Prediabetes
What is prediabetes and how is it different from diabetes?
Prediabetes is the state that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. About 10 percent of people with prediabetes develop type 2 diabetes each year over next 3 years.
Is prediabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose?
Yes. Doctors sometimes refer to this state of elevated blood glucose levels as Impaired Glucose Tolerance or Impaired Fasting Glucose (IGT/IFG), depending on which test was used to detect it.
What problems can arise from prediabetes?
People with prediabetes are at higher risk of cardiovascular disease (e.g. heart disease, stroke etc.). People with prediabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. People with diabetes have a 2- to 4-fold increased risk of cardiovascular disease. We now know that people with prediabetes can delay or prevent the onset of type 2 diabetes through lifestyle changes.
Why do I need to know if I have prediabetes?
If you have prediabetes, you can and should do something about it. Studies have shown that people with prediabetes can prevent or delay the development of type 2 diabetes by up to 58 percent through changes to their lifestyle that include modest weight loss and regular exercise. The experts recommends that people with prediabetes reduce their weight by 5-10 percent and participate in some type of modest physical activity for 30 minutes daily. For some people with prediabetes, intervening early can actually turn back the clock and return elevated blood glucose levels to the normal range.
What is the treatment for prediabetes?
Treatment consists of losing a modest amount of weight (5-10 percent of total body weight) through diet and moderate exercise, such as walking, 30 minutes a day, 5 days a week. Don’t worry if you can’t get to your ideal body weight. A loss of just 10 to 15 pounds can make a huge difference. If you have prediabetes, you are at a 50 percent increased risk for heart disease or stroke, so your doctor may wish to treat or counsel you about cardiovascular risk factors, such as tobacco use, high blood pressure, and high cholesterol.
Could I have prediabetes and not know it?
Absolutely. People with prediabetes don’t often have symptoms. In fact, millions of people have diabetes and don’t know it because symptoms develop so gradually, people often don’t recognize them. Some people have no symptoms at all. Symptoms of diabetes include unusual thirst, a frequent desire to urinate, blurred vision, or a feeling of being tired most of the time for no apparent reason.
Gestational Diabetes Mellitus
What is gestational diabetes mellitus (GDM)?
GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.
What is the frequency of GDM?
Approximately 7% of all pregnancies are complicated by GDM, but incidence of GDM is on the rise.
When should GDM be evaluated?
Risk assessment for GDM should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria (presence of glucose in urine), or a strong family history of diabetes) should undergo testing for diabetes as soon as feasible. In pregnant women not known to have diabetes, screen for GDM at 24–28 weeks of gestation, using an oral glucose tolerance test.
What is the initial management for GDM?
All women with GDM should receive nutritional counseling. Programs of moderate physical exercise have been shown to lower maternal glucose concentrations in women with GDM. Women without medical or obstetrical contraindications are encouraged to start or continue a program of moderate exercise as a part of treatment for GDM.
What are blood glucose targets in case of GDM?
Target maternal capillary glucose concentrations (tested by glucometer) in pregnant ladies with GDM are
Preprandial (pre-meal) ≤95 mg/dl and
either 1-h postmeal ≤140 mg/dl
or 2-h postmeal ≤120 mg/dl
What if diet and exercise fails to control blood glucose?
If dietary and lifestyle changes fail to bring down maternal blood glucose levels to above targets, insulin is recommended. Insulin is the agent that has most consistently been shown to reduce fetal morbidity due to GDM. It is also the safest drug that is available to reduce blood glucose in pregnancy. Human insulin should be preferred (in place of analogs) when insulin is prescribed, and self monitored blood glucose values at home should guide the doses and timing of the insulin regimen.
How can we know whether the fetus is having any damage from GDM?
Assessment for asymmetric fetal growth or large sized fetus by ultrasonography, particularly in early third trimester, may aid in identifying fetuses that can benefit from maternal insulin therapy
Can medicines be used for treatment of GDM?
