Screening for Diabetes – Fasting Blood Sugar

The best way to know if you have diabetes mellitus is to have yourself screened by doing a FASTING BLOOD GLUCOSE (FBS) test.  It is also called the FASTING PLASMA GLUCOSE (FPG) test.  To prepare, do not eat or drink anything except water for 8 to 10 hours before your scheduled fasting blood glucose test.

The results are interpreted as follows: you have diabetes is your fasting blood sugar is 126mg/dl and above, you have pre-diabetes if it is 100-125mg/dl, and you have normal blood sugar levels at 99mg/dl or less.

If your results show that you have either diabetes or pre-diabetes, talk to your doctor right away, for advice on proper lifestyle and diet, and to start you on the right medication.

DM FBS cut offs

top photo credit: http://www.heart.org/HEARTORG/Conditions/More/Diabetes/AboutDiabetes/Pre-diabetes-Whats-the-Problem_UCM_461554_Article.jsp#.WN3zfRKGNvc

Foot Complications of Diabetes

Foot gangrene is one of the most dreaded forms of diabetic foot. It may initially present as frequent cramping of the legs with long distance walks. It is worsened with smoking, uncontrolled hypertension and high blood cholesterol levels. The risk of foot amputation is around 15x higher for diabetics (Gayle R, Benjamin AL, Gary NG. The burden of diabetic foot ulcers. The American Journal of Surgery 1998Aug 24; 176(Suppl 2A):65-105).

Diabetes complications like this are preventable with early diagnosis and good control of blood sugars (http://www.nejm.org/doi/full/10.1056/NEJMe0807625).

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What is ENDOCRINOLOGY?

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WHAT IS ENDO.jpg

🏥 Room 206, OPD 3, Lorma Medical Center, Brgy Carlatan, San Fernando City, La Union
📆 Mondays – Fridays 1-5PM/Saturdays by appointment
☎️ 072-7000000 local 206/0932-9992511 (contact: Ms. Khriz)
💻 doktora.hannah@gmail.com

What is ENDOCRINOLOGY?

WHAT IS ENDO

Endocrinology is a sub-specialization in Adult Medicine, this entails:

  • 3 years of Internal Medicine Specialty Residency Training
  • 2 years of Endocrinology Fellowship Training

Fellowship training involves clinical (out-patients, in-patients and critical care patients) and research training.  Upon completion of fellowship, satisfactory marks on a written and an oral board examination are required to be conferred the status of “Diplomate” in Endocrinology.

Unusual diseases of the adrenal/pituitary/parathyroid glands, metabolic bone diseases such as post-menopausal osteoporosis and complicated cases of thyroid disorders and diabetes are best handled by an Endocrinologist.

Check out http://endo-society.org.ph/find-an-endocrinologist/ to find an Endocrinologist near you. 🙂

WEIGHT MANAGEMENT

Upang malaman kung tama ang iyong timbang para sa iyong height, o Body Mass Index (BMI):

Body Weight (kg) / Height (m2)

Halimbawa, ako ay 5’ feet at 4 inches = 1.62 meters (5 foot 4′ = 64 inches = 162 cm = 1.62 m), at ang aking timbang ay 58 kg:

58 kg / 1.622 = 22.1 (ang aking BMI)

Ikumpara sa susunod na chart ang resultang makukuha:

Mga Antas ng BMI para sa mga Pilipino

Underweight < 18.5 kg/m2
Normal 18.5 – 23.9 kg/m2
Overweight 24 – 27.5 kg/m2
Obese > 27 kg/m2

Ang normal na BMI para sa mga Pilipino ay nasa 18.5 hanggang 23.9. Mas mababa sa 18.5 ay underweight, at and sobra naman sa 23.9 ay overweight o obese.

Upang maabot ang nais na timbang natin, isa sa mga epektibong weight loss strategies ay ang pagbibilang ng calories. Ang ating pagkain ay may katumbas na caloric content at ang pagbabawas ng calories ay makababawas ng timbang.

Upang makabawas sa timbang, limitahin ang dami ng calories na kakainin at damihan ang calories na ibu-burn sa pamamagitan ng exercise. Narito ang ilan sa mga exercise at kaakibat na calories na nababawas kada uri ng ehersisyo:

Weight: 150 lbs Weight: 200 lbs
30 minutes a day Calories burned Calories burned
Basketball 153 153
Bicycle 272 272
Bowling 102 102
Dancing 153 153
Gardening 136 136
Running (5 mph) 272 272
Swimming (leisure) 204 204
Tai Chi 136 136
Washing Car 102 102
Yoga 85 85

* Adapted from Lilly Diabetes Personal Solutions Pamphlet

Heto naman ang ilang sa mga usual na pagkain natin at ang calories na nilalaman nila:

Food Caloric Content
Rice, cooked ½ cup 100 calories
Pandesal, 3 pcs small 100 calories
Pan Amerikano, plain, 2 pcs 100 calories
Chicken, no skin, 1 oz 41 calories
Shrimps, 25 gms 41 calories
Balut, 1 pc 122 calories
Bacon, 1 strip 45 calories
Fresh cow’s milk, 1 cup 170 calories

* Adapted from Lilly Diabetes Personal Solutions Pamphlet

Ang basic na principle dito ay kailangang mas malaki ang calories na nabuburn sa pamamagitan ng exercise at iba pang activities kaysa sa calories na dinadagdag sa pagkain. Para sa mas kumpletong listahan, maaring i-download mula dito ang: Calorie Count of Exercise and Food pamphlet mula sa lilly diabetes. Maari itong i-print at ipaskil sa bahay kung saan madaling makikita ito. Iba pang mga websites na maaring makatulong ang sumusunod:

http://caloriecount.about.com/tools/calories-goal

http://www.lillydiabetes.com/Pages/index.aspx

Tantyahin kung gaano karami ang calories na kinakain bawat araw at bawasan ng 500 ito. Halimbawa, kung ang aking usual na calories sa isang araw ay nasa 1,700, babawasan ko ito ng mga 500 = ibig sabihin, dapat limitahan ko sa 1,200 na lamang ang aking kakainin para mabawasan ang timbang.

Kung ikaw ay may smartphone, subukan i-download ang app na myfitnesspal – kumpleto ito sa tips at charts para sa weight management.

Kung kayo ay seryoso sa pagpapapayat, disiplina, tamang pagkain, ehersisyo at tamang kaalaman lamang ang katapat nito. Sumangguni sa iyong doctor para sa iba pang detalye. Huwag mag-umpisa ng kahit anong weight loss regimen nang hindi muna nagpapa-clear sa inyong doctor upang makaiwas sa kumplikasyon.

OMG! Wag mawalan ng pag-asa!

OMG! Wag mawalan ng pag-asa!

For more information, maari ninyong i-download ang aking lecture on weight management: Weight Management

Sanggunian (Reference):

WHO expert consultation; THE LANCET • Vol 363 • January 10, 2004 http://www.thelancet.comhttp://www.who.int/nutrition/publications/bmi_asia_strategies.pdf

image credit:http://noalicious.blogspot.com/2012_03_01_archive.html

Pericardial Effusion Complicating Graves’ Disease In Pregnancy

Authors: Hannah C. Urbanozo1, Marcelyn A. Fusilero2, Marc Gregory Y. Yu3, Cherrie Mae C. Sison1

1 Section of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital, Department of Medicine, Manila, Philippines

2 Section of Cardiology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines

3 Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines

Cardiovascular alterations in the thyrotoxic patient are attributed to hypermetabolism and the need to dissipate the excess heat produced, which results to increased circulatory demands.  While sinus tachycardia, atrial fibrillation and congestive heart failure with long-standing atrial fibrillation are well-recognized cardiovascular manifestations of thyrotoxicosis, the occurrence of pericardial effusion due to thyrotoxicosis is rarely reported.

We report the case of a 32-year-old Filipino woman in the 23rd week of her fourth pregnancy, with a seven-year history of a gradually enlarging anterior neck mass associated with palpitations, exophthalmos, heat intolerance and easy fatigability.  She was treated as a case of thyroid storm on initial presentation at the emergency room, with a baseline FT4 of 40.2 pmol/L and TSH of 0.1 uIU/ml and subsequently discharged.  She developed exertional dyspnea, 3-pillow orthopnea and bipedal edema without associated chest pain or fever, days after discharge.  Echocardiogram on readmission revealed massive pericardial effusion in tamponade.  Her FT4 upon at this time was within normal limits.  Immediate pericardiostomy was done.  Pericardial fluid was negative for mycobacterium tuberculosis or any bacterial isolates.  Serum ANA was likewise negative.  After initial pericardiostomy and treatment with anti-thyroid medications and prednisone, pericardial effusion resolved.

Table 1: Pericardial Fluid Studies

Qualitative Examinations

Result

Color

Dark red

Transparency

Slightly hazy

Red Blood Cells

283,000 x 106/L

White Blood Cells

578 x 106/L

Polymorphonuclear Cells

82%

Lymphocytes

17%

Distorted Cells

0.01%

Glucose

4.95 mmol/L

Total Protein

59.01

Gram Stain

PMN 0-1/OIF

Gram positive cocci in pairs 0-1/OIF

Bacterial Culture

No growth

AFB Smear

Negative

AFB Culture

No growth

Cytology

A repeat 2decho upon follow-up showed no residual effusion.  To date, there are no published cases in the Philippines on thyrotoxic pericardial effusion.

In a thyrotoxic patient with worsening heart failure symptoms despite adequate treatment, it is prudent to consider a pericardial effusion, to facilitate timely management.

Fig. 1.  Chest radiograph on 1st admission, with LV cardiomegaly

trapago xray1

Fig. 2.  Chest radiograph on 2nd admission showing water-bottle shaped cardiomegalytrapago xray2

References:

Kahaly G, Dillmann W. Thyroid Hormone Action in the Heart. Endocrine Reviews. 2005. 26(5):704–728.

Sampana A, Jasul G. High Grade AV Block Complicating Hyperthyroidism: A Case Report. Philippine Journal of Internal Medicine July-Septemner 2010; 48:2.

Braunwald E, Fauci AS, Kasper D, Hauser HL, Longo D, Jameson JL. Disorders of the thyroid gland. In: Braunwald E, Fauci AS, Kasper D, Hauser HL, Longo D, Jameson JL, editors. Harrison’s principles of internal medicine. 15th ed. Vol 2. New York: McGraw-Hill; 2001. p. 2069-73.

Ovadia, S, Lysy y L, Zubkov T. Pericardial effusion as an expression of thyrotoxicosis. Tex Heart Inst J 2007; 34:88-90.

Teague E, O’Brien C, Campbell N. Pericardial effusion and tamponade complicating treated Graves’ thyrotoxicosis. Ulster Med J 2009; 78 (1) 56-58.

Nakata A, Komiya R, Ieki Y, Yoshizawa H, Hirota S, Takazakura E. A patient with Graves’ disease accompanied by bloody pericardial effusion. Internal Medicine 2005; 44(10):1064-1068.)

Levy PY, Corey R, Berger P, Habib G, Bonnet JL, Levy S, et al. Etiologic diagnosis of 204 pericardial effusions. Medicine (Baltimore) 2003; 82: 385-91.