Professor Umesh Kumar

Professor Umesh Kumar
I am trying to answer your query by doing a self-study from Google. You will agree that Technology and Medical science advancement is a continuing process. In India there are hardly any funds available for R & D. USA is the country where Medical Advancement is a continuing process.
Nobel Prize winners in USA till 2015 were 360 compared to India’s 11 while the Population of India is 4 times that of USA. This itself will gives you an idea why USA is the No. 1 Country in the World.
The Article of mine you have mentioned is written by a Medical Professor of Harvard. He has himself mentioned that “When I was in medical school, and for many years thereafter, “lower is better” was what doctors believed.” “We knew that people with diabetes could develop severe, even fatal, complications if their blood sugar got very high. Plus, we had powerful blood-sugar-lowering treatments available.

On the other hand, there was a limit to “lower is better.” Too much of a good thing could be a bad thing:
Over treatment could push blood sugars too low — dangerously low. Sustained very low blood sugar can produce confusion, coma and death. So we measured blood sugars frequently, with the goal of having blood sugar as low as it could go without causing bothersome symptoms.”

Being Prepared for Hypoglycemia

People who use insulin or take an oral diabetes medication that can cause low blood glucose should always be prepared to prevent and treat low blood glucose by
• learning what can trigger low blood glucose levels
• having their blood glucose meter available to test glucose levels; frequent testing may be critical for those with hypoglycemia unawareness, particularly before driving a car or engaging in any hazardous activity
• always having several servings of quick-fix foods or drinks handy
• wearing a medical identification bracelet or necklace
• planning what to do if they develop severe hypoglycemia
• telling their family, friends, and coworkers about the symptoms of hypoglycemia and how they can help if needed

Hyperglycemia

Hyperglycemia can lead to diabetic ketoacidosis
It is important to attend to hyperglycemia since it can lead to a dangerous complication known as ketoacidosis that can result in coma and even death. Ketoacidosis rarely occurs in type 2 diabetes, typically occurring in cases of type 1 diabetes.
High levels of glucose in the blood mean that insufficient levels of glucose are available to cells for their energy needs. As a result, the body resorts to breaking down fat so that energy is derived from fatty acids. This breakdown produces ketones, leading to higher acidity of the blood.
Diabetic ketoacidosis requires urgent medical attention and, alongside hyperglycemia and its symptoms, is signaled by:
 Nausea or vomiting
 Abdominal pain
 A fruity smell on the breath
 Drowsiness or confusion
 Hyperventilation
 Dehydration
 Loss of consciousness.
Hospital treatment of ketoacidosis includes the administering of intravenous fluids and insulin.2

What are ACCORD, ADVANCE, and the VADT?

First, some background: ACCORD, ADVANCE, and the VADT were three large clinical trials that compared the rates of heart disease in patients receiving either “intensive” diabetes treatment (targeting near-normal average blood glucose levels - A1c closer to 6%), or “conventional” diabetes treatment (targeting somewhat higher blood glucose levels - A1c closer to 7.5%).

ACCORD was designed to test 10,000 people in North America and Canada over eight years, half with an A1c goal of 6%, the other half with a 7.5% goal in the diabetes part of the trial.

ADVANCE tested 11,1400 people over six years in Australia of whom half had a 6.5% A1c goal and half targeted 7%.

VADT included almost 2,000 veterans in the US with an A1c goal of less than 6.0% for half of the participants, and 8.0-9.0% for the other half. These studies were designed to test the theory that extremely tight control of BG would help reduce heart disease.
As a reminder, the A1c is a measure of average blood glucose. An A1c of 7.0% is equivalent to an estimated average blood glucose level of 154 mg/dl (8.5 mmol/l), whereas an A1c of 6.0% is equivalent to an average blood glucose level of 126 mg/dl (7 mmol/l).
Roughly two-thirds of people with type 2 diabetes die from heart disease, a much higher rate than in the general population. As such, researchers for these three studies wanted to see if reducing blood sugar to near-normal levels would reduce the risk of heart disease.
The three trials differed in the precise blood glucose levels targeted, as well as in their patient populations. Patients were mostly over 60 years old with a long duration of type 2 diabetes. Thus, the results may not be relevant to people less than 60 years of age, people with type 1 diabetes, or people with either newly diagnosed or well-managed type 2 diabetes. If you have type 2 diabetes and are at high risk of heart disease, or have had a heart attack, then these results are more likely to relate to you.
Contrary to many researchers’ expectations, none of the three trials showed a clear benefit of tight glucose control on heart disease risk over the study periods. In ADVANCE, which lasted five years, and the VADT, which lasted seven and a half years, the rate of heart attacks, stroke, and heart disease was similar between the intensive and standard glucose arms of the studies. Even though both studies went to completion, some doctors believe that a longer study would have shown greater benefits of intensive glucose control on heart disease.

