CHANDIGARH, May 13 — Experts participating in an update on diabetes and hypertension at the Lecture Theatre Complex of the PGI here today highlighted the relationship of diabetes and hypertension with heart diseases and kidney failure. They attributed a phenomenal increase in these problems to unhealthy diet, consumption of oil, obesity, ageing, stress and sedentary lifestyle. The update was organised by the Executive of PGI Doctors' Alumni Association.

Do not chase the blood sugar for control of diabetes. Chase the weight of the person. This catchy slogan was advocated by Dr R.J. Dash, Head of the Department of Endocrinology, PGI, in his talk on Diabetes mellitus — changing scenario. He said persons who were more prone to becoming diabetic were those with family history of diabetes, all obese patients, especially those with central obesity, persons suffering from high blood pressure and heart disease, and women with bad obstetric history, recurrent foetal waste (miscarriage) and those who gave birth to babies weighing more than 3.5 kg.

Dr Dash emphasised the need of early diagnosis, which would help achieve good blood sugar control for preventing complications of diabetes. He elaborated on revised diagnostic criteria in the changing scenario. The single blood sample after an overnight fast made diagnosis easy, he maintained. All persons above 30 years of age should undergo an annual test to exclude diabetes. Persons at high risk must undergo blood glucose testing when they visited a doctor for any medical problem, and if negative, must have a regular annual check-up thereafter.

For prevention of the disease, one should ensure that one did not put on weight, took a regular walk of at least 3 km five times a week and avoided fast food and intake of empty calories such as pure sugar drinks. One should take living foods such as germinated grams, green vegetables and leaves and avoid overcooked food, reheated food, highly spicy food and food rich in oil and fat.

Dr Amod Gupta, Head of the Opthalmology Department, PGI, maintained that all patients at the time of diagnosis for diabetes should be subjected to dialated eye examination and annually thereafter. In case doctors observed any changes in the eyes of a diabetic patient, they should refer them to an eye specialist so that they could characterise the patients who needed treatment with lasers.

According to him, in 95 per cent of the cases, blindness could be prevented and in few other cases of diabetics, vision could be restored through laser as well as other surgical intervention. He added that changes in eyes were asymptomatic and if a person started seeing cobwebs or black spots, they required immediate eye check-up.

Dr Vijay Kher, Senior Nephrologist in Apollo Hospital, New Delhi, emphasised the need to prevent development of kidney disease in diabetic patients. For prevention it was essential to identify the high-risk group of persons such as those with family history of kidney disease, history of hypertension in the family or whose blood pressure was on the higher side.

He highlighted the need to control blood sugar meticulously in such cases. Blood sugar should be tested every 2to 3 months and it should be less than 7 per cent. These tests would give the average blood sugar levels during the past 2 to 3 months. The BP in these patients should also be maintained below 130/80. According to him, the micro-alibum urea must be checked in every diabetic at the time of diagnosis and then annually as it helped identify the person who would have a kidney problem. Efforts should be made to bring down the micro-albume urea to normal albume level, which was less than 30 mg for 24 hours. The intake of salt should be less than normal, with moderate decrease in protein content, without allowing people to develop malnutrition. Patients should also be made aware of the complications they were likely to develop.

Dr Anil Bhansali, Associate Professor in the Endocrinology Department, talked about the common mistakes a general practitioner made while treating a routine diabetic patient, like prescription of drugs, underutilisation of insulin and lack of awareness of newer drugs. He advocated use of insulin in patients with blood sugar more than 300 mg per decilitre at the time of diagnosis and more frequent use of metformen in obese patients.

Dr R. Murlidharan, Associate Professor of Endocrinology, threw light on newer modalities of therapy and emerging trends in the management of type-II diabetes. He also talked about the new drugs, which were likely to enter the market, for better management of diabetics in future.

Dr K.K. Malhotra, a senior consulant at Pushpwati Singhania Hospital, New Delhi, and former Head of Department of Medicine, AIIMS, said hypertension was a silent killer and a leading cause of death. Various complications could occur such as heart failure and kidney failure, besides effect on the vision and brain, he said. Persons who were diabetic or obese, or those who suffered from kidney disease, were prone to develop blood pressure. Such persons ought to be careful and should go for regular investigations for an early diagnosis.

Dr Malhotra was of the view that changes in lifestyle could help control mild pressure in initial stages. For instance, one should maintain proper weight by regular 2 km of brisk walking, moderate drinking of alcohol, stopping smoking and not taking too much fat. General practitioners should be more vigilant about checking blood pressure, especially in cases of patients suffering from diabetes or kidney disease, or in case of pregnant women. This would not only help control blood pressure but might also reverse it without administering drugs, he said.

Dr Anil Grover, Associate Professor of Cardiology, talked of various risk factors for coronary artery disease, including hypertension, diabetes and obesity. He also highlighted vascular remodelling in hypertension and the link between these diseases.

Dr Sunit Singhi, Additional Professor of Pediatrics, pointed out that 1 to 4 per cent children were hypertensive but since doctors did no check it routinely, it was often missed. The blood pressure of every sick child should be regularly checked. High blood pressure should be lowered gradually, for in case of neurological disorders, a child might go blind. He recommended the need for a new task force for hypertension diagnosis.

CHANDIGARH, May 13 — Having been treated by Dr Jaswant Rai, an orthopaedician at the PGI, Shruti Dhawan, a former national junior tennis champion, took part in an ITF tournament in Mumbai recently. She had not been playing since May 1999 due to a back injury.

She had begun her playing career at Chandigarh. After some regional and state level tournaments, she participated in ITF, AITA and other major tournaments all over India. Though it was taxing for her father, Mr R.M. Dhawan, her love for the sport deterred him from letting her have financial problems.

Shruti took part in the ITF $ 5000 tennis tournament in 1998, where she lost in the preliminary rounds. In the next leg at Bangalore, she lifted the title, defeating Rushmi Chakarvorty and Sai Jailakshamy on the way. She was the runner-up in the third leg at Delhi, where she lost to Anna Nefedova of Russia in the final. It was here that she felt slight pain in her back. She participated in the Masters tournament at Lucknow, where she won the doubles title with G. Sheethal. She was ranked among the top six among seniors that year.

She felt pain and came to Chandigarh to get herself examined by doctors. Dr Jaswant Rai advised her to have complete rest and to do some exercises regularly. When asked how she passed this phase, she said, "It was a difficult time but I never wanted to lose my mental balance. I tried to anticipate the strength I would get once I started playing."

The results of today's matches are as follows: Sub-junior girls — Government Senior Secondary School, Sector 23, b Government Model Senior Secondary School, Sector 37, 12-11; Government High School, Sector 24, b Government High School, Sector 11, 8-7.

Sub-junior boys — Government Model Senior Secondary School, Sector 37, b Government High School, Sector 24, 12-2.

Junior girls — Striker Club b Government Model Senior Secondary School, Sector 37, 18-8; Government High School, Sector 24, b Government High School, Sector 11, 8-7.