Diabetologist in mumbai - Dr Nikhil Prabhu

Diabetes and fungal infections

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

Diabetes when uncontrolled, leads to increased chances of fungal infections. About 20 percent of India population suffers from fungal infections of the foot. Both Diabetes and fungal infections are linked with eachother. When the blood sugar levels are increased, there is increased growth of yeast resulting in fungal infections. The most common fungal infection is caused by Candida albicans (Yeast). Diabetes affects each and every part of the body, especially the skin. The first sign or symptom appearing is itching of the skin, especially the vagina in women. The most common skin symptoms include diabetic dermopathy, diabetic blisters, eruptive xanthomatosis and necrobiosis lipoidica diabeticorum.

Many bacterial infections of skin include stye (infection of glands of eyelid), carbuncles, furnuncles, folliculitis (infection of hair follicles) etc. The most common bacterial infection is staphylococcus bacteria. Fungal infections like Candida albicans are yeast-like fungus which create itchy rashes of moist, wet, red areas surrounded by tiny small blisters and scales. These infections occur in warm and moist folds of the skin. Most common regions are under the breasts, around the nails, between fingers and toes, in the corners of the mouth, under the foreskin of penis (in uncircumcised men), and under the armpits and groin.

Common fungal infections include ringworm (a ring-shaped itchy patch), jock itch, athlete’s foot and vaginal infection that causes itching.

Severity of these fungal infections varies from asymptomatic-mild mucocutaneous infections to life threatening systemic infections.

Factors contributing to Fungal infections:

The main determining factors of fungal infections are linked to geographical and socio-economic characteristics and increasing number of at-risk populations. Patients susceptible to fungal infections include those with immunosuppressive illnesses such as HIV/AIDS, chronic pulmonary diseases (COPD), tuberculosis, cancer and diabetes. It has been observed that patients with systemic fungal infections are at high risk of developing disseminated fungemia and prolonged stay in hospital. This condition is worsened if the patient has a metabolic disorder due to diabetes mellitus. This is because the diabetic patients are more prone to high blood sugar concentration which weakens the immune system and causes several other health complications.

There is high risk of fungal infections in individuals suffering from Diabetes Mellitus. Also it is difficult to treat fungal infections when the blood sugar levels are high.

Pathophysiology:

Usually there is presence of yeast in skin and mucous membrane. But when the blood sugar levels are high, yeast multiplies and form colonies which stick to the skin and mucous membranes. This leads to fungal infūections. There is itching, pain and inflammation of the skin in moist and wet regions.

In type 1 Diabetes Mellitus, the immune system is weak resulting in highl risk for fungal infections especially of foot. When the blood sugar levels are high, the extra glucose is excreated in mucus, urine and sweat. Once the yeast has formed colonies, it’s easier for the fungal infections to return.

Sites of infection:

In women with high Diabetes, the vagina and folds below breast are the common site where there is itching, with foul odour, vesicles formed.

In men, penis is the common site of infection.

Foot infections are very common for fungal Infections.

Eye infections with discharges, blurring of vision, itching and pain in eyes.

Oral thrush, with white patches in mouth, loss of taste, burning and cottony sensation in tongue.

Management:

Usually the patient is examined for the affected area of the skin and prescribed antifungal topical application and suppositories as well as oral medication like fluconazole, Itraconazole, cotrimazole, Miconazole, luliconazole and in severe infections even variconazole. Also Diabetes is also kept under complete check.

Now a days Many Diabetologists have noticed that the resistance to antifungal drugs is increasing day by day and even after using a combination of 2 or sometimes 3 antifungals not able to control the infection.

Also local hygiene is also maintained of the affected area. Diet is also monitored.

In resistant cases personal hygiene play an very important role. fungal spores are not easily destroyed so merging cloths in boiling water and changing bedsheets every alternate day. not using same cloths again without washing. not sharing cloths. breaking scratch-itch-scratch cycle by anti allergic medication. keeping genital area free of moist and clean plays a pivotal role.

