What is the most shocking thing in your career as a Diabetologist? After cataract, diabetes is the biggest reason for blindness in India. Whenever you pee in the toilet, if you see ants there, it is diabetes. What lies do you tell to the audience? One thing is wrong that there is no such biscuit for those with diabetes. There are names of 2-3 companies which seems to be a biscuit for diabetes. Sir, why are you denying it? Go and read, the first ingredient is refined flour, the second is palm oil. An early symptom of diabetes is that the neck turns black. It is a term called acanthosis nigricans. There are some other serious causes of this like gastric cancer. Many people who are watching this podcast have already suffered from diabetes. And many people are definitely going to suffer from it. Based on current lifestyle. There are many people who are suffering from diabetes but they don't know that they are suffering from it. This is a big number. Friends, I believe that through this podcast, I want to bring free of cost knowledge and free of cost consultation. If possible, I want to bring free of cost consultation. 
Today's guest, Dr. Rahul Baxi. He is considered to be the most reputed diabetologist in our country. In today's podcast, we will discuss diabetes A to Z. If you don't know anything about diabetes. Or if you want a consultation on diabetes. Or the most important thing. If you want to get knowledge about diabetes. Because diabetes is a silent killer. Anyone can have it. If you want to prevent that condition then learn about diabetes. I just want to say this. This is a disease because in today's world India is considered as the world's diabetes capital. So sit quietly and learn from this podcast. and ideally watch this whole podcast with your family. It's a very knowledge packed podcast and for every person, especially for every Indian, it's important to have this kind of knowledge. Enjoy today's episode with Dr. Rahul Bakshi. How are you, sir? Hello. Thank you for inviting me. I am very good. You tell me. I want people to sit and watch and hear today's conversation with their family. We had a cancer-related conversation with Dr. Putam Bekar. He is a doctor from India. He is a cancer surgeon but doctors from all over the world respect him. And doctors from all over the world especially Indian doctors respect them. And doctors from all over the world, especially Indian doctors, respect them. And in India, there are some doctors who are considered top of the field. Doctors like you. Who treat celebrities, who treat ultra-hnis, etc. When we released the Dr. Putambikar's podcast, People commented that thank you. Because when we go to doctors, Sometimes we get scared of doctors that we are not taking their time. That's the feeling. So, we can't ask you in detail.
This is the mindset of some patients. Such long conversations, many people get a lot of value from these conversations. And we are not doing these conversations for India, we are doing them for India. Absolutely right. So, Sir, Diabetes. According to the data, this has become a very big problem in India. And the problem is increasing. It's not that we are going to get a solution to the problem. Many people who are watching this podcast have already suffered from diabetes. And many people are definitely going to suffer from it. Based on current lifestyles. I will add here, many people are like this. But they don't know that they have diabetes today. This is a big number. Which is the hidden part of the pyramid. The iceberg that we call, that is visible beyond the water. The one below the water is a big number. Which no one has checked. No chance to check it. And diabetes is asymptomatic. It means you won't have any symptoms or problems in the beginning. That is a very very big problem. If I give you a small example, if your sugar level increases today and you have pain in your leg, you will go to the doctor today itself and ask why you are having pain in your leg, test me, treat me. But if the sugar is increasing slowly, if the sugar is 100, 150 and you are not feeling well, then you will go to the doctor. Because you don't know anything. This is the biggest problem of diabetes. It is asymptomatic. That's why it is called silent killer. It does its work silently on the eyes, heart, and kidney. And one fine day, it will tell us that how many patients we see in the hospital that a heart attack happened and the patient came at 2 am. When we checked the sugar, it was 300. And one fine day, he will tell us how many patients we see in the hospital. That a heart attack happened and a patient came at 2 in the night. When we checked the sugar, there are 300 sugars. The patient is saying that he doesn't have diabetes. The HB1C which is an average test of 3 months, we will talk about that later. There they said that we did HB1C test and it came 9. Now 9 doesn't happen in a day or a night. It takes a few months, it takes a few months, it takes a year to get 9. This is a big problem that people don't know about diabetes. But what happens in their life a few months or years before that someone gets diabetes? Yes, this is a very good question. So this starts very early. These days we are seeing, let's talk about ***. In ***, we have changed in our diet. You will see that we talk about different things like sweet and tomato. People's ordering has increased a lot. The food outside has increased a lot. I will give an example. A child, my father is my patient. People order a lot more food. I will give you an example. My father is a patient. He noticed his son going to the toilet at night. He remembered that when he was 10 years old, he also had the same symptom. He was taking the exam. As soon as the exam was over, he got fasting pp sugar. It came to 150-200. I am talking about an 18 year old child. What is the normal level? If we talk about the numbers, the normal fasting sugar is below 100. It will be called normal up to 99. From 100 to 125, there is something called as pre-diabetes. It means you are neither normal nor in the stage of diabetes. In the middle, a term has been created, pre-diabetes. This term is the reason why your pre-diabetes. above, means 126 fasting sugar or more, that is diabetes. These are the numbers. So, I was telling that the child who noticed that he is studying and going to the toilet, then drinking water and going to the toilet, he remembers that even in my time, I had these symptoms. So, it is not that everyone is asymptomatic. Some people have these symptoms, which we will talk about later. Some people have some symptoms. So, the next day he called me, took an appointment and brought his child to me. Sugar test. So, this was the diagnosis of his father. If the father doesn't take care of the child, then how do you know that it is sugar? Some years pass, sometimes people come after the kidney is damaged. People come after the heart attack. Many people have heard the word diabetes. But they don't understand exactly what diabetes is. So how will you explain a 5 year old child about diabetes? Sorry, I broke the flow of your podcast. But I just want to say, firstly thank you for supporting us throughout the years. Secondly, we have started a new initiative called Beer by Sips Kill House. Its intention is to contribute to India's upskilling journey. We have brought a commercial editing course for you. Because this is the core skill set of the Beer Biceps team. There are many upskilling courses coming. So, at least check out Beer Biceps Skill House. Follow our YouTube channel. Follow our Instagram page. But for now, enjoy this episode of TRS. So, in simple words, diabetes is that sugar is made in our body. And sugar is utilized. In a normal person, that sugar will be used in itself, sugar will be used in the body, fat, muscle and we eat food. So when you eat anything, be it nuts, ghee, carbohydrates, protein, your body breaks down that and uses it. Exactly. If you break down the body, then the building blocks of the body are cells. Similarly, the building blocks of any food are glucose. Correct? Absolutely. If you break down the food, then it comes out as glucose. Your body converts your food into glucose. Am I right? Absolutely. Now, to convert food into glucose. Am I right? Yes, absolutely. To convert it into glucose, a hormone is needed, which is called insulin. Please correct me. No, you are right. It is insulin, which will break down glucose. And then it will go to the muscles, fat, and other places where it is necessary to use. So, this is go there. Okay. So this is a normal functioning body which will break down food into glucose through insulin. Hormone means there is something in your body due to which some other function occurs. Like a key opens a lock, similarly hormones create some function. So insulin breaks down your food and converts it into glucose. And then your body uses glucose for energy. When you eat, you get energy. That's the logic. But, there are two types of diabetes. Type 1 diabetes and type 2. Type 1 is a genetic case. Meaning, you can have type 1 diabetes at birth. No, I'll correct it here. Type 1 is a genetic case. You can have Type 1 Diabetes at birth. No, I will correct you here. Type 1 is in young people. Genetic does not mean that it comes from parents. It is not necessary that Type 1 is in the parents. In fact, if the genetic component is in the mother, then there is a 3% chance of being in the child. If the mother and father are in both, then there is a 6-7% chance. So this is basically an autoimmune condition. There are some substances in your body that work against insulin. Is this a birth? No, it can also be a birth, neonatal diabetes. But it can also be in childhood, in 15 years of age, it can also be in 20-25 years of age. But generally speaking, it happens in young people. It's not like it's born