Over Weight is now a main issue of great concern in our day to day life,whether child or adult or a retired person or old every body now is concerned for this.It is a known fact that Overweight is related to bad physique,uglylooking,inferiority complex,a psychological complex leading neropsychiatric disease mixed with anxiety,depression, sleepnessness,bad performance in day to day activities,less concern for education,sports ,l azyness and no interst in personal and physical meeting leading to overeating and viceversa gaining more weight.Beside this aspect of Weight concerns in our middle aged and youngesters,it is of our concern in aged person as it is directly related to Diabetes,Hypertension(High BP)leading cause of more hear attack,Chest pain,Storke and paralysis, Kidney Failure,clogging and blockage of Arteries, changes in vision,sedantry habits,addictions, psychosomatic and sexual diseases beside arthritis,pain over heels and knee joinst and over accidents and skin diseases.

I know each and everyone of us (including me) at some point in our lives are fighting the “battle of the bulge”, hence it is a worth writing on this topic.
Another reason for this writing is the fact that notwithstanding the “magical guaranteed weight loss” as advertised as we regularly see in print or electronic media,internet or socalled practitioners of different types like yoga,acupressure,reki,physical educator,gyms and physical training centres, Exercise centres and instrument sellers and companies of different type of weight reducing machines and devices and beauty ayurvedic,homeo and ingenious and allopathic centres are claiming and attracting every set of people and now senior Doctors are running a camp of Obesity reducing surgeries through laproscopes (Mini Hole surgeries )with a surest gurantee of melting down few KGS in few days.But is it so easy! or so safe without any side effects ? Let me be a party pooper here by saying emphatically…there are no and I mean NO SHORT CUTS.EVERY TIME WE RESORT TO THESE DEVICES EITHER MOST OF THE ARE SHORT LASTING OR WE HAVE TO BEAR SOME SIDE EFEFECTS IF WE ARE NOT VERY MUCH DEDICATED FOR OUR EFFORTS TO REDUCE OVERWEIGHT SERIOUSLY,SO WE GAIN WHAT WE LOOSE IN EARLY DEDICATION.

So let us see why this is such a big problem and what are some of the factors that play a role in weight gain. I would call it weight gain rather than obesity because the term obesity does not include overweight people by definition.

This brings us the fundamental question, when would one be called normal / overweight/ obese or morbidly obese? This classification is based on BMI or Body Mass Index, which is basically a product of a person’s bodyweight divided by a person’s height. A BMI of 18-25 is normal, 25-28 over weight, 28-35 obese and above 35 morbidly obese.

You can calculate your BMI using this online link on any health portal website.


Why does one gain weight? This is a question the answer to which each and everyone wants to know, because if we know the answer to this, very easily we can avoid the causes thereby avoiding weight gain.

Sounds pretty simple, doesn’t it?? Sadly it isn’t that simple.

But to take a common analogy that I give to my patients’ weight gain is like a bank balance, there are only to ways to increase your bank balance (weight) either you earn more (increased intake) or spend less (decreased output).

But sadly I’m sure all of us agree it’s easier to gain weight (except for the lucky few who have genetics on their side), than increase your bank balance. Now once we have the grass root level basic fundamental cause of weight gain let us examine a few reasons as to why and how it actually happens.

INCREASED INTAKE / WRONG INTAKE / IMPROPER INTAKE

As you can see from the heading, it is not only increased intake but also the intake of wrong kinds of food and improper intake, which also contributes to weight gain.

1.Over eating: Though most of us tend not to agree to it, it is often the most common cause for weight gain. Every time you have that extra spoonful, it adds up in the long run. It is said that after a meal one should feel that he can have a little more…. that, is the time one should stop. But more often than not, we stop when we feel full and that is already too much.

2. Fast food: Fast food is fast to make and convenient to eat can be eaten on the move but more often than not is full of fats/cheese & salt.
Anyone who has read science in school knows that fat has more calories (9Kcals/gm) as compared to protein (4Kcals/gm) or carbohydrates (4Kcals/gm). So, the more fats you eat the more calories you are putting in. Carbohydrates are easy to absorb and after your basic energy requirements are met, are converted to fat for storage.

Chips – a favorite amongst most is another common cause. An old saying for them, which holds very true, is “ A minute on your lips & a lifetime on your hips”, hence avoid them.
Increased salt intake causes more water retention in the body and hence is also an important factor for weight gain.

