Category: General

Growth hormone therapy can be initiated at any age before a child’s growth plates fuse, which is typically around 14 years for girls and 16 years for boys. It’s common for parents to seek medical advice when their child in primary school or approaching puberty appears significantly shorter than their peers or is growing more slowly than expected. Even infants born with growth hormone deficiency can benefit from this therapy. This deficiency might result from abnormal pituitary gland development, causing a lack of growth hormone and potentially other hormones as well. Recognizing that growth hormone deficiency can manifest at any age is important.

Early diagnosis and intervention are crucial for children with growth hormone deficiency to ensure they achieve their full growth potential. The timing of growth hormone therapy significantly impacts a child’s height outcome, with the best results observed when treatment is started between the ages of 2 to 9 years. This is because early initiation helps catch up on the growth deficit before puberty begins. Once puberty starts, the effectiveness of growth hormone therapy diminishes considerably due to the natural fusion of growth plates, which limits further growth in height.

In conclusion, while growth hormone therapy can be highly beneficial, its success largely depends on timely diagnosis and appropriate management. Parents and caregivers should be vigilant about their child’s growth patterns and seek medical advice if there are concerns about short stature or slow growth, ensuring that any potential growth hormone deficiency is addressed promptly and effectively.

Dr. Tittu Oommen MD, DM

Kids are given growth hormone to treat growth hormone deficiency. Some parents doubt whether their kids may grow too tall by taking growth hormone. However, this does not happen.

The kid’s growth stops when the growth plate fuses. When patients are started on GH, the growth plate matures and they increase in height. Ultimately, the growth plate closes, and the person reaches the final height. This height is in keeping with the individual’s genetic potential. So, kids won’t grow too tall if they receive growth hormone.

Dr. Mathew John MD, DM

No. Most people reach adult height by 18 years; girls reach by 14-15 years, and boys by 16-18 years. A person gains height when their bones grow progressively. The bones grow at a growth plate (epiphyseal cartilage). However, due to the effect of male and female hormones, the cartilage plate reduces in width and ultimately fuses, preventing any further growth. The status of the growth plate can be checked in X-rays.

So, in adults, there is no more growth plate to promote growth. So, normal adults cannot grow taller even if they take growth hormone. However, the growth plate remains open for a long time in diseases like growth hormone deficiency. Hence, growth may continue beyond 18 years. However, this growth is promoted only when treated with growth hormone.

So don’t fall for therapies advertised to promote height in adults. Despite the best efforts, it will not happen.

Dr. Mathew John MD, DM

Growth hormone (GH) is naturally produced and secreted from our pituitary gland. GH is essential to stimulate normal growth, muscle and bone strength, and fat distribution. In some instances, growth hormone secretion gets compromised and may result in Growth Hormone Deficiency (GHD). Although not common, GHD can occur at any age. Still, it is usually identified among infants and children, and children may grow shorter than their expected standard height.
The causes of growth hormone deficiency are varied. Most are congenital, but some may be acquired due to diseases of the pituitary gland like surgery, trauma or radiation. Congenital causes of GHD occur from birth due to genetic mutations.

The common symptoms are

• Slow growth

• Younger looking round face

• Absent or delayed pubertal changes

• Short stature

• Reduced bone strength

Usually, GH treatment is given for the following conditions.

• Growth Hormone deficiency ( acquired, congenital or idiopathic)

• Prader-Willi Syndrome

• Turner’s Syndrome

• Idiopathic short stature ( cause is unknown).

• Small for gestational-age children who do not have adequate catch-up growth

• Noonan’s syndrome

• SHOX gene haploinsufficiency

• Chronic Renal Insufficiency with poor growth.

Adults can also develop GHD, which can affect their structure and metabolism. These are due to trauma, pituitary surgeries or radiation.

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

People living with diabetes often fear diabetes complications. Of course, uncontrolled blood sugars are the reason for diabetes-related health issues and complications. People with diabetes may experience a fear of hypoglycemia (low blood sugars) and hyperglycemia (uncontrolled blood sugars) and are prone to long-term complications that may affect the heart, kidneys, eyes, legs, and brain. Such fear may affect self-management skills and impair the quality of life and emotional well-being.

Why do people fear diabetes complications?

• Inadequate knowledge about diabetes and its complications

• Lack of social support, i.e., from friends, colleagues, and partners.

• Previous episodes of low blood glucose

• Limited understanding of hypoglycemia management and sick day management.

These situations can be overcome through proper diabetes education by a certified diabetes educator, psycho-educational interventions, and regular consultation with a treating consultant.

How can I overcome these fears?

