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Myth #1: Diabetes is caused by eating too much sugar.FALSE. Diabetes is not caused by eating too much sugar. There are two types of diabetes: type 1 and type 2. Type 1 diabetes occurs when the pancreas completely stops making any insulin, a hormone that helps the body to use glucose (sugar) found in foods for energy. The exact cause or causes of type 1 diabetes isn’t known, but researchers suspect environmental factors, viruses or genetics play a role. What is known is that eating too many sweets doesn’t cause diabetes!Type 2 diabetes, on the other hand, results when the body doesn’t produce enough insulin and/or is unable to use insulin properly (this is also referred to as ‘insulin resistance’). This form of diabetes usually occurs in people who are over 40 years of age, overweight, and have a family history of diabetes, although today it is increasingly occurring in younger people.Myth #2: Taking insulin means you have “failed.”FALSE. If you have type 1 diabetes, you must take insulin to survive once you’ve been diagnosed—there is no other treatment for the disease.People with type 2 diabetes may initially be able to manage their diabetes with a combination of healthy eating and physical activity. Many people start on oral diabetes medication when they are first diagnosed, and eventually, most people will need to go on insulin. This is because diabetes changes over time. If you have type 2 diabetes, starting insulin doesn’t mean you’ve done a bad job—just the opposite, in fact! Starting on insulin will help you to better manage your diabetes which, in turn, lowers your risk of developing complications.Myth #3: If you have diabetes, you can’t lead an active lifestyle.FALSE. This myth is particularly problematic because many long-term studies have shown the positive impact regular physical activity has on lowering glucose. Naturally, any physical fitness program needs to be approved by your diabetes care team prior to starting, but once you’ve settled into a program, being active and healthy with diabetes is absolutely possible and is definitely encouraged!If you have any complications, such as heart disease, retinopathy (eye disease) or neuropathy (pain or loss of sensation in your feet), talk with your provider before you start any kind of exercise program. You may need special tests to make sure it’s safe for you to exercise. Ask your provider for a referral to an exercise physiologist or qualified exercise trainer for suggestions on types of exercise that are best for you. If you’ve never been very active, start slow. Walking and yoga are great ways to ease into an activity program.Myth #4: Injecting insulin is painful.FALSE. If you take insulin injections, it doesn’t have to hurt. In fact, it shouldn’t hurt! Practice good injection technique and the experience will be virtually painless. If you inject insulin with syringes, Andrea Penney, RN, CDE, of Joslin Diabetes Center, offers this advice: "After selecting and cleaning an injection site, firmly--but not tightly--pinch up an area about 2–3 inches wide. Inject at a ninety degree angle while the skin is pinched. Leave the needle in while you relax the pinch. Count to five slowly. Then remove the needle. Do not massage the area after the injection."If you use an insulin pen and experience discomfort, ask your provider or diabetes educator about using shorter pen needles and needles that are thinner. These can help minimize discomfort and do not require you to “pinch up.”

“POST DOCTORAL FELLOWSHIPCOURSE IN DIABETOLOGY”for the academic year 2018-19Name of the Course: Fellowship course in Diabetology2. Duration of the course: One year3. Eligibility Criteria for admission: MD / D.N.B in General Medicine recognised byMedical Council of India/National Board of Examinations.Intake capacity: 2 per year.4. Complete curriculum of the course:a. Goal:To provide candidates specialised training and skills necessary for appropriatediabetes care to patients with Diabetes Mellitus.b. Objectives:o To provide information on basic, clinical and management aspects of diabeteso To provide comprehensive diabetes care for Urban and Rural populationo To familiarize diet counseling, physical activity programmes and diabeteseducationo To impart competence in dealing with diabetes up to secondary level and previewfor referring to tertiary care e.g. Diabetic retinopathy, neuropathy, coronary arterydisease, peripheral vascular disease, nephropathy etc..o To develop leadership in prevention and control of diabetes and forming supportgroups for diabetes health careo To be able to handle diabetes inpatient care including diabetic emergencieso Plan and carry out research in diabetes care in clinical and community settings.5. Course Content:I. Basic Science:• History of Diabetes• Anatomy & Development of Pancreas• Insulin Biosynthesis & Secretion• Mechanism of Insulin action and regulation of glucose and lipidMetabolism• Glucagon, Glucagon like Peptide and Insulin like growth factors.