3.Improper timing: The time of a meal also is an important factor. Food should be eaten at least 2 hours before one goes to bed to allow digestion to occur properly. So, siesta’s after a heavy lunch or eating just before going to bed are not such good ideas after all.
There is research also to suggest that, the later in the night one eats, the more chances are that all that food is being converted to fat. So, having “ a midnight snack or munchies” is again not such a great idea.

4.Alcohol: Alcohol has often been blamed for gaining weight but the gain in weight is more related to the increased snacking, which goes along with consumption of alcohol.

5.Fizzy Drinks: These are aerated drinks with empty calories, which are of no use and add up to the over all “Bank Balance of Calories”. Instead, substitute it with fresh fruits or fresh lime, which is much healthier but of course try and avoid excess salt or sugar in them.

DECREASED OUTPUT:

This is now turning out to be an important part of the whole weight gain process, especially so in youngsters and children.

1.Sedentary lifestyles: Now with the comfort levels increasing, activity has reduced. We use the lifts instead of stairs, vacuum cleaners instead of brooms, cars instead of walking, etc. The amount of calories burnt per day is decreasing with more mental activity than physical.
Some amount of physical activity is needed daily to keep the Basal metabolic rate higher so that you can burn more calories. Of course though ideal, considering family and work pressures, it is understandable that a regular gymming schedule is not always possible.
But, one can incorporate small things into the daily schedule to increase the output like taking the stairs instead of the lift, walking to the nearby store instead of driving, morning or evening walks, etc which do not take up too much of your time but help in spending those calories.

2. Children especially should have some regular physical activity in their daily schedule or we are going to be waking up to a generation of overweight youngsters. It is already happening in the west and is a major health hazard. We can see it happening around us in India too.

Real games instead of Video Games, fruits instead of chips or pizza & fruit juices instead of a fizzy drink should be the mantra for the kids.

MEDICAL CONDITIONS FOR WEIGHT GAIN:

There are a few medical conditions that can be a cause for weight gain. These are usually hormonal imbalances. The most common being:

1.Hypothyroidism: Here there is a decreased secretion of “Thyroid Hormone” which is responsible to maintain the Basal Metabolic Rate and hence there is a tendency towards weight gain. This is a treatable condition and after proper tests to find out the hormonal levels, replacement of the hormones causes a reduction in weight.

2. PCOD: Poly Cystic Ovarian Disease or PCOD is another condition associated with weight gain. Here again the hormonal imbalances cause weight gain and the weight gain in turn worsens the PCOD. Medical & surgical options are available for treatment of this condition. A curious thing seen here is that weight reduction helps with the gyneacological condition with normalization of hormones.

3. Adrenal Hormonal Imbalance: This also can cause weight gain because of water retention.

WEIGHT GAIN & DIETING

A lot has been written n said about dieting and weight loss. Every other person is an expert in some sort of a diet. But a recent study has brought the proper perspective, as I have been saying for quite some time now, its not what kind of a diet you follow but the total intake versus the total output.

So whether it’s a low carb diet, a low fat diet or an only protein diet, it doesn’t really matter. What matters is,the total amount of calories going in.

Crash Dieting is a not a way to loose weight at all. You might loose weight initially but you are loosing muscle bulk and replacing it with fat. And most of the food that one eats gets converted to fat directly because of the body’s survival mechanisms. Secondly, with crash dieting there is a tendency to alternate binging with crash dieting and this doesn’t help.

So, what one needs is a proper balanced diet according to the work he or she does, which has all the necessary nutrients.

TREATMENT OPTIONS

I’m sure all of us have heard or read quite a bit on the treatment options. I’m not going to discuss exercise, lifestyle modification and diet control which are essential to all treatments as an adjunct.
For the ease of understanding, I will divide the treatment options according to the BMI.

BMI of 25-28(30) – Overweight Category:

This is the category for which we have the most number of options.

1. Isometric Exercise/ Non Surgical Body Contouring – This is an option where in, with the help of targeted muscle stimulation & Infra red waves, isolated areas of the body are treated to achieve targeted contouring and inch loss. Here the patient comes in twice or thrice a week to the center, where the machine does the work for them and helps to achieve targeted contouring.