Hope this article clarifies your doubts and queries regarding the Fungal infections in Diabetes.

i will soon write a new article on Ringworm infection and white discharge through PV soon.

if you have any queries drop me a meassage in comments here or on Youtube.

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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Glycemic index- it’s role in Diabetes.

October 29, 2020 by Dr. Nikhil Prabhu ( Diabetes Specialist )

The glycemic index (GI) is a scale in units assigned to a food for carbohydrates, with pure glucose value of 100, which represents the relative increase of carbohydrates in the blood sugar levels 2 hours after consuming that food. Low GI foods increase glucose levels gradually. High GI foods increase glucose levels instantly.

The GI scale ranges from 0 to 100. Pure glucose contains highest GI and is given a value of 100.

Having low GI foods can help you attain better control over your blood sugar. Monitoring the GI of foods can be another tool to manage diabetes, along with carbohydrate control and counting. A low-GI diet also helps with weight loss program.

Glycemic Index of Certain Foods discussed below:

Low GI foods (0 to 50):

Barley
Pasta, parboiled (converted) rice
High-fiber bran cereal
Oatmeal
Quinoa
Carrots, non-starchy vegetables, green vegetables
Oranges, grapefruit, apples and many other fruits
Legumes, nuts and beans
Milk, yogurt and milk products.

Moderate GI foods (50 to 65):

Pita bread
Raisins
Rye
Brown rice
Chapatti (whole wheat)

High GI foods (65 and higher):

White bread
Processed cereals and instant oatmeal, including bran flakes
Roasted snack foods
Potatoes(boiled, mashed)
White rice
Honey
Pineapple, watermelon

For glycemic load, below 10 is said to be low, 11 to 20 is said to be medium, and above 20 is considered high.

Several factors are taken into consideration while assigning a food a glycemic rating.

These factors are stated below:

Acidity

Foods that are highly acidic, such as pickles, citric fruits tend to be lower on the GI than foods that are not. Hence the fact proves that breads made with lactic acid, such as sourdough bread, are lower on the GI than white bread.

Cooking Time

The longer a food is cooked, the higher its GI. When a food is cooked, the carbohydrates begin to break down more quickly.

Fiber Content

In general, foods that are high in fiber have lower glycemic index. The fibrous coatings around seeds and beans reveals that the body breaks them down more slowly and gradually.

Process

As a general rule, the more the food is processed, the higher it is on the glycemic scale. For example, fruit juice has a higher GI scale than fresh fruits.

Ripeness

The more the fruit or vegetable is ripe, the higher it tends to be on the GI.

Importance of GI in Diabetes:

The main purpose of GI is it helps us in monitoring the post meal blood glucose levels. This helps the patient to eat the choice of combinations of foods an individual can eat.

Effects of eating low GI foods:

It helps in natural weight loss

Helps keep cholesterol level under control
It increases the body’s sensitivity to insulin
Help refuel carbohydrate stores after intense exercise
Reduces the risk of cardiac diseases

Effects of eating high GI foods:

It can lead to interference with cell function
It can increase the production of insulin
Increases the risk for obesity and type 2 diabetes and it’s complications in uncontrolled Diabetes.
Helps in accumulation of free fatty acid in the body

Hope this clarifies the importance of GI in our day to day life and also it’s role in Diabetes. Thus GI helps an individual especially suffering from Diabetes to chose the food wisely and monitor the blood glucose levels post lunch or dinner.

Glycemic Load : This is the actual value of GI x portion size.

Even if you eat low GI food but the portion size is more then your blood sugar levels will rise. In diabetes portion size per serving plays a very important role. so every diabetic should focus of Glycemic load rather than Glycemic Index only.

