Diabetologist in mumbai - Dr Nikhil Prabhu

Diabetic Nephropathy – Symptoms Pathophysiology Treatment

September 26, 2020 by Dr. Nikhil Prabhu ( Diabetes Specialist )

Diabetic Nephropathy (DN) is also known as Diabetic kidney disease. DN leads to chronic loss of kidney function due to diabetes mellitus. Over 45 percent of cases of kidney failure are caused by diabetes, and it’s estimated that approximately 190,000 people are living with kidney failure caused by complications of diabetes. When the blood sugar levels are increased, there is progressive damage to the kidneys.

Diabetic nephropathy is one of the causes of end stage kidney disease. The kidneys regulate the levels of salts and fluids in the body, which is important for controlling blood pressure and protecting cardiovascular health. In ESRD, the kidneys donot work well enough to meet the needs of daily life. This leads to kidney failure due to failure in filtration of salts and fluids.

Pathophysiology:

When our bodies digest the protein we eat, this process creates waste products. In the kidneys, millions of tiny blood vessels with even tiny holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products pass through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are larger in size do not pass through the holes in the filter and stay in the blood. High blood glucose levels interfere with the function of the glomerulus. The filter function of the kidneys get damaged and proteins start to leak from the blood into the urine. Albumin being the smallest of proteins goes first hence by measuring its presence in urine we can measure the damage to kidneys.

Symptoms of Diabetic Nephropathy(DN) :

Albumin in urine
Nausea
Vomiting
Drowsiness/ disturbed sleeping pattern
Dryness of skin and itching
Stomach upset
Swelling of face, feet and hands.
Loss of appetite
Uremia due to retention of waste products.

Risk factors:

People who have diabetic nephropathy also often have high blood pressure. High blood pressure can further contribute to kidney damage. High blood pressure lead to increase in filtration pressure and can further lead to pores wide open. under high pressure it increases the chances of albumin to slips into the urine and increasing the kidney damage further. so controlling blood pressure is essential to halt kidney damage.

Other risk factors include obesity, smoking, alcohol, hereditary and people suffering from cardiovascular diseases. Diabetic nephropathy is a complication of uncontrolled Diabetes mellitus and usually accompanied with diabetic neuropathy and diabetic retinopathy.

Diagnosis and Management of Diabetic Nephropathy(DN) :

X ray kidney ureter bladder (KUB) can help in detection of any damage to the kidney.
CBC, ESR, Urine routine and C reactive protein are some of the tests which can help in detecting the nephropathy.
Also Blood sugar levels should be monitored at regular intervals.
Estimated glomerular filtration rate (eGFR) gives an indication of the kidney function to filter waste products from your blood.
Albumin / Creatinine ratio or 24hr albumin in urine is another important test.

Treatment for Diabetic Nephropathy:

Early detection and treatment of diabetic nephropathy can not only stop the progression of kidney disease, but during the early stages can actually reverse it. Treatment involves controlling both your blood glucose levels and your blood pressure. ACE inhibitors and ARBs are the class of drugs which helps in restricting the kidney damage by reducing those pores size by altering the renal glomerular blood vessels flow (afferent and efferent arterioles) and preventing albumin loss. CKD is not reversible as such but we can obviously delay its progression.

Oral medication usually helps in controlling diabetes. Also insulin injections are given when the sugar levels are out of the limits.

Lifestyle changes are a must for a healthy normal life. Working on your obesity is equally important as per body mass index.

Quiting smoking and drinking alcohol usually improves the overall wellbeing of an individual.

Plate diet plan helps often in improving the condition of the patient. Avoid seedy foods like lady’s finger, tomato, seedy foods are a must to consider. A reduced protein diet can help to prevent Diabetic nephropathy this preventing protein in urine.

Exercising regularly for half an hour is a must to vent out energy and utilize extra glucose. (not advisable in last stages)

In last stages salt restriction and water restriction plays an important role in its progression.

If you like this article do share it with friends and family.

have a great day.

