Endocrine Disorders

There is an alarming rise in the number people suffering from lifestyle disorders and non-communicable diseases in India. Caused mostly due to changing lifestyles, these diseases are major contributors to hospitalization. Preventable in many cases, people in India are prone to conditions like diabetes, thyroid disorder, metabolic bone disorders, and other endocrine disorders.

Find how to identify these endocrine disorders right from the asymptomatic stage. Know about conditions, their symptoms, and treatment options along with preventive measures.

Diabetes & Eyesight – How does it impact your current Eyeglass Prescription?

There is something about eyeglasses that tends to add character to a person. We shop for latest eyeglass frames to look the best. Beyond looks, did you know that subtle changes in your eyeglass prescription actually say something about the damage diabetes has done to your eyes?

Most people are aware that one of the symptoms of diabetes is blurry vision. However, only a few of them realize the significance of this. Getting a prescription for eyeglasses is by far the only thing they do.

Why eyes need extra care in diabetes?

Diabetes is one of the primary causes for many eye diseases that lead to blindness. Diabetes causes dry eyes, smaller-sized pupils, cataracts, glaucoma, diabetic retinopathy, and macular edema. It affects every part of the eye. In fact, damage to eyes begins even before the diagnosis of diabetes.

The precursor to diabetes is prediabetes. In this stage, people already have high blood sugar levels. It is only that sugar levels are not high enough to be diagnosed as diabetes. Since sugar levels are already on the higher side, there is bound to be damage.

As blood sugar levels rise, blood vessels tend to bear the brunt of extra sugars. Stress of extra sugar levels in blood damages both the larger and smaller blood vessels. Over a period of time, these blood vessels can no longer provide cells with life-giving oxygen and nutrients. When cells do not get their quota of oxygen and nutrients, they tend to lose their efficiency and die away slowly.

This process of degeneration might be rapid in some people and gradual in others. However, there are certain clear changes in people with prediabetes also.

How diabetes affects your eyeglass prescription?

The eye is a delicate and intricate structure that has numerous small blood vessels. And, two enemies that constantly damage these delicate structures are high blood pressure and high sugar levels. Since sugar levels are high even in prediabetes, there are chances of some eye damage. In fact, some people with prediabetes already have diabetic retinopathy.

People who have refractive errors (farsightedness or near-sightedness) need eyeglasses. They generally get them as prescribed by an optometrist. If these people have diabetes, prescriptions might keep changing as diabetes causes fluctuations in vision.

As your blood sugar levels fluctuate, your eyeglass prescription changes too!

Many people might not be aware that as blood sugar levels rise, there is swelling of the lens inside the eyes. This is the primary reason for many people with undiagnosed diabetes to have decreased vision. In such cases, the eye exam might look normal, but because of high or low sugar levels, vision fluctuates. That’s why you find it difficult to zero-in on a perfect prescription.

So, how to find the right prescription?

In most cases, controlling blood sugar levels with the help of medications can reduce lens swelling inside the eyes. As soon as blood sugar levels get stabilized, you can get the right prescription without further fluctuations.

When your sugar levels are high, fluid enters the lenses and this leads to swelling. When sugar levels are controlled, this fluid recedes and normalizes the crystalline lens.

If you have diabetes or prediabetes, never ignore any changes in visual perception. Don’t write off blurry vision as being tired or just having a headache. Get an eye test and consult your diabetes doctor.

If you do not have diabetes and your current prescription glasses do not work properly, get a diabetes risk assessment today.

Importance of Medication Adherence in Diabetes

Diabetes is a complex disorder typically requiring multiple medications to achieve control of blood sugar levels. Blood sugar control is an important aspect of diabetes treatment in order to avoid serious and long term complications.

For a person with diabetes, sticking to the treatment plan provided by the diabetes doctor is the first step to take in order to stay healthy. This involves taking medicines on time as instructed by the doctor and is called medication adherence in medical parlance.

 

What is medication adherence?

Taking medications as instructed at the right time of day, frequency, and dosage is medication adherence. This is a significant factor for a patient’s successful management of diabetes. Medication adherence directly influences glycemic control and clinical consequences.

More often than not, people with diabetes find it difficult to adhere to their medication plan totally. This is because of various factors including complacence, lack of knowledge, unavailability of specific medications, and lack of communication between the care teams and patients.

