Category: General

While standard treatments for PCOS—like weight management, diet, lifestyle changes, and prescribed medications (e.g., Metformin, oral contraceptives)—are the most effective approach, many people are curious about natural supplements.

Let’s look at the evidence for the most popular options:

Myo-inositol : This natural sugar can help reduce insulin resistance and high androgen (male hormone) levels. Studies confirm it can improve insulin sensitivity and ovulation.

Verdict: Promising, but current research shows it is less effective than standard medications like Metformin.

Vitamin D : Can improve glucose levels and markers of inflammation.

Verdict: Recommended only if you have a confirmed Vitamin D deficiency.

Curcumin (from Turmeric) : Small studies show it may reduce inflammation and slightly improve blood glucose.

Verdict: No proven benefit for regulating periods or improving fertility.

Coenzyme Q10 (CoQ10) : This antioxidant may reduce inflammation markers.

Verdict: No significant effect on menstrual cycles or fertility has been found.

Omega-3 Fish Oils : May have minor effects on improving insulin resistance.

Verdict: Lacks definitive studies showing a real impact on important PCOS outcomes.

Others (N-acetylcysteine, Berberine, Zinc, Magnesium)

Verdict: Current evidence does not support their use for PCOS.

Myo-inositol and Vitamin D (if you are deficient) have the most scientific support, but they are not a replacement for standard medical treatment. Other supplements have very limited evidence.

Important : Supplements can interfere with medications and may not be safe for everyone. Always consult your endocrinologist before starting any new supplement.

Dr. Tittu Oommen MD, DM 

More than 50% of women with PCOS are overweight or obese. This is a critical point because excess fat is a primary driver of the condition and its related health risks, including diabetes, hypertension, and fatty liver disease.

The Impact of a Small Change The good news is that even a modest weight loss of just 5% can lead to significant improvements. For a 100 kg person, that’s just 5 kg!

 Key Benefits of Weight Loss 

 Periods : Helps restore menstrual regularity.

 Fertility : Can restart ovulation and improve the chances of conception.

 Health : Lowers abnormal glucose levels and reduces other health risks.

 How is Weight Loss Achieved? 
Effective strategies, often guided by a doctor, include:

1. Calorie-controlled nutrition

2. Medications (e.g., Metformin, Semaglutide, Tirzepatide)

3. Bariatric surgery (for eligible individuals)

4. Setting Realistic Expectations :It’s crucial to know that weight loss is for management, not a cure.

 What improves MOST?
Menstrual cycles, ovulation, and insulin resistance.

 What improves LESS ?
Symptoms driven by high testosterone, like hirsutism (excess hair growth), may only show limited improvement.

 Take Control of Your Health 
Ready to discuss your options? If you have PCOS, speak with your endocrinologist to see if a medically supervised weight loss plan is a suitable next step for you.

 Mrs. Rejitha Jagesh, MSc

Of course, many people with diabetes face a dip in sugar after a meal. A main meal consisting of high amounts of refined carbohydrates and low in dietary fiber, protein, or fat can lead to a sudden spike in blood glucose, followed by a dip in sugar levels. To prevent the variability in blood glucose after a meal, incorporate the following foods that help to stabilize your blood sugar levels.

1. Protein-rich foods : Protein-rich foods take more time for digestion and absorption. These foods provide fullness for a longer duration than carb-rich foods. Protein-rich foods include pulses and legumes, chicken, fish, eggs, Tofu, paneer, and cottage cheese should be included in the meal. Restrict red meats in the diet.

2. Complex Carbohydrates (Low-Glycemic Index Foods): Complex carbs (e.g., whole grains and vegetables) are high in fiber and digest more slowly than refined carbs (e.g., maida), thus helping manage blood sugar levels. The fibers in these foods delay the digestion and release of glucose into the bloodstream, leading to better control over blood sugar and hunger cravings throughout the day. Low GI foods include whole grains, legumes, fruits, and vegetables.

3. Healthy Fats : Fats contribute to early satiety and also slow down the digestion of food, and thus manage the glucose levels in the bloodstream. These should be consumed in the recommended quantity and used properly in cooking methods. Good sources of healthy fats are nuts and seeds, avocados, fatty fish (sardines, salmon), and olive oil. 

 Points to be remembered
 
•    To avoid such episodes, follow an individualized and balanced meal pattern based on overall health status, duration of diabetes, current medicines, and physical activity. 

•    Avoid refined carbs and sugars, especially white bread, pasta, sugary cereals, soft drinks, and many processed snacks. 

•    Do not skip your meals, which can cause hypoglycemia (low sugar).

 Mrs. Sreekutty S, MSc

Yes, there are several common medications that can cause hypoglycemia, which means low blood sugar. This condition can make you feel shaky, dizzy, weak, confused, or even faint if not treated quickly.

