Endocrinology

Should I eat a chocolate bar to bring my sugar back up? Chocolate is not usually the best choice because the fat in it slows down the absorption of sugar. Treat a low blood sugar reaction with some type of fast-acting sugar, such as glucose tabs, four ounces of juice, four ounces of nonfat milk, or half of a can of regular soda.

Diabetes often causes poor circulation in the legs and feet. This is one reason people with diabetes must take special care of their feet. Diabetics are likely to have foot problems, such as fungus, ingrown toenails, infections, bunions, and ulcers. Most foot amputations can be prevented with good foot care. Note any changes in your feet, such as cuts, scratches, red areas, corns, cracks, itching, or other abnormalities. Any changes should be reported to your podiatrist. To smooth down calluses, use a pumice stone when bathing and never cut calluses off. Trim or file toenails straight across to cut down on the chance of ingrown nails. Make sure shoes fit properly. Pressure from ill-fitting shoes can cause sore areas and lead to ulcers and infections. Patients who have foot pain should see a podiatrist regularly. Most insurance companies will cover podiatry care for patients with diabetes.

Diabetes is a condition in which glucose remains in the blood without getting transported out into the cells and used as a source of energy. There are two types of diabetes:

• Type 1 or insulin-dependent: It is diagnosed during childhood. In this condition, the body is unable to make enough insulin, a hormone that is required for blood sugar metabolism.
• Type 2 or non-insulin dependent: It is a more common type of diabetes, usually develops in adults, and may remain undiagnosed for some time. In this condition, the body is capable of producing insulin, but the tissues become resistant to its actions, and hence blood sugar levels increase.

The blood sugar levels in type 1 and type 2 diabetes may be controlled. Type 1 requires daily injections of insulin, whereas type 2 is controlled by dietary modification, weight loss, and exercise. Foods that contain a high amount of simple sugars, such as fruit juices, sports drinks, candies, jelly, jams, and honey, should be avoided. The American Diabetes Association recommends the following:

• After fasting, your blood sugar should be between 80 and 120 mg/dl.
• Before meals, it should be less than 140 mg/dl.
• Two hours after a meal, it should be less than 180 mg/dl.

We recommend using new lancets and syringes for each injection. However, many people reuse their personal lancets for one week. This is acceptable as long as the lancet device is not shared with anyone else. In reusing the syringe, patients run the risk of insulin contamination. Therefore, every syringe should be discarded after use.

Blood sugar levels change all the time and vary with each individual. The American Diabetes Association recommends the following:

• After fasting, your blood sugar should be between 80 and 120 mg/dl.
• Before meals, it should be less than 140 mg/dl.
• Two hours after a meal, it should be less than 180 mg/dl.

Blood sugar levels should be checked at least twice each day.

Visit the ophthalmologist once a year. For patients with retinopathy, an ophthalmologist should be seen on a routine basis.

Signs include extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, and nausea.

Signs include shaking, fast heartbeat, sweating, anxiety, dizziness, hunger, impaired vision, weakness/fatigue, headache, and irritability.

Your blood sugar level should be between 60 and 90 mg/dl when you have been fasting and less than 120 mg/dl two hours after a meal.

Total carbohydrates include sugar, starches, and dietary fiber. The total amount of carbohydrates is what affects blood glucose levels—not just sugar.

Patients who take blood pressure medication should limit sodium intake to 2,000 mg a day. One teaspoon of salt contains about 2,300 mg of sodium. Most sodium in the American diet comes from processed or prepared foods, not from the kitchen table salt shaker. Foods that have 400 mg per serving are considered high-sodium foods.

The recommended amount of fiber is 25 to 30 grams per day. Check for fiber on food labels to help reach this number. Some examples of high-fiber foods are fruits, vegetables, legumes, and whole grains. Fiber is not completely digested and absorbed in the intestinal system, and it is unavailable as blood sugar.

Therefore, a high-fiber meal does not provide as many available carbohydrates as a similar-content low-fiber meal. To avoid constipation, increase water intake as more fiber is added to the diet.

Synthetic hormones may be given to replace low hormone levels due to the malfunctioning of the pituitary gland. These may be either taken orally or injected. Some pituitary tumors can be controlled with medication. Others may require surgery or radiotherapy.

No, these tumors are caused by an abnormality in the genetic material of the pituitary cell, which causes the cells to continue growing and dividing.

We have synthetic hormones that patients take either by mouth or injection to replace the missing hormones from the malfunctioning pituitary gland.

The body constantly replaces old bone with new bone, like growing new hair and skin. Osteoporosis occurs when the body does not make enough new bone to replace the old, or old bone is lost too fast for the body to replace it. A number of factors cause bones to begin thinning and become frail. As women become menopausal, they make less estrogen, the female hormone that helps keep bones strong. Other causes of osteoporosis may be a diet low in calcium or vitamin D, heavy steroid use, and alcoholism.

Preventing osteoporosis starts early in life with a good diet rich in calcium and vitamin D. Frequent exercise also plays an important role since it increases bone strength and makes patients less likely to experience fractures or breaks.

After menopause, some women may take estrogen supplements to help keep bones strong. Persons at risk for osteoporosis should be checked regularly by a doctor. When the disorder is discovered early through bone scans and X-rays, the doctor can suggest changes in diet, exercise, and medications to keep bones healthy.

Unfortunately, when osteoporosis is discovered as a result of a broken or fractured bone, it is too late to take preventive action.

Women should take 1,000 mg of calcium in their daily diet. If there is a strong family history of osteoporosis or osteoporosis has already been diagnosed, a woman should take 1,500 mg of calcium daily. A small daily supplement of vitamin D (400 IU) is recommended because it improves the absorption of calcium by the body. Either calcium carbonate tablets or calcium citrate tablets may be taken four to six times a day, up to 1,000 to 1,500 mg total. Calcium citrate is absorbed better by some patients and may have fewer digestive tract side effects.

Men with osteoporosis are usually given calcium supplements of between 1 and 1.5 grams a day. When there are signs of reduced calcium absorption, supplements can be increased up to three grams a day, and vitamin D supplements of 50,000 IU may be given once or twice a week. However, at these dosage levels, these high calcium levels should be closely monitored.

Some people with osteoporosis experience no symptoms at all, while others may experience pain in the bones and muscles, particularly in the back. A person may experience fractures or broken bones (particularly of the hip and wrist) with very little to cause them.

Some people develop humps in their upper back or experience shrinking height because of compression fractures in their backs. When symptoms are experienced, a person may have pain that comes on suddenly, does not radiate, gets worse when weight is put on the area, may be tender locally, and generally begins to go away in a week. However, some pain may remain for three months or more.

Both men and women can get osteoporosis. In fact, a rare form of osteoporosis can occur in children and young adults of both genders. Postmenopausal osteoporosis tends to occur between the ages of 51 and 75. Although osteoporosis is six times more common in women, it can also occur in men with low levels of testosterone.

Another type of osteoporosis is associated with the normal aging process. It usually occurs in people who are 60 or older, and it is twice as common in women as in men. Osteoporosis can also develop as a side effect of:

Not everyone gets osteoporosis, but as we age, it is more likely that we will experience some osteoporosis. Besides age and gender, certain things will make osteoporosis more likely, including:

• A family history of osteoporosis
• Being less active
• Not taking in enough calcium, phosphorus, and vitamin D
• Having your first period late and menopause early
• Not bearing children
• Drinking coffee or alcohol and smoking
• Being Caucasian or Asian (Blacks and Hispanics have a higher bone mass than Caucasians or Asians)