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Is this hit and trial approach the right way to control my high blood sugar?

Dr Karthiyayini

Dr Karthiyayini Mahadevan  |1146 Answers  |Ask -

General Physician - Answered on Jun 26, 2024

Dr Karthiyayini Mahadevan has been practising for 30 years.
She specialises in general medicine, child development and senior citizen care.
A graduate from Madurai Medical College, she has DNB training in paediatrics and a postgraduate degree in developmental neurology.
She has trained in Tai chi, eurythmy, Bothmer gymnastics, spacial dynamics and yoga.
She works with children with development difficulties at Sparrc Institute and is the head of wellness for senior citizens at Columbia Pacific Communities.... more
Asked by Anonymous - May 09, 2024Hindi
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I am 54 years M ,having Diabetes and High BP (HTN) since the past 13 years. At times it has been in poor control also like in May 2021 the HbA1c was 10.10 which gradually went down to 7.70 and then remained constant between 7.90 and 8.10 with the medications and 'not so strict' diet regime. Plus the body weight was also increasing and i gained around 10 kgs (101.2 Kgs) in a span of around 06 months. Recently in March 2024, the test reports indicated it as 8.70 causing me some concern and in April 2024 the reports showed a value of 9.20, which made me think about the reliablity of Lab report as well as made me change the doctor. My medicines were changed from Glimepiride (2 mg),Metformin (500 mg) Pioglitazone (15 mg) and METFORMIN-500MG + VILDAGLIPTIN-50MG twice daily ( taking for about 20 months) to GLIMEPIRIDE-2MG + METFORMIN-500MG + VOGLIBOSE-0.2MG and Dapagliflozin 5 mg+Metformin 500 mg twice daily recently in Mid April 2024. I was asked by the doctor to report after a month with Fasting and PP readings. However after few days,I started realising that my blood sugar was approaching higher and then I experienced needle like sensations in feet and hands plus sticky urine with a heavy head and hot face. I again went for a checkup three days back and the randomn sugar was 291 mg/dl. The medications have again been changed to Dapagliflozin (10mg) + Metformin (500mg) + Sitagliptin (100mg) + Saroglitazar (4mg) in the morning and METFORMIN-500MG + VILDAGLIPTIN-50MG since yesterday (08.05.2024) and I have been asked to take daily readings and report after 10 days. All this has lead to a panicky feeling in me, resulting in increased HTN. I am worried that how this hit and trial or permutations and combinations will help me in achieving a perfect set of medicines to lower my blood sugar to normal levels. Kindly advice. I shall be highly obliged.

