(For the information of non-medical public)


About 2 out of 10 people over the age of 40 develop this condition of inability to lower adequately the sugar levels from fast digesting starch containing food or sugar. If your blood sugar levels were over 200 mgs (11mmols) at any time you might have the condition of Diabetes. Without having to go through a number of blood test such as glucose tolerance test following suggestion should assist you in finding out whether you have the condition.

The best time to check blood sugar level is very soon after festive season or when you have had more than usual amount of your favourite food items.

Have your usual breakfast (what ever starch containing foods in its usual quantity, lunch with usual content of starch containing food items and desert or fruit. If you are less active after lunch usually be less active for the test. Exactly at 2 hours following lunch take a trip in a vehicle to nearest laboratory for a blood sugar test. If the blood sugar is below 140 mgs your body is able to handle the usual diet satisfactorily. If it is over 140mgs. then you have to adjust your diet a little and recheck after 2 weeks following the above instructions.

If the blood sugar is above 200mg consider following questions.

Have you been ill very recently such as a 'flu', operations. or having mental worries?

Have you been having too much sugar containing food items ?

Have you been losing weight for unexplained reasons?

If any of the answers to above questions is yes, a proper assessment by a physician is needed before embarking on any medication to lower blood sugar, preferably, by a specialist dealing with diabetes to find out the cause of abnormal blood sugar.

Dietary management of Diabetes
Choose foods containing starch in smaller quantity. Instead of having very large lunch and a snooze after lunch try small lunch and moderate physical activity such as shopping or attending to household chores after lunch. Shifting some portion of the starch diet to the evening meal would also help to reduce the stress on insulin producing cells in the pancreas.

Always aim to keep the 2 hour post lunch blood level to below 140mg by diet than with medications.

Above is the simplified and most appropriate way to manage the Diabetes. The non medical person with reasonable intellect may be able to grasp the essence of sugar level regulation by the body.
Do not take medications without consulting medical practitioner with special interest in Diabetes.

Tablets. No tablet is a substitute for managing Diabetes without dietary modification.

Insulin. Very rarely ,insulin injection may be needed to tide over critical illnesses or operation for the Diabetic person.

Follow advise from clinicians strictly if you are on insulin in order to avoid complications.

( Try not to manage Diabetes by trial and error. - Sugar level regulation is far too complex for you to understand with out adequate medical knowledge)

Additional Information.
About half of the sugar produced by digesting starch is used by the leg muscles, quarter by the brain and the other quarter by rest of the body organs.

Sugar levels in the body are regulated mainly by Insulin, Glucagon, Cortisol, Growth Hormone and Adrenaline.

The body is more responsive to available insulin in the evening than in the morning.

If no food is taken the body converts glycogen ( stored in muscles and Liver) and fat inside the abdomen to sugar in order to maintain normal blood sugar levels. (If you are on tablets or Insulin to lower sugar levels then you could suffer from a reaction known usually as 'Hypo', confusion or blackout and sweating until the body corrects the sugar levels by itself in a few minutes, More rapid correction is possible with a sugary drink or glucagon injection.)

High blood sugar levels damage the inside lining of the blood vessels to cause heart attacks, Stroke, bleeding in the eyes, Kidney failure , High Blood Pressure, Infections, Cataracts, Glaucoma etc.

If you are also a smoker you are at more risk to develop the above complications.


The world population is visibly becoming overweight owing to consumption of increased amounts of calories with sugar and solid or liquid fat.

The body systems are geared to store available nutritional load to tide over lean times in the form of fat layer in the abdomen and under the skin. It takes a few months to few years to build up the fat layer to be overly noticeable. Famines or non availability of food is unlikely to affect many parts of the world.

Cooking food in oil and adding refined sugar in various forms contributes to the nutritional load for the body to tackle in order to keep the body systems functioning without significant ill effects other than the mobility. However, over time it become a cause of diseases like Diabetes, Heart disease, Cancers. Arthritis. etc.

How to control weight by losing excess body fat.
Without calorie shortfall month by month the excess fat cannot be shifted.

However, it is not advisable to reduce the calorie consumption drastically as the body systems switch its metabolism to different strategy for survival.

Think of your monthly savings account in the bank where you save little by little every month to build up a sizeable sum after a few years. The reverse process would need to be set in place where drawing small amounts every month from the capital built up. This same principle applies to stored energy in the form of body fat.

Our psychology and philosophy are also a crucial part of what we want to achieve and would achieve.

There is also a need to continue to enjoy your favourite food items in small amounts once or twice a month. Otherwise we would not be able to sustain our plan to reach our target weight loss.

Exercise would keep you fit, but it also increases your appetite for food and craving for favourite food items. The stored fat will not alter visibly with exercise alone and when you stop your vigorous exercise routine the fat stores in the body would fill up very soon. Therefore, choose only the gentle type of exercise routine which you can maintain for years.

Check your resolve to reach your desired body proportion.

Are you able to resist the temptation to join in when your friends or family are gobbling up your favourite food items right in front of you?

Are you able to control hunger pangs when you feel very hungry ?

Are you able to fast just for 24 hours without food while being active?

If your are able to do the above you would most likely reach your desired body proportions in a few months or in a few years.

See if you can stop buying or using oil, solid fat, and sugar for the first month as well as ration the amounts for your family members. The reason for suggesting this is to switch your body metabolism away from storing fat as a matter of routine. After a month you would not tolerate food containing large amounts of fat, and the sugar in your diet might taste odd and unpleasant.

If you are able to modify your diet in the first month the body system would be conditioned to utilize energy from natural food source and cooked food with minimal fat and sugar.

Energy yield from starch/sugar- 4 calories/gram

Energy yield from fish, meat, egg, cheese - 4 calories /gram

Energy yield from oil or fat- 8 calories/ gram

A normally active adult needs about 1500 cal/ day = 45000 cal/ month

Aim for a shortfall of calorie of 8000/ month – ( 1 kilo of fat loss per month)

Do not check your weight other than every 2 months. As our body consists of about 60-70% water we get a wrong impression of body weight loss with fluctuating movement of water in and out of our body. Amount of fat loss is a little difficult to calculate by checking the weight. If you have lost 6 pounds in 2 months the amount of fat loss is likely to be about 3 pounds.(1.5 kg- same as loss of 1.5 litres of cooking oil)

Avoid coffee, tea, fizzy drink, beer, wine spirits chocolates etc. for the first month.

You can have any fruit in any amount or a few raw nuts when ever you feel hungry for the first month. Any amount of cold or warm water without additives for the first month.

If you are on any medication check with your doctor the safety aspect of embarking on weight loss program.


Cancer develops from just one abnormal cell while the neighbouring cells and the immune system fails to recognize it as abnormal.

In the early stages of cancer no symptoms will be present. Depending on the rate of growth and position of the cancer lump some symptoms may be experienced.

Older age group is more prone to cancers. The site and extend of the cancerous growth should be ascertained by specific invasive or non-invasive tests. Once the cancer cells have spread from the original site to liver, lungs brain etc. it is very unlikely that treatment with surgery or chemotherapy would prolong life to more than 5 years. The management is usually palliative in controlling symptoms in advanced metastatic spread than getting rid of the cancer as only less than 5 % cases of advanced cancer remain alive for 5 years with or without the condition.

Commonest cancers are in the breast, prostate, colon, blood and lungs.

Self examination of breast weekly before taking a shower may give you an indication whether to seek more definitive tests and clinical consultation. Fortunately, many lumps in the breast are not cancerous. Any ambiguity in test results is usually treated as cancer to be on the safe side.

Prostate cancers are usually very slow growing and it would be prudent to seek consultation to consider treatment to slowdown the cancer further so that we may be able to reach a normal life span.

Colo- rectal cancer detection usually needs an invasive test to assess fully the extent of the disease. Removal of the cancer lump and lymph nodes followed by chemotherapy course is the standard treatment. Other surgical procedures are mainly to prevent obstruction of the intestinal tract or to alleviate recurring symptoms.

If you are a smoker and if any tinge of blood is seen in the sputum, cancer of the windpipes needs to be ruled out by specific tests.

Expensive chemotherpy courses are not vastly superior to available less expensive combination of anti-cancer treatment.


Heart attack symptoms are due to sudden obstruction of one of the three blood vessels supplying the heart muscle. Usual symptom is a tightness or pain in the centre of the chest, and usually in the early morning or when exerting physically or rarely with mental stress. If you suspect that the pain is due to heart attack be calm and arrange a lift up to local cardiac facility to assess fully the severity and extend of the disease. An emergency angiogram may be required if the blockage could be corrected by stenting. If the affected part of the heart muscle is already dead, the clinicians might opt for an elective angiogragm to assess the state of remaining blood vessels.

Try not to self diagnose or treat without adequate assessment of the heart function. Do not consider pain in the chest is due to indigestion until a detailed assessment is carried out by cardiologist. Do not run, drive or panic if you suspect experiencing a pain from the heart. Even if the pain goes away in a few minutes you would still need a lift up in an ambulance or a taxi with a relative or a friend to nearest facility for a fuller assessment.

Angina is due to partial obstruction of one or more of the heart blood vessels, with symptoms coming on physical exertion which clears up with a short rest. Again, if this is new, you need a consultation with a cardiologist without undue delay.


When hit with a pain wherever that may be, think twice before you pop up a pill into your mouth.

Ask yourself following questions.

1. Do you really know what caused the pain? Diagnosing oneself the cause of pain might lead to harm in the short or longer term. Medical fraternity armed with the knowledge and experience is better placed to make informed decision to deal with the situation.

2. In addressing the management of pain after assessment by medical staff consider the following.

Is the pain bearable ? Do you really want to upset your body’s adaptive and recovery process and stressing the metabolic system to deal with consumed pill to be detoxified by the liver and excreted by the kidneys? By killing off the pain you might not be protecting the affected part of your body sufficient time to recover or heal itself? Do you you really want to remove the monitoring parameter such as the pain to assess whether the condition is getting better or not?

As we get older many system controlling our bio-systems are on the decline. Many would experience limited tolerance to toxic compounds previously handled efficiently during healthy state before midlife such as cooked starch and sugars ( Diabetes), Alcohol ( liver damage and declining brain function) Caffeine ( dependence causing on and off state) unaccustomed physical over-exertion ( straining the heart to cause a heart attack and muscle soreness and injuries) etc.

To understand the above physiology of the bio-systems study the following analogy.

You can keep your finger in a candle flame for a short time without causing significant damage to the skin. What if your pain is killed off by medical drugs. You would not be removing the finger from the flame before damage to your finger occurs.

Many medical drugs interact with other drugs and bio- systems.

Hyperacidity treated with alkali stimulates production of more acid which is needed for digestion.
When alkali is stopped there might be a rebound hyperacidity. Therefore, assess what caused the hyperacidity in the first place Symptom relief temporarily can lead to harm and dependence on medication.

Many clinicians agree that fewer medications are better for the elderly.


Many patients are wrongly labelled ‘Hypertensive’ by using improperly calibrated medical equipments measured in an unnatural setting Patients also might have a degree of anxiety causing errors in blood pressure recording.

Ask the doctor or the nurse the following questions.
Was the high blood pressure mild, moderate or severe ?
Could the doctor ascertain the reason for the high blood pressure?

Could the patient be given sufficient instructions to check blood pressure at home using digital blood pressure monitors before committing to lifelong medication?

Mild hypertension is better managed by lifestyle changes than with medication. More than a third of hypertensive patients would not respond adequately to medication. There may be danger by increasing the medication in the elderly population as perfusion of vital organs is dependent on higher blood perfusion pressure.

Anxiety and the first few minutes of physical exertion should physiologically cause higher pulse rate and blood pressure to achieve perfusion demands of vital organs and the musculature.

Reducing the risk of Heart attacks.

Regular body weight bearing activity such as standing, walking on the level or against a slight incline for more than 10 to 15 minutes continuously stimulate opening up the heart’s collateral circulation thereby reducing the risk of heart attacks or the effects of heart attacks.

It should be understood that even when all the blood levels of sugar and coronary circulation are known to be normal a chest pain or discomfort in the chest during physical exertion or at rest needs prompt medical assessment.

Screening for pre-diabetes.

Many individuals continue to run high blood sugars during the day but with a fasting blood sugar levels in the normal range. In order to screen for pre-diabetes a finger prick glucose test at 2 hours after lunch post festive season ( January each year ) could alert the person to be cautious with the diet and level of physical activity, thereby reducing the risk of developing overt diabetes and complications resulting from high blood sugar levels such as stroke, heart attacks, kidney failure, eye diseases etc.

More info and amendments to above text is being sought with the help of local linguist.

In the mean time, if you need a lot more information regarding Diabetes, visit NHS choice website by clicking or copy and paste the link shown below on top most window on your screen. Details of other medical conditions are also available at the nhs.uk website

Dr. Mathew Varghese
Former consultant Physician, UK