and the next day the diabetes is diagnosed. Like Vasim Akram has type 1 diabetes. Yes, he has type 1 diabetes. Vasim Akram has type 1 diabetes. He has type 1 diabetes. Lot of celebrities have type 1 diabetes. And he is also an athlete. He is healthy and he also has type 1 diabetes. Absolutely. He had type 1 diabetes. He had type 1 diabetes and he has done a good career with it. Priyanka Jonas' husband, Nick Jonas, he has type 1 diabetes. Okay. He has type 1 diabetes. So you can see how successful people are. There are many more examples who have type 1 diabetes. But one thing I would like to remind our listeners is that diabetes, whether type 1 or type 2, will not bring any change in your life or career. If you are careful, if you control yourself well, if you show your doctor well, take the medicines well, then it will not make any change and you can be successful. This is a very big message. Okay. And type 2 diabetes happens because of your lifestyle. Often or always? Always. Always? This is a lifestyle disease. Okay. So if you didn't take care of your body, If you didn't take care of yourself, Then type 2 diabetes can happen. And when people say that diabetes has happened, They are actually talking mostly about... Type 2 diabetes because 90-95% diabetes is type 2. So if we are saying that diabetes is there, Then we are talking about type 2 only. Unless we specify that something like this is happening in type 1. Okay. So basically, assume that you have not taken care of yourself all your life. Which mostly happens in diabetes type 2 patients, that you have eaten a lot of desserts all your life, your weight has gained, you have eaten a lot of rice all your life, you always eat idli dosa, you have drunk a lot of alcohol. You have done such naughty things. So what happened in your life? Mostly we talk about sugars, dessert and rice. Then there is one thing in your body called pancreas. Pancreas produces insulin. Whenever you are eating sugar, rice or alcohol, your pancreas gets alerted that sugar is here, let's break it down and increase insulin. Your pancreas has produced a lot of insulin throughout your life. At some point, your insulin stops working on your body. Absolutely right. You gave a good example that we are eating something and as soon as the pancreas sees sugar, it produces insulin. As the weight increases, we do exercise activities, and when we eat such things, sugar starts increasing. Now, what will the pancreas do after seeing sugar? It will produce more insulin. It will produce more insulin. Sugar increases because either you ate high sugar food or because you are doing less activity that sugar does not get any place to go. In simple terms, it is absolutely correct. And insulin is also not working its work. That is why pancreas is producing more insulin. In a normal person who will take care of his health if he eats two Gulab Jamuns today with cream or ravi then also his sugar will be controlled. Because pancreas will produce insulin and insulin will work. What is the problem in diabetes is that the pancreas which is producing insulin is not able to work. It is telling the sugar to go to muscle, go to fat, but sugar is not going. Why is insulin not working? This is called insulin resistance. The effect of insulin is decreasing because of the increase in reduced because of weight gain and exercise activity. And slowly pancreas gets tired. How much should I produce? That's why people get serum insulin test done. We are not big fans. I am not a big fan of getting serum insulin test done. I don't do it in all my patients. I only do it in those who need it. Insulin is a reason for there. Because in diabetes patients, they need more insulin in type 2 diabetes. Because your pancreas is tired of insulin. And that insulin is just floating in your blood. But it is not working. So sugar is high and insulin is high. This is insulin resistance. So if you have insulin resistance, then your insulin goes to your bloodstream. It goes to the bloodstream anyway. And it does its work in the bloodstream. Sugar is also in the blood. So the sugar that is floating in the blood, will tell you to go to the muscles or fat, empty the blood, the blood sugar should not increase. Okay. The sugar doesn't listen, it gets addicted. Because we have made the body so that the sugar is also increasing, but it is not letting the insulin do its work. This is how we can explain insulin resistance. Okay. It's like, suppose pancreas is like a gun. And if you abuse that gun a lot in life, then the firing of that gun decreases a little. Firing is not in fact increasing, the bullets are coming out more. But that bullet is not going to the target. Okay. The firing has increased because all the bad people are roaming around. Consider it as sugar. So, you have to fire it. So, the pancras is firing but the bullet is not going to the target. So, the bad people are also increasing and the bullets are also increasing. I am trying to understand in more detail. Yes. So, normally, a healthy person. I am very healthy. I am eligible and single in case you want to set me up. But, I am healthy. I have an active lifestyle. But I like food. So I end up eating food from outside. But because I am exercising. So if I eat Pav Bhaji tomorrow. So that Pav Bhaji, that bread, that potato will go in my stomach and get digested. The sugar that will come out of it will go into my bloodstream. But because my insulin resistance is normal. Insulin sensitivity and insulin resistance is normal. That's why that potato and that bread will be utilized in my bloodstream better. Because I am playing football too, so it takes energy. I am focusing on the podcast, so it takes energy. If an unhealthy person who doesn't exercise and who has eaten a lot of dessert or alcohol all his life, his body will digest that same paav bhaji in a different way. So when that bread will break down in the stomach into sugar, that sugar will go into the bloodstream. Now here in my body, I am a healthy person. That sugar breaks down in my bloodstream because of insulin. In his bloodstream, because his pancreas are tired. Due to lifelong abuse, that sugar will keep floating. Correct explanation? Absolutely correct. Because as soon as the sugar will be seen, we have eaten Pav Bhaji, we have taken some dessert. Pancreas will be active, that take out sugar. Make insulin. And insulin will be made, it will not be be able to push sugar in the right place. In the right place, there is muscle and fat. Insulin works there to put sugar. It will not be able to put. After eating, you will check after 2.5 hours. 200, 250, 350, 300 is coming. And as you said that you are healthy and fit. If you do in this, it will not go above 140 or 150. It will not go above 140 after eating. Which is normal sugar after eating for 2 hours. Less than 140. The purpose of insulin is basically how the sugar or glucose that is floating in your bloodstream is sent to every cell of your body. That is the purpose of insulin. To take it to the right place. Where it can work. Okay. Means, there are cells in your body. There are bone cells, skin, etc. If you want to take petrol to those cells, that is the work of insulin. Absolutely. Now, let's talk about an extreme diabetic patient case to understand more. Suppose someone has a very intense diabetes, worst case. Then what happens? Then how can your body use that sugar? Now, there is a situation where the body is not able to use it. So, you will pay attention to those who have sugar 300-400. Yes. I talked about asymptomatic, but they don't have symptoms. When there is so much sugar and it is taking some time, for 6 months, for a year, they get symptoms. What are the symptoms? A lot of hunger. A lot of thirst. So, you will see that sugar is 400, but it is hungry. Because your body is telling your mind that is not getting enough energy and petrol. Exactly, because the sugar level is not reaching the body even after it has increased. Because the insulin is not working properly. So, they eat a lot. That is the symptom of diabetes. You are hungry, thirsty, and you are constantly getting a urine test. You will get urine test and then you will get thirsty and then you will drink water. Why do you get so much urine? Urine is a method of the body. When my sugar level is above 180, there is a threshold of the kidney. When the sugar level goes above 180-200, the kidney releases the sugar through urine. That's why I got a report that my sugar level is plus plus plus. Why did it come? Because the blood sugar level is increasing in urine. The body is not able to tolerate the blood sugar. The body is trying to do its work by going down the urine. But the fluid and water come out. Then what will happen? You will feel thirsty. The signal will go, drink water. You will drink water and the urine will come out. So your excretion system thinks that how is the blood sugar so high? Come on, take it out. Absolutely. And actually, it pulls water from your body and throw it in the urine. And when the water comes out, your tongue will dry, your mouth will dry. People say, sir, my throat gets so dry. Patients who sit in front of me, HB1C 12, 13, which is a report of increased sugar, they say, sir, I feel so thirsty, sir, my whole throat gets dry. And I drink half a liter of water. At night, people have to go to the toilet 4-5 times. You can imagine. So, sleep is also bad, you get tired, all the symptoms are related to diabetes. So, when we discuss this, I will tell you more but this is the cycle. What is the most frightening or shocking thing that you have felt in your entire career as a Diabetologist? Meaning, some surprising thing that you didn't even expect that this can happen in this world. Okay. Here I will tell you didn't expect. I will tell you something interesting. Blood tests started in 1970-1980. Before