1. Control blood glucose/sugar levels: glucose control has been found to reduce all the complications of diabetes. So, intensive blood glucose control with diet, medicines, self-monitoring and Continuous Glucose Monitoring (CGM) devices helps maintain glucose levels.

2. Maintain target blood pressure & LDL levels to avoid risks of heart attacks and stroke.

3. Practice preventive foot care with an annual neuropathy and blood vessel disease evaluation.

4. Annual dilated eye examinations for diabetic retinopathy

5. Modifying lifestyle: Sugars should be cut out of the equation altogether, and fibre intake, adequate protein, and low-glycemic carbohydrates should be increased. Other lifestyle changes that include stopping tobacco and alcohol and regular physical activities should be done as well.

6. We are using appropriate medicines and preventive measures to avoid complications.

It is good to understand diabetes and its complications and prevention methods. Knowledge helps; fear does not!

Ms. Revathy V.K, MSc

As new medicines enter the market, they tend to be expensive. However, they become cheaper over the years since they may be off-patent and manufactured by local pharmaceutical firms. As consumers, we are all aware that any product requires costs to produce, transport, and market with a fair profit for the seller. However, often, people may tend to choose medicines purely for cost concerns, ending up buying substandard drugs.

Most of the affordable drugs belong to an older generation, like metformin and sulphonylureas. While these medications can help manage diabetes, they may not be sufficient for everyone. As the duration of diabetes increases, people may require newer medicines and insulin, which may be expensive. So, a medicine that worked well initially may not work later. Further, not all diabetes medications work the same for everyone. Each person’s body reacts differently to treatments, and what works for one person may not work for another.

Cheap medications can be effective, but they might not be the best fit for your specific needs.

New medicines like GLP-1RA (Liraglutide, Semaglutide, Dulaglutide, etc.) have protective effects on the heart, kidneys and liver. Hence, these medicines can be chosen if you are at high risk of these diseases.
If you’re on a low-cost medication but still struggling with diabetes management, it’s crucial to consult your doctor. Your doctor may recommend adjustments to your treatment plan or additional therapies that better suit your needs.
So,

1. Discuss with your doctor if you are on the correct type of medicine, regardless of cost.

2. Choosing very cheap medicines may also increase your risk of receiving substandard drugs, which are less effective and may be harmful to your health.

3. If cost is a significant concern for you, talk to your doctor to understand which are the best alternatives, e.g. good quality generics and biosimilars

Dr. Tittu Oommen MD, DM

Living with diabetes can be tough, especially when work keeps you busy. The role of exercise in managing blood glucose and improving heart health is proven beyond doubt. So, it is essential to incorporate physical exercise into daily routine. In addition, exercise can improve blood pressure, cholesterol and reduce stress. Energy expenditure can happen with exercise and with improved general physical activity. This is called Non Exercise Activity Thermogenesis (NEAT) So, despite the limited time, find methods to improve exercise and NEAT.
If you’re struggling to fit activity into your busy workday, here are some easy ways to help you stay active with diabetes:

• Take the stairs instead of the elevator: It’s a great way to get your heart pumping and burn extra calories.

• Take a walk during your lunch break: A short walk can give you some exercise and fresh air. Even a quick 10-minute stroll is beneficial. The walk can be replaced with exercises like jumping jacks, pushups etc. to avoid being monotonous.

• Stand up and move every hour: Sitting all day isn’t good for your health. Set a reminder to stand up and move around a bit every hour.

• Join a walking group with coworkers: Walking with colleagues makes it more enjoyable. You can encourage each other to stay active.

• Take a fitness class before or after work: Classes can keep you motivated and add variety to your routine. Try yoga, Pilates, or strength training.

• Do yoga pose to relieve stress and boost flexibility: Yoga helps reduce stress and improve flexibility. Simple poses like mountain pose and downward dog are great options.

• Use a pedometer or fitness tracker to monitor your steps: A tracker helps you set goals and see your progress. Aim for at least 10,000 steps a day.

• Park farther from your workplace entrance: Parking farther away means you’ll walk more and burn extra calories. If you take public transport, try getting off a stop or two early and walking the rest of the way.

• Take stretch breaks: Sitting for too long can make your muscles tense and tired. Make sure to take stretch breaks during your workday. Stretch your arms, legs, and back every now and then.

• Choose the longer route sometimes: Instead of always picking the quickest path, opt for the longer route to add some extra steps to your day. Whether it’s walking to the restroom, the printer, or the break room, those steps can add up.

By adding these simple activities to your day, you can stay active and can make a big difference in managing your diabetes while maintaining a busy schedule. Remember, small changes can lead to big improvements in your health and well-being.