Medications That Commonly Cause Hypoglycemia:
1.     Insulin – Used to treat diabetes, insulin lowers blood sugar. If you take too much insulin, skip a meal, or exercise more than usual, it can cause your blood sugar to drop too low.
2.     Sulfonylureas – These are diabetes pills (like glipizide or glyburide) that help the pancreas to release more insulin. They can cause low blood sugar, especially if meals are missed.
3.     Meglitinides – Similar to sulfonylureas, these (like repaglinide) also increase insulin secretion and can lower blood sugar too much.
4.     Quinine – A medication used for malaria can sometimes lower blood sugar, although this is less common.
5.     Certain antibiotics – For example, fluoroquinolones (like levofloxacin) may occasionally cause low blood sugar, especially in older adults or people with diabetes.

Key Points
Consult Your Doctor Before Starting a New Medication
1. To Ensure Safety
Your doctor can determine if the new medication is safe based on your medical history, allergies, and current health conditions.
2. To Avoid Harmful Interactions
Some medications can interact with others you’re already taking, leading to side effects or reduced effectiveness. Your doctor can check for these interactions.
3. To Determine the Right Dosage
Doctors can prescribe the correct dose tailored to your age, weight, kidney or liver function, and overall health.
4. To Manage Side Effects
Your doctor can explain possible side effects, how to manage them, and what signs to watch for.
5. To Discuss Alternatives
There might be safer or more effective alternatives to the drug you’re considering. Your doctor can help you choose the best option.
6. To Plan Monitoring and Follow-up
Some medications require blood tests or follow-up visits to monitor how your body responds.

Mrs. Anila Nisha, D Pharm       

Insulinoma is a rare tumour of the Pancreas which produces excess insulin leading to very low sugar levels .Most of them  are found to be benign, but rarely some can become malignant. These are rare with an estimated incidence of 1 to 4 cases per million people per year.It is seen more in women and often get  diagnosed in the age groups of 40-60 years. It can occur associated with multiple endocrine neoplasia (MEN-1 syndrome) a genetic condition affecting multiple endocrine glands.

 Symptoms include
1.Undue tiredness due to repeated low sugar levels
2.Irritablity and difficulty in concentration
3.Anxiety
4.Blurring of vision
5.Slurring of speech
6.In severe cases it can lead to unconsciousness or seizures.

We can detect this condition by conducting a supervised prolonged 72 hour fasting test where we can find out the blood glucose fluctuations and take samples for insulin and C peptide levels. By doing imaging studies like CT scan, MRI scan or specialized PET scan we can confirm the diagnosis and take further steps to treat it. Usually surgical removal is done as part of the treatment.Dietary adjustments including small frequent meals with high protein and fiber are recommended.

 Dr. Deepa G, MHSc (Diab), Dip (Diab)  

Experiencing fatigue after consuming a meal is common and often a typical response to digestion, particularly following a substantial meal. Tiredness post-meal can indicate reactive hypoglycemia, especially if it occurs within two to four hours after eating and is accompanied by additional symptoms.

Besides feeling sleepy, reactive hypoglycemia can bring on a range of other symptoms:

•    Shaky or trembling hands
•    Dizzy spells or feeling light-headed
•    Sweating or having clammy skin
•    Anxiety or nervousness kicking in
•    Irritability or confusion setting in
•    A racing heart or palpitations
•    Intense hunger or cravings for sweets
•    Blurry vision clouding your sight
•    Difficulty concentrating or experiencing brain fog

To confirm if reactive hypoglycemia is the culprit, it’s essential to check your blood glucose levels when these symptoms occur—typically during that 2–4-hour window—and note if they improve as your blood sugar normalizes.

Dr.Tittu Oommen, MD, DM  

When the level of glucose in our blood drops below 70 mg/dl, it is called hypoglycemia. The symptoms of Hypoglycemia usually depend on the level of blood sugar.

When blood sugar is between 60 – 70 mg/dl, we call it mild hypoglycemia. The early warning signs of mild hypoglycemia include shakiness or tremors, sweating, paleness, irritability or mood swings and fast heartbeat.

When blood sugar level is between 50 – 60 mg/dl, it is called moderate hypoglycemia. The warning signs of moderate hypoglycemia include dizziness or lightheadedness, confusion, blurred or double vision and weakness or fatigue.

When blood sugar level is below 50 mg/dl, it is called severe hypoglycemia. Severe hypoglycemia is a medical emergency. The warning signs of severe hypoglycemia are seizures, Loss of consciousness, coma and it may become fatal without treatment.

Why is Hypoglycemia considered as Dangerous?

•    A significant drop in blood sugar can impair mental and physical functioning.

•    If untreated, it can lead to seizures, unconsciousness, or death.

 Mrs. Soumya R Dharan

 Hypoglycemia is a condition where blood sugar (glucose) level is lower than the standard range (below 70 mg/dL). A timely and accurate diagnosis is essential to prevent complications, particularly in cases of unrecognized or recurrent hypoglycemia.

Hypoglycemia is often associated with diabetes. Hypoglycemia in diabetes is usually related to treatment. Non-Diabetic hypoglycemia must be investigated thoroughly.  It can arise from underlying disorders such as insulin overproduction, medication side effects or hormonal deficiencies.

