DIABETES ; RECENT ADVANCEMENT OF CONTROL & TREATMENT

DR.D.R.NAKIPURIA ,SENIOR GASTRO INTEST SPECIALIST & HIV/AIDS CONSULTANT
DR.MRS.RANJU NAKIPURIA,SENIOR GYNAECOLOGIST,OBST & INFERTILITY EXPERT
DR.MAYANK NAKIPURIA ,GENERAL PHYSICIAN.
drnakipuria@gmail.com, 09434143550,09832025685, 07838059592,09832025033.,
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About 61.3 million people in India suffer from diabetes, and according to estimates,one in every 5 people in India will be diabetic by 2025. Similiary in China The number of Diabetic patients will increase like anything.Diabetes is a metabolic disease which is characterised by high blood sugar levels. It can be caused either due to the lack of insulin (type 1 diabetes) or because the body’s cells fail to respond to the insulin produced (type 2 diabetes). There’s another form of diabetes that afflicts pregnant women called gestational diabetes.
Symptoms:In diabetes,the body is unable to absorb glucose which leads to a host of problems. Here are some of the symptoms that could indicate diabetes:
1.Increase in appetite,Frequent urination,Feeling too thirsty,Loss of weight,Feeling fatigued all day long,Frequent infections,Poor wound healing,High irritability/Depression
,Blurred vision etc.
Our Digestive system breaks down whatever food we eat into glucose.This glucose is absorbed by the blood with the help of a hormone called insulin. Diabetes occurs when the body is not able to produce insulin or is not able to use it effectively. Here are some of the reasons why this happens.
1. Genes:Genes can be responsible for causing both Type 1 and Type 2 diabetes. Having certain combination of genes may increase or decrease the risk of diabetes. If your parents were diabetics, you should be extra careful about your lifestyle.So it runs in family,so if both mother and father diabetic child being diabetic is very high.
2. Autoimmune destruction of beta cells:Sometimes,our own immune system may recognise the beta cells that produce insulin as antigens, and create antibodies to destroy them.Often, diabetes is diagnosed after most of the cells are destroyed and the patient then needs a daily dose of insulin to survive.
3.Lack of physical activity/obesity:Lack of exercise and obesity can be major causes of Type 2 diabetes. An imbalance between calories consumed and calories burned renders our body incapable of absorbing insulin properly. Just 30 minutes of physical activity reduces the chances of you having diabetes by 30 per cent. So, make sure you include activities like walking and cycling in your daily timetable.
4.Age:As a person ages, several parts of his/her body stop functioning at their optimum best. This can lead to diabetes, along with several other ailments.
5. Certain drugs :Certain medicines like nicotinic acid, psychiatric drugs, diuretics, etc. can destroy the beta cells that produce insulin or disrupt insulin absorption.
6.Pancreatic disease or injury:Since the beta cells are present in the pancreas – any injury or diseases like cancer, pancreatitis, etc. can stop beta cells from functioning and ultimately lead to diabetes.
Diagnosis:Diabetes is diagnosed using blood tests, and the three tests used for diagnosing diabetes are:
1.A1C test or glycohaemoglobin test;This test is used for diagnosing Type 2 diabetes. It measures a person’s average blood glucose levels over the past three months.If a person’s A1C level is below 5.7%, it means that he/she is normal. If it is between 5.7 to 6.4%, it indicates prediabetes which may lead to diabetes if appropriate measures are not taken.A person is diagnosed with diabetes if he/she has an A1C level of 5.7% or above.
2.Fasting Plasma Glucose (FPG) test;The Fasting Plasma Glucose test is the most common test used for diagnosing diabetes. It is performed by measuring a person’s blood sugar level, after he/she has fasted for at least 8 hours.If a person has a fasting glucose level of 126 mg/dL or above, he or she has diabetes. It is advised to repeat the test on another day for confirmation.
3. Oral glucose tolerance test (OGTT);In an oral glucose tolerance test, a person has to fast for at least 8 hours. After that, he/she has to drink a glass of water mixed with 75g of glucose.If a person’s 2-hour blood glucose-level is between 140 to 180 mg/dL, the person has prediabetes which could lead to diabetes if appropriate measures are not taken. If the blood glucose-level is above 180 mg/dL, then the person is diagnosed with diabetes as this level kidney excerete sugar in urine and urine show sugar and patient is called diabetic below this level sugar not seen in urine of person.
