Diabetes and Endocrinology

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

Endocrine disease results when a gland produces insufficient or an excessive amount of an endocrine hormone called hormone imbalance. Diabetic Ketoacidosis is caused in type 1 diabetes where there is reliance on fatty acids for energy and complete lack of insulin. This uncontrolled lipid breakdown leads to formation of causes acidosis, ketones and ketonemia. This is a medical emergency.

Endocrine pathophysiology offers a comprehensive introduction to diseases of the endocrine system. Rather than providing an overwhelming amount of content on one topic, this book serves as a bridge between basic endocrine physiology and endocrine disorders. The text includes case studies covering a variety of endocrine disorders in hospital and outpatient settings. With the changes in many medical study programs into a clinical study program, this book offers a cutting-edge approach to endocrine pathophysiology.

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

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

• Adrenal Venous Sampling for Aldosterone, Androgen Levels, Angiography, Arterial Stimulation with Venous Sampling, Arginine Stimulation Test, Autonomic Function Tests
• Basal Acid Output (BAO), Bilateral Simultaneous Inferior Petrosal Sinus Sampling (IPSS) with CRF, Bone Marrow Aspirate
• C-peptide Suppression Test, Captopril Test, Clomiphene Test, Calcium Infusion Test for Medullary Cancer of the Thyroid, Clonidine Suppression Test, Cortisol Day Curve, CRH Test, Combined Pituitary Function Tests (CPT).
• Glycated hemoglobin (A1C) test, Exercise Test, Finger Size Assessment, Gastric Acid Secretion, Glucagon Test, Glucose Tolerance Test, Fasting Test, Fine Needle Aspiration of a Thyroid Nodule (FNA), Gonadotrophin Releasing Hormone GnRH/LHRH Test

High Dose Dexamethasone Suppression Test, Hydrocortisone Day Curve (HCDC), Hydroxy corticosterone (18-OHB) and, Hyperparathyroidism Investigations, - cortisol (18-OHF) Tests, Hyperaldosteronism Investigation.

Reproductive Endocrinology is a sub-specialty of Gynecology & Obstetrics. Reproductive endocrinologist is a very vital part of obstetrics and gynecology in which physician is trained in reproductive medicine explaining about the hormonal functioning because it is indirectly associated with reproduction. They are prepared to evaluate and treat malfunctioning in males and females outside infertility. Reproductive endocrinologists are trained in obstetrics and gynecology before they undergo sub-specialty training in Reproductive endocrinology and infertility.

• Check your risk of diabetes: Risk assessment test and learn more about your risk of developing type 2 diabetes. A 12+ score shows that you are at high risk and may be eligible for the Life! Program - a free Victorian lifestyle modification program that helps you reduce the risk of type 2 diabetes and cardiovascular disorder.
• Manage your weight. Excess body fat, particularly if stored in the abdomen, can increase the body’s resistance to the hormone insulin. This can lead to type 2 diabetes.
• Exercise regularly. Moderate physical activity on most days of the week helps manage weight, reduce blood sugar levels, and may also improve blood pressure and cholesterol.
• Eat a balanced, healthy diet. Reduce the amount of fat in the diet, especially saturated and trans fats. Eat more fruit, vegetables, and high-fiber foods. Cut back on salt.
• Limit takeaway and processed foods. ‘Convenience meals’ are usually high in salt, fat and kilojoules. It is best to cook for yourself using fresh ingredients whenever possible.
• Limit your alcohol intake. Too much alcohol can cause weight gain and can increase your blood pressure and triglyceride levels. Men should not have more than two standard drinks a day and women should not have more than one.
• Quit smoking. Smokers are twice as likely to develop diabetes as non-smokers.
• Control your blood pressure. Most people can do this with regular exercise, a balanced diet and by keeping a healthy weight. In some cases, it might need medication prescribed by the doctor.

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

Diabetic Nephropathy is a disease/ the damage caused by diabetes to your kidney, which in some sever cases can lead to renal failure. The waste from our blood is filtered by tiny blood vessels present in our kidney, and they are often destroyed by high sugar level in our body. The body retains excess salts and water than required leading to weight gain and ankle swelling. This results in malfunction or kidney failure in further stages. No symptoms are shown in primary stages so, regular urine tests are required to detect kidney damage.