Very good for people in whom muscle laxity is a cause for bad body contour especially in the tummy area. Also very good immediately post pregnancy to help reduce the flab and tighten the muscles which have become loose post pregnancy and child birth

2. Ultrasonic Lipolysis: This involves breaking down the fat cells directly with the use of a non-invasive ultrasonic wave. The patient comes in once a month for the treatment, which lasts 45 mins to an hour. The released fat has to be reabsorbed and excreted by the body. It works well for small isolated areas like the saddlebags, lower tummy. This doesn’t work for large areas.

3. Injection Lipolysis or MESOTHERAPY: This involves giving multiple injections in the target areas to help dissolve fat in that area. The injection is usually of a derivative of Soya protein, which helps the cell membranes of the fat cells to break down and release the fat into the body. This is absorbed by the body and excreted.

It requires injections maybe once a month for 4 or 5 times. It works well if given properly and for small areas like the double chin or the saddlebags. Contrary to what people might claim it is not for large areas. Complications in the form or small injections abscess or collections of liquefied fat, which may require drainage, are occasionally seen.

4. LASER Lipolysis: This is a minimally invasive procedure which involves insertion of a small LASER probe in the affected area help break down the fat cells in the track of the probe thereby releasing fat into the body which is reabsorbed and excreted. This is also an office procedure and requires multiple sittings maybe a month apart.

Works well again for isolated areas like double chin, cheek fat, saddlebags, arms, etc. Large volume Lipolysis again is technically possible to a certain extent but not practical. The patient does need to use pressure garments, should have the patience to wait for the results for a few months and of course undergo multiple sittings.

5. Liposuction: This is a surgical procedure where a cannula is inserted under the skin by small 1-1.5 cm incisions in hidden areas to suck out the fat. This again is a procedure for body contouring. Though one does loose weight, he will loose more in inches

There are various techniques like the mechanical, ultrasonic, VASER, power assisted. All these are different methods of suction depending on the type of probe used to breakdown the fat cells.

As regards to the technique there is also the tumescent technique which is the preferred technique nowadays and basically involves infiltrating large volumes of saline along with some drugs to help minimize bleeding and trauma to other structures in the vicinity.

Liposuction can also be classified according to the volumes to be removed. Small, moderate or mega liposuctions. Small volume suction can be done under local anaesthesia. Moderate volumes can be done under local anaesthesia with sedation or general anaesthesia depending on the patient’s comfort level. Mega liposuctions require anaesthesia, hospitalizations and in some rare instances blood transfusions.

Internationally, the accepted volumes of fat that can be safely sucked out at one sitting is @ 8% of body weight in men and @ 9-10% of body weight in women. This is because of the fact that men tend to have an equal amount of fat inside the abdomen, whereas in women most of the fat is extra abdominal and also the fat that men have more fibrous fatty deposits. Hence, women are good candidates for liposuction.

Problems after liposuction are because of the swelling. Here as the fat is physically being sucked out, the effects are noticed immediately, but in a few days swelling sets in and takes around a month before significant changes can be felt. This also depends on the areas targeted and the amount removed. Full healing takes around 3-4 months and during this period the patient needs to wear a pressure garment to help the skin shrink. Some amount of unevenness maybe present which gradually settles with time and massages.

Rarely in smokers, there maybe areas of skin necrosis. Sometimes especially with large volume liposuctions, there maybe some collection of fluid called seroma’s which might require drainage.

BMI of 30-35 – Obese Category:

This category is the so-called “Grey Zone” of weight loss treatments. As these patients are not yet candidates for a Bariatric procedure and the procedures for the overweight category cannot fully help in treating these patients. But increasingly we are seeing patients in this category.

In these patients it has to be a combination of procedures and sometimes multiple sittings are needed to get the desired changes.

More often than not we do large volume liposuction in such cases, maybe one or two sittings with a gap of 6 months in between combined with a proper diet and exercise schedule. The procedure of Liposuction has already been discussed.

BMI of 35 and more – Morbidly obese Category:

These patients have other metabolic problems along with the fact that they are overweight. These are candidates for Bariatric procedures that are procedures aimed at reducing the intake drastically (Gastric banding or Sleeve gastrectomy) or reducing absorption of food (Gastric & Duodenal bypass procedures).

These are major surgeries and have to be done in specialized centers and involve a multidisciplinary approach with the involvement of plastic surgeon, gastroenterologist, psychiatrist, dietician, physical therapists, anesthetists, etc. This itself is a topic by itself.