Medicines like metformin and glibenclamide are approved for treatment of GDM in some countries. If you are advised these medicines have a detailed discussion with your doctor regarding its advantages and disadvantages relative to insulin.
Do I need to undergo cesarean delivery if I have GDM?
GDM is not of itself an indication for cesarean delivery or for delivery before 38 completed weeks of gestation. Prolongation of gestation past 38 weeks increases the risk of fetal macrosomia (large sized baby) without reducing cesarean rates, so that delivery
during the 38th week is recommended unless obstetric considerations dictate otherwise.
What are the risks to the newborn from GDM?
GDM of any severity increases the risk of fetal macrosomia. The presence of fasting hyperglycemia (>105 mg/dl) may be associated with an increase in the risk of intrauterine fetal death during the last 4–8 weeks of gestation. Other complications in the neonate as a result of GDM can be hypoglycemia (low neonatal blood glucose), jaundice, polycythemia (increased RBC), hypocalcemia (low calcium) and respiratory distress.
When should I undergo my next check up for diabetes after delvery?
Screen women with GDM for persistent diabetes 6–12 weeks postpartum.
Can I breast feed my baby?
Breast-feeding, as always, should be encouraged in women with GDM.
What are the problems I may have in future after GDM?
Women with GDM are at increased risk for the development of diabetes, usually type 2, after pregnancy. Obesity and other factors that promote insulin resistance (e.g. PCOS) appear to enhance the risk of type 2 diabetes after GDM. Women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years.
What are the problems my baby can have in future?
Offspring of women with GDM are at increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood.
Osteoporosis
What is Osteoporosis?
Osteoporosis (or porous bone) is a disease in which bones become weak and can result in fractures often from a trivial trauma. Osteoporosis results from loss of bone density over time. As you age, calcium may be reabsorbed back from the bones, which makes the bone tissue weaker. This can result in brittle, fragile bones that are more prone to fractures, even without injury.Fractures commonly occur in the hip, spine, and wrist.
What Causes Osteoporosis?
Bones may seem like hard and lifeless structures, but they are in fact living tissue. Old bone is constantly broken down (through a process called bony resorption), and new bone is deposited. Any time bone is broken down faster than it is deposited, low bone mass (osteopenia) and osteoporosis can occur.
What are the Symptoms of Osteoporosis?
In most people, low bone mass (osteopenia) and osteoporosis occur without any symptoms and can only be detected on testing (DEXA or BMD). In people with osteoporosis, a simple everyday movement, such as picking up a grocery bag, can cause a sudden onset of back pain, and that can be the first symptom. As osteoporosis progresses over a period of time, the bones in the spine (verebrae) can begin to collapse. Collapsed vertebrae may be felt as severe back pain or seen as loss of height or spine deformities such as a hunchback.
When Does Osteoporosis Occur?
Osteoporosis is common in people older than 50 years, and the older a person is, the greater the risk is of osteoporosis. This is because during childhood and teenage years, new bone is generally added faster than old bone is removed. This is the time when a diet rich in calcium and vitamin D is important. As a result, bones become larger, heavier, and denser. Maximum bone density and strength is reached at age 20-25 years. The density and strength of the bones is fairly stable from age 25-45. A slight loss of bone density begins to occur after age 30 because bone slowly begins to break down (a process called resorption) faster than new bone is formed. For women, bone loss is fastest in the first few years after menopuase, but it continues gradually into the postmenopausal years. As bone density loss occurs, osteoporosis can develop. This process is slower by 10 years in men.
Who is at Risk for Osteoporosis?
Certain risk factors are associated with developing osteoporosis. Many people with osteoporosis have several risk factors, but some people with osteoporosis have none. Some risk factors cannot be changed. These include the following:
Sex: Women are more likely to develop osteoporosis than men.
Age: The older a person is, the greater the risk of osteoporosis.
