Diabetes Expert Prof. (Dr.) Anoop Misra Answers Your Queries

 Prof. (Dr.) Anoop Misra, Chairman, Fortis-CDOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology

Chairman, Center for Internal Medicine, Fortis Hospitals, New Delhi

President, National Diabetes, Obesity and Cholesterol Foundation, India

User Query by Neelabh Kumar: I would like to know how can we come to know that we have a heart problem? I am 31 years old, we have family history of heart problem, my father and grandfather expired because of a heart attack. For last one week, I’ve been feeling a bit of pain in my heart and had pain in left hand. I do not know if it is heart problem or some other problem, very confused and getting scared. Please suggest me what should I do.
Other Relevant Medical Info: My father is not hypertensive

• Prof. (Dr.) Anoop Misra’s Answer:  In some patients metformin can cause weight loss, diarrhoea, nausea and vomiting. These are the common side effects of this medicine

User Query by Santosh Chandola: I am 74 and diabetic. I have blockage in rca and lca. My doctor recommend for CABG. Is it safe at this age and is there any alternate safe treatment for this? I also have gall bladder stone, could i operate my stone in this condition?

• Prof. (Dr.) Anoop Misra’s Answer:  CABG poses risks, especially when diabetes is uncontrolled. It is best to tackle gall bladder stones later.

User Query by Praveen Godbole: I am a 58 years old male, vegetarian and non-alcoholic. I have been diabetic for past 8 years and hypertensive for 10 years. Three years ago, I underwent CABG procedure involving 5 grafts (SEQ LIMA -> DG1 ->DG2 -> LAD (in situ) , SEQ LRA -> OM1 -> OM3 (on Aorta Over SV Patch). I have been on recommended medication since then and have been periodically going to same hospital for follow up visit. So far all parameters are good. About a year back, I developed condition where I used to go short of breach upon making small effort e.g. climbing two flight of stairs or brisk walk of even 100 meters, especially with small weight (7-8 Kgs). I had consulted the doctor. After undergoing stress echo, I was diagnosed as having developed condition known as ‘Diastolic dysfunction’ in early stages.

My questions are:

1. Could this condition be a result of CAPG procedure that I underwent 3 years ago?

2. What is the risk associated with this condition? Is this condition life threatening?
Other Relevant Medical Info: I am both diabetic and hypertensive. I am on regular medication and these conditions are under control.

• Prof. (Dr.) Anoop Misra’s Answer:  It’s the ability of the heart to relax after each beat.  When the heart is not able to relax fast enough, it is called diastolic dysfunction. Diastolic dysfunction is linked to excessive weight, limited physical activity (a sedentary lifestyle), diabetes, and age (the heart becomes less efficient at relaxing as we get older). Check with a cardiologist for the cause of the abnormal relaxation.

User Query by Ulhas Bharambe: Dear Doctor,  My age is 60 ,am having no health problem except acidity.I walk approx 8 km everyday. My cholesterol level is 199, triglycerides 182, HDL cholestero l45, LDL 114 and very low density lipoprotein 36.4.  I am not having any ongoing medication course.  Kindly prescribe precautionary life style, medical treatment, diet etc for restoration of normalcy.
Other Relevant Medical Info: Height -169 cm, Weight 60 kg ,no medicine course undergoing .

•  Prof. (Dr.) Anoop Misra’s Answer: No Medication is required at the moment as you have borderline dyslipidemia, but certainly dietary precautions are needed and continue with your physical activity.
  Dietary measures include:
  • Freshly ground flax seeds(Alsi);15-20gms/day,
  • soy products, legumes(beans, lentils and peas),walnuts (akhrot),almonds(badam),and dark leafy green vegetables:lettuce(salad patta),spinach(palak),broccoli,cabbage(patta gobhi),fenugreek leaves(methi sag),mustard green(sarson sag),spirulina(algae)
  • Increase fish intake up to 2 portions  per week(1portion:140gms cooked):(rohu,singhara,tuna,salmon)
  • Rotation of cooking oils like olive/canola and mustard. Recommended amount:<3teaspoon/day (15ml) for cooking
  You should repeat your lipid profile after 3 months and follow up with doctor for any medication required.

User Query by Ashwani Mahajan: I had an heart surgery in December 2013 and I was asked for second stent for 70% block. but 9 months after, i went for echo test and it shows block at 45% but  still my TMT test is positive. Doctors say that I do not need another operation but I need to continue my present regimen. Any advice and precautions in this regard?
Other Relevant Medical Info: I am a diabetic patient too.