The aim of this blog was to try and bring things into perspective for a person looking at weight loss or to just get in shape. Ultimately, “ a Stitch in time does save Nine”! So the earlier we wake up to the fact that weight is becoming a problem to all of us, the better it is. If not to reduce, at least try and modify our lifestyle and being about some changes in how we do things, it might help prevent the problem from becoming worse, where a much more drastic and major procedure might be required.

As you must have seen in the course of the blog that, this is not a simple topic and I have not even scraped the surface of the problem. But, the aim is to try and simplify things so one can understand what are the little things we can do to bring about a bigger change.

Whatever said and done, all the procedures are only an adjunct to lifestyle modification to get the full benefits in the long run. Change in dietary habits, maintaining a negative intake output balance, increasing physical activity will all go a long way in helping one keep fit and stay healthy.Simple formula is enought your ouput or expenditure should be more than your input or intake,a strong mind with dedication brings change drasitically but one fact is common in India after heart attack or Kidney failure or Stroke many Obese becomes thin dur to strong dedication and confrmed rigid power of determination to reduce weighrt ,so be positive result must come.


So let us bring about the change… by being the change!!!!
DR.D.R.NAKIPURIA
SILIGURI

Healthy Greens is the sogan which is heard everywhere because we know this green by absobing noxious carbondioxide excreted by all living animals of world and by giving oxygen to breathe, bringing rains,wood,forest,fetilising our soil, conserving soil,forest and human Eco atmoshphere preserve us and our Earth by keeping intact our Glaciers and ozone layers save us from ultra violet radiation of this Universe leaving no hazard of its decomposition like of man made plastic materials.
In this article,we shall like to discuss the importance of a beverage in the form of "TEA" which is most prevalent in our country as well as almost in every part of world where it is consumed by almost every family twice a day or being offered to every guest coming to home/business centre or any other interaction in our day to day personal or social gathering.
Green Tea which is directly plucked as fresh upcoming triplet Leaf from a Tea Bush or plant (First Flush,i.e.,First sesonable tea in month of April May every year from a Plant after a rest of 03-4 months shrugging off its old leaves completely form Hilly tops of darjeeling or Assam Valleys) are very rich source of Many Anti Oxidants which burns fat of our body reduce bad Cholesterol,Open or dilate our blood vessels ,prevent ,Prostate cancer(Prooved by study in Mice from Dr.Chan in USA)Lung cancer reduce recurrence of Breast,Stomach,Colorectal Cancer prevent Strok,Heart Attack and Diabetes Mellitus.This Green Tea leaves like Black tea leaves are not crushed or withered,steamed and fermented and powdered to form Blak tea or Oolong tea but here leaves are dried and preserved for making tea.
For drinking this tea we have to boil one or two or three cups of Water as per our requirement but small preparation is good and then put some Green leaves inside it (or 3/4 tsf or one tsf Green Tea )as per concentration needed and then allowed to get these leaves shocked into this water for few minutes and then we can add sugar or sugar free tablets and lemon inside it (Not MILK AS IT HAS BEEN PROOVED THAT MILK DILUTES THE BENEFICIARY AFFECT OF THIS GREEN TEA OXIDANTS) and allow it to cool for few minutes and then drink it slowly taking few minutes not very hot and not in just few seconds.the Top variety of Tea Garden,More HILLY terrain where water is less logged and stayed but comes and go under cold temperature with high humidity or tea organic where not fertiliser used to produce it are of best variety but their cost some time is very high thousand rupees per kg .Usually Black Tea should be taken twice a day or two cups a day ,it should be used as food supplement not as Drug .It has been prooved that Caffienated Black Tea is more important as it burns our fat and reduce bad cholesterol LDL markedly.
Tea beside containing "Tanins" which are not very useful contain "CATECHINS" OR EGCG(Epigallo catechins 3 gallate ) compond and Antioxidant which is responsible for dilating Blood Vessels,burning Fat (reducing Atherosclerosis,Reducing Cholesterol thus preventing Hear attack,Strok and Prevent cancers ) like other good Anti oxidant substance like red wine,Grapes,Berries,and Dark Chocolate. But out of all these Tea is more consumed in almost every household of our Human world so this should be more included as our foos supplement.

