ENDOCRINOLOGY & DIABETOLOGY

Endocrinology is the field of hormone-related diseases. An endocrinologist can diagnose and treat hormone problems and the complications that arise from them.

Hormones regulate metabolism, respiration, growth, reproduction, sensory perception, and. Hormone imbalances are the underlying reason for a wide range of medical conditions.

Endocrinology focuses both on the hormones and the many glands and tissues that produce them.

Humans have over 50 different hormones. They can exist in very small amounts and still have a significant impact on bodily function and development.

Here are some key points about endocrinology.

• Endocrinology involves a wide range of systems within the human body.
• The endocrine tissues include the adrenal gland, hypothalamus, ovaries, and testes.
• Polycystic ovary syndrome is the most common endocrine disorder in women.

What is the endocrine system?

The human endocrine system consists of a number of glands, which release hormones to control many different functions.

When the hormones leave the glands, they enter the bloodstream and are transported to organs and tissues in every part of the body.

Endocrinology refers to a medical focus on hormones. Hormones shape the body and drive its systems.

 An endocrinologist, a doctor who specializes in endocrinology is

 Trained to diagnose and manage diseases that affects the glands and the hormones.

An endocrinologist aims to restore hormone balance within the body’s systems.

Endocrinologists in our hospital treat the following conditions:

 

    Diabetes

    Osteoporosis

    Menopause

    Metabolic disorders

    Thyroid diseases

    Excessive or insufficient production of hormones

    Some cancers

    Short stature

    Infertility

Diagnostic Process:

The hormone levels affect so many different systems in the body that just small changes in one gland can impact parts of the body far from the site of the glands themselves.

They will check the patient’s heart rate and blood pressure, and look at the condition of their skin, hair, teeth, and mouth.

Blood and urine samples may be taken.

Following diagnosis, the endocrinologist will suggest a treatment plan. This will depend on which underlying condition is causing the symptoms.

DIABETOLOGY:

Diabetes affects a person’s blood sugar levels and can require various treatments. Understanding which doctors help treat diabetes can simplify the process and make it less stressful.

Diabetes develops when the pancreas no longer produces insulin in the way it should do. The pancreas is a gland, and insulin is a hormone. The pancreas produces the insulin we need to regulate blood sugar. When a person has diabetes, the pancreas either does not produce insulin or the insulin does not work properly.

Our Dialectology specialists meticulously follow the process of treatment from diagnosis, through the latest and most accurate tools for diagnosis available in our hospital and take the course of medication and diet and healthy lifestyle advice to treat the patients with Diabetic ailments.

PREVENTIVE DIABETOLOGY

Medical nutrition therapy (MNT) is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. It is, therefore, important at all levels of diabetes prevention (MNT is also an integral component of diabetes self-management education (or training). This position statement provides evidence-based recommendations and interventions for diabetes. Since overweight and obesity are closely linked to diabetes, particular attention is paid to this area of MNT.

The goal of these recommendations is to make people with diabetes and health care providers aware of beneficial nutrition interventions. This requires the use of the best available scientific evidence while taking into account treatment goals, strategies to attain such goals, and changes individuals with diabetes are willing and able to make. Achieving nutrition-related goals requires a coordinated team effort that includes the person with diabetes and involves him or her in the decision-making process. It is recommended that a registered dietitian, knowledgeable and skilled in MNT, be the team member who plays the leading role in providing nutrition care. It is of significance that all our team members, including physicians and nurses, are knowledgeable about MNT and support its implementation.

Primary prevention interventions seek to delay or halt the development of diabetes. This involves public health measures to reduce the prevalence of obesity and includes MNT for individuals with pre-diabetes. Secondary and tertiary prevention interventions include MNT for individuals with diabetes and seek to prevent (secondary) or control (tertiary) complications of diabetes.

GOALS OF MNT FOR PREVENTION AND TREATMENT OF DIABETES

Goals of MNT that apply to individuals at risk for diabetes or with pre-diabetes

To decrease the risk of diabetes and cardiovascular disease (CVD) by promoting healthy food choices and physical activity leading to moderate weight loss that is maintained.

