National Heart Institute

Hello,

My name is Dr. Anirban Biswas. After the last talk about how to increase your height & how to loose weight today we are dealing with another good topic on sexual dysfunction. So there are a few questions which I going to answer. What are the types of sexual dysfunction in males? So the first type is erectile dysfunction in which the organ doesn’t get hard enough to penetrate. The second is premature ejaculation in which there is ejaculation soon after starting of sexual intercourse and doesn’t last that long. And 3rd is loss of libido or the lack of sexual drive. So the causes are hormonal, less testosterone level which is the main male hormone in the body. Second is drugs like anti depressant anti psychotics anti hypertensive. Yes, antihypertensive is also important. Most of us they will say that blood pressure ki bimari hain and they will take whatever medicines they find from a local chemist but do you know that 70% of patients of blood pressure can get erectile dysfunction because of antihypertensive drugs?

So this is another thing which needs to be taken into consideration. Blood pressure itself diabetes one of the leading causes nowadays because India is the diabetic capital of the world so diabetes causes neuropathy and it leads to lack of sexual drive as well as ED as well as PE. Smoking & alcohol yes these can cause vascular disturbances and psychological because of the modern stress & anxiety depression, then any past history of sexual trauma and marital disharmony all these things can lead to this is one of the big causes. Because we see more & more people have psychosexual related sexual decline. And last is surgery this is also seen in some cases of prostrate or other bladder cancer or bladder surgery. So the diagnosis is based on mainly 3 things first is the hormone analysis which needs to be done. Second is if the vascular anatomy needs to be evaluated then we need to go for penile Doppler and third is psychosexual or the psychological analysis which is another important thing.

This can be done through cross referrals across a physician endocrinologist and psychologist or psychiatrist and sometimes even a urologist comes to play. The treatment is mainly medicines there are phosphodiesterase inhibitors like sildenaphil viagara you know very well sabko pata hain so that is a important medicine which can be used in such diseases. Then hormone replacement therapy like lack of testosterone we can add testosterone or aajkal aise dawaiyan bhi aagayi hain jo direct testosterone ko jagah indirectly testosterone ka level barhati hain. So aise dawaiyan bhi hum de saktey hain patients ko. And psychological therapy which is again provided by either psychiatrist or psychologist after the diagnosis have been made, which sometimes lead to no medicines at all. You don’t require any medicines just counseling sessions with the psychologist or psychiatrist can help. And this is indeed have been proven in various studies.

And the 4th is other methods like vacuum & penile implants which are surgical or mechanical. So these are the ways by which we can treat sexual dysfunction. The question arises whether sexual dysfunction infertility or sterility is the same – No it is not. Infertility is basically not able to produce children but it has nothing to do with sexual dysfunction, the patient may be sexually potent but he may be not able to produce children. So that is another aspect for which comprehensive analysis of the male & the female partner should be done. So with this, I hope you have learned well in today’s topic and I will be waiting for your queries and questions and will be very happy to answer them. So if you have any queries or if you want to book an appointment with me regarding your sexual queries then you can please book the appointment through Lybrate. Thank you and stay well stay healthy.

Thanks!

Hi,

I am Dr. Anirban Biswas, Endocrinologist. Today I will talk about perfect height and weight. These ar the common questions. Height badhane ke 2 hi option hain. First is genetic and 2nd is growth hormone. Inme nutrition ka bhi important role hota hai. Iske lia aap Dr ko dikha skte hain and check krva skte hain ki apki growth hormone kaisi hai. Growth hormone ke supplements aate hain jo hum apko de skte hain. Balanced diet lena bhut jruri hai. Kuch patients ka question hota hai ki weight kaise reduce kren. Obesity se kafi complications hote hain.

