Diabetes- Think Different!


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This is mainly intended to health professionals & diabetic patients, requesting a change in view of 'seeing beyond insulin and insulin resistance' to treat diabetes.
A MUST read!

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  • All i was wondering throughout is how all these things happen?! The mechanism.... Which makes so many things happen which has an impact on diabetes
  • Bcos, all along we are focus only on....
  • It was taught in the very first year of the medical school and medicine is not the same since then. God might or might not have created man, but man did create God, because Man is mightier than God....
  • Then, i wish to conclude saying that...
  • This might or might not be true, but i wanted to emphasise that plsdont keep focusing only on insulin and resistance. Its not working. Stop cutting the branches and let us uproot the tree of diabetes, if we dare to think different. Thats the reason to put on these slides in front of this mixed bag of health professionals. It is time to open our eyes and view diabetes with different pair of eyes.
  • Diabetes- Think Different!

    1. 1. An Alternate Approach To Diabetes!!Viewing Diabetes with fresh pair of Eyes
    2. 2. YOGA - In treating Diabetes and its Complications
    3. 3. Yoga helps in… -• Genetic - X (No evidence available)• Insulin Resistance √• Insulin Production √• Diabetic √ Complications• Body weight √• Stress √• Lipid Profile √
    4. 4. Complications of Diabetes & Yoga
    5. 5. Neuropathy• Increase in Nerve conduction velocity (Malhotra et al, 2002)• In the control group, who were continuing conventional medicine, the nerve conduction velocity deteriorated.
    6. 6. Evoked Reaction Potential (ERP)• Increase in the Cognitive brain function in T2DM (Kyizom et al, 2010)• ERP is a measure of the cognitive brain function.• Yoga seem to reverse the decline in cognition in type 2 diabetes.
    7. 7. Drawbacks
    8. 8. Complex Nature & Flexibility (Myth) Source : Google Images
    9. 9. Age factor• South Asian getting T2DM around 54.6 years (DAWN Studies, 2005)• And, united kingdom the mean age being 64.1 years (DAWN studies, 2005)
    10. 10. You can’t expect… Source : Google Images
    11. 11. Other drawbacks...• Lack of blinded randomised controlled trials• Scoring very low in Jadad Score (Jadad, 1996)• Which proved high level of Bias• Bias of two extremes (Skoro-kondza et al, 2009)
    12. 12. Mechanism
    13. 13. • Thus, Yoga proved efficacious in almost all the factors associated with diabetes (Except genetic factor)But, instead of concluding that yoga is effective for type 2 diabetes...
    14. 14. It is worth considering…Mechanism/ the pathway through which yoga actsSo that, we can design a much better and holistic way to deal with diabetes, in the same way as yoga is helping.
    15. 15. Manjunatha et al, 2004• Tested the hypothesis of whether twisting helps in DiabetesHe Found:• Effects are not all about twisting and squeezing insulin out of pancreas• β cell sensitivity to glucose was increased after doing yoga.• In other words, yoga activated Glucose Transporter 2 (GLUT2).
    16. 16. Questions• Could the GLUT2 receptor activation in a more effective way be the answer to treat, or even CURE diabetes?!• Are there any treatment modes or drugs that specifically targets on GLUT2 ?!• Has there been enough limelight on GLUT2 receptors or on increasing glucose sensitivity in the β cells? NO...
    17. 17. WHY…..?!• Answer for this big question of WHY is…. -Because of our ‘narrow vision’
    18. 18. Narrow Vision Insulin & Insulin Resistance Seeing through the pipeand seeing only ‘Insulin & Insulin resistance’
    19. 19. Evidence free zone You are about to enter the ‘Evidence- free’ zone
    20. 20. Other targetsApart from Insulin, there are other hormonesthat influence in Diabetes like…Glucagon Like Peptide (GLP)Gastric Inhibitory Polypeptide (GIP)Dipeptidyl peptidase inhibitors (DPP-4)TestosteroneLeptin‘Glucagon (Hyperlink)
    21. 21. Other Targets…Apart from Insulin resistance andPancreas, there are other organs to target… Pituitary & Hypothalamus- Bromocriptine (sympatholytic & dopamine agonist) Liver – Main organ in carbohydrate metabolism Kidney – Phlorizine (SGLT 1 & SGLT 2 inhibitor)
    22. 22. Other Hormones: •Glucagon Like Peptide (GLP) •Gastric Inhibitory Polypeptide (GIP) •Dipeptidyl peptidase inhibitorsLiver (DPP-4) •Testosterone •Leptin •‘Glucagon’ ∞ Phlorizine –SGLT1 & SGLT2 inhibitor Bromocriptine – sympatholytic & dopamine agonist
    23. 23. Vitamin D and Diabetes Mellitus (DM)• Some association found between Vitamin D and DM• Vitamin D was found less in Diabetes Mellitus patients• So, they concluded saying, Vitamin D is the cause of DM (Mathieu et al, 2004)
    24. 24. If…• Vitamin D is the cause of Type 2 diabetes, then South Asians having sunlight almost 12 months a year should have at least some advantage over type 2 Diabetes• But, it is not the case.• Because, it is not as simple as ‘sunlight hitting skin & getting converted to vitamin D’
    25. 25. Actual process is Vitamin D3 in Skin(Prohormone) 25-hydroxy D3 (Liver) 1,25 – dihydroxy D3 (Kidney) Active Vitamin D
    26. 26. • It is a known fact that, in type 2 diabetes liver & kidney are the main organs to be damaged.• There are high chances that the affected organs in the diabetes prone individual fail to produce Vitamin D from sunlight
    27. 27. – So... Low levels of Vitamin D could not only be a cause but also be a result of diabetes.
    28. 28. Glucagon• Study done UT South western Medical centre• Young Lee, the lead author of the paper concluded saying, ‘This means that there is some other mechanism than insulin that is working to let the sugar be absorbed into the cells for use as fuel’. (so, insuin resistance has got nothing to do with insulin?!)• Researcher Roger Unger in the article concluded that this result means Insulin may not be the preferred treatment for type 1 diabetes in the future, as insulin injections are not an accurate method for controlling blood sugar
    29. 29. It is time to... Open our eyes Wider
    30. 30. • 90 years after the discovery of Insulin by Banting and Best• More than 100 years since associating pancreas with DM and• With more and more new class and new generation of drugs coming in and going out
    31. 31. Still...DM can only be controlled and not cured?!!!Of course,With an excuse that Diabetes is not a disease and so, it cannot be cured
    32. 32. • It cannot be cured not because it is a metabolic disorder, but because..... Insulin & Insulin Resistance
    33. 33. • Perhaps, Its time to view ‘Diabetes Mellitus’ with fresh pair of eyes!It is time to think...
    34. 34. Diabetes Tree• Are we busy cutting the branches, without bothering about theroots...?!• Or, in fact without even knowing what and where the rootsare.....?!
    35. 35. Conclusion• Considering the valuable comment made by the researchers Roger Unger and Young Lee...• And, with a tint of uncertainty in the cause & effect relations of major influential factors...• And, if Insulin and treating insulin resistance not being the only modes of treating diabetes.... (Glucagon, GIP, GLP, DPP-4 inhibitor, SGLT inhibitors & hypothalamus, kidneys being the other modes of treatment)
    36. 36. Then…. Insulin or the Insulin resistanceMIGHT only be the effect, and not thecause of Diabetes mellitus(DM).
    37. 37. Thank you
    38. 38. Earth is not flat....! - Pythagoras