Sing-Yung Wu, Mark Chambers, Mazhar Khan, Maureen Chinweze, Thao-My Cao, Haibo Zhao
<p><strong>Objective: </strong>By analyzing the etiology of abnormal TSH in randomly selected veteran patients, we set our heart on improving future clinical care/management of the clinical/subclinical hyper- and hypothyroidism in the aging veteran population.</p><p><strong>Methods: </strong>A total of 1100 patients' charts in alphabetical order were selected. Excluded cases of insufficient information, 897 patients' charts were reviewed and analyzed for causes of abnormal TSH. Among them, 602 for the cause of low TSH (below 0.55 uU/mL) and 295 for high TSH (above 4.78 uU/mL) were reviewed retrospectively.</p><p><strong>Findings: </strong>Among the 1100 patients selected, 680 (61.8%) were 60 y or older (female=44, 6.8%); 420 were under 60 y (female=80, 19.0%); significantly more female patients were found in the younger age group (P<0.001). After excluding patients with insufficient data, the most common cause of suppressed TSH is iodine-induced, CT iodinated contrast and betadine use caused 35.0% in the older group (n=126) compared to 23.6% in the younger group(n=57) (P = 0.027). The significant difference is that older veterans received more contrast CTs (P < 0.05 compared to the younger group). In both age groups with concurrent FT4 study, we found four high FT4 among 90 studies, 4.4% overt hyperthyroidism. The second most common cause of suppressed TSH is due to thyroid hormone (TH) replacement in the older group (119 patients, 33.1%) with age > 60y, significantly more frequent compared to the younger group, P<0.001. There is significantly more overt hyperthyroidism, 27.8/%, than the iodine-load induced suppression of TSH, P<0.001, due to 17 patients on TSH suppression therapy after total thyroidectomy for thyroid cancer. Among the 295 patients with elevated TSH, the most common cause of high TSH was due to hypothyroidism on T4 replacement: a total of 128 (59.3%) in the older group (N=216) is, similar to 47 (59.5%) in the younger group (N=79). In both age groups, there were 139 patients with concomitant FT4 measurement; 17 overt hypothyroidism were found, 12.2%. No significant difference is seen in the two age groups. The next most common causes of elevated TSH are CT contrast infusion, 23 (10.6%) in the older group and 7 (8.9%) in the younger group. We find high TSH is associated with a higher death rate of 101/238 (42.4%) in a 5-year follow-up (from 2016 to 2021), as compared to low TSH of 68/238 (28.6%), in the older age group, p<0.03； both were significantly higher than the age- and sex-matched general US population, 19.7%, P<0.01.</p><p><strong>Conclusion: </strong>Even though most, ~ 90%, were subclinical, the suppressed and elevated TSH are associated with severe consequences in CV/CNS and immune-suppression complications in aging veterans. Therefore, cautious use (and more frequent check of TSH) of TH replacement and CT contrast in aging veterans is recommended. The alarming increase in 5 years death rate in older patients with elevat
{"title":"The Etiology of Abnormal TSH in Veterans Cared by a VA Medical Center - One High Serum Thyrotropin is Associated with Higher 5-Years Mortality.","authors":"Sing-Yung Wu, Mark Chambers, Mazhar Khan, Maureen Chinweze, Thao-My Cao, Haibo Zhao","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>By analyzing the etiology of abnormal TSH in randomly selected veteran patients, we set our heart on improving future clinical care/management of the clinical/subclinical hyper- and hypothyroidism in the aging veteran population.</p><p><strong>Methods: </strong>A total of 1100 patients' charts in alphabetical order were selected. Excluded cases of insufficient information, 897 patients' charts were reviewed and analyzed for causes of abnormal TSH. Among them, 602 for the cause of low TSH (below 0.55 uU/mL) and 295 for high TSH (above 4.78 uU/mL) were reviewed retrospectively.