Diagnosing hypoglycemia involves a combination of clinical evaluation and specific laboratory tests to determine the underlying cause and guide appropriate treatment.  The diagnostic tests help to differentiate between Insulin dependent or Insulin independent hypoglycemia and Iatrogenic hypoglycemia.

 Specific Diagnostic Tests for Hypoglycemia :

Blood sugar levels to determine the severity of hypoglycemia
•    <70 mg/dL: Low
•    <54 mg/dL: Severe Hypoglycemia

Critical Sample Collection

During a hypoglycemic episode blood should be drawn for Glucose, Insulin, C-peptide, Cortisol, Growth Hormone and Sulfonylurea/meglitinide screen when the corresponding RBS is <45 mg/dL.  This helps in confirming whether the disease conditions causing hypoglycemia can be due to Insulin dependent hypoglycemia, Insulin independent or Iatrogenic.
Investigations to determine the cause for hypoglycemia

I. Insulin dependent Hypoglycemia

1. C-peptide

• Measures the levels of C-peptide (the byproduct of insulin production)
• Low C-peptide can suggest exogenous insulin administration (eg: insulin injections)
• High C-peptide indicates endogenous insulin overproduction, such as in Insulinoma.

2. Insulin Levels :

Insulin levels are checked to assess whether the pancreas is overproducing insulin, which can be a cause of hypoglycemia.

3. Insulin Antibodies :

If the body is producing antibodies against insulin, it can lead to insulin-dependent hypoglycemia. Testing antibodies can help in the diagnosis.

II. Insulin independent Hypoglycemia

Tests for Cortisol levels, TFT (Thyroid Function Test) and GH (Growth Hormone) may be conducted to investigate the possibility of other endocrine disorders such as adrenal insufficiency, hypothyroidism and Growth Hormone deficiency.

III. Iatrogenic

Sulfonylurea/Megalitinide Screen :

These are medications that can cause hypoglycemia. A screen for these medications in the blood and urine helps identify if they are contributing to the low blood sugar.

The evaluation of hypoglycemia requires a strategic approach, integrating symptoms, history with biochemical tests. Proper timing of sample collection especially during a spontaneous or induced hypoglycemic episode is critical. Accurate diagnosis not only guides effective treatment but also prevents recurrent episodes and associated morbidity.

Mrs. Manju M J, Msc

It is very common for patients to approach doctors complaining of low blood sugar. It is essential to  understand two crucial information before you think that you have hypoglycemia ( or low blood glucose)

1. The common symptoms of low blood glucose are trembling, palpitations, sweating, anxiety, hunger, nausea and tingling.  If unattended, it may progress to confusion, weakness, drowsiness and vision changes.  So, just constant fatigue and exhaustion may not be symptoms of low blood glucose levels.

2. Although the fasting glucose for healthy adults is in the range of 70-100 mg/dl, most healthy adults may not feel any specific symptoms even if the glucose dips below 70 mg/dl. The healthy body has corrective mechanisms to keep it functioning normally.  However, when it goes below 55 mg/dl, people may start experiencing symptoms of hypoglycemia.

If you experience documented low glucose levels below 55 mg/dL, you should consult an endocrinologist. The tiredness and exhaustion that you have mentioned may be a sign of a different disease, and you should not attribute it to the blood glucose. You should meet a doctor to understand that.

Dr. Mathew John, MD, DM

Diabetes is diagnosed when the fasting blood sugar is more than 126mg/dL and post meal glucose level is more 200 mg/dL. FBS measures the glucose levels after 8-10 hours of fasting. It provides a baseline measurement of how much sugar is in your blood without the influence of food. It helps to assess whether you are suffering from prediabetes or diabetes. In some persons we see that FBS or the fasting sugar levels are found to be higher than the post-meal values. This can occur due to various reasons.

1. Can be due to high levels of glucose release from the liver at night which is a sign of insulin resistance.

2. If the person has taken very heavy meals that too late at night can also lead to higher FBS.

3. High levels of hormones including Cortisol, growth hormone at night can lead to higher FBS.

4. In some persons due to the effect of medicines, sugar levels can drop at night leading to a rebound effect causing higher fasting levels in the morning -This is termed as Somogyi effect.

5. In the early morning hours due to the influence of hormones released in our body, sugar levels can go up leading to higher fasting levels. This is termed as Dawn phenomenon.

6. In prediabetes condition termed as Impaired fasting glucose, the fasting blood sugar can go high ranging from 100 to 125 mg/dL. But their post meal sugar levels will remain normal.

7. The effect of certain medications like insulin and sulphonylurea drugs can cause low sugar levels at night leading to a rebound effect causing higher  fasting levels.

Hence if you find abnormality in FBS, consult your doctor and find out the reason for it. If you are already on diabetic medications you may need fine adjustments of it to avoid this problem.  

 Dr. Deepa G, MHSc (Diab), Dip (Diab)