Ans: Medicines alone cannot work in these Lifestyle diseases.
Lifestyle modification plays a vital role
So start with your dietary discipline. Strict no to Sugars and refined carbohydrates.
Have less portion of Carbohydrate in a complex form
Timely meals with early dinner before 7 pm
DISCLAIMER: The answer provided by rediffGURUS is for informational and general awareness purposes only. It is not a substitute for professional medical diagnosis or treatment.
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Asked by Anonymous - May 27, 2023Hindi
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Hello Doctor, I am 44. I was suffering from gastric issues Somewhere in Oct 2021, i started feeling anxious and all negative thoughts. As a nature, i take good care of self. But due to this anxiouness, i was unable to sleep well or even concentrate well. I thought to consult a MD and he took my BP reading, which was in range of 142/90. He avoided started any medications and advised for lifestyle changes to alter this situation, to which i stared with certain life-style changes like, - sun-bath in morning. - walking - morning & evening - meditation - in evening. i continued this till Dec 2021 and again revisited the MD in Jan 2022, to which he advised to continued with the same routine. By March 2022, i was feeling better. Again, the same story repeated in Sep2022 and this time, with lot of gastric issues, sleep troubel and feeling of fear and anxiety and again i visited him in Nov 2022, was getting more anxious. Looking at my condition he started with beta-blocker. The condition was not very much improving and i took the blood tests on my own in Nov 2022 end, to which, Lipid profile was bit out of range, HaB1c - in pre-diabetic zone and in liver tests - SGPT was 62. I visited to the MD with report and he advised me to continue with beta- blocker and to start with the statins daily 10 mg, after dinner. I continued this for Dec 2022 with life style change with yoga and meditation routines along with walks. In Jan 2023, the tests were repeated and it was all NORMAL. The doctor advised to stop the medicines wef Jan 2023 and again advised to repeated tests in Feb 2023. In Feb 2023, all parametere were normal , but Lipid profile was again out of range. The MD again started with the same medicines from March 2023 onwards ie 1 beta - blocker in morning after break-fast and 10 mg statin after dinner. I repeated the tests in April 2023 and it was again all NORMAL. Now, the MD reduced the statin drug to 5 mg from 10 mg and continued with beta - blocker. I am leading a healthy life with yoga, meditation, diets with more fibres and less oily or say no oil deits to the extent possible. I have stopped eating any outside food and fully on home made food only now. benefits till now, - Sleep paterrn improved - Gastric issues has gone - IBS gone, - better mood My questions to you sir, - The MD is again planning to stop the medications in next visit, since all reports are normal and i feel normal. is that okay? - Again, i may develop the symptoms? - I am following a better life style - yoga, meditation, walkings, proper diets, are there chances that i would remain off medicine always? - What are the benefits and disadvantages of station and beta -blockers, if at all, i have to take it? thanks.
Ans: Beta blockers have probably been prescribed for your symptoms of anxiety but they can increase the levels of the lipids. You need to consult a psychiatrist about the best treatment for anxiety.
Ideally statins need to be taken for long because the lipid levels are bound to go up once you stop the statin. We need to decide however whether you really need a statin at your age. Do you have a family history of premature heart disease. If you do not have a family history of premature heart disease, you can probably stop statins for a few years . Can consider doing a CT Coronary calcium score

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Dr Hemalata

Dr Hemalata Arora  | Answer  |Ask -

General Physician - Answered on Jun 07, 2023

Asked by Anonymous - Jun 01, 2023Hindi
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Hello Doctor, I am 44. I prefer healthy life and all nice in terms of health, except that I was suffering from gastric issues, IBS and related issues. I had covid also in April 2021 and somewhere in Oct 2021, i started feeling anxious and all negative thoughts. In about Aug 2021, i noticed that my heartbeats is high than normal, which initially i tried to control with routine meditation. But somehow, was not feeling that well from within and mind was like getting anxious, as if , something is happening which i could not understand, what. I visited to MD - Medicine, in Oct 2021. As a process, the vitals were taken and BP reading was taken which was 145/90. The concern MD, which after going through the reading, did not tagged me as BP patient and advised me to have changes in lifestyle with yoga, walking, meditation and dietary changes. I throughly followed the advised and started feeling better from Jan 2022 onwards and it was all nice. Again from Sep 2022 onwards, i started feeling the same issues. And i visited the MD in Oct 2022. From Nov 2022, he put me on 25mg dose of beta-blocker , daily in the morning after breakfast. While, i was on beta-blocker, i was still not feeling that nice from within and i unilaterly took the decision to go for complete blood tests in Nov 2022 end. The results were, - Lipid profile - was disturbed. - Sugar : I was in pre-diabetic range. - Uric Acid : I was on borderline high. I visited the MD with the report and he add another dose of 10 mg of Statins from Dec 2022 onwards. I followed the medication along with dietary changes, yoga & meditation routine and took the tests in Jan 2023, which shows the results as under, - Lipid : Normal - Sugar: I was back to Non-Diabtic range from pre-diabetic. - uric acid - normal. And all other parameters improved too like Hemoglobin - 15 and all other paramters of cbc was normal, thyroid - normal , Liver function - normal - when certain times SGPT was bit on higher sides, but normal in this report. With this report the MD stopped the statin drug from Feb 2022 onwards and advised me to continue with beta-blocker of 12.50 mg instead of 25 mg. I followed the same routine for full Feb 2022 and again took the test in March 2023, and results were as under, - Sugar : non-diabetic - all other paramters - normal - Lipid - Not normal. So again from March 2023, the MD started with the same statin dose of 10 mg and beta- blocker of 25 mg. I took the test in April 2023 and again the reports were normal, so now, again he reduce the statin dose to half ie 5 mg and continued with the same dose of beta-blocker 25mg. My questions: 1. AT present, i follow proper diet schedule as prescribed by dietcian , have been doing meditation and yoga on regular basis. 2. Stress level is minimum. 3. I am feeling overall better. 4. BP levels are always normal 5. Gastric issues, IBS seems to have gone. 6. Sleep patern is improved. My question: a. I feel, in the next visit the MD may stop the statin. Can the lipid profile remain in normal range , when i am follwing all diet patterms , with yoga and exercise. Why the lipid profile became abnormal, previously even when i was following all routine very property ? b. Is it okay to consume beta - blocker 25mg regularly, even after doctor told me to stop statin or may stop my statin in next visit? c. Is there any way to know, to find, if i am feeling better normally or due to medicine? as i am feeling normal and unable to check, what after i stopped beta-blocker? Any other care which i should take and lead a healthy life.
Ans: Hello. These are good questions and a lot of people go through the same stages. Cholesterol levels are generally genetically determined and don't change much from dietary or lifestyle changes. It can be reduced by medications. However if it is the only risk factor for heart disease/stroke, then it need not be corrected unless it is very high, LDL> 160. On the other hand the B blocker, if it was taken only for BP, may be stopped if BP comes down and remains normal. A closer monitoring may be required for that. If BP stays normal or low on taking the medicine, reduce the medicine and recheck, if it still stays low or normal, stop and see. Take it slow.