Diabetes may also cause damage to nerves, which may further lead to difficulty in emptying bladder and creating pressure injuring your kidney. Long time retention of urine in bladder leads to infections as bacterial growth in urine with high blood sugar level is high.

About 10 to 40 % of those with Type 2 diabetes and 30% of patients with Type 1 diabetes gradually will suffer from kidney failure.

Diabetic Retinopathy is caused because of the damages in the blood vessels in the tissue of retina. Poor control of blood glucose levels is one of the risk factors. The blood vessels may swell and leak fluid and therefore the abnormal development of new blood vessels on the surface of the retina is observed. The accompanying scar tissue might contract and detach from the retina.

Symptoms in initial stages include blurriness, floaters, dark areas of vision and difficulty perceiving colors. There is no cure for diabetic retinopathy but are often treated laser treatments and therefore the surgical removal of vitreous gel (vitrectomy) for good vision.

Diabetes can cause affect to every part of body including the skin. It sometimes helps in recognizing people with diabetes earlier. Most of the skin conditions are treatable. Other skin disease like necrobiosis lipoidica diabeticorum, diabetic dermopathy, diabeticorum, eruptive xanthomatosis  and diabetic blisters are mostly likely affected in diabetic persons only.

Adults with diabetes are more inclined to cardiovascular complication (6% of individuals) like atherosclerosis which narrow the arteries and leads to reduced blood flow to heart. The partial blockage of coronary arteries produces angina and the complete blockage lead to heart stroke. Atherosclerosis also leads to stoke and the complete blockage of blood flow to brain and the arterial disease – poor supply of blood to the legs. These are the major reasons for the death of people with diabetes.

Maintaining a suitable diet is very essential in the diabetic patients to reduce the risk of diabetic complications. A proper physical activity and healthy eating pattern is the key component. Generally low carbohydrate is insisted as these are macronutrients which raises the blood glucose levels, foods like whole grains, vegetables, fruits, and nuts, low fat food are best source and high fiber diet is preferred. Some of the methods for healthy diet plan are carbohydrate counting, Glycemic index, the My Plate method, and  TLC diet plan.

Diabetic patients should monitor their feet on regularly basis to avoid the risks which leads to amputation. Even minor wounds like blisters to foot cause serious consequences, as blood flow decreases in diabetic cases due to which the wound healing is delayed resulting infection. Predominant pathogens include gram +ve cocci especially streptococci and staphylococci. Chronic or previously treated wounds causes several microbial cultures which requires proper antimicrobial therapy.

Molecular biomarker is a naturally occurring gene, molecule or a character which helps in recognizing the diseases. In case of diabetes HbA1c is considered as a biomarker to identify the risk factors for retinopathy, vascular diseases, and nephropathy. These provides preventive measures during subclinical stage. The well usage of biomarker within the growth of anti-diabetes medication can help in quick and better understanding of the pathologic process of diabetes.

The main aim of diabetes management and complication is to bring the carbohydrate metabolism to balanced state. To achieve the patients with the insulin deficiency are with pumps or insulin injections and patients with insulin resistance are treated with proper exercise and diet maintenance. The other complication caused due to other disease are to be treated or to be prevented. Maintaining a healthy diet is the best to have a healthy living.

Diabetes is a main factor for development of other secondary conditions and cardiovascular disease. Regular check-ups on blood pressure, HDL, cholesterol, LDL and triglyceride levels, eye examination to prevent diabetic retinopathy.

Genomic endocrinology is explained because the insights which will be gained about physiology and endocrine pathology from application of full range of genetic approaches. Genetic mechanisms result in endocrine disease and functional studies of genetic mutations that shed novel insights into the pathogenesis and aetiology of endocrine disorders.

Endocrine system regulates the interactions of organisms with the environment. The system comprises all the glands and tissues within the body that synthesize, and release chemical-signaling molecules called as hormones. Hormones are made by specific glands, including the hypothalamus, thyroid, pituitary, adrenal glands, pancreas, ovaries, testes, parathyroid glands and pineal body and Several other tissues within the body, including the adipose cells, alimentary canal.