Physical build: People who are small and have thin bones are at greater risk.
Race: White and Asian women are at the highest risk.
Family History: If a person’s parents had osteoporosis, he or she may be at risk.
Some risk factors can be modified. These include the following:
Levels of sex hormones: Low estrogen in women and low testosterone in men are associated with osteoporosis.
Diets low in calcium and phosphate.
Low vitamin D levels
Use of medications: Glucocorticoids, which are medications prescribed for a wide range of diseases, including arthritis, asthma, ulcerative colitis, lupus, and other diseases, can cause osteoporosis.
Inactive lifestyle
Excessive alcohol intake
How is Osteoporosis Detected?
Unfortunately, many people do not know they have osteoporosis until they experience a broken bone. By that time, bones are already weak. However, osteoporosis can be prevented or delayed by early detection and treatment. Specialized tests called bone density tests can measure bone density (solidness) in various sites of the body, such as the hip, spine, and wrist. These tests are quick (taking less than 15 minutes), painless, and noninvasive. A bone density test can detect osteoporosis before a fracture occurs and can predict your chances of having a broken bone in the future. A dual-energy x-ray absorptiometry (DEXA) scan of bone mineral density (BMD) can determine your rate of bone loss and/or monitor the effects of treatment. Talk to the doctor about these tests.
How Can Osteoporosis Be Prevented?
Osteoporosis is prevented by reaching the peak bone mass (maximum bone density and strength) during the childhood and teenage years and by continuing to build more bone as one gets older, particularly after the age of 30. A few things that can be done to maintain healthy bone are as follows:
Get enough calcium and vitamin D by drinking milk or eating milk products and taking Vitamin D supplements.
Exercise
Do not smoke
Avoid excessive intake of alcohol
Be aware that long-term use of some medications such as glucocorticoids (medications prescribed for a wide range of diseases, including arthritis, asthma, Crohn disease, lupus, and other diseases of the lungs, kidneys and liver) can lead to a loss of bone density. Contact the treating doctor to discuss either prevention or treatment of osteoporosis under these circumstances.
Other drugs that can cause bone loss include certain antiseizure drugs, such as phenytoin (Dilantin) and barbiturates; gonadotropin-releasing hormone (GnRH) analogs used to treat endometriosis; excessive use of aluminum-containing antacids; certain cancer treatments in both men and women; and excessive thyroid hormone. Talk to the doctor. Also, talk to the doctor about the many medications that are available to delay or prevent osteoporosis.
How is Osteoporosis Treated?
Osteoporosis treatment includes both lifestyle changes and medications. Treatment programs focus on nutrition, exercise, and safety issues to prevent falls that may result in broken bones. The doctor may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk. Available oral medications include alendronate, risedronate and raloxifene for preventing and treating postmenopausal osteoporosis. Teriperatide is a self-injectable medication used to treat osteoporosis in postmenopausal women and men.
Other medications, including estrogen or hormone replacement therapy (ET/HRT), are used to prevent postmenopausal osteoporosis, and calcitonin is approved for treatment. Talk to the doctor about these medications.
All medicines for treatment of osteoporosis require calcium and vitamin D supplementation in adequate dosage to be effective.
Obesity & Overweight
1. What is obesity?
Obesity is a condition where there is excess fat in your body. Obesity is associated with many other problems like high blood pressure (hypertension), diabetes, heart disease, osteoarthritis, sleep apnea, etc.
2. How do I know if I am obese or just overweight?
There is a classification sysytem developed by the World Health Organisation (WHO ). It states that, to have a healthy weight for your body size your BMI should fall between 18.5 and 24.9 on the BMI scale. If your BMI is between 25 and 29.9 you are overweight. A BMI between 30 and 39.9 classifies you as obese, which also qualifies you for treatment. People who have a BMI of 40 fall into the ‘morbidly obese’ weight bracket and should strongly consider treatment.