</p><p><strong>Findings: </strong>Among the 1100 patients selected, 680 (61.8%) were 60 y or older (female=44, 6.8%); 420 were under 60 y (female=80, 19.0%); significantly more female patients were found in the younger age group (P<0.001). After excluding patients with insufficient data, the most common cause of suppressed TSH is iodine-induced, CT iodinated contrast and betadine use caused 35.0% in the older group (n=126) compared to 23.6% in the younger group(n=57) (P = 0.027). The significant difference is that older veterans received more contrast CTs (P < 0.05 compared to the younger group). In both age groups with concurrent FT4 study, we found four high FT4 among 90 studies, 4.4% overt hyperthyroidism. The second most common cause of suppressed TSH is due to thyroid hormone (TH) replacement in the older group (119 patients, 33.1%) with age > 60y, significantly more frequent compared to the younger group, P<0.001. There is significantly more overt hyperthyroidism, 27.8/%, than the iodine-load induced suppression of TSH, P<0.001, due to 17 patients on TSH suppression therapy after total thyroidectomy for thyroid cancer. Among the 295 patients with elevated TSH, the most common cause of high TSH was due to hypothyroidism on T4 replacement: a total of 128 (59.3%) in the older group (N=216) is, similar to 47 (59.5%) in the younger group (N=79). In both age groups, there were 139 patients with concomitant FT4 measurement; 17 overt hypothyroidism were found, 12.2%. No significant difference is seen in the two age groups. The next most common causes of elevated TSH are CT contrast infusion, 23 (10.6%) in the older group and 7 (8.9%) in the younger group. We find high TSH is associated with a higher death rate of 101/238 (42.4%) in a 5-year follow-up (from 2016 to 2021), as compared to low TSH of 68/238 (28.6%), in the older age group, p<0.03； both were significantly higher than the age- and sex-matched general US population, 19.7%, P<0.01.</p><p><strong>Conclusion: </strong>Even though most, ~ 90%, were subclinical, the suppressed and elevated TSH are associated with severe consequences in CV/CNS and immune-suppression complications in aging veterans. Therefore, cautious use (and more frequent check of TSH) of TH replacement and CT contrast in aging veterans is recommended. The alarming increase in 5 years death rate in older patients with elevat","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":"7 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10826222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139643512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this article was to describe obesity mechanisms and why obesity and meal properties during a circadian phase are interrelated. Obesity remains a major challenge globally. The increasing rates of obesity and diabetes indicate that current perspectives on obesity etiology are not adequately explanatory. The common view on obesity is energy balance model (EBM), suggesting that energy is stored as fat when overconsumed. However, since EBM is driven by physics, biochemical pathways of fat storage are overlooked. Insulin is secreted by increased blood glucose which drives positive energy balance and thus fat deposition. Such pathways present an innovative concept known as carbohydrate insulin model (CIM). This model might offer a more mechanistic perception into obesity development. Considering that glucose metabolism possesses circadian rhythmicity, CIM and chrono-nutrition may be interconnected. Preventing glycemic load through limiting carbohydrate-rich diets intake and care of meal timing would benefit obesity and diabetes prevention strategies. In conclusion, energy source and chrono-nutrition should be contemplated together as key factors influencing energy partitioning and fat deposition in the modern human.