Goals of MNT that apply to individuals with diabetes

Achieve and maintain

• Blood glucose levels in the normal range or as close to normal as is safely possible
• A lipid and lipoprotein profile that reduces the risk for vascular disease
• Blood pressure levels in the normal range or as close to normal as is safely possible
•  To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle
•  To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change
•  To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence

 

Goals of MNT that apply to specific situations

     For youth with type 1 diabetes, youth with type 2 diabetes, pregnant and lactating women, and older adults with diabetes, to meet the nutritional needs of these unique times in the life cycle.

 

    For individuals treated with insulin or insulin secretagogues, to provide self-management training for the safe conduct of the exercise, including the prevention and treatment of hypoglycemia, and diabetes treatment during acute illness.

EFFECTIVENESS OF MNT

    Individuals who have pre-diabetes or diabetes should receive individualized MNT; such therapy is best provided by a registered dietitian familiar with the components of diabetes MNT.

    Nutrition counselling we offer is sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes.

ENERGY BALANCE, OVERWEIGHT, AND OBESITY

    In overweight and obese insulin-resistant individuals, modest weight loss has been shown to improve insulin resistance. Thus, weight loss is recommended for all such individuals who have or are at risk for diabetes.

    For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term (up to 1 year).

    For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed.

    Physical activity and behaviour modification are important components of weight loss programs and are most helpful in the maintenance of weight loss.

    Weight loss medications may be considered by our team in the treatment of overweight and obese individuals with type 2 diabetes and can help achieve a 5–10% weight loss when combined with lifestyle modification.

    Bariatric surgery may be considered for some individuals with type 2 diabetes and BMI ≥35 kg/m2 and can result in marked improvements in glycaemia.

The importance controlling body weight in reducing risks related to diabetes is of great importance. Therefore, these nutrition recommendations start by considering energy balance and weight loss strategies.

Because of the effects of obesity on insulin resistance, weight loss is an important therapeutic objective for individuals with pre-diabetes or diabetes. However, long-term weight loss is difficult for most people to accomplish. This is probably because the central nervous system plays an important role in regulating energy intake and expenditure

Evidence demonstrates that structured, intensive lifestyle programs involving participant education, individualized counselling, reduced dietary energy and fat (∼30% of total energy) intake, regular physical activity, and frequent participant contact are necessary to produce long-term weight loss of 5–7% of starting weight.
Exercise and physical activity, by them, have only a modest weight loss effect. However, exercise and physical activity are to be encouraged to all patients here because they improve insulin sensitivity independent of weight loss, acutely lower blood glucose, and are important in the long-term maintenance of weight loss.

Diabetes in youth

Increasing overweight and obesity in youth appears to be related to the increased prevalence of type 2 diabetes, particularly in minority adolescents. Although there are insufficient data at present to warrant any specific recommendations for the prevention of type 2 diabetes in youth, interventions similar to those shown to be effective for the prevention of type 2 diabetes in adults (lifestyle changes including reduced energy intake and regular physical activity) are likely to be beneficial.

NUTRITION RECOMMENDATIONS FOR THE MANAGEMENT OF DIABETES (SECONDARY PREVENTION)

Carbohydrate in diabetes management

    A dietary pattern that includes carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health.

    Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation remains a key strategy in achieving glycemic control.

    As for the general population, people with diabetes are encouraged to consume a variety of fibre-containing foods. However, evidence is lacking to recommend a higher fibre intake for people with diabetes than for the population as a whole.

Control of blood glucose in an effort to achieve normal or near-normal levels is a primary goal of diabetes management. Food and nutrition interventions that reduce postprandial blood glucose excursions are important in this regard since dietary carbohydrate is the major determinant of postprandial glucose levels. Low-carbohydrate diets might seem to be a logical approach to lowering postprandial glucose. However, foods that contain carbohydrate are important sources of energy, fibre, vitamins, and minerals and are important in dietary palatability. Therefore, these foods are important components of the diet for individuals with diabetes.