In contrast, the intensive glucose control arm of the ACCORD study was famously discontinued in February, long before its expected completion date. This happened after a committee responsible for overseeing the study found that the intensive glucose control arm had significantly more deaths than the standard control arm (257 versus 203)
May be Professor Umesh Kumar that these trials and study gave an idea of the course to follow:
We knew that people with diabetes could develop severe, even fatal, complications if their blood sugar got very high. Plus, we had powerful blood-sugar-lowering treatments available.

On the other hand, there was a limit to “lower is better.” Too much of a good thing could be a bad thing:
Over treatment could push blood sugars too low — dangerously low. Sustained very low blood sugar can produce confusion, coma and death. So we measured blood sugars frequently, with the goal of having blood sugar as low as it could go without causing bothersome symptoms.
Too much of a good thing might have been fatal. One possible reason is that the low blood sugar may have triggered a dangerous heart rhythm.

So, while lowering blood sugar with treatment definitely improves health, there are limits. "Today I and many other doctors do not treat blood sugar as intensively as we used to." more  

View all 9 comments Below 9 comments
Thanks Vinod ji. more  
You are absolutely right Raja Sahib. Jisne Jeebh pe kaabu paaliya (both on taste and speech!) usne duniya jeetliya. more  
For Diabetic Patients. WILL POWER is of ESSENCE. Never Over Indulge. Keep control over your Tongue. Even for Normal Person: Do not over indulge in any thing. Food, Drinks, Chocolates , Good Food etc. more  
Mr. Sanjay Kumar, Your call is for Dr. Raja Chandra, who may give remedies. However, in the meanwhile, I am suggesting following
1. Let him not drink water directly from a bottle in standing position. Use of a glass/cup in sitting posture is required.
2. Avoid cold water/drinks.
3. Get acupressure treatment from a specialist.
4. Learn Jal Neti, Dhoti, Few Naturopathy Treatments particularly for Throat, Throat and Neck Exercises and Pranayama from a Naturopath and do them regularly. Better get admitted in a residential naturopathy center for minimum 20 days for treatment. more  
Thanks Sir for taking so much time out to delve on the subject. Surprising these studies are similar to latest studies on cholesterol and yet ready to believe. With your permission I am giving further details of hyperglycemia of which many diabetics may perhaps not be aware of and the knowledge below may help them a lot.
HYPOGLYCEMIA (Low Blood Glucose) is a condition characterized by abnormally low blood glucose (blood sugar) levels, usually less than 70 mg/dl. Each person's reaction to hypoglycemia is different, so it's important that you learn your own signs and symptoms when your blood glucose is low.
SIGNS & SYMPTOMS OF HYPOGLYCEMIA (happen quickly)
1.Shakiness
2.Nervousness or anxiety
3.Sweating, chills and clamminess
4.Irritability or impatience
5.Confusion, including delirium
6.Rapid/fast heartbeat
7.Lightheartedness or dizziness
8.Hunger and nausea
9.Sleepiness
10.Blurred/impaired vision
11.Tingling or numbness in the lips or tongue
12.Headaches
13.Weakness or fatigue
14.Anger, stubbornness, or sadness
15.Lack of coordination
16.Nightmares or crying out during sleep
17.Seizures
18.Unconsciousness
TREATMENT
1.Consume 15-20 grams of glucose or simple carbohydrates or a little more sugar. Recheck your blood glucose after 15 minutes
If hypoglycemia continues, repeat.
Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.
2.Glucagon: Injectable glucagon kits are used as a medication to treat someone with diabetes that has become unconscious from a severe insulin reaction.
DO NOT:
Inject insulin (will lower blood glucose even more)
Provide food or fluids (individual can choke)
Put hands in mouth (individual can choke)
HYPOGLYCEMIA UNAWARENESS: Very often, hypoglycemia symptoms occur when blood glucose levels fall below 70 mg/dl. But, many people have blood glucose readings below this level and feel no symptoms. This is called hypoglycemia unawareness.
Hypoglycemia unawareness occurs more frequently in those who:
1.Frequently have low blood glucose episodes (which can cause you to stop sensing the early warning signs of hypoglycemia)
2.Have had diabetes for a long time,tightly control their diabetes (which increases your chances of having low blood glucose reactions).
Severe hypoglycemia has the potential to cause accidents, injuries, coma, and death.If left untreated, hypoglycemia may lead to a seizure or unconsciousness (passing out, a coma).
If you think you have hypoglycemia unawareness, speak with your health care provider. Your health care provider may adjust/raise your blood glucose targets to avoid further hypoglycemia and risk of future episodes and prescribe Glucagon Kit and ways of administering it to people you are frequently in contact with you or what to do & what not to do, if Glucagon Kit is not available in case of acute hypoglycemia. more  
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