Sub Logo

Dr K K Aggarwal

Managing diabetes

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on Managing diabetes

  • If no contraindications are present always start with metformin as initial therapy in most patients with type 2 diabetes. However, consider insulin as first–line drug in patients presenting with A1c >10%, fasting sugar >250 mg/dL, random sugar consistently >300 mg/dL, or ketonuria.
  • Start with metformin at the time of diabetes diagnosis, along with lifestyle interventions. Titrate dose to its maximally effective dose (2000–2500 mg/day) over 1 to 2 months.
  • If situations predisposing to lactic acidosis are present, avoid metformin and consider a shorter–duration sulfonylurea.
  • Star with lifestyle intervention first, at the time of diagnosis. If lifestyle interventions have not produced a significant reduction in symptoms of hyperglycemia or in sugar levels after 1 or 2 weeks, add the first drug.
  • Those who cannot be given metformin or sulfonylureas, repaglinide is an alternative, particularly in a patient with chronic kidney disease at risk for hypoglycemia.
  • Other alternative is a pioglitazone, which may be considered in patients with lower initial A1c values or if there are specific contraindications to sulfonylureas. There is a concern about atherogenic lipid profiles and a potential increased risk for cardiovascular events with rosiglitazone.
  • One can consider sitagliptin as monotherapy for those intolerant of or have contraindications to metformin, sulfonylureas, or thiazolidinediones. It is a drug of choice as initial therapy in a patient with chronic kidney disease at risk for hypoglycemia. It is however, less potent than repaglinide, which can also be used safely in patients with chronic kidney disease.
  • In patients in whom it is difficult to distinguish type 1 from type 2 diabetes, start with insulin.
  • Further adjustments of therapy should be made every three months based on the A1C result aiming it close to the non diabetic range. If A1c values >7%, one need to further adjust the diabetic regimen.
  • If A1c remains >7% another drug should be added within 2 to 3 months of initiation of the lifestyle intervention and metformin.

Managing Diabetes

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Managing Diabetes

• People with prediabetes are at increased risk for developing type 2 diabetes, heart disease and paralysis.

• More than 25% people have prediabetes (blood sugar level more than 90 but below 126 mg/dL) but only 4% know it needs attention.

• Diabetes is not just about controlling blood sugar. Controlling BP (<120/80) and LDL bad cholesterol (<70) is equally important.

• Smokers face 44% increased risk of diabetes when compared to nonsmokers (Swiss researchers JAMA)

• Advancing age, diabetes, high BP, obesity, smoking, drugs, heart diseases, alcohol, cycling for > 3 hours/week can cause erectile dysfunction.

• Each 1 mg increase in serum uric acid increases the risk of developing diabetes by 18%.

• Keep your fasting sugar, lower BP, bad cholesterol, abdominal girth all below 80.

• Recent studies have shown that people at risk of type 2 diabetes can prevent onset of diseases by losing 5 to 7% body weight.

• Patients with diabetes should drive only if their blood sugar is under control and there is no evidence of end organ disqualifying disease.

• Significant snoring with episodes of cessation of respiration during night can lead to diabetes.

• Treating depression may help people with diabetes get their blood sugar under control.

• Sudden cardiac death is preventable – keep your diabetes under control.

• If BP and diabetes are kept under control, 75% dialysis and transplants can be prevented.

• One in five patients with diabetes have abnormal Treadmill Stress Test

• Patients with metabolic syndrome are 5 times more likely to develop diabetes (National Heart, Lung, Blood Institute).

• Diabetic patients have similar risk as non–diabetics with one heart attack.

• Fifty percent of diabetic patients may have associated high blood pressure.

• Uncontrolled diabetes can cause heart attack.

• Hypertension and diabetes together raise the chances of heart attack manifold.

• Diabetics can have heart attack without the classical symptom of pain.

• Diabetes can remain silent for over five years.

• Uncontrolled diabetes can cause impotence.

• Uncontrolled diabetes can cause blindness.

• Uncontrolled diabetes can cause paralysis.

Managing Diabetes

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on Managing Diabetes

• People with pre diabetes are at increased risk for developing type 2 diabetes, heart disease and Paralysis.

• More than 25% people have pre diabetes (blood sugar level more than 90 but below 126 mg/dL) but only 4% know it needs attention.

• Diabetes is not just controlling blood sugar. Controlling BP (<120/80) and LDL bad cholesterol (<70) is equally important.

• Smokers face 44% increased risk of diabetes when compared to nonsmokers (Swiss researchers JAMA)

• Advancing age, diabetes, high BP, obesity, smoking, drugs, heart diseases, alcohol, cycling for > 3 hours/week can cause erectile dysfunction.

• Each 1 mg increase in serum uric acid increases the risk of developing diabetes by 18%.

• Keep your fasting sugar, lower BP, bad cholesterol, abdominal girth all below 80.

• Recent studies have shown that people at risk of type 2 diabetes can prevent onset of diseases by losing 5 to 7% body weight.

• Patients with diabetes should drive only if their blood sugar is under control and there is no evidence of end organ disqualifying disease.

