Category: General

Experiencing fatigue after consuming a meal is common and often a typical response to digestion, particularly following a substantial meal. Tiredness post-meal can indicate reactive hypoglycemia, especially if it occurs within two to four hours after eating and is accompanied by additional symptoms.

Besides feeling sleepy, reactive hypoglycemia can bring on a range of other symptoms:

•    Shaky or trembling hands
•    Dizzy spells or feeling light-headed
•    Sweating or having clammy skin
•    Anxiety or nervousness kicking in
•    Irritability or confusion setting in
•    A racing heart or palpitations
•    Intense hunger or cravings for sweets
•    Blurry vision clouding your sight
•    Difficulty concentrating or experiencing brain fog

To confirm if reactive hypoglycemia is the culprit, it’s essential to check your blood glucose levels when these symptoms occur—typically during that 2–4-hour window—and note if they improve as your blood sugar normalizes.

Dr.Tittu Oommen, MD, DM  

When the level of glucose in our blood drops below 70 mg/dl, it is called hypoglycemia. The symptoms of Hypoglycemia usually depend on the level of blood sugar.

When blood sugar is between 60 – 70 mg/dl, we call it mild hypoglycemia. The early warning signs of mild hypoglycemia include shakiness or tremors, sweating, paleness, irritability or mood swings and fast heartbeat.

When blood sugar level is between 50 – 60 mg/dl, it is called moderate hypoglycemia. The warning signs of moderate hypoglycemia include dizziness or lightheadedness, confusion, blurred or double vision and weakness or fatigue.

When blood sugar level is below 50 mg/dl, it is called severe hypoglycemia. Severe hypoglycemia is a medical emergency. The warning signs of severe hypoglycemia are seizures, Loss of consciousness, coma and it may become fatal without treatment.

Why is Hypoglycemia considered as Dangerous?

•    A significant drop in blood sugar can impair mental and physical functioning.

•    If untreated, it can lead to seizures, unconsciousness, or death.

 Mrs. Soumya R Dharan

 Hypoglycemia is a condition where blood sugar (glucose) level is lower than the standard range (below 70 mg/dL). A timely and accurate diagnosis is essential to prevent complications, particularly in cases of unrecognized or recurrent hypoglycemia.

Hypoglycemia is often associated with diabetes. Hypoglycemia in diabetes is usually related to treatment. Non-Diabetic hypoglycemia must be investigated thoroughly.  It can arise from underlying disorders such as insulin overproduction, medication side effects or hormonal deficiencies.

Diagnosing hypoglycemia involves a combination of clinical evaluation and specific laboratory tests to determine the underlying cause and guide appropriate treatment.  The diagnostic tests help to differentiate between Insulin dependent or Insulin independent hypoglycemia and Iatrogenic hypoglycemia.

 Specific Diagnostic Tests for Hypoglycemia :

Blood sugar levels to determine the severity of hypoglycemia
•    <70 mg/dL: Low
•    <54 mg/dL: Severe Hypoglycemia

Critical Sample Collection

During a hypoglycemic episode blood should be drawn for Glucose, Insulin, C-peptide, Cortisol, Growth Hormone and Sulfonylurea/meglitinide screen when the corresponding RBS is <45 mg/dL.  This helps in confirming whether the disease conditions causing hypoglycemia can be due to Insulin dependent hypoglycemia, Insulin independent or Iatrogenic.
Investigations to determine the cause for hypoglycemia

I. Insulin dependent Hypoglycemia

1. C-peptide

• Measures the levels of C-peptide (the byproduct of insulin production)
• Low C-peptide can suggest exogenous insulin administration (eg: insulin injections)
• High C-peptide indicates endogenous insulin overproduction, such as in Insulinoma.

2. Insulin Levels :

Insulin levels are checked to assess whether the pancreas is overproducing insulin, which can be a cause of hypoglycemia.

3. Insulin Antibodies :

If the body is producing antibodies against insulin, it can lead to insulin-dependent hypoglycemia. Testing antibodies can help in the diagnosis.

II. Insulin independent Hypoglycemia

Tests for Cortisol levels, TFT (Thyroid Function Test) and GH (Growth Hormone) may be conducted to investigate the possibility of other endocrine disorders such as adrenal insufficiency, hypothyroidism and Growth Hormone deficiency.

III. Iatrogenic

Sulfonylurea/Megalitinide Screen :

These are medications that can cause hypoglycemia. A screen for these medications in the blood and urine helps identify if they are contributing to the low blood sugar.

The evaluation of hypoglycemia requires a strategic approach, integrating symptoms, history with biochemical tests. Proper timing of sample collection especially during a spontaneous or induced hypoglycemic episode is critical. Accurate diagnosis not only guides effective treatment but also prevents recurrent episodes and associated morbidity.