• Prof. (Dr.) Anoop Misra’s Answer:  You should consider your cardiologists and keep blood sugars well under control.

 User Query by Harshit Mahajan: My mother 60 yes old Suffering from diabities, fluctuated B.P & CAD. She is taking medicine properly. So what  can she do for her for better life?
Other Relevant Medical Info: Also facing catract

• Prof. (Dr.) Anoop Misra’s Answer:  For a better life good control of blood sugars, blood pressure is required which can be achieved by simple measures like:

1.  Maintain a healthy weight
2. Control salt intake <5g/day
3. Control cholesterol
4. Exercise (60 minutes/day)
5. Balanced diet
6. Keep blood sugar under control
7. Regular checkup

User Query by Jitender Kumar: Sir mera name Jitender hai our mujhe humesha se chest mai jakdan si mehsus hoti hai our kai baar heart ke ass pass pain bhi hota ha. Mai kya karoo raat ko neend bhi nahi aati sahi se aur subha jab utthta ho to din bhar aisa mehsus hota hai jaise abhi neend aa rahi ho. Please help me.

• Prof. (Dr.) Anoop Misra’s Answer:  You should get a physical examination and  ECG done.

User Query by Atul Malhotra: I had my lipid profile done on 27th June 2014 by Thyrocare at thet time my total was 292, triglycerides was 281, LDL was188, HDL was 52. I went to a doctor & he prescribed me tablet  Finate 160 & Tonact 20. I took it for 45 days & again went for lipid & that time my total cholestrol was 158, triglycerides was 138, LDL 75, HDL was 48. Post these results my doctor told me to stop medicines & I stopped taking medicines. yesterday again I went 4 lipid  profile by SRL & my result is total cholestrol is 249 Triglycerides is 235, HDL is 45, LDL is 177, Chol/HDL is 5.5, LDL/HDL is 3.9, VLD is 47.0.& my eating habits was same even when I was taking medicines. Please guide me to whether to take medicines or not.

• Prof. (Dr.) Anoop Misra’s Answer:  Yes you need to continue these medications for controlling your cholesterol and triglyceride levels for long time alongwith diet and physical activity.

User Query by Shashikant Mohite: At age 32 my left kidney was operated removed calcium oxlate stone. Thereafter I have been suffering from high BP. I check up the same Cardiologist said that i have been suffering from cardiomypathy. I am regularly taking medicine bp is normal. My pulse is 50 to 60. I get tired when i walk on steep roads but not on the plain surface. Some time get suffocation but as soon as the gas passes away I get relief. Now I take atenex 25mg, rehase h 25mg,nicardia 20 mg, sorbitrate 10mg  Please guide me.

• Prof. (Dr.) Anoop Misra’s Answer:  You need a regular follow up with a cardiologist.

User Query by Chittoor Ramanathan Krishnamurthy: Does the continued use of cholestrol lowering drugs, ecosporin and BP control drugs, create any side effect, particularly spasms and blisters on body?
Other Medical Information: I have undergone CABG eight years before and leading a life based on medical advice.

• Prof. (Dr.) Anoop Misra’s Answer:  Cholesterol lowering drug can cause spasm but it could also be a  reaction of any of the other medication/medical condition.

User Query by Ranjitsingh Tomar: I am a 39 year old male, in the year 2008 I am feeling tiredness, hence doctor advised me blood sugar test. The report of my blood sugar as on 09/08/2008 is fasting 117 and post meal is 181 and at that time my hight was 177.0cm and  weight was 79.2 kg. After that on 11.08/2008 I have done my HBA1c test which shows result of 5.8% .  That on 27.06.2009 I have done Glucose Tolerance Test and the result were fasting blood glucose 83 mg % and blood glucose after 1 hour glucose load 164 mg, blood glucose after 2 hour glucose load 127%. That on 24/09/2014 I had got eye infection and at that time I check my blood glucose post prandial after 2 hrs and the value were 199 mg/dl . I have done my fasting blood sugar on 27/09/2014 and it was 91 mg/dl and HA1C value on 27/09/2014 was 6.28%. I am working as advocate and in my family both my father and mother are non-diabetic only thing is that my father has thyroid problem. My question is whether I am called as diabetic or prediabetic. That what seem to be cause of my problem.

• Prof. (Dr.) Anoop Misra’s Answer:  You are a pre diabetic if your fasting blood sugar is between:
  • 100-125mg/dl (Impaired fasting glucose)
  • After 75 gram OGTT(oral glucose tolerance test) is  140-199(Impaired glucose tolerance)
  • HBA1c is between 5.7 to 6.4%
  Prediabetes state is also known as borderline diabetes, as per these values you will be called as a prediabetic.
  In your case another OGTT is required after 2 months.

