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Diabetics consult doctors before fasting during Ramadan to adjust medications and monitor blood sugar levels : experts

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Diabetics consult doctors before fasting during Ramadan to adjust medications and monitor blood sugar levels : experts


Experts urge to undergo a pre-fasting blood sugar evaluation before starting Ramadan | Image used for representational purpose only
| Photo Credit: Getty Images

The ongoing Ramadan season is an auspicious time when Muslims fast through the day and break it only after sunset. They have an early breakfast, before dawn and dinner post-sunset. 

For people with diabetes who undertake the fast doctors have some tips: they must get tested before the start of the fasting period. This will enable doctors to advise them on the medication during fasting. Diabetologists say the dosage recommendation is on a case-to-case basis.  

Pre-fasting evaluation and recognising symptoms

Patients must undergo evaluations of their blood sugar levels prior to the start of fasting season. Around 20%-30% of diabetics require insulin thrice a day, said A. Panneerselvam, a senior diabetologist in Chennai.  

“Those who take two doses of insulin or tablets can continue, even if timings vary. But those on medication in the afternoons as well, should skip the dose if they are fasting. Insulin should be administered 30 minutes before food, in the morning and evening,” he said, adding, “Any uneasiness should make them suspect drop in sugar level. People should check their sugar levels using glucometer. They must reduce the dosage if they experience sweating in the afternoon.” 

People with good control of their blood sugar before Ramadan may sail through the period. If they experience slight palpitation they may reduce their morning dose by half, he suggested. “In case of alarming signs patients should consult their concerned doctor,” he said.

Seeking medical care

A. Shanmugam, a senior consultant diabetologist, said, “We are here to help to have a safe fasting period and let them complete the fasting successfully. We give special prescriptions to be followed during Ramadan. “

He also emphasised maintaining adequate hydration and selection of specific foods during non-fasting hours (in between ifthar (in the evening) and suhur (in the morning), particularly rich in fibres and avoiding fried and sugar rich foods will help the patients complete the fasting without becoming hypoglycaemic or hyperglycaemic.  

Prolonged fasting not advised for high-risk groups

People should be educated about symptoms of hypoglycaemia such as excessive sweating, giddiness, jitters and tremors. “They must be educated regarding treatment of hypoglycaemia as well,”Dr. Shanmugam said. 

Vijay Viswanathan, head and chief diabetologist at MV Hospital for Diabetes in Royapuram, said,  “Those prone for hypoglycaemia, persons with uncontrolled diabetes with HbA1c above 9; persons on multiple doses of insulin (basal + 3 bolus) and those with chronic kidney disease, those whose eGFR (estimated glomerular filtration rate) is below 30, persons with a history of heart failure or infections such as tuberculosis, should avoid fasting.”

Though generally doctors do not interfere with their patients’ decision on fasting these high-risk groups should avoid prolonged fasting.



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Sonia Dasgupta: A Queen’s Gambit Approach To Business – Forbes India

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Sonia Dasgupta: A Queen’s Gambit Approach To Business – Forbes India


Sonia Dasgupta, Managing director and CEO, Investment Banking, JM Financial
Image: Mexy Xavier

 

The Queen’s Gambit as a strategy is a calculated risk that provides a chess player with a competitive edge. For Sonia Dasgupta, managing director and CEO, investment banking, JM Financial, it isn’t just a move but her entire approach to business. In a career spanning almost 30 years, she has consistently shown her ability to make daring moves and drive growth in the face of uncertainty.

Dasgupta has been a pivotal force in driving the success of JM Financial’s investment banking division, which she has been heading since April 2022. Under her leadership, the company has achieved milestones, including groundbreaking transactions. She has held key leadership positions at the company, including head of FIG (financial institution group) coverage, head of M&A origination, and head of group borrowings.

Sanjiv Bajaj, chairman and managing director, Bajaj Finserv, says, “I have had the pleasure of working with Dasgupta for over two decades across numerous fundraising and M&A deals. With her vast experience, she is able to structure deals with a clear customer focus.” He adds that she works with passion, looking for the best outcomes from every deal. “She has an excellent acumen and leads with clarity and conviction, making her an effective leader. She is a believer in building lasting relationships and I am confident she will take her firm to greater heights, providing inspiration to others.”