Resistant-starch/high-amylose foods.

It has been proposed that foods containing resistant starch (starch physically enclosed within intact cell structures as in some legumes, starch granules as in raw potato, and retrograde amylose from plants modified by plant breeding to increase amylose content) or high-amylose foods, such as specially formulated cornstarch, may modify the postprandial glycemic response, prevent hypoglycemia, and reduce hyperglycemia

    High-protein diets are not recommended as a method for weight loss at this time. The long-term effects of protein intake >20% of calories on diabetes management and its complications are unknown.

Optimal mix of macronutrients

Although numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet, it is unlikely that one such combination of macronutrients exists. The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances. For those individuals seeking guidance as to macronutrient distribution in healthy adults, the Dietary Reference Intakes (DRIs) may be helpful. It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goals. Further, individualization of the macronutrient composition will depend on the metabolic status of the patient (e.g., lipid profile).

NUTRITION INTERVENTIONS FOR SPECIFIC POPULATIONS

Nutrition interventions for type 1 diabetes

    For individuals with type 1 diabetes, insulin therapy is generally integrated into an individual’s dietary and physical activity pattern.

The first nutrition priority for individuals requiring insulin therapy is to integrate an insulin regimen into their lifestyle. With the many insulin options now available, an appropriate insulin regimen can usually be developed to conform to an individual’s preferred meal routine, food choices, and physical activity pattern. For individuals receiving basal-bolus insulin therapy, the total carbohydrate content of meals and snacks is the major determinant of bolus insulin doses.

For planned exercise, reduction in insulin dosage is the preferred method to prevent hypoglycemia. For unplanned exercise, intake of additional carbohydrate is usually needed. Moderate-intensity exercise increases glucose utilization by 2–3 mg · kg−1 · min−1 above usual requirements. Thus, a 70-kg person would need ∼10–15 g additional carbohydrate per hour of moderate-intensity physical activity. More carbohydrate is needed for intense activity.

Nutrition interventions for type 2 diabetes:

    Individuals with type 2 diabetes are encouraged to implement lifestyle modifications that reduce intakes of energy, saturated and trans-fatty acids, cholesterol, and sodium and to increase physical activity in an effort to improve glycaemia, dyslipidemia, and blood pressure.

    Plasma glucose monitoring is used to determine whether adjustments in foods and meals will be sufficient to achieve blood glucose goals or if medication(s) needs to be combined with MNT.

Healthy lifestyle nutrition recommendations for the general public are also appropriate for individuals with type 2 diabetes. Because many individuals with type 2 diabetes are overweight and insulin resistant, MNT should emphasize lifestyle changes that result in reduced energy intake and increased energy expenditure through physical activity. Because many individuals also have dyslipidemia and hypertension, reducing saturated and trans fatty acids, cholesterol, and sodium is often desirable. Therefore, the first nutrition priority is to encourage individuals with type 2 diabetes to implement lifestyle strategies that will improve glycaemia, dyslipidemia, and blood pressure.

Progression of diabetes complications may be modified by improving glycemic control, lowering blood pressure, and, potentially, reducing protein intake

Treatment and management of CVD risk:

    For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk.

    For patients with diabetes and symptomatic heart failure, dietary sodium intake of <2,000 mg/day may reduce symptoms.

    In normotensive and hypertensive individuals, a reduced sodium intake (e.g., 2,300 mg/day) with a diet high in fruits, vegetables, and low-fat dairy products lowers blood pressure.

    In most individuals, a modest amount of weight loss beneficially affects blood pressure.

Hypertension, which is predictive of the progression of micro- as well as macrovascular complications of diabetes, can be prevented and managed with interventions including weight loss, physical activity, moderation of alcohol intake, and diets such as DASH (Dietary Approaches to Stop Hypertension). The DASH diet emphasized fruits, vegetables, and low-fat dairy products; included whole grains, poultry, fish, and nuts; and was reduced in fats, red meat, sweets, and sugar-containing beverages. The effects of lifestyle interventions on hypertension appear to be additive.