Treatment:Beast way to treat Diabetic is first to control food avoid Glycemic food or food which produce more sugar as sugaar and its product or food under ground like potato,reddish,carrot,beet,sugar cane,rice,apples,grapes etc even hifh fat is changed in to sugar so high fat content or high starch food or high calorie diet lead to more load of high calorie to our gut and as aresult of less Insulin or This food being les utised so high bloodglucose or Diabetes occurs.So food having less gluscose,freen veteables and leafy food should be taken.
If we do excersie this excessive food is burnt so excercise is also good and is second step to control diabetes,mostly pre Diabetic condition is controlled by food and excercise only.If diabetes can’t be controlled with diet, xercise and weight control,ten we take anti-diabetic medications or insulin.Type I diabetes occur only in children and young s and there is lack of Insulin so treatment is only Insulin which is injected either three times or once or twice with long acting insulin.
Most people who have type 2 diabetes start with an oral medicine. Here are some of them:
Drugs that act on your pancreas ;
Sulfonylureas (DiaBeta, Glucotrol, Amaryl, etc.) lower blood glucose levels by increasing the release of insulin from the pancreas. These drugs decrease blood sugar rapidly but may cause abnormally low and dangerous levels of blood sugar (hypoglycaemia) leading to mental confusion and even coma. Meglitinides (Prandin, Starlix, etc.) also work on the pancreas to increase insulin secretion. Their effects depend on the level of glucose. Victoza (lyraglutide), an injectable medicine, helps the pancreas make more insulin after eating a meal. It improves blood sugar in people with type 2 diabetes when used with a diet and exercise programme.
Drugs that decrease the amount of glucose released from the liver:
Biguanides (Metformin) decrease glucose production by the liver, decrease the absorption of glucose in the intestines and improve the body’s resistance to insulin. It also suppresses hunger, which may be beneficial in diabetics who are overweight.
Drugs that increase the sensitivity (response) of cells to insulin :
Thiazolidinediones (Actos and Avandia) lower blood glucose by increasing the sensitivity of the muscle and fat cells to insulin. These drugs may be taken with metformin and/or a sulfonylurea. They can cause mild liver problems but are reversible with discontinuation of the drug.
Drugs that decrease the absorption of carbohydrates from the intestine:
Alpha glucosidase is an enzyme in the small intestine which breaks down carbohydrates into glucose. Acarbose is the drug that inhibits this enzyme. Carbohydrates are not broken down as efficiently and glucose absorption is delayed, thus preventing high glucose levels after eating in people with diabetes.
Drugs that slow emptying of the stomach:
Exenatide (Byetta) is a substance like gut hormone (GLP-1) that cannot be easily broken down. It slows stomach emptying, slows the release of glucose from the liver and controls hunger. Administered in the form of an injection, Byetta also causes weight reduction, thus making it particularly suitable for patients with type 2 diabetes who are also overweight. DPP-IV inhibitors (Januvia, Onglyza, Tradjenta), inhibit DPP-IV enzyme from breaking down gut hormone (GLP-1). This allows the hormone already in the blood to circulate longer. They also increase insulin secretion when blood sugars are high and signal the liver to stop producing excess sugar.
Insulin Injections – Insulin is the backbone of treatment for patients with Type 1 diabetes. Insulin is also important in Type 2 diabetes when blood glucose levels cannot be controlled by diet, weight loss, exercise and oral medicines. Different types of insulin are:
1. Rapid-acting insulin – starts working in about 15 minutes and lasts for 3 to 5 hours. There are 3 types of rapid-acting insulin: Insulin lispro, Insulin aspart and Insulin glulisine
2. Short-acting insulin (regular insulin) – starts working in 30 to 60 minutes and lasts 5 to 8 hours.
3. Intermediate-acting insulin (insulin NPH) – starts working in 1 to 3 hours and lasts 12 to 16 hours.
4. Long-acting insulin (insulin glargine and insulin detemir) – starts working in about 1 hour and lasts 20 to 26 hours.
5. Premixed insulin- combination of 2 types of insulin (usually a rapid-acting or short-acting insulin and an intermediate-acting insulin).
Various methods for administering insulin are:
