Dr. Anirban Biswas

The lifestyle condition, diabetes, is occurring in a substantial percentage of the population across the world, and quite a lot of research goes into the treatment options. If you experience a weight gain as you started taking medication for diabetes and wondering if there could be a correlation between the two, your observation is most likely correct as studies report that diabetic medication in some rare cases can lead to weight gains in some patients.

Weight gain due to insulin

• Insulin is used to control blood glucose levels by enabling glucose absorption in the body. However, excess glucose in the blood can sometimes be not used as energy by the muscles and is often stored as fat. Moreover, many patients that take insulin to reduce blood sugar levels might be taking too much insulin, which leads to increased appetite, and it makes them eat much more than they normally would. If you happen to be putting on weight while being on insulin, it is recommended to consult your physician immediately to help control weight gain.
• As the insulin runs through its course of treatment and reduces the blood glucose levels in the body, it should reduce an adult's appetite to normal, and the cravings for food will also reduce over time. It is also to be noted that low levels of blood sugar due to an overdose of insulin can lead to increased appetite and ask your physician to revise the insulin dosage can help.

Weight gain due to Sulphonylureas

• Sulphonylureas is one of the most commonly prescribed medications for blood glucose control that works by stimulating a patient's pancreas to produce higher levels of insulin. By doing so, the body has access to more insulin, and it helps transfer glucose out of the blood and into cells which can be used as energy. Just like the health risks that are associated with taking insulin, if you happen to be putting on weight because of Sulphonylureas, you need to visit your physician immediately to seek treatment and bring the symptoms in check.
• Steroid hormones are also recommended by many physicians in cases of high blood glucose, and they can have the same symptoms and effects as insulin or Sulphonylureas. Lower insulin levels always need to be supported by a healthy diet and proper lifestyle changes to allow the treatment to be effective.

So, if you notice any signs of weight gain while undergoing treatment for diabetes, you should consult your physician at the earliest to avoid further complications. It is important to not to cut back on the dosage of the prescribed medications to deal with the weight gain issue as it will not help and consulting a physician is the right way to go about it.

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The body produces a number of chemicals called hormones which are essential for the regulation of various functions including growth and metabolism. These hormones are produced by endocrine glands which are located in various parts of the body. One such important gland is the pituitary gland which produces the important growth hormone. This is essential for regulating optimal growth during the growing years and for maintaining proper amounts of body fat, muscles, and bones in the later years of life.

Causes: Deficiency of the growth hormones can occur due to a number of causes, some of which are listed below. It can be congenital (present at birth) or acquired later in life.
The congenital issue could be due to problem in the pituitary gland structure, leading to complete absence or reduced secretion of the hormone.
With age, there is a decrease in the amount of secretion. However, infections, injuries, brain tumors, surgery and radiation can also lead to altered amounts of secretion.

Symptoms: While growth hormone deficiency can occur at any age, symptoms differ depending on the age when the deficiency sets in.
In the early ages:

• Lower rate of growth for a given age
• Delayed developmental milestones
• Delayed onset of puberty
• Short stature/reduced height
• Younger looking compared to other children their age
• Fat deposition around the waist
• Delayed dental development

When the deficiency sets in during the later years, there is

• Low energy levels, constant tiredness
• Decreased strength
• Decreased exercise tolerance
• Decreased overall muscle mass
• Thin and dry skin
• Increased fat deposition and weight gain around the waist
• Changes in social behavior including alternate cycles of anxiety and depression
• Lack of motivation
• History of pituitary tumors
• High levels of fat and cholesterol

The diagnosis depends on the age of the person

• Blood tests are carried out to check the hormone levels in circulation
• In children, in addition to the hormone levels, x-rays to see the status of growth plates is very helpful.
• An insulin hypoglycemia test where insulin is given intravenously to see the levels of the growth hormone after 30 minutes.
• Total cholesterol levels, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, and triglyceride levels can be used to supplement the above tests.
• CT scan and/or MRI of the brain may be needed if tumors are suspected.

Treatment: Once diagnosed, replacement therapy is given as shots a few times a week under the skin. This restores normal growth and helps in controlling the symptoms in adults too.
In cases of tumor, radiation or surgery may be required, but most cases are managed with hormone replacement.
Watch out for the symptoms if your child has delayed developmental milestones and early intervention can help restore growth and function to normal levels. In case you have a concern or query you can always consult an expert & get answers to your questions!

Cushing’s syndrome occurs due to abnormally high levels of the hormone cortisol. This can happen for a variety of reasons. The most common cause is overuse of corticosteroid medications.

