Endocrinology – FAQs

A diagnosis of diabetes does not always mean a lifetime of complications. By devising a plan of action for your diabetes management, you’ll reduce many of the risks associated with having type 1or type 2 diabetes.

A- HbA1c & Blood glucose: Take control of blood glucose. By maintaining tight control over your blood glucose, you may minimize the damaging effects of unpredictable glucose levels on your body. Aim for an HbA1c reading of less than 7%.

B- BloodPressure: Keep blood pressure in check. High blood pressure increases your risk of stroke,heartattack,kidney,and eye diseases. Aim for a reading of 130/80 mm of Hg.

C- Cholesterols: Watch your cholesterol. Total cholesterol levels should generally be 200 mg/dl, but discuss personal goals with your doctor. Watch out for LDL and HDL cholesterol levels, too much LDL can clog the walls of arteries, so keep it under 100 mg/dl to avoid problems. In addition, HDL cholesterol should be greater than 40 mg/dl for men, and 50 mg/dl for women. Triglycerides, a type of fat, should also be under 150 mg/dl.

D- Diabetic Nephropathy: Don’t forget your kidneys. When you have diabetes, your kidneys can become compromised due to poorly controlled blood glucose and high blood pressure, so be certain to have a microalbumin test at least once per year, with a goal of less than 20 mg per litre or 30 micrograms per milligram creatinine.

E- Eye complications: Look out for your eyes. High blood glucose can cause serious vision problems. If you have diabetes, it is crucial to have a dilated eye exam once per year. If you have any vision problems,report them to your doctor immediately.

F- Foot problems: Examine your feet. It’s very important for people with diabetes to check their feet for wounds or fissures on a daily basis. If you discover a wound, treat it immediately and monitor the healing process.

• Check your blood glucose – ask your healthcare provider how often and the best times of day to check.
• Examine your feet and toenails for any wounds.
• Be physically active each day.
• Take aspirin if your doctor has suggested it.

• Have your HbA1c checked by your doctor or healthcare provider.

• Visit your doctor to discuss goals for the care of your diabetes.
• Visit your dentist for a regular check-up.
• Get a flu shot to prevent complications from illness.
• Have your doctor check your blood pressure and discuss the results with you.
• Have a dilated eye exam.

Gestational diabetes (GDM) is a form of diabetes that occurs during pregnancy. Gestational diabetes usually is detected between the 24th and 28th week of pregnancy. It may be comforting for you to know that the condition can be easily managed. You should speak to your doctor regarding your medical, nutritional & fitness goals that will help you take control of gestational diabetes and decrease the risk of complications.

Diagnosis: Shortly after your pregnancy is confirmed,your doctor will arrange for you to have an Oral Glucose tolerance test (OGTT) if you are at risk of having diabetes.You may be at risk of having GDM if:you have a previous history of GDM, have had a large baby, there is a persistence of glucose in your urine,have a familY history of diabetes or you are overweight.

The OGTT is usually performed at approximately 28 weeks ofpregnancy.However,you may be referred earlier if your doctor feelsyou may be at risk.

Complications due to GDM:

In case your sugars are not under controlconsistently:

• The baby can be larger in size which can lead to complications during delivery.
• Pre mature delivery or still birth or birth hypoxia.
• Post delivery, baby can have low sugars that need immediate attention or else it can be life threatening.
• Mother may suffer from pre-eclampsia.

Insulin pumps are small, portable devices used to deliver insulin under the skin via a canula. Insulin pumps are usually placed in pouches, pockets, belts and their features vary considerably. All contain a disposable cartridge inside the unit and deliver insulin in two ways: “basal” or background insulin that is delivered every few minutes and “bolus” insulin that is delivered when meals are eaten or to correct high blood sugars.

A canula is inserted under the skin and worn at all times when an insulin pump is in use. The canula is changed every 2-3 days or if the site goes “bad” and no longer properly works for insulin doses. Canulas may be worn anywhere where insulin can be injected such as on the stomach, thighs, buttocks and fleshy areas of the arm.

