be really beneficial???

Isn't it trying to treat a alcoholic... with alcohol???

[dharmendrapanchal in reply to cure]

thats why i say first investigate and try to know the exact scenario. not a single guideline says to use SU as a first drug and as second drug also guidelines says to choose from all the class not only SU.

[cure Administrator in reply to dharmendrapanchal]

sir first priority should be to give rest to her pancreas...

that can be achieved only by going low carbs....

Once insulin spikes are controlled...slowly patient will regain insulin sensitivity...

Low carb and weight reduction is the key....

[dharmendrapanchal in reply to cure]

we cant allow glucotoxicity to remain there till patient regains insulin sensitivity. give OAD as per pathophysiology till diet improves insulin sensitivity.

remember we can not allow fever till our antimalarial works. we have to give paracetamol.

[dharmendrapanchal in reply to cure]

There is specific type of Diabetes known as MODY which mistakenly treated as type 1 with insulin, where there is secretory insulin defect, and SU is drug of choice in this case only

[cure Administrator in reply to dharmendrapanchal]

exactly sir...so you will also agree that going low carb should be first priority....for T2

[dharmendrapanchal in reply to cure]

correct its first priority but not the only.

[cure Administrator in reply to dharmendrapanchal]

thank u sir....

also do u think scanning such patients for fatty liver is also essential???

[dharmendrapanchal in reply to cure]

mostly the 70-90% with BMI 28 or more will have it and it reverses with improving insulin sensitivity and weight loss.

[cure Administrator in reply to dharmendrapanchal]

And what is cause of excess BMI??? what could be cause of fatty liver???

[dharmendrapanchal in reply to cure]

so not for all patients, clinical decision..

[cure Administrator in reply to dharmendrapanchal]

and what all we can do to regain insulin sensitivity???

This is the key issue....once we get this key.... we can save many patients from further complications....

What do u think we should do to regain insulin sensitivity???

[cure Administrator in reply to cure]

Sir....may I take your permission plz?? its late night....need to get up early tomorrow....we will continue our discussion next time whenever you are free....

It is really wonderful to have you among us...

[dharmendrapanchal in reply to cure]

Thank you... its my pleasure to be a part.

[suramo Star in reply to dharmendrapanchal]

dharmendrapanchal

Thank you for letting us know the entire set of investigations. But imho let's start with first gear. The investigations i'd recommend are

1) pertaining to D

Fbs fasting insulin and a1c

2) to judge the most possible organ damage.

Lipid profile for now

Microalbuminuria

tsh

3) abd scan to know visceral fats. Nafld

and yes as you said eye examination, hscrp or crp.

Ecg tmt can be exempted in the initial investigations and veg and people taking metformin are always b12 deficient. B12 estimation cost is pretty high 700-1200 rs. Correct me if wrong. So homocystein levels are also high. Rather i'd love giving b12 sl or injections. D3 estimation i'd withhold. Rather give treatment.

Liver hormones may be advised but only if nafld is found on scan.

The cost of entire D profile is costing around 7000/ or more. Patients may not afford.

Well what drugs do we have specifically acting to reduce ir ? I think none. Most drugs including insulin increase blood insulin levels which nature itself is doing. And while these drugs try to control bs increase lipogenesis and inhibit lipolysis. So increase ir. 🐒. That's why ultimately all t2d patients end up with insulin and then we have to go on increasing insulin dosages while they get severe complications of both drugs and D.

[jsahoo60]

You can go for 2nd test both in empty stomach and after food then consult doctor. You can take bitter gourd juice also.

[Hidden in reply to jsahoo60]

type 1 D is the deficiency and type 2 is disorder . Both of them are not same and the steps , food and medicines taken should be different . There is no uniform policy .In type 2 medicines are not the solution.

[DrRizwanYousaf]

Take Homeopathic REmedy Syzigium and Phlorizinum both in 30 potency , 5 drops , both two times in a day. see the difference..

[barani19 Administrator in reply to DrRizwanYousaf]

Dr Rizwan, I use Syzigium+ Gymnema+Cephalandra. Do you see any issues with this combination?