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Dr Chandrakant

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Ramalingam

Ramalingam Kalirajan  |7213 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Dec 06, 2024

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Planning to start an SIP of 15K with HSBC Multicap fund Regular growth. Is it a gooddecision?
Ans: Starting an SIP of Rs 15,000 monthly is a disciplined investment step. The choice of a multicap fund reflects a willingness to diversify. Let's analyse this decision comprehensively.

Multicap Funds: Key Features
Diversified Portfolio: Multicap funds invest across large-cap, mid-cap, and small-cap stocks. This balances growth potential and stability.

Flexibility: Fund managers can dynamically adjust allocations across market segments based on market trends.

Long-Term Potential: Multicap funds aim for consistent returns over 7–10 years or longer.

Risk Factor: Multicap funds carry higher risk compared to pure large-cap funds. They are not suitable for short-term goals.

Evaluating Regular Growth Option
Reinvestment Advantage: The regular growth option helps in reinvesting gains for compounding over time.

No Payouts: Unlike dividend options, there are no regular payouts, which suits long-term wealth creation.

Tax Efficiency: Growth options are more tax-efficient as gains are realised only on redemption.

Benefits of Investing Through a Certified Financial Planner
Expert Guidance: A Certified Financial Planner ensures your fund aligns with your risk tolerance and goals.

Portfolio Monitoring: They help monitor and rebalance the portfolio periodically.

Benefits of Regular Plans: Investing through regular plans gives access to expert advice without additional effort.

Alternatives to Consider
While multicap funds are good, actively managed equity funds may also suit your needs.

Mid-Cap Funds: Offer higher growth potential but with greater risk. Suitable if your risk appetite is high.

Hybrid Funds: Provide a balanced mix of equity and debt, reducing volatility.

Diversified International Funds: Offer exposure to global markets and hedge against domestic market risks.

Key Considerations Before Investing
Investment Horizon: Multicap funds are ideal for long-term goals of 7+ years.

Risk Tolerance: These funds involve exposure to mid- and small-cap stocks, which are volatile.

Review Fund Performance: Assess the fund's past performance over 5–10 years. Look for consistent returns and robust fund management.

SIP as a Long-Term Strategy: SIPs mitigate market volatility by averaging the cost of investments over time.

Rebalancing Your Overall Portfolio
If this SIP is part of a larger portfolio, ensure it complements your existing asset allocation.

Equity-Debt Mix: Maintain a balance between equity and fixed-income investments based on your age and risk profile.

Diversify Across Fund Categories: Avoid overexposure to one type of fund or sector.

Emergency Fund First: Ensure your emergency fund is sufficient before committing to long-term SIPs.

Tax Implications
Equity Funds: Gains above Rs 1.25 lakh are taxed at 12.5% (LTCG). Short-term gains are taxed at 20%.

Regular Portfolio Reviews: Assess gains periodically and plan redemptions to minimise tax liability.

Steps to Enhance Returns
Increase SIP Amounts Over Time: Increase SIP contributions with salary hikes or surplus cash inflow.

Avoid Redeeming Early: Stay invested for the long term to allow compounding to work effectively.

Use STP for Lump Sum Investments: If you have additional funds, consider a Systematic Transfer Plan (STP) to mitigate timing risks.

Final Insights
Starting an SIP in a multicap fund is a promising move for long-term wealth creation. Ensure this investment aligns with your goals and complements your existing portfolio. Regularly review performance and rebalance when needed. Work with a Certified Financial Planner for ongoing advice and insights.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,
www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment

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Ramalingam

Ramalingam Kalirajan  |7213 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Dec 06, 2024

Asked by Anonymous - Dec 01, 2024Hindi
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I am 40, a single parent with 2 daughters aged 2 and 1. I have following assets that i have accumulated over my employment 1. 1.6 Cr in Indian equity 2. 60L in indian MFs 3. 2 Cr in EPF 4. 72L in PPF 5. 12L in NPS 6. 51 L in SGBs 7. 72L in Gold/diamond jewellery 8. 5Cr in company stocks. These are from the 2 employers i have worked for, almost equally distributed and are mostly vested (trading publicly) 9. Real estate - 3 houses worth 8.7 Cr. Primary house is 6 Cr 10. I have 4 term insurance schemed running, in around 7 years, they will start generating an average income of 60L annually till 2043 11. 60L in Bank/FDs 12. 8L in SSYs for girls While i feel i am doing well, at times with hugely inflation in medical and education fees, i feel its just so hard to estimate what will i need to plan for when my children are ready to go to college in 16 odd years. I keep on hearing mind boggling college fees from my friends, so an approx assessment of education corpus will help. Also i feel keeping equity in single stock as in case with my 2 employers is highly risky, so any suggestion on how to systematically withdraw and invest elsewhere will help. Also looking at my portfolio, do you have any rebalancing advice. I am planning to work as long as possible so have another 18 to 20 years of work life left but given the volatile job market nowadays, want to be mentally and financially prepared
Ans: The cost of education, especially higher education, has been rising significantly. Assuming a 16-year horizon for your daughters, we need to estimate the corpus required for both domestic and international education.

Domestic Education Costs: Presently, premier institutions in India charge around Rs 25–50 lakh for undergraduate courses. Factoring an annual inflation of 8–10%, this amount may grow to Rs 1.5–2 crore per child for a 4-year course.

International Education Costs: For studies abroad, current fees range between Rs 1–2 crore for undergraduate programs. Adjusted for inflation, this could increase to Rs 3–5 crore per child in 16 years.

Considering both scenarios, you should aim for a total education corpus of Rs 6–8 crore. This amount provides flexibility for either domestic or international options.

Recommendations for Your Employer Stock Holdings
Your company stocks form a significant portion of your portfolio (Rs 5 crore). Holding large amounts in single stocks increases risk. Here's how to diversify systematically:

Gradual Divestment Plan: Avoid selling all shares at once. Instead, divest 10–15% annually over the next 5–7 years.

Reinvest in Diversified Assets: Allocate the proceeds into actively managed equity mutual funds, fixed-income instruments, and sovereign gold bonds. This ensures diversification across asset classes.

