Dr Alex Saunders, MD, is president and founder of US-based Chronomed Inc, which was founded to exploit the retrospective time resolved testing. He holds to his credit 26 patents, and more than 50 peer reviewed papers.

His well known inventions include - clinical immuno cytometry instruments and methods, time resolved testing diabetes and others, liquid assays (to replace ELISA testing), two phase optical assay (POC Device), methods and automation for WBC differentiation, foetal cells from maternal cells genetic diagnostics, and DNA analysis from single cell genetic analysis.

Dr Saunders spoke to Prabodh Chandrasekhar of Pharmabiz on diabetes and the need to create awareness among diabetics in the country on proper medication, diet, exercise, and above all adequate monitoring of blood glucose. Excerpts:

What is the alarming situation in India as far as diabetes is concerned?

A lack of co-operation from diabetics in India due to their reduced awareness about the disease is a major cause for concern. Diabetes is a slow killer and word of caution is, if the disease is not diagnosed properly, controlled adequately or is left undetected, the patient is likely to suffer from complications in the long run. Some of the common complications faced by diabetes patients include narrowing of arteries and blood vessels, and malfunction of the kidneys, eyes etc.

Moreover, there is a need for proper control of blood sugar. Only about 0.1 % of the total diabetic population in India uses glucose monitoring devices compared to 33 % in US.

For leading normal healthy life, a diabetic will need to stress on balanced diet, adequate exercise, regular sugar monitoring, and above all, charting her daily diet schedule. Specific hyperactivity cases like periods of overdoing of exercise or of taking excessive stress have to be noted. Simultaneously, the sugar level has to be monitored about five times a week.

This will help the patient in understanding the increase or decrease in the sugar levels in relation to changes in diet or during times of stress. After every three months, she is supposed to meet her family doctor.

When should the patient move from sugar control pills to insulin?

Only 5 % of the diabetes in the world is insulin dependent diabetes (Type I). The remaining 95 % is non-insulin dependent diabetes (Type II). In Type I, the patient cannot survive without his regular dose of insulin. Among type II incidences, the patient should change to insulin only if the pills are not helping her in controlling sugar. In other words, the patient should stick to pill if it is bringing her blood sugar in controllable range. In India majority of the cases detected are Type II in nature.

Clinically, which is the best test approved for proper blood sugar monitoring?

HbA1c is a recent test, which gives the average level of blood glucose in blood sugar for the last three months.

A physician would normally ask a person with diabetes to take an HbA1c or glyco-haemoglobin test, twice a year. One could ask a physician about this test and its role in managing diabetes. Glucose attaches itself to haemoglobin molecules in blood. Red blood cells live for about 4 months. Hence an HbA1c test tells us the average level of blood glucose in blood during the past 3 months or so.

A person with poor diabetes control will have an HbA1c reading of over 7, while a person without diabetes or one with diabetes that is judiciously controlled may have an HbA1c reading of between 4 and 6. The HbA1c tells us not just whether blood glucose is under control on a particular day but the average level of control over a considerable period of time.

The HbA1c test helps physician control diabetes in an even manner so that a patient does not develop one or more of the debilitating complications of diabetes.

What are the symptoms showed by patients suffering from high blood sugar (hyperglycaemia) and low blood sugar (hypoglycaemia)?

When a person's blood sugar is high (significantly greater than 120 units), more often significant amounts of acid is produced in her body. This acid, when reacts with ketones, causes imbalance in the body's chemical reactions, resulting into the person getting hyper. She may even suffer from breathing problems.

In case of low blood sugar (significantly lower than 120 units, particularly when sugar level falls below 60), the patient may start behaving as if she has lost her mental balance. This is due to inadequate flow of glucose to brain, essential for brain functions. In extreme cases the patient may lose his senses and if not treated on time, could go into coma.

What are the latest devices that have revolutionised blood glucose monitoring and insulin delivery?

As far as blood sugar monitoring is concerned glucose monitoring meters or glucometers are the best available instruments in the market today. These devices come with date and time storage, which helps the patient in keeping note of the exact date and time, when his blood sugar level was measured. 100 different readings could be recorded in sequence by today's glucometers.

In the area of insulin delivery, needleless delivery devices are available today. Research has reached advanced stage on insulin inhalers. Insulin pumps are available in the market today that automatically deliver insulin as and when required by the body. Research has reached an advanced stage in the development of an underskin balloon, which delivers insulin.

How diabetes impacts patient's kidneys?

The kidney is on the first stage of malfunction, when it starts liberating out albumin. The right time to detect the loss is when the kidneys liberate albumin at a micro level. Albumin is often followed by the loss of vital nutrients and proteins with the urine. It is at this stage when the patient often feels tired and leads to a gradual deterioration in his health.

Comment on the research focussed towards the control of side effects in diabetes?

C-peptide is a hormone which is secreted by the liver, whose role is to prevent side effects and preserve organs like kidneys. Unfortunately, in most diabetics, the natural capacity of the liver to produce c-peptides is lost. Research is being undertaken to produce c-peptides from outside, which could be injected as and when the body require them.

What is the future of diabetes detection and control technology?

In future, monitoring and feedback will be the focus of research. Stress will be given to diagnostics without the involvement of blood. We might see an instrument developed in future, which would monitor blood sugar levels and at the same time deliver insulin as and when required.