In terminal illness careful control to avoid long-term complications is not required. Management of diabetes during terminal illness will not only depend on the type of diabetes, but also on prognosis, oral intake and the presence of co-existing disease such as renal and hepatic impairment. All dietary restrictions relating to diabetes are removed from the early stage of terminal illness. In both T1DM and T2DM, glucose monitoring should be reduced to an acceptable minimum. In the case of a patient treated with insulin, this may be 2–3 times per week and for a patient treated with oral agent’s blood glucose could be monitored 1–2 times per week., only in case of special situation frequent monitoring is advisable. This may include: hypoglycaemia, poor food intake, nausea and vomiting, enteral or parenteral feeding or corticosteroid use. The clear aim is to avoid hypoglycaemia and osmotic symptoms, so the recommendations suggest a target blood glucose range between 10 and 15 mmol/l in the early stage of terminal illness with a more liberal range of 5–20 mmol/l in the later stages. Subsequently there are no agreed, evidence-based strategies to manage diabetes at the end of life or during terminal illness. Therefore, in this review I will try to uncover some of the challenges and discuss the available guidelines associated with managing diabetes at the end of life and terminal illness from the available scientific evidence.

Background: Osteoporosis, an important cause of fracture in Bangladesh is a highly unrecognized and unaddressed issue among health professionals. Osteoporosis means low bone mineral density (BMD) and screening is not done routinely to diagnose it. Moreover, the prevalence of low BMD among Health professionals in the country is not well known. To prevent osteoporosis-induced fracture it demands more attention to early detection, prevention, and treatment. Objectives: The present study was carried out to assess the bone mineral status of health professionals of Cox’s Bazar medical college and also to find out the correlation with age, sex, Vitamin D, calcium supplementation, and physical activity by using quantitative ultrasound (QUS) of the calcaneus. Materials and Method: This is a descriptive, cross-sectional study that has been done at Cox’s Bazar Medical College. Result: The total number of participants was 267 which were screened by using a calcaneal ultrasound heel bone densitometer. Among them 190 were female and 77 were male. The majority of the health professionals 237(88.76%) were below 45 years. Mostly, 194(72.66%) participants had normal BMD, 73(27.34%) participants were in osteopenia and none of them were osteoporotic. Among those above 45 years old study people, nearly half 14(46.67%) were osteopenic, and for ages below 45 years of health professionals, only 59(24.89%) were osteopenic. Out of 77 male participants, 15(19.48%) were osteopenic and out of 190 female participants, 58(30.53%) were osteopenic. Out of the total 267 study people, 81(30.34%) agreed to take calcium and vitamin-D supplementation with significant p-value = 0.003 whereas 32(39.51%) participants were in the osteopenic stage and 49(60.49%) had healthy bony status. The number of using Calcium and vitamin-D supplementation was high, which may be due to positive answers from particular participants like the elderly and health care supporting staff. In our study 120(44.94%) participants did exercise but mostly irregularly, and 147(55.06%) did not do exercise. Out of 120(44.94%) participants doing regular exercise 37(30.83%) were osteopenic and the rest of 83 (69.17%) health professionals were in normal BMD. Conclusion: Among the health care professionals, osteopenia is not uncommon and regular exercise practice and rational Calcium and vitamin-D supplementation may be preventive for osteoporosis. J MEDICINE 2023; 24(2): 131-134

Evidence of a bidirectional relationship between depression and diabetes has recently been documented in large prospective studies. Comorbid depression is associated with an increased risk of poor glycemic control, diabetes complications and mortality. Moreover, incident diabetes has also been found to be risk factors for subsequent development of depressive episodes. Furthermore, in a recent systematic review, depression is associated with the subsequent development of T2DM by up to 37% as it causes central obesity, increased release of circulating corticosteroid hormone (which antagonizes the action of insulin) and insulin resistance that is a more common etiological pathway for the development of T2DM. Subsequently, the presence of depression with diabetes has a severe impact for self-care management and long term outcome which includes long term disturbance of mood. Therefore, the purpose of this review is to explain the bidirectional relationship between diabetes and depression and explore the management options that are advocated to enhance the Diabetes self-management education and improve the quality of life for diabetic patients with depression Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 50-54

Background: Hypoglycemia is the commonest medical emergency in diabetic patients. It is also the most important limiting factor in intensive control of diabetes. To find out the frequency of hypoglycemia in Medical Emergency of BIRDEM General Hospital. Materials and methods: This cross sectional observational study was done at the Medical Emergency Department of BIRDEM General Hospital, Dhaka, during the period of March, 2015 to November, 2015. Among the patients attending the emergency department, hypoglycemic patients were identified. Socio-demographic, clinical and biochemical data was collected from these patients. Statistical analysis was done with SPSS version 23.0. Results: Among the 20564 patients attending the medical emergency department in the specified time period, 577 (2.8%) patients had hypoglycemia. More than half (50.09%) patients were found mild impairment of consciousness (GCS >12). Conclusion: The present study found that frequency of hypoglycemia in patients attending in Medical Emergency Department of BIRDEM General Hospital was 2.80%. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 8-11