3. What is my body mass index (BMI)?
BMI is a way medical professionals check if you are at a healthy weight for your height.
BMI = Weight in kilograms divided by (height in meter)2 for example if your weight is 65kg and height is 165 cm = 1.65 m, your BMI will be 65/1.65x 1.65 = 23.8, which comes in the ideal range.
4. Is obesity hereditary?
Obesity often runs in families, which suggests there is a genetic link. Parents also pass on common dietary habits to their children and may share a similar attitude towards physical exercise and lifestyle habits. However, there is no certainty that these factors must result in obesity; they may contribute, but do not make obesity a certainty.
5. What other factors contribute to the development of obesity?
A main cause of obesity is a poor diet coupled with a lack of exercise. As most of us do not have physical occupations, it becomes harder to get enough exercise during our daily routine. Consuming large portions of fatty foods, sweet foods and sugary drinks (high in calories and low in nutrients) consumed on a frequent basis leads rapid weight gain. Other possible causes can be due to stress or insomnia; the use of antidepressants and steroids; and hormone problems, such as polycystic ovarian syndrome or Cushing’s syndrome.
6. Does being obese put my health at risk?
Serious health complications can arise if obesity is left untreated. Short-term problems such as breathlessness, difficulty sleeping and aches and pains are most noticeable with intense weight gain. Further long-term problems may include type 2 diabetes, high blood pressure and coronary heart disease. Women who are obese are more likely to have problems during and after pregnancy.
7. How can I prevent obesity from developing?
Arrange an appointment with your doctor as he or she can suggest an appropriate health plan to stick to. This plan may involve following a healthy eating plan, decreasing the size of your meals, more regular exercise, regular monitoring of your weight, and potentially the use of a medical treatment.
8. What methods of treatment are available?
Obesity can be treated by proper diet and exercise. If there is a specific medical condition that is giving rise to obesity that needs to be corrected. Oral medicines are also available for treatment of obesity. Those with morbid obesity can benefit from bariatric surgery.
9. Is surgery a worthwhile risk?
Weight loss surgery is carried out to restrict the amount of food a person can eat. Common methods include gastric band surgery, gastric bypass, bilopancreatic diversion and sleeve gastrectomy. Procedures can take from 30 minutes to several hours to successfully complete. A private operation performed by a professional surgeon can cost as much as Rs. 1,50,000 or more.
Polycystic Ovary Syndrome
How common is PCOS?
PCOS affects an estimated 5-10 percent of women of childbearing age and it is a leading cause of infertility.
What are the symptoms of PCOS?
Hirsutism (excess hair) — Excess hair growth such as on the face, chest, abdomen, upper par of arms and legs.
Amenorrhea (no menstrual period), infrequent menses, and/or oligomenorrhea (irregular bleeding) — Cycles are often greater than six weeks in length, with eight or fewer periods in a year. Irregular bleeding may include lengthy bleeding episodes, scant or heavy periods, or frequent spotting.
Alopecia (scalp hair loss) — The balding is more common on the top of the head than at the temples.
Acne/Oily Skin/Seborrhea — Oil production is stimulated by overproduction of androgens. Seborrhea is dandruff — flaking skin on the scalp caused by excess oil.
Infertility — Infertility is the inability to get pregnant within six to 12 months of unprotected intercourse, depending on age. With PCOS, infertility is usually due to ovulatory dysfunction.
Obesity or weight gain — Commonly a woman with PCOS will have excess weight concentrated around the abdomen. It should be noted that most, but not all, women with PCOS are overweight.
Is PCOS a Syndrome or a Disease?
PCOS is generally considered a syndrome rather than a disease (though it is sometimes called Polycystic Ovary Disease) because it manifests itself through a group of signs and symptoms that can occur in any combination, rather than having one known cause or presentation.
What causes PCOS?
