Updated: Dec 6, 2021
Diabetes is one of the biggest epidemics of the 21st century, not just in developed countries anymore but also in developing nations. In fact, WHO estimates approximately 422 million people suffering from diabetes worldwide with India and China being the largest contributor to the world's diabetic burden.
I was diagnosed with type 2 diabetes back in the summer and it was heartbreaking. As someone who is constantly striving to lead a better lifestyle, eat healthy, and try to stay active as much as possible, this came as a bit of shock. Why me? I thought. The answer was clearly insulin resistance and what that essentially means is my body isn't responding to whatever insulin is being produced.
Why is that you ask? I have had PCOS for 12 years now. PCOS and insulin resistance go hand in hand. While staying active in general is very important to keep these lifestyle disorders at bay, as someone with PCOS, it mandates that you go out of your way to fight this insulin resistance. Plus the genetics matters. Ethnicity matters.
I am not sure I went out of my way though. These were my prime years of training, through med school, through residency, and to be honest, that stayed my priority and it's no surprise that as physicians we tend to ignore our own physical as well as our mental health throughout our training. It's what is expected of us.
If you are reading this as a med student or someone earlier in your training, I wish you would take away this one important message - Do not take your health for granted!
Coming back to the questions around type 2 diabetes - how am I managing it? What can you do? What are some holistic ways to improve insulin resistance? Let's talk about all things diabetes!
Q. What is Diabetes?
A. To put in simple words - Inability to normalize blood sugar levels caused either by lack of insulin or lack of insulin sensitivity leading to excess blood sugar levels. There are many different types of diabetes based on whether it is inherited or acquired later in life.
Q. What are some of the common symptoms of Diabetes?
A. The classic symptoms are increased frequency of urination (polyuria), increased thirst (polydipsia), and an increased tendency to eat (polyphagia) however these symptoms are more common in type 1 diabetes. Type 2 diabetes is generally asymptomatic first few years unless its highly uncontrolled in which case there is an increased tendency to acquire infections like UTI, respiratory infections, delayed wound healing, etc.
Q. What causes Diabetes?
A. Since we are talking about type 2 diabetes, it is important to understand that type 2 diabetes occurs mainly due to insulin resistance in overweight/obese individuals. Insulin is an important hormone that helps organs like the liver, skeletal muscle, and fatty tissue to take up extra glucose and save it as a source of energy for the future. When these organs fail to respond to insulin (either due to family history or certain environmental risk factors) the blood glucose levels remain high eventually leading to diabetes.
Q. What causes insulin resistance?
A. Simple answer is obesity/excess weight, especially around our belly and waist region. So any condition that causes weight gain can virtually lead to insulin resistance in the long run. PCOS is a good example. Of course, our ethnicity and genetics make some of us more prone than others, to become diabetic.
Q. How does one gets diagnosed with Diabetes?
A. It is important to understand one's family history and know they need to make necessary lifestyle changes from early on. Yearly screening is very important to get diagnosed early as you may not have any symptoms to begin with especially in type 2 diabetes. Unexplained fatigue should raise suspicion in an individual with risk factors.
Generally, a simple random blood sugar test will give an idea of whether someone needs to get tested for fasting and postprandial (after food) blood glucose levels or not.
Fasting blood glucose levels >126 mg/dl or HbA1c (tells about glycemic control of last 3 months) > 6.5% is enough to label someone as diabetic.
Q. What is pre-diabetes?
A. It is virtually a state of consistently increased blood glucose levels but the body is able to compensate for that by increasing insulin secretion. However, it often precedes frank type 2 diabetes if not controlled in time. A fasting blood glucose level between 100 to 125 mg/dl or HbA1c between 5.7% to 6.4% is considered a state of pre-diabetes.
Q. What can be done to prevent the state of insulin resistance?
A. Active lifestyle. Period. WHO recommends 60 minutes of moderate exercise at least 5 days a week to take care of insulin resistance. Strength training is very effective in combating insulin resistance. Of course, eating healthy and sleeping well is just as important. Including more plant-based food, avoiding processed food and sugar will inadvertently take care of insulin resistance in type 2 diabetes.
Q. How am I doing and what is currently working for me?
A. I have never been better. Getting diagnosed with diabetes was like a wake-up call I needed all my life. I am writing this article to let you know that there's so much you can do to prevent this from happening at all but also if you are already diagnosed with type 2 diabetes, THAT IT IS NOT THE END OF THE WORLD. I am trying to stay active as much as possible, working out every single day, and eating everything except for sugar and dairy. Avoiding rice and the wheat first couple of months personally helped to a great extent in reducing weight. I am 12 Kgs down than when I was diagnosed and my blood sugar levels are well within the limit.
So that's it. I hope you found this post useful. The most important thing to keep in mind is consulting your doctor/endocrinologist when you get diagnosed and following their advice religiously plus getting the right information is crucial. Don't fall victim to the useless detoxifying drinks people are trying to sell you online to reverse your diabetes.
If you have any questions I would be happy to answer them below in the comments. Thank you for being here and giving this a read, if I am able to educate and empower you in any way that means the world to me :)
Meanwhile, you can watch my video to further understand what it is that's making you diabetic?
Enjoy and happy learning!
Who doesn't like a great study tip? I have always been a sucker for them. It's like one of those 'feel good' things in life for me 🤩 However anyone who has spent a significant part of their lives mastering this art will tell you it's a skill that is acquired over time and the good ones can literally change the game for you!
As a resident, being smart about fetching the right information in as little time as possible is critical, so here's some of my favorite tips and tricks:
Feynman's Technique - If you want to learn something better, explain it. As simple as that. Find someone to teach and you are already halfway there.