that, urine tests were done. They put a strip in the urine and if it had sugar plus, it was diabetes. Before that, when there were no urine tests, Do you know how doctors diagnose diabetes? Whenever you pee in the toilet, if you see ants there, that is diabetes. Because there is sugar in the pee. There is sugar in the pee, ants will come and they will feel sweet. And by the way, I have a patient, he saw that whenever she goes to the toilet in the morning, she sees ants. And then he found out who is doing the is doing toilet and who is going to pee at night. He had an 18-19 year old son. He used to go to pee at night 2-3 times. So he came to me. He used to play cricket. We were all trapped at home. So cricket was stopped. And with the start of Swiggy Zomato, that boy was very fond of Chinese food. So he used to order Chinese food at 10-11 am every night. And then he used to study at night or watch TV. So he used to urinate once or twice. And in the morning, he used to strike the ants with a mother's note that they should be tested for sugar. That boy got sugar. I brought my son home. I asked him why he was being given Chinese food. You know, he is my patient. You know you should eat home-made food. He said, sir, what should I tell you? I used to feed him home-made food at 7-8 am. I used to feed her family at 7-8 pm and then she used to order dinner once more. This was a bit different, looking at ants in the toilet. Otherwise, it is not known. And if it is not known, then I told you that it is a silent killer. It can damage the eyes, kidney and heart. Nowadays, we are also seeing heart attacks in the age of 20, 22, 25 years. So there are other reasons for this. But diabetes is also a hidden cause. The blood supply of your heart is due to atherosclerosis. When you collect cholesterol, it stops the blood supply of the heart. That is why heart attacks happen. Technically, it seems that diabetes is an atom bomb for your body. Correct? Absolutely. Like cancer happens after a very late stage. And that is also an atom bomb for the body. But diabetes, especially for type 2 diabetes takes a lot of time and can destroy everything in your body. Absolutely, it is very powerful to destroy everything and it is a slow poison. It is a slow poison. You will suddenly know that you will have cancer. Of course, we will not go into that discussion. But here diabetes is a slow poison which slowly slowly, how many times, I will remember one more thing. There is a husband, he knocked on my door in the hospital and brought his wife holding his hand. The wife is walking slowly. For the first time, a patient is coming to me. He made her sit on the chair. It took me 2-3 minutes to know that both of her eyes have gone because of diabetes. What? Young 30-odd couple, 30 years old. Diabetes can affect the eyes too. In fact, after cataract, diabetes is the biggest cause of blindness in India. Everyone has cataract from their age. Diabetes is preventable. You can't stop cataract. We call it Motiya Bindu. You can't stop it. But we can stop diabetes. I was so sad to see him. He was holding my hand and bringing it. Imagine, my husband and his wife both came and left. They sat in front of me and said, sir, he has diabetes. And you control the sugar. That means, any tissue of the body can destroy diabetes. Absolutely. And the logic is the same. Your blood sugar is not reaching those tissues because of the problem of insulin. No, there is more blood sugar reaching there. More blood sugar reaching there. There is sugar in the blood but it is not being utilized. It is not being utilized. So, in a normal healthy person's body, sugar reaches but it gets used. It gets used. If it is not being used here, then the curtain in the eye, we call it retina. There, sugar does small bleeding first. It does small bleeding. It bleeds because of glucose. Yes, because blood vessels are affected by sugar. And cholesterol is also affected. That's why there is bleeding in the eyelids. There is a problem here too. You won't see small bleeding. I would like to say to my listeners that if you have diabetes, it is very important to see your eye doctor once a year. Biologically speaking, can you explain how sugar can destroy your cells? Basically, there is a small bleeding on the eye. The problem is that you will not know. You will say that everything is fine. The bleeding is so small that only an ophthalmologist can see it with a special camera. That's why I tell so many patients that you have to see an eye doctor once a year. They say, sir, everything is looking fine, why are you looking? The reason is that in the early stage, you will not get any symptoms at all. So it is important to get an eye checkup done once a year for every patient. But why is it that you have taken care of your body all your life, you are exercising, suddenly you have reduced your exercise a little, then you have diabetes. I tell the patients that your sugar is ready to increase. In anyone's body. Give me a deal of one month. Now I talk to my patients who already have diabetes. Who are coming with good reports, HBNC which I talked about, 6 came, 6.5 came. So I am very happy that you controlled it. I told them that I didn't do it. I told you to change it. You controlled the sugar. I always say this. I give all credit to the patients. Because it is important to understand the patient. Because what is the problem there? You gave a little deal. We went to the village for 15 days. 15 days, the festival came in the house. The wedding came. Sugar is just ready to increase. Sir, does everyone have diabetes in old age? Not everyone, but if you look at it percentage wise, then the risk of diabetes increases with age. Because the reason is that when you are 80 years old, your pancreas gets tired slowly. Insulin production is also a little less, which was producing insulin at the age of 40 in your youth, at the age of 30, today it is not possible at the age of 80. There are other reasons with age. So that's why diabetes comes. But if you take good care of your body, maintain your diet and exercise, if you do yoga, if you do walking, then it may not come. And if it comes, it will not come that much that I have to give 4 pills or insulin. It may be that I can control it with diet and walking. Or it may be that I can control it with one pill. That is important. Because you should not get faith in diet and walking. Or maybe I can control it with just one tablet. That is important. Because you should not get distrust of diet and exercise. That is your support. The old patients you have, I mean, if you study all the elderly people in India, some people have diabetes and some people don't. What is the difference between the two? Can't you predict anything? No, we can't predict anything. There must be genetic factors too. Genetic factors, stress, pollution. Even after COVID, some patients have diabetes. Studies are still going on. But the coronavirus is also affecting the pancreas and modifying it. There is an ACE receptor attached to it and modifying insulin production. Studies are still going on. But there are many reasons. One of them is stress. Sleep is another important thing. If you are sleeping for 7-8 hours, you are doing a big favor to yourself. Because sleeping less increases the risk of diabetes increases. All the medical conversations that are happening, whether it is with a cancer doctor, a skin doctor, or with you, whatever you talk to, these same factors come out. Sleep, eating, exercise, activity. This is the lifestyle. Lifestyle is one word, but all these things are coming under it. If you take care of all these, then you will think that your skin will be good, the risk of cancer will be less, sugar, BP, cholesterol, heart, all these things will be healthy for you. Still sir, people will not listen. It is very difficult. It is difficult but some people learn after getting beaten up. Some people may bring some news after our conversation. When I found out that I was talking to you, I was preparing for the podcast. I thought how can I talk? Either I can talk to the audience in a harsh way and say that it's okay. If you don't want to bring discipline in life, you will have illness. You will have diseases in life. You will have diabetes most likely. But then I also thought that nothing will change from my words. People are going to live as they live. Our job is to teach them about diabetes. Talk to them with love. I want to say some things with love. If I had to say this thing in a harsh way, I would have said this. I would have said that look, deny yourself sometimes. If you feel like eating Gulab Jamun, Rasgulla, or any dessert, don't say it to your mind. And get the habit of not saying it. You get a lot of benefits. Your mind gets stronger. If you are doing exercise regularly for 1-2 years, it becomes a habit. You then need exercise. You become addicted to that. People say that it takes a habit in 21 days. We also make changes. In the beginning, 20-21 days. I also tell the patients that sugar in tea. Like the patients I see in Mumbai, 4-5 cups of tea a day is not a big deal. I ask the patient that if he takes sugar in tea, then I take it from there. He says, how much sir a big deal. So I ask the patient, do you take sugar in tea? He says, yes, I take it from there. I ask, how much sir? 1 spoon. Then I ask, can you leave it? He says, no sir, I need sugar in tea. Then I ask, how many cups a day? He says, 6 cups. How many cups a month? He says, 180 cups. So here I am not talking about getting 1 spoon removed. Here I am talking about getting 180 spoons of sugar removed. The patient understands it instantly, sir, I had never thought of it like this. And I will leave the stop drinking tea from tomorrow. Then my answer is, not from tomorrow, you have drunk your last sugar tea at home. The patient who