The exact cause of PCOS is unknown. There are studies being conducted to see if there may be a genetic link — that PCOS is passed along in families. Just as one might have a genetic predisposition to diabetes, one might also have a disposition to PCOS. The above analogy to diabetes seems appropriate as many current studies into PCOS are focusing on the body’s ability to process insulin. A growing collection of data suggests that elevated insulin levels are unhealthy and contribute to increased androgen production, worsening PCOS symptoms from cosmetic issues to infertility, and eventually increasing the risk of certain cancers, diabetes and heart disease. It is also possible that PCOS may be caused or worsened by valproate, a medication used to treat seizures.
How should PCOS be diagnosed?
PCOS should be diagnosed based on physical exam, ultrasound of the ovaries, and the results of various blood tests.
Is it possible to have polycystic ovaries without having the syndrome?
About 15-20 percent of normal women can have the appearance of polycystic ovaries. Diagnosis of PCOS is based on signs and symptoms as already mentioned along with corroborative laboratory results. It may be best to consider the finding of polycystic ovaries as a possible sign of PCOS, but not to rely on this as the sole criterion in making a diagnosis.
What are the chances of pregnancy in PCOS?
Even though PCOS is one of the leading causes of female infertility, infertility related to PCOS is treatable in the majority of cases. Women with PCOS can and do still get pregnant—sometimes naturally, sometimes with help. Lifestyle changes, such as losing weight, can trigger body changes that improve pregnancy rates. For many women with PCOS who want to get pregnant, health care providers will recommend weight loss and other lifestyle changes before adding medications to see if fertility returns and pregnancy occurs naturally.
Sometimes PCOS is not the cause of the infertility. Instead, it results from other factors, such as fallopian tube blockage or a low concentration of sperm in male partners. Women with PCOS and their partners may be screened for non-PCOS infertility factors before starting treatment.
Is the miscarriage rate higher in women with PCOS?
There does appear to be a higher miscarriage rate in women with PCOS, but the exact reason is still under investigation. One possibility is that PCOS may be associated with poor follicle development and decreased egg quality.
Is there anything that can be done to reduce the chance of miscarriage in a woman with PCOS?
The primary way to reduce miscarriage associated with PCOS is to normalize hormone levels. For women with low progesterone levels in the luteal phase, improving ovulation through the use of clomiphene citrate, or injectable FSH or FSH/LH may help the problem. Addressing ovulation issues is more useful than progesterone supplementation as low progesterone is usually a symptom of a problem, such a weak ovulation, rather than the actual cause of miscarriage. Normalizing blood sugar and glucose levels may help, and lead to lower androgen levels, so use of metformin during pregnancy is increasing.
Isn’t metformin a diabetic drug?
Metformin was originally prescribed to diabetes patients, but is widely used to treat PCOS. PCOS patients commonly have insulin resistance. Lowering of insulin resistance by metformin provides symptomatic benefits in PCOS . There is some evidence that women who continue metformin throughout pregnancy have lower rates of miscarriage.
Growth Hormone Deficiency
What is growth hormone deficiency?
Growth hormone deficiency is a disorder that involves the pituitary gland (a small gland located at the base of the brain). This gland produces growth hormone and other hormones (chemical messengers of the body). When it does not produce enough growth hormone, growth will be slower than normal. If other pituitary hormones are absent or present in inadequate amounts, the condition is called panhypopituitarism.
Growth hormone deficiency can occur at any age. Growth hormone is necessary for normal growth and development in children. In adults, growth hormone is needed to maintain the proper amounts of body fat, muscle, and bone. In adults, low or absent growth hormone can also cause tiredness, lethargy and lack of motivation.
What causes growth hormone deficiency?
Growth hormone deficiency is caused by low or absent secretion of growth hormone from the pituitary gland. This condition may be present at birth, or it may develop after birth due to trauma, infections, radiation to the head, or other conditions (for example, tumors).
How do I know if my child has a growth disorder?
