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Hypoglycaemia

Management Team

Hypoglycaemia

Overview

Hypoglycaemia is a condition manifested by abnormally low levels of blood sugar. It frequently occurs in people having diabetes who use insulin or any specific medications.

Skipping meals, excessive physical activity, or too much insulin.

Confusion, shakiness, sweating, and even loss of consciousness in severe cases.

Measuring blood sugar levels during an episode.

Rapid consumption of fast-acting carbohydrates like glucose tablets or fruit juice can elevate blood sugar levels. Preventing hypoglycaemia involves regular monitoring, adjusting medications, and eating balanced meals. Education on recognising and treating hypoglycaemia is essential for the management of diabetes in diagnosed individuals.

If someone with diabetes or a history of low blood sugar levels experiences severe symptoms or loses consciousness and is not responding to treatments such as drinking juice, eating candy, or taking glucose tablets, it's crucial to seek immediate emergency assistance.

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Diabetic Neuropathy

Management Team

Diabetic Neuropathy

Overview

Diabetic neuropathy refers to a condition in which high blood sugar levels lead to nerve damage. It can affect various body parts such as the digestive system, heart, and blood vessels.

Symptoms like pain, tingling, and numbness, often in the legs and feet.

Physical exam, nerve conduction studies, and blood tests to assess blood sugar control.

Treatment for diabetic neuropathy involves managing symptoms and regulating blood sugar levels. Medications, physical therapy, and lifestyle changes can help alleviate pain and enhance the quality of life. Early diagnosis and management are crucial for preventing severe complications and for maintaining nerve function.

The American Diabetes Association suggests starting screening for diabetic neuropathy right after a person is diagnosed with type 2 diabetes or 5 years after being diagnosed with type 1 diabetes. It is advised to have a screening once every year after that.

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Diabetic Retinopathy

Management Team

Diabetic Retinopathy

Overview

Diabetic retinopathy is an eye disorder arising when elevated blood sugar levels cause damage to the blood vessels in the retina. It can result in vision problems and blindness if left untreated.

Blurred vision, dark spots, and difficulty in seeing colours.

Comprehensive eye evaluation, including dilated eye exams and imaging tests.

Depends on the severity and may include laser therapy, injections, or surgery to prevent vision loss. Managing blood sugar levels, cholesterol levels, and blood pressure is the best way to prevent and prolong the progression of diabetic retinopathy. Regular eye exams are crucial for early detection and treatment.

If you have diabetes, make sure to have a yearly eye check-up with dilation, even if your vision appears to be normal. If you experience sudden changes related to your vision, for e.g., blurriness, dark spots, or haziness, please contact your ophthalmologist immediately.

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Charcot Foot

Management Team

Charcot Foot

Overview

Charcot foot, also known as Charcot arthropathy, is a condition affecting people with significant nerve damage (neuropathy), causing weakening of the bones in the foot. Initially, you may not notice any symptoms; however, as the condition advances, the bones become fragile enough to fracture. Continued weight-bearing can cause the foot to change shape over time. As the disorder progresses further, the joints may collapse, resulting in an abnormal shape of the foot characterised by a rocker-bottom foot deformity.

It is a common condition for people with diabetes. However, other causes, including spinal cord disease or injuries, alcohol abuse, Parkinson’s disease, infection, and HIV infection, can also cause nerve damage.

  • Swelling
  • Warmth (the affected foot often feels warmer than the unaffected)
  • Changes in foot colour.
  • Changes in foot shape.

Consists of two types: nonsurgical & surgical treatment. Nonsurgical treatment comprises:

  1. Immobilisation
  2. Custom shoes and bracing
  3. Activity modification

Successful treatment can be achieved by early diagnosis of Charcot foot. Doctors will examine the foot X-rays and other imaging scans. Charcot foot can be prevented by controlling blood sugar levels and undergoing regular checkups with a foot and ankle surgeon.

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C

Evoked Potentials (EPs)

Management Team

Evoked Potentials (EPs)

Overview

Evoked potentials are electrical responses in the brain or nervous system that are elicited by specific stimuli such as sound or touch. EP tests the intactness and conductivity of sensory conduction pathway from peripheral receptor organ to the brain.

  • Electrodes are placed over cortical areas
  • Stimulus is given as described above
  • The electrical response is recorded from the scalp electrodes
  • Latency and amplitude of stimulation is analysed.

  1. Visual evoked potential (VEP)

    Visual stimulation is given in the form of inverse checker board pattern or flash stimulation and the response is recorded from the occipital areas.

    Indications

    • Optic neuritis
    • Demyelinating disorders like multiple sclerosis
    • In head injury/ encephalopathy to check the visual pathway functioning

  2. Auditory evoked potentials (BAER)

    BAER, also known as brainstem auditory evoked response, measures the electrical activity generated in response to an auditory stimulus.

  3. Somatosensory evoked potentials (SSEP)

    SSEP measures the responses to touch or pressure stimulation. They enable to check the integrity of large sensory pathways through peripheral nerves, spinal cord, and brain.

    Indications

    • Differentiate between central and peripheral causes of large fibre sensory dysfunction
    • Study proximal peripheral nerves, when standard sensory NCV are normal
    • Confirmation of non-organic peripheral sensory loss
    • SSEPs in specific conditions
    • Multiple sclerosis (increased sensory latencies).
    • Need for localizing the level of lesion in spinal cord
    • Coma (bilateral absence of the thalamo-cortical (N19–P22) waveforms indicate poor prognosis)
    • Brain death (Absence of N19–P22 waveforms)
    • Cortical myoclonus (progressive myoclonic epilepsy, CJD, post-hypoxic myoclonus)

  4. Motor evoked potentials

    Measures the electrical response of muscles to electrical stimulation of brain or spinal cord.

    Indications

    • Assess motor pathway function
    • Spinal cord injury or multiple sclerosis
    • Intra-operative monitoring in spinal cord surgeries
    • Nerve injury evaluation
    • Assess muscle function in muscle weakness/ paralysis
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E

Diabetic Foot

Management Team

Diabetic Foot

Overview

Diabetic foot refers to complications in the feet of people with diabetes, including infections, ulcers, and poor circulation. These issues arise from high blood sugar levels which result in damaged nerves and blood vessels.

Pain, numbness, and slow-healing sores.

Wound care, antibiotics for infections, and occasionally surgery to remove damaged tissue.

Involves regular foot inspections, use of proper footwear, and management of blood sugar levels.

Regular monitoring and prompt treatment of foot problems are crucial to prevent severe complications like amputations. Education on foot care and diabetes management helps reduce the risk of diabetic foot issues.

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D

Obesity

Management Team

Obesity

Overview

Obesity is a medical condition characterised by excess accumulation of body fat, which can negatively impact health and elevate the risk of various diseases like diabetes, heart disease, and certain cancers. It results from a mix of genetic, behavioural, and environmental factors.

Obesity symptoms include fatigue, difficulty in doing physical activity, and potential emotional distress.

Obesity management includes dietary changes to reduce calorie intake, regular physical activity, and behavioural therapy to address poor eating habits. However, some severe cases may require medications or bariatric surgery.

Efforts should aim at promoting healthy lifestyle choices and regular monitoring to prevent associated health complications.

If weight-related concerns or health issues are troubling you, please contact your endocrinologist regarding obesity management. Together with your healthcare team, you can assess your health risks and explore potential strategies for weight loss.

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O

Insulin Injection

Management Team

Insulin Injection

Overview

Insulin injections are a common treatment option for diabetes, particularly for type 1 diabetes and advanced type 2 diabetes. Insulin allows glucose to enter cells for energy, thus helping to regulate blood sugar levels.

There are different insulin types, including rapid-acting, short-acting, intermediate-acting, and long-acting insulin, each with specific timing and duration. Proper technique and timing are crucial for effective management.

Patients need to regularly evaluate blood sugar levels and accordingly adjust insulin doses. Education on injection techniques, insulin types, and managing blood sugar levels is essential for individuals using insulin pump therapy to maintain good health and prevent complications.

Using insulin can be challenging for some people, but it is an effective way to lower your blood sugar levels. If you are having trouble with your insulin routine, talk to your healthcare team.

If your at-home blood sugar tests show very low or high levels, get help immediately. Your insulin or other medicines might need to be altered. With time, you can figure out a routine that works well for you and fits your lifestyle.

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I

Smoking and Pulmonary Health: The Critical Role of Smoking Cessation

Management Team

Smoking and Pulmonary Health: The Critical Role of Smoking Cessation

Overview

Medical management plays a crucial role in aiding individuals in their journey to quit smoking, a habit notorious for its detrimental health effects. This comprehensive approach combines various strategies from multiple specialties to address both the physical and psychological aspects of addiction.

  • Firstly, nicotine replacement therapies (NRTs), such as patches, gums and lozenges deliver controlled amounts of nicotine to alleviate withdrawal symptoms. These aids help gradually wean smokers off nicotine, reducing cravings and making the quitting process more manageable.
  • Additionally, prescription medications like bupropion and varenicline target nicotine receptors in the brain, effectively reducing the pleasure derived from smoking and minimising withdrawal symptoms. These medications can be prescribed based on individual health profiles and smoking habits, enhancing their efficacy.
  • Furthermore, behavioural counselling and support groups are integral components of medical management. Counselling sessions provide smokers with coping mechanisms, stress management techniques, and strategies to modify behavioural triggers associated with smoking. Group support fosters a sense of community and encouragement, reinforcing motivation and accountability.
  • Medical professionals play a pivotal role in guiding and monitoring progress, adjusting treatment plans as needed to optimise success. Regular follow-ups ensure adherence and provide opportunities for addressing challenges or relapses.
  • Ultimately, the synergy between medical interventions and behavioural support maximises the likelihood of long-term smoking cessation, promoting better health outcomes and a higher quality of life for individuals overcoming tobacco addiction.
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S

Continuous Glucose Monitoring System (CGMS) Technology

Management Team

Continuous Glucose Monitoring System (CGMS) Technology

Overview

CGMS is a device used to track levels of glucose in the interstitial fluid throughout the day, offering real-time data and trends. This helps individuals with diabetes regulate their blood sugar levels more efficiently.

CGMS includes:

  • A sensor that is inserted under the skin
  • A transmitter
  • A receiver or smartphone app for displaying data

  • Better glucose control
  • Reduced hypoglycaemia risk
  • Improved quality of life.

CGMS can alert users to high or low blood sugar levels, providing timely interventions. Regular use and proper calibration are important for getting accurate readings. CGMS is a valuable tool for diabetes management, particularly for those using insulin therapy.

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