• Animal models for the study of Diabetes.II. Diabetology:• Definition, Diagnosis and classification of Diabetes• Epidemiology of Diabetes• Genetics of Type 1 and Type 2 Diabetes• Insulin resistance & beta-cell dysfunction in Type 2 Diabetes• Secondary forms of diabetes• Maturity Onset Diabetes in Young (MODY)• Obesity assessment and Management• Metabolic Syndrome• Clinical features and examination in patients with Diabetes mellitusIII. Management of Diabetes:• Patient Education• Medical Nutrition therapy• Laboratory investigations in Diabetes• Oral anti-Diabetic Drugs• Principles of Insulin therapy• Insulin analogues• Insulin delivery devices• Hypoglycemia and its management• Self Monitoring of Blood Glucose• Exercise, physical activity and non drug therapy in DMIV. Complications of Diabetes:a) Acute metabolic complications:o Diabetic ketoacidosiso Hyperosmolar Hyperglycemic stateso Hypoglycemiab) Chronic complications:Micro vascular(i) Retinopathy(ii) Nephropathy(iii) NeuropathyMacro Vascular(i) Coronary artery disease(ii) Peripheral vascular disease(iii) Cerebro-vascular accidentsV. Other related issues:o Epidemiology, Treatment and preventive aspects of vascular Complicationso Hypertension in diabeteso Foot problems in Diabeteso Diabetes and Pregnancyo Sexual dysfunction in Diabeteso Infections in Diabeteso Skin and connective tissue disorders in Diabeteso Bone and Joint problems in Diabetes.o Diabetes and Surgeryo Dietetics in Diabeteso Diabetes in special situationsVI. Prevention of Diabetes:• Prevention of Type 1 and 2 Diabetes – current Strategies and Recent Trials.• Primary prevention and critical research issues.VII. General Topics:• Research methodology• Teaching methodology6. Practicals:• Diet exhibition and diet workshops - and well designed charts• Diabetes - laboratory techniques - visiting diabetes laboratories• Instrumental Diabetology - various instruments –Doppler, NCV, Biothesiometry,Sops Nerve Conduction Velocity, Pedometer, ECG, ECHO, Vascular laboratorytechniques.• Self Glucose Monitoring techniques, Insulin Infusion Pumps, CSII monitoringmachines.• Eye and diabetes - fundus examination and techniques (photocoagulation)demonstration• Visiting connected specialty referral clinical services. Art of maintaining clinical caserecords and electronic case recording techniques• Insulin, insulin syringes and Insulin pens - display and explanation• A visit to intensive Coronary Care, the intensive medical care & EMS facilities• Organisation of diabetes camps for public.7. Framework of Training:1. Basic Sciences (20% time) Immuno-genetics, Insulin resistance, Intermediarymetabolism, Pathogenesis of micro-vascular and macro-vascular complications, andlipid disorders.2. Clinical problem solving exercises (60% time) Problems in diagnosis, Screening forcomplications, Management issues, Drug interactions, Emergencies and Patienteducation. This may include clinical demonstrations, C.P.C. or other similaractivity.3. Related specialty interaction (20% time) Ophthalmic, Neurology, Nephrology,Surgery, Reproductive, Obstetric, Dermatological and Psychological and other areasincluding value added attendance at diabetes update meets and conferences.4. Postings: 12 months in the Department of Diabetology including Special Postings in theFollowing Departments• Intensive Medical Care Unit - 15days• Cardiology department - 15days• Nephrology department - 15days• Neurology department - 15days• General Medicine - 7 days• Diabetic Foot Clinic - 15 days• Ophthalmology - 7 daysCandidates will have to attend the Diabetology OP from 8 am to 10 am during theSpecial postings.Course Coordinator: Professor of Diabetology5. Attendance: 80% attendance as per the University regulations.6. Seminars, journal clubs, bedside case discussion and reviews in diabetes and related illness.7. Recent Advances in Diabetology.8. Research methodology in diabetes.9. Research conference at state level - 110. Research conference at national level - 18. Training Module:(i) Didactic Lectures: 1-2 / week, covering almost all chapters as in the RSSDI textbook(ii) Dissertation: 15 case histories - 1 Pregnancy & Diabetes, 1 Type 1, 5 peri-operative(varying specialties), 2 diabetic foot, 6 with complications (includingemergencies)9. Working hours:To be decided by the Institute.10. Log Book of daily activity with:
Outpatients:o 100 Type 2 Diabetes Mellitus cases including: Complicationso 10 Type1 Diabetes Mellituso 5 Gestational Diabetes Mellituso 5 Perioperative Diabetes Mellitus
Inpatients:Minimum 20 cases of Diabetes MellitusMinimum procedures /skillsClinical bedside skills – Anthropometry including Waisto Fundoscopyo Monofilamento Ankle Brachial indexo Life support and resuscitative skillso Recording and interpreting an ECG• Skills in dietetics – planning and constructing a diet chart for type2 DiabetesMellitus, Type 1 Diabetes Mellitus, Diabetes Mellitus with Pregnancy,Diabetes Mellitus in special situations; inclusive of meal planning,• Skills in patient education: Type 2 Diabetes Mellitus, Type 1 DiabetesMellitus.• Other skills:Glucometer use Lab skills: -blood glucose, HbA1, C and MicroalbuminLog Book to be signed with evaluation weekly.Minimum of 40 hrs a week / or 8 hrs /day.All clear.!!