Green tea was first brewed in China, where it was known as a 'miracle medicine'. In her book, Green Tea: The Natural Secret for a Healthier Life, Nadine Taylor states that green tea has been used as a medicine in China for at least 4,000 years.

Today, research shows us how true that ancient claim was. Green tea, with its medicinal properties, is a boon for the health-conscious and a wonder, even to modern science. The benefits of green tea are many as told earlier above but again summarised below:-------------------------
Inhibits Cancer:----------------
The main ingredient in green tea, Epigallocatechingallate (EGCG) inhibits the growth of cancer. The latest good news about green tea comes from a study done at the Karolinska Institute in Stockholm. A team of researchers headed by Dr Yihai Cao found that green tea can block angiogenesis, the development of new blood vessels that tumors need, in order to grow. In an interview, Dr Caoexplained that the polyphenols in green tea prevent angiogenesis, which also explains why green tea is effective in preventing cancer. According to Dr Hasan Mukhtar, professor and research director of Case Western University, Cleveland, studies have shownthat the risk of stomach cancer goes down as consumption of green tea goes up.
Prevents High Blood Pressure and Heart Disease:----

With the chaos of our daily lives, we can do without the added tension of high blood pressure, which can result in heart problems. Scientific studies show that daily consumption of green tea can prevent high blood pressure. 3 to 4 cups of green tea a day, can substantially reduce an individual's risk of heart disease and stroke.
Restricts Buildup of Cholesterol:---------------

We all know that fat and cholesterol are bad for our health. Bur that doesn't stop us from drooling over a sinfully creamy dessert, does it? Now green tea brings along some great news for food freaks. Experiments demonstrate that green tea restricts the excessive buildup of blood cholesteroJ. It reduces the bad cholesterol (LDL) in the blood and increases the levels of positive cholesterol (HDL), thus reducing the chances of heart disease. For years, researchers were puzzled by what they called the 'French Paradox' … the fact that, despite consuming a diet rich in fat, the French had a very low incidence of heart disease. The answer was found to lie in red wine, which contains resveratrol, a polyphenol that limits the negative effects of smoking and fatty diets. In a 1997 study, researchers from the Universiry of Kansas determined that EGCG, strongly present in green tea, is twice as powerful as resveratrol. Which explains why the rate of heart disease among the Japanese, who are regular drinkers of green tea, is quite low, even though approximately 75 % are smokers.
Lowers the Blood Sugar Level:---------------
Let green tea take care of health worries like blood sugar levels. The extract of green tea has the ability to actually lower blood sugar. It is believed that both the EGCG and polysaccharides in green tea are factors in lowering blood sugar.
Strengthens Immune System:------------------
Today, we live life right in the midst of the madding crowd ... with deadlines and schedules that leave no time for ourselves. With its share of ups and downs, our body needs to be strong enough to fight common diseases like the flu and other infections. Green tea helps to strengthen a weak immune system, guarding us from illnesses and infections that take a long time to heal.
Prevents Ageing:========
Oxygen is very important to us, but it can also be a very harmful agent in the form of active or free radical oxygen. One way to slow the ageing process is to prevent the accumulation of active oxygen in our body. This can be done by antioxidants, which are strongly present in green tea.
Oral Hygiene and Dental Care:------------------
Now you can flash that charming smile without worrying about bacteria and bad breath. Fluoride in green tea protects tooth enamel and EGCG reduces the development of bacteria growing in the plaque. Green tea can also kill other oral bacteria, which cause bad breath. It also stimulates the production of saliva and reduces the harmful acids that form in the mouth.
Boon for Dieters:-----------------
Get yourself in shape with a new slimming potion. Yes, green tea can actually help burn fat. In November 1999, the American Journal of Clinical Nutrition published the results of a study at the University of Geneva, in Switzerland. Researchers found that men who were given a green tea extract burned more calories, since green tea helped to excrete more fat.
So Drink To Your Health:--------------------
People who drink green tea daily, have lower rates of heart disease and cancer and a higher life expectancy. Unlike other antioxidants, those found in green tea cause no toxic side effects. Sounds good enough to put the kettle to boil and give green tea a try?Many more good compounds are found in Green Tea but not seen in same quantity and concentration in Black or White Tea (which is powdered or steamed or fermented tea)are found but their direct contribution on organs and tissue Human health system is yet to be discovered .
Dr.D.R.Nakipuria
Ambika Multi speciality Hospital
29 Agrasen road
P.O.Siliguri-734005
Dist:Darjeeling(W.B.)
09434143550,

