Category: General

Medicines are used to bring blood glucose levels to near normal in people with diabetes. For type 1 diabetes, insulin is the primary option, but for type 2 diabetes, various options, including oral and injectable drugs, are available. Type 1 diabetes is due to the destruction of the beta cells of the pancreas that produces insulin. In type 2 diabetes, various reasons are responsible for the elevated blood glucose levels: this includes reduced insulin production, reduced insulin action, reduced output of GLP-1 (a molecule that stimulates insulin production), and decreased urinary loss of glucose (due to increased activity of a protein called SGLT2). In addition, there are various other reasons, including inflammation and brain-related reasons for type 2 diabetes.

The various drugs used in diabetes act by correcting these abnormalities: reduced insulin production is improved by sulphonylureas (e.g. Glimepiride, Gliclazide) and insulin; reduced insulin action is enhanced by Metformin and Pioglitazone; GLP-1 is improved by DPP4 inhibitors (e.g. Vildagliptin, Sitagliptin, etc.) and GLP-1RA (e.g. Liraglutide, Dulaglutide) and SGLT2 action is reduced by SGLT2 inhibitors (Empagliflozin, Dapagliflozin, etc).

Author
Dr. Mathew John

Delayed puberty is treated with hormone therapy. For example, boys might get a course of treatment with testosterone, and girls with low doses of estrogens. The endocrinologist may also suggest medicines like hCG or FSH to boys. Sometimes doctors prescribe a short span of hormone replacement therapy to see whether they can trigger puberty. After treatment ends, the child’s hormones usually take over to complete the process of puberty. If they don’t, the doctor will discuss long-term sex hormone replacement.
Using testosterone and estrogen is safe in children. However, hormone treatment has to be supervised by an endocrinologist. Hormone replacement therapy is safe and essential for the child’s physical and emotional well-being. The duration of treatment for delayed puberty depends on its cause.

At 14 years, it can be upsetting for a child not to grow and develop physically as quickly as their peers. An endocrinologist is often able to detect signs that puberty has started. Boys can start puberty at a wide range of ages beginning between 11 and 14, so we consider puberty delayed when it has not begun by age 14. The earliest sign of puberty in boys is an enlargement of the testicles, followed by growth of the penis and pubic hair. The growth spurt usually starts a year or so after the genitals enlarge, generally by age 15. Only later, hair develops over the face and the chest.
For boys who don’t show any signs of puberty by 14, it should be evaluated by an endocrinologist. Fortunately, by far, the most common cause is constitutional delayed puberty. This is a normal variant of growth. These boys are generally healthy and will eventually go through puberty if given enough time. In most cases, it is inherited from one or both parents.
The physical exam is often enough, and the key finding is that the penis and testicles do not enlarge by age 14. Sometimes investigations are done to find out if there are actual disorders of male hormone production. Also, An x-ray of the hand and wrist to determine the bone age is often ordered, to look for the delay in bone maturation. Rarely imaging tests such as MRI and Ultrasound are asked to determine the exact nature of delayed puberty.

Author
Dr. Tittu Oommen

Girls generally attain puberty between the ages of 10 and 14. But in some children, these changes can normally occur earlier too. The first sign of puberty in girls is that their breasts begin to develop. This is followed by the appearance of pubic hair. In addition, some girls may notice more hair on their legs and arms. Around two years after beginning puberty, girls usually have their first menstrual period. After that, girls go through a growth spurt – from the time their periods start, girls grow 5 to 7.5cm (2 to 3 inches) annually over the next year or two, then reach their adult height.
Most commonly, especially in girls, early puberty is due to the brain sending signals earlier than it should. There is no other underlying medical problem or trigger. This also can often run in families. Less often, early puberty stems from a more serious problem in areas in the brain responsible for the timing and occurrence of puberty (Pituitary and Hypothalamus. This could be due to a tumour or trauma. Thyroid or ovarian problems also can trigger early puberty.
Girls who show signs of puberty before the age of 8 should consult an endocrinologist for evaluation. To diagnose early puberty, the doctor may order blood tests to look for high levels of sex hormones. In addition, X-rays of your child’s wrist and hand can show whether the bones are maturing too early. Rarely, imaging tests such as MRIs and ultrasound studies are done to rule out uncommon causes of early puberty, such as a tumour in the brain or ovary.

Author
Dr. Mathew John

The onset of puberty below eight years in girls and below nine years in boys is called precocious puberty. The endocrinologist should see all kids with suspected precocious puberty. Some of them turn out to be normal puberty that started earlier than expected. On the other hand, some kids with early puberty may turn out to have diseases of the pituitary, the hypothalamus or the gonads( testes and ovaries) or even the adrenals.
Early-onset of puberty will bring both emotional and physical problems. The biological concern includes early bone growth stoppage, leading to short adult height. In addition, kids with early puberty are highly self-conscious about the changes occurring in their bodies. This may lead to low self-esteem and increase the risk of depression and substance abuse. The early onset of menstrual periods in girls is also a concern to parents.
Medicines called GnRH analogues (e.g. Leuprolide, Triptorelin) are commonly used to stop the production of gonadotropins and hence arrest the progression of puberty. When used early and at an appropriate age, these drugs help to improve the final height of kids with precocious puberty. They are generally safe and have very few adverse effects.

