Say Goodbye To Diabetes

Vitamin D: Are We Treating the Patient—or Chasing a Number?

A 40-year-old woman has a Vitamin D level of 24 ng/mL.

Does she automatically need 60,000 IU every week?

Not necessarily.

According to the US National Academies, a level of 20 ng/mL or above is adequate for most healthy people. Some Indian laboratories use 30 ng/mL as their threshold for sufficiency.

But here is the important question:

Does raising a Vitamin D level from 24 to 35 automatically make a person healthier?

We do not have evidence to support that assumption for every healthy individual.

Vitamin D is essential, but more is not always better.

In a JAMA trial, women aged 70 and above who received 500,000 IU of Vitamin D once yearly experienced more falls and fractures. This was an extremely large annual dose and should not be confused with a properly prescribed weekly treatment course.

The 2024 Endocrine Society guideline suggests against routine extra Vitamin D supplementation beyond recommended dietary intake in generally healthy adults without a clear indication.

For a healthy adult with a level of 24, high-dose treatment is not automatically necessary. The decision depends on clinical circumstances, risk factors and the reason for testing.

A daily multivitamin containing 600 IU of Vitamin D3 may be a reasonable nutritional option for some people—but it is not a substitute for treatment when treatment is genuinely required.

The goal is not to achieve the highest Vitamin D number. It is to maintain adequate levels and support health.

Don’t fear Vitamin D. Respect the dose.

Dr. K. S. Aulakh

Educational information only—not individual medical advice. Please consult your doctor before changing any supplement.

References:

1. NIH Office of Dietary Supplements — Vitamin D Fact Sheet.
2. Demay MB et al. Endocrine Society Clinical Practice Guideline, 2024. doi:10.1210/clinem/dgae290.
3. Sanders KM et al. JAMA. 2010;303:1815–1822. doi:10.1001/jama.2010.594.

Are Antidiabetic Drugs Really Tackling Diabetes?

The term antidiabetic drugs sounds simple. As the name suggests, these drugs are fighting diabetes.

But there is something worth thinking about.

Are we treating diabetes, or are we mainly treating high blood glucose?

Most of us have been trained to focus on one number —— blood glucose.

But type 2 diabetes is not just a glucose problem. It involves altered metabolism, insulin resistance, insulin secretion, and the handling of carbohydrates, fats and proteins.

Different antidiabetic drugs work differently. Some reduce glucose production by the liver. Some increase insulin action or secretion. Some help the kidneys remove glucose. Some also help with weight and broader metabolic health.

But here is the point I want you to think about:

A lower glucose reading does not automatically mean that the underlying metabolic dysfunction has been corrected.

If we focus only on the sugar number and ignore the bigger metabolic picture, are we missing an important part of diabetes management?

Can you replace rice with cauliflower?

YES — try this!

Take fresh cauliflower and crush/grate it into rice-sized pieces.

Then roast or saute it well until it becomes slightly dry and develops a nice roasted flavour.

Now use it just like rice — serve it with your favourite sabzi, chicken, paneer or dal.

I m not saying it tastes exactly like rice, but when properly roasted, the texture and eating experience can be surprisingly close.

And the big advantage?

Cauliflower is a much lower-carbohydrate alternative to rice. For example, USDA data lists about 3.9 g carbohydrate per cup of raw cauliflower, while cooked white rice is much more carbohydrate-dense.

For someone trying to reduce the carbohydrate load of a meal, this is a very practical swap.

Where Does the Glucose Go?

A person with type 2 diabetes takes a glucose-lowering medicine or insulin, and his blood glucose falls.

What can happen to the glucose that is no longer circulating in the blood?

A:- It simply disappears from the body

B:- It is only passed out through urine

C:- Some is taken up by tissues and used or stored. With excess energy and high insulin levels, some can also be converted to fat and stored, including in adipose tissue and the liver.

D:- The medicine destroys the glucose

One Report Comes High… What Else Might Be Hiding?

Imagine this:

You get your liver function tests done.

ALT (SGPT) comes back elevated.

Let’s say:
👉 35
👉 45
👉 60
👉 or even higher

Most people think:

“My liver report is abnormal.”

And stop there.

But here’s an interesting question:

❓If ALT is elevated, which of the following are you also more likely to find?

A) High HbA1C or high post-meal sugars

😎 High triglycerides

C) High fasting insulin or C-peptide

D) High uric acid

E) Borderline or elevated TSH (in some people)

F) All of the above

👇 What’s your answer?