Advantages of insulin pump :

• It delivers better blood sugar control as it can imitate your pancreas the closest out of all the insulin modes.
• With insulin pump your frequency of pricking also limits majorly (once in 3 days).
• You get more flexibility to eat yourfavorite food items occasionally as your pump has a lot of other wizard features to assist you in better bloodglucose control.
• A decreased risk of dangerously low sugars.
• No unpredictable effects from long or intermediate acting insulin as it uses only rapid acting insulin.
• It has the ability to accurately dose even the tiny amount of insulin.
• It is a precise consistent way to deliver a basal rate of insulin.
• It has the ability to program variable insulin rates throughout the day based on your sugar readings.

If you’re like most parents who have just been told your child or teen has type 1 diabetes, it is a complete shock. Only about 10 percent of the time do we find a family history of type 1 diabetes. There is more to learn about what causes, prevents and cures type 1 diabetes.

In the meantime, we must all work together to help your child live a long and healthy life.

And yes, that is a realistic goal. Research studies show that people with type 1 diabetes who aim to keep their blood glucose levels as close to normal as possible can significantly lower the chances of life-threatening complications related to diabetes.

What goes wrong ?

The diagnosis of type 1 diabetes was made because your child’s level of glucose (sugar) in the blood was above normal. This indicates that the metabolic system of checks and balances in the body is not working. Insulin is not being produced. Insulin is essential to escort the glucose from the foods we eat into cells of the body where it is critically needed to function properly. As a result, glucose builds up in the bloodstream.

Your child may still be producing some insulin at this point, but in type 1 diabetes the pancreas loses all ability to produce insulin. The islet cells in the pancreas that produce insulin are gradually all destroyed, a process that we cannot at this point stop. Injections of insulin or an insulin pump are then needed to survive.

Why not an insulin pill ?

Insulin can’t be given orally because it is a protein and would be digested instead of getting to the blood stream where it is needed. Just about all of the commercially available insulins now are genetically engineered as human insulin. Insulin comes in a variety of preparations that differ according to how fast it takes effect, when that effect is the greatest, and how long it continues to work in the body.

Living with diabetes.

What seems overwhelming now will eventually become routine. One of the first hurdles to get over is that to help your child, you must prick him or her with a needle. This will get easier for all involved. There are new devices as well as some in development that make blood glucose testing and insulin injections less painful, easier and more precise.

To live successfully with diabetes essentially means to learn how to be a pancreas. You have to learn how to monitor blood glucose levels and adjust the levels of insulin needed accordingly. To do this,you must consider severalfactors :

• Blood glucose levels, measured several times a day.
• The timing and content of meals eaten (specifically, considering type and amount of carbohydrates in the foods).
• The amount of physical activity, which requires more glucose and thus more insulin.
• And then based on need, getting doses of insulin through multiple injections or an insulin pump into the body multiple times a day.

Insulin hormone is produced by our pancreas in response to our blood sugars. Insulin acts like a key, unlocking doors that allow glucose to enter cells. In diabetes, either pancreas is unable to produce insulin or the cells are unresponsive to insulin’s effect.

Insulin is the safest medicine that your doctor can give you & your body does not get used to it. If your body is not producing insulin at all, you will need it for lifetime. Other conditions that might need insulin are: Gestational diabetes, diabetes complications where in oral diabetic drugs have some side-effects, infections, surgery etc.

How to handle insulin ?

Insulin is a hormone, which is easily damaged by mishandling & extreme temperatures.

To keep insulin in good condition, remember :

• Avoid excessive physical trauma to insulin such as by vigorous shaking before injecting.
• Avoid excessive heat – like closed cars in warm weather, exposure to direct sunlight
• Avoid excessive cold – like freezer compartment in refrigerator, cargo compartment of air craft.

How to store insulin ?

Unopened vial– can be stored at room temperature for up to 1 month & in the door compartment of the refrigerator till the expiry date.

Opened vial- can be stored for 28 days at room temperature & till the date of expiry in the door compartment of the refrigerator.

Insulin pen- can be stored in the door compartment of the refrigerator or Air-conditioned room. Pen can tolerate up to 30 degree centigrade of temperature.

Insulin cartridges- should be stored in the door compartment of the refrigerator.

While traveling…

While traveling by air, insulin should be kept in the handbag & not in the luggage compartment.

While traveling by train, bus or car, insulin should be kept in a pouch with ice pack or gelpack or dry ice….