Causes:

Your adrenal glands produce cortisol. It helps with a number of your body’s functions, including:

1. Regulating blood pressure and the cardiovascular system

2. Reducing the immune system’s inflammatory response

3. Converting carbohydrates, fats, and proteins into energy

4. Balancing the effects of insulin

5. Responding to stress

Your body may produce high levels of cortisol for a variety of reasons, including:

1. High stress levels, including stress related to an acute illness, surgery, injury, or pregnancy, especially in the final trimester

2. Athletic training

3. Malnutrition

4. Alcoholism

5. Depression, panic disorders, or high levels of emotional stress

The most common cause of Cushing’s syndrome is the use of corticosteroid medications, such as prednisone, in high doses for a long period. High doses of injectable steroids for treatment of back pain can also cause this syndrome.

Other causes include:

1. Pituitary gland tumor in which the pituitary gland releases too much adrenocorticotropic hormone, which is also known as Cushing’s disease

2. Ectopic ACTH syndrome, which causes tumors that usually occur in the lung, pancreas, thyroid, or thymus gland

3. Adrenal gland abnormality or tumor

Symptoms of Cushing’s Syndrome:

The most common symptoms of this condition are:

• Weight gain
• Obesity
• Fatty deposits, especially in the midsection, the face and between the shoulders and the upper back (causing a buffalo hump)
• Purple stretch marks on the breasts, arms, abdomen, and thighs
• Thinning skin that bruises easily
• Skin injuries that are slow to heal & acne
• Fatigue, bone loss & muscle weakness 
• Increased thirst & urination
• Women may also notice extra facial and body hair, as well as absent or irregular menstruation.

Men may also have:

• Erectile dysfunction
• Lack of sexual interest & decreased fertility

Children with this condition are generally obese and have a slower rate of growth.

Every organ of the human body has a set of functions that it does perfectly until the entire system is normal. And, when things are not normal, the disruption can be felt in several parts of the body.
The thyroid is a classic example, as you suffer from the condition, several body functions are affected. Hyperthyroidism is the thyroid disorder that occurs when the thyroid produces excessive hormones. Hormones produced by thyroid gland regulate the body’s metabolism; hence, it is quite obvious that hyperthyroidism will increase several metabolic functions of the body.

Following is an account that gives a brief overview of the systems and functions affected in the body due to underlying hyperthyroidism:

1. Heart Health: The cardiovascular system reacts to even little disturbances, and in the case of an overactive thyroid, the person may experience increased heart rate, hand tremors, and palpitation. The increased heart rate may result in anxiety.
2. Reproductive system: Women affected by hyperthyroidism may face fertility issues due to irregularity in the menstrual flow. You may have lighter or irregular periods and may have difficulty conceiving. The thyroid hormone plays a significant role in embryonic development, and hence a thyroid disorder can be the cause of a miscarriage. Also, an overactive thyroid can result in preterm delivery, pre-eclampsia, heart failure in the newborn, growth restriction, and stillbirth.
3. Bone health: Hyperthyroidism or the low TSH levels can lead to a lifetime risk of bone fractures. This may not reverse even after the hyperthyroidism is cured.
4. Cholesterol levels: While hypothyroidism elevates the cholesterol levels, hyperthyroidism has an exactly opposite effect. An overactive thyroid may decrease the cholesterol levels to alarmingly low level, thus taking medications to treat hyperthyroidism become crucial.
5. Skin: A person with hyperthyroidism may experience several symptoms on the skin. Due to excessive metabolism the body heat increases which result in the skin becoming warm or hot to touch. Also, the skin can become thin and delicate, and gets excessively dry. The skin on some parts of the body can become hyperpigmented.
6. Weight loss: Thyroid hormones are responsible for regulating metabolism, and when they are over-produced, the body’s metabolism is accelerated thus resulting in significant weight loss. This is one of the classic symptoms of hyperthyroidism. Since hyperthyroidism also increases appetite, some people may end up gaining weight instead of losing it.
7. Excessive sweating: When the body processes speed up, the person suffering from hyperthyroidism will experience excessive sweating as well.
8. Anxiety and Insomnia: As an overactive thyroid activates the entire body processes higher than normal, the nervous system also becomes more active. An accelerated nervous system may cause anxiety and eventually lead to sleeplessness. In fact, anxiety and insomnia aggravate each other.
9. Increased bowel movements: Again, an increased production of thyroid hormone may accelerate your bowel movements. Sometimes, this may result in diarrhea as well.

So, the ideal way to deal with the situation is to seek medical attention as soon as you notice the common symptoms such as fatigue, lack of tolerance to cold or unexplained weight gain to avoid the complications involved.

In case you have a concern or query you can always consult an expert & get answers to your questions!

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Hello! Good Morning!

I am Dr. Anirban Biswas. I am an endocrinologist practicing in South Delhi. Today I am going to answer a few questions asked by my patients regarding new treatment modalities in diabetes and a few questions on insulin. 

