Although patients with diabetes can have cataracts or glaucoma, the most important complication is diabetic retinopathy. Diabetic retinopathy progresses through various stages that include mild, moderate and severe retinopathy. If untreated and uncared for, it can result in macular oedema, retinal bleeding and retinal detachment.
Diabetic retinopathy in early stages can be quite silent with no significant visual disturbances. But diagnosing at this stage can help tighten up diabetes control, blood pressure control and lipid control and prevent further progression of the disease. Get your eyes checked for retinopathy at least annually if you don’t have any symptoms and more frequently if you have any disease. Ophthalmology services in Providence (Monday and Friday 9:30 AM-1:00 PM)
Excessive hair growth in areas like face, chest and abdomen in women is called hirsutism. When someone has hirsutism, it is important first to find a reason for the same. It could be very simple problems like idiopathic hirsutism or it could even be quite sinister like an ovarian or adrenal tumour. In women with polycystic ovary syndrome, we will need to evaluate and manage your metabolic problems also. Once a diagnosis is made, we can decide on the right treatment. There are medicines which can reduce the speed of hair growth and thickness of hair so that it is much easier to manage hirsutism. It is high time that always make a diagnosis before we start treatment.
Our endocrinologists can help patients with hirsutism by making a diagnosis by clinical and hormone testing. We can start and adjust medicines monitoring for possible adverse effects. Being experts in endocrinology, our team can help in care of medical therapy even while undergoing LASERS, so that your outcomes are optimal. For appointments call 0471-6662880
Craniopharyngioma is a brain tumour which is common in children. All children with craniopharyngiomas undergo surgery following which some children require radiation to prevent recurrence. Since the tumour is located in areas which are quite close to the pituitary and hypothalamus, many of these children suffer from deficiency of pituitary hormones. If these hormones are not appropriately replaced, these kids suffer various problems including short stature, tiredness and lack of pubertal development. Some of these kids also suffer from diabetes insipidus, a condition causing increased thirst and urination.
Our endocrinologists can help patients with craniopharyngiomas asses their pituitary function and give age appropriate treatment to improve their outcomes. Being experts in both paediatric and adult endocrinology, our team can help in care during transition period. For appointments call 0471-6662880
In patients with type 2 diabetes, the beta cells of pancreas slowly become dysfunctional and reduce insulin production. It was believed that these cells die as diabetes progresses. It was once believed that the beta cells of pancreas do not have the ability to regenerate once they become dysfunctional. It is now known from animal experiments that beta cells of the pancreas become dysfunctional by changing themselves to immature cells or alfa cells. It is also now known that alfa cells can change their face and become fully functional beta cells. Alfa cells in the pancreas can modify themselves to produce GLP-1 which can stimulate multiplication of beta cells. Certain other cells in the pancreas can also generate beta cells. We believe that in the future there will be therapies which can help beta cell regeneration. For appointments call 0471-6662880
It was traditionally thought that diabetes affected only the eyes, nerves, kidney and the blood vessels. By affecting the blood vessels, it affects the heart causing heart attacks and the brain causing strokes (cerebrovascular accidents). But of late we have realised that patients with diabetes have an increased risk of liver disease. In fact, liver disease has become one of the major causes of death in subjects with diabetes. Most of these patients have non-alcoholic steatohepatitis (#NASH) which progresses to cirrhosis. Liver disease is not something that is easy to diagnose especially in the early stages. It is important to prevent liver disease in diabetes by these measures
1.Control blood sugars strictly
2.Reduce consumption of carbohydrates and fat
5.Selectively use drugs for diabetes which have a favourable profile in liver disease.
Drugs belonging to SGLT2 inhibitors class (Canagliflozin, Dapagliflozin and Empagliflozin) are well known to reduce the risk of heart disease and death in patients with diabetes. The same class of drugs are now known to reduce the risk of kidney disease progression in patients with diabetes, especially if they have proteinuria (condition of having more protein in urine). Large studies together involving more than 34000 patients have substantiated these claims.
In a new research called CREDENCE, Canagliflozin has been found to reduce progression of kidney disease in subjects with diabetic kidney disease. However, not all patients can use these drugs. Your doctor can help you understand the benefits and risks of these drugs.
Can we Start using Dapagliflozin (Forxiga, Farxiga) in type1 diabetes patients?
You might have come across a news that there is now an oral drug that has been approved for use in subjects with type 1 diabetes.
You Should understand the following facts about this drug and its approval.
- In this research (DEPICT 2), only subjects who are adults were included. So if you are a child with type 1 diabetes, you should not use the drug
- The average HbA1c reduction was around 0.4%
- Recommended only if your BMI > 27Kg/m2
- More Patients using the drug had a potentially fatal complication called Diabetic Ketoacidosis (DKA)
- This is not a substitute to insulin. It is used along with insulin
- It should not be used if your insulin requirements are low
- It should be used only under extreme medical supervision
Insulin is essential for survival of patients with type 1 diabetes. The aim of treatment has changed from just helping patients survive the disease to having children live longer without any complications. Insulin is preferably given by 4 or more injections. The aim is to adjust the doses according to food and activity so as to keep the blood sugars on target. Most children will require short acting insulin with every meal and a long acting insulin once daily.
Developments in the insulin technology has resulted in long acting insulins like Glargine (20-24 hours action) and Degludec (more than 24 hours) action. These insulins have revolutionized the way we manage children with diabetes. This has resulted in lower risk of night time hypoglycemia.
Glucose monitoring is required to maintain the fine balance between high and low blood sugars. Regular glucose monitoring can help identify low sugars (hypoglycemia) and high sugars. Glucose monitoring is advised before the meal (pre-meal) to decide on the dose of correction insulin to be given. The blood sugar is checked on waking up to decide on the doses of long acting insulin and make sure that there are no low sugars. Blood sugars are checked 2 hours after the meal (post meal) to understand how high the sugars go after a meal. This can help adjust the insulin dose to a meal.
It is not just the HbA1c and the self-monitored blood sugars that are important. It is also important to know how the blood sugars behave throughout the day. This can be done with a Continuous Glucose Monitoring System (CGMS). We usually use a Medtronic Enlite Sensor or an Abbott Freestyle Libre Flash monitoring system. CGMS has helped doctors and patients understand the details of daily blood glucose fluctuations. This helps them make better decisions for patients.
Type 1 children and adults can get their sugars better controlled by using multiple insulin doses or insulin pumps. In this process of achieving good blood sugars there is a risk of low blood sugars. Over time, it has become clear that we need to maintain good blood sugar control even in children with type 1 diabetes to prevent diabetes complications. The targets for blood sugars is as follows:
- Fasting plasma glucose level of 70 – 130 mg/dl on waking
- a plasma glucose level of 70-130 mg/dl before meals at other times of the day
- a plasma glucose level of 90–160 mg/dl after meals
And children and young adults (less than 18 years) are encouraged to maintain their HbA1c less than 7.5 %. These targets are lesser than the previously recommended targets for children with diabetes.