What is insulin resistance and how to determine (calculate) it?
youtu.be/hpW9nBQFgX0?si…
➡️Even if your fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1C) are normal, it may not mean that everything is normal.
➡️Prediabetes: FBG between 100-125 mg/dL or HbA1C between 5.7 and 6.4 is referred to as prediabetes. People with prediabetes have a higher risk of developing type 2 diabetes and cardiovascular diseases.
➡️Insulin resistance can occur even if FBG and HbA1C are within normal limits.
➡️HOMA IR (Homeostasis Model Assessment Insulin resistance) can be obtained if you have serum insulin and FBG values. HOMA IR above 2 is suggestive of insulin resistance.
➡️Triglyceride/HDL cholesterol (TG/HDL-C) ratio above 2 is considered a surrogate marker of insulin resistance.
➡️Triglyceride Glucose (TyG) index above 4.7 is also a surrogate marker of insulin resistance. If your blood tests reveal insulin resistance, discuss with your physician and nutritionist.
➡️Lifestyle measures such as healthy diet, regular exercise and reduction of weight if overweight or obese can help in improving insulin sensitivity in most cases. HOMA IR Calculator
mdcalc.com/calc/3120/homa…

Running is better than walking for insulin resistance (personal experience=anecdotal or Class 4 evidence)

➡️I had switched to walking since May 2024 due to flare up of ankylosing spondylitis. Weekly mileage: 35-40 Km
Blood test reports (Sep 2024)
Serum Insulin- 19.8
Fasting Glucose- 95
HOMA- IR: 4.6
HbA1C- 5
➡️I restarted running from Dec 2024. (Weekly mileage 35-40 Km)
Blood test reports (Feb 2025)
Serum Insulin- 10.8
Fasting Glucose- 92
HOMA- IR: 2.5
HbA1C- 4.3

➡️There was no other change in lifestyle: diet, working & sleeping hours remained same.

➡️Other metabolic parameters, such as weight, Waist circumference, BMI, and lipid profile parameters did not show any significant change (between Sep 2024 and Feb 2025).

Take home message
✅Running is superior to walking for reducing insulin resistance (or improving insulin sensitivity).
(As stated earlier, this is a personal experience of one person, and therefore, the findings are not conclusive). There are two other ways of measuring insulin resistance:
1. Triglyceride/HDL Cholesterol ratio (TG/HDL ratio)
2. Triglyceride Glucose index (TyG index)

Sep 2024
1. TG/HDL ratio was 1.49
2. TyG index was 4.42
Feb 2025
1. TG/HDL ratio is 1.72
2. TyG index is 4.43

(Reference for cut-off values below is from a small study in South India- Madurai)
doi.org/10.7759/cureus…

Why you should NOT reheat your tea and drink?
We all enjoy a hot cup of tea. Sometimes, if one is unable to have tea on time, and it gets cold, tea is often reheated and served. But this practice is unhealthy. Here are the 5 reasons:
1/n 1. Polyphenols and other bioactive compounds in tea can get damaged with repeated heating, thereby reducing their antioxidant properties.
2/n

Short Story of a minor Struggle and Successfully overcoming it
May 2024
Flare up of ankylosing spondylitis (AS), caused pain in multiple joints, tendons and ligaments.
Sudden break on running after three and half years.
Even walking was difficult- every step was painful.
1/n Waited for a day or two for pain to reduce/subside; as that was the norm earlier (during the past 34 years, after the most severe relapse in 1990, when I was hospitalized for more than three weeks at CMC Vellore).
Pain did not reduce, instead, it became more severe.
2/n

Running as a form of aerobic exercise increases longevity, but there are other factors to consider too.

The news of Jogi ji's passing away due to cardiac arrest during sleep is shocking. Our heartfelt condolences🙏

1. Joginder Chandna ji was extremely fit and had amazing statistics for a long-distance runner. His PB for 5k, 10k, HM and FM were 23 min, 46 min, 1:39 hours and 3:40 hours.
2. He had an amazing control over heart rate while running long distances. His latest long run (23 Km) was on Sunday, 28th July (2 days before we lost him). An AHR of 127 bpm (and a max HR of 139 bpm) for a pace of 6:50 min/Km is amazing.

By the time diabetes mellitus is diagnosed, it is already too late.

Take control when insulin resistance sets in. Or may be even before that.

Low carbohydrate diet and regular exercise are the keys to prevent insulin resistance, prediabetes and type 2 diabetes.