It is important for both the caregivers, clinic team, and the patients to work together and address key issues that hinder medication adherence. This way, by sticking to the treatment plan, people with diabetes have better chances to avoid serious complications and lead a healthy life.

 

Key strategies to improve medication adherence

Spreading Awareness and Knowledge:

Studies reveal that taking medications as part of a daily routine and utilizing pill boxes were the most frequently reported helpful methods to improve adherence.  The three most motivating factors that patients identified were their knowledge that diabetes medications work effectively to lower blood glucose, understanding how they could manage side effects of their medications and a better understanding of the drugs’ benefits.

 

Addressing side effects:

Non-adherence has been linked with poorer treatment outcomes and progression of disease symptoms and complications. Another interesting aspect is that factors such as inability to afford a prescription or adverse reactions to a drug such as weight gain or nausea, also contribute for patient’s non-adherence to medications. In such cases, the clinic team and patients should work closely in order find the right prescription that works for the patient.

 

Ensuring Constant Communication:

Non-adherence of medications is found to have a significant impact on risk of diabetes complications. However, once patients leave the clinic, they generally find it difficult to communicate with the care team for any small query. By keeping communication channels open so that the clinic team and patients constantly interact ensures better results.

Diabetes Care in People with Thyroid Disorders

Thyroid disease has become quite common in India and prevalence increases with age. Hypothyroidism is by far the most common thyroid disorder in the adult population and is more common in older women.  It is usually autoimmune in origin, presenting as either primary atrophic hypothyroidism or Hashimoto’s thyroiditis. Thyroid failure secondary to radioactive iodine therapy or thyroid surgery is also common.

Thyroid Disorder in Diabetes – How common is it?

While thyroid disease rate in the general population is 6.6%, people with diabetes have a higher likelihood of getting thyroid disorders when compared to the normal population. Thyroid disease prevalence in diabetes:

  • Overall prevalence: 10.8­1%
  • Hypothyroidism: 3­6%
  • Hyperthyroidism: 1­2%
  • Postpartum thyroiditis: 11%

How Thyroid Dysfunction affects People with Diabetes?

In case of overactive thyroid, excess thyroid hormones promote hyperglycemia by facilitating glucose intestinal absorption, increasing insulin clearance, and enhancing glycogenolysis and gluconeogenesis. Also, hyperthyroidism is associated with:

  • Increased hepatic glucose output
  • reduced insulin action
  • increased lipolysis

In people with under active thyroid, hypothyroidism leads to reduction in hepatic glucose output, gluconeogenesis and peripheral glucose utilization. Uncontrolled hyperglycemia with ketosis alters the thyroidal blood profile in a manner similar to that seen in severe acute illnesses.

Diabetes Care in hyperthyroid patients:

  • The diagnosis of glucose intolerance needs to be considered cautiously since hyperglycemia may improve with treatment of thyrotoxicosis.
  • Underlying hyperthyroidism should be considered in diabetes patients with unexplained worsening hyperglycemia.
  • In diabetes patients with hyperthyroidism, physicians need to anticipate possible deterioration in glycemic control and adjust treatment accordingly.

Diabetes Care in hypothyroid patients:

  • Reduced rate of insulin degradation may lower exogenous insulin requirement.
  • Subclinical hypothyroidism can exacerbate coexisting dyslipidemia commonly found in type 2 diabetes and further increase the risk of cardiovascular diseases.
  • Adequate thyroxine replacement will reverse the lipid abnormalities.

Diabetes & Thyroid Care in young women with type 1 diabetes:

  • Transient thyroid dysfunction is common in the postpartum period and warrants routine screening with serum thyroid-stimulating hormone (TSH) 6­8 weeks after delivery.
  • Glucose control may fluctuate during transient hyperthyroidism followed by hypothyroidism typical of the postpartum thyroiditis.

Tips and Techniques to Inject Insulin

It is common for many people who use insulin injections to commit errors while administering insulin.  Here are a few tips and techniques that would help you understand how to use insulin injections effectively.

Steps for injecting insulin

Insulin Kit:

  • An insulin pen
  • Enough insulin inside to give the required dose
  • A new pen needle
  • Cotton wool or a tissue

Injecting your insulin shot

When you are injecting insulin, you should aim to inject into the fatty tissue just underneath the skin. To perform your insulin injection:

  • Wherever possible, wash your hands with soap and water before injecting
  • Put a new needle onto your pen
  • Perform an ‘air shot’ of at least 2 units to clear any bubbles out of the needle – if you do not get a steady stream, repeat the air shot until you do get a steady stream
  • Dial up your dose – how you do this exactly may depend on which pen you have
  • Pick a soft fatty area to inject – tops of thighs, belly, bum and triceps (not always recommended for children or thinner people)
  • Raise a fold of fatty flesh slightly between your thumb and fingers – leaving plenty of space between to put the needle in
  • Put the needle in – if you are particularly slim, you may need to put the needle in at a 45 degree angle to avoid injecting into the muscle
  • Push the plunger, to inject the dose, relatively slowly
  • After the dose has been injected, hold the needle in for a good 10 seconds to prevent too much insulin from escaping out
  • If any blood or insulin escapes, wipe this with cotton wool or a tissue
  • Ensure that the used needle is deposited into a sharps bin

How to avoid pain when injecting insulin

Many diabetes patients are worried about the pain of injecting insulin. There are several methods that can help avoid or minimise pain when injecting.

  • Making sure the muscles above which you’re injecting are relaxed, this will allow for a better coverage of fat where you’re injecting.
  • Use insulin and a needle which is at room temperature
  • Push the needle in quickly
  • Try not to wiggle the needle as you’re injecting or withdrawing the needle
  • Always use a new needle

Injections and Bruising

You may notice a little blood leaking out after injecting. This is not a cause for concern as it just means the needle has gone through a small blood vessel.

If this happens, you may notice a raised area of your skin from the blood underneath but this should ease down over the next few hours and you’ll be left with a bit of a bruise for a few days.

Tips for Injecting Insulin

  • Stomach:  Stay at least two inches away from the bellybutton or any scars you may already have when using the abdomen for injections.
  • Thigh: Inject at least 4 inches or about one hand’s width above the knee and at least 4 inches down from the top of the leg. The best area on the leg is the top and outer area of the thigh. Do not inject insulin into your inner thigh because of the number of blood vessels and nerves in this area.
  • Arm: Inject into fatty tissue in the back of the arm between the shoulder and the elbow.
  • Buttock: Inject into the hip or “wallet area” and not into the lower buttock area.
  • When rotating sites within one injection area, keep injections about an inch (or
    two finger widths) apart.
  • Do not inject into scar tissue or areas with broken vessels or varicose veins. Scar tissue may interfere with absorption.
  • Massage or exercise that occurs immediately after the injection may speed up absorption because of the increased circulation to the injection site. If you plan on strenuous physical activity shortly after injecting insulin, don’t inject in an area affected by the exercise. For example, if you plan to play tennis, don’t inject into your racquet arm. If you plan to jog or run, don’t inject into your thighs.
  • When injecting with an insulin pen, inject straight in and be sure to hold the pen in place for a few seconds after the insulin is delivered to ensure that no insulin leaks out.

Diabetes Care for the Elderly

Many age-related changes affect the clinical presentation of diabetes. These changes can make recognition and treatment of diabetes complicated. Because of normal physiological changes associated with aging, elderly diabetes patients rarely present with typical symptoms of hyperglycemia.  Though it is recommended for all adults, the ideal HbA1c target of less than 7% may be difficult to achieve.

Here are a few aspects of diabetes care in the elderly:

Diet Tips for the Elderly with Diabetes

A diabetic diet is a healthy meal plan with small and frequent meals and a good mix of carbohydrates, protein, and fats. It needs to be low on the glycemic index and should have a good distribution of carbohydrates. Elderly need to be more careful as they are vulnerable to fall into the trap of malnutrition. With decreased metabolism, peristalsis and absorption, it is essential to get a customised plan based on one’s biochemical and physical parameters.

  • Use whole grains and pulses rather than refined cereals like maida(all-purpose flour).
  • Ensure liberal intake of green leafy vegetables in the form of salads, soups, cooked vegetables as sabzis etc.
  • Ensure judicious intake of roots and tubers like potatoes, colocasia (arbi), sweet potato, yam, etc.
  • Select snacks that are roasted or steamed like sprouts, or poha.
  • Preferably consume at least 2 litres of water every day.
  • A gap of 2 hours after dinner is required. Avoid going to bed immediately.
  • Add legumes to diet since they can reduce cholesterol levels in blood.
  • Add calcium-rich sources like milk to strengthen bones.

Importance of Medication Regimen

Timely intake of medication and diet will prevent senior diabetes patients getting into hypoglycaemia or hyperglycaemia. Compromised cognitive abilities in the elderly can make them forgetful about their medicines. It is suggested they pre-order for medication refill from online or pharmacy stores to ensure medication adherence. It is also suggested to consider storing three days of diabetes supplies which may be handy in emergency. Poor medication adherence results in increased risk of developing diabetes-related complications.

Physical Fitness Goals for the Elderly

ADA recommends 150 minutes of moderate physical activity per week for people with diabetes. As age advances, slight discomfort and minor aches and pains are normal at the beginning of any new fitness regimen. However, seniors should cease or reduce any exercise or movement that causes sharp, stabbing pain or joint pain.

Diabetes Complications in the Elderly

Complications of diabetes occur in the elderly at higher rates. This includes, but is not limited to, autonomic neuropathy, nephropathy, cardiovascular complications, retinopathy and foot ulcers.

Prolonged high blood sugar levels can damage blood vessels of the retina causing them to break and leak blood into the eye which can cloud or obscure vision. Hearing loss can result from damaged blood vessels and nerves inside the ear. Arthritis can limit their mobility and effect their physical activity.  Elderly diabetes patients are more prone to gum infections and are advised to visit a dentist in case of any gum bleeding/ bad breath.

Considering the susceptibility of diabetes complications, and taking age into consideration, elderly people with diabetes should keep a close watch on blood sugar levels, get regular tests, and never ignore any minor changes in the body.

Symptoms of Type 2 Diabetes

Symptoms of type 2 diabetes help to detect the disease early and get it under control before any irreversible damage is done to the body. The chance of developing complications from type 2 diabetes decreases with early detection and treatment of type 2 diabetes as showed by many recent studies.

Type 2 diabetes symptoms, can be very subtle or many at times harmless though you have diabetes symptoms at all. Ignoring the symptoms, over time, and not taking medical advice may develop diabetes complications, even if the patient haven’t had symptoms of type 2 diabetes.

What is type 2 diabetes symptoms profile look is the common question that an individual with high risk of diabetes has?

Individuals do experience different signs and symptoms of type 2 diabetes, and sometimes there may be no typical symptoms. Patients with type 2 diabetes commonly experience with:

  • Frequent urination
  • Excessive thirst
  • Increased hunger
  • Weight loss
  • Tiredness
  • Lack of interest and concentration
  • A tingling sensation or numbness in the hands or feet
  • Blurred vision
  • Frequent infections
  • Slow-healing wounds

Few patients may also associate with diabetes symptoms like experience extreme lethargy, agitation, and sometimes may also feel irritable without any reason.

The best thing if any individual sense the above said symptoms please do go to Apollo Sugar or any health care facility in out vicinity to take doctor advice.

Apollo sugar is able to provide entire spectrum of diabetes services for effective diabetes management.

Understanding types of Diabetes Mellitus

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There are three main types of diabetes mellitus: Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus and Gestational Diabetes Mellitus. There is also a stage before diabetes called pre-diabetes. People who have pre-diabetes are at risk of developing Type 2 Diabetes Mellitus later in life if they do not monitor their condition carefully.

The first and one of the main types of diabetes mellitus is Type 1 diabetes, an autoimmune disease where the pancreas produces very little insulin or no insulin at all. Type 1 Diabetes Mellitus presents usually under the age of 20, when the person is a child or young adult. Type 1 Diabetes Mellitus is mostly a genetic condition where the pancreatic cells are destroyed and hence no insulin production. Thus lifelong insulin therapy is the main stay of type 1 diabetes mellitus treatment.

Type 2 Diabetes Mellitus is normally found in people who are overweight. Although it is sometimes called adult onset diabetes, more children and young adults are being diagnosed with Type 2 diabetes because they are not getting enough activity.

About 90 percent of all cases of diabetes are Type 2 Diabetes Mellitus and here the pancreas does not produce enough insulin or the body does not properly use it.

Type 2 Diabetes Mellitus is also considered a lifestyle disease because it is normally triggered by living a fairly sedentary life, being overweight and not participating in exercise. However, age is a factor as well as heredity.

The third main type of diabetes is gestational diabetes, which is a condition that women can get when they are in the second trimester of pregnancy.  Unlike Type 1 and Type 2 Diabetes Mellitus, gestational Diabetes Mellitus will disappear after the baby is born.

The best thing if any individual sense the above said symptoms please do go to Apollo Sugar or any health care facility in out vicinity to take doctor advice.

Apollo sugar is able to provide entire spectrum of diabetes services for effective diabetes management

What are the symptoms of Gestational Diabetes?

Symptoms of gestational diabetes

What is gestational diabetes?

Gestational Diabetes Mellitus (GDM) is defined as glucoseintolerance that begins or is firstdetected during pregnancy.
The detection of gestational diabetes is important because of its associated maternal and fetal complications. According to the ADA guidelines, patients should be screened for risk factors for gestational diabetes during pregnancy at their initial visit.

Symptoms of gestational diabetes

Gestational diabetes develops because pregnancy increases requirements for insulin secretion while increasing insulin resistance, upping demands on pancreatic β-cells. A woman is considered high risk if she has one or more of the following: marked Obesity, personal history of gestational diabetes, glucose intolerance or glycosuria, or astrong family history of type 2 diabetes, age > 25 years, multiparity, and previous macrosomic or largefor-gestational-age infants (> 9 lb or 4 kg)

All women should be screened for gestational diabetes during pregnancy at 24 – 28 weeks of gestation following standard guidelines.
The best thing for a women who is at 24-28 weeks of gestation to go to Apollo Sugar or any health care facility in out vicinity to take doctor advice and get screening for Gestational Diabetes Mellitus.

Apollo sugar is able to provide entire spectrum of diabetes services for effective Gestational Diabetes Mellitus management

Gestational Diabetes Complication – Diabetes during pregnancy

Woman with gestational diabetesWhat are the complications if you’re diabetic during pregnancy?

There is no bigger gift than to have life growing in you!

Certain hormonal changes in the body, your ethnicity, lifestyle, and your weight can make you diabetic during pregnancy. Though temporary, the symptoms of gestational diabetes and its complications might adversely affect your baby.

When you are pregnant, everyone around you advises. Do this, do that. Never do that, don’t do this. There is the pleasure of life growing inside you and the anxiety for its wellbeing. It’s joyous sometimes while other times you feel it would have been great if the stork brought the baby!

However, are you aware that you need to take utmost care of your diet to avoid high blood glucose levels?

What is gestational diabetes?

In the list of screening tests a pregnant woman undergoes, testing for gestational diabetes is vital. Gestational diabetes is a condition that is characterized by the prevalence of high blood glucose levels. This condition can cause numerous complications both in the mother and the fetus.

Sugar levels are high during this condition as the cells of the tissues become resistant to insulin in order to nourish the fetus. However, when the pancreas cannot produce enough insulin to process additional glucose, it causes gestational diabetes. It can be caused due to obesity in the mother, hormones in the placenta, and a family history of diabetes.

Symptoms of gestational diabetes:

Gestational diabetes does not generally show up with any noticeable symptoms and so it is extremely important for pregnant women to have a screening test between the 24th and 28th week of the pregnancy.

Gestational Diabetes Treatment:

Once gestational diabetes is diagnosed, it is very important to consult a diabetologist and a dietician in order to manage the blood glucose levels. In most cases, it is managed with the help of dietary modifications and exercises, but some cases demand medical management.

Complications of Gestational Diabetes:

Many women that undergo treatment deliver healthy babies, but some of them can experience complications including:

Macrosomia. This is a condition in which the baby weighs more than the normal weight.
Having a C-section.
Need for induced labor.
Hypoglycemia in the newborn baby.
Risk of type 2 diabetes in children.
Perinatal death.

Taking into consideration the seriousness of the complications, it is of utmost importance to manage it under the supervision of diabetologists, dieticians, and health counsellors.