Takedown notes - Whenever you can, wherever you can. Writing things down always helps. Concise a larger chunk of information into smaller digestible bits.
Find your best slot - For some reason, morning works wonders for me. I love the quiet, the breeze that wakes me up right away, coffee, and the solid 3-4 hours of laser focussed study sessions.
One day at a time - give yourself daily tasks. Decide what you want to finish 'today', plan only for that particular day! Don't make unrealistic and unnecessary plans for the whole month. Long-term goals don't work for me personally.
Rewarding yourself - if you want to be efficient you have to allow yourself some leisure. I treat myself with a favorite cup of cold coffee the week I am on top of my everyday schedule. Tell me how would you like to reward yourself?
Well, those were my top 5 study tips that completely changed the game for me. I hope they help you too. Let me know about your favorite study tips?
Updated: May 17, 2021
'Why Pathology' was written on March 17th, 2020 when I was a second-year Pathology resident. This post was originally published on ilovepathology.com, a blog hosted by a wonderful teacher and Pathologist, Dr. Vijay Shankar.
Why Pathology?
Well, why not?
If you are a curious med-student considering a life in Pathology or just someone wondering about what it is and what role does a Pathologist plays in patient care, then you, my friend, have stumbled upon the right place. First, let’s talk about what exactly is Pathology? The word in itself translates to the ‘study of diseases’ but essentially, it is a branch of medicine that deals with the cause, the diagnosis, and the effects of the disease, to be precise. Often regarded as the bridge between basic and clinical science, Pathology is a unique amalgamation of life in research, academics, and diagnostics.
Pathologists are rightfully called ‘the detectives’ in the field of medicine because they do much more than just blood tests, which unfortunately is a common misconception among the general population. We diagnose cancer, we grade cancer, and that in turn decides the treatment plan for our patients. We diagnose infections, autoimmune conditions, various allergies, and the list can go on.
There are various sub-specialties within Pathology like hematology, cytology, histopathology, and a Pathologist can choose to specialize in either one of them or can practice as a General Pathologist, a trend we see very often in our country. As a resident, we are required to rotate through each of these sub-specialties, learning how to interpret each and every cell under the microscope, to pick up the essential clues pointing towards specific diagnosis and not to forget, develop procedural skills like doing an FNAC or biopsy when required.
A usual day in a life of a resident specializing in Pathology consists of screening through various biopsy slides, researching about the clinical background, coming up with the differential diagnosis, correlating and substantiating the same. We see Pap smears, study the CSF or look for malignant cells in body fluids. In addition, we examine a tonne of hematology slides, that essentially forms the significant burden of any laboratory for suspected blood-related disorders.
We also get to teach medical students, paramedics, those in nursing, and other allied health science students. We ‘gross’ various specimens that are received in histopathology ranging from a small biopsy to large amputated limbs. We learn how to sample the area that represents the pathology, process these tissues, and monitor their staining in order to finally be able to see them under the microscope.
Like any other specialty, most of the learning happens while at work. Unlike medical school, there is no conventional teaching in residency. You learn by doing, by observing, and by assisting diligently. However, we do have academic programs to assess our learning from time to time, like journal clubs where we learn about current trends, new research, or developments happening in the field of Pathology. We also have biopsy review sessions and slide seminars to keep our progress in check.
It is rather unfortunate that many a time, even medical professionals are unaware of what we do and how we do it. A lot of unappreciation towards our specialty stems from the lack of awareness and more importantly, the lack of communication. Having an open conversation with a Pathologist about the differentials in your mind and what specific tests to order can indeed improve the quality of patient care.
Another beautiful aspect of Pathology is the fact that ‘it’s a very specific science’. There is no shooting in the blind. You see the tissue exactly for what it is. To be able to give some answers to our patients and tell them exactly what’s wrong can be extremely satisfying in my opinion. Even though we never get to meet our patients personally, we know the valuable role we get to play in their lives on a daily day-to-day basis. We despair an unfavorable outcome just as much if not more before signing out something as malignant. We have sleepless nights too when we cannot find a way to reach a conclusion.
It is a common notion that Pathologists lead a very balanced lifestyle and hey, I am not denying that, it’s all about the balance but all that glitters is not gold kind of holds true here. While we do work in a very controlled environment, there is still pressure, a pressure to be accurate, a pressure to be precise, a pressure to know things, all of it, all the time, and don’t get me wrong, we love knowing things. If there’s one trait that the Pathologists worldwide would share, it would be their zest to ‘know things’.
Pathology is truly an amalgamation of it all. It’s interesting but demands hard work, it’s diverse, so much that you never really know what to expect under the microscope but offers a great work-life balance. It’s intellectually stimulating but also serves as a potential medium for modern medicine to integrate with the cutting-edge technology of tomorrow.
So, the bottom line is – • Choose Pathology only if you cannot see yourself doing anything else. Not because you imagine a certain lifestyle for the future. • Do not shy away from having an open conversation with your Pathologist, tell them what are you thinking and why? The goal for both of us is the same, to be able to find an answer for our patients. • Next time, you get a test done, ask who is reporting your sample. Make sure to meet your pathologist and understand your results. • Precision medicine is the key to the future. Integrating the branches like Pathology and Radiology with clinical medicine can help us deliver more personalized care to our patients. • Even though we work from behind the microscope, the assumption that we don’t like to socialize is far from reality. In fact, the majority of Pathologists I have met carry an extremely dynamic personality and are great conversationalists.
Let us not forget what a privilege it is to be able to do what we do and what a pleasure it is to share that with the world! -From the wandering mind of the ‘Pathology resident’