 

Reduction in blood pressure in people with diabetes can occur with a modest amount of weight loss, although there is great variability in response. Regular aerobic physical activity, such as brisk walking, has an antihypertensive effect

Heart failure and peripheral vascular disease are common in individuals with diabetes, but little is known about the role of MNT in treating these complications

    An interdisciplinary team approach is necessary to integrate MNT for patients with diabetes into overall management.

 DIABETIC RETINOPATHY

Our doctors know the importance of anyone who has diabetes to get the annual eye exams done by an ophthalmologist so diabetic retinopathy can be detected early.

Some of the features of diabetic retinopathy cannot be seen during a basic eye exam and require special exams. To get a better look at the inside of the eye, your doctor might administer drops to dilate your pupils and will then view the retina with lenses and a special light called a slit lamp. A test called fluorescein angiography can reveal changes in the structure and function of the retinal blood vessels. For this test, the doctor injects a fluorescent yellow dye into one of your veins and then photographs your retina as the dye outlines the blood vessels.

The eye exam will likely also include a check for glaucoma and cataracts both of which occur more frequently in people with diabetes and can cause vision problems.

Treatment for Diabetic Retinopathy

Treatment for diabetic retinopathy in our hospital involves both a medical doctor and an ophthalmologist

Laser treatment for diabetic retinopathy, called laser photocoagulation, works in part by creating tiny, painless retinal burns that seal off leaking vessels and reduce swelling. The number of burns the doctor makes and the number of treatments you need depends on the type and extent of your retinopathy and how well it responds to treatment. You may have to wait several months to find out if this treatment is improving your condition.

Your doctor may recommend vitrectomy surgery if you have a haemorrhage that doesn't clear, if you have retinal detachment, or if laser treatment doesn't sufficiently halt the growth of new vessels. During a vitrectomy, your doctor drains the gel-like substance inside the eye, allowing them to clear any lingering blood and to remove scar tissue. The vitreous fluid is then replaced with a substitute fluid.

Rare complications of treatment may include blurred vision, headache, and glaucoma, difficulty seeing in the dark, decreased peripheral and colour vision and bleeding. In most cases when treatment is recommended, the benefits outweigh the risks.

Prevention of Diabetic Retinopathy

Diabetic retinopathy can be minimized with a combination of strict blood sugar control and routine screening with eye exams -- though even with optimal medical care, it is not always possible to prevent or slow retinal damage.

Routine screening offers the best hope for early detection of diabetic retinopathy. People with type 1 diabetes should have a complete eye exam within five years of diagnosis; those with type 2 should have an eye exam at the time their diabetes is diagnosed. After these initial exams, all people with diabetes should have an eye exam at least once a year. Our doctors here may recommend more frequent screenings depending on the severity of retinal damage and on other diabetes complications patients have.

Pregnancy can precipitate or worsen retinopathy in women with diabetes who take insulin, so any such woman considering pregnancy should discuss the risks with their doctor. The doctor will usually recommend an eye exam before pregnancy, a second exam during the first trimester, and additional exams at intervals based on the status of your retinopathy. Women who suddenly develop diabetes during pregnancy (gestational diabetes) are not at risk of developing retinopathy during pregnancy.

High blood pressure, high blood cholesterol, and obesity can all promote diabetic retinopathy and should be treated. Smoking is also a culprit: We advise our patients to never ignore the symptoms of infection, which can worsen diabetic retinopathy

DIABETIC FOOTCARE

People who suffer from diabetes need to take extra care to protect their feet from infection. Diabetes raises the amount of sugar in the blood. High sugar levels can damage the nerves in the feet causing a condition called peripheral neuropathy. Our dialectologists here help the patients know the importance of foot care through their course of diabetic therapies.