is sitting in front of me in the hospital, that from now on, there is no sugar in tea. Because it is a small thing, sugar, biscuit, bread, toast, these are all things which are daily things. According to me, it causes more harm. Every religion in the world talks about self-control. Every religion. Absolutely. If you actually get into the Bhagavad Gita, then its core message is this only. Control yourself a little. If we were born in this world, in this world of delusions, actually God is testing you. That these are all distractions for you, will you control yourself? I mean, one kind of distraction is ***. There are drugs. Absolutely. There is alcohol. According to me,, there is a kind of distraction called sex. There are drugs, alcohol. According to me, eating is also a kind of distraction. You should enjoy eating. But God will test your balance. If you want to enjoy, then how much will you enjoy? At least this is my point of view. I am saying this because I had a gall stone at age 16 I had a gall stone. Because like that cricketer, I was also a bit active, I used to do martial arts. So I thought I am very strong, I am strong. At age 16, I had a gall stone. And the doctor who did my gall bladder surgery, He sat and told me that if your lifestyle remains like this, Then in a few years you will have diabetes and at 25 or 30 you will have a heart attack. And I am still alive today. Because I took care of myself and changed my lifestyle a lot. I studied a lot in 10th standard to impress girls. But for the motivation of that study, I used to eat Gulab Jamun. And this surgery happened after 10th standard. My lifestyle was so bad. So learning to say no at an early age was the best thing I did. I got the discipline from that which we used in YouTube as well. We are releasing so many podcasts through discipline. Okay? I am showing this off but I am also explaining the meaning of discipline to you guys. Because my favourite biological topic is neuroscience. The science of the brain and the science of your nervous system. There is a concept called neuroplasticity. Meaning your brain is like a tree. And the shape and size of that tree will keep changing throughout your life. And you can influence the shape and size of that tree. So if you have eaten Gulab Jamun throughout your life, then you get addicted to rose and sugar. And that tree becomes more addicted to sugar. But if you stop and think that you don't want to be addicted to it and you won't say no to yourself. Then the next day the craving will be a little less. Your heart wants a little less sugar. A little less sugar. Next day a little less. Next day a little less. One day you won't crave sugar. Your heart won't want Gulab Jamun. Your heart will want protein. Homemade food. Vegetables. And this is real but it's a reality that many people can't imagine. I focus on yoga and weight training. I eat protein too. I don't drink alcohol and I don't imagine that. I focus on yoga and weight training. I eat protein and I don't drink alcohol and smoke. But there was a phase in my life where I used to drink alcohol, eat non-veg and eat sugar as in desserts. Then I reduced dessert a little. Slowly, I think at age 25 I stopped eating non-veg. And I gradually stopped that too. Now I have become pure veg. It's helped me. I am not saying that you should stop eating non-veg and that too gradually. Now I have become pure veg. It's helped me. I am not saying that you should leave non-veg. That's a completely different discussion. But here the discussion is mainly about junk food. Okay. People say that I have sweet tooth. I like eating sweets. Actually, the neuroplasticity that was being discussed, because of that neuroplasticity, because of your lifelong habits, you feel that your mind likes sugar. you feel that your mind likes sugar. You feel that your heart likes sugar. But the truth is that you have become an addict yourself. Sorry, I am talking in such a harsh way. No, no, this is important what you are telling to understand. And you can change neuroplasticity. All these neuroscientists have said on the show. So, what do you need to change that neuroplasticity? Only willpower. Absolutely. Absolutely. Sir, would you like to say something before we move on? No, it's very important. I also tell patients that this disease is a disease of discipline. Because in diabetes, sometimes it happens that the patient shows one doctor, 2-3-4-6 months, if it didn't happen, then he showed another doctor. When the patient comes to me, I feel that it would be beneficial to not call the doctor. The medicines are working properly for the patient. There is no fault in the medicines. The patient has come to me, the sugar has come, the medicines are right. So what is my role here? My role is to show him the right way. Treatment is not going to happen by changing the doctor nor by changing the medicines. Sometimes I don't change the medicines. Sometimes I send it by reducing it. But what do I give time to the patient? Sometimes I reduce it. But I don't give time to the patient. I understand his diet from morning till night. So my one thing is eat in moderation. If you do anything in moderation, in a limit, you can do everything. As far as I know, people often think that diabetes is due to sugar. Meaning they have eaten desserts all their life. That is also a reason. But the main reason is, I feel, our Indian breakfast. Breakfast is the main reason. Very very important. It's very important. That's why I was giving an example of different parts of India. There are parathas, poha, upma. In Mumbai, I have so many patients who leave home at 6 in the morning, stay in Bhorivali, Sabab, do their work at the Marine lines, at the church gate, leave early in the morning, don't have time to make breakfast, come, take a Vada Pav from the station, eat, drink tea and leave. Vada has fried potatoes and Pav has its own refined bread. So if you eat this thing 5 times a week, then you will have to face difficulties. But as time goes on, is there progress in the science of diabetes and anti-diabetes? Absolutely. I am seeing that the new medicines that are coming in the market every year will be used for diabetes. And all the medicines are being used for weight loss. The other medicines are not being used to reduce sugar. Now the weight is coming because scientists and doctors have understood that weight is a big reason for insulin resistance. Which we have discussed in the beginning. If your patient is 90 kgs, ideal body weight should be 80 kgs, 6 ft. So if I make him 80 kgs, then diabetes, blood pressure, cholesterol, everything should be normal. If we make him lose 10% body weight, 7-10%, 90 kgs is 9 kgs. So half of your body weight will be lost and the medicine will be stopped. I want to ask a question to understand this more. Are there any fat people among your patients? Absolutely. This is a very good question. We think that only fat people have diabetes. Diabetes is of different types. In the beginning, we discussed type 1 and type 2. There is a type 1.5 diabetes in between. Or LADA in English. Latent Autoimmune Diabetes of Adult. L A D A. This diabetes will behave like type 2 in the beginning. What is the main difference between type 2 and type 1? Since the time you are diagnosed with type 1 diabetes, you will have to take insulin every day. The pills don't work and if you stop taking insulin, you will be sick and you will have to take it. This is called diabetic ketoacidosis. Without insulin, they cannot survive. Injection. Every day in life. 3-4 times a day. Like Nick Jonas and Vasim Akram are still… Absolutely. They are applying insulin. For that, there are insulin pumps that are being used. But insulin is also being used continuously. You can use an injection or a continuous pump. But you have to take insulin throughout the day. You can't take it after eating. There is no insulin tablet. This is a very good question. Because patients also come to me sometimes and ask, Sir, have you got any insulin pills in the market? No? This is a good question. Patients also ask me if there is any insulin tablet available in the market. Research is still going on. A few years ago, an inhaled insulin was available. You could take it like a pump, but it did not give good results. But there is no insulin tablet available yet. But there is hope that it will come in the future. And I think whoever invents this will be a Nobel Prize winner. Because this will be a big change in the lives of our patients. Next year, another insulin tablet will be available in India. Which will be the Nobel Prize winner. Because this will be a big change in the lives of our patients. Next year, another insulin is going to come in India. Which will be once weekly insulin. Why in India? I mean, it will come out. Next year, it will launch in India. Because some medicines come out first. And come out after a little while in India. Because of the regulations and clearances. Eat once a week. No, apply it. Injection only. Injection only. Today, a person has to apply it daily. This will work once a week in type 2. Type 1 patients will still have to take short acting insulin 3 times a day. But the person who is taking it 30 times a month, I will tell him that you will take it 4 times a month from tomorrow. So you see the happiness. Injection is injection. Even though they get used to it, they get used to it. But the freedom that is given, that is why in type 2, I get another happiness that a patient whose diet and exercise are not good, the day I am injecting 2-3 times, I get their diet and exercise changed, get them to lose some weight, get them to do insulin 2-3 times or 1-2 times of insulin, and in some patients, insulin can be stopped in type 2. So the patient who has accepted that he has been tired of using insulin for the last 7-10 years, but has