Ref: (1/n)doi.org/10.3390/antiox… Lifestyle tips to manage insulin resistance

1. Lose excess weight (especially abdominal and visceral fat),
2. Engage in regular physical activity,
3. Sleep well,
4. Minimize stress,
5. Reduce carbohydrate intake,
6. Quit smoking.
(2/n)

Running and heart diseases
Learning points from the past 30 years of published research

1. Runners have a lower risk of heart attack, as compared to people leading sedentary lifestyles,

2. Runners are 45% less likely to die from heart disease than non-runners,

3. The benefit starts with as little as 10 minutes of running per day, and increases with increasing running duration up to 60 minutes. There is no additional mortality benefit from running beyond 60 minutes per day (or beyond 7 hours per week),

4. In terms of distance, the benefit starts with 1 mile (1.6 km) of running and increases with greater running mileage. There is no established upper limit beyond which running is detrimental to heart health, however, benefits may plateau beyond 80 km of running per week,

5. Runners have a lower resting heart rate. Lower resting HR is associated with greater longevity,

6. Running has a favourable effect on risk factors for heart attack. Running is associated with higher HDL-cholesterol, lower LDL-cholesterol, lower triglyceride, lowering of BP, improved insulin sensitivity, lower HbA1C level and lower body mass index,

7. Sudden cardiac arrest during long distance running is rare. The incidence is 0.8 per 100,000. The fatality due to sudden cardiac arrest during running is 0.4 per 100,000,

8. Majority of cardiac arrests occur while a person is sleeping, sitting or standing; only a miniscule of them occur while a person is running or doing some form of exercise,
9. Sudden cardiac arrests that occur during marathons make it to the headlines, as they are dramatic, unexpected and those affected are younger and fitter,

10. Marathoners have a greater chance of surviving a cardiac arrest, as compared to non-runners,

11. Sudden cardiac arrest during running is more common among men as compared to women,

12. Sudden cardiac arrest during running is most often NOT caused by running. However, running may precipitate sudden cardiac arrest among people with pre-existing cardiac diseases,

13. The commonest cause of sudden cardiac arrest in people aged 35 or less is hypertrophic obstructive cardiomyopathy,

14. The commonest cause of sudden cardiac arrest among people above 35 is coronary artery disease (due to blockage of artery supplying blood to the heart muscles),

15. The ideal average heart rate while running is 180 minus age (ref: MAF method). This ensures better recovery between runs, reduces the risk of injuries, and allows adaptation of the heart for better pace during races,

16. A good night sleep (7-8 hours) before a long run is of paramount importance,

17. Periodic hydration/nutrition breaks during a long run is also important. Dehydration, exhaustion, fatigue, and heat stroke can lead to a runner collapsing during a marathon,

18. If the body gives signals, such as dizziness, breathing difficulty, chest pain, tightness in chest, severe fatigue, or light-headedness, during a run; withdraw from the run and seek immediate medical help,

19. Do not start a run with a pre-meditated pace or finishing time. Alter thepace (increase or decrease) based on the route, elevation, temperature, how you feel and other race-day factors,

20. Long distance running is not a competition to be ahead of others. It is a passion to be enjoyed and cherished. Enjoy the entire run and not just the chip time.

Dr Sudhir Kumar MD DM 26-01-2024 There are various causes for cardiac arrest among runners and they differ based on the runner's age. Survival depends on the underlying cause of cardiac arrest; prompt performance of CPR (by the bystander) and use of defibrillator (on site).

Why are teenagers (adolescents) getting affected by heart attacks?

1. Heart attacks commonly affect older people. However, we have seen a recent increase in number of young people and even teenagers getting affected. What are the underlying reasons? 2. It is easy to put the entire blame on Covid 19 illness & covid vaccines, but that won't do proper justice (to our youth). There are several other possible reasons that have increased the risk of heart attacks in younger population, including adolescents. Let us look at them:

Tips for NMDC Hyderabad Half Marathon

Hyderabad marathon is scheduled on August 27th (3 weeks from now). It is one of the most popular marathons in the country and many of you may be planning to run here. I have done two half marathons on this route.
Sharing my experience
1/n https://t.co/0XGzatZkIatwitter.com/i/web/status/1…
The HM flag off time is 6 AM. Location is near Necklace road (Hussain Sagar lake, Secunderabad). Since one needs to assemble by 5 AM, it would be wiser to stay closer to this location, or make advance transport arrangements accordingly. Ample parking space is available.
(2/n)

A woman whose head dropped and eyes closed after talking to someone for 30 minutes or more

1. 49-year old Mrs Jhuma consulted me with a strange problem for one month. Whenever she talked with a friend or family member for 30 min or more, her head dropped forwards.
#MedTwitter twitter.com/i/web/status/1… 2. In addition, her eyes closed. She could not voluntarily raise her head or open her eyes. However, after taking rest for a few minutes, she was able to raise her head & open eyes.
She had no other problems.
She consulted local doctors without any success.
#neurotwitter

Neurological problems that occur or get worse with sleep
1. In addition to providing relaxation and rest, sleep has many health-related benefits. However, there are some problems that occur only during sleep (or they get aggravated in relation to sleep). Here are some of them: twitter.com/i/web/status/1… 2. Hypnic jerks
As one is falling asleep (period of transition from wakeful to sleepy state), about 70% people experience brief jerky movements of arm or leg (like a twitch). It is usually mild, however in some, it can be so severe as to disrupt the sleep of person or partner.