The interesting part is that many of these abnormalities often travel together.

Because in many cases, the liver is not the only organ involved.

The real story may be:
> insulin resistance
> fatty liver
> metabolic dysfunction

Sometimes one abnormal report is not the disease.

It’s the clue.

आपने अपने Liver Function Tests करवाए।

ALT (SGPT) बढ़ा हुआ आया।

मान लीजिए:

👉 35
👉 45
👉 60
👉 या उससे भी अधिक

अधिकतर लोग सोचते हैं:

“मेरी liver report खराब है।”

और बात वहीं खत्म कर देते हैं।

लेकिन एक दिलचस्प सवाल है:

❓ यदि ALT बढ़ा हुआ है, तो इनमें से और क्या मिलने की संभावना अधिक हो सकती है?

A) HbA1C या खाने के बाद की sugar readings बढ़ी हुई

😎 Triglycerides बढ़े हुए

C) Fasting insulin या C-peptide बढ़ा हुआ

D) Uric acid बढ़ा हुआ

E) कुछ लोगों में TSH borderline या बढ़ा हुआ

F) उपरोक्त सभी

👇 आपका उत्तर क्या है?

दिलचस्प बात यह है कि ये abnormalities अक्सर अकेले नहीं आतीं।

कई बार ये साथ-साथ चलती हैं।

क्यों?

क्योंकि समस्या सिर्फ liver तक सीमित नहीं होती।

असली कहानी कई बार होती है:

👉 Insulin resistance

👉 Fatty liver

👉 Metabolic dysfunction

कई बार एक abnormal report बीमारी नहीं होती।

वह एक सुराग (clue) होती है।

एक ऐसा संकेत जो शरीर हमें पहले से दे रहा होता है।

Dr. K. S. Aulakh

Wednesday Question…Real-Life Solution

Many people ask me:

“what should they eat when they r travelling and away from home?” 🚗✈️

Simple Answer

Don’t look for the perfect diabetic snack.

Look for foods that keep you full and don’t overload your metabolism.

Here are some practical options:

✅ Option 1: Travel Nut Mix

Mix together:

• Walnuts
• ⁠Almonds
• Roasted peanuts
• Roasted chana (optional, if it suits your glucose goals)
• Roasted soy nuts (optional)

Optional seasoning:
• black salt
• roasted cumin powder
• black pepper
• chilli flakes

This mixture provides:

✔ protein
✔ healthy fats
✔ good satiety
✔ fewer glucose spikes than typical travel snacks
Carry it in a small container and keep it with you during travel.

Simple.
Portable.
Filling.

✅ Option 2: Paneer Snack Box

• paneer cubes
• cucumber slices
• lemon
• black pepper
• ⁠roasted peanuts (optional)

Easy to carry and rich in protein.

✅ Option 3: Egg Bhurji Bowl

• eggs
• onion
• tomato
• green chilli
• coriander

A much better option than biscuits, chips or bakery items.

✅ Option 4: Plain Curd
Can add
a few almonds or walnuts
• pinch of roasted cumin powder
• black pepper

If available, plain curd can be a simple travel-friendly option that many people tolerate well.

But remember:

The goal is not to keep replacing one snack with another throughout the day.

The goal is to reduce unnecessary snacking itself.

Many people with diabetes are not truly hungry.

They are simply eating because food is available.

So before reaching for a snack, ask yourself:

>>> “Am I really hungry?”

Sometimes the best snack is no snack at all.

बहुत से लोग मुझसे पूछते हैं:

“डॉक्टर साब, जब हम घर से बाहर हों या यात्रा कर रहे हों, तो क्या खाएं?” 🚗✈️

मेरा जवाब बहुत सरल है।

Perfect diabetic snack ढूंढने की कोशिश मत कीजिए।

ऐसे foods चुनिए जो आपको पेट भरा हुआ महसूस कराएं और आपके metabolism पर अनावश्यक बोझ न डालें।

यहाँ कुछ practical options हैं:

✅ Option 1: Travel Nut Mix

इन चीज़ों को मिलाकर एक छोटा डिब्बा तैयार कर लीजिए:

• अखरोट (Walnuts)
• बादाम (Almonds)
• भुनी हुई मूंगफली (Roasted Peanuts)
• भुना चना (अगर यह आपके glucose goals के अनुसार suit करता हो)
• भुने हुए सोया नट्स (वैकल्पिक)

स्वाद के लिए:

• काला नमक
• भुना जीरा पाउडर
• काली मिर्च
• चिली फ्लेक्स

यह मिश्रण देता है:

✔ Protein
✔ Healthy fats
✔ अच्छी satiety (पेट भरा होने का एहसास)
✔ आम travel snacks की तुलना में कम glucose spikes

Simple.
Portable.
Filling.