User Query by Rachana Singla: Hello Sir,    My father is a diabetic patient from past more than 12 years.   At home, my mother used to avoid to give any sweetened material. But my father has a habit of having tea with sugar when he is at his workplace.    On an average his fasting sugar level remains between 150-175.    Please suggest whether this is fine or we need to take some precautions or any other measure.

• Prof. (Dr.) Anoop Misra’s Answer:  The normal range for fasting sugars is between 90-130mg/dl. He needs to be put on medication certainly and also diet control and exercise will help achieve normal levels.

User Query by Thakur Harisingh: I am 51 years old high school teacher.I am a diabetic patient since 2 years but my sugar level is under control.My Post Lunch blood sugar reading is 125 and urine sugar is nil.I am on medication ie.,Morning after breakfast 1 tab Glimstar M2 and  metasons 500mg and at night after dinner 1tab Glimstar M2and Metasons 500mg and  for high blood pressure 1tab Enam 2.5mg daily in the morning.I go to walking in the morning for 5km.Kindly suggest me further steps as to how to keep sugar level under control.

• Prof. (Dr.) Anoop Misra’s Answer:  Your sugars are in targets ranges which are fasting (90-130mg/dl) and post meals (120-180mg/dl). Just follow these simple steps healthy balanced diet, regular exercise, timely intake of medicines prescribed, self-monitoring of sugars at home and regular follow up with doctor to maintain  your sugar levels.

User Query by Madhura H: My family has a medical history. FIL expired at 43 bcz of diabetes. Now   my husband at 37 has type 1 diabetes and his levels are arnd 208 (fasting) and post is 280 and takes 5mg of tab dosage. He does lot of exercise and takes care but still levels are not under control. Is it because of stress?. Have a 1 yr old baby boy. Will he also inherit and what precautions can I take for my son?. Please advice.
Other Medical Information: Family History–DIABETES

• Prof. (Dr.) Anoop Misra’s Answer:  In type 1 diabetes, OHA’s have no role to play, insulin therapy is needed to control sugars as it is not secreted by pancreas. You need to consult your diabetologists immediately for insulin initiation and sugar control if you have type 1 diabetes. Genetic risk factors for type 1 diabetes are non-modifiable, however lifestyle related factor can be controlled like maintaining healthy weight, eating healthy balanced diet, exercise regularly which can prevent from development of type 2 diabetes.

User Query by Ojesvi Garg: Dear Dr. Anoop,    I am 34 years old. I’ve had diabetes for the past 4 years or so. I am a Project Manager in an IT firm. I am 5’10 and slightly overweight at 88 Kg. My mother has Type 2 diabetes as well and there is a history of Diabetes from her side of the family. I would admit that I love to eat fried food and I have a sweet tooth but I have curbed my eating habits a bit to control the diabetes. I am taking Janumet 50/1000. I wanted to know if there is a better medication in comparison to the one I am taking. I travel 100 KMs every day for work and its really hard to find time for exercise as I have client calls and meetings with the US team in the evening. I know I should exercise but there just isn’t energy left at the end of the day.

• Prof. (Dr.) Anoop Misra’s Answer:  There is no substitute for exercise, It is important for good control of blood sugars. 45-60 minutes of exercise is daily recommended for sugar control. You can split your exercise  regimen (30 minutes morning and 30 minutes evening)/ you can also exercise in between office hours like with small weights(1-2kg) or walking in lobby for 15-20 minutes after lunch.The best drug is the component included in Janumet; metformin. This drug should be maximised in your case.

User Query by Manas Nandi: Hi Sir, I am a male of  years living in Noida.  Around 4 to 5 years back I found that I am a type  2 diabetic .  In the beginning i was very careful about my medication and lifestyle etc. From the last  year I’ve done nothing but now I’ve decided to fight again. Sir for a very long time almost 1.5 year i dont know what was happening inside me. I request you to suggest the tests from which i know is anything wrong going with my kidneys etc.
Other Medical Information: Diabetic from 4 years. Had hepetosplinomegaly 7 years back

• Prof. (Dr.) Anoop Misra’s Answer:  Diabetes is a chronic disease with multiple complications. Its important to have periodic check-ups for assessment of blood sugar and early detection of complications. You should get the following investigations done: HBA1c,lipid profile, LFT, KFT, urine microalbumin, CBC, ECG, Fundus examination , simple foot tests like VPT(Vibration perception test) and ABI(Ankle brachial index), ultrasound whole abdomen for completes assessment.