You can ask any doubts in comments. i will love to explain them

Have a great day

Dr. Nikhil Prabhu ( Diabetes Specialist )

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Diabetes and Hypertension

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

Diabetes and Hypertension both are linked with each other. Both hypertension and Diabetes are metabolic disorders and correlated with each other. Diabetes damage the blood vessels and arteries resulting in increase in atherosclerosis which leads to hypertension, renal disorders and cardiovascular diseases. Hypertension is usually caused in elderly population but off late it is seen in mid 40’s population in India.

Common Factors causing both Hypertension and Diabetes:

Obesity
Stress
Bad lifestyle
Increased cholesterol
Hypothyroidism
Improper Diet: Junk food, sweets
Smoking
Alcoholism

All these are some common factors which one needs to work upon. Type 1 Diabetes occurs in younger age and adolescence. But it can also occur in later age. In type 1 diabetes, immune system hampers the pancreas which produces insulin.

Type 2 Diabetes occurs in later age of life and so does hypertension. Usually there is accidental detection of Diabetes and hypertension by the physician. When a middle aged patient complains of severe headache and goes to the physician where he actually finds out with the physician.

Epidemiology:

In the US population, hypertension occurs in approximately 35% of patients with type 1 diabetes and in 40% to 90% of patients with type 2 diabetes. A cohort study in the United States revealed that type 2 diabetes mellitus was almost 3 times likely to develop in population with hypertension as in subjects with normal blood pressure.

According to the AHA, blood vessels in the brain are more susceptible to damage due to high blood pressure. This makes it a major risk factor for dementia and stroke.

Gestational Diabetes usually occurs in pregnancy where the blood pressure rises. A lady who manages to maintain her blood sugar levels maintains her blood pressure.

White-coat hypertension is defined as increased office blood pressure (≥140/90 mmHg) usually at doctor’s clinic and normal home blood pressure (<135/85 mmHg).

Role of hyperglycemia:

The biochemical changes of diabetes of both microvascular and macrovascular complications is well established. Hyperglycemia-induced abnormalities in the hexosamine, polyol and protein kinase C pathways have revealed to cause tissue damage in diabetes. In addition to this, hyperglycemia helps the formation of toxic advanced glycated end products and induces glomerular hyperfiltration, growth factor expression, and free radical damage from reactive oxygen genre.

The pathophysiologic link between hyperglycemia and hypertension includes direct effects of glucose, activation of protein kinase C, activation of athero-inflammatory cytokines, endothelial dysfunction from oxidative stress, and epigenetic changes and others. The imposing factor of hypertension on diabetes further aggravates microvascular and macrovascular complications through additive mechanisms that include artery and capillary damage in renal, retinal, cerebral, coronary and peripheral vascular territories.

Management of Diabetes and Hypertension:

Diet: Avoid junk food, smoking, alcohol, limit salt intake, sweets, fried, and potatoes. Use plate diet method. Have fruits instead of juices.
Improve your lifestyle.
Exercising regularly keeps you fit to prevent obesity.
Monitor regularly your blood pressure and blood sugar levels to keep a check.
Keep yourself well hydrated.

Treatment and Medication:

Most of the diabetologist use ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers). Even though other medicines treat high blood pressure, these medicines also prevent or slow kidney disease in patients with diabetes.

Metformin and it’s combination are used to control Diabetes. Insulin injections are used usually in uncontrolled Diabetes and type 1 Diabetes.

Hence both Diabetes with superimposed hypertension raises an alarming signal if not well treated.

Dr. Nikhil Prabhu ( Diabetes Specialist )

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Diabetes and Aloplecia

October 15, 2020 by Dr. Nikhil Prabhu ( Diabetes Specialist )

Diabetes and Aloplecia are usually linked but very rarely discussed. Nearly 45% of the Indian population faces Aloplecia areata due to Diabetes and other causes.