{"title":"Obesity and Chrono-Nutrition","authors":"A. Nikkhah","doi":"10.31579/2640-1045/115","DOIUrl":"https://doi.org/10.31579/2640-1045/115","url":null,"abstract":"The objective of this article was to describe obesity mechanisms and why obesity and meal properties during a circadian phase are interrelated. Obesity remains a major challenge globally. The increasing rates of obesity and diabetes indicate that current perspectives on obesity etiology are not adequately explanatory. The common view on obesity is energy balance model (EBM), suggesting that energy is stored as fat when overconsumed. However, since EBM is driven by physics, biochemical pathways of fat storage are overlooked. Insulin is secreted by increased blood glucose which drives positive energy balance and thus fat deposition. Such pathways present an innovative concept known as carbohydrate insulin model (CIM). This model might offer a more mechanistic perception into obesity development. Considering that glucose metabolism possesses circadian rhythmicity, CIM and chrono-nutrition may be interconnected. Preventing glycemic load through limiting carbohydrate-rich diets intake and care of meal timing would benefit obesity and diabetes prevention strategies. In conclusion, energy source and chrono-nutrition should be contemplated together as key factors influencing energy partitioning and fat deposition in the modern human.","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42034286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Humulin 70/30 insulin is an intermediate acting medication used for treatment diabetes mellitus. According to systematic review and there have been forty four case reports of overdoses with different types of insulin. We present a unique case of insulin Humulin 70/30 overdose due to suicidal attempt that presented with persistent hypoglycemia and required prolonged hospital treatment. A47 years old female patient presented to the emergency department due to decreased level of consciousness after self -administration of 2000 international unit Humulin insulin 70/30 suicidal attempt. In the emergency department patient treated with 250 ml D10% then shifted to the medical department. The patient continue treatment with dextrose 10% 200 ml/hour as continuous infusion, unfractionated heparin 7500 international unit/12 hour, hydrocortisone 100mg /6 hours, octreotide 100 microgram /8 and glucagon 1 mg . On the fourth day all medication and D10% stopped and the patient still under observation then discharged on will general condition without hypoglycemia attacks. A single high overdose of Humulin insulin can present with prolonged persistent hypoglycemia that is refractory to D10% alone. All physicians should know the guidelines to treat severe form of hypoglycemia and when to admit into medical department or intensive care unit with follow up for blood glucose and serum electrolyte monitoring.
{"title":"Refractory Hypoglycemia due to Humulin","authors":"Mao Tang, Lu Cixin","doi":"10.31579/2640-1045/109","DOIUrl":"https://doi.org/10.31579/2640-1045/109","url":null,"abstract":"Humulin 70/30 insulin is an intermediate acting medication used for treatment diabetes mellitus. According to systematic review and there have been forty four case reports of overdoses with different types of insulin. We present a unique case of insulin Humulin 70/30 overdose due to suicidal attempt that presented with persistent hypoglycemia and required prolonged hospital treatment. A47 years old female patient presented to the emergency department due to decreased level of consciousness after self -administration of 2000 international unit Humulin insulin 70/30 suicidal attempt. In the emergency department patient treated with 250 ml D10% then shifted to the medical department. The patient continue treatment with dextrose 10% 200 ml/hour as continuous infusion, unfractionated heparin 7500 international unit/12 hour, hydrocortisone 100mg /6 hours, octreotide 100 microgram /8 and glucagon 1 mg . On the fourth day all medication and D10% stopped and the patient still under observation then discharged on will general condition without hypoglycemia attacks. A single high overdose of Humulin insulin can present with prolonged persistent hypoglycemia that is refractory to D10% alone. All physicians should know the guidelines to treat severe form of hypoglycemia and when to admit into medical department or intensive care unit with follow up for blood glucose and serum electrolyte monitoring.","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47242344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A novel gastrointestinal tract (gut) mediated exercise theory was developed to explain how highly disciplined physical activity can help prevent obesity and cancer. The gut serves the modern human body as another brain. The gut microbiota plays crucial regulatory roles in determining the health of the gut itself and entire body. Adequate exercise has been recommended to increase energy expenditure and reduce fat deposition, especially visceral adiposity. This article presents a gut-brain axis related theory based upon which with adequately intense and regular physical activity, the gut does assimilate foods and nutrients more effectively. Thus, the amount and flow of excreta are optimized. As such, the excretion of unhealthy compounds such as cholesterol, fatty acids, and to some extent starch increase. As a result, hepatic load of nutrients decrease. Consequently, the entire body tissues experience a relief in the time-consuming and energy-burning process of metabolite turnover and detoxification. Therefore, regular intense exercise does not only reduce unhealthy nutrient deposition, it can also decrease appetite and nutrient intake. This theory should permit innovative research to formulate new gut-centered public recommendations regarding the importance of adequate regular exercise to help prevent obesity and cancer and associated metabolic complexities.