Q1. Mrs. Anshu Garg: Whether a person who is on insulin can be shifted to oral medicines? 

Answer: My answer is “Yes. Why not?” We can always shift a patient from insulin to oral medicines if there are certain conditions which are fulfilled. We need to perform a few tests and based on that we can find out whether the pancreas are still active. I personally have shifted around more than 1000 patients who were on insulin to non-insulin based regimens or they have substantially lowered their insulin requirement and I have detailed all this in my website www.insulin.com. So, it is possible that there are newer drugs which can make it possible.

Q2. Mr. Atul Thakur: What are the newer medicines that can be used?

Answer: There are two classes of new medicines which have arrived. First are the gliptins which are based on the ingredient pathway and they act not necessarily on the pancreas. They act through the intestinal pathway of controlling sugar. Now let me explain you how this is possible. We all know that there is a test done in which we feed a patient 75 grams of glucose. This test is known as the Oral Glucose Tolerance Test (OGTT) and when scientists were replicating the OGTT through intravenous glucose, they were surprised to find out that only 25 grams of glucose is sufficient to replicate the graph of 75 grams of glucose in OGTT.

So, where does this 50 grams of glucose go, which was fed orally? Scientists asked this because both the graphs were similar. So the answer lies in ingredient pathway. So ingredient pathway was responsible for taking care of the 50 grams of extra glucose which had been fed orally. So, in this way we came to know about the ingredient pathway.

The other treatment modality which has arrived is the SGIT tool, the receptor inhibitor pathway which acts through the kidneys. It decreases the retention of glucose through the kidneys and increases the excretion of glucose through the kidneys and this results in fall in the sugar level in the patient’s body. It also causes some increment in the blood pressure and the cholesterol level also. So, these are the two essential newer modalities which have arrived.

Q3. Ravi Bhatnagar: What is CGMS? 

Answer: CGMS is Continuous Glucose Monitoring Device. This has been found to be useful in not control of the sugar level like the fasting, BP and the HbA1c levels. Other than that, it has been found to improve the glycemic variability, i.e., the day-to-day variations of the sugar levels can be very easily found out, and this device is available and has been manufactured by Abbott. This is a very good sensor device which can be pain free and can be used in all the patients and I have used in my patients and have got excellent results. 

With this I come to the end of today’s Questions & Answers and hope to see you soon.

The body has various chemicals called hormones which play a significant role in controlling various functions. Produced by organs that weigh as less as 0.5 g, these hormones control height to weight to reproduction to metabolism. It is not surprising that even little amount of variation in these hormones have a noticeable effect on the body’s functioning.

It is well acknowledged that pregnancy is a highly crucial, complicated, and anxious period of a woman’s life. The mother-to-be has the dual responsibility of taking care of her health in addition to ensuring the child within is protected and nurtured well to develop into a full-term baby. Pregnancy is controlled my many hormones and the thyroid also plays a significant role during this time. The connection between pregnancy and thyroid hormone is quite strong.

Women are more prone to develop hypothyroidism, and if diagnosed during pregnancy, extra care must be taken to ensure thyroid levels are maintained in the optimal range. Women with hypothyroidism who get pregnant can have multiple effects including the following

1. Higher incidence of miscarriages: When a woman has multiple miscarriages in the first trimester, one of the reasons to rule out would be hypothyroidism. The incidence of second trimester miscarriage is also quite high in women with hypothyroidism. It is believed that thyroid controls the other female hormone levels and therefore optimal levels of T4 are essential for maintenance of pregnancy.
2. Developmental defects and delays: The developing child requires its supply of hormones from the mother until it can start producing them on its own. This would take time and unless the mother is producing optimal amounts for herself, the child would not be receiving the required amounts of hormones. This means the child’s growth and development controlled by the hormones would be affected. Even after birth, there could be delays in terms of developmental milestones.
3. Low birth weight: Underdevelopment of the child leads to low birth weight.
4. Stillbirth: Women with hypothyroidism can also have a higher incidence of stillbirth.
5. Hypertension and preeclampsia: The blood pressure could be significantly elevated and lead to complications in the later trimesters.
6. Maternal emotional health: Lower levels of thyroid bring about fatigue, depression and mood swings in all women. Given the added state of pregnancy, it is not surprising there would be greater mood swings and bouts of depression and low self-esteem.

With prenatal care improving, comprehensive thyroid screening, especially in people with family history of thyroid problems, is being made mandatory. Talk to your doctor to ensure your thyroid functions are normal. This ensures thyroid levels are maintained for optimal growth of the newborn and the health of the mother is not jeopardised. If you wish to discuss about any specific problem, you can ask a free question.