Dr. Nikhil Prabhu ( Diabetes Specialist )

Dr Nikhil Prabhu is a consultant Diabetologist from mumbai. he has been practicing for more than 10 years and currently over 7000 patients are under his treatment for diabetes and thyroid disorder from mumbai and navi mumbai area. | you can book his appointment for tele-consultation on 9082523295 | follow us on YouTube for more diabetes & health related tips

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Diabetes in Elderly Patients – a concern

September 21, 2020 by Dr. Nikhil Prabhu ( Diabetes Specialist )

Diabetes in elderly people above 65 years of age nearly contributes to 25 to 30 percent of the whole population. Diabetes is a very common but a serious chronic ailment. Some of the people take it lightly. Type 2 Diabetes being more prevalent in elderly people. The role of genetics plays a very important part in elderly population.

Factors contributing Diabetes in elderly:

Obesity
Sedentary lifestyle
Faulty eating habbits like sweets, chocolate etc
Lack of exercise
Smoking
Alcohol affecting liver and pancreatic metabolism
Autoimmune diseases

All these factors contribute or I can say play major role in Diabetes apart from genetics or hereditary family history.

The studies have shown that patients have several metabolic abnormalities, including altered glucose-induced insulin release, increased fasting hepatic glucose production and marked resistance to insulin-mediated glucose disposal.

Image credits: Aging.com

Symptoms in elderly group:

Symptoms of type 2 diabetes may include:

Fatigue
Increased thirst or hunger
Losing weight without trying
Urinating often in night
Blurred vision.
Repeated Skin infections like candidiasis or slow healing from cuts and bruises.
Insomnia, disturbed sleeping pattern due to increased frequency of urination in night time.

Some people with type 2 diabetes may not realize they have it because symptoms often develop slowly and go undiagnosed. Sometimes older adults ignore these symptoms as “getting old,” but they can be indication of a serious problem.

Pathophysiology:

When the glucose levels in the blood increases, we say that a person is suffering from Diabetes. Our body gets it’s energy from food. When we eat food a lot of glucose is formed which gets converted to energy. Insulin converts glucose into energy. The production of insulin is controlled by pancreas. Hence the insulin production is less or the patient is insulin resistant, glucose levels in blood increases, leading to Diabetes.

Senior citizens and middle aged population are at high risk of developing Diabetes. Mostly they develop type 2 Diabetes. Nearly 15 to 20 percent of population are Prediabetics.

Now what do you mean by Prediabetics? It is a condition where in the sugar levels in blood are marginally high and is undiagnosed.

Management of Diabetes in elderly:

Firstly the diagnosis and management of a prediabetes is very important. Regular checkups and monitoring glucose levels is of utmost importance. Improvement in lifestyle and way of living is of great help to the individual.

Diet also equally contributes in management of Diabetes. Having healthy diet and following plate diet is of utmost importance. Grapefruit, bitter gourd and black jamun are some foods that help in reducing blood sugar levels.

Going for daily walks or exercise really helps to burn out extra glucose or fat in our body by utilizing energy. Being active is the key mantra to keep Diabetes at Bay. Yoga, pranayams, meditation help a lot to prevent depression.

Avoid drinking water in night after 9 pm helps bladder control and prevents increase frequency of urination in night. Thus this prevents disturbed sleeping pattern.

Taking your timely medicine metformin or insulin as prescribed by your diabetologist prevents further complications of Diabetes.

Regular eye check-up helps you to avoid complication like retinopathy. If any nerve pain or age related neuropathy then one must visit a neurologist for advice and monitor glucose levels. Charcot’s foot and gangrene can be avoided by keeping sugar levels under check. Also be cautious of any injury or a slip.

Stay Safe# Stay Healthy# Prevent Diabetes.

Dr. Nikhil Prabhu ( Diabetes Specialist )

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Diabetes & Depression Link Diagnosis Treatment

September 13, 2020September 11, 2020 by Dr. Nikhil Prabhu ( Diabetes Specialist )

Hello friends, today we shall discuss about diabetes and it’s role in depression. What’s depression about? Dealing with depression is not a social stigma. Both these diseases are global issues and around 19 million of the population of the world is suffering from these diseases. The prevalence rates of depression could be up to three to four times higher in patients with type 1 diabetes and twice as high in people with type 2 diabetes compared with the overall general population worldwide.

