Global Experts Meeting On Diabetes, Hypertension & Metabolic Syndrome

Biography

Biography: Premanidhi Panda

Abstract

Introduction:- Diabetes mellitus often simply referred to as diabetes—is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.

It is my view many things should be changed in diabetes concept.

My views in diabetes for which i have got more number of control diabetes patient.

 (1)Definition of diabetes should not be based on blood sugar. it is my observation only glycosylated  haemoglobin (hb1ac) is the criteria to diagnose as diabetes when more than 6.5%. it  depends   upon  what  type of food  taken  in the previous night.it is   my observation  if we consider that  blood  sugar  in 30%  cases will be  incorrect.so  i  used  consider  upon  hba1c   rather than  FBS and 2hr  PPBS.I have got more then 90000 patient all are having HBA1C 5.5 TO 6.4.

(2)Stop polished rice. carbohydrate in polished rice is not equal to carbohydrate contained  in wheat. particular importance for India and china scenarios.

WHEAT VS RICE

Thus I advised my patient to consume Wheat than rice.  Another point Indians can consume more rice than wheat. In a good items Indians will consume too much rice. Thus “ZERO RICE”.

(2)A diabetic patient will have good control with by avoiding sugar based fruits.

Know your fruits
(apple VS tomato)

*Avoid all sugar based fruits apple:-I used to advice not to take apple till blood sugar comes to normal. Previous slogan has been changed from:- “an apple a day keeps the doctor away.” To “A Tomato a Day Keeps the Doctor Away.” I have seen in my study a person with diabetes consuming apple blood sugar has increased greatly in comparison to tomato. Although apple is advised for its anti-oxidant property.  Now a days it has been seen that Tomato contains Lycopene which is more potent than any Anti-oxidant. That too it has got anti cancerous property. 

(Anti Cancerous Property),

Here  i want to emphasize  apple  does  not  contain any “Ambruta” that  is  gods  any  very beneficial things.it contains  only  phytooxidant and fibre. Thus I used to advice “tomato” and “mushroom”, lemon. avocado(HEATHIEST  FRUIT), strawberry, guava.

 (3)Mango should not be advised. It is  my  observation  by taking one mango  blood  sugar  increases  to 3-4 times. Please do not advice to the world  “mango” is good for  diabetes. instead  “avocado” worlds healthiest  fruit.

4) Instead of apple please advise tomato and avocado

 (5)I am against insulin in type II diabetes except six indications

 My view insulin therapy in type II diabetes: - Six conditions in type II diabetes.

• (1)In Type II Diabetes when maximum oral hypoglycaemic drug does not work
• (2)You are having infection
• (3)You are undergoing surgery
• (4)When target organs involved(brain, heart, kidney, nerves)
• (5)Fulminating Conditions
• (6)Gestational Diabetes   With Previous History of Type II diabetes

(6)Pioglitazone is a marvelous drug Do not blame it. i and all my family members including more than 60000 patients are under pioglitazone.no side effects till now i have received. i strongly say "Pioglitazone" never causes bladder cancer. you are not blaming polluted foods, polluted drinks, polluted environment, nuclear explosion which causes change in biomarkers. out of 61millions patient only 8 persons develop bladder cancer blame "Pioglitazone"

Pioglitazone is the golden drug 

There is great war for Pioglitazone. It Causes Bladder Cancer, Fracture, Heart Failure for which On June 9, 2011 the French Agency for the Safety of Health Products decided to withdraw pioglitazone in regards to high risk of bladder cancer. On June 10, 2011 Germany's Federal Institute for Drugs and Medical Devices also advised doctors not to prescribe the medication.
On June 15, 2011 the U.S. FDA announced that pioglitazone use for more than one year may be associated with an increased risk of bladder cancer. April 2014 The U.S District Court in western Louisiana ordered a $6 billion penalty for Takeda Pharmaceutical Company. 2013 the health ministry of India has suspended the sale of Pioglitazone. But after one month on July 2013 ban lifted. Here I want to emphasize that till now only 8 cases of Bladder cancer found out. Why we will blame Pioglitazone. In my Institute I have given >20000 Patients are under pioglitazone. alone or Mixed with other drug. Including me I am under Pioglitazone for last 8Years Except Pedal oedema and few cases of Weight gain I have not found any other serious consequences. Rather I will tell Its an Golden drug as anti diabetic drug to reduce the Postprandial Hyperglycaemia. Pioglitazone gives good glycaemic control than Voglibose.I choose Voglibose as it also reduces post Prandial hyperglycemia.
Voglibose:-
 