{"title":"A Novel Gut-Orchestrated Exercise Theory on Obesity and Cancer Prevention","authors":"A. Nikkhah","doi":"10.31579/2640-1045/117","DOIUrl":"https://doi.org/10.31579/2640-1045/117","url":null,"abstract":"A novel gastrointestinal tract (gut) mediated exercise theory was developed to explain how highly disciplined physical activity can help prevent obesity and cancer. The gut serves the modern human body as another brain. The gut microbiota plays crucial regulatory roles in determining the health of the gut itself and entire body. Adequate exercise has been recommended to increase energy expenditure and reduce fat deposition, especially visceral adiposity. This article presents a gut-brain axis related theory based upon which with adequately intense and regular physical activity, the gut does assimilate foods and nutrients more effectively. Thus, the amount and flow of excreta are optimized. As such, the excretion of unhealthy compounds such as cholesterol, fatty acids, and to some extent starch increase. As a result, hepatic load of nutrients decrease. Consequently, the entire body tissues experience a relief in the time-consuming and energy-burning process of metabolite turnover and detoxification. Therefore, regular intense exercise does not only reduce unhealthy nutrient deposition, it can also decrease appetite and nutrient intake. This theory should permit innovative research to formulate new gut-centered public recommendations regarding the importance of adequate regular exercise to help prevent obesity and cancer and associated metabolic complexities.","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45666095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Currently the prevalence of obesity and diabetes is increasing throughout the world. The unsatisfactory long-term results observed in the treatment of both are due to their complex pathophysiologies and the difficulties related to maintaining lifestyle changes. From the knowledge of the incretin effect and its alteration in patients with type 2 diabetes mellitus, GLP-1 receptor agonists arise, molecules with high structural homology with native GLP-1. Scientific evidence supports its use for the long-term treatment of diabetes, especially in the presence of associated cardiovascular and/or renal failure. In 2009, the use of liraglutide for patients with diabetes was approved in Europe, and in 2014 it was signed for the first time in the United States to treat obesity, since it was observed that the use of these drugs causes significant weight loss.
{"title":"Glp-1 Analogs for the Treatment of Obesity and Diabetes","authors":"B. J., Tapper X","doi":"10.31579/2640-1045/116","DOIUrl":"https://doi.org/10.31579/2640-1045/116","url":null,"abstract":"Currently the prevalence of obesity and diabetes is increasing throughout the world. The unsatisfactory long-term results observed in the treatment of both are due to their complex pathophysiologies and the difficulties related to maintaining lifestyle changes. From the knowledge of the incretin effect and its alteration in patients with type 2 diabetes mellitus, GLP-1 receptor agonists arise, molecules with high structural homology with native GLP-1. Scientific evidence supports its use for the long-term treatment of diabetes, especially in the presence of associated cardiovascular and/or renal failure. In 2009, the use of liraglutide for patients with diabetes was approved in Europe, and in 2014 it was signed for the first time in the United States to treat obesity, since it was observed that the use of these drugs causes significant weight loss.","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42604306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetes affects millions of patients round the world, with dancing complications, inclusion, cardiovascular diseases, neuropathie and rétinopathie. Howe ver, the progression of type 2 diabetes mellites might be slowed down and its health impact limited. Nevetheless, current anti-diabetic treatments have limitations and is not Enugu to significantly improve the cardiovascular prognosis of diabetic patients. This work focus on herbal supplement and nutrition as potentiel thérapies for type 2 diabètes mellitus. Actually, Herbal and nutritional supplémentation is required in the management of diabétiques patients, a binding shared unanimously by scientists. Récent diabetologists have come to the évidence that a therapeutic supplement consisting of nutrients and herbal is necessary to optimize the treatment of diabetes. The treatment of Type 2 diabetes mellitus, winch is very often Associate with overweight, is based on hygiene and dietetic measures and, where appropriate, on taking oral antidiabetics. This review describes the therapeutic arsenal of conventionnel oral antidiabetic drugs and emphasizes on innovative therapeutic option introduction herba medicine and nutrition to the management of diabetic patients. Recent studies showed interesting potential in the reduction of blood sugar for many herbal for example Cinnamon, also berberine has been linked to the reduction of blood glucose levels, insulin levels and showed to be as effective as metformin, the most commonly prescribed drug for diabetics, at controlling blood sugar levels in diabetics. Moreover, a medicinal plant or herbal mixture can provide multi-targeted therapeutic action due to its complex chemical composition with hundreds of active ingredients such as oligosaccharides, alkaloids, polyphenols, flavonoids, tannins and at the same time ensure safety for the patients. We conclude by the fact that herbal and nutritional supplementation can bring major and promising progress in order to improve the patient care, by slowing the progression of type 2 diabetes and limiting its complications.