Pre-filled Insulin Pens – This is similar to an ink cartridge in a fountain pen. An insulin cartridge is held by a small pen-sized device. The amount of insulin to be injected is dispensed by turning the bottom of the pen until the required number of units is seen in the dose-viewing window. The tip of the pen consists of a needle that is disposed off with each injection.
Insulin pump – This is the most recently available advance in insulin delivery. It is composed of a pump reservoir similar to that of an insulin cartridge, a battery-operated pump and a computer chip that allows the user to control the exact amount of insulin being delivered. The pump is used for continuous insulin delivery. The amount of insulin is programmed and is administered at a constant rate.
Insulin Inhalers – Inhaled form of insulin is not much in use these days. The insulin is packaged in dry packs which are inserted into an inhalation device. This device allows the insulin to enter a chamber that has a mouth piece. Through this mouth piece the user can inhale the insulin.
Newer injectable injections - Symlin (pramlintide) is an injectable medication for use in diabetes patients treated with insulin but unable to achieve adequate sugar control. Amylin is a hormone synthesised by pancreas and helps control glucose after meals. It is absent or deficient in patients with diabetes. Pramlintide, a synthetic form of human amylin, when used with insulin, can improve sugar control. Symlin reduces blood sugar peaks after meal, reduces glucose fluctuations throughout the day and increases the sensation of fullness (leading to weight loss).
Insulin pills: insulin has been synthesises in tablet form by nano particle and will be absorbed in intestine passing Gastic acid and it is succesful in mice.
Permanant : Either transpnting B-cells of langerhans in Pnacreas a or complete pancreatic transplant to control diabetic in patient undergoing idney replacement due to high diabetes.But process is expesive and and dosenot work well with so many immunosuppresants.
Bariatic Surgery/Obesity Surgery:bariatic surgery bypass food from stomach to intestines so less food absorption and weight loss so daibetes is controlled.
Prognosis/complications:
Diabetes, if uncontrolled can lead to deadly complications.
1. Effect on fat and metabolism (Diabetic ketoacidosis): Since the hormone insulin which breaks down glucose is lacking, in uncontrolled cases, the body starts using fat as the fuel source. While you might think it’s not such a bad idea to lose some fat, what this leads to is build up of by-products of fat digestion called ‘ketones’. If you’re not taking your insulin doses regularly, have fever/diarrhoea/vomiting and/or going through a lot of stress or are an alcoholic, you need to be extra careful about developing this condition called ‘ketoacidosis’. If you develop symptoms like deep gasping breathing, acute pain in the abdomen, bad dehydration leading to weakness and fainting, vomiting, it’s time you take it seriously and contact your doctor.
2. Effect on the eyes (Diabetic retinopathy): Retina (the innermost layer of your eye) is affected by ineffective blood glucose control. The small blood vessels in the retina are damaged and weakened. The early symptom of eye problems related to diabetes is blurred vision and double vision. It can also cause a severe, permanent loss of vision. Diabetes increases the risk of developing cataracts and glaucoma.
3. Effect on kidneys (Diabetic nephropathy): If you notice swelling in your feet and legs or around your eyes, your kidneys might get affected because of the uncontrolled blood sugar levels. If you have hypertension (or high BP), your chances of developing this is even higher.
4. Effect on nerves: Some of the nerves, especially around your peripheries like legs might get affected first leading to a loss of sensation. You might not be able to figure out if you’ve had an injury and it may end up getting infected. Diabetic gangrene (infection of the leg, leading to decay of flesh) can occur and the leg may have to be amputated. Uncontrolled diabetes can also affect nerves that control your heartbeat, blood pressure, digestion, blood flow to organs etc leading to diarrhoea, erectile dysfunction, loss of bladder control, vision changes, and dizziness.
5.Effect on heart: If you are a smoker, have high blood pressure, are grossly overweight and/or have a family history of diabetes and are diagnosed with diabetes, you have a greater risk of developing heart disease, strokes.