Long siesta (napping) is associated with obesity & metabolic syndrome

1. In a recent cross sectional study, the association between siesta- no siesta, short siesta (<30 min) and long siesta (>30 min)- and diabetes, obesity, hypertension and metabolic syndrome (MetS) was studied. twitter.com/i/web/status/1… 2. Compared with the no-siesta group, long siestas were associated with higher values of Body mass index (BMI), waist circumference (WC), fasting glucose, systolic blood pressure (SBP), and diastolic blood pressure, as well as with a higher prevalence of MetS.

An accidental doctor

1. I remember my first day in college-eight of us seated around a table, with a cadaver (with strong smell of chemicals used to preserve dead body) placed on it, ready to learn anatomy (of human body) by dissecting various parts, under guidance of a tutor. 2. This is not the kind of “welcome” that I had imagined (on day 1 in MBBS). I had no clue what to expect, as no one in my family was a doctor. I had taken the long journey (from Bihar to CMC Vellore) to become the first doctor among our extended family.

Nagging pain in the neck could be a symptom of migraine

1. Headache is the commonest symptom of #migraine. Other recognized symptoms are nausea, vomiting, hypersensitivity to bright lights and noise.
Neck pain is often attributed to slipped disc in neck region or muscle spasm. 2. I routinely see patients, in whom, the main problem is neck pain, or their pain starts in the neck, which radiates to head (usually frontal region and around eyes).
Both these situations can commonly occur with migraine.
#MedTwitter #neurotwitter

When Manya paused after taking only five phere with her husband-to-be…
1. Manya was excited as she was getting married to Sanju, her childhood crush.
Wedding preparations, including shopping had gone on for 6 months. The week preceding the wedding day had been hectic for Manya. twitter.com/i/web/status/1… 2. The wedding ceremony was going well with friends & family from both sides meeting each other after long (due to intervening Covid). There was happiness & smiles all around.
Manya & Sanju were tired after night-long rituals, however, it was nearing the end with saat phere.

2016: Age 45; Wt: 99 Kg, finished 10 Km run in 70 min 28 sec
2023: Age 52; Wt 70 Kg, finished 10 Km run in 49 min 16 sec

Here I briefly outline how I made it possible:
#runningmotivation #running #weightloss #fitness #fitnessjourney https://t.co/NPF1xtOKUUtwitter.com/i/web/status/1…
1. Work life balance
*Reduced working hours to 8-9 hours (from 12-13 hours)
*Increased sleeping time to 7-8 hours (from 5-6 hours)
*Preponed dinner time to 7 PM instead of 10 PM
*Started sleeping at 10 PM instead of 1 AM, and getting up at 5 AM instead of 7 AM
#WorkLifeBalance

1. Ms Shivi to me: “Dr. I am a burden on my parents. I am good for nothing. I have wasted my parents’ hard-earned money. All my friends are better than me. I wish I could just die so that my parents would be relieved.”
#MedTwitter #NeuroTwitter #psychtwitter twitter.com/i/web/status/1… 2. 18-year old Shivi was brought to OPD with repeated convulsions for 3 days. She was taken to physician in her village, who started her on anti-epileptic drugs (AEDs). Despite being on two AEDs at maximum doses, her convulsions continued. Physician referred her to a neurologist.

Exercise may erase the genetic risk of type 2 diabetes (T2D)
1. Exercise reduces the risk of developing T2D.
A recent research looked at the association between types (moderate-vigorous versus light) & duration of physical activity on risk of developing T2D.
#diabetes #exercise twitter.com/i/web/status/1… 2. 68.4 min/day of moderate-vigorous physical activity (MVPA) was associated with a 74% lower risk of developing T2D when compared with participants who spent less than 5.2 min in MVPA.

Less common symptoms of stroke

1. Weakness of one side of face, arm or leg; and speech impairment are the commonest symptoms of stroke.
However, it is important to be aware of lesser known symptoms of stroke, so that an early diagnosis can be made.
#MedTwitter #stroke twitter.com/i/web/status/1… 2. Sudden onset Confusion- due to involvement of speech area (located in left side of brain) concerned with comprehension of spoken words. Patients are unable to appropriately respond to queries and keep talking something that doesn't make sense. (Sensory or Wernicke's aphasia).

10 commonly asked questions about stroke answered

1. Stroke affects heart
No.
#stroke affects brain and causes paralysis.
#heart attack is known by the term myocardial infarction.
#MedTwitter #NeuroTwitter twitter.com/i/web/status/1… 2. Common symptoms of stroke:
SUDDEN ONSET
*Weakness of arm, leg or face, usually on one side
*Inability to understand spoken words or to speak
*Imbalance while walking
*Reduced vision on one half or in one eye
*Sudden onset severe headache

Patients with Inflammatory bowel diseases (IBD) have a higher risk of suffering a stroke

1. Persons with Crohn's disease or ulcerative colitis have an increased risk of developing thrombo-embolic events. A recently published study looked at the association between IBD & stroke. twitter.com/i/web/status/1… 2. >85,000 patients with IBD were followed up long-term (1969-2019), and the risk of stroke in them was compared to those without IBD.
Patients with IBD had 14% higher risk of suffering from ischemic stroke during follow up.
#MedTwitter #stroke #IBD