So here’s the detailed day by day itinerary of my recent Sikkim trip. So much to explore in this beautiful state. We covered Gangtok, Lachung and Pelling. Day trips from each place. Also visited Darjeeling mainly for the heritage train and the zoo. It was an awesome trip and… twitter.com/i/web/status/1… So we had a flight from Mumbai to Bagdogra (West Bengal) which is the nearest airport. I took an early morning flight (about 3 hrs duration) as the road journey to Gangtok is about 4-5 hours and we wanted to reach by evening latest. We had lunch on the way. After settling in the… twitter.com/i/web/status/1…

Came across an interesting article by John P Higgins.

“Ten Traits of Great Physicians”

Beautifully described by quotes. Summarising in the below thread. Much of it would be true for other professions too. Do read.

🧵

#Medtwitter

1/n Be a Detective like Sherlock

“When you have eliminated the impossible, whatever remains, however improbable, must be the truth.”— Arthur Conan Doyle, The Case-Book of Sherlock Holmes

2/n

“Doctor, what should be my targets for Hba1c, Fasting and Post meal (PP) glucose?”

Many of our friends with Diabetes have this question. I will try to explain in the thread below.

#Diabetes #GlycemicTargets #HbA1c (1/n) HbA1c should be done at least 2 times a year if goals are met and glucose control is stable,

Done more often if goals not met or there is change in the medicines.

A1c goal for many non pregnant adults is < 7% without any significant hypoglycaemia.

#Diabetes #HbA1c (2/n)

What all steps can our friends with Diabetes take to keep their feet healthy?

Always remember, Prevention is better, cheaper and safer than cure.

Few pointers about footcare for patients with Diabetes. A thread 🧵

Do read and share.

#Diabetes #Footcare (1/n) Diabetes can be dangerous to your feet🦶

Even a small cut can have serious consequences.

It can affect blood flow to the lower limbs, affecting healing and making prone to infection.

It can affect nerves leading to reduced sensation including pain. #Diabetes #Footcare (2/n)

Yoga doesn't work, Anulom Vilom Pranayama doesn't work, Cardiac coherence breathing does #Yoga #CardiacCoherenceBreathing (1)

https://twitter.com/sciam/status/1089538576222699521

This article by @AskDrShashank et al sheds light on role of yoga based lifestyle modifications in Type 2 Diabetes and associated factors #Diabetes #Yoga (2) ncbi.nlm.nih.gov/pmc/articles/P…

In the sea of tweets about high glucose levels, let’s not forget something which can be equally important and more dangerous. Hypoglycaemia (low glucose levels). Below are some of the symptoms which can be due to low glucose levels #Diabetes #COVID19 #Steroids (1/n) Many patients who are on steroids may be on medications for hyperglycemia(tablets as well as Insulin). Once steroid dose is gradually reduced, the glucose levels will tend to improve. Some may have low glucose levels in morning too #Diabetes #Hypoglycemia #COVID19 (2/n)

This chat with wife of one of my #Diabetes patients adm with #Covid19

1. Please trust the Doctors taking care of you. They know best at that point of time.

2. Steroids may be one of the drugs used for treatment especially when oxygen saturation low (1/n) 3.Steroids can significantly affect glucose levels.They can typically cause rise in after meal glucose levels during the day & morning fasting glucose levels are better

4.Some oral agents (tablets) for Diabetes may need to be stopped on admission(2/n)

#Diabetes #COVID19India

Me: Since how many years u have Diabetes?

Patient: Sir, I had ‘borderline diabetes’ since 5 years. Not on medicines, only diet. First time now, I have checked in yrs,sugars 220 (Fasting) 310 (after food)

What’s ‘borderline diabetes’ Thread. #PreDiabetes #Medtwitter (1/n) What is #Prediabetes

When glucose levels don’t meet criteria for Diabetes but r still high to be considered normal. Includes

1. IFG - Impaired Fasting glucose - FPG 100-125 mg%

2. IGT (75 gm OGTT)- Impaired Glucose Tolerance - 2 hr PG 140-199 mg%

3. HbA1C - 5.7-6.4% (2/n)

In this thread I will mention precautions to be taken by #Diabetes patients in today’s scanario with #COVIDー19 #coronavirus #India #Mumbai (Ref IDF) @drmohanv @DrAmbrishMithal @AskDrShashank @docanoopmisra @Unnikri @DrDeepakKrishn1 @serioustaurean @DNeurosx @viswas_mr (1) Recommendations for general public are doubly important for patients with #Diabetes & those living in their close contact 1.Wash hands thouroughly and regularly 2.Avoid touching face before washing and drying hands #COVIDー19 #coronavirus (2)