Voglibose is an an alpha-glucosidase inhibitor used for lowering post-prandial blood glucose levels in people with diabetes mellitus. Voglibose delays the absorption of glucose thereby reduces the risk of macrovascular complications. Voglibose is a research product of Takeda Pharma, a Japan-based company. Postprandial hyperglycemia (PPHG) is primarily due to first phase insulin secretion. Alpha glucosidase inhibitors delay glucose absorption at the intestine level and thereby prevent sudden surge of glucose after a meal. There are three drugs which belong to this class, acarobose, miglitoland vogliboseof which voglibose is the newest. Voglibose scores over both acarbose and miglitol in terms of side effect profile.Voglibose does not increase the weight or causes Pedal Oedema.
Sideffects are Hypoglycemia, delay in digestion and absorption of disaccharides, abdominal pain and swelling, increased flatus, intestinal obstruction like symptoms, fulminant hepatitis, serious hepatic dysfunction with increased AST (GOT), ALT (GPT), LDH, gamma GTP or ALP, jaundice, diarrhea, loose stools, borborygmus, anorexia, nausea, vomiting, heartburn, anemia, numbness, edema, blurred vision, hot flushes, malaise, weakness hyperkalemia, increased serum amylase. But in my study mild loose stool is the common side effects.

In my study:-
Present study was open with 2000 cases , randomized parallel group comparison of two active treatment groups over a six months period. Sixty patients of either sex in the age group of 30-75 years, suffering from type 2 DM, with FBG> 126 mg/dl and HbA1c between 7- 10 % were taken. Pioglitazone and voglibose were given to 2000 cases given 3months & 3 months trial in each drug to all. Different parameters are taken into consideration like FBS, 2Hr PPBS, HBA1C, Blood Urea, Serum Creatinine, Serum cholesterol & Triglyceride. It has been observed Pioglitazone reduces FBS,2Hr PPBS, HBA1C, Blood Urea,Serum Creatinine ,Cholesterol,Triglyceride more than Voglibose. In my study also seen in mixed drug like Glimiperide+Metformin+Pioglitazone works better than Glimiperide+Metformin+Voglibose. One case was Under Inj Humalog 78Units before breakfast 72 Before dinner Blood Sugar does not come to normal level. Only with Inj Novomixtard 14Units BBF & 8Units Before Dinner Plus Combined drug Glimeperide1Mg+Metformin500+Pioglitazone 15mg ½ Tab BID Blood sugar came down to 89FBS & 127Mg PPBS. Out of 2000 cases with voglibose FBS after taking for 3 months comes down to 90 to 136mg/dl. But with same Patient with Pioglitazne comes down to 80-120mg/dl.2Hr PPBS come down with voglibose 110- 168mg/dl.HBA1C comes down to 5.9 to 6.9.Urea,Creatinine,Cholesterol& Triglyceride remaining same .In few cases little low.
But with Pioglitazone Maximum Patients FBS comes to 78-120mg/dl.2Hr PPBS to
95 to 145mg/dl.HBA1C 6.1 to 5.4.Urea, Creatinine, Cholesterol, Triglyceride to low level. Side effects with Pioglitazone Side Effects limited to Pedal Oedema in all my Patient as description in the Many Text book. In My Opinion There is not necessary to have Panic to Patient that this will cause bladder cancer. In Every drugs many side effects are there.I have used this drug since Nine Years. I have discussed with  Several Diabetologist and Endocrinologist all have supported me. With Voglibose diarrhea, loose stools, borborygmus, anorexia, nausea, vomiting, heartburn, anemia, numbness, edema are common side effects observed.
Conclusion:-In my study shows there is no reason for any side effects OR banning this drug or writing Warning to make Patient in Panic.Pioglitazone works better than Voglibose in better control of blood sugar.Out of >45000Patients >20000Patients are under Pioglitazone.

 (7)All diabetics should be advised to take 20petals of raw garlic, two onions and one lemon a day to protect heart, kidney and liver fatty change can be reversed by taking these three.

 (8)I do not find micro vascular and macro-vascular complications Insulin vs OHD. I may request to invite me give my views in the scientific stage.