Depression actually means when a person is disappointed due to some reason and is sad all the time with mood swings, doesn’t want to do anything, a very laid back attitude, can binge chocolates and food in depression or not eat at all. The incidence of occurrence of depression is about three to four times higher in patients suffering from diabetes. About 12% of the Indian population is suffering from diabetes where in depression remains undiagnosed. Depression could be explained as a first episode, a recurrent or chronic episode. It could be mild, moderate or severe, with or without psychotic features.

Diabetes and depression link:

Diabetes and depression go hand in hand. People suffering from depression often land up borderline diabetes or prediabetes state.

Managing diabetes can be stressful, monitoring factors, which can lead to depression.
Faulty eating habits, sedentary lifestyle, lack of exercise, obesity, smoking, managing diabetes can lead to depression.
On the other hand, depression itself lead to lack of communication, lack of interest in anything, no exercise, insomnia, irregular eating habits etc which can lead to diabetes.

Diabetes and depression are the most common causes amongst people and a serious medical condition. Depression being the 4th cause, while diabetes the 8th cause of disability adjusted life years (DALYS) in developed countries.

Image credit: thediabetescouncil.com

Physiology of Depression in Diabetes :

People suffering from diabetes reveal mood swings and emotional changes. Any alteration of blood sugar levels leads to alteration of mood swings, low feeling and irritability.

Diagnosis of Depression or depressive features in Diabetes:

Before starting my diabetes practice i have also did more than 2 plain posts (6 months each) in psychological medicine department in BMC hospital mumbai where i used to see an alternate day OPD of more than 80-100 patients under the guidance of AMO and HOD. i can still remember that my AMO was used to teach me from DSM 5 of psychological medicine book how to distinguish from depressive features or traits from Major Depressive Disorder (MDD).

Based on my experience if you want to diagnose that whether you have depressive features or not ? just ask yourself 5 questions !

Is there a feeling of worthlessness, helplessness, hopelessness, loss of self esteem?
Do you cry when your alone ?
Do you feel sad or low with or without reason? ( repeated negative thoughts which affects your sleep and appetite)
Have you lost interest in your daily activities? (e.g avoiding your relatives friends)
Do you feel that your life is not worth living or is better to die? (there’s nothing left in this world for you / suicidal ideation)

if your answer is YES to any 3 of the above questions you may be suffering from depressive features and you should consult a expert in psychological medicine or MD psychiatrist.

Management of Depression in Diabetes :

Both diabetes and depression have the potential to cause a dangerous vicious cycle if not treated at the correct time. Constant monitoring is required to manage blood sugar, medication side effects, health care services and other related health conditions can lead to an increased risk of depression.

Treating diabetes type 1 or type 2 is of utmost importance so that diabetes complications can be well avoided. Also depression should be treated with appropriate anti depressant medication and regular counselling /psychotherapy under the guidance of expert in psychological medicine or MD psychiatrist. The patient should be made to realise the importance of improving lifestyle changes, regular exercise and timely medication. Eating healthy food is also of prior importance. Plate diet method in diabetes is very helpful in controlling diabetes. Sleeping pattern should be maintained properly.

Impact of depression on diabetes:

Depression increases the risk and accelerates the risk of diabetes and it’s complications like retinopathy, neuropathy, macrovascular diseases, gangrene etc. Many people think that both these diseases are isolated and do not have any link between them. But various studies have proven that there is a cause and effect cycle between the two diseases. Well ignoring your depression and not accepting it due to social stigma doesn’t help one much.

Let’s conclude this article, considering that how important are these 2 D’s in our lives and so well linked with each other.

Dr. Nikhil Prabhu ( Diabetes Specialist )

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Diabetes and Sleep Disorders

September 8, 2020 by Dr. Nikhil Prabhu ( Diabetes Specialist )

Type 2 diabetes mellitus (T2DM) is mostly associated with higher incidence of sleep disorders, which may be due to disease itself or due to secondary complications of diabetes. However, shorter sleep duration and erratic sleep behavior itself have been linked with higher incidence of obesity, metabolic syndrome and T2DM. Sleep disturbances are more common in people suffering from diabetes. Diabetic patients usually suffer from sleep disorders like insomnia, day sleepiness, disturbances in sleeping pattern, etc.