accepted that insulin is lifelong, if I can stop that, then you think of taking insulin for the last 7-10 years But has accepted that insulin is his lifelong If I can stop that Then you think of the happiness of the patient and I think of my happiness And this is the process of lifestyle factors Apart from this, there is no other treatment for type 2 diabetes You change your diet Exercise if your weight is in the range of overweight or obese If the weight is more Then reduce the weight And you see how the medicines will run away Realistically, there are many people who are listening to this podcast Who may not be able to afford a consultation from a top quality doctor. The main advice for them is this only. That do exercise, do exercise, keep your body active, and keep eating and drinking healthy. I mean, reduce the amount of alcohol you are drinking. Absolutely, that is the best. It is best to stop drinking. There is no such recommendation that you should drink in 15 days or 7 days. It is good if you stop drinking, but we understand that it is a social life. It is a meeting and meeting. So, once in 15 days. Once a month, if it happens socially, then it is fine. But it is difficult to get used to it. And it is not the case for the doctor also. Look, I am telling you, the doctor will have the same medicines wherever you go. Ultimately, I told you that the patients who come to me, I don't change the medicines so many times. I write the same medicines, I give time only to diet and lifestyle. This is as good as a consultation. I talk to the patient for 20-25 minutes or we can talk for 1-2 hours. This is a good thing that I am talking to the patient. Your patient is sitting in front of me, I am talking about that. There is a term in English called Blue Zones. There are some geographical locations all over the world, where people's average age is more than 100. Now, when research was done on these geographical regions, then it was found that there are some common factors. One of the most common factors was that in all those regions, the old people also had a slightly active lifestyle. And how was it active? They mostly used to farm. Farming is a kind of sustainable activity. Because you are sitting down, you are using your hands, you are standing up, working your legs, using your hands, you are getting up, you are working on your legs, you are using your hands, you are using your core. Basically, the body should be kept a little active. Apart from that, less desserts, less hotel food, you should not order food on the phone. Etc. Which you already know. It's the same thing. Absolutely, 100%. Like you are giving names, Singapore, Korea, and European countries, life expectancy is very high there. Japan eats rice. But what do they eat with rice? Fish and vegetables. Their food is very simple. Because fish is also allowed. I am a vegetarian, but I tell patients when they come. So fish is also allowed. I am a vegetarian but I tell patients when they come. So fish is also allowed. You can eat fish in diabetes. In fact, when my patients from Bengal and Odisha come, I tell them that we talked about rice. Rice cannot be stopped. If someone is from Odisha, Bengal, Andhra Pradesh, Tamil Nadu, I tell them to stop eating rice and start eating roti from tomorrow. It is not going to happen. So I can't talk like this to my patients. I should know where the patient is from, what they are eating, and what small changes should be made in it. So if the quantity of rice is this much, then I will say that let's reduce it by 30%. If you are taking fish, then increase the fish. Increase the salads, increase the vegetables, take lentils, take lentils. You have to balance it that way. What I have to know about rice from an Indian perspective, I have also talked about this with the dietician, I have talked to a lot many people on the podcast. In India, there are different species of rice. But often we only eat Basmati rice. We eat the basic white rice. If you want to eat rice, then you change the species of rice. Eat red rice, eat black rice, eat white rice. That is a good practice. It is a healthy practice. It is very difficult. If I ask a 60 year old person to start eating brown rice from tomorrow, he will start it at least once. But I'm sure you have eaten brown rice. It tastes good. It's not that easy. I was also used to it when I was in Singapore. We were also in India. Now, you get brown basmati rice in India. If you go to the supermarket, you will find brown basmati rice. So it is very good. If it is started from the beginning, if it is started at a young age, then it is easy. But quantity is also important. Like brown rice, it is not that we can eat so much. Quantity will also have to be kept correct. But to know from where the patient is, from which location, what they eat culturally, what they like to eat. According to that, there will be a slight difference between Gujarat patient and Mumbai patient. Or Maharashtra patient. Or Odisha patient. So I change by understanding their day and night. Which works well. Often, when Indian people go to a hotel, they order food. Like paneer sabzi, etc. etc. They order dal. And after eating everything, naan, roti, rumali, they order rice after eating naan, roti, etc. Wow! Absolutely right. Rain of carbohydrates. Absolutely right. So, there are two angles to this. One is for those who are not diabetic, who are young. Many people must be hearing this. And one is for those who have diabetes. First, I will talk about those with diabetes. I often refer them to a dietician. Diabetes patients are referred to dietitians. In fact, my wife is a dietitian and she sees many of my patients. Apart from that, I tell them about 5-10 things. I believe that whatever word I say to the patient in 30 minutes, that word is going to them. They will store it because they have come to the doctor with so much care and love. They will take each word of the doctor with them. They will not have to write or remember anything. It will sit in their mind. So I will tell them that they have to stop bread and biscuits. This is refined flour. This is not a good thing. You should stop it. Next time I will come and say that I have not touched a single biscuit since you said. I will not take the names of the companies. said, I haven't touched a single biscuit. I won't take the names of companies, but there are 2-3 companies whose names are like this. Which is like, this is a biscuit for diabetes. Sir, why are you refusing for this? You go and read. The first ingredient is refined flour. The second is palm oil. The third is invert sugar syrup or something. So, all those things are included in it. The company didn't say that it is for diabetes. One thing is lost that there is no biscuit for diabetes. Which you can get in the market for 20 rupees. And you can eat a diabetic biscuit. There is nothing like diabetes. It's a thing that there is no biscuit for diabetes. Which you can get in the market for 20 rupees. And you can eat diabetes patient. There is no such thing. So, what I do in small changes. Next time the patient comes and says, Sir, since you have said, I have not touched the biscuit. That's my happiness. Because those small things will bring changes. The way we were taught math in school. That 15 plus 15 is equal to 30. Someone has taught you this in life. And this is a life skill. So that if someone gives you 15000 life. And this is a life skill. So that if someone gives you 15000 or more, then you know that you have earned 30,000. Learn life skills in your school. Similarly, there is another life skill that you should learn in school. But we don't learn. Absolutely right. You know what I am going to say. Read the label. Absolutely right. Turn anything and read the label. What is written the label by looking at something. What is written? What lies are we being told? Learn this. Because in our world, in today's world, you are being lied to. Doctor, what lies are being told to the audience? Absolutely right. So, how many things will be told that are special for diabetes? Like oats. Oats is a good thing in itself. But when I saw the oats biscuit near the patient's bed once, I asked him, do you eat biscuits? He said, yes, but these are oats biscuits. I got him to read the ingredients in front of the patient. After oats, it had flour mixed in it. There was sugar in different forms. And there was palm oil etc. So, said a very good thing about food label reading. I am very close to this. I write this on different social media as well. Food label reading should be part of school curriculum. There should be a part of education in our schools and it should be started very early. As we talk about simple banking, how to make a checkbook? I grew up and I didn't know how to make a checkbook. I never did it. My father sent it for the first time. So, who helped me in the bank. So, these small things should also be taught in schools. Especially, nutrition, food label reading. It will be very beneficial. I would like to highlight a brother's YouTube channel. He is Vivek Mittal. His channel is Fit Tuber Hindi. Please go and sit on that channel. He has done this label education. I mean, their channel is Fit Tuber Hindi. Please go and sit on that channel. They have done this label education. And all these companies, we call them liars, they are very big companies. They are international companies. And when YouTubers call out these companies, they file legal cases on them. I have seen this. So, you will never know. And people like Vivek Bhai, Food Farmer is another one, who makes content on Instagram, all these people want to expose these fake companies. But they are facing a lot of problems in their lives because of these companies. So all we can do as consumers is, first go and subscribe to these people, support them. Because these people are