In boys, puberty generally starts between ages 11 to 14. However, it could start anytime after nine years of age. The first sign of puberty in boys is the enlargement of the testes. However, this is rarely noticeable from the outside. Later the pubic hair starts to appear.
Gradually the penis starts becoming more prominent, and thicker pubic hairs start appearing. Later the underarm hairs begin to grow, and the voice deepens. It is common to have acne at this stage. At this stage, growth spurts occur and boys grow distinctly faster. Later, hair develops over the face and the chest. Most boys would complete the pubertal growth by 18 years of age.
If you notice any signs of puberty below nine years in a boy, it merits a visit to an endocrinologist. The investigations are directed at the causes of increased androgen (male hormone) production. Increased androgen production could be from the testes (directly or triggered by the pituitary ) or the adrenal glands.

Author
Dr.Mathew John

Puberty is a time when the boy or girl becomes sexually mature. Puberty is an exciting phase for kids. Although the physical aspect of puberty triggers curiosity, the psychological aspects are also equally exciting. It is the stage when the appropriate hormones start acting slowly and steadily. As a result, boys gradually become men, and girls are on their way to becoming women.
It starts at between the ages 10 and 14 for girls and ages 11 and 16 for boys. Since the range for starting puberty is quite broad, it is not unusual to have a kid start and progress in puberty, but another kid of the same age not having any signs of puberty. However, these age ranges are not strict, and normal puberty in a small number of kids can start below this age.
There is a small gland in the head called the pituitary responsible for producing gonadotropins that start puberty. This gland is regulated by an area of the brain called the hypothalamus responsible for deciding the timing of puberty. The gonadotropins act on the testes (in boys) and ovaries (in girls) and produce hormones -testosterone (in boys) and estrogen (in girls). These hormones lead to most of the changes that we see externally in boys and girls in puberty.

Author
Dr. Mathew John

High blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and its blood vessels. Over time, this damage can lead to heart disease. People with diabetes tend to develop heart disease at a younger age than people without diabetes. Adults with diabetes are nearly twice as likely to have heart disease or stroke as adults without diabetes. If you have any of these warning signs of a heart attack, you need urgent medical care.

• Pain or pressure in your chest that lasts longer than a few minutes or goes away and comes back
• Pain or discomfort in one or both of your arms or shoulders, or your back, neck, or jaw
• Shortness of breath
• Sweating or light-headedness
• Indigestion or nausea (feeling sick to your stomach)
• Feeling very tired

Warning signs can be different in different people. You may not have all the listed symptoms. Women may experience chest pain, nausea, and vomiting, feel very tired (sometimes for days); and have pain that spreads to the back, neck, throat, arms, shoulders, or jaw. People with diabetes-related nerve damage may not notice any chest pain, and so it is termed as “silent heart attack”. Only minor heartburn or extreme fatigue may be the only symptoms, Other than heart attacks, tic people are more susceptible to developing heart failure.

• Symptoms of heart failure include swelling of legs, difficulty in breathing, more at night, unable to perform routine activities without breathlessness, chest discomfort on exertion.

People with diabetes have a two to fourfold increased risk of CVD and are up to three times more likely to die after myocardial infarction than people without diabetes. Regular exercise training, individual dietary modification, and smoking cessation are significant lifestyle changes for the primary prevention of CVD. Certain glucose-lowering medicines like sodium-glucose cotransporter 2 (SGLT2) inhibitors (Empagliflozin, Dapagliflozin, Canagliflozin) or injectable GLP-1 receptor agonists (Liraglutide, Dulaglutide) can reduce the risk of heart disease and death in people with diabetes and cardiac risk. In addition, strict blood pressure control with BP lowering medicines and management of LDL with statins reduces the risk of heart attacks in people with diabetes.

When a heart attack occurs, the aim should be to reach the hospital at the earliest to undergo primary angioplasty of thrombolysis. Coronary angiography can help decide the need for coronary artery bypass grafting. Long term treatment of these individuals will include medicines like antiplatelet drugs(Aspirin, Clopidogrel, Prasugrel), Beta-blockers, Statins and ACEI inhibitors.

Author
Dr. Deepa

You can reduce your risk of developing heart disease by making the following changes:

• You can reduce the chances of developing heart disease by controlling blood sugar levels, blood pressure and cholesterol. Please make sure you get advice and support from your doctor to keep them within your target range. Monitor your blood glucose, glycated haemoglobin (HbA1c), blood pressure and blood cholesterol as advised by your doctor. Scientific studies have shown that normalising blood glucose, controlling hypertension to target with blood pressure lowering medicines, and using statins to keep LDL cholesterol levels on target helps reduce the risks of heart disease.
• Quit Smoking. Smoking makes it harder for blood to flow around your body, especially to your heart.
• Eat a healthy, balanced diet to protect your heart, significantly reducing saturated fat in your diet.
• Be physically active and do regular exercise. Avoid sitting for long periods.
• If you are obese or overweight, discuss with your doctor methods to help you lose some weight. Even losing a small amount can make a real difference.
• Take your medication as prescribed. Adherence to drugs controlling diabetes, blood pressure and cholesterol will help in reducing your risk of developing a heart attack.

Author
Dr. Tittu Oommen