Multiple factors may contribute to insomnia in persons with diabetes:

pain associated with peripheral neuropathy
periodic limb movements
restless leg syndrome
rapid changes in blood glucose levels during night leading to hypoglycemic and hyperglycemic episodes, nocturia and depression.

Image Credit: Thediabetescouncil.com

Categories of Sleep:

The categories of sleep disturbances that contribute to obesity and T2DM include the following:

(1) alterations of sleep duration, chronic sleep restriction, and excessive sleep

(2) alterations in sleep architecture

(3) sleep fragmentation

(4) circadian rhythm disorders and disruption (i.e., shift work).

Epidemiological data have suggested higher risk of obesity and T2DM in individuals with shorter sleep duration (<4–5 h/night) as well as those of poor sleep quality.

Difficulty initiating sleep increased the risk of T2DM by 57%, while difficulty maintaining sleep increased its risk by 73%. Similarly, the risk of developing T2DM associated with insufficient (≤5 h/day) or excessive sleep duration (≥9 h/day) or performing shift work was comparable to that of being physically inactive.

Two studies revealed that the insulin response to an oral glucose challenge was higher when comparing the total sleep deprivation condition to the normal sleep condition. This suggested that an insulin resistant state was induced by acute sleep deprivation. Another study reported that a 1-week period of sleep restriction (only 4 h of sleep daily) in young, healthy subjects could lead to a prediabetic state.

Metabolism and Mechanism of sleep disorders and diabetes :

Possible causes of impaired glucose metabolism in sleep disordered breathing (SDB) might be intermittent hypoxia and sleep fragmentation associated with them. Sleep fragmentation increases sympathetic activity, which in turn increases blood glucose levels by decreasing insulin sensitivity.

Diabetes and Sleep Apnoea:

Obstructive sleep Apnoea (OSA) is a sleep-related breathing disorder characterized by collapse of the upper respiratory tract leading to cessation of airflow in the setting of continued respiratory effort. This results in hypoxia which inturn leads to frequent arousals causing sleep fragmentation and symptoms of excessive daytime sleepiness. The prevalence of OSA in the population with type 2 diabetes may be as high as 24%, and the prevalence of any SDB may be as high as 59%.

Common symptoms of OSA include:

Loud snoring
Frequent cessation of breathing during sleep
Choking and gasping episodes during sleep
Waking up sweating during sleep
Feeling unfreshed in the morning after apparently adequate night sleep
Morning headaches
Excessive daytime sleepiness and lethargy
Rapid weight gain and cognitive deficits

Evaluation of sleep disorders :

Assessment of sleep quality, sleep disorders, and sleep hygiene is of primary importance in persons with diabetes. As discussed earlier above, etiology of sleep disruption in diabetes is often multifactorial. Hence, a detailed history, careful examination and some laboratory investigations will be required for successful evaluation and subsequent treatment of sleep disorders in this population. Maintaining a 2 week diary would help ascertain the sleeping pattern.

Management of sleep disorders:

Behavioral approaches are very important in the management of insomnia, which include adherence to good sleep hygiene, sleep restriction, cognitive behavioral therapy, and relaxation therapies. Yoga, meditation, improving life style also helps in improving sleeping patterns. Eating excessive in night time result in increase glucose levels in blood which may lead to nocturia. Thus eating habits needs to be monitored on regular basis and exercise daily to maintain body weight. BMI needs to be monitored.

Dr. Nikhil Prabhu ( Diabetes Specialist )

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Pathophysiology:

Symptoms of Diabetic Nephropathy(DN) :

Risk factors:

Diagnosis and Management of Diabetic Nephropathy(DN) :

Treatment for Diabetic Nephropathy:

Related posts:

Factors contributing Diabetes in elderly:

Symptoms in elderly group:

Pathophysiology:

Management of Diabetes in elderly:

Related posts:

Diabetes and depression link:

Physiology of Depression in Diabetes :

Diagnosis of Depression or depressive features in Diabetes:

Management of Depression in Diabetes :

Impact of depression on diabetes:

Related posts:

Categories of Sleep:

Metabolism and Mechanism of sleep disorders and diabetes :

Diabetes and Sleep Apnoea:

Common symptoms of OSA include:

Evaluation of sleep disorders :

Management of sleep disorders:

Related posts: