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What Is Diabetes & What Does It Do to Your Body? | Raj Shamani Clips — Transcript

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0:01What is diabetes
0:03and why whoever is either pre-diabetic
0:08or diabetic is
0:10not able to manage it and maintain it
0:14properly because only 7.7% people out of
0:17100 are able to manage it. More than 92%
0:20people are failing in either reversing
0:22it or managing just their sugar, blood
0:24pressure and cholesterol.
0:26>> Yeah.
0:26>> Why?
0:28Okay, let me go to the first question.
0:30What is diabetes? And you can feel free
0:33to explain it through paper in charge if
0:34you want.
0:35>> I I'll do that. So, diabetes simply put
0:39is a condition where the blood sugar
0:41level is above normal. So, what people
0:45don't know is that everybody has sugar
0:47in the body. Sugar is like fuel. If you
0:50don't have sugar, you'll die.
0:51>> Your sugar goes down below particularly
0:53incompatible with life. Okay. So the
0:56normal sugar fasting
1:00it'll be say around 80
1:02>> 80 90 less than 100 definitely okay
1:05maybe 70 to 100 after food it may go to
1:08say 120
1:09>> m
1:10>> it won't go beyond that HB A1C we said
1:13will be less than 5.6 six m
1:16>> if these three are there you're not
1:17having diabetes you're not having
1:19pre-diabetes also
1:21if it starts going up fasting goes from
1:24100 to 125 the post post glucose not
1:28postprandial 140 to 199
1:32>> m
1:33>> then hbc 5.7 to 6.4 four then it's
1:37pre-diabetes
1:39then you got diabetes this will be more
1:42than 126 this will be more than 200 that
1:45will be more than 6.5 HBNC so this is
1:48diabetes this is pre-diabet this is
1:50normal so this is the how you classify
1:53now you may have one of this that means
1:56you got diabetes but it's not one
1:58disease about 50 60 different types of
2:02diabetes the common thing we know is
2:04type 1 type
2:06gestational diabetes and then another
2:08set of but there are I just now
2:10mentioned neonatal diabetes like this it
2:12goes on and on fibroalphic I mentioned
2:14there are so many many types of diabetes
2:16this only tells you you've got diabetes
2:19>> now we have to start classifying what
2:20type of diabetes it makes a big
2:22difference type one you go treat with
2:24tablet you you're going to kill that guy
2:26type two you go and start giving insulin
2:28unnecessarily they'll put on weight and
2:30so on so that is called precision
2:32diabetes you have to diagnose so you
2:33have got certain
2:35rules by which we see one simple thing
2:37is that age at all. So below 6 months
2:39it's neonatal diabetes. So look for
2:41neonatal diabetes. If all neonatal ruled
2:44out it still could be rarely type one at
2:46that age but it's usually type above
2:48that is likely to be type one. So we do
2:51simple test ceptide test that is insulin
2:53secretion. If it is zero finished it's
2:55type one. No other diabetes will go to
2:57zero. Okay.
2:59>> Now it's showing good ceptide. I told
3:01you little older 15 16 year old 18 year
3:04old he comes with aanthtosis strong
3:06family history obes type two
3:09not obese not needing insulin but strong
3:13family history there's a type of
3:14diabetes called modi maturity onset
3:16diabetes of yum modi in that there are
3:1814 types of modi okay so some of those
3:22modi types like neonatal diabetes can be
3:25treated with tablets okay just like
3:27neonatal diabetes they belong to that
3:29same class modi 1 modi they respond to
3:32that. So when you come to us it doesn't
3:35mean everybody will do genetic test for
3:38some I I may think he's got this FCPD
3:40I'll just take an X-ray stone finished
3:42diagnos stops there
3:44>> ceptide absent type one diagnos stops
3:47there obese man coming with this obvious
3:50type two you don't have to proceed for
3:51you don't keep on doing everything for
3:53everyone it's a waste of money waste of
3:55time but not fitting in everywhere then
3:57we start asking is this modi is this
4:00something else is it some genetic
4:02syndrome. Is it something else? Somebody
4:04will say hearing is affected. Oh, does
4:07your mother also have diabetes? Yes.
4:09Does she also have hearing problem? Yes.
4:10Then it's maternally inherited diabetes
4:13with deafness. Mid it's coming from
4:15mother maternally inherited diabetes
4:17with deafness. Finished. So deafness
4:19gives a clue. So like Sherlock Holmes
4:21you can easily with the experience say
4:23ah this is this this is that this for me
4:25as a patient walks in itself I can say
4:27this is the the rest of it is only to
4:29confirm.
4:29>> Okay. like shalom you can just pick it
4:31up just like with experience you can
4:32pick it up okay so that that's what
4:36makes this disease so interesting there
4:38are so many types in this and with
4:40knowledge you you learn over years and
4:43so on now once you know which type of
4:46diabetes you also know see in type two
4:48diabetes only you talk about reversal
4:50and all type one is not possible FCPD is
4:53not possible in Modi it's not possible
4:55it's genetic how can it type one how
4:57will all the cells are gone here stones
4:58are there how are going to reverse
5:00certain things we know you can GDM
5:02gestational diabetes they have diabetes
5:04during pregnancy the moment they deliver
5:05the diabetes will go away the day they
5:08deliver up to that they'll be diabetic
5:11they'll be on insulin or not the day
5:13they deliver glucose will drop because
5:14baby's out baby's producing it
5:17>> that'll go but they may get it back
5:19within 5 years so what do we do now we
5:22start with them don't put on weight
5:24don't do this you can prevent diabetes
5:26so you have to focus on that in a
5:28different I was reading up something
5:30about you that Stanford
5:32>> Yeah.
5:32>> has put you in top 2% scientist of the
5:34world.
5:35>> Yeah.
5:35>> Right.
5:36>> And you have said something about
5:38Indians. This is shocking
5:39>> that if an Indian gets diagnosis of
5:44pre-diabetes.
5:45>> Yeah.
5:45>> Within 8 years there's 40% chance that
5:48they'll develop full diabetes.
5:50>> Even higher.
5:52>> Why specifically Indians? like what is
5:54there about Indians that we are building
5:56and developing diabetes faster than any
5:58other population on earth.
6:00>> So partly it's genetic. So through
6:04centuries of genes coming down the pool.
6:09So we have had um
6:12unangous marriages. It's may not be so
6:14much in the north but in the south and
6:16all we get a lot marrying your cousin,
6:18marrying your uncle all that is uh very
6:21common. So the gene gets multiplied. So
6:24that is one thing. Second thing is that
6:27intrauterine itself and the mother is uh
6:31malnourished and thin. The baby is also
6:35thin and therefore already born with a
6:37smaller pancreas. The amount of beta
6:40cells are very much reduced and so
6:44they're destined to get diabetes. On top
6:47of that, what brings out all the insulin
6:49from the pancreas is your carbohydrate.
6:53We consume too much of carbs,
6:55>> whether it's rice or wheat or whatever.
6:59And that pulls out the little insulin
7:01you have also gets pulled out very fast
7:04and to burn it, you have to do a lot of
7:06exercise. We really don't do much
7:09exercise. So all this put together
7:11becomes a deadly uh combination to push
7:14you into pre-diabetes and then into
7:16>> diabetes. You said first let's talk
7:18about all four topics individually.
7:20First you said
7:22>> the marriages.
7:23>> Yeah. So if you what happens like when
7:26you mar somebody from the same family or
7:29same
7:29>> let us say that there are these families
7:32which have the gene for diabetes and
7:35let's say there's another set of
7:38families where there's no gene nobody in
7:40that family has diabetes at all.
7:43>> If this family marries into that family
7:46the gene is going to get diluted
7:49>> because there's no gene here at all.
7:50>> There is a gene here. Now within this if
7:53you scap keep marrying within that the
7:55gene will get multiplied multiplied
7:56multiplied multiplied they marry their
7:59uncle also has a gene you also have the
8:01gene okay their kids will have the gene
8:04then they're going to marry another
8:05cousin so again the gene will get
8:06multiplied if you keep doing this for
8:08generations then they you're already
8:11filled with those genes
8:13>> to get heart disease and to get diabetes
8:15and so on so that's one thing then the
8:18diet also doesn't help because so much
8:20of carbs we take that we are pulling out
8:23all the insulin. So coming back to the
8:26marriage part do you think is it
8:29>> from purely just medical point of view
8:32from the health from the point of view
8:33of health of your offsprings of your
8:35kids
8:36>> should you not marry inside the family
8:38>> should not at all
8:39>> never
8:39>> it's much healthier to at least not at
8:42the first cousin level or in Tamil Nad
8:45they actually marry their own uncle
8:47mother's brother is the first uh uh he
8:51has a right
8:52>> he has a right actually to to marry.
8:56Suppose Yeah. Suppose my uh sister was
9:00there
9:01>> and my mother had a brother. Uh the
9:04first he should say no before she can
9:07marry someone else. That has been this
9:09is to keep
9:10>> wait
9:14mother's brother.
9:15>> Yeah. Mother's brother. Uncle
9:17>> has uncle has the first right to
9:20>> to marry the mother's child
9:23>> first. He has to say no.
9:24>> Yeah, it it'll actually happen there.
9:28But if he's not interested and
9:30everything,
9:30>> it won't be too much. No, see marry
9:33young. Yeah. Or maybe younger brother.
9:35See, suppose mother itself used to marry
9:37at 19, 20.
9:40>> Then her her brother maybe five or six
9:42years younger uh to her, maybe even 10
9:45those times a large family. So maybe
9:47even 10 years younger uh uh to her. And
9:51so her when her daughter becomes 18 20
9:54he'll be 25 28 something and so the
9:58first we we say that that's an automatic
10:01choice to get it used to be done like
10:03that for several reasons number one it's
10:05the same cast so you don't have to go
10:07outside the cast the same family you
10:09know the family
10:11>> third is the wealth is kept within the
10:12family
10:14>> suppose a very rich family within the
10:16family itself the wealth goes
10:18>> somebody else comes in and then the
10:19wealth goes off to the thing you That's
10:21how it was. It's it's decreasing now.
10:23It's not the same anymore, but that's
10:26how it used to be.
10:27>> So, that has probably caused
10:28>> and in every like there's a lot of casts
10:31and religions where this shape and form
10:33in different ways is is seen
10:35>> where you marry your family members,
10:38right?
10:39>> Marrying cousins is very common. See,
10:41uncle is less common but cousins is very
10:44common.
10:45>> So,
10:46>> okay. So, that's the first reason. That
10:48is one. So because if one sort of gene
10:50then they start dominating and then
10:52eventually over the years you start
10:54developing similar kind of diseases.
10:56That's one. Second you said if mother is
11:00malnourished
11:02>> the child is also thinner
11:03>> thinner
11:04>> and then the thin. So isn't diabetes for
11:08people who are obese? Later on they'll
11:10catch up. So when the child is born,
11:14>> it's born with a smaller pancreas with a
11:16limited capacity to produce insulin
11:18because didn't get enough nutrition. So
11:21the child is born small. Okay? With a
11:25smaller pancreas. Now what happens of
11:28course they remain led they may not get
11:30it but what happens is later on they'll
11:31put on weight. No. So when they put on
11:34weight a normal pancreas person with a
11:37normal pancreas can adjust to that load
11:40of that extra fat extra here is already
11:43born with limited capacity.
11:45>> So now when you put on weight you you
11:48are not the it's not able to meet the
11:50demand demand supply problem. So you're
11:52telling me that if someone like me who
11:55is probably in his 20s
11:58is thin and looks fit at least from the
12:01outside
12:02>> just because probably my mother was
12:05malnourished during her times.
12:07>> Yeah.
12:07>> I have equal amount of risk as much as
12:10>> even higher risk probably than somebody
12:12whose mother was not malnourished and
12:16when the child was born was not
12:18malnourished but normal. your risk is
12:20already higher. But by taking enough
12:23precautions, by being very active and
12:25not putting on weight and not becoming
12:27obese, you can postpone it to a large
12:30extent. If now you become obese also
12:33already you're born with a limited
12:35capacity. Now you put on weight also
12:38which is the driver, you will succumb to
12:40diabetes much faster. You will develop
12:42diabetes much faster than somebody
12:44>> who's not that. The impact of diabetes,
12:46sugar, glucose on liver, kidney, eye,
12:50brain, bunch of things. You just use
12:51these words.
12:53>> Explain me organ by organ. I'm going to
12:54put organs here.
12:55>> Sure.
12:56>> And you tell me exactly
12:58>> like I'll give you a checklist and where
13:00does sugar attack first. Let's start
13:02with the eye.
13:03>> So when you see the eye, you'll be
13:06seeing it like this. Okay, we have a
13:09thin film
13:10>> and then just behind that we have the
13:13the pupil through which the light
13:15enters. You can see that round thing and
13:18then you have the iris. Then behind that
13:21you have the lens.
13:23>> Okay.
13:23>> Okay.
13:24>> It's there in all our eyes.
13:25>> All our just behind there is the lens
13:28and it is this lens which focuses the
13:32image. See the light is going from there
13:35through the lens and at the back portion
13:39there that is called as a retina.
13:41>> Okay, that's a retina the back portion.
13:43So you have a front portion, a middle
13:45portion, then you get a back portion
13:47there. So when the light goes in there,
13:50it has to converge to a point there and
13:53then you'll be able to focus clearly.
13:56Now what will happen is if this lens
13:58becomes thicker or thinner you'll get
14:02long sight or short sight. So before 40
14:04years mostly it's myopia long distance
14:06you cannot read.
14:07>> After 40 reading will become a problem.
14:10>> Sure.
14:10>> So yeah so that's called long sight. The
14:12other one is called short sight. Myopia
14:14hypometropia. So all that is in the
14:16lens. The same lens. So those changes
14:19can also come due to diabetes because
14:21more water in the lens less water in the
14:23lens. If you have very high sugar,
14:25you're feeling thirsty. That means
14:27there's no water in the body. There's no
14:28water in the lens also. Lens will
14:30shrink. So your focus and all will go
14:31and you won't be blurred vision. Next
14:34stage which is very common in diabetes
14:37is catact. So catact is normally a lens
14:40will be like this. You can see through.
14:42Okay. Now you can get different types of
14:46catact. Now in this only the central
14:49portion is so through the side you can
14:51see this portion you cannot see
14:53properly. Okay. Then you can get these
14:56type of thing like a star. It is this is
14:58a typical diabetic kind of a catact like
15:00a star stellar kind of a what does it
15:02mean catact it these are catacts which
15:05is forming but uh there is still some
15:08portion left. This particular shape if
15:10you see is likely to be diabetes. Then
15:12you got complete
15:15blockage like this. Now it's become
15:18opaque.
15:19>> This is catact. So once it has come like
15:22this, you have to operate. So what they
15:25do is they'll remove the lens and put
15:28another lens in. I've had both my eyes
15:30operated for catact. Within a week I got
15:32both uh done. It's a 5 10 minute
15:35procedure for a good surgeon. Make a
15:37small link. They just pull out that lens
15:39and there's a small lens they push it
15:41in. That's it. Finished over. then it it
15:43just stays and the new lens then can be
15:46there for long time 10 20 years more
15:50also. So, so that is catact that also is
15:53accelerated in diabetes when you have
15:54very high sugar the catact comes
15:56earlier. If normally catact comes at 60
15:5965 in diabetic people 505 it's come
16:02because the high sugar driving the
16:04catact metabolism
16:06>> when the sugar increases the first thing
16:08it does is start forming these cracks.
16:11Uh it's not cracks it is um transparent
16:15thing becoming opaque.
16:17It's the sugar inside sorbital we call
16:20it. It's again related to sugar. So that
16:22sugar metabolism changes and then the
16:26this become start becoming opaque. So
16:28that's called catact. That's also a
16:30simple thing. You won't lose your
16:32vision. You can remove the catact and
16:34bring even non-diabetics also to us.
16:36What happens in really in diabetic
16:39people is retinopathy. Diabetic
16:42retinopathy.
16:43>> Retinopathy means inflammation or
16:46disease. Retinopathy mean retina getting
16:49affected. So this is the retina. So that
16:51portion is the retina. You can see the
16:53blood vessels there. When you have
16:56uncontrolled diabetes,
16:58these blood vessels start getting
17:01affected.
17:02>> First small sack like thing will come.
17:05We call it as microanurism. Small sack
17:07will form. Then they'll start leaking.
17:11So you'll find when you do a ex see what
17:13the doctor will do, retinal specialist
17:15will do. They'll put in drops and this
17:18pupil which is small will become bigger.
17:20So you can see what you're seeing at the
17:22back you can actually the whole retina
17:25you can then see without any surgery and
17:27you can just see the whole retina.
17:29Normally all the normal blood vessels
17:31you can see but in diabetic retinopathy
17:34what happens is first of all the small
17:36circular thing will form micronurism we
17:38call it then it'll start leaking then
17:41small hemorrhages will start blood clots
17:43small blood clot then because it is not
17:47getting enough oxygen
17:49is not efficiently flowing new vessels
17:52will try to form so instead of these
17:55small vessels from there what will
17:58happen is that if the vessel is like
18:02this that vessel will form new vessels.
18:06We actually call it as new vessels neo
18:08vascularization.
18:10>> This is original one. This is a new one.
18:12These new ones are very thin.
18:14>> Okay. It'll easily burst. So if it
18:16bursts what happens is the whole retina
18:19will get filled with blood and overnight
18:22you can go blind.
18:24So it'll just like that leak
18:27>> and the whole purely because of glucose
18:29mismanagement in your body
18:30>> not controlled
18:32>> diabetes not yeah uncontrolled diabetes
18:34>> where sometimes sugar is going super up
18:36or super down this
18:38>> remaining high
18:40>> okay more
18:40>> not not due to the fluctuation but
18:42because sugar is continuously kept high
18:44that's where this concept of hbc test
18:47comes this 3 months average test hbc
18:50study after study done 10 20 years ago
18:53have shown see the norm Normal HBNC is
18:555.6
18:56>> or below. 5.6 to about 6.4 is called
19:00pre-diabetes. 6.5 and above is diabetic.
19:03Similarly, you got for the glucose.
19:04Fasting above 126 is diabetic. In a GTT
19:072our value about 200 is called diabetic.
19:10In a random blood sugar done at any time
19:12more than 200, it is diabetic. Many
19:14people are saying don't treat diabetes.
19:15It's normal to have high sugar. So, age
19:17old age everybody will have little
19:19diabetes. That's where all these myths
19:21are, you know, are demystified. When you
19:24do these studies, what they found was up
19:27to seven HP and 5.5 5.6 to around 7 is a
19:32safe limit.
19:33>> M
19:33>> you don't develop I kidney nerve
19:36complications
19:36>> up to 5.7
19:38>> up to seven
19:39>> up to seven from 5.5
19:41>> 5.5 5.6 6 is normal. 5.7
19:45to 7
19:46>> okay
19:46>> that range if a diabetic is able to
19:49maintain can be 6 6.2 2 6.3 6.5 up to 7
19:54there is no risk of developing I kidney
19:56nerve complications
19:59as it goes above from 7 to 8 8 to 9 that
20:031%
20:05increases your risk of developing eye
20:08kidney nerve complication by 25%.
20:12So 7 to 8 25% risk 8 to 9 50% risk 9 to
20:1710 75% risk about 10 100% risk of
20:22developing complication. So any 1%
20:26lowering also reduces your risk by 25%.
20:29And all we're trying to do is to keep
20:31that A1C below 7.
20:33>> That's our entire goal of treatment. We
20:36call it as a ABC. Actually A is A1C
20:40below 7%. B is blood pressure. You have
20:43to keep it at whatever is normal for
20:44your age at least below 140 90
20:47preferably 130 80.
20:49>> C is cholesterol. The bad cholesterol is
20:52LDL cholesterol. Should be below 100
20:54below 70 is good. Even below 50 is even
20:57better. But at least below 100 to start
20:59with for the whole population you want
21:01to bring everybody 50 and all may be
21:02difficult but if it's possible then you
21:04bring that. D is discipline, diet,
21:08exercise, sleeping, this, that, all
21:09that. If you follow this A alone, you
21:14can prevent eye complication. Nobody
21:15will develop diabetic retnopathy.
21:18There'll be no blindness due to
21:19diabetic. Same thing for kidney.
21:22>> Same thing for nerves, neuropathy,
21:24burning feet and numbness of feet. These
21:27three can be eliminated if you just keep
21:28that A1C below 7. Nothing more you have
21:31to do. Okay? If you want to prevent
21:33heart attacks, strokes, gangrine of the
21:37feet, then B and C also have to keep
21:39blood pressure also under control,
21:41cholesterol also under control. D also
21:43includes no smoking and all that cuz you
21:45smoke then all gone. So if this A B C D
21:48you do, I have been telling year after
21:52year on World Diabetes I've been saying
21:55we should have a complicationsfree
21:57India. People ask me can you have a
22:00diabetes free India? I say it's
22:03difficult.
22:05>> It's difficult because age is a
22:07non-modifiable risk factor. As you grow
22:09older you'll get little diabetes. Okay.
22:12Can you completely prevent graying of
22:13hair? May can you completely prevent
22:16balding? It may not be possible.
22:18>> Okay.
22:19>> But it doesn't matter if you get little
22:20diabetes as long as you don't suffer
22:22it's okay. So I keep telling people
22:24don't worry about diabetes free world.
22:27we'll worry about a diabetes
22:30complications free world that is
22:32possible and I want to see it in my
22:34lifetime and for that I'm saying ABCD
22:39that's it get your A1C down keep your
22:42blood pressure down keep your
22:43cholesterol under control and follow
22:44some discipline diet exercise no smoking
22:47get to sleep on time take your medicines
22:49go for a checkup finished we will you
22:52may say is this rhetoric or you have
22:55actually done it I have done it. In
22:592013,
23:00we showed 50 years survival of type 2
23:03diabetic patients. 50-0.
23:06Okay. I had about 300 400 patients who
23:09finished 40 years and some who finished
23:1250. Now some finished 60 65 years with
23:15type 2 diabetes. So the American
23:17diabetation gave me the Harold Rifken
23:19Award as the first to show in the world
23:2250 years survival of type two diabetic
23:24patients. Partly because I was lucky
23:27because their diabetes itself comes only
23:29at 50 60. For them to get 50 60 they
23:32should all 110 years old.
23:34>> Yeah.
23:34>> For us we get it 20 30. So to get 50
23:36years survival when you're 70 years old
23:38you can get 50 years survival. So that
23:39way we're little lucky that people get
23:42it at a younger age. So they able to
23:43show 50 years but nobody had shown it.
23:45So they gave me the one of the highest
23:47awards in American deputization is the
23:48Harold Riiffken Award. So they gave me
23:50that. But the point is not the award.
23:52Point is that people can live for 50
23:54years without. Then they said you only
23:56showed 50 years survival. You didn't
23:58show people living up to 90 100. So I
24:00said that's my next project. So we
24:02collected people who have finished 90
24:05years 95 years 100 years with diabetes
24:09large series now 102 years old diabetic
24:1350 years 60 years nothing. They walk in
24:16they they're able to one guy wrote a
24:18book at the age of 97.
24:21Okay, one man when I called all these uh
24:2590 year old people for a uh for a press
24:28conference and to show the world that
24:29it's possible, the chief guest of 101
24:31years old,
24:32>> but here's my chief guest.
24:34>> But tell me if you said a keep your B1 C
24:41under control,
24:42>> blood pressure under control,
24:44cholesterol under control, do diet,
24:46exercise, sleep, all of that under
24:48control. When all of it is lifestyle
24:51management, why do I need a doctor like
24:52you to tell you that?
25:00How do you know all that? You know your
25:02blood pressure. You know what
25:03cholesterol to do. You know how to bring
25:05it down. You know all the glucose. You
25:07know it took me 50 years to learn all
25:09that.
25:14The lifestyle part is one. The ABC is
25:16done by the doctor. the D only you're
25:18doing okay the ABC where to give the
25:20medicine how to how to lower it how much
25:22to lower should I bring the A1C to seven
25:24or to six for you which is safer for you
25:27those things I I decide no based on your
25:29condition suppose your heart is already
25:31little at risk now if I go and push your
25:34A1C below I can produce heart attack for
25:36you
25:36>> I can produce you know some ariththmia
25:38for you and push you into
25:40>> it's not just lifestyle management
25:42>> lifestyle is important beyond that there
25:45it's another thing which we showed code
25:47regular checkup is also very important.
25:50Okay.
25:50>> But tell me if I if I do regular checkup
25:53and I am following discipline
25:56>> walking every day, sleeping on time,
25:58doing weights to do some building some
26:00muscles, eating greens, eating proteins,
26:03doing everything that you just suggest.
26:04>> Yeah.
26:05>> Do I still need a doctor?
26:06>> You still need a doctor and you still
26:07need a checkup. I'll tell you why.
26:09Because because of your age, things may
26:13go wrong. Okay. I'll show. Okay. Now if
26:17you got HB let's say 7 I want the HBNC
26:21at 7.
26:22>> Okay. Now you have come to me
26:25>> and your HBNC has come there.
26:28>> This is 2026.
26:31I've told you HBNC is 6.5. Now you're
26:34saying
26:35>> I don't need a doctor now. I have
26:36reached 6.5. He told me below 7.
26:39>> I'm not I don't need a doctor.
26:41>> Now we talked about headonic. We talked
26:43about things slowly changing in the
26:45body. There are also biochemical change
26:46will occur due to age, due to so many
26:48other factors. Things can change. Now my
26:52next checkup I'm saying is before 2027
26:57you come once more to me after 6 months
26:59I'm telling but you are saying no I
27:00won't come. I don't this guy want to
27:02make money is calling me I'm not coming.
27:04What will happen is
27:06>> it'll go there. No symptoms asymptomatic
27:10disease and you're saying I'm fine
27:13because I don't feel
27:14>> yeah because you don't check HP and say
27:15anyway it'll be some sugar ah that's
27:17because you know I went for a marriage
27:18last week so everything you'll have an
27:20excuse also then it'll go there
27:23okay then it'll go there then it'll go
27:28there and one day you'll say doc it's 10
27:31now
27:33and of course I don't want to tell you I
27:34told you so but I have I told you so
27:37Because if you only come here, I'd have
27:40brought it down.
27:41>> Mhm.
27:41>> Then again you go again I bring it down.
27:43Again I bring it down. So always your
27:46HBNC is okay. Other is going up up up.
27:49This happens also with people who try
27:51reversal things you know.
27:54>> And what happens if I go above?
27:57>> Yeah. Because your every every 1% I'm
28:00telling you that your risk of developing
28:03eye kidney nerve complication from 7 to
28:068 when it has gone already it is 25%
28:10extra risk. It's gone to 9 it is 50%.
28:14It's gone to 10 it is 75%. It's gone
28:17about 10 is 100% risk. You're now going
28:19at 100% risk of developing kidney. Next
28:22time you come here I'll check your
28:25kidney and say gosh you started leaking
28:28protein
28:29finished sometimes is not reversible
28:33after that then what I'll be trying to
28:35do is how to prevent diialysis for you
28:38that'll be my next aim not to bring all
28:40this down my next aim is how long can I
28:42push him without him undergoing
28:45diialysis or transplant because once a
28:48creatin goes to a certain point there
28:50only two things either diialysis
28:51transplantation or death finished only
28:53three things that are possible if you
28:55don't do these two you'll die and how
28:58many transplant can you do in India
29:00there are 101 million people with
29:02diabetes assuming 20% will develop
29:05complications 80% will not 20% 20
29:08million people 20 million kidneys you're
29:11doing 10,000 transplants in a year
29:14whatever transplant you do it's only
29:1610,000 in India 20 million where are you
29:19going to do so you have to prevent to
29:22prevent its ABC D. For that you have to
29:24come only if you come only we'll bring
29:27this A and A and only A has come now B C
29:30also I'll take care when you come A also
29:32I'll check check B also I'll check C
29:34also I'll check then I'll talk to you
29:35about D I'll further reinforce saying
29:38hey this okay now next 6 months let's be
29:41a little more careful I motivated you
29:44I'll give you an example okay how how
29:46this works from the other side now
29:49you're the doctor and I am sitting on
29:50this side
29:52>> when I got married. My wife used to tell
29:55me
29:55>> why are you brushing your teeth only
29:57once?
29:58>> You should do once more at night. What?
30:00Yeah. Morning anyway you're going to get
30:02up and brush. So why should I brush at
30:04night? Okay. So I never did. Then I had
30:06some small dental problem and I went to
30:09my dental surgeon. Um and um so she told
30:14me you know Dr. on
30:17from today till you die, you're going to
30:21brush twice a day. Okay? If you come
30:24back at 1:00 a.m. from somewhere flight
30:28or something, you come, you'll brush and
30:29then go to bed. Okay? Since the time she
30:33told me till today, I've not changed.
30:35I've done it. So I go back home and then
30:38I told my wife, you know, this doctor
30:40told me that I have to brush my teeth
30:43twice a day, so I'm doing it. What did I
30:45tell you? I told you this years ago. I
30:49said, that's the difference. When my
30:51dental surgeon tells me, I think, no,
30:53your wife tells me I don't listen.
30:54You're not my dental surgeon. What do my
30:56dental surgeon tell me? I listen. So
30:58there is a certain power and that power
31:01is very powerful.
31:03>> Tell me about kidney. You said you you
31:05spoke about kidney because
31:07>> it's like by the time people see bubbles
31:09in their urine
31:10>> kidney is already 50% damaged right
31:13>> no that's not true actually the bubble
31:15actually is not so I'll show you the
31:17kidney so this is a kidney it's a kidney
31:20shape they call kidney bean is called
31:22that because it's like a kidney shaped
31:24thing this is the adrenal gland actually
31:26so you have the artery and the vein and
31:27this is the urine tube the urethra
31:29through which it goes and then if you
31:31open up uh the kidney
31:34You can see the the collecting tubules
31:37and the thing. If you put this under the
31:40microscope, if you take a bit of that,
31:42you do a biopsy or if you want to do a
31:44biopsy, we need not don't need to do it
31:47or thing. If you take that, these are
31:49what are called as nephrons. And these
31:52nephrons,
31:53>> these red yellow.
31:54>> Yeah. I mean, they're just pictureing
31:56blood vessels and so on. But if you the
32:00these are too big to see. But if you
32:02take you know small tissue and then see
32:06it under the microscope then you can see
32:10uh what is called as
32:12a basement membrane. Okay. This is
32:15called as a basement membrane. And this
32:18is a normal thickness of the basement
32:20membrane let us say. Okay.
32:21>> You have uncontrolled diabetes. What
32:23happens is this thickness of the so it's
32:25through the basement membrane that the
32:27blood circulation blood will come and
32:29then go back and all that. So the first
32:32thing that will happen due to diabetes
32:33is the basement membrane will get
32:35thickened now. Okay. Once it gets
32:39thickened
32:40so that's called basement membrane. So
32:42basement membrane is thickened. Once
32:44basin membrane is thickened it's also
32:46become porous and so there are small
32:48small holes through that through that
32:51albamin will start leaking.
32:53So normally if you measure how much
32:56albamin is there in the urine it's very
32:57small quantity some 4 mg 5 mig that's
33:00called normal
33:02>> okay near zero or very very small then
33:05slowly it'll become above 30
33:0930 microgram minute or 30 mg you can
33:11call it we call it as micro albaminora
33:15>> that is the first stage of diabetic
33:18kidney disease before the result do a
33:20biopsy you can see thickening of this
33:23basement membrane and other changes
33:25there gomealosclerosis we call it. Now
33:28the first thing that will happen is
33:29small quantities of protein will start
33:32leaking alamin that's called microaloria
33:3430 to 300 we call it as microalinoria if
33:38it goes above 300 it's macro albalinoria
33:42after that reversal becomes difficult at
33:46this stage micro albinoria there are
33:48tablets you give it it'll become normal
33:51kidney itself will become normal blood
33:52pressure will start blood pressure will
33:54start going up by the time the kidney
33:55start blood pressure blood pressure will
33:57drop everything will become normal.
33:59Sugar is normal. HBNC has come down. You
34:01give these tablets everything normal.
34:03Kidneys become normal once it goes to
34:05macromorary above 300, 400, 500, 1,000,
34:082,000. Almost difficult to reverse it
34:12back at that stage. So this can be stage
34:15zero, stage 1, stage two, whatever you
34:17want to call. Stage three,
34:20creatinin is now beginning to go up to
34:22this creatin serum. creatin 8.9 it's
34:26normal
34:28>> once it process one the kidney is going
34:30in for failure now okay one 1.5 1.6 six
34:34it's going up we measure it in another
34:36form from that creatin there's a formula
34:38eGFR estimated GFR
34:41>> normally it will be around 90 then
34:43become 60 50
34:47it's coming down creatin become 2 3 4 as
34:51it goes higher and higher going nearer
34:53and nearer diialysis and transplantation
34:55okay now creatin has become 8 10 your
35:00eGFR has become 10 15
35:03Now it's called the last stage of
35:05kidney. It's called endstage renal
35:07disease. ESRD endstage renal disease.
35:10That stage there's nothing you can do.
35:12If you control diabetes now also control
35:15blood pressure now you can give all the
35:17medicines you want. It's a relentlessly
35:20progressive condition.
35:22So the more or less I'm not frightening
35:24people by saying that but once you reach
35:26that stage nothing you can do. I also
35:29you get this small small spot then it
35:31starts bleeding inside then the whole
35:32eye the whole vision can go can go blind
35:35due to then you try to suck out the
35:37blood try to do some major surgery
35:39vitrectomy this that you may get 50% of
35:42vision back okay they are all eminently
35:46preventable I'm saying we got 50 people
35:48without any eye trouble that's why I'm
35:50saying diabetes complicated free world
35:52I'm talking up to that okay so that is
35:54preventable early stages also it is
35:57still reversible
35:58So the point of no return
36:00>> beyond that next stage next stage next
36:02stage now you come you take foot first
36:06some numbness tingling in the foot okay
36:09you give medicine become okay control di
36:11okay then it starts burning the whole
36:13night you're not sleeping then some
36:16callus forms and then the ulcer forms
36:18and then small gangrine starts forming
36:22now you have to remove the toe you
36:23develop gangrine gang means death
36:26>> death of tissue has occurred How can you
36:27keep a dead foot? I mean toe it'll
36:30infect the next one also. Next toe will
36:32go. Next toe will go. Next toe will go.
36:33So then you start removing one toe. Then
36:36if there's good blood circulation it'll
36:37heal. There's no good blood circulation
36:39that also won't heal. Then you'll end up
36:41with a below knee amputation above knee
36:43amputation. Those are the things which
36:46in the past we used to see but
36:48unfortunately even today it's happening.
36:50They'll be from a village. They won't
36:52have proper advice. They'll go to some
36:54native healer. He'll say don't go to all
36:56these alopath fellows. I will cure you.
36:58They will give some treatment. They will
37:00put something a band-aid something.
37:02They'll put some herbs something they'll
37:03put that will worsen it that will you
37:05know infect the foot also won't be clean
37:08also. They'll infect the foot and
37:09they'll come the bad thing. Some say my
37:11leg somehow save my leg.
37:13>> Everything is possible up to a certain
37:15point. Beyond a certain point diabetes
37:19can be an absolute killer. But what is
37:21in in simple words what is there in a
37:24diabetic person that one small wound
37:28>> doesn't heal
37:29>> doesn't heal it takes them years months
37:31years probably and the same thing like
37:34some wounds then then start becoming in
37:36>> bigger and bigger
37:36>> bigger and bigger that at one point they
37:38have to like probably cut off
37:39>> cut off yeah it will become black and
37:42become gang then dead the the toe is
37:45dead you can't keep a dead toe you have
37:47to remove it so then it will go to the
37:49next toe
37:50>> to one small cut what happens? So two or
37:52three things. One is glucose. Once you
37:55have glucose in the skin, glucose is a
37:58very good source for bacteria to grow.
38:00See what how do we do cultures in the
38:02lab. We put some glucose and then allow
38:05the bacteria to grow. That's how we see
38:06whether there's bacteria there or not.
38:08Here you got a natural like culture lab.
38:10You got in your leg itself. You got so
38:12much of glucose there. It'll keep
38:14getting uh more and more the bacteria
38:16will grow. That's number one. Number
38:18two, neuropathy. Okay,
38:21>> the nerve is affected because a nerve is
38:24affected the when you walk also you're
38:27not walking lightly. You know, you're
38:29putting pressure because you're not
38:31feeling the the surface. So, you're
38:33putting more and more pressure. So, more
38:35and more damage will occur. The chance
38:37of it breaking a bone is very easy. The
38:39bone's also a little weak because of all
38:42the calcium is gone from the bone. So,
38:43very easily. Deadly one. The third one
38:46most deadly one is blood circulation
38:48problem. Even this neuropathy infection
38:51you can give antibiotic you can do
38:53something remove one toe let out the pus
38:56you can just cut it let out all the puss
38:58it'll heal. Even the big wound is there
39:00you can just bring a big incision let
39:02out all the puss it'll heal. The deadly
39:04one is es is eskeeia. If you don't have
39:07blood circulation without blood nothing
39:10will enter there. Whatever nutrient you
39:12give, whatever antibiotic you give,
39:15whatever you go, the blood has to go
39:16there and there's no blood. It's
39:18blocked. Then what do you do? Of course,
39:21you can try to do a bypass or you can do
39:23a stenting and open up the vessel and
39:26try to do and so on. It may work
39:29sometimes. Sometimes even that doesn't
39:31work or you cannot if the
39:32>> So why does the blood's not going there?
39:34>> Because the blood is blocked. The
39:36arteries are blocked just like the heart
39:38arteries are blocked. Like the stroke
39:39that you get there, the arteries are
39:42blocked due to cholesterol, due to
39:43uncontrolled diabetes, due to
39:45inflammation, the vessels are blocked.
39:47If it's a big vessel going from the
39:49thigh, you can operate it and just open
39:51it up and the whole blood will then go.
39:53It's like a highle block.
39:56>> Suppose a lowle block, the vessels are
39:58so small and multiple, where are you
40:01going to go and open it? Thank you so
40:03much for watching this video till the
40:04end. If you'd like to watch
40:06moreformational and educational clips,
40:09please subscribe to Rajamani Cliff
40:10channel and share this video with
40:12someone who you think would like to
40:14learn

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