"Diabetes Special" u Editorial u Diabetes & Mahabhart u Guest Editorial:Diabetes Dangal u Hypoglycemia Prevention & Management u Fasts in Haryana u Insulin Injection Technique u Haryanavi Diet u Outdoor Management of Ketosis u Chasing Euglycemia u Fasts & Ramadan u Diabetic Nephropathy u Bionic Pancreas u Diabetic Retinopathy u Renal Nutcracker Syndrome Haryana Medical Journal Chief Editor : • Dr. Ashok Taneja March 2017, Vol. 40, Issue No. 1 Guest Editor : • Dr. Sanjay Kalra • Dr. Sameer Aggarwal Editorial Board : Editorial Chief Editor Dr Ashok K.Taneja Gurgaon Dear Friends and Collegues Associate Editor : Dr Kapil Midha-Gurgaon Welcome to the HMJ renaissance. Dr V K Gupta-Hisar HMJ is back. Back from the void. After a long Jt. Editor : Dr Rajesh Kakkar-Gurgaon hiatus of several years, now in your hands in a Advt. Editor : new Avatar. Dr Anil Hans- Gurgaon Members : Welcome back folks! and we come back with the promise; " HMJ Dr Arun Narula-Rohtak is now here to stay". Not going anywhere now. This new lease of Dr Devender Sangwan-Rohtak life is long. Very Long! Dr Kamla Singh-Panchkula Dr Kavita Lekhi-Panchkula Just to remind you , my dear friends and comrades. We are an Dr Manoj Aggarwal-Ambala indexed journal. I reiterate and emphasize this. " We are an Dr Narender Taneja-Bhiwani Dr Narottam Goel-Palwal indexed journal". All articles published in this journal have Dr Nidhi Sanduja-Fatehabad lasting value. We know that this is important and even more so Dr Pawan Goel-Rewari for residents; who wish to publish their research Dr Pawan Gupta-Bahadurgarh Dr Raj K.Sharma-Narnaul We welcome original research articles and reviews and case Dr R L Arya-Shahbad reports. We also invite yours suggestions to make this journal Dr R P Jindal-Panipat Dr Rohtas Yadav-PGIMS,Rohtak more relevant in today's scenario. Dr Rajan Gupta-Tohana The first issue ;ie the one in your hands is focussed on diabetes Dr Rajiv Aggarwal-Ambala City Dr Rajiv Gupta-Karnal and its myriad manifestations. Dr Rajiv Gupta-Ambala Cantt My dear IMA collegues, Dr Ramesh Batra-Sonepat Dr Shailesh Tomar-Sirsa Our profession is increasingly under siege. Both from the Dr Surat Yadav-Mahendergarh patients and the authorities. Attacks on doctors continue Dr Surender Mehta-Kurukshetra Dr Suresh Arora-Faridabad unchecked throughout the country, and this coupled with a Dr Suresh Jain-Jind lackadaisical response of the administration is making our Dr Vijay Arya-Kaithal survival almost untenable. Newer and tougher regulations ; President IMA : DR A P Setia-Hisar without a single thought about the ground realities and the Secretary IMA : situations under which most doctors practice, are heart Dr Ajay Mahajan-Hisar breaking and morale busting. President Elect : Dr Munish Prabhakar-Gurgaon What can we do about? The answer pals! is actually as clear as Advisors : daylight. We Prosper together. Together we carry a big punch to Dr Anil Goel-Faridabad do almost anything. We must stand together for the common Dr Dhruv Chaudhary-Rohtak Dr H K Aggarwal-Rohtak good and take a tough and united stand. It is actually much Dr P D Pahwa-Gurgaon easier to achieve this than to suffer heartless misconceived and Dr P S Gehlot-Khanpur Med.College impossible to comply regulations. Dr Pankaj Mutneja-Panipat Dr R P Gupta-Gurgaon HMJ thus dear friends is also your mouthpiece; and will work to Dr Rajan Sharma-Yamunanagar promote unity amongst the fraternity. Dr Ramesh Goel-Gurgaon Dr S K Dhatarwal-PGIMS Rohtak Welcome you once more and thanking you for your support Dr S L Verma-Rohtak Dr S P Yadav-Gurgaon Dr Sansar Sharma-Nuh Medical College your truly Dr Satish Chugh-Kalanaur Dr Ashok Taneja Dr Satish Gulati-Rohtak Dr Suresh Singhal-PGIMS Rohtak Editor HMJ Dr V K Katyal-PGIMS Rohtak Dr Ved Beniwal-Sirsa E-mail : [email protected] IMA IMA President Secretary Dear IMA Members, Dear Friends, Namaskar ! It gives me immense It is a matter of immense pleasure to address all the pride that the mouthpiece of IMA Haryana esteemed members of IMA Haryana is seeing the light of the day after a break of through this medium of Haryana Medical few years. Journal. With the efforts of Dr Ashok Taneja, the reprinting of our association The icing on the cake is its latest journal after a gap of two years is indexation. commendable, and I hope a harbinger of The editorial team of HMJ, led by dynamic the good things to come up this year. IMA leader Dr.Ashok Taneja has made persistent and pains taking efforts for the The first month in itself has been quite revival as well as indexation of Haryana hectic for the association with the Medical Journal. observation of the “National Solidarity Day” and “Say No to NEXT” campaign. I am It would be a source of authentic, scientific overwhelmed by the unity shown and the and practical knowledge for the medical response