Insulin pump ensures customized insulin delivery as per requirement of the body- Shazlee Naseer


 Endocrinology session at SMDC Int. Medical Conference

Insulin pump ensures customized insulin delivery
as per requirement of the body- Shazlee Naseer

Basal ganglia calcification complications are very
frustrating for patient and physicians-Maria Javed

LAHORE: One of the scientific sessions during the Second International Medical Conference organized by Shalamar Medical & Dental College from February 2-4th was devoted to Endocrinology. This was moderated by Prof. Bilal Bin Younis.

Dr. Shazlee Naseer consultant Diabetologist and Endocrinologist from USA was the first speaker in this session and she talked about Insulin Pumps and Continuous Glucose Monitoring. She pointed out that due to fast moving technology, different types of insulin pumps are now available in the market. The insulin pump is downloaded in the clinic and data is analyzed. It helps to know if the patient is telling the truth which can be verified from the pump.

Insulin pump, she further stated, ensures continued customized insulin delivery as per requirement of the body. The patient’s insulin requirements are also determined automatically.  Patient has to come to the clinic every week, hence patient compliance is a problem. She also talked about bionic pancreas and artificial pancreases which is being developed. The pump also has an alarm system which identifies if the blood glucose levels become too low or too high any time. Device has some problem as compliance is extremely important. First the patient has to come every week, then once a month. Patient education to use this pump is important and it is difficult to use in children. Cost of the insulin pump was yet another factor.

Dr. Shazlee Naseer cautioned that one should not use these insulin pumps in patients with other co-morbidities as well as in Type-2 diabetes mellitus patients. The patient has to be constantly monitored. Obesity is a problem. Diet and education remain important and at present there is no cost reduction in insulin pumps but in future it might become possible. She made it clear that the patient have to learn how to use this insulin pump. I refer it and have reserved these insulin pumps for selected patients. Poor people with Type-I diabetes cannot afford it. Patients who are prone to get infections should not be advised and referred to use insulin pumps. Some patients, who have to take multiple dose injections, do develop some clot after three months. In UK there have been reports that some patients maintain fake diaries. Pump has got to be changed and if the patient does not change it, they will get infection. Critically ill patients, hospitalized patients get finger stick wound very frequently, she added.

Dr. Maria Javed talked about Hyperthyroidism and its management. She pointed that its chronic complications cannot be reversed. Ectopic calcification, dementia, Parkinson’s diseses are some of the causes of hypocalcaemia. One needs to check it for proper diagnosis. Always check PTH levels and assess Vitamin-D levels. Management goals of hyperparathyroidism are to prevent signs and symptoms. Do not over treat and avoid hypocalcaemia as it has its own complications. One can use dietary calcium or oral calcium supplements for calcium replacement. She also highlighted the safety and efficacy of active Vitamin D analogue, magnesium. She then discussed monitoring guidelines on conventional therapy in detail. Limitations of the currently available approved treatment options were also highlighted. Use of PTH improves bone quality. Basal ganglia calcification complications are very frustrating for patient and physicians. Most patients, she stated, get better but few will not. Use of omeperazole reduces absorption of calcium while calcium requirements are also reduced during pregnancy.  She concluded her presentation by stating that detailed family history of the patient is very important for diagnosis. Both medical and surgical history should be taken. In case of severe symptoms, one should start intravenous calcium therapy immediately which should be continued till the patient is stabilized.

Dr. Abbas Raza from Shaukat Khanum Cancer Research Centre Lahore was the last speaker in this session and he talked about obesity epidemic and updated treatment options. By healthy nation, he opined, we can save lot of money due to increased production at work place. We need to lose weight as we are overweight at lower BMI. Over weight reduces life span. Those patients, who are overweight and smoking, reduce their life span by 10-13 years. By diet and exercise, one may not lose much weight. Surgery results in more meaningful weight loss, benefits start even with just 5% reduction in weight and sleep apnea gets better in 10% of patients. Other co-morbidities like cancer and cardiovascular diseases also get better. Some people are in the habit of eating all the time while working. He also referred to genetic obesity. After eating one uses and burn the fat and a bit is also left in reserve. It all depends on what you are eating and how you are eating?

Speaking about the treatment options Dr.Abbas Raza mentioned about surgery, pharmacological therapy besides life style modifications. If you eat less, you will definitely lose weight. He also laid emphasis on ideal diet. He then referred to the criteria for the use of anti obesity drugs and emphasized that medications are in addition to diet and exercise. Medications have their own side effects and in some cases the drugs had to be withdrawn later on.  GLP agonists help glycemic control and weight loss. This is a combination therapy for obesity.  Patients should be on one to three months follow up. He reminded the audience that even if the drugs do not reduce weight, it helps the patient not to gain more weight. If after six months use of drugs, there is no reduction in weight, stop the medication as it may be wrong choice. Surgery definitely helps. Obesity may mask malnutrition. Some people may not lose weight because of their genetics. Combination treatment has added benefits, he added.

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