• Significant snoring with episodes of cessation of respiration during night can lead to diabetes.

• Treating depression may help people with diabetes get their blood sugar under control.

• Sudden cardiac death is preventable – keep your diabetes under control.

• If BP and diabetes are kept under control, 75% dialysis and transplants can be prevented.

• One in five patients with diabetes have abnormal Treadmill Stress Test • Patients with metabolic syndrome are 5 times more likely to develop diabetes (National Heart, Lung, Blood Institute).

• Diabetic patients have similar risk as non–diabetics with one heart attack.

• Fifty percent of diabetic patients may have associated high blood pressure.

• Uncontrolled diabetes can cause heart attack.

• Hypertension and diabetes together raise the chances of heart attack manifold.

• Diabetics can have heart attack without the classical symptom of pain.

• Diabetes can remain silent for over five years.

• Uncontrolled diabetes can cause impotence.

• Uncontrolled diabetes can cause blindness.

• Uncontrolled diabetes can cause paralysis.

Managing Diabetes

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Managing Diabetes

• People with pre diabetes are at increased risk for developing type 2 diabetes, heart disease and Paralysis.

• More than 25% people have pre diabetes (blood sugar level more than 90 but below 126 mg/dL) but only 4% know it needs attention.

• Diabetes is not just controlling blood sugar. Controlling BP (<120/80) and LDL bad cholesterol (<70) is equally important.

• Smokers face 44% increased risk of diabetes when compared to nonsmokers (Swiss researchers JAMA)

• Advancing age, diabetes, high BP, obesity, smoking, drugs, heart diseases, alcohol, cycling for > 3 hours/week can cause erectile dysfunction.

• Each 1 mg increase in serum uric acid increases the risk of developing diabetes by 18%.

• Keep your fasting sugar, lower BP, bad cholesterol, abdominal girth all below 80.

• Recent studies have shown that people at risk of type 2 diabetes can prevent onset of diseases by losing 5 to 7% body weight.

• Patients with diabetes should drive only if their blood sugar is under control and there is no evidence of end organ disqualifying disease.

• Significant snoring with episodes of cessation of respiration during night can lead to diabetes. • Treating depression may help people with diabetes get their blood sugar under control.

• Sudden cardiac death is preventable – keep your diabetes under control.

• If BP and diabetes are kept under control, 75% dialysis and transplants can be prevented.

• One in five patients with diabetes have abnormal Treadmill Stress Test

• Patients with metabolic syndrome are 5 times more likely to develop diabetes (National Heart, Lung, Blood Institute).

• Diabetic patients have similar risk as non–diabetics with one heart attack.

• Fifty percent of diabetic patients may have associated high blood pressure.

• Uncontrolled diabetes can cause heart attack.

• Hypertension and diabetes together raise the chances of heart attack manifold.

• Diabetics can have heart attack without the classical symptom of pain.

• Diabetes can remain silent for over five years.

• Uncontrolled diabetes can cause impotence.

• Uncontrolled diabetes can cause blindness.

• Uncontrolled diabetes can cause paralysis.

Managing Diabetes

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Managing Diabetes

• People with pre diabetes are at increased risk for developing type 2 diabetes, heart disease and Paralysis.

• More than 25% people have pre diabetes (blood sugar level more than 90 but below 126 mg/dL) but only 4% know it needs attention.

• Diabetes is not just controlling blood sugar. Controlling BP (<120/80) and LDL bad cholesterol (<70) is equally important.

• Smokers face 44% increased risk of diabetes when compared to nonsmokers (Swiss researchers JAMA)

• Advancing age, diabetes, high BP, obesity, smoking, drugs, heart diseases, alcohol, cycling for > 3 hours/week can cause erectile dysfunction.

• Each 1 mg increase in serum uric acid increases the risk of developing diabetes by 18%.

• Keep your fasting sugar, lower BP, bad cholesterol, abdominal girth all below 80.

• Recent studies have shown that people at risk of type 2 diabetes can prevent onset of diseases by losing 5 to 7% body weight.

• Patients with diabetes should drive only if their blood sugar is under control and there is no evidence of end organ disqualifying disease.

• Significant snoring with episodes of cessation of respiration during night can lead to diabetes.

• Treating depression may help people with diabetes get their blood sugar under control.

• Sudden cardiac death is preventable – keep your diabetes under control.

• If BP and diabetes are kept under control, 75% dialysis and transplants can be prevented.

• One in five patients with diabetes have abnormal Treadmill Stress Test

• Patients with metabolic syndrome are 5 times more likely to develop diabetes (National Heart, Lung, Blood Institute).

• Diabetic patients have similar risk as non–diabetics with one heart attack.

• Fifty percent of diabetic patients may have associated high blood pressure.

• Uncontrolled diabetes can cause heart attack.

• Hypertension and diabetes together raise the chances of heart attack manifold.

• Diabetics can have heart attack without the classical symptom of pain.

• Diabetes can remain silent for over five years.

• Uncontrolled diabetes can cause impotence. • Uncontrolled diabetes can cause blindness.

• Uncontrolled diabetes can cause paralysis.