✅ Option 2: Paneer Snack Box

• Paneer cubes
• Cucumber slices
• Lemon
• Black pepper
• Roasted peanuts (optional)

साथ ले जाना आसान और protein से भरपूर।

✅ Option 3: Egg Bhurji Bowl

• Eggs
• Onion
• Tomato
• Green chilli
• Coriander

Biscuits, chips और bakery items की तुलना में कहीं बेहतर विकल्प।

✅ Option 4: Plain Curd Bowl

• Plain curd
• कुछ बादाम या अखरोट
• थोड़ा भुना जीरा पाउडर
• काली मिर्च

अगर उपलब्ध हो, तो plain curd एक बहुत अच्छा travel-friendly विकल्प हो सकता है जिसे अधिकांश लोग आसानी से tolerate कर लेते हैं।

लेकिन एक बात याद रखिए:

लक्ष्य यह नहीं है कि आप पूरे दिन एक snack की जगह दूसरा snack खाते रहें।

लक्ष्य है —
अनावश्यक snacking को कम करना।

मेरे अनुभव में, diabetes वाले बहुत से लोग वास्तव में भूखे नहीं होते।

वे सिर्फ इसलिए खा रहे होते हैं क्योंकि खाना सामने उपलब्ध होता है।

इसलिए अगली बार snack लेने से पहले खुद से एक सवाल पूछिए:

👉 “क्या मुझे सचमुच भूख लगी है?”

कई बार सबसे अच्छा snack,
कोई snack न लेना होता है।

Dr. K. S. Aulakh

Metabolic Wednesday

“How this food behaves inside the body.”

Today’s food: 🍓 Strawberry

One medium strawberry contains roughly around 0.5–1 gram of sugar.

So if you add 3–4 strawberries to a salad, curd bowl, or another recipe, the overall glucose impact is usually quite small for most people.

That is why foods should not be judged only by taste.

Some foods taste sweet,
but metabolically behave quite differently because of:

• lower total sugar load
• fiber
• water content
• slower glucose absorption

The bigger picture always matters:
overall meal composition, PORTION SIZE, activity levels, and insulin sensitivity.

🍓 Sometimes a few (2-4)strawberries may affect blood sugar far less than people expect.

And one more important thing:

👉 Enjoy a walk after you eat
as much as you enjoy the fruit itself.

Metabolic Wednesday

“यह भोजन शरीर के अंदर कैसे behave करता है?”

आज का food: 🍓 Strawberry

एक medium strawberry में लगभग 0.5–1 ग्राम sugar होती है।

इसलिए अगर आप 2–4 strawberries salad, curd bowl, oats या किसी दूसरी recipe में डालते हैं,
तो ज्यादातर लोगों में इसका glucose impact काफी कम होता है।

यही कारण है कि किसी food को सिर्फ उसके taste से judge नहीं करना चाहिए।

कुछ foods मीठे लगते हैं,
लेकिन metabolically उनका behavior काफी अलग होता है क्योंकि उनमें:

• कुल sugar load कम होता है
• fiber होता है
• water content ज्यादा होता है
• glucose absorption धीमी होती है

बड़ी picture हमेशा महत्वपूर्ण होती है:

• पूरा meal कैसा है
• PORTION SIZE कितना है
• आपकी activity levels कैसी हैं
• insulin sensitivity कैसी है

🍓 कई बार 2–4 strawberries blood sugar पर उतना असर नहीं डालतीं जितना लोग सोचते हैं।

और एक बात हमेशा याद रखें:

👉 खाने के बाद walk का आनंद
उतना ही लें जितना fruit का लेते हैं।

Dr. K. S. Aulakh

Taking Calcium for bones… but harming arteries?”

QUESTION

What helps direct Calcium to bones instead of arteries?

A) Vitamin C
B)Vitamin K2
C) Zinc
D) Iron

Not all vegetables behave the same

Broccoli:
✔ very low sugar
✔ almost no starch
✔ good fiber

helps keep glucose rise slower

Small choices
Big difference