Tax Considerations: Plan divestment to optimise tax liabilities. Gains from these stocks may be subject to long-term capital gains (LTCG) tax at 12.5% after Rs 1.25 lakh.

Portfolio Rebalancing Advice
Your portfolio shows strong accumulation across multiple asset classes. However, rebalancing is necessary to manage risks and align with goals.

Asset Allocation Overview
Equity Investments:

You have Rs 1.6 crore in Indian equities and Rs 60 lakh in mutual funds. Including Rs 5 crore in employer stocks, equity dominates your portfolio.
Gradually reduce exposure to individual stocks and shift to actively managed equity mutual funds.
Fixed Income Investments:

Your EPF (Rs 2 crore), PPF (Rs 72 lakh), and NPS (Rs 12 lakh) provide stable, low-risk returns.
Keep these investments as a core part of your portfolio to ensure stability.
Precious Metals:

You have Rs 72 lakh in gold/diamond jewellery and Rs 51 lakh in sovereign gold bonds.
Jewellery has sentimental value but does not generate returns. Focus on financial gold like SGBs.
Real Estate:

Your real estate portfolio (Rs 8.7 crore) is substantial, with Rs 6 crore in your primary home.
Avoid adding further real estate investments due to low liquidity and high maintenance costs.
Cash and Bank Deposits:

Rs 60 lakh in FDs and Rs 8 lakh in SSYs are good for short-term needs and children's savings.
Suggested Reallocation Strategy
Increase Mutual Fund Investments:

Channel proceeds from employer stocks into equity mutual funds. Use SIPs or STPs for a gradual investment approach.
Actively managed mutual funds offer better returns and professional management.
Diversify into Balanced Assets:

Allocate a portion of your equity proceeds into balanced advantage or hybrid mutual funds.
These funds reduce risk and provide moderate growth.
Build an International Equity Portfolio:

Explore international equity funds to benefit from global diversification.
Strengthen Fixed Income Investments:

Invest in high-quality corporate bonds or debt mutual funds for additional stability.
Emergency Fund Allocation:

Ensure you have at least Rs 30–50 lakh as an emergency fund in liquid instruments like ultra-short-term debt funds.
Optimise SSY Contributions:

Continue annual contributions to the Sukanya Samriddhi Yojana (SSY) for tax-free growth.
Planning for Income Stability
You plan to work for 18–20 more years, but the volatile job market can be unpredictable.

Term Insurance Payouts:

In 7 years, your term plans will generate Rs 60 lakh annually till 2043.
Use these payouts to fund living expenses and reinvest the surplus for long-term goals.
Passive Income Generation:

Consider creating a passive income stream through investments in dividend-paying mutual funds.
Avoid single stocks for dividends as they are riskier compared to mutual funds.
Retirement Corpus Growth:

Your EPF and PPF are excellent retirement tools. Avoid withdrawals to maximise compounding benefits.
Additional Financial Goals
Healthcare Planning:

Rising medical costs make comprehensive health insurance essential.
Ensure sufficient health coverage for yourself and your daughters.
Estate Planning:

Create a will to safeguard your assets for your daughters.
Consider setting up a trust for seamless asset transfer.
Tax-Efficient Withdrawals:

Use tax-saving strategies while withdrawing from investments. Consult a Certified Financial Planner for guidance.
Some Final Insights
Your portfolio is well-diversified across asset classes, but equity exposure to single stocks poses risks.
Focus on systematically reallocating from employer stocks to actively managed mutual funds.
Aim for a robust education corpus of Rs 6–8 crore to meet your daughters' future needs.
Strengthen your financial plan with proper healthcare coverage and estate planning.
Regularly review and rebalance your portfolio to ensure alignment with goals.
Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,
www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment

...Read more

Ramalingam

Ramalingam Kalirajan  |7213 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Dec 06, 2024

Asked by Anonymous - Nov 27, 2024Hindi
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I am 62 and planning to retire. I have a corpus of 1.25 crore and need around Rs 75000 every month for expenses. What are the various avenues where I can invest and would fetch me the desired amount?
Ans: Retirement planning is crucial, especially when the goal is financial independence. Your corpus of Rs 1.25 crore and monthly need of Rs 75,000 require careful investment. The objective is to ensure the corpus lasts while meeting your expenses. Diversifying investments and balancing returns with risks is essential.