presenting the truth in front of you. But basically, the logic is, I will tell you my everyday logic. I turn the packet. If it says refined flour, I put it down. I don't open it. Don't eat it. It is poison. Sugar is present in everything. As much as possible, if you should eat less table sugar, what does that mean? It means that if you want to add sugar in tea, then instead of sugar, drink jaggery tea. People will start abusing jaggery now. If you eat more jaggery, then that will also give you diabetes in the end. But my point is that table sugar is like a poison. And all these packaged food items have table sugar and all that. And palm oil is the third thing. Absolutely right. If these three things are written, refined flour, sugar, palm oil, keep one of these, two or three, in the packet. Absolutely right. And one more thing I will add here, fruit juice. When the patient comes to me, if any patient is sitting with me, without asking this question, I will ask him, do you drink juice? He says yes sir, but I drink home made juice without sugar. He thinks that he is healthy after doing this much. Home made juice without sugar, which should be the best, you understand that it is also the water of sugar. Yes. Whatever fruit it is, it is the water of sugar. I allow fruit, I encourage patients to eat one or two fruits a day. But don't touch touch juice after today. I also eat a lot of fruits but only once a day. And that too I try eating it without eating anything else. If I eat fruits, I only eat fruits. And usually either before workout or in the morning. I used to drink a lot of juice. I stopped drinking juice. My fat percentage went down. Absolutely right. I don't think juicing is a good habit. If you are going out, going to a restaurant, and you order a juice, that's a different thing. If you drink juice everyday, it's not good. And basically it boils down to the same neuroplasticity example. That you have got used to eating sugar. You are just replacing it with juice. Instead, eat some fruit. And once a day, a handful. Good patients ask me, Sir, you are asking me to eat fruits, like I can eat oranges, but why can't I drink juice? So, I give them a simple practical explanation. In a glass of juice, there are 4-5 oranges. One thing. Second, take out the orange juice and strain it. We threw away the fiber of the strain and drank its juice. And when we eat oranges, I ask them, Can you eat 6 oranges? They say, no sir, I will eat one or two. But you can drink 6 oranges juice. I ask the patient, how many oranges does one glass of juice contain? The patient says, sir, 5-6 oranges. So, we took out the juice of the oranges, we threw away the fiber or anything else. And the sugar water, I believe you didn't add sugar, the sugar, the orange's own sugar, you drank that water in 60 seconds. A person can drink a glass in 60 seconds. Can you eat 6 oranges in 60 seconds? No. You will peel the oranges, you will eat each of its leaves, each of its peels, you will chew them. Its fiber also goes into your stomach. It forms a layer in your stomach and it increases. So you can't eat 4-5-6 oranges at once. But we drink juice at once. By drinking juice, sugar increases like a rocket. And the same sugar also affects your liver. We are seeing fatty liver a lot these days. Fatty liver is a new disease that is being discussed. Trendy disease. Yes, absolutely. Actually, it was mainly caused by alcohol. Non-alcoholic fatty liver disease or metabolically associated fatty liver disease. Nafld or mafld. This is a new terminology. Because it is believed that diabetes and liver have a very close relationship. And this is a simple example. All this sugar will be stored and will accumulate in your liver. And in the future, in the liver, fibrosis, hepatitis, cirrhosis and in some cases, it will also increase the risk of cancer. The risk of liver cancer. You know, I myself don't drink alcohol now. I have drunk it in my life. But now I don't drink it because of yoga. I have got a lot of health benefits. But there are a lot of people in India who judge other people. See, he are drinking alcohol. But they are eating a legal drug called sugar. And they are living a lifestyle like a legal drug by eating outside food. It seems like they are on a high moral ground because they are not drinking alcohol. But actually the lifestyle is that bad. In the end your body will treat you the same way as the alcoholic body is treating them. You can also have liver cirrhosis. Absolutely right. In fact, the metabolic-related fatty liver disease, its risk is going to increase more than the alcohol liver's risk in India. So that will be less common and it is going to be more common because obesity, weight, is becoming more common. People are reducing alcohol slowly too. So this is one thing that we should pay attention to. Ultimately, the liver will also be involved and this is one thing we should pay attention to. Ultimately, liver will be involved. And there is one more big problem. Liver and sugar have a very close relationship. I have lived that unhealthy lifestyle. Pre-age 16. I had obesity problems. And I also saw how my mindset was different then. And the way I am today with a healthy lifestyle, I like this version very much. I am happy. Basically, I am today with a healthy lifestyle, I like this version of me. I am happy, basically I am very happy. What does everyone want in life? They want happiness at the end of the day. Why do we run after money, fame, all these things for happiness? So at the end of the day, you are doing all this for your own peace and happiness. That's why for a little while, keep yourself disciplined. If you keep yourself disciplined for 6 months or a year, then you will get happiness in the long term. Right? 1 to 6 months will be difficult. But go beyond 1 to 6 months. Now I want to give a practical CTA in call to action. Because people are listening to us. That you should not drink juice, sugar, or refined flour. But when you get craving, when your heart tells you that no, give sugar. Then what should you do? My practical solution was that Earlier I used to focus a lot on the gym. For that, protein is required. So if you eat more protein, I believe believe you should drink a lot of water. So, if I had cravings, I used to drink a lot of water. And I used to eat a little protein and a little fiber. I mean, suppose some vegetable omelet or something like that. That worked a lot for me and my cravings also went away. And if I have an unbeatable cravings on Saturday or Sunday, I would eat a little dessert once in a week. One month was very difficult for me but after that, the changes that come in your mind, means you can literally change your own cravings too. After a point, you won't crave sugar that much. Your sweet tooth will really go away. And I am repeating this again in the podcast but this is very effective advice. Take 1-6 months of self-discipline. That's all I want to say. Very important. We should give time and change our habits. When I meet diabetes patients, I see them more often. New patients also come but they are complicated and have long-term diabetes. I will explain the right diet with them. But I will be lenient with them once in a week or once in 10 days. There is a season of mangoes. There are ways to eat mangoes. So I allow them some sweets once in 10 days. If you are living well for 7 days, you have walked, yoga, exercise, you have salad, if you are a vegetarian, you have got good curd, if you are non-veg, you have followed the diet guidance. So, once in a week, once in 10 days, there is no harm in eating sweets. Because I think that gives the patient more motivation. If you become too strict, the patient doesn't follow anything. They get tired and leave everything. So if we don't do it, the doctor has said that we can eat once a week. If the husband and wife are sitting, the patient will say, the doctor said that I can eat once. From a practical perspective, I believe that you should be incrementally strict with yourself. First remove one thing, then if you get used to it, remove the other thing. Absolutely right. If you get used to it, as in if you get a positive habit, then remove the other thing. You can gradually clean up your life style. And when you are exercising and you are active, you will go to that zone where you will have to take care of your body. You know, if you have to go to the gym tomorrow or you play football, you are telling me. So you don't have to disturb that thing. So you won't feel like it. So it is important to go to the gym tomorrow or play football. You don't have to disturb that. You won't feel like it. So, it is important to go to that zone. Of course, when patients come, I see patients with different problems. They have pain in the leg, they have to get a knee operation done. Or walking is stopped. So, of course, I advise them to exercise in upper limb. How many times it can happen that the patient can't exercise. Just now, the heart operation happened but the sugar level is high. So, we see those kinds of complicated patients also. But, you know, we focus more on diet and medicines. But, as long as we can exercise, you know, it is a big advantage if you are active, your hands and feet are healthy, you can walk, please take advantage of that. Because, every patient can't do it after complications. Okay. Sir, we have started a new exercise. Where we talk about things using the screen. And this exercise goes very well with doctors. So I will ask you, like when we go to watch a movie, that anti-tobacco ad plays that at the age of 27 this happened etc. We are doing something like that. But with a little biological perspective. So type worst diabetes photos. This is diabetic foot ulcer. Diabetes is long standing diabetes. Means, if you have diabetes of 10-12 years, the nerves of the feet