Mrs. Manju M J, Msc

It is very common for patients to approach doctors complaining of low blood sugar. It is essential to  understand two crucial information before you think that you have hypoglycemia ( or low blood glucose)

1. The common symptoms of low blood glucose are trembling, palpitations, sweating, anxiety, hunger, nausea and tingling.  If unattended, it may progress to confusion, weakness, drowsiness and vision changes.  So, just constant fatigue and exhaustion may not be symptoms of low blood glucose levels.

2. Although the fasting glucose for healthy adults is in the range of 70-100 mg/dl, most healthy adults may not feel any specific symptoms even if the glucose dips below 70 mg/dl. The healthy body has corrective mechanisms to keep it functioning normally.  However, when it goes below 55 mg/dl, people may start experiencing symptoms of hypoglycemia.

If you experience documented low glucose levels below 55 mg/dL, you should consult an endocrinologist. The tiredness and exhaustion that you have mentioned may be a sign of a different disease, and you should not attribute it to the blood glucose. You should meet a doctor to understand that.

Dr. Mathew John, MD, DM

Diabetes is diagnosed when the fasting blood sugar is more than 126mg/dL and post meal glucose level is more 200 mg/dL. FBS measures the glucose levels after 8-10 hours of fasting. It provides a baseline measurement of how much sugar is in your blood without the influence of food. It helps to assess whether you are suffering from prediabetes or diabetes. In some persons we see that FBS or the fasting sugar levels are found to be higher than the post-meal values. This can occur due to various reasons.

1. Can be due to high levels of glucose release from the liver at night which is a sign of insulin resistance.

2. If the person has taken very heavy meals that too late at night can also lead to higher FBS.

3. High levels of hormones including Cortisol, growth hormone at night can lead to higher FBS.

4. In some persons due to the effect of medicines, sugar levels can drop at night leading to a rebound effect causing higher fasting levels in the morning -This is termed as Somogyi effect.

5. In the early morning hours due to the influence of hormones released in our body, sugar levels can go up leading to higher fasting levels. This is termed as Dawn phenomenon.

6. In prediabetes condition termed as Impaired fasting glucose, the fasting blood sugar can go high ranging from 100 to 125 mg/dL. But their post meal sugar levels will remain normal.

7. The effect of certain medications like insulin and sulphonylurea drugs can cause low sugar levels at night leading to a rebound effect causing higher  fasting levels.

Hence if you find abnormality in FBS, consult your doctor and find out the reason for it. If you are already on diabetic medications you may need fine adjustments of it to avoid this problem.  

 Dr. Deepa G, MHSc (Diab), Dip (Diab)

Hypoglycaemia, also known as low blood sugar, can unexpectedly affect anyone, not just individuals with diabetes. Have you ever wondered what could trigger such a sudden drop in your blood glucose levels? Here are some causes worth noting:

• Certain medications : Specific antibiotics, heart medications, or anti-malarial drugs can lower your blood sugar levels unexpectedly.

• Excessive alcohol consumption: Drinking alcohol without eating can result in a stealthy decline in blood sugar levels.

• Severe illnesses : Conditions affecting vital organs such as the liver, kidneys, or heart can also lead to low blood sugar.

• Infections: Serious infections, including cerebral malaria, can cause significantly low glucose levels.

• Long-term starvation or eating disorders : Disorders like anorexia nervosa can severely disrupt glucose balance.

• Pancreatic tumours (insulinomas) : These tumours produce excess insulin, leading to low blood sugar levels.

• Hormone deficiencies : Issues related to adrenal or pituitary glands can contribute to hypoglycaemia.

• Post-stomach surgery occurrences : Procedures like gastric bypass may result in unexpected drops in blood sugar levels.

If you experience symptoms that indicate hypoglycaemia and find relief by elevating your blood glucose, it is crucial to seek medical evaluation!                   

Dr. Tittu Oommen, MD, DM 

Thyroxine is most effective when taken on an empty stomach, typically in the morning. This allows for optimal absorption in the small intestine, as food can reduce its bioavailability, potentially leading to less effective treatment. It is recommended to wait at least 30 to 60 minutes before eating or drinking anything after taking the medication. Alternatively, thyroxine can be taken at night, provided it is at least 4 hours after the last meal.

Certain foods and beverages can affect thyroxine absorption, including high-fiber meals, soy products, and foods high in calcium and iron. Additionally, coffee, tea, and dairy products should not be consumed close to the time of taking thyroxine. Supplements such as calcium, iron, and antacids may also impact absorption and should be taken at least 4 hours apart from thyroxine.

Here are some guidelines to optimize the effectiveness of thyroxine:

• Take thyroxine at the same time every day to maintain consistent hormone levels.

• Swallow the pill with a full glass of water.

