Treatment Modalities In Diabetes

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.