There are various causes of Aloplecia as follows:

Diabetes Mellitus especially type 1.
Hypothyroidism
Stress
Hormonal imbalance
Iron deficiency anaemia
Hereditary

image credits: yalemedicine,org

Diabetes:

Usually Type 1 Diabetes leads to significant hair loss. When blood sugar levels in your body are uncontrolled, it results in significant changes and damage to the blood vessels. This results in poor oxygen supply to smaller blood vessels leading to damage to the hair follicles. Usually, in normal hair growth cycle, due to anagen catagen activity, the hair falls in the final cycle after which the new hair grows from the hair follicles. But due to uncontrolled Diabetes, the immunity hampers the growth of new hair follicles and thus resulting in patches of baldness. In Type 2 Diabetes similar effects do occur but generally are less extensive.

Hypothyroidism:

Due to endocrine imbalance, there is increased TSH levels and decreased thyroxine production leading to imbalance in hormonal levels. Thus leading to hair loss.

Stress and hormonal imbalance:

Both stress and hormonal imbalance goes hand in hand. Increased stress levels results in Anxiety which in turn disturbs sleeping pattern of an individual resulting in imbalance in hormonal levels . This affects the growth of hair follicles and leads to hair fall.

Iron deficiency Anaemia:

Due to decreased iron in haemoglobin, decreased hemoglobin count resulting in anaemia.

Heriditary:

Genetic cause is ofcourse not ruled out. Aloplecia in early aged population is usually hereditary.

Thus all these factors affect the hair follicle resulting in hairfall and leaving patches of baldness.

But Type 1 Diabetes, usually affects the anagen catagen phase in a more severe manner, affecting the immune response. So there is loss of hair overall like the scalp, over eyebrows, over chest etc. In Insulin resistant cases, hairfall occurs faster due to damage to the hair follicles.

Management and treatment of Diabetes and Aloplecia:

One must monitor and control Diabetes so as to keep the cause under control to control hairfall. In type 1 Diabetes, insulin injections along with medication usually help to control autoimmune Diabetes. Regular checkup with your diabetologist usually helps in monitoring your blood glucose levels.
Patches of Aloplecia are usually tackled with Minoxidil tab orally and also local application.
Apply onion juice or aloe vera juice locally over the affected area for months together is often of great help (I don’t recommend but some found it useful).
Improvement in lifestyle changes benefits an individual to avoid stress and improve good quality sleep.
Keeping a check on thyroid hormones, like treatment for Hypothyroidism helps. Eltroxin (Levothyroxin) tab orally helps to keep a check on Hypothyroidism and obesity.
Using proper sulphate free shampoo and regular oiling your hair helps to a certain extent for hair growth and prevents dandruff.
Ofcourse Tricology has advanced souch in this field of hair grafting which is of help to cover certain patches of hair.
Multivitamins like B complex, Vitamin E and Biotin helps in growth of the hair follicle and prevents hairfall.
Trace elements like selenium, zinc, etc and vitamin D suppliments found out to be having a good effect on hair growth.

I’m sure most of the Diabetics especially type 1 must be facing this problem but is hesitant to discuss it due to scalp shaming and ignore it unless very severe patches are shown. Hope the significance of hairfall, it’s causes is well understood and it’s correlation with Diabetes!!!

Have a great day!

Dr. Nikhil Prabhu ( Diabetes Specialist )

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Factors contributing to Fungal infections:

Pathophysiology:

Sites of infection:

Management:

Related posts:

Glycemic Index of Certain Foods discussed below:

Low GI foods (0 to 50):

Moderate GI foods (50 to 65):

High GI foods (65 and higher):

Acidity

Cooking Time

Fiber Content

Process

Ripeness

Importance of GI in Diabetes:

Effects of eating low GI foods:

Effects of eating high GI foods:

Glycemic Load : This is the actual value of GI x portion size.

Related posts:

Common Factors causing both Hypertension and Diabetes:

Epidemiology:

Role of hyperglycemia:

Management of Diabetes and Hypertension:

Treatment and Medication:

Related posts:

Diabetes:

Hypothyroidism:

Stress and hormonal imbalance:

Iron deficiency Anaemia:

Heriditary:

Management and treatment of Diabetes and Aloplecia:

Related posts: