Diabetes and Endocrinology

The primary goal of managing diabetes and its complications is to balance carbohydrate metabolism. In order to achieve insulin deficiency patients are with insulin pumps or injections and patients with insulin resistance are treated with proper exercise and diet. The other complication due to another disease is to be treated or prevented. Maintaining a healthy diet is the best way to have a healthy life.

Diabetes is a major factor in the development of other secondary conditions and cardiovascular diseases. Regular checks of blood pressure, HDL, cholesterol, LDL and triglycerides levels, eye examination to prevent diabetic retinopathy.

Diabetes can affect all parts of the body, including the skin. This sometimes helps to recognize people with diabetes earlier. Most skin conditions can be easily treated. Other skin problems like necrobiosis lipoidica, diabetic dermopathy, diabeticorum, eruptive xanthomatosis and diabetic blisters are mostly likely to be affected in people with diabetes only.

Adults with diabetes are more prone to cardiovascular complications (6% of individuals) such as atherosclerosis which narrows the arteries and leads to reduced blood flow to the heart. Partial blockage of the coronary arteries produces angina pectoris and complete blockage leads to stroke. Atherosclerosis also leads to strokes and complete blockage of blood flow to the brain and arterial disease - poor blood supply to the legs. These are the leading causes of death for people with diabetes.

Diabetic retinopathy is due to damage to blood vessels in the tissue of the retina. Poor blood sugar control is one of the risk factors. Blood vessels may swell and leak fluid and abnormal development of new blood vessels on the surface of the retina is observed. The accompanying scar tissue may contract and detach from the retina.

Symptoms in the initial stages include blurring, floaters, dark areas of vision, and difficulty perceiving colors. Diabetic retinopathy is incurable but can be treated with laser treatments and surgical removal of the vitreous gel (vitrectomy) for good vision.

Diabetic nephropathy is a disease/damage caused by diabetes to your kidneys, which in severe cases can lead to kidney failure. Waste products from our blood are filtered by tiny blood vessels present in our kidneys, and they can be destroyed by high sugar levels in our body. The body retains the excess salts and water needed, which leads to weight gain and ankle swelling. This leads to kidney dysfunction or failure in later stages. No symptoms appear in the early stages, so regular urine tests are needed to detect kidney damage.

Diabetes can also damage nerves, which can lead to difficulty emptying the bladder and create pressure that injures your kidney. Prolonged retention of urine in the bladder leads to infections because bacterial growth in urine with high blood sugar level is high.

About 10-40% of people with type 2 diabetes and 30% of patients with type 1 diabetes will develop kidney failure over time.

Check your diabetes risk: Take the risk assessment and learn more about your risk of developing type 2 diabetes. A score of 12+ indicates that you are at high risk and may be eligible for the LIFE program! Program - a free Victorian lifestyle modification program that helps you reduce your risk of type 2 diabetes and cardiovascular disease.

Manage your weight: Excess body fat, especially if stored around the abdomen, can increase the body's resistance to the hormone insulin. This can lead to type 2 diabetes.

Regular exercise: Moderate physical activity most days of the week helps manage weight, lower blood sugar, and may also improve blood pressure and cholesterol.

Have a healthy and balanced diet: Reduce the amount of fat in the diet, especially saturated and trans fats. Eat more fruits, vegetables and high fiber foods. Reduce the salt.

Limit takeout and processed foods: "Prepared meals" are typically high in salt, fat, and kilojoules. It's best to cook yourself using fresh ingredients whenever possible.

Limit your alcohol consumption: Too much alcohol can lead to weight gain and can raise your blood pressure and triglyceride levels. Men should drink no more than two standard drinks a day and women no more than one.

Stop smoking: Smokers are twice as likely to develop diabetes as non-smokers.

Control your blood pressure: Most people can achieve this by exercising regularly, eating a balanced diet, and maintaining a healthy weight. In some cases, it may require medication prescribed by the doctor.

Reduce your risk of cardiovascular disease: Diabetes and cardiovascular disease share many common risk factors, including obesity and physical inactivity.

A molecular biomarker is a gene, molecule, or natural trait that helps recognize disease. In diabetes, HbA1c is considered a biomarker to identify risk factors for retinopathy, vascular disease and nephropathy. These provide preventative measures during the subclinical phase. The proper use of the biomarker in the growth of anti-diabetic drugs can help in a quick and better understanding of the pathological process of diabetes.

Maintaining a proper diet is very essential in diabetic patients to reduce the risk of diabetic complications. Appropriate physical activity and healthy eating habits are key. In general, low carb is required as these are macronutrients that raise blood sugar, foods like whole grains, vegetables, fruits and nuts, low fat foods are the best source and a diet high in fiber is preferred. Some of the methods for a healthy diet are carb counting, glycemic index, My Plate method, and TLC diet.

Diabetic patients should monitor their feet regularly to avoid the risk of amputation. Even minor wounds like foot blisters lead to serious consequences as blood flow decreases in diabetes and wound healing is delayed leading to infection. The predominant pathogens include gram + ve cocci, especially streptococci and staphylococci. Chronic or previously treated wounds lead to several microbial cultures for which appropriate antimicrobial therapy is necessary.

The butterfly-shaped gland located at the base of the Adam's apple neck is called the thyroid. It is part of the endocrine system, which is responsible for coordinating many body activities. The thyroid glands produce androgen prohormones that regulate the body's metabolism. When the thyroid produces less hormone it leads to hypothyroidism and when excess hormone is produced it leads to hyperthyroidism. Thyroid diseases affect women more than men. In women, infertility problems during pregnancy, miscarriages, menstruation and childbirth.

Graves' disease is an immune disorder that causes excessive production of thyroid hormones called hyperthyroidism. Thyroid hormone metabolism is regulated by carbohydrates, proteins, and fats.

Endocrine disorders can be classified according to the origin of the endocrine disorder and the intensity of hormonal activity. From the intensity of the hormonal activity of the endocrine gland, we can distinguish the hyper function of the endocrine gland, which is characterized by increased secretion of its hormone and an increased concentration of this hormone in the circulating blood. Hypo function of the endocrine gland, characterized by a decrease in the concentration of this hormone in the circulating blood and a decrease in the secretion of its hormone.

Endocrine disease occurs when a gland produces too little or too much of an endocrine hormone called hormonal imbalance. Diabetic ketoacidosis is caused by type 1 diabetes where there is a dependence on fatty acids for energy and a complete lack of insulin. This uncontrolled breakdown of lipids leads to the formation of acidosis, ketones and ketonemia. This is a medical emergency.

Endocrine disorders occur when a gland produces too much or too little of an endocrine hormone, known as hormonal imbalance and due to the development of lesions in the endocrine system, which may or may not affect hormone levels.

·Adrenal insufficiency: The adrenal gland releases little hormonal cortisol and sometimes aldosterone. Symptoms include upset stomach, dehydration, and fatigue.

·Cushing's disease: Overproduction of hormones from the pituitary gland leads to an overactive adrenal gland. A similar condition called Cushing's syndrome can occur especially in children who take high doses of corticosteroids.

·Hypothyroidism: The thyroid gland does not produce enough thyroid hormones, which leads to fatigue, depression, constipation, dry skin.

·Hypopituitarism: The pituitary gland releases less or no hormones. It can be caused by several different diseases. Women with this condition may stop menstruating regularly.

·Acromegaly and other growth hormone problems: If the pituitary gland produces too much growth hormone, a child's bones and other body parts can grow abnormally. If growth hormone levels are too low, a child may stop growing.

·Multiple endocrine neoplasias: These rare genetic diseases are passed down through families. They cause tumors of the adrenal, parathyroid and thyroid glands, resulting in overproduction of hormones.

·Precocious puberty: Abnormally early puberty that occurs when the glands tell the body to release sex hormones too early in life.

·Adrenal vein sampling for aldosterone, androgen levels, angiography, arterial stimulation with venous sampling, arginine stimulation test, autonomic function tests

·Basal acid output (BAO), simultaneous bilateral inferior petrosal sinus sampling (IPSS) with FRC, bone marrow aspiration

·C-peptide suppression test, captopril test, clomiphene test, calcium infusion test for medullary thyroid cancer, clonidine suppression test, daily cortisol curve, CRH test, and combined pituitary function tests (CPT).

·Glycated hemoglobin (A1C) test, stress test, finger size assessment, gastric acid secretion, glucagon test, glucose tolerance test, fasting test, fine needle aspiration of a thyroid nodule (FNA), GnRH/LHRH gonadotropin releasing hormone test

·High dose dexamethasone suppression test, hydrocortisone (HCDC), hydroxycorticosterone (18-OHB) day curve and, hyperparathyroidism investigations, - cortisol (18-OHF) tests, hyperaldosteronism investigation.

Pediatric endocrinology deals with disorders of the endocrine glands, such as variations in childhood sexual development, diabetes, physical growth, and many others. The most common disease in the specialty is type 1 diabetes, which usually accounts for 50% of typical clinical practice.

Pediatric endocrinologists are typically the primary physicians involved in the medical care of children and infants with intersex disorders. This deals with hypoglycemia and other forms of childhood hyperglycemia, variations in puberty, as well as other adrenal, pituitary, and thyroid problems.

Reproductive endocrinology is a subspecialty of gynecology and obstetrics. Reproductive endocrinologist is a very important part of obstetrics and gynecology in which the doctor is trained in reproductive medicine explaining hormonal functioning as it is indirectly related to reproduction. They are prepared to assess and treat dysfunctions in men and women apart from infertility. Reproductive endocrinologists have specific training in obstetrics and gynecology before undergoing subspecialty training in reproductive endocrinology and infertility.

Male endocrinology

Testicular glands produce abnormally low amounts of testosterone, may receive testosterone replacement therapy. For some men, lower than normal testosterone produces no apparent effect; for others, the effects of this condition may include:

·Reduced sexual function, in terms of desire, erections and fertility

·Reduced muscle size and strength, more body fat and lower bone density

·Insomnia or other sleep problems

Female endocrinology

Female endocrinology is largely concerned with the reproductive cycle driven by estrogen and other cyclic female hormones. Related issues that the endocrinologist can help assess:

·Heavy, light or absent periods

·Premenstrual syndrome

·Abnormalities that can produce symptoms that accompany menstruation, such as ovarian cysts or uterine fibroids

·Early or delayed menarche

·Menstrual irregularity

Genomic endocrinology is explained as the knowledge that can be gained about endocrine physiology and pathology from the application of a full range of genetic approaches. Genetic mechanisms lead to endocrine diseases and functional studies of genetic mutations that bring new insights into the pathogenesis and etiology of endocrine disorders. 

The endocrine system regulates the interactions of organisms with the environment. The endocrine system includes all of the glands and tissues in the body that synthesize and release chemical signaling molecules called hormones. Hormones are made by specific glands including the hypothalamus, thyroid gland, pituitary gland, adrenal glands, pancreas, ovaries, testicles, parathyroid glands, and pineal gland. Several other body tissues including fat cells, gastrointestinal tract.