Born and raised in Mumbai, Dasgupta was part of a family of six siblings where education and intellectual pursuits were valued. Her mother, a homemaker and a writer of Hindi literature, and her father, a lawyer with a strong emphasis on academics, instilled in her a deep respect for knowledge and learning, she says.

“There was no differentiation in the academic ask from the boys and girls. The soft conditioning was that engineering was not a career path for women, even though gender equality was a conditioning in the family,” Dasgupta says.

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But when she failed to get into her dream passion medicine despite being a class topper, her love for math and her adaptability led her to a new path. She completed her graduation in economics from St Xavier’s followed by an MBA from IIM-Ahmedabad.

Even as she was doing her MBA, the year 1994 marked a turning point for her.  It was a time when the Indian capital markets were opening up to foreign institutional investors (FIIs), transforming the landscape. She joined JM Financial soon after, in 1995.

Dasgupta recounts her first boss and mentor, veteran investment banker Nimesh Kampani (chairman of JM Financial Group), never differentiated between the genders for the M&A deals. “It was so similar to how I was brought up,” Dasgupta says.

Also read: It’s important to think about human impact; it’s not only about buying and selling bonds: Franklin Templeton’s Sonal Desai

But she feels fortunate to have had several senior women leaders as role models, including Radhika Haribhakti (a banking veteran formerly at JM Morgan Stanley and from IIM-Ahmedabad), and Dipti Neelakantan (former group COO, JM Financial).

It’s important for women to find their way up, she says. “If they are not there at the mid-level jobs, they are not in the reckoning for the senior jobs. They do not hang in there [enough]. Women need to find their role models and build self-confidence from within,” she says.

 JM Financial’s ECM (equity capital market) closed 42 deals cumulatively raising approximately ₹88,996 crore in 2024. Under Dasgupta’s leadership, the ECM team advised on a wide range of transactions, initial public offerings, follow-on public offers, rights issues, and qualified institutional placements.

The year was strong for JM Financial in M&A and PE transactions with 17 deals worth over ₹41,800 crore across various sectors. It advised Shriram Finance and other shareholders on the sale of Shriram Housing Finance to Warburg Pincus, marking the largest all-cash buyout transaction in the affordable housing segment.

It also advised Advanta on its fundraise from Alpha Wave, which was the largest PE fundraise in the agri & allied space in India. JM Financial advised SeQuent Scientific on its merger with Viyash Lifesciences and its subsidiaries, creating a unique platform with a leadership position in the Animal Healthcare space. It was involved in advising JSW Infra on its acquisition of Navkar Corp, enabling the company to foray into logistics and other value-added services.

 Going ahead, Dasgupta says the focus on 2025 will be to retain talent and expand the investment banking team at JM Financial. For 2025, she has set a strong growth target of her business segment at JM Financial.

The group also hopes to grow its large and mid-cap corporate clientele by five times to 2,000 in the next seven years, Vishal Kampani, the non-executive vice chairman of the group, has said, betting big on the financial and structured credit businesses.

Dasgupta is confident India is the place to invest. “In the last two to three years, private equity investors have done so many exits from Indian companies that they realised this is a country where they can invest and also make money,” she says. She is expecting larger M&A transactions and ECM deals across sectors such as renewables, financial services, auto, auto components, industrials and consumer health care.

(This story appears in the 18 April, 2025 issue
of Forbes India. To visit our Archives, click here.)



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The Mosquito Effect: how malarial chaos influenced human history

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The Mosquito Effect: how malarial chaos influenced human history


April 25 has been recognised globally by the World Health Organization (WHO) as World Malaria Day (previously African Malaria Day), since 2006 to highlight the need for continued investment and innovation. The “butterfly effect” from chaos theory might result in a Tornado, but the “mosquito effect” (through the parasite it carries) has fundamentally altered human migration patterns, enabling European colonisation and reshaping the geopolitical landscape of entire continents. The mosquito, a seemingly insignificant insect, wielded astonishing power and profoundly altered human civilisation. Malaria, derived from the Italian “mala aria,” meaning “bad air”, is a saga of discovery, colonisation, human suffering and scientific breakthroughs.

Miasma to parasite

Before modern science unravelled malaria’s secrets, people believed it was caused by miasma—poisonous air emanating from marshes. It wasn’t until 1880 that the French military doctor Alphonse Laveran observed the malaria parasite from the blood of soldiers who had succumbed to fever in Algeria. However, identifying the parasite was just the first puzzle; the full picture of malaria’s transmission remained elusive. In 1885-86, Camillo Golgi and Angelo Celli demonstrated the cyclical nature of the fever in relation to the parasite. In 1892, Ettore Marchiafava further characterised the five species of the parasite, distinguishing Plasmodium falciparum from others. Of notable mention is Patrick Manson, often regarded as the ‘father of tropical medicine,’ who first established the role of mosquitoes in disease transmission with filariasis and later mentored Ronald Ross. In 1894, Manson hypothesised that mosquitoes could transmit malaria, too. Ross, inspired by Manson’s theory, identified the parasite in the gut of the Anopheles mosquito after studying avian malaria in birds in 1897. His breakthrough paved the way for understanding human disease. Giovanni Battista Grassi made significant contributions by linking human malaria to the female Anopheles mosquito in 1898. By 1898, the complete transmission cycle of malaria was scientifically understood.

Before these discoveries, European colonial efforts in Africa were severely constrained by extraordinarily high mortality rates. In coastal African colonial trade posts, European troop mortality averaged 500 deaths per 1,000 soldiers annually in the 1800s, with those venturing inland facing even worse prospects of up to 60% mortality. In 1865, a British parliamentary committee recommended withdrawing from West Africa altogether due to disease threats. When the Gold Coast (modern Ghana) became a colony in 1874, the first three candidates declined the governor’s position due to “health concerns”, and the fourth died of malaria within a month of taking office. Consequently, until 1870, European powers controlled only 10% of the African continent, with settlements primarily restricted to coastal areas. Africa was known as “the white man’s grave,” a place where European colonial ambitions perished.

The correlation between understanding malaria and colonial expansion is striking. As scientists decoded malaria’s mysteries between 1880 and 1900, European powers dramatically expanded their control across Africa. Following the 1884 Berlin Conference, which regulated European colonisation and trade in Africa, the “Scramble for Africa” accelerated rapidly. By 1914, European powers had seized control of nearly 90% of the continent, with only Liberia, Ethiopia, and a few more maintaining independence. This was no coincidence. With knowledge about malaria transmission, colonial administrators implemented targeted prevention strategies for European settlements: draining mosquito-breeding swamps, establishing segregated European quarters, and creating hill stations at higher elevations with fewer mosquitoes. Scientific findings about malaria transmission quickly percolated into colonial policy. By 1901, the British adopted a policy of segregated living based on new knowledge about Anopheles mosquitoes and the racist perception of Africans as disease reservoirs.

Scramble for Africa

King Leopold II of Belgium epitomised this exploitation in the brutal colonisation of the Congo. Equipped with quinine, mosquito nets, and a scientific understanding of malaria, European troops subdued resistance and established lucrative colonies. Quinine, derived from the bark of the Cinchona tree, was discovered during Portuguese conquests in South America. Its use post-1880s was guided by scientific understanding. But, the success of colonizing Africa was not purely biological. Innovations and technology to build railroads, steamships, enhanced rifles, and telegraphs helped navigate and control vast territories. But, knowledge about malaria transmission was the “keystone technology”. It neutralised nature’s deadliest resistance, allowing soldiers to survive and civil servants to administer colonial machinery.

The impact of malaria extended beyond Africa. In the trans-Atlantic slave trade, Africans with a natural genetic resistance to malaria were preferred labour in malaria-infested regions like the Caribbean and the Americas. Consequently, they were traded at higher prices than European labourers, who succumbed to the disease. It created a racialised labour economy, the aftershocks of which echo even today. The modern racial tensions in American and European societies bear this genetic legacy. The valuation of African bodies not only established brutal slavery systems but also seeded pseudo-scientific justifications for racial superiority. Thus, malaria contributed to the present long-standing racial prejudices and social structures.

Malaria today

With quinine as a base, more refined drugs like chloroquine and artemisinin followed. Insecticide-treated bed nets and indoor spraying revolutionised prevention. Today, the malaria vaccine RTS,S brings new hope, though challenges persist. Malaria remains treatable, but Africa still shoulders 94% of the global burdens (as per the WHO World Malaria Report 2024). Beyond medicine, malaria is increasingly considered in modern environmental impact assessments. Deforestation, water stagnation, and climate change influence mosquito habitats, making disease control part of ecological planning.

While colonial empires have dissolved, malaria’s grip remains strong, particularly in Africa. Today, malaria continues to afflict approximately 263 million people annually, killing over 600,000, with Africa reporting 95% of the mortality. Although the death toll has decreased substantially, in absolute numbers, malaria remains a major public health challenge. The history of the discovery of malaria transmission is a powerful reminder that scientific breakthroughs can have complex and contradictory impacts. The discoveries that eventually saved millions of lives also enabled colonial exploitation. Knowledge intended to heal the troops was wielded to subjugate the natives.

(Dr. C. Aravinda is an academic and public health physician. The views expressed are personal. aravindaaiimsjr10@hotmail.com)



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More than a smile: why orthodontic care for students is imperative

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More than a smile: why orthodontic care for students is imperative


Symbol of health: Orthodontic interventions often lies outside the scope of conventional insurance and welfare coverage, placing it beyond the reach of many families, especially in rural areas. Hence, the Virudhunagar
district administration adopted a collaborative approach towards handling the problem.
| Photo Credit: SPECIAL ARRANGEMENT

It began on what seemed like an ordinary day: just another school inspection, a few conversations, and a few observations. And then, a moment. A young girl, head slightly bowed, kept her hand over her mouth, as if trying to disappear. When I gently called her forward, I saw what she was trying to hide: severely protruding teeth. But more than her dental condition, it was her silence that struck me: the quiet language of self-consciousness, of a child trying not to be seen.

That image stayed with me. It brought back a personal memory: my younger brother, once painfully shy, bore the same condition. My father, with modest means, took a small loan to get him treated. The transformation was dramatic not only in his appearance but also in his confidence, expression, and outlook on life. That’s when the question began to take shape: why do we often view orthodontic care as a cosmetic consideration, when it holds deeper functional and psychological relevance?

Not only aesthetic concern

Malocclusion or misalignment of teeth is not merely an aesthetic concern. It can cause difficulty in chewing, affect speech, complicate oral hygiene, and increase the risk of tooth decay and gum disease. The social and emotional toll is no less important. Children with prominent dental issues often experience low self-esteem, reluctance in peer settings, and anxiety linked to appearance and acceptance. While public health efforts have made remarkable progress in areas such as nutrition, immunisation, and preventive care, orthodontic interventions are yet to gain similar attention. Classified in most frameworks as cosmetic, such care often lies outside the scope of conventional insurance and welfare coverage, placing it beyond the reach of many families, especially in rural areas.

Various studies across Indian States suggest that 20%-30% of school-aged children may require orthodontic attention. But treatment is often delayed or avoided because of cost, lack of awareness, or stigma. Even among those with severe protrusion or bite-related issues, access remains limited without systemic facilitation.

In Virudhunagar, we sought to explore what could be done at the district level. A school-based screening was launched through our block-level dental officers, identifying more than 600 children with significant orthodontic needs. The clinical requirements were clear, but the financial barrier, with treatment cost averaging ₹50,000 over 18-24 months, made intervention unlikely for most.

CSR partnerships

We adopted a collaborative approach. Through CSR partnerships and with the support of Nala Dental Hospital, Madurai, a hub-and-spoke model was developed. Local dentists screened and followed up on children. Referred cases were treated at the hospital, while logistical needs such as transport, meals, and incidental cost were met through philanthropic support. Schools and families were engaged throughout, and the response from the community was deeply encouraging.

What began with one hesitant girl became a movement, a quiet yet powerful affirmation of what compassionate and locally driven public health care can achieve. This experience has underlined an important insight: for children, dignity and self-confidence are not optional. A smile is more than a symbol of health; it is often the first expression of self-worth. Supporting it, therefore, is not a luxury but an investment in holistic development.

‘Language of the soul’

As Pablo Neruda wrote, “Laughter is the language of the soul.” Let us ensure that no child holds back a smile, a laugh, or a future for want of care. Every effort that nurtures their confidence today is a step towards a stronger, healthier tomorrow. After all, empowered individuals are the true strength of any society.

(Dr. V.P. Jeyaseelan, IAS, District Collector, Virudhunagar.)



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