Latest news with #PushpaNarayan
Time of India
08-07-2025
- Health
- Time of India
It was the mangoes! What glucose trackers catch that lab tests miss
Continuous glucose monitors (CGMs) are revolutionising diabetes care by offering a real-time picture of how everything from your morning coffee to evening workout affects blood sugar levels. Pushpa Narayan speaks to Dr Vijay Viswanathan, president of the Research Society for the Study of Diabetes in India (RSSDI), about how these wearables are helping in diabetes management How good are CGMs at monitoring blood sugar levels? These wearables give real-time information about glucose levels, providing greater insight into the body's sugar trends than traditional finger-prick tests. CGMs can show how different foods, exercise, sleep, and stress impact a person's glucose levels 24x7. This data helps doctors offer dietary and medicinal adjustments to optimise blood sugar levels. Some studies suggest CGMs can detect early signs of impaired glucose tolerance or prediabetes even in those with normal HbA1c (2-3 month blood sugar average) levels. Also, the feedback can motivate people with diabetes to adopt healthier lifestyle choices such as regular physical activity and balanced diet. When do you recommend them? In specific cases. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like An engineer reveals: One simple trick to get internet without a subscription Techno Mag Learn More Undo Last week, I had a patient whose HbA1c was 6.1, which is very good control for a person with diabetes, but the fasting and postprandial (after a meal) sugar levels were extremely high. We found it was possibly because my patient had been eating mangoes almost every day. HbA1c is the gold standard but doesn't reveal glucose fluctuations that occur throughout the day. A normal HbA1c with frequent low and high blood sugar indicates wide swings that the average doesn't capture. A high HbA1c despite 'good' clinic readings could mean post-meal spikes or overnight high sugar that are not being captured by intermittent testing. We recommend a CGM when a patient's average might be masking significant glycemic variability. It provides the timing, magnitude, and frequency of fluctuations, allowing doctors to pinpoint the root cause of disparity and adjust meal plans and medical treatment accordingly. Are they tools to improve diagnosis? Yes. For instance, the Somogyi phenomenon or rebound hyperglycemia (high blood sugar) and the Dawn phenomenon are two distinct causes of high morning blood sugar in people with diabetes. Somogyi phenomenon occurs when an episode of low blood sugar (hypoglycemia) during the night triggers the release of counter-regulatory hormones such as glucagon, cortisol, and epinephrine which work to raise blood sugar. In diabetics who lack sufficient insulin, this mechanism can overshoot, leading to high blood sugar levels in the morning. Dawn phenomenon is a more natural process where the hormones cause a blood sugar rise between 2am and 8am to prepare for waking. These hormones increase insulin resistance and signal the liver to produce more glucose. In those without diabetes, the pancreas releases enough insulin but not in diabetics, leading to elevated blood sugar levels upon waking. Unlike Somogyi phenomenon, Dawn phenomenon is not preceded by a hypoglycemic event. It's important to distinguish between the two as treatment varies. CGMs help the caregiver diagnose, adjust insulin dosage and medication timing, with better long-term health outcomes and lower risk of complications. The information overload can cause anxiety, unwarranted dietary restrictions, and sometimes an unhealthy obsession with food among healthy folk. Not to mention needless expense Dr Viswanathan Even healthy people are using CGMs as a predictive health tool to prevent diabetes. Would you recommend it? Doctors' bodies, including RSSDI, are cautious about recommending widespread use in healthy people as the need is not yet proven. Also, most devices have algorithms tailored only to a diabetic's needs, which can lead to data misinterpretation. There's also the danger of an information overload that can cause anxiety, unwarranted dietary restrictions, and sometimes an unhealthy obsession with eating among healthy folk. Not to mention the needless spending. That said, manufacturers have designed over-the-counter devices for those who don't use insulin and are not at severe risk of low blood sugar. For healthy people, I would recommend a balanced diet, exercise, and maintaining a healthy weight for glucose management. Can CGMs help kids and the elderly? They greatly reduce the need for painful finger-prick tests that kids may dislike and the elderly may have difficulty with. Both may be more susceptible to hypoglycemia and may not experience typical symptoms. A CGM can provide life-saving alerts for low glucose that would help prevent severe episodes. And modern CGMs are often user-friendly, which can benefit older adults with cognitive impairments.
Time of India
11-06-2025
- Health
- Time of India
‘Anti-rabies vaccine is very effective but there are other factors at play'
Rabies remains a formidable public health challenge in India, with around 20,000 annual deaths accounting for 36% of the global toll, according to WHO. In a conversation with Pushpa Narayan, Dr B Sekar, former director of the Pasteur Institute of India in Coonoor which supplies vaccines to the Centre, explains why some bites are more dangerous than others Last month, three children died in Kerala even after rabies shots, raising questions about quality. Why are such deaths happening despite vaccinations? Aren't the vaccines effective? Anti-rabies vaccines are incredibly effective. But, in some cases, they may fail owing to several factors, including the time of vaccination, dosage, and the type of wound care. For instance, if someone is bitten by a rabid animal and has a category 3 wound, then getting the vaccine right away, along with a rabies immunoglobulin shot, is crucial to make treatment 100% effective in preventing the disease. Also, the person must complete the full vaccination course — day 0, 3, 7, 14, and 28 for most intramuscular route vaccinations and day 0, 3, 7, and 28 for most intradermal vaccinations. Many skip vaccinations if they see the wound heal or if they don't see visible wounds, both of which are wrong. What is a category 3 wound? Why is it so serious? Doctors classify wounds into categories to determine appropriate post-exposure treatment for rabies. Category 3 is considered the most severe type of exposure and typically has one or multiple transdermal bites or scratches where the animal's teeth or claws puncture the full thickness of the skin, causing bleeding. Such wounds carry the highest risk of rabies transmission as the virus-laden saliva has a direct pathway into the body's tissues and potentially the nervous system. If the animal licks a person's eyes, nose, mouth, broken skin (or wound), or any other mucous membrane, that's also category 3 exposure. Any direct contact with bats can be very tiny and go unnoticed but is often treated as category 3. The recommended treatment for category 3 exposures involves immediate and thorough wound washing and rabies vaccination, along with a rabies immunoglobulin (RIG) shot which provides the immediate antibodies to neutralise the virus at the wound site, offering crucial passive protection while the body develops its own immune response from the vaccine. Does the bite site play a key role in prevention? Yes, it does. The rabies virus travels along the peripheral nerves to reach the brain through the spinal cord. If a bite is on the head, neck, or face, the virus has a shorter distance to travel, which can lead to a shorter incubation period and faster onset of symptoms. Prompt and aggressive medical response is critical in such cases. Areas with a lot of nerve endings, such as fingers and toes, also pose increased risk as the virus can easily find a nerve to latch on to. Of course, category 3 wounds, deep bites, contamination of mucous membranes, or broken skin allow more direct access for the virus, whereas a superficial scratch or lick on intact skin carries a much lower risk. What about the risk of a higher viral load in the animal? The amount of rabies virus present in the biting animal's saliva directly impacts the likelihood of transmission. An animal in the later stages of rabies (when the virus has multiplied significantly and spread to the salivary glands) will typically have a higher viral load in its saliva. If it bites, more virus particles are introduced into the body and can enter the nervous system to cause infection. This can overwhelm the local immune response much before vaccination takes effect and contribute to a shorter incubation period before symptoms appear. One step to a healthier you—join Times Health+ Yoga and feel the change