that we have received from all the professionals. members. I am sure that under the My best wishes to the editorial team for the guidance of the seniors and enthusiasm of success of the venture. all the worthy members, we will be able to My special thanks to the Guest editors for establish an unprecedented rapport in the accepting the invite and making the current association. issue a masterpiece. The email of the association this year is [email protected]. You can Long live IMA ! share your views and branch activities with us on this. We are also in the process of putting up our own website this year. With regards, Hoping for the cooperation and blessings of Dr. A. P. Setia all the members throughout the year! State President, Jai IMA! IMA Haryana Dr. Ajay Mahajan Honorary State Secretary Haryana Medical Journal - March 2017, Vol. 40, Issue 01 01 Guest Editorial THE DIABETES DANGAL: HARYANA IN ACTION Sanjay Kalra Arun Kumar Sameer Aggarwal Department of Endocrinology Department of Community Medicine Department of Medicine Bharti Hospital, Karnal SHKM Government Medical College, Pt BDS PGIMS, Rohtak Nalhar, Mewat DIABETES been spared the worst of the diabetes As the diabetes epidemic spreads across the pandemic. The lowest prevalence of globe, it spares no country or state. India, and dysglycemia is found in women of Kurukshetra Haryana, too, face a heavy burden of diabetes (2.9%), Mahendragarh (2.8%), Hisar (3.0%) and its associated complications. The and Jind (3.1%), as well as men from Sirsa epidemiological trends in our part of the world (1.6%), Jind (3.5%), rural Sonipat (2.2%), and are such that apart from being a diabetes urban areas of Hisar (2.6%), Yamunanagar capital, diabetes is now being considered an (3.4%), and Karnal (3.7%). (2). endemic, rather than epidemic, condition (1). OUR CULTURE, OUR STRENGTH DYSGLYCEMIA IN HARYANA Haryana’s lifestyle has much to contribute Data from the National Family Health Survey-4 towards prevention and management of suggests that overweight and diabetes are diabetes. Focus on simple diet, regular physical highly prevalent in Haryana. A district-wise activity, and religiosity is the hall mark of our breakdown reveals a heterogeneous spread of state. These virtues can be highlighted to these conditions across the state. Districts persons living with diabetes and their care which are urbanized, industrialized, or home to givers. We call ourselves the state of ‘milk and migrant populations, report a greater yoghurt’ (jit doodh dahi ka khaana) (3). This prevalence of metabolic dysfunction. The epithet should be popularized, to encourage highest prevalence of high glucose values in consumption of milk, yoghurt and buttermilk, women aged 15 to 49 years is seen in urban and as opposed to butter, ghee or cream (malai). rural areas of Panipat (12.2% and 8.6% Reliance of traditional cuisine on locally respectively), Faridabad (6.4%), Rewari sourced, fresh foodstuffs, including coarse (6.6%) and Gurgaon (6.5%). In men, the order grains and green leafy vegetables, should be is: Rewari (11.4%; rural=13.7%), Faridabad reinforced as a healthy habit. (9.4%), Panipat (9%; urban=11.8%) and In our state, we encourage respect for rules and Gurgaon (9.5%) (2). Haryana, therefore, has regulations, and obedience to elders. This become the Dangal of Diabetes today. characteristic can be utilized to promote No stranger to challenges and obstacles, proactive health-seeking behavior and Haryana has weathered much larger wars and acceptance of modern diagnostic, therapeutic battles in the past, including those of and monitoring strategies. Religious teaching Kurukshetra and Panipat. Culture of Haryana, can be used to create a positive attitudes is such that people are able to survive against towards health care (4). Yoga too is a useful all odds. Even today, rural districts, which still intervention, which enjoys widespread follow the traditional Haryanvi way of life, have acceptance in Haryana. This can be promoted Haryana Medical Journal - March 2017, Vol. 40, Issue 01 02 as a primordial health preventive strategy (5). REFERENCES The robust social scaffolding which exists in 1. K a l ra S , Ku m a r A , J a r hya n P, Haryana, such as strong community Unnikrishnan AG. Endemic or epidemic? interaction in chaupals and panchayats, Measuring the endemicity index of diabetes. facilitates community-based campaigns to Indian journal of endocrinology and promote healthy lifestyle. metabolism. 2015 Jan 1;19(1):5. Our successes on the sports field, and off it (on 2. Key findings from NFHS-4. Available at: Bollywood movie screens) act as positive http://rchiips.org/nfhs/HR.shtml. Last motivation for the community at large. accessed on 7 January 7, 2017 Dissemination and discussion of these facts creates a diabetes-friendly social environment, 3.