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Stringent monitoring of blood glucose in diabetes plays an important role as the treatment of the disease itself. Blood glucose monitoring (BGM) strategies such as measurement of Hb1Ac, Self-Monitoring of Blood Glucose (SMBG) and Continuous Glucose Monitoring (CGM) plays a vital role in achieving the important goal of preventing long term complications of diabetes. Although the use of BGM is recommended by various international guidelines in T1DM and T2DM, there is no consensus on the utility of BGM in India. So, there is a need to develop a guidance for uniform monitoring mechanism among the care givers taking into account the variations and challenges that are unique to Indian population. A committee was established that comprised of physicians, researchers and other healthcare professionals having expertise in diabetes treatment to oversee the formulation of guidelines on different monitoring and treatment aspects of diabetes. Extensive literature searches were conducted to identify and analyze the evidence available on BGM. An initial draft of BGM guidelines was presented to core members who discussed the subject matter and presented their opinion. This was then taken to wider expert audience to invite their comments that were incorporated in the initial draft. The first compilation was presented at a conference attended by nearly 200 experts. Again, their opinion was sought and the next version was prepared which was sent to core committee members for the final inputs. The Indian consensus guideline on BGM using Hb1Ac, SMBG and CGM as the primary tools was then finalized.

The epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can substantially reduce morbidity have made the effective treatment of hyperglycemia a top priority. Despite compelling evidence that tight glycemic control is crucial for delaying disease progression, increased risk of hypoglycemia associated with such control underscore the complexity of diabetes management. In most cases, hypoglycemia results from an excess of insulin, either absolute or relative to the available glucose substrate and the factors perhaps exacerbating the risk are pharmacokinetic imperfections, behavioral, co-morbidities etc. Additionally, many patients remain undiagnosed, and many diagnosed patients are not treated appropriately. In this article, the challenges of hypoglycemia, confronting health care providers and their patients with diabetes, are discussed for making treatment decisions that will help minimize risk of hypoglycemia and eventually overcome formidable barriers to optimal diabetes management. Strategies to treat and minimize the frequency and severity of hypoglycemia without compromising on glycemic goals are also presented.

Background: Thyroid disorders have emerged as a common disease in India. Hence, it is pertinent to search the real reasons behind the high prevalence of thyroid disease in India, post salt iodization phase. Objective: This study was executed to unravel the nature of thyroid disorders and there associations with thyroid autoimmunity in the unexplored North east Indian region. Methods: This community based Cross sectional (pilot) survey involved 8 wards of Guwahati city, implementing the “cluster sampling technique”. Abnormal thyroid parameters were classified as Hypothyroid: serum T4 4.2) μIU/mL; Subclinical hypothyroidism (SCH): normal serum T4 (4.6-12 μg/dL) and TSH > 4.2 IU/mL, and Anti-TPO antibody positive: titre of ≥ 34 IU/ml. Results: Out of the 209 subjects enrolled, incidence of newly detected SCH, self reported hypothyroidism, and cumulative figure of the hypothyroidism cohort were higher amongst female population (27.84%, 14.43%, and 42.27% respectively). Significant association was found between female sex and hypothyroidism [Relative risk (RR) 1.73 (1.16-2.56), P Conclusion: A considerable percentage (33.01%) of the adult population in Guwahati city has some form of thyroid disorder. There is lack of evidence pointing out auto immunity being the major driver for primary hypothyroidism; hence we are left to reflect upon whether dietary iodine deficiency or being geographically located near to the sub-Himalayan goitrogenic belt, or frequent consumption of cyanogenic food stuffs, is cumulatively involved in thyroid disorder development.

Autoimmune polyglandular syndromes (APS) comprise a wide clinical spectrum of autoimmune disorders. APS is divided into Type I, Type II, Type I and Type IV depending upon the pattern of disease combination. Ghronic diarrhoea is one of the many manifestations of APS and many aetiological factors have been suggested for it. Apart from the established aetiological factors, intestinal lymphangiectasia may be responsible for chronic diarrhea in some cases.Intestinal lymphangiectasia has been reported in Type I APS. We report a case of Type III APS with hypocalcaemia and hypothyroidism who had chronic diarrhea of long duration and was finally diagnosed to have intestinal lymphangiectasia.

Dual ectopic thyroid is a rare presentation of thyroid ectopia. Only a few cases have been reported in the world literature. Dual ectopic thyroid in the presence of a normally located thyroid is even rarer. We report a case of dual ectopic thyroid in the lingual and submandibular areas in a seventeen-year-old female with hypoplastic thyroid gland in its normal location. The patient presented with a midline swelling at the base of tongue with dysphagia. Thyroid function test revealed primary hypothyroidism. Ultrasonography of the neck showed hypoplastic thyroid in its normal location. A thyroid scan with Technetium-99 m pertechnate showed two intensely hyperfunctioning foci of ectopic thyroid tissue at a higher level in the midline consistent with dual ectopic thyroid, one at the base of tongue and the other in submental region. No uptake was seen in the normal bed.

Disorders of thyroid hormone metabolism are commonly encountered in clinical practice. Apart from conditions affecting the thyroid gland, thyroid hormone homeostasis may be altered by medications used in varied clinical settings. Drugs may interfere at different steps in thyroid hormone synthesis or secretion leading to hypothyroidism or thyrotoxicosis or may cause changes in hormone binding leading to difficulties in the interpretation of thyroid function tests. These difficulties have been largely overcome by the development of improved diagnostic tools including radio-active uptake studies, estimation of thyroid auto-antibodies and highly sensitive hormone assays.