ORAL SEX OR FELLATIO-HIV/AIDS and otherr STds;SEMEN DRINKING HARM

PROF.DRRAM ,HIV/AIDS,SEX DISEASES,SEX WEAKNESS & ABORTION SPECIALIST
profdrram@gmail.com,07838059592, DELHI –NCR,marriage & sex counseling
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MAN TO MAN OR MAN TO WOMAN or vice versa ORAL SEX is enjoying but some time leads to seriuos DISEASES OF LOW INFECTIVITY LIKE HIV/AIDS/HERPES etc so is question of lickin ,drinking semen if infected and oral cavity mucosa is breahed or gut mucosa or denture lining is rubbed off or inflammed disease transmission may occur BUT AS USUAL SUCH TRANSMISSION IS OF LOW INFECTIVITY.

Therefore it can be ddescribed as below:-----
1. Oral Sex Is A Lower-Risk Sexual Activity, But It Is Not A Risk-Free Sexual Activity.
Oral sex can transmit certain kinds of sexually transmitted diseases, but it can also transmit colds and flu viruses and the germs that cause soft tissue infections. Cuts and sores in the mouth of the partner performing oral sex and on the penis of the partner receiving oral sex offer easy entry to infectious microorganisms into bloodstream, even if they aren't visible to the naked eye. Chapped lips and sores on the lips also receive and transmit infection, as can gums damaged by gingivitis.Severe sperm allergy as sen in 10-20% of ladies after vaginal intercourse leading to infertility to Urticaria,itching, swelling of ext Genitilia or cevrvix or vagina and severe infectionis not usually seen with oral sex as protein in semen may be allergant to another person.and afte eating it is neutralised by salive gastric hcl and enzymes so severity is not that much.there is no benefit with Semen drinking except to raise orgasm and sexual pleasure,energy or protein is of very less quality and quantity.

2. A Male Receiving Fellatio Can Receive Infections From His Partner Performing Oral Sex.
Certain kinds of infections can be passed from the mouth of the partner performing fellatio to the man receiving it. This is particularly true of gonorrhea and chlamydia. In a study of men who have sex with men in San Francisco which focused on men who only receive oral sex, never giving it, about 4.1% were found to have become infected with chlamydia and about 4.8% were found to have become infected with gonorrhea, without having performed oral sex on another man. There were similar rates of these infections in men who reported only have active anal sex with other men.

3. Transmission Of HIV During Unprotected Oral Sex Is Rare But Not Impossible.
The virus that causes AIDS is relatively seldom transmitted during oral sex. There are relatively few of the kind of white blood cell, the CD4+ cell, that HIV infects, in the gums and in the lining of the mouth. If the lining of the mouth and throat are intact, there is relatively little risk of the partner performing fellatio's catching the disease. There are only a few known cases of men getting infected with HIV while receiving a blow job without wearing a condom. However, the presence of cuts, scratches, sores, or abrasions, including abrasions from friction due to excessive sexual activity, can create tiny passageways for the virus. Cavities in the teeth can also become an entryway for the virus. There is much greater risk of exposure to the virus from semen than from saliva.
4. Transmission Of Herpes During Unprotected Oral Sex Is Very Possible, And Not Especially Unusual.