A child’s growth pattern is an important part of determining normal growth. No child has a perfectly steady growth rate; children go through growth spurts and periods of slower growth. The best way to evaluate a child’s growth pattern is to plot the child’s height and weight on a growth chart. This can be completed by a doctor or a health care practitioner, at school, or even at home. The growth chart will show the child’s growth over a period of time.
Any departure from a prior growth pattern appropriate for the child’s genetic background may signal the appearance of a disease. Contact a doctor or healthcare practitioner if the child’s growth or height is a concern. The doctor may suggest seeing a specialist who can perform tests to determine if the child has a hormone deficiency.
Adults with growth hormone deficiency usually have a history of pituitary tumors that may have been treated with surgery or radiation.
In some cases, no cause can be identified.
What are the symptoms of growth hormone deficiency?
The most common sign of growth hormone deficiency is the slowing of growth. A child with growth hormone deficiency may also have the following symptoms:
Short height for child’s age
Increased fat around the waist and in the face
The child may look younger than other children his or her age
Delayed onset of puberty
Delayed tooth development
Adults with growth hormone deficiency may have the following symptoms:
Low energy
Decreased strength and exercise tolerance
Decreased muscle mass
Weight gain
How is growth hormone deficiency diagnosed?
For children, the doctor will ask about the child’s medical history. If the child’s height and weight have been plotted on a growth chart, the doctor will evaluate if the child’s growth appears to be leveling off or departing from the child’s established growth curve. Past growth patterns are important in determining if the child has a growth problem; the earlier a problem is detected, the earlier it can be treated (if possible) and the better the chance the child has at reaching his or her full growth potential.
The doctor may perform blood tests to determine if a hormone deficiency or other disease is present. X-rays may also be taken to check how the child’s bone size compares to the child’s height and chronological age.
In adults, blood tests may be performed to determine if a hormone deficiency is present. Adults with growth hormone deficiency may also have increased level of total cholesterol, low-density-lipoprotein (LDL) cholesteroland triglycerides. Other tests that may be performed include MRI of the brain. Images from these tests may reveal tumors or a hypoplastic (small) gland.
How is growth hormone deficiency treated?
Growth hormone deficiency can be treated with growth hormone replacement therapy. A drug called somatropin or growth hormone is injected into the fat underneath the skin.
What is a growth disorder?
A growth disorder is any type of problem in infants, children, or teenagers that prevents normal growth. Normal growth depends upon several factors, such as nutrition, genetics, and hormone. Endocrine (hormonal) causes of growth disorders include thyroid hormone deficiency (hypothyroidism), growth hormone deficiency, hypopituitarism, or other hormone disorders. However, some growth problems are not necessarily growth disorders; normal variants of growth patterns include genetic short height (familial short stature) and slow growth/delayed puberty (constitutional growth delay).
Although growth hormone was originally used to treat growth hormone deficiency (this group of patients respond the best to growth hormone therapy), there have been other conditions for which growth hormone therapy has been approved for use. These include Turner syndrome, chronic renal insufficiency, Prader Willi Syndrome and children who were small for gestational age and have not caught up in their growth by the age of two years. In 2003 the FDA approved the use of growth hormone for children who have “Idiopathic Short Stature,” that is, children who are quite short (more than 2.25 SD below the mean in height), and who are unlikely to have an adult stature in the normal range.
How do I know if my child has a growth disorder?
A child’s growth pattern is an important part of determining normal growth. No child has a perfectly steady growth rate; children go through growth spurts and periods of slower growth. The best way to evaluate a child’s growth pattern is to plot the child’s height and weight on a growth chart. This can be completed by a doctor or a health care practitioner, at school, or even at home. The growth chart will show the child’s growth over a period of time.
Any departure from a prior growth pattern appropriate for the child’s genetic background may signal the appearance of a disease. Contact a doctor or healthcare practitioner if the child’s growth or height is a concern. The doctor may suggest seeing a specialist who can perform tests to determine if the child has a hormone deficiency.