In India, vitamin D is generally dealt with at the level of primary health care practitioners, with a limited understanding of vitamin D replacement regimens. Often massive doses of vitamin D are administered parenterally (intramuscular) with doses as high as 1800 000 to 3600 000 units, administered over a 6-week period, risking life-threatening hypercalcemia and hypervitaminosis D.

The new class of drugs known as sodium-glucose co-transporter 2 (SGLT2) inhibitor (INVOKANA by Johnson and Johnson and FORXIGA by Astra Zeneca) have revolutionized the way we treat diabetes. They work by blocking the re-absorption of glucose by the kidney, increasing glucose excretion. Clinical trials for these drugs started in the early 1970's and their safety and effectiveness have been thoroughly evaluated.

In our experience they have show to reduce the insulin doses by approximately 33% and oral glucose lowering therapy by 50% additionally causing a weight loss between 2-4 kg over a 6 week period consistent with major clinical trials. Risk include fungal infection of the private areas that has forced stopping the drug in <1% of the population

With reference to the recent Times Of India article for these class of drugs, the recent reports of elevated ketones (acid) and warning by the FDA DOES NOT mean that the drug is harmful but needs monitoring in those people at RISK of a life threatening type of diabetes called Diabetic Ketoacidosis. This DOES NOT APPLY to most type 2 diabetics if they have been chosen and followed up well, as our practise takes pride in doing.