• Avoid taking calcium, iron, or fiber supplements within four hours of the dose, as they can interfere with absorption.

• If consuming coffee or tea, have them after eating, not with the medication.

• Regular blood tests are important to monitor thyroid levels and adjust the dosage if necessary.    

Mrs. Bini S John , D Pharm

Thyroid disorders and polycystic ovary syndrome (PCOS) are two of the most common endocrine disorders in the general population. Although the etiopathogenesis of hypothyroidism and PCOS is completely different, these two entities have many features in common. An increase in ovarian volume and cystic changes in ovaries have been reported in primary hypothyroidism. It is increasingly realized that thyroid disorders are more common in women with PCOS as compared to the normal population.

Hypothyroidism can lead to polycystic morphology of the ovaries. While this morphology can vary with severity and duration of hypothyroidism, there is no evidence to suggest that primary hypothyroidism can lead to PCOS. Research suggests that those with PCOS may have a higher risk of developing hypothyroidism. this could be due to common factors like insulin   resistance, autoimmunity, and genetic predisposition.

Managing both these hormonal conditions require drugs to maintain the thyroid hormone levels, strict life style measures including diet and regular exercises and in some cases drugs to manage menstrual irregularities. Hence those have features of hypothyroidism screen for PCOS and vice versa. Follow the advice of the endocrinologist and dietician and manage these problems effectively to avoid related problems.

Dr.Deepa G, MHSc (Diab), Dip (Diab)

Hypothyroidism is a common thyroid disorder in India, with a prevalence of around 11%. This means that approximately one in ten adults in India may be affected by hypothyroidism. The prevalence is higher in women and older adults, A significant portion of the population may also have subclinical hypothyroidism, where thyroid hormone levels are not severely low, but still affect thyroid function. These persons are kept under follow up only and don’t need hormone replacement.

Common Symptoms of Hypothyroidism:

1. Fatigue or feeling tired and lacking energy is a very common symptom.

2. Unexplained weight gain despite diet and exercise can occur

3. Feeling colder than usual or having difficulty tolerating cold temperatures.

4. Dry, brittle skin and hair , including hair loss or thinning.

5. Changes in bowel habits, including constipation  

6. Menstrual Changes include heavy or irregular periods in women.

7. Pain , stiffness , and swelling in muscles and joints.

 8. Cognitive issues- Problems with concentration,   memory, and thinking.

9. Symptoms of depression , including sadness, loss of interest, and fatigue.

10. Hoarse Voice : Changes in voice quality, including hoarseness.

11. Slowed Heart Rate : A slower than normal pulse

Hypothyroidism characterised by low thyroid hormone levels can lead to slower metabolic rate leading onto weight gain even if the calorie load is the same. On the other hand, obesity itself is associated with increased risk of subclinical hypothyroidism. In fact both the problems share common risk factors like sedentary life style, poor diet control and genetic predisposition. Hence addressing obesity through strict life style measures which include balanced diet and regular exercises can improve thyroid function. Similarly treating hypothyroidism with appropriate medication can help in managing weight gain. So a comprehensive approach is required if you have thyroid problem and obesity.

 Dr.Deepa G, MHSc (Diab), Dip (Diab)

This is one of the most commonly asked questions by people with thyroid diseases. The answer is “ YES ”, cabbage and cruciferous vegetables like cauliflower, Brussels sprouts, and kale can be consumed, but in moderation.

Cruciferous (brassica) vegetables contain many healthy nutrients, including phytochemicals, with anti-carcinogenic, anti-oxidative, and anti-inflammatory activity. They also contain goitrogens, which can interfere with the thyroid gland’s ability to absorb iodine, which is essential for producing thyroid hormones. Multiple studies suggest that cooking these vegetables significantly reduces goitrogens and is not harmful for most people, even those with thyroid diseases. Cooking cruciferous vegetables (steaming, boiling, sautéing) reduces goitrogenic activity by leaching of glucosinolates into water and inactivation of the enzyme myrosinase.
 
Recommendations:

• Eat in Moderation : Enjoy cabbage and other cruciferous vegetables as part of a varied diet, rather than consuming large quantities regularly.

• Cook Them : Opt for cooked versions of these vegetables more often than raw.

• Ensure Adequate Iodine Intake : If you have thyroid disease, ensure you are getting enough iodine through your diet (e.g., iodized salt, seafood, dairy) unless your doctor advises otherwise.

• Listen to Your Body : Pay attention to any symptoms that might arise after consuming these vegetables and discuss them with your doctor or a registered dietitian.

• Consult Your Doctor : If you have a thyroid condition, it’s always best to discuss your diet with a qualified registered dietitian. They can provide personalized advice based on your specific condition and needs.

Mrs. Sreekutty.S, MSc