Juvenile diabetes is one of the most common chronic conditions to affect children all over the world and each day, over 200 children are diagnosed with type 1 diabetes. Although Diabetes is a metabolic disorder, it can have psychosocial effect, if not handled in the right manner. As a long term condition that affects day-to-day living, diabetes can be particularly stressful on the child and parents. Newly detected Diabetes impacts all aspects of a child's life and its management requires the parents to tackle challenges at multiple levels physical, psychological, social and educational. If not effectively addressed, a spectrum of psychological issues ranging from lack of confidence to severe depression may result. However with proper training, learning about diabetes and making small changes in life style as a family, you can live a fairly normal life.As Diabetes affect all most organs of our Body ,it is decribed as Diabetes=flow or excess urine,(diuresis or called as POLYURIA),Mellitus= sweet as urine becomes sweet as sugar is excreted in it once our Blood Sugar level cross 180 mg% our kidney cannot absorb all sugar passing through it as sugar is lost person becomes weak(disabled) and need more food or hungry(POLYPHAGIA) and as with sugar more water or urine is also passed so person becomes more thirsty(POLYPEPSIA),these symptoms are very much seen in Juvenile Diabetes or young children then in Maturity Onset diabetes Mellitus (MODS) which affects mostly above 40 yrs of aged persons and mainly present with Metabolic Syndrome.Diabetes thickened intima of our Arteries because of Atherosclerosis as a result micro vessels or Arterioles becomes thickened and Hypertension develops which causes Kidney changes and chronic Renal Failure,Angina,Ischaemic Heart Disease,heart failure,Blocks etc,cerebro Vascular Accident, Ischaemia in Limbs,Ulcers and infections because of excess sugar in blood as well as inert and less responsive protective pain Nerve Fibres.Pain, Parasthesia,Numbness,Paresis due to radiculopathy are common in Diabetic patient,Ulcers and ischaemia of toes and fingers are serious because of single end arteries .patient also notice Sexual Dysfunction often not asked by doctor to patient and all these leads to depression and many psycho neurotic changes in patient and family members and parent leading to total social unjustment and belief in life leading to suicidal tendency due to despairness and loss of hope in life.

In this article, we examine the need for counseling and the various counseling options that a parent has to help a child and themselves deal with such issues.Becuase we belif that Diabetes is harmful but not invinsible,we can easily control it with modern medicines and change in life style with regular precautions and these children will live a normal life rather a better intelligent life ,only love,assurance and encouragement and help from parents and society is needed.
Counseling the diabetic child
A child diagnosed with diabetes is suddenly thrust into the unenviable position of dealing ith a chronic condition. Starting from dietary restrictions to insulin injections, the child has to come to terms with the all-pervasive impact of this condition. As a result, the child ay suffer from stress. Resentment, fear of being mocked at by peers, a fear of being branded as a 'sick' or 'ill' person, and anger at parental control on diet and activities are ome of the feelings that a child may experience. If allowed to build up, such feelings can have a debilitating effect on the child's mental and physiological health.
Parents can do a lot towards helping the child cope with diabetes. In fact, the attitude of parents plays a great role in forming the child's response to the condition. Paying enough attention to the psychological needs of the child can be as important as providing medication. By following these simple do's and don'ts, parents can empower the child as he/she work on responding to the condition.
Do not be over-protective. Many parents confuse precaution with apprehension and cross the fine line between being protective and over-protective. Understand that diabetes need not stop your child from leading a healthy, active life. Do not deter the child from participating in active sports and games in the mistaken belief that your child has to be protected.
2. Do listen and watch out for cues to your child's state of mind. Loss of appetite, sudden loss of interest in studies, reluctance to go to school, a listless attitude are some signs that your child needs help in coping with the condition.
3. Do not refer to the condition as a disease.It only helps to firm up an opinion that diabetes is to be feared and dreaded.
4. Do discuss the condition, its causes, treatment and precautions to be followed. An understanding about the physiological conditions and changes associated with diabetes will alleviate your child's fears about this condition and will equip him/her with the requisite knowledge to tackle it.
5. Do not express worries about the child's future, especially within earshot of the child.
6. Do not treat the child differently from his/ her siblings. This will only make your child more conscious about his/her condition.
7. Do take every opportunity to stress that diabetes is treatable.
8. Do focus on success stories of fellow diabetics from your child's area of interest - for example, successful cricketers, or athletes who are diabetics. Your child will profit from such role models.
9. Letting some one know about the fact that your child is diabetic should occur as naturally as divulging any other personal fact about yourself. If someone were to notice your child taking a shot and wondered what it was or why it was so, that would be a reason to explain! Don't express being diabetic as a negative thing or something that defines a person. Let it come naturally but definitely don't hide it. Be short, precise and positive while telling about it.
10. Be realistic in the goals set of your child.
11. Do set a personal example. Follow a healthy regimen of diet and exercise yourself to make it easy for your child to adhere to his.
12. Be understanding during the instance that your child deviates from the prescribed routine – your child is still a child and there may be occasions when he she feels the need to bypass the routine.