Like diabetes, blood pressure, stroke, cholesterol, breathing problem, snoring, cancer, arthritis. BMI se hum check krte hain ki apka obesity kitna hai. Hume apna BMI 25 se niche rkhna hai. 25-30 is overweight and above 30 is obesity. Apko diet me calories ko reduce krna hai. 2nd way haia ki aap calorie ko spend kren and iske lia hum apko walk ka suggestion dete hain. Swimming kren and weight lift, stretching exercises kren. Medicines bhi apko help krti hain. 7% weight loss krne se apki diabetes ki medicines adhi ho skti hain. Apka blood pressure 5 units se kam ho skta hai. heart attack ke chances bhi kam ho jate hain. Knee pain me bhi apko kafi help ho jati hai. Islai weight loss sabse important hai and apko agar or koi information chaiye to aap mujhse contact kr skte hain Lybrate ke through.

Thank You.

Individuals from all age groups have been affected by obesity and diabetes. Anxiety and depression are also on the rise. Other lifestyle disorders like Alzheimer's disease, Stroke, Arteriosclerosis, Hypertension, Hypothyroidism, Cancer (mostly skin and lung), Cardiac problems, Renal failure, Chronic Liver problems, cannot be neglected either.

Hello! Good Morning!

I am Dr. Anirban Biswas. I am an endocrinologist practicing in South Delhi. Today I am going to answer a few questions asked by my patients regarding new treatment modalities in diabetes and a few questions on insulin. 

Q1. Mrs. Anshu Garg: Whether a person who is on insulin can be shifted to oral medicines? 

Answer: My answer is “Yes. Why not?” We can always shift a patient from insulin to oral medicines if there are certain conditions which are fulfilled. We need to perform a few tests and based on that we can find out whether the pancreas are still active. I personally have shifted around more than 1000 patients who were on insulin to non-insulin based regimens or they have substantially lowered their insulin requirement and I have detailed all this in my website www.insulin.com. So, it is possible that there are newer drugs which can make it possible.

Q2. Mr. Atul Thakur: What are the newer medicines that can be used?

Answer: There are two classes of new medicines which have arrived. First are the gliptins which are based on the ingredient pathway and they act not necessarily on the pancreas. They act through the intestinal pathway of controlling sugar. Now let me explain you how this is possible. We all know that there is a test done in which we feed a patient 75 grams of glucose. This test is known as the Oral Glucose Tolerance Test (OGTT) and when scientists were replicating the OGTT through intravenous glucose, they were surprised to find out that only 25 grams of glucose is sufficient to replicate the graph of 75 grams of glucose in OGTT.

So, where does this 50 grams of glucose go, which was fed orally? Scientists asked this because both the graphs were similar. So the answer lies in ingredient pathway. So ingredient pathway was responsible for taking care of the 50 grams of extra glucose which had been fed orally. So, in this way we came to know about the ingredient pathway.

The other treatment modality which has arrived is the SGIT tool, the receptor inhibitor pathway which acts through the kidneys. It decreases the retention of glucose through the kidneys and increases the excretion of glucose through the kidneys and this results in fall in the sugar level in the patient’s body. It also causes some increment in the blood pressure and the cholesterol level also. So, these are the two essential newer modalities which have arrived.

Q3. Ravi Bhatnagar: What is CGMS? 

Answer: CGMS is Continuous Glucose Monitoring Device. This has been found to be useful in not control of the sugar level like the fasting, BP and the HbA1c levels. Other than that, it has been found to improve the glycemic variability, i.e., the day-to-day variations of the sugar levels can be very easily found out, and this device is available and has been manufactured by Abbott. This is a very good sensor device which can be pain free and can be used in all the patients and I have used in my patients and have got excellent results. 

With this I come to the end of today’s Questions & Answers and hope to see you soon.

Good afternoon everybody. I am Dr Anirban Biswas and I am a diabetologist, practising in South Delhi. Today we are going to discuss the screening and diagnosis of Prediabetes and Diabetes.

Most of my patients send me their reports and tell and that they have a fasting sugar of 128 and a PP sugar of 142, whether they are diabetic or not. So, by listening today's topic, you will be able to know whether you are a diabetic or not. Let me tell you first that diabetes is a deadly disease and as you all know that India is a diabetic capital of the whole world. Every 7th second, one person dies due to diabetes in this world. And it is a huge burden on us. And most of the diabetic care and treatment is born by the patients in India. On an average Rs, 10,000 per year is the annual cost of the treatment without any complication. So, it is a huge amount, hence, we need to find out whether we have diabetes or not.