The global answer is lack of a free market, but that takes many forms. I'll go into some of the major forms.1. The Flexner Report prior to WWI and especially Abraham Flexner's follow-on muckraking book caused Congress to shut down half the medical schools in the US (including all those of alternative practices) and to support the inherently costly gatekeeper model of medicine (physician as sole accessway to treatment and medications).Shutting down the schools and increasing their stringency greatly limited the supply of physicians. Here's a quick illustration of the costliness of the gatekeeper model. My oldest at 15 accompanied an author to Guatemala. She came down with tourista and gave him a dollar to go to the corner farmacia to buy opiates. Within a couple of hours, problem solved. That inexpensive option gets jail time in the US. One must have a doctor's signature to mend legally.2. Third-party payers. The more insurance companies have to pay, the more they get to charge for premiums. They lack incentive to keep costs down. They also have an incentive to cover as much as possible, including non-medical problems.Example: Kaiser did a study and broke its membership into six segments, three profitable and three quite unprofitable. Profitable were people like me who avoid going to doctors, people who faithfully go for checkups and follow their regimen, and chronics--people with diabetes, cancer, heart disease and so on who follow their regimen. Unprofitable were chronics who did not follow their regimen and who live abusive lifestyles (smoking, alcoholism, sedentary, drugs), acutes--people, usually immigrants, so fearful of the system that they do not present until a problem is acute, and hypochondriacs--people who use any sniffle as an excuse to see the doctor. You will notice that the common factor making the unprofitable segments unprofitable is behavioral rather than medical. Yet we all get to subsidize it. Subsidized activities seldom subside.3. Absence of self-medication--partly because of the gatekeeper model, partly because of paucity of ready, reliable information and partly because of bogeyman stories from doctors and the medical press, most people want to go to the doctor for problems they could easily take care of themselves. Example: I got a large cyst on my neck that a doctor charged me $450 to remove (almost $2000 in today's money). A month later while visiting my parents it came back. Not knowing what else to do, I went to see my old pediatrician. He told me to go home and put a hot "washrag" on it and don't come back again--I was grown up now--and charged me nothing. I put a hot compress on it. In half an hour it opened and drained and has never come back.4. Lack of disintermediation. Disintermediation is the opposite of gatekeeperism. If A has to go to B to get to C and you remove B, the process is usually swifter and cheaper. It's well known in medicine that RNs could handle the bulk of items handled by doctors but that remains a no-no, a legal no-no. But here's a better example. Benign paroxysmal positional vertigo affects lots of older people but a simple treatment was developed in the last couple of decades. An ENT might perform the head manipulation every other day, but a GPs office might see only one or two cases a month. They do not bother to learn the procedure, which is not effective if not done precisely. I helped an ENT who'd developed a cap with clinometers on it to make it difficult to do the procedure imprecisely so that a nurse practitioner in a GP's office could offer it. He thought it would make the procedure an $85 walk-in affair rather than the week-or-two ordeal waiting for a referral appointment that charged $2000 affair. But he was solicitous that other ENTs not be able to source the product to him as he knew they would resent the threat to their income. There was no legal restriction in this case--just peer pressure-- but a great deal of medical practice has legal constraints to disintermediation. No free market.5. We can estimate from the Pareto principle that twenty percent of medical procedures offer eighty percent of the benefit. Studies support this. Trauma care, vaccinations and antibiotics are of unquestioned benefit. Roughly half of medical procedures offer on average no bang for the buck (we do heal on our own most often). And in some ten percent of cases, we are better off not to see a doctor, especially when the presenting symptoms are vague. For example, my brother went to some sixty doctors over fifteen years and was rebuffed with offers of referrals to psychiatrists, told to give up--he would not get the drugs he was after, told it was all in his head and so on. He was suicidal. Finally, he saw an immigrant doctor from Africa who said, "The symptoms you are describing are those of Lyme Disease but given how many physicians you've seen, someone is bound to have tested you for that." Sure enough, he had gone all that time undiagnosed with a disease that is a priority in Continuing Medical Education.Despite such discrepancy in benefit to patients, the AMA heralds a "gold standard" treatment for every condition and presents the front that all of medicine is equally efficacious. This is part of the reason Obamacare will fail to control costs.Medicine is a sector badly in need of free-market reforms.Charles Tips's answer to What are the problems with Free Markets?