Modes of insulin injection :

• Syringe
• Insulin pen
• Insulin pump

It’s important to keep in mind that if you have diabetes, you always need to be prepared before exercising. Always speak with your diabetes care team prior to starting a new fitness routine. Keep in mind these points before starting your exercise session :

• If blood glucose levels are less than 90 mg per dl & you are on oral medication- take 3-4 tsp sugar before leaving for exercise.
• If blood glucose levels are less than 110 mg per dl & you are on insulin- take 3-4 tsp sugar before leaving for exercise.
• If blood glucose levels are more than 300 mg per dl (in case you are on insulin)- don’t go for exercise until you speak to your healthcare team for further management.
• Make sure you are carrying some sugar or fruit or non diet soft drink or toffee (sugar candy) with you while working out because your sugars might just go low in between or after a work- out.
• Bring your glucose meter, since you’ll want to check your glucose after every 30 minutes of exercise.

Sick day management is important for people with diabetes in order to avoid hospitalization. When you fall sick your body is under stress, due to which it releases some hormones to get rid of this stress condition. These hormones can lead to unexpected changes in the blood glucose levels. Moreover, during illness, your appetite might vary, along with changes in your exercise or drug routine. These changes can lead to further complications like Ketoacidosis etc. Thus keeping your blood sugars under control when sickwill prevent alot of serious complications.

Please read the points mentioned below to manage your diabetes when sick:

Continue your diabetes medicines. Stress of being sick can cause blood sugarsto increase unusually. If you take oral diabetes medication, you will have to continue taking it. In case of stomach upsets or vomiting or breathing difficulty, you might have to change some medication, for which you should immediately consult your doctor. You may also need to start with insulin for a short period of time depending on your blood sugar control. Incase, you are already on insulin, you need to get your dose revised you’re your doctor considering your present sugar levels, even if you cannot eat your regular food.

Taking care of your feet is extremely important if you have diabetes as foot & leg complications are common causes of hospitalization in persons with diabetes & can also lead to limb amputation if not treated on time. However, most foot problems can be prevented through proper care & precautions.

You just need to follow these simple steps!!!

• Notice and feel vour feet daily for blisters, open sores, cuts, color changes, or ingrown toe nails.
• Wash your feet daily with soap and lukewarm water.
• Take care to wash between toes.
• Keep your feet. dry especially between toes. Use powder if needed.
• Keep your skin soft. Put lotion on top and bottom of your feet. Do not apply between toes.
• Cut toe nails straight across

Celiac Disease is an autoimmune disease which damages the lining of small intestine and interferes with the absorption of nutrients from the food. People with celiac disease cannot tolerate gluten, a protein which is found in wheat, rye, barley and oats. Celiac disease is genetic, it means has high chance of running in the families. This disease can occur at any age group from infancy to late adulthood.

• Abdominal Pain, Bloating
• Dental Enamel Defects
• Diarrhea
• Foul smelling stools which are difficult to flush away
• Growth Failure in children
• Vomiting
• Constipation

On having any of the above symptoms the patient should get in touch with the doctor for diagnosis of the disease Diagnosis of celiac disease involves a blood test, for levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). A blood test is followed by a biopsy of the small intestine to confirm the diagnosis of the disease.

(Starting on with a Gluten Free Diet before being tested, may result in negative test for Celiac disease even if th1 disease is present. Hence one should not start Gluten Free diet before a confirmed diagnosis is made.)

The only treatment for celiac disease is a strict gluten free diet for life. It’s essential that patients with celiac disease should go for a initial assessment, education and follow up with Dietitian and the Doctor for gluten free diet.

Naturally Gluten-free foods include plain meat, poultry, fish, eggs, legumes, nuts, seeds, milk, yogurt, cheese fruits, vegetables, as well as many gluten-free flours, cereals and starches that can be substituted for wheat, rye and barley. Distilled alcoholic beverages and wines are also allowed, however beer derived from barley must b avoided. Patients should consume Gluten Free Foods rich in Iron, Calcium, Vit .D and Dietary fiber.

Patient should totally eliminate wheat and its products, Rye, Barley, Oats from the diet.

Many patients with type 1 Diabetes are also diagnosed with Celiac Disease, in such cases patients should consult Dietitian who can guide about long term goals and guidelines for management of both disease. Frequent follow u visits are essential for how to take Gluten free diet in accordance with diabetic meal plan, monitoring and insulin adjustment.

Use accurate and practical resources on managing both disease. There is a lot of misinformation about the GF: (Gluten Free Diets) on the internet and from other sources.