Mrs.Rejitha Jagesh, MSc

Diabetes Mellitus is a complex metabolic disease which requires life-long care. It has a great impact on one’s life in every aspect like physical, mental, psychological, and social. The progression of diabetes reflects a dark influence on a person’s life when complications start to make their presence. The complications of diabetes are multifaceted and can affect every organ system in the body. Both microvascular and macro vascular complications can influence the quality of life and reduce the life expectancy of an individual. But with proper management, education and support, it is possible to manage the condition.

Managing blood sugar levels is the key part of diabetes management. Keeping track of your blood sugar helps avoid both dangerously high (hyperglycemia) or low (hypoglycemia) levels, which can lead to serious health complications. A diabetes-friendly diet with balanced carbohydrates, protein, and fats is inevitable to maintain steady blood sugar levels.

Living with diabetes can be stressful and emotionally taxing. The constant alertness needed to manage the condition can lead to burnout, anxiety, or feelings of isolation. “Diabetes distress” is a term used to describe the emotional burden of managing diabetes, and seeking support is a critical part of diabetes care. A psychological support from their family, friends and colleagues can help in reducing the distress.

Diabetes management requires discipline, but it also teach resilience, self-care, and empowerment. Over time, many people with diabetes develop a deep understanding of their body and gain the skills needed to manage their health—creating a sense of control and normalcy despite the challenges the condition presents.

Mrs. Sreekutty S, MSc

Mr Ajith, the bank manager, has been having diabetes for 16 years and is currently on multiple medicines and insulin. He is very well aware that he has to monitor his glucose 3- 4 times daily and take injections 4 times daily. In addition, he has doctor visits (3 doctors, one for diabetes, heart and kidney) almost monthly. He tries to follow foot care, eye care, diet, medicines and monitoring. He says he is attempting his level best but feels fed up and sometimes thinks of stopping all his medicines. He avoids official trips and even personal events since he is perturbed that he may become blind or have kidney failure.

“ Diabetes distress ” refers to the emotional and psychological challenges of managing diabetes. It’s different from depression but shares similar feelings.

What are the signs of diabetes distress?

• Feeling frustrated, guilty, or overwhelmed by diabetes care

• Skipping medication or neglecting self-care

• Unstable blood sugar levels or missing medical appointments

• Feeling overwhelmed by constant monitoring and management

• Anxiety about blood sugar levels or complications

• Feeling isolated and avoiding necessary tasks

• Struggling with negative thoughts

• Experiencing emotional exhaustion

How is diabetes distress assessed?

Healthcare providers use standardized questionnaires. We have included a simple questionnaire called The 2-Item Diabetes Distress Screening Scale (DDS2) to test yourself (see the creative below)

What should I do if I am experiencing diabetes distress ?

• Consult your healthcare provider or endocrinologist

• Consider professional mental health support (psychologist/therapist)

• Prioritise self-care (exercise, meditation)

• Educate yourself about diabetes

Ms. Aneesha Joseph, MSc

People with diabetes will require reliable information about various aspects of their disease to manage it well. This includes information about the disease’s nature, complications, tests, food, medicines and follow-up. Well-informed people can discuss treatment options with their physicians and make informed decisions.

However, the field of diabetes has its share of misinformation. With the increasing use of social media and streaming services like YouTube, anyone can air their opinions about various aspects of diabetes. These may be drugs and diets that have worked for them to biased views on drugs, supplements and disease manifestations. Some may be advertisements disguised as information to promote a product or service. Some may be unproven therapies like alternative medicines or herbs with potential downsides. Due to ease of access and attractive packaging of information, the public is likely to depend on these as if they are the truth.

The current science of medicines and therapies used in diabetes is developed after detailed research. These undergo human trials for safety and effectiveness and are approved by regulatory bodies for use. Professional bodies analyze this information and translate it into clinical practice guidelines for use by physicians and information for people living with diabetes. Modern medicine doctors who practice diabetes will explain some of these on their websites and blogs. These can be considered as authentic information.

Reliable sources of information includes

1.    American Diabetes Association: https://tinyurl.com/3ybr8kxh

2.    International Diabetes Federation https://tinyurl.com/k9ddd32z

3.    Research Society for Study of Diabetes in India https://tinyurl.com/35s8wu9w

4.    Diabetes Research and Wellness Foundation: https://tinyurl.com/2h3suy65

5.    Providence Endocrine and Diabetes Specialty Centre: our website has blogs on various diseases, including diabetes and obesity
 https://www.providence.co.in/blog/

As  Elliott P. Joslin , a pioneer in diabetes education, said, “The diabetic who knows the most lives the longest.”

Mrs.Rejitha Jagesh, MSc