When someone is infected with the herpesvirus, he or she remains capable of infecting others even when there aren't any active sores. Although there hasn't been a new survey since 1993, the last time a study of genital herpes was conducted in the USA, antibodies to the infection were found in 45% of African-Americans, 22% of Mexican-Americans, and 17% of white Americans. Nearly all Americans of any race have been exposed to the milder form of herpes that causes cold sores. It is possible to transmit a cold sore from the mouth to the penis, although this does not always happen after contact

HEPATITIS B TREATMENT : EITHER ALONE OR WITH HIV /AIDS & HCV INFECTION -RECENT ACHIEVEMENTS
DR.D.R.NAKIPURIA ,SENIOR GASTRO INTEST SPECIALIST & HIV/AIDS CONSULTANT drnakipuria@gmail.com, 09434143550,09832025O33
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Treatment for chronic hepatitis B virus (HBV) infection has advanced as fast as approval of new drugs has led to higher response rates.

Nucleoside/nucleotide analogs are the mainstay of hepatitis B treatment. FDA-approved options include Baraclude (entecavir), Epivir (lamivudine or 3TC), Hepsera (adefovir dipivoxil), Tyzeka (telbivudine), and Viread (tenofovir disoproxil fumarate). Emtriva (emtricitabine) is also active against HBV, but has not yet been approved for this purpose. These are all pills taken once daily. Conventional interferon and pegylated interferon alfa-2a (Pegasys) are also approved for treating hepatitis B. The more potent formulation, Pegasys, is injected once weekly.

Not everyone with hepatitis B needs treatment, depending on the extent of liver damage and other factors. A complete cure, meaning HBV clearance and development of protective antibodies, is uncommon. But most people can achieve viral load suppression, which lowers their risk of developing liver cirrhosis and liver cancer. Treatment usually lasts for at least one year, and many people stay on nucleoside/nucleotide analogs for several years to maintain viral suppression.

There are three ways to measure hepatitis B treatment response. Virologic response means suppression of viral replication, ideally reaching undetectable HBV DNA viral load in the blood. Biochemical response is normalization of the liver enzyme alanine aminotransferase, or ALT. Serological response refers to clearance of HBV antigens and development of antibodies (seroconversion).

U.S. and European treatment guidelines recommend Baraclude or Viread monotherapy for first-line hepatitis B treatment for HIV-negative people. These drugs offer the best overall response rates and a high barrier to resistance. There are two types of HBV, hepatitis B "e" antigen (HBeAg) negative and positive, the latter being harder to treat. In clinical trials, virologic response rates for Baraclude and Viread were 90% and 93%, respectively, for HBeAg-negative people, and 67% and 76% for HBeAg-positive people. Both drugs are generally safe and well tolerated, though tenofovir can sometimes cause bone loss and kidney impairment. Combining nucleoside/nucleotide analogs does not significantly improve response for hepatitis B treatment-naïve people, but it may be beneficial for people with drug-resistant HBV.

Lamivudine, which is available in a generic formulation, is the least expensive treatment, but drug resistance is common. Pegylated interferon promotes HBeAg seroconversion, and combining interferon with nucleoside/nucleotide analogs improves effectiveness. But interferon can cause difficult side effects, and combining it with Tyzeka can cause peripheral neuropathy.

Viread, Epivir, and Emtriva are active against both HBV and HIV. Guidelines recommend that people with HIV and HBV co-infection should include dually active drugs in their antiretroviral regimen. HIV/HBV co-infection should be managed by clinicians who have experience treating both diseases, since using these medications incorrectly can lead to drug resistance in one or both viruses.if cd4 count is low then first HIV treatment started and later HBV is started and drugs mostly choosen Tenofovir Fumarate with Lamivudine or Emtricitabine with Ritonavir boosted Atazanavir or daruprenavir .But if HBV detected with HIV and whatever CD4 c ount being presentHIV treatment is immedaitely started.With HCV first started HIV and then pegalyated Interferon 2a or 2b started as tackle both HCV and HBV with it Ribavarin added which kill HCV.New DASS drugs like Sobosfuvir,Sime revir ,GS5885 ,Tela previr,Sovaprevir Boceprevir may be also helpful. HBV can be prevented by a three-dose vaccine. This is now included in routine infant vaccinations and is recommended for many adults, including gay men, pregnant women, and people with HIV or hepatitis C.