{"title":"Herbal Supplementation to Improve Management of Diabetes Mellitus Patient Care: Current Progress","authors":"A. K., Ghouini A, G. A, I. H.","doi":"10.31579/2640-1045/120","DOIUrl":"https://doi.org/10.31579/2640-1045/120","url":null,"abstract":"Diabetes affects millions of patients round the world, with dancing complications, inclusion, cardiovascular diseases, neuropathie and rétinopathie. Howe ver, the progression of type 2 diabetes mellites might be slowed down and its health impact limited. Nevetheless, current anti-diabetic treatments have limitations and is not Enugu to significantly improve the cardiovascular prognosis of diabetic patients. This work focus on herbal supplement and nutrition as potentiel thérapies for type 2 diabètes mellitus. Actually, Herbal and nutritional supplémentation is required in the management of diabétiques patients, a binding shared unanimously by scientists. Récent diabetologists have come to the évidence that a therapeutic supplement consisting of nutrients and herbal is necessary to optimize the treatment of diabetes. The treatment of Type 2 diabetes mellitus, winch is very often Associate with overweight, is based on hygiene and dietetic measures and, where appropriate, on taking oral antidiabetics. This review describes the therapeutic arsenal of conventionnel oral antidiabetic drugs and emphasizes on innovative therapeutic option introduction herba medicine and nutrition to the management of diabetic patients. Recent studies showed interesting potential in the reduction of blood sugar for many herbal for example Cinnamon, also berberine has been linked to the reduction of blood glucose levels, insulin levels and showed to be as effective as metformin, the most commonly prescribed drug for diabetics, at controlling blood sugar levels in diabetics. Moreover, a medicinal plant or herbal mixture can provide multi-targeted therapeutic action due to its complex chemical composition with hundreds of active ingredients such as oligosaccharides, alkaloids, polyphenols, flavonoids, tannins and at the same time ensure safety for the patients. We conclude by the fact that herbal and nutritional supplementation can bring major and promising progress in order to improve the patient care, by slowing the progression of type 2 diabetes and limiting its complications.","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48815078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nanda Rachmad Putra Gofur, Aisyah Rachmadani Putri Gofur, Soesilaningtyas Soesilaningtyas, Rizki Nur Rachman Putra Gofur, M. Kahdina, Hernalia Martadila Putri
Introduction: Diabetes mellitus (DM) is a metabolic disease characterized by high blood glucose levels (hyperglycemia) resulting from disturbances in insulin secretion, insulin action or both. Insulin is a hormone produced by pancreatic beta cells, which is needed to utilize glucose from digested food. Comprehensive care is taken to treat patients with either prediabetes or diabetes. Diabetes management includes lifestyle interventions along with pharmacologic therapy and routine blood glucose monitoring. So that a decrease in blood glucose can occur and can be stable for a long time. Discussion:Lifestyle modification is an economical treatment that saves costs to prevent or delay the onset of diabetes. On the other hand, nutritional management provided by a dietitian is also recommended. Moderate weight loss goals are an important component of diabetes prevention and treatment, as large body weight can increase blood glucose levels, and can also have an increasing impact on blood pressure and cholesterol levels. Weight loss can be achieved through a balanced diet, with total control of calories and free carbohydrates. However, for diabetic patients following a low-carbohydrate diet, they should be informed about possible side effects such as hypoglycemia, headaches and constipation. Other studies have suggested the consumption of complex dietary fiber and whole grains to improve blood sugar control. Greater adherence to diet combined with light physical activity was associated with a lower likelihood of diabetes after adjusting for various factors. Conclusion:Lifestyle modification is a fairly cost-effective treatment to prevent or delay the onset of diabetes, with a risk reduction of about 58% in 3 years. It is strongly recommended by the ADA that patients with IGT, IFG or HbA1C levels of 5.7-6.4% be counseled on lifestyle changes such as diet and exercise. On the other hand, nutritional management provided by a dietitian is also recommended.
{"title":"Lifestyle Modification Therapy in Diabetes Disease: A Review Article","authors":"Nanda Rachmad Putra Gofur, Aisyah Rachmadani Putri Gofur, Soesilaningtyas Soesilaningtyas, Rizki Nur Rachman Putra Gofur, M. Kahdina, Hernalia Martadila Putri","doi":"10.31579/2640-1045/112","DOIUrl":"https://doi.org/10.31579/2640-1045/112","url":null,"abstract":"Introduction: Diabetes mellitus (DM) is a metabolic disease characterized by high blood glucose levels (hyperglycemia) resulting from disturbances in insulin secretion, insulin action or both. Insulin is a hormone produced by pancreatic beta cells, which is needed to utilize glucose from digested food. Comprehensive care is taken to treat patients with either prediabetes or diabetes. Diabetes management includes lifestyle interventions along with pharmacologic therapy and routine blood glucose monitoring. So that a decrease in blood glucose can occur and can be stable for a long time. Discussion:Lifestyle modification is an economical treatment that saves costs to prevent or delay the onset of diabetes. On the other hand, nutritional management provided by a dietitian is also recommended. Moderate weight loss goals are an important component of diabetes prevention and treatment, as large body weight can increase blood glucose levels, and can also have an increasing impact on blood pressure and cholesterol levels. Weight loss can be achieved through a balanced diet, with total control of calories and free carbohydrates. However, for diabetic patients following a low-carbohydrate diet, they should be informed about possible side effects such as hypoglycemia, headaches and constipation. Other studies have suggested the consumption of complex dietary fiber and whole grains to improve blood sugar control. Greater adherence to diet combined with light physical activity was associated with a lower likelihood of diabetes after adjusting for various factors. Conclusion:Lifestyle modification is a fairly cost-effective treatment to prevent or delay the onset of diabetes, with a risk reduction of about 58% in 3 years. It is strongly recommended by the ADA that patients with IGT, IFG or HbA1C levels of 5.7-6.4% be counseled on lifestyle changes such as diet and exercise. On the other hand, nutritional management provided by a dietitian is also recommended.","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44434154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 25-year-old man with a past medical history of type 1 diabetes presented to the emergency department with 2 days of progressive abdominal pain, nausea, and vomiting after stopping insulin. His heart rate was 125 and the respiratory rate was 26. The glucose was 832 mg/dl, the potassium was 6.6 mmol/L, the beta-hydroxybutyrate was 111.8 mg/dl, and the pH was 6.95.
{"title":"Type 1 Brugada pattern induced by DKA","authors":"Drew Johnson","doi":"10.31579/2640-1045/106","DOIUrl":"https://doi.org/10.31579/2640-1045/106","url":null,"abstract":"A 25-year-old man with a past medical history of type 1 diabetes presented to the emergency department with 2 days of progressive abdominal pain, nausea, and vomiting after stopping insulin. His heart rate was 125 and the respiratory rate was 26. The glucose was 832 mg/dl, the potassium was 6.6 mmol/L, the beta-hydroxybutyrate was 111.8 mg/dl, and the pH was 6.95.","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46812302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
India is a developing country and lacks many things including Podiatry as subspecialty of Diabetes. There are no Podiatry Collegesnor provision for regular training of young physicians in podiatry. Missing job opportunity, kills interest of physicians in Podiatry. Most physicians have acquired some degree of skill by self-reading or doing observer ship abroad and by attending a few International conferences on Podiatry.
{"title":"Common Problems Related to Podiatry","authors":"Lk Shankhdhar, K. Shankhdhar, S. Shankhdhar","doi":"10.31579/2640-1045/108","DOIUrl":"https://doi.org/10.31579/2640-1045/108","url":null,"abstract":"India is a developing country and lacks many things including Podiatry as subspecialty of Diabetes. There are no Podiatry Collegesnor provision for regular training of young physicians in podiatry. Missing job opportunity, kills interest of physicians in Podiatry. Most physicians have acquired some degree of skill by self-reading or doing observer ship abroad and by attending a few International conferences on Podiatry.","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45994292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rationale: A novel COVID-19 with the severe acute respiratory syndrome had arisen in Wuhan, China in December 2019 Thromboembolism is a critical clinical entity commonly recognized sequel in COVID-19 patients. Interestingly, the presentation of COVID-19 infection with thromboembolism has a risk impact on both morbidity and mortality in COVID-19 patients. Morbid obesity may add over significant risk value in the presence of COVID-19 pneumonia with thromboembolism. Patient concerns: Middle-aged housewife female COVID-19 morbid obese patient presented to physician outpatient clinic with unilateral pneumonia suspected acute pulmonary embolism. Diagnosis: COVID-19 pneumonia with acute pulmonary embolism in morbid obesity. Interventions: CT pulmonary angiography, non- contrasted chest CT scan, electrocardiography, and oxygenation. Outcomes: Dramatic of both clinical and radiological improvement had happened. Lessons: The combination of morbid obesity, QTc prolongation with COVID-19 infection is an indicator of the over-risk of thromboembolism. It signifies the role of anticoagulants, antiplatelet, anti-infective drugs, and steroids in COVID-19 patients with unilateral pneumonia and acute pulmonary embolism in morbid obesity are effective therapies. An increasing the dose of both low-molecular heparin and oral anticoagulant with a morbidly obese patient was reasonable.
{"title":"Covid-19 Pneumonia with Acute Pulmonary Embolism in a Morbidly Obese Patient; At Home Dramatic Reversal Management","authors":"Yasser Mohammed Hassanain Elsayed","doi":"10.31579/2640-1045/113","DOIUrl":"https://doi.org/10.31579/2640-1045/113","url":null,"abstract":"Rationale: A novel COVID-19 with the severe acute respiratory syndrome had arisen in Wuhan, China in December 2019 Thromboembolism is a critical clinical entity commonly recognized sequel in COVID-19 patients. Interestingly, the presentation of COVID-19 infection with thromboembolism has a risk impact on both morbidity and mortality in COVID-19 patients. Morbid obesity may add over significant risk value in the presence of COVID-19 pneumonia with thromboembolism. Patient concerns: Middle-aged housewife female COVID-19 morbid obese patient presented to physician outpatient clinic with unilateral pneumonia suspected acute pulmonary embolism. Diagnosis: COVID-19 pneumonia with acute pulmonary embolism in morbid obesity. Interventions: CT pulmonary angiography, non- contrasted chest CT scan, electrocardiography, and oxygenation. Outcomes: Dramatic of both clinical and radiological improvement had happened. Lessons: The combination of morbid obesity, QTc prolongation with COVID-19 infection is an indicator of the over-risk of thromboembolism. It signifies the role of anticoagulants, antiplatelet, anti-infective drugs, and steroids in COVID-19 patients with unilateral pneumonia and acute pulmonary embolism in morbid obesity are effective therapies. An increasing the dose of both low-molecular heparin and oral anticoagulant with a morbidly obese patient was reasonable.","PeriodicalId":72909,"journal":{"name":"Endocrinology and disorders : open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42008235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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