don't work. Why feet? Because the long nerves supply the feet. So, first of all, long nerves are affected. So, first of all, it long nerves supply the legs. So, first of all, long nerves are affected. So, first it will start from the legs, then it will come to the knees, and then it will start in the hands. So, when the symptoms come to the knees, like itching, sensation, or if there is a cut in the leg, then it is not felt. We know all those things. So, the nerves of the legs do not work. So, my sensation goes away. I lose my sensation. I am walking on the table. If I get a knock on my foot, I will get injured. I will bleed a little. But I won't feel the pain. I will walk on the table. I might feel the pain of my feet. Or I might get a shoe bite. I might get a shoe bite. There is a shoe bite, wearing a new shoe. You won't even know. You won't even know because the sensation has gone. The protection that God has given to the foot, that if someone hits me with a needle, I get pricked, I get a needle in my hand, suddenly there will be pain and I will treat it. If you don't have pain, you won't treat it. So this is the beginning. Either wearing a new shoe or a small injury, we didn't pay attention to it. And until we saw it, it was too late. This is diabetic beginning of the disease. You wear new shoes or you get injured and you don't notice it. And it was too late till we saw it. This is a diabetic foot ulcer. And how many times we see that the patient's fingers are cut, or the leg is cut from here, or from the knee, which is called below any amputation, from the knee, which is called above any amputation. These are all very common complications. It starts with a fine needle or a cut, or from a nail or a shoe bite. So, there is no sensation there. This is an important complication of diabetes. But why do we have to cut the whole leg? It becomes gangrene. It becomes gangrene. When there is a small infection in the gangrene, the infection in the blood involves the bones and muscles. And the blood supply there is very low. Blood supply is low in diabetes. What is the reason for heart attack? The arteries that are going to the heart. The blood supply of the heart itself is blocked. Sir, is the logic the same that we talked about? That your blood sugar is not used. No, here it is a little different. I will use an English term. Atherosclerosis. That means the artery that is supplying blood to us. Artery is a pipe. If there is a blood flow in the pipe, blood will reach there less. If there is a blood circulation, used to treat the antibodies. If I get an injury here, but the blood circulation is not good, then the wound will not be treated. If it is not treated, it will spread. If it is from here, it will spread to here. It will be completely red. And what do patients do in diabetes? They ignore it. They take a pill, or they go to a doctor, and if they don't show it after a day or two, then it keeps on increasing. Then, when it happens, they go to a surgery doctor. They say that the wound has spread to here. If you don't take out this much of this much, then the problem will increase. The poison will spread in the body, we call it sepsis, septicemia. This is the problem. So the beginning is very small. Here the message for our diabetes patients is that even a small injury in the hand or leg, you take action quickly. Show it to the doctor and follow what the doctor has told you. Otherwise, it can be a big operation and we may have to lose a part of our body. The infection in the leg is a bacterial infection. Ultimately, it is the same leg. If we did not take care of the small injury in the leg, it has spread and after a little operation, it has been cleaned. This is how we are showing the leg. The inner part of the leg is visible and the lower part is visible. So, leg is visible from the inside and the skin is visible from below. So this is one complication. There is bleeding on the eyelids. The second photo is an extreme photo. The round in the middle. It looks like the sun. This is the same as there is bleeding on the eyelids. You can also see through the eyes. It also affects the kidneys. If it affects the kidneys, complications increase. Dialysis is also needed in the last stages. I would like to talk about a surface level thing. An early symptom of diabetes is that the neck turns black. What do you say, sir? It is a term called acanthosis nigricans. It's very common in fact. You're travelling in a train, I see it sometimes. I'm a doctor, so I get my eyes on it. Same. When I used to see this in my childhood, it's seen on the heavy and healthy people. Absolutely. It's a sign of insulin resistance. When I was a kid, I used to tell my friends to take a bath. But this is actually actually a gun. No, this is not a bath or a rub. This is a skin change that comes due to insulin resistance. There are some other serious causes like gastric cancer etc. But that is not that common. Normally, this is a sign of insulin resistance. What is happening biologically? Biologically, I think some pigments are getting accumulated there. But this is acanthosis nigricans which is a sign of insulin resistance. It means that your weight is high. And what we talked about in the beginning, sugar is increasing, insulin is increasing, then more sugar increased, then more insulin increased, pancreas is working double. Insulin is increasing but not able to reduce sugar. This is a sign of that. You check their sugar, it will increase. This is 100%. This is pre-diabetes symptom. Could be in post. It can be in pre or diabetes. Is there any other common symptom? It is behind the neck, in the axilla, underarms. Other than this, obesity is the main thing. It is called visceral obesity is called. I will tell you a good thing about Indians. A term is used for Indians, the thin fat Indian. In the world of fitness, it is called skinny fat. Yes, absolutely. They have used the same terminology. If Indians have a BMI of 23 or 23.5, which is ideal for us, after that Indians have found that the fat of the liver, the visceral fat which is the momentum or eccentric fat, that fat is more compared to Western counterparts or Europe or America, who have 23.5 BMI, they will be very healthy. So if we Indians don't have more weight, then also our risk of diabetes is more because of this reason. Because the fat in our body is stored in the wrong place. In the liver, around the stomach, and visceral fat. In the language of the common people, around the stomach and visceral fat. Like in the language of the common people, there is a body like uncle. It looks like yes, he is not fat but he looks a little unhealthy. He is thin but definitely not athletic, he doesn't play sports. Exactly. If we will weight and height them, all the numbers will be correct. But that thin fat tendon is a very good concept that Professor Yagnik, is still in use today. Visceral fat means fat is stored on organs. Yes, and mainly it comes from the liver. There is a fascia around the stomach, it is called omentum. So fat is stored there too. We have seen this in studies, fat is stored there. And that is the most dangerous because it also has to do with insulin resistance and diabetes. So, you can see that positively that even after diet and exercise, if you do weight loss, your visceral fat will also reduce and your sugar will also reverse. Okay. I think we have reached almost the end of the podcast. You said that we should talk about some misconceptions today. What are the misconceptions about diabetes? Patients have a lot of misconceptions about medicines. They think that once the medicine starts, it will not stop. Or some patients think that sir, don't give medicine, do anything. I am not going to take medicine. Because medicine, I ask why not to take medicine? Sir, I have learned from that medicine that the kidney gets damaged. So it is't want to take medicines. He said that he had read from the medicines that the kidneys get damaged. So, it is very important to understand that if diabetes patients have increased sugar, diet exercise, of course, your doctors will explain, dietitians will explain and you will also do the nutrition. But if the sugar is increased to that level that the doctor feels that the medicine is needed, then it is really needed. The kidneys do not get damaged from the medicines. When does the kidney get damaged? When your increased sugar remains high for some time. We have medicines that are 30-40 years old. And there are some medicines that are 10-12 years old. No, but they are 10-12 years old. I am not saying that medicines are 12 years old in medicine. Because some medicines are 30-40 years old. These medicines are studied. they have small side effects. It is not that the medicine is without side effects. Side effects are of everything. But I know what I am giving. And I will explain the side effects to you. If you come next time, I will get a blood test done. Every test has a reason. This is a treatment for diabetes, not for medicines. Diabetes treatment is to change the lifestyle of the patient. When we understand this, half of my work is done. So, that's how we get success basically. That's why I believe that we should start exercising in our 20s. 20s is also late according to me. Teenage. In any child or any adult, do you know when that will start? Neither in school nor after the birth of the patient. That will start before the child's conception, from the behavior or lifestyle of the mother. Before the mother is pregnant, how is her health? When the mother is pregnant, what did she eat and drink in those 9 months? Did she do any wrong smoking or alcohol? When the birth happens, it starts from there. If the expectant mothers or those who are pregnant take care of their health, keep their diet and exercise healthy, they should keep their weight healthy, then it will