1. Emergency Fund Allocation

Allocate Rs 10 lakh to an emergency fund.
Invest this in liquid funds or high-interest savings accounts.
Ensure funds are accessible during emergencies.
2. Monthly Income Requirement Analysis

Your monthly need is Rs 75,000, or Rs 9 lakh annually.
This is around 7.2% of your total corpus.
Investments must generate this return without eroding the principal.
3. Systematic Withdrawal Through Debt Mutual Funds

Debt mutual funds provide stability and moderate returns.
They suit investors seeking steady cash flow.
Withdraw monthly using a systematic withdrawal plan.
Taxation Perspective

Gains from debt funds are taxed per your income slab.
Plan withdrawals efficiently to minimise tax.
4. Balanced Funds for Growth and Stability

Balanced funds invest in both equity and debt.
These offer potential growth and regular income.
They reduce risk while ensuring inflation-beating returns.
Why Avoid Index Funds?

Index funds lack flexibility in stock selection.
Actively managed funds provide better downside protection.
Fund managers can outperform during market fluctuations.
5. Actively Managed Equity Mutual Funds for Growth

Equity mutual funds can provide higher returns over time.
Opt for diversified funds managed by experienced professionals.
Use regular plans through mutual fund distributors with CFP credentials.
Why Choose Regular Funds?

Certified financial planners offer valuable guidance.
They assist in selecting funds tailored to your goals.
Direct funds lack this personalised support and expertise.
6. Fixed Income Options for Stability

Invest a portion in fixed deposits with reliable banks.
Senior Citizen Savings Schemes (SCSS) offer regular income.
Explore RBI floating-rate bonds for assured returns.
Benefits of Fixed Income Options

Low risk ensures stability.
These options supplement your core investment strategy.
7. Diversified Investment Portfolio

Allocate across equity, debt, and fixed income.
Diversification reduces risks and maximises returns.
Maintain liquidity for unplanned expenses.
8. Inflation Protection

Inflation erodes purchasing power over time.
Allocate 40–50% of your corpus to equity for growth.
Adjust allocations annually to maintain balance.
9. Periodic Portfolio Review

Review your investments every six months.
Adjust based on market conditions and life changes.
A Certified Financial Planner can guide these reviews.
10. Avoid Insurance-Cum-Investment Plans

If holding LIC or ULIP, consider surrendering them.
Reinvest proceeds into mutual funds for better growth.
Separate insurance and investment for clarity.
11. Health Insurance

Comprehensive health insurance is critical in retirement.
Avoid relying on savings for medical emergencies.
Ensure coverage meets inflation-adjusted medical costs.
12. Tax Planning and Efficiency

Structure investments to minimise tax outgo.
Utilise senior citizen exemptions and deductions wisely.
Keep track of the latest tax rules for financial decisions.
13. Creating a Will

Draft a clear and legally valid will.
Specify asset distribution to avoid future disputes.
Periodically update it as per life events.
Final Insights

Retirement planning is about ensuring financial independence and peace of mind. A diversified investment portfolio is key to balancing returns and stability. With disciplined management and regular reviews, your corpus can sustain your needs throughout retirement.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,
www.holisticinvestment.in
https://www.youtube.com/@HolisticInvestment

...Read more

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Investment in securities market are subject to market risks. Read all the related document carefully before investing. The securities quoted are for illustration only and are not recommendatory. Users are advised to pursue the information provided by the rediffGURU only as a source of information and as a point of reference and to rely on their own judgement when making a decision. RediffGURUS is an intermediary as per India's Information Technology Act.

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