So, the first thing is that whether you have diabetes or not. So, the first question is that if anybody can have diabetes? So the answer to this question is that, yes anyone can suffer from Diabetes. There are some symptoms of Diabetes, those are;

• Weight loss
• Lethargic
• Thirst
• Excessive urination

But often, diabetes is silent. It has been found out by various researchers that half of the population does not know that they are diabetic patients. Not only in India but also in the US. It is very important to find out that who are diabetic. It is a very simple way to find out whether you are diabetic, pre diabetic or have normal sugar level.

The value what I am going to tell you that how you get to know that you are diabetic.

• First thing is the fasting blood glucose. This can be done in any lab. So, you can go in the morning without taking any meal. One thing you need to remember that if your fasting blood glucose is less than 100 then it is normal. If your fasting blood glucose is between 100-126 mg then you are prediabetic. And if the fasting blood sugar is more than 126 then it means that you are a diabetic patient.
• The second way to know whether you are diabetic or not is the HBA1C. It is also known as Glycosylated Haemoglobin. Again it is a routine test which is done in all the labs. If the value of HBA1C is below 5.7 then you are non-diabetic, if the HBA1C level is between 5.7- 6.5 then you are prediabetic. And if the HBA1C level is above 6.5 then you are a diabetic patient.
• The other test is OSTT, which is done at a certain level when there is some amount of doubt. The Oral GTT test is by means 75 g of glucose is fed to you and the sugar is checked after 2 hours. So, after 2 hours of feeding the glucose, if the sugar level is less than 140 then you are normal. If the sugar level is between 140-200, then you are prediabetic, and if the value is more than 200 then you are diabetic.

Which individual should get screened for diabetic and pre diabetic?

Any individual above the age of 40 years. And from your weight and height, anybody can calculate the BMI ( Body Mass Index). If the BMI is more than 23 then you should go for screening even if your age is not 40+. If you have symptoms of Diabetes, or if any blood relative is having diabetes or is pre-diabetic should go for a checkup.

And last but not the least, who has a history of GDM i.e, Gestational Diabetes Mellitus which is very common in females throughout the whole world, after the pregnancy they should regularly get screened for diabetes. So these are the people who should get screened for Diabetes. And by getting a screen from Diabetes we can save ourselves from the complications of Diabetes.

Diabetes can cause so many complications, especially the cardiac and heart-related complications. You can have a stroke, heart attack, neuropathy, kidney failure, also you can have blindness or retinopathy, amputations i.e, your arm or leg can be cut because of diabetes.

So friends may be with this I can conclude that you have learnt something from my talk. And please remember that you should get yourself screen with diabetes. Next I will talk about the type of Diabetes.

If you want to consult me or have any query, You can contact me through Lybrate.

Here are some facts & Myths about Diabetes

Hello. Good Afternoon. I am Dr. Anirban Biswas. I am a diabetologist. I am practicing at Fortis Hospital. I want to discuss with you a few facts about Diabetes.

As you all know friends that diabetes is a leading cause of mobility in India. There are, basically, two types of diabetes; one is Type 1 Diabetes which is insulin dependent and usually occurs in small kids and children. The other one is Type 2 Diabetes which is mainly in adults and can be treated without the need of insulin. Now, first of all, we should focus what are the symptoms of diabetes. The symptoms of diabetes are weakness, lethargic, and you are not able to do your daily activity and second is that you are feeling irritable and disturbance in sleep, excessive thirst and hunger and frequent visits to the loo as you are not doing it earlier. You are having frequent breakages in you are sleep and you have to go to the toilet even at night time.

You may have non-healing ulcer, or skin infections which are not healing, you can also have other disturbances like visual disturbances and urinary infection or chest infection which is taking enough time to heal. All these symptoms can lead to diagnosis of diabetes and sudden loss of weight is also seen in few adults. So if you have diabetes, the best test to do is fasting and PP Sugar. Fasting sugar could be less than 110 and the PP sugar which is done after two hours of having your breakfast should be less than 140. If one of them is high then it is known as pre-diabetes then it is followed by a HbA1c test. HbA1c test is a glycosylated hemoglobin which tells us about the average blood sugar which is present in our body in the last three months. It should be less than 6 in case of a normal individual.