affect your children too. We have to start from here, not after 20 years, not in college, not after being born. We start from there, and of course, when the child is young, we should not introduce them to chocolate and sweets. You know, these days, you open the fridge, there are 4 types of chocolates in our time. You know, these days, you open the fridge and there are 4 types of chocolates. In our time, chocolate was a luxury. That we ate some chocolate today. Today, there are 4 in the fridge and the kid has eaten so much that he is just fed up. In our time, we used to come and eat and it was good. I believe that dessert, chocolate, any processed food and any snack, which we eat for breakfast, like apple, we should not bring it home. Absolutely right. Because we will take whatever is in front of us. I advise the patients the same thing. What do you keep on the dining table? Sev, vujia, or almonds, chickpeas, and some kormora mumra. This is a big life hack. When you apply this life hack, then you will know its power. Don't bring it to your home. If you want to eat, then go out and eat. Absolutely right. Because there are patients who ask why do you eat biscuits? Sir, they eat it because it is for children. You are feeding your children. You will bring your son to me after 20 years. I actually tell them. So, don't feed your children because this is a disease that is going to come to everyone if they don't take care of themselves. Which is the truth. And they understand that no sir, you are right, we will not feed the children. Some people are thinking that what should we eat for breakfast? There are many healthy options. There is chana, kormora, mamra, you can keep walnuts, you can make something else, there are sprouts, there are so many things, there are fruits, you can eat papaya, you can eat apple, if we see look at it, we will find 10-15-20 other things. But there are many healthy things. You can eat curd in a bowl. You can mix fruit in curd. Salad is not just chopped tomatoes. Salads can be made in such an interesting manner. You can make a salad in such a good way. You can do something in oil or ghee. You can roast paneer. You can do something with vegetables. Paneer looks so good for vegetarians and non-veg. Something with chicken, egg, fish. So, there are many things to eat. You should go there once. And before that, download TRS's podcast in your mind and heart. Now, we should cover the insulin myths before ending the podcast. What is insulin myths? It is very important when I see a patient and whenever it comes to insulin, the patient's how about, you know, they go into their shell. Because people are scared of insulin. So my message will be, don't be scared of insulin. Insulin myths, the wrong myths about insulin that people have in their minds, I will tell you 4-5 things about insulin and will give you the right answer. The first myth is that if the doctor says insulin, then the last stage of diabetes is here. There is no truth in this. In fact, when the patient comes to me, I start insulin in the beginning and stop it after 2-3 months. Because insulin has a very good effect in the beginning, the effect of insulin is very good. The patient gets rest. The patient who has weight loss, the other problems, like thirst, weight loss, muscle loss, these are all symptoms of diabetes. In some extreme cases, insulin gives a very good result in 15 days. The second patient thinks that insulin will damage the kidney. In fact, when kidney failure happens, when the patient feels that the insulin will damage the kidneys, which is not true. In fact, when kidney failure or dialysis starts, the patient has only one medicine that is safe. There is no medicine that is safe except for one or two pills, which is insulin. Insulin does not damage the kidneys, it damages the kidneys by keeping high sugar. Because here you are looking at the trade-off. Either the sugar is increasing or I should reduce the insulin. There is no point in thinking about it. If your doctor is saying that insulin is necessary, then it is necessary at that time. And the patient feels that he has to take it lifelong after starting the insulin. So it is not like that. If the insulin starts at the right time, insulin can be stopped. Not in every patient, but in selected patients, if it is used correctly, if it is used at the right time, we can stop the insulin. The question arises that why people are afraid of insulin in the first place? One is that it is used at the right time, we can stop using insulin. The question is, why do people get scared of insulin in the first place? Firstly, it is an injection. Secondly, the myths that I told you about insulin being given at the last stage. My friend started using insulin, but it is still going on for life. It is not stopped. Why should you use it? You will get used to it. People say that you will get used to insulin, so don't give it. It is correct to not give it. But today, your situation is that you are on 4-5 so don't give it. Don't give it, it is okay. But today your situation is that you are on 4-5 pills which are not working. There is swelling on your liver. Sugar is also increased. Hb1c test which we call 12-13% which we should keep around 7 for diabetes, it has doubled. So, apart from insulin, I don't have any other way at this time. So, there are many advantages of starting insulin at the right time. So, my message is that when your doctor says that you have to start insulin, don't worry. You discuss it. Ask the doctor 10 questions. Ask him why you have to start, how to apply, when will it work, how much time you have to take, what is the cost of it. Ask all these questions. But don't run away from insulin. If the doctor is telling you, then there will be a reason and you will get the benefit. And when the doctor also says that you to subscribe to Ranveer Allahbadia, then you should subscribe. Absolutely. I am also a doctor and I am saying please subscribe. And there are very good podcasts. I was watching in detail in the last few days. And I enjoyed every bit of it. I would like to say that I was impressed with his knowledge. The questions that he is asking, Ranveer was asking and the things that he was discussing. You know, if you have that kind of knowledge, I also enjoy discussing it. You can go one step further. You can go one step ahead. So, I enjoyed a lot. Thank you, sir. Biology is actually my favorite subject. But I didn't get the chance to pursue it in life. So, I'm surprised that I'm getting a chance at age 30. I'm just enjoying it. Definitely, it's very good. And I'm sure our listeners will also benefit from it. If people follow the simple things we have told, then many people will not have to face diabetes. Many people who are above 30, 35, 40 years of age, if someone in your family has diabetes or if your weight is a little high, then you can do a simple thing. Fasting and PP sugar. Fasting means empty stomach. PP means after 2 hours of any meal. After 2 hours of breakfast or lunch. And HbA1c which is glycosylated hemoglobin. These are the 3 tests. You can do this in any good lab. And go to your doctor and show this report. These are basic tests. Especially if you are over 30-35 years old, if someone in the family has diabetes, or your brother or sister, or if your weight is high, then it is absolutely necessary to get this test done. And if you are over 40, then you can get it done. As I said in the beginning, we are only looking at the tip of the iceberg, the numbers of diabetes. There is such a big hole under the water, that diabetes cases are roaming around in India, but they don't know. So how will they know? Either when there is a big problem, they will check that day. Or we will get it checked as a precaution. Which is called diabetes screening. Pre-employment, like patients come to me, Sir, I was going on a cruise to work. For 6-7 months, some cook or chef, they go on a cruise, I also see patients in Mumbai. And before that, a blood test is necessary. Diabetes is caught there. Pre-employment offices, annual check-ups, are done by big corporates. Diabetes is caught that way. And in the company's favour, I would encourage those people, corporates also, to check their employees' blood test and basic work-up every year. Because if you prevent it, it will be beneficial for you. There won't be any major complications. You will have a loss of time. The patient will stay at home. And the cost will also increase. There is a lot of benefit in prevention. Dr. Bakshi, it was fun today. Thank you. I enjoyed also. And thank you for inviting me. When I wanted to lose weight and become healthy, I used to watch intense motivational videos. Nowadays, the world of motivational videos is not, it's not the time for motivational videos. It's the time for podcasting. That's why thanks for watching. Nowadays, you make motivational podcasts. Of course, always sir. Thank you sir, lots of love. Thank you for your time. Thank you, my pleasure. Thank you sir. So friends, this was today's podcast. I just want to say that keep giving feedback. We are making a medical series on TRS. We have done a lot of medical episodes in English as well. I want you to watch these episodes with your family. And what topics should we make medical episodes on? Give us suggestions. And please, if possible, the medical conversations that took place in English podcast. The flavour is a little different. You can't watch those conversations with your family. But still tell us how we can make these conversations better. I am always hungry for your feedback. Thank you for watching. And I hope that through today's podcast, you got value and help. Lots of love. If you are going through diabetes, then sending you all the healing, sending you all the motivation, the bottom line is discipline and self-love. I'll see you next time.