Counseling partners and caretakers
Juvenile diabetes impacts the entire family, not just the affected child. The parents of a diabetic child are also subject to stress, although for different reasons. In the case of parents, possible stressors are a fear of societal ridicule, apprehension about a girl child's marital prospects, worry about the child's longevity and future and sometimes guilt on not being able to protect the child from this condition. Counselling of parents and caretakers can go a long way in helping them tackle the emotional impact of this condition. While child counselling sessions help to assure the child, reinstate confidence and also infuse the belief that diabetes is a manageable condition, parental counseling seeks to allay the parents' fear regarding their child's future.

External sources of counselling
Depending on the extent of the psychological impact, counselling of the child is therefore not just desirable but even required. Although parents may be able to provide suchadvice, external help and counseling can effectively supplement the efforts of parents.

There are various counseling options available.
These are :
Family physician: The family physician is often the first line of support. The family physician will have an intimate knowledge of the child, his/her interests, and temperament. Further, the family physician enjoys the trust of the parents and the child alike. A talk with the family physician may be a timely confidence-booster.

Friends and family: Advice from friends and family, especially fellow-patients can also be very effective. A family member or friend who is successful and happy, despite such a diagnosis can be a very effective role model.

Online and offline support groups: Online support groups for both children and parents alike, provide a global network of support and also resources that the parents and child can tap into. Online support groups overcome the barriers of distance and allow parents to communicate, share and get answers to mutual concerns on bringing up a diabetic child.
Professional counseling: Where the emotional impact is deeper, professional counseling is not just desirable but required. Where thepsychological impact has resulted in mild or severe Depression,advice from a psychiatric professional is mandatory.
Tretment
Like MODS this Diabetes is too curable but here oral Medicines like Glipizide,Tolbutamide, Chlopropamide, Gliclazide,Glimperide etc.which stimulate Insulin production from Beta cell of Pnacreas does not work as Beta cells are absent in these children's pancreas,even Peripheral receptors stimulator like Metformin or Pio or Rosigliatazone or Repaglinide or Netaglinide or acrabose,Vobiglose,Majlitol,Vidagliptine or Sitagliptine does nor work.
Sole therapy is Injectable Insulin which may be porcine or Bovine Soluble insulin three times a day (used as cheap but leads to resistance and more lipidostophy ,now a days Human or recombinant tech E.Coli produced soluble Insulin three times or Protamin or Zinc insulin Suspension as Lente or UltraLente Insulin in various mixture proportion with Soluble Insulin 1-2 times used as subcutaneous injections at thigh or at belly part.Now a days prtamine fine preparation as Lispro Insulin and once used Insulin Glargin is used.Insulin Detemir or Expenta Injections are too used.Genetherapy and Stem cells are also coming with Pancreatic Beta cell transplant is also practised in developed rich countries.Insulin pump and Nasal Insulin spray is now also used in our country.

Conclusion
Dealing with diabetes is not just about taking medication, it is about dealing with its invisible and intangible effects. Counselling is one of themost potent tools that parents have to successflly manage the psychological consequences of this condition.
For stories on successful role models for children and more tips to young people on self management, coping and living with diabetes should be written and available to children sothat they never give away rather becomes more courageous to face it with change in life style,control over food and regular medicines and prevention of getting infected with infections and avoiding trauma to toes and nails with every care for any dental or any other minor sugical intervention.Such precautions will allow to lead the Child to lead a normal life with normal development ,activities,education and Social upbringing.
Dr.D.r.Nakipuria