If it is more than that then you are either a pre-diabetic or diabetic. so, now coming to the treatment and modification part; the first thing that doctors advise is that insulin resistance is there so to break the insulin we have lose weight and for that we have to do regular exercise and control in our diet. The diet should be such that it should include all the course grain, milk, fruits, vegetables, sprouts and less of carbs, maida, processed food, fatty, oily should be avoided. The other focus should be on exercises as we all know that a 30 minute exercise and even 10000 steps everyday can reduce our insulin resistant drastically. If we can do all these things and it reduces our sugar then it is very well otherwise we have to take medicines and for that you have to visit any doctor.

The complications of diabetes basically it is known as diabetic triopathy. Diabetes is basically a vascular disease and has microvascular defects which causes disease in the retina, small vessels of the heart and brain and kidneys are involved and because this the patients weasel equity can go low and that is known as diabetic retinopathy. It is usually diagnosed by frequent eye checkups and the second disease which is known as chronic renal failure, for this also you have to go for the KFT test or even a better test is there which is known as microalbumin creatinine ratio and the third is diabetic neuropathy which is which causes pain and tinian sensation in the nerves. For this we have to take some medicines and vitamin B12 supplements along with diabetic supplements.

Thank you. If you have any query or you need to consut me then you can contact me through Lybrate. Thanks a lot.
 

Lybrate - Dr. Anirban Biswas talks about Thyroid Problems

Hello friends, I am Dr. Anirban Biswas. I am practicing diabetologist in Fortis C-Doc Hospital in New Delhi.

Today I am going to discuss with you about thyroid disease as you know thyroid disease is very common these days and most of the patients when they check their TSH is high, doctors suddenly declare that they have hypothyroidism. Now basically you have to understand what is thyroid disease? Thyroid is a disease which is a cause of a poor functioning of thyroid glands. It is a butterfly shaped organ which is located in our throat, basic function of a thyroid gland is to produce thyroid hormone and when thyroid hormone is deficient it is known as hypothyroidism. Basically the T4 and T3 are the active thyroid hormones.

TSH is a thyroid stimulating hormones which is not secreted by the thyroid gland but it is secreted by the pituitary gland. In response to the lesser secretion of thyroid, it is a feedback mechanism which is developed in our body. So whenever a patient has hypothyroidism, T3 and T4 levels are low or normal. TSH is high and it is compensating for the lack of the thyroid hormones. So this stage is known as sub-clinical hypothyroidism. And the symptoms of sub-clinical hypothyroidism is that patients may have sudden weight gain, patient may feel weak, lethargic, dryness of skin, patients may have other difficulty in managing their memory, routine activities, issues with their sexual and hormonal problems as well, heat and cold intolerance may also be there. So all these things are very common with thyroid patients, most of the patients come with the problem of weight and usually thyroid patients improve after substituting the thyroid hormone which is in the form of tablets.

Now a days, once a weekly tablets are also available for thyroid. Many of the doctors and patients don’t know but I have started once weekly which has a very good response and better come plans and I recommend the patients to take once weekly. Management of thyroid is easy but dose has to be titrated with frequent checkup of the thyroid function. And I am organizing thyroid checkup camps in my clinic on regular basis. The other problem of thyroid is hyperthyroidism which is the reverse of the hypothyroidism and in this, thyroid gland secretes the excessive thyroid hormone which causes the reverse action like weight loss, increases basal metabolism rate, eyes may start to protrude. These are the symptoms of hyperthyroidism. For this also, treatment is available.

Other things we should be careful about is that if we are having thyroid problem then we should avoid having too much of soya product and few vegetables like cabbage, cauliflower and broccoli and we should take our medicine regularly.
If you have any queries regarding thyroid, you can please contact me through Lybrate.
Thank you.