Diabetology/Endocrinology

Diabetology is a specialised branch of medicine that mainly focuses on diagnosing and treating diabetes mellitus. This is one of the major specialities that is currently blooming due to the increased prevalence of diabetes in our country. It is a subspeciality of endocrinology, which is a study of the endocrine system and its disorders. This field addresses the rising issue of global health. 

Endocrinology is a wider speciality that largely covers a range of hormonal imbalances and conditions affecting the endocrine glands, such as the thyroid, adrenal, pancreas, and pituitary. These hormones and organs play an important role in maintaining the balance in our health. Endocrinologists are doctors who study extensively regarding the endocrine system and are involved in treating a variety of endocrine diseases and disorders. They aim to provide interventions, comprehensive care, and persistent support for individuals living with endocrine disorders. These metabolic diseases are growing daily, and research advances are paving the way to combat these conditions, thus highlighting their importance in modern medicine.

Understanding diabetology/endocrinology

The endocrine system is a complicated framework of organs and glands that produce, store, and release hormones. The Endocrine system comprises major glands, including the thyroid, pancreas, adrenal glands, pituitary gland, and reproductive organs. Hormones are chemical messengers that play a vital role in regulating various bodily functions, including growth, metabolism, and reproduction. Endocrinologists are specialists in the treatment of disorders related to the imbalance or dysfunction of hormones and glands, such as diabetes, thyroid dysfunction, and adrenal gland disorders.

Diabetologists are doctors specialised in the management of diabetes through medications, lifestyle changes, and preventing complications that arise from long-term hyperglycaemia. Diabetes is a metabolic disorder characterised by elevated blood sugar levels; uncontrolled blood glucose levels can lead to various health complications. The rising issue of increased prevalence has been proven with the latest incidences and scenarios of our loved ones being succumbed to death. It is always best to keep your sugars under control and have a constant blood check-up.

Symptoms of diabetes and endocrine disorders

The symptoms of diabetes and endocrine disorders vary with the conditions and type. One can result in uncommon symptoms; however, it should be caught at an earlier stage to prevent long-term complications. Some of the symptoms include,

• Symptoms of diabetes:

- Excessive thirst and urination: These are the hallmark symptoms; increased thirst occurs due to elevated blood sugar levels. Increased urination depletes fluid and increases feelings of thirst by making it difficult for the kidneys to filter and eliminate excess glucose from the body.

- Unexplained weight loss: Unintentional weight loss occurs especially in type 1 diabetes, because the body starts breaking down muscle and fat for energy as the system can’t get the glucose from the blood due to the extensive lack of insulin in the body.

- Fatigue and irritability: Constant tiredness or fatigue occurs as the body’s cells lack glucose, their main energy source. This may lead to a lack of proper functioning of the organs.

- Blurred vision: High blood sugar levels can cause the lens in the eyes to swell, leading to alterations in vision. If left unmanaged, diabetes can also lead to long-term eye damage, known as diabetic retinopathy.

- Slow-healing wounds or frequent infections: Diabetes impairs circulation and the immune system, making it difficult for the body to heal wounds and fight off infections. This leads to delays in wound healing and frequent infections. Common areas for slow healing include the feet and gums.

- Tingling or numbness in the hands and feet: High blood sugar for a long time can damage nerves, especially in the feet, leading to symptoms such as pain or numbness known as diabetic neuropathy.

• Symptoms of endocrine disorders: Endocrine disorders can cause many different symptoms because they affect a variety of hormones that control important body functions. Common symptoms include:

- Unexplained weight gain or loss: This is often associated with thyroid dysfunction or diabetes.
- Fatigue or weakness: It is very common in all types of endocrine disorders, including thyroid problems and adrenal insufficiency.
- Irregular menstrual cycles: These are mainly seen in PCOS or other hormonal imbalances. 
- Changes in mood or mental function: Hormones play a major role in brain function, mental health, mood, and energy levels.
- Infertility: This can happen because of hormonal imbalances that affect the reproductive organs.
- Osteopenia or bone fractures: Signs of muscle weakness and body pain occur due to hormonal imbalance.
- Increased sweating, tremors, or palpitations: This is mainly seen in hyperthyroidism or adrenal disorders.
- Hair loss or excessive hair growth: Hair loss is observed in hypothyroidism, whereas excessive hair growth is seen after an imbalance of androgen.
- Sensitivity to cold or heat: It is a major sign of imbalance in thyroid hormone.

Diseases treated by diabetology and endocrinology experts

• Diabetes mellitus: Diabetes is due to many pathologies, and based on the possible causes of diabetes, they are classified into multiple categories. The main hallmark feature of diabetes is increased glucose in your blood. This causes thickening of your blood and results in various complications such as heart attack, cardiomyopathy, cardiac failure, and so on. Types of diabetes are as follows,

- Type 1 diabetes: It is an autoimmune disease where the pancreas can produce little or no insulin. It usually appears in children or early adulthood.

- Type 2 diabetes: A chronic condition that affects the body to metabolise and absorb glucose, which is often caused by insulin resistance. This type is more common and mainly develops in adults, sometimes even in the case of children, due to obesity and poor lifestyle habits. 

• Diabetic complications include:
      Diabetic retinopathy: It is damage to the blood vessels of the eyes, caused by prolonged high blood sugar.
      Diabetic nephropathy: This refers to an injury of the kidney due to chronic diabetes. 
      Diabetic neuropathy: It is the peripheral nerve damage that leads to pain, tingling or numbness in the limbs.
      Diabetic Foot Ulcers: Open sores or wounds are observed on the feet due to poor blood circulation. This is a common complication of uncontrolled diabetes.
• Gestational diabetes: Mainly observed during pregnancy when the body cannot produce enough insulin to handle the increased blood sugar levels, this may cause increased risks to both mother and child.
• Thyroid disorders: This occurs due to an imbalance in the thyroid hormones. It can be due to low or high production. The thyroid disorders are classified as follows,
• Hypothyroidism: It is a condition wherein the thyroid gland does not produce enough thyroid hormone, leading to fatigue, weight gain, and depression.
• Hyperthyroidism: This is a condition of overproduction of thyroid hormones that can cause weight loss, rapid heart rate, and anxiety.
• Goitre and thyroid nodules: It is the abnormal enlargement of the thyroid gland due to an imbalance in thyroid hormones.
• Polycystic ovary syndrome (PCOS): It is a hormonal disorder in women characterised by irregular menstrual cycles, high levels of androgens, and cysts in the ovaries. PCOS can cause infertility.
• Adrenal disorders: The adrenal glands produce hormones like cortisol and adrenaline. Disorders such as Cushing’s syndrome (excess cortisol) or Addison’s disease (insufficient cortisol production) are handled by endocrinologists.
• Metabolic syndrome: It refers to a group of conditions that increase the risk of heart disease, stroke, and diabetes, including high blood pressure, high blood sugar, excess body fat, and abnormal cholesterol levels.
• Osteoporosis and calcium disorders: Conditions related to the imbalance of calcium and bone metabolism regulated by hormones like parathyroid hormone and vitamin D. Endocrinologists treat osteoporosis, a condition where bones become weak and brittle due to hormone imbalances, such as low oestrogen in women or testosterone in men.
• Pituitary disorders: In children, endocrinologists may treat conditions like growth hormone deficiency, leading to stunted growth or excessive growth. These include tumours or pituitary gland dysfunction, which can lead to imbalances in the growth hormone.

Treatment options in diabetology and endocrinology

There are multiple treatment options available in both diabetology and endocrinology. Treating diabetes and other hormone-related issues generally involves both medications and lifestyle modifications. In some cases, surgical interventions are also needed to correct the underlying cause.

• Lifestyle modifications:

- The cornerstone of treatment for diabetes is lifestyle modification. The majority of individuals suffer from type 2 diabetes, which is acquired diabetes due to their sedentary lifestyle.

- Diabetologists advise patients to look after their diet and exercise regularly to control their sugar levels. Patients are advised to follow a balanced diet such as a low carbohydrate diet, which includes reduced consumption of refined sugars and a high fibre content diet. 

- Regular exercises, such as brisk walking, jumping, and push-ups, will help your body utilise the glucose and reduce excessive fat in your body. Additionally, weight loss is the key factor to improve insulin sensitivity and reduce the need for medications in early-stage diabetes.

- The diet also plays a major role in thyroid disorders. Some cruciferous vegetables such as broccoli, cauliflower, cabbage, soy products, excessive iodine, gluten, processed foods, caffeine, and many more are to be avoided in order to have a balanced hormonal status. 

• Medications: Diabetes cannot be managed only through lifestyle medications; however, there may be a few exceptions. But, it also requires medications that help reduce elevated blood sugar levels. They include,

- Insulin therapy: Insulin is the hormone produced in the body that helps consume glucose from the blood to the tissues and cells. Type 1 diabetes fails to produce insulin and requires external supplementation of insulin. Thus, insulin is the cornerstone therapy in Type 1 diabetes mellitus. However, in the later stages of type 2 diabetes also, insulin is prescribed due to decreased production over time. 

- Oral hypoglycaemic agents: These are the medications that are prescribed to reduce the increased glucose levels in the body. They include medication classes such as biguanides, sulfonylureas, SGLT2 inhibitors, and many more. Sometimes, these are combined with insulin to manage the diabetes. 

- Hormonal supplements: As said earlier, endocrinological disorders result greatly in hormonal imbalance, which requires external hormonal supplementation. Hormonal replacement therapies are employed in cases of thyroid and adrenal insufficiencies. 

- Bone-strengthening medications: For patients suffering from osteoporosis, medications such as calcium and bisphosphonates are used to strengthen the bones.

• Cutting-edge innovations: As the prevalence and incidence rates of endocrinological diseases skyrocketed, research innovations evolved to combat these diseases. Advanced hormonal and sugar monitoring and adjustment devices have emerged to maintain a balanced, healthy lifestyle in patients suffering from endocrinological diseases. Some of them include,

- Continuous glucose monitors: These devices are applied to the patient’s skin, which allows continuous monitoring of the glucose levels in real-time. They provide better glycaemic control and aid in easy management of the diseases. 

- Insulin pumps: These are tagged along with the monitors, which deliver the required amount of insulin when your body’s sugar levels go beyond normal. 

• Surgical interventions:

- Bariatric surgeries: These are typically advised for morbidly obese patients who want to reduce their weight drastically. This can help correct some metabolic disorders.

- Pituitary surgeries: Pituitary gland excision is performed in order to maintain a properly balanced hormonal status. However, it varies with each patient’s condition and type.

- Thyroidectomy: This is performed in the case of goitre or Hashimoto’s disease, where the thyroid gland is causing immense trouble to the patient. This is also done in case of cancerous thyroid.

- Fertility treatments: Women who are suffering from PCOS or reproductive hormonal imbalances that affect their child-carrying capacity may require assistive reproductive surgeries such as in-vitro fertilisation.

Conclusion

Diabetology and endocrinology are vital fields that address the global concern of endocrinological diseases. These diseases typically affect millions of people worldwide. Early detection, intervention, and patient education are crucial in order to have a successful, healthy environment. India, known as the world diabetes capital, has a predominant exposure to this diabetes in the genetic